Update: It all went well, and I am very pleased with the results. I’ve experienced the usual LASIK side effects, including halos at night, dry eyes, and subconjunctival hemorrhage. None are debilitating, and all are likely to fade over time. I can’t say in all cases that LASIK is a good idea, but it seems to have been so for me.
Tomorrow I will meet a man armed with a laser.
The first thing he will do is give me a sedative, one that will decrease my reaction time and impair my judgment. He will then aim his laser at my eye and fire it.
Instantaneously, a circular portion of my cornea will vaporize, just beneath the epithelium. The latter will be pulled back, and then the real fun will begin: The man will direct his laser to reshape the interior of my cornea. If all goes well, the whole procedure will be over in about ten minutes, and next he’ll do the other eye.
I will then begin taking all kinds of different drugs – a steroid, a painkiller, an antibiotic, a lubricant, and some other thing whose function I can’t quite recall at the moment. If all goes well once again, I should within a day or two enjoy better vision than I have ever known in my life. More than 11 million Americans have already done the same, and they overwhelmingly report satisfaction with the procedure.
Now, I barely know the guy with the laser. I couldn’t begin to tell you how it works. In all probability there’s a lot he doesn’t know about it either. I certainly couldn’t use it myself. And if something goes wrong, I might not even know about it until after my vision has been irreparably damaged.
This is a story about trust. But not the kind of trust that one has in a friend. It’s a different trust entirely, and not only because I wouldn’t trust any of my friends to run the laser. To put it simply, it’s a story about distributed trust – a trust that’s spread, thinly but firmly, across a surgical clinic, a pharmacy, a half-dozen drug companies, the maker of a laser (whose name I don’t even know!), the makers of the laser’s components, the makers of the bottles my drugs come in, and on and on. At the most fundamental level, it’s about trust in the research scientists of probably a dozen different major fields. Together their work has brought some other people – people whom I apparently also trust – to trust in turn that this whole business might amount to something much more than a particularly ghastly form of torture. It will probably help me to see a whole lot better. I trust.
And finally, it’s about trust the legal system that will compensate me financially in the unlikely event that this little essay is among the last things my eyes ever behold.
That’s a lot of trust. Those of a libertarian bent will probably already have thought of Leonard Read’s famous essay “I, Pencil,” to which my story bears a pointed resemblance. “The market allows you to trust these people,” they will say, “even though you don’t know them, and you’ll never meet them, and you don’t even really know why you’re trusting them. In a market economy, everyone has an incentive to be trustworthy; the suppliers of untrustworthy goods get punished and go out of business – or more likely they don’t even bother trying.”
Our friends of the left will of course disagree. “Sure you trust these people,” they will say. “But that’s only because the law allows you to. The medical sector might be the most heavily regulated in the whole economy, and with good reason. If it weren’t heavily regulated, eye doctors could do whatever they pleased. Especially while you were sedated, and while they held a laser.”
Neither of these is quite correct, I don’t believe. The coordination on display in “I, Pencil” is a marvelous thing, but above all it serves not to generate trust, exactly, but rather to generate a product that could not be made otherwise, or that could not be made as cheaply. Whether we trust the product or not is a separate question entirely, one that will be settled by trial and error after the product’s development, and by personal taste – all in an environment that is suffused with legal guarantees against misbehavior. I’ve been very public about getting LASIK, and one common reaction has been in effect “Oh, no. I could never do that…” But consider the people saying this: are they not admitting that their lives would probably get a whole lot better, if only they could trust? (What further regulations would it take? Which existing regulations do they not trust? Or which aspects of the procedure?)
And the legal recourses supplied by the government in the event of misbehavior – these don’t actually make any products. The recourses are welcome, and they’re probably necessary, at least with the social technologies we have on hand today. But they don’t cure myopia. They don’t even make decent pencils. Doing either of those takes a great deal more. And that added work won’t be done without the sort of I-Pencilish stuff that the left would prefer to denigrate.
I do depend on regulation, in going for this surgery. I trust in it. And yet it should also be remembered that not all state measures that aim at raising public trust are necessarily good ones. Are we not as trustable as Venezuela? Why can’t we also have fingerprint scanners to prevent consumers from hoarding? After all, our consumers have a lot more money, and while our grocery stores might be better stocked, one never knows what Warren Buffett might get up to in his spare time, just for kicks…
I joke, but in the field of supplying trust, there are multiple ways to go wrong. As with our decisions about which products to personally consume, we will be guided by a process of trial and error. It could hardly be otherwise.