W. F. Bynum

1901 and all that

The last will and testament of Alfred Nobel provides rich pickings.

Sexually transmitted retribution

A history of attitudes towards sinning and its consequences.

A healthy interest

815 the reader to play with the ideas discussed in the book. Unfortunately, the plan to put examples from the book together with related material on a website (www.complexcity.info) is yet to be realized. The book certainly succeeds in making the topic of urban growth accessible and interesting to those already familiar with formal modelling of complex systems. However, practitioners in urban planning may find some of the concepts and models too abstract and ‘academic’ to give solutions. But at least they should agree that this complex-systems perspective sheds new light on to the dynamics of urban evolution by highlighting relations to seemingly distant phenomena, such as swarming or epidemics. Apart from the necessary technical details of the models, the author gives a number of illustrative examples and facts to elucidate his viewpoint, widening the appeal of the book to a broader audience. ■ Frank Schweitzer is chair of systems design at ETH Zürich, Kreuzplatz 5, 8032 Zürich, Switzerland.

A taste of a rotten past

422 problems, well, just send in the nanobots to sort them out. “All technologies,” claims Kurzweil, “will essentially become information technologies, including energy.” On the vexed issue of the speed of light, Kurzweil cites evidence that the fine-structure constant, which expresses the strength of the electromagnetic force and contains the speed of light as a factor, may have increased very slightly over the past 6 billion years. The primary evidence comes from an analysis of quasar spectral lines by John Webb of the University of New South Wales in Australia and his collaborators, not from a study of the Oklo natural nuclear reactor in Gabon, as Kurzweil states. Furthermore, even if the observations opened the way to manipulating the value of the fine-structure constant, that is not the same as increasing the speed of light and leaving everything else unchanged. Indeed, the manipulation would involve a reduction of the finestructure constant, which would slow the rate of information processing at the atomic level, and so prove self-defeating. These technical hiccups are irritating, but the book should not be read as a scientific treatise. Rather, it is a futuristic and somewhat breathless romp across the outer reaches of technological possibility, limited only by human imagination. Kurzweil coins the horrible term ‘singularitarian’ for someone who embraces his vision with alacrity. If Kurzweil is to be believed, we will all be singularitarians in just 29 years’ time. Hang in there. ■

The monster that is medicine

140 evaluation of their encounters. Collins and Pinch argue that the placebo effect is the hole in the heart of medicine, making the assessment of therapeutic interactions and the introduction of new drugs problematic. Later chapters describe the difficulty of uncovering bogus doctors (those practising without qualifications); the diagnostic variability among ‘real’ doctors when confronted with such things as enlarged and inflamed tonsils; the problem of contested diseases such as chronic fatigue syndrome, Gulf War syndrome and fibromyalgia; the dubious effectiveness (but sacrosanct position) of cardiopulmonary resuscitation; and the current debate about the relationship between autism and vaccinations, especially the triple measles, mumps and rubella (MMR) vaccine. A chapter on HIV and the patient as expert is reprinted from the earlier volume on technology. What is at stake with each of these topics is the fundamental uncertainty of medicine as science and its clumsiness as succour. The authors write as patients as well as sociologists, and the chapter on MMR, on which subject Collins and Pinch have diametrically opposed attitudes, is particularly effective. It has to be said that the authors want medicine to be more scientific, not less so. Their volume is hardly a plea for alternative medicine or even for the uncritical democratization of conventional medicine. Rather, it is an analysis of the problems of contemporary medical knowledge, and is stronger on diagnosis than on prescription. The authors offer stringent critiques of modern medicine’s inadequacies, but are reluctant to suggest what might be done to change it for the better. This detachment was also present in the earlier volumes and stems, I think, from their attitude towards the nature of ‘expertise’. Their discussion of HIV makes a strong case for sufferers having their own kind of expertise, and this may not be simply about the subjective nature of their illness. Many AIDS activists became expert in the nuances of retroviruses, how antiviral drugs work and the design of clinical trials. But as Collins and Pinch point out, meaningful dialogue about scientific issues requires that both parties know what they are talking about. The Internet may not be the best place to acquire expertise, for its unregulated nature most starkly exposes the difficulties of democratic knowledge. The authors have selected their topics reasonably well, but there are some gaps and curious decisions. The chapter entitled ‘Alternative Medicine’ is not about alternative medicine at all. It looks at Linus Pauling and Ewan Cameron’s advocacy of massive doses of vitamin C as a treatment for cancer. Pauling and Cameron worked entirely within the framework of scientific medicine, offered a testable hypothesis about why vitamin C might have the effect they postulated, and wanted clinical trials to be done. They disagreed about the actual design and implementation of the trials, and of course about their outcome, but this episode is about scientific, not ‘alternative’ medicine. Collins and Pinch’s familiar, cosy style may grate on some, but their purpose is highminded. They have in fact discovered what the Hippocratics knew more than two millennia ago: “Life is short and art long; the occasion fleeting; experience fallacious, and judgement difficult.” ■