Doing Better, Feeling Worse

Reviewed by James Trefil

When I was in college, I had an unnerving experience. While traveling with my brother, I suddenly developed a fever and stomach pains. The doctor I called on shunted me immediately to a hospital, where my appendix was removed. A week later I was back in school, functioning more or less as usual.

Today, as I get deeper into middle age than I like to contemplate, I find that chronic medical problems play a much larger role than they used to. An old football injury to my knee, for example, twice operated on over the years, prevents me from running and restricts my exercise program.

Now let me make one thing absolutely clear. I am delighted that the surgeons in that emergency room had the technology to remove my inflamed appendix and, in the process, allow me to live long enough to worry about whether that twinge in my knee is incipient arthritis or just a strained muscle. In fact, I would argue that I’d be an idiot not to feel this way.

All this is by way of introduction to one of Edward Tenner’s main points in this book: that modern technology inevitably leads to what he calls “revenge effects.” Systems bite back, he argues, and the consequence of solving one problem is often the appearance of another problem, more intractable than the first. In the case of medical science, for example, the development of the ability to deal with acute crises like my appendicitis produces a population plagued by chronic problems and diseases that modern medicine has difficulty handling. He goes into great detail in describing revenge effects in the area of the environment, modern information technology, and sports as well.

It’s important to understand that what Tenner calls a “revenge effect” is not just a breakdown of the system. A flat tire on your car isn’t a revenge effect—it’s just one of those things. But when you (and everyone else) gets into a car because it’s such a convenient mode of transport only to find the roads so clogged that you can’t get anywhere, you are encountering a revenge effect. In Tenner’s argument, these effects arise in complicated systems and are often unintended consequences of solutions to more pressing problems.

I have to admit that when I started this book, I expected to find another dreary Luddite screed, full of fulminations about the evils of technology (and written, of course, on a word processor). In fact, it is nothing of the kind. Tenner is the past editor of Princeton University Press, and the fairness and thoroughness of the best in academic writing is manifest on every page. There is also a decidedly scholarly turn to much of the book—I particularly enjoyed the discussion of the origin of Murphy’s Law (If something can go wrong, it will) in the 1950s experiments on the effects of extreme acceleration on human beings.

Sometimes, however, this fair-mindedness works against him. Although it makes the book intellectually defensible and sound, it also tends to weaken some of his points. For example, he argues that one revenge effect attributable to better weather forecasting and improved building codes is that people are more willing to build in areas subject to natural disasters like earthquakes and hurricanes. He then goes on to cite data indicating that the loss of life in such disasters is much higher in less developed countries than in the industrialized world, and closes by suggesting that more lives were lost in construction accidents in the cleanup after Hurricane Andrew hit Florida than were lost in the hurricane itself. These statements are undoubtedly true, but they do weaken the original argument a bit.

Tenner winds up admitting that, in the phrase of Aaron Wildavsky, we’re “doing better and feeling worse.” I may grumble about my knee and rail against medical science for not being able to do anything about it, but at least I’m alive to do the grumbling. In the same way, the introduction of pesticides may have led to a breed of resistant pests that have to be dealt with using newer pesticides, but we’re all reading about these problems at breakfast tables loaded with food produced by the most efficient agricultural system ever known.

So in the end, it seems to me that Tenner’s argument comes down to this: when we solve one problem, we will find other problems waiting to be solved, and some of the new problems will result from the solutions to the old. We will never be able to solve all of our problems.

What else is new?

James Trefil is the Clarence J. Robinson Professor of Physics at George Mason University and the author of The Edge of the Unknown, Houghton-Mifflin, 1996.