[Reader-list] .Net / Hailstorm Initiative

[Menso Heus]

On Thu, Jul 05, 2001 at 05:47:14PM +0530, Jeebesh Bagchi wrote:

Hi,

> To make some sense let me take a detour to the world of medicine.
> 
> Many medical practitioners take it for granted that when treating 
> 'lay pains', just treat them and tell them nothing about what the 
> hell is going on - no explained diagnosis, and no explanations about 
> the medicines that are being prescribed, or the 'risky' side of its 
> usage.

My doctor always tells me the diagnosis, what is going on and will 
have to write this down for insurance reasons in any case too.
All medicines you can get in The Netherlands must legally have a 'manual'
as far as I know, saying what dosage to use, what the side-effects are
and on whom they will have effect. 
Your doctor will tell you this too, in my experience so far. 

> The pharmaceutical companies know that `knowledge is power`, which is 
> why we tend to know so little - almost nothing - about the `process 
> of creativity` inside the laboratories. We only know that it is 
> something very important called `process` OR `product`, and patents 
> needs to be upheld as an important motivations and incentives for 
> `innovation` and `generalised public good`.

I thought the patents were being upheld to prevent other companies 
from walking away with your inventions. For most branches, this works, 
I'm a bit afraid of the medical branch using this approach though. 

Recently I read a posting on a mailinglist on how some company figured
out how to make your body make mosquito repellant naturally. I do not 
know if this is possible or if it was a joke. The thing about the article
however was that these pills one would take to enable the body to create
the repellant would have a built in clock. If you did not take another 
pill every month, half year, year, the process would stop.
The reason this frightened me is because I started wondering about how 
long it would take before the doctor will fix your broken leg and you 
needing to take a subscription to keep it that way.
Imagine getting a pacemaker and needing a subscription to keep it working,
you can't afford it anymore, *BANG!* you're dead!
Before you know it, MDS will be the next big buzzword (Medical Service 
Providers) and you will 'lease' all the health restoring things that 
doctors do to you. If you don't pay the bill in time each month the cure 
will stop working. The world will be flooded by a new breed of junkies, 
uphold by the new world of medicine and pharmacies. 

> Well this `lay lazy user` cannot afford too many sickness or 
> fatalities so s/he experientially evaluates (with the help of complex 
> oral `slashdots`) and decides to take different routes. Which is why 
> today such a large number go to `traditional` modes of healing and 
> curing to survive.

I do not have any experience with traditional ways of healing (except
homeopathy, if that's 'traditional') so I don't feel I'm very much in 
the position to make useful comments on this :)

> But, the legal apparatus does not recognize this. It values the so 
> called `modern medicine` (basically allopathic) and the rest are all 
> suspect (sometimes framed as evil quacks) and thus susceptible to 
> legal prosecution.

Same goes for this, fortunately, 'modern medicine' as you call it is too. 
If some doctor screws up my operation, I can prosecute them for that too.
If some traditional guy turns out to be a quack too, why shouldn't I be 
able to prosecute them?

> Why do I write this? Primarily to pose a few questions.
> - What would it mean to practice medicine `ethically`?

I guess to cure your patients disease without inflicting another one.

> - Can the profession justify `opaque` and `closed` practice by taking 
> recourse to an argument that mobilizes the intellectual level of the 
> `user`in an uncritical manner?

Not really getting this sentence :)

> - Can't we imagine an informed protocol of usage that undermines the 
> separation between experts and users?

This is a bit of a strange thing, to answer it we must first look at what
differs the expert from the user.
In my opinion, the user is someone with no or very basic knowledge.
The expert is, well, the expert on topic X, Y, Z or several.

Thus, the expert could inform the user only up to a certain point. Saying
'the computer isn't working because it doesn't have power' is similar to 
saying 'you can't walk because your knee is broken'. 
Explaining why the computer needs power, how it flows through the machine
and what exactly happens inside it will turn the user into a somewhat more
expert in the computer area.
Explaining how my knee works and all the medical details that are involved
and how the natural healing process works will turn the user into a somewhat
more medical expert too. 

The question is, do you want this, do you have time for this?

Imagine you wake up and there is no water coming from the tap. You phone up 
the guy that's responsible for it and he says "It's not working because there
are problems with pump #1234" and then continues to explain exactly how the 
pump works and where the mistake is. 
Three hours later, after the man has finished the story, you hang up the 
phone and walk outside your house to the corner where the autorickshaws stand.
The one autorickshaw that is there isn't working. You ask why, the guy starts
explaining to you how engines work and two hours after that you tell the men 
you're sorry and will find another autorickshaw.
Coming at the office, you discover the fridge isn't working. You call the 
repairman over and he explains why it isn't working, three hours later he 
tells you he needs to replace some part and will be back tomorrow, it's getting
late already, you know.

Or do you want the first guy to tell you "The pump's not working, we're 
trying to fix it, it'll be up again quite soon hopefully", the second guy
"I'm out of gasoline, find someone else" and the third guy "Yeah, a fuse
has blown, I'll need to replace it, I'll be right back" leaving you with 
the rest of the day to do your own thing?

The separation between user and expert can only be taken away by becoming 
an expert too, or almost one imho. It depends on the level of information 
you want: basic things a user will understand, too much details and he will
need more and more details to understand the first set, so eventually he 
knows how the entire thing works and is thus, an expert.

Kids seem to have this phase when they're about three years old: they answer
every answer with another question. Perhaps at some point in evolution our 
society and it's tools and our understanding of things were suitable for this
behaviour and have a child know everything about it by the time he reached 
four. Currently however, I do not believe this is the case.

> - Should not the counter-expert at all times critically evaluate all 
> tall and big claims of `benefits` and point to the socially risky 
> side of these claims?

Yes and no. On the one hand the counter-expert should always question anything
an expert says, then again, one should always question everything in any case.
On the other hand, because of the lack of knowledge a user likely has he is not
in the position to question thoroughly. If I ask my plumber if he can do XYZ 
and he says it can't be done I might phone a couple of others, if they all tell
me the same I'll accept the answer while, if I would be knowledgeable on the 
subject of plumbing myself, I could verify if they are speaking the truth.
So, this is where a form of trust seems to show itself. If I get a lot of good 
feedback on a certain expert I will trust him more than one I do not here a lot 
of good things about. Also, verify'ing the status of the expert through diplomas,
letters of recommendation or now, search engines, or even through other experts,
seems a good way to go too. 

The user differs from the expert in the fact that he has less knowledge, the 
expert on the other hand, is essentially a user on steroids. He uses the same
things you do, whether it's the medicine he adviced you or the computer network
to check his email, only he has exact knowledge on it works. 

> - And finally, what does the `expert` want from the lay user?

The expert provides a service for which the user usually pays. This is basically
the description of any job I think. Whether you are an expert in the medical 
field and provide advice for which someone gives you something in return or 
whether you're a system architect and design a complete networked solution for 
a problem your customer has, this is, essentially, what you do. Expert helps 
the user, user pays for it.

Ofcourse, in both cases, the satisfaction that comes with tackling the problem
others are not able to tackle and giving a helping hand is an important aspect 
too. 

In modern society with all it's technological tools it seems to me impossible 
to be an expert on everything. You can study to become a doctor, and a pilote
and an engineer, yet if you do so you will die by the time you've finished 
your last study and will never have had any time to practice the things you've
learned. 
Also, there seems to be another factor: will. Do I *want* to know how a fridge
works or do I just want it to work and pay someone to fix it if it doesn't?
Do I want to spend my time on figuring out how my body works and how to patch 
my knee when it's broken or do I want to spend that time relaxing a bit from 
my normal job and let someone else who does know this have a look at it?

Key factors here seem to be the short period of human live and the huge
amount of fields in which one could become an expert. 
In most cases, knowing the essentials and accepting them seem to be 
sufficient. I do not know the entire process on a molecular level of what 
happens to the food I insert in my mouth, yet I do know what happens if I
don't, I'll grow hungry and eventually die.
A user does not know what exactly happens when he pushes that button on his
computer yet he does know that if the screen says "ERROR" there is something
wrong and he should call someone to look at it.
A user does not know how to patch his own knee when broken, yet he does know
that if he does not let someone look at it quick that the damage might be 
irreversable and infect. 
A user does not know what chemical process taking an asprin starts, yet he 
knows that it will, in most cases, achieve the desired result. 

Knowing everything is impossbile, yet I agree that it should always be 
possible to fully figure out how something works. If that means you have
to work for $COMPANY because otherwise you won't get to see their 
patented stuff, that's what you'll have to do.

Menso "Hey, again it's all about the money" Heus

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