State of the World 2013: read the conversation

Bruce Sterling and I (with substantial contributions from others) conversed online for two weeks about the state of the world, as we do every year; that talk ended yesterday, but is archive for your perusal:

State of the World 2013

Here’s my concluding post, in response to a post by Gail Williams on war as metaphor and war as hard reality:

Gail, your post makes me think about the perception of (or,
trendier, optics for) war post WWII, sanitized by the many postwar
films and accounts. Those who knew better kept quiet. Meanwhile those
of us who grew up in the 50s were deluded; we played war games, it was
fun. Vietnam taught us better, or I should say, taught us bitter.
Bitter disillusionment.

Drone war reduces risk but, arguably, increases the probability of
collateral damage. In fact, in war all damage could be characterized as
collateral damage, as powerful elders, safely away from the front,
send the young and innocent, true believers, into battle.

Hopefully by now many more of us, a majority, understand that war is a
nightmare to be avoided. And the war metaphor doesn’t serve us all
that well.

We won’t end rape by declaring war on it. We’ll end rape through
education, cultivation of sensitivity and empathy, rethinking the
meaning of gender difference.

We won’t end poverty by declaring war on it, or by throwing money at
it. We’ll end poverty by caring about it.

We won’t end drug problems by declaring war on drugs. We’ll end drug
problems by understanding why and how drugs become a problem, by
treating addiction as a very human issue, maybe a disease, not a crime.

Self-Diagnosis and Participatory Medicine

The Journal of Participatory Medicine has published an interesting piece on Self Diagnosis, subtitled A Discursive Systematic Review of the Medical Literature. It’s a complex subject – as patients become more informed and empowered, they are more liable to want to have a role in diagnosis, and more apt to question a doctor’s perception or framing of their condition. This isn’t new for some of us – thirty years ago I was disagreeing with my physician to the extent that he would prescribe to treatments, one based on his assessment and one based on mine.

The systematic review published in the JOPM turned up 51 articles, of which 38 were suitable for inclusion in the review. There are three assessments of self-diagnosis: that it’s reliable and desirable (31%), that it’s not reliable but still desirable (23%), or that it’s neither reliable nor desirable (29%).

I’m sure the assessments depend to some extent on context and personality, which varied in the papers assesed. One significant problem considered in the discussion is that “self-diagnosis obviously challenges the authority of medicine, an authority which may already be in decline.”

A decline in medical authority is not necessarily a bad thing, even from medicine’s perspective. The notion of self-care and the changing nature of the doctor-patient relationship have been lauded as positive changes in the health system.

The article goes on to discuss how the patient/doctor relationship was historically “characterized by an authoritative, paternalistic doctor managing the care of the submissive patient.”

With respect to patient self-diagnosis, the modern patient clearly would participate in diagnostic decision making, but not necessarily with ease. The ability to assess quality and reliability of health information is not necessarily within the grasp of most lay people, presenting a difficulty on two fronts. On the one hand, any attempt to mediate access to information, or to recapture control of its delivery will infringe upon lay autonomy, returning the patient to the paternalistic care of the omniscient physician. On the other, consuming information without adequate understanding results in individual vulnerability for both patient health and the doctor-patient relationship.

I think this gets to the challenge we face in advocating participatory medicine, but the same challenge is inherent in any democratization of knowledge: to participate, you have to be able to make informed decisions – you have to be informed, and you have to be capable of understanding the information that’s accessible to you. The real source of empowerment may be, not just in the education and participation of the patient, but in the mutually empowering relationship of physician and patient.

The article concludes “that there are no clear binaries to guide the incorporation of self-diagnosis into contemporary health management.”

It is a complex matter, because it is a relational one, tightly bound up in the ways lay people and doctors position themselves and interact relative to one another and relative to particular disease categories.

Look like a winner

Yesterday I had the privilege to attend an informative talk about effective communication by my friend and colleague Kevin Leahy, aka Knowledge Advocate. One point among many in Kevin’s talk: the content of a communication doesn’t matter as much as we think it does. Kevin, an attorney, said that post-trial conversations with jurors finds that they often recall little about what was said, but much about how they felt about witnesses, based quite a bit on their perception of body language. Coincidentally this morning I find an article about research, conducted by MIT political scientists, that shows how the appearances of politicians strongly influence voters, that people around the world have similar ideas about what a good politician looks like. [Link to the paper “Looking Like a Winner”  (pdf)] 

Sounds like you can take this to the bank: how you LOOK is important, and your BODY LANGUAGE is also important. What you think and what you say? Not such a big deal.

Another point, reading between the lines of the MIT Study: you’re better off if how you look is congruent with people’s perception of your role – there are definite stereotypes. If you don’t look like a politician but you have political ambitions, it’s better to work behind the scenes. (I think politicians already know this).


A bit of free form writing from a Saturday workshop…

Stars, achingly beautiful stars over Arizona as we clean the plugs so the car will fire synchronously down the road. We’re on the road from Scottsdale to Flagstaff, having spent the day watching stars projected Cinerama dream of the ultimate, Kubrick’s 200, inspiration for curious speculation bout the expansive reality, the Universe, the stars that sparkle and flow through our evolving thoughs and wonderments. What is real? Is there a fundamental truth in what we see? A few years later I park by the side of the road again, embrace the night sky, zoom out the universe and see it as fabric, atoms and molecules of another level of reality, how many levels beyond that? How do you measure the infinite? The stars are cartoons in the Hollywood futures but they are real in this night sky, and I embrace them though I can’t, really – the distance is unfathomable. I am so limited, my perception is so imperfect. I want to know. I can’t know but I must. Stars and spaces between stars – so near, so far. The universe is spinning and I’m in it.