On Pivots

What happens when all the energy's focused on one thing?

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I’ve been thinking in recent days about the lasting consequences, both obvious and subtle, of large-scale, single-minded public investments. During World War II and the Cold War, the US government poured almost unimaginable sums into scientific and technical research in the name of defeating Communism. Historians estimate that the US Department of Defense supplied 96 percent of federal support for university research in the physical sciences in 1949. In the 1950s, the DOD supplied, on average, a third of all R&D funds in private industry. Entire fields—like game theory—emerged from scratch. The defense agencies of Cold War superpowers poured funds into everything from genetics to physics.

My first book, Competing with the Soviets, was an attempt to grapple with the scale of these investments in American science. My scholarly subfield—the role of science in the Cold War—exists largely because both historians and scientists wanted to understand how such a massive government investment changed the scientific enterprise, both in and outside of the academy. Much of this earlier work focused on assigning blame and evaluating scientific “distortion,” on questions of resistance and complicity. When you’re talking about responsibility for the nuclear weapons complex, these are important questions to ask. But with the passage of time, it’s the scale of these investments that really pops. When nearly an entire field turns its energies to solving a single problem, the field changes—and the world changes with it.

We’re now watching in real time as, one after another, countries across the globe reorient their entire healthcare systems to containing COVID-19. This isn’t “distortion”: fighting a global pandemic obviously falls under the umbrella of health care. At the same time, things that aren’t COVID-19 are getting squeezed out. People are being asked to hold off on elective surgery, a category that includes everything from cataract removal to knee replacements. Research labs are turning away from existing projects and toward developing antibody tests and vaccines. It’s still biomedical research and public health, but the number of people and the amount of resources focused on a single problem are on a different scale than any of us are accustomed to.

Other things happen when no one’s looking. Last week the AP reported that the Environmental Protection Agency would be not be enforcing a wide range of environmental and public health laws for the duration of the pandemic. What else are we missing while all the science and medicine journalists are covering the crisis?

History tells us that the effects of the global response to COVID-19, particularly on biomedical research and healthcare delivery, will broad and somewhat unpredictable. Another example from the Cold War is instructive: many historians of science attribute the growth of interdisciplinary research to defense contracting, which tended to focus on projects rather than disciplines. There’s nothing inherently defense-oriented about interdisciplinary research, but the new patrons had different needs than academic departments. The scale of their support shifted research culture well after the funds ran out.

A lot of the talk on the potential changes wrought by COVID-19 focuses on the big social and political issues. Things like: Will mass unemployment associated with COVID-19 finally spell the end of employer-based private health insurance in the United States? Will the WHO be replaced by a new, more powerful international body for disease surveillance? Will the routinization of strict quarantine measures normalize mass surveillance and authoritarianism? How will mourning change in an age of social distancing?

Important questions, obviously! But a pivot of this scale will have long-term repercussions both large and small that will be felt throughout every part of contemporary biomedicine. Yesterday, historian of medicine Deborah Levine had a fantastic op-ed in the Washington Post on the fatal consequences of U.S. hospitals’ preference for high-tech gadgets over basic life-saving equipment, like face masks. Will this be back-to-basics moment for health care in the United States? Who will provide care if frontline teams are ravaged by illness? Will telemedicine finally have its moment? How does lab culture change if researchers routinely work from home? And so on.

Whatever “normal” was, medicine will not be returning to it. What replaces it has yet to be seen.

On my nightstand: I can’t think of a timelier book right now than Michelle Murphy’s The Economization of Life. This relatively short, theoretically sophisticated book looks at how population-based social scientific practices value life in macroeconomic terms—for instance, determining a given category of people’s contribution to GDP. Order soon: All in-stock titles from Duke University Press are 50 percent off through May 1.

Something nice: Absolutely everything is blooming in Philadelphia. The plants, at least, have hope. Here, enjoy a blossoming cherry tree from my neighborhood (taken while on an appropriately social distanced once-a-day walk).

Shameless self-promo: The paperback of Freedom’s Laboratory is now available for preorder direct from Johns Hopkins University Press. Use code HTRY for 30% off.