Yesterday I posted about discovering a really good year-old video about something I’ve often blogged: the importance of letting people see the prices of what they buy, in healthcare.
The process by which I found it is a crystal clear illustration of a profound change in how information moves around today. It’s totally different from before the web, and anyone who wants to understand the present and the future needs to understand how it works now. Because as hard as it may seem – especially to a trained scientist – the path to finding the best information is no longer through a methodical, linear, step by step process.
This drives some people insane, but it’s true. In the past year I’ve found four major publications about this from three unrelated sources, and I’m convinced.
First, the story; then about the books. (If you don’t know how Twitter works, ignore the jargon; it’s just a way of messaging, and this story isn’t about Twitter itself.)
How I ran across the video illustrates how the network of social media works, and how centralized control is becoming impotent:
- Sunday morning I was up early – 4:30 a.m. – because I’m still adjusting to time zones after 2 weeks of travel.
- Twitter buddy @KGApo, in Greece, has been monitoring the #right2health tweets coming out of a conference in Salzburg, Austria, Realizing the Right to Health. (She and I met there two years ago at another event.)
- To address an issue we thought the conference might be missing, I wanted to find a quick summary of an important principle, “the social determinants of health.” I tweeted a request, expecting an answer in the next day or two.
- Instead, 18 minutes later a guy from Illinois, Ross Silverman (@phlu), tweeted a link to a great 2-page piece! By this time it was about 5 a.m. for me, 11 a.m. for Kathi (and Austria), and 4 a.m. for Ross.
- I tweeted it to the conference, and within minutes the organizer had retweeted it so anyone following him would see it.
- Then, idly exploring Ross’s Twitter feed, I found that he’d recently tweeted that video.
Look what happened: I went looking for something, wasn’t sure exactly what it was or who would know, and found it.
Book 1: That’s part of what’s described in The Power of Pull, written by three guys at Deloitte, the big consulting firm. In short, the forces that used to bind valuable knowledge within institutions have come apart at the seams: hyperlinks and social links enable all kinds of connections, and things like this can happen.
Book 2: The “coming apart at the seams” aspect is the core of Eric Topol’s phenomenal book last year, Creative Destruction of Medicine. I don’t like the “destruction” term because I don’t think it’s about destroying hospitals, but the term comes from the 1940s and describes the same effect: as knowledge is no longer bound in the institution, its particles can leak out and get recombined in many new ways. This enables innovation in ways nobody could have imagined.
(It closely parallels part of Clayton Christensen’s “disruptive innovation” idea, which among other things involves recombining parts of an old value system, in ways that don’t hew to the old system itself. My favorite example is that thirty years ago fonts existed only in typesetting systems, and now they’re on your computer and sometimes even your phone. That’s creative destruction.)
Book 3: Shift Index. Strictly speaking this isn’t a for-sale Amazon book, it’s an annual report (again from Deloitte), tracking how major shifts in our infrastructure are changing how value arises and moves around: we’re switching from a economy (in all senses) where people hoard info and extract value by selling it, to one where people create value by participating in flows of information. Can you see that – the flow of information – in the story above?
Book 4: Too Big to Know lays out how it’s no longer possible to get on top of everything. And even if you could, it says, the facts themselves are no longer where the real value is – the greatest value is in their connection to each other through links and social connections, and to other people’s comments and related links. More on this book below.
The full title is Too Big to Know: Rethinking Knowledge Now That the Facts Aren’t the Facts, Experts are Everywhere, and the Smartest Person in the Room is the Room. That sounds stupid but believe me, if you want to understand how to get information to where it needs to be, you need to understand this book.
Get a Clue(train): If you find this hard to imagine, consider that Too Big is by David Weinberger, one of the authors of the landmark 1999 book The Cluetrain Manifesto, which I often mention in speeches. Written by four gurus of marketing, just five years after the Web came alive, it correctly foresaw that marketing had already been forever changed: “Markets are conversations,” it said – marketers no longer had control of what customers could hear – or think, or say – about their products.
It was modeled after Martin Luther’s 95 theses, which he nailed to the cathedral door, starting the Reformation; and Cluetrain was just as revolutionary: both said “We can read it ourselves, now – we don’t need you to control us anymore.”
Cluetrain was visionary and hard to imagine. Can you remember how long it took some companies to adjust and get online? Even today some don’t participate in social media, user ratings, blogs, etc. And now, Weinberger, who foresaw that world (about connections), writes this, about knowledge itself. And I’m listening.
From all the conferences I’ve been attending I can see the parallels to medicine. I expect this industry will be slow to change – but, tellingly, patients aren’t waiting. As internet guru Clay Shirky said at Connected Health in 2008, “The patients on ACOR don’t need our permission and they don’t need our help.”
Look what happened in my Sunday Twitter anecdote: with no centralized control, someone in Greece connected with people in New Hampshire and Illinois, and got a paper written in New Jersey sent to a conference in Austria. All within 30 minutes, and without knowing who had the paper or even knowing that it existed. (Power of Pull talks about being able to go looking for something without knowing what it is – and find it.)
For a final bit of frosting on the cake, Kathi says she’ll use that two-pager in a presentation she’s doing at the European Union this week. A totally unexpected, unplanned discovery of value, ultimately connecting people, needs, and events in very different places.
Knowledge is leaky now. It doesn’t stay in boxes. Build your network, and listen to others’ networks!
dean reinke says
Dave, have you been considering what Vinod Khosla has to say about;
Do We Need Doctors Or Algorithms? I flippantly responded that the best solution was to get rid of doctors and teachers and let your computers do the work, 24/7 and with consistent quality. Computers could tell you what things cost.
Susannah Fox says
Dave, I wonder if you’ve seen this blog post about Facebook’s newsfeed “optimization”:
Understanding Like-gate, by Dalton Caldwell
A key paragraph:
“Facebook newsfeed is an embodiment of our war on noise. We depend on the newsfeed optimizer to protect our limited attention span, and as a consequence, Facebook gets to choose what stories we do and don’t see, just as Google chooses which search results we do and don’t see. Conceptually, this seems very lucrative: Facebook is auctioning off our limited attention span to the highest bidder, as long as the bidder has a candidate newsstory to promote.”
Personally, I use Twitter as my morning newsfeed. Yes, I still take a daily dead-tree newsfeed (I consider it progress since my parents took FOUR newspapers when I lived at home). But the stories I find most intriguing are ones suggested to me by the people I follow on Twitter — or even better, the people I follow on lists, such as my EU friends whose day is half over by the time I wake up. If I didn’t have them on a list, I’d miss their insights.
When it comes to health information and communication, of course, the tail grows even longer. One of my favorite follows is @SolidFooting, who blogs about her journey as a rare-disease mom. Reading her detailed, beautiful entries is a searing experience for me, like armchair travel to a distant land. But I imagine another reader out there, wishing he or she could figure out why their baby is losing her hearing, or vomiting all night, or experiencing the other symptoms that are described in Julie’s posts. What a gift that will be – a newsfeed tailor-made for that family. How will they find it? On Facebook? On Twitter? In a open search? That’s the attention economy I want to contribute to. That’s the one that matters to me.
e-Patient Dave says
Holy cow – that Dalton Caldwell post requires a boatload of mulling. Having worked in SEO and AdWords at my last day job (and good at it), I have a PILE to think about.
You never toss me once-over-lightly links… if we were playing catch, you’d be the one who always makes me reach for it. :-) KEEP IT UP!
Carolyn Thomas says
Your phrase “being able to go looking for something without knowing what it is” reminded me of what Dr. Kent Bottles calls being an “information flâneur”. Or, more appropriately for me – a flâneuse, the female version of this affliction.
These words come from the French verb flâner, which means “to stroll”. The term originally referred to “a person who walks the city in order to experience it” – often affectionately associated with the city of Paris.
But Dr. Bottles tells us that this meaning has now expanded to include much more than just exploring a city, as he once wrote:
“This has validated my approach to information gathering – wandering around and finding things I did not know I was looking for.”
And as you’ve illustrated here so succinctly, sometimes this is the most serendipitous – and satisfying – form of looking stuff up!
e-Patient Dave says
Sure, Carolyn – I’d just point out that the flaneur/flaneuse is a wholly different kind of search than what a person with a *problem* needs to do.
A person out for a leisurely stroll might have a chance encounter and be pleased. But my interest (assessing how to improve healthcare) is to explore how to find things when *you do have an intention*.
Said differently, to a seeker with a problem – a sick baby – a failure leaves them with the problem; to the flaneur a “failure” just leaves them insufficiently amused.:)
I spent yesterday at a meeting of biologists discussing a hard-core biomarkers project. Mid-way through the conference, I realized that the over-arching vision for the project had no chance of success: no biomarker would be found. I elected to keep my mouth shut rather than argue against the prevailing belief in the room because (a) I also realized that their efforts would yield something interesting, anyway, and (b) many of these people had raised a lot of money with the promise of biomakers and had a financial interest in arguing their (incorrect) position. Instead, I made my case briefly and in a friendly way to a couple of selected people.
The problem with the idea that “the smartest person in the room is the room” is that the “room” includes many visions. It’s like saying that my age is “a number” — sure the set contains the right answer, but it also contains many wrong ones. Dave’s experience with twitter-sourcing a document works because (a) he was qualified to figure out what he wanted when it was presented to him and (b) he was not presented with an array of compelling but divergent resources where choice was difficult.
I’m on a panel where we are setting national standards for neurology care. At the panel meeting, time and again I had to argue against our group substituting our consensus for evidence-based solutions, as they were often in conflict. The “room” consensus model is one that was tried in medicine and has largely been abandoned as a failure, and people in the social space need to think hard about why expert consensus has been abandoned in medicine for standards-setting in favor of evidence.
The upshot of this is, it’s great when social networks curate and improve on search results for fact-based insight. Be careful when you consider using the opinion of your social network as a replacement for finding the facts, however.
Adding to my last comment, we have to remember that building the right social networks is how science has advanced since time immemorial. However, the key considerations have always been a well-curated network sharing well-curated information, and a healthy dose of skepticism. The last element is key.
e-Patient Dave says
Pete, it’s always a treasure when you show up!
Re “is the room,” please withhold final judgment until you’ve read his whole discussion of it (which isn’t too long). As I said, on the surface it sounds stupid, but he goes into exactly how different communities have experienced the issue and how it works out.
(I’m about halfway through the book.)
I know I’m kinda babbling here -sorry, trying to get this written in too little time.