Building a Real Health System – Open Source Health

( See Open Source Health for a previous post by me on this subject )

It took Linux, Hackers and the Open Source community a decade to make Open Source Software a legitimate and viable business practice as well as a design approach. The movement has been world changing and profound.

The last decade has seen the acceptance of those ideas by wider society outside of the area of networking and computers.

The Rath Foundation has a vision of “Health for all by 2020” (please note, I am not a member of the Rath Foundation). How can that vision be achieved in the face of seemingly unmanageable financial interests in the pharmaceutical industry ? Open Source holds the answer. Open Source successfully faced down and won the battle against the Microsoft antitrust practices that are very similar to the practices used by the pharmaceutical industry to lock consumers into proprietary technology.

The Open Source approach is not applicable to all areas. For example a book or a piece of music with a bug in it; a spelling mistake, or a bad note … is not that much of a problem, and does not lend it’s self to the peer review by the thousands that built Linux and Open Source software. Books and music are also not critical activities. However a piece of software that has a bug, especially a serious one, can ruin a business or simply frustrate someone enough to the extent that they turn off their computer. There is another endeavour that is of this critical nature. In Health Care a mistake or “bug” in treatment can cause serious problems … even death. Treatments are peer reviewed at the moment to a certain extent. In “peer review” journals. But those journals often have a restricted readership and as a result current treatments are plagued with “bugs” … side effects. So Health Care is a number one candidate for the application of Open Source ideas. Having the “code” of treatment exposed to public view makes sense in the same way as it does in the software world. Problems can be fixed fast and efficiently. If a “bug” is discovered then having it exposed to as many people as possible is advantageous. At the moment this process is stymied by corporate interests who get bogged down in purely proprietary concerns often to their detriment, as we can see by looking at the regular payouts to those damaged by those treatments.

I do not take this idea lightly, and it did not come to me quickly but over many years of research. I have read the book “The Cathedral and the Bazaar” by Eric S Raymond. It covers the period of the Open Source movement up to 1999. At the back of the book Raymond addresses the idea of applying Open Source ideas to other areas as you can read in the following extract.

~~~

THE CATHEDRAL AND THE BAZAAR

AUTHOR’S AFTERWORD

BEYOND SOFTWARE ?

The essays in this book were a beginning, but they are not an end.
There are many questions not yet resolved about open-source soft-
ware. And there are many questions about other kinds of creative
work and intellectual property that the open-source phenomenon
raises, but does not really suggest a good answer for.

I am often asked if I believe the open-source model can be use-
fully applied to other kinds of goods than software. Usually the
question is asked about music, or the content of some kinds of
books, or designs for computer and electronic hardware. Almost
as frequently I am asked whether I think the open-source model
has political implications.

I am not short of opinions about music, books, hardware, or poli-
tics. Some of those opinions do indeed touch on the ideas about
peer review, decentralization, and openness explored in this book;
the interested reader is welcome to visit my home site (ht1p://
http://www.tuxedo.org/~esr) and make his or her own deductions. How-
ever, I have deliberately avoided such speculation in connection
with my work as a theorist and ambassador of open source.

The principle is simple: one battle at a time. My tribe is waging a
struggle to raise the quality and reliability expectations of soft-
ware consumers and overturn the standard operating procedures
of the software industry. We face entrenched opposition with a lot
of money and mind-share and monopoly power. It’s not an easy
fight, but the logic and economics is clear; we can win and we will
win. If that is, we stay focused on that goal.

Staying focused on the goal involves not wandering down a lot of
beguiling byways. I often feel this needs emphasizing when I
address other hackers, because in the past our representatives have
shown a strong tendency to ideologize when they would have been
more effective sticking to relatively narrow, pragmatic arguments.
Yes, the success of open source does call into some question the
utility of command-and-control systems, of secrecy, of centraliza-
tion, and of certain kinds of intellectual property. It would be
almost disingenuous not to admit that it suggests (or at least har-
monizes well with) a broadly libertarian view of the proper rela-
tionship between individuals and institutions.

Having said these things, however, it seems to me for the present
more appropriate to try to avoid over-applying these ideas. A case
in point; music and most books are not like software, because they
don’t generally need to be debugged or maintained. Without that
requirement, the utility of peer review is much lower, and there-
fore, the rational incentives for some equivalent of open-sourcing
nearly vanish. I do not want to weaken the winning argument for
open-sourcing software by tying it to a potential loser.

I expect the open-source movement to have essentially won its
point about software within three to five years. Once that is
accomplished, and the results have been manifest for a while, they
will become part of the background culture of non-programmers.
At that point it will become more appropriate to try to leverage
open-source insights in wider domains.
In the meantime, even if we hackers are not making an ideologi-
cal noise about it, we will still be changing the world.

THE CATHEDRAL AND THE BAZAAR (1999), P.225

~~~

“I expect the open-source movement to have essentially won its
point about software within three to five years.”

That was written in 1999. It is now 2009. 2003 to 2005 saw the success of Linux and the first release of Ubuntu (in 2004) that has now clearly become, along with other versions of  Linux, a user friendly GUI interface for all sorts of different types of users. It has not usurped Windows but is a GUI driven OS in it’s own class. In fact it is set up to work with Windows not against it. Open Source has triumphed.

“Once that is accomplished, and the results have been manifest for a while”

Well, now it is 2009, a few years after that accomplishment in 2003 to 2005. Open Source has proved many times over that a “disorganised” group of people (often who don’t even know one another) can create wonders. Linux. Wikipedia. This is a revolution that is changing our world. To cap it all Open Source is also now an accepted business practice. Eric S Raymond met and conferenced with Wall Street and investment bankers about Open Source. Although libertarian, it is not an agenda to turn the world communist. It works with consumerism and capitalism rather than getting into conflict with them.

There is an important approach to be learnt here. Instead of fighting the Pharmaceutical companies we should be working on a new proven way of practicing Health Care that has a libertarian and a financial aspect to it. Then the investment interests that power Pharmaceutical companies can be courted in their own ball park. They don’t care if Pharma is unethical in the same way they are not concerned if the defense industry makes weapons that get used for nefarious purposes … they just want to make money; an unfortunate aspect of global capitalism that operates all around us. But that is how things are, for the moment at least. Why not court that to make the world a better place ? Just like Open Source has freed us from the Microsoft behemoth so can an “open Source” approach to Health Care free us from the financial interests in that arena. This is pragmatism. Why go on and on about lofty ideological goals that want to do away with those financial interests while there are people dying and suffering now ? Removing those interests is not going to happen, at least not any time soon. So why not take a pragmatic approach that helps as many people as possible as soon as possible ?

But it needs to be proved. Could Doctors and Hospitals run with close feedback from patients, staff, companies and the public ? There is a tacit assumption that it is only the Doctor who can understand a patients health. Yet Open Source depends on the amateur being involved for it to work. In the world of Natural Health care we see a system that is already somewhat like “Open Source” with non patented, non proprietary treatments. This is the case in India, and India recently moved to free those treatments from being patented – free from being made proprietary just like the standards that Microsoft used to patent and make obscure to lock people into their business model … before Open Source arrived.

But this is not an argument for making all Health Care “free” – free as in not paying for it. Much of it may be freely available just like a lot of software is. But in the Open Source world people live in the real world where there are financial interests who always want to elbow their way in. Why not give them a way to make money from Health Care that does not entangle them in expensive law suits and that makes Health Care safe for us as well as them ?

Barney Holmes, 2009

UPDATE (3rd June 09): Wonderful ! There is already a very similiar project called OpenSourceScience that is thinking along similair lines.

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