Thinking about my post on Theranos yesterday it occurred to me that one thing that’s great about all of the innovation and technology coming out of places like Silicon Valley is the tremendous reduction of friction in our lives. With Uber it’s much easier to get a ride because of improvement in communication and an increase in the supply of cars. With Amazon, I can get that jug of vegetable oil that I always wanted without having to leave the house, because Amazon.
So why is there all this friction? Sometimes it’s because of regulation, which may have made sense at an earlier time, but perhaps doesn’t make as much sense now. Sometimes, you need a company like Amazon to really master the logistics operation to be able to deliver anything anywhere. Otherwise, you’re just stuck driving to the grocery store to get that vegetable oil.
But sometimes there’s friction for a reason. For example, Ben Thompson talks about how previously there was quite a bit more friction involved before law enforcement could listen in on our communications. Although wiretapping had long been around (as noted by David Simon of…The Wire) the removal of all friction by the NSA made the situation quite different. Related to this idea is the massive data release from OkCupid a few weeks ago, as I discussed on the latest Not So Standard Deviations podcast episode. Sure, your OkCupid profile is visible to everyone with an account, but having someone vacuum up 70,000 profiles and dumping them on the web for anyone to view is not what people signed up for—there is a qualitative difference there.
When it comes to Theranos and diagnostic testing in general, there is similarly a need for some friction in order to protect public health. John Ioannides notes in his commentary for JAMA:
Even if the tests were accurate, when they are performed in massive scale and multiple times, the possibility of causing substantial harm from widespread testing is very real, as errors accumulate with multiple testing. Repeated testing of an individual is potentially a dangerous self-harm practice, and these individuals are destined to have some incorrect laboratory results and eventually experience harm, such as, for example, the anxiety of being labeled with a serious condition or adverse effects from increased testing and procedures to evaluate false-positive test results. Moreover, if the diagnostic testing process becomes dissociated from physicians, self-testing and self-interpretation could cause even more problems than they aim to solve.
Unlike with the NSA, where the differences in scale may be difficult to quantify because the exact extent of the program is unknown to most people, with diagnostic testing, we can precisely quantify how a diagnostic test’s characteristics will change if we apply it to 1,000 people vs. 1,000,000 people. This is why organizations like the US Preventative Services Task Force so carefully considers recommendations for testing or screening (and why they have a really tough job).
I’ll admit that a lot of the friction in our daily lives is pointless and it would be great to reduce it if possible. But in many cases, it was us that put the friction there for a reason, and it’s sometimes good to think about why before we move to eliminate it.comments powered by Disqus