Crisis, conflict or business as usual?

The implications of technology for planning over the next decade by the ACT Community and Health Service

A report to the Australian Capital Territory Community and Health Service

27 June 1989


Brian Martin

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Summary of scenarios

Scenario 1: Crisis

Description: major disasters affecting health and welfare directly or indirectly, including nuclear war (global or limited), world economic collapse, conventional war involving Australia, major terrorism, epidemic disease (including AIDS).

Likelihood: small but not negligible.

Impact: very large.

Possible planning implications:

Possible obstacles to plans:

Scenario 2: Struggles over technology

Description: major conflicts between different interest groups (medical profession, government, community groups, etc.) in the form of disputes over technologies, including medical, computer, energy and biotechnologies.

Likelihood: conflicts are certain; some major conflicts are likely.

Impact: moderate in most cases; large in some cases, especially if handled poorly.

Possible planning implications:

Possible obstacles to plans: pressures from interest groups which believe that programmes will not serve their interests.

Scenario 3: Business as usual

Description: no major crises or conflicts as indicated in scenarios 1 or 2.

Likelihood: reasonably likely.

Impact: minimal.

Possible planning implications: carry on business as usual, or consider changes further down the track.

Possible obstacles to plans: pressure from interest groups for major change (e.g. financial squeeze from government).


Technologies are commonly seen as physical objects, but they are also profoundly social and political. It is the social and political dimensions of technology that are of greatest significance in health and welfare planning. For example, the existence of a drug to arrest the development of AIDS is not very significant in itself. What counts is whether people believe it works (whether it does or not), whether they are willing to push for programmes to make possible or to require the use of the drug, and who actually ends up paying for and receiving the drug.

Canberra is not a centre of technological innovation, and so the technological changes which will affect it are almost certainly ones which will arise in the wider national or international context. Furthermore, parameters for policy on technology are likely to be set elsewhere first, and often it will be hard to resist doing what others are doing. Nevertheless, in some areas there will be crucial decisions to be made, especially in controversial areas where contending groups are involved.

Historically, technologies have regularly had major impacts on health and community welfare, whether in the form of medical drugs, public health measures, general affluence, alienation at work, war and communications. The vast range of possible developments is suggested by a simple exercise. Consider the major events or trends which affected industrialised societies over the decades following each of the following years:

1899: business as usual.

1909: world war.

1919: business as usual; social turmoil, economic expansion.

1929: economic depression.

1939: world war.

1949: business as usual; cold war, economic expansion.

1959: business as usual; rise of 'new social movements' (student, feminist, peace, environment, etc.).

1969: business as usual.

1979: business as usual.

1989: ?

Going by this record over the past century, the prospects for 'business as usual' over the next decade are perhaps not as great as the term might suggest.

The other consideration here is the way in which certain technologies have been connected to major social changes over the last century. Here are some prominent examples, with periods of greatest change roughly indicated.[1]

Machine gun: 1914-1918

Radio: 1920s

Car: 1920-1950

Airplane: 1940-1960

Pesticides: 1943-1960

Nuclear weapons: 1945-1960

Antibiotics: 1950s

Computers: 1970-

Genetic engineering: 1990- (?)

It is with this sort of perspective that I have selected three scenarios concerning technology and society as applied to the ACT Community and Health Service. The crisis scenario is immediately suggested by the infrequent but overwhelming impact of war and economic collapse on societies. The 'struggles over technology' scenario is an obvious one in light of the increasing demand by various groups for involvement in decision-making and the way decision-making occurs. Finally, business as usual does apply sometimes. The danger is that it is much too easy to plan for the predictable and difficult to prepare for disruption to programmes and policies.


'Crisis' here refers not to the commonly expressed concerns about shortages of hospital beds, exploding medical costs or spiraling unmet welfare needs, but rather to cataclysmic events which would make these normal concerns pale into insignificance.

Now that the peace movement is less active and media attention to nuclear war has waned, it is easy to forget about the prospect of nuclear war. Yet the risks of this occurring are probably as great as ever. The likelihood of nuclear war in the next ten years may be small,[2] but its impact on society would be enormous, and hence some preparation would seem wise as a form of insurance.

Even in a global nuclear war, Australia is not likely to be severely affected by direct effects of nuclear weapons. The most likely targets, such as Pine Gap, are remote from major population centres.[3] The health effects of radioactive fallout from the northern hemisphere would be virtually undetectable, and even the much touted nuclear winter effects are unlikely to be severe in the southern hemisphere. The most important impacts are likely to be indirect. They include economic dislocation (especially as imports from devastated countries are interrupted), refugees and perhaps psychic trauma. It is also possible that Australia could be affected by nuclear electromagnetic pulse,[4] potentially rendering much computer-based equipment inoperable in the short or long term.

Contrary to much rhetoric emanating from doctors opposed to nuclear war,  there is much that can be done to counter the effects of nuclear attacks.[5] Most important in the case of direct attack is widespread knowledge of simple first aid measures, such as treating wounds and shock. In the case of Australia (assuming no direct attack), the major problem would be interruptions to imports. It would be crucial to ensure supplies of vital medicines, including antibiotics, vaccines, anaesthetics and analgesics, sufficient to last months or years, or until local manufacture could be established. These issues have been canvassed in a sensible manner by the New Zealand Planning Council in their book New Zealand After Nuclear War. The social effects of nuclear war are also likely to be far-reaching. A massive relocation of resources to vital industrial and perhaps military functions would mean reduced community services for vastly increased needs.

Global nuclear war may be an extreme case, but in practical terms its impacts are likely to be similar to other forms of crisis. These include Australian involvement in a war using conventional, biological or chemical weapons, terrorist use of any of these weapons, a major natural disaster, or world economic collapse. In the latter case, imports of medical supplies could be severely limited and welfare needs would rapidly expand; preparation for nuclear war would also, therefore, serve as preparation for world economic collapse.

Another crisis scenario is epidemic disease. The most likely candidate currently is AIDS, but it is also possible to imagine new contagious diseases, perhaps triggered by genetic engineering or susceptibilities peculiar to contemporary chemical-based societies.

In these crisis situations, many specialist medical services would become irrelevant in the face of extremely urgent basic requirements for dressings, pain relief, etc. Basic planning would go a long way towards easing the path in such emergencies. This means, first of all, having relevant information readily available (if only in the form of networks of knowledgeable people and pertinent documentation on file). For example, being able to inform people of the risk and responses to fallout or increased ultraviolet radiation (from reductions in stratospheric ozone) would be important in promoting sensible responses and preventing overreaction.

Secondly, having many people willing and able to offer simple measures (first aid; administering iodine tablets, antibiotics and vaccines; care for the aged and people with disabilities) in an emergency would be crucial.[6] This means basic training for members of the lay public not now considered even in the category of para-professionals. Depending solely on registered professionals is a prescription for inefficiency and overload, if not collapse, in a major emergency.

Thirdly, procedures need to be set in place to make decisions about allocation of limited supplies of drugs, personnel and all scarce resources and to set in motion efforts for local production or training of substitutes.

To my knowledge, at the moment there is no community or health service in the country which has plans to deal with a major emergency such as nuclear war.[7] The Service would be setting a model for other parts of the country should it initiate even a modest programme of investigation and preparation for a range of crisis scenarios.

Struggles over technology

Technologies regularly become arenas for struggles between different groups in society. In recent years there have been major struggles over abortion, nuclear power, in vitro fertilisation, weapons systems, pulp mills, computer identification systems and many other technologies. What happens in these cases is that technologies are seen to embody the interests of particular groups -- and others oppose these interests by opposing the technologies.

Medical technologies have often been the subject of social struggle. In Canberra in the 1970s, chest x-rays were routine and supported by the medical profession. A small group of critics raised questions about risks from radiation outweighing the benefits.[8] The issue became a focus for a struggle between two groups each presenting themselves as defenders of the public interest. It is safe to predict that this sort of conflict over technologies will continue to emerge. The only question is which technologies will become the focus of attention and how vociferous the debates will be.

One of the major continuing clashes is likely to be between supporters of the medical model of health care involving sophisticated medical intervention against manifest disease, and supporters of the holistic health model emphasising diet, megavitamin therapy, mental state, exercise and prevention in general.[9] For example, radiotherapy and chemotherapy for cancer could well become the focus for opposition campaigns, perhaps against expanded screening programmes for breast and other cancers. A similar sort of struggle arises when the expansion of certain programmes is hindered by medical professionals, as in the case of low salt diets as an alternative to anti-hypertensive drugs or oral rehydration therapy in the Third World.

From a policy point of view, a choice can be made to either work with or against any particular campaign, or to stand aside. In the case of anti-smoking campaigns, medical workers have played a crucial role in supporting grassroots campaigns. In other campaigns, such as fluoridation, medical workers have mostly opposed community activists.

In all such cases, there are a range of options, often centred around use or non-use of certain technologies. The configuration of social forces usually leads to all but one or two options being left off the agenda: for example, the choice is seen as fluoridation or no fluoridation; other alternatives, such as organised individual use of fluoride or nutrition, are left out of the debate. The challenge is to use struggles positively and creatively, rather than treating them as threats to traditional authority.

Struggles over technology in areas other than medicine can also have a major impact on health and welfare. Information technology is rapidly creating changes whose social impacts are only gradually being recognised. Recognition could easily crystallise into major campaigns, as in the sudden groundswell of opposition to the Australia Card [a proposed national identity card].

For example, the issue of computers, telecommunications, data bases and privacy is one which contains a great potential for controversy. Developments in information technology are quickly eroding de facto safeguards which have protected people from scrutiny or control in the past. Combining data bases for payrolls and child maintenance payments for example allows automatic deductions from salaries.

Records on medical and welfare status are an obvious target for data base hookups. For example, a person's medical history has implications for welfare payments, insurance, compensation claims, employment applications and sexual relations. Governments, corporations and individuals each may have strong interests in obtaining information from people's medical and welfare records. This could increase, as illustrated by pressures for compulsory blood testing for AIDS antibodies and the intense desire by many people to know the status of vital others.

The pressures for opening records are usually countered by demands for privacy. This could one or more of several forms. One response would be to demand that files not be amalgamated with other data bases. This may seem straightforward, but the technological opportunities for amalgamation may overwhelm formal safeguards. Another response would be to demand access by individuals to their own files, in order to correct false information. This would have large implications for medical and welfare record-keeping and liability for incorrect diagnoses. A third response would be for individuals to take responsibility for their own files, as occurs in some other countries, rather than authorities. Again, the implications would be large.

Industry is another area profoundly affected by computers. The impact of industrial technologies on health and welfare is always connected to the social organisation of work. For example, RSI [repetition strain injury] is connected to physical stresses, the division of labour (which leads to some individuals carrying out repetitive motions), and the atmosphere of support, competition, monitoring and so forth. Exactly the same technology may lead to few problems or to many, depending on the organisation of work.

The medical model responds to RSI either by treating physical symptoms or by dismissing complaints as psychological. Another approach is to redesign work so that, for example, repetitive tasks are shared among more workers or eliminated entirely. The issue of the organisation of work is, therefore, central to health and welfare on the job.

The 'epidemic' of RSI in Australia in the 1980s could not have been predicted in the 1970s, even though the existence of the syndrome had been documented for decades The 'emergence' of RSI depended on a combination of circumstances, including new technology (word processors), low job mobility due to a slowdown in the economy, the new prominence of white middle-class women among the victims, and the sympathetic role of feminists, some trade unions and media.

For the same reason it is hard to predict what occupation-related diseases will surface in the 1990s. What can be predicted is that the organisation of work, and in particular the processes of decision-making in the workplace, will be crucially involved. The implication of this is that organisational structures which are adaptable and which involve people in decision-making about their own work are likely to be more successful in responding to emerging problems. For the Service, there are at least two ways to respond. One is to liaise with groups investigating or promoting work redesign. Another is to set up one or more redesign programmes in the Service itself. This latter approach would provide insight into the processes and problems involved, and thus help in developing ways to promote health and welfare through job redesign elsewhere.

Energy technologies also can have a major effect on health. Currently, the issues of the greenhouse effect and reductions in stratospheric ozone have captured the headlines. Yet the greenhouse effect so far has not had much impact on behaviour or policy. Australia's contribution is primarily by burning of coal for electricity and use of petrol for motor transport. No quick change seems likely in these areas, but it is conceivable that a resurgent environmental movement could bring about policies to increase the cost of fossil fuels, provide incentives for energy efficiency and renewable energy technologies which are currently viable,[10] and promote policies favouring cyclists and pedestrians.

Looking at the pattern of Canberra's development, the most that might be expected on the transport scene is a slowing of automobilisation. The most promising development would be passive solar design (mainly in new buildings[11]) and active solar systems which would reduce the necessity for wood-burning as well as electricity from coal. The Service could participate in this process by maintaining liaison with proponents of low-health impact energy technologies, adding its voice in support of relevant energy policies which would help prevent respiratory and other diseases, and by applying such energy policies to its own operations.

There are also significant welfare impacts of energy policy. The poor are most affected by the cost of energy and by the viability of non-car transport modes (bus, bicycle, walking). The trouble is that policy-making is dominated by well-paid car drivers, who do not see the world from the point of view of children, the aged or the poor. Therefore the pattern of Canberra's energy use is unlikely to change much except in the face of overwhelming outside impact (such as war in the Middle East or economic collapse).

Technological breakthrough (a special case of struggle over technology)

New technologies are being introduced all the time, and old ones transformed. What is called a technological 'breakthrough' is really simply an accelerated version of the usual pattern.

Historically, rapid technological change has often had major impacts on health and community services. This includes medical technologies such as antibiotics, public health measures such as clean water supplies, and other technologies such as industrial pollution and the car.

'Technological breakthrough' always includes a technical and a social dimension: technical knowledge must be applied to be effective. A 'cure' for AIDS, involving a chemical or biological treatment of affected individuals at a reasonably low cost, probably would be implemented quickly because there would be few objections.

Another pattern is the availability of technical means met by social resistance. One way of treating kidney stones is with enormously expensive shock wave lithotripters. Another approach is to prescribe magnesium and vitamin B6 to prevent kidney stones. This is cheap, easy and well proven, but little known. It would be a 'technological breakthrough', in a sense, to promote this simple nutritional approach. In the case of the 'abortion pill' RU486, its introduction would have a major effect on health services; whether the pill is introduced depends more on social factors than its medically assessed technical effectiveness.

Almost by definition, breakthroughs cannot be predicted. The major implication for planning is to favour flexibility. A breakthrough often means benefits, but it also means that large investments of resources and skills quickly become obsolete.

The other side of a breakthrough is potential massive costs, ethical dilemmas and conflicts over use of the technology. An expensive drug to prevent AIDS in uninfected individuals could cause a nightmare of expense and conflict.

In vitro fertilisation is undoubtedly a breakthrough, but its main impact has been to trigger struggles over moral issues and disputes over the large costs. As IVF becomes more widespread (it is a standard treatment for infertility in Denmark), the costs will increase and conflicts may occur. The same sort of problems apply to many medical procedures, such as dialysis, organ transplantation and CT scanning. From a planning perspective, the breakthrough occurs not when technological intervention is possible, but when it is demanded by significant groups and when it requires significant investment in capital and skills.

Struggles over technology are usually perceived as disruptive of careful and informed policy-making. But the real significance of such struggles is the clash of interest groups, and this is not something which can be avoided. To appear to avoid controversy is usually to take sides with the more powerful party and ignore the claims of the weaker. Another approach is to actively participate in debates, not necessarily as a partisan,[12] but certainly as a body actively open to sensible arguments from a range of individuals and groups.

Likely focuses for conflict

Medical technology: high-technology medicine versus holistic approaches (costs and effectiveness); AIDS; cancer screening; drug legalisation.

Information technology: privacy/surveillance; employment.

Biotechnology: genetically engineered organisms; IVF.

Energy technology: health effects of energy generation.


Business as usual

If there is no crisis or major conflict, then supposedly business is as usual. This is deceptive, since technological change is incessant in contemporary industrial societies. The question is whether it becomes visibly the subject of major concern. Even the business as usual prospect will involve processes such as continued computerisation, new medical technologies, new knowledge about threats to health and welfare from the workplace, etc. Possibly the wisest course is to prepare for major struggles over technology; this then may be just sufficient to deal with so-called business as usual, remembering that planning is more often modelled on the past than on the future.


There are two themes in my assessment: planning for flexible response, and dealing with conflict. In a 'turbulent environment', in which organisations find it hard to plan because other organisations are changing their behaviour and the rules of the game are changing too, flexibility is crucial. The implication is to be able to take up any of a range of paths as the circumstances change. One way to achieve flexibility is to support many trial programmes and introduce routine mechanisms for keeping in touch with a wide range of views and groups. Some of the programmes will fail, and some of the views and groups consulted will be unhelpful, but what is important is the process of maintaining flexibility itself. In the event of a crisis or major conflict, the dividends will be large.

In dealing with conflict, the great difficulty is making decisions which carry weight. Any decision or policy can be attacked, no matter how well justified. A decision which can be presented as taken both in the public interest and by public demand has the best chance of being accepted.[13]

There are a number of formal ways in which decisions about technology can be made, such as expert committees[14], public inquiries[15] and direct executive decree. Any method which does not have 'participation' built in is a prescription for continued contestation. The usual procedure is to include 'community representatives' on certain committees. The Service might consider investigating some innovative ways to involve citizens in the process of decision-making. Some possibilities are setting up community discussion groups (as done in Sweden on nuclear power), search conferences (as run by the Centre for Continuing Education at the ANU) and setting up 'policy juries' (groups of volunteer citizens, randomly selected, as done in trials in Minnesota).

The Service can, if it so decides, have a major impact on the process of policy development. It can decide to take initiatives which deal with existing and impending issues in an active way, or it can wait to be forced to act by various pressure groups.



Eric Chivian et al. (eds.), Last Aid: The Medical Dimensions of Nuclear War (San Francisco: W. H. Freeman, 1982).

Johan Galtung, Peter O'Brien and Roy Preiswerk (eds.), Self-reliance: A Strategy for Development (London: Bogle-L'Ouverture, 1980). An argument for an economic and social strategy of self-reliance which is quite contrary to the present government's strategy of seeking market niches.

Wren Green, Tony Cairns and Judith Wright, New Zealand After Nuclear War (Wellington: New Zealand Planning Council, 1987). This is the best available study of the policy implications of nuclear war for Australia, although its primary focus is on New Zealand. It includes a special chapter concerning impacts on health. The authors have made some attempt to promote a similar study in Australia, but nothing has eventuated.

M. A. Harwell and T. C. Hutchinson, Environmental Consequences of Nuclear War, Volume Two. Ecological and Agricultural Effects (Chichester: Wiley, 1985). The most comprehensive study to date.

Arthur M. Katz, Life After Nuclear War: The Economic and Social Impacts of Nuclear Attacks on the United States (Cambridge, Mass.: Ballinger, 1982). Good on effects but little on planning implications.

Colin Kearton and Brian Martin, 'Technological vulnerability: a neglected area in policy-making', Prometheus, Vol. 7, No. 1, June 1989, pp. 49-60. A brief survey of the issues.

Amory B. Lovins and L. Hunter Lovins, Brittle Power: Energy Strategy for National Security (Boston: Brick House, 1982). The best source for a range of examples and issues concerning vulnerabilities in contemporary technological society.

Brian Martin, 'How the peace movement should be preparing for nuclear war', Bulletin of Peace Proposals, Vol. 13, No. 2, 1982, pp. 149-159. On preparing for the political consequences of nuclear war.

Jeanne Peterson (ed.), Nuclear War: The Aftermath (Oxford: Pergamon, 1983).

A. Barrie Pittock, Beyond Darkness: Nuclear Winter in Australia and New Zealand (Melbourne: Sun, 1987). A popular account by a leading atmospheric scientist, showing that Australia will not necessarily be greatly affected directly by nuclear winter.

A. B. Pittock et al., Environmental Consequences of Nuclear War, Volume One. Physical and Atmospheric Effects (Chicester: Wiley, 1986). The most comprehensive study to date.

F. Solomon and R. Marston (eds.), The Medical Implications of Nuclear War (Washington DC: National Academy Press, 1986).

Technology and society

These publications provide insights into the power struggles which take place over technology.

Phillip M. Boffey, The Brain Bank of America: An Inquiry into the Politics of Science (New York: McGraw-Hill, 1975). Case studies and analysis dealing with the usual conflicts involving scientists, community groups, government bodies and others.

David Dickson, Alternative Technology and the Politics of Technical Change (London: Fontana, 1974). An argument that forms of technology reflect the way society is organised.

David Dickson, The New Politics of Science (New York: Pantheon, 1984). A study of the rising power of corporations over the production and use of science.

Lesley Doyal et al., Cancer in Britain (London: Pluto, 1983).

Samuel S. Epstein, The Politics of Cancer (San Francisco: Sierra Club Books, 1978). The science of cancer, case studies (workplace, consumer products, general environment), and the politics of the issue. This book provides some indication of the sort of struggles over issues of disease which are likely to continue to occur.

Jim Falk, Global Fission: The Struggle over Nuclear Power (Melbourne: Oxford University Press, 1982). The best account of the political struggles in different countries over nuclear power.

Allan Mazur, The Dynamics of Technical Controversy (Washington, DC: Communications Press, 1981). Case studies and insights.

Charles Perrow, Normal Accidents (New York: Basic Books, 1984). The social factors involved in the occurrence of major accidents.

Joel Primack and Frank von Hippel, Advice and Dissent: Scientists in the Political Arena (New York: Basic Books, 1974). Case studies and analysis dealing with struggles over issues (such as pesticides, nuclear waste) involving scientists, community groups and government bodies.

Evelleen Richards, 'The politics of therapeutic evaluation: the vitamin C and cancer controversy', Social Studies of Science, Vol. 18, 1988, pp. 653-701. On how scientific disputes about randomised clinical double-blind trials can never be resolved solely by scientific means, but always involve wider social issues.

Richard J. Roddewig, Green Bans: The Birth of Australian Environmental Politics (Montclair, NJ: Allanheld, Osmun, 1978). A political analysis of the rise of the green bans, which provides insight into the social institutions which made them occur in Australia, rather than a legal-intensive trajectory as in the United States.

Harvey M. Sapolsky (ed.), Consuming Fears: The Politics of Product Risks (New York: Basic Books, 1986). Case studies of product safety issues and the interest groups struggling over them, including cigarettes, diet and heart disease, salt, artificial sweeteners, tampons and toxic shock, and formaldehyde insulation.

Arthur M. Silverstein, Pure Politics and Impure Science: The Swine Flu Affair (Baltimore: Johns Hopkins University Press, 1981). A medical/political disaster for which, Silverstein argues, no one was truly to blame.

Wendy Varney, Fluoride in Australia: A Case to Answer (Sydney: Hale and Iremonger, 1986). A political analysis of the fluoridation controversy.

Social construction of social problems

There is a body of literature on this topic, which basically argues that the existence of social conditions is neither necessary nor sufficient to create a social problem (i.e. the widespread perception that a serious social condition needs to be dealt with). Therefore, the challenge is to understand the processes by which social problems are defined and promoted by different social groups.

Joseph R. Gusfield, The Culture of Public Problems: Drinking-Driving and the Symbolic Order (Chicago: University of Chicago Press, 1981). How drinking-driving was turned into a social problem.

Ritchie P. Lowry, Social Problems: A Critical Analysis of Theories and Public Policy (Lexington, MA: D. C. Heath, 1974).

Armand L. Mauss, Social Problems as Social Movements (Philadelphia: J. B. Lippincott, 1975). An argument that social problems do not exist unless promoted as such by social movements, with many case studies.

Joseph W. Schneider and John I. Kitsuse (eds.), Studies in the Sociology of Social Problems (Norwood, NJ: Ablex, 1984).

Joseph W. Schneider, 'Social problems theory: the constructionist view', Annual Review of Sociology, Vol. 11, 1985, pp. 209-229.

Malcolm Spector and John I. Kitsuse, Constructing Social Problems (Menlo Park, CA: Cummings, 1977). Social problems are the result of claims-making activities.


On search conferences see Merrelyn Emery, Searching (Canberra: Centre for Continuing Education, Australian National University, 1982). Merrelyn Emergy can be contacted at the Centre for Continuing Education, ANU.

On policy juries see Ned Crosby, Janet M. Kelly and Paul Schaefer, 'Citizens panels: a new approach to citizen participation', Public Administrative Review, Vol. 46, March/April 1986, pp. 170-178. Two of the three Policy Juries carried out so far have dealt with health issues, namely organ transplantation, and school-based clinics to deal with teen-pregnancy, AIDS and other STDs. For details contact Jefferson Center, Plymouth Building, 12 S. 6th St., Minneapolis MN 55402, USA.


The following references for the most part do not deal directly with the issues of concern here, but are relevant to some of the points raised in the text.

On the argument against chest x-rays important in Canberra in the early 1970s, see Mark Diesendorf (ed.), The Magic Bullet: Social Implications and Limitations of Modern Medicine; an Environmental Approach (Canberra: Society for Social Responsibility in Science, 1976).

For a criticism of mass cancer screening, see Petr Skrabanek, 'Shadows over screening mammography', Clinical Radiology, Vol. 40, 1989, pp. 4-5.

On technology and abortion see Daniel Callahan, 'How technology is reframing the abortion debate', Hastings Center Report, Vol. 16, February 1986, pp. 33-42. On why RU486 is unlikely to be made available in the US, see Laura Fraser, 'Pill politics', Mother Jones, Vol. 13, No. 5, June 1988, pp. 31-33, 44.

On information technology, privacy and surveillance, see Roger Clarke, 'Just another piece of plastic for your wallet: the "Australia Car" scheme', Prometheus, Vol. 5, No. 1, June 1987, pp. 29-45; 'Information technology and dataveillance', Communications of the ACM, Vol. 31, No. 5, May 1988, pp. 498-512.

On RSI and work design see Merrelyn Emery, 'Learning about the unpredicted: the case of repetition strain injury (RSI)', Studies in Continuing Education, Vol. 10, No. 1, 1988, pp. 30-45; Trevor A. Williams, 'Visual display technology, worker disablement, and work organization', Human Relations, Vol. 38, No. 11, 1985, pp. 1065-1084.

Nancy G. Kutner, 'Issues in the application of high cost medical technology: the case of organ transplanatation', Journal of Health and Social Behavior, Vol. 28, No. 1, 1987, pp. 23-36. Cost, ethics and quality-of-life issues.

On nutritional preventives for kidney stones, see Stanley F. Gershoff and Edwin L. Prien, 'Effect of daily MgO and vitamin B6 administration to patients with recurring calcium oxalate kidney stones', American Journal of Clinical Nutrition, Vol. 20, May 1967, pp. 393-399; Edwin L. Prien and Stanley F. Gershoff, 'Magnesium oxide-pyridoxine therapy for recurrent calcium-oxalate calculi', Journal of Urology, Vol. 112, No. 4, 1974, pp. 509-512.


1. The initial date indicated is when the technology began to have a major impact on the bulk of the population. The final date is when the pattern of impact became routinised. (Obviously, impacts have continued in every case.) Needless to say, the dates are very approximate. These examples are intended only as triggers for thinking; the process of technological change is much more complicated than indicated by such a list.

2. The last three Europe-wide wars ended in 1815, 1918 and 1945. The length of time since World War Two should give no confidence that a global war could not occur in the next decade.

3. Canberra, as the national capital and home of the Defence Department, could conceivably be targeted. The city's large geographical spread means that there would be many survivors even in the case of a direct hit.

4. The explosion of a nuclear weapon very high in the atmosphere results in a massive pulse of electromagnetic energy at the surface of the earth, over an area as large as a continent. It has a rise time ten times as great as lightning and hence may interrupt or destroy many microcircuits.

5. The usual argument is that nuclear war would create so many casualties and also destroy such a large fraction of medical facilities that any medical response to the crisis would be totally inadequate. This argument is then used to claim that the only suitable response to nuclear war is to prevent it. But the premises do not apply in the southern hemisphere where few population centres are likely to be targeted, and in any case ignores many simple practical measures which can ameliorate an undoubtedly horrible situation.

6. For example, a literature exists on nutritional antidotes to radioactivity. It would be important that such information be available for quick use and dissemination. The consequences of no preparation were apparent in many countries in the aftermath of the Chernobyl accident, a comparatively minor disaster compared to the ones contemplated here.

7. Even the Defence Department seems to have no plans to deal with the aftermath of nuclear war.

8. The issue was whether x-rays should be compulsory, especially for low-risk groups.

9. These two 'models' are of course simplifications of a much more complex situation involving a range of approaches and mixes.

10. Energy efficiency is by far the most cost-effective response to energy problems, and it almost always reduces health impacts unambiguously. By comparison, any new energy technology, whether nuclear or solar, involves some novel health impacts.

11. It has long been possible to construct buildings, in climates colder and less sunny than Canberra, which require no fuels for heating aside from power for lights and equipment. The scare over radon levels in houses which arose in the United States last year is not an insuperable obstacle to energy efficiency in buildings; incidentally, the radon controversy illustrates the way in which a long-standing situation (radon levels in houses) can suddenly become a burning social issue. No policy can escape this process.

12. Sometimes it is entirely appropriate to be partisan, as when evidence against smoking is overwhelming. The more difficult cases are when evidence is contested by different interests. The trouble is that evidence can always be contested: after all, the tobacco companies persist in a rearguard action in defence of the innocence of smoking. The difficulty is where to draw the line.

13. Politicians of course attempt to achieve this impression, and the use of opinion polls is one reflection of the need for justification by public support.

14. The NHMRC [National Health & Medical Research Council] is the prime example relevant here. Also important are committees of the Australian Academy of Science, etc.

15. In terms of the quality of argument and due process in the receiving of testimony, the Ranger Uranium Environmental Inquiry is a good model here, while the Evatt Royal Commission into the effect of herbicides on Vietnam veterans is a poor model. Significantly though, in neither case did the inquiry lead to the end of debate on the issue. It is widely perceived by many people familiar with the politics of inquiries that they are usually set up to legitimate a preformed viewpoint, or in other words to defuse or whitewash an issue. The anti-uranium movement believed this to be the case for the ASTEC inquiry, and so set up its own 'independent' inquiry which in due course found against uranium mining and nuclear power.


I benefited from discussions with Sue Andrews, Patrick Colmer, Karen Freedman and Fran Parker. Evelleen Richards offered useful comments on a draft.