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Here Comes Everybody: How Change Happens When People Come Together.
Clay Shirky Penguin. 2009. PB 352p. £9.99 ISBN: 978-0141030623.
If you're reading this in the pages of the BJGP, then I fear that you are probably past it. Clay Shirky in his readable and thought provoking book, Here Comes Everybody: How Change Happens When People Come Together, describes a world that will be unfamiliar – and even threatening – to many doctors.
Shirky's thesis is that when people are given new and easy ways to come together – through email, social networking sites, wikis, and the like – then remarkable and unexpected things happen. The young may ‘overestimate fads,’ but it's the old – those born before 1980, most GPs in other words – who are likely to dismiss a ‘real, once in a lifetime change’ as a fad. I think of many doctors I know chuckling dismissively at Facebook, My Space, Twitter, and Wikipedia, and I agree with Shirkey that they are making a serious mistake.
Consider this thought experiment, which I heard described by Jamie Boyle, an academic lawyer and enthusiast for making as much culture as possible open to all. Imagine that 5 years ago you are responsible for developing the most comprehensive and up-to-the-minute encyclopaedia the world has ever seen. One strategy is to create a global company, employ the brightest people available, check every fact produced, and implement the most rigorous editorial controls. A second option is to ‘just create a website and let anybody put up anything.’ Most of us would opt for the first strategy, and, as Shirky describes, the founders of Wikpedia did initially try something like the first strategy. The second strategy seems little short of mad, and yet this is the strategy that has produced Wikipedia.
Through the new tools we can ascend the ladder of sharing, cooperating, and taking collective action, humbling professions, churches, and authoritarian governments as we go.
What Shirky calls ‘mass amateurisation’ got rid of the medieval profession of scribes when printing produced books and many people learnt to read and write. Relatively cheap books were also important in allowing Bibles in local languages and the spread of Protestant protests against the Catholic Church. Now anybody can publish, and newspapers and journalists are disappearing as everybody can be a journalist.
Instead of filtering and then publishing (the traditional method of newspapers and the BJGP), because publishing is expensive we can now ‘publish and then filter,’ so creating something magnificent like Wikipedia. It has virtually no employees, is free to everybody, has avoided most vandalism, and runs on love not money. People care, whereas people didn't care enough about the Wikieditorial of the Los Angeles Times that was vandalised in hours. The same processes of love and ‘publishing and then filtering’ has also created open source software, including Linux, which runs about 40% of the world's servers.
Collective action requires the most commitment, but Shirky describes several cases of where people have come together through the new technologies to take action. He begins his book with a story of how they were used not only to get back a woman's stolen mobile phone but also to force the New York Police Department to take action when they were reluctant to do so. In another example, Voice of the Faithful acted to depose the Archbishop of Boston, who had covered up the sexual abuse perpetrated by his priests. We are still at the beginning of what Shirky describes, and his central point is that we will be constantly surprised. We can't imagine all that will happen, and we don't yet have examples of medicine being transformed through the new possibilities. Medpedia (www.medpedia.com/) has just been launched, but I found myself wondering whether the 10-year cover up of the surgical incompetence at Bristol would have been possible if it happened now. We might soon see the toppling of a medical authority – perhaps even the Royal College of General Practitioners.