The problem is that there's no incentive to contribute. You can take, but nothing makes you give back. Especially because if you give back, you're effectively working fo your competitors.
Let's start with the last phrase: you are not working for others, since you are selling a product yourself. Right there you made a factual, conceptual mistake.
Second, you assume, as a premise, that there are no incentives in contributing. But it easily seen that the incentives might lie in contributing to the maintenance of a common source tree which would otherwise be too laborious to maintain yourself. This constitutes a rational, work-related reason, totally alien to one's political views of the world (which seems to be part of the GPL thing).
Furthermore, the modifications I make give me an exclusive edge, because of customizations that might only be relevant to me, due to circumstances, not to the majority.
First, as *BSDs show, the GPL is not a sine-qua-non for having a pretty good open source operating system. This piece of evidence is frequently neglected by the wishful thinking/fallacious thought process of GPL fanboys or members of the Cult of Stallman. Going further, the adoption of FreeBSD userland code in Mac OS X has allowed for a truly great thing, a Unix for the masses (and, BTW, Apple has contributed code back as well as hired FreeBSD developers).
Second, most big open source projects are business-friendly through their licenses (look in there for the LGPL or exceptions or other licenses): KDE, Google software, Firefox, Perl, GNOME, etc.
Third, to stay away from the obvious, I'd like to consider the fact that there would be other, better, languages to program software in Linux, with faster and safer development cycles. Specifically, I'm talking about Eiffel and Ada that had powerful IDEs and compiler released under dual-licenses (GPL is your project if your project is GPL) but that didn't result in even a bleep on the radar screen of developers. Now, I know there's a cultural barrier (overindulgence in C/C++) but the fact is that releasing dual-licensed IDEs and compilers didn't help.
Third, the Church of FSF gets it all wrong by focusing on "freedom for code." Code is an abstract, inanimate thing. "Freedom" as a category applies to humans. Humans should be free to choose what to do with code. Open-source code can't be "stolen" because the fountain of resource keeps on giving. The Church of the FSF is a moralist cult.
Fourth, there is no way small software houses can compete with huge firms if they release GPL code. Everybody knows this. They'll take your code and give it to their staff. Greenspun wrote about this eons ago.
Finally, fifth, quit with the non-proprietary code hating. Currently, what's needed for the widepsread adoption for, e.g., Linux, is the hability to use a machine as a normal machine. Therefore, we need proprietary codecs, unless all the free software signal processing freaks (you there?) get together on a project like the BBC dirac, which is not happening for whatever reason... Otherwise, e.g., Linux will not be usable. So, the community's got to stop hating on distros that mingle Linux with those codecs, and stop hyping distros that require too much tweaking. Right now, throw some RAM and something like Matisse and Linux can impress people as much as, say, Vista.
And apt-get can potentially unisintall the kernel package - this is documented - for instance, on the academic literature about package management - about which you probably know shit.
Yes, Linux binary emulation actually works. A couple of years ago, the usual Linux ABI breakage - of which they are very proud of - made me unable to use Maple 8 (for which you have to buy an expensive license) on Ubuntu.
I installed FreeBSD and the Linux emulation layer, tweaked some stuff on the Maple side (basically, some scripts) and there you go - Maple ran on FreeBSD with the Linux emulation layer, while it refused to run on Linux itself, whcih it had done, just a release earlier (i.e., a couple of months).
I've tried this on other commercial software and it worked too (but this on a tweak-it-yourself basis).
This emulation layer is great and I wish more people (i.e., commercial software) used it, because you can write software for Linux and get FreeBSD customers, too.
This experience convinced me FreeBSD hackers were a notch higher in skills and experience than their Linux (Debian, Ubuntu, whatever) counterparts.
I've moved to Mac OS X since but still hang on to my FreeBSD. Don't want Linux anymore, thank you.
In Brazil, the Senate recently passed legislation demanding that ISPs keep logs for 3 years. It's causing total outrage at the ISP side, because it'll raise operational costs. The project still has to go through the Chamber of Deputies (i.e., Congress). The Budapest Convention (whatever that is...) requires 90-days logs.
Use your translator here (or, if you are able to comprehend Spanish you shouldn't have a lot of trouble with written Portuguese):
And Terra Soft was bought out by Fixstars, I keep forgetting.
A little tale of an epic Linux fail
on
Linux Needs Critics
·
· Score: 3, Interesting
Some couple of years ago, Brazil's government cut taxes for "popular" computers - low-end machines that came with Linux out-of-the-box. The idea was to create a competitive atmosphere and offer a cheap alternative to Windows XP.
This was an epic fail. The UI was so badly done - obviously by a Linux nerd who spent too much time in his life with fluxbox, that Linux looked, 2 years ago, something out of the stone age.
Massive uninstalls was what happened. A great time for computer technicians to install XP.
You talk to people who used those out-of-the-box Linux and they shudder just to hear about it. They describe it as something terribly outdated. The other day I was talking to a sales guys at the audio/video section at FNAC (a French chain also present in Brazil). I told him he should install Linux on one the PlayStation 3 units and show people how flexible the PS3 is - you get a BluRay DVD player, a video game that's the best on the market AND a nice operating system for the home. Do you know what he said? "Oh, but isn't Linux kinda old - it looks very old." Of course, I was thinking about gorgeous Englightement TerraSoft used on PS3's, but he was thinking about the pathetic thingies he saw.
Now, you might not care about killing a niche for Linux on a big market, but many people do. But when linux developers act like autistic nerds (when they're not autistic), then it's suicidal.
Re:Nope, it's the putative new users problem
on
Linux Needs Critics
·
· Score: 1, Flamebait
You guys keep discussing drivers, as if it were the only problem with Linux. But Linux has many issues.
For instance, within a "short time" (2 or 3 KDE GNOME releases, that is, around 1 1/2 year), bloat will render your machine useless.
On the other side of the fence, Joe Sixpack still has Windows XP because it just works. A Vista or Mac OS user will also have a longer lifetime and he/she won't have to jump through all the hoops just to get the damn thing updated.
Updates, for instance: even on a modern distro, updates just break, because most C/Linux developers have no theory about what to do - except keep doing what they do, which is making it up as they go along (contrast: OpenSuSE SAT solver for packages).
On GUIs: GNOME, for example, has conducted one usability study in more than 10 years (!) (that I know of). Spinning cubes do not make a smart solution or improvement on GUIs - it's eye candy
Another example: the UNIX help system. Will it ever use AI?
Linux and BSD are open but they benefit very little from experimentation and smart choices - exception made to OS systems programming - and this is a field very removed from the normal user.
Oh, I forgot: add the mandatory anti-virus software subscription for Windows, the (much more) costly office package (for most users, iWork fits the bill) and tell me Windows is still $500 cheaper in the same range of hardware.
Visual Studio 2008 Professional Edition with MSDN Premium Subscription$2,499 Visual Studio 2008 Professional Edition with MSDN Professional Subscription$1,199
Yeah, and it's either through the research agencies from their own countries or via grants and fellowships awarded through foundations (Rockefeller, Ford, UNESCO, etc.). None of these are "American taxpayer's money", I'd say...
You know what I think? By any standards, Americans have it too easy: houses are too big (compare them to any European), cars waste too much fuel, credit is too easy, etc.
Think about it: anybody who's got to compete with you has to at least bilingual, be up-to-date with everything you know (that is, read your books, read your papers), spend shitloads of money doing it that, etc.
I've heard US American presidents for decades preach about the free market. Well, there's free market and globalization for you - you get to rub elbows with Indians, etc. You don't like it? Tough it out.
But what I really expect your government to do is just to trample on the WTO's rules of trade and put forward a protectionist program, that is: to really come across once again as the jingoist nation full of B.S. that you are, one in which the rules apply to everyone else (for instance, the rule of international law), but not to you.
This isn't exactly correct, although it happens to some PhD applicants.
Sometimes, they'll be awarded a fellowship (Ford Foundation, Rockefeller Foundation, UNESCO, etc. Other times, their own government will give them their stipends, which might run over a 7 digit number in their local currency (because the US dollar is so overvalued).
In none of these cases are the US people "paying for their education." Rather, the only currency that is being bought and paid is scientific research.
So some of you'd guys better shut the f* up with the xenophobic arguments.
The united states became the worlds dominant technological power house through the exercise of liberal education benefits. Unlike Europe and a lot of countries you could become educated with fairly modest means if you are willing to work.
Bullshit. A lot of countries have public education systems where anyone that's busted his balls in school can get in, even get a medical or engineering degree in the best of schools.
I know many such people - guys who came from simple families and now are out of life of travail that their parents were in. I'm talking getting out of practically a peasant's life and landing a job in engineering in a top corporation.
In the US, only the elite gets into Ivy League colleges. You just don't know enough about the world, that's why you say those things. Think about some of the Chinese PhD student that gets to work on on the largest tech firms in the US. Do you think he came form a wealthy family back in China? Or India? What are the odds they are self-made through their educational effort? Compare it with the typical Caltech, Harvard, Yale, etc. student. A lot of them are 4th generation Harvard students, etc., and come from wealthy families, obscene wealth when you compare them with their Indian, Chinese, etc. colleagues.
What shocks me every time I stand on the US customs line is how come it's so fucking easy for complete losers to simply immigrate to the US (where they'll do any menial job that's available), while if you're a scientist, engineer or a doctor (that is, you have a lot to loose with immigration - but also a lot to gain), it's a complete PITA to simply become a US resident/worker?
Same thing in Europe. Boat people simply immigrate. Engineers, scientists and other highly qualified workers etc. must face a veritable via crucis.
Despite what the lady says, this will end up as the government telling doctors what they can and cannot do, what medicines and treatments to prescribe.
These needn't necessarily be as you depicted. In Brazil, we have a system where the federal government oversees major issues in public health policies (e.g., thwarting an AIDS epidemic in the 80s and 90s, dengue fever epidemic, infant mortality and vaccination, etc.) but then you have a federal medical board, and each state has its own state medical board. The guidelines for therapy are suggested by the specialists in the medical societies, just like in the USA. The boards get involved in the guidelines in malpractice cases. These cases are not under common criminal law (unless a crime was effectively committed) and are not subject to a jury of layman, but to medical specialists. In a malpractice case, the board may examine whether the normal widely accepted therapy was adopted and, if not, why not.
The public health guidelines are suggested by the public health specialists, working together with the other relevant specialist and some diseases involve compulsory notification, just like the CDC in Atlanta does for some diseases.
It's not all bad. Doctors don't live under a totalitarian state.:-) Most doctors in the Western world already follow guidelines by their respective societies.
US health care doesn't run on logic, but rather puritan morals and vague capitalist ideology
US Americans reject any sort of Federal Government interference, it seems. However, I believe that in issues of public health and education, you must set some guidelines for all, lest you end up with Bizarro World situations like, having to choose which finger you can afford to have reimplanted, or a school board rejecting the Theory of Evolution.
This has nothing to do with "socialism". The fact that politicians from the GOP would even use that term associated with universal health care shows how little reading they've done in their life. The fact is countries with huge populations, such as the USA, Brazil, China, India, etc. are not like a tiny country like Switzerland, where they can get together in their "cantons" and vote stuff. Furthermore, the USA is much more like the BRICS (Brazil, China, India and Russia) in that the population is huge and there's a substantial portion of its population that is falling through the cracks in terms of quality of life and other standards of living.
In my country (Brazil), you'd have the option of walking to a public health facility in your neighborhood and get yourself seen by a doctor (a GP), who would ask for exams and, depending on the results, would refer you to a hospital (or immediately if it was the case of a medical emergency). Not fancy, but at least it wouldn't cost you $3150 for a shitty job. Because, really, that was a shitty job. You'd probably land in a hospital you'd consider disgustingly shitty, but it would be free and they would follow generally-agreed international guidelines (so, no voodoo medicine for you).
Or, you could go see the private practitioners if you have a health plan. The difference from America is that the Federal Government sets standards via legislation regarding what the health care providers can reject or not. In America, there's no oversight, it really is a free market and the result is John Doe is completely lost in a jungle of contracts and catch 22s. Free market sounds great, but most people aren't capable of grasping medical treatment gotchas in their contracts, so they end up being treated like suckers.
A sad fact for the clinician in private practice (I say this because some countries have public health services) is that, were he/she to give a much cheaper and older medication, the patient would walk out the door and find a new doctor, because his old doctor wasn't up-to-date (the patient thought). Everybody knows newer meds that cost $80 work better than old stuff that cost $10. Right? It's obvious! Otherwise, why would the pharma industry even develop it in the first place?
There's a joke about the medical student who, when asked what he wanted to do as a speciality said: "I just wanna stay in a dark room, in the basement, and not see any patients." "Ah! A radiologist!", said the doctor who inquired.
Now the evidence suggests that I place him on a beta-blocker to treat his HTN and his CHF concurrently. But beta-blockers are relatively contraindicated in acute exacerbations of COPD. The evidence suggests that I place him on an ACE inhibitor to treat his DM and HTN, but that would decrease his kidney function, and he's already at the tipping point of needing dialysis soon. He was on clonidine, which is terrible in a patient like him that misses doses regularly because rebound from clonidine will make his HTN worse. He also came in on a maximal alpha-blocker and maximal CCA with no control (yet). This is the conundrum that doctors frequently find themselves in, because there is no evidence that matches up to this patient, because he (and the millions like him out there) are frequently the patients that are left out of RCTs due to their preexisting comorbidities (confounding factors, if you will). Which leaves us, the medical community, with jack-squat since we still have to treat real-world patients.
I would say this is precisely the case why the medical practice sorely needs electronic medical records, so that you could resort to some sort of case-based reasoning software analysis and/or data-mining.
However, just as medical practitioners shun EBM (and remember when the theory supported CCAs for hypertension but then the evidence said they had increased the risk of mortality?) they will probably reject computer-aided diagnosis. This, in part, is because of the intrusive nature of computer aid today. But somebody posted up somewhere in this Slashdot thread an article about checklists and how physicians reject even this simple measure that can significantly reduce errors and misdiagnosis, which reveals that there seems to be a cultural problem with the medical class too.
We need to resort to new techniques of long-term follow up. We need to be able to do huge data-mining on these records, precisely to discover who - and why - is "falling though the cracks of evidence."
Slashdot Mirror
Don't make the software as your business.
Consider firms selling router/applicances/etc with FreeBSD.
IMHO, unless you're IBM (or, realistically, just a worker for IBM), Linux makes this very, very hard.
The problem is that there's no incentive to contribute. You can take, but nothing makes you give back. Especially because if you give back, you're effectively working fo your competitors.
Let's start with the last phrase: you are not working for others, since you are selling a product yourself. Right there you made a factual, conceptual mistake.
Second, you assume, as a premise, that there are no incentives in contributing. But it easily seen that the incentives might lie in contributing to the maintenance of a common source tree which would otherwise be too laborious to maintain yourself. This constitutes a rational, work-related reason, totally alien to one's political views of the world (which seems to be part of the GPL thing).
Furthermore, the modifications I make give me an exclusive edge, because of customizations that might only be relevant to me, due to circumstances, not to the majority.
First, as *BSDs show, the GPL is not a sine-qua-non for having a pretty good open source operating system. This piece of evidence is frequently neglected by the wishful thinking/fallacious thought process of GPL fanboys or members of the Cult of Stallman. Going further, the adoption of FreeBSD userland code in Mac OS X has allowed for a truly great thing, a Unix for the masses (and, BTW, Apple has contributed code back as well as hired FreeBSD developers).
Second, most big open source projects are business-friendly through their licenses (look in there for the LGPL or exceptions or other licenses): KDE, Google software, Firefox, Perl, GNOME, etc.
Third, to stay away from the obvious, I'd like to consider the fact that there would be other, better, languages to program software in Linux, with faster and safer development cycles. Specifically, I'm talking about Eiffel and Ada that had powerful IDEs and compiler released under dual-licenses (GPL is your project if your project is GPL) but that didn't result in even a bleep on the radar screen of developers. Now, I know there's a cultural barrier (overindulgence in C/C++) but the fact is that releasing dual-licensed IDEs and compilers didn't help.
Third, the Church of FSF gets it all wrong by focusing on "freedom for code." Code is an abstract, inanimate thing. "Freedom" as a category applies to humans. Humans should be free to choose what to do with code. Open-source code can't be "stolen" because the fountain of resource keeps on giving. The Church of the FSF is a moralist cult.
Fourth, there is no way small software houses can compete with huge firms if they release GPL code. Everybody knows this. They'll take your code and give it to their staff. Greenspun wrote about this eons ago.
Finally, fifth, quit with the non-proprietary code hating. Currently, what's needed for the widepsread adoption for, e.g., Linux, is the hability to use a machine as a normal machine. Therefore, we need proprietary codecs, unless all the free software signal processing freaks (you there?) get together on a project like the BBC dirac, which is not happening for whatever reason... Otherwise, e.g., Linux will not be usable. So, the community's got to stop hating on distros that mingle Linux with those codecs, and stop hyping distros that require too much tweaking. Right now, throw some RAM and something like Matisse and Linux can impress people as much as, say, Vista.
And apt-get can potentially unisintall the kernel package - this is documented - for instance, on the academic literature about package management - about which you probably know shit.
Yes, Linux binary emulation actually works. A couple of years ago, the usual Linux ABI breakage - of which they are very proud of - made me unable to use Maple 8 (for which you have to buy an expensive license) on Ubuntu.
I installed FreeBSD and the Linux emulation layer, tweaked some stuff on the Maple side (basically, some scripts) and there you go - Maple ran on FreeBSD with the Linux emulation layer, while it refused to run on Linux itself, whcih it had done, just a release earlier (i.e., a couple of months).
I've tried this on other commercial software and it worked too (but this on a tweak-it-yourself basis).
This emulation layer is great and I wish more people (i.e., commercial software) used it, because you can write software for Linux and get FreeBSD customers, too.
This experience convinced me FreeBSD hackers were a notch higher in skills and experience than their Linux (Debian, Ubuntu, whatever) counterparts.
I've moved to Mac OS X since but still hang on to my FreeBSD. Don't want Linux anymore, thank you.
In Brazil, the Senate recently passed legislation demanding that ISPs keep logs for 3 years. It's causing total outrage at the ISP side, because it'll raise operational costs. The project still has to go through the Chamber of Deputies (i.e., Congress). The Budapest Convention (whatever that is...) requires 90-days logs.
Use your translator here (or, if you are able to comprehend Spanish you shouldn't have a lot of trouble with written Portuguese):
http://br-linux.org/2008/ja-era-senado-aprova-projeto-de-lei-da-internet-todos-os-acessos-deverao-ser-arquivados-no-provedor-por-3-anos/
http://idgnow.uol.com.br/internet/2008/07/10/prazo-para-guardar-logs-de-internautas-deve-ser-modificado-diz-abranet/
s/Englightement/Enlightenment
And Terra Soft was bought out by Fixstars, I keep forgetting.
Some couple of years ago, Brazil's government cut taxes for "popular" computers - low-end machines that came with Linux out-of-the-box. The idea was to create a competitive atmosphere and offer a cheap alternative to Windows XP.
This was an epic fail. The UI was so badly done - obviously by a Linux nerd who spent too much time in his life with fluxbox, that Linux looked, 2 years ago, something out of the stone age.
Massive uninstalls was what happened. A great time for computer technicians to install XP.
You talk to people who used those out-of-the-box Linux and they shudder just to hear about it. They describe it as something terribly outdated. The other day I was talking to a sales guys at the audio/video section at FNAC (a French chain also present in Brazil). I told him he should install Linux on one the PlayStation 3 units and show people how flexible the PS3 is - you get a BluRay DVD player, a video game that's the best on the market AND a nice operating system for the home. Do you know what he said? "Oh, but isn't Linux kinda old - it looks very old." Of course, I was thinking about gorgeous Englightement TerraSoft used on PS3's, but he was thinking about the pathetic thingies he saw.
Now, you might not care about killing a niche for Linux on a big market, but many people do. But when linux developers act like autistic nerds (when they're not autistic), then it's suicidal.
See: http://www.linux.com/articles/59637
You guys keep discussing drivers, as if it were the only problem with Linux. But Linux has many issues.
For instance, within a "short time" (2 or 3 KDE GNOME releases, that is, around 1 1/2 year), bloat will render your machine useless.
On the other side of the fence, Joe Sixpack still has Windows XP because it just works. A Vista or Mac OS user will also have a longer lifetime and he/she won't have to jump through all the hoops just to get the damn thing updated.
Updates, for instance: even on a modern distro, updates just break, because most C/Linux developers have no theory about what to do - except keep doing what they do, which is making it up as they go along (contrast: OpenSuSE SAT solver for packages).
On GUIs: GNOME, for example, has conducted one usability study in more than 10 years (!) (that I know of). Spinning cubes do not make a smart solution or improvement on GUIs - it's eye candy
Another example: the UNIX help system. Will it ever use AI?
Linux and BSD are open but they benefit very little from experimentation and smart choices - exception made to OS systems programming - and this is a field very removed from the normal user.
Disclaimer: Proud Ubuntu user since 7.10 and have never even considered moving back to windows.
That sort of ranks you as a n00b.
Oh, I forgot: add the mandatory anti-virus software subscription for Windows, the (much more) costly office package (for most users, iWork fits the bill) and tell me Windows is still $500 cheaper in the same range of hardware.
Don't forget also the freebies: the developer environment for programmers, the free picture and music software, the free Oxford dictionary, etc.
"How much does visual studio 2008 cost and where can i buy it?"
http://answers.yahoo.com/question/index?qid=20080311063249AA3e1v2
Visual Studio 2008 Professional Edition with MSDN Premium Subscription$2,499
Visual Studio 2008 Professional Edition with MSDN Professional Subscription$1,199
Maybe there's your $500 ?
Yeah, and it's either through the research agencies from their own countries or via grants and fellowships awarded through foundations (Rockefeller, Ford, UNESCO, etc.). None of these are "American taxpayer's money", I'd say...
What are you talking about? Is it really that bad nowadays? I can't believe it...
You know what I think? By any standards, Americans have it too easy: houses are too big (compare them to any European), cars waste too much fuel, credit is too easy, etc.
Think about it: anybody who's got to compete with you has to at least bilingual, be up-to-date with everything you know (that is, read your books, read your papers), spend shitloads of money doing it that, etc.
I've heard US American presidents for decades preach about the free market. Well, there's free market and globalization for you - you get to rub elbows with Indians, etc. You don't like it? Tough it out.
But what I really expect your government to do is just to trample on the WTO's rules of trade and put forward a protectionist program, that is: to really come across once again as the jingoist nation full of B.S. that you are, one in which the rules apply to everyone else (for instance, the rule of international law), but not to you.
You guys have it easy. Stop complaining.
Our taxes pay for their education and research
This isn't exactly correct, although it happens to some PhD applicants.
Sometimes, they'll be awarded a fellowship (Ford Foundation, Rockefeller Foundation, UNESCO, etc. Other times, their own government will give them their stipends, which might run over a 7 digit number in their local currency (because the US dollar is so overvalued).
In none of these cases are the US people "paying for their education." Rather, the only currency that is being bought and paid is scientific research.
So some of you'd guys better shut the f* up with the xenophobic arguments.
The united states became the worlds dominant technological power house through the exercise of liberal education benefits. Unlike Europe and a lot of countries you could become educated with fairly modest means if you are willing to work.
Bullshit. A lot of countries have public education systems where anyone that's busted his balls in school can get in, even get a medical or engineering degree in the best of schools.
I know many such people - guys who came from simple families and now are out of life of travail that their parents were in. I'm talking getting out of practically a peasant's life and landing a job in engineering in a top corporation.
In the US, only the elite gets into Ivy League colleges. You just don't know enough about the world, that's why you say those things. Think about some of the Chinese PhD student that gets to work on on the largest tech firms in the US. Do you think he came form a wealthy family back in China? Or India? What are the odds they are self-made through their educational effort? Compare it with the typical Caltech, Harvard, Yale, etc. student. A lot of them are 4th generation Harvard students, etc., and come from wealthy families, obscene wealth when you compare them with their Indian, Chinese, etc. colleagues.
What shocks me every time I stand on the US customs line is how come it's so fucking easy for complete losers to simply immigrate to the US (where they'll do any menial job that's available), while if you're a scientist, engineer or a doctor (that is, you have a lot to loose with immigration - but also a lot to gain), it's a complete PITA to simply become a US resident/worker?
Same thing in Europe. Boat people simply immigrate. Engineers, scientists and other highly qualified workers etc. must face a veritable via crucis.
Despite what the lady says, this will end up as the government telling doctors what they can and cannot do, what medicines and treatments to prescribe.
These needn't necessarily be as you depicted. In Brazil, we have a system where the federal government oversees major issues in public health policies (e.g., thwarting an AIDS epidemic in the 80s and 90s, dengue fever epidemic, infant mortality and vaccination, etc.) but then you have a federal medical board, and each state has its own state medical board. The guidelines for therapy are suggested by the specialists in the medical societies, just like in the USA. The boards get involved in the guidelines in malpractice cases. These cases are not under common criminal law (unless a crime was effectively committed) and are not subject to a jury of layman, but to medical specialists. In a malpractice case, the board may examine whether the normal widely accepted therapy was adopted and, if not, why not.
The public health guidelines are suggested by the public health specialists, working together with the other relevant specialist and some diseases involve compulsory notification, just like the CDC in Atlanta does for some diseases.
It's not all bad. Doctors don't live under a totalitarian state. :-) Most doctors in the Western world already follow guidelines by their respective societies.
US health care doesn't run on logic, but rather puritan morals and vague capitalist ideology
US Americans reject any sort of Federal Government interference, it seems. However, I believe that in issues of public health and education, you must set some guidelines for all, lest you end up with Bizarro World situations like, having to choose which finger you can afford to have reimplanted, or a school board rejecting the Theory of Evolution.
This has nothing to do with "socialism". The fact that politicians from the GOP would even use that term associated with universal health care shows how little reading they've done in their life. The fact is countries with huge populations, such as the USA, Brazil, China, India, etc. are not like a tiny country like Switzerland, where they can get together in their "cantons" and vote stuff. Furthermore, the USA is much more like the BRICS (Brazil, China, India and Russia) in that the population is huge and there's a substantial portion of its population that is falling through the cracks in terms of quality of life and other standards of living.
In my country (Brazil), you'd have the option of walking to a public health facility in your neighborhood and get yourself seen by a doctor (a GP), who would ask for exams and, depending on the results, would refer you to a hospital (or immediately if it was the case of a medical emergency). Not fancy, but at least it wouldn't cost you $3150 for a shitty job. Because, really, that was a shitty job. You'd probably land in a hospital you'd consider disgustingly shitty, but it would be free and they would follow generally-agreed international guidelines (so, no voodoo medicine for you).
Or, you could go see the private practitioners if you have a health plan. The difference from America is that the Federal Government sets standards via legislation regarding what the health care providers can reject or not. In America, there's no oversight, it really is a free market and the result is John Doe is completely lost in a jungle of contracts and catch 22s. Free market sounds great, but most people aren't capable of grasping medical treatment gotchas in their contracts, so they end up being treated like suckers.
A sad fact for the clinician in private practice (I say this because some countries have public health services) is that, were he/she to give a much cheaper and older medication, the patient would walk out the door and find a new doctor, because his old doctor wasn't up-to-date (the patient thought). Everybody knows newer meds that cost $80 work better than old stuff that cost $10. Right? It's obvious! Otherwise, why would the pharma industry even develop it in the first place?
There's a joke about the medical student who, when asked what he wanted to do as a speciality said: "I just wanna stay in a dark room, in the basement, and not see any patients." "Ah! A radiologist!", said the doctor who inquired.
Sorry. I forgot my own grammar-nazi at home.
Now the evidence suggests that I place him on a beta-blocker to treat his HTN and his CHF concurrently. But beta-blockers are relatively contraindicated in acute exacerbations of COPD. The evidence suggests that I place him on an ACE inhibitor to treat his DM and HTN, but that would decrease his kidney function, and he's already at the tipping point of needing dialysis soon. He was on clonidine, which is terrible in a patient like him that misses doses regularly because rebound from clonidine will make his HTN worse. He also came in on a maximal alpha-blocker and maximal CCA with no control (yet). This is the conundrum that doctors frequently find themselves in, because there is no evidence that matches up to this patient, because he (and the millions like him out there) are frequently the patients that are left out of RCTs due to their preexisting comorbidities (confounding factors, if you will). Which leaves us, the medical community, with jack-squat since we still have to treat real-world patients.
I would say this is precisely the case why the medical practice sorely needs electronic medical records, so that you could resort to some sort of case-based reasoning software analysis and/or data-mining.
However, just as medical practitioners shun EBM (and remember when the theory supported CCAs for hypertension but then the evidence said they had increased the risk of mortality?) they will probably reject computer-aided diagnosis. This, in part, is because of the intrusive nature of computer aid today. But somebody posted up somewhere in this Slashdot thread an article about checklists and how physicians reject even this simple measure that can significantly reduce errors and misdiagnosis, which reveals that there seems to be a cultural problem with the medical class too.
We need to resort to new techniques of long-term follow up. We need to be able to do huge data-mining on these records, precisely to discover who - and why - is "falling though the cracks of evidence."