One of the reasons I think being an anthropologist in the tech world is essential is that it offers a critical eye that often gets lost in the tech world bubble. As a researcher at a health tech startup, I saw firsthand how easily the Bay Area and those within the tech sector presume a lot about the role of technology in everyday lives. For example, the iPad 2 had just been released, and the company's leaders were convinced that all the doctors were wondering what they were going to do with their new gadget. A day or two at a specialty conference made patently clear to me that most doctors in the U.S. were not fretting about the newest Apple gadget. Some Bay Area (and elsewhere) physicians were excited to be on the cutting-edge of mobile devices, but for most MDs, the iPad (1 or 2) was not a core element of their daily concerns. This doesn't mean that the technology won't become well-integrated into physicians' practices, and it is important to have an eye to future technology engagement when building a new product. But hyper-familiarity with certain practices and processes can lead to the inability to understand how and why users might engage with a new product. Some naysayers point to Steve Jobs' unwillingness to do user research, but I think this misses the point. It's not that we need more focus groups or direct market research to understand users' interpretation of technology or a new tool, but rather we need a more nuanced and complex understanding of users' behaviors to anticipate and to improve on existing tools.
Intel is a company that understands that broader research questions can be amazingly informative. Dr. Genevieve Bell, Intel's director of User Experience, is one of the lead anthropologists in the private sector. Her role at Intel and Intel's willingness to include an anthropologist as a key leader in their company demonstrate the company's foresight. Bell's work contributes to the very dynamic that I think is far too absent in the tech world. It's not that every company needs their staff anthropologists, but rather that the interdisciplinary nature of Intel's User Experience department is a sign of creative thinking and the willingness to imagine the world as radically different than just an American-centric world. It's easy to forget that mobile tools outside of the U.S. may have different meanings and utility for their users. The Intel approach has pushed its developers to think about technology in Western China or among the aging population, reminding the people who design and build the products that not everyone uses technology in the same ways. The first four minutes of this video-cast is worth skipping, but here's a chance to hear what Dr. Bell does at Intel and why it matters. If this episode has been updated (I can't find a direct link to the show), it's episode 41.
Showing posts with label technology. Show all posts
Showing posts with label technology. Show all posts
Thursday, September 8, 2011
Tuesday, June 21, 2011
Excess of care and the ongoing need for improvements in women's health
One of my main critiques of the HPV vaccine has been that the new technology may pre-empt efforts to improve existing practices. Women's healthcare remains full of unnecessary interventions, insufficient information, and an over-emphasis on reproductive health rather than holistic health. In the case of the HPV vaccine, I have argued that gynecological care remains static and frozen (in some respects) with the availability of new method for preventing HPV, rather than critically refining the way we do things now. And the way we do things now could use some refinements.
Almost two years ago, the guidelines for mammograms, the screening of women's breasts for potential tumors, were changed from recommending screening at age 40 to starting screening at 50. Part of the change was due to concerns of unnecessary tests that may produce false positives. The cost and the stress of the ambiguous results did not seem worthwhile. Further, the earlier testing failed to demonstrate a "significant" reduction of mortality due to breast cancer.
A lot of women were publicly outraged. They felt their health was being sacrificed for solely cost-saving reasons. My favorite post was George Lakoff's, a philosopher who teaches at Berkeley, who claimed that there would be thousands of women's lives affected by the changes. His argument was highly suspect, as he uses arithmetic to argue that nearly 42,000 women would die due to the new regulations. This is a far too simplistic argument for understanding health risks. Further, I expected more from a philosopher; his statement that women would die due to the regulations is completely fallacious. Not every woman with breast cancer dies. The reaction across the States to the change in regulations is a common one when it comes to shifts in existing medical interventions. None of us wants to be the one "sacrificed" for population-level purported benefits. And yet, this sense of entitlement is so very American and so very much part of why we have one of the most bloated and expensive healthcare systems in the world.
In a related article, shortly after the 2009 changes in mammogram recommendations, Barbara Ehrenreich wrote very convincingly about how the breast cancer advocacy industry has, in some ways, co-opted the feminist movement. The pink ribbon consumerism is the new rallying cry for women, rather than more substantive women's health concerns. Women's outrage about the mammogram guidelines' shift lacked a real understanding of the reasoning for the shifts. She also takes Lakoff to task for overly individualizing the experience of breast cancer (by a man, whose wife received a false positive, no less, though she does not make this point). And this undermines women's movements and the quest for improvements in women's healthcare, for which Ehrenreich calls.
Similarly, cervical cancer screening guidelines have also changed in the recent past. Instead of annual screenings with a pap smear (the scraping of cervical cells to identify abnormalities in the cervix), women over 30, who have normal results with a combined HPV test (a DNA-based test that can determine whether a woman has the higher-risk type of HPV that can lead to cervical cancer or the lower-risk type that does not lead to cervical cancer) and pap smear can then shift to the every three years' pap smear. Similarly, younger women should receive the pap every two years. (I should add that the guidelines are very convoluted and full of logic twists and turns that it's no wonder no one knows what is considered "appropriate" anymore.)
There's a recent government study that shows that MDs are actually over-testing women using both the pap smear and the HPV test. The issue of over-testing is similar to the reasons that the mammogram guidelines shifted. Or rather, similar, but also different. Young women are likely to have HPV if they're sexually active. But they're also likely to clear the infection on their own. If all women who are identified as having HPV receive the progressively more invasive interventions due to their positive HPV results, many women will be over-treated than necessary. And here, even more so, I think, than with mammograms, over-treatment is about more than just the economic burden. The biopsies and colposcopies that make up cervical cancer prevention are incredibly traumatic as is the even more invasive technique of loop electrosurgical excision procedure (LEEP).
Both the skepticism about mammograms and excessive gynecological interventions support my argument that we're not actually thinking very carefully about medical technologies. Another recent article on the excessive use of mammograms proposes that mammograms may not be the real reason for the decline in mortality due to breast cancer. The emphasis has been on more is more!! Let's do more! But this thinking obscures the existing problems with well-tread practices, and it fails to improve practices that might require tweaking without full-on replacement of new methods that have their own limitations.
Almost two years ago, the guidelines for mammograms, the screening of women's breasts for potential tumors, were changed from recommending screening at age 40 to starting screening at 50. Part of the change was due to concerns of unnecessary tests that may produce false positives. The cost and the stress of the ambiguous results did not seem worthwhile. Further, the earlier testing failed to demonstrate a "significant" reduction of mortality due to breast cancer.
A lot of women were publicly outraged. They felt their health was being sacrificed for solely cost-saving reasons. My favorite post was George Lakoff's, a philosopher who teaches at Berkeley, who claimed that there would be thousands of women's lives affected by the changes. His argument was highly suspect, as he uses arithmetic to argue that nearly 42,000 women would die due to the new regulations. This is a far too simplistic argument for understanding health risks. Further, I expected more from a philosopher; his statement that women would die due to the regulations is completely fallacious. Not every woman with breast cancer dies. The reaction across the States to the change in regulations is a common one when it comes to shifts in existing medical interventions. None of us wants to be the one "sacrificed" for population-level purported benefits. And yet, this sense of entitlement is so very American and so very much part of why we have one of the most bloated and expensive healthcare systems in the world.
In a related article, shortly after the 2009 changes in mammogram recommendations, Barbara Ehrenreich wrote very convincingly about how the breast cancer advocacy industry has, in some ways, co-opted the feminist movement. The pink ribbon consumerism is the new rallying cry for women, rather than more substantive women's health concerns. Women's outrage about the mammogram guidelines' shift lacked a real understanding of the reasoning for the shifts. She also takes Lakoff to task for overly individualizing the experience of breast cancer (by a man, whose wife received a false positive, no less, though she does not make this point). And this undermines women's movements and the quest for improvements in women's healthcare, for which Ehrenreich calls.
Similarly, cervical cancer screening guidelines have also changed in the recent past. Instead of annual screenings with a pap smear (the scraping of cervical cells to identify abnormalities in the cervix), women over 30, who have normal results with a combined HPV test (a DNA-based test that can determine whether a woman has the higher-risk type of HPV that can lead to cervical cancer or the lower-risk type that does not lead to cervical cancer) and pap smear can then shift to the every three years' pap smear. Similarly, younger women should receive the pap every two years. (I should add that the guidelines are very convoluted and full of logic twists and turns that it's no wonder no one knows what is considered "appropriate" anymore.)
There's a recent government study that shows that MDs are actually over-testing women using both the pap smear and the HPV test. The issue of over-testing is similar to the reasons that the mammogram guidelines shifted. Or rather, similar, but also different. Young women are likely to have HPV if they're sexually active. But they're also likely to clear the infection on their own. If all women who are identified as having HPV receive the progressively more invasive interventions due to their positive HPV results, many women will be over-treated than necessary. And here, even more so, I think, than with mammograms, over-treatment is about more than just the economic burden. The biopsies and colposcopies that make up cervical cancer prevention are incredibly traumatic as is the even more invasive technique of loop electrosurgical excision procedure (LEEP).
Both the skepticism about mammograms and excessive gynecological interventions support my argument that we're not actually thinking very carefully about medical technologies. Another recent article on the excessive use of mammograms proposes that mammograms may not be the real reason for the decline in mortality due to breast cancer. The emphasis has been on more is more!! Let's do more! But this thinking obscures the existing problems with well-tread practices, and it fails to improve practices that might require tweaking without full-on replacement of new methods that have their own limitations.
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