The Next Big Thing is You


An optimistic introduction to what could come after the VC funded cycle of disruptions and consolidations.

Various new kinds of software, we are endlessly being told, are the Next Big Thing, just about to disrupt like a volcano of New e-Things that will certainly upend all of the things in the next X years. After you’ve read enough in this genre, it turns into a guessing game: will they put X at 5 years, or 9, or 7? You can usually tell by the adjectives in the first three sentences, as the rhetoric is at best overblown Ciceronian pomp and at worst Ted Talk runoff. I like to fill out a bingo card seeing how many rhetorical and ideological crimes I can identify in a given breathless Medium “article” promoting a new startup, written by someone literally overleveraged in the success of its product offering. Here’s a partial list, in case you want to make up bingo cards of your own:

  • Misappropriated macroeconomic jargon
  • Consequences of disruption and other economic violence naturalized and downplayed via bastardized theories by Darwin or Malthus
  • Milton Friedman-esque swipes at central banks as irredeemable cabals that hate freedom
  • The word “gamechanger
  • Endruns around anti-trust law dressed up as Quantum Leaps for Mankind
  • Any pricepoint under $150/month dismissed as “less than you spend on your coffee every morning”
  • A photo of a “founder” or two standing on a stage at a trade show, preferably wearing a cordless mic
  • Market prolepsis
  • Smarmy appeals to how obviously governments can’t be trusted with the task of regulation, or with “data” itself

Venture capital is the real audience of these missives, and, as Mike Judge’s blunt, Aspie CEO seminally quips on the HBO comedy, Silicon Valley, “The stock is the product.” The winner of this debate tournament is whoever promises the most disruption, since that is what the gamblers came to bet on. As we say in Spanish, “A río revuelto, ganancia de pescadores”—when the waters are choppy, [only] the fisherman comes out ahead. (And no, there are not fisherwomen in this analogy.)

These mammoth disruptions very rarely correspond to giant technical leaps, however; most of them are results of the tiniest of innovations in user experience design, marketing, or convenience engineering. From a computer science point of view, these disruptive apps are apex predators on many levels. They centralize or repackage the data traces left by human experience in a tidy, privatized bureaucracy of monetizable information, but to do so, they stand on the shoulders of data processing giants, mammoth infrastructural investments, decades-long collective refinements funding by private-public partnerships and backroom deals with national-security agencies. In just a few short decades, to the tune of neoliberalism’s mantra (“but who will pay for it, surely not me, or us?”), all of this mammoth infrastructural apparatus was rapidly and irrevocably privatized in both legal substance and public perception. The casino of speculative finance not only wrested away from government any control or even regulatory power over the internet “industry,” but in the process it has also convinced the public that many new, dangerous economic practices and social structures are permanent, natural, and inherent to “the internet age”.

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Open Source / Software As Medicine


I believe that closed-source, proprietary clinical software is fundamentally unethical, going beyond even the pharmaceutical industry in how closed source clinical software subverts the duty to share medical knowledge, and protects intellectual property to the detriment of patients.

The Chamberlen Forceps via

When developing healthcare software it is important to recognise the additional ethical dimension that medicine brings with it. Medicine affects all human life in such profound ways that we need to consider the moral dimensions of its technological developments in a completely different way to that of other industries:

In other areas of human endeavour, for example, there is usually more choice available to the consumer — including, often, the choice to opt out of use of that technology. People cannot ‘choose’ not to need healthcare.

Further, the consequences to an individual of being denied access to the best available treatment may well include physical harm, early death, unnecessary pain, avoidable disability, and many other unpleasant and potentially permanent disadvantages.

Medical Software now IS Medicine

Not long ago, clinical software consisted of simple systems for patient administration, databases for recording clinical information, and messaging. Nothing particularly exciting, and nothing particularly likely to make huge differences to clinical outcomes. One can easily see how these dull systems weren’t considered to be ‘part of medicine’ and not thereby subject to the scientific process and moral obligations of a medical innovation.

Now, however, we have a range of complex interactive clinical systems which have become so integral to the delivery of care that it’s likely that a good system could positively influence clinical outcomes (and conversely, a bad system could cause harm!). We have disease-specific scoring systems, clinical algorithm implementations, clinical decision support, patient-facing and clinician-facing mobile apps, triage engines and much more. These things can certainly influence clinical outcome. Yet they are in most cases closed-source, proprietary, non-peer-reviewed, and not independently testable.

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