Slashdot Mirror
Introducing Open Source to the Doctors
TCook writes "Dr. Daniel Johnson introduced the morals of open source to the American Medical Informatics Association. Read his
presented paper.
" Medical technologies are one of those areas that I think should be open-sourced for obvious reasons. The notion of bugs and flaws that no one can get at in medical technology gives me the willies. As well, if by applying the "thousands of eyes" we can save lives, I think that's good for all.
I'm working for a company which is currently moving from a Solaris x86 platform to Linux. Our company believes that open source is important and has many benefits... but we wouldn't dream of open sourcing our entire product. The benefits of open source don't apply equally to every software product, and sometimes the benefits of closed source still outweigh those of open source.
Why doesn't open source always provide enough benefit? It's quite simple - sometimes, the only eyes that are useful are trained eyes. Dr. Johnson's paper notes an open source benefit of "Large numbers of skilled programmers", but not every programmer knows how to develop and improve neural network algorithms. The algorithm group at my company consists mainly of highly-degreed math and computer science majors. The algorithms they work on are complex and it's unlikely anyone not intimately familiar with the field would be of any help in looking at the code. ANY field that requires complex mathematics suffers this problem; anyone who's trained enough to help fix bugs in the code is either already an employee or is probably working for a competitor, which brings me to my other point...
The major benefit of closed source is higher return on investment. The people who founded the company invested many dollars into the research and development of highly-specific algorithms. They want a significant return for their work - they don't want to just give it away and diminish their profit. You can dream about medical industry companies co-operating rather than competing, in an attempt to bring better health to all, but the truth is that profit is the most significant incentive to get people to invest in the medical industry.
Companies like mine want to help other people, but want to make a profit, too. It's a balance of morality and self-interest. Sometimes open source fits neatly into that balance, but not always.
Anyway, we are hoping to release our product running under Linux next year, and it seems quite likely that some of our work could end up open-sourced... it's not entirely clear yet. For example, there's already an Elotouch touchscreen driver with XFree86, but no calibration utility of which we're aware... so we may be writing one of those.
Counterpoint. I did talk a bit about the application of computers and information management technology during my medical school interview (1997), and not only did they allow me to leave with my limbs still attached to my body, but they let me in. Since then, I've been intimately involved in the school's attempts (however feeble at times) to incorporate IT into their curriculum.
Physicians aren't as scared of tech as many might think. Well... not all of them. :^)
(I'm not a doctor, but I play one on IRC.)
-DrPsycho - Coping with reality since 1975
As a physician, I've turned my attention to efforts directly in the computer industry rather than trying valiantly to bring my collegues forward into the computer age. The reasons are many: Physicians don't want technology. I make this assertion based on observation of physician habits and policy statements. In fact, I attended a medical informatics conference last year with thoughts of doing a fellowship there were several prominent physician informaticists there who stated "I'd rather take someone into my program who knows nothing about technology rather than someone who has ideas about how it can change the world," and "we don't want to use technology to change the practice of medicine." So, I've moved on to the private sector. Physicans won't spend money on technology. The only Y2K disasters that I know of are private doctor's medical billing systems that they've been too cheap to upgrade. There are more 8088 based machines in physician offices than just about anywhere else. Physicans can't get along well enough to open source. Peer review in medicine is so much of a 'good ol' boy' game that the Reviewers would likely never relinquish control of medical information. Physicians fear liability too much. Doctors aren't going to take a risk on something new unless they can be totally insulated from liability. If a CT scanner produces a faulty image, they can blame GE. Who can they foist blame on if the code that produced the buggy image was Open Source? I know this sounds kind of jaded and bitter, but the medical profession needs to get to 1990 in their technological thinking before they are ready for a 21st century solution like Open Source. Dr. Warren Magnus
I'm pretty sure these things are mostly hardware. (I haven't opened one up to check.) I can't imagine doing a CAT scan in an emergency situation, anyway. I doubt anyone needs Win NT or *NIX to run medical equipment. Most of the software apps are with regards to sending/retrieving information. I wonder, has anyone died because they weren't able to retrieve a medical record fast enough? You don't really need to know a patient's previous history to be able to diagnose MI.
Would you want a doctor who got an A or a doctor who got all C's. You can't gaurantee the A's with OSS.
Med-school grades don't have that great of an impact on how good a doctor you get to be. (Your board score matters a lot more) A lot of good schools have abolished grading all together (like Yale.)
http://people.delphi.com/salfter/cs301.ht ml
It's mainly an account of incidents (some of them fatal) involving the Therac-25, a radiotherapy machine that was almost completely computer-controlled. Numerous race conditions in the code combined with a lack of hardware-based safety interlocks allowed the machine to be operated in unsafe configurations. Several people were killed or badly injured before the machines were recalled. The software problems would've stood a better chance of being caught in a more open review process. (A case might also be made regarding the replacement of hardware-based interlocks with software, and how this is awfully similar in basic concept to Winmodems and their problems, but that's beyond the scope of this thread. Besides, nobody had heard of Winmodems back in 1993. :-) )
20 January 2017: the End of an Error.
"How many medical schools have you attended that you can make such an authoritative sounding statement?" Attended? None. By choice. Visited? Many. I go through the local one at least weekly. It's happening there, and also at 1 others I have visited recently. And, I know of 2 that do it in the third year.
"Maybe you don't like it, but I honestly feel that most patients don't want to be examined, to be poked and prodded, to reveal all sorts of personal secrets to by somebody they refer to as "Bob" or "Jacky." Maybe I'm wrong, but such has been my experience." I truely believe you _are_ wrong. And I also believe the AMA did a study on that very point in the last 10 years. The conclusions AFAIK were that patients 1) would rather know the specifics of the credntials, like where exactly they went to medical school, and how well they did (what do you call the guy who graduates at the bottom of his class in Medical School? "Dr." :-( I'd rather know how he did and know where he went!). And, I believe the AMA study also found 2) Patients who are on a first name basis with thier care giver (used generically intentionally) are more likely to be open with thier problems, and recieve better treatement (which actually can give PA's an advantage over MD's and DO's in some cases).
So... I guess I disagree. :-/
Um.
Doctors get paid for implementing their expertise in the transplantation/transfusion procedure itself... not for the selling the biomatter. There is no way you can claim physicians are making heavy cash by selling organs... at least, not legally. It's absurd.
Then again, with the HMO system as it's emerged in the United States (as viewed from my Canadian perspective), I wouldn't be surprised if the insurance companies started trying to get their greedy fingers into the organ donation game... :^)
-DrPsycho - Coping with reality since 1975
Have you read the disclaimers that come with medical software?? I work for several small doctors offices here in Southern Colorado. I'm not a programmer, I just install the software they bought. It *all* comes with the same sort of disclaimers that Windows, WordPerfect, etc come with. The shrink wrap licenses on these packages say that the software company is *not* responsable for any failures of the software.
Why do people like this author insist on completely ignoring how capitalism is acutally practiced in a modern society? Sure, the ideal concept of unrestrained capitalism has severe problems. But that went out over 100 years ago except in the minds of some academics, libertarians and those who swallowed Ayn Rand.
Modern western societies practice a form of encumbered capitalism where the societal tension is between those who debate how encumbered it should be. Sure, a pure capitalism would be anarchic and probably inefficient. But that is not at all what we have. The system of English common law we live under has been regulating corporate behaviour to a societal moral standard for 300 years; since at least the start of the industrial revolution. Most of the examples of problems with pure capitalism have been adjusted or ameliorated by law and regulation.
The example of tradesmen keeping their technology secret was in fact the prime motivation for the development of a patent system. Now tradesmen are granted a period of exclusivity in exchange for the publishing of their invention. Patents specifically allow for R&D activities to insure further technological benefits from publication. Casting away the concept of rewards for invention makes me very uneasy.
Publication by academics is in fact no particular high minded activity. The root cause for this is to gain continued employment, tenure and grant money. In today's environment such publications are always closely reviewed for potential commercial applications and patentability before they are released to reviewers.
The benefits of rapid technological change that we see today are in fact the result of a enlightened policy that BOTH allows for economic exploitation of ideas and free exchange with the protection of the economic value of the ideas.
The author makes a lot of claims for the success of Linux that I think are very unjustified at this point in it's development. I am not at all sure that anything innovative has or will come out of Linux. Linux has and is feeding off the technology that was developed in closed source environments, and trying very hard to just equal the features of these systems. Where are in fact the new algorithms, or the new technologies that have come out of Linux?
Patient record software, though important, always has a human interpreting the results, so it is considered less critical. Many commercial patient record systems have terrible reliability today - many run on Windows and Windows NT. Even some of the mainframe based products have to be taken off-line nightly to do backups, for they don't have the capability to backup their databases online. Open Source would do these products a world of good, IMHO.
Moreover, in my experience, the FDA mostly looks at software developed by commercial entities. I am familiar with one prominent hospital where a physician developed an information system (in Fortran(!)) used on a daily basis, then lost the source in a disk crash! The system was apparently used for years without the ability to make changes to it. I'm sure the FDA never bothered to audit that program or its maintenence. How's this for another benefit of OSS, one that is never cited - backups!
I agree with you 100%, you are one of the rare few. But you are wasting your breath on slashdot, particularly on something so broad as to capitalism. Most slashdot-commentors do not know their history very well, and lack even a basic understanding of what makes capitalism work (and other systems fail).
I think the author is trying to make the point that things *CAN* be different in the medical industry, if the open-source ideals (which have only really hit the general public over the last year or two, if at all) are embraced now. Give it another ten years or so and we'll see what the playing field looks like then.
-DrPsycho - Coping with reality since 1975
I'm just pointing out that SlashDot's reader base is likely to contain many people who possess a "doctorate" but have no medical training.
Maybe I'm wrong, and /. is really just a bunch of teen age script kiddy trolls like I've been told, but I have seen comments from some pretty bright people here on occasion, some of which actually are "doctors" in the correct use of the term, but probably know little about medicine.
I am not a GNU/Linux or free software / open source zealot; I simply recognize its genuine strengths and enormous potential.
It's a bad sign that this sort of disclaimer has to go on top of articles about open source; I've done it myself on a couple of occasions.
I'm not going to make the usual plea to the zealots to be polite when talking about OSS; I know by now that it's not going to work. What's needed is for those of us capable of pressing the point without being an asshole to do so when the opportunity presents itself.
OSS' greatest enemy isn't Microsoft; it's its own zealots.
Why the first post? I mean, you have to be aware that just about everyone here think it's stupid and childish. I'm not attacking in anyway, I just have ask you why you (and others) insist on doing this?
Finkployd
Yeah, whatever you say, Metcalf.
-- Remember: Wherever you go, there you are!
If a member of my family dies because somebody put = where they meant ==, I want to know who they are, and I want to sue the pants off them. Most open-source software has disclaimers that absolve the developers of all blame. I guess the solution is for companies like Redhat to distribute the software with a guarantee. Any other ideas?
grep -ri 'should work'
After Previewing TWICE, it took all my tags out! Here is a "retaged" verson, if it works: Common public misconception about terms has caused all kinds of problems in society, minor and major. Slashdot has went on numerous crusades in the past about the misuse of "hacker" when it was meant to be "cracker," but now has no problem with the use of the term "doctor." Yes, this is picking a nit. Doctor is a person who receives a Doctoral Degree, not the person who helps you when your sick. Although Hollywood and the media would like to perpetuate the misuse of this term, what your really looking for is "MD" which is the specific subset of doctors who studied medicine. Not a _huge_ deal, but it just makes you it sound like you don't know that there are other "doctors" out there. I suspect there are probably a large number of doctors in the slashdot reader base who have studied computers, math, physics, chemistry, engineering, and many other fields. In a small way, by making the comment "Introducing Open Source to the Doctors" your insulting them, when it should read "Introducing Open Source to the MDs"
"Physician" is not necessarily better. Surgeons are considered, by some, to be different from physicians, yet they are still medical doctors.
I looked in a couple of dictionaries. There are several accepted uses of the word "doctor." Do you mean correct according to you?
My point is that "doctor" is a term with several meanings, and you have no monopoly on the word. Those people with the most advanced degrees are indeed doctors, but they're hardly the only type. Language is fluid. While the original use of "doctor" seems similar to "teacher," it is different today. Not everyone who has the little special piece of paper teaches. Should we take back their diplomas and tell them that they are not doctors? Let's give them and speakers of nearly all European languages spankings for corrupting the perfectly good Latin language while we're at it. They're not using the Latin terms correctly.
WTF is up with the "HTML Formatted" option!!!? Is it NOT working THIS is a TEST.
INVENTED Peer review. We've had it for 100's of years. It's the standard for how things are done in medicine.
CS people didn't invent Open Source, they adapted Peer Review from other Scientists.
"I have no respect for a man who can only spell a word one way." - Mark Twain
"Going to war without France is like going deer hunting without your accordion." - Jed Babbin
You can guarantee in the vast majority of cases that the software produced for those specific "mission-critical" devices will be proprietary to the device itself. How the assertion of this turns the previous replies in this thread to "complete garbage," however, is beyond me.
-DrPsycho - Coping with reality since 1975
Their business is just software, network and servers, not medical equipment, that's the Equipment Department's business.
The software was both in-house development, and analysis and ordering of external solutions for information exchange software (secure mail system for the hospital) and software such as electronic medical-records, care planning tools and even intranet solutions.
The one thing that struck me most was that commercial or closed-source software was always the only thing thought of, even if most of the developer's headaches seemed to be chasing external software consulting companies who had failed to deliver the product wanted or failed to deliver it on time, and even more often with a significantly larger price than expected. There were also external contracted companies who had, without warning, stopped developing products entirely that were essential to the hospital. All these problems ended up at the IT department. I'm not an software development expert but I can tell you that there was easily more people involved in keeping track of external vendors and external projects and patching this software up so that it would work as expected than would have been needed developing all this software themselves.
(As a side-note, add to this the fact that the hospital had an ancient policy not just to focus on commercial software, but only Microsoft software everywhere, i.e. Windows9x, NT, IIS, SQL Server, ASP, MS Exchange, MS Proxy, Internet Explorer, MS Office, and the various MS development tools... Such a single-minded policy isn't helping productivity in my opinion)
Due to the problems with external vendors it seemed that doing more stuff on their own in the future was the new policy. Therefore the IT department had doubled the number of employees the last year. And the policy seemed to be that almost all of the development should be made in-house, with as little input from the outside as possible. And from what I heard this was also the situation at most other hospitals that could afford a large IT department. And therefore cooperation between hospitals or even the thought of sharing software between hospitals seemed to be out of the question. I spoke to a lot of the developers there during my work, and even if the historical explaination of the situation varied, this seemed to be the situation right now.
So from what I've learned, hospital IT departments have a lot to learn from open source, co-development and code-sharing. I was truly happy when I saw this article.
GNU/Linux. The Freshmaker.
You don't seem to grasp how quickly Linux Grew. It came from a 1 man operation to a better operating system that you can't beat the price/performance ratio. As Windows devolves and regresses, linux explode's with growth.
As a recent example of this, a year ago Linux has no journalizing file systems. We now have 2 being devloped with one stable. Window NT dosen't even have 1 being devloped yet, although I'm not sure if Windows 2k is suppose to be a new file system.
Yes Linux benefits of capitalism but Capitalism also benefits off Linux. Look at all the business that will soon be hitting the stock market that write Linux software, sell support or build machines specifically for Linux. Look at redhat's stock that tripled in the first opening day. Their ceo was worth over 580 Million in a day, yes it has gone down but Linux can make you rich too. Linux's popularty has exploded despite it not having a basterdly marketing department like some other software maker.
If you worried about economics, you should want to get rid of monoplies.
There are obvious problems in using opensource software for medical purposes. The first is that someone has to pay the enormous cost of getting any technology to pass numerous tests to be certified okay for keeping humans alive. This is an expesive process to make the FDA and any other government body resposible for health products, and I doubt that the people who pay for this process are going to be willing to risk the return on this investment by giving away the software. Perhaps, the source could be open and able to be improved by people who have bought the software from the owners.
Secondly, there needs to be somebody to be liable for any damages/lawsuits that might spring up. I doubt that any medical assoc. will be willing to take the liability onto themselves.
Just a few problems.
I think the guy has a point, and I tend to agree with that point. However, I don't think anything like this will be accepted in the near future for one reason: people outside the OSS comunity just dont get it.
Admittedly this is anecdotal, but I'll repeat it here because I found it illuminating:
I hang out on undernet's #linuxhelp quite a bit. A 15 year old was on asking questions. Someone suggested he buy a copy of RedHat from cheapbytes, but he pointed out that cheapbytes wont let a 15 year old purchase from them. Of course, someone told him to get his parents to buy it for him. His response? "my parents dont want me to get linux, because they think I will become a cracker"
Draw your own conclusions.
>get on the future now...
take your medicine! you're delusional!
In the medical case, the freeware and group development of open source don't matter. It's the thousands of eyeballs hunting for bugs that would help. So making medical source open would improve the quality.
But, to make that work, the original developers of the code need protection for the development costs. Patents helped innovation by opening trade secrets. Can we do the same for source?
Of course, that doesn't work if "open source" is really "free software" dressed in a costume.
Scott Ferguson
Scott Ferguson
Caucho Technology
Contrary to being "interesting" I think this guy must have interviewed at some offshore medical school or was rejected for some other reason.
I can assure you that as someone working at 2 different medical schools in the past year, there are tons of people doing development using OSS for their own use.
It's kinda like Visicalc invading the corporations in the 80s, there are simply too many brilliant MD/PhD students out there who happen to know how to code and want to make it easier to check out a scan from radiology without having to drive into the hospital when they're on call...
Recursive: Adj. See Recursive.
I waded through the morality speech, and listened to the really specious discussion of capitalism. But when I got to the part where the good doctor starts explaining software development (including mentioning that one of these open sources groups is basing their design on "CORBA-based OMG's (operational management groups)" it became clear to me that this guy is clueless. Writes well. Means well. But he's living proof of the idea that you need a license to write computer code.
His fundamental argument is this:
Had the good doctor stopped right there he would be on to something. He could, conceivably, produce a product that both benefits the medical community and makes himself rich. Instead he chooses to clutter his idea with the notion that Open Source--per se--would make his idea better. He then goes further--launching into a review of existing Open Source projects that are attempting to do what he describes. And he completely ignores a major weakness of Open Source.
I have been involved in large-scale, complex database programming for more than 12 years, in the U.S., Canada, and Japan. I have both developed large-scale systems for corporations, and developed component tools for database tool vendors (Logic Works, makers of Erwin/ERX; and Bader Technologies, makers of ObjectBase). I have also worked for a small software company that does for book publishers precisely what the good doctor wishes that somebody would do for his medical practice: the company developed the drop-dead, hands-down, be-all and end-all book publishing computer system.
If you call up any customer, they will rave about the software. They will tell you that buying the system will cost you a mint--but it will revolutionize your business, improve your bottom line, make your life more enjoyable, and cause your dog to love you more. Even if you don't have a dog. (I'm not exaggerating--that exact sentence is one customer's standard response to queries about the system.) If you have bought "Open Source" books from any well-known publishers of "Open Source" books your order was almost certainly handled by this system.
Wanna know the dirty little secret? Under the hood, the system is--in one sense--crap. It doesn't even have a relational database--it's built on a collection of flat ASCII files, using a semi-proprietary language named Databus that originated on the Datapoint mini and hasn't been used by practically anybody else in more than a decade. If this system was "open sourced" nobody would want to have anything to do with it. It would be regarded as a joke.
But the company's customers love them. They worship them. They love them so much that customers routinely send presents. I used to run the East Coast office, and my office today is decorated with posters from clients--and I haven't worked for those guys in ten years.
Why? How? Because more than anything else, this company understands that it is not the perfect algorithm that makes the software work. It is not the most up-to-date database engine that the end users want. It is not the baddest, highest, hardest, fastest, coolest, or most groovy new feature that matters. What this company provides to their customers is the answer to any and every problem they have. Even if it has nothing to do with the software.
Get a letter from Borders indicating that all invoices have to be submitted electronically? The software vendor will take up the issue with Borders. Get a chargeback invoice from Waldenbooks? They'll patiently explain the bookkeeping of chargebacks to your staff, again and again and again--as many times as it takes to make sure your staff does it right. Nobody, at any time, ever, speaks of an "end luser."
How far does this go? Back in the 1980s Louisiana State University Press bought the software system. At the time the software only ran on Datapoint minicomputers. Most customers bought the Datapoint mini from us--but LSU got cheap and bought it from a local dealer. For some unbelievable reason they decided that the obvious place to put a minicomputer (this is Louisiana, right?), which is supposed to be kept in a temperature-controlled room, is in the warehouse, right by the loading dock door. And in the summer, when it got hot (this is Louisiana, right?) they'd open the loading dock door to keep the mini cool. So what happens in the summer, when it's hot and humid? (This is Louisiana, right?) Thunderstorms. They take a lightning strike--a direct hit--right smack on the mini.
And what did they do? They called our tech support people. Did we laugh at them? Did we point out that they'd bought the hardware from somebody else, so it wasn't our problem? Did we suggest that they were morons, and LART them? No. The tech guy they talked to calmly responded, "have you called the fire department yet? No? Do you want me to call the fire department? If you have a fire, get out of the building first--we'll call the fire department from here...."
LSU has told that story to every university press in the country. Its one of the reasons why 2/3 of the university presses use this company's software. Because it isn't the code--it is the end-user relationship that matters.
The good doctor can create a huge Open Source project. They can give it a cute name like QuickQuack and hold online chats and chant selections from The Cathedral and the Bazaar. They can build the system with OS software from Microsoft, Apple, IBM, Unisys, or some guy from Finland who was named after a cartoon character. Ain't gonna make a lick of difference--because whenever they have something to install, and wherever they install it, it won't meet the needs of the end users. Because NOBODY--ESR, Linus, Stallman, Dust Puppy, the good doctor, NOBODY is prepared to discuss "Open Source" End User Support. They're all reading BOFH postings and telling one another "end luser" stories.
And it is precisely in the area of End User Support that those less-than-adequate commercial software companies are meeting their customers needs and making money. They're explaining how to reconcile reimbursements from health-insurance carriers; they're explaining how to use new EDI links to Blue Cross/Blue Shield; they're explaining the advantages of two-sided page scanning equipment; they're explaining why the optical archiving system runs better if its mounted vertically; they're explaining--for the fifteenth time--why nightly backups are a Good Thing. They help the end users run their businesses--they help the end users care for their patients. Their end user support people become indispensable parts of their clients medical practices. And if they have any desire to last in this business, they don't ever dare think the words "end luser."
The good doctor is talking about a vertical-market solution. And the business in vertical-market solutions isn't development--it's support. "Open Source" development won't do anything for quality--because without end user support nobody will use it. And I haven't heard anybody offer to step up and provide long-term, expert end-user support "open source"--which is to say, for free.
Just another example of a microsoft peon. If you had ever seen a real journalizing file system you would know that NTFS is as far from journaled as you can get. A journaled file system dosen't take 10-30 minutes for a 2.3 gb drive to be checked. Microsoft just calls it journaled.
I agree with you because my employer and previous employer have done a lot of work for local and conglomerate medical centers -- the locals are more clueless than the conglomerates, but neither seems to have a problem with ER Admissions being run by a 5 year old box with no disk fault tolerance :-)
However in the spirit of picking nits, there's a difference between software designed to analyze blood samples or calibrate a pacemaker and software designed to transmit information. When you look at a transmission of data problem, it doesn't matter what the data is. All you have to do is establish the importance of the data, which is then used to establish:
1) level of error checking and what OSI layers it's done at
2) what to do if error-check fails (resend or abort?)
3) who and how to alert in the case of an abort
The content could be financial, medical, or neither.
However, if you're working on software designed to calibrate a pacemaker I would want you to be MIT's best and I'd want you to have some damn good doctors and ME/EE grads working with you. Now the problem is bigger than data transmission (which has been pretty damn reliable since X.25). The content matters a lot and has to be accurate.
my 2 cc's of lymph
"Nothing was broken, and it's been fixed." -- Jon Carroll
While there may indeed be scads of patents that have something to do with tree sap or various other biological compounds, you cannot patent the natural compound itself. That's kind of the ultimate "prior art" claim. You can, however patent a process to extract or artificially replicate a natural compound.
Oh, all right... No, I am not a patent lawyer
Ahh - My eye!
The doctor said I'm not supposed to get Slashdot in it!
I work in the medical software field, so I'm qualified to comment:
"Even highly scientific stuff needs spiffy GUIs and the like, stuff that anyone can write."
Bullshit! The user interface needs to be simple, plain, unadorned, with all necessary information instantly accessible. When the patient is pried wide open during open heart surgery, a "spiffy" interface will kill him!
"Got the fastest FFT out there, and only five people in the universe can understand how it does it? I can write a GIMP plugin frontend for it."
If you don't understand FFT, and you program medical software that uses it, you're a idiot. This isn't a GIMP plugin, it's a person's life!
"The point is morality."
I'm surprised. You got that one right! It's immoral to subject someone's very life and death to a particular political view. A truly moral physician would use the most accurate, bug-free, and technically superior software. It doesn't matter that if it's open or closed source. You may believe, and even be right, that the open source solution fits the bill, but if it doesn't, then what? Let the patient die?
"It's WRONG to sell the right to use software. If you do it, you're a software hoarder, and you're evil."
I will tell you what true evil is. True evil is disallowing a physician to save a person's life just because the software he uses doesn't suit your personal fancy. Well fuck you! If that's what GNU is, I don't want anything to do with it!
"RMS is way more eloquent than I am."
And apparently way more intelligent as well.
A Government Is a Body of People, Usually Notably Ungoverned
I find particularly amusing that you don't even bother to type correctly(ridicurous?).
Hey, chill out! Maybe he is oriental.
Erchie
"as for linux, in 2.4 SMP kernel, it is about 3000% more efficient than sun solaris and scales better."
I thought so. You really don't know what you're talking about, do you? Somebody scrubbed too hard while washing your brain.
A Government Is a Body of People, Usually Notably Ungoverned
Why exactly do you need to sue the pants off them? Is it to get revench (the economic equivalent of a pointless punch in the face) or because you have just won on the American wheel of litigation and want the chance cash your reward?
If a company guarantees that something works and it doesn't, then they have broken there promise and should possibly be sued (such legislation being there so people have to stand up for their promises). What does that have to do with whether the software was developed as open or closed source? The guy who forgot the second = was not doing it because negligence, he made a mistake. It is whoever promised you that the system would work that was negligent, and people can promise that for regardless of how it was developed (closed or open source, they better have tested it well).
Personally (but, of course I'm not American) I would prefer if there was no suing going on at all, as long as less people are dying. This is what the thousand eyes reference was about if you missed that.
-
We cannot reason ourselves out of our basic irrationality. All we can do is learn the art of being irrational in a reasonable way.
A lot of people seem to have trouble with how open source projects work. There are very few, if any public access, read/write CVS repositories available. Every patch by a non-trusted, non-core developer much be approved by the maintainer. That is where the quality control and accountability is. Just because everybody isn't fully qualified and willing to help you that is no reason to forbit anybody to help.
There are LOTS of OSS developers, but how many dare/bother working on the kernel? Or X? Or any other project for that matter. This is one of the big advantages of OSS projects, people contribute where they can. Where they are competent and interested in, instead of where they are assigned.
Concider it this way: Some person, or small group of people at one hospital start working on something for their hospital. They get to talking with an IT person at another hospital. The other person also needs a peice of software similar to what is being developed at the first hospital. What do they do? Does the second hospital buy a copy of the current software? Hell no, that would be STUPID. Instead the guy at the second hospital downloads the software, checks it out, and make it suitible for his task. He then submits his changes back to the first hospital, which is greatful for the help and they continue working together. Both hospitals enjoy the fruits of the labor of more people then they, themself, have on payroll for no extra cost.
- kimo_sabe
While your point may or may not have any merit, the "F" actually stands for "Food." As in Food and Drug Administration.
So I suppose while the Feds may or may not be trustworthy, I wouldn't go around denouncing "Food" quite so quickly...
Currently, in the medical world, there are biotech firms that are discovering gene sequences that would help determine a predisposition to various diseases. What is sad is that many of these firms are allowed to "patent the genes" I may be wrong, it may be the processes that they use to discover the pertinent gene sequences that they are allowed to patent. But in any case, this is horrifying. http://www.msnbc.com/news/302971.asp
1979: This will never amount to anything.
1989: Ok, this can be used to make developement tools, but you'll never make a whole OS.
1999: Ok, you could make a whole OS, but you'll never innovate on it.
Wanna bet?
-
We cannot reason ourselves out of our basic irrationality. All we can do is learn the art of being irrational in a reasonable way.
Consider:
(Although, with relative velocity vectors of a goodly number of Km/s, a little Sun 3/60 could probably do a good number...)
I have not the Real Time skills to deal with that; the absolutism of the comments were what offended me.
Consider that:
RT is not the only issue; free software has considerable things to offer in the non-hard-RT areas.
If you're not part of the solution, you're part of the precipitate.
Sounds like a challenge for a distributed-processing project... :-)
Yikes, now look what we've started.
You're a Network Engineer you say?
What school is your four year engineering degree from? Or do you have a Masters? Is it an accredited engineering school?
Or do you really mean you pull cable?
Sounds like a need for Open Doctor Schedules.
No. It's not your beef. It's the owner of the building where the Device Manufacturer used to be located's beef with the FDA. Because after the FDA gets done with the Device Manufacturer, all the building owner has left is a plot of scorched earth.
A lot of the replies so far have been arguing about whether open source is appropriate for medical software. The problem is that everyone has a different idea of what medical software actually is. Some posters seem to think it refers to the programs that control pacemakers, ecg's, and other medical tools and electronics. Others include even programs used to transfer information among doctors. The linked page is down now (possible slashdot effect) so I have no idea what the original page was talking about. Until everyone agrees (or finds out by reading the article) on exactly what types of software are being opened up to OSS, there is not much point debating the appropriateness of it.
Concerning my personal experience, this past summer, I worked on what I would consider to "medical software." It actually dealt with testing the accuracy of various pieces of medical hardware. Although I am no longer working on the project, there are plans to sell the resulting software to hospitals and other institutions, which is clearly incompatible with open source. In fact, most medical software of this type is probably developed for profit. OSS might have applications in other areas, however. The transfer of medical information among doctors and institutions, for example, could benefit from open standards and free tools. Treatment planning systems, on the other hand, are developed (at least partially) for a profit, and OSS would probably have little application there.
If you want to work on medical software professionally you need serious formal EE or CS degrees to the cieling. (sic)
I hate to burst your bubble, but you don't know of what you speak. I wrote hospital lab software for 3 years at the largest medical software company in the country (the former HBOC, now McKessonHBOC). While I do have a CS degree, I don't have them "to the ceiling", and most of the senior people I worked with didn't even have degrees.
While there are lots of regulations you must know, it isn't nearly as strict as you suggest. Most of the design review involves MDs, RN's, or Phlebotomists, so the coders and designers aren't expected to have mastered all the federal rules. There are design meetings, sanity checks, etc, with field professionals, but that's about it.
Perhaps because it is strictly a vertical market, the code written for these applications varies widely. Also, most hospitals, labs, etc, have simply attrocious security in place. It's frightening how easy it would be for someone to get their fingers on your medical records, or even tamper with them.
For example, many sites use no passwords on their servers, and fully 90% have direct dial in modems which will give you a shell prompt. I know, I had to dial into these sites many times to chase bugs, upload new software, or do maintainence on their system because their budget was so tight that a $10/hr lab tech was assigned responsibility for the system.
So, to put a point on it, just because it's "the medical field" doesn't mean the requirements for entry is so high. The only reason I see open source failing in this market is the need for hospitals to have someone on call 24/7, a way they can demand a fix be made, and someone to sue when someone dies. I'm not willing to be that person for free on an open-source project.
But, don't listen to me, I only worked in the industry.
Some guy named Chris
You've just proved why free software can be economically viable. You surely don't think Microsoft (for example) will provide a level of support that effective? Their sheer size forces them to offload the support burden onto just the sort of hostile drones you lambast.
You're absolutely right that it's the support. However, there's no reason this and the rigorous checking required can't be _combined_ with non-proprietary code. Everyone can benefit from sorts of code subjected to _severely_ ruthless testing and quality control (oh look, this routine causes a race condition/wrong answer/segfault one ten billionth of the time. *tweet* outta the pool!) and the resulting code could offer lessons to all OSS projects, whether or not they must be comparably reliable and safe. And again, it all comes down to who's willing to go the farthest for the customer, who can often be quite offbase. It's not possible to monopolise on this partly for simple reasons of efficiency, but in the normal flow of business, it's quite reasonable to stake out a really _solid_ niche based on such a level of support (think the Nordstrom's department stores on the West Coast). The emphasis in recent years of monopolise, cash out, quantity over quality business is a distortion of how the markets naturally work- normally trying to stake out a service niche is not only feasible but a really winning proposition. Only in situations of extreme competitive pressure from a monopolist dumping crapware and cutting off distribution, does it become unreasonable to try to establish a quality specialty product that doesn't attempt to seize the whole of the market as cheaply as possible.
I've read this thread with some interest, since I used to write medical software. Many of you are talking about imbedded systems, real-time stuff, like pacemakers, heart monitors, bypass machines, etc.
That is not what this article is about. This is about medical informatics, which is mostly database software. You know, patient records, lab reports, patient billing systems, handheld charting systems, radiology image storage/retrieval systems, stuff like that.
You know, like when you've been in the hospital for several days, and each day they put a new report with all the lab tests you've had run so far, trended so with a glance the MD can see if your red blood cell count is dropping, or if you are getting too much of a drug. The system that stores that data and generates the report, thats the kind of software that is being talked about.
Medical devices (which may contain software) are a whole differnent can of beans. Those require FDA testing and approval, and are a heap harder to bring to market.
The name American Medical Informatics Association should have tipped you off to the difference. Info, as in information.
Some guy named Chris
Hey we all want the A doctors- but oddly enough, somehow 50% of all doctors graduated in the bottom half of their class . . .
An obvious troll... but with the attention span of a 2-year-old. I find particularly amusing that you don't even bother to type correctly(ridicurous?).
Almost all of medical science is based on peer review. Only the final stages of drug development are keep out of the public domain. I assume the medical field will embrace open source faster than others, especially medical schools at Universities with good IT departments.
Medical technologies are one of those areas that I think should be open-sourced for obvious reasons. The notion of bugs and flaws that no one can get at in medical technology gives me the willies. As well, if by applying the "thousands of eyes" we can save lives, I think that's good for all.
I would agree full heartidly, but most of the general public I have talked with about this, and many papers I have read, have the idea that the opensource model is "peicemeal" and that with code from many different coders you some organization, security, and stability. I fear that unless the public is far better educated about opensource, and more popular things come from opensource, that these fears will keep opensource from entering such a sensitive field as the medical field.
by the FDA before that piece of equipment may be placed in production. The code review process that is used for medical equipment makes the code review process used by almost any other company look like a peacemeal process.
The long and the short of it is that it seems to me that using open source techniques on medical equipment won't significantly improve the quality of the code--but it may reduce the amount of time it takes before the code quality demanded by an FDA review can be met. Further, code reuse of pieces of code that has already been verified as correct by the FDA may help reduce the development time. And that would be a Great Thing...
I wonder whether an open source project in which changes have to go through a rigorous review/regression testing etc process can really survive, I can only see the participants getting bored and going back to work on some project that is more welcoming to quick hacks.
Open source isn't a magic bullet.
Damn, that's a troll if I've ever heard one. Being and M.D. is more than just memorization, though the first two years of training are largely memorization. Clinical thinking is not just memorization any more than programming is merely memorizing a few algorithms and syntax. As for the comment about no original work, each new patient is a completely new ballgame, a completely new and original job for me. True, the practice of medicine is not pure science, but it's not held out to be such. It's science applied, much like engineering. 90% of M.D.'s intolerably arrogant swine? Given the same logic, I could use your post as proof that 90% /. posters are intolerably arrogant swine. Just as in any field, medicine has it's share of jerks, but most of the people are normal decent folks. One could just as easily get the opinion that /.'ers (and technies) in general are arrogant swine by reading some of the posts on here, and it would be just as biased an opinion as yours seems to be. As for being less interesting and less use than carpentry, I would beg to differ. I find it fascinating, and I think you'd find it pretty damned useful if you suddenly started having severe chest pain today.
So much for the proprietary companies claiming that oss is unreliable and less useful than their "pay programs". If hospitals start using OSS en masse then it's a step ahead for the software industry, and a step back for proprietary software. YAY!
Restating the obvious since nineteen aught five.
______/._____/.___/.__/._/._/././././
*bzzzt!* Stupid slashdot effect....
--
In medical school, during the second year, students are told they must start refering to one another as "doctor." Meanwhile, 4th and 5th year graduate students in Physics call themselfs, each other and thier professors by thier first name. Medical school is the "boot camp" of education, where they "build you up" much like a Marine or something.... As for the "It's a trade. It's a more respectable and remunerative trade than carpentry, but certainly less interesting and arguably of less use." thing, your right. But, you call carpenters carpenters, and not "journeyman" or "apprentice", you don't assume all "journeyman" are carpenters and not electricians. That's the point I was makeing.
Has anyone even thought through the implications of Open Source medical software? Look at what a typical OSS project is like: release early and often; if it doesn't work today, don't worry there's a new release tomorrow; the users are the testers; etc., etc.
Aaaargh! Don't any of you even dare releasing any medical software until it has been 101% tested by experts in the field. A thousand eyes may see all bugs, but I don't want those eyes being medically illiterate hackers. And neither do I want it under a license that has a warranty disclaimer. If the developers don't trust it enough to warranty it, then neither should my physician. After it's finished, tested, beta tested and FDA approved, then, and only then, can you release it to the public.
If you think I'm off my rocker for saying this, keep in mind that this is what I do for a living. I'm a QA engineer for medical software. When the developers have done their own unit testing, integration testing, received FDA approval, and signed off on it, then I get it. And what usually happens is that I find a literal life-or-death bug in the first day of testing.
A Government Is a Body of People, Usually Notably Ungoverned
Meanwhile, hopefully he (the english professor) will attempt to preserve our language. Or, does everyone want to backpedal now and let the press refer to "crackers" as "hackers."
My point was, it's a SlashDot double standard to constantly correct one misused term, and feel fine to use another.
Now, call me Dr. and I'll laugh ;-) `cause I'm "Rob" not "Dr. Current" and think that it's only a sign of insecurity to require use of your title in anywhere other than a strict professional setting.
Hey, I was a carpenter for 15 years, now I'm a network engineer. Carpentry _can_ be very satisfying. Obviously, you're not saving lives, but you _do_ directly impact peoples lives. Where the hell was I going with this, anyway? Oh well, it's late. As far as the name thing, who cares?
webmaster: http://amazing.divingdeals.com
--- Think of it as evolution in action ---
I would recomend always sho bringing open sores to a doctor. I sure wouldnt depend on some programing to take care of it. ArsonSmith
Paying taxes to buy civilization is like paying a hooker to buy love.
The medical software company I used to work for always had an open source policy. The code is not GPL'd etc, its on a restricted license, but the principle of open source is there - release the source code to the customer; don't hide it.
This dates back to 1979 when the company was setup.
When the system was installed all the source was left on the machine too. This meant that we could easily debug on-line without the messiness of tapes and the resulting delay.
Our customers developed and maintained the software.
I'm now working in a hospital, and I develop and maintain the same software as a customer.
It's useful - I can determine exactly where a problem occurred and report it. The fault is fixed within minutes.
Most of the competition had a turn around time of 24 hours in getting a bug fix to us.
This is where the open source in medicine should be.
Our laboratory information system is open source as is our patient database.
I too worked for a decade developing database information systems for hospitals, clinics, etc...
What a quagmirish mess. In a typical larger facility, there would be dozens of seperate unconnected databases per patient. healthcare's recent answer to this, has been the development of data repositories (connecting the disparage of inf.), followed by efforts to merge reports from the relevant inf..
In my estimation, the medical/healthcare system would be served by coming to a standard interview format/health status screening, for this to happen, the medical/healthcare profession would need to approach the o-s community with the intention of same.
The result could be, a uniform patient assessment across an almost insolvent industry. part of the reason for the near insolvency, is the inability of the players to be able to agree on ANYTHING (therefore, scattering their info$ to the WINd), even though they ALL strive to obtain the same information.
The next part, that is also a shambles, is the notion of providing patients with a minimum amount of privacy concerning their medical records. recently, uncle s(h)am, at the behest of mr/ms megasloth, granted "business" a pretty much free access pass to the medical records of almost anybody who does "business" with a bank. can marketeers of everything else be far behind?
Since the net became a thing, I have found patient databases sitting on ftp sites, which speaks to the lax attitude of practitioners, as well as the lack of knowledge of webmasters re: the importance of keeping such records private.
We would be interested in discussion re: this situation with any/all interested, as it does not get any attention, in comparison to the gravity of the situation.
If a useable solution to the mess were to be developed, it would by it's very nature, be open-source.
harryjo@imcnet.net
True; for a good essay on why this is bad, read Lars Wirzenius' article Advocating Linux. After I read this, I started really thinking about the necessity of MS bashing. Raving about 'your own OS' can be fun, but in the long run it hurts the reputation of the community. And that's a loss for us all.
In 1996 if you even brought up the subject of computers in medicine at an interview they would have drawn and quartered you and used your remains to teach gross anatomy (personal experience). Now that they've opened that up, their next brick wall is allowing anyone but the most highly qualified MIT grads touch the source code used in medical applications. There's a reason why most of these medical technology companies are in the northeast. If you want to work on medical software professionally you need serious formal EE or CS degrees to the cieling. Managers in that area are more anal retentive about the formalities than Bill Gates is about using Windows. So maybe in 5 to 10 years if the medical profession becomes really really strapped for cash you'll be able to get an open source project running a patient information system but today it's more likely used as a web server, a mail transport agent, and the same drill.
many people here are wondering about accountability etc of those who wrote the
software. theres nothing wrong with a hospital
paying for the development of open source software
and still holding the authors accountable, or
at least going back to them when/if something
goes wrong. thats between the two parties
involved.
There's just too much money in proprietary drug$. It's also why so little research is being put into finding natural cures. No one can patent tree sap, but if you develop an artificial drug that cures the same thing, you can patent that and kaching! cash in bigtime.
Baloney. Drug companies canvas the earth looking for natural compounds to serve as drugs. Look at the success of Taxol, for example. And comments like 'you can't patent tree sap' are flat out wrong. I'd bet there are HUNDREDS of patents in the PTO files that have to do with tree sap and it's derivatives. Naturally occurring compounds are one of the biggest areas for pharmaceutical research.
There are at least two varieties of medical doctors. Most I have known had earned MD degrees at allopatric medical schools. Some medical doctors earn DO, doctor of osteopathic medicine, degrees. Osteopathic doctors have a more holistic view of the body. Osteopathic doctors are most prevalent as primary care physicians.
For that matter, a doctor is not simply one who earns a degree at a university. A certain Christian scholars, such as Thomas Aquinas, are known as the "doctors of the church." While it is a degree of recognition by the Roman Catholic Church, receiving the title is different from writing a dissertation at a university.
Etymologically, the word is related to the Latin docere meaning "to teach."
In short, you are wrong about both language and medicine.
Any of you interested in a C++ DICOM3.0 library? Medical Imaging area is mostly populated by proprietary software, so I just thought it needed a change. The library emerged from the "ashes" of a PACS project here at Bilkent, I wrote a quite extensive DICOM lib (because other sol'ns just didn't make it) on the damned NT, and I'm just porting that to the GNU platform. It's going to be a rather modern piece of medical imaging and communications package, so watch out for that! Thanks to a talk by RMS, I was able to convince our project supervisor of the greater good in free software.
If you're interested in such stuff, please let me know. Once I make the public release, there's gonna be need for discussions over how to cope with new versions of the standard and such...
We're also planning to push some GNOME/GTK+ components for the lib as well, (even a volume visualization component). This's gonna be tasty. I'd like to see how those $million proprietary software systems are going to crash.
Wohooo, the next century belongs to a GNU generation!
--exa--
I agree, mostly. I happen to work at a medtech company that is the process of developing a device (can't name it here) that is in many ways just as critical as a pacemaker, I can attest to the strength of the FDA review process. Futhermore, these companies are forced to review their own code simply to protect themselves from liability, if nothing else. There is a world of difference between doing extensive field and lab testing (which have obviously failed in the past), and verifying that the code does what it is supposed to do (relatively easy to verify).
I don't believe that Open Source would make any significant contributions in terms of development. In fact, I think it would be a really bad idea to seek out snippets of code from others. There is simply no substitute for a truely excellent and experienced programmer.
Open review might be worthwhile as a final test, though I think few would really provide review that even approaches the FDA--it is very labor intensive and requires certain detailed knowledge of the product. To really properly review the code (at a company like mine), it requires detailed knowledge of the product (as in mechanical, electrical, and optical engineering). Damn few people can even approach it...