Techno-pessimism, MOOCs and market failure in med ed

Attention: Some slipping of the causal nexus is evident.

An article in the Economist reviewing, or at least discussing, a couple of books about the rate of innovation caught my eye,  in particular a snippet that I will expand on below. The books were “The Rise and Fall of American Growth” by Robert Gordon, and the “The Innovation Illusion” by Fredrik Erixon and Bjorn Weigel. I haven’t read either, but enjoyed a review of the Gordon book in the NYRB by Willian Nordhaus. Based on my reading of the Nordhaus book review the issue is that the rate of innovation and productivity is declining — we are not hurtling towards any singularity — and that the century of out of the ordinary innovation was 1870 to 1970. Here is Nordhaus:

Gordon focuses on growth in the United States. Living standards, as measured by GDP per capita or real wages, accelerated after 1870. The growth rate looks like an inverted U. Productivity growth rose from the late nineteenth century and peaked in the 1950s, but has slowed to a crawl since 1970. In designating 1870–1970 as the special century, Gordon emphasizes that the period since 1970 has been less special. He argues that the pace of innovation has slowed since 1970 (a point that will surprise many people), and furthermore that the gains from technological improvement have been shared less broadly (a point that is widely appreciated and true).

In the Economist article, we read:

The figures from recent years are truly dismal. Karim Foda, of the Brookings Institution, calculates that labour productivity in the rich world is growing at its slowest rate since 1950. Total factor productivity (which tries to measure innovation) has grown at just 0.1% in advanced economies since 2004, well below its historical average.

I do not find this view strange. Medical advance is slowing, not accelerating. Medicine was transformed between 1940 and 1970, but the rate of new discovery has slowed. There is more data , more activity, and more scientists, of course. And a lot more hype and university press officers. Just less advance in comparison with what went before. The same is true about university education, too.

Criticisms of these views include questions about the data used to support the various arguments. In the Economist piece, the ‘techno optimists’ make two criticisms. The second is that the ‘techno’ revolution hasn’t really started yet, but it is the first one that caught my eye:

The first is that there must be something wrong with the figures. One possibility is that they fail to count the huge consumer surplus given away free of charge on the internet. But this is unconvincing. The official figures may well be understating the impact of the internet revolution, just as they downplayed the impact of electricity and cars in the past, but they are not understating it enough to explain the recent decline in productivity growth.

Paul Mason elsewhere uses the example of Wikipedia:

Wikipedia is a non-market form of activity—it’s a $3bn hole in the advertising world.

Now bringing this back to my own little world, I am intrigued by how the battle between, on the one hand, free or OER, and on the other, books or content, you have to pay for, will work out. I touched on this in an article on teaching and learning several years ago, and one of the reasons I wrote the freely accessible textbook of skin cancer, www.skincancer909.com* was out of frustration at the poor quality of dermatology textbooks targeted at medical students. When I surveyed medical students a large fraction did not buy a dermatology textbook, yet it is clear that the university did not provide suitable alternatives, nor was the university able to provide reasonable online alternatives. Now, I do not believe that free is always best, nor do I think that the endgame is anytime soon. But I do believe content is critical, and despair at how the med ed (medical education) world largely ignores it. But there are amazing commercial books out there — think Molecular Biology of the Cell for instance — and there is a battle to be waged about whether you invest large amounts of money in producing material used by many, or continue with the traditional approach taken by universities (those ‘bloody PowerPoints’ and dull lectures, all done on a shoestring budget).

Woodie Flowers touched on cognate issues in a critique of MOOCs and MITx

In the United States, our “education” system is choking to death on a failed training system. Each year, 600,000 first-year college students take calculus; 250,000 fail. At $2000/failed-course, that is half-a-billion dollars. That happens to be the approximate cost of the movie Avatar, a movie that took a thousand people four years to make. Many of those involved in the movie were the best in their field. The present worth of losses of $500 million/year, especially at current discount rates, is an enormous number. I believe even a $100 million investment could cut the calculus failure rate in half.

The criticism stings because Flowers is an educational legend (it also speaks to MIT that they broadcast such critiques of their own activities). Here is Flowers again:

Properly designed new media materials can improve K–12, residential, distance, and life-long learning. In their highly developed form, these learning materials would be as elegantly produced as movies and video games and would be as engaging as a great novel.

I do not know how all of this will work out. I am intrigued by the view that we might be underestimating ‘production’ because much of it is free, but I think we are seeing real market failure, both from the commercial world and from the universities.

* Skincancer909 is due an update, and I am aiming for early 2017.