Wednesday, August 20, 2014

Commodities and Experts, Part 1

Hearing Sandeep Jauhar interviewed by Terry Gross yesterday about the changing world of being a physician got me thinking about something that's been on the edge of my awareness for a while now: the conflict in our society between what I'll call "commodification" and "expertise." It's not strictly speaking an economics argument, though economics do certainly play a central role. It actually has to do more with the creation of a commons, the kind of thing I ascribed to "the grid" and other pidgin mindpaces, several years ago here.

Jauhar's point, or at any rate the piece that grabbed me, was that doctors are being steered from private practice into larger, integrated environments like hospitals, so their care will be more integrated with other specialists, and can be shared instead of overlapping inefficiently. And these arguments from efficiency really do make a lot of sense. I don't want to have doctor one take a full medical history and draw blood only to have doctor two do the same exact thing two days later. Talk to each other, people!

But doctors also feel a lot of stress. Jauhar ascribes this to the mechanical, no-time-for-hands-on-medicine life doctors have to lead these days, but I also think part of it is related to what Atul Gawande referred to in his book and article about the need for checklists in modern medical treatment: in essence, medicine has now gotten complex enough and the consequences of forgetting a step (especially in regards to infection) so great, that seat-of-the-pants reliance on a doctor's orderly mind is not enough. You need to conform to a system, rigorously, in order to be as good a doctor as you can be.

I know why doctors get nervous about this. It's not just the adrenaline rush, the cowboy scalpel-jockey thing. It's that their own aura of expertise disappears, the more dependent that they become on an external system. I know this because I'm a cartographer. It's kind of hard to imagine today, with ubiquitous data and maps, that maps used to have a kind of mystery to them, and the making of them was kind of an arcane skill. Like being a scribe in an age of illiteracy. It's not that we were superhuman, but we had a kind of mysterious cabal going: we knew how to make these elaborate, complex things. And you didn't.

Except, now you do. Or you can. It's not that hard. And there are fewer of us as a result.

But something interesting happened on the way to this glut of cartographers: maps got noticeably better, especially bad maps. It used to be there were companies that made terrible, hard-to-read, really almost illegible maps, but they were cheaper, and so people used them. Now? The cheapest map is a screen-shot from Google Maps (not legal, but lots of people do it), and you know, they don't look half bad.

At my former employer, we made a point of not entering what we called the "commodity map" market. This was a situation where a map retailer or distributor just wanted a generic "road map" or "street map" and didn't actually care how good it was. Like selling milk or windshield fluid: get something in the rack that people will buy if they just want a map. We specialized in a cut above that: maps for people who actually cared about which map they were buying. Selective buyers...

And it's not a bad niche to try and fill, if you can persuade people your product is better. You can get it placed, and maybe you can sell it for a little more. Not always, but sometimes.

The thing is, the way you persuade anyone that your product is better, is by comparing it to those products that are not as good as yours. And so the rising quality of the worst maps has made it harder to market oneself as a "premium" map publisher. The gap just isn't as dramatic as it used to be.

I was listening to a CD of the Cars on my car stereo this week, and thinking about the incredible time and technical expertise that went into their work and some of the other top acts of the 1960s through 1980s. When I was growing up, in the mid-1970s, the technical difference between the music of thirty years prior and then was enormous: Glenn Miller vs the Eagles. That same gap doesn't exist today. Recordings aren't really all that different from 30 years ago, c 1984. Heartbeat City, which apparently took months of excruciating work to get to sound like Ric Ocasek wanted... to sound like a lot of pop records today. And that's the difference: you don't have to be a genius or have tens of thousands of dollars floating around to make a pop record that sounds like a top-quality recording. The bottom bar has raised.

And in a lot of ways, this is a really good thing. The overall technical quality of our stuff is better. Cars routinely last for way more than a decade and 200,000 miles is not freakish. I remember our old Volvo was old at ten years and 100,000 miles back in 1976. And that was a Volvo. They would run forever.

Commodification—the creation of standards—also allows things like recipe books. A cup of flour is a cup of flour now, in a way that it wouldn't have been before flour mills became national operations in the late 19th Century. What variance there is in gluten or moisture content is the kind of thing an epicure, or a commercial baker, might care about. If you want to make a cake yourself? Pillsbury, Gold Medal, King Arthur... all will do the job just fine.

But this commodification also meant that the hands-on tinkering that local millers engaged in, the learning and re-learning what this machine will do at that time of year, and how to adjust to make the best flour from the local fields... this kind of expertise is now put into a context where responsibility is given to a higher order. That miller, now working for ADM or General Mills or whatever, is working in much less forgiving conditions, in a marketplace where there are seemingly faceless competitors ready to wipe you aside in the unlikely event that you should fall off of the pretty precise standards for "flour" in todays market.

About 15 years ago, I abruptly learned from a fellow actor what "professionalism" meant in his world. He had worked in the professional world, and was now doing high-end community theater. He was good at his craft, but what he defined professionalism as was not quality but consistency. It was his employer knowing that he could be called upon to show up on time, and deliver the same quality of performance he'd demonstrated previously. Obviously, he'd be paid more and get better gigs if the quality was better. And there are plenty of examples of performers whose performance is anything but consistent... except that even these are mostly consistent in their eccentricity. Robin Williams and especially Andy Kaufmann would deliver a surprise. That was their promise. And they did.

And speaking as broadly as possible, that kind of genius is one end of what I mean by expertise. When you are selling your ability to solve a problem and deliver a finished result—whether it's by a doctor or a plumber or a comedian or a cartographer—what you are selling is expertise. But it's harder and harder to escape the fact that you are also selling the consistency of the results you deliver. So much of our economy is now based in comparison shopping for equivalent results within a narrow range of acceptable standards, it takes an effort to carve out a space where expertise is actually valuable.

In some fields (writing for example), this has been true for a long time. "Everyone's a novelist, and anyone can sing/But no one talks when the TV's on," as Moxy Früvous sang. Writers who work for non-publishers regularly face the fact that "lots of people can write." Not as consistently, but most college educated people can put together a letter in written English that will be understood by the recipient. 500 years ago, this was not so true. Also way fewer people went to college.

Others of us are just getting used to this mode of working for pay in a technology that "anyone can do." But more and more of us are living in a data-rich world, where our special knowledge isn't all that special anymore. And as the distance between what anyone can do and what only a few can do continues to narrow, will we really end up with experts anymore? Those of us who grew up into an expertise really want to find a way to hang on to that, but is it really necessary? What happens to the place experts hold in our society?

We're seeing some of that now in America, with the declining respect given to experts: scientists, doctors... what do they know? This anti-elitism is nothing new, but it's backed up now by a diffusion of knowledge—not wisdom, but knowledge—that gives those expert elites less to stand upon.

I think those elites—the knowledge and technical cabals of old—are really evidences of imbalance. I'm not sorry to see them go, except that I kind of like it when people say, "Oooh, you make maps?!?!" at dinner parties. I like it, but it gets kind of old, honestly. I'd rather focus on what makes a humane way to be "professional," in the sense that actor meant. There the expertise was not black-box magic hocus-pocus. It was a practiced skill, an ability to perform consistently. That is valuable and it's healthily sustainable.

So why then does commodification sound so unpleasant, like The Prisoner's "I am not a number, I am a human being!"? What is the difference between professionalism and commodification? I'll discuss that in the next post.