When the Russians invaded Ukraine, there was such a mismatch between the opposing forces in terms of personnel and equipment, that experts predicted the country would be overrun in a matter of days. We are a year in, and the Russians have been pushed back. How can the predicted and actual outcome be so different? It’s not just the “will to fight.”
I think this is the best explanation. US military leaders understand this critical phrase “tactics lag technology”. There were 60,000 allied casualties in the first day of the Battle of the Somme in World War I because the attacking soldiers walked shoulder to shoulder into repeating rifles and machine guns using tactics that were 2000 years old. You might think that is madness!! And you would be right! It is a great example of how old technical paradigms are dogmatic and extremely difficult to displace.
US military leaders have been consulting with the Ukrainians since 2014 to help them integrate the latest science and technology into their tactics. The core concept started to take hold with our military leaders in about 1925 and ‘tactics lag technology’ is a core concept that students in our military academies learn in the first year or two of their education.
Continuing to learn the latest translation of science and technology and how to integrate it into coordinated combined arms operations is part of our core military culture. “U.S. officers go to schools throughout their careers to learn combined operations in each of the Army’s combat branches – infantry, artillery, armor, signal and engineers. As lieutenants, officers first attend basic training in their branch, then they attend branch advance schools as captains who will command infantry, armored, artillery or air defense companies. As majors, they are sent to the Command and General Staff College at Fort Leavenworth, Kansas, to learn battalion and brigade combined operations. As colonels, they attend the Army War College at Carlisle Barracks, Pennsylvania, to learn division and army-size operations.” That is how our military consistently integrates the latest science and technology into the way we fight. There is nothing like that in medicine.
The war in Ukraine is a battle between conventional forces. The Ukrainians have brilliantly integrated the new drones, anti-tank missiles, HIMARS rockets, and other new technology into their smallest units in the most practical ways possible. New science and technology exists in genetics, epigenetics, molecular biology, and diagnostics that could transform our war against chronic diseases but we not even begun to translate that in ways that benefit patients.
We have known for 28 years that opening arteries in stable patients does not prevent heart attack or sudden death, but we continue to march young men shoulder to shoulder into machine guns. When will we adopt a “tactics lag science and technology” culture in medicine?
Bill, it took the British Navy, the finest fighting power of its day, over 2 centuries to acknoledge the scorbitcutic properties of fresh fruit and particularly of lemons and limes. Thousands and thousands of British sailors suffered scurvy and many died of it as a result. Now, I wish the Germans and Poles would just get on with it and hand over those Leopard 2 tanks to the Ukrainians, goddammit!
When? When medicine and health care services are no longer driven by capitalistic requirements to maximize profit, when public health is the driver of a true health and health care system dedicated to doing the most for the most people, regardless of their ability to pay. We feed lives and treasure into the maw of the provider system, and the result is a continuous loss of generations of healthy citizens. That’s the better analogy for WWI suicide marches into machine guns in trenches.