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Erik Isberg: Why was it so difficult for utopian technologies to become realised?

The Division’s PhD-Candidate Erik Isberg wrote an essay for Sveriges Radio P1 (Radio Sweden), about the question why throughout history, it was so difficult to realise potential technologies that fostered utopian promises – at least in theory. Below you find an English translation of his text that was originally published here on Sverigesradio’s website today on 20 February 2023 at 6am. You can also download the text as .mp3 under the same link!

Profile picture of Erik Isberg


Erik Isberg, historian

A misconception continues throughout the history of online doctors

Technology has utopian potential, but why is it so difficult to realise it? Erik Isberg is looking for an answer in the history of technological remote care.

One afternoon in Boston in 1876, physician Clarence John Blake saw a telephone for the first time. I imagine him gently picking up the phone and holding it to his heart, whereupon his friend Alexander Graham Bell, who had been showing his new invention, looked at him questioningly. Why didn’t he hold the phone to his ear, as was intended? They began to discuss what kind of device they had in front of them. Their notions of the phone differed. Where Graham Bell saw a means of communication, Blake saw a kind of electronic distance stethoscope. The possibilities, Blake said, were enormous. Around Boston, people would hold the phone to their chests and let their heartbeats travel through the newly drawn-out telephone lines, finally landing in a liaison center where Blake and his colleagues sat ready to listen and diagnose.

A couple of years later, Blake was forced to state that despite diligent attempts, he was “nowhere near” to get a good enough sound quality. There would never be a liaison centre. The patients pressed their phones to their chests, but Blake only heard noise.

The dreams of practicing care remotely, despite Blake’s failure, have hardly disappeared. Today, the collection of health data constitutes a billion-dollar industry, app companies offer doctor’s visits via video calls, where crackly telephone lines have been replaced with high-resolution front cameras. In 2016, the then government and Sweden’s municipalities and regions decided that Sweden will be the world’s best country when it comes to digital care. Communication technology has never, the agreement wrote, offered such great opportunities.
On TikTok, a large amount of followers can take part in KaisTheSurgeon’s attempts to perform surgeries remotely. With the expansion of the 5G network, the idea is that remotely controlled scalpels will be able to carry out operations with the patient in one country, and the surgeon in another. While waiting for human patients, KaisTheSurgeon is allowed to hold on to fruit. In his almost hypnotic clips, he elegantly dissects grapes, bananas and oranges without being in the room himself.
When KaisTheSurgeon fillets an orange that is in the room next door, the future seems for a while both bright and high-tech. But while utopian promises of technological revolutions are succeeding each other, many of healthcare’s central problems don’t seem to be going away at all; It concerns accessibility, equality, staff density. Why is it so difficult to realize the utopian potential of technology?

The physician and medical historian Jeremy A. Greene argues in his book The Doctor Who Wasn’t There. History, Technology and the Limits of Telehealth that one reason why those who have made grand promises of technological innovations often found it difficult to realize them is a one-eyed focus on technology itself. Just because a technology exists and works, it is not obvious that you know how it will be used, or who will benefit from it.

In the late 1800’s, it wasn’t just Blake who experimented with the telephone. Exactly what one would use it for was unclear. It was used for live broadcasts of concerts as well as for private conversations. Gradually, it became clear that the phone had created a new kind of room: where you could be physically apart but still close. The voice could be disconnected from the body. But the telephone also became a symbol of modernity’s anonymous and lonely existence, where thin telephone lines were the only thing that bound the isolated individuals together. In Franz Kafka’s The Castle, the telephone is the tool of faceless bureaucracy. Protagonist K watches in despair as the bureaucrats make their calls, but what is actually being said and who it is that says it, remains unclear.

In healthcare, during the first decades of the 1900s, the telephone came to have an opposite symbolism. Rather than marking distance, it became an expression of a modern and alert medical profession that was constantly present. A doctor who didn’t answer the phone was not only archaic, but also bad at his job. In the United States, the new doctor role was summed up with a slogan: The doctor is on call.

Over time, other communication technologies came into the picture. But while they often worked excellently, Greene shows how this still wasn’t enough for them to be long-term successful. He finds one such example in a pilot project in Harlem, New York, in the early 1970s. In poor areas of America’s major cities, it was not uncommon at this time for an area to share a television antenna, which was then connected by telephone cables to the households around it. A group of doctors in Harlem realized that these local cable networks could be used to organize video meetings, thus reaching a group of patients who were used to a racist care system and were reluctant to seek care.

A local telemedicine system began to take shape: film cameras were rigged up in assembly halls around Harlem and nurses who themselves lived in the area were on hand to assist. The cable network was owned by the residents themselves. Although the project was not perfect, it showed a way forward for a democratically anchored remote care, which put the needs of the most vulnerable at the center. But this was not enough. In 1977, the project was discontinued. State money was running out and local cable networks had begun to be bought up by major telecom companies, with the aim of creating a national television market. Economics, not technology, decided the outcome.

If everything had instead been just about the performance of the technology, the story would have been different. Then all it took was for Blake’s liaison center to work is a good enough sound quality and the video calls in Harlem had continued as long as there were patients. Our delight in spectacular technical solutions obscures the view, all that other stuff – money, people, knowledge – crowds into the background.

The path from Clarence John Blake’s heartbeat liaison center to KaisTheSurgeon’s viral fruit surgeries may not be as long as it might seem. They both represent a utopian view of technology, which captures the potential of new technology but at the same time misses everything that is around and that is necessary for the technology to work. After all, it doesn’t really matter if the phone can perceive one’s heartbeat if there is no doctor to call. The opposite of presence, recalls technology historian Hannah Zeavin, is not distance, but absence. In KaisTheSurgeon’s comments section, one of his followers writes laconically: “That orange probably gets better health care than me”.

Literature:
  • John Durham Peters, Speaking into the Air. A History of the Idea of Communication (Chicago: The University of Chicago Press, 2001).
  • Jeremy A. Greene, The Doctor Who Wasn’t There. History, Technology and the Limits of Telehealth (Chicago: The University of Chicago Press, 2022).
  • Hannah Zeavin, The Distance Cure. A History of Teletherapy (Cambridge, MA: MIT Press, 2021).

Beyond Unprepared and Sustainability’s Formative Moment – Formas’ Grants Two New Projects

Division researchers Fredrik Bertilsson and Eric Paglia recieved funding for four years each in the Formas Annual Open Call 2021 – Research projects for early-career researchers. In 2022 the Division looks forward to two new projects: one on humanistic expertice and knowledge and one that question the earlier periodization of the sustainability narrative.

Summary Beyond “unprepared”: Towards an integrative expertise of drought

Profilbild av Fredrik Bertilsson

The overarching hypothesis of this project is that the understanding of preparedness is fundamentally transformed in the era of Anthropocene. In Sweden, recent events such as the corona pandemic and the extreme weather in 2018 have pointed out insufficiencies in public readiness. This project explores drought in Sweden, which until recently was a marginal problem on the national agenda but is now a priority of the Swedish government. Both public agents and researchers call for collaboration an “integrative expertise” that combine the expert knowledge of natural sciences, social science and the humanities to advance public preparedness. However, the potential of humanistic expertise and knowledge is under-researched. The potential of humanistic knowledge becomes relevant in new contexts where problems and potential solutions fall outside the domain of previously dominating expertise. The aim of this project is to contribute to the expertise for increasing public preparedness. The purpose of the project is to study: the identification of Swedish “unpreparedness” in relation to the drought in Sweden in 2018, the historical processes behind this present unpreparedness, and the formation of future experts focusing on the significance of humanistic expertise. The project provides a novel and timely assessment of integrative expertise of drought. It engages with actors in the public sector, NGOs, academic research, and arts and culture

Summary Sustainability’s Formative Moment: The Birth of the Boundaries Narrative and the Rise of the ‘Human Environment’

Profile picture of Eric Paglia

This project examines the emergence of the “Boundaries narrative” between 1968-1974 in connection with the 1972 UN Conference on the Human Environment. “The environment” as a problem was well known, but in 1968 there were no international political institutions for managing it. Neither developing countries nor the business community had an interest in imposing restrictions for the environment’s sake. In this struggle between scientifically and ideologically motivated demands for restraint, and economically and politically motivated demands for continued expansion, the idea emerged that growth and environment could be reconciled—what would later be called sustainable development. We will study in detail the interplay of different expert cultures, from governments via constellations of scientists, to smaller groups that could include executives, researchers, diplomats, activists, economists and others. We are particularly interested in three key individuals and their networks: Canadian businessman Maurice Strong, economist Barbara Ward and MIT management professor Carroll Wilson. We will both question the earlier periodization of the sustainability narrative, and develop a new understanding of its scientific and political basis. The project is of potentially great importance for the narrative’s legitimacy in a time of mounting conspiracy theories, when the world could at the same time be on a path towards decisive transformation through the implementation of Agenda 2030.