There is a point at which information ceases to increase knowledge and understand and begins to undermine it, creating a paradox. When information on nearly anything is more abundant than ever the choices we make about how to engage it become more important than ever.
The Information Age has been described as the period where industrial production was replaced by knowledge production as the key driver of social and economic benefit for society. Underpinning the thinking behind the information age (and the digital revolution that accompanies it) is that having more information, more access to it and improved tools to use it to solve problems will improve life for everyone. Presented with a choice to have access to more information or less people will almost always choose more.
More information leads to more options, which equals more choice and more choice is about freedom and that is seen as an inherent social good derived from the capitalist system, which further leads to better choices, more freedom and greater happiness overall. At least, this is what we’ve been led to believe and Barry Schwartz explains this quite eloquently in the opening of talk embedded later in this post.
This is the theory of change that underpins information theory as its played out in modern capitalist societies. It’s also the source of many of our modern paradoxes and problems.
Systems of influence: The case of the ePatient
I’ve stopped going to health-related hackathons and design jams altogether for the simple reason that one can almost always guarantee that one third or more of the solutions generated will be some form of app or information-focused tool. These well-meaning, creative tools are part of a consumer health movement that is all about putting information in the hands of patients with the idea that putting information in the hands of patients is the key to empowerment and better health outcomes, except they rarely lead to this promised land.
Few are better at explaining — and indeed living — this reality than Dave deBronkart or ‘e-Patient Dave’ who has been a tireless advocate for better information tools, access and engagement on health for patients. His Ted Talk captures the spirit of the movement nicely.
With all due respect to the positive sentiments around what the ePatient movement is about, it is based on a series of assumptions about health systems, patients and health itself in ways that don’t always hold. For certain patients, certain conditions, and certain contexts having more information delivered in the right format is indeed empowering and may be life saving as deBronkart’s story illustrates. But what’s often missing from these stories of success are the many layers of assumptions and conditions that underpin information-driven healthcare.
A few years ago I interviewed a patient who spoke about his experience with health care decision-making and information technology and his response was that having more information didn’t make his life much better, rather it made it even more complicated because with more access to more information he had more responsibility related to that information.
“I don’t know what to do with it all and there’s an assumption that once I know (this health information) I am in a position to do something. I don’t have the foggiest idea what to do, that’s why I am going to see (the health professionals) because that is what their job is for. They are the ones who are supposed to know what is to be done. It’s their world, not mine.”
This case is less about deferral to authority, but about resources (e.g., knowledge, skill, time, networks, etc..) and expectations around what comes with those resources. When you are unwell the last thing you want is to be told you have even more work to do.
The assumptions around personal health information and decision-making are that people have:
1) access to the data in the first place, 2) time, 3) information gathering tools, 4) knowledge synthesis tools, 5) skill and knowledge of how to sift, sort, synthesize and sense-make all the information obtained (because it may be in different formats, incomplete, or require conversions), 6) access to the people and other knowledge and skills required to appropriately sense-make the data, 7) the resources to act on whatever conclusions are drawn from that process, 8) a system that is able to respond to the actions that are needed and taken (and in a timely manner), 9) the personal willpower, energy, and resolve to persist through the various challenges and pushback from the system to resist the actions taken, 10) social support (because this is virtually impossible to do without any support at all) and 11) the motivation and interest in doing all of this in the first place.
Dave deBronkart and his peers are advocating for patient engagement on a broader level and that includes creating spaces for patients to have the choice as to what kind of information they use or not. This also means having choice to NOT have information. It’s not about technology pushing, but having a choice about what to access, when and how. That’s noble and often helpful to those who are used to not having much say in what happens, but that, too has problems of its own.
The paradox of choice
Barry Schwartz’s work (pdf) doing and synthesizing research on consumer decision-making puts truth to this lie that more choice is better. Choice options add value only to a certain point after which they degrade value and even subvert it altogether. The problem is that choice options are often ‘all or nothing’ and may be addictive if left unconstrained as we’ll see below.
Schwartz addresses the matter of decision-making in healthcare in the above video and points to the shifting of responsibility away from experts to everyone. Perhaps it is not surprising that we are seeing an incredible backlash against expert-driven knowledge and science in a way that we’ve not seen in over a hundred years. This is at a time when the public has access to more scientific data — the same data that scientists and other experts have — through open data and open access scientific publications to validate the claims by experts.
As discussed in a previous post, another feature of this wealth of information is that we are now living in what some call a post-truth political climate where almost anything goes. Speaking on the matter of science and climate change former Alaska Governor and Vice Presidential candidate Sarah Palin suggested that, when compared to Dr Bill Nye (the Science Guy and a rocket scientist — yes, a real rocket scientist ), she is as much of a scientist as he is.
Why have science when you can have opinion?
Distracted driving on the information superhighway
Recent data from Canada shows that year-over-year growth in smartphone use at 24% to over two thirds of the population with 85% reporting some form of mobile phone ownership. One of the key features of modern smartphones is the ‘always on’ nature of their tools and alert systems allowing you to bring maps, address books, a digital library, video and audio telephony, and the entire Internet in your pocket.
The distractions that come from the tools meant to deliver information are becoming crippling to some to the point of distancing us from our humanity itself. The title of a beautiful, sad piece in New York Magazine by Andrew Sullivan put this into perspective: I used to be a human being. (We will come back to this in a future post.)
But even if one still feels human using information technology, its a different experience of humanity than it once was. Behaviour change writer and coach Tony Schwartz (I’m not sure if he’s related to Barry), writing in the New York Times magazine, noted how his use of information technology was affecting his ability to, ironically, glean information from something simple as a book.
One evening early this summer, I opened a book and found myself reading the same paragraph over and over, a half dozen times before concluding that it was hopeless to continue. I simply couldn’t marshal the necessary focus.
He goes on to explain what is being exchanged for the books he had aspired to read:
Instead of reading them, I was spending too many hours online, checking the traffic numbers for my company’s website, shopping for more colorful socks on Gilt and Rue La La, even though I had more than I needed, and even guiltily clicking through pictures with irresistible headlines such as “Awkward Child Stars Who Grew Up to Be Attractive.”
We can laugh at the last bit because most of us have been online and lured by something we thought was impossible or ridiculous and had to inquire about. Link bait is not new or particularly clever, but it works. It works for a variety of reasons, but largely because we need to inhabit the same space to work as well as to play. The problem comes when these worlds cross-over into one another.
For example, I recently was shopping for a safe (no, it’s not to store my non-existent millions, but rather protect hard drives and enhance data security) and wanted to return to a story I’d read in the Guardian for a different blog post. As I returned to pull the URL for this I found the page looking like this:
All of a sudden I am confronted with shopping choices amidst a quest for a URL.
Information wealth: A Faustian bargain to knowledge poverty?
“We willingly accept the loss of concentration and focus, the division of our attention and the fragmentation of our thoughts, in return for the wealth of compelling or at least diverting information we receive.”
Tony Shwartz’s comments above and below point to what we know about how information works in our brain. We can try and resist, but the evolutionary reasons we pay attention to things and the biological limitations we have to processing it all are most likely to trump any efforts to resist it without substantial shifts to our practices.
Endless access to new information also easily overloads our working memory. When we reach cognitive overload, our ability to transfer learning to long-term memory significantly deteriorates. It’s as if our brain has become a full cup of water and anything more poured into it starts to spill out.
I wish I had the answers to what these are. Schwartz, has proposed a digital vacation. As beneficial as it was for him, he was also willing to admit that it’s not a perfect strategy and that he still spends too much time online, too distracted. But, its better.
Comedian Louis C.K. has taken to ‘quitting the internet’ altogether and, in a touching moment of reflection (as he often does with wit), notes how it has improved the relationship with his daughters.
It’s these relational aspects of the new information technology and how it impacts our world that concern me the most and creates the most troubling paradox: the tools that are designed to bring us together might just be making it harder to be together and pushing us apart from each other and ourselves. This is what I will look at in the next piece in this series on paradox.
Image credit: Information by Heath Brandon used under Creative Commons License and by author