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Miscellany, Messiness and Medicine

by Fred Fortin

David Weinberger’s new book, Everything is Miscellaneous, is simply going take a long time to digest before I can understand its ramifications for the question that I always ask of those on the leading edge of new media, namely, how can we use it to help those in need of health care? Weinberger’s fascinating and insightful work describes to us the changes in how new media/internet organizes knowledge. New media is creating a miscellaneous world in which information is disordered. This messiness is in contrast to the standardized, ordered, covertly political, and authority-driven construction of knowledge all around us. The virtue of this miscellany is that it bypasses these inherent limitations by creating information “without borders.” As he argues,

“The digital world . . . allows us to transcend the most fundamental rule of ordering the real world: instead of everything having its place it’s better if things can get assigned to multiple places simultaneously.”

In the miscellaneous world, scientific knowledge

“comes in gradations and varieties. Some knowledge is good enough to pass the most rigorous of peer reviews and make it into the pages of a prestigious journal. Some that past peer review turn out to be well done but wrong. Some knowledge is reliable and important, but just not interesting enough for the top journals, so it shows up elsewhere. Some knowledge is unpublished but worth reading and discussing. Some knowledge is tantalizingly possible. Some knowledge used to be true, and some isn’t true yet. If knowledge is king, the royal bloodline isn’t as pure as we once thought.”

Even more important is how the new media is pushing the “public construction of meaning” — what does this knowledge mean and to whom? The “echo chamber” of blogging, for example, are often conversations meant to develop a social understanding of knowledge and facts.

So how does this apply to medical science? Well we see what’s happening all around us in both the dissemination of medical studies through the internet (such as the Public Library of Science — PLoS, for example), as well as commentary and interpretation of those studies by professionals and ordinary folks alike (Revolution Health?). Weinberger only touches on this evolution in the diffusion of medical knowledge. But he does reminds us of what most of us are all too well aware of when it comes to how we try to organize information in health care delivery:

“Medical records are a mess of the second order. Each hospital and clinic has had its own way of encoding patient information in its computer systems. Some might label their first name as “First_Name” and others might call it “Name01″. Some might record an e-mail address and others might not. Hospital records are so out of alignment with one another that doctors still fax paper to their colleagues instead of exchanging electronic information. Worse, as a patient moves through the system, there’s no automatic way to link records at her previous clinic to those at her new clinic. The second order of mess is, by its nature, a mare’s nest of metadata.”

Where this is all heading is anyones guess, but Weinberger offers up a hopeful and refreshing reading on the what is swirling around us. As he says, “In the world after the Enlightenment, the cultural task was to build knowledge. In the miscellaneous world, the task is to build meaning even though we can’t yet know what we’ll do with this new domain.”


[…] my entire post over at the World Health Care Blog. Posted in WorldHealthCareBlog, New Media, […]

  Alijor wrote @ August 13th, 2007 at 3:21 am

Wow. That is a lot to take in. Wouldn’t it be better than the old “mysterious world”, where no one, apart from medical schools, had information (other than superstition?). It has practical value, like Electronic Health Records, but what do you predict will be physician’s reactions?


  Alfred J. Fortin wrote @ August 14th, 2007 at 2:25 am


We already know what physician reactions are to EHRs — cautious to resistant — for easily understandable yet unfortunate reasons. For the “Miscellany” that Weinberger describes, physicians will simply not be able to exert the control they may want. The world, in this regard, is even bigger than medicine. Thanks for your question and good luck on your own great blog.


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