Iatrogenesis - "retained surgical items"

New York Times - Sept. 24, 2012 - When Surgeons Leave Objects Behind:

On an overnight shift in 2005, Sophia Savage, a nurse in Kentucky, felt a crushing pain in her abdomen and started vomiting.

The next day she underwent a CT scan, which led to a startling diagnosis: A surgical sponge was lodged in her abdomen, left behind, it turned out, by a surgeon who had performed her hysterectomy four years earlier.

Ms. Savage’s doctor ordered immediate surgery to remove the sponge.

“What they found was horrific,” Ms. Savage said. “It had adhered to the bladder and the stomach area, and to the walls of my abdominal cavity.”

The festering sponge had spread an infection, requiring the removal of a large segment of Ms. Savage’s intestine. She sued the hospital where the hysterectomy had taken place, and in 2009 she won $2.5 million in damages. But the award has been appealed, and her life has been in tatters. Suffering from severe bowel issues and unable to work, Ms. Savage, 59, has been racked by anxiety and depression. Most days, she said, she cannot bring herself to leave home.

“I never dreamed something like this would happen to me,” she said.

Every year, an estimated 4,000 cases of “retained surgical items,” as they are known in the medical world, are reported in the United States. These are items left in the patient’s body after surgery, and the vast majority are gauzelike sponges used to soak up blood. During a long operation, doctors may stuff dozens of them inside a patient to control bleeding.

Though no two cases are the same, the core of the problem, experts say, is that surgical teams rely on an old-fashioned method to avoid leaving sponges in patients. In most operating rooms, a nurse keeps a manual count of the sponges a surgeon uses in a procedure. But in that busy and sometimes chaotic environment, miscounts occur, and every so often a sponge ends up on the wrong side of the stitches. ….

After Atheism, a 5-part radio series by David Cayley

Friend and interviewer of Ivan Illich, David Cayley has produced a series of quite interesting radio programs about religion for the CBC. They don't specifically mention Illich, but anyone who has listened to Cayley's The Corruption of Christianity radio program or read the accompanying book, The Rivers North of the Future, will likely appreciate this new program a good deal. We have, anyway.

The program is called After Atheism, and it consists of five interviews with thinkers, some believers, some not, who have been delving into religion and faith from a modern point of view. For instance, John Caputo is an expert in the philosophy of deconstruction, as put forth by Jacques Derrida, and he finds that method of analyzing texts very helpful in understanding Christianity. Indeed, he came to the surprising conclusion that Derrida himself had been thinking along religious lines right from the beginning, a thought that the radical and presumably atheistic philosopher eventually confirmed quite explicitly.

William Cavanaugh, meanwhile, has looked carefully at how religion and state relate to each other. Put simplistically, he finds that in certain ways, the state itself has created religion as a foil, as something whose clutches it can claim to have saved society from and thereby justify itself.

James Carse wonders what religion is and finds that belief actually has little to do with it. Instead, the great religions look to him like never-ending conversations, endlessly fascinating to those involved -- and to those on the outside, too -- because they attempt to answer questions -- could a guy nailed to a cross, for instance, really be god? -- that seem impossible to answer. The intent is not actually to answer these questions conclusively -- that would end the conversation -- but to make sure that the questions remain in play, so to speak. This leads Carse to some interesting thoughts on death, too -- and much more.

We're unable to do Cayley or his interview subjects justice. Anyone interested, however, can download and listen to his program as a set of five podcasts, available (at no charge) through the iTunes store or here on the CBC Ideas podcast page.

We highly recommend these shows, and especially to anyone who, like us, has sought to grapple with the religious aspects of Illich's thought. Like many people, we suspect, we came to Illich through his early books, about tools and schools, about hospitals and cars. There, Christian thought was quite implicit, lurking very far in the background. Only the occasional hint shined through - an intriguing citation of Thomas Aquinas in the introduction to Tools for Conviviality, for instance. It was clear enough to his readers that Illich was a Christian believer, but he made a point of never relying on biblical references, for instance, to buttress his critiques of major institutions. He knew better, he would later admit, than to lose his audience that way. Towards the end of his life, though, and largely in the interviews he gave to a well-informed and deeply appreciative David Cayley, he made his religious beliefs more explicit. And looking back, it's quite clear that those beliefs were always there, informing his thought, shaping his understanding much as we, for one, suspected all along but never were quite able to pin down.

Mother Jerome

A Web page devoted to Mother Jerome, Ivan Illich's friend and collaborator, can be viewed here. She was born Melanie “Muska” von Nagel in 1908, in Germany. She entered the Benedictine Abbey of Regina Laudis, in Hartford, Connecticut in 1958, and died there in 2006. According to this biographical page, which is part of the Abbey's own website, she had quite a life. And the Abbey itself looks to be a lively place.

Illich wrote his paper, "The Scopic Past and the Ethics of the Gaze" (available at the Pudel site in Bremen), he states, "after discussions with Barbara Duden, Mother Jerome, O.S.B., and Lee Hoinacki." Matthias Rieger, a collaborator and friend in Bremen, talks at some length about Mother Jerome in his paper, "The disembodiment of the utterance" (also available from the Pudel site). We've always assumed that Illich's 1989 paper, "Posthumous Longevity, An open letter to a cloistered community of Benedictine nuns" (also at Pudel), was addressed to Mother Jerome. "Dear Mother Prioress," it opens. But we may be wrong about that. (Can anyone help?)

Under the name Muska Nagel, she translated the works of Paul Celan, who was possibly Illich's favorite poet.

Medical Nemesis redux

We just saw this in The New York Times, August 27, in a blog called The Well Column, and it made us think of Medical Nemesis:

Overtreatment Is Taking a Harmful Toll

When it comes to medical care, many patients and doctors believe more is better.

But an epidemic of overtreatment — too many scans, too many blood tests, too many procedures — is costing the nation’s health care system at least $210 billion a year, according to the Institute of Medicine, and taking a human toll in pain, emotional suffering, severe complications and even death.

“What people are not realizing is that sometimes the test poses harm,” said Shannon Brownlee, acting director of the health policy program at the New America Foundation and the author of “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer,” a 2007 book.

“Sometimes the test leads you down a path, a therapeutic cascade, where you start to tumble downstream to more and more testing, and more and more invasive testing, and possibly even treatment for things that should be left well enough alone.”

Have you experienced too much medicine? As part of The New York Times’s online series The Agenda, I asked readers to share their stories. More than 1,000 responded, with examples big and small.

The article continues to examine many instances of overtreatment. More than 140 readers posted comments. Of course, Illich's concern was not so much over-expenditure on medical care but the harm and extra suffering that the medical system causes those in its care.

Eugene J. Burkart, R.I.P.

We're deeply saddened to learn that Gene Burkart, a devoted and articulate reader of Ivan Illich, died this past Saturday. Gene visited CIDOC in the early 1970s and years later got in touch with Illich and his circle at Penn State. He worked as a lawyer in Waltham, Mass., mainly representing immigrants and other have-nots, as he put it. He was hoping, we understand, to see a gathering of the Illich crowd at Penn State this year, the tenth anniversary of Illich's death.

Gene contributed a piece to The Challenges of Ivan Illich with the title, "From the Economy to Friendship: My Years Studying with Ivan Illich." We recommend it as one of the better responses to Illich that one can find, dealing with the essential question: What should I, what can I, do with the knowledge and awareness of the world that I have obtained through Illich's work?

His essay is available for reading here, at the website Scribd. It opens with a quite remarkable anecdote about Gene's first encounter with Illich at CIDOC in 1973. He had gone to CIDOC quite enthusiastically but soon found Illich to be arrogant and hypocritical, a "phony … enmeshed in his own cleverness." But then, while giving a talk to an audience seated on a porch at CIDOC, Illich turned to look at Gene, who was far off to the side: " … he did not know me. I wondered, Had he sensed my anger? He continued speaking, all the while looking intensely at me, as if he really wanted me to understand what he was saying. I returned his gaze and although I did not understand a word he said, I felt the confusion of my thoughts and feelings inexplicably lifted from me. In those few moments I had the experience of intimately seeing this person, Ivan Illich, for the first time; I then knew he was someone I could trust. But I would not have a direct conversation with him for many years to come."

"I found myself in a quandary," he writes further on in the essay. "If all economic activity has a corrosive effect on society, how is one to act ethically? Modern life is tightly bound up by market relations. Illich contrasted the economic with premodern ways of living he called subsistence or the vernacular. He proposed a 'modern subsistence as an alternative to economics as a way to break the cash nexus.' But, I wondered, where were the examples? I knew that many of those who had attempted to live outside the economy in the back-to-the-land movement failed. I admired the success of the Amish but felt no calling to their way; further, I had friends and family I did not want to leave. Also, being married, I could not just force my ideas on my wife. What could I do? Was there no way out?"

"I eventually concluded," Gene writes, "that the best way to understand Illich's work is as a detailed study of the myriad and varied barriers to friendship that exist in modern life."

"Friendship does not lend itself to an accounting, to economics," Gene finishes his essay. "The only way I can hope to show my gratitude [to Illich] is to strive to be for others the kind of friend Ivan Illich has been to me."

Illich on Television

Here is a pair of photos made of Ivan Illich on television. He was appearing with John Holt. The photos appear on a site devoted to Holt's work. (Specifically, here.) We're not sure what year this was, but our best guess is the early to mid 1970s, when both men were in the news for their criticisms of the educational system.

One thing 'Deschooling' missed ...

… is the increasing use of schools as marketing channels for corporations trying to reach new generations of potential customer.

OK, this kind of thing was not going on when Illich wrote his book, so he can't be faulted for "missing" it. But look at what's happening as schooling "goes digital" and turns into a battleground fought over by traditional textbook publishers and now, reports the New York Times, media companies, too:

… And then there is the Walt Disney Company. It is building a chain of language schools in China big enough to enroll more than 150,000 children annually. The schools, which weave Disney characters into the curriculum, are not going to move the profit needle at a company with $41 billion in annual revenue. But they could play a vital role in creating a consumer base as Disney builds a $4.4 billion theme park and resort in Shanghai.

This is from a news story titled, "Media Companies, Seeing Profit Slip, Push Into Education." The story states: "Conventional textbooks for kindergarten through 12th grade are a $3 billion business in the United States, according to the Association of American Publishers, with an additional $4 billion spent on teacher guides, testing resources and reference materials. And almost all that printed material, educators say, will eventually be replaced by digital versions." The fight to capture the spoils is underway.

Using teaching materials as a way to market brands and branded products to young children is nothing new, of course. A few years ago, a textbook was published that taught children to count and do simply arithmetic in terms of Cheerios, a donut-shaped breakfast cereal. Apple and Microsoft have long been slugging it out in the market for school computers, too. Many brochures and textbooks supplied by corporations are used by cash-strapped high schools to teach other subjects, such as personal health. Marketing wisdom has it, of course, that if a brand manages to make a strong impression on people when they are young, they will quite likely to remain loyal to the brand as they grow older. Hence the billions spent on marketing to pre-teens and teens, albeit mostly outside of school.

If nothing else, using branded textbooks and developing branded schools fits into Illich's general observation that school is where children learn to be consumers. And the use of such teaching materials seems inevitable as the pressure for educational reform mounts, school budgets shrink, and society doubles down on education as a way to help "make America more competitive in the global economy." There is a kind of desperation in the air and corporations are more than glad to step in and help out, and to use the situation to their own ends, as well. It helps, too, that there is a growing call to privatize more of public schooling as a way to slash costs and make it more effective.

Illich's Journey to America, 1951

We've just found a passenger list for the steamship that brought Ivan Illich to America in 1951. On Oct. 27, in Bremerhaven, Germany, the newly-ordained priest got on board a former troop ship named USNS General Harry Taylor. It arrived in New York harbor on Nov. 6, evidently carrying many refugees and displaced persons.

Here is a portion of the passenger list showing a "John Illich" from Austria:

(We have to wonder if Illich stopped in Bremen on his way to Bremerhaven. Bremen, a few miles inland from the harbor, up the River Weser, was the home of his childhood drawing teacher. In the speech he gave in 1998 upon receiving the Culture and Peace Prize of Bremen, Illich remembered her:

I first heard of Bremen when I was six, in the stories told me by my drawing teacher, who came from one of your patrician families, and in Vienna was homesick for the North. I adopted the tiny, black-dressed lady as Mamma Pfeiffer-Kulenkampf. One summer, she came along with us to Dalmatia, to paint. Her watercolors still grace my brother's study. From her I learned how to mix different pigments for the contrasting atmospheres of a Mediterranean and an Atlantic shore.

Later in life, of course, Illich taught and lived in Bremen for much of the year, and he died there in December, 2002.)

Illich has listed his destination as 452 Madison Ave. in New York. This is the Cardinal's Residence, situated directly behind St. Patrick's Cathedral. We'd be surprised if Illich actually stayed there; it is a small building and he was a fairly junior person in the church hierarchy. In fact, he told interviewers such as David Cayley that upon arriving in New York, he stayed with friends of his family on the Upper East Side (or such is our memory.) And it was in speaking with a maid there, an African-American woman, that he learned of the Puerto Rican barrio in East Harlem. After visiting that place, he said, he decided not to proceed to Princeton University, where he had planned to study the history of medieval alchemy, but to work instead as a parish priest in Washington Heights, on the far upper west side of Manhattan.

USNS General Harry Taylor was built in 1943 for use as a transport ship. She served in the Pacific and then, after the war, helped to bring soldiers back from Europe. Here is a watercolor painting of the ship:

And below is the ship birthed in Staten Island, NY. It later was equipped with specialized radar instruments to help with the testing of ballistic missiles. In 2009, the ship was sunk in Key West Harbor to serve as the second-largest artificial reef in the world.

'Deschooling Society' available as an audiobook

Ivan Illich's book Deschooling Society has been turned into an audiobook by a pair of amateur readers. Their readings of the book's seven chapters are available here for downloading in MP3 audio format at no charge. (Combined, the files add up to 128MB.)

The readers are Robin Upton and Tereza Coraggio, associated with an online "talk radio" show called Unwelcome Guests. It's of a radical, subversive bent. Evidently, Illich has been the subject of several of its weekly programs. For example, a show broadcast in October, 2010, is titled "Ivan Illich and The Collapse of Power." It includes a recording of a talk about Illich given in England in 2009 by a Robert Hutchison, which we noted earlier, here. This show, too, is available for downloading.

Illich at the Newman Center, and 'Deschooling' Misunderstood

In 1973, with his book Tools for Conviviality about to be published, Ivan Illich spoke to an audience at Newman Hall Holy Spirit Parish, which is the Catholic community at the University of California's Berkeley campus. For all we know, this was the first time Illich publicly sketched out his notion of conviviality and its contrast with growth-oriented, consumer-focused industrial society. As part of this effort, he offered some compelling thoughts about education and deschooling, thoughts that shine revealing light on what we've long taken to be a widespread misunderstanding of his argument in Deschooling.

A recording of this talk was broadcast on KPFA, San Francisco's Pacifica station (listener-sponsored and renowned for its radical politics), and a recording of that broadcast recently came into our possession. Here is our transcription of the last few minutes of the broadcast, with Illich wrapping up his answer to a question from the audience:

… Let's recognize what schools really do. Now, all over the world, schools school. I never forget when I first realized what this means, with a group of Black Power leaders in Chicago three years ago, and suddenly somebody said to me, 'You know, yeah, you're right, schools are made to school you.' And I understood that schools are made to school you, and everybody laughed when in the afternoon they showed up with buttons saying 'School you.'

You cannot go to school for a year without learning at least one thing: that the society as it is considers that it would be better that you had gone on for the second or the third year. Therefore, the people who drop out -- the concept of drop out is also a beautiful one -- who drop out of the school system are already deeply schooled. They're schooled today into inferiority. You cannot have a pyramidal class education system no matter who gets up there - if he gets up there because his parents are rich, or he is particularly gifted, or because he's particularly in favor with the ideology which prevails - without teaching many more people that they are inferior.

So, one question is, How can we accept joyfully, even though somewhat with fright, the breakdown of the legitimacy of this particular ritual on which our society, growth society, has been relying on for a few generations?

The second question, which goes much deeper, is, Is education a legitimate enterprise, public education? Is it necessary that we live in a society in which you cannot become a citizen until you first have consumed a non-tangible product of an institution where other people have cooked up for you a program by which you will be educated?

This question is deeply connected with the origins of the concept of education. Until the Reformation, people were born in sin until baptized. They were born lacking something - they couldn't become citizens unless they had gone through a ritual which provided them that something.

Now, I'm personally, hopefully, a very traditional Catholic and I have no difficulty whatsoever with the concept of original sin, and grace, and baptism, and sacraments, and what have you. But the form which this took in the 14th, 15th, 16th and 17th century was, you couldn't be a member of society, of civil society - in Spain, for instance - unless you were baptized.

This goes very much further. The treatment mentality then developed, the idea that there were institutions that would treat people into being as they have to be in order to fit into the society which we construct for them.

I thought … John McKnight showed me the transcript of a speech which a … pediatrician gave at a big meeting of the medical association in Chicago, in which he called on his colleagues to remember that children are born patients until certified healthy by the doctor.

Now, it is not only through school that people's inborn deficiencies as citizens can be remedied. We could invent, during the next 10 years, other methods of channeling an intangible commodity called education in varying degrees to different people according to their needs.

I ask, at this moment, with this paper, … I'm trying to ask a more radical question: Ought we not to call a desirable society one so designed - so transparent, so simple - that most people, most of the time, have access to most of the facts and policies and tools which shape their lives? If universal education means anything, it means that most people most of the time know what's going on around them. … It's pretty logical.

And we have used school, or education, as the means which makes it possible for society to develop tools and institutions to which most people have no access by saying they have all universal education and they know how to read and write, and then, they find it difficult even to teach them that.

As we see it, that second to last paragraph expresses an important refinement of Illich's deschooling argument that unfortunately is widely overlooked or ignored. Here, in fact, is the bridge between Deschooling and Tools for Conviviality, a key thought for understanding both books. Consider:

Deschooling is not a particularly easy book to read. It is dense and its rhetorical style takes some getting used to. And this, we believe, is one reason many readers come away from the book with the incorrect idea that Illich was just another school reformer, albeit more radical than most. Just make schools more "humane" or more "free," these readers understand him to be saying, or just find the right set of educational technologies, and all will be well. Schooling can be made more efficient in its ability to reach and "educate" more people more effectively. All that's needed is more research and perhaps some rethinking of grades, homework, or teacher training. This interpretation also informs many efforts and much thinking in the homeschooling and unschooling movements, many of whose parent-practitioners make no bones about their aim to outperform the "failing" public schools and supercharge their children's education, often with an eye on helping those children get into better universities and thereby earn more money as adults.

The most explicit and most egregious expressions of this shallow reading and the wishful thinking it encourages can be seen on the many websites that trumpet Illich's idea of "learning webs" as an endorsement of - and justification for - Web-based schools and computer-based instruction. Using technology to re-energize schooling as we know it is widely discussed, of course, among reformers such as Bill Gates and among a growing raft of technology entrepreneurs who are enjoying serious attention from Silicon Valley venture capitalists and other investors. Educational publishers have their own plans for harnessing computers for schooling, too. The push to privatize public schools is based largely on the idea that teaching can be done more effectively, and more profitably, were more classroom time turned over to computers.

But Illich never sought merely to reform public schooling. He argued for nothing less than its inversion - and an inversion of society as a whole, no less. A truly convivial society would be one in which there'd be no need for the traditional schooling and educational system that he dissects so skillfully in Deschooling. And by the same token, the deschooling measures that he describes, such as the fostering of "learning webs," could not take hold in the kind of industrial society we live in today, rooted deeply in what Illich called "knowledge capitalism."

Another way to put it is that the schooling system as we know it today leads to the destructive, anti-convivial society we're stuck with. And likewise, industrial society must have, and will always fight to maintain, the schooling system and essential arrangement (based on the assumption that knowledge is scarce and best provided by specially trained teachers) that it currently has. One begets the other, each needs and reinforces the other.

Convivial society, as we understand it, would, through political discussion and action, set limits on tools such that the kind of intensive training and constant re-training that we now take for granted would not be necessary. A convivial society, as Illich put it in his talk at the Newman Center, would be one in which "most people, most of the time, [would have] have access to most of the facts and policies and tools which shape their lives." Tools would be simple enough that the knowledge needed to use them and repair them would be widely available, not confined to scarce and costly schools and training classes. As it is, most producers of tools today depend on selling training courses for a major portion of their profits. Know-how is purposely kept scarce, both by limiting it through systems of certification and by continuously changing -- aka "enhancing" -- products in ways that require users of those tools to pay for periodic retraining.

The bicycle is perhaps the ideal example of a convivial tool. No individual's use of a bike infringes on anyone else's use of a bike; it's difficult to clog the roads with enough bicycles to cause a "traffic jam" of the crippling kind that often arises when too many cars show up in the same place. The bike, moreover, is a machine whose workings most people are able to understand simply by looking at it, and it's one that most people also can fix by themselves. And if they can't or don't want to bother fixing their bike, many others can do it for them precisely because knowledge about the machine and its workings is widespread; it's not scarce, in other words, as is the know-how needed to work on many modern car engines, for instance. (Indeed, many car makers, today, design their engines and other components such that only those with special training and with access to specialized wrenches and other tools can repair those engines. Scarcity is artificially imposed for the sake of extra profit.)

Unfortunately, most of those who proclaim their enthusiasm for Deschooling Society seem not to have even heard of Tools for Conviviality, much less read the book and understood how its argument relates to and extends that of the earlier book. One result is an endless stream of rhetoric about moving schools online and even the occasional dropping of Illich's name as justification for some techno-education project or another. Which is, in our book, a shame.

Illich criticized the school system as essentially an attempt to "funnel" students through a rigorous, near-industrial process of education. Year after year, school subjects them to pre-fabricated lessons taught by professionally trained and quite anonymous teachers. There's no room or regard for any student's particular interest or curiosity at any given moment, students are forced to consume what's served to them when it's served. Illich also criticized the notion, made explicit in certain engravings from the past, that education can be understood as a matter of pouring knowledge through a funnel lodged in the student's cranium.

The third paragraph of his book's introduction reads:

Universal education through schooling is not feasible. It would be no more feasible if it were attempted by means of alternative institutions built on the style of present schools. Neither new attitudes of teachers toward their pupils nor the proliferation of educational hardware or software (in classroom or bedroom), nor finally the attempt to expand the pedagogue's responsibility until it engulfs his pupils' lifetimes will deliver universal education. The current search for new educational funnels must be reversed into the search for their institutional inverse: educational webs which heighten the opportunity for each one to transform each moment of his living into one of learning, sharing, and caring. We hope to contribute concepts needed by those who conduct such counterfoil research on education--and also to those who seek alternatives to other established service industries.[emphasis in original]

The sixth chapter of the book is titled "Learning Webs," and it puts forth an alternative to the idea of school as "a pyramid of classified packages accessible only to those who carry the proper tags." That alternative Illich describes using the terms "network" and "opportunity web." But he is careful to qualify his choice of words.

The essential idea underlying this chapter, as we understand it, is that people (and therefore society as a whole) would be better off if they were able to learn from each other as peers, or friends, free to engage with each other as and when they chose, not as student and teacher compelled by law or custom to sit together in a certain room at a certain hour each day. And to help out, Illich says, a simple matching service could be set up to help those who'd like to learn or teach certain skills or who would enjoy discussing a particular topic or book, for instance, to find each other. Illich briefly mentions the idea of using a computer to run such a "peer-matching" service, but he comes nowhere near suggesting that the computer itself be used as an educational tool or teaching medium.

In fact, the learning webs that Illich proposed could be - and indeed, have been - implemented using only a telephone or bulletin board and a box of 3x5 file cards.

Illich actually expresses a certain reluctance in using the term network:

I will use the words "opportunity web" for "network" to designate specific ways to provide access to each of four sets of resources ["things, models, peers, and elders"]. "Network" is often used, unfortunately, to designate the channels reserved to material selected by others for indoctrination, instruction, and entertainment. But it can also be used for the telephone or the postal service, which are primarily accessible to individuals who want to send messages to one another. I wish we had another word to designate such reticular structures for mutual access, a word less evocative of entrapment, less degraded by current usage and more suggestive of the fact that any such arrangement includes legal, organizational, and technical aspects. Not having found such a term, I will try to redeem the one which is available, using it as a synonym of "educational web."

Naturally, today's technology enthusiasts have latched on to this last phrase, some of them even crediting Illich explicitly for supposedly envisioning, if not "inventing," the World Wide Web as we know it, in principle, at least. Illich reportedly scoffed at this.

For the record, Illich describes four kinds of "learning web." In his words:

1. Reference Services to Educational Objects -- which facilitate access to things or processes used for formal learning. Some of these things can be reserved for this purpose, stored in libraries, rental agencies, laboratories, and showrooms like museums and theaters; others can be in daily use in factories, airports, or on farms, but made available to students as apprentices or on off hours.

2. Skill Exchanges -- which permit persons to list their skills, the conditions under which they are willing to serve as models for others who want to learn these skills, and the addresses at which they can be reached.

3. Peer-Matching -- a communications network which permits persons to describe the learning activity in which they wish to engage, in the hope of finding a partner for the inquiry.

4. Reference Services to Educators-at-Large -- who can be listed in a directory giving the addresses and self-descriptions of professionals, paraprofessionals, and free-lancers, along with conditions of access to their services. Such educators, as we will see, could be chosen by polling or consulting their former clients.

Compared to what it is today, the computer was a crude device when Illich was writing about education. Illich suggested it be used only as a sophisticated file-card matching system, we are quite sure, not as a machine facilitating "live" communications or "long-distance learning," as so many educational-Web enthusiasts yearn to implement.

In fact, the main technology Illich suggests using is the tape recorder - low-cost, easy to use, and able to convey lessons of all kinds:

What are needed are new networks, readily available to the public and designed to spread equal opportunity for learning and teaching.

To give an example: The same level of technology is used in TV and in tape recorders. All Latin-American countries now have introduced TV: in Bolivia the government has financed a TV station, which was built six years ago, and there are no more than seven thousand TV sets for four million citizens. The money now tied up in TV installations throughout Latin America could have provided every fifth adult with a tape recorder. In addition, the money would have sufficed to provide an almost unlimited library of prerecorded tapes, with outlets even in remote villages, as well as an ample supply of empty tapes.

This network of tape recorders, of course, would be radically different from the present network of TV. It would provide opportunity for free expression: literate and illiterate alike could record, preserve, disseminate, and repeat their opinions. The present investment in TV, instead, provides bureaucrats, whether politicians or educators, with the power to sprinkle the continent with institutionally produced programs which they-or their sponsors--decide are good for or in demand by the people.

Technology is available to develop either independence and learning or bureaucracy and teaching.

Clearly, today's Web is a technology that's doing both, helping individuals to share knowledge with each other, often for the love of it, and serving as a platform for the delivery of all kinds of commercially-packaged lessons and "educational resources" including even live, one-on-one tutoring for hard-pressed schoolchildren. Look on YouTube, for instance, and you can learn from others about everything from how to play guitar to fixing your own computer to playing soccer. At the same time, however, established educational institutions are scrambling to harness the Web as a low-cost means of conducting classes for credit. Illich, we suspect, would applaud the former while seeing the latter as a prime example of what he warned his Newman Center audience about 30 years ago, namely newly-invented "methods of channeling an intangible commodity called education in varying degrees to different people according to their needs" as a way to "remedy people's inborn deficiencies as citizens."