Thread by @doctorow

The "shitty technology adoption curve" describes the arc of oppressive technology: when you have a manifestly terrible idea, you can't ram it down the throats of rich, powerful people who get to say no. You have to find people whose complaints no one will listen to.

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So our worst tech ideas start out with prisoners, asylum seekers and mental patients, spread to children and blue collar workers, and ascend the privilege gradient to the wealthy and powerful as they are normalized and have their roughest corners sanded down.

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For example: If you ate your dinner under the unblinking gaze of a networked, remote-monitored video-camera 20 years ago, it was because you were in a supermax prison. Today, it's because you've been unwise enough to buy home cameras from Amazon, Google, or Apple.

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I'm skeptical of prediction (fortune tellers are charlatans), but I do believe in leading indicators. If you want a look at your likely techno-oppressive future, just look at how we treat kids, blue-collar workers, and prisoners:

slate.com/technology/201…

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Another important concept: the quantitative fallacy. If you want to do computer work on a complex issue, the qualitative elements are daunting. Say you want to do exposure notification - it's easy to use Bluetooth beacons to tell whether two people are close to each other.

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But it's hard to know what's actually going on with the people those beacons represent: are they in adjacent, sealed cars stuck in traffic, or are they college kids attending an eyeball-licking party?

pluralistic.net/2020/08/20/dub…

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Rather than address chewy, irreducible, hard-to-compute qualitative stuff, quants are prone to just incinerating it, leaving behind a quantitative residue of dubious value, which is nevertheless easy to do computation on.

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It's not just contact tracing: think of the urge to reduce fair use (a complex, qualitative doctrine hinging on an artist's intent and the resulting aesthetic effect) into a set of hard and fast rules: if you quote two lines of poetry, you're cool. Three lines? Piracy.

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This powers Goodhart's Law: "a measurement becomes a target, then ceases to be a good measurement." Discarding the qualitative leads us to extend the lives of suffering, terminally ill people even when they beg for release: they're living longer!

en.wikipedia.org/wiki/Goodhart%…

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Connected to this: Chickenization, a term from the poultry industry, describing the misclassification of workers as contractors, allowing employers to shift all the risk onto workers and all the benefits to themselves.

pluralistic.net/2020/10/02/chi…

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Think of Uber drivers, paying their own insurance, gas, depreciation, etc, but not being able to set their prices, not being able to decline a fare, not being able to form a union, having no guaranteed minimum wage, no disability benefits and no workplace safety guarantees.

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Put it all together: the shitty technology curve, the quantitative fallacy, and chickenization, and what do you get?

Telemedicine.

techcrunch.com/2020/11/17/why…

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As @oliver_kharraz writes in @techcrunch, telemedicine is here to stay, and while there are many ways telemedicine could benefit doctors and patients, that's not the system we're getting.

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Instead, we're getting doctors-as-commodities, paid for piecework (chickenization), with outcomes measured in patients-per-hour not long-term health (quantitative fallacy).

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Doctors are powerful, wealthy white-collar workers, but the pandemic has replaced their working conditions with those of a Pacific Rim outsource call-center worker (shitty technology adoption curve).

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An exploited call-center worker who can only fill in online forms - not change policies, make exceptions, or even relay your dissatisfaction - rarely solves your problem. That's not what the system's for - it's there to neutralize your ability to negatively impact profits.

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If they end up helping you, it's incidental to containing the risk you present.

Likewise, shareholder-first telehealth isn't designed to make you well, it's designed to respond to your immediate complaint and get you off the line.

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This medical worst-practice: replacing a personal relationship with a medical professional that develops over time and treats you as a whole person with hastily jotted EHR notes. The literature and the practice of medicine are unequivocal: this doesn't make people well.

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Kharraz provides two fixes that are critical to a qualitative, non-shitty, de-chickenized telehealth system:

* The ability to choose a doc

* The ability to specify a nearby doc

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The fact that these modest goals are out of reach of contemporary telehealth really tells you all you need to know about who it serves.

Cryteria (modified)
commons.wikimedia.org/wiki/File:HAL9…

CC BY:
creativecommons.org/licenses/by/3.…

eof/

ETA: Here's a permalink for this thread: pluralistic.net/2020/11/18/alw…