Just because Wakefield's MMR research has been discredited doesn't mean parents can't question vaccine orthodoxy. Photo: John Moore/Getty Images
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What if not all parents who question vaccines are foolish and anti-science?

It is not completely unreasonable for parents to ask about safety concerns.

For reasons that will become clear, I feel the need to begin this by trying to prove I’m pro-vaccine. Here goes.

To my knowledge, I have always kept my son exactly on the vaccination schedule required by our state of Michigan. Now almost 15 years old, he is fully vaccinated according to public-health recommendations.

I’ve also kept myself on the recommended vaccine schedule and I pester my doctor about whether there are any vaccines I am missing. By some measures, I am actually more vaccinated than “necessary”; the HPV vaccine is not specifically recommended for women in their forties, but I bothered to get it for myself when it became available a few years ago. I did so in part because I thought I would sound more convincing when I urged young people to get it – which I do, all the time, because the HPV vaccine can help prevent cervical cancer, anal cancer, throat cancer and genital warts.

But I suspect all that testimony won’t matter given what else I’m about to say. Because as soon as one questions anything about vaccines – as soon as one expresses any doubt or concern about any vaccine practice – one risks being labelled an “anti-vaxxer”. Or at least represented as a kind of gunrunner to the anti-vax camp.

 

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As American historians of science of the same generation, Mark Largent and I have run into each other professionally for almost two decades. So when he showed up for a bookshop signing of my new book, Galileo’s Middle Finger – about the sometimes fraught relationship between scientists and activists – I thought he was just being collegial. Instead I discovered he wanted to talk about what had happened since he had published Vaccine, a book that tries to unpack why so many parents are resisting vaccinations for their children.

In his work, Largent refuses to take sides with either a) the anti-vaxxers, who think vaccines cause disorders such as autism, or b) the anti-anti-vaxxers – let’s call them the vaccine zealots – who think any parent who resists any vaccination is a dangerous idiot. Even though Largent is easily as “pro-vaccine” and pro-science as I am, among the frenzied zealots his sympathy for resister parents has marked him out as a heretic.

Talking with him over coffee a few days after the signing, I learned that, like other scholars whose misery I trace in my book – who have put forward challenging ideas about gender identity, sexual orientation, the nature of rape and childhood sexual abuse – Largent didn’t wade into his chosen topic naive about the potential for upsetting someone. Nevertheless, like those other scientists, he was caught off-guard by how difficult it has been to make his voice rise above deeply embedded dogma and polarised debates to suggest a different way of thinking about things.

A professor at Michigan State University, Largent tries in his book to do something potentially very useful: to sort out how to think about the “nearly 40 per cent of American parents [who] report that they delay or refuse a recommended vaccine for their children”. Refusing to write off those parents as anti-science, Largent finds in fact that “the percentage of [hardcore] anti-vaccinators in the US has held steady throughout the last 100 years at about 3 per cent of the population”. In this category, he counts people who consistently refuse all vaccinations: some religious groups such as Christian Scientists, some minority groups such as the Amish, and some people who are firmly against modern western medicine. Largent purposely does not include people who resist particular vaccines or who deviate from the mandated schedules.

So, controversially, he chooses not to label as “anti-vaxxers” the likes of the actress Jenny McCarthy, who has suggested that holding all children to the same vaccination schedule might severely harm some of them. McCarthy’s own son was diagnosed with autism after he suffered febrile seizures the night following half a dozen inoculations, and she has publicly speculated that his problems were due in part to the vaccines. Her move has led to a website, jennymccarthybodycount.com – which blames her for over 9,000 infectious disease deaths since June 2007.

Largent also bucks the usual trend among the sometimes self-righteous zealots by refusing to see public-health vaccine recommendations as a purely scientific prescription. In fact, he calls the recommended childhood vaccination schedule “a political artefact” – not a simple blooming of the science but a wrangled set of mandates and recommendations that it is not unreasonable for parents to question.

He prefers to call McCarthy and most other parents who doubt or hesitate “vaccine anxious” rather than anti-vaxxers, and suggests that doctors try to understand why parents might resist jabs for their children. For saying this, some have accused him of being part of the problem of vaccine non-compliance. This is a grave charge; if enough people refuse vaccinations for diseases such as polio, our “herd immunity” will be put at risk, and those children and adults who are too medically fragile to receive vaccines – perhaps because their immune systems have been weakened through illness – will end up at risk of severe disability and even death.

Talking to him over that coffee, I got the sense Largent is not sure what is worse: not being heard because he doesn’t fit in easily on either side of the public vaccine debate, or
being positioned as an anti-vaxxer because he dares to try to think deeper about the history and the facts of vaccination campaigns.

 

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To understand Largent’s argument, it’s useful to consider what a child’s vaccine schedule now is. US public-health officials recommend that in the first 18 months of life a child receive no fewer than 25 vaccinations. By the age of six, the appropriately vaccinated American child will have been subject to about three dozen vaccinations. In Britain, the schedule begins at two months with three injections: a pneumococcal vaccine, rotavirus, and a combination jab that protects against diphtheria, tetanus, whooping cough, polio and Hib, a type of bacterial infection. There are three more jabs at three months, another two at four months, and six more before starting school. That’s a lot of interventions for a parent to manage in a short space of time.

The number was similar when my own son was little and, talking to Largent, I remembered with some surprise that I could have reasonably been labelled a “vaccine-anxious parent”. My maternal instinct was riled with every new round of shots and cries and tears: I remembered one particular visit to our paediatrician when my gut instinct had a sharp argument with my brain. I can’t even remember what the vaccine was; I just remember that Gut was yelling, “Enough already! Stand between our baby and that needle!” Trying to stay calm, Brain answered: “Vaccines are safe, and necessary not just for our baby’s health but for the health of those around him, especially children more vulnerable than him . . .”

That one time, I asked the nurse if I could see the written literature on this vaccine. I wanted more information not because I was going to refuse the shot, but because I wanted Brain to shut Gut up. She looked shocked and annoyed and told me testily that there wasn’t any information available. The jab was just compulsory.

No pamphlet in the box, for parents? I asked.

No, she said.

I suddenly regretted even asking. Would I be labelled a “worried” mother, or worse, a  “non-compliant” one?

Fortunately, our doctor came into the room at that moment. He knew that I had a PhD in history of science, and that I am a deep believer in science, in evidence-based medicine, in public health and so also in vaccines. Maybe because of that, or maybe just because he’s a good doctor, he quickly understood the situation. He went to his computer and printed out several pages of information about the vaccine. He gave me time to read, and waited for me to say “OK” before telling the nurse to proceed.

 

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Not everyone is as sympathetic to anxious or resistant parents as our doctor was. ­Writing on a blog under the pen name “Orac”, David Gorski, a surgeon and professor at Wayne State University in Detroit, has lambasted Mark Largent for talking about “vaccine-anxious” parents rather than “anti-vaxxers”. Gorski calls Largent “clueless” and insists that “the concerns of these parents are almost always rooted in pseudoscience, fear-mongering, and outright scientific misinformation”.

He goes on: “What ‘moral concern’ could lead parents to leave their children unprotected against vaccine-preventable diseases, particularly deadly ones?” How dare Largent suggest that paediatricians “address their concerns”, he writes, “as if paediatricians don’t try to do that every time a parent brings her child for a well-child visit and baulks at allowing her child to be vaccinated”?

I wonder if Gorski would have been appalled at my hesitation in my ­paediatrician’s office, like the nurse was. But here’s the thing: I don’t think my anxiety was rooted in pseudoscience, fear-mongering or outright scientific misinformation. While Gorski might want to write me off as a bad and anti-scientific mother, in most clinical encounters a mother asking for data about medical necessity, safety and efficacy before consenting to an offered medical intervention would be seen as a good and scientific mother. So why are vaccines treated in such an exceptional way? Why are they seen as different from most interventions in medicine and public health – requiring old-fashioned paternalism and even heavy-handed legal compulsion?

First off, as every vaccine zealot will (rightly) tell you, vaccines are not your usual sort of medical intervention. To state the obvious, with few exceptions (such as the tetanus vaccine), vaccines don’t just protect the individual being vaccinated; they also help to create “herd immunity”. It is hard not to look at the history of diseases such as polio, diphtheria and smallpox and not feel motivated to sing whatever rousing song will convince everyone to enlist in the army of the vaccinated.

Vaccine zealots also understand vaccines (again, rightly) as being different from other medical interventions because they are subject to higher levels of safety monitoring. They are, as a class, arguably the safest type of medical intervention we have in the world. Any time a vaccine is found to be unsafe or is even perceived as potentially unsafe, public-health campaigns may be put at risk, so most public-health officials are quite vigilant about safety-testing before releasing vaccines into the market and about monitoring them afterwards.

Finally, the history of terrible falsehoods that have been spread about vaccine safety causes in anti-anti-vaxxers the kind of fervour you should expect to find among people who feel their enemies have cheated. In terms of major falsehoods about vaccine safety, best known is the case of Andrew Wakefield in the UK, who claimed to have evidence of a link between the MMR (measles, mumps and rubella) vaccine and autism. In 2003, the investigative journalist Brian Deer began to uncover evidence that Wakefield didn’t just have his data wrong, but had actively misrepresented it. (The Lancet, which had published Wakefield’s work in this area, finally retracted it in 2010.)

In Galileo’s Middle Finger, I write about another major case of falsehoods spread about a measles vaccine. This involved the book Darkness in El Dorado, published in 2000 by the self-styled journalist Patrick Tierney. He suggested that the geneticist James Neel purposely conducted a Nazi-like eugenics experiment on the Yanomami people of the Amazon by giving them a vaccine that caused a measles outbreak. Tierney was wrong: the epidemic started before Neel arrived in Yanomami territory, the vaccine didn’t cause measles, and Neel and his team did everything they could to race ahead of the disease to vaccinate those at risk. But Tierney’s work has fed ­anti-vaxxers and spread false beliefs about vaccines.

Given the Wakefield and Tierney falsehoods, the high safety and efficacy rates of vaccines, and the history of vaccine success worldwide, it is hardly surprising that some public-health advocates see vaccines as the biomedical equivalent of Nelson Mandela.

You can guess what that makes parents who resist.

 

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So why isn’t Largent – and why aren’t I – a vaccine zealot? Well, despite the understandable passion of the vaccine fundamentalists, there are some inconvenient facts that are often overlooked in public debates about vaccines. Noticing them won’t make you an anti-vaxxer but they can make you feel like a vaccine heretic.

First, consider the question of necessity. Not all illnesses for which vaccines exist are as grave as polio or smallpox. Take chickenpox. Some American states have made the chickenpox vaccine mandatory – keeping children out of school unless they get it – ­after a lot of heavy lobbying by its manufacturer. But it is reasonable to ask, as I did, if it wouldn’t be just as safe to let your healthy child catch chickenpox, which is a minor disease for most healthy children, instead of giving them the vaccine. (That is the strategy of the NHS in Britain: it does not routinely offer the jab, claiming “there’s a worry that introducing chickenpox vaccination for all children could increase the risk of chickenpox and shingles in older people”.)

Next, consider safety: all vaccines do carry some risk – even if it is only a very, very small one. Some vaccines, in fact, are not generally given to the public because of concerns about safety. (The anthrax vaccine would be a good example here.) It is not completely unreasonable for parents to ask about safety concerns with vaccines.

Finally, consider the influence of money in the public-health system. Make no mistake: vaccines are a boon to big pharmaceutical companies, and the companies that make and push vaccines are the same kind that have been repeatedly fined for all sorts of bad behaviour where drug marketing is concerned. Moreover, studies consistently show that financial ties to the pharmaceutical industry influence the behaviour of doctors and policymakers – and yet many in those groups maintain such financial ties anyway. I’ve seen British medical journals that are normally vigilant about conflicts of interest “forgive” failure to disclose funding from vaccine-makers by an ethicist who pushes those companies’ vaccines as “necessary” in those journals and in the mainstream press.

Monetary influence on politicians’ decisions about vaccines is even easier to find. One example: there has been huge resistance to the HPV vaccine, which prevents a sexually transmitted disease that causes cervical cancer, because religious groups argue (against the scientific evidence) that it may encourage promiscuity in teenagers. Yet Rick Perry, the then Republican governor of Texas – who might be expected to pander to the Christian right’s abhorrence of the vaccine – suddenly decided to mandate the HPV vaccine for schoolgirls after a series of donations from the vaccine’s maker.

The facts listed above might lead you to wonder if all this suspicious behaviour isn’t ultimately as dangerous to public-health vaccine campaigns as someone like Jenny McCarthy is claimed to be – because it breeds cynicism, conspiracy theories and distrust of the medical profession itself.

But as Largent has been learning, you can’t say these things. You have to subscribe to vaccine exceptionalism – vaccines are all necessary, safe and effective and should never be questioned! – or risk being crushed. In the zealots’ eyes, in the battle to vaccinate the world, moderates must be crushed so that children can be saved.

The problem is that the zealots’ approach doesn’t work. Studies show that haranguing people with proof that vaccines are safe doesn’t increase parental compliance. Ironically, if you really take science seriously, you have to admit that beating people over the head with scientific studies generally doesn’t get them to be act in more rational ways, particularly if some important parental psychology is getting in the way.

If you want to understand and reduce vaccination non-compliance, what probably has to happen is what Largent has been trying to do. You have to work to achieve a subtler understanding of parental decision-making, along with a recognition that ­public-health campaigns aren’t Pure Science but are influenced by politics and money (although maybe they shouldn’t be). You have to stop talking about “vaccines” as if they were all one thing, and stop talking about vaccination schedules as if they were simple products of value-free science. You have to stop claiming “we” have science and “they” have stupid.

 

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Mark Largent is working now with public-health officials with the goal of improving vaccination rates by understanding the reasons why a reasonable, well-informed parent might decide to opt out of vaccinations.

Like Largent, I wonder if this more respectful, more generous approach will work. I wonder if it has any hope of even catching on as a public-health approach. Ultimately, given the perceived risk that moderate voices such as Largent’s allegedly present in this matter, the idea of taking vaccine-anxious parents seriously may be declared too heretical to be preached within the church of public health.

Even if Largent is declared a dangerous heretic by those who claim to be the true defenders of vaccine science, he likely won’t end up as badly off as many of the scientists I interviewed for my book. He probably won’t end up accused of genocide, accused of having sex with a research subject, having 20,000 people email his university president calling for his dismissal, or having to fight in court for his right to publish results of his research, as various of the beleaguered scholars I interviewed were.

Moreover, Largent is a big boy with a tough skin. I am not too worried about him. The people I am worried about are the ones who may end up harmed because we couldn’t bring ourselves to think more clearly about what is really going on in vaccination campaigns – because we couldn’t see that it was time to give up on the dogma and bring in the heretics if we want to save more souls.

Alice Dreger is the author of “Galileo’s Middle Finger: Heretics, Activists and the Search for Justice in Science” (Penguin Press)

This article first appeared in the 27 May 2015 issue of the New Statesman, Saying the Unsayable

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Fitter, dumber, more productive

How the craze for Apple Watches, Fitbits and other wearable tech devices revives the old and discredited science of behaviourism.

When Tim Cook unveiled the latest operating system for the Apple Watch in June, he described the product in a remarkable way. This is no longer just a wrist-mounted gadget for checking your email and social media notifications; it is now “the ultimate device for a healthy life”.

With the watch’s fitness-tracking and heart rate-sensor features to the fore, Cook explained how its Activity and Workout apps have been retooled to provide greater “motivation”. A new Breathe app encourages the user to take time out during the day for deep breathing sessions. Oh yes, this watch has an app that notifies you when it’s time to breathe. The paradox is that if you have zero motivation and don’t know when to breathe in the first place, you probably won’t survive long enough to buy an Apple Watch.

The watch and its marketing are emblematic of how the tech trend is moving beyond mere fitness tracking into what might one call quality-of-life tracking and algorithmic hacking of the quality of consciousness. A couple of years ago I road-tested a brainwave-sensing headband, called the Muse, which promises to help you quiet your mind and achieve “focus” by concentrating on your breathing as it provides aural feedback over earphones, in the form of the sound of wind at a beach. I found it turned me, for a while, into a kind of placid zombie with no useful “focus” at all.

A newer product even aims to hack sleep – that productivity wasteland, which, according to the art historian and essayist Jonathan Crary’s book 24/7: Late Capitalism and the Ends of Sleep, is an affront to the foundations of capitalism. So buy an “intelligent sleep mask” called the Neuroon to analyse the quality of your sleep at night and help you perform more productively come morning. “Knowledge is power!” it promises. “Sleep analytics gathers your body’s sleep data and uses it to help you sleep smarter!” (But isn’t one of the great things about sleep that, while you’re asleep, you are perfectly stupid?)

The Neuroon will also help you enjoy technologically assisted “power naps” during the day to combat “lack of energy”, “fatigue”, “mental exhaustion” and “insomnia”. When it comes to quality of sleep, of course, numerous studies suggest that late-night smartphone use is very bad, but if you can’t stop yourself using your phone, at least you can now connect it to a sleep-enhancing gadget.

So comes a brand new wave of devices that encourage users to outsource not only their basic bodily functions but – as with the Apple Watch’s emphasis on providing “motivation” – their very willpower.  These are thrillingly innovative technologies and yet, in the way they encourage us to think about ourselves, they implicitly revive an old and discarded school of ­thinking in psychology. Are we all neo-­behaviourists now?

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The school of behaviourism arose in the early 20th century out of a virtuous scientific caution. Experimenters wished to avoid anthropomorphising animals such as rats and pigeons by attributing to them mental capacities for belief, reasoning, and so forth. This kind of description seemed woolly and impossible to verify.

The behaviourists discovered that the actions of laboratory animals could, in effect, be predicted and guided by careful “conditioning”, involving stimulus and reinforcement. They then applied Ockham’s razor: there was no reason, they argued, to believe in elaborate mental equipment in a small mammal or bird; at bottom, all behaviour was just a response to external stimulus. The idea that a rat had a complex mentality was an unnecessary hypothesis and so could be discarded. The psychologist John B Watson declared in 1913 that behaviour, and behaviour alone, should be the whole subject matter of psychology: to project “psychical” attributes on to animals, he and his followers thought, was not permissible.

The problem with Ockham’s razor, though, is that sometimes it is difficult to know when to stop cutting. And so more radical behaviourists sought to apply the same lesson to human beings. What you and I think of as thinking was, for radical behaviourists such as the Yale psychologist Clark L Hull, just another pattern of conditioned reflexes. A human being was merely a more complex knot of stimulus responses than a pigeon. Once perfected, some scientists believed, behaviourist science would supply a reliable method to “predict and control” the behaviour of human beings, and thus all social problems would be overcome.

It was a kind of optimistic, progressive version of Nineteen Eighty-Four. But it fell sharply from favour after the 1960s, and the subsequent “cognitive revolution” in psychology emphasised the causal role of conscious thinking. What became cognitive behavioural therapy, for instance, owed its impressive clinical success to focusing on a person’s cognition – the thoughts and the beliefs that radical behaviourism treated as mythical. As CBT’s name suggests, however, it mixes cognitive strategies (analyse one’s thoughts in order to break destructive patterns) with behavioural techniques (act a certain way so as to affect one’s feelings). And the deliberate conditioning of behaviour is still a valuable technique outside the therapy room.

The effective “behavioural modification programme” first publicised by Weight Watchers in the 1970s is based on reinforcement and support techniques suggested by the behaviourist school. Recent research suggests that clever conditioning – associating the taking of a medicine with a certain smell – can boost the body’s immune response later when a patient detects the smell, even without a dose of medicine.

Radical behaviourism that denies a subject’s consciousness and agency, however, is now completely dead as a science. Yet it is being smuggled back into the mainstream by the latest life-enhancing gadgets from Silicon Valley. The difference is that, now, we are encouraged to outsource the “prediction and control” of our own behaviour not to a benign team of psychological experts, but to algorithms.

It begins with measurement and analysis of bodily data using wearable instruments such as Fitbit wristbands, the first wave of which came under the rubric of the “quantified self”. (The Victorian polymath and founder of eugenics, Francis Galton, asked: “When shall we have anthropometric laboratories, where a man may, when he pleases, get himself and his children weighed, measured, and rightly photographed, and have their bodily faculties tested by the best methods known to modern science?” He has his answer: one may now wear such laboratories about one’s person.) But simply recording and hoarding data is of limited use. To adapt what Marx said about philosophers: the sensors only interpret the body, in various ways; the point is to change it.

And the new technology offers to help with precisely that, offering such externally applied “motivation” as the Apple Watch. So the reasoning, striving mind is vacated (perhaps with the help of a mindfulness app) and usurped by a cybernetic system to optimise the organism’s functioning. Electronic stimulus produces a physiological response, as in the behaviourist laboratory. The human being herself just needs to get out of the way. The customer of such devices is merely an opaquely functioning machine to be tinkered with. The desired outputs can be invoked by the correct inputs from a technological prosthesis. Our physical behaviour and even our moods are manipulated by algorithmic number-crunching in corporate data farms, and, as a result, we may dream of becoming fitter, happier and more productive.

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The broad current of behaviourism was not homogeneous in its theories, and nor are its modern technological avatars. The physiologist Ivan Pavlov induced dogs to salivate at the sound of a bell, which they had learned to associate with food. Here, stimulus (the bell) produces an involuntary response (salivation). This is called “classical conditioning”, and it is advertised as the scientific mechanism behind a new device called the Pavlok, a wristband that delivers mild electric shocks to the user in order, so it promises, to help break bad habits such as overeating or smoking.

The explicit behaviourist-revival sell here is interesting, though it is arguably predicated on the wrong kind of conditioning. In classical conditioning, the stimulus evokes the response; but the Pavlok’s painful electric shock is a stimulus that comes after a (voluntary) action. This is what the psychologist who became the best-known behaviourist theoretician, B F Skinner, called “operant conditioning”.

By associating certain actions with positive or negative reinforcement, an animal is led to change its behaviour. The user of a Pavlok treats herself, too, just like an animal, helplessly suffering the gadget’s painful negative reinforcement. “Pavlok associates a mild zap with your bad habit,” its marketing material promises, “training your brain to stop liking the habit.” The use of the word “brain” instead of “mind” here is revealing. The Pavlok user is encouraged to bypass her reflective faculties and perform pain-led conditioning directly on her grey matter, in order to get from it the behaviour that she prefers. And so modern behaviourist technologies act as though the cognitive revolution in psychology never happened, encouraging us to believe that thinking just gets in the way.

Technologically assisted attempts to defeat weakness of will or concentration are not new. In 1925 the inventor Hugo Gernsback announced, in the pages of his magazine Science and Invention, an invention called the Isolator. It was a metal, full-face hood, somewhat like a diving helmet, connected by a rubber hose to an oxygen tank. The Isolator, too, was designed to defeat distractions and assist mental focus.

The problem with modern life, Gernsback wrote, was that the ringing of a telephone or a doorbell “is sufficient, in nearly all cases, to stop the flow of thoughts”. Inside the Isolator, however, sounds are muffled, and the small eyeholes prevent you from seeing anything except what is directly in front of you. Gernsback provided a salutary photograph of himself wearing the Isolator while sitting at his desk, looking like one of the Cybermen from Doctor Who. “The author at work in his private study aided by the Isolator,” the caption reads. “Outside noises being eliminated, the worker can concentrate with ease upon the subject at hand.”

Modern anti-distraction tools such as computer software that disables your internet connection, or word processors that imitate an old-fashioned DOS screen, with nothing but green text on a black background, as well as the brain-measuring Muse headband – these are just the latest versions of what seems an age-old desire for technologically imposed calm. But what do we lose if we come to rely on such gadgets, unable to impose calm on ourselves? What do we become when we need machines to motivate us?

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It was B F Skinner who supplied what became the paradigmatic image of ­behaviourist science with his “Skinner Box”, formally known as an “operant conditioning chamber”. Skinner Boxes come in different flavours but a classic example is a box with an electrified floor and two levers. A rat is trapped in the box and must press the correct lever when a certain light comes on. If the rat gets it right, food is delivered. If the rat presses the wrong lever, it receives a painful electric shock through the booby-trapped floor. The rat soon learns to press the right lever all the time. But if the levers’ functions are changed unpredictably by the experimenters, the rat becomes confused, withdrawn and depressed.

Skinner Boxes have been used with success not only on rats but on birds and primates, too. So what, after all, are we doing if we sign up to technologically enhanced self-improvement through gadgets and apps? As we manipulate our screens for ­reassurance and encouragement, or wince at a painful failure to be better today than we were yesterday, we are treating ourselves similarly as objects to be improved through operant conditioning. We are climbing willingly into a virtual Skinner Box.

As Carl Cederström and André Spicer point out in their book The Wellness Syndrome, published last year: “Surrendering to an authoritarian agency, which is not just telling you what to do, but also handing out rewards and punishments to shape your behaviour more effectively, seems like undermining your own agency and autonomy.” What’s worse is that, increasingly, we will have no choice in the matter anyway. Gernsback’s Isolator was explicitly designed to improve the concentration of the “worker”, and so are its digital-age descendants. Corporate employee “wellness” programmes increasingly encourage or even mandate the use of fitness trackers and other behavioural gadgets in order to ensure an ideally efficient and compliant workforce.

There are many political reasons to resist the pitiless transfer of responsibility for well-being on to the individual in this way. And, in such cases, it is important to point out that the new idea is a repackaging of a controversial old idea, because that challenges its proponents to defend it explicitly. The Apple Watch and its cousins promise an utterly novel form of technologically enhanced self-mastery. But it is also merely the latest way in which modernity invites us to perform operant conditioning on ourselves, to cleanse away anxiety and dissatisfaction and become more streamlined citizen-consumers. Perhaps we will decide, after all, that tech-powered behaviourism is good. But we should know what we are arguing about. The rethinking should take place out in the open.

In 1987, three years before he died, B F Skinner published a scholarly paper entitled Whatever Happened to Psychology as the Science of Behaviour?, reiterating his now-unfashionable arguments against psychological talk about states of mind. For him, the “prediction and control” of behaviour was not merely a theoretical preference; it was a necessity for global social justice. “To feed the hungry and clothe the naked are ­remedial acts,” he wrote. “We can easily see what is wrong and what needs to be done. It is much harder to see and do something about the fact that world agriculture must feed and clothe billions of people, most of them yet unborn. It is not enough to advise people how to behave in ways that will make a future possible; they must be given effective reasons for behaving in those ways, and that means effective contingencies of reinforcement now.” In other words, mere arguments won’t equip the world to support an increasing population; strategies of behavioural control must be designed for the good of all.

Arguably, this authoritarian strand of behaviourist thinking is what morphed into the subtly reinforcing “choice architecture” of nudge politics, which seeks gently to compel citizens to do the right thing (eat healthy foods, sign up for pension plans) by altering the ways in which such alternatives are presented.

By contrast, the Apple Watch, the Pavlok and their ilk revive a behaviourism evacuated of all social concern and designed solely to optimise the individual customer. By ­using such devices, we voluntarily offer ourselves up to a denial of our voluntary selves, becoming atomised lab rats, to be manipulated electronically through the corporate cloud. It is perhaps no surprise that when the founder of American behaviourism, John B Watson, left academia in 1920, he went into a field that would come to profit very handsomely indeed from his skills of manipulation – advertising. Today’s neo-behaviourist technologies promise to usher in a world that is one giant Skinner Box in its own right: a world where thinking just gets in the way, and we all mechanically press levers for food pellets.

This article first appeared in the 18 August 2016 issue of the New Statesman, Corbyn’s revenge