In 1974, Lewis Thomas wrote an essay titled "The Technology of Medicine".
The entire essay is extremely interesting, and – while I know little of the technology of medicine nor of its delivery and advancement – it has fascinating parallels with web technologies. These parallels are present as early as the second paragraph:
Somehow medicine, for the $80-odd billion that it is said to cost the nation, has not yet come in for much of this analytical treatment [i.e. technology assessment]. It seems taken for granted that the technology of medicine simply exists, take it or leave it, and the only major technologic problem which policy-makers are interested in is how to deliver today’s kind of health care, with equity, to all the people.
With providers competing to connect more and more – from residents to offices to cafés, with civvies making a ruckus over net neutrality and with Canada’s Radio-television and Telecommunications Commission pushing usage-based billing, it really does seem to me like the only major technologic problem which policy-makers are interested in is how to deliver today’s Web. The focus seems – quite literally – on matters of quantity and not really of quality.
The Technology of Medicine
Thomas wrote his essay in anticipation of analysts and policy makers making decisions about budgets and funding for medicine, to distinguish between 3 levels of technology:
- halfway technology
- genuinely decisive technology
… each level technology was built upon a deeper understanding of biology than the one before it. As a result, each level is both more effective than the one before it and less expensive – significantly less expensive.
As an example, Thomas considers the treatment of Typhoid Fever. A thousand years ago, it would have been treated with non-technologies; a healer would attend to the patient – who would be isolated and bed-ridden or "hospitalized" in some way – and minimize their discomfort in the hopes that they would recover. A century ago, advances in technology would allow a physician to treat a patient who would be hospitalized for 50 days, in need of demanding nurse care, (a nontechnology) laboratory monitoring (a halfway technology) and occasional surgery (also a halfway technology) – at the very least. Today, however, biological science has advanced to the point where a $5 vaccination can combat the disease (a genuinely decisive technology) and no health professionals need tend to the patient as they simply take the day off work.
In the essay, Thomas goes to great lengths to emphasize the difference between halfway technology with genuine decisive technology; he expresses concern that policy makes would take genuinely decisive technology for granted…
The third type of technology [i.e. genuinely decisive technology] is the kind that is so effective that it seems to attract the least public notice; it has come to be taken for granted.
… while emphasizing the shortcomings of halfway technologies:
In fact, this level of technology [i.e. halfway technology] is, by its nature, at the same time highly sophisticated and profoundly primitive. It is the kind of thing that one must continue to do until there is a genuine understanding of the mechanisms involved in disease.
The Technology of the Web
I think web technologies can similarly be divided into these 3 levels, and the same predicament – of halfway technologies being glorified and genuinely decisive technology being taken for granted – exists. The inexpensive, long-standing technologies which have defined the web for decades and were created by people with a genuine understanding of the mechanisms involved in web development – technologies like HTTP, HTML, CSS – are all too often taken for granted in favor of less cost effective halfway technologies like Applets, Silverlight, ActiveX or sometimes Flash.
It’s important to note, though, that the great success stories of the web are often very observably genuinely decisive technologies:
- Google was built upon a fundamental understanding of the nature of hypertext and its importance to the Web. While it wasn’t cheap to build Google, compared to Yahoo! Directory – which paid a team of editors who were sifting through search results (an expensive nontechnology) – and AltaVista – which simply searched and indexed the content of web pages without considering their place in the web (a costly but in the end ineffective halfway technology) – I think Google can be thought of as the less expensive technology.
- I always like to talk about how Facebook overtook MySpace because it understood how the Web is an information medium and not a visual one; it didn’t allow users to change the layout of their profile pages.
Altogether, what got me thinking about these parallels between Thomas’ article and Web technologies was a quote from Dr. Hugh Herr:
There are no disabled people in the world, only disabled technology [because of] poor design.
Currently there’s a big ruckus in Canada about making federal web sites accessible – in particular to the blind. I believe this is a struggle between people who take genuinely decisive technology for granted (who focus on how highly sophisticated halfway technologies are) and those who have a genuine understanding of the mechanisms involved in the Web. Any genuinely decisive web technology will inevitably be accessible, and the reality is that the costs of genuinely decisive technology is always lower. Among other things, they usually don’t result in the kind of 5 year legal battle the current halfway technologies are resulting in.