DIY Health?

Do-It-Yourself (DIY) Health. To many people the two terms do not really go well together. Minds will automatically conjure up images of botched stiches, a swollen lip and a toothache worse than before. But DIY is not just about home operations gone wrong – there’s a lot more to this new phenomenon than meets the eye. The New York Times reported that people in their 20s have recently taken up a more DIY approach to their health, ‘borrowing leftover prescription drugs from friends, attempting to self-diagnose ailments online and stretching their diabetes and asthma medicines for as long as possible, in an effort to avoid paying the rising costs of medical insurance.’ DIY health can be beneficial to both patients and doctors in many respects. I sometimes wonder why the health care system has not adopted the produsage model yet – the underlying principles of medicine and relating fields are concerned with information – physical products, such as medications and operations – are only supplementary to this information. Author Axel Bruns concludes how even in ‘nonintangible, physical realms of collaborative and innovative research, design and development, produsage may have its place’. The current model of health care fits this ‘nonintangible, physical realm’, and definitely includes stages of ‘research, design and development.’

Bruns goes on to point out how the scientific community can benefit from adopting this produsage model, especially in the research phase. Bruns hypothesizes that enthusiasts would be able to rent lab time to conduct their experiments and observation, and contribute their results back to the wider community of researchers. With more research being conducted in the same time frame, this will mean that discoveries for new drugs, vaccines and preventative methods will occur at a much faster pace, benefiting the entire community of not only health professionals, but more importantly, the patients. Produsage, or DIY methods, can also be applied to individuals who traditionally consult the current health care system. The Perth online portal, inMyCommunity, has recently supported the Rotary Bowelscan, a program that provides do-it-yourself home tests for men aged over 40. Simple diagnostic tests such as these will provide a quick indication to the patient if they are required to seek further assistance, reduce the burden on the existing health care system, and provide an effective way to target large portions of the populations.

If a few aspects of the health care system were to adopt the produsage model, then much benefit can be gained. This is not to say that the entire health care system will move to a digital and intangible realm, it will mean an assimilation of both produsage and industrial production techniques, or as Bruns puts it ‘to produce the artefacts of produsage’. Those that are currently using DIY health practices, are doing it to save money, and many of these procedures do more harm than good. I think I have an answer to my previous question of why the produsage model was not integrated into the health care system earlier. People traditionally turn to experienced experts to deal with their health, which is explainable as no one would turn to DIY practices to decide matters of life and death. But if these DIY tests are disseminated through authoritative sources, then it would eliminate any doubts of credibility that people may hold. There is a future for DIY health.

The Pro-Am: Effective Community Participation?

The rise of the Pro-Am, or what Leadbeater and Miller describe as one who ‘pursues an activity as an amateur, mainly for the love of it, but sets a professional standard’, has popularised many produsage models. People can now contribute to their communities of interest without achieving any sort of professional accreditation. This happens in both offline and online communities with interests in topics that vary from DIY crafts to discussing the economics of coffee production. As with the principles of produsage, open participation is vital in such pro-am communities. People can contribute knowledge to a community without any filtering/screening process as is common with the procedures for content production in the new media age. But this brings with it one implication of the pro-am and the extent to which it is effectively able to participate in the community.

When people contribute information/knowledge to communities of their interest, they are doing so with the assumption, that whatever they have chosen will be of value to the community and will build on the existing knowledge base. But how does one assess the significance and value of one’s contribution? This can go one of two ways: the individual could think that their contribution is very valuable and should therefore be contributed, but in actual fact, this contribution may have very little value to the interests of the community, and may seem unnecessary in the eyes of the other members. In this case, the process of communal evaluation would eventually remove the individual’s contribution. On the other hand, the individual could feel that their knowledge isn’t worth contributing, and so would hold back from adding to the community’s knowledge base, but in actual fact the individual’s contribution could be very valuable to the community. Bruns clearly states what this all comes down to is that: ‘the question of self-awareness of one’s own abilities and limitations produces perhaps the greatest hurdle to constructive community participation in produsage’.

Yochai Benkler, author of The Wealth of Networks, also agrees when he explains how ‘the self-identification that is central to the relative information efficiency of peer production is not always perfect’. What he means is that everyone has different perceptions of how useful/valuable their contribution will be, there is no set standard to determine this. And it also relates to an individual’s self-assessment, and the honesty with which they assess their own skills and abilities. This self-assessment is known as equipotentiality, explained by Michael Bauwens, creator of Foundation for P2P Alternatives, to Richard Poynder: ‘equipotentiality is the assumption that the individual can self-select his contributions, which are then communally validated.’ But I think the most important thing, is the honesty with which individuals perceive and assess their contributions. People should not assume more than they are capable, nor should they do the opposite, downplaying their abilities. Disregarding this means disrupting the effectiveness of both community participation and also the contributions made to the community. While it is hard to set up a common standard to eliminate this ambiguity concerning the self-assessment of individual contributions, communities need to highlight this issue and stress its importance to new members.

Wikipedia encourages the selfless human

Many people wonder why online communities such as Wikipedia have gained popularity at such an alarming rate. (Wikipedia currently has 12 million articles in dozens of languages since its inception in 2001). Their contributors vary from experts in the field of quantum physics, to die hard fans of Tolkein’s Middle Earth – but they all have one thing in common, each person contributes to Wikipedia without any monetary compensation. The creation of common, and more importantly freely accessible to all, content, is in itself a reward for all those who contribute. People are satisfied that their contribution of knowledge will make a difference to the online community. As knowledge educator David Gurteen points out, people contribute to Wikipedia because ‘They do it for the love of doing it – contributing to a mission – to a worthy cause. They see the value in it’. The lack of monetary return or even recognition, encourages a selfless attitude in those that contribute. Bruns also gives another reason that motivates people to share their knowledge on Wikipedia. He states that maybe it is the sense of ‘teaching the world stuff which they are enthusiastic about’. Or maybe people get a strong feeling of community when working with people within their various knowledge domains.

These shared values of contributing for a greater cause, for a sense of community, also exemplify two aspects of the ‘Old Paradigm’ of economic development as outlined by Dr Robin Batterham. There is a shift from key factors capital, resources and labour, to rising importance of knowledge and creativity. The knowledge contribution of Wikipedians clearly demonstrates this. There is also a shift to strategic alliances and other forms of collaboration, such as networks and clusters, which is illustrated by the ‘strong community of like-minded peers’ existent on Wikipedia. Jonathon Zittrain, Professor of Internat Governance and Regulation further comments on this collaborative aspect in his book, The Future of the Internet and how to stop it. He states, ‘It (Wikipedia) stands for the idea that people of diverse backgrounds can work together on a common project with, whatever its other weaknesses, a noble aim—bringing such knowledge to the world’.

Many people may argue that this ‘noble aim’ aim of Wikipedians comes with a price. Allowing anyone to participate can mean vandalism and damage to the wiki pages of controversial topics, figures or events. But these incorrect edits are quickly reverted back to their original status by a group of enthusiasts who regularly keep watch on recently edited articles. Newcomers are also required to undergo a lengthy process of socialisation in order to assume key roles within Wikipedia (Bruns), a feature that further hinders the existence of any unwanted changes. Zittrain goes on to say how even those not active in making edits, who are mere ‘consumers’ of the Wikipedia model, have the chance to make a difference. ‘Every time someone reads a Wikipedia article and knowingly chooses not to vandalize it, he or she has an opportunity to identify with and reinforce its ethos.’

Doing things for the wider community without any economic benefits or recognition, is a selfless and noble deed – a value encouraged by Wikipedia. It is a testament that altruism really does pervade through all realms – the deliberate pursuit of the interests or welfare of others.

Traditional or Citizen: Which is better for health?

Citizen journalism heralds a new way of receiving and understanding news. The traditional method of news production takes place in a hierarchical and somewhat controlling environment. The media industry has become quite a lucrative market, and with only a handful of companies owning the majority of mainstream news outlets, it is no surprise that many times, commercial interests outweigh the need for quality journalism and reporting. This economically-driven environment fostered the rise of citizen journalism, which emerged, according to Bruns (2008), ‘as a corrective and a supplement to the output of commercial, industrial journalism’. This new process of news production sees, similar to the principles of produsage, new ways of producing and consuming the news.

Previously, the gathering, filtering and disseminating of news was all done in the confines of a media organization, each stage carefully monitored by company journalists and editors. In citizen journalism, there as been a shift in roles. Now, all three processes are undertaken by citizens, the public – people who were previously viewed as the ‘consumers’ of mainstream media. Citizen journalism takes place mainly in online environments, SourceWatch gives a list of some global participatory journalism websites. (Nguyen, identifies a range of ‘self-reflective terms’ to describe participatory publishing: ‘personal publishing’, ‘participatory journalism’, ‘citizen journalism’ and ‘collaborative publishing’ among a multitude of terms.)

Henry Jenkins identifies the difference between traditional and citizen media, and in doing so, highlights one of the advantages of citizen journalism – its ability to provide a plethora of viewpoints.

‘the power of the grassroots media is that it [sic] diversifies; the power of broadcast media is that it amplifies’ (Convergence Culture: Where Old and New Media collide).

But is this ‘multiperspectival journalism’ (Gans) necessarily beneficial for all aspects of society. Undoubtedly, a range of views on political, economic and humanitarian issues is good, as it allows different people from differing walks of life, to give their opinion and contribute to increasing others’ knowledge on that particular issue. But what about topics from the health industry? Reporting on health issues via the traditional and citizen journalism models, can have adverse effects.

The tight ownership structure of current media companies, sees a lot of overlapping of these media organizations with other companies across different industries. For example, directors on the board of ABC/Disney, also sit on the board of (among other companies) Columbia/HCA Healthcare and directors on the board of Wall St Journal/Dow Jones, also sit on the board of Pfizer, the world’s largest research-based pharmaceutical company. When a health story of interest emerges, the media companies will only present a viewpoint that lies consistent with the policies of their affiliated pharmaceutical/health companies. The readers/consumers of news will only come to know about the broadcast perspective.

The diversification of citizen journalism can have detrimental effects on users in regards to health stories. A range of viewpoints on a health issue and excessive media attention (which is common in citizen journalism), can cause confusion and bewilderment within the community. Frank Furedi comments on the dramatisation of swine flu, and while it is not directly attributed to citizen journalism, a close look at some popular citizen journalism websites, will reveal just how popular swine flue has been with citizen reporters (Allvoices and OhmyNews are two examples).

So what model works best for reporting of health issues? Or would a combination of the traditional and citizen journalism model be appropriate?

Was there evidence of produsage in the industrial production chain?

As times have changed, the means through which content, either physical or intellectual, has been produced have also experienced dramatic changes. The Industrial revolution was characterised by the production of content in a very linear fashion. Anything to be created was produced solely by a producer or manufacturer. The task of dissemination took place through a distributor, and the final product or service was consumed or used by a consumer. The chain was uni-directional, proceeding only in the following way:

The Industrial Production Chain

In this model, power lay largely with the producers or manufacturers, who had control over the creation of the product or service. The consumers were passive recipients, and were only a part of the model because of their need or want.

Time went on, and this model became a little bit more disorderly. Toffler introduced the ‘prosumer’ – a consumer who was capable of making alterations to products purchased according to his or her own preferences. This did not change the role of the producer or distributor, but merely extended the abilities of the consumer.

The last stage of this evolving model was concerned, not with the agents (the producers, distributors or consumers), but more with the generation of and contribution to, content. It was in this model that Bruns coined the term produsage – referring to a form of content creation and enhancement, in which the roles of the producer and consumer are blurred. Produsage is fostered through an open, communal and meritocratic environment; is a continuous process, devoid of any definite end-point; and rewards each individual involved.

But can evidence of produsage be found in the industrial age? In his book, Blogs, Wikipedia, Second Life and Beyond: from production to produsage, Bruns comments on the industrial production chain: ‘However this model tells only part of the real story: in practice, consumers in monopoly markets have the choice at least to withhold consumption and thereby influence development, manufacturing, and pricing options of producers and distributors.’ It is clear that this scenario does not illustrate produsage in its entirety, but the fact that consumers are given a choice which influences producers, questions the linear explanation of the industrial production chain. Real world examples show, how the simple act of either choosing to buy or refusing to buy, a certain product or service, can cause major repercussions for the manufacturer or producer.

Once the Taliban was expelled from Afghanistan, the demand for burkhas among Afghan women fell dramatically. This decrease in demand resulted in an increase of supply, so until the supply equalled the demand, the price of burkhas fell. It was the consumer’s action (or lack of) that influenced the change in prices, and so they were no longer viewed as merely users of the production chain, but agents who were able to pressure the producers into changing production methods. Consistent with produsage, this example portrays how the role of the consumer or user, is contributing more to the overall creation of content – both physical and intellectual.

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