April's free article
BOOK REVIEW
Here Comes Everybody: How Change Happens When People Come
Together
Clay Shirky
Penguin, 2009
PB, 352 pages, £9.99, 978-0141030623
If you’re reading this in the pages of the BJGP, then I
fear that you are probably past it. Clay Shirky in his readable and
thought provoking book, Here Comes Everybody: How Change
Happens When People Come Together, describes a world that will
be unfamiliar — and even threatening — to many doctors.
Shirky’s thesis is that when people are given new and easy ways
to come together — through email, social networking sites, wikis,
and the like — then remarkable and unexpected things happen. The
young may ‘overestimate fads,’ but it’s the old — those born before
1980, most GPs in other words — who are likely to dismiss a ‘real,
once in a lifetime change’ as a fad. I think of many doctors I know
chuckling dismissively at Facebook, My Space, Twitter, and
Wikipedia, and I agree with Shirkey that they are making a serious
mistake.
Consider this thought experiment, which I heard described by
Jamie Boyle, an academic lawyer and enthusiast for making as much
culture as possible open to all. Imagine that 5 years ago you are
responsible for developing the most comprehensive and
up-to-the-minute encyclopaedia the world has ever seen. One
strategy is to create a global company, employ the brightest people
available, check every fact produced, and implement the most
rigorous editorial controls. A second option is to ‘just create a
website and let anybody put up anything.’ Most of us would opt for
the first strategy, and, as Shirky describes, the founders of
Wikpedia did initially try something like the first strategy. The
second strategy seems little short of mad, and yet this is the
strategy that has produced Wikipedia.
Through the new tools we can ascend the ladder of sharing,
cooperating, and taking collective action, humbling professions,
churches, and authoritarian governments as we go.
What Shirky calls ‘mass amateurisation’ got rid of the medieval
profession of scribes when printing produced books and many people
learnt to read and write. Relatively cheap books were also
important in allowing Bibles in local languages and the spread of
Protestant protests against the Catholic Church. Now anybody can
publish, and newspapers and journalists are disappearing as
everybody can be a journalist.
Instead of filtering and then publishing (the traditional method
of newspapers and the BJGP), because publishing is
expensive we can now ‘publish and then filter,’ so creating
something magnificent like Wikipedia. It has virtually no
employees, is free to everybody, has avoided most vandalism, and
runs on love not money. People care, whereas people didn’t care
enough about the Wikieditorial of the Los Angeles Times that was
vandalised in hours. The same processes of love and ‘publishing and
then filtering’ has also created open source software, including
Linux, which runs about 40% of the world’s servers.
Collective action requires the most commitment, but Shirky
describes several cases of where people have come together through
the new technologies to take action. He begins his book with a
story of how they were used not only to get back a woman’s stolen
mobile phone but also to force the New York Police Department to
take action when they were reluctant to do so. In another example,
Voice of the Faithful acted to depose the Archbishop of Boston, who
had covered up the sexual abuse perpetrated by his priests. We are
still at the beginning of what Shirky describes, and his central
point is that we will be constantly surprised. We can’t imagine all
that will happen, and we don’t yet have examples of medicine being
transformed through the new possibilities. Medpedia (www.medpedia.com/) has just been
launched, but I found myself wondering whether the 10-year cover up
of the surgical incompetence at Bristol would have been possible if
it happened now. We might soon see the toppling of a medical
authority — perhaps even the Royal College of General
Practitioners.
Richard Smith
DOI: 10.3399/bjgp09X420437
Would you like to discuss this article online? Visit
Discussion
forum.
If you'd like to subscribe to the BJGP, see
Subscription information.
To view other free content, return to the Free content
index.