and convention by dominic.cecilia

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                       Scale and Convention: Programmed
                       languages in a regulated America
                            Saturated Introduction: A Program of
                            Contents

                                   This thesis treats a variety of programmed
                                languages in late twentieth century life in America
                                and 'the rest of the world'. It begins as an
                                ethnographic description of a small set of sites in
                                healthcare information technology, where I was
                                entangled in the bureaucratic bathos of a huge
                                academic hospital and experienced the excitement
                                of an internet healthcare start-up company. It ends
                                in many places. As a result, and in order to say
                                some complicated things, this dissertation
                                somersaults through an eclectic set of issues,
                                viewed from a variety of disciplinary perspectives
                                any one of which alone would have missed the
                                connections that I intend to make concerning
                                language, software, standards, regulations, and the
                                internet; it uses the American healthcare
                                industry— in particular that segment dealing with
                                radiological images for diagnosis— to explain the
                                scale and convention of a fluidly programmable
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                                            scale and convention of a fluidly programmable
                                            international market economy.

                                               What I am calling programmed language
1 . If there is a single tex t
that orients this project it is
                                            includes all of the ways in which language is both
Of            Grammatology                  meaning and action at the same time. When
[Derrida7 6], in particular
the first part (in particular,              language is both representational and
in particular, see pages
6-1 0, which begin the                      performative, I call it programmed [1]. This
inv estigation by reference
to the program). It is the                  implies first a connection to the empirical fact of
argument of this tex t,
among other things, that all                the ubiquity of computers, computing, and
language is so programmed,
from its beginnings to the                  networked communication in modern life, but also
present. This tex t is not in
this thesis, nor is it the                  to the similarly ubiquitous fact of design as a
thesis and y et it is what
motiv ates it. To continue
the metaphor, it is the taste
of Scale and Conv ention.                   medium for constraining, influencing or
                                            controlling actions. From the simplest search
                                            algorithm to a democratic constitution,
                                            programmed language designs constraints on the
                                            actions of actors and changes the configuration of
                                            organized society, its symbolic structure and the
                                            subjectivities of its inhabitants. These are not
                                            solely the function of language itself, however, but
                                            the character of language that has been designed—
                                            that has yielded, however insignificantly, to the
                                            actions of other actors and other programs. I find
                                            programmed languages everywhere.

                                               Programmed language in technical standards,
                                            especially those concerning the specification of
                                            telecommunications and software design, (in
2. The Prov erber being of
course, Gregory Bateson.
                                            particular, the internet, which is differentiated
The difference that I identify              from other telecommunication networks and other
here     might     suffer     a
confrontation       with      a             kinds of software design) is explored both as a
particular
theoretical-historical                      representation and as a thing. That is to say,
literature that I identify
with Foucault's The Order of                standards are explored as representations that
Things [Foucault7 3] The
question    of     the    tex t             order reality, and as performatives that "do
concerns the historicity of
representation      and     its             things". My label for the latter: the ubiquitous cry
relationship to a world of
documents,      things    and
                                            of the happy programmer: "it works!". My research
ideas.    The    orders      of             led me to the conclusion that there is an essential
representation      somewhat
ineluctably unfurl in time                  difference between two types of standards-setting
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                                              processes. There is the hierarchical,
                                              "consensus-oriented incrementalism" of national
                                              and international standards development
                                              organizations who have complex bureaucracies
                                              that intend standards to be complete, and separate
                                              from any mere implementation of them in the real
                                              world. Call them Platonic standards, perhaps. Then
                                              there is the seat-of-the-pants standardization work
                                              of the internet (in particular the Internet Society
from age to age, with the
occasional signature ev ent                   and its connected organizations) that insists on the
marking their separations.
This approach is ex tended                    existence of two working implementations as the
in    Discourse        Networks
1 800/1 900 by Friedrich
Kittler    [Kittler90]       and
[Kittler99] which specifies
these           orders         of
                                              minimum requirement for becoming a standard
representation in a crucially                 (which is subsequently no less modifiable). Call
material form: by reference
to the sy stems of writing                    them pragmatic standards. It is unclear whether
that gov ern them, and
ev entually , as the twentieth                the distinction between these two orders of
century approaches, the
ex panded         array        of             representation (or between the order of
inscription        technologies
ordering and attempting to                    representation and the order of programming) is
control the representations
and actions of words. I hav e                 tenable, but it is the goal of Scale and Convention
not      conv inced          this
dissertation        that      the             to investigate this with specific emphasis on the
difference it has identified is
such       an         elemental
                                              internet, which is not merely one network among
representational           break,             others, but is the proverbial difference that makes
partially because I hav e
been more concerned with a                    a difference [2].
circumscribed           political
implication          of      this
difference, and partially
because       I     think     the                Programmed language in software and
prov enance of programmed
language is v ery old, and I
                                              networking design, especially concerning the
default     again       to     Of             concept of openness, to which I was led almost
Grammatology , see note 1 .
                                              inevitably from the question of standards raised
                                              above, via the term 'open standards' and from
                                              there to details of how software and networks are
                                              open: technically, legally, religiously, and
                                              world-historically. Openness comes in all forms,
                                              from weak to strong, but it concerns, above all,
                                              communicability. That is, openness depends on
                                              conventions that themselves are open, freely
                                              available and in the furthest case, modifiable by
                                              anyone. The structure of such a situation is what
                                              the Free Software Foundation and opensource.org
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                                            find themselves proposing to a software industry
                                            entrenched in a world of copyright. The languages
                                            of software therefore include the availability of
                                            source code, the adherence to the standard
3. This distinction is the                  protocols of the internet, and a certain ideology of
same ambiguous distinction
as         that       between               openness that is yoked to a myth of the scientific
mathematics, or numbers,
and ordinary language. To                   method. Also important here is the distinction
the      ex tent    that    all
communication must be                       between technical and non-technical. Software,
situated (or contex tualized)
to     'work',    mathematics               especially the source-code of high-level
participates in this (when it
is not a          metaphy sical             programming languages possesses peculiar
substance, or a Platonic
Idea). The thesis relies on                 relations to 'ordinary' language that make the
the assumption that their is
a     continuity      between
ordinary       language    and
mathematics (or software in                 distinction between technical and non-technical
this particular case), and
that the differences that                   non-obvious [3]. Standards that govern the
ex ist between them are a
function of conv entions, not               communicability of software are what decides
natures.
                                            between the technical and the non-technical, and it
                                            is therefore worth paying attention to the political
                                            organization implied by the standardization of
                                            software. Openness itself has become that which
                                            legitimates an open standard [4].

                                               Programmed language in law, especially that of
                                            trademark, patent and copyright law, and of
                                            commercial contract law. Law is the quintessential
                                            example of performative language, and the
                                            investigations of law's legitimacy rarely fails to
                                            recognize this peculiar procedural function. Law
                                            enters this thesis in two places: first in the form of
                                            a lawyer, Larry Lessig, who I take as a kind of foil
                                            for a second wave of internet related 'hype' (that
4. Throughout this thesis, I                concerning the revolutionary power of "open
use the word legitimacy
when referring to          the              source" software, more below on hype). His
ex istence of a standard or
conv ention.     This    term
                                            discussion of how the "code" of the internet
implies some relationship of                regulates "us" just as much as the "code" of the US
desire,    faith,     passion,
resistance to accepting a                   congress is a perspicacious entry to the peculiar
conv ention that has not
been arriv ed at organically .              ubiquity of programming techniques in legal
Max Weber, of course, is the
primary reference for this                  langauge. Copyright, obviously, opens onto a
concept, and I rely to a
                                            history of the legal regime of property, which will
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                                           be essential for understanding the problematic
                                           distinction between product and service, or thing
                                           and person. Trademark, and the gerund
                                           "branding" relate the issues of the tangibility or
                                           intangibility of property to the legal basis of right
                                           to the technical reconfiguration of manufacturing
                                           to the power of marketing. In the second section, I
                                           take the history of the legal regime of property in
                                           the US as an essential background to
large ex tent on his ty pology
of legitimate domination                   understanding the possibilities created on and by
and its relationship to the
structure of economy and                   the internet. The possibility for the variety of
society [Weber68]. I hav e
tried     to     specify   the
particular      instances   of
legitimation with respect to
the languages of the actors
                                           "services" and "solutions" that have appeared on
in each case, rather than                  the internet forces certain questions not just about
rely ing on Weber as just
such         an      inorganic             the legitimacy of property, but the very source of
conv ention.
                                           value as well [5].

                                              Programmed language in regulation, especially
                                           the legal implications of a property regime that has
                                           moved always in the direction of intangibility of
                                           property, towards the guarantee of rights and
                                           hence the need for expertise in the discernment of
                                           rights to property. The twentieth century creation
                                           of an American regulatory state— the delegation of
                                           legislative power to private, unelected citizens, and
                                           the subsequent erosion of the distinction between
                                           public and private governance— is also essential to
                                           understanding the role that standards have today
                                           as law. The legacy of regulation is its power and its
                                           ubiquitousness, producing a situation that some
5. The treatment of law in                 economists now refer to as a 'political economy of
this thesis is necessarily
cursory . It appears both too              fairness.' The history of healthcare as an
generally       and       too
specifically . The former                  infrastructure of medical technologies submitted
because there are hundreds
of    references    for   the              to this complex political economy of fairness
relationship         between
language and law (the
                                           should appear as an obvious test case for any
Cardozo studies in Law and                 description of the current status of the regulatory
Literature, and the works of
Robert Cov er are a good                   state and the technical configuration of society.
starting point [Cov er92]);
the latter because I focus on              The specific test case drawn from my fieldwork
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                                           concerns the Company Amicas and the internet
                                           service it provides to radiology in healthcare [6].

                                             Programmed language in hype and buzz,
                                           especially as it exists in the healthcare industry
                                           (and I admit no immunity to it, as I can now say
                                           "healthcare industry" without flinching). This
                                           language also concerns the descriptive and the
                                           performative, or as I prefer, use and mention.
a particular set of legal
concerns ov er A rticle 2B of              There is a tendency to dismiss hype as simply
the Uniform Commercial
Code and its relationship to
                                           meaningless. This is true, but no one ever confused
copy right law (see the
special issues of Berkeley
Technology Law Rev iew
1 3:891 , 1 998 and California
Law Rev iew January 87 :1
                                           meaning with force. Throughout my research, I
1 999).                                    repeatedly experienced the mention of certain
                                           terms or turns of phrase that only began to make
                                           sense when I tried to watch what they did for or to
                                           other people. In some cases, hype is experienced as
                                           such, and dismissed by people, without effect. In
                                           others, hype actually controls a situation. In the
                                           end, hype just becomes language, one learns to
                                           speak that way, like one learns to write a certain
                                           way, and with due diligence the words that
                                           sounded like blabber to begin with, can become
                                           either poetry or tool. In my discussions with the
                                           members of the company Amicas Inc., (described
                                           below) I experienced a transformation of this kind.
                                           Chapters P and Q contain some detailed musings
                                           based on the words of Adrian Gropper, the CEO of
6. Histories of the A merican              Amicas, that I would have dismissed as hype
Regulatory state are boring,
as might be ex pected, but
                                           without a two years experience of the mention, and
see    [Skorownek82]      and              eventually, use of these words. They concern the
[McCraw84]. My references
for     understanding      the             structure of the healthcare information technology
implications       of      the
regulatory state for law, the              industry and the replacement of the infrastructure
market, culture, society and
subjectiv ity are Martin Sklar             of healthcare by the internet, and are related
[Sklar88], James Liv ingston
[Liv ingston94] and Morton                 directly to the langauge of law and regulation and
Horwitz [Horwitz92].
                                           to programmed language in standards and
                                           openness explored in Chapters E-M. If at any time
                                           I appear to be uncritical of his or others' words, it
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                                            I appear to be uncritical of his or others' words, it
                                            is most likely because I am.

                                               Finally, the English language is poorly
                                            programmed herein, it is an open question as to
                                            whether "it works." This might be just a question
                                            of style, in the sense of fashion. However, I prefer
                                            to imagine that the language of this dissertation
                                            takes baby steps towards articulating a thesis that
                                            would be invisible in any given disciplinary
                                            vocabulary— the nominalopathic colon-enhanced
                                            excesses of cultural studies as much as the


7 . The relationship between
decision and justification in
                                            "narrative clarity" of history as much as the
a firm scans unev enly .                    soulless argumentative rigor of law or economics
"Decision     analy sis"   and
"management engineering"                    as much as the authoritatively luminous
seek to improv e the making
of decisions,       ev en    to             insistences of philosophy. At times I have tried all
quantify        justifications;
"stakeholder       capitalism"              of these and others, always breaking their rules
seeks that the justification
for decisions be ex panded                  and always coming up short in vocabulary that
past the pure demand for
profit; and the ex perience of              would capture what I want to express. This is also
making decisions can tend
to either ex treme, Wy hship
                                            a question of programmed language. Ordinary
Hillier, the conscience of                  English language (and especially academic
this dissertation, reminds us
of two phrases that capture                 discourse) only works because it possesses all kinds
this: "ex tinct by instinct"
and "paraly sis by analy sis."              of conventions, and it is these conventions we seek
                                            when we seek meaning; this begs the question,
                                            however, of what conventions mean, how they
                                            work, and to what end they are endlessly
                                            proliferated. Programming, however, is not simple
                                            automation, it is design. Effective design demands
                                            good data structures, sound physical principles, or
                                            inspired energy.

                                               The design of this thesis, then, is inspired by the
                                            genuinely infectious energy of the internet
                                            healthcare start-up company Amicas. I began the
                                            "fieldwork" for this thesis intending to study the
                                            "culture" of telemedicine research, I was
                                            confronted instead by a bewildering array of
                                            problems involving 'scale' and 'convention'— two
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                                           terms that I have reduced to primitives, the sound
                                           physical principles of this dissertation. I did not,
                                           however, find any "culture". It was like a place
                                           without a culture, which at first seemed a welcome
                                           change to the familiar contemporary problem of
                                           cultures without place. I found "culture-change",
                                           "corporate-culture handbooks", and culture in the
                                           form of Bostonian films, food and theater— but
                                           none of these things were at that place (where?).
8. One place to look for an
analy sis of this fact is Bill             Worse than no culture, even the place (which
Readings' The University in
Ruins, [Readings96] which                  place?) started to seem unstable, it didn't feel local,
continues some of the
arguments in [Ly otard84]
and ex plains how univ ersity
research has mov ed from a
concern with producing
                                           it dealt with problems close at hand and far away
students as national bearers               as if they were all the same. Telemedicine, of
of liberal culture to a
concern        with       the              course, is all about "overcoming distance" and
production of "ex cellence."
                                           "increasing access," yet it was not a problem of
                                           distance that confronted me, it was a problem of
                                           "scale". Scale is both noun and intransitive verb:
                                           something can be big or small scale, but when it is
                                           both big and small at the same time, then it scales.
                                           This scalability, I insist, appeared with the recent
                                           massive acceptance of the internet. Reluctantly,
                                           skeptically, I call it new. The internet covers the
                                           globe in a creep. It is not an imperialist tool, or a
                                           viral social process, but the result of hundreds of
                                           millions of deliberate individual decisions to
                                           participate. It is a convention to which people
                                           constantly, provisionally assent. This should raise
                                           questions about international and national
                                           governance— and about the design of that
                                           governance. I reach this question from the example
                                           of an internet healthcare start-up company's
                                           discovery of this scalability, and its constant
                                           struggle with the variety of conventions that enfold
                                           it (standards, regulations, law, and customs). I
                                           offer no solutions.

                                              Below, I describe the sections of the dissertation
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                                in more detail.


                            Saturated Introduction

                    You are presently reading the saturated introduction.


                            Monounsaturated Introduction:

                    The monounsaturated introduction has two parts. It begins
                    as a theoretical introduction to language in the context of
                    concerns about the "computerization of society." It does this


                    by teasing an influential report published in France (Nora
                    and Minc's The Computerization of Society) in the late 1970s
                    about its language— in particular the troubling status of the
                    terms 'information' and 'communication.' The report was
                    influential in France at a time when Minitel had started to
                    appear, and is a reference point for a now more well known
                    report by Jean François Lyotard. The point, therefore, of
                    teasing the text, and more importantly, the introduction by
                    Daniel Bell, is that it is an important foil for the concept of
                    programmed langauge. Bell's introduction performs good
                    little examples that serve to connect ordinary language and
                    writing to software and to technical standards, without at any
                    point recognizing the examples as such.

                    The second part tracks arguments by two theorists who
                    should make my own arguments sound less outrageous. The
                    well known report by Lyotard, The Postmodern Condition, is
                    usually referenced as either a study of the "disappearance of
                    Grand Narratives" or once again "the computerization of
                    society" (which leans heavily on the above report for any
                    actual computers). My focus, however, is on the report's
                    programmatic statements about the need for a socio-political
                    organization that is based on "legitimation by parology" with
                    explicit reference to the function of "language games" as its
                    basis. This, I insist, is a call for the abolition of intellectual
                    property, and I hope to explain why, with reference to the
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                    property, and I hope to explain why, with reference to the
                    dissertation, but without boring the reader to tears with
                    details of Lyotard's argument. Opposite these themes, are
                    those of Charles Sabel's work on what he calls "Learning by
                    Monitoring" (on the new organizational structure of firms)
                    and out of which he spins programmatic statements of
                    reform that he refers to as "democratic experimentalism" and
                    "directly-deliberative polyarchy". Sabel's proposals are by far
                    the more detailed, and they amount to nothing short of a call
                    for a new American government; sadly, these details find no
                    home in this thesis. They are better saved for another project.
                    What is more important to this thesis is that Sabel also


                    insists on the importance of language to the new
                    organizational forms that he identifies. Sabel's reference is
                    pragmatism, especially those strands of pragmatism which he
                    claims conceive of life and activity on the model of language
                    (as a set of rules consistent enough to allow communication,
                    but flexible enough to be modified in the face of ambiguity).
                    Pragmatism, the history of the American regulatory state,
                    and observations about "Learning by Monitoring" become
                    important to this thesis as it nears its end, when I try to
                    explain the reasons why Amicas is doing what it does now
                    and here. My guide for this is Charles Sabel.


                            Polyunsaturated introduction

                    The thesis really begins in the polyunsaturated introduction—
                    an ethnographic description of some corporations and
                    hospitals developing information and communication
                    technologies for healthcare. Polyunsaturated fats, I'm told,
                    have on average more than one carbon-carbon double bond.
                    Certainly strong bonds were formed with some in my field,
                    but I prefer a more cis-literal meaning. Call them
                    polyunsaturated facts— untheorized, unschematized, of
                    diverse natures, liquid— an introduction to the nouns of my
                    field, to the quotidian details and the unusual events, to the
                    language of this there, and maybe to its boundaries (though I
                    couldn't always find them). It begins there (your introduction
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                    couldn't always find them). It begins there (your introduction
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                    does) because I want the reader to know where I was before
                    the central Text of the dissertation was written. It is meant to
                    program the reader with experiences that justify the
                    see-sawings across the eclectic collection of disciplines,
                    relevances, and arguments of the Text. They are essential
                    facts, like essential fats, because a body can't manufacture
                    them on its own, but needs to eat them. It is not, however,
                    protein.

                    Such an ethnography is most recognizably a "Multi-locale"
                    [Fischer90] or "Multi-sited"[Marcus94] ethnography. Having


                    more than one site is a strategic research decision and in this
                    case the very problem of locale recurses through this decision.
                    There are several physical sites, most in the Boston area.
                    Some are the various sites of the same company (Amicas,
                    Inc.) some are the multiple clinics and hospitals of a single
                    healthcare organization (Partners Healthcare System,
                    including its two most well known hospitals— Massachusetts
                    General and Brigham and Women's), some are the offices of
                    individuals marginally connected to either of these places. In
                    addition there are the connected hospitals and business
                    outside of Boston and the sites of conferences and trade
                    shows in Chicago and Atlanta (conferences representing a
                    peculiar non-space of association by profession, less Atlanta
                    or Chicago, thana "professional" home). Some sites are in
                    foreign countries (Turkey, Greece, Saudi Arabia, Israel, India,
                    Australia, Argentina, China), all of which sites yield their
                    specificity "at a distance" via email, video conferencing and
                    telephone conversations.

                    Something more than the difficult multiplicity of physical
                    locations haunts this ethnography, however. Several "things"
                    in my field are mysteriously unlocatable, or located no where
                    in particular. Most importantly, the internet, but also, the
                    economy, the market, the firm, the household, and culture. I
                    defer answers until the Text, if only to attempt to give some
                    sense of the confusion of being in the middle of these things—
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                    sense of the confusion of being in the middle of these things—
                    as an actor or as an observer. Several answers to this question
                    of location, concerning principally the concept of scale (the
                    intransitive verb, especially, as in "markets scale") will be
                    given in the Text, Scale and Convention.

                    The bulk of this section will appear to be about a single
                    company: Amicas Inc. It is. This is because I would like
                    Amicas to stand in as a figure for the whole tangled array of
                    people, things, places, and decisions that I was confronted
                    with. Occasionally I will compare Amicas to The Partners
                    Telemedicine Center at the Massachusetts General Hospital


                    (part of Partners Healthcare System) which will often be
                    Amicas' foil. Amicas concentrates questions concerning the
                    location of the firm (including the hospital as firm, the firm
                    as home, and the home as firm), the scale of the internet and
                    the market, and the navigation of the myriad conventions of
                    everyday life into a single figure. The folks who run this firm
                    and write its software are at degree zero— if I take their
                    words seriously, it is because I think they channel and process
                    something much larger than themselves. I have found myself,
                    at times, wanting to say something about the theoretical
                    concepts of social theory, yet having no other word come to
                    mind than Amicas. This does not mean they are exceptional,
                    or alone— quite the contrary. Amicas may occupy a small
                    market segment in a peculiar corner of the software industry
                    with strange ties to a particular set of institutions, but this is
                    incidental to the much larger set of concerns that occupy
                    them: American start-up capitalism, entrepreneurialism, the
                    internet economy (the "new" economy), the science and
                    technology of digital imaging, economies of scale in
                    software— including international business, the technical
                    details of internet and healthcare standards, the relationship
                    of academia to corporate America, fair allocation of access to
                    medical technology, the source of value in software, the
                    nature of property and its relationship to the contracts,
                    licenses, and significantly for anthropology, to the gift. These
                    are not concerns specific to Amicas, they are eminently
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                    are not concerns specific to Amicas, they are eminently
                    'academic' concerns. However, there is a related problem that
                    studying a corporation makes explicit: the difference between
                    understanding and doing. E.B. White's famous observation
                    holds for corporations as well: "Analyzing humor is like
                    dissecting a frog. Few people are interested and the frog dies
                    of it." Solving problems, making things, creating value,
                    effecting a change is the goal of corporate behavior. The
                    'profit motive' masks this expanded motivation as singular.
                    This focus on doing, especially doing things with
                    programmed language, is a concern for decision first and
                    justification second [7].

                    Participating in such an environment therefore tends to look
                    a little more like switching than fighting— especially from the
                    perspective of an academic environment that seems to be
                    focused either on willfully parochial enclosures of theory and
                    research or disingenuous participation in an ever expanding
                    economy of expertise [8]. However, at the point at which
                    research encounters the experience of others, neither of these
                    attitudes is acceptable as a strategy. On the one hand, the
                    concept of "research" is overvalued in the corporate world,
                    and the work produced in its name would never meet the
                    standards of an academic conception of "research." On the
                    other, academic research is to often confused by its desire to
                    be objective, to maintain critical distance, and yet to still
                    have an effect in the world. The spectrum of things that
                    stretches from the "research" of Amicas to the "research" of
                    economists or social scientists at a University is continuous,
                    and I was just as often expected to contribute to one end, as I
                    have been to the other. Critical distance, therefore, meets
                    itself coming and going. The point is not that the point is not
                    to interpret the world but to change it, but that the point is
                    not to divide the world up into interpreting and changing,
                    thinking and doing, saying and acting. I therefore offer
                    Amicas as the figure for this challenge.

                    The scene setting of the Chapter A begins with Amicas and
                    covers the details of the development of their technology at
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                             the Massachusetts General Hospital and its relationship to
                             other technologies and other corporations involved in similar
                             endeavors. It introduces some of the people with various
                             degrees of detail. It ends with the movement of Amicas from
                             MGH to Adrian Gropper's home. This movement is the
                             reverse of most start-up companies, but as I explain, MGH
                             was Amicas' garage, and Adrian's house (The World Wide
                             Head Quarters) is the company's first sedimentation as a
                             "real" company (as opposed to a "virtual" one).

  Last Modified
  11-Sep-99 9:27 PM
  ckelty@mit.edu

  Go Back to the Start
                             Chapter B is a story, one I find particularly indicative. In
                             Chapter C, I discover that one of the advantages of being
                             involved on the ground floor of a start-up is closeness to the
                             action. Many meetings that would be strictly inaccessible to
                             anyone but the executives in any larger company, happened
                             in public, because a virtual company has no boardroom. In
                             this chapter I relate a particular meeting with some venture
                             capital types as an example. This also leads to a meditation
                             on the function of reputation, association, and networking
                             and the slightly torturous story of my participation in this
                             economy of reputation.

                             Sean Doyle is the person whose generosity made this study
                             possible, and he is also the person whose creativity and
                             intelligence make Amicas, the technology, possible. There are
                             several stories and discussions with Sean in the thesis, but the
                             most important, as in Chapter D, involve dinosaurs. Sean's
                             eclecticism is energizing, and it served as a (re-)introduction
                             to the functions of passion and humor in science and
                             engineering.

                             Chapter E contains stories of the RSNA meeting in Chicago.
                             Lurking as a foil to Amicas throughout the dissertation is
                             another fieldsite that failed to yield anywhere as much energy,
                             but perhaps as much experience: The Partners Telemedicine
                             Center. This group is connected to Amicas technically,
10.08.2010   http://web.archive.org/web/20010308220...introductions /s aturated/s aturated.html   #16
                    Center. This group is connected to Amicas technically,
                    spatially, and in terms of personnel. In chapter F, I explain
                    some of this history and how the configuration of the site as I
                    found it came to be. Partners Telemedicine itself is detailed in
                    Chapter G, including some of the most interesting stories I
                    have from there. The Partners Telemedicine Center was in the
                    unfortunate position of having little money for large
                    ambitions, having poor management and high turnover of
                    employees, and of being one of the few ships not lifted by the
                    rising tide of the internet and the web. This section is
                    anonymous for these reasons, and because it must serve as a
                    foil here to what Amicas represents: the free-marketing of


                    healthcare, and the replacement of the technical
                    infrastructure of healthcare by the internet. It is not Partner's
                    fault that these things happened, but in their status as victim
                    of these changes, they occupy an important role, and it is
                    worth telling the stories that occurred during this work.


                            Text: Scale and Convention

                    Each of the Chapters in this section has a short title and a
                    Pooh-style subtitle of the major points of each chapter. They
                    are reproduced here for clarity's sake.

                    In Brief: This Text introduces the primitives 'scale' and
                    'convention,' which circulate throughout the dissertation.
                    There follows a literature review, an example, four chapters
                    that attempt to present the details of standards, beginning
                    from the fieldwork but extrapolating to standards in general,
                    by virtue of an essential difference that is identified. There is
                    an interlude before the narrative picks up again on one side of
                    this essential difference— the internet and openness. Four
                    chapters follow that narrate the wacky world of openness and
                    its relation to scale and convention, via several prominent
                    characters in the internet/free software/open world. There is
                    then a second interlude before I pick up the question of value
                    that I intend to answer by reference to Amicas and the
                    business strategies and software design of Adrian Gropper
10.08.2010
                    business strategies and software design of Adrian Gropper
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                    and Sean Doyle. In order to set up this answer however, I
                    attempt to fill in some of the historical, legal, and social
                    theoretical details of the history of the American regulatory
                    state and the American healthcare system and its
                    infrastructure. This legal and medical history serves as an
                    explanation of the political economy that explains why
                    Amicas exists now, why it is engaged in a fragile attempt to
                    create value in an unfamiliar way, and ultimately what this
                    means for the organization of healthcare, the legal regime of
                    property rights, and the configuration of international
                    governance. The immodesty of these claims is tempered by


                    the empirical research in healthcare, yet healthcare is not be
                    treated as a peculiar institution here, rather, as one aspect of
                    a market economy among others.

                    In Detail:

                       A. Introduction

                            Primitive operators 'scale' and 'convention' are introduced — Mice
                            and Elephants compared in the context of scale, and related to
                            discussions of the economy, the internet and Santa Fe — Scale
                            becomes intransitive verb — Convention explained with respect to
                            community, communication, empire, and telecommunications — the
                            internet is identified as an Important Difference within convention
                            — Convention and Scale form the beginning of a beautiful
                            relationship — the location of the internet is sought, and not found
                            — Various Philosophical Musings.


                    The Introduction uses an example from some "complexity"
                    theorists of the Santa Fe Institute concerning the different
                    sizes and metabolisms of animals to both explain the concept
                    of scalability and to register its ubiquity as an analogy for
                    internet startup firms. The concept of self-similar networks is
                    often suggested as a model for the internet— in some cases is
                    formalized as a mathematical problem— because it allows
                    people to think about scale as an intransitive verb (e.g. "the
                    internet server scales"— meaning it can handle a large
                    number of transactions as simply as it handles one). The term
                    convention is then introduced by reference first to scale (the
                    present community vs. an international scientific community,
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                    present community vs. an international scientific community,
                    for example), second with reference to communication and
                    control, and its role in empire, and third as it relates to the
                    convention (the technical standards developing processes) of
                    the internet.

                    Scale and Convention have become the primitives of this
                    dissertation because of the way that they change and
                    challenge the notions of culture and locale, which might have
                    been more familiar as anthropological notions. Scale is a
                    better way of capturing what is usually attempted in the dual
                    use of the terms 'local' and 'global' and any teratomas of that


                    attempt, like "glocal." Convention, in my opinion, specifies
                    what is important about how culture functions, and I try to
                    justify this in various places in the dissertation. The emphasis
                    on coordination is as important to social theory as it is to any
                    theory of meaning, and 'culture' may suggest that, but only
                    with great difficulty. I did not choose Scale and Convention
                    initially to replace these terms, but upon reflection, realized
                    that they might be usefully compared.

                    As a way of introducing the internet, I ask where it is. I ask
                    this because I think that wherever it is, it is in the same place
                    as the market (and sometimes 'the economy'), the public
                    sphere and society. I do not intend to mystify the internet
                    (and to this end I suggest some ways in which it has already
                    been mystified by scholars— either as too material, or too
                    metaphysical), but I do intend to suggest that it is not simply
                    one technology (or place) among others.

                       B. Scholars wonder standards

                            In which a tangled bank of standards is discovered — their
                            diversity is marveled at, then characterized by scholarship — a
                            literature review is undertaken — an exemplary studier of
                            standards is critiqued for whiggishness.


                    Chapter B is primarily a kind of literature review. I start from
                    the assumption that conventions are everywhere ('standards'
                    are the most familiar problems of technical coordination and
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                    are the most familiar problems of technical coordination and
                    production, and therefore to much of the literature in the
                    history and social study of science and technology). Beginning
                    with a philosophical distinction between nature and
                    convention in Plato, I try to explain the basic structure of
                    convention, its relationship to the decision, especially the
                    decision to make something standard and to the subsequent
                    use and legitimacy of that standard. Theodore Porter's work
                    on mechanical objectivity assists me here in making these
                    connections, as does Bruno Latour's focus on how something
                    becomes accepted as scientific truth in Science in Action. I
                    turn then to Ken Alder's work on standards for French


                    artillery during the French revolution and find it extremely
                    rigorous in all but one respect, his use of the term
                    'information technologies.' I object first because it obscures
                    his argument that things and their representations were
                    standardized at the same time (which would be a useful idea,
                    if not so obscured), and second because I try to suggest that it
                    is telecommunications itself which should be the model and
                    sine qua non of an understanding of standards— not French
                    guns, as he does— and that treating "information
                    technologies" the way he does is anachronistic. I offer
                    Friedrich Kittler as a counter-example that historicizes
                    information technology too deeply, and find, ironically, that
                    Kittler also refers us to a history of warfare as the essential
                    ground of the competition of technical standards.

                       C. Exapple

                            A lowly apple is dissected for the purpose of explaining
                            standardization's transformations in the 20th century — the
                            imperative that drives these changes is sought, but not found.


                    Chapter C offers an example that tries to simultaneously
                    bring together the problems of scale, convention and
                    programmed language in a humble everyday apple and to
                    suggest how standards might have evolved from the age of
                    mass production (Alder's concern) to today. I pose the
                    question of what it is that drives these transformations, and
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                    ask if one might be able to read them off something like an
                    apple, or the Price Look Up sticker on the apple.

                       D. Economists ponder standards

                            Path dependency, increasing returns and network effects butt in —
                            their sudden ubiquity in business is discussed — an example from
                            the field is used to illustrate how 'standards' are now a common
                            element in business strategy.


                    In chapter D, the literature review resumes, but with a
                    difference. In the course of doing fieldwork and studying the
                    internet economy, the terms path dependency, network


                    effects, and increasing returns repeatedly appeared "in the
                    field." The economic scholarship that concerns these words is
                    a recent and fascinating set of theories (once again, partially
                    derived from the Sante Fe Institute's focus on "complexity"
                    theory) about the function of markets of goods that are
                    constituted as networks that require compatibility of some
                    kind (typewriters and typing teachers, computer software and
                    computer hardware, videocassette formats— these are the
                    conventional examples). These theories are little object
                    lessons for actors in the internet economy, and it has become
                    clear that technical standards, especially technical internet
                    standards have become a strategic part of internet
                    businesses. As an example, I offer a article written by Adrian
                    Gropper that plainly emphasizes the importance of standards
                    to hospitals considering buying a new PACS system. I explain
                    how this story functions for him, how it circulates in the trade
                    literature and that it relates to the Microsoft anti-trust suit as
                    the government's first test of monopoly and anti-trust law on
                    the internet.

                       E. Standard Differences

                            Scholarly literature is departed for an Example from ethnography —
                            and Another from an email discussion on standards in which
                            Religion and Heresy appear — some Very Important Distinctions are
                            made — between freely available standards and not — between
                            written standards and implementations — the concept "it works" is
                            introduced and discussed.
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                    Chapter E is an important chapter for understanding a
                    crucial distinction between types of technical standards,
                    especially with respect to the internet. I suggest that
                    engineers and programmers from different traditions learn to
                    relate to standards in different ways (in addition to simply
                    learning different standards, given the enormous number of
                    them). The first cut is to divide internet hackers from
                    electrical and telecommunications engineers, which is simply
                    a way of suggesting that the standards that govern the
                    internet are only to be learned on the internet, while
                    engineers trained or certified in a more traditional manner

                    through classes and certification programs learn standards
                    that way. The difference between these two forms of
                    legitimacy is the difference between "it works" and legitimate
                    authority in institutions of certification and teaching (the
                    technical distinction is further explored in chapter G). I offer
                    a particularly interesting email as an example of how this
                    very discussion manifests itself on the internet, and how the
                    contradictions and mysteries of the standards process are
                    experienced. My 'evidence' for this distinction derives from
                    my experience of it at Amicas and Partners Telemedicine (in
                    the form of Sean as internet hacker and Tim O'Neil as
                    electrical engineer). I offer some thoughts on the nature of the
                    term "it works" and its difference from "it works well."

                    Further, two more important distinctions are made with
                    respect to standards. 1) That between a freely available
                    standard (which might or might not cost money) and an
                    unavailable standard (such as a trade secret) and 2) that
                    between a standard and an implementation of the standard.
                    In the latter case, it is important to recognize that it is
                    possible for an implementation of a technology (say, an
                    application) to become a standard, and then be specified as
                    such. This distinction is returned to in chapter H, with
                    respect to the official bodies that set the standards. In this
                    chapter, the examples of the Java and C programming
                    languages, and compilers for those languages are offered as
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                    languages, and compilers for those languages are offered as
                    examples. These examples unravel themselves into a
                    parallelogram of concerns that includes ownership,
                    availability, workability, and national/international
                    legitimacy.

                       F. Healthcare's Standards

                            A focus on healthcare — the knot of healthcare standards is
                            partially unravelled — medical education standards and standards
                            concerning specialties — the role of scientific authority in
                            standards — scientific accounting — computers in medicine —
                            clinical decision systems — technical standards and nomenclatures
                            — the knot of healthcare standards is severed, leaving radiology
                            standards — radiology workflow — diagnostic standards — DICOM
                            takes up space — and time — informants are called upon to


                            distinguish standards — Sean talks of DICOM and HTTP — Tim talks
                            of IP and OSI — stupidity beckons.


                    Chapter F takes a sidestep into healthcare to explain the
                    diversity of standards that exist in healthcare, in particular
                    the chiasmic aspect of standards for "quality" and standards
                    for technical or compatibility issues, which are constantly
                    fading into each other. This fade-out can be seen in several
                    examples from the history of healthcare, as well as the
                    subsequent stories of them. I invoke the history of the
                    standards for medical education and the Flexner report as an
                    example of this double ideological and technical function of
                    standards. I also look to the History of Medicine for further
                    examples from the progressive era history of licensing, the
                    college system, and the relationship between professional
                    societies, hospitals and practitioners.

                    The growth of administration in this period (both in terms of
                    organized corporate capitalism and the administrative
                    growth in the government) affected healthcare in large and
                    small ways. The examples of the adoption of Taylorism and
                    scientific accounting are related to the infrastructure of
                    healthcare, and to the growth of computerization and
                    electronic medical records, all of which can be seen as
                    imposing standards even as it uses them to ideologically
                    legitimate specific kinds of change.
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                    Clinical decision systems are also discussed before explaining
                    the DICOM and radiology standards. The DICOM standard
                    and its development is discussed briefly before returning to
                    the explanations of Sean Doyle about the difference between
                    DICOM and the protocols of the internet. His distinction is
                    then opposed by the story of the engineer Tim O'Neil and his
                    reasoning for the use of proprietary OSI-based networking in
                    healthcare rather than the Internet Protocol (IP). Sean and
                    Amicas are in the position of having to use both DICOM and
                    the internet protocols, while Tim, whose work at the
                    Telemedicine center also needed to be aware of DICOM but


                    refused to use the internet protocols, because they sacrifice
                    something "Quality of Service." Quality of Service concerns
                    the integrity of data, and signals a concern for networks as
                    "real-time" collaboration media rather than asynchronous
                    collaboration media.

                       G. Stupid

                            An article from the field is used to explain some things — modernity
                            and progress are related to standards for networks — differences
                            between Other Networks and The Internet are stressed —
                            questions are posed — a word becomes tiresome.


                    Chapter G returns to the distinction between the internet
                    savvy people, and telecom/electrical engineers, this time in
                    the context of an article given to me by Adrian Gropper that
                    distinguishes between "stupid" and "intelligent" networks
                    (the former is the internet, and no other, but the article
                    typologizes).

                    In addition to clarifying the reasons why the internet is a
                    different kind of network than all previous telecom networks,
                    the article engages a discourse of modernity and progress
                    that is peculiarly opposed to the kind of progress that the
                    distinction it offers would imply. The concepts of abundant
                    infrastructure, underspecification, and the particular
                    importance of IP, the Internet Protocol, are all explained
                    within this framework of progress and modernity. With
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                    within this framework of progress and modernity. With
                    tongue in cheek, stupidity is repeatedly called a desirable
                    engineering value.

                       H. It works

                            The Internet Protocol is sought, and found! — detail about the
                            distinction between paper standards and implementation standards
                            is given — standards processes of ISO and ITU compared to those
                            of ISOC — structure of ISOC and IETF explored — emergence of
                            W3C wondered about — the politics of standards making is
                            discussed and critiqued — TCP/IP is compared to OSI.


                    Chapter H accepts the challenge of stupidity offered by the
                    previous chapter and asks, what, exactly it is that allows

                    stupid networks to be stupid. The answer is found in IP, the
                    Internet Protocol and this chapter endeavors to explain just
                    how it works and for whom. I begin with a book by Schmidt
                    and Werle that analyzes international telecommunications
                    standardization in the 70's and 80's. Schmidt and Werle
                    make sound analytic distinctions and give great detail about
                    the two most important telecommunications standardization
                    organizations: ISO, the International Organization for
                    Standardization and ITU, the International
                    Telecommunications Union. They discuss the organizational
                    structure of ISO and ITU, both of which are firmly in support
                    of a American and European consensus on trade
                    liberalization and see standardization as a means to that end.
                    The internet, however, they treat as just one network among
                    others, and the Internet Society and its standards body, the
                    Internet Engineering Task Force (IETF) are called
                    "parastandardization" bodies. This typology is appropriate to
                    the period of research that the book covers, but clearly, since
                    then, the internet has come to be something much more than
                    just one network among others, and with it, its mode of
                    standardization has become a well known style of
                    standardization— at least for internet zealots. I try to give
                    some detail about how this process works and relate that to
                    the distinction that I identify in chapter E between "paper"
                    standards and "implementation" standards, and in particular
                    to the mechanism of political legitimacy implied by the IETF
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                    to the mechanism of political legitimacy implied by the IETF
                    standards process and embodied in the phrase "rough
                    consensus and running code," a synonymous sentiment to "it
                    works." The chapter returns briefly to the question of the
                    ISO-OSI standard raised in chapter F, and raises the question
                    of the creeping power of the internet standards organizations
                    and the people who participate in them. This power will be
                    important for the concerns that follow in the next four
                    chapters, about openness, and about the regulation of users
                    on the internet by the internet.

                       I. Open Begin (various yarn)

                            A connecting interlude unravels — A section from Ellen Ullman's
                            book Close to the Machine — a diversion on a piece by Robert
                            Musil about doors and openness and design — an example of how
                            programmed language has come to be expected, and how
                            dissemination must be counter-programmed.


                    This interlude consists of three pieces that serve as a toggle
                    between the five semi-expository chapters that precede it,
                    and the four that follow, which focus in closely on the words
                    and actions of certain personalities: Sean Doyle, Richard
                    Stallman, Larry Lessig and Eric Raymond. First there is an
                    excerpt from Ellen Ullman's novel/autobiography Close to the
                    Machine, which tells a brief parable of "it works." Ullman's
                    book is an indispensible reference to the emotional life of
                    software, to the lyrical expression of work, and to some gritty
                    details of life in Silicon Valley.

                    In the second piece, I reflect on Robert Musil's short piece
                    "Doors and Portals" for what it reveals about the relationship
                    between two things: openness and design. Most of the four
                    chapters that follow, deal with the vicissitudes of the term
                    "open" but never with the kind of clarity that Musil's piece
                    offers for the door. The door represents the boundary between
                    public and private for Musil— a boundary he says is no longer
                    operative. The variety of uses of the terms open and closed
                    could all have been condensed into this figure of the door (e.g.
                    Max Weber on open and closed societies, Karl Popper's Open
                    Society, Elias Cannetti's open and closed crowds, Alexandre
                    Koyre's closed worlds and open universes, the list goes on and
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                    Koyre's closed worlds and open universes, the list goes on and
                    on). More importantly than simply being a figure for open
                    and closed, however, the door figures design as essential to
                    the distinction. In the same way that Walter Benjamin's
                    Passagenwerk steals through the streets of Paris connecting
                    personalities and architectural phenomena into a meditation
                    on the progress of history, Musil's piece imagines the space
                    between inside and outside that the door had once so clearly
                    ordered and controlled as a hole "still left open to the
                    carpenter." I insert it here, because the following chapters
                    make liberal reference to concepts and uses of openness that I
                    try to critique or object to, and ultimately, to explain.

                    The third piece is an example of programmed language, and a
                    peculiar one at that. It is an excerpt from an SEC filing for an
                    Internet startup company's IPO, available on the SEC's Edgar
                    service. It is something J.L. Austin would be thrilled by, I
                    imagine. It attempts not so much "to do things with words,"
                    as to warn people that words don't always do things, and
                    thereby to do something: reduce liability. The particular
                    words it worries over— anticipatory, promissorial words— are
                    precisely those words that signal an irreducible openness that
                    can only be incompletely captured, by other words, or by risk
                    profiles.

                       J. Source and Passion

                            Open source appears suddenly, frightens some — opensource.org
                            and the Free Software Foundation are distinguished — Sean's
                            words noted as the experience of one 'hacker' — hacker
                            authenticity considered — the relentless myth of scientific method
                            is identified and dismissed as ideology — Sean's experience a
                            counter-proposal to the scientific method myth — the excitement
                            of learning and sharing identified as An Important Thing —
                            Heidegger referenced.


                    This chapter introduces the organizations opensource.org and
                    the Free Software Foundation, via some discussions with one
                    of my informants, Sean Doyle. I have tried to explore how
                    Sean's experience of the internet, software design, science,
                    and academia fits uneasily with the common narratives and
                    marketing proposals that surround the "open source
                    revolution." This is difficult to do without obscuring the fact
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                    revolution." This is difficult to do without obscuring the fact
                    that Sean is very excited by the prospects of using "open
                    source" as a business model and has in fact benefitted from
                    something on the internet that, while it may not be just the
                    way "open source" people say it is, is still substantially
                    different from other versions of research and science that
                    happen "off the internet". The details of this difference
                    concern the separation by academic discipline, by place (Sean
                    worked at the Federal Reserve Board, a place rarely identified
                    as a hotbed of hacker wackiness), and by platform (machine
                    or operating system).

                    Opensource stories inevitably begin with some version of a
                    myth of the "scientific method" either to explain what are
                    seen as similar principles, or to justify the movement by
                    reference to the ideological power of science. I suggest that
                    the power of the scientific method as a myth obscures the
                    very real connection that the internet has had over its 30
                    years to the institutions of science, and to try to explain, via
                    the example of Sean, how such a connection can yield an
                    experience of science as a valuable exercise in sharing
                    knowledge and collaborating in an ad hoc manner— not
                    exactly a vocation rooted in ascesis. The "communities" that
                    form are fragile, formed only to solve a given problem, and
                    once the problem is solved, abandoned for new problems.
                    This mode of research is significantly different from what I
                    try briefly to relate to Heidegger's understanding of science
                    and research as "putting in reserve." Though the chapter
                    would need to be significantly expanded in order to explore
                    whether this difference is ontic or ontological (to use his
                    terms), I prefer to stick with Sean, for now, as both explanans
                    and explanandum.

                       K. Geek Programs Law

                            Opensource.org and The Free Software Foundation further
                            distinguished — opensource.org attacks FSF — Richard Stallman
                            explained — FSF's veritable political actions in licensing is
                            contrasted with Stallman's incessant talk of freedom — FSF
                            critiqued — the distinction between the technical and the
                            nontechnical is identified as A Major Problem --FSF attacked by
                            opensource.org, again — opensource.org is called disingenuous by
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                            opensource.org, again — opensource.org is called disingenuous by
                            the author.




                    In chapter K, I begin with the reasons why an "open source"
                    model of software development are appealing to Sean and to
                    Amicas. They include real and calculated concerns about
                    Microsoft products, and about the political implications of
                    Microsoft's strategies. The difference between opensource as
                    a better software design tool, and open source as "free
                    software"— a political stance— is the difference between a
                    deliberately political economy, and just an economy. I begin
                    the exploration of this difference with Richard Stallman and
                    the Free Software Foundation, often identified as the origin of
                    all subsequent free software and open source initiatives.
                    Stallman's storied life in hackerdom experiences, crucially,
                    the break up of the MIT AI lab community and the
                    "commercialization" of software. Since that time, Stallman
                    has been a very vocal proponent of "free software". His
                    political speeches and manifestos detail his positions and
                    harp on the importance of "values" (such as freedom) that he
                    insists, in good classical liberal form, must be discussed and
                    circulated lest they be forgotten. However, in contrast to this
                    political speech is the political action of the FSF's General
                    Public License, which manipulates copyright and contract
                    law to guarantee that the software it licenses will never be
                    owned by anyone (by effectively nullifying copyright law with
                    contract law). This maneuver, I suggest, is akin to
                    programming the legal system like a giant computer, to do
                    something very clever, it is a Hack.
10.08.2010   http://web.archive.org/web/20010308220...introductions /s aturated/s aturated.html    #29
                    something very clever, it is a Hack.

                    The chapter then proceeds to a discussion of some of
                    Stallman's writings with this fact in mind. Stallman's
                    justifications of when something should be copyrighted and
                    when it shouldn't depend on an arbitrary distinction between
                    the technical and the non-technical that is unsupportable in
                    any absolute sense, but only decidable in each specific
                    instance. The distinction technical/non-technical then
                    becomes the hinge on which property swings, and it swings
                    towards contract, and away from copyright.



                    The differentiation of opensource.org from FSF, and the
                    bitter denunciations by the former of the latter are part of
                    what will be called later a "corporate reconstruction of
                    capitalism" in which opensource.org participates with the
                    fanaticism of converts. Opensource.org has successfully
                    shifted the discussion away from "freedom" and politics, to
                    that of business models and marketing, but this is ideological
                    packaging for the weakening of vigilance over the attention to
                    licences that the FSF performed. In particular opensource.org
                    abandons a vigilance over the structure of licences and the
                    terms of contract in favor of an even weaker version of IP law,
                    namely trademark law. This weakening leads the direction of
                    a strengthened commercial contract law, compounded with
                    the protection of intellectual property law that could be used
                    to elaborately control software. This maneuver, by
                    opensource.org, is therefore a disingenuous disavowal of
                    politics that hides a strengthening of both property and
                    contract rights of software corporations.

                       L. Lawyer worries nature

                            Law is consulted on the subject of convention — Larry Lessig
                            takes the case — Lessig's work critiqued — some ideology
                            surrounding the regulability of the internet is denounced — 'Nature'
                            identified as culprit — Lessig replaces nature with code — values
                            are sought, but not found — the first person plural becomes very
                            annoying — an aporia of value is stumbled on — the forgotten role
                            of government is remembered — "We are the World" — the values
                            of the internet are identified by Lessig and proposed as a new
                            constitution — efficiency is decried as an inadequate value.
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                            constitution — efficiency is decried as an inadequate value.


                    Chapter L is an investigation of Lawrence Lessig's work on
                    and participation in this field of internet law and politics. He
                    is consulted as a lawyer not for an explanation of what is
                    going on, but as an example of how one lawyer has come to
                    participate in it. Lessig's writings offer a partially convincing
                    explanation of how "regulation" works (in the expanded sense
                    of "rules that govern behavior"), especially, how the code of
                    the internet regulates users. The discussions tend to be more
                    rhetorically edgy than classically argumentative, but
                    nonetheless manage to stumble onto the very problem of the


                    source of values in regulation that I identify with Jacques
                    Derrida's essay "Force of Law", that is to say, the
                    regulating/regulated aporia of value. This discovery is
                    significant because it raises the question of the first person
                    plural explicitly. Lessig constantly returns to a "we" who don't
                    want "our" government messing with things. Yet this "we" on
                    the internet is no longer the "we" of America, and Lessig
                    realizes this. The problem Lessig raises is therefore a problem
                    of international, not national governance.

                    This discovery, significant in itself, is complicated by the fact
                    that Lessig uses the open source movement as a figure for a
                    revolution in "openess" that he represents as a political
                    platform for the recovery of values and the potential
                    regulation of the internet. This puts the reader at the mercy
                    of a language that is hype, marketing, and political speech at
                    the same time. Lessig identifies what he says are the "values"
                    of openness in cyberspace— he calls them "open forking" and
                    "universal standing" but misses the fact that it is openness
                    itself here, not these values, that legitimates the openness of
                    the internet. One thing Lessig does not miss, however, is that
                    opensource.org doesn't care about these values, but rather,
                    about the fact that open source software is more stable,
                    robust, and efficient than commercial software; and Lessig
                    knows this is not a sufficient value for a democratic
                    revolution.
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                    revolution.

                       M. Anthropologist seeks navel

                            Eric Raymond, libertarian anthropologist assessed — Stallman
                            attacked, again — Raymond's various writings discussed and
                            critiqued — several crucial insights about property and legitimacy
                            in open source gleaned — the gift appears, and is examined for its
                            contents — reputation identified as the source of value —
                            questions remain.


                    Chapter M returns to the ostensible, disavowing organizer of
                    opensource.org, Eric Raymond. Raymond is a peculiar figure,
                    no one's hero, but everyone's leader. He has played a
                    remarkable part in bringing the model of open source

                    software development to the attention of business and the
                    media. His attacks on the FSF and his disingenuousness
                    about his own political role are features of this chapter, which
                    is highly critical of Raymond's words. At the same time,
                    however, Raymond figures himself as an anthropologist, and
                    in the course of his "fieldwork" has unearthed several
                    fragments of the "culture" of hackers, that are worth
                    pondering. Two of Raymond's articles are discussed then, the
                    most famous being "The Cathedral and the Bazaar" which
                    elaborates on the mechanisms of an open source software
                    development model. For anyone unfamiliar with "open
                    source," this is considered essential reading. The other is an
                    article entitled "Homesteading the Noosphere," which
                    attempts to formalize some observations that Raymond
                    makes about property customs in cyberspace and the
                    function of a "gift culture" among software designers. To this
                    last point I am unable to resist responding, and rather than
                    savaging Raymond's misunderstanding of the gift, I try a
                    counter-example: Sean Doyle's occasional musings and
                    comments on "giving back."

                    The chapter ends by focusing on Raymond's assertions that
                    the economy of open source occurs by reference to a structure
                    of reputations that provide real and symbolic value to
                    participants.
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                       N.Open End (a ligature)

                            A second connecting interlude flexes — Ellen Ullman cynicises —
                            some arguments are recapitulated — the reader is warned of the
                            author's attitudes — Amicas is reintroduced — Amicas's values
                            posed as question — culture avoided in favor of story.


                    This interlude binds the middle four sections to the last three
                    by returning from the land of openness to the specific
                    example of Amicas and the histories of property, the
                    regulatory state, and the healthcare infrastructure. The piece
                    by Ullman marks the interlude in the same way as the
                    previous one, but this time pointing forward to the


                    relationship between revolutionary rhetoric, hype in the
                    software industry, and the regrets of an erstwhile socialist
                    software engineer.

                    Explaining the political economic conditions of possibility of
                    Amicas, or any other internet company, and the people
                    involved, is a difficult endeavor. To do so with the tools of
                    anthropology and science studies, perhaps impossible. At
                    bottom, I think there is a simple question of explaining what
                    is going on, and how people are doing it, before any
                    possibility of critique. In the case of Amicas, I learned enough
                    about a particular aspect of healthcare (radiology imaging
                    and healthcare information technologies) that I could put
                    myself in Amicas' position and experience their activities as
                    the solution to a difficult problem coupled with a desire to
                    create value (which does not always mean 'make money').
                    This fact, I think is what demands critique, and this interlude
                    introduces the chapters that open up the route to that
                    critique. Furthermore, it is no longer meaningful to me to call
                    such critique "cultural," and I try to explain why here, and
                    what America means to Amicas and the internet, if it isn't
                    "culture."

                       O. Properties of Americans

                            James Livingston and Martin Sklar join the author in a round of
                            history — basic details of late nineteenth century corporate
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                            history — basic details of late nineteenth century corporate
                            capitalism related — the legal status of property as rights and the
                            creation of a regulatory state are identified as Important Related
                            Subjects — Morton Horwitz joins the party — Significant Articles in
                            the history of property law cited — institutional economics tapped
                            — Charles Sabel joins the party and Stays Late.


                    In chapter O, I return to Amicas, to explain at least partially,
                    in a larger political economic sense, why they can exist now,
                    and what historical events are essential to this possibility. In
                    order to do this, I rely on two historians, Martin Sklar and
                    James Livingston, to tell the history of a late nineteenth
                    century change in American corporate capitalism (with
                    occasional reference to alternative stories by Karl Polanyi and


                    stories derived from Marx). The changes that they identify
                    are legal and regulatory changes, and a crisis of consumption
                    that led to a changed notion of value, shifting property rights
                    in the direction of intangibility. I also rely on Morton
                    Horwitz's histories of the transformation of law to add detail
                    to this story. I retell in particular the narrative of the
                    transformation of the concept of property in the nineteenth
                    and twentieth century from a question of "customary value"
                    to a bundle of rights in a thing, tangible or intangible. This
                    transformation in property rights allowed what Sklar calls "a
                    corporate reconstruction of American capitalism," and what
                    Livingston identifies as a "cultural revolution" in the
                    subjectivities of people confronting a changed capitalism.

                    In addition, the change in legal conceptions of property was
                    concomitant with the rise of the administrative and
                    regulatory regime of the American government. The creation
                    of these regulatory agencies were much promoted and
                    discussed during the progressive era by reformers,
                    economists and the American Legal Realist school of Law.
                    The delegation of power from public government to private
                    citizens is identified here as the crucial change in
                    governmental structure, one that has become painfully
                    obvious since the seventies, as regulatory agencies and
                    administrative bureaucracy have grown to positively unwieldy
                    sizes while simultaneously being criticized relentlessly for
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                    sizes while simultaneously being criticized relentlessly for
                    their meddlesome inefficiency and interest group politicking.

                    Enter Charles Sabel and "Learning by Monitoring." Sabel's
                    solutions to these problems reach beyond the bounds of this
                    admittedly expansive dissertation, and should make the
                    claims made here look modest. His studies of automotive
                    firms and the disciplines of "simultaneous engineering" and
                    "learning by monitoring" are identified here in their
                    similarity to what Amicas does. In particular, though Sabel
                    does not emphasize it, there is a relation to the standards for
                    both healthcare and the internet. Sabel refers to a "single


                    language of practical reason" (by reference to the Pragmatists
                    Dewey, Mead, and Peirce) that allows people in "disciplines
                    with similar syntax" to conduct meaningful explorations of
                    possibility (economic and design possibilities in the case of
                    firms). I suggest that this syntax is standards, in particular
                    standards for the internet (or standards for networks and
                    software more generally). Sabel's claims are not restricted to
                    economic organization, however, but are suggested as a
                    manner of reforming the American regulatory state, and in
                    it's strongest form the constitutional government itself ("A
                    constitution of democratic experimentalism" with Michael
                    Dorf).

                       P.Infrastructure

                            Rosemary Stevens joins the author in a last round of history —
                            social insurance and the Blues are sung — Medicare, utilization
                            review and DRG's identified as Important Changes —
                            investor-owned hospitals and HMO's tapped — Charles Sabel
                            returns to discuss guiding rules, tacit norms and fixed costs —
                            Adrian Gropper enters — Adrian's notion of infrastructure
                            dissected.


                    In Chapter P, I return to history again, this time to specify the
                    history of the American healthcare industry. Rosemary
                    Stevens is the best guide here, and one of the only ones whose
                    work extends close enough to the present to capture the
                    important recent changes. It supplements a larger history of
                    healthcare focuses on the Hospital and it makes a strong case
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                         Monounsaturated Introduction
                             A. Games with Language, or Neither A Bell
                             Toll Nora Minc Stole.

                                   In the late seventies, the French government
                                 commissioned two inspecteurs des finances to
                                 produce a study of "L'informatisation de la
                                 société." The last paragraph of Simon Nora and
                                 Alain Minc's four volume report to the French
                                 Government, The Computerization of Society
                                 [Nora78] reads:

                                       In order to make the information society possible, it is
                                       necessary to have knowledge but also to have time.
                                       The reciprocal learning process (apprentissage) of
                                       disciplines and aspirations takes place slowly: it
                                       operates through the generations, by transforming
                                       cultural patterns—families, universities, media, and so
                                       on. Data processing (l'informatique) has falsely
                                       crystallized our concerns. They rise again, more general
                                       and stronger, at the end of this analysis. Will the
                                       urgency and scope of the constraints to which French
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                                                  urgency and scope of the constraints to which French
                                                  society will be subjected grant it the time required for
                                                  this vital learning process (cet apprentissage
                                                  vital)?(141)




                                               "Data processing (l'informatique) has falsely
                                            crystallized our concerns." Such temperate
                                            optimism is rare in the wide-eyed world of social
 1 . Nora and Minc's report                 diagnoses treating the "computerization of
 commissioned by           then
 President V aléry Giscard                  society." Nora and Minc's conclusion to their
 d'Estaing      proposed       to
 stimulate "thinking on how
                                            report condenses the concerns of philosophers in
 the computerization of                     the language of policy and decision. Above all it is
 society should be carried
 out." (x v ii) There is really             not computers that occupies their report, but the
 no question here that it can
 be         directed,         by            circulation of information and its relationship to
 gov ernment, or by design,
 but that it should be                      the authority of French national government [1].
 thought now and not later.
 Such      urgency       infects            They know the slow movement of learning, the
 nearly ev ery title in the list
 of promises to ex plain the                pace of deliberated progress, and ask if there is
 changes        wrought       by
 computerization              (of           danger in the non-synchrony of "data processing"
 course, this list is long, and
 includes, a little at random,
                                            and the necessary apprenticeship of life. Machines
 the following names, in no                 crystallize our concerns, blind us to the "vital"
 particular order: Marshall
 McLuhan, A lv in and Heidi                 issues of "constraints", "disciplines" and
 Toffler,     George     Gilder,
 Nicholas Negroponte, Bill                  "aspirations." Information must be socialized.
 Mitchell, Sherry Turkle,
 Michael Dertouzos, Peter
 Drucker,       A rthur     and
 Marilouise Kroker, Mark
                                              Information is a disseminated word, however,
 Poster,       Paul     V irilio,           bereft of the specificity that Nora and Minc
 Shoshanna Zuboff, Howard
                                            demand of it. Learning and knowledge require it,
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                                           demand of it. Learning and knowledge require it,
                                           but cannot distinguish it. It is not just information
                                           that is necessary, but information and a means of
                                           communicating it to where it needs to be, so that
                                           the right decisions can be made.
                                           Telecommunications are needed. To capture this
                                           dual necessity required for the vital learning
                                           process to proceed, Nora and Minc neologize:

 Rheingold, Kev in Kelley ,                   Telematics (la télématique) is its contribution:
 Pierre Lév y . See James
 Beniger's    The     Control
                                           informatics plus telecommunications. This
 Rev olution for an older,                 linguistic nationalism is quite deliberate. The word
 less      recent,       more
 depressing list of tex ts, pgs            l'informatique itself hearkens back to an earlier
 4-5 [Beniger86] ).
                                           story and a conjugation of l'information and
                                           l'automatique, and the English translation insists
                                           on a new substitution for this temporarily gauche
                                           word: data processing [2].

                                              But this single neologism is not alone, especially
                                           in the world of telecommunications and
                                           computers: the report cycles through
                                           minicomputers, microcomputers, modems,
                                           telecopiers, 'paracomupter equipment', facsimile
                                           transmission, "laser optical systems," the
                                           'Transmic system, and all manner of such terms.
                                           The authors play on ordinateur and ordannateur,
                                           computer and director.

 2. The word Informatics
 was trademarked in the US,
                                              The prominence of this linguistic issue, in fact,
 the name of a company                     is strong enough that at the beginning of Daniel
 (again, see the story ), but
 became an "official" term in              Bell's introduction to the book he devotes the first
 France,     accepted      by
 L'A cademie Française in                  paragraph to his own fascination with this
 A pril 1 966 and giv en the
 following definition:                     fascination, redoubled with an irresistable and
 "Science du traitement
 rationnel, notamment par                  signature prediction: "The word télématique, a
 machines automatiques, de
 l'information    considérée               French neologism coined by Simon Nora and Alain
 comme le support des
 connaissances humaines et                 Minc—or, in its Englished version,
 des communications dans
 les domaines techniques,
                                           telematics—may soon spread in our language, as it
 économiques et sociaux ."                 already has in France."(vii) But Bell disavows even
 The word was not adopted
 in english, which tried to                faster than he can English, denying us this spread:
 support "data processing"
                                           "But telematics (or télématique, I prefer the
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                                          "But telematics (or télématique, I prefer the
                                          French for Euphony)..."(ix).

                                             His supposed resistance to this English
                                          clumsiness is weak, however, as he then parades
                                          out compunications, a forgotten word from
                                          Harvard that claims neither euphony nor
                                          acknowledges the rules of Greco-Roman neologic.
                                          Bell throws down the gauntlet: "Which word will
 instead, which is the                    prevail is a matter of linguistic
 preferred translation for
 "l'informatique" in     this             convenience;*"(vii)[3].
 report, further confusing
 matters. Today , it appears
 occasionally               in
 conjugations             like
 "bioinformatics" but has
 none of the specificity that
 it does in French, German,
 or Spanish. Indeed, it may
 ev en be actionable.




                                             It is clear that 'linguistic convenience' (is this
                                          American, or Latin convenience? a question of
                                          pronouncability, or a question of accuracy?)
                                          favored neither of these terms, perhaps much to
                                          the dismay of Bell's friend at Harvard. Though in
                                          France, la télématique; continues to designate
                                          what it was intended to: the conjugation of
                                          information and telecommunications.

                                             Bell's introduction to Nora and Minc's report is
                                          an excellent place to start an investigation of the
                                          relationship between language and the
 3. A nd      the    beautiful
 footnote radicalizes:                    technologies of information and communication.
 "* Ten Y ears ago, A llan
 Kiron, a research scientist              His perorations on technology and society are
 in the Patent office, coined
 the word "domonetics," a                 troubled by a submerged and complicated
 word       deriv ed     from
 domicile,     nex us,     and
                                          structure of relations between "ordinary" language,
 electronics, to indicate the             programming language, information,
 change in liv ing patterns
 that the decentralization of             communication, convention and standards, speech
 work would make possible.
 Others     hav e    probably             and presence, and technology and writing. The
 coined similar terms in the
 past, for the idea has been              task at hand is less to articulate the philosophical
                                          genealogy or structure of these things, or to
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                                           genealogy or structure of these things, or to
                                           critique Bell's introductions, than to explain how
                                           certain empirical questions about technology and
                                           any social theory of computing in the late
                                           twentieth century requires an attentiveness to this
                                           spectrum of language and technology— and how
                                           they can be discovered almost everywhere, in the
                                           mundane details of language.


 "in the air" for a long time."               So we let Bell continue: "what is clear is that the
 (p. 1 .)
                                           term expresses a new reality, an innovation that
                                           has the possibility of transforming society in the
                                           way that railroads and electricity did in the
                                           nineteenth century."(vii) Newness and
                                           transformation must be captured by new terms. If,
                                           as the report explicitly suggests, the
                                           "computerization of society" must be directed if


                                           France is to control her fate, such new words are
                                           essential, even if linguistic convenience or the
                                           dandyish, idiosyncratic preference of American
                                           social prognosticators for French euphony dictates
                                           them. Or perhaps, precisely because of it: Bell
                                           notes that the threat to the French nation comes
 4. Nora and Minc note in                  primarily from an "American domination of
 their own footnote on the
 subject: "1 . This neologism              telecommunications and computers" that has
 closely resembles the term
 used in the United States,                been, according to him, evaporating in the 1970's.
 "compunication." The fact
 that the A merican term                   Nora and Minc note a "set of power relationships
 stresses the computer and
 ours                       the
                                           that give [telecommunications] the upper hand"
 telecommunications                        [4]. The French invent euphonic words to defend
 aspect is not accidental. It
 ex presses a set of power                 themselves from crass unpronouncable acronyms
 relationships       that    in
 France giv e the upper hand               like IBM, while American Social Theorists blandly
 to the latter" (p. 1 7 9).
                                           disavow this imperialism as America's own crisis
                                           of defense.

                                             Later, Bell acknowledges that the impact of this
                                           report on French public life, was due in part to the
                                           word: "(There was also—and this should not be
                                           minimized—the impact a new concept or new idea
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                                         minimized—the impact a new concept or new idea
                                         can have when it is expressed in a bold new
                                         word.)" Bold new words, whether forgotten or
                                         italicized by Americans, are not just the special
                                         province of a threatened nation that insists on
                                         filtering them as a defense against imperialism,
                                         they can affect public life within as well.

                                            While American academics might prefer French
 5.Lev i Strauss, in the                 euphony as a sign of culture, the French anxieties
 chapter "Univ ersality and
 Particularity " of Savage               over it concern more political and economic issues
 Mind       [Lev istrauss66],
 ex tends his information                of centralization, standardization, and linguistic
 science of kinship , but
 also, Derrida again, "The               purity. American common sense, of course, has
 Name of Man", in Of
 Grammatology                            never trucked with such French squeamishness,
 [Derrida7 6].
                                         preferring a discourse of the obvious when it
                                         comes to words, Bell continues: "Behind the term
                                         is an instrument and a concept. The instrument is


                                         the computer; the concept, information" (vii). Case
                                         closed— fancy-sounding words for obvious
                                         concepts are just French arrogance. The
                                         instrument and the concept hide behind the term,
                                         so the term does not represent, so much as block
                                         reality. However, even common-sensical Bell, who
                                         tells it like it is, worries that the vagueness of the
                                         terms 'information' and 'communication' might
                                         confuse and therefore cites science advisor Lewis
                                         Branscomb to explain:
 6.     Mots       d'order—
 passwords, from Deleuze
                                               The two terms— information and communication— are
 and Guattari's "Postulates
 of   Linguistics"   in    A                   often blurred when they are tossed about loosely, but it
 Thousand            Plateus                   is important to make the distinction if one is to look at
 [Deleuze87 ].                                 what may happen in the upcoming years.
                                               Communicating, from an engineering point of view,
                                               means simply moving electronic traffic from one place to
                                               another. It matters little if the signal represents random
                                               noise or a Shakespeare sonnet. When information is
                                               available in machine-readable form it can be both
                                               processed and communicated. Processing permits
                                               meaningful manipulation of the contents of the
                                               electronic traffic, thus enhancing its value.


                                            It appears that 'information' here is defined as
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                                               It appears that 'information' here is defined as
                                            'that which can be processed' while
                                            communication is explained in terms of
                                            movement. Of course, it is hard to know because in
                                            the footnote to this passage, Bell admits "(I have
                                            rearranged Mr. Branscomb's paragraph to
                                            emphasize the relevant point.) (viii)." Bell has thus
                                            processed Branscomb to make a relevant point
 7 . I lov e the pleasure of the
 v ariable.              Ev ery             (but which relevant point?) more emphatic. Has he
 programming language has
 them and most high lev el
                                            increased its value? What is the nature of the value
 languages allow y ou to giv e              of information, and how does processing it
 them full names. Naming
 something m akefootnote                    increase it? One would imagine that if Bell had
 as opposed to m kfn or
 just m f, opens up a world                 said "I have rearranged Mr. Shakespeare's sonnet
 once familar only to A dam,
 whose job it was to name                   to emphasize the relevant point," there would be
 the animals (though with
 their proper names, a more                 outcry. Value, in this instance is far more
 difficult                task).
 Programming, in its own                    complicated than the obviousness of "an
 little world, with its own
 div ersity of creatures, is
                                            instrument" and "a concept". And certainly, the
 endless eden. I imagine
 y oung IPR lawy ers must
 ex perience the same thrill
 from trademarking names,                   concepts information and communication are no
 giv ing possessions that
 little ™ to indicate their                 clearer, having been processed in the service of
 function and propriety in
 the world at large. A kind                 increasing "value" for a relevant point long since
 of control that resists the
 messiness of language, at                  forgotten. What is important here is the decision
 least for a while.
                                            to rearrange the paragraph, and the implicit
                                            conventions that suggested to Bell that this was a
                                            legitimate thing to do. Rearranging Shakespeare's
                                            sonnets is something only Shakespeare scholars
                                            and postmodern poets do. Rearranging Lewis
                                            Branscomb is something anyone can do. Why? It
                                            will serve well to remember this example in the
                                            context of a discussion of the modifiability of
                                            software (Chapter K), because it concerns a
                                            decision between the technical and the
                                            non-technical that is made according to a
                                            convention in a certain context of time and place
                                            to program a new context.

                                              So now we find ourselves juggling several words
 8. This argument is part of
 chapters K, L, P and Q. For
                                            that hide ("behind the word") (new) instruments
                                            and (new) concepts. More than that, the specific
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                                         and (new) concepts. More than that, the specific
                                         words hiding here threaten to double our
                                         confusion, because they are the highly fraught
                                         words that today organize our notions of words
                                         and concepts: information and communication.
                                         These are the primitives of Shannon-Theory,
                                         straight out of Bell Labs and American
                                         cryptology— not the bold new words of a French
                                         Nation Defending Herself. Again, Bell tries
 the legal issues, see the               directness: "The 'computerization of society' will
 special issues of California
 Law Rev iew (87 :1 January              shape, allow, facilitate, determine—which verb will
 1 999)     and     Berkeley
 Technology Law Journal                  be the operative one depends upon our
 (1 3:891 December 1 998).
                                         consciousness and public policy—an extraordinary
                                         transformation, perhaps even greater in its impact
                                         than the industrial revolution of the previous
                                         century,"(x).




                                            Such a profound transition seems to demand
                                         less neurosis about the choice of verbs, especially
                                         from one so cavalier about rearranging other
                                         people's verbs. Perhaps this uncontrollability of
                                         language indicates more than simply the openness
                                         of the future. It is not the transition itself that is in
                                         question, but how authoritatively "the
                                         computerization of society" operates this
 9. See Sabel and Piore's The            transition. Why this incessant advance and retreat
 Second Industrial Div ide,
 and [Sabel95], [Sabel95a]               from concept into word, from the force of "bold
 as well as Dorf and Sabel
 [Dorf98] and Cohen and
                                         new words" on the French consciousness to the
 Sabel [Cohen99].                        determination of verbs by "our consciousness and
                                         public policy"? How are things behind words?
                                         Whence this force of impact on consciousness if
                                         determined first by consciousness? What does
                                         "communication" communicate? What
                                         information does "information" contain?

                                           (Parenthesis: So fight euphony with
                                         parenthetical french euphony, and call on another
                                         bold new word: la grammatologie. If we are to
10.08.2010   http://web.archive.org/web/20010308223...s /monouns aturated/monouns aturated.html   #10
                                 bold new word: la grammatologie. If we are to
                                 believe Derrida and Heidegger, all of western
                                 philosophy is an exhaustion of the metaphysics of
                                 presence, a metaphysics, for Derrida, based on a
                                 notion of self-presence, full speech present to self.
                                 Hearing myself speak is the basis of consciousness,
                                 and the locus of truth is the interior of
                                 consciousness and the production of speech. My
                                 "consciousness" that supposedly determines my
                                 verbs, according to Bell, is in fact reversed—
                                 conscious only in as much as I can hear myself
                                 verb. The relation of non-phonetic writing to
                                 phonetic writing to the entire range of thinking
                                 about means and ends, tools and tasks, in short,
                                 the entire concept of technè, will be contained in
                                 an understanding of la télématique as medium. Or
                                 software plus network— and I will coin no words—


                                 as medium. The fact that software is now routinely
                                 merged or confused with service (conceived as
                                 something singular, non-tangible and
                                 non-transferable, but measurable and valuable), is
                                 precisely why I understand Derrida's assertions
                                 about the generalization of language, in particular,
                                 the generalizations of 'writing' to be relevant here.
                                 )

                                    The diagnoses of "the information age" or the
                                 "computerization of society" have not yet focused
                                 on the practice and experience of this
                                 transformation, but only on the incessant search
                                 for it's proper name (information age,
                                 communication age, third wave, post-this,
                                 post-that et. al.). For those who don't write
                                 (software), for those who manage, organize, or
                                 otherwise try to "carry out the computerization of
                                 society," the force of language is contained in its
                                 power to direct and to order. Knowing the name of
                                 something, is half the struggle. [5] Owning the
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                                 something, is half the struggle. [5] Owning the
                                 name is the other half. Buzzwords and hype are
                                 such names— and their coinage and use (one
                                 should say "mention" to maintain the
                                 philosophical distinction) prove that they in fact
                                 contain nothing except performative force. They
                                 are 'order-words' [6]. My sense in experiencing the
                                 mention of these words, is that despite the
                                 immense amount of data (sometimes referred to as
                                 'crap') that will have been produced by them and
                                 around them, their force is inaccessible to a simple
                                 reading. They must be met head-on, triangulated,
                                 researched-experienced— in order to use hype, as
                                 opposed to simply mentioning it, it is necessary to
                                 go through it.




                                     Buzzwords are eminently situated, local in very
                                 constrained way (though not simply geographical)
                                 force is always relative, and it makes sense that
                                 these words make no sense out of context. When
                                 the force of buzz becomes clear, it suddenly
                                 appears that it borders on both ordinary language
                                 and scientific, specialized discourse. This, to me, is
                                 a remarkable mystery. Knowing buzz is good, but
                                 owning it is better. Trademark, branding,
                                 copyright and patent are all legal modes of owning
                                 the language that does things. In this the
                                 connection between the social ordering force of
                                 hype, the technical ordering force of software and
                                 the legal ordering force of trademark and
                                 copyright should be intuitively clear, if not
                                 'literally' obvious [7].

                                   This set of programmed languages, represented
                                 by software/code, buzzword, and trademark, all
                                 partake of the descriptive and performative
                                 function of ordinary language. The difference
10.08.2010   http://web.archive.org/web/20010308223...s /monouns aturated/monouns aturated.html   #12
                                 function of ordinary language. The difference
                                 consists in the regimes of convention that
                                 surround them as attempts to fix their force and
                                 meaning: to eradicate ambiguity or to make
                                 decisions. When literary theorist Paul de Man
                                 discusses the undecidability of language, he refers
                                 to the radical absence of conventions that would
                                 guarantee the meaning of words. In poetry, for de
                                 Man, this fact is the central meditation of the poet:
                                 the meaning of conventions, or more accurately,
                                 their endless proliferation and the possibility of
                                 their absence. This may not seem surprising, but
                                 rather a renewed reason for the continued search
                                 for the right conventions, the right standards, and
                                 the right laws. Recursion should issue warning
                                 here, however, because it there is still no manner of
                                 specifying absolutely, the standard that will decide


                                 all other standards without deciding on that
                                 standard.

                                    Empirically, in the complicated world of
                                 institutions, laws, governments, constitutions,
                                 networks, there is also an endless proliferation of
                                 conventions, from technical standards to
                                 regulations, to rules, to customs, to laws.
                                 Information and communication are not immune
                                 from this problem, on the contrary, they are the
                                 very model of standardization in the modern era.
                                 However, there is no 'aporia' of the poet, no
                                 "undecidability" of language, no crisis of
                                 representation. Quite the opposite: decisions are
                                 made constantly, all day long, in constant
                                 succession, sometimes without the mediation of
                                 any individuals at all. In fact, decisions are all that
                                 matter in most cases, and often there need not
                                 even be a justification, only a prompt and firm
                                 decision. Justifications, when needed, are available
                                 anywhere, even if the search for them paralyzes.
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                                 anywhere, even if the search for them paralyzes.
                                 The world seems somehow to be at peace with the
                                 notion that there is no ultimate authority for those
                                 decisions. But who gets to make decisions? Whose
                                 responsibility is guaranteeing the just-ness of these
                                 innumerable daily decisions?


                                       B. Language Games, or Lyotard:

                                       The Emperor's New Clothes and Able

                                       Sabel spins a Fable.




                                   In a roundabout way, it is the question above
                                 that cues the last page of another report, more
                                 familiar to American audiences, commissioned the
                                 Quebecois government, Jean-François Lyotard's
                                 The Postmodern Condition: A Report on
                                 Knowledge, [Lyotard84] it reads:

                                       We are finally in a position to understand how the
                                       computerization of society affects this problematic. It
                                       could be the "dream" instrument for controlling and
                                       regulating the market system, extended to include
                                       knowledge itself and governed exclusively by the
                                       performativity principle. In that case, it would inevitably
                                       involve the use of terror. But it could also aid groups
                                       discussing metaprescriptives by supplying them with the
                                       information they usually lack for making knowledgeable
                                       decisions. The line to follow for computerization to take
                                       the second of these paths is, in principle, quite simple:
                                       give the public free access to the memory and data
                                       banks. Language games would then be games of perfect
                                       information at any given moment. But they would also
                                       be non-zero sum games, and by virtue of that fact
                                       discussion would never risk fixating in a position of
                                       minimax equilibrium because it had exhausted its stakes.
                                       For the stakes would be knowledge (or information, if
                                       you will), and the reserve of knowledge—language's
                                       reserve of possible utterances—is inexhaustible. This
10.08.2010   http://web.archive.org/web/20010308223...s /monouns aturated/monouns aturated.html   #14
                                       reserve of possible utterances—is inexhaustible. This
                                       sketches the outline of a politics that would respect
                                       both the desire for justice and the desire for the
                                       unknown. (67)


                                    Lyotard's theory of games and differends will
                                 depend on a sharp distinction of knowledge from
                                 what he calls performativity— the efficiency of a
                                 world system of capitalism and its legitimation.
                                 The game of science, and its "postmodern" mode of
                                 legitimacy is that of "paralogy." Paralogy exists in
                                 the postmodern science of Rene Thom, Stenger
                                 and Prigogine, Benoit Mandlebrot and others
                                 associated with Chaos theory, and "complexity
                                 theory" and represents a mode of legitimation (an
                                 appeal to an authority that decides the
                                 undecidable) that is based on 'dissensus.' Lyotard
                                 stumbles on this absolutism (indeed, it is the
                                 subject of a whole other book, the Differend)


                                 because it is forced into a kind of arbitrary
                                 separation from other games. Despite the fact that
                                 Lyotard is fully aware of the embeddedness of
                                 science within society (especially within the "grand
                                 narratives" of legitimation of the University and
                                 the state: 'speculation' and 'emancipation' {see
                                 sections 8, 9 10}), knowledge is inconsistently
                                 distinguished from information. While the focus
                                 on rules, especially the rules of legitimation by
                                 paralogy, is apposite, the stark separation of
                                 knowledge from its vulgar uses and abuses in the
                                 market, in society, or in actually existing
                                 computers will ultimately frustrate the simple
                                 assertion that we open the data and memory
                                 banks.

                                    Compare this with the constant assertion of the
                                 Free Software Foundation (FSF), that "information
                                 wants to be free." The FSF frees information daily,
                                 and wages a war against the ownership of
                                 information. Lyotard worries that IBM could put
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                                     information. Lyotard worries that IBM could put
                                     all the information in satellites and restrict access
                                     to it, even to governments! (Of course, this
                                     happens all the time today, though none of the
                                     information is actually in the satellites, per se). But
                                     what is essential to this gap is not the pure
                                     problem of legitimation by paralogy, but the
                                     deliberate programming of a legal regime of
                                     property rights. The FSF realizes this all too well
                                     (see section K) and it is the creation of a license
                                     like the General Public License, which uses
                                     contract law to prevent information from ever
                                     becoming property, which represents at once an
                                     example of Lyotard's moves in a language game,
                                     and the legitimate adherence to an existing
                                     system. FSF and their nemesis opensource.org
                                     both argue that 'openness' itself should be what


                                     legitimates a convention, a standard, a piece of
                                     software, and that that openness should be based
                                     on its workability, not some reference to an
                                     authority outside of itself. But "openness", like
                                     "paraology" in each specific case will depend on
                                     another convention. Very quickly, we return to the
                                     question that began this section: if someone must
                                     decide, who and how? Lyotard is cynical on this
                                     point. This "syndrome" of contemporary society
                                     "necessitates a serious revision." Once again, "for
                                     brevity's sake," Lyotard reduces the problem:
                                     "suffice it to say that functions of regulation and
                                     reproduction, are being and will be further
                                     withdrawn from administrators and entrusted to
                                     machines. Increasingly, the central question is
                                     becoming who will have access to the information
                                     these machines must have in storage to guarantee
                                     that the right decisions are made.(14)" The
  Last Modified
  11-Sep-99 9:20 PM                  simplicity cracks up here. A series of predictions
  ckelty@mit.edu
                                     start flowing, to which I oppose some empirical
                                     nuggets:
10.08.2010         http://web.archive.org/web/20010308223...s /monouns aturated/monouns aturated.html   #16
                                       nuggets:

                                             "Access to data is and will continue to be, the
                                             prerogative of experts of all stripes."


                                          (Parenthesis: Consider a discussion with Sean
                                       Doyle about hiding data on the internet. The
                                       internet, intimately connected with the institutions
                                       of science that produce data, tools for
                                       manipulating data, and organizing and presenting
                                       data, now finds itself an immense sea of
                                       information. Some of the data is not scientific data
  Go Back to the Start
                                       (such as medical information, or business
                                       statistics), but could be very useful for
                                       understanding patterns. In most cases there is no
                                       utility in hiding such data; in other cases, Sean
                                       suggests there are people who are trying to come
                                       up with ways of scrubbing the data so that data


                                       can be made public, used in experiments and
                                       clinical trials without endangering privacy
                                       concerns. Such "access" will either be radically
                                       open, or will obey the provisional justifications of a
                                       system of reputation that might be incompatible
                                       with the hierarchical system of decision makers
                                       that Lyotard imagines. Or consider what
                                       bioinformatics proponents suggest: what people
                                       will pay for and where power rests is not so much
                                       in exclusive access to information, but in "first
                                       crack" at the data. The time horizon might be
                                       sufficient for people to force a decision, to get
                                       ahead, to fall behind, to catch up, to produce
                                       something that can then be called proprietary. In
                                       this instance, a drug or a gene. This all important
                                       term "term" as in "term of credit" is what Lyotard
                                       fails to include when he impies that the ownership
                                       of information is forever. It connects the
                                       differing-deferring of Derrida with the simple fact
                                       of the temporality of both knowing and owning.
                                       When owning can be conceived of as contract, then
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                                 When owning can be conceived of as contract, then
                                 it is not power, in Lyotard's sense, but just one
                                 more move in his language game. Pace FSF.)

                                       "The ruling class is and will continue to be a class of
                                       decision makers." (14)


                                    (Parenthesis: Consider the power struggle in
                                 medicine over "order entry"-- the decision about
                                 what tests or images to order, in order to make a
                                 decision about a patient's state. The power to
                                 make that first decision is increasingly being
                                 controlled not by a restriction of information, but
                                 by a simple interdiction: too expensive. Because
                                 the tests are ordered to provide a basis for liability
                                 protection as much as for actual access to
                                 'knowledge' this curtailment is a first question of
                                 risk sharing between the doctor and the manager


                                 (a struggle not so much over the decision as the
                                 responsibility for the decision). Only second does it
                                 become a question of a game of "perfect
                                 information," to use the language of Lyotard. The
                                 "decision maker" is a figure that haunts the whole
                                 of The Postmodern Condition, and it is the
                                 'arrogance' of the decision maker which would
                                 presumably be held to account for the ills of
                                 society. Consider the function again of 'buzzwords'
                                 and the control that managers wield based on the
                                 proper and improper use of buzzwords. In every
                                 case, decisions are made according to a naïve
                                 realist assumption that these words have things,
                                 when in fact they function only as a haphazardly
                                 circumscribed set of signifiers whose mention in
                                 specific contexts is primarily a form of justification
                                 for a decision that is made based on either a
                                 strictly calculable set of criteria, when accounting
                                 makes the decision, or a strictly incalculable
                                 criteria, when the manager makes the decision
                                 based on "intuition" or "experience." The division
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                                 based on "intuition" or "experience." The division
                                 between marketing and sales and the management
                                 of production has historically let this kind of 'hype'
                                 circulate as epiphenomenal to the product. This is
                                 of course complicated by the existence of 'decision
                                 analysis' techniques which allow for things like
                                 intuition, experience and belief to be given a
                                 probabalistic weight and thus made calculable).

                                    Lyotard's firm simplicity in stating such
                                 predictions may be exactly what prevents him
                                 from giving an answer other than the call for
                                 postmodern dissensus based on paralogic
                                 legitimations. Cynicism aside, and despite the 213
                                 footnotes, The Postmodern Condition forgoes the
                                 specificity of political economy in favor of a
                                 narrative that would justify— if not legitimate—


                                 his conclusions. Even at the end of the report,
                                 when programmatic statements fly and ponderous
                                 words run behind them, there is a sense that The
                                 Postmodern Condition, in all its simplifications,
                                 has made a breakthrough:

                                       We must thus arrive at an idea and practice of justice
                                       that is not linked to that of consensus. A recognition of
                                       the heteromorphous nature of language games is a first
                                       step in that direction... The second step is the principle
                                       that any consensus on the rules defining a game and
                                       the moves playable within it must be local, in other
                                       words, agreed on by its present players and subject to
                                       eventual cancellation. The orientation then favors a
                                       multiplicity of finite meta-arguments, by which I mean
                                       argumentation that concerns metaprescriptives and is
                                       limited in space and time (66).


                                   This overly theoretical programmatic conclusion
                                 nonetheless references a very local change:

                                       This orientation corresponds to the course that the
                                       evolution of social interaction is currently taking; the
                                       temporary contract is in practice supplanting
                                       permanent institutions in the professional, emotional,
                                       sexual, cultural, family, and international domains, as
10.08.2010   http://web.archive.org/web/20010308223...s /monouns aturated/monouns aturated.html   #19

                                       well as in political affairs (emphasis mine, 66).


                                   Since this is one of the few sentences in the book
                                 without a footnote, we'll have to assume that
                                 Lyotard is referring to the temporary labor
                                 contract— and that he imagines this as
                                 corresponding to a local language game with
                                 agreed upon rules and the possibility of
                                 cancellation. The labor contract, however, may not
                                 be the best example, since it has always been
                                 subject to such negotiation, whether by virtue of
                                 the employer-employee relationship (which
                                 reduced negotiation to firing and quitting) or the
                                 association with the various corporate bodies that
                                 have represented labor over the years, such as
                                 unions. However, if the contract is for the use of
                                 software, the suggestion seems ever more


                                 reasonable today given an ostensible conflict
                                 between American intellectual property law and
                                 contract law. In particular, much discussion by
                                 lawyers over the amendment of Article 2B of the
                                 Uniform Commercial Code concerns the priority of
                                 contract or copyright. Some argue that the
                                 Amendment will give contract law an expanded
                                 legitimacy that it has not had to date, over the
                                 constitutionally guaranteed rights of intellectual
                                 property. The contracts at issue are those for
                                 software of various kinds that could be designed to
                                 control a host of aspects of the users use of them.
                                 On one end of the spectrum, this amounts to a
                                 complete form of governance by the corporations
                                 that control the writing and negotiating of these
                                 contracts (and their transformation into software
                                 that controls them). On the other is the Free
                                 Software Foundation, who depend on the very
                                 same possibility to guarantee a contract in which
                                 all such abilities to control the software (or the
                                 user) are guaranteed to the user. The combination
10.08.2010   http://web.archive.org/web/20010308223...s /monouns aturated/monouns aturated.html   #20
                                 user) are guaranteed to the user. The combination
                                 of contract and copyright law, therefore could rest
                                 on a simple legitimation by consensus
                                 (Constitutional Law and America's broken
                                 representative democracy) a legitimation by
                                 'dissensus' (temporary contracts negotiable by all
                                 parties, such as GPL'd piece of software) or a worst
                                 case scenario of both (temporary contracts
                                 negotiable only by the party that owns the software
                                 rights— legitimated by constitutional law). The
                                 implication being that governance is not always
                                 conducted by governments [8].

                                    Lyotard's solution, to paraphrase, is to abolish
                                 intellectual property guarantees: "give the public
                                 free access to the memory and data banks." If this
                                 were to ever occur, then, what Lyotard calls "games


                                 of perfect information" would be possible, and
                                 perfect information levels the playing field for the
                                 making of decisions, or so we hope.

                                   I would suggest that Lyotard's is not alone in his
                                 hope, nor his insistence on the role of language as
                                 essential to this hope.

                                    Coming from another perspective to reach
                                 similar conclusions, is Charles Sabel, whose
                                 familiar assessments, with Michael Piore, of
                                 flexible specialization and The Second Industrial
                                 Divide has since led him to articulate nothing less
                                 than a new American Constitution that he calls,
                                 variously, "democratic experimentalism" and
                                 "directly deliberative polyarchy." In an article
                                 called "Design, Deliberation, and Democracy: On
                                 the New Pragmatism of Firms and Public
                                 Institutions," Sabel unravels a particularly complex
                                 argument with respect to the "syndrome"
                                 diagnosed and treated by Lyotard above [9]. He
10.08.2010   http://web.archive.org/web/20010308223...s /monouns aturated/monouns aturated.html      #21
                                 diagnosed and treated by Lyotard above [9]. He
                                 begins with a discussion of the traditions of
                                 theorizing self-organizing social behavior and their
                                 relationship to institutions that he identifies with
                                 Durkheim and Hayek. Sabel overturns a
                                 distinction central to both traditions, between
                                 tacit norms and guiding rules by virtue of an
                                 empirical familiarity with new economic modes of
                                 organization that he refers to as "Learning by
                                 Monitoring." These firms (Sabel studied
                                 automotive designers) are reorganized around
                                 teams that set the pace and goal of work by
                                 reference to other teams in vertical and horizontal
                                 relationship to them.

                                    Significantly for this thesis, Sabel makes the
                                 following concise but encompassing claim:


                                       These institutions, we will see, allow articulation of a
                                       single language of practical reason in which questions
                                       regarding the performance and the coordination of
                                       particular tasks can be addressed by disciplines with
                                       similar syntax. These innovations transform general
                                       ideas about the social exploration of ambiguity originally
                                       formulated by the pragmatists by extending them to
                                       economic and, potentially, political life. They reintegrate
                                       conception and execution by transforming corporate
                                       bureaucracies founded on their distinction; they evoke
                                       as well the prospect of joining democracy and workaday
                                       activity to combine the freedom of the ancient citizen
                                       to participate directly in lawmaking, but in a state that
                                       disdained concerns of daily life, and freedom of the
                                       modern citizen to express views on every manner of
                                       activity, but in a form, that of the public opinion apt to
                                       influence the law only at a remove. (Section 1, ¶7,
                                       emphasis mine).


                                    Not only does Sabel relate the organization of
                                 economic activity to the structure of public life via
                                 pragmatism, but he insists on the linguistic nature
                                 the bond that allows intitutions to coordinate. I
                                 insist, here, and elsewhere (chapter P), that this
                                 linguistic focus is apposite, both in the general
                                 sense of "convention" and in the much more
                                 specific sense of standards for software and
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                               A. Amicas.
                                    What is Amicas?

                                    Throughout this dissertation, Amicas refers to both a technology
                                    and a company. There should be little confusing about this—after
                                    all Kleenex is both a product and a company— except that a
                                    central problem of this dissertation is the distinctions amongst
                                    technology as a product, as a service, and as a community
                                    (whether corporation or nation). Therefore, I am indiscriminate in
                                    my use of the term Amicas as agent (corporations are persons too,
                                    remember) or patient; sometimes it is a product— a tangible thing;
                                    sometimes it is a service— an intangible force, or value, sometimes
                                    it is a company— a community of humans. This is much less true of
                                    other entities in the thesis— Partners Telemedicine Center,
                                    WorldCare, Free Software Foundation, opensource.org or various
                                    individuals and authors which maintain a more conventional status.
                                    As such Amicas is a central figure in the dissertation, even if the
                                    dissertation is not really 'about' Amicas.

                                    Despite this preamble, Amicas is, technically speaking, the
                                    following:

                                    A web/intranet based radiology image management system. It was
  Last Modified                     conceived first as a "teleradiology" system that would leverage the
  11-Sep-99 9:26 PM                 internet to deliver radiological images (the ubiquitous acronyms of
  ckelty@mit.edu                    healthcare: CT, MRI, CR, CF, NMR, Ultrasound) to doctors who are
                                    geographically remote from each other. However, as a result of
  Go Back to the Start              several factors, it quickly became a technology for the
                                    management of radiological images inside hospitals as well as
                                    between them. It is now both a teleradiology and a Picture
                                    Archiving and Communication System (PACS).

                                    Amicas is an internet software architecture. Amicas is written in
                                    Java, a language designed by Sun Microsystems to take advantage
                                    of the standard protocols of the internet and the World Wide Web.
                                    It's motto is "write once, run anywhere" and intends to be
                                    "platform independent." More accurately, it shifts the "platform"
                                    from hardware to software (i.e. rather than needing a specific
                                    processor and hardware architecture, it needs a specific software
                                    application— a Java-enabled web browser, such as Netscape and
                                    Internet Explorer— to allow the programs written in Java to run).
                                    Amicas consists of several things:

                                    An internet server: a computer that holds the Java software and
                                    makes it accessible to any other computer that requests it; in this
                                    particular case, it is a Java Web server.

                                    An image viewer: this allows the remote computer to display
                                    radiology studies in a browser window, it is written in Java and
                                    downloaded to the requesting computer. As of this writing, it also
                                    requires a "plug-in" which is a piece of code that is specific to the
                                    user's operating system (Windows, Mac, etc.), and adds functions
                                    to the browser on that user's computer. In this case the plug in is
                                    required in order to decompress the images that are compressed
                                    using wavelets. The preferred alternative would be to write the
                                    same piece of code in Java, and have it be downloaded with each
                                    viewing, eliminating extra complexity on the user end. This is costly
                                    and difficult, however.
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                             and difficult, however.




                             A database: The database manages images and their associated
                             information. It allows searches by name, number, doctor, etc.

                             Web-based management tools: These are tools designed by the
                             system administrator (Jonathan Gourd) to allow the service and
                             support staff to monitor, update, or fix the system as it runs, all
                             through a browser interface. This allows them to do support from
                             basically anywhere they can access the internet.

                             An archive: The archive holds the radiology images. Over the last
                             two years, as with consumer computing, the cost of storage has
                             dropped so dramatically, that storage archives are now a very low
                             cost addition to a system like Amicas, a far cry from the enormous
                             optical and tape storage systems of the early nineties.


                                                 Jonathan Gourd's product promo


                             For updated info, go to the source http://www.amicas.com/



                             Who is Amicas?

                             Adrian Gropper, President and CEO
                             Sean Doyle, Vice President and Principle Architect
                             Jack Gray, Software Engineer
                             Barry Gutwillg, Vice President, Business Development
                             Bill Pope, Director of Operations
                             Jan Moe, Director of Commercial Activities
                             Jonathan Gourd, Information Systems Officer, and Lord High
                             Minister of All Things Electrical and Fluid
                             Kevin Conway, Technical Services Manager



                             Where is Amicas?

                                   Amicas officially began in the late nineteen
                                eighties, as Adrian Gropper's consulting and
                                medical device business, then called Autocytgroup,
                                Inc. Like so many one person businesses,
                                incorporation was a necessary identity, even if it
                                didn't signal profit, payroll or cigar-smoking
                                chairmen of the board. Just one cigarette smoking
                                chairman. It took another ten years before the
                                company actually had an official payroll, and an
                                official smoking policy, even if it still wasn't paying
                                its employees regularly. Since about late 1996, the
                                employees of Amicas (between 8-10) have been
                                yoked together by cell phones, pagers, PalmPilots,
                                virtual private networks [software-based
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                                networking for the internet, see section 1, Chapter


                                G, footnote 1], and real public internets. They are,
                                in the unFortunately banal language of Fast
                                Companies circa 1997-8, a "virtual corporation."

                                    Amicas's virtuality has been a source of pride for
                                CEO Adrian Gropper, even if it has occasionally
                                been a source of pain in the asses of his staff. When
                                Jan Moe joined the company, she explained that
                                she had been working on the Amicas web site at
                                the local library near her home in New Hampshire.
                                Adrian was tickled, insisting that the truly virtual
                                company of the future would work only in public
                                libraries. The canonically public space of the
                                library has probably hatched many a business, but
                                until now, it couldn't strictly have been run from
                                there. These days, a whole business can be run
                                from a closet, or from under a desk, or behind a
                                filing cabinet. All of the members of Amicas are
                                intimately familiar with this particular problem of
                                the location of work.

                                   One measure of this pleasure in mystery is the
                                preoccupation with personal gadgetry for
                                distributed virtual organization and
                                communication on the internet. Jonathan Gourd's
                                enthusiasm for the networkable helped fuzz every
                                line between software and hardware that might
                                conceivably be taken for granted: web pages that
                                dial pagers, phones that receive email, and my
                                favorite, PCAnywhere, which produced endless
                                spectral events on any computer I might sit at (PC
                                Anywhere is a program that dials into any remote
                                computer and emulates the OS, if you happen to be
                                sitting at a computer that someone PCAnwhere's
                                into, it will be taken over). Virtuality takes many
                                forms. Their slow movement towards reality has
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                                consisted mostly in the kind of conventional


                                corporate details that lag behind their visions of
                                distribution and dispersal: health plans (an irony
                                that hardly escapes attention), liability insurance
                                (including the all-important insurance against
                                "omissions and electronic errors"), stock options,
                                payroll.

                                   Despite this movement towards becoming a
                                "real company," Amicas is divided by the
                                non-existence of a "real" public space of the office
                                (located, as it is, either in the closed confines of a
                                public hospital or the 1st floor of a private
                                residence) and the real fantasy of a
                                hyper-anonymous space of the public library— an
                                image that captures something of their business
                                plan for that eminently public realm called
                                healthcare. "Virtuality" like so many of the
                                buzzwords that sound outdated even before the
                                end of the paragraph, is both asset and liability. At
                                a theoretical level, the asset stems from the
                                possibilities of extensibility and scalability without
                                regard to location or infrastructure, the liability
                                from the confusion such an approach wreaks on
                                Amicas' market and customers. In the end, Amicas
                                is attempting to circumvent the banal notion of the
                                internet as a "virtual" reality. "Virtual" in its
                                opposition to "real" obscures the work of
                                distancing and timing that Amicas and every other
                                start-up company tries to make miscible in the
                                "real world." The most important conceptual
                                difference contained in this circumvention is that
                                the internet is the world.

                                  Of course, the world without the internet still
                                exists, barely, but this is not important to the fact
                                that the distinction is only an attempt to save a
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                                reality that is natural and not technical. Perhaps


                                this discussion could be extended, but the only
                                point to be made, and one will be made again
                                further down (See Section 1, Chapter L), is that the
                                internet is public sphere, legal regime, mass
                                media, and technical infrastructure at once. All of
                                these things existed as the architecture of society
                                and state prior to the internet, and all of them will
                                now be part of the internet.


                                       The Alledgedly Advanced Imaging

                                       Lab. January 1998-July 1998.

                                   My first six months with Amicas took place on
                                the second floor of the Blake building at
                                Massachusetts General Hospital (part of the
                                Partners Healthcare System in Boston, which also
                                includes the Brigham and Women's Hospital) in a
                                little room labeled "Advanced Imaging Lab."
                                Employees of Amicas refer to it as "The Alledgedly
                                Advanced Imaging Lab." The Alledgedly Advanced
                                Imaging Lab is hidden inside the radiology
                                department at MGH, a busy, self-important place
                                swamped with high-priced, high-end, high-tech,
                                high-level people; littered with machines large and
                                small. Occasionally one glimpses a patient, prone,
                                inside a huge vibrating, screeching, or buzzing
                                donut of some kind. Occasionally, doctors' white
                                coats pass, but more often a pin-stripe suit
                                wanders, cell-phone in hand, a parody of magnetic
                                interference and disorientation, an emblem of the
                                new healthcare.

                                  The Alledgedly Advanced Imaging Lab was a
                                room about half the size of my Boston
                                micro-apartment, which I hadn't thought possible
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                                in the late 90's re-population and


                                neo-gentrification of inner cities and brownstones,
                                where square-footage is coin of the realm (my
                                particular patch measured under 400 square feet).
                                No— location seemed far too valuable for a
                                corporation to have less space than an individual.
                                But it turns out that Amicas never really 'rented' it,
                                per se. Amicas had been 'lent' the use of this space
                                by the head of Radiology, Dr. James Thrall. The
                                history of the relationship of the members of
                                Amicas to MGH goes back at least ten years, and
                                through various ventures that ultimately,
                                chemically, circuitously precipitated the present
                                arrangement. In this space they managed to fit
                                some 17 monitors of between 15 and 21 inches in
                                size, 2 laser printers, a regular flatbed scanner, 13
                                CPUs of various sizes, networking hubs and
                                routers, an X-ray digitizing scanner, and a set of 2
                                full-size radiology workstation monitors (2K x 2K),
                                and what felt like hundreds of keyboards and mice,
                                more , in any case, than there were screens or
                                computers. The staff maintains that this was
                                meant primarily to intimidate or impress,
                                depending on the day and that they really only
                                needed one of the computers. Off to one side, the
                                fax machines seemed archaic and clunky, and in
                                fact were never once used while I was there,
                                (though I was assured that they saved lives in the
                                occasional case) and like so many technologies that
                                have achieved some kind of ubiquity, disposing of
                                them became unthinkable.

                                   More striking than this array of technology,
                                Amicas were never the only people in this very
                                small cluttered room. In this space there worked,
                                during any given period, a variety of
                                infrastructural go-betweens: information systems
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                                support staff, radiology docs and technicians, other


                                researchers on other pet projects. Since the 'lab'
                                was in the same general area as the radiology
                                department, any interested radiologists and/or
                                researchers were also allowed to use various pieces
                                of public equipment that were located there (X-ray
                                scanners, flat-bed scanners, decaying Macintoshes,
                                X-Ray monitors, etc.). There was also one woman
                                who used the printer very regularly, though I never
                                asked who she was, or what she was printing. I
                                decided to assume it was important to some other
                                realm of the hospital.

                                   There was also the Radiology Information
                                Systems staff, three gentle and generally quiet
                                people who had to keep watch over the voice
                                recognition software, and the aged IDXrad system,
                                which contained all (god-willing) the demographic
                                information associated with each radiology study.
                                During my early visits they rarely interacted with
                                Amicas, only offered the requisite Monica
                                Lewinsky joke, and on occasion, would spread
                                rumors about famous people who had just been
                                X-rayed in the hospital. But by the end of my
                                tenure, when Amicas moved out of the lab in late
                                1998, they had become de facto support staff for
                                the Amicas system at MGH, fielding many of the
                                support calls, and helping newbies install browsers
                                and plugins so they could use it.

                                   Guarding this array of equipment and the
                                virtual world it subtends is Jonathan Gourd, Lord
                                High Minister of All Things Electrical and Fluid. As
                                the party responsible for the administration of all
                                network systems for Amicas, Jonathan is at the
                                center of the company. Over the months, Jonathan
                                was the sole person who I saw repeatedly on a daily
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                                or weekly basis. He constituted the present center


                                of an absent structure, the virtual company which,
                                from the inside, might look like it was entirely
                                controlled by Jonathan. One of our first
                                discussions was about the horror film Relic, the
                                story of an anthropologist who turns into a genetic
                                mutant monster after a trip to the savage jungles
                                of South America and is subdued, drowned, and
                                exploded in the Chicago Museum of Natural
                                History by a lovely evolutionary biologist. It was a
                                way for me to explain my research. Over the
                                months we would often talk film and music.
                                Jonathan was a sound engineer who had lived in
                                the Boston area for most of his life. He was full of
                                stories of bands from the seventies, eighties, and
                                nineties, and had a truly amazing recall of names,
                                lyrics, anecdotes. Jonathan's film taste turned
                                especially to the more obscure, extreme examples
                                from the horror genre. Evil Dead and, later, Street
                                Trash were gruesome topics of discussion. His
                                knowledge of all kinds of commercial technology
                                was an unmissable asset to the company.
                                Jonathan's immersion in the commercial world of
                                technology was a common focus of decisions.
                                Constantly deferred to on purchase decisions,
                                Jonathon's offical title as the System
                                Administrator downplays his actual importance to
                                the company. Jonathan's immersion in the
                                internet was by far the deepest and many tentacled
                                of anyone at Amicas. Without Jonathon, the
                                newest hippest technologies might well have
                                passed the company by. Everything from Palm
                                pilots, pagers and phone systems, to Javascript or
                                ASP web-site tools to MP3 players and a world of
                                music and software clining to the inderside of the
                                internet.
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                                   Even in his official role as system administrator
                                (sysadmin), Jonathan is a perfect example of the
                                invisible work of the internet. The sysadmins of the
                                world do much more than fix problems, if this
                                wasn't clear. To the extent that the internet can be
                                imagined as automatic, it is because sysadmins do
                                the articulation work to make it look that way.
                                Stray emails, crashed servers, fatal or annoying
                                bugs in software. "Work arounds" are the stock in
                                trade, and if there is anyone who experiences the
                                internet's growth and change as slow, it is
                                probably the sysadmin.

                                   During the first phase of Amicas' history, then, I
                                could always find Jonathan in the Advanced
                                Imaging Lab. Sometimes he would be downloading
                                random MP3s (I shall probably never forget
                                "Short-Dicked Man"), sometimes manually
                                transferring radiology studies that didn't make it
                                to where they were going.

                                  One other set of people occassionally occupied
                                this room: the support staff from Agfa. Agfa had
                                installed a Picture Archiving and Communication
                                System at MGH (more below) and along with it
                                were two full time support employees who were
                                half sysadmins, half support staff (that is, half
                                each, I never really talked to them on account of
                                the fact that they were usually in another room
                                entirely, and because they were obliquely in
                                competition with Amicas. The relationship
                                between these two tehnologies was fascinating, and
                                perhaps essential to the kind of differentiation
                                with respect to the internet that Amicas eventually
                                made of itself. Before this, however, some details
                                about the MGH radiology department.
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                                       The MGH Radiology Dept. and a

                                       history of PACS

                                   MGH's radiology department, like many other
                                high-tech academic medical center radiology
                                departments has all the hippest technology: 4
                                Computed Tomography (CT) scanners, 2 and a half
                                magnetic resonance (MR) scanners, pediatric and
                                cardiac ultrasound, countless X-ray machines,
                                both traditional film-based and computed
                                radiography (CR) (in addition there are nuclear
                                medicine, PET, and various other more or less
                                experimental devices in the hospital, though they
                                are used primarly for research purposes, rarely
                                daily clinical use— though like all research
                                hospitals the routine is devalued to the point of
                                experiment, and the 'interesting' sought
                                relentlessly). In the past, each of these machines
                                was sold individually to the hospital by major
                                equipment manufacturers such as GE or Siemens.
                                CR, MR, and CT machines produce digital images,
                                they do not, at any point require the use of
                                chemical-based film processing to produce an
                                image. And yet until April of 1997, almost all of the
                                scans performed in the hospital were printed out
                                to film, using a special digital-to-film printer, and
                                sent to the radiology film-viewing center.

                                   Film, goes the accounting refrain, is expensive.
                                Why produce so much more of it than is
                                necessary? One powerful reason is workflow. The
                                radiologists of MGH were all trained to view
                                images using a set of familiar technologies:
                                light-boxes, films and film jackets and the filing
                                system that went with them, and in some cases a
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                                system that went with them, and in some cases a
                                set of large rotating cylindrical drums that a


                                radiologist could use to view several images in
                                series, and in comparison. These technologies were
                                located in viewing centers in the radiology
                                department. Often light-boxes were in doctors
                                offices or examining rooms, but most diagnosis
                                was done in the radiology viewing center. This
                                meant that radiologists clustered together in this
                                one central area, and informal collaboration is a
                                common function of such an organization. For
                                digital modalities such as CT and MR, that
                                workflow was difficult to disrupt. Getting the data
                                to the doctor meant getting it to where the doctor
                                went. Two solutions emerged. The first, as
                                suggested above, was simply to print everything
                                out to film. The second involved the growth of the
                                PACS industry. A second reason, was that viewing
                                digital images on the screen was perceived as
                                unreliable, since the images, in some cases, need to
                                be of such a resolution that they can be used for
                                accurate diagnosis. This concern has faded, as the
                                resolution and refresh rates of standard monitors
                                has increased, as the cost has come down, and as
                                the ACR has issued protocols and
                                recommendations for diagnosing images on the
                                screen. For some images, such as mammography,
                                film is still the gold standard.

                                   These days, the standard CT and MR machines
                                in MGH are usually sold along with a set of
                                expensive, high-end radiology-viewing
                                workstations, a pair of high-resolution (2K X 2K)
                                monitors hooked to a workstation, networked
                                securely and proprietarily to the scanners in the
                                hospital and to the archive servers that store the
                                digital images. These workstations are a relatively
                                recent innovation (from the late 1980's to the early
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                                1990's) even though MR and CT themselves date to


                                the seventies. They can be used to view the scans
                                with some of the versatility of the film-based
                                reading techniques that have been developed over
                                the last 100 years. These workstations and archives
                                are generally made by the same companies that
                                have been in on the film workflow: Polaroid, GE,
                                Agfa, Kodak, Siemens. They leave the workflow
                                untouched— in terms of physical space, and the
                                actions of radiologists— even if they selll this new
                                technology as a whole new industry, the PACS
                                market.

                                   The acronym itself signifies a certain break from
                                the medical technology market of the seventies and
                                eighties, which was dominated by autonomous
                                stand-alone devices— "big ticket items"— that
                                required the installation, configuration, and
                                support network of the corporation that sold it (as
                                Adrian Gropper mocks it: "a dotted line, a metal
                                box, an ON button"). The emergence of a PACS
                                market at least expressed some of the desire to
                                make these technology more commodity-like; to
                                componentize them into pieces that would work
                                together to solve the information needs of the
                                radiology world. In many cases, however, this
                                differentiation has been ambiguously and unevenly
                                achieved (this is partially the subject of Section 2
                                below).

                                  PACS vendors appeared in the late eighties and
                                early nineties as an attempt to innovate not the
                                quality or content of the imaging technologies
                                themselves, but their integration and use. It was a
                                natural trajectory for companies such as GE or
                                Agfa, who had been involved in the production of
                                the various imaging modalities or film based
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                                systems from the beginning. At the same time,


                                widespread interest in "telemedicine" was
                                perceived as a growing market possibility, and
                                though it never reached the level of investment
                                that would have made it a regular on the business
                                page, it was commonly used as a justification for
                                the kind of research and development PACS
                                companies saw themselves engaging in. This led to
                                increased investment in the communications and
                                storage aspects of radiology, and fueled interest in
                                the creation of a protocol for the transmission and
                                storage of images. This protocol, which would
                                come to be called the Digital Imaging
                                COMmunication (DICOM) protocol was a joint
                                standards effort overseen principlly by the
                                American College of Radiologists (ACR) and the
                                National Electronic Manufacturers Association
                                (NEMA). With DICOM under development, a
                                round of research produced the first PACS devices.
                                The market was poised to take off. Around 1994,
                                however, the world was broadsided by the Web.

                                   The Web represented a very different tradition
                                of software and networking expertise than the
                                primarily proprietary mode of the large imaging
                                comapnies or the information systems companies.
                                It was just before this time that the MGH
                                radiology department had funnelled money into an
                                external commercial PACS/telemedcine endeavor
                                (see history). MGH, being an academic medical
                                center, could hardly pass up what was initially
                                perceived as primarily an academic project,
                                especially if it included the glamour of information
                                and communication technology and if it
                                represented a potential expansion into
                                international markets, but because there were no
                                companies outside of the hospital itself that would
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                                manage the financial and logistic aspects necessary


                                to actually perform telemedicine, MGH started its
                                own (called RStar and later American
                                Telemedicine International, and still later, bought
                                by WorldCare, Inc.). This project failed to produce
                                a technology that would make telemedicine a
                                success, but not for lack of effort on the part of the
                                engineers involved (including Adrian and Sean),
                                and didn't really have the expertise to compete
                                directly with the PACS vendors. As this project
                                dwindled, the MGH radiology department had
                                hired Agfa to come in and install a PACS system.

                                   Agfa installed a PACS system that would route
                                images from all of the digital modalities to two
                                refrigerator-sized 800GB optical disk storage
                                units, do some basic verification, and make them
                                available to a set of Radiology workstations (the
                                two headed 2K by 2K monitors). As explained
                                above, the system left the radiology workflow from
                                the days of film intact.

                                   As it became clearer that the internet and the
                                web were generating the kind of buzz that makes
                                decisions split MGH— with Agfa already in the
                                radiology department— agreed to house Amicas as
                                the internet 'complement' to the existing PACS
                                system. Like so many large corporations during the
                                early years of the Web's explosion, Agfa was paying
                                little attention to the web. It's size and its power in
                                making deals with large organizations like MGH
                                made it more or less invulnerable to most
                                competing technologies. As the mystery of the web
                                began to work itself out in the media and in
                                business plans, it eventually presented Agfa with a
                                map they could not locate themselves on. Not only
                                was it unclear who their competitors would be, or
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                                why an upstart start-up who seemed to be building


                                a glorified image-viewer, might constitute this
                                threat, but it was also unclear how the internet
                                intersected with what they did— networking a
                                radiology system inside a hospital. Agfa— at least
                                the public presentation, and its actions at MGH
                                indicate— would be a victim of the internet as
                                infrastructure (see Section 2, chapter C).


                                       Amicas Development

                                   The Amicas image management system was
                                developed in vivo at MGH. There was no single
                                period during which it was first tested, and then
                                installed; all along it was installed as a kind of
                                actual test, an implementation-in-use. This should
                                not, however, be seen as cause for alarm. From the
                                beginning, Amicas' purview was well defined: it
                                was to use the internet to deliver images to the
                                desktops of physicians. It was not
                                "mission-critical" and it was not the only solution
                                for viewing images. In this sense it was an
                                academic research project, devoted to developing a
                                particular kind of technology. It was housed in
                                "The Advanced Imaging Lab" and it used new
                                internet technologies like Java and cutting-edge
                                wavelet compression technology.

                                   It was not a research project, however. It was a
                                start-up company. This fact reappeared across the
                                city— at BWH, at Partners Telemedicine Center
                                and at MIT— as something unusual, if not
                                downright suspect. To complicate matters, MGH
                                paid Amicas (then still called Autocyt) for its
                                services, and treated the product as a
                                "demonstration" for purchase. Meanwhile, Adrian
                                Gropper and Keith Dreyer (the purchasing director
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                                Gropper and Keith Dreyer (the purchasing director
                                for MGH Radiology) wrote a paper for the


                                academic Journal of Digital Imaging, published in
                                August 1998. This dual life as a start-up company
                                seeking to sell its product to other hospitals at the
                                same time that it actually developed it at MGH
                                was indeed unusual (J Digit Imaging 1998
                                Aug;11(3 Suppl 1):12-7 Enterprise-scale image
                                distribution with a Web PACS Gropper A, Doyle S,
                                Dreyer K). Adrian himself often remarked on the
                                fact that they were breaking all the implicit rules.
                                Despite this, both Amicas and MGH, because of
                                their experience with ventures like Rstar, were very
                                careful about the relationship between MGH and
                                Amicas. MGH did not own the rights to any of
                                Amicas' software. They did not pay Adrian or Sean
                                to develop it, and the employees of Amicas were
                                not employees of MGH (with the exception of
                                Barry Gutwillig, who started out as a business
                                development director at MGH, but slowly moved
                                over to full time work at Amicas).

                                   What MGH did provide for Amicas was
                                overhead. They allowed Amicas to squat in the
                                Advanced Imaging Lab and to use MGH as an
                                enormous, real-life testing environemnt to develop
                                software in. By the beginning of 1998, Amicas was
                                being used in MGH regularly, by clinicians,
                                radiologists, the telemedicine researchers of the
                                Partners Telemedcine Center and the MGH
                                teleradiology department, and any one else who
                                stumbled on or was directed to it by peers of by
                                support staff.

                                  Clearly, the notion of 'testing' falls short of what
                                they were engaged in. No classical model of
                                problem-oriented design process captures the
                                dynamic of what Amicas had achieved. More than
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                                a few times, both Sean and Adrian have noted that


                                they could not have built the system they did
                                without the familiarty accorded by being in the
                                hospital. The expected boundaries of firm, hospital
                                and academic research lab are nowhere as
                                permeable as in this example.

                                   To complicate matters, the relationship to Agfa
                                was also somewhere in between testing and
                                research. Agfa's PACS system was
                                "mission-critical." In many cases, it held the only
                                copy of an image, so short of doing a study over
                                again, which was either dangerous or inconvenient
                                for the patient, it was up to Agfa to make sure all
                                the studies were available. There were a variety of
                                reasons why a scan might not be available. The
                                first might be that it was sent to "the penalty box"
                                because there was something wrong with it—
                                missing information, incorrect or unverified
                                information, or corrupt image data. The DICOM
                                protocol was largely responsible for the kinds of
                                information and verifications that should be
                                performed by a system like Agfa's. The second
                                might be that it never got to the Agfa system— inly
                                recently were the scanners themselves configured
                                to automatically send an image to the PACS, prior
                                to that it was the tech's duty to do so. The last of
                                course, includes all manner of mysterious,
                                unexplained phenomena. All too often, a missing
                                study is simply inexplicable.

                                   The reason this is all important to Amicas is
                                that the Amicas system retrieved images directly
                                from the Agfa PACS. So when an image came into
                                the Agfa PACS, a copy was immediately routed to
                                Amicas. This might not make much difference to
                                Amicas or Agfa, but to the radiologists and the
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                                clinicians, it made all the difference. For the most


                                part, this behind the scenes image transfer was
                                invisible to the doctors, and they were little aware
                                whether they were using Amicas or Agfa (nor did
                                most of them probably care). However, when an
                                image was not available in Amicas, as a result of
                                some fault in Agfa or elsewhere, it was often
                                Amicas that the doctor would call. Amicas could
                                rarely do much to get an image that Agfa had sent
                                to the penalty box, but occasionally they could, and
                                this made all the difference to the doctor. Thus did
                                Amicas slowly become a presence as the people
                                who were in charge of images.

                                   Other anecdotes illustrate the unconventional
                                relationship between Amicas and Agfa. For
                                instance, consider the practice that the technicians
                                developed using Amicas. Normally, when a
                                technician performs a study, a CT scan for
                                example, the image is verified, visually and for its
                                information, it is often printed out to film, and
                                then it is sent to the Agfa PACS. The PACS system
                                provides no way for the technician to verify that
                                the image actually made it there, short of leaving
                                the room, going to the radiology viewing room and
                                looking at the Agfa Radiology workstation, to see if
                                it is available in the PACS. Since most techs have a
                                PC on their desk next to the scanner console, they
                                developed the practice of checking Amicas (since
                                Agfa routes a copy of all incoming images to
                                Amicas) to see if the image had gotten to Agfa.
                                Such an Ad Hoc verifcation procedure was
                                completely outside the control of Agfa, and
                                possible only because of the unique arrangement of
                                Amicas in MGH.

                                    Understanding this relationship between Agfa,
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                                Amicas and the users in the hospital is important


                                for understanding how the internet has become
                                infrastructure, and why people like Adrian and
                                Sean are so convicted that it is the only way. Given
                                that the changes proposed by the internet have
                                only become visible to the mass media and
                                business press in the last fiv years, it was hardly a
                                simple thing to understand how Amicas could
                                eventually become Agfa's competitors. By 1998-9,
                                however, every PACS company in existence was
                                promising web-based this and internet standard
                                that. There was no selling a 'closed' 'proprietary'
                                system regardless of how good it was. The internet
                                represented the future, and every insistence that it
                                was, tipped decisions towards further this future.
                                That Agfa allowed Amicas the parasitic
                                relationship it had was essential to the
                                development of Amicas, and from Agfa's point of
                                view, participation in "research." From one
                                perspective, Agfa did not have to do what it did
                                (allow Amicas access to the images). However,
                                Agfa was in a similarly precarious position, in that
                                it was possible that they might be kicked out of
                                MGH, or fail to renew a contract, or sell more
                                equipment, so it was in their best interests
                                tocooperate with Amicas.

                                  Amicas, meanwhile, was becoming a much more
                                familiar name around MGH, even if people did not
                                necessarily realize that it was a product under
                                development by a third party start-up company.
                                Anecdotes suggested radiologists and clinicians
                                experienced it as either an extension of the Agfa
                                PACS system or as some integration produced by
                                the information services department, rather than a
                                product produced by a tiny start-up company,
                                using a p[ublic network.
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                                  Both of these assumptions tickled rather than
                                dismayed Amicas members— a testament to the
                                sudden ubiquity and naturalization of browsers
                                and the web, and to the more subtle difficulty of
                                distinguishing between layers of the distributed
                                world that had infiltrated the medical center:
                                workstation, application, intranet, internet, web.
                                Not to mention the slightly righteous irony they all
                                identified in the assumption that either of the two
                                lumbering giants— Agfa or Partners— could have
                                produced such an agile system.

                                   The good thing for Amicas was, that like the
                                drug dealer, they were providing free samples in
                                order to build a reputation and produce a need.
                                The trick, it wasn't quite a method, lay in the fact
                                that they were using Partners as an
                                enterprise-sized testing site, in which actual
                                clinical images were being used in actual
                                mission-critical environments, to provide actual
                                diagnosis of actual patients. In the process, they
                                were "hooking" doctors and radiologists on
                                Amicas. Since the system hadn't been purchased
                                by MGH, nor was it owned by MGH, it was still in
                                a testing phase, but one that quickly proved to the
                                doctors that it worked, and worked as well and
                                simply as something like email.

                                   By designing this technology in vivo, Amicas
                                generated a kind of post-hoc, informal research
                                that indicated that what they were doing could
                                radically alter the organization of healthcare. By
                                building and deploying Amicas, the members of
                                the company inserted themselves directly into the
                                most particular of issues, and thereby could see
                                clearly the 'inefficiencies' from at least one
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                                perspective (that of the technology) they knew they
                                could solve.

                                  Fermented understanding of a workflow in a
                                hospital radiology department led directly to the
                                kind of business process re-engineering insights
                                that management ideologues have wet-dreams
                                about. Mix one part detailed understanding of that
                                context with ten parts internet zealotry and obtain
                                business plan. Become drunk on possibility.

                                  Such insights subsequently became, for Adrian
                                Gropper, the principle selling points for the
                                company. What began as an attempt to provide
                                image and teleradiology services within and
                                betweem hospitals became a web-based
                                enterprise-wide image distribution system for
                                radiological images has since morphed into a
                                cheaper, more efficient PACS, based on internet
                                and web protocols.


                                       Amicas outside MGH

                                  By the fall of 1998, Amicas had moved out of the
                                Advanced Imaging Lab and into the first floor of
                                Adrian Gropper's home in Watertown. What
                                sounds like a step backwards is actually not. MGH
                                was Amicas' garage, and it only made sense to
                                move into the house. The World Wide
                                Headquarters was a substantially larger space,
                                with more quiet, more control, and better coffee.

                                  Adrian Gropper's House sits on a corner near
                                the center of Watertown MA. The Three story New
                                England Victorian frame dominates the street. It is
                                a block from the Watertown High School. The
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                                house is three stories: two of the three stories do


                                business during the day and night, and all three
                                stories are constant home to the family. In this way
                                it mocks liminality, without dissolving the
                                boundaries liminality serves.

                                   The first floor is divided into two rooms. In the
                                room nearest the entrance are Jonathan Gourd
                                (Lord high minister of all things electrical and
                                fluid) and Dawn Bursk (Dawn-of-all-trades). The
                                room also doubles as a boardroom of sorts, with a
                                meeting table, a new aquarium, and less clutter.
                                Jonathan and Dawn sit against the front wall,
                                facing away from the double doors that lead to the
                                room that Sean and Jack program in. Their room
                                has two desks facing the windows, opposite a
                                fireplace, on which are stacked various Java, XML,
                                HMTL or Microsoft books, dinosaurs and a
                                Paleontologist Barbie(tm).

                                   Across the hall are the stairs that lead to the
                                living room, also known as Adrian's office, where a
                                19 inch monitor is precariously balanced on the
                                base of an old office chair, which sits next to the
                                couch I always find Adrian sitting on. Some sort of
                                antique intercom system appears to connect him
                                to the first floor, and sits next to a new and
                                elaborate Siemens phone system (which everyone
                                seemed a little bit uncomfortable with at first, as if
                                it were designed for a much larger organization,
                                not someone's home), his ubiquitous cell phone,
                                pager and palm pilot. There is a grand piano
                                accross from him and an elaborate display of Lego
                                constructions on the shelf above the doorway. The
                                third floor is presumably less an office and more a
                                home, but the liklihood of such a distinction not
                                only seems unlikely (because, for instance, Adrian's
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                                   B. Driven

                              In the car, driving to Harvard square, as we passed
                              the High School, I asked Adrian how old his kids
                              were.
                              "12 and 15" he said.
                              "So one is in high school? Here in Watertown?" I
                              asked.
                              "No BBN, Buckingham, Brown and Nichols. The last
                              bastion of Aryan homogeneity."
                              Adrian darts the car in front of an oncoming number
                              77. "Well, at least we live in a diverse
                              neighborhood."
                              I laugh.
                              "I'm serious, there are people at BBN who are so
                              totally like me... that... well, I know them, I went to
                              school with them." It isn't clear whether he means
                              this literally or figuratively, it seems not to matter—
                              they represent types.
  Last Modified               "The further along I get in what I'm doing the less
  11-Sep-99 9:25 PM
  ckelty@mit.edu
                              and less diverse things get." I don't know if he
                              means in the world of work and healthcare or in
  Go Back to the Start
                              terms of raising children, he continues, "Well,
                              actually, I guess the preschool at Harvard was
                              pretty homogenous."
                              I laugh.
                              "You know, everybody who sends their kids there is
                              a doctor or a lawyer. It's just unbelievable."
                              "What about Cambridge Rindge and Latin?" I ask.
                              "Thats a public school."
                              "Yes, but you have to test to get in, so its pretty
                              good right? And, I mean isn't it more diverse?"
                              "Yes, but this whole private school thing, that's like
                              something that's happened in the last 20 years. I
                              mean I went to public school, Judy went to public
                              school."
                              "But?" I say.
                              He trails off as we pull into the Watertown Savings
                              bank.
                              "Get this on video," he says," The starving
                              entrepreneur has to pay his mortgage on the last
                              possible day because cash flow is so bad."
                              He darts out of the car. I wait. When he returns, I
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                       He darts out of the car. I wait. When he returns, I
                       say "Congratulations."
                       "For what?"


                       "For getting in under the wire." I say.
                       "It's not really as bad as it sounds." He lights a
                       cigarette and swerves past two cars with a motion
                       that rocks the little hatchback like it's changing
                       course on high seas. "I mean, when I was doing
                       this, I was never so. I never."
                       He checks the sentence as the car stops behind
                       another in the left hand lane, turning left. Adrian
                       glances back, continues to inch the car into the
                       onconming traffic in the right lane. His beeper has
                       gone off so he is diving his right hand into his
                       pocket and steering with the left, cigarette in lips.
                       "When I was like, corporate director, or consultant,
                       I never felt the same about money. You don't have
                       the same relation. Now, I am, I have. What I
                       understand, and what Barry cannot understand from
                       his position is that there isn't any way to know how
                       much I am making, or if I am making, I sink
                       $20,000 into the project, and then I sink another
                       $20,000. You know, it used to be that I never
                       understood that apocryphal story about people
                       taking out a second mortgage on their home to start
                       a business, but it's clear to me know, it's like an
                       addiction."
                       He swerves across a wide crenellated, typically
                       cantabrigian 'intersection' towards and elderly
                       bicylist. He is trying to dial his cellular phone as he
                       smokes and tells me this story.
                       "It's a controllable addiction though." The phone
                       rings, he flips open the credit card-sized device,
                       takes a drag, and says "Hi Barry, I'm on my way."
                       Flips shut the phone and downshifts, swerves
                       across the opposite lane, then brakes abruptly
                       behind a school bus. The sun-bleached dashboard
                       begins to crumble under my white knuckles. "The
                       only addiction that isnt controllable, I've found, is
                       smoking. It is so addictive." He stops just outside
                       Harvard Square, "This is where you get out."
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                                       C. Fast company, fast car
                            5/14/98.

                                  On the day after the repeated nuclear tests in
                                India, I sat in on a meeting that Adrian had with
                                three Harvard Business School alumni. One older
                                man, one young man and one young woman. The
                                young man, Adrian told me, was representing
                                several Indian software companies. They were not
                                exactly venture capitalists, but only in the sense
                                that they did not represent themselves as such.
                                Their interest was clearly marked investment.
                                Adrian confided after the meeting that it was a
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                                         Adrian confided after the meeting that it was a
                                         first for him: the doublespeak, economic and
  Last Modified                          marketing jargon, and futurology so dominated the
  11-Sep-99 9:25 PM
  ckelty@mit.edu                         discussion that Adrian was worried they might
  Go Back to the Start                   never get to the demo ("That would have been a
                                         real first"). As it happened, they barely looked at
                                         the demo near the end of the meeting. Instead
                                         focus was on business strategy.

                                           The HBS people wanted to know who the
                                         customers were, who controlled the purchasing
                                         decisions, and Amicas' current pricing strategy.
                                         Amicas intervenes in a chaotic milieu, one only
                                         partially primed for the strategic thinking of HBS
                                         people, Adrian tries to explain: "We make a
                                         technology. In internet parlance it is an application
                                         server with customization for the imaging market.
                                         In hospitals there is a dual decision making issue:
                                         the money comes from elsewhere (not from within
                                         radiology) but the decision to buy is made within
                                         the department. 'Sales cycles' depend on budgets.
                                         In imaging center chains (e.g. Med Resources,
                                         Syncor (Nuclear medicine specialists), other


                                         affiliated radiology imaging centers that clinics
                                         outsource to) the purchasing decisions depend on
                                         IS people to evaluate products. We license by
                                         image capacity. For most PACS companies, the
                                         prime vendor issue is the person involved in the
                                         workstations. Resellers might want to sell on a
                                         per-seat basis, but we don't want to do that."

                                            Of course Amicas' pricing model changed over
                                         the year I followed them, but it was always a
                                         version of this transactional model where the
                                         customer could be charged for how many times
                                         they used the system (i.e. the number of studies
                                         either stored, or sent from one point to another).
                                         The transaction is the thing in internet commerce.
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                                The transaction is the thing in internet commerce.
                                The Thing. It is the source of value, despite the fact
                                that it is only an exchange of values measured in
                                some other currency. This thingly mystery is what
                                HBS students chase after. The model is similar to
                                that of a service provided a number of times,
                                except that in this case, the service is only to
                                provide a medium, a channel, a background, an
                                infrastructure for some other service or product.
                                The selling point for Adrian, however is a
                                "shrink-wrapped" product: software that works.
                                The fulcrum of pricing is the transaction. Moving
                                information better and faster is the service.

                                      "From the products point of view, or from the software
                                      systems point of view, whats going to happen is that
                                      people are going to increasingly focus on transactional
                                      networked things. So instead of having to buy your
                                      front end and back end from the same people...these
                                      things will mix and match happily." (3/9/99)




                                  The business plan discussion continues in
                                semi-confusion. Adrian offers the conventional
                                wisdom that when proprietary systems dominated
                                the scene in hospitals, there was no notion that
                                things could be done this way; hardware and
                                software were products. Film was a particularly
                                expensive product that everyone needed. Radiology
                                was a "cost center" not a "revenue center." For
                                years, the RFP process dominated the PACS and IS
                                markets in hospitals. Such was the "reputation
                                mechanism" of the eighties, when procducts were
                                products— the "box business" as he calls it. But
                                today, Adrian suggests, 80% of RFPs never get
                                funded because people are too squeamish about
                                investing in film, and yet they don't understand the
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                                investing in film, and yet they don't understand the
                                big picture that would allow them to see the
                                potential for big money.

                                   The HBS people want to know: "why will I be
                                addicted to this system?" and "Who is providing
                                me with the idea that this is a better solution?"
                                and "Is it a missionary solution?" "If its gonna
                                change my life, its got to be clear." They pose as
                                customers, mock-ups, or mockeries of the people
                                who actually have to figure it out. They repeat the
                                question "how do you addict people" more than
                                once, suggesting that there need not be
                                non-economic value in improved workflow, or that
                                any system is like any other system, but that
                                marketing makes it so. The term "missionary
                                solution" sticks with me, both because it is a
                                striking example of HBS buzz, but also because the
                                quasi-religious notion of proselytization crops up
                                repeatedly in this world. Strange that the default
                                mode of explanation should be the threat of
                                damnation. Make them want it. Madison avenue
                                never felt so wide.

                                   Adrian tries to return to his strategy: selling to
                                ISPs or phone companies or security experts who
                                provide infrastructure to the hospital and provide
                                an easy sales channel, but it appears not to interest
                                them. They ask, "How large a company can you
                                be?" "$3-4 million, perhaps, the
                                PACS/Teleradiolgy market was valued at 1.6billion
                                by 2005 by a March Frost and Sullivan Report."
                                They end by suggesting that Amicas establish an
                                identity as a solution to this problem and throw a
                                lot of money at partnership issues. before they
                                leave, the young man suggests that what Adrian
                                really needs is an elevator pitch. He doesn't
                                explain, but after I think about it for a while, I
                                realize that he means a pitch that one can throw to
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                                an executive in the elevator from the top of the
                                building to the bottom.


                                      6/15/99

                                  This kind of meeting and its vocabulary became
                                more and more familiar to Adrian over the year I
                                watched. Venture capitalists, angels, lawyers, and
                                consultants of all stripes started to circle around
                                the company.

                                      "Well I've got two of them writing business plans, one of
                                      them is Gil, I've got one of them is writing a cover letter
                                      to the existing business plan, wants to go run around
                                      and pitch it to VCs, I've got an accountant... that
                                      certainly counts as a consultant. I've got one lawyer
                                      recommending that maybe we should get a part-time
                                      CFO, so there's another one, i've got two lawyers, one
                                      of them wants to do corporate the other one wants to
                                      do intellectual property and that sort of stuff, one
                                      woman from Florida who just sent me email over the
                                      weekend who's trying to do me favors, a consultant
                                      from that point of view, she sent me this Hambrecht
                                      and Quist report. I've got another one who works for
                                      Concord Consulting group who wants to have lunch.
                                      [Laughter] Is that enough?"




                                   Despite their location far from Silicon Valley, the
                                stories and people intersect. Adrian and Sean both
                                seem quite content to avoid the madness of Silicon
                                Valley, but recognize that they would probably get
                                more funding and have more opportunities if they
                                were out there. On the other hand the association
                                with MGH and Harvard certainly does them a
                                world of good as reputations go. Academic
                                credentials still mean something powerful,
                                especially the sexiness of the Harvard Business
                                School which— when it isn't met with cynicism—
                                often means instant access.

                                  It was a strange thing, then, that happened
                                when I tried to participate in this economy of
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                                when I tried to participate in this economy of
                                reputations. Adrian and I had talked about Regina
                                Herzlinger's book "Market-driven healthcare"
                                several times, especially the concept of "focussed
                                factories." He had seen Professor Herzlinger, who
                                teaches at Harvard Business School, give a lecture
                                at MGH. He suggested to me that it would be great
                                to set up a meeting with her, and that I should try
                                and set it up because I was a student, and she
                                would be more likely to give a student her time. I
                                agreed, but was confused as to what I should ask
                                for. We decided that I should tell her what I was
                                doing, and ask if she would be interested in talking
                                to Adrian, Barry and myself about the role of
                                technology in focused factories. Arranging the
                                meeting was an absurd adventure. I sent off a
                                message, got an instant reply from Professor
                                Herzlinger's secretary asking for agenda items. I
                                sent off a few vague agenda items, and waited. And
                                waited. About a month later, I sent another
                                message, got a curt apology and instructions to try
                                again in two months when Professor Herzlinger
                                returned. This went on for a year. One whole year.


                                That's four generations of the internet economy. It
                                became apparent that I was the lowest possible
                                priority candidate for a meeting. Each time, I was
                                teased with the promise of a meeting, and then
                                strung along for another month. I explained to
                                Adrian what was happening, and he was as
                                surprised as me that a student would be least likely
                                to get a meeting. He suggested I drop it. But after a
                                year, it had become habit, and I sent off one last,
                                dismissisve missive, explaining that I would simply
                                like to be told if I would never get a meeting, since
                                I didn't enjoy playing the chump. Needless to say,
                                hostility forced a calendar date, which I promptly
                                agreed to. I called Adrian, and he was pleased, it
                                fell on his brithday.
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                                fell on his brithday.

                                  Market-Driven Healthcareis a kind of
                                organizational handbook for the healthcare
                                industry. Whether healthcare should be "driven"
                                by the free market is not in question in the book,
                                but assumed. The book starts from the observation
                                that in the 1980's the US Economy went through a
                                "convenience revolution." Firms learned the value
                                of high-quality service: without so much as a trace
                                of irony in the pages of "Market Driven
                                Healthcare" Herzlinger compares the "focused
                                factory" in healthcare to McDonalds, which she
                                refers to as having an "excellent, consistent
                                product at a relatively low cost." Her praise of the
                                McDonalds French Fry is positively
                                mouthwatering. Either that or payola. The idea
                                behind focussed factories is that healthcare could
                                be more efficiently broken up by procedure and
                                disease. Rather than having every kind of specialist
                                in a hospital to handle any potential problem, they
                                should be clustered in factories that do one thing
                                well. Her example is hernia surgery.

                                  Adrian latched onto this idea precisely because
                                he recognized what was happening to radiological
                                workflow as a result of the internet, or what could
                                happen. An early version of the business plan
                                (when Amicas was selling itself to PACS and
                                radiology companies, before reinvention as an
                                internet company: Amicas.com) captured this
                                knowledge in an diagram:

                                w orkflow
10.08.2010   http://web.archive.org/web/20010310084...roductions /polyuns aturated/C.Fas t.html   #8




                                   The image is intended to show first that all of
                                the technical components of radiology will be
                                digital by 2002. Acquisition (CR to replace X-ray,
                                CT, MRI, Ultrasound, etc.), storage (no more
                                warehouses filled with fading x-rays), radiologist
                                display (the large 2K by 2K monitors), Clinician
                                display (the desktop computer— and for Amicas,
                                there is no difference between these two except the
                                monitor, whereas for Agfa, or other PACS systems,
                                they are two different kinds of workstation),
                                integration with multiple sites (the use of internet
                                standards to build virtual private networks that
                                hook the hospitals clinics of a healthcare
                                corporation), integration with legacy HIS and RIS
                                (desiging interfaces to existing systems that allow



                                people to continue using familiar systems, but all
                                therough the interface of the browser).

                                   The "strategic components" are the most
                                interesting, however. All of these components are
                                to be imagined as predictions that will come true if
                                (read when) the internet becomes the
                                infrastructure of radiology. The first indicates that
                                doctors mobility is freed up, allowing data to find
                                doctors wherever they may be, rather than having
                                radiologists cluster in the reading room in the
                                radiology department. It is true that the data could
                                be brought to the doctor in the case of films, but
                                generally, such activity required a sub-network of
                                couriers and film librarians that had limited range
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                                couriers and film librarians that had limited range
                                and significant time constraints.

                                  The second concerns the result of improved
                                functional imaging technologies, new digital signal
                                processing techniques for viewing images, and the
                                changed workflow of sub-specialized radiologists.
                                The move to functional images changes the role of
                                the radiologist, making the technically savvy
                                sub-specialized radiologist more valuable that
                                what Keith Batchelder referred to as "the
                                memorizers"— radiologists who diagnose by
                                recognizing "bad anatomy"— anatomy that has
                                recognizable traits of some functional problem.
                                Functional imaging provides numbers. The
                                important thing for Adrian's business plan was
                                that this meant that the film workflow would
                                actually now reward organization into 'focused
                                factories'.




                                   The third, fourth and fifth strategic components
                                spell this out. As the internet seeps into
                                organizations and brings more radiologists on-line,
                                the more specialized ones will have access to larger
                                and larger markets of patients needing specific
                                expertise. This, in turn, implies conceivable cost
                                savings for organizations who no longer need to
                                hire a complete range of radiological expertise and
                                functional imaging technology, but can rely, to
                                some extent on remote diagnosis. Thus does
                                technology lower cost, rather than raise them. The
                                end result— or so went Adrian's thinking at the
                                time— being that radiologists would join specialty
                                clinics rather than general hospitals, thus creating
                                focused factories organized around the expertise of
10.08.2010   http://web.archive.org/web/20010310084...roductions /polyuns aturated/C.Fas t.html   #10
                                focused factories organized around the expertise of
                                functional imaging. Such clinics would be
                                organized by disease or procedure (like heart
                                disease or cancer or hernia surgery) and thus
                                would benefit from increased specialization, while
                                general hospitals would contract with these clinics
                                to identify the patients and send the images and
                                records (and eventually the patient) to them.

                                   I waited at WWHQ— Adrian's house— for
                                Adrian so we could go together to the Business
                                School. I sat on the porch as a man on a cell phone
                                in a flashy sports car sped by, stopped and then
                                reversed in the middle of the street to turn,
                                backwards, onto a side street and into a parking
                                place. The maneuver seemed to derive less from
                                the bravado of a sports car owner than from a
                                typical Boston parking strategy. I ignored it and
                                went back to re-reading parts of Professor
                                Herzlinger's book. Adrian came out of the house on
                                to the porch and said hello. He chatted with
                                people, went back inside, and I talked with other
                                employees who were now having lunch. Adrian


                                suggested we go out for lunch, and his phone rang.
                                I waited while he talked, alternately animated and
                                agitated. Only on the cell phone have I seen Adrian
                                agitated, and only when it involves control over the
                                company. I waited, he talked. There was some
                                discussion of intellectual property rights, and some
                                delicate phrasing about who had more experience
                                in this realm. Eventually he motioned for me to
                                come with him, still on the phone. I followed along.
                                We walked down the steps and across the street,
                                up the sidewalk and stopped in front of the car.
                                The Car. The flashy sports car I had seen the crazy
                                driver park backwards. I flashed back to my
                                previous driving experiences with Adrian in the
                                relative safety of mini-vans and hatchbacks. I
10.08.2010   http://web.archive.org/web/20010310084...roductions /polyuns aturated/C.Fas t.html   #11
                                relative safety of mini-vans and hatchbacks. I
                                couldn't say anything, however, because he was
                                still on the phone, still somewhat agitated. I got
                                into what turned out to be a champagne-colored
                                convertible Corvette, c. 1998. He started the car
                                and I quickly reached for the seatbelt. The next 15
                                minutes are a little bit hazy, but I do remember
                                thinking that I hadn't yet done much with my life,
                                and that I hadn't called my mother in at least three
                                weeks. The conversation on the cell phone
                                continued until we arrived at the restaurant,
                                darting between traffic and stopping inches behind
                                large slow-moving construction trucks. We
                                dismounted and went into the restaurant to eat. By
                                the time we had ordered, he had managed to
                                disentangle himself from the conversation, and I
                                had managed my heart rate back down to a
                                reasonble level. I was embarrassed at my own
                                wimpiness.

                                   Adrian gave me the latest business plan and we
                                talked about what we would say to Professor
                                Herzlinger. Arian suggested that what he wanted


                                from Professor Herzlinger, ideally, would be to
                                have her be a scientific Advisor for the compnay. I
                                said I would leave that to him, and perhaps try to
                                keep the discussion "academic." We discussed my
                                thesis and the relationship between standards and
                                communities of peoplein healthcare and business.
                                When we returned to the car, I could finally ask
                                him who he had stolen it from. "It was a gift from
                                my father. The beauty of being an only child with a
                                father doing very well in the stock market." He
                                demonstrated its acceleration. "I can really only
                                accelerate for one second in town." I demonstrated
                                hyperventilation. He took curves at full speed, to
                                show how well it handled. My lunch threatened to
                                liberate itself. When we arrived at the Harvard
10.08.2010   http://web.archive.org/web/20010310084...roductions /polyuns aturated/C.Fas t.html   #12
                                liberate itself. When we arrived at the Harvard
                                Business School, I said, "Well, you have become the
                                very image of a CEO: fast car, constantly on cell
                                phone, meetings at Harvard Business School, what
                                are you doing with me?" "Yeah, really, where's your
                                3 million dollar investment!"

                                   We navigated HBS for a while and arrived at
                                Professor Herzlinger's office where she apologized
                                liberally for delaying our meeting. I had worried
                                that this meeting would be awkward, having taken
                                an awkward number of months to get, and coming
                                from a history and anthropology graduate student
                                with few new ideas to share. She dove right in,
                                however, and from there on out it was Adrian and
                                Regina trading names of people and companies
                                back and forth, each plying the other for
                                information, recommendations, listening carefully
                                to assessments of reputation.

                                  Twenty minutes later, the meeting was over and
                                Adrian and I left with a few names. Adrian was
                                particularly excited by something he had learned


                                in this meeting. Something that is still puzzling to
                                me, but clearly clicked with Adrian's business plan
                                for the future. Professor Herzlinger had mentioned
                                that it was the growth in 401K plans that was
                                driving the current economic boom, and that some
                                similar kind of investement scheme for healthcare
                                would provide the only solution to the current
                                system. Under a system such as this, I understood
                                her to say, people with certain diseases or certain
                                needs, would all of a sudden become valuable
                                commodities, rather than costly liabilities because
                                they would represent a certain amount of money
                                available to competing healthcare providers. The
                                system made little sense to me, bypassing, as it
                                seemed to, the problem of who payed for it in the
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                               D. Sean and the Dinosaurs
                                          One thing that has become painfully obvious:
                                       jobs and money come through kinship and
                                       reputation. Knowing someone is often more
                                       important that knowing anything. When people
                                       marvel at how small the world is, I marvel at how
                                       many different, non-overlapping small worlds this
                                       world is. We don't call it 'class' in America, because
                                       most people honestly believe that it is a
                                       meritocracy, even if that meritocracy ultimately
                                       points back to your SAT scores in high school (or
                                       to which high school you were zoned for) and your
                                       scholarship to Harvard (or your scholarship to
                                       Waynes College of Cosmetology). Most are
  Last Modified                        frustrated by, but resigned to this fact, those who
  11-Sep-99 9:24 PM
  ckelty@mit.edu                       aren't rage against affirmative action or decry the
  Go Back to the Start                 ailing public school system. Does it self-select? Not
                                       without help from others. No one is exempt from
                                       this structure it seems, certainly not without
                                       disingenuousness: My access, therefore, could not
                                       have come without two things: in the case of
                                       Partners, my affiliation with MIT, and in the case
                                       of Amicas, my acquaintance with Sean Doyle.

                                         Sean deserves a thesis all his own. I've been to
                                       Sean's apartment twice. The first time was for a
                                       movie. Sean's apartment contains a giant plastic
                                       brachiosaur head attached to one wall of the living
                                       room. It juts out into the center of the room,
                                       perhaps looking for leaves on a chandelier (there is
10.08.2010   http://web.archive.org/web/20010310123...roductions /polyuns aturated/D.S ean.html   #2
                                perhaps looking for leaves on a chandelier (there is
                                some argument about the exact composition of its
                                diet). It absolutely dominates the room. I was there
                                to watch films by Jan Svankmeyer and eat Tibetan
                                momos. However fascinating the films, I could not
                                stop looking at the brachiosaur. In the kitchen,


                                there is a plastic inflatable pterandon, or perhaps
                                another species altogether, it is dark. The films,
                                which Sean has rented for me and another guest,
                                Johanna, are the Czech filmaker/animator's short
                                films, and his feature length Faust. We watch them
                                on Sean's circa 1985 Amiga monitor. Sean has no
                                television, preferring this small relic of Atari's
                                success as primary veiwing station. It works very
                                well.

                                   We watch Faust, which mixes several of the
                                versions with puppets, animation, live-action
                                cinema, and filmed theatre in a circular narrative.
                                We liesurely discuss absolute knowledge (the
                                ostensible subject of the film) over ice-cream. Sean
                                fast-forwards through the shorts to one in
                                particular that fascinates us: The Ossuary. It is a
                                film of a Czech ossuary, jump-cut in a manner that
                                makes it look animated (a svankmeyerian
                                signature), set to syncopated jazz and a female
                                voice reading a Jacques Prevert poem about
                                drawing a cage to attract beautiful birds. The
                                ossuary is indeed cage-like; an elaborately
                                constructed church-like crypt filled with elaborate
                                chandeliers, banisters, thrones, settees, all made
                                from human bones: victims of a 14th century
                                plague. Beautiful enough to lure the dead back to
                                life.

                                  I had heard of the director, but not this
                                particular piece, which Sean had tracked down
                                over the internet (either this, or another had been
10.08.2010
                                over the internet (either this, or another had been
             http://web.archive.org/web/20010310123...roductions /polyuns aturated/D.S ean.html   #3


                                ordered directly from Czechoslovakia). This kind of
                                discrimination permeates every aspect of Sean's
                                life. His dilletantism, as he modestly refers to it, is
                                deeper than most people's expertise, in science and
                                in the arts. Before the momos are all gone, he


                                demonstrates this again, by bringing out a book he
                                has been reading: The Developmental Biology of
                                Butterfly Wing Patterns. The book details the
                                experimental research of butterfly wing patterns,
                                an ideal semiotic register of the developmental
                                parameters and sequences of the cell. Sean
                                explains: "That's another project that I would start
                                in my copious free time: a visual database of
                                butterfly-wing patterns for use in doing
                                developmental biology." It is a precious example of
                                Sean's focus on the processing of visual
                                information. The tools he uses, wavelet encoding in
                                particular, constantly find such examples in the
                                wide world of science around him. Later, in an
                                interview, I asked him to elaborate on something
                                he often mentions: that he would rather be
                                creating software for scientific research projects
                                involving dinosaurs' fossils and other organisms.

                        S: In the latest scientific American, which I was just showing
                        Adrian, there are these tomographic projections of mosquito
                        knees.


                        C: Mosquito knees?


                        S: That shows the sort of resolution that you can get from
                        these different techniques. But then one of the things that
                        you can do, like once you can get tomographic projections of
                        these things or you can build models of it (you know,
                        wavelets are one of the techniques) you could use all these
                        techniques for building models of, basically polygon
                        approximations of the fossils or the organisms. Obviously
                        this will work very very well with insects since there aren't
                        that many insects systematists— that is, people that study
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                        that many insects systematists— that is, people that study
                        systematics— in the world, it's sort of a dying specialty. But
                        you know if you could digitize enough of these creatures and
                        build the representation in a way that you could search by
                        shape, and find analogous structures, in other organisms,
                        that might be a way to help draw relationships between
                        different creatures. You could look at— say if you sequence


                        the DNA for different creatures you might find convergent
                        structure in a wing or a leg or something like that, long after
                        these two lineages divided, and that might give you some
                        information about what sort of things were likely to arise,
                        and how the mechanism of DNA expressing itself can be
                        constrained and not constrained, because you can build
                        these better models of the shapes of things. If you digitize
                        a whole range of species with this technique, you wouldn't
                        even need to kill them or take them apart it's just fairly low
                        doses of x-rays. You can look at them over time and
                        establish growth patterns and if you could specify what
                        those growth mechanisms were mathematically you might be
                        able to look for differences between species. Or if you found
                        a specimen, you could say, "well its not like any of the ones
                        I had before, but it fits in between here and here so it's the
                        same species or something. With insects its fairly hard,
                        because they change and they molt, they can change fairly
                        rapidly in body plan, but I think it's one of the interesting
                        things in science, you got all these techniques, its true in
                        medicine is well, you got all these techniques that can get
                        you more and more data, but the traditional form presenting
                        them is such that people haven't adjusted.


                        C: so, in a way, it seems like it's not just a change in scope
                        and scale, but a qualitative change in the way the data is
                        represented, so that you can actually do different kinds of
                        experiments.


                        S: Sure, imagine that, for the home market, you could, if you
                        had these polygon representations of dinosaurs, there's no
                        reason you couldn't print them out in three dimensions, and
                        have life size dinosaur kits for cheap. [Laughter] you know,
                        out-replicate Barney on the planet, that would be a very
                        important thing to do. But also for scientific study, just
                        being able to compare— I mean right now if you want to
                        measure something on a bone, you have to call up the
                        person who has that specimen, and asked them to measure
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                        person who has that specimen, and asked them to measure
                        it. If you had these representations you could play around
                        with it, and you can probably find patterns that right now
                        you couldn't. But it's not enough just to accumulate the
                        numbers, you need a way that people can digitize lots of
                        stuff quickly, and safely, and the mechanism for sharing it,
                        visualizing the data. And because I'm curious about lots of


                        different things, making it accessible is important— because
                        what do I know about this stuff other than what I can read
                        in the gutter or in Science or Nature. You know, I'm a
                        dillettante. And so the idea that instead of having to read
                        these long descriptions, you can just say that there's this—
                        you know, say off the sqasimosal bone, there's this sort of
                        process that's unusual, I can say, well, so I know that's on
                        the head [points]... it's on the skull... but what does that
                        look like in other creatures? And since I don't have a
                        command of the literature, and I haven't seen a lot of these
                        specimens, its hard for me to make the instant association:
                        'Oh its like this in Triceratops, but not in Proceratops.' You
                        know, to be able to navigate back and forth like that, would
                        be very fun for a dillettante like me. It might be of scientific
                        use as well.
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                       E. The anthropologist travels, finally.
                            The 1998 Radiological Society of North
                            America (RSNA) Meeting. McCormick
                            Center, Chicago, IL.

                                   The experience of travel— the entry to the
                                fieldsite— is an irreverent entry. Trespassing,
                                despoilation, imposition, unwelcomeness.
                                Countless narratives of difficult arrival and
                                unhappy departure. Like Levi-Strauss "I hate
                                travelling and explorers. Yet here I am proposing
                                to tell the story of my expeditions." In this case,
                                however, this experience reverses itself. Not only
                                did my Amicae provide me with a badge, a hotel
                                bed, hospitality beyond the call of my weak
                                promises, but the conference itself has taken over
                                Chicago. The distancing and defamiarizing power
                                of travel is reversed here. Consider RSNA 1998,
                                upwards of 45,000 attendees installed for one
                                week, in a conference center the size of a small
                                town. 45,000 people sharing not names or nations
                                but membership— professional identity. Consider
                                this professionalism the contemporary pretender
                                to nationalism, identity to identity. Structural
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                                             similarity, spatio-temporal randomization. If so,
                                             then the signs at the airport, the chartered buses
                                             all over town, ubiquitous welcoming marquees
1 . A micas uses a third-party
wav elet-encoding       plug-in
                                             make of Chicago a placeless place for these men
licensed from a company                      and women (not even considering the Starbucks
called A ware. This plug-in is
the only piece of software                   and McDonalds that do so for the permanent
that keeps A micas from
being 1 00% Jav a and                        resident), where home (i.e. profession) is
accessible      without    any
additional configuration of                  temporarily constructed, a virtual private network
user        software,       i.e.
downloading and installing                   in the windy city. Not everyone at O'Hare will get
the plug-in, which takes up
much of the support call                     such treatment.
time. Sun intended to
release a wav elet encoding
algorithm as part of the Sun
Jav a libraries, which would
hav e been v ery good for
A micas,      assuming      the                 As I picked up my luggage, I tried to decipher
software was well done. A t
this meeting, howev er, the                  the signs and maps to figure an inexpensive way to
software they sent Sean was
written in C++, but wrapped
                                             Hall B of the McCormick Place. I walked haltingly,
in a Jav a "Bean" which                      angering swifter radiologists and businessmen.
allowed it to appear to the
outside world as Jav em but                  Then I saw what others knew to look for (though
continue to ex ist as C++.
Sean was ex pected to                        hard to miss, for anyone but me): the gigantic red
incorporate        this    into
A micas and make it work in                  banner that said "RSNA Members check-in here." I
time for a demonstration in
Sun's booth.                                 was issued a map, several booklets about fine
                                             Chicago dining establishments, and a fare by
                                             airport shuttle (rountrip $29) to the convention
                                             center. The shuttle made three stops at hotels, each
                                             one featured a doorman wearing a red RSNA
                                             button and a marquee that read "Welcome RSNA
                                             Members!" When we arrived at McCormick Place
                                             there was line of taxis and buses. Departing the
                                             good ship RSNA, I wandered in. After recovering
                                             from the initial disorientation, I asked at the large
                                             information booth where Hall B was. Remarkably,
                                             the women in the booth did not know, but handed
                                             me an elaborate map nonetheless. I asked where I
                                             was, and she said "Level One" which seemed
                                             somehow incommensurable with the alphabetical
                                             system I was prepared to navigate. After a few
                                             spins, I headed for the escalator.

                                               Emerging onto the main floor of the convention
                                             center was a shock I was only partially prepared
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                                         center was a shock I was only partially prepared
                                         for. Clearly my past experience of conventions and
                                         trade shows had been worlds apart. First visible
                                         were the towering two-story signs for GE, Siemens,
                                         Toshiba. Second, the shock of realizing that those
                                         two-story signs were perched atop two story
                                         booths. The number and ostentation of the booths
                                         was overwhelming, here was potlatch. I walked for
                                         about a mile, passing roww after row of
                                         radiology-oriented companies, until I found the
                                         main hallway. Signs pointed to Hall B, and at the


                                         back, I found my informants, huddled around a
                                         kiosk that looked startlingly modest in comparison
                                         to the mall that Philips had erected next to them.
                                         Arrival.
  Last Modified
  11-Sep-99 9:23 PM
  ckelty@mit.edu                               Batches? We don' need no stinkin'
  Go Back to the Start
                                               batches...

                                            Turns out, the badges are elaborately coded.
                                         When I mentioned to Jan in September that I
                                         intended to go to the RSNA meeting, she had
                                         offered to put my name on their guest list, and get
                                         me a badge for the conference. This was a coup,
                                         since the most inexpensive membership was $695
                                         for students. It also seemed preferable to trying to
                                         finagle a press pass based on my contributions to a
                                         certain journal published by The Economist
                                         Intelligence Unit, called Healthcare International
                                         (this would have to wait until February and the
                                         HIMSS conference). The first code was that the
                                         badge said "Christopher Kelty, Amicas Inc." In
                                         addition the badges had color codes: brown for
                                         commercial exhibitors, red for non-members, blue
                                         for members, green for "associated sciences", light
                                         blue for staff. This meant my badge marked me as
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                                a commercial exhibitor from the company Amicas,
                                Inc. Sean explained that this meant I was like a
                                vampire— not allowed to go into another
                                exhibitor's booth unless invited. In theory this is a
                                reasonable constraint, guaranteeing openness to
                                the radiology community coupled with secrecy in
                                competition between companies. In practice, it is
                                either ignored, or precipitates paranoiac behavior.
                                In practice, it really only applied to booths
                                belonging to direct competitors, that is, no one was
                                going to notice me wandering around in the


                                Philips Mall, or the GE Galleria, and no one was
                                barred from entering the "Info-rad" village or the
                                scientific exhibits hall (though Sean did relate
                                stories of how this line between science and
                                commerce produces unsightly effects as well— in
                                particular, commercial vendors using academic
                                credentials as marketing tools, and paranoid
                                researchers refusing to share information with the
                                brown-badgers). Nonetheless, the badge, it turns
                                out, is everything.

                                   At the end of the day, everyone heads for the bar.
                                Jan Moe notes that all the Amicas employees head
                                for their email, not the bar, and that there is some
                                strange relationship to testosterone levels. She
                                later observed a similar relatioship to elevator
                                buttons and walk-sign buttons. We discussed the
                                possibility of a hydraulic theory of testosterone,
                                where repeatedly pushing an elevator button was
                                actually a release of dangerously high levels. Jan
                                suggested more research was in order. I go to
                                dinner with Sean, who has had three hours of sleep
                                and a very long week before that, but is nonetheless
                                hyperactive for it. Sean suggest a Wolfgang Puck
                                franchised Chicago Spago where we suffer a waiter
                                in emphatic and cheesy wait-mode— like
                                melodrama, but interactive. As usual, when in
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                                melodrama, but interactive. As usual, when in
                                discussion with a polymath-autodidact-dilletante
                                with second-nature modesty and never-ending
                                wonder, topic ranges. The four volume Chinese
                                novel Journey to the North had been occupying
                                Sean's "free time", so he related various parts. He
                                talked wavelet encoding, paleontology and
                                sword-swallowing (everyone's favorite 'scientific'
                                exhibit was a set of images of a sword swallower,
                                offering scientific explanation of how the master
                                performs the trick, diaphragmatically speaking).


                                My end of the conversation freeloads on Sean's; he
                                talks, I learns.

                                  Sean is angry with some folks at Sun because
                                they requested a collaboration, offered to send him
                                Sun's Java Wavelet encoding software and then
                                waited until Friday (a day before they left) to do
                                send it to them[1]. Sean was expected to
                                incorporate this into Amicas and make it work in
                                time for a demonstration in Sun's booth— even
                                more than that, they somehow expected that
                                Amicas would be in Sun's booth, but had made no
                                arrangements for that. The code was so buggy and
                                broken that he coudn't get it to display more than
                                one image at a time, this after spending four days
                                and nights at the hotel (they brought his and
                                Jack's computers, so they could program in the
                                hotel) trying to finish "Personal Amicas" so it could
                                be demonstated at the show. The demo eventually
                                happened, but Sean seemed to think it wasn't
                                helping anyone. I asked if this was management
                                disorganization, if it was a question of too many
                                demands, not enough resources. Sean demurred,
                                modesty overcome, to suggest that was a strict
                                disregard for other people, nothing more.

                                   The next three days provided the most visceral
10.08.2010   http://web.archive.org/web/20010310124...uctions /polyuns aturated/E.Travels .html   #6
                                   The next three days provided the most visceral
                                'participant' observation, especially where badges
                                are concerned. Kevin Conway said to me: "Aren't
                                there other people here you want to talk to, surely
                                you must want to talk to other people besides us?"
                                It seemed reasonable, and yes, I thought, I do want
                                to talk to other people. Resolved to ignore my
                                brown badge, I marched over to several of Amicas'
                                direct competitors. I presented myself as an MIT
                                social scientist studying the impact of IT on
                                radiology and that I would like to talk. At


                                MedWeb, the woman listened to me, looked at my
                                badge, then looked at me and said: "Maybe you
                                could come back later, right now we have
                                customers." The people at Access
                                Radiology/Telemedicine believed me, and were
                                happy to talk, though it was the CEO that
                                recognized the name on my badge, not the random
                                employee I had walked up to. The CEO thanked me
                                for my interest and wished me good luck with my
                                "paper." At Algotec, an Israeli company in direct
                                competition woth Amicas, I explained who I was
                                again, got that peculiar look, and my interlocutor
                                said, "You know Amicas is our competition?" And I
                                said, "Yes, I know that, but as I said, I'm not with
                                the company, this is an academic project, and I'm
                                simply trying to find out if you would be willing to
                                talk?" And he replied: "No, I do not think we have
                                an interest." And I was shooed on my way. By now
                                I was probably getting a reputation, and rather
                                than risk Amicas' hospitality further, I decided it
                                would be best just to talk to random people not
                                involved in the internet or the PACS business in
                                any way. This proved more enjoyable, but much
                                less useful.

                                  Back at the Amicas booth, I ask Dr. Keith
                                Batchelder, an occasional consultant to Amicas,
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                                Batchelder, an occasional consultant to Amicas,
                                what he finds surprising about this years meeting.
                                Some things were surprising, he responded, but
                                none were exciting. He explained that radiology is
                                a declining market, that everything is going digital
                                but nobody really knows what that means, that
                                functional MR/CT is forcing the "memorizers" out
                                of business. Memorizers, he explained, were
                                radiologists who memorize anatomy so that they
                                can say "oh that's 'bad anatomy'— that artery
                                probably has stenosis," whereas functional MR can


                                tell you flow volume in an artery is x cm3/s— it
                                gives numbers, and you no longer need a
                                radiologist. So I asked, how are radiologists
                                protecting themselves from that? Some are vying
                                with IS/IT in the hospital to control images, others
                                are becoming functional specialists, some are just
                                getting out. Later I asked Adrian about what Keith
                                had said, and Adrian just said: "Well, you can't get
                                any more pessimistic that Keith."

                                  It was at about this time, as I was standing in
                                the Amicas booth talking to the occasional
                                interested radiologist, chatting with staff, that
                                Suzanne Fishman from WorldCare stopped by. She
                                recognized me and we chatted briefly about the
                                conference and she suggested I come by the
                                WorldCare booth and talk. I thought nothing of it,
                                but didn't take her up on her offer. This seemingly
                                innocuous interchange would eventually sediment
                                the reality of my badge.

                                  Suzanne Fishman, COO of WorldCare, whom I
                                had interviewed on one occasion and briefly talked
                                with on another, worked closely with Walter
                                Terner of Partners Telemedicine Center. Shortly
                                before RSNA, I had been working with Walter
                                Terner to try and get access to some of the foreign
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                                Terner to try and get access to some of the foreign
                                connections with Partners Telemedicine. I had
                                designed a questionnaire, which Walter had kindly
                                revised into a marketing instrument for Partners.
                                Walter had suggested that I contact Suzanne to
                                ensure that any such instruments were okay with
                                WorldCare, and I had scheduled a meeting after
                                RSNA to discuss it with her. When I returned from
                                Chicago, I received a message that Suzanne
                                Fishman would not be meeting with me, and that
                                she regretted the inconvenience, but had no time.


                                Shortly thereafter, Walter Terner called, and said,
                                very abruptly, "Who do you work for?" I said I was
                                a student at MIT, and that I didn't work for
                                anyone.

                                "Yes, but who do you work for?"
                                "I answered that already."
                                "Chris, Suzanne has information that you are
                                under contract with Amicas, Inc. She is concerned
                                you are spying for them on WorldCare. Do you
                                work for Amicas?"
                                "No, and I don't appreciate being accused of being
                                a spy."
                                "No one's accusing you."
                                "Only assuming. I think there has been some major
                                miscommunication, and I have no idea who told
                                her that I was under contract. Perhaps I should call
                                and explain the situation to her."
                                "Yes that would be very good, but I think you
                                should wait, and calm down, you're agitated right
                                now, you might say something you don't mean."
                                "Yes. I will do that."

                                  My explanation seemed to satisfy Suzanne, but it
                                was easy to tell that there was no healing this
                                suspicion. Adrian, Sean and Jonathan had all
                                worked at WorldCare at some point. Sean had
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                                F. Some history of the fieldsites
                                            The history of the companies and hospitals that
                                         comprise my field-sites is complex and
                                         intersectional enough that I never managed to
                                         uncover all of the details. "Telemedicine" at MGH,
                                         even when not under that name, is proudly traced
                                         back to the late sixties. Being a high-profile
                                         academic medical center, all manner of research
                                         projects have been begun, continued, abandoned,
                                         or concluded. The residue of these projects
                                         sometimes hold over, since the hospital is large
                                         and bureaucratically slow-moving; it is possible for
                                         individuals and projects to continue well past
                                         results into parasitism, before someone notices, or
  Last Modified                          the money simply fails to arrive. I occasionally saw
  11-Sep-99 9:22 PM
  ckelty@mit.edu                         old equipment from ventures I had heard about,
  Go Back to the Start                   heard stories of people in offices that no one could
                                         locate, or whose function people just couldn't
                                         pinpoint. A catalogue of such people places and
                                         technologies would update Borges, or Kafka.

                                            In the eighties, MGH started funnelling money
                                         into commercial ventures of various kinds. Adrian
                                         Gropper related three: a nursing home venture, a
                                         home care and pharmacy venture, and a PACS
                                         company called RStar (which, according to a
                                         lecture by Dr. James Thrall, Chief of Radiology at
                                         MGH, was begun in 1992). This last one is what
                                         brought Adrian, Sean, and Jonathan together
                                         initially. These ventures were not unusual for the
                                         eighties, but they were unusual for the healthcare
10.08.2010   http://web.archive.org/web/20010310124...uctions /polyuns aturated/F.His tory.html   #2
                                eighties, but they were unusual for the healthcare
                                world, which went through a series of high-profile
                                financial fiascos during this time. According to
                                Adrian, the executives started referring to
                                proposals by whether they passed "The Globe


                                Test"— meaning that the venture was a safe one if
                                it didn't show up on the front page of the Boston
                                Globe, regardless of what they said about you. It
                                was a lose-lose situation for most of these
                                attempts, because if they failed it was a waste of
                                healthcare money that should have gone to charity,
                                and if they succeeded it was an abuse of non-profit,
                                charity status to make money.

                                   RStar was a PACS business when Adrian joined
                                it, and at about the time he did (the early 1990's),
                                it was in the middle of a major management shake
                                up. The chairman of the hospital (J. Buchanan)
                                and the second in command had moved to take
                                over the company, partially, for the chairman, as a
                                retirement move out of the hospital, but also
                                because the radiology department was unhappy
                                with the role and performance of this company.
                                They intended to turn R*Star away from the PACS
                                business and towards telemedicine, which during
                                this time, far more than in 1998-9, was a powerful
                                buzzword. They intended to leverage the
                                reputation of MGH, which had recently merged
                                with BWH (December of 1993) to sell services to
                                people around the world. This company focussed
                                much of its resources on the creation of this
                                business: the marketing of reputation, financing
                                and general business issues. Adrian, Sean and
                                Jonathan have all at one point or another
                                expressed a certain outrage at the way the
                                management of R*Star viewed technology and
                                engineers— as the least important part of the
                                business, just above janitorial staff.
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                                business, just above janitorial staff.

                                  Eventually the company tried to develop a
                                consortium of hospitals and clinics that could sell
                                the service of telemedicine abroad. MGH founded


                                an additional venture called American
                                Telemedicine International, which was to be the
                                service component to RStar. Apparently, Rstar
                                either dwindled to nothing, or was folded into
                                A.T.I. before A.T.I. was sold to a company called
                                Wellcare, which was a Dutch holding company
                                connected to a series of Saudi Arabian interests
                                which would eventully organize under the
                                multinational label (Headquartered in Bermuda)
                                of WorldCare. A series of promotional videos from
                                1993 and 1994 show A.T.I./Wellcare engaging in
                                fairly high-profile demonstration projects in Saudi
                                Arabia. One in particular, called "The Global Cure"
                                features J. R. Buchanan offering to bring "the
                                expertise of the West, to the rest of the world." The
                                demonstration required the creation of technology
                                that would allow images to be digitized and sent
                                via a hub and spoke network of routers between
                                MGH and Riyadh and Jedda. The system was not
                                internet-based, but it was the technology out of
                                which the idea for Amicas emerged. From about
                                1994 until 1998, WorldCare took over this
                                technology and developed the business of A.T.I.
                                into a consortium that included MGH, Cleveland
                                Clinic, Duke Medical Center and Johns Hopkins
                                Medical School. For several years the President of
                                A.T.I./Wellcare was Mark Goldberg, a well-known
                                name in the academic world of telemedicine, and a
                                senior editor of the Telemedicine Journal. When
                                Sean left RStar, he spent some time working for
                                one of the Medical Informatics groups in Boston,
                                Peter Szolovits' Clinical Decision Group at MIT,
                                helping with a project called "Guardian Angel"
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                                helping with a project called "Guardian Angel"
                                that intended to provide a secure medical record
                                for pateints. By late 1996, they had come together
                                to form what would become Amicas (which went
                                by the name Autocytgroup, Inc. until the fall of


                                1998, the name of Adrian's medical device
                                consulting business).

                                   Also in approximately 1996, Partners
                                Information Service had decided to begin a clinical
                                telemedicine research department, and had asked
                                Dr. J. Kilborn to head it up. The group he collected
                                consisted of some people in patient TV and Video
                                production from Brigham and WOmen's hspital
                                (BWH), with the existing business of teleradiology
                                consultations that were being managed by
                                WorldCare. The Partners Telemedicine Center
                                (PTC) became the bureaucratic home of
                                telemedcine, even though there existed several
                                different interests including WorldCare, Agfa,
                                Amicas/Autocyt and the Radiology department's
                                own homegrown projects. Add to this the fact that
                                BWH, now part of Partners, also had its on
                                teleradiology project called Brahms, run by Ramin
                                Khorosani and Bill Hanlon in the Radiology
                                department at BWH. By the time my fieldwork
                                finished, none of this was any less confusing. The
                                sheer size of Partners lent momentum to such
                                competing endeavors, but it also served to
                                frustrate people absolutely, since there was neither
                                anyone in charge, nor any sense that someone
                                could be in charge of it all. A general sense of
                                paranoia affected everyone involved.
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                   G. Partners Telemedicine
                            The members of Partners Telemedicine have been given
                            pseudonyms


                                   I chose the Partners Telemedicine Center (PTC)
                                because it was the only official telemedicine
                                program in the Boston. Without a doubt there
                                were countless other more accomplished research
                                programs in various stages of offialdom, or
                                disrepair, and numberless individuals with stated
                                interests in telemedicine. On top of that there is a
                                strong and well-known Medical Informatics
                                community that spanned MIT, Partners, NEMC,
                                Childrens, Beth Israel, BU, and often intersects
                                with researchers and programs called
                                telemedicine. Managed Care companies, insurance
                                companies were an option, though generally
                                impenetrable and but a few of the handful of
                                independent companies specializing in radiology,
                                networking, or software had stated interests in
                                telemedicine or internet healthcare. Nonetheless, it
                                seemed obvious, if not wise, to go with the site that
                                had signs of permanence, a place to dwell, staff to
                                pester and a connection to one of the largest and
                                most well known teaching hospitals in the world.
                                That, and it was really close to my apartment. My
                                initial investigations had bypassed Partners
10.08.2010               http://web.archive.org/web/20010310124...ctions /polyuns aturated/G.Partners .html   #4

                                            initial investigations had bypassed Partners
                                            Telemedicine, primarily because they had a
                                            pathetic and broken online presence, a poor
                                            indication of the technical innovations I was in
[1 ] To be clear, the MGH
prides itself on narrating the              search of. I called, set up an appointment with
history of telemedicine back
to 1 967 and a project to link              Paul Kilborn, the corporate director, and was well
a nurses station at Logan
A irport to MGH in order to
                                            received, and with enthusiasm.
send         x -ray s       v ia
closed-circuit      microwav e
transmission. The project                      I met with Dr, Kilborn for the first time in
was apparently a success by
the standards of the time,                  November of 1997, at his office in the Partners
but appears to hav e been
simply a demonstration.                     Telemedicine Center. The first surprise was the
During the 7 0's there
seemed to be little activ ity
                                            location: the mezzanine level of a residential tower
in tlemedicine at MGH, at
least until the mid-eighties
when      a      v ariety     of
commercial projects were                    on the far edge of the MGH campus. Walking
begun, some of which
included the early stages of                through the lobby of the apartment building, past
WorldCare that Sean and
A drian are familiar with
                                            the laundromat or the entrance to the swimming
(R*Star     and       A merican             pool, up the stairs to the door with a tiny buzzer
Teleradiology
Incorporated,             which             and a label that said Partners Telemedicne. No
ev entually became Wellcare
and     was      bought      by             other signs of the hospital were present. Of course,
Worldcare ??? Fact-check!).
                                            space is tight in the center of Boston, and even
                                            more so at MGH, which has been built over,
                                            grafted onto, oddly extended to become a comic
                                            visual diorama of twentieth century building
                                            styles: nineteenth century neo-classical, art-deco,
                                            80's corporate, parking-grarage chic etc. The
                                            Partners Telemedicine Center offices therefore
                                            seemed like an extension of this making-do with
                                            space. This strange urban-surburban isolation
                                            contrasted starkly with a set of other offices
                                            located at the very center of the main building,
                                            with prominent sinage that directed the tour
                                            groups and corporate benefactors to the pulsing
                                            heart of MGH's high-tech international presence.
                                            This smaller set of offices housed two Telemedicine
[2] A nd this despite the fact              employees (Karin Kiley and Walter Terner) and
that MGH and BWH, under
the sign of Partners hav e                  was shared with the MGH international patient
been     among     the    last
institutions to feel the                    center, the organizing office for patients from
effects of nationwide change
under      managed       care,              around the world.
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                                                 Despite my vague proposal, Dr. Kilborn seemed
                                             genuinely excited about having an anthropologist
                                             look at the projects they proposed. He insisted that
                                             I talk to people at WorldCare Inc. (about whom I
                                             had heard from Sean and Adrian, both of whom
                                             had worked there in various capacities before it
                                             became WorldCare), and the corporate managers
                                             Janine Porter and Walter Terner. He proceeded to
indemnity     reimburement                   fill me in on the work that Partners Telemedicine
schemes and        capitation
schemes of all sorts.
                                             was currently engaged in. In retrospect, surprise
                                             two should have been the stream of buzzwords that


                                             he used to describe the projects he was involved in:
                                             sharing information, exporting expertise,
                                             integrated delivery enterprise (sometimes,
                                             environment-IDE), asynchronous monitoring,
                                             adding value in a capitated environment, remote
                                             care management, add-ons, plug-ins, direct links,
                                             plain-old telephones, pop-up companies, work-flow
                                             interface, desktop videocon links, outcome/cost
                                             ratios, hi-res realtime images, value per dollar.
                                             Note that none of these words are medical terms,
                                             or even medical buzzwords, which was an early
                                             indication of the degree to which Dr. Kilborn, and
[3] The medicine: TpA .                      PTC fashioned themselves as technical and
                                             business savvy members of the Partners
                                             "Integrated Delivery Enterprise," rather than
                                             doctors with specific medical goals to solve.

                                               Dr. Kilborn explained the basic activities of the
                                             Telemedicine Center:

                                                1.Under the label of "Exporting Expertise" went
                                             the ongoing efforts to link hospitals in other
                                             countries with MGH. This end of the busisness was
                                             associated primarily with WorldCare(tm) and the
                                             legacy of telemedicine and teleradiology efforts
                                             that MGH had begun in the late 80s and early 90s
10.08.2010                                  that MGH had begun in the late 80s and early 90s
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                                            in the middle east (principally the oil-rich
                                            nations)[1]. Kilborn explained that they had
[4] Indeed this relationship                performed 415 remote second opinions in the
between       ignorance       of
anthropology and concern                    previous year, sure to increase as the number of
ov er the definition of
research was recapitulated                  participating physicians went up. A primary goal
in the attempt to get IRB
approv al from MIT, first,                  of PTC in this endeavor was, as Janine Porter
and then from MGH. The
IRB's purpose is genuine,
                                            would repeatedly tell me, to "excite the
but its practice feels more                 stakeholders of this institution" about the possible
like Der Prozeß than any
simple form to fill out. The                revenue streams that existed around the world. By
medical world knows one
kind of research, deriv ied                 stakeholders, she meant the various disciplines and
from the protocols of lab
research, and        requiring              subdisciplines of the hospital, such as dermatology,
ex plicit    elaboration      of
ev ery thing      beforehand.
Cultural         anthropology
rarely     knows      such     a
method, precisely because                   cardiology or pediatrics, not the "stakeholders" of
it intends to enter a site
without such constraints, to                Partners Healthcare Inc. in the sense opposed to
participate        and        to
ex perience.     This    is    a            "shareholders" as entities outside of the hospital.
profound problem in a
medical-corporate
env ironment              when                2.Three local 'research projects' were underway.
ev ery one's    actions     and
words         are       strictly            The goal of these projects was a clinical trial and a
accounted for. Participation
dissolv es justification, and               published paper that indicated a good
demands only decisions,
which is not the kind of                    outcome/cost ration for the IDE.
participation                 an
anthropologist might want—
especially when it precedes                    a. The first of these was the Congestive Heart
any     clarity   about      the
structure or organization of                Failure (CHF) project. The justification goes:
the site.. —Timmermans
article—                                    elderly CHF patients are costly because of the
                                            number of emergency room visits that they make.
                                            There are not enough nurses to perform all of the
                                            home visits that would be necessary to make sure
                                            these patients avoided coming to the emergency
                                            room if it wasn't necessary. Several CHF patients
                                            will be part of study in which they will have a small
                                            "Windows CE powered device" in their home,
                                            which will measure their vital signs. The purpose
                                            of measuring these signs is as an indicator of CHF
                                            that might necessitate a hospital visit. If the
                                            number of hospital visits can be reduced, money
                                            will be saved. Though well-conceived, the project
                                            met with a wide array of problems and was in a
                                            state of limbo when I left.
10.08.2010                                  state of limbo when I left.
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[5]     Of     course,     my
disingenuousness         wont
change the fact that 8 of
those 9 times, I did know
how to do what they
wanted: not because I had
somehow       absorbed      an
enginnering degree while
being at MIT, but because
the nature of the technical
work they were engaged in
was rarely more difficult
than desiging a web-site,
configuring       a    serv er,
running statistics in a
spreadsheet,                or
programming the clock on a
V CR, all things I consider to
be the rough equiv alent of
changing the oil in a car,
which ironically , I don't
know how to do. There was
perhaps a generational issue
that        made         these                b. The second clinical trial was a Vascular
technologies seem more
my sterious      than     they
                                            Wound Care treatment program in which
needed to be, but the fact                  home-care nurses were issued lap-top computers
that I was repeatedly asked
how to do simple things,                    and hand-held digital cameras that they could
rather than complex things
that I actually had no idea                 used to document the progress of wound healing.
how to do, seems to indicate
that there was a v ery broad                This particularly graphic kind of wound
spectrum of things that were
consigned to the realm of                   necessitated constant care and attention, and often
"technology ." This would
account for the intense                     the nurses caring for the patients needed consults
demands on Tim O'Neil, the
sole engineer at PTC.                       with the surgeons to verify progress. The images
                                            that the nurses snapped could be stored on a
                                            network file system accessible to surgeons so that
                                            the nurses and doctors could consult them
                                            "asynchronously."

                                               c. The third trial was a teledermatology project
                                            that would show that patients visiting primary
                                            care physicians in clinics could have pictures taken
                                            and consultations made of those pictures rather
                                            than coming to Boston for a specialist office visit.
                                            The pictures were taken with a digital camera ("a
                                            very high tech Nikon E2N digital camera" Kilborn
                                            informed me) transfered to a computer, uploaded
                                            to a shared hard drive on the Partners IS network.
                                            From there it could be downloaded to a specialist's
[6] A t first hearing, it wasn't            computer on which he would make a diagnosis and
obv ious that both of the
                                            recommend treatment, then submit the completed
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                                            recommend treatment, then submit the completed
                                            diagnostic form to the same shared disk where,
                                            within 24-48 hours, the primary care physician
                                            could look at the diagnosis and inform the patient.
                                            The two primary care sites for this clinical trial
                                            were the Women's health center at MGH, and the
                                            Cape Ann Medical Center in Gloucester, MA. The
                                            diagnostic accuracy of dermatologists with
                                            technology, according to Kilborn, was about equal
sites had technicians who                   (under 20% off), and this because dermatologists
were actually responsible
for taking the pictures and
                                            train on 2D images of skin to begin with. On top of
making sure they got where                  that, the system had a "clear work-flow interface"
they were going. Unhappy
clarity dawned on me when
I heard that the first person
they had hired to work the
Cape A nn site had left on the              and was a web-based system (by which he meant
first day because it turned
out she had nev er used a                   that doctors would use a web-browser to look at
computer before, and had
no idea how to operate a                    the images, not that the entire system was based
mouse. She was quickly
replaced by a friend of the                 on internet transfer or mail-transfer protocols;
second technican Jay cee,
who I later met
                                            also, at the time, according to Kilborn, HCFA
                                            proscribed the exchange of medical data over the
                                            internet) so that doctors could look at the image
                                            and make a simple report back to the physician
                                            suggesting either wait, treat, or refer in person.

                                               All of the clinical trials were attempts to "add
                                            value in a capitated envirnoment." The fact of this
                                            strategy signals the profound legitimacy with
                                            which managed care already functioned in this
                                            environment [2]. Dr. Kilborn proceeded to tell me
                                            a fable about two men on a desert island awaiting
                                            a Tsunami: the believer/hedonist and the
                                            pragmatist. The beleiver/hedonist spends the last
                                            days before destruction partying and basically
                                            living under the shadow of death. The pragmatist
[7 ]   Corporate      cultural              spends the last days before destruction building a
studies. Social Tex t citation.
                                            raft. In this parable, the Tsunami is managed care,
                                            and in particular, capitated payment systems.
                                            According to Kilborn, as large managed care
                                            institutions moved towards a capitation model,
                                            smaller hospitals and primary care clinics have
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                                          smaller hospitals and primary care clinics have
                                          moved to an "outsourcing" model where they have
                                          realized that they "need Partners' expertise." This
                                          kind of thinking allowed PTC to experience what
                                          they were doing as a kind of altruism, building
                                          rafts for the heathen around them who need the
                                          help of the large academic medical center. At the
                                          same time the 'sink or swim' mentality demanded
                                          that everyone engage in the rhetoric of the
                                          "difficult realities of business."

[8] this produced from
much speculation about
how 'elderly people' would
react to hav ing this dev ice
in their home. In the end,
the designers were right and                 3. Three less well defined projects were in the
wrong, as some participants
hated it, and others pried                works while I was observing. A remote stroke
the metal plate off, plugged
the phone jack into the wall,             management project bases on the existence of a
and promptly logged on to
the internet.
                                          new "clot-busting medicine" that was out of
                                          clinical trials, but only available at first tier
                                          hospitals [3]. The goal was to diagnose those cases
                                          that were candidates for this drug using remote
                                          videoconferenencing and the Amicas tele-radiology
                                          system (this was the first and only mention of
                                          them). Again, by "moving these patients
                                          appropriately," PTC hoped to save cost. Another
                                          project involved putting a high bandwidth
                                          proprietary ATM link to Salem that would allow
                                          MPEG compressed digital echocardiography
                                          images to be sent to an EC Peditrician at MGH.
                                          The project was stalled, however, for various
                                          reasons that would become clear during my stay as
                                          I watched doctors and engineers try to imagine
                                          what it would look like.
[9] High blood pressure
induced by the presence of a
healthcare prov ider.                        4. The last set of activities that PTC was involved
                                          in, which Dr. Kilborn did not go into, were the
                                          video production and video conferencing activities.
                                          The video production wing was a two-man
                                          operation that produced educational, training, and
                                          rehabilitation videos for the hospital. Their output
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                                rehabilitation videos for the hospital. Their output
                                was consistent and they had a windowless office on
                                the twenty third floor of the glass Tower at MGH; I
                                met them once, and almost never saw them. The
                                video conferencing network had been up for about
                                a year, provided mostly for the remote
                                conferencing of Grand Rounds, of which there were
                                several per week (Nursing, Pediatrics, Surgery,
                                Medical, etc.). On occasion, however, I did witness
                                them use this system to provide remote diagnosis
                                to doctors and patients in other countries.




                                  When Dr. Kilborn concluded, he suggested that I
                                meet with Janine Porter, the corporate manager,
                                and June Baylin, the research coordinator to
                                determine how I would go about my work.

                                   My first meeting with Janine Porter provided
                                another surprise. This one is now a familiar
                                experience, and it takes the form, most succinctly,
                                of a misfit of experience. Within the first five
                                minutes of speaking with Janine, it became clear
                                that she expected 1) that I was there to work for
                                them, or at least with them, 2) that (1) should not
                                take the form of making copies or other such busy
                                work (!) and 3) that I needed to formulate
                                hypotheses (which she often called 'tasks' or
                                'problems') about which solutions I could report
                                back to her. The meeting lasted about six minutes,
                                with my sole contribution being: "Well I can only
                                see what I can do once I get in and observe what's
                                going on, and maybe then I can pinpoint a
                                problem that I can focus on."

                                  Janine immediately "tasked" me to set up
                                meetings with the research assistants and the
                                director of research. Access was as easy as that,
                                even if unease concerning my role made
10.08.2010                      even if unease concerning my role made
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                                observation, much less participation confusing to
                                everyone.




                                   There are two ways people will react to the
                                statement that I am an anthropologist who wants
                                to study corporations and the role of information
                                and communication technologies in healthcare. 1)
                                "You're an anthropologist? Don't you study old
                                bones?" 2) "That's very interesting." Sarcasm
                                aside, however, it quickly became apparent that
                                the best way of introducing myself was to jettison
                                the anthropological identity and rely on my MIT
                                credentials and some vague story of "research"
                                which left people considerably less bewildered, and
                                not a little less anxious about what I would be
                                doing there.[4]

                                   The absolute devaluation of the notion of
                                research is central to understanding how the
                                boundaries between corporate, academic medical,
                                and university work. The fact that Janine could use
                                "hypothesis" and "task" interchanegeably is the
                                first clue to the nature of this devaluation. Nearly
                                any activity except operating a copier can be called
                                "research." But the idea that I might want to
                                observe people at work, talk to them about
                                "personal" issues, participate in daily activities, or
                                simply hang out without any intention of
                                improving the way things are done seemed pure
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                                improving the way things are done seemed pure
                                madness to most. Research, I re-discovered, has
                                one purpose for most people: to improve life, work,
                                health, and happiness.

                                   Squatting on MIT's name produced a different
                                set of problems, however. By the second or third
                                self-introduction, I had cycled through the various
                                possibilities and settled on the introduction that
                                went: "I'm a resercher from MIT, and I'm studying
                                the impact of information and communication
                                technologies on healthcare, especially the use of


                                telemedicine." Occasionally I would add that I was
                                doing this in part under a grant from France
                                Telecom to do a comparative assesment of US and
                                French telemedicine. The problem I now
                                experienced was that the word 'MIT' tended to
                                produce a hearing-deficit in almost anyone who I
                                met, so that whatever I might add after I uttered it
                                simply became details irrelevant to the fact that I
                                was an engineer (which I am not). Nine meetings
                                out of ten ended in someone turing to me and
                                uttering the now familiar staement "Chris, you're
                                from MIT, you must know how to do X? Right?"
                                Most of the time, I did my best to explain that I
                                wasn't there to do X, even if I knew how." To which
                                I inevitably received a blank uncomprehending
                                stare, whose meaning I can only guess at[5].

                                   So this was my environment: in which research
                                is objectively devalued, in which university
                                reputation trumps not only actual skill (which
                                most people are disposed to conceal regardless)
                                but also active disavowals of that skill, and in
                                which my role was more akin to consultant than
                                observer.
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                                  Teledermatology




                                   Of the three projects that were underway at
                                Partners Telemedicine, the furthest along was a
                                clinical study on the use of teledermatology. As a
                                dermatologist, Dr. Kilborn could get excited about
                                this. The study intended to show that patients
                                visiting primary care physicians in clinics could
                                have pictures taken and consultations made of
                                those pictures rather than coming to Boston for a
                                specialist office visit. The pictures were taken with
                                a digital camera transfered to a computer,
                                uploaded to a shared hard drive on the Partners IS
                                network. From there it could be downloaded to a
                                specialist's computer on which he would make a
                                diagnosis and recommend treatment, then submit
                                the completed diagnostic form to the same shared
                                disk where, within 24-48 hours, the primary care
                                physician could look at the diagnosis and inform
                                the patient. The two primary care sites for this
                                clinical trial were the Women's health center at
                                MGH, and the Cape Ann Medical Center in
                                Gloucester, MA. From both of these sites would
                                come a more or less steady stream of patients that
                                would be "randomly" assigned to one of three
                                dermatologists, one of which was doctor Kilborn
                                (in practice, randomization was more or less
                                superceded by the time-commitment, so that one
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                                superceded by the time-commitment, so that one
                                doctor's failure to diagnose the patients meant
                                another had to pick up the ball.

                                   On day one of the study, a peculiar issue
                                surfaced. When looking at the first patient, Dr.
                                Kilborn was very unhappy with the initial pictures
                                that were taken; not due to quality or resolution,
                                but due to the fact that the images were not
                                "protocol derived," meaning that the PCP hadn't
                                followed instructions when taking the picture so
                                that the angles, lighting, and magnification of the


                                set of images that had been taken wouldn't meet
                                the criteria to be included in the study (and while
                                they anticipated that the study would generate
                                upwards of 500 patients, Dr. Kilborn was very
                                sensitive to the problem of throwing out patients
                                who had agreed to participate in the study. He
                                repeated his phrase to the research coordinator
                                June Baylin: "Please tell this doctor that all images
                                need to be protocol derived."

                                   The rub here is the effect produced by this
                                departure from protocol: Dr. Kilborn couldn't tell
                                what part of the body he was looking at. The
                                profundity of this problem was lost on the
                                participants, who were, quite justifiably more
                                concerned about doing the study right, and getting
                                the PCP to listen to the technician [6]. The absence
                                of a point of reference crystallized the
                                instrumental, realist attitude towards these
                                technologies of representation, recusing and
                                unlabeling itself. Situatedness rises, and the
                                problem of keeping track not just of the patient
                                and his or her history, but of a map of the patient's
                                body as well. The necessity of triangulating a set of
                                photographs with a "protocol" that would ensure
                                the uprightness of a body, and is orientation in
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                                       the uprightness of a body, and is orientation in
                                       another space (Gloucester, MA. in this case) came
                                       crashing into a habitual, embodied knowedledge
                                       that never would have dreamed of such a problem.
                                       Needless to say, all subsequent photographs were
                                       "protocol-derived" and the problem never showed
                                       up on my radar screen again.


                                             2/4/98

                                          A meeting to discuss the first few days of the
                                       teledermatology project. It is here that I learn that


                                       none of the technology involved in this project has
                                       been designed or built at the Partners
                                       Telemedicine Center. Present are two
                                       representatives of a small startup company called
                                       Global Telemedix Inc. who have been contracted to
                                       build, maintain and support the teledermatology
                                       system. It turns out there is little security, since
                                       Kilborn noticed that he could view the pictures
                                       from home, as could anyone at a public
                                       workstation in the hospital. An issue of perrenial
                                       shrugs. Security is something everyone is deathly
  Last Modified                        afraid of, but no one has any real ideas about.
  11-Sep-99 9:22 PM
  ckelty@mit.edu                       Security at Partners, like all aspects of the network
  Go Back to the Start                 is handled by Partners IS, a molasses like
                                       substance with tremendous inertial force. Concern
                                       over security takes two forms: 1) concern about
                                       medical data traveling "on the internet" (which,
                                       note, it was not, because the network was an
                                       internal Microsoft-based NT network), during
                                       which travels "anyone" might be able to look at it;
                                       and 2) the assertion over against (1) that the better
                                       part of the security problem rests inside the walls
                                       of the organization, and not outside. During my
                                       tenure I heard many concerns over security, many
                                       assertions that security was taken care of, but no
                                       specificity about either the concerns or the
10.08.2010   http://web.archive.org/web/20010310124...ctions /polyuns aturated/G.Partners .html   #16
                                specificity about either the concerns or the
                                solutions. However, as with all agenda items
                                during this meeting, the representatives of Global
                                Telemedix are vague and appear generally
                                unhappy to be there. From what I can tell, they are
                                developing a technology called "Tele-Consultant"
                                that they will eventually commercialize. Partners is
                                thus a test for them, and an unsuccessful one, it
                                appears, given the complaints: that the image
                                viewer is too basic, doesn't provide annotation,
                                that the buttons are on the wrong sections of the
                                page, all the tools are in different formats and in


                                different databases, that Internet Explorer crashes
                                all the time (surprise!), that modem connections
                                from home are slow, JPEG image sizes are too
                                large. None of these are issues that Global
                                Telemedix really has any control over, and it is the
                                first example of many of a repeated experience of
                                doctors and nurses asking the impossible of
                                technology that they are struggling to understand.
                                It is as if the successes of the past had so inflated
                                expectations that the future became a graphic
                                asymptotic modernity in which anything is
                                possible.

                                   Related to these frustrated expectations is an
                                issue that Kilborn continues to encypher as
                                "ubiquity." At least three times during the
                                meeting, the word comes up, referring as much to
                                the ubiquity of dermatological conditions in the
                                population as to the presence of PCs on desktops.
                                Part of the excitement of this atmosphere is the
                                sensation that the "research" they do will be
                                somehow exported to the rest of the world. There is
                                a strong sense that this is the center, even though
                                the technologies and ideas they pursue are no more
                                central and no more exportable than research
                                conducted at a hundred other academic medical
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                                conducted at a hundred other academic medical
                                centers around the country and the world.
                                Ubiquity is therefore a code-word for a kind of
                                political willfulness about the inevitablity of
                                progress, in this particular case, of the internet
                                and telemedicine and an assertion of their
                                participation in it. Ubiquity is the sign of not
                                simply success, but sameness, the success of
                                standardization that will make the problems of
                                cost-cutting and managed care disappear. The
                                imagination that permits ubiquity to stand in for
                                the realities of political and/or economic power is


                                the same one that makes statements like 'What will
                                Be" (Dertouzos), "The Road Ahead" (Gates), the
                                countless futurological promises of journalists and
                                internet pundits and the everyday vernacular
                                version in which people continuously assert some
                                version of "the internet changes everything, it is
                                inevitable." It's the Tsunami story internalized,
                                encapsulated in the word 'ubiquity.' In this
                                particular case, its portrayed as a technical issue.
                                Kilborn says: "I'm just thinking about ubiquity,
                                will the image viewer be freely available?" Or,"the
                                ubiquity of images means that they will need to be
                                highly compressed." Non-sequiturs are the
                                brain-children of buzzwords and technical terms.

                                   The fact that basically the entire project was
                                outsourced to Global Telemedix leaves Partners in
                                charge only of the clinical trial, largely unable to
                                compensate for the technical problems that might
                                interfere— such as the fact that Cape Ann's
                                computers are too old to have Windows 97
                                (Perhaps this referred to Office 97, it is unclear)
                                installed on them, so they cannot perform the
                                "doctor-use feasability study" which is apparently
                                in a Microsoft Access Database that runs only on
                                this new software, an irony for an organization
10.08.2010   http://web.archive.org/web/20010310124...ctions /polyuns aturated/G.Partners .html   #18
                                this new software, an irony for an organization
                                that finds itself technically, perpetually behind
                                itself with respect to computer infrastructure. But
                                absent these issues, the project would still not be
                                without hurdles. Confrontational and otherwise
                                uncooperative doctors at the Cape Ann medical
                                center threaten to disrupt the trial. One of the staff
                                members explains that they have gotten most of
                                their patients to date (6 to 7) from MGH and only
                                2 from Cape Ann, because they are "forgetting" to
                                offer it to potential patients. There is smoe
                                discussion about the mystery of why one group


                                would be so excited about the project while
                                another would not. Kilborn offers "I characterized
                                this project as 'early-beta testing' to both groups. If
                                [Cape Ann] is angry about that, then they don't
                                understand the spirit of participation. This is a
                                culture change, they will have to get used to doing
                                this."

                                   "Culture Change" is a phrase that reappears
                                regularly. Pause to dwell on this usage, because it
                                will be imporant to the some of the arguments in
                                this dissertation. As with much of corporate
                                America in the eighties and nineties, 'culture' has
                                become a commonly used term to reference the
                                norms, tacit and otherwise, that permeate an
                                institution. These norms can be good or bad,
                                managers can leverge them to make employees feel
                                more "at home" or leverage them as a kind of
                                marketing tool[7]. At partners, the 'culture' had
                                come, among other things to reference the
                                historical organizational differences between BWH
                                and MGH, which had recently become part of the
                                same corporate entity. Janine Porter and June
                                Baylin both recognized and complained of these
                                differences. Janine explained that she saw BWH as
                                having a culture of authority and inflexibility, and
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                                having a culture of authority and inflexibility, and
                                MGH as having a culture of collaboration and
                                intellectual integrity, and that these two things
                                conflicted often; BWH usually "won" because "they
                                just refuse to do it any way but their own. June
                                Baylin had worked at BWH: "22 years with some of
                                the toughest chiefs at BWH. People are
                                intimidated by my resume." She had just recently
                                moved (with Janine) to Telemedicine, and within
                                the year had decided to leave, because, she
                                explained, she saw how much independent
                                consultants to PTC were making, and how little she


                                was making, and decided she could be a consultant
                                instead. Her reaction to the merger is a telling
                                instance of this change from career-oriented
                                "culture" to a "culture" or casulaized consulting:
                                "When I was at BWH I knew it by names, faces,
                                places, ffunctions and responsibilities. Partners
                                Healthcare System is just three words that flash
                                across my brain. I have no idea what they mean."
                                Whether explicit or not, every mention of
                                "culture-change" referenced something that was
                                unarticulated, only understood at the level of
                                frustration. During a meeting on the creation of a
                                Center for Clinical Telemedicine at BWH, members
                                of PTC expressed frustration with the people
                                positioned to make decisions (e.g. "Dr. W is an
                                asshole, he only wants to know where the money is
                                coming from"), Dr. Kilborn and Janine Porter
                                complained that they don't understand the nature
                                of the "culture change" that they are trying to
                                effect.

                                  Often "culture change" in business has meant
                                the switch to flexible production, modifiable
                                work-groups, what Charles Sabel calls "Learning by
                                Monitoring" and, as a result, general career
                                insecurity. "Culture change" in medicine references
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                                insecurity. "Culture change" in medicine references
                                the same things, but misunderstands them as a
                                change to a "business" model, as if the business
                                world had not also changed. The executive
                                directors, in particular, were adamant to the point
                                of madness about this. With the fanatacism of
                                converts, they insisted on business priniciples over
                                against any kind of traditional, paternalistic or
                                welfare-oriented principles of the hospital. This
                                was indeed "culture change."

                              2/25/98 "Town Meeting"


                                   The "town meeting" was the first time I saw all
                                of the members of Partners Telemedicine together.
                                It was also my first introduction to their intense
                                focus on the management of resources and
                                attempts to sell themselves to corporations. In
                                retrospect, this meeting represented a focus and
                                critical mass of energy that I never saw repeated in
                                the subsequent fragmentation of the Partners
                                Telemedicine Center. Dr. Kilborn's report to the
                                staff consisted of 'goals' and 'strategies'. Under
                                goals he offered 'business goals', 'operational goals,'
                                and 'academic goals.' Under strategies,
                                'Fund-raising,' 'technology,'remote consultation,'
                                and remote education.

                                   The general goals, titled "Three year goals"
                                (incidentally, an unimaginable time-line compared
                                to the internet start-up world) included the
                                following:
                                1) Demonstrate the utility of telemedicine as a tool
                                for the distribution of Partners knowledge to
                                patients and providers internally and globally.
                                2) Demonstrate a sound business case for
                                telemedicine,
                                3) Enhance awareness of telemedicine and its
                                potential among the professional and lay public.
                                The hopeless generality of the goals is key to the
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                                The hopeless generality of the goals is key to the
                                general sense of either excitement or confusion
                                that suffused this environment. Excitement for the
                                individuals whose day to day activities were
                                stretched to the breaking point (the three
                                members who ran the video-conferencing were
                                working ten to twelve hour days running all over
                                the greater metro area setting up
                                video-conferencing calls and providing support to
                                individuals who used the system. One member
                                confided at one point that he honestly thought that
                                he could drive around town and pick up all the


                                people who were going to meet via video, bring
                                them to one place for a meeting and then return
                                them, and he would probably be doing less work),
                                but confusion for the rest, many of whom were
                                hard pressed to say what telemedicine is, was, or
                                could be.

                                    Dr. Kilborn storied these goals:

                                      "Patients love the stuff, because it means less time
                                      spent and more access to care. I've spoken a great
                                      deal about this with [members of the international
                                      patient center] and we have decided it is necessary to
                                      clarify our vision statement in order to create an
                                      international business based on this. Telemedicine has a
                                      very high premium for specialists and providers,
                                      especially teledermatology, but demonstrating a sound
                                      business case here is more difficult. When you are
                                      increasing efficiency but at the same time adding
                                      technology costs, that's a hard sell. It's very difficult to
                                      overcome. Our vascular project will probably result in
                                      the nurses buying the cameras, because they are
                                      relatively inexpensive and they see the value added. In
                                      the Telederm project, there is the question of who
                                      pays; either 1) the PCP will pay because it saves him
                                      referral costs or 2) dermatology specialists will pay
                                      because it definitely increases revenue streams, there
                                      is a high premium for them. Now on the subject of
                                      enhancing awareness of telemedicine among the lay
                                      public, our penetration of lay knowledge is very bad.
                                      The popular press has a tendency to do a story once
                                      every six months where they say "robots will replace
                                      doctors" and that doesn't help us very much. Part of
                                      the problem is that they always want to see a doctor
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                                      the problem is that they always want to see a doctor
                                      WITH a patient, and we can't really do that. If anyone
                                      has any ideas on this please relay them to Eric."


                                   Even in the cases where goals were clearly
                                labeled 'academic' the language surrounding them
                                included 'business plans' 'cost effectiveness',
                                'technology planning' and 'management strategy.'
                                Locating the surprise in this is difficult. On the one
                                hand, it shouldn't surprise that medicine is a
                                business, and that academic medical centers are
                                the most agressive in this industry. On the other, it
                                is quite significant that, as these stories should


                                indicate, the people who work in telemedicine were
                                drawn to these jobs because it offered something
                                other than the crass callousness of the business
                                world, or in the oft-repeated phrase: "I feel like I'm
                                helping people here." Over the months I observed
                                the telemedicine center, more and more people
                                indicated frustration with the language of
                                "increasing access and decreasing costs" both
                                because it wasn't what they came to do, but also
                                because it felt like a relatively meaningless Mantra.
                                The vagueness of the goals and strategies— goals
                                like "enhance revenue streams" and strategies such
                                as "target large corporations that may have an
                                interest in funding research in an emerging
                                industry,"— also served confusion for the staff,
                                while leaving the directors roles undefined.

                                  Goals and strategy aside, however, the meeting
                                did eventually turn to more concrete problems.
                                Financial problems concerning short term
                                purchases, growing expense debts, last minute
                                purchase decisions, professional association fees
                                etc. These concerns, which centered largely around
                                the videoconfernecing activities, since they
                                appeared to be the sole activties increasing in scale
                                and scope. The stock answer was that budgets were
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                                and scope. The stock answer was that budgets were
                                tight, that Partners could not fund us at the
                                current "burn rate," and that the main issue was to
                                complete the tasks that needed to be completed.
                                Space was also raised as a concern, and the
                                promise of new office space seemed to be
                                forthcoming.

                                   At this point in the meeting, it was Janine
                                Porter's turn to "address the team members about
                                being part of the team." In what would be the first
                                of several examples of a kind of infantalizing


                                management dribble, she began by insisting that
                                "flexible time is part of your career, but it is not an
                                everyday occurence." This coded chastisement for
                                being late to work, I later learned, was precipitated
                                by one person in particular, but Janine saw fit to
                                insist on it to the entire staff. She continued, "just
                                because we might not need to be doing something
                                in the office, doesn't mean that other people don't
                                need us. Meetings need to start when they need to
                                start and we, as a team, need to make a
                                commitment to that so that we can grow in various
                                ways." The spiraling vagueness of this first person
                                plural reprimand appeared to be improvised based
                                on the Janine's reaction to the facial expressions of
                                the staff. As she reached the nadir of her speech
                                she appeared to suddenly decide "that each of us
                                take our job descriptions, look at the tasks that are
                                listed there, and make sure that they are tasks that
                                we need to be doing. Also make sure that we add
                                any tasks that you do that are not listed there. By
                                March 15th I would like new job descriptions from
                                each of you, listing these tasks, which tasks need
                                education, where you would like to go in the future,
                                and jobs can be done that currently aren't. I will
                                also make a commitment to do a new report on
                                employee development."
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                                employee development."

                                   I was a bit shocked by this, mostly because it felt
                                so much like high school, but also because I
                                couldn't figure out what she wanted, yet no one
                                seemed to be asking any questions about it. Either
                                I was missing something in the shallow
                                management rhetoric, or the staff intended to
                                ignore this woman's request as soon as they stood
                                up. The latter turned out to be closer to the mark.
                                As the meeting ended, I was left wondering how




                                many people at PTC had a firm sense of what they
                                were supposed to go do right then.


                                  CHF, Michael, Rob and

                                  Management Bathos

                                  I settled in to a routine of meeting with two
                                people in the research wing of PTC, Michael
                                Carpenter and Rob Prasad. Michael and Rob were
                                both young men working as Research Assistants on
                                the three Clinical Trials that were being conducted.
                                Rob was principally responsible for designing and
                                runnig the Vascular Surgery project, Michael was
                                overseeing the CHF project. Both were
                                good-humored without reserve, and both had
                                entered the job under the assumption that it would
                                be challenging and good resume material. Michael
                                planned on going to Medical School, Rob either to
                                medical school or to business school. Rob spent
                                most of his time teaching himself new development
                                tools for building and managing websites. PTC
                                would occasionally send him to classes, and he
                                would pick the brains of the Global Telemedix
                                people who came by to update of fix the systems
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                                people who came by to update of fix the systems
                                that had been hired to build. After a year and a
                                half, Rob was ready to move on to an internet
                                healthcare startup.




                                   Michael, on the other hand, was pinned beneath
                                the CHF research project. He referred to it as the
                                Mammoth in a tar pit project. His experience of
                                this project was colored both by its poor design
                                and by the bathos of management. Michael's uphill
                                struggle against the project and the people around
                                him was the very last thing that I came intending
                                to observe, but the most intense and fascinating.
                                The CHF clinical trial was designed by PTC staff,
                                but the technology had been built primarily by
                                Global Telemedix. The device they designed was
                                based around a hand-held Hewlitt-Packard
                                computer ('palmtop') running the 'stripped down'
                                Windows operating system Windows CE. They had
                                inserted this computer into a box that was about
                                10 times its size, about the size and shape of a
                                toaster oven (or more accurately, the size and
                                shape of an Atari 2600). The palmtop was hooked
                                to a series of devices: a sphhygmomanometer, a
                                pulse-oximeter, and a scale. The keypad of the
                                palmtop was covered with a metal plate so that the
                                only interface was a touch-screen [8]. The system
                                also used a modem to dial into a server and
                                download the measurments into a database. They
                                built approximately 20 of these devices to be put
                                into selected patient's homes for the trial.
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                                into selected patient's homes for the trial.

                                   The protocol for the study required
                                measurments of each of four 'CHF triggers'. The
                                triggers were weight gain or loss, pulse, blood
                                pressure, and blood oxygen level. I significant
                                change in any one of these factors was enough to
                                alert a nurse that a visit might be necessary. For
                                the purposes of the study, these four triggers were
                                each measured three times: first by a nurse,
                                manually, without the use of the device, second by
                                a nurse operating the device, third by the patient


                                operating the device him or herself, but with a
                                nurse present. This seemingly straightforward
                                protocol produced a series of "alarming"
                                correlations. Michael sent out a memo.

                                   The alarm came as a result of the fact that the
                                correllation of the measurements of blood pressure
                                and weight taken by nurse, nurse with device, and
                                patient with device were so different as to suggest
                                some kind of malfunction. Any number of issues
                                were suggested: Nurses were helping the patient
                                with machine, nurses were not helping the patient
                                with the machine, Nurses were using
                                "non-calibrated" home scales to measure weight,
                                'natural' variation in blood pressure over short
                                periods of time, patients were experiencing
                                "white-coat hypertension" [9], patients were small
                                and frail, so accurate measuements were more
                                difficult (in some cases, normal BP cuffs were
                                replaced by pediatric cuffs to attempt to remedy
                                this problem). It was even suggested that Nurses
                                were sabotaging the project because they were
                                involved in a clinical trial with a competing home
                                care company. Rob returned from a meeting with
                                Dr. Kilborn and June Baylin with the suggestion
                                that Michael recorrelate all the values in order to
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                                that Michael recorrelate all the values in order to
                                see if any particular patient or nurse were
                                throwing the numbers off. Michael was concerned
                                that the nurses were responsible because no one
                                could watch them, and because they had no real
                                incentive to participate in the study.

                                  Some time in the middle of this fiasco of
                                measurement, June Baylin officially left, to be
                                replaced by Dr. Anne Edwards. Michael had
                                managed to clean up some of the data to recover a
                                few transcription errors, but the data was still so


                                bad as to be unpublishable. At one point they
                                decided to run a mini-trial to determine if the CHF
                                device was measuring blood pressure correctly.
                                This ad-hoc protocol, as far as I could tell,
                                consisted of making one of the secretaries wander
                                wround the office taking people's blood pressure
                                with an ancient sphygmomanometer attached to a
                                metal stand with wheels, and then again with the
                                device. In my case, she took my blood pressure
                                with the cuff, but not with the device. I asked
                                Michael and Rob why she had neglected the
                                protocol, they shrugged. Clearly they were not
                                taking this so seriously any longer.

                                   About a month later, a single meeting occurred
                                in which a set of people from other parts of MGH
                                try to involve PTC in a CHF project with great
                                potential. Apparently, the Tufts Health plan is
                                trying to get a registry of its CHF patients together
                                so that MGH can treat all of them. One of the
                                meeting participants explains that these patients
                                are "hemorrhaging money" and that the potential
                                for cost savings is enourmous. Dr. Kilborn, Anne
                                and Michael try to present the CHF project as
                                something still under investigation, unfinished,
                                "the data hasn't been thoroughly analyzed yet." Dr.
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                                "the data hasn't been thoroughly analyzed yet." Dr.
                                Kilborn tries to interest them in "phase 2" in which
                                he claims they will move to a WebTV set-top box
                                for CHF patients to use. This is the first I have
                                heard of this, and it turns out, the first Michael or
                                Anne had heard of it. Nothing comes of the
                                meeting and the project recedes further into the
                                past.

                                  During this time, I was more likely to witness a
                                kind of organizational and management
                                auto-immune response than any actual research


                                work. Anne, having just arrived, in the middle of
                                this project, was the most confused and frustrated.
                                She knew less than I did, and was having as much
                                trouble getting people to fill her in. During an
                                informal meetin with Michael and Rob, she had
                                asked Michael for information about the
                                organizational structure of PTC. Michael offered to
                                get the official organization chart and asked Dr.
                                Kilborn's secretary, who agreed to print them out
                                for Michael to take back to Anne. Dr. Kilborn
                                overheard this request and for some reason
                                decided to ask Janine why Michael would need the
                                organization charts. Janine having no idea, asked
                                Martha to go and ask Michael why he needed
                                them. Michael, however, sensed that Martha was
                                asking for someone, and when he managed to get
                                her to admit that it was Janine, chastised Martha
                                for doing Janine's dirty work. Martha later
                                apologized, but said that Janine still needed to
                                know before she could print out the reports. So the
                                meeting on organizational structure was
                                postponed, Anne was left only with my vague and
                                incomplete description of the organizational
                                structure, with Michael filling in details that he
                                knew.
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                                  Also during this time, Michael had been working
                                on getting a proposal through to start a research
                                project that would use telemedicine to care for
                                AIDS patients in their homes. He had worked hard
                                on the project, and clearly cared deeply about it.
                                When the budget was presented to Partners,
                                however, it was not accepted. Since Michael was
                                not present at the budget proposal meeting, he was
                                disposed to imagine all manner of reasons for its
                                non-acceptance. I caught him in a particularly
                                bitter mood just afterwares, when he insisted that


                                these were the worst conditions of management he
                                had ever worked under. "It's like they're playing
                                house and one says, 'Now I'm the daddy and I say
                                its going to be like this,' and another says, 'No I'm
                                the momy and I say its going to be like this!' Never
                                before have I seen it like this, not in the service
                                industry, not in law firms, but these people are so
                                full of corporate jargon that means nothing that I
                                have no idea what they are talking about, they just
                                wander around making things difficult." As if in
                                illustration, Anne peeks in and asks where Rob is,
                                and Michael says he's coming in a half hour late.
                                Janine overhears this, and within earshot of
                                Michael says "In the futuer, Anne, have your
                                employees call you when they will be late, and then
                                you should call me so that we can know where
                                everyone is." I raise my eyebrows, and Michael says
                                "I call this the 'downtown Burger King approach to
                                management," he mocks: "You betta call yo
                                managah, you gonna git in trouuuble." And then
                                again: "I wan' you ta pinch-hit on the fry-station
                                today, Jason's fixin to git fired!"

                                   All of this met its apotheosis in Michael's
                                "performance evaluation." Written by June Baylin,
                                after her departure, and presented by Janine in a
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                                after her departure, and presented by Janine in a
                                meeting, the evaluation shocked Rob and I with its
                                harshness. Personal issues that had hitherto been
                                tacit between June and Michael, foremostly
                                concerning sexuality and religion, where just
                                barely contained beneath the surface. Michael was
                                blamed for the failure of the CHF project and
                                saddled with every disruptive trait in the book.
                                Even from my brief and inevitably biased
                                observations of the situation, the evalutation (upon
                                which rested a letter of recommendation for
                                Michael's application to Med school) was blatantly


                                vindictive. The CHF project was abandoned, and
                                Michael stuck it out for six more months, ironically
                                outlasting June, Rob and Janine, before he went on
                                to med school.

                              Watching TV with Important Doctors


                                      2/26/98 Catherine Hall Lecture

                                      Room, Brigham and Women's

                                      Hospital

                                  Julianna Lee and Tim O'Neil invited me to
                                observe a teleconsultation that they were
                                performing with Tel Aviv, Israel. The Partners
                                Telemedicine Center, largely because of the skill
                                and effort of Tim O'Neil, had managed to install 21
                                Video Conferencing units (at a cost of somewhere
                                around $1 million) at sites throughout the Partners
                                network. These units are made by Vtel, a company
                                specializing in the video conferencing hardware.
                                They normally consist of two 32 inch televisions, a
                                PC, a remote control video camera, a hardware
                                codec, a video cassette recorder, a pen and
                                keyboard based infrared input system, and
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                                keyboard based infrared input system, and
                                software for communications, compression, and
                                integration with the VCR and camera. These
                                systems are widely sold, and they are built to
                                comply primarily with ITU standards, but are
                                nonetheless a perfect example of a proprietary
                                technology, like VCR's themselves, that have found
                                sudden competition (though not intense, due to
                                quality issues, see "Scale and Convention") from
                                the internet.




                                   The system is impressive, especially if it isn't on,
                                its mysterious power obscure. The two televisions
                                sit side by side, an odd sight to begin with. On top
                                is a small video camera that is operated by the
                                'expert', in this case Tim. The VCR and PC are
                                generally obscured underneath in a cabinet that
                                gives it the false bottom of a home entertainment
                                center. I like to imagine a variety of home
                                recordings of consultations and surgeries stored
                                underneath, unlabeled, in disarray. When the
                                system is on, disorientation takes over. When there
                                is no connection to a remote site, both monitors
                                show the room that the system is in— the view
                                from the video camera on top of the TV's. TVs
                                showing you in stereoscopic vision what they see.
                                Dial a remote site, however, and one of the TV's
                                switches to the view from the remote system. Side
                                by side, are television images of the interlocutors:
                                one, the person on the far end, the other, yourself,
                                staring back at you in the frame next to the person
                                you speak to. It almost seems appropriate to turn
                                the televisions to face each other.

                                  On this day, a consultation was scheduled
                                between the Ezra Lemarpeh Medical Center in Tel
                                Aviv and the Chief of Cardiac Surgery at Brigham
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                                Aviv and the Chief of Cardiac Surgery at Brigham
                                and Women's Hospital, Lawrence Cohn, MD. The
                                consult was scheduled for 8am EST (3pm in Tel
                                Aviv) and I arrived at about 7:30am. The room at
                                BWH was a large auditorium, and when I entered I
                                noticed that the camera was zoomed out to the
                                point where most of the room was visible on
                                screen. I wanted to remain off-screen, a camera
                                shy newbie, and installed myself in a far corner a
                                few rows back, just off of the left side of the screen.
                                Tim proceeded to dial the telephone number of the
                                remote site in Tel Aviv, to ensure that the


                                connection was working and to test any equipment
                                before the consultation. On the screen appeared a
                                series of instruction, a series of noises, and then
                                the screen focused on a small room with a table
                                and three men. Tim says 'Shalom,' then 'hello,' then
                                repeats 'hello.' From the far end, we hear "yes, we
                                hear you" and a wave. The picture looks very clear,
                                two of the men sit at the table, the other leans
                                against the wall. One wears a Rabbi's attire, the
                                other a business suit. The man against the wall
                                appears to be in vaguely orthodox dress, though he
                                also appears to be sleeping, and is hunched over. I
                                wonder if this is the patient, but later learn that
                                the patient is not present. On the other screen Tim
                                is clearly visible, standing next to his laptop, and
                                holding the pen-based input baord. There is only a
                                1/2 second delay in the audio (it is a 384 Kb/s
                                connection). Tim introduces himself and begins
                                small talk about the weather. They ask if he is will
                                go to Florida where the weather is nice, and Tim
                                laughs. It is February in Boston, and he suggests
                                that if the room had windows he would show them
                                the snow outside.

                                  Conversation slows, though it is only about 7:50.
                                There is a pause, and then they ask about the
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                                There is a pause, and then they ask about the
                                room, which they can see. Tim explains that it is a
                                conference room, usually used for large gatherings.
                                With its typical ostentations mahgony excess, it is
                                a stark contrast to the small white room they
                                occupy, the rear wall of which hangs a slightly
                                off-center banner that reads "Ezra Lemarpeh." Tim
                                zooms the camera out to show them. I am
                                mesmerized by this interchange of virtual
                                exploration. Mesmerized until the camera swings
                                left and settles directly on me.




                                   The man dressed like a Rabbi smiles, waves and
                                says "Hello." Startled I return the hello. After a
                                pause he says "What's your name?" "Chris Kelty.
                                I'm an anthropologist studying science and
                                telemedicine," I realize that across distance and
                                language this probably isn't clear, so I add "I'm
                                here to observe and see how this stuff works." But
                                as I'm saying it, the delay too long for normal
                                phatic interaction, he responds to my first
                                statement: "Oh, an anthropologist" he says,
                                hardening the G, "what do you think about the Big
                                Bang and the Origin of the World?" Or rather, I
                                think this is what he said. I look back at him, and I
                                say "not that kind of anthropology," wondering
                                what kind he is talking about, or for that matter,
                                what I was thinking about. He was persistent
                                though, still smiling: "Do you believe in the
                                scientists?" "Excuse me," I say. "The scientists, do
                                you believe in the scientists?" I look at Tim for
                                guidance, he says "He asked if you believe in the
                                scientists." No help there, so I say "I'm not sure I
                                understand." "Well, he says, if you study the
                                anthropologia, and the origins, then you must
                                believe in the scientists' words, no?"

                                    At this point, some clarity dawns on me: he
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                   Section Header




                       A. Introduction: What's true for e.
                       coli...
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                                       Primitive operators 'scale' and 'convention' are
                                       introduced — Mice and Elephants compared in the
                                       context of scale, and related to discussions of the
                                       economy, the internet and Santa Fe — Scale
                                       becomes intransitive verb — Convention explained
                                       with respect to community, communication,
                                       empire, and telecommunications — the internet is
                                       identified as an Important Difference within
                                       convention — Convention and Scale form the
                                       beginning of a beautiful relationship — the
                                       location of the internet is sought, and not found —
                                       Various Philosophical Musings.



                                       La conventientia est une ressemblance liée à l'espace dans la
                                       forme du "proche en proche." Elle est de l'ordre de la conjunction
                                       et de l'ajustement. C'est pourquois elle appartient moins aux
                                       choses elles-mêmes qu'au monde dans lequel elles se trouvent. Le
                                       monde, c'est la "convenance" universelle des choses.

                                       Conventienta is a resemblance connected with space in the form
                                       of a graduated scale of proximity. It is of the same order as
                                       conjunction and adjustment. This is why it pertains less to the
                                       things themselves than to the world in which they exist. The world
                                       is simply the universal 'convenience' of things.

                                               Michel Foucault from "La Prose du Monde" in Les Mots et Les
                                                                                                   Choses


                                              In January of 1999, at dinner with Sean Doyle
                                           and some friends, Sean told me about an article
                                           from the New York Times 'Science Times'. The
1 . Geoffrey West of Los                   piece [Johnson99] described mathematical models
A lamos              National
Laboratory , James Brown,                  of quarter-power scaling for biological entities, like
Univ ersity of A lbequerque,
and     Brian    Enquist    of             mice and elephants. As organisms ascend in
theSanta      Fe     Institute
announced their research at                absolute size, their relative metabolic rates scales
the 1 999 A A A S meeting.
The quarter power scaling                  as the 3/4 power of that. The mouse's heart rate
laws they describe hav e
been observ ed repeatedly
                                           beats the mouse's size far faster than does the
by biologists, but according               elephant's. If you posit a spherical mouse (Sean
to these researchers, the
problem has nev er been                    said: "You have to make some simplifying
approached       using     the
mathematics of complex
sy stems and self-similar
fractal    networks.     West
ex plains in a Santa Fe
                                           assumptions"): surface area grows in two
Bulletin "Metabolic rate -                 dimensions, but volume in three. Mice and
how much energy             an
organism consumes per                      elephants' ratios differ (surface to volume),
second to maintain life - is
proportional to body mass                  offering a possible explanation for their heart rates
to the three-fourths power,"
                                           and metabolisms [1]. As in so many recent cases,
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                                              and metabolisms [1]. As in so many recent cases,
                                              we can thank the willfully wacky folks in Santa Fe
                                              for insisting on research into what was obvious to
                                              many to find the non-obvious answer— that
                                              self-similar fractal networks of vessels of invariant
                                              size (such as the smallest capillaries) might have
                                              something to do with blood pressure, heart rate
                                              and metabolism. So bigger is better, it turns out.
                                              Or at least, bigger is better if you are a dinosaur
West said.         (To     obtain             fan: for Sean, this indicated that dinosaurs were
three-fourths power of body
mass, take the square root                    actually very efficient creatures, and probably very
of the square root of an
animal's weight and cube it.)                 long lived. The story was one of hundreds that
The rule, known as Kleiber's
Law, has been around for
                                              Sean and I have traded over the year or two that I
decades,      but      no     one             have been watching Amicas, but by some peculiar
understood the reason for
it, West said. "A cat is                      combination of math and animals, this story stuck.
roughly one hundred times
larger than a mouse," West
ex plained, "so y ou'd ex pect
a cat's metabolic rate to be                     Such narratives birth powerful analogies. Small
one hundred times larger
than a mouse's, but it isn't.
                                              strong ants (start-up companies) can lift hundreds
The metabolic rate is only                    of times their body weight, while lumbering giant
about thirty times larger - a
number        predicted        by             octopi (multinational corporations) have no such
Kleiber's Law." The article
continues the ex planation                    strength, but live for decades and routinely crush
The researchers built their
model           on          three             smaller animals on their route. The metabolism of
assumptions:          that       a
space-filling        fractal-like             small companies is high, burn-out is common, but
branching         pattern       is
required         to       supply              they extract maximum energy from minimum
life-sustaining fluids to all
parts of the organism; that                   input (Amicas employees sometimes go months at
the final branch of the
network-the twigs of a tree
                                              a time without paychecks, foraging in the wild for
or the capillaries of a                       credit), the metabolism of large companies is slow,
circulatory sy stem-are the
same size regardless of a                     a limit case perhaps being the University, in
species' body mass; and that
the energy used to transport                  perpetual hibernation, or at least molting. But in
resources       through       the
network is minimized.                         the case of Amicas (or internet start-ups
The first assumption came
from      the       researchers'              specifically) the image is more than analogy. Not
observ ation         that        a
space-filling         branching               only are convenient metaphors good business plan
network      is     a     natural
structure for transporting
                                              material, but in fact the substance of their work:
nutrients to ev ery cell in an
animal's body . Thus, the
billion plus cells present in
the human body are fed                        the particular problem of the technical (structural,
regularly      through        the
cardiov ascular sy stem that                  organizational, and communicational) scalability
transports          ox y genated
blood through the aorta,                      of institutions, organizations and 'enterprises,' and
decreasingly             smaller
arteries, and through about                   their speed and stability as they grow is less
ten billion capillaries, each
                                              analogous than homologous. Something tricky
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of which feeds a small                       analogous than homologous. Something tricky
number of cells.
The second          assumption
                                             about the problem, and indeed, a certain class of
arose from the researchers'                  scientific investigation conducted mostly in Santa
knowledge that all liv ing
cells, the building blocks of                Fe, New Mexico, seem to bring together the
life, are the same size
regardless of an organism's                  biological and the computional problems [2] into
species or body weight.
Lastly , to minimize the                     an object lesson that challenges the creative
energy        required        to
transport resources through                  imaginations of entrepreneurs.
the sy stem, the network
must be a fractal-branching
one. Fractals are structures                    In recapitulation, the analogy-cum-theory
that ex hibit self-similarity in
the manner of Russian                        quickly extends outside of the firm to the market.
nested dolls or snowflakes.
The smallest fraction of the                 We recognize that firms and organization grow.
sy stem must be a miniature
replica    of     the    entire              From the Sherman Anti-Trust act on, the
network, the only difference
between the two being one                    twentieth century has been one long experiment in
of scale.
                                             pure size, corporations representing the pure
                                             products of American bigness [3]. Markets scale,
                                             however, and in the modernism of the corporate
                                             era, the size of a corporation allowed it to reach
                                             "economies of scale." Today, such a relation leans
                                             more on complexity theory than brute growth.
                                             Bigger is not necessarily better, diminishing
                                             returns to scale— that gravitational constant of
                                             industrialism that was Marshall's natural
                                             constraint on size, has given way to "increasing
                                             returns" to scale and the creation of "economies of
                                             scale" from the smallest capillary units. Absolute
                                             size and reach are no longer related. Markets are
                                             made, scaled to order. Scale is an intransitive verb.
                                             [4]
2. See Stefan Helmreich on
the Santa Fe Institute for
more detail [Helmreich98]




                                               The technically specific component of this
                                             change is the internet. The internet scales also.
                                             Internet servers are scalable when the technical
                                             constraints on one transaction are the same as
                                             those for a billion. No need for a billion servers to
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                                            those for a billion. No need for a billion servers to
                                            serve a billion hamburgers, this baby scales. The
                                            intersection of a certain class of problems
                                            represented by the Santa Fe Institute with the
                                            history of computing would demand a more
                                            complete genealogy [5]. The models, metaphors,
3. The Sherman A nti-trust                  and mixed messages that go by the sundry names
act        is       commonly
misrepresented as an act                    open systems, distributed processing, distributed
that put limits on the size of
corporations, when in fact,
                                            computing, enterprise computing, distibuted
one of its results was to                   object-oriented computing, object management,
challenge     businesses to
grow as large as possible                   complex systems (the list scales) is part of a more
without v iolating the terms
of the A ct, which limited                  general scientific and technical interest in the
only "restraints on trade." It
is thus here that the Gigantic              problem of large, complex organizations— and at
A merican Corporation we
are so familiar with learned                one end— in theories of self-organizing behavior of
first to be really big, without
necessarily        being      a             which the market and evolution are the two most
monopoly (See [Sklar88]
[Liv ingston94]             and             familiar and commonly repeated exemplars.
[Chandler7 7 ]).

                                              But scale is only the login to the present.
                                            Convention is the mot d'ordre [6]. Convention will
                                            be the password to a single file of terms that lie,
                                            appropriately, in convenientia, step by step:
                                            agreement, standard, contract, custom,
                                            convention, regulation, law. At various points, this
                                            section touches on all of these terms, in specific
                                            contexts where they appear, and as ciphers for a
                                            more general theory of the social bond. In
                                            particular three related "negentropic eddys" (to
                                            employ the fanciful language of "complexity
                                            theory") form around convention.

                                              One. Community was once the scale of
                                            convention— the space of sharing. Community is
4.      A ssumptions         of
increasing or decreasing                    an absolutely devalued word today, it is agreed,
returns are the economist's
sine qua non, and despite                   indicating palpably only what is gone [7].
their      simplicity       as
measures, debates rage on                   Community is an emblem of scale as well, in
top of them. A lfred Marshall
is the locus classicus of a
                                            particular the small scale opposed to corporate
modernist formalization of                  bigness— the space of authenticity and presence
diminishing            returns
(Priniciples of economics,                  where a moral frame orders obligations and
[Marshall61 ]), often cited by
the darling of 'increasing                  responsibilities by virtue of conventientia—
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                                               propinquity. The "scientific community" in
                                               particular is the example that appears and
                                               appears here. What is it that allows sharing in
                                               science— sharing data, sharing techniques,
                                               sharing ideals, sharing knowledge? For Weber it is
                                               a vocation, a calling that comes from the severity
                                               of desire. For Lyotard it is sharing based on
                                               dissensus, a calling to outdo in an agonistic game
                                               with mutable rules. For many scientists it is the
    returns' theorist W. Brian
    A rthur [A rthur94], who
                                               dream of a perfect language, a final theory, or the
    assumes increasing returns                 revelation of secrets— callings no less powerful for
    by     reference     to    the
    probability mathematics of                 their mythicalness. There is also sometimes a
    Poly a Urns (if each draw
    from an urn of colored balls               desire to share what is learned or discovered, to
    affects     the   subsequent
    distribution of colors, then               transmit, to teach. The discovery or solution of a
    the initial draws can hav e an
    inordinate effect on the                   problem is only half the desire, because it is the
    subsequent      distribution).
    The      lesson     is    that             explanation and teaching that actualizes it. Once
    organizational size need not
    match market size, to                      the university was the locus of this activity, but in
    achiev e max imum returns
                                               the very recent past, the internet has taught a new
                                               generation of scientists to come and go with vastly
                                               different speed and scale. The community, such as
.
                                               it is, is stable by reference only to a set of shared
                                               interests, unsolved problems, articulated concerns,
                                               not by reference to people or place. The usenet
                                               group, the ftp site and the free-software model of
                                               software development (the Linux and GNU
                                               operating system) are the models of collaboration
                                               for a genearation that is migrating "science"
                                               outside of universities [8]. The boundaries of the
                                               university are denaturalized, rexognized as the
                                               arbitrary barriers to solution that they often are.

                                                 Two. The convention of communication that the
                                               internet represents is not new. It is, in Bernhard
    5. A geneaology of this
    scientific tradition might
    start (going backwards) with               Siegert's terms, part of "the epoch of the postal
    The         Ecology       of
    Computation. 1 988, by B.                  system." The engineering of empire has always
    Huberman. [Huberman88].
    A n important work in the
                                               included systems of control and communication
    story of computing, and one                whose model is the post. "Reason must be
    of the first to attempt to
                                               delivered to consciousness." [9] Its successes and
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                                             delivered to consciousness." [9] Its successes and
                                             failures in the past have depended on cooperation
                                             and agonism, assent and persuasion.
                                             Communication itself [10] is the metric of freedom
                                             for the subject whose face, in the sand at the edge
                                             of the sea, has washed away to reveal grains of
                                             sand as silicon wafers, or as bits. To communicate
                                             freely? But what does this mean? Every example of
                                             a communications 'network'— roads and routes
imagine the internet outside                 and posts and messengers and secrets, every
of        any        particular
configuration.        Complex                example of an empire's scale from the runner at
networks,                fractal
self-similarity , and the the                Marathon to the cipher of Enigma to the Global
network operating sy stem.
Models and metaphors of
                                             Positioning Satellite— is recapitulated in the
"global minds", and endless                  internet. It's what makes a thousand just-so stories
analogies              between
ecologies, markets,         and              of its origin make sense to a thousand new users—
distributed         computing
env ironments abound here.                   the internet is TV, the internet is newspaper, the
K. Drex ler and Mark Stefik
appear early on as two of                    internet is nuclear-war proof military network, the
the v isisble figures (Drex ler
has become more well                         internet is post office, the internet is hypertext
known for his work on
Nanotechnology , and Stefik                  (secret message) and cyberspace (outer space).
for his work on "trusted
sy stems"       for      digital             There is an historical imagination here, or an
certificates). E.O. Wilson
and Richard Dawkins garner
                                             imagination of history and the world as totality.
the most references. Out of                  The keywords of this epoch were development,
this     will    come      Sun's
marketing mantra for Jav a:                  growth, progress, evolution, revolution, modernity.
"the      network     is     the
computer." This particular                   This was conventional modernity.
geneology does not truck
with metaphors of space, as
in cy berspace and v irtual
reality , since in most cases,
                                                Three. The convention of the internet is
the distinction has either                   different. The standardization of the internet, the
been quickly eroded in
fav or of market and ecology                 particular technical standardiztion that allows for
models. V arious genologies
connect: time-sharing, MIT                   its scalability is in fact the only thing that has the
hacker culture; Mach at
Carnegie      Mellon; Chaos                  dubious distinction of being called 'new'. The
Theory ;      Prigogine     and
Stenger's work on far-from                   method of standardizing is a pragmatic and fluidly
equilibrium           chemical
reactions... this list also                  programmable one. It is strictly, explicitly opposed
scales.
                                             to standardization by empire. Or perhaps it would


                                             be safer to say that the internet is empire by other
                                             means. The moral equivalent of imperialism.
                                             These standards (e.g. TCP/IP, HTTP) have
                                             achieved world-wide agreement through a process
                                             that is less explicit than 'evolutionary' (though if it
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                                          that is less explicit than 'evolutionary' (though if it
                                          is, it is Lamarkian). Not only has it leveraged itself
                                          onto an existing network of institutional
                                          connections (e.g. universities and labs first, then
                                          corporations), but in its modiafiability, threatens
                                          to change them each time it changes. This
                                          pragmatic, modifiable method of 'agreement' has
                                          riven 'us'. The internet— this new space— this
                                          public sphere that is outside of any nation, but 'in'
6. The 'order' word, the
password,         is      the             all of them, that is outside of any corporation,
performativ e word, is the
elemental term in Deleuze
                                          factory, university, institution, home, but 'in' all of
and Guattari's "Postulates of             them, highlights the connection between location,
Linguistics"      from      A
Thousand             Plateus,             value, and the first person plural of organization in
[Deleuze87 ] drawn with
force from A ustin's How to               all forms. 'We' are no longer the same 'we.' The 'we'
Do Things w ith Words
[A ustin7 5] and transformed              that decides on agreement is no longer primarily
into a marshalling word for
the control of subjects. It               spatio-temporally together, it is an asynchronously
connects       here     more
ex plicitly to the force of               transnational 'we'.
language in sotware and in
trademark law, two sy stems
of control that are ex plored                The conjugation of scale and convention is
in this section.
                                          intended to act out the connections between
                                          culture and locale, where the internet, and its
                                          standards in particular, serve to signal the end of
                                          the conventionality of such connections. The
                                          empirical question is always located. The location
                                          of the firm, the location of the hospital, the
                                          location of work, the location of suffering. No
                                          methodology without constraints, no ethnography
                                          without place. As the world turns, the young and
                                          the restless are at home and away everywhere.
                                          Migration, casualization, increased tourism,
                                          Rupert Murdoch, all these simple things militate
                                          against culture being bound to place. Culture is
                                          packed up, moved, installed in new places, its

7 . On community , I defer to
Jean-Luc Nancy 's ex cellent              tenaciousness is well known— it inheres in
inv estigation    of      the
philosophical   status     of             performance, in repetition, in formalization. It
community       in       The
Inoperative     Community                 resists, it transforms, it syncretizes, it gives
[Nancy 91 ]. I would only
foreshadow the interference               meaning. Sean Doyle's joke about standards
                                          somehow depends on this notion of culture as
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                                            somehow depends on this notion of culture as
                                            diversity: "The great thing about standards is that
                                            there are so many to choose from." However, in the
                                            worlds of telemedicine, internet healthcare, and
                                            corporate execution, culture is absent (and
                                            certainly not only in the healthcare industry). It is
                                            either 'in museums' or it is banalized into a
                                            management strategy ('corporate culture' or
                                            multiculturalism). Standards are generally
that     I    see    between                experienced as the furthest possible thing from
inoperativ ity in his terms,
and the "It works" or my                    'culture'. They are technical problems solved by
inv estigation. See Section H
and I.                                      engineers.

                                               But what if there is a conceptual continuum
                                            between technical standards on the one hand and
                                            'culture' on the other? Then technical standards
                                            are more than just technical solutions to arcane
                                            problems, and more than simply agreements
                                            achieved by various means (however
                                            conventionally political or customarily scientific).
                                            And 'culture' therefore demands a description
                                            adequate to the technical components that
                                            constitute it— whether religious conventions, or
                                            international organizations for standardization— a
                                            description that is not a scientistic reduction to
                                            formal problems of coordination and control
                                            (systems theory, game theory, convention theory),
8. Such as it is. 'Science,' of             but which resists the metaphysical implications of
course, suffers definition
ov erload, and I hardly                     its indiscriminate application (the hermeneutic
ex pect it to clarify this
mov ement. Y et, as will be                 temptation to attribute the ephemeral ineffable to
apparent later        in this
section (chapters J, K, L and               'culture' or 'meaning', to close the circle by
M), the my th known as "the
scientific method" prov ides                reference a center outside itself [11]). My stab at
powerful legitimation ev en
when the activ ty under
question     (free    software
dev elopment) is radically
unmethodical. Science is as
inclusiv e as possible here,                this comes via the internet in its scale
call it research, if the term
shocks: building a better                   (world-wideness) and convention (standards).
mail routing program is
science, as is programming
a        better        wav elet
compression algorothm.
                                                  Where is the internet?
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                                              One way to answer this question is the way Carl
                                           Malamud [Malamud92] or Neal Stephenson
                                           [Stephenson96] ask it: as Hacker tourists who
                                           travel the world sampling the twin delectations of
                                           terrestrial cables and exotic cultures.
                                           Anthropology's monsters, these two in their
                                           respective accounts provide readable, albeit
                                           insufferably self-aggrandizing portraits of the most
                                           material aspects of the internet. These cables,
                                           routers and hubs do not quite connect to the
                                           keyboards of hackers with less wanderlust and
                                           more prosaic pleasures. Here the location of the
                                           internet is a technical question, much like the
9. Siegert, quotng Leibniz, p.             location of empire. Malamud's book traces the
5 Relays: Literature as an
Epoch of the Postal System.                outlines of the question of standards raised here.
[Siegert99]
                                           His mission was to take the standards published
                                           by the International Telecommunications Union—
                                           standards needed by engineers all over the world—
                                           and post them on the internet. In 1992, this turned
                                           out to be a Sisyphian task, and Malamud's
                                           impatience makes the story of his globtrotting
                                           techno-ethnography of early internet
                                           homesteaders a classic example of Hacker Humor,
                                           a mix of obnoxious and perceptive, ultimately
                                           tending towards self-promotion. It is a story of the
                                           misfit between the open ethos of information
                                           sharing of the internet and the closed hierarchical,
                                           decision-tree oriented bureacracy of the ITU. It
                                           will reappear further down.


1 0. A cross the disciplines,
                                             Stephenson's travels have a richness that wavers
language is incorporated                   between technophile novelist and wannabe hacker,
into theoretical edifaces v ia
Claude               Shannon
[Shannon48]—           Stev en
Pinker's        ev olutionary              mixing the obnoxiously perceptive with the
psy chology to cognitiv e
linguistics   to    Friedrich              historically portentious and the fictionally
Kittler's Kulturwissenschaft
to Niklas Luhmann's sy stem                impossible. It is a journalistic corrective to the
theoretic social science. See
also, the work of Derek                    much more sober catalog by Daniel Headrick, The
Bickerton, Manfred Eigen,
                                           Invisible Weapon[Headrick91], which details the
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                                          Invisible Weapon[Headrick91], which details the
                                          reader to death with the pre-history of the
                                          international web of wires and their role in the
                                          threat and cracking of secrecy. Stephenson's
                                          stories rely on a sharp cut between real and cyber
                                          space, or as he prefers referring to it: 'meatspace'
                                          and 'cyberspace'. His method is to follow the laying
                                          of roughly 28K among hundreds of thousands of
                                          kilometers of cable laid in the 90's. In particular,
Marc Hauser, Francisco                    the FLAG cable laid cooperatively by AT&T US and
V arela. A nother scalable
list.                                     KDD in Japan. Again, this kind of locating,
                                          although essential to a demystification of
                                          cyberspace as some total cinema of the mind,
                                          mystifies in another way by ignoring the non-glass,
                                          but no less material software (and standards) that
                                          runs both the laying of the cable and its
                                          subsequent uses. If Kittler can insist that there is
                                          no more software, does this not imply its opposite
                                          as well [12]?

                                             Another way of locating the internet might be
                                          the psychosocial mysticism of current scholarship
                                          on "cyberspace" ranging from sociologists and
                                          psychologists studying the dynamics of interaction
                                          in MOOs and MUDs, where avatars are imagos for
                                          a new era of psychoanalysis to the strange
1 1 . See Derrida Structure,
Sign and Play in the
                                          connections of 'hypertext scholars' such as George
Discourse of the Human                    Landow and Jay Bolter who insist that cyberspace
Sciences, [Derrida7 8] for a
discussion.                               is little more than a literalization of 20th century
                                          French philosophy [13]. For these studies the
                                          internet's location is somewhere in between the
                                          screen and the mind, in which self-contained egos
                                          learn pretense in the imaginary space of


                                          role-playing that cannot ultimately be materially
                                          differentiated from novels or theatre. These
                                          treatments do not yet ask how we might share the
                                          internet, much less how we already share
                                          "culture." It perhaps unfair to demand of this
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                                           "culture." It perhaps unfair to demand of this
                                           scholarship an answer to the question, where is the
                                           internet? However, in some cases this scholarship
                                           will call itself a "sociology of the internet,"
                                           (begging the question of where 'society' is), and in
1 2. Kittler "There is no                  others it engages a long-standing philosophical
software," in [Kittler97 a].
                                           discourse on reality and appearance, or on the
                                           platonic idea and its location- yet for all that it
                                           rarely references 'cyberspace' as a cave, much less
                                           as a physical criss-cross of copper, glass and
                                           waves, layered with software and bits.

                                             A third way of locating the internet, and this is
                                           the most promising and least attended to, would
                                           be to chart the political economy of manufacturing
                                           that is the absolute sine qua non of the internet,
                                           whether it be its cables, its software, or most
                                           importantly, its semi-conductors. The clean rooms
                                           and home-work, the international division of labor
                                           and the forgotten interstices of a development
                                           consensus that is neith in nor yet on the internet,
1 3. See, in particular,                   but nonetheless controlled by it [14].
George Landow, Hybertext:
the      convergence        of
contemporary          critical
theory    and     technology
[Landow92], and Jay Dav id
Bolter [Bolter91 ].




                                              This corporate map of the globe is in direct
                                           conflict with the globe that the internet will
                                           become, especially in the hands of a vulgar version
                                           of development economics that would demand
                                           that economies all over the world move through
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                                            that economies all over the world move through
1 4. See for instance A ihwa                the various stages of capitalism in order to achieve
Ong's      work,    [Ong99]
[Ong87 ] Behind the Silicon                 modernity and the promised land of information
Curtain [Hay es89]
                                            society. The conflict precipitates non-synchronous
                                            nows all over the world, regimes of power and
                                            decision-making focused on a past imagined in the
                                            present, committed to the impossibility of the
                                            future that organizes these regimes. Modernity
                                            and revolution locate themselves in states, or at
                                            least in societies, whether those associations are
                                            professional or class based, collectivity dominates
                                            the promise of progress. But the internet's focus on
                                            singularity, its game-theoretic model of collectivity
                                            is strictly opposed to progress of this type. History,
                                            or its end, becomes one preference among others,
                                            awaiting revelation.

                                               Materialism demands that the internet reveal its
1 5. The original Thing
                                            innards. Theology, its spirit. But can the internet
(1 950) was less parasitic                  be a thing, or not be a thing? Like The Thing [15],
than blindly destructiv e. Its
habitat was the north pole,                 it is from another world, yet it gets inside you.
the pinnacle of modernist
science, the destination of                 Once there, the thing takes over, its only mission
the                 masculine
scientist-ex plore and the                  to contract with another you and make more
stronghold of a Cold War A ir
Force. This Thing was an                    things. Is The Thing society? Joe Dumit directs
animate v egetable, a classic
boundary confusion, but                     this thought by a reversal: not the social life of
one that left the integrity of
the human intact. By 1 981 ,
                                            things but the thingly life of the social. Not just the
John Carpenter's The Thing                  commodity as fetish (society in misrecognition)
had rev ised this confusion,
setting the play ers in the                 but society as the unfetishized, the not-yet
remotest reaches of a
forgotten A ntarctica, shared               thinglike but living substance (or even, that which
not with hostile russians,
but benign scandanav ians,                  fetishizes humans) [16]. Stability exists no where
all engaged in a global
scientific research project.                in society, least of all in what is blithely imagined
Carpenter's Thing infects the
scientist and takes ov er,                  to be 'the medium' (not always the message,
mov ing from host to host,
nev er showing it's true self,              sometimes only the medium, pace Freud). The
and     worse     than    that,
mimcking the host, creating
a crisis of authenticity that
is the v ery image of the                   internet is society, but it is a society that a
impossibility                of
commuinity : the necessity                  recognizable 'we' no longer share in the same way.
of     ex clusion      become
impossible, ultimately all                  The internet is also culture, as I hope to show with
are destroy ed.
                                            respect to convention, that is standards and their
                                            role in cooperation, contract, and conflict; but
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                   Section Header
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                       B. Scholars wonder standards
                            In which a tangled bank of standards is discovered
                            — their diversity is marveled at, then
                            characterized by scholarship — a literature
                            review is undertaken — an exemplary studier of
                            standards is critiqued for whiggishness.



                                   The first thing that an observer hears in the
                                overlapping worlds of healthcare, telemedicine,
                                and the internet is the demand for standards.
                                Follow this thread out the door of the hospital and
                                it becomes a ubiquitous background noise to every
                                appearance of information and communication
                                technologies. While such a demand is particularly
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                                            technologies. While such a demand is particularly
                                            constant in healthcare, it is not restricted to it by
                                            virture of some inherent difficulty in the nature of
                                            the enterprise or some congenital defect of its
                                            participants. Regardless of level or discipline or
                                            industry or specialty or place, informational
                                            complexity is fought with convention. In fact,
                                            telecommunications should represent the locus
                                            classicus of concerns with technical standards, and
                                            this includes mass production's interchangeable
                                            parts. Not only is communication at the heart of
                                            convention, but telecommunications is also the
                                            oldest example of international standardization—
1 . Perhaps Habermas v s.
Ly otard,        in       their
                                            the International Telecommunications
mini-non-argument         ov er             Convention— signed on May 17, 1865 (now known
consensus and dissensus,
ov er the impossibility of                  as the ITU, International Telecommunications
some     final    ground     of
meta-agreement would be a                   Union, discussed in chapter H). This priorty will
starting point        for   the
inv estigation of consensus                 serve to justify a critique of Ken Alder's work,
and dissensus as a question
of implicit and ex plicit                   below, that relies on a notion of information
standards. See Habermas,
The          Theory          of             technologies which is not only asssumed to be
Communicativ e A ction, 2
V ols. Boston: Beacon Press,                outside standardization, but outside of history.
1 984        [1 981 ]      and
[Ly otard84].
                                               A demand for standards is inherently intriguing,
                                            since at first it seems standards are something we
                                            have, not something we create. Standards serve
                                            progress of all kinds— from the growth of a
                                            company to scientific improvement— one needs to
                                            have objective measurements for comparison, and
                                            hence standards. In healthcare, however, this
                                            desire for improvement has as its emotional core
                                            the incessant frustration of cacophony— the noise
                                            of overlapping unstandardized
                                            (mis)communications (it is part of the constant
                                            perception that healthcare "lags" behind other
                                            industries [Kaplan87]). What the participants in
                                            these worlds are struggling with, however, is not
                                            simply a local problem of noise in an industry
                                            plagued by complexity. What this demand invokes
                                            is a specific historical legacy that connects
                                            invisible hands in theories with visible ones on
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                                               invisible hands in theories with visible ones on
                                               keyboards in a culturally specific, but universal
                                               handshake. In healthcare, the diversity of
                                               standards is complicated by the use of that word
                                               to refer to standards of quality as well as standards
                                               of technical compatibility or conformance with
                                               regulations. The diversity of standards in
                                               healthcare will be deferred until section F, while
                                               this chapter offers a longer view of scholarship,
2. See Gerard Genette,                         selective, but hopefully highlighting the relevance
Mimologiques [Genette7 6].
                                               of standards to the history, philosophy and social
                                               study of science


                                                      A Literature Review

                                                  The subject of standardization is as well studied
                                               as it is oft-invoked across disciplines. Can I offer a
                                               map? Yes. Shall it be in cylindrical, azimuthal or
                                               Mercator? Can I offer a measurement of
                                               standards? Yes. In metric or American, in what


                                               notation, with what tolerance? On whose time:
                                               daylight savings, Amtrak's, GMT? With which
                                               language, shall English Orthographie Dycktate
3.     Lewis     is     at     the             thee Petioles of Truth, or shall charset=iso-8859-1?
intersection of game theory
and analy tic philosophy ,
and          with          lov ely                Let's begin at the beginning. Year one. Or shall
anglo-american             clarity
ex hausts the problem of                       we forget this most fundamental standardization,
conv ention           in          a
cy bernetic-monadic world.                     the Christian Calendar, root of all teleological
It is a perfect illustration for
both       economists         and              possibility, the innovation of Dionysius Exiguus in
philosophers         and        its
influence is widely felt.
                                               a year that he would only retrospectively imagine
[Lewis69] It is most likely to                 himself as part of: 525 A.D. (perhaps this locution
be criticized by Chomsky -ite
ev olutionary theories that                    already signals the connection between a
would nev er accomodate an
impossible animal such as                      linearized language and a standardized time,
"innate conv entions".
                                               between memory and technology) Such an
                                               innovation, insignificant in itself (ultimately
                                               arbitrary perhaps) would not have been interesting
                                               without the subsequent systematic rise of
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                                          Christianity in the west. The chronology we live by,
                                          the one that threatens us with judgement, Anno
                                          Domini, is perhaps the most insidious metric of
                                          domination by standardization. Even in
                                          acronymical terms, the standard betrays a
                                          concession that traverses religions: B.C. no longer
                                          references Christ, but instead, commonality, the
                                          common era, what is shared: B.C.E., just as C.E.
                                          resists particularistic domination even as it
                                          concedes the essential technical standard.

4. A process Derrida berates
Searle and kids A ustin about
in Limited Inc. [Derrida88].




                                             The end of history itself is theorized as a
                                          particular relation to time, a time that is universal
                                          for all who believe in it, across religion and history.
                                          And now, even for those who don't: today, for very
                                          different reasons we await the millennium beside a
                                          corps of engineers contemplating a judgement all
5. On this problematic see                too banal: Y2K. [Fischer99] Our standardized
Bruno Latour, Science in
A ction [Latour87 ], also,                chronology, wantonly truncated by a COBOL
Paul Fey erabend, A gainst
Method [Fey erabend7 5].                  Cabal, threatens us with all seven broken seals (or
                                          do we measure seals in binary? 111 seals?) of
                                          mundane mechanical failure, or perhaps worse. A
                                          self-fullfilled prophecy, a numerologist's nirvana.
                                          Dionysius Exiguus calculated a calendar for the
                                          age of a judgement day promised and always
                                          anticipated, now aged programmers offer the
                                          meek excuse that they never anticipated that the
                                          systems they built would still be in use come
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                                             judgement day. Is it irony that this literalization of
                                             the calendar puts us at the mercy of a nature less
                                             natural than technical, at the mercy not only of
                                             cycles of the seasons, but the cycles of a processor?
                                             Or is it therapture.com?

                                                The arbitrariness of the Christian calendar
6. 20th century A merica
and France hav e seen the                    transforms a convenient measure into scripture.
most                  v igorous
ex perimentation with the
                                             Millenarianism and fins de siecle have a technical
standardization             and              connection to Christianity, even if the standard
professionalization           of
scientists and engineers. In                 were neither decided upon by men, nor whispered
many way s, this focus
relates directly to the more                 to a prophet. Its existence signals a coordination of
circumscribed realm of the
history of Science that has                  men and seasons whose cause is inessential to this
focused on the rise of
probabliity          (Lorraine               very remarkable fact of agreement achieved
Daston's work on classical
probability [Daston88], the                  through some means (whether force or faith). In
two v olume collection of
essay s on the probablistic
                                             fact, any given standard signals the existience of
rev olution [Kruger87 ], Ian                 political and economic (and theological) strings of
Hacking's Taming of Chance
[Hacking90]), which is the                   committees, institutions, governments, firms,
trajectory     that      Porter
followed in mov ing from a                   markets, accidents, and laws that work to make
history    of probabalistic
methods [Porter86] to a                      obligation cohere to cooperation. A spectrum
question of probability as a
means of        measurement
adequately          mediating
between the incorrigibly
objectiv e and necessarily                   haunts this set-up, ranging amongst standards,
subjectiv e. The history of
risk and insurance also
                                             conventions, customs, laws, regulations, perhaps
follows this path, both in the               even connecting up consensus[1] and common
history of sciece from
Daston, et al. and from the                  sense. Are Durkheim's social facts standards,
French        historigraphical
school       initiated       by              connecting religion and standardization in the
Foucault,            including
[Ewald86],      [Donzelot94],                problems of spontaneous self-generation? And
[Poov ey 98],     [Burchell91 ]
etc.                                         Geertz's culture? Hidden behind the bewildering
                                             swirl of seeming signs and actions? Historical,
                                             economic, anthropological, sociological
                                             approaches emphasize sides of an investigation of
                                             standards, conventions, and laws; each locates
                                             responsibility differently, but all aim at partially
                                             thematized political theory— a social theory that
                                             carries traces of a problem of cooperation,
                                             coordination, and allocation. Games, collective
                                             action, cake-cutting, dialectics of recognition, love
                                             and sharing, passion and spite— these are not the
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                                             beloved tales of social theorists solely for their
                                             exemplary power, but because the problem of
                                             reaching across justification to make a decision
                                             and back again is a fabulously difficult and
                                             seemingly essential social theoretic problem.
7 . See Derrida, Speech and
Phenomena        [Derrida7 3]
and     Of    Grammatology
[Derrida7 6].
                                                Almost all questions of convention, if not exactly
                                             standards, reference a classic debate in the
                                             philosophy of language that generally begins in
                                             Greek: physis and nomos. Cratylus [Plato61] is the
                                             standard, by nature or by convention is less clear,
                                             for the problematic of nature and convention in
                                             language. The argument for nature inevitably rests
                                             on some version of etymology, onomotopoeia, or
                                             mimologism,[2] while the argument for
                                             convention stumbles on the impossibility of
                                             knowledge and the divinity of the world. The
                                             argument between Socrates and Cratylus picks
                                             through the nature of naming and name-giving,
                                             the relationship to legislation and to the justness



8.      The        information               and unjustness of names, engaging a familiar
rev olution. The information
society .             Infomap,
                                             economy of the proper and property. A first
infoculture,          infoplex ,             reference to the relationship between knowing and
infopreneurs;              daily
neologisms grind the edges                   owning that will reappear throughout this section.
off of this concept. Geoff
Bowker [Bowker94] suggests
that the ex cluded middle of
the     equation        between                Such a debate is never confined only to
current              economic
structures and the nature of
                                             language; which is only another way of saying that
life that is so commonly                     the problem of language is never just one among
solv ed by information is
actually that of organization                others. Alain Boyer, in a brief article on
work.       Essential         to
understanding the my th of                   "Conventions and Arbitrariness" [Hjort92] gives
the information rev olution
is    the      "infrastructural              some familiar examples of the ubiquity of the
inv ersion" which comes
down to the recognition that                 concept from Cratylus to David Lewis [3].
the world must first be
ordered by control and then                  Arbitrariness is the quintessentially semiotic
it can be perceiv ed as
hav ing the same structure
                                             intervention: motivation and unmotivation being
as information. Such a                       the mysterious operators of nature against
recognition is crucial for
escaping      the      ideology              convention for semiotics, a secret manner of
produced by the dogma of
information, but still fails to              evading the metaphysical implications of the
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                                          problematic of the foundation of legislation and
                                          the justness of naming opened up by Plato.

                                             Boyer traces arbitrary to the latin abitrarius
                                          and the derivative arbitrator, to the third party
                                          responsible for deciding (I trace decide to the latin
                                          decidere, which retains some of its root cidere, to
                                          cut, and thus some of the violence necessary for
                                          the production of convention— I too reference
approach the       no    less             nature in the form of etymology) and thus for
long-standing historical and
contemporary problems of                  originating a convention, even if that convention
control and organization by
standardization, or more                  then becomes the very form of the natural [4]. Or,
problematically for most
theorists: the problem of                 in fact, precisely because it does: the third party
spontaneous organization.
                                          that decides a dispute, whether it be cutting a cake
                                          or coordinating the size of screw threadings, is
                                          ultimately arbitrary in a cosmological sense
                                          (though, I'm suppose ANSI would be alarmed to
                                          hear this said of their decisions about screwing).
                                          That is to say, its reasoning must either be
                                          ultimately unknowable— divine, maybe, or simply
                                          couched in a language of truth or efficiency
                                          masking the arbitray decision— or completely
                                          transparent to users and standardizers alike, in
                                          order to allow the arbitrary to be naturalized (in
                                          the case where convention is implicit, but
                                          references a deeper convention— truth, nature,
                                          tradition) or to allow it to remain always and
                                          radically open, subject to almost constant revision,
9. This is the appropriate                having, as its essense, almost no force as
point to reference A v ital
Ronell's   study   of   the               convention at all (in the case where convention is
telephone,    schizophrenia
and the metaphy ics of                    explicit). No standard will ever be allowed to be
disembodied— telepresent—
speech [Ronell89]
                                          arbitrary (in the sense of random), and yet its
                                          justification must be either forgotten
                                          (black-boxed, perhaps) or constantly referenced
                                          ("first principles" perhaps) such that it fails to
                                          appear as convention, and becomes natural unto
                                          truth. It is only by reference to the objectivity of a
                                          measurement, in the specific sense of its
                                          independence from a subjective being, that is, to a
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                                               independence from a subjective being, that is, to a
                                               somehow shared agreement (an agreement that,
                                               among scientists and engineers, takes the form of
                                               a demand that it be called truth, and no less, and
                                               this truth is transcendental in both a secular and a
                                               religious sense) that an object is measured by a
                                               standard of some sort, that these difficulties are
                                               resolved[5].

1 0. In particular,                               In the fields of the History of Science and the
a. the centralization of
military production. The                       Social study of science, there has been a
important figure of the
"artillery inspector" (508)                    substantial quantity of work on the relationship of
whose role cov ered both
quality       assurance        and             standards to the production of scientific truth, or
anti-corruption (that no
deals outside the centralized                  experimental verification. Theodore Porter and
sy stem might be made).
Simultaneously a way of
                                               Ken Alder's works stand out as strong examples of
controlling "precision and                     this work, attempts to explain truth (in the case of
uniformity " and creating
loy alty through detailed                      Porter) and mass production (in the case of alder)
standards.
b. The v ery perceptiv e focus                 with reference to standards. In both cases, this
on the necessity of going
bey ond          images         as             focus leaves the very problem of convention— from
two-dimensional images to
"follow     the      efforts     of            arbitration to justification— untouched.
engineers to translate their
images         into      phy sical
objects" (51 1 ).
c. Points to a similar
problematic         in     French
engineering,           projectiv e                One of the most well known recent works on the
drawing, as that ex plored by
Diane Greco, with respect to                   production of scientific truth that deals with
structures and ex planatory
frameworks. A lder calls it
                                               standardization is Theodore Porter's Trust in
'epistemological         mistrust              Numbers. I choose this example out of others on
that ex ists between the
inner ey e and the ex ternal                   objectivity because it Porter treats objectivity as
world".(51 3)
d. The fate of Gribeauv al's                   an effect of standardization. Standardization per
Tables de construction,
specifically , the claims that                 se is not his study, but rather the fact that the
they 1 ) had the force of law,
and 2) that they where                         growth of science can't be told without a
unpublished until after the
rev olution               because              concomitant story of the growth of the
"publically             v alidated
representations would make                     bureaucracy of standards. Mechanical
it difficult for the artillerists
to alter their designs as
                                               objectivity— rule-based validation— depends,
circumstances           changed.               obviously, on rules [Porter95]. But rules are not
These observ ations bring
A lder closest to articulating                 quite the same as laws, whose role is discipline and
the difficult problem of the
collectiv e legitimacy of a                    consequence— punishment. Rather, these rules are
standard (as opposed to the
indiv idual problem of trust),                 intended to conquer subjectivity first, distance and
which might affect the speed
of a collectiv e response.                     time next. Quantification is the means of
e. Mechanical authority —
                                               achieving a result over which no individual has
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                                            ultimate control. Yet, as Porter duly notes,
                                            objectivity and law are relentlessly identified with
                                            each other in the scientific and political culture of
                                            Europe and America. The rule of judgment must
                                            be countermanded by the rule of law. 'Trust,' is
                                            Porter's (and certainly not his alone) powerful
                                            name for the exergue of truth.

                                               What Porter calls 'standardization' is different
the     Porter    v ersion of
things— as the appeal to
                                            from the subterranean means by which
something ex ternal to the                  techniques, practices, methods, tools, apparatus
untrustworthy other, or
self, works to the adv antage               and training are transmitted via personal and
of both parties, as long as
they understand how to                      institutional connections to constitute something
argue with it (and here
again, we catch sight of the                that has come to be called "the scientific
inadequacy of a concept like
'information technologies' in               community," or "the scientific method. Much
this contex t, since it is one
thing to point to the                       recent scholarship in the history of science has
co-negotiation of standard
representations            and              begun an investigation of these networks of
standard things, and to
point out how mechanical
                                            learning and research techniques, either by
authority was a boon to                     reference to explicit contacts (in the form of
both parties, but it is still
y et a my stery how one                     schools, patronage or apprenticeship) or 'tacit
learns     to    argue     with
standards? What infinite
regress of meta-standards
finally    determines      this
political struggle?) (523-4).               knowledge' and the transmission of techniques
"The price of standards is
eternal v igilance." (528)                  through either direct training or laboratory
                                            experiment and communication networks. For
                                            Porter, all of this would be impossible without the
                                            sine qua non of agreed upon measurments: "The
                                            bureaucratic imposition of uniform standards and
                                            measures has been indispensible for the
                                            metamorphosis of local skills into generally valid
                                            scientific knowledge."(21) and "In this [social and
                                            natural scientists] were allied to the centralizing
                                            state and to large scale economic institutions."(22)
                                            The activity of standardization was rarely the
                                            subject of science, but always the limit point of the
                                            legitimacy of science.

                                               Porter appeals to familiar problems of
                                            standardization, time-tables and maps in
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                                particular, reiterating the classic historical
                                insights of E.P. Thompson [Thompson67] and
                                Witold Kula [Kula86] — the imposition of the
                                metric system in france, the struggles over the
                                cahiers de doléance, the creation of electrical
                                standards in the late 19th century and the
                                development of national bureaus of
                                standardization, trade groups and the intertwining
                                of regulation and science[6].




                                   "For most purposes, accuracy is meaningless if
                                the same operations and measurements cannot be
                                performed at other sites."(29) The conquering of
                                distance made possible the expansion of science,
                                and with expansion came legitimacy and power
                                (though these are not the foci of Porter's study).
                                Porter dwells on measurement as the core of
                                standardization— the appeal to an authority other
                                than human judgement; and even if every
                                standard is somehow produced in judgement to
                                begin with, this much is somehow forgotten (i.e.
                                the arbitrariness of the decision is naturalized) by
                                those who appeal to the standard.

                                  This is a foundational explanation of how
                                objectivity and standardization work together.
                                Porter's title Trust in Numbers sums up the
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                                troubling relationship of truth and trust in the
                                context of an endeavor (science) whose entire
                                history is focused on relinquishing the latter in
                                favor of the former. But Trust is no less mysterious
                                for that, and Porter's description only shows the
                                half of it. The difficulty through which
                                standardization is achieved, its remarkable
                                persistence, and its inextricable dependence on
                                'truth' for its legitimacy is left open for another
                                history while Porter surprises the history of
                                science with its secret political history of
                                quantification.




                                   Some of Porter's theory references Bruno
                                Latour's work [Latour87], in particular, the
                                concession that modern science is not a miracle of
                                individual geniuses and a passive nature they
                                unveil, but the result of the hard work of
                                stabilizing conventions. Latour's work, along side
                                the more politically engaged works of Donna
                                Haraway, asks the hard questions about how
                                something comes to be true, for whom, and why
                                this is not only a philosophical conundrum, but a
                                social one as well. In Latour's craw,
                                standardization takes the form of agonism.
                                Science, like politics, is just War by other means
                                (as it also is in Lyotard's treatment, though it
                                emphasizes the strategy of the game first). Allies,
                                enlisting, recruitment, are the terms of Latour's
                                investigation, and the result is a temporary
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                                stabilization based on the threat of exclusion or
                                worse. Ultimately, Latour's interest is not in the
                                empirical structures of standardization, nowhere
                                referenced in his works because they are
                                fundamentally arbitrary, and as such, uneccessary
                                to a theory of action in which opportunistic actors
                                enlist standards as needed in order to win
                                arguments, settle disputes and make society
                                durable. This is only a gesture to the depth of
                                Latour's thought, however, and his counterpoint to
                                this investigation would be a more thorough
                                investigation of the concept of networks in his
                                work, expecially as it relates to the historical and
                                worldwide network called "the scientific
                                community" and its uses of networks of
                                communication and dissemination, including,
                                most importantly, the internet and its kin.

                                  The range of sources that could be included
                                under a review of standardization and its


                                relationship to science would include the following,
                                at least: Simon Schaffer's work on late victorian
                                metrology [Bud92] and measurement [Wise95];
                                Jed Buchwald's work on experimental standards
                                [Buchwald94] [Buchwald89] and collected volume
                                on standardization [Buchwald96]; Tim Lenoir's
                                collection of essays about the institutions of
                                science [Lenoir97]; Peter Galison on 'image' and
                                'logic' as two standards of proof [Galison97];
                                Norton Wise's collection of essays on precision
                                [Wise95], Bob Brain's work on the graphical
                                method [Brain99] and the standardization of
                                language under the 19th century regime of writing
                                [Lenoir98], Eugen Weber's work on the creation of
                                the French state [Weber76], Timothy Mitchell's
                                Colonizing Egypt [Mitchell88], Thomas Richard's
                                Imperial Archive [Richards93]. In addititon,
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                                various social scientific studies from the tradition
                                of Latour and SSK exist, exemplars are
                                [Hanseth96], [Mallard98], [Hogle95].


                                       Ken Alder

                                   Ken Alder's article "Making things the Same:
                                Representation, Tolerance, and the end of the
                                ancien regime in France," [Alder98] is a rich
                                starting point for the question of standardization.
                                Drawing on Theodore Porter, Bruno Latour, and
                                the "social construction of technology," Alder
                                compels technical description to enrich two very
                                storied stories: the politics of the French
                                Revolution and the technology of the industrial
                                revolution. In his telling, the tale revolves around
                                riflings. The bores and balls of the French
                                industrial system make exemplary drawings for
                                imaging the vicissitudes of interchange and
                                standardization. Parts is not just parts.

                                   Dissenting from "the usual response" (499) to
                                support what "historians have shown"(500) he
                                finds the origin of (mass?) mechanization, not in
                                post-fordism, nor even with Ford, but with the
                                French Revolution. "Making things the same" is
                                his clever tag for the focus on identity in artifacts
                                and representations. "Things" help this historian
                                insist on identifiying new origins for old stories.
                                His two fold goal is to depart familiar theoretical
                                narratives of production for more aggressively
                                historical ones, and yet to do so without giving up
                                the drama of politics and ideologies that inform
                                the boring drawings of French guns. This laudable
                                goal is a corrective to economic speculation and to
                                the bogeyman of American History of Technology:
                                technological determinism. However, in setting
                                sights, Alder's curious anachronism surprises:
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                                "Long before the advent of the computer, material
                                artifacts were being produced in conjunction with
                                techniques and representations ('information
                                technologies') that were themselves subject to a
                                process of standardization.(500)" Things and
                                representations were standardized together,
                                artifacts have politics, as do their representations,
                                so that the co-negotiation of things and
                                representation demands a rich focus on the
                                political stakes of the time.

                                   "The technology that results from this
                                process...is both the bearer of political values and
                                can in some sense be called 'objective' {emphasis
                                in original}" (503) Objectivity is a political value
                                that can (Alder believes Porter here) coordinate
                                research in order to standardize the representation
                                of natural phenomena. Science needs number plus
                                communication to contact truth, objectivity and
                                standardization relate in a dialectic, and it is
                                Alder's goal to get inside this dialectic and show
                                exactly how truth is its sublation. Alder claims the
                                'thick description' of Geertz to make a strong case
                                for the interpretation of things as manipulative of,
                                constrained by, or effective of representations
                                (according to the workings of both political and
                                technical constraints— but what constrains,
                                nature or convention?). These representational
                                tools— in this specific case, mechanical drawing
                                tools and manufacturing tolerance tools— are
                                called by Alder 'information technologies.'

                                   On the one hand, this amounts to a deep
                                disavowal of the problematics of representation,
                                including the specificities of language and
                                communication and the familiar vicissitudes of the
                                metaphysical imputation of voice as the measure
                                of presence [7]. Language and meaning, the loci of
                                interpretation, and the core of human judgement
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                                in matters of standardization, are here reduced to
                                just another technology. This is an anachronism,
                                to be sure, but one no worse than a thousand other
                                texts that now impute theories of information and
                                communication to all aspects of human history,
                                and at the limit, give nature itself the structure of
                                information [8].

                                   On the other hand, it is equally a mystification
                                of what 'information technologies' are today. That
                                words are now things (software), yet somehow
                                retain something of the problematic of
                                representation (software needs comments—
                                interpretation— in order to be understood by
                                humans, or code specifically designed for
                                translating code from one language to another, or
                                from one machine to another; all of which can be
                                standardized at some level or another), is obscured
                                in the reduction of information technology to
                                drawing and measuring tools. Speech and writing


                                still inhere in things, while action has become
                                more disembodied and thing-like than ever. No
                                compass and pencil ever achieved quite the
                                unheimlich qualities of the telephone and
                                phonograph, for instance [9]. And the
                                combination of pencil and compass, or telephone
                                and phonograph in the internet (software plus
                                communication) demands an attention whose
                                focus is not only representation, but— and this
                                should excite Alder— the structure of war and
                                revolution itself. In Alder's case the war is
                                background for standardization of weaponry,
                                offering constraints on negotiation. It is the source
                                of political beliefs about objectivity and
                                standardization— not, as Clausewitz might
                                suggest, "standardization by other means."
                                Friedrich Kittler [Kittler97], on the back of this
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                                         other hand, insists that all war is nothing more
                                         than a competition amongst technologies: "War,
                                         as opposed to sheer fighting, has been for a long
                                         time an affair of persuasion." (117) These
                                         techniques of persuasion that wars intend are
                                         enhanced, even replaced by technologies of
                                         communication and control. Kittler constantly
                                         slides the needle across this record, unable to keep
                                         it from skipping, insisting that culture is no more
                                         than a diversion from the progess of war, and that
                                         the war's apotheosis is the struggle between
                                         media: "wars of persuasion culminated and ended
                                         in persuading the enemy that traditional secret
                                         services and not computers had gathered the most
                                         vital information. Thus the name of man and the
                                         title of intelligence are pronounced, proclaimed,
                                         and published only in order to better veil machines
                                         'At some stage,' wrote Alan Turing, 'we should
                                         have to expect the machines to take control" (127).
                                         Alder's approach, far less fanatic, lets war stand as


                                         event and background, without insisting on its
  Last Modified                          connection to persuasion and its role as an
  11-Sep-99 9:01 PM
  ckelty@mit.edu                         arbitrator's arbitrator, as a struggle to decide
  Go Back to the Start                   which technologies are superior, and by that,
                                         which nation. However, revolution, especially the
                                         French one, as Alder recognizes, was a much more
                                         difficult background against which to forge this
                                         contraction of society and technology. But it is this
                                         question of origins that grows a third hand on my
                                         reading of this article.

                                            On the third hand, in the emphatic statement
                                         that this is "the story of the origins of 'making
                                         things the same'"(500) [emphasis in original]
                                         Alder sets t equal to zero. It is perhaps appropriate
                                         to see in the confluence of networks and software
                                         that are called "information and communication
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                             Section Header




                                C. Exapple
                                     A lowly apple is dissected for the purpose of
                                     explaining standardization's transformations in
                                     the 20th century — the imperative that drives
                                     these changes is sought, but not found.



                                           Sigfried Gideon offers something that cannot be
                                         automated, he offers us his hand [Giedion48].
                                         Shake it, but once. "It cannot continue a
                                         movement in endless rotation. That is precisely
                                         what mechanization entails: endless rotation."
                                         According to Gideon: "It wholly contradicts the
                                         organic, based on growth and form, to suffer
                                         automization" (45). Citing "master of motion
                                         studies" Frank Gilbreth on the nature of manual
                                         activity: no movement can exactly repeat another.
                                         My hand is fundamentally unstable, for better
                                         (Gideon) or for worse (Gilbreth). It can be
                                         automated and hence, standardized in its
                                         movement, only by augmentation, or
                                         replacement— but never completely.
                                         McLuhan-esque extension is not out of place here,
                                         as always, in the service of recuperating the
                                         ineffable, the unmanageable, or the
                                         romantic-poetic essential, making of endless
                                         rotation a souless spinning void. Or consider also
1 . See [Kittler99]    and
[Hodges83] Kittler    uses               Kittler's Turing, who types, preferring discrete
10.08.2010             http://web.archive.org/web/20010310130...ritings /s caleconvention/C.Exapple.html   #2

                                          machines to continuous ones (i.e. his handwriting,
                                          so notoriously bad) [1], forsaking the hand
                                          completely for the turning platen of the typewriter.

                                            These hands pick apples and type 'apple'. All our
                                          time, for Gideon, of hands and apples is filled with
                                          the ceasless specialization of hands and apples.


                                          "Specialization goes on without respite" (132). In
Turing relentless in this
manner, as genius-hero of a
                                          the process of mechanization, somehow,
new age of ubergeeks. My                  uniqueness disappears, we— and our products—
point howev er, would be to
oppose two v ersions genius,              become more same, isomorphic. The old refrain:
the romantic in Gideon's
work whose mind demands                   "The influence of mechanization—or more
more than repetitiv e labor,
and the discrete geniuses of              accurately, here, of mass production— leads to
Kittler's    work,   Turing,
Hilbert, or Shannon.                      standardization of the fruit into few varieties. A
                                          million peach trees, it is claimed grow on a
                                          commercial farm. We have seen an orchard of
                                          42,000 McIntosh trees; and the apples were so
                                          uniform that they might have been stamped out by
                                          machine" (132). These apples—applets, perhaps—
                                          lose their uniqueness, become less individual. On
                                          the one hand, a profound recognition that identity
                                          consists only in difference, and disappears bit by
                                          bit, bite by bite, as taste, color, shape and other
                                          measurables regress to the mean. On the other,
                                          this attribution of a non-repetitive identity to an
                                          apple seems absurd, romantic. As if in the past,
                                          God had made each apple. By hand. [2] Growth
                                          and form, wholly contradicting automatic apples,
                                          are figured as pure chance. It's a world of chance,
                                          where God drops dice, not apples. But modernist
                                          growth and form are never pure chance. Nor are
                                          genetic engineering and the shiny, waxy, over-ripe,
                                          thick-skinned, juicy, red McIntosh displaying its
                                          Price Look-up code #4152 that sits now on my
                                          desk.

                                            Dwell on the difference between Gideon's apples
                                          and mine: his 42,000 trees are evidence of
10.08.2010              http://web.archive.org/web/20010310130...ritings /s caleconvention/C.Exapple.html   #3
                                           and mine: his 42,000 trees are evidence of
                                           modernism and mechanization. An era of
                                           consolidation and corporate capitalism on a scale
                                           never seen. The taste of his apple will evoke
                                           fantasies of subsistence farming, hand-picked
                                           apples steaming in patriotic pies, followed by the
                                           indigestion of modernist speed, contractions of


                                           time and space in the belly of the corporate beast.
2. This is Hawthorne's
romanticism in Mosses from
                                           What is standardized is the practice of growing,
an old Manse, cited by                     harvesting and the scaling of production.
Gideon: "There is so much
indiv idualty of character,
too, among apple trees...
One is harsh and crabbed in                   My apple, in the other hand, is evidence of a
its manifestations; another
giv es us fruit as mild as                 deeper tampering, a deeper mechanization. My
charity . One is churlish and
illiberal, ev idently grudging
                                           apple— #4152— does not taste like that. It evokes
the few apples that it bears;              fantasies of rotting and bruised apples,
another ex hausts itself in
free hearted benev olence.                 dun-colored and waxless, of an era before the
                                           apple's skin was protected by it's own genes and
                                           cells (or maybe those of an Arctic Char), harnessed
                                           to harden its own skin. But it also invokes
                                           memories (call them fantasies, if necessary, to
                                           reveal the structure of nostalgia) of a taste that
                                           transcends taste, a taste without reserve, receding
                                           ever further backwards into a fantasized apple as
                                           much the result of perfect chance in evolution as
                                           that of a lost community of farmers and artisans
                                           for Gideon. If Gideon fantasized about wild apples,
                                           formed by God, we Bread and Circus™ shoppers
                                           dream of a perfect apple, of a genetic purity since
                                           tampered by the abuse of everything from tractors'
                                           exhaust to PCBs to the gentle squeeze of a pipette.
                                           The merely natural world obscures the pure
                                           crystalline phase space of genetic information.

                                              On another key, my #4152 taunts not just scale
                                           and scope, but control and communication. My
                                           apple talks to other Apples™. My apple recognizes
                                           itself in it's M(a)cIntosh doppelganger. My #4152
                                           is an apple in its own right, the merely empirical
10.08.2010                               is an apple in its own right, the merely empirical
                      http://web.archive.org/web/20010310130...ritings /s caleconvention/C.Exapple.html   #4


                                         apple destined for my jaws, but it is also another
                                         apple, circulating through systems and networks
                                         as a standardized and quality-assured apple, it is
                                         marketable, traceable, gradeable, saleable; it
                                         generates a wake of statistics, it produces more
                                         produce. Does this apple matter? Is it matter?
                                         Shall we still call it apple, or should we pretend the
                                         distinction is clean and insist that this apple is
                                         called #4152? Think of its doppleganger, an
                                         Apple™ processing PLUs (admittedly unlikely in
                                         this world of Windows™, but suffer the
                                         substitution for the sake of a lesson) in your corner
                                         grocery. You call it apple, apple growers and
                                         distributors may call it #4152, what does Apple™
                                         call it? Perhaps it calls it ð [apple-glyph]. Can you
                                         see it? Ponder this apple's glyph-name— or its
                                         absense, perhaps replaced by that operator of
                                         confusion, the question-mark— and reach the
                                         seedless core of this dissertation. By one standard
                                         (the ASCII table of entities for the Apple
                                         Macintosh Symbol Font) this apple is called
                                         'ð'— by no means the same apple as #4152.
                                         These names aren't symmetrically written and
                                         read, however, and the circulation will depend on
                                         who agrees with who. If I agree to represent this
  Last Modified                          glyph as a proper HTML entity, for example, it
  11-Sep-99 9:01 PM
  ckelty@mit.edu                         would read 'ð'. but such an
  Go Back to the Start                   endeavor recurses endlessly and uninterestingly
                                         between encoding and presentation. Still you will
                                         not see what I want you to see, namely ð
                                         [apple-glyph], whatever you see here, because the
                                         Apple Macintosh operating system encodes some
                                         entities (especially trademarked ones) differently
                                         than every other system of encodings, such as that
                                         for the HTML standard, for example. I can trump
                                         this trick only by switching— but it shall be no less
                                         a problem of standardized communication— and
                                         showing you the name of the apple: . These
10.08.2010   http://web.archive.org/web/20010310130...ritings /s caleconvention/C.Exapple.html   #5

                                prosaic problems of representation are solved daily
                                by computers and their coders, yet it is the
                                existence of this irreal world of names that
                                destines one particular for my stomach.

                                  There is no discontinuous break between
                                Gideon's orchard and mine. In the language of


                                capitalist accumulation, there are only crises and
                                contradictions in the growth of something that we
                                have not yet stopped calling capitalism. Scope and
                                scale are still essential, but now so are control,
                                communication and information. Standardization
                                has taken over from mechanization because we no
                                longer only build machines that simply stamp out
                                apples, we build abstract machines that need
                                languages to interact with other abstract
                                machines, that, in some cascade of relations,
                                produce an apple, or an Apple™. The Price Look
                                Up (PLU) code— that bothersome little sticker,
                                probably soon to be replaced by some less intrusive
                                means of identification— is the apple's other. Its
                                consumption precedes it, offering itself in a frenzy
                                of scannings and registrations inside another
                                Apple™. This mechanization does not demand
                                simply that it be more like other apples, it
                                demands that it be more like itself. The possible
                                fate of #4152 is determined in advance, even if I
                                choose not to eat the apple bearing this name, but
                                to let it moulder on my desk, where it reminds me
                                that it chose me, not I it.

                                   There is an imperative that drives the
                                transformation of this standardization of apples
                                and Apples™, keys and trees, yet it still remains
                                untheorized. This world-wide techno-economic
                                imperative that transforms the identifications of
                                patriotism, loyalty, ascesis, or cynicism as
                                justifications for decisions made in the names of
10.08.2010   http://web.archive.org/web/20010310130...ritings /s caleconvention/C.Exapple.html   #6
                                justifications for decisions made in the names of
                                apples is somehow familiar in America, if not the
                                world (America-world?); a necessary work that has
                                superficial, provisional justifications, but which
                                remains largely unarticulated, buried in the
                                unconscious of everyday busy-ness, of promise and




                                circulation, afternoon snacks and morning
                                meetings.

                                   Such an imperative is not controlled from the
                                top-down, no apple is an island. No insidious
                                corporation has made the apple what it is today,
                                though many have given it names. The processes of
                                standardization that lie at the core of the 'internet'
                                and the world it subtends are the purest example
                                of this system of doubles, different than a system
                                controlled by nations or corporations, and yet not
                                separate from either of these hierarchical bodies.
                                Indigestion guides the researcher who tries to
                                follow out the standardization of apples, on
                                Apples™, or of Apples™. But indigestion passes.
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                   Section Header




                        D. Economists ponder standards
                             Path dependency, increasing returns and network
                             effects butt in — their sudden ubiquity in business
                             is discussed — an example from the field is used to
                             illustrate how 'standards' are now a common
                             element in business strategy.



                                    Economists sometimes ponder apples, and when
                                 they are not under the apple, dreaming like
                                 physicists of Newton(s), they ponder qwertyness as
                                 they type on it. If one were surveying the possible
                                 scholarly approaches to standardization, one
                                 would discover the economic mini-consensus that
                                 goes by the names "path dependency, increasing
                                 returns and network effects." However, even
                                 outside of such a survey, the rhetoric and the ideas
                                 of this consensus have begun to permeate the
                                 worlds of internet commerce and were common
                                 references in the trade and quasi-academic
                                 literature of standardization— less in healthcare,
10.08.2010                http://web.archive.org/web/20010310130...ings /s caleconvention/D.Economis ts .html   #2

                                              but present with the internet nonetheless. While
                                              the tiny abstract machine of network effects makes
                                              instant sense to many actors in the field, it is
                                              perhaps only convincing as a scholarly endeavor
                                              for mathematical economics— the deliberate
                                              choices of actors may not be reached by the
1 . Paul Dav id's A rticle "Clio
and the Economics of
                                              simplistic means they propose, but the
QWERTY " is the locus                         justifications for those decisions often follow their
classicus for studies of "path
dependency ," a 'cleopatra's                  lead. It appears here in brief explanation of its
nose' method of matching
"historical small ev ents" to                 importance as a narrative justification for actors
current              economic
regularities. In most cases                   in the internet economy— particularly for the
economics is chosen in
fav or of history , and the                   general importance of standards to the actors in
goal is to supplement the
inadequacies of economic                      my field and their marketing tools.
science, not to produce
accurate history . See "The
Fable      of     the     Key s"
[Liebowitz90] for a detailed
attack on the historical
inadequacy        of    Dav id's
                                                 The literature on increasing returns and path
article, not to sav e history ,               dependency has increasingly returned in the last
but     to    disprov e      the
economic        thinking       it             twenty years, largely a result of a few key articles
implies.     For     a    more
complete       critique      see              that made the object lessons contagious.
"Intelligible      Differences"
[Sabel95]. Brian A rthur's                    Beginning with W. Brian Arthur's 1983 working
work      is   collected      in
[A rthur94],       see      also              paper "On competing technologies and historical
[Farrell86], [Katz85]
                                              small events: the dynamics of choice under
                                              increasing returns" [Arthur83] and Paul David's
                                              1985 article "Clio and the economics of QWERTY"
                                              [David85] economists learned departures from
                                              single-equilibrium solutions via the mathematics
                                              of probability in stochastic processes (in Arthur's
                                              case) and via the "essential" role of chance
                                              historical events (in the case of David). The game
                                              is played largely by matching model to metaphor
                                              and the play of chance and necessity (Arthur cites
                                              Monod as chief inspiration) in the service of
                                              systemic change enthrall to the point of concern.
                                              As Charles Sabel puts it in his critique of path
                                              dependency, (see below): "and so the dismal
                                              science finds a new way to be dismal (Section 2,
2. A n ex tended, incomplete,                 paragraph 6)" [Sabel95].
critical summary of this

                                                For these economists, standards adopted for any
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                                              For these economists, standards adopted for any
                                           reason, call it chance or necessity, can have a
                                           profound effect on markets. David types QWERTY
                                           on his Apple because a few manufacturers learned
                                           the hard way that once a population of typewriters
                                           learns by using one thing, the prohibitive cost of
                                           changing keeps them coming back[1]. Path
                                           dependence thus emerges as the economist's
                                           genuflection before history, even as history is
literature has been ex cised,              reduced to the chance event. QWERTY, or more
it is here.
                                           mythically VHS, is not the superior technology
                                           that neo-classical welfare economics demands the
                                           market favor. Inferior technology has achieved
                                           'lock-in' and it is economically disadvantageous—


                                           read impossible— to improve. To save a
                                           neo-classical synthesis, these events fall outside the
                                           closed system: they are network externalities.
                                           Externalities are a familiar beast of economic
                                           theory, but combined with path dependency and
                                           the "complexity theory" of stochastic processes, it
                                           becomes a question of a few wrong moves making
                                           a monopoly of mediocrity. Conveniently, the price
                                           system still functions in this theory, as long as
                                           history is simply accident, as long as history is only
                                           "cleopatra's nose." QWERTY is an accident for the
                                           economist, albeit an especially significant one,
                                           updating and reversing the apiarian party-line
                                           with a fable of the butterfly from chaos theory.
                                           Virtue no longer rests in vice (self-interest),
                                           market failures require correctional institutions to
                                           return vice to its hive. [2]

                                              Economists Margolis and Liebowiz, vigoruous
                                           opponents of this theory's implications for classical
                                           economics, critique Paul David on historical
                                           grounds by unearthing every last bit of
                                           information about the Dvorak keyboard that an
                                           economist playing historian can uncover. Their
10.08.2010          http://web.archive.org/web/20010310130...ings /s caleconvention/D.Economis ts .html   #4
                                        economist playing historian can uncover. Their
                                        critique uses brute force, but makes its point:
                                        historical small events are arbitrarily common,
                                        which historical event is important can still be
                                        investigated by standard classical and
                                        neo-classical economic tools. Charles Sable
                                        critiques path dependency in much subtler and
                                        broader sense. He offers counter examples (such as
                                        the choice to switch from a typewriter to word
                                        processor, clearly a larger switch in sunk costs
                                        than from QWERTY to Dvorak) to prove a thesis
                                        about the mutual intelligibility of different choices.
                                        Sabel points towards the pragmatism of economic
                                        institutions that he identifies elsewhere, in order


                                        to show that the existence of "increasing returns"
                                        as an assumption in the economies of today, is
                                        countermanded by a pragmatic deliberation on
                                        the goals of economic activity.

                                           Curiously, the word and the concept "standards"
                                        is absent from the most theoretical of this work,
  Last Modified                         even from Sabel's critique. Perhaps this is because
  11-Sep-99 9:01 PM
  ckelty@mit.edu                        for the economist who studies the market as
  Go Back to the Start                  nature, standards are still yet culture. Or perhaps
                                        it is because standards are seen as complex but
                                        unproblematic technical decisions. They can and
                                        must be included under the heading of regulation
                                        and law, since supposedly deliberate process
                                        determine them. They may then have an effect on
                                        a market or an economy, but they are certainly not
                                        an essential component. On the contrary, when
                                        theorists of increasing returns pick examples, they
                                        call them "technologies," "solutions," "adoptions."
                                        The impossiblity of this inversion is signalled
                                        syntactically in Arthur "The standard technology
                                        problem in economics was figuring out the
                                        economic circumstances under which a new,
                                        superior technology might replace an old inferior
10.08.2010   http://web.archive.org/web/20010310130...ings /s caleconvention/D.Economis ts .html   #5
                                 superior technology might replace an old inferior
                                 one, and how long this process might take."
                                 [Arthur83] Problems can be standard, given, in
                                 need of transcendence— but technologies should
                                 not. Technologies are not arbitrary conventions,
                                 they are rational evolutions. The quickly told story
                                 of VHS and Betamax often serves to illustrate:
                                 VHS gained an early market lead that led to the
                                 purchase of more VHS players and to the
                                 distribution of major films more commonly on
                                 VHS. With every decision to go VHS over Beta the
                                 "network" (the sunk costs of the VHS market)
                                 gained incrementally in inertia until it became
                                 disadvantageous for someone to buy Beta initially


                                 or to switch from VHS to Beta. The rub is that,
                                 accrding to the story, VHS is "an inferior
                                 technology" whose success depended on some set
                                 of chance events that led to VHS cassettes being
                                 more widely distributed. VHS was at no point
                                 declared a standard by any governing body, other
                                 than perhaps internally by JVC, and yet it quickly
                                 became the de facto standard for the industry,
                                 requiring that any corporation that wanted to
                                 participate in the lucrative business of
                                 videocassettes would have to use this standard,
                                 and more importantly that any existing
                                 competitor would be driven out, not on price, and
                                 not on quality, but on the "network externality" of
                                 incompatibility — a market failure that drives
                                 economists batty. Of course the criteria by which
                                 "inferiority" is measured is never explored—
                                 though it is largely immaterial, since the key
                                 problem for the economist is that competition and
                                 equilibrium are disturbed by problems associated
                                 with the existence of increasing returns—which is
                                 also not questioned— which leads to lock-in and
                                 market failure. Until the work of Carl Shapiro,
                                 Garth Saloner, Joseph Farrell, and Michael Katz
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                                 Garth Saloner, Joseph Farrell, and Michael Katz
                                 (responding in various ways to the proposals of
                                 Arthur and David) which looked at idealized
                                 standards decisions, the role of standards was
                                 assumed to be unproblematic.

                                    This contrasts starkly with the strategic use of
                                 'standards-talk' in the justification of decsions in
                                 both my fieldsite, and the internet economy at
                                 large. These descriptive economic theories quickly
                                 become normative when funneled into the array of
                                 publications with wider than library circulation.
                                 What has come to be called the "winner take all"
                                 economy (and when Adrian Gropper refers to "the


                                 impact of standards beyond healthcare") is the
                                 vernacular version of this economic
                                 mini-consensus. Path dependency and lock-in are
                                 memorable fables, and a convenient explanations
                                 for both success and failure, but when combined
                                 with the object lesson of "network externalities"
                                 (and especially the word 'network', which even
                                 though it does not refer only to technical networks,
                                 is constantly made to bear the weight of every
                                 amateur explanation of the 'New Network
                                 Economy') they become explicit strategy for the
                                 participant in economic life. Add this
                                 self-monitoring management behavior to the
                                 already complex attempt to create standards and
                                 what used to be a game of coordination played
                                 with implicit gains, becomes a game of monopoly
                                 with explicit support from the science of
                                 economics.

                                    This introduces a whole new level of
                                 publications, from trade journals in the world of
                                 standards as well as the glossy journals and
                                 tipsheets marketed at CIOs and other executives
                                 that disseminate this langauge. These sources
10.08.2010   http://web.archive.org/web/20010310130...ings /s caleconvention/D.Economis ts .html   #7
                                 that disseminate this langauge. These sources
                                 range from the cotton candy punditry of Gilder,
                                 Negroponte, Forbes, Fortune, Fast Company to
                                 the expertise of someone like Carl Cargill, former
                                 standardization strategist for Netscape, to various
                                 quasi-academic management handbooks such as
                                 Peter Grindley's Standards Stragtegy and Policy:
                                 Cases and Stories (whose introduction is
                                 sub-titled "Winning with standards")
                                 [Grindley95]to trade and quasi-academic
                                 publications, in particular, StandardView. All of
                                 these sources preside over what they experience
                                 and communicate as a change from a purely
                                 technical concern to a newly commercial one


                                 (though not yet political, unless, ironically
                                 someone breaks a law, especially a patent or
                                 copyright law).

                                    In 1998-9, along with the Open Source
                                 movement (q.v. section H below), the jargon of
                                 increasing returns and network effects are
                                 officially the Buzzwords du Jour. Carl Shapiro and
                                 Hal Varian published Information Rules: A
                                 strategic guide to the Network Economy
                                 [Shapiro99] and Kevin Kelley, futurist, wacko, and
                                 ex-editor of Wired has published an even more
                                 watered down version called New Rules for the
                                 New Economy : 10 Radical Strategies for a
                                 Connected World [Kelly99]. The emphasis on
                                 'rules' is primarily a sort of auto-immune response
                                 to the extraordinairy quantity of speculation that
                                 circulates about the radical transformation and
                                 functioning of the internet economy. Shapiro and
                                 Varian say on page one: "Technology changes,
                                 economic laws do not," in an attempt to leverage
                                 the ailing legitimacy of economic theory and the
                                 sexy academic glamour of Harvard Business
                                 School onto a handbook for capitalists who are
10.08.2010   http://web.archive.org/web/20010310130...ings /s caleconvention/D.Economis ts .html   #8
                                 School onto a handbook for capitalists who are
                                 tired of hearing that "everything has changed" or
                                 that you can "make your own rules." This
                                 handbook gives digestible versions of all of the
                                 writings on increasing returns and path
                                 dependency and offers sagely advice on what that
                                 means for Your Business. It finds its way into
                                 venture capital firms, the justice deparment's case
                                 against Microsoft, and the everyday language of
                                 business plans and strategy abstracts. While few of
                                 these books and annoucements offer any real detail
                                 about the technical structure being put in place,
                                 they do at least sense that standardization (not
                                 just mechanization, or formalization) have a


                                 significant role to play— and do a fine job of
                                 converting anyone who needs only a little
                                 convincing.

                                    Consider— as an example of this process— an
                                 article[Gropper99] that Adrian wrote— the details
                                 of which are less important than the insistence on
                                 standards, and especially the distinction between
                                 DICOM [DICOM is explained in more detail in
                                 section F] and Internet standards:

                                       The Internet has demonstrated the value of standards.
                                       Cost, ease-of-use, functionality and growth all benefit
                                       from the widespread adoption of standards. It's hard to
                                       imagine filmless radiology without standards to replace
                                       the film, film jacket, flash-card and light box.


                                    Rarely does an editor let such repetition pass,
                                 but in this case it is par for the course in an
                                 industry where such statements are only slightly
                                 less common than the demands for
                                 standardization that precede them. Adrian's
                                 article also tries to differentiate within standards,
                                 which we will come to shortly, in order to train
                                 CIOs and PACS buyers about their importance:
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                                       DICOM is essential. DICOM however, was not designed
                                       to the same standards of accessibility, security and
                                       cost-effectiveness as the Internet. As a result, neither
                                       PACS nor teleradiology can be designed exclusively
                                       around the DICOM standard. The DICOM standard will
                                       continue to evolve, but in those areas where the
                                       Internet offers an alternative standard, DICOM may not
                                       evolve fast enough to compete.


                                    The language of evolution and competition
                                 should not obscure the fact that the difference was
                                 one of design. "DICOM however, was not designed
                                 to the same standards of accessibility, security and
                                 cost-effectiveness as the Internet." The
                                 conotational slippage deserves the focus. A
                                 standard (the internet standards) "designed to the


                                 same standards" captures the blur of history,
                                 economics and technical design that differentiates
                                 DICOM from Internet. What standards are these?
                                 Implicitly high standards of accessibility, security
                                 and cost-effectiveness? Why wasn't DICOM privy
                                 to these same "standards" when it became a
                                 standard? What peculiar dissemination is signaled
                                 by this homophony? Some specificity is offered,
                                 especially concerning the danger of the
                                 "vendor-specific" standard:

                                       The use of Internet standards such as firewalls, virtual
                                       private networks (VPN), digital certificates and
                                       directory servers such as the Lightweight Directory
                                       Access Protocol (LDAP) all combine to provide a
                                       complete range of security and administration solutions
                                       that are much more powerful and cost-effective than
                                       any vendor-specific technology


                                    Some sort of explanation of this difference
                                 constitutes the rest of this section, especially as it
                                 becomes a concern that crosses more than just
                                 competiting vendors, but includes lawyers,
                                 revolutionaries, and hackers in collectively
                                 reconstructing capitalism. But for Adrian,
                                 statements like these serve primarily to "educate"
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                                 potential customers about the uses of the internet,
                                 and strategically leverage a widespread concern
                                 about standards in healthcare:

                                       Standards, specifically those surrounding the Internet,
                                       have impacted all aspects of health care.


                                   These statements, directed at hospital
                                 radiologists, purchasing agents and CIOs (and
                                 explained in more detail below {q.v. below}, are
                                 perfect examples of the manner in which strategic
                                 thinking has come to incorporate standards as a
                                 primary economic consideration. And whether
                                 increasing returns and network effects theorists
                                 become justification for such decisions or not, this

                                 indicates that standards decisions have penetrated
                                 to a level of strategic thinking that used to be
                                 occupied only by marketing, sales, returns and
                                 occasionally, regulation.

                                    The commercial focus may be appropriate, a
                                 recognition that corporate executives never spoke
                                 of, or worried about, standards as a strategic issue
                                 until now. But of course, that doesn't mean that
                                 these battles were ever purely technical issues (q.v.
                                 section F), only that they were informally political,
                                 rather than programmable by managers and CEOs

                                   From the standpoint of the increasing returns
                                 theorists, as well as managers who treat
                                 themselves to these lessons, standards can be
                                 achieved by explicit agreement, and often are, but
                                 the system is hierarchical, inefficient and riddled
                                 with rule by judgement and abuse of power. By
                                 analogy with Nature, the object lessons of
                                 increasing returns, lock-in, path dependency,
                                 especially when applied to technology, teach how
                                 markets use positive feedback to reinforce choices,
                                 and the principal problem then becomes: how to
10.08.2010   http://web.archive.org/web/20010310130...ings /s caleconvention/D.Economis ts .html   #11
                                 and the principal problem then becomes: how to
                                 make the right choices at the right time to ensure
                                 that the 'right' standard is chosen. (as with the
                                 problem of VHS's inferiority, the issue of rightness
                                 is a technical one, which invokes a set of criteria
                                 no less governed by a problematic of convention
                                 and nature, and often the last instance metric of
                                 correctness in standards is reference to some
                                 convention of simplicity, elegance, robustness and
                                 completeness— Sean's admiration of the HTTP
                                 and HTML standards cites the "non-commercial"
                                 work of scientists collaborating around the globe.)

                                  The uses to which this common sense is put are
                                 myriad and contradictory— but they recuperate a

                                 sense of freedom in the development of technology.
                                 Rather than always waiting for an authority to
                                 standardize a technology, companies and
                                 executives can aim any technology at a market and
                                 hope that consumers "make the right choice."
                                 CEO's may approach this set of theories with
                                 cupidity or cynicism, they may believe the
                                 economics has the certainty of science, or they
                                 may simply urge the theory towards towards truth
                                 by insisting it against lived experience of the
                                 economy (that companies conscionably release
                                 poor quality technology, and leverage marketing to
                                 make it standard, thus becomes a familiar
                                 denegration). The strange mix of normative and
                                 descriptive language the bedveils economic
                                 science, and especially economic popularization,
                                 leads to an equally strange mix of actions on its
                                 behalf. On the one hand, defeatism strikes those
                                 who miss the jackpot of lock-in, while a kind of
                                 unreconstructed genetic determinism often infects
                                 those who watch their products "become the
                                 standard." On the other hand, the Justice
                                 department has taken a very serious interest in
                                 these theories (which has in turn prompted more
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                    Section Header
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                        E. Standard differences
                             Scholarly literature is departed for an Example
                             from ethnography — and Another from an email
                             discussion on standards in which Religion and
                             Heresy appear — some Very Important
                             Distinctions are made — between freely available
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                                        Distinctions are made — between freely available
                                        standards and not — between written standards
                                        and implementations — the concept "it works" is
                                        introduced and discussed..



                                               As the scholarly literature on standards
                                            expands, it is easy to lose sight of what might be
                                            the crucial differences between kinds of standards.
                                            The diversity of technical standards, especially
                                            those for software and networking— for
                                            information communication— can easily
                                            overwhelm the important theoretical differences.
                                            In order to maintain some specificity, without
                                            losing the generality that will connect the
                                            primitives of scale and convention to the
                                            programmed languages of the internet and society,
                                            ethnography studs the following exploration with
                                            stories that may seem more or less real, more or
                                            less explanatory, or more or less obfuscating. The
                                            spectrum of laws, regulations, contracts,
                                            standards, conventions, and customs continues to
                                            enfold a problem of location— the spectrum of
1 . The work of sociologists of
science in the wake of                      boundaries: world, global, international, national,
Michael Polany i's book, The
Tacit Dimension, [Polany i66]
                                            legal, commercial, mediatic, governmental, local,
is relev ant here, though it is             virtual.
the precise nature of the
institutions that allow the
transmission of such 'tacit'
knowledge that ties standards
to this question




                                               At ground level, as it were, to use a metaphor of
                                            space that somehow still makes sense, there is the
                                            problem of how anyone knows what standards
                                            (techncial or otherwise) are appropriate for
                                            anything at all. Engineers and technicians from
                                            different communities will have been trained to
                                            respect different sets of standards, based on
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                                            reasons that may be obscure— issues of technical
                                            'elegance,' national or international endorsement,
                                            explicit teachings, or learning of a more implicit,
                                            customary or 'tacit' kind [1]. This is the sole point
                                            where existing national and cultural
2. See Weber, Economy and                   identifications have specific technical impacts.
Society , V ol. 1 , Part one,
chapter one, sections 5,6,7                 Training varies, socialization varies, and access to
and Part one Chapter Three,
sections i,     ii,  and   iii              information varies. Engineering is not one, nor is
[Weber68].
                                            medicine, and the differences that result translate
                                            into differences in standards that are applied or
                                            obeyed. Rightness and authority reference all
                                            standards, from the metric system to rituals of
                                            construction. Herein classical Weberian concepts
                                            still work: obeyed standards are the probablistic
                                            measure of an obcure, but identifiable given
                                            authority. [2]

                                               The first cut divides internet-savvy
                                            programmers and engineers from
                                            telecommunications and electrical engineers.
                                            Software programmers who associate themselves
                                            with the internet as a kind of ethic ( a 'community'
                                            occassionally refereced as 'hackers') tend to be
                                            auto-didiacts who view the authoritarian attitude
3. I don't know if this need be
said, but it does not imply                 of "a right way to do something" as suspect, and
that those indiv iduals who
are 'on' the internet, or 'in
                                            substitute instead a demand for demonstrable,
cy berspace' are libertarians,              measurable quality. Telecommunications and
any more than people who
use the phone sy stem can be                electrical engineering is a profession with a great
said to be so. But the fact
remians        that       those             diversity of certification and licensing practices,
indiv iduals most inv olv ed in
the design, maintanence and                 that engages a much more bureaucratic and
redesign of the internet, are
more often than not, fans of
A y n Rand
                                            institutional version of authority, and often
                                            demands adherance over demonstrability. This cut
                                            inevitably effaces the differences within each field,
                                            in order to connect the differences between them
                                            to different sets of conventions, standards,
                                            standards making procedures, and political
                                            affiliations whose distinctions are difficult to
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                                            perceive from within either one. For example, from
                                            the perspective of individual advocacy, the internet
                                            is easily identified not only a separate set of
                                            engineering ideals (I refer to the ideals of the
                                            internet as a stupid network, discussed in section
                                            G), but a different political ideal, most often—
                                            libertarianism. Telecommunications and electrical
                                            engineers might be less likely to be libertarians. In
4. C was initially dev eloped at            any case (assuming we could make such
Bell Labs, by Brian Kernighan
and Dennis Ritchie and used                 generalizations), to simply allow that these
for the initial dev elopment of
the Unix operating sy stem,                 differences issue from different 'cultures' obscures
no doubt there is a history of
its ownership by A t&T to be
                                            more than it enlightens[3].
told somewhere, howev er,
the basic point is that the
definition of the language—                   The fact remains that engineering ideals (the
the standard promoted by
A NSI— is not owned by                      Bildung of the engineer, his or her tacit knowledge,
A T&T. For more on the
history of these languages see              and explicit professional affiliations) and political
http://cm.bell-labs.com/
cm/cs/who/dmr/chist.html
                                            actions (the promotion or blocking of specific
and                                         decisions) are inseparable. The distinction is a
http://ei.cs.v t.edu/~history /
Y oumans.Jav a.html                         vulgar one, necessary to get work done, like the
                                            distinction between real work and philosophy.
                                            Political action was never confined to the voting
                                            booth, except in the justification of actions. Like
                                            the relationship between trust and truth identified
                                            by Porter, engineering decisions and political
                                            action share the same bargaining table. When
                                            people are convinced that they are right, when
                                            they insist that their way is a better way, a direct
                                            access route to obscured political beliefs is opened.




                                               When, in the case of the internet, engineering or
                                            programming decisions are experienced as
5. The irony in this sentiment
                                            'political' or at least, as more than simply
is borne out by Donald                      'technical' choices, standards are inevitably at the
Madison's study of early
tewntieth century hospital                  heart of the discussion. Standards issues, like
organization,      and      the
importance of the term                      platform wars, tend to take on the character of
"cooperation" in Progressiv e
era hospital and          A MA              religious disputes, sometimes with strictly
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                                 articulate rules for their arbitration (levels of
                                 specificity, arguments about users, cost, or
                                 self-evidence, testimony, especially "It works,"
                                 which we will see later is one of the most powerful
                                 political assertionas of will) sometimes with all-out
                                 dogmatic insistence, unchangeable minds, ALL
                                 CAPITAL LETTERS. Often, when the specificities
                                 have been exhausted, explicit arguments about the
                                 nature of laissez-faire capitalism and its
                                 corruption by large corporations and governemnt
                                 regulation take center stage. In the end, these
                                 debates come close to engaging legitimacy at a
                                 very high level— that is to say, the cover of a
                                 distinction between technical and political issues
                                 is shorn for a direct attack on forms of political or
                                 economic action. Consider, for instance, a sample
                                 from the discussion list for XML developers, sent
                                 to me by Sean.

                                       It seems that the word "standard" is a new modern
                                       marketing magic wand. what do this means exactly? If
                                       W3C has 320 members and claim to produce
                                       "standards." Does this means that if I get 320 friends
                                       (not from the same company) and produce a spec,
                                       could this be a "standard"? if not why? Did we forget
                                       some historical lessons when at some period of time
                                       people where claiming authority based on some
                                       "standards", even attributed themselves the right to
                                       burn people not conforming to the "standards." So,
                                       what this word really mean today? disguised power
                                       struggle? Do "standard" really mean "against Microsoft"
                                       (this does not necessarily I am for _ and that I have to
                                       say this just put more emphasis on the quest to find
                                       the real meaning of "standards") ? Do "standard"
                                       mean... What this word really means anyway? What is
                                       really behind it?


                                    We can appreciate the difficult English of this
                                 email, if for a moment we treat it as 'non-standard'
                                 English, and listen to the bewilderment manifested
                                 at the fact that the emotional attachment to
                                 legitimate authority inevitably refers us to some
                                 version of revolution and heresy, here it is Bruno,
                                 burnt at the stake for proposing to speak truth to
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                                 the prevailing authorities' standards. This email is
                                 a perspicacious example of this phenomena—
                                 common enough to be very recognizable on such
                                 newsgroups and mailing lists, and often just
                                 referred to, somewhat cynically by my informants
                                 as "religion and philosophy."

                                    The discussions are inevitably confused by this
                                 maneuver, where the artifactual nature of
                                 standards and the purely politcal game is confused
                                 with an extra-cultural progression towards truth.
                                 The result is that standards discussions very
                                 quickly become religious disputes, disputants very
                                 quickly recognize this, and in the end, the only
                                 arbitration is a grunt insistence an a piece of
                                 technology: "it works."

                                    These discussions came to make sense to me as
                                 a result of observing the differences between the
                                 Partners Telemedicine Center and Amicas,
                                 specifically with respect to the difference between
                                 the electrical engineer who learned information
                                 technology via night classes and Microsoft
                                 certification programs (Tim O'Neil) and the
                                 economist who learned programming and
                                 information technology on Usenet groups, from
                                 programming handbooks and O'Reilly texts, or
                                 just by asking around (Sean Doyle). Tim (as well as
                                 Dr. Kilborn) was a representative of an
                                 engineering tradition that valued consensus,
                                 certification, professional identity and treated

                                 standards as a kind of legitimate authority,
                                 whether they were the standards of a public or
                                 private entity. Sean on the other hand, preached
                                 the gospel of openness and open standards,
                                 partially as a result of his experience of learning
                                 via the internet's openness, and often referred to
                                 the Evil spread by Microsoft into the world. The
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                                 mutual unintelligibility of this choice is what I
                                 insist is the central and most imortant difference
                                 for standards setting specifically, but for the
                                 internet and the technical-legal society it
                                 programs in general.

                                    For now, two important distinctions:




                                    1) That between a standard that is freely
                                 available (though not free) to anyone and one that
                                 is not. In the first case, it may be copyrighted or
                                 not, and there may be a nominal charge associated
                                 with it, usually justified in terms of covering the
                                 costs of its development or publishing— and
                                 usually associated with a non-profit,
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                                         non-commercial organization that is made up of
                                         members of different companies in an industry.
                                         Standards organizations with the backing of
   Last Modified                         governmental authority are most often of this
   11-Sep-99 9:01 PM
   ckelty@mit.edu                        kind, but not always. In the second case, the
                                         standard may be unavailable because important
                                         parts of it are kept secret by the company that
                                         created it— thus a proprietary standard—
                                         especially if that company is the only
   Go Back to the Start                  manufacturer (and here, monopoly and antitrust
                                         issues become relevant, as do legislation protecting
                                         "trade secrets"). A company or standards
                                         institution may also engage in some commercial
                                         activity such as licensing the standard (which
                                         depends on some protection accorded by patent
                                         and copyright law, though this will be further
                                         complicated by software licensing practices, q.v.
                                         sections K and L) or engaging in some activity
                                         with another company that necessitates sharing a
                                         standard for the production of a specific
                                         technology. Examples include the standard for
                                         Microsoft Word documents, Adobe PDF files, or
                                         the Windows Operating system.

                                            2) That between a standard and an
                                         implementation of that standard. The published
                                         standard may be, for all intents and purposes,
                                         useless to most people (Sean Doyle: "there's open
                                         like in DICOM where people can use it but it might
                                         take them 3 months with a good C++ programmer


                                         to download the code and then understand it.")
                                         either because it is too complex or because it may
                                         set specifications that need to be tested and
                                         measured against something. Example: standards
                                         for weights and measures— whether a standard
                                         iron bar in the center of town, or the wavelength of
                                         a Krypton atom. Tolerance in Alder's work: the
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                                 devices for measuring tolerance in bore size need
                                 to be available to testers, not just a number. But
                                 more than this, in the world of software
                                 engineering and management, designers need
                                 implementations to work with— to test against,
                                 and to understand how a piece of technology
                                 works, either to reproduce it, or to fix it when it
                                 breaks. If you don't have the implementation of the
                                 standard, then complying comply with the
                                 standard adds a level of complexity to the creation
                                 of software that makes producing compatibility
                                 difficult enough to discourage the most persistent
                                 designers.

                                   In the case of this second distinction, standards
                                 are much more than simply about measurement or
                                 control: they provide examples to learn from, and
                                 challenge the distinction itself. It is possible (and
                                 indeed, required in some instances, as I explain in
                                 Chapter H) that an implementation could become
                                 the standard. That is to say: there is a working
                                 example of a protocol (or a piece of software),
                                 implemented in a working network, that is then
                                 declared a standard by a governing body. This is
                                 what the path dependency theorists theorize, but
                                 without the last step, so that, for instance
                                 Microsoft Word is the de facto standard for word
                                 processed documents, but certainly, no legitimate
                                 authority of any kind has declared it a standard.
                                 On the other hand the protocol for ftp is also a de


                                 facto standard— it was adopted in a similar
                                 manner, by use and incremental improvement—
                                 but was then declared a standard by the IETF (see
                                 chapter H). Those familiar with the internet
                                 understand this well: by making the source code of
                                 any system available, you allow not only massively
                                 parallel testing and development, but a working
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                                 implementation that people can learn from, copy,
                                 comply with, compare to, and for the entrepreneur
                                 in each of them: adopt. Sean Doyle tells a version
                                 of this distinction:

                                       S: Well, its also, very hard, because if the standards
                                       are sufficently complex— and almost all standards that
                                       are worth anything are complicated— if they don't
                                       come with a sample implementation then you know,
                                       you're toast.


                                    Sean is thinking here about the DICOM
                                 specification, which is a hopelessly complex
                                 document, and without a system to test against, or
                                 at least to look at, he insists, you're toast. Sean,
                                 however, gives a different and more complex set of
                                 examples to illustrate the point:

                                       S: If you look at the definition of the C language, you
                                       know, it's pretty terse, if you look at the one for Java,
                                       [the Java programming language definition is a
                                       proprietary standard wholly owned by Sun
                                       Microsystems, written James Gosling, Bill Joy, and Guy
                                       Steele, whereas ANSI C is a standard that was
                                       published by ANSI, and in 1990 included by ISO/IEC,
                                       Sean could be referring to the earlier specification by
                                       Kernighan and Ritchie, but it is unclear] it's really much
                                       longer, even though the language is much more
                                       semantically clean, and that's because they spent a lot
                                       of time trying to be really serious about having a
                                       language that is cross platform. The main thing is that
                                       they had a working implementation that other people
                                       could test against... you sort of need both the written
                                       [standard] and the implementation in order to make it
                                       go along.


                                   What Sean is trying to get at here is more
                                 complicated than he lets on. Trying to explore the


                                 relationship between a standard and an
                                 implementation in terms of computer languages
                                 doubles the complexity of the difference between a
                                 "written" standard and its implementation and a
                                 de facto standard as an implementation and its
                                 written standard. To begin with, a "language" is
                                 never implemented, per se, but would require a
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                                 compiler or an interpreter for that language, and
                                 in the case of C, it would have to be specific to the
                                 operating system and machine that it was to be
                                 run on. In the case of Java, as Sean points out, the
                                 specification for the language is more terse
                                 because they needed to include specifications that
                                 would allow it to work on several different
                                 operating systems, and potentially be expanded to
                                 others. Furthermore these technical details are not
                                 the only thing at issue, consider the difference
                                 between C and Java more carefully.

                                    The C programming language definition is
                                 available from the Online ANSI standards store for
                                 $135, 12MB, Document Number: ANSI/ISO
                                 9899-1990 (R1997). This means it is not a paper
                                 document (though you can get a paper one), that it
                                 is expensive, and that ANSI controls its
                                 distribution. The specification cannot be extended
                                 or transformed (which might seem obvious, since
                                 it is a standard, but it needs to be said, because
                                 this is not always true, only true in this instance).
                                 If you do change it, you are forgoing national and
                                 international standards, and would be unable to
                                 pass conformance statements that would give your
                                 implementation (of a complier, for instance) the
                                 ANSI stamp of apporval. If you wanted to get an
                                 implementation of the C programming language,
                                 you would need to find a piece of software that
                                 implemented the language for some reason, say, a


                                 compiler that turned C code into object code.
                                 There are several of these, such as gcc, the GNU C
                                 compiler from the Free software foundation
                                 (which is also free of charge). Or you could
                                 purchase whichever "software development
                                 environment" you might prefer (such as one of
                                 Microsoft's Visual Studios). However, only in the
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                                 former case would you be able to look at the source
                                 code of the compiler/development environment to
                                 see how it implements the C language
                                 specification. A proprietary environment will not
                                 include the source code, usually only the binary
                                 executables. Both may conform to the ANSI C
                                 standard, if ANSI has approved them, but ANSI
                                 does not police every implementation of C, which
                                 would probably be impossible. However, in th case
                                 of gcc, the source code is available and it is also
                                 'free' (see section K), which means that you could
                                 conceivably change it to produce a new version of
                                 the gcc (perhaps different than the ANSI
                                 standard), if you determined that was necessary
                                 for whatever reason. The relevant point for Sean's
                                 example is that if you only have a specification for
                                 C, you can't make it (perhaps your compiler) "go
                                 along" [4]. If you already have an implementation
                                 of the specification, you can at least copy its
                                 structure, or learn how it "worlks."

                                    The Java programming language definition, on
                                 the other hand, is wholly owned by Sun
                                 Microsystems and will be given to you for free on a
                                 limited license (one copy) here. This means that
                                 Sun owns the copyright to the specification and
                                 has licensed it on a per copy basis to people who
                                 want it. It is free of charge, but it cannot be
                                 redistributed. The specification cannot be
                                 extended or transformed under threat of legal


                                 action from Sun Microsystems. Sun provides a free
                                 (though also proprietary) programming
                                 environment called the Java Development Kit
                                 (Recently changed to the Java 2 SDK, there are
                                 versions of it for Windows and Unix). Under a new
                                 license, the source code is available, but still owned
                                 by Sun. Sun allows other vendors to create
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                                 development environments using the specification,
                                 but it contracts with them to implement the
                                 specification as they have designed it. Java is
                                 slightlly more complex in that it depends on the
                                 inclusion of an interpreter in the various Web
                                 browsers (for different operating systems) made by
                                 any web browser manufacturer to interpret the
                                 source code that is downloaded over the net (this
                                 is the theory behind the "write once, run
                                 anywhere" logic of Java). The inclusion of this
                                 interpreter depends on a complex licensing and
                                 contracting practice that tries to incent browser
                                 manufacturers to include an implementation of
                                 Java in their browsers. If the browser manufacture
                                 implements the language according to spec, it
                                 should run any jave program written on any
                                 platform. This was the subject of Sun's law suit
                                 against Microsoft in 1998, because Microsoft
                                 implemented a version of Java that did not
                                 correspond to Sun's specifications for Java, and
                                 thus did not always run Java programs the same
                                 way, or at all. Sun claimed a breach of contract.
                                 The point, I take it, for Sean, is that in the
                                 development of the various interpreters in various
                                 web browsers for Java, Sun had provided an
                                 implementation of Java-compatible browser to fro
                                 developers of the interpreters to test against. This
                                 made cross-platform compatibility easier than
                                 each having to write an implementation based
                                 soley on the specification of the language.

                                   Sean offers a second example, this time of a
                                 protocol, that is also meant to prove this point:

                                       I've heard, and this may be a bit of folklore, that
                                       TCP/IP, you know, one of the reasons that worked so
                                       well as a standard was that some of the initial
                                       implementations were part of the UNIX kernel and they
                                       were made free [such as, perhaps, an early version of
                                       BSD], and so when there were things that weren't in
                                       the spec you could look back at the implementation and
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                                       the spec you could look back at the implementation and
                                       say "I want to make it compatible with this one" then
                                       you could make it work that way. So it's really not
                                       enough to have the paper, you need to have an
                                       implementation, and it's really hard to have the
                                       incentives, for people to release both the
                                       implementation and release the code.


                                    The last sentence is crucial for these distinctions
                                 with respect to the internet: having a standard is
                                 one thing, having an implementation of a standard
                                 is a second thing, having the source code for that
                                 implementation (in the case of software) is still yet
                                 a third thing. Having all three is often too much to
                                 ask. The distinction Sean points to— between the
                                 paper specification of a standard and the working
                                 implementation of a standard and its source code
                                 is recapitulated by every story of the internet, even
                                 if the conditions of possibility of this story (ARPA's
                                 hand in the development of the internet, or the
                                 NSF's, or the instiitutional conventions of
                                 university computer scientists) are effaced or
                                 troped. It is the case that this distinction is
                                 meaningful to many of the actors who write
                                 software or build networks— and it suggests that
                                 what people find compelling about the story is the
                                 suggestion of its openness, specifically that one can
                                 use it to learn how something works.

                                   These examples should at first recall the
                                 distinction between a patent and its device, and
                                 the problematic issues of toggling between them,
                                 especially in the case of "technology transfer." But


                                 they should also give just some sense of the
                                 quadrilateral set of concerns: national and
                                 international legitimacy, availability and
                                 accessibility, corporate ownership, and
                                 workability. The corners of this shape fold to meet
                                 in a variety of conformations, and the difference
                                 between any two engineers will often depend on
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                                 which corner is most dog-eared.

                                   My use of this paralellogram of interests is in the
                                 the comparison between Partners (Tim O'Neil)
                                 and Amicas (Sean Doyle). Partners developed no
                                 software of their own, preferring to outsource most
                                 of the technical work, but this did not make them
                                 immune to standardization issues, or to the
                                 relation between standards and communities of
                                 practice, or the necessity of knowing how things
                                 work in order to make decisions about what to
                                 spend money on. For Partners, legitimacy rests
                                 outside the organization, in the structure of
                                 certification and recognition that makes up the
                                 national medical-corporate establishment. This
                                 history of standardization and certification is at
                                 least a century long, and mixes the recognition of
                                 authority in the person of the doctor with the
                                 baptism by the hand of the administrative state in
                                 the guise of the various professional societies.
                                 Goodness, skill, rightness, truth— all issues of pure
                                 validation, peer-review by the proper authorities.
                                 Authority precedes (both personal and
                                 institutional), accreditation follows, credentials
                                 bear witness. For Sean and Adrian, this history is
                                 the reason that healthcare is a frustratingly
                                 anti-competitive environment [5]. For Tim O'Neil
                                 and others at Partners, this authority is both a
                                 bureacratic hassle, and a positive external
                                 guarantee of quality— or at least the promise of


                                 quality, even if they are sometimes cynical about
                                 it.

                                    Amicas therefore serves as the example of a
                                 company that insists on the necessity of both the
                                 standard and the implementation (though not yet
                                 necessarily the source code): it works, and the only
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                    Section Header
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                        E. Standard differences
                             Scholarly literature is departed for an Example
                             from ethnography — and Another from an email
                             discussion on standards in which Religion and
                             Heresy appear — some Very Important
                             Distinctions are made — between freely available
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                                        Distinctions are made — between freely available
                                        standards and not — between written standards
                                        and implementations — the concept "it works" is
                                        introduced and discussed..



                                               As the scholarly literature on standards
                                            expands, it is easy to lose sight of what might be
                                            the crucial differences between kinds of standards.
                                            The diversity of technical standards, especially
                                            those for software and networking— for
                                            information communication— can easily
                                            overwhelm the important theoretical differences.
                                            In order to maintain some specificity, without
                                            losing the generality that will connect the
                                            primitives of scale and convention to the
                                            programmed languages of the internet and society,
                                            ethnography studs the following exploration with
                                            stories that may seem more or less real, more or
                                            less explanatory, or more or less obfuscating. The
                                            spectrum of laws, regulations, contracts,
                                            standards, conventions, and customs continues to
                                            enfold a problem of location— the spectrum of
1 . The work of sociologists of
science in the wake of                      boundaries: world, global, international, national,
Michael Polany i's book, The
Tacit Dimension, [Polany i66]
                                            legal, commercial, mediatic, governmental, local,
is relev ant here, though it is             virtual.
the precise nature of the
institutions that allow the
transmission of such 'tacit'
knowledge that ties standards
to this question




                                               At ground level, as it were, to use a metaphor of
                                            space that somehow still makes sense, there is the
                                            problem of how anyone knows what standards
                                            (techncial or otherwise) are appropriate for
                                            anything at all. Engineers and technicians from
                                            different communities will have been trained to
                                            respect different sets of standards, based on
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                                            reasons that may be obscure— issues of technical
                                            'elegance,' national or international endorsement,
                                            explicit teachings, or learning of a more implicit,
                                            customary or 'tacit' kind [1]. This is the sole point
                                            where existing national and cultural
2. See Weber, Economy and                   identifications have specific technical impacts.
Society , V ol. 1 , Part one,
chapter one, sections 5,6,7                 Training varies, socialization varies, and access to
and Part one Chapter Three,
sections i,     ii,  and   iii              information varies. Engineering is not one, nor is
[Weber68].
                                            medicine, and the differences that result translate
                                            into differences in standards that are applied or
                                            obeyed. Rightness and authority reference all
                                            standards, from the metric system to rituals of
                                            construction. Herein classical Weberian concepts
                                            still work: obeyed standards are the probablistic
                                            measure of an obcure, but identifiable given
                                            authority. [2]

                                               The first cut divides internet-savvy
                                            programmers and engineers from
                                            telecommunications and electrical engineers.
                                            Software programmers who associate themselves
                                            with the internet as a kind of ethic ( a 'community'
                                            occassionally refereced as 'hackers') tend to be
                                            auto-didiacts who view the authoritarian attitude
3. I don't know if this need be
said, but it does not imply                 of "a right way to do something" as suspect, and
that those indiv iduals who
are 'on' the internet, or 'in
                                            substitute instead a demand for demonstrable,
cy berspace' are libertarians,              measurable quality. Telecommunications and
any more than people who
use the phone sy stem can be                electrical engineering is a profession with a great
said to be so. But the fact
remians        that       those             diversity of certification and licensing practices,
indiv iduals most inv olv ed in
the design, maintanence and                 that engages a much more bureaucratic and
redesign of the internet, are
more often than not, fans of
A y n Rand
                                            institutional version of authority, and often
                                            demands adherance over demonstrability. This cut
                                            inevitably effaces the differences within each field,
                                            in order to connect the differences between them
                                            to different sets of conventions, standards,
                                            standards making procedures, and political
                                            affiliations whose distinctions are difficult to
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                                            perceive from within either one. For example, from
                                            the perspective of individual advocacy, the internet
                                            is easily identified not only a separate set of
                                            engineering ideals (I refer to the ideals of the
                                            internet as a stupid network, discussed in section
                                            G), but a different political ideal, most often—
                                            libertarianism. Telecommunications and electrical
                                            engineers might be less likely to be libertarians. In
4. C was initially dev eloped at            any case (assuming we could make such
Bell Labs, by Brian Kernighan
and Dennis Ritchie and used                 generalizations), to simply allow that these
for the initial dev elopment of
the Unix operating sy stem,                 differences issue from different 'cultures' obscures
no doubt there is a history of
its ownership by A t&T to be
                                            more than it enlightens[3].
told somewhere, howev er,
the basic point is that the
definition of the language—                   The fact remains that engineering ideals (the
the standard promoted by
A NSI— is not owned by                      Bildung of the engineer, his or her tacit knowledge,
A T&T. For more on the
history of these languages see              and explicit professional affiliations) and political
http://cm.bell-labs.com/
cm/cs/who/dmr/chist.html
                                            actions (the promotion or blocking of specific
and                                         decisions) are inseparable. The distinction is a
http://ei.cs.v t.edu/~history /
Y oumans.Jav a.html                         vulgar one, necessary to get work done, like the
                                            distinction between real work and philosophy.
                                            Political action was never confined to the voting
                                            booth, except in the justification of actions. Like
                                            the relationship between trust and truth identified
                                            by Porter, engineering decisions and political
                                            action share the same bargaining table. When
                                            people are convinced that they are right, when
                                            they insist that their way is a better way, a direct
                                            access route to obscured political beliefs is opened.




                                               When, in the case of the internet, engineering or
                                            programming decisions are experienced as
5. The irony in this sentiment
                                            'political' or at least, as more than simply
is borne out by Donald                      'technical' choices, standards are inevitably at the
Madison's study of early
tewntieth century hospital                  heart of the discussion. Standards issues, like
organization,      and      the
importance of the term                      platform wars, tend to take on the character of
"cooperation" in Progressiv e
era hospital and          A MA              religious disputes, sometimes with strictly
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                                 articulate rules for their arbitration (levels of
                                 specificity, arguments about users, cost, or
                                 self-evidence, testimony, especially "It works,"
                                 which we will see later is one of the most powerful
                                 political assertionas of will) sometimes with all-out
                                 dogmatic insistence, unchangeable minds, ALL
                                 CAPITAL LETTERS. Often, when the specificities
                                 have been exhausted, explicit arguments about the
                                 nature of laissez-faire capitalism and its
                                 corruption by large corporations and governemnt
                                 regulation take center stage. In the end, these
                                 debates come close to engaging legitimacy at a
                                 very high level— that is to say, the cover of a
                                 distinction between technical and political issues
                                 is shorn for a direct attack on forms of political or
                                 economic action. Consider, for instance, a sample
                                 from the discussion list for XML developers, sent
                                 to me by Sean.

                                       It seems that the word "standard" is a new modern
                                       marketing magic wand. what do this means exactly? If
                                       W3C has 320 members and claim to produce
                                       "standards." Does this means that if I get 320 friends
                                       (not from the same company) and produce a spec,
                                       could this be a "standard"? if not why? Did we forget
                                       some historical lessons when at some period of time
                                       people where claiming authority based on some
                                       "standards", even attributed themselves the right to
                                       burn people not conforming to the "standards." So,
                                       what this word really mean today? disguised power
                                       struggle? Do "standard" really mean "against Microsoft"
                                       (this does not necessarily I am for _ and that I have to
                                       say this just put more emphasis on the quest to find
                                       the real meaning of "standards") ? Do "standard"
                                       mean... What this word really means anyway? What is
                                       really behind it?


                                    We can appreciate the difficult English of this
                                 email, if for a moment we treat it as 'non-standard'
                                 English, and listen to the bewilderment manifested
                                 at the fact that the emotional attachment to
                                 legitimate authority inevitably refers us to some
                                 version of revolution and heresy, here it is Bruno,
                                 burnt at the stake for proposing to speak truth to
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                                 the prevailing authorities' standards. This email is
                                 a perspicacious example of this phenomena—
                                 common enough to be very recognizable on such
                                 newsgroups and mailing lists, and often just
                                 referred to, somewhat cynically by my informants
                                 as "religion and philosophy."

                                    The discussions are inevitably confused by this
                                 maneuver, where the artifactual nature of
                                 standards and the purely politcal game is confused
                                 with an extra-cultural progression towards truth.
                                 The result is that standards discussions very
                                 quickly become religious disputes, disputants very
                                 quickly recognize this, and in the end, the only
                                 arbitration is a grunt insistence an a piece of
                                 technology: "it works."

                                    These discussions came to make sense to me as
                                 a result of observing the differences between the
                                 Partners Telemedicine Center and Amicas,
                                 specifically with respect to the difference between
                                 the electrical engineer who learned information
                                 technology via night classes and Microsoft
                                 certification programs (Tim O'Neil) and the
                                 economist who learned programming and
                                 information technology on Usenet groups, from
                                 programming handbooks and O'Reilly texts, or
                                 just by asking around (Sean Doyle). Tim (as well as
                                 Dr. Kilborn) was a representative of an
                                 engineering tradition that valued consensus,
                                 certification, professional identity and treated

                                 standards as a kind of legitimate authority,
                                 whether they were the standards of a public or
                                 private entity. Sean on the other hand, preached
                                 the gospel of openness and open standards,
                                 partially as a result of his experience of learning
                                 via the internet's openness, and often referred to
                                 the Evil spread by Microsoft into the world. The
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                                 mutual unintelligibility of this choice is what I
                                 insist is the central and most imortant difference
                                 for standards setting specifically, but for the
                                 internet and the technical-legal society it
                                 programs in general.

                                    For now, two important distinctions:




                                    1) That between a standard that is freely
                                 available (though not free) to anyone and one that
                                 is not. In the first case, it may be copyrighted or
                                 not, and there may be a nominal charge associated
                                 with it, usually justified in terms of covering the
                                 costs of its development or publishing— and
                                 usually associated with a non-profit,
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                                         non-commercial organization that is made up of
                                         members of different companies in an industry.
                                         Standards organizations with the backing of
   Last Modified                         governmental authority are most often of this
   11-Sep-99 9:01 PM
   ckelty@mit.edu                        kind, but not always. In the second case, the
                                         standard may be unavailable because important
                                         parts of it are kept secret by the company that
                                         created it— thus a proprietary standard—
                                         especially if that company is the only
   Go Back to the Start                  manufacturer (and here, monopoly and antitrust
                                         issues become relevant, as do legislation protecting
                                         "trade secrets"). A company or standards
                                         institution may also engage in some commercial
                                         activity such as licensing the standard (which
                                         depends on some protection accorded by patent
                                         and copyright law, though this will be further
                                         complicated by software licensing practices, q.v.
                                         sections K and L) or engaging in some activity
                                         with another company that necessitates sharing a
                                         standard for the production of a specific
                                         technology. Examples include the standard for
                                         Microsoft Word documents, Adobe PDF files, or
                                         the Windows Operating system.

                                            2) That between a standard and an
                                         implementation of that standard. The published
                                         standard may be, for all intents and purposes,
                                         useless to most people (Sean Doyle: "there's open
                                         like in DICOM where people can use it but it might
                                         take them 3 months with a good C++ programmer


                                         to download the code and then understand it.")
                                         either because it is too complex or because it may
                                         set specifications that need to be tested and
                                         measured against something. Example: standards
                                         for weights and measures— whether a standard
                                         iron bar in the center of town, or the wavelength of
                                         a Krypton atom. Tolerance in Alder's work: the
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                                 devices for measuring tolerance in bore size need
                                 to be available to testers, not just a number. But
                                 more than this, in the world of software
                                 engineering and management, designers need
                                 implementations to work with— to test against,
                                 and to understand how a piece of technology
                                 works, either to reproduce it, or to fix it when it
                                 breaks. If you don't have the implementation of the
                                 standard, then complying comply with the
                                 standard adds a level of complexity to the creation
                                 of software that makes producing compatibility
                                 difficult enough to discourage the most persistent
                                 designers.

                                   In the case of this second distinction, standards
                                 are much more than simply about measurement or
                                 control: they provide examples to learn from, and
                                 challenge the distinction itself. It is possible (and
                                 indeed, required in some instances, as I explain in
                                 Chapter H) that an implementation could become
                                 the standard. That is to say: there is a working
                                 example of a protocol (or a piece of software),
                                 implemented in a working network, that is then
                                 declared a standard by a governing body. This is
                                 what the path dependency theorists theorize, but
                                 without the last step, so that, for instance
                                 Microsoft Word is the de facto standard for word
                                 processed documents, but certainly, no legitimate
                                 authority of any kind has declared it a standard.
                                 On the other hand the protocol for ftp is also a de


                                 facto standard— it was adopted in a similar
                                 manner, by use and incremental improvement—
                                 but was then declared a standard by the IETF (see
                                 chapter H). Those familiar with the internet
                                 understand this well: by making the source code of
                                 any system available, you allow not only massively
                                 parallel testing and development, but a working
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                                 implementation that people can learn from, copy,
                                 comply with, compare to, and for the entrepreneur
                                 in each of them: adopt. Sean Doyle tells a version
                                 of this distinction:

                                       S: Well, its also, very hard, because if the standards
                                       are sufficently complex— and almost all standards that
                                       are worth anything are complicated— if they don't
                                       come with a sample implementation then you know,
                                       you're toast.


                                    Sean is thinking here about the DICOM
                                 specification, which is a hopelessly complex
                                 document, and without a system to test against, or
                                 at least to look at, he insists, you're toast. Sean,
                                 however, gives a different and more complex set of
                                 examples to illustrate the point:

                                       S: If you look at the definition of the C language, you
                                       know, it's pretty terse, if you look at the one for Java,
                                       [the Java programming language definition is a
                                       proprietary standard wholly owned by Sun
                                       Microsystems, written James Gosling, Bill Joy, and Guy
                                       Steele, whereas ANSI C is a standard that was
                                       published by ANSI, and in 1990 included by ISO/IEC,
                                       Sean could be referring to the earlier specification by
                                       Kernighan and Ritchie, but it is unclear] it's really much
                                       longer, even though the language is much more
                                       semantically clean, and that's because they spent a lot
                                       of time trying to be really serious about having a
                                       language that is cross platform. The main thing is that
                                       they had a working implementation that other people
                                       could test against... you sort of need both the written
                                       [standard] and the implementation in order to make it
                                       go along.


                                   What Sean is trying to get at here is more
                                 complicated than he lets on. Trying to explore the


                                 relationship between a standard and an
                                 implementation in terms of computer languages
                                 doubles the complexity of the difference between a
                                 "written" standard and its implementation and a
                                 de facto standard as an implementation and its
                                 written standard. To begin with, a "language" is
                                 never implemented, per se, but would require a
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                                 compiler or an interpreter for that language, and
                                 in the case of C, it would have to be specific to the
                                 operating system and machine that it was to be
                                 run on. In the case of Java, as Sean points out, the
                                 specification for the language is more terse
                                 because they needed to include specifications that
                                 would allow it to work on several different
                                 operating systems, and potentially be expanded to
                                 others. Furthermore these technical details are not
                                 the only thing at issue, consider the difference
                                 between C and Java more carefully.

                                    The C programming language definition is
                                 available from the Online ANSI standards store for
                                 $135, 12MB, Document Number: ANSI/ISO
                                 9899-1990 (R1997). This means it is not a paper
                                 document (though you can get a paper one), that it
                                 is expensive, and that ANSI controls its
                                 distribution. The specification cannot be extended
                                 or transformed (which might seem obvious, since
                                 it is a standard, but it needs to be said, because
                                 this is not always true, only true in this instance).
                                 If you do change it, you are forgoing national and
                                 international standards, and would be unable to
                                 pass conformance statements that would give your
                                 implementation (of a complier, for instance) the
                                 ANSI stamp of apporval. If you wanted to get an
                                 implementation of the C programming language,
                                 you would need to find a piece of software that
                                 implemented the language for some reason, say, a


                                 compiler that turned C code into object code.
                                 There are several of these, such as gcc, the GNU C
                                 compiler from the Free software foundation
                                 (which is also free of charge). Or you could
                                 purchase whichever "software development
                                 environment" you might prefer (such as one of
                                 Microsoft's Visual Studios). However, only in the
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                                 former case would you be able to look at the source
                                 code of the compiler/development environment to
                                 see how it implements the C language
                                 specification. A proprietary environment will not
                                 include the source code, usually only the binary
                                 executables. Both may conform to the ANSI C
                                 standard, if ANSI has approved them, but ANSI
                                 does not police every implementation of C, which
                                 would probably be impossible. However, in th case
                                 of gcc, the source code is available and it is also
                                 'free' (see section K), which means that you could
                                 conceivably change it to produce a new version of
                                 the gcc (perhaps different than the ANSI
                                 standard), if you determined that was necessary
                                 for whatever reason. The relevant point for Sean's
                                 example is that if you only have a specification for
                                 C, you can't make it (perhaps your compiler) "go
                                 along" [4]. If you already have an implementation
                                 of the specification, you can at least copy its
                                 structure, or learn how it "worlks."

                                    The Java programming language definition, on
                                 the other hand, is wholly owned by Sun
                                 Microsystems and will be given to you for free on a
                                 limited license (one copy) here. This means that
                                 Sun owns the copyright to the specification and
                                 has licensed it on a per copy basis to people who
                                 want it. It is free of charge, but it cannot be
                                 redistributed. The specification cannot be
                                 extended or transformed under threat of legal


                                 action from Sun Microsystems. Sun provides a free
                                 (though also proprietary) programming
                                 environment called the Java Development Kit
                                 (Recently changed to the Java 2 SDK, there are
                                 versions of it for Windows and Unix). Under a new
                                 license, the source code is available, but still owned
                                 by Sun. Sun allows other vendors to create
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                                 development environments using the specification,
                                 but it contracts with them to implement the
                                 specification as they have designed it. Java is
                                 slightlly more complex in that it depends on the
                                 inclusion of an interpreter in the various Web
                                 browsers (for different operating systems) made by
                                 any web browser manufacturer to interpret the
                                 source code that is downloaded over the net (this
                                 is the theory behind the "write once, run
                                 anywhere" logic of Java). The inclusion of this
                                 interpreter depends on a complex licensing and
                                 contracting practice that tries to incent browser
                                 manufacturers to include an implementation of
                                 Java in their browsers. If the browser manufacture
                                 implements the language according to spec, it
                                 should run any jave program written on any
                                 platform. This was the subject of Sun's law suit
                                 against Microsoft in 1998, because Microsoft
                                 implemented a version of Java that did not
                                 correspond to Sun's specifications for Java, and
                                 thus did not always run Java programs the same
                                 way, or at all. Sun claimed a breach of contract.
                                 The point, I take it, for Sean, is that in the
                                 development of the various interpreters in various
                                 web browsers for Java, Sun had provided an
                                 implementation of Java-compatible browser to fro
                                 developers of the interpreters to test against. This
                                 made cross-platform compatibility easier than
                                 each having to write an implementation based
                                 soley on the specification of the language.

                                   Sean offers a second example, this time of a
                                 protocol, that is also meant to prove this point:

                                       I've heard, and this may be a bit of folklore, that
                                       TCP/IP, you know, one of the reasons that worked so
                                       well as a standard was that some of the initial
                                       implementations were part of the UNIX kernel and they
                                       were made free [such as, perhaps, an early version of
                                       BSD], and so when there were things that weren't in
                                       the spec you could look back at the implementation and
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                                       the spec you could look back at the implementation and
                                       say "I want to make it compatible with this one" then
                                       you could make it work that way. So it's really not
                                       enough to have the paper, you need to have an
                                       implementation, and it's really hard to have the
                                       incentives, for people to release both the
                                       implementation and release the code.


                                    The last sentence is crucial for these distinctions
                                 with respect to the internet: having a standard is
                                 one thing, having an implementation of a standard
                                 is a second thing, having the source code for that
                                 implementation (in the case of software) is still yet
                                 a third thing. Having all three is often too much to
                                 ask. The distinction Sean points to— between the
                                 paper specification of a standard and the working
                                 implementation of a standard and its source code
                                 is recapitulated by every story of the internet, even
                                 if the conditions of possibility of this story (ARPA's
                                 hand in the development of the internet, or the
                                 NSF's, or the instiitutional conventions of
                                 university computer scientists) are effaced or
                                 troped. It is the case that this distinction is
                                 meaningful to many of the actors who write
                                 software or build networks— and it suggests that
                                 what people find compelling about the story is the
                                 suggestion of its openness, specifically that one can
                                 use it to learn how something works.

                                   These examples should at first recall the
                                 distinction between a patent and its device, and
                                 the problematic issues of toggling between them,
                                 especially in the case of "technology transfer." But


                                 they should also give just some sense of the
                                 quadrilateral set of concerns: national and
                                 international legitimacy, availability and
                                 accessibility, corporate ownership, and
                                 workability. The corners of this shape fold to meet
                                 in a variety of conformations, and the difference
                                 between any two engineers will often depend on
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                                 which corner is most dog-eared.

                                   My use of this paralellogram of interests is in the
                                 the comparison between Partners (Tim O'Neil)
                                 and Amicas (Sean Doyle). Partners developed no
                                 software of their own, preferring to outsource most
                                 of the technical work, but this did not make them
                                 immune to standardization issues, or to the
                                 relation between standards and communities of
                                 practice, or the necessity of knowing how things
                                 work in order to make decisions about what to
                                 spend money on. For Partners, legitimacy rests
                                 outside the organization, in the structure of
                                 certification and recognition that makes up the
                                 national medical-corporate establishment. This
                                 history of standardization and certification is at
                                 least a century long, and mixes the recognition of
                                 authority in the person of the doctor with the
                                 baptism by the hand of the administrative state in
                                 the guise of the various professional societies.
                                 Goodness, skill, rightness, truth— all issues of pure
                                 validation, peer-review by the proper authorities.
                                 Authority precedes (both personal and
                                 institutional), accreditation follows, credentials
                                 bear witness. For Sean and Adrian, this history is
                                 the reason that healthcare is a frustratingly
                                 anti-competitive environment [5]. For Tim O'Neil
                                 and others at Partners, this authority is both a
                                 bureacratic hassle, and a positive external
                                 guarantee of quality— or at least the promise of


                                 quality, even if they are sometimes cynical about
                                 it.

                                    Amicas therefore serves as the example of a
                                 company that insists on the necessity of both the
                                 standard and the implementation (though not yet
                                 necessarily the source code): it works, and the only
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                   Section Header
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                                 F.Healthcare's standards
                                      A focus on healthcare — the knot of healthcare
                                      standards is partially unravelled — medical
                                      education standards and standards concerning
                                      specialties — the role of scientific authority in
                                      standards — scientific accounting — computers in
                                      medicine — clinical decision systems — technical
                                      standards and nomenclatures — the knot of
                                      healthcare standards is severed, leaving radiology
                                      standards — radiology workflow — diagnostic
                                      standards — DICOM takes up space — and time —
                                      informants are called upon to distinguish
                                      standards — Sean talks of DICOM and HTTP —
                                      Tim talks of IP and OSI — stupidity beckons.



                                            The number and kinds of standards in
                                          healthcare is overwhelming. The word itself is a
                                          disseminated and weak word that is used just as
                                          often to refer to a moral imperative as it is to a
                                          specific, institutional standard. The present
                                          inchoate demand for standards in the hospitals I
                                          observed is not wholly new, and the word
                                          'standard' itself has a notorious and important
                                          history in 20th century healthcare.

                                            To begin with, there is a semantic confusion that
                                          cannot always be relabeled: standard as a
1.     See     Marc    Berg's             minimum level of quality, beneath which doctors
Rationalizing Medical Work,
Chapter 1 for a discussion of             and hospitals should not slip; and standard as a
this [Berg97 ]
                                          measure for comparison and control. The
                                          confusion is complex, quality fades to quantity and
                                          back again in each empirical example, as each
                                          problem of improvement demands its own
                                          measure. Measures might tend towards the
                                          objective in Porter's sense, or toward the
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                                         ideological, as a cover for power. Convention,
                                         guideline, protocol, rule all have a similar
                                         vagueness, but they all signal a similar desire to
                                         figure out a way to progress. A call for standards
                                         most often hides a call for some kind of
                                         measurment of quality, often elided in call itself,
                                         since it is precisely that slide between medicine as
                                         a science and medicine as an art that is at issue in
2. The original report was
published in 1 91 0, see                 such discussions [1]
[Flex ner1 0].           For
information on its impact on
the dev elopment of teaching               The Flexner report, for example, is a commonly
hospitals      and   medical
schools, see [Ludmerer85]                cited example of the beginning of the
and [Burrow7 7 ].
                                         standardization of medical schools. The
                                         measurement of such standards however, was by
                                         no means itself 'standard' but represented a
                                         long-standing elite consensus on reform . However,
                                         its effects were extremely significant, despite their
                                         justification now or at the time, and the report has
                                         become, in a strange roundabout way, the
                                         "standard" reference for doctors of the
                                         improvement of medical practice [2]. As such it
                                         served as a kind of legitimation for other attempts
                                         over the course of the Progressive era to institute
                                         standards. Flexner had collaborated with the
                                         American Medical Association's Council on
                                         Medical Education, which controlled the rating of
                                         colleges [3], as well as writing the report for the
3. See Rosemary Stev ens,                Carnegie foundation. The combination gave the
A merican Medicine and the
Public Interest, p. 66ff                 new "medical standards" legitimacy in the double
[Stev ens7 1 ].
                                         form of the AMA's stamp of approval and the
                                         virtual guarantee of foundation grant money as
                                         well. It was not an accident that Flexner stressed
                                         the role of the university as medical educators,
                                         over the proprietary medical school [4]. During
                                         this time, the professional organizations also
                                         developed or expanded institutions to monitor,
                                         certify, and licence doctors, nurses, hospitals, and
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                                         schools. The structure of rhetoric was the same, a
                                         "standard" identified always as something
                                         everyone would agree should be improved, used as
                                         a political tool. The growth of specialties in the
                                         same period is yet another example as
                                         orgainzations like the American college of Clinical
4. See Brown, Rockefeller
Medicine Men, [Brown7 9]                 Pathologists and the American College of Surgeons
                                         formed and gained power over their members,
                                         licencing boards were used to prevent the growth
                                         of other specialties, like osteopathy and
                                         chiropractic medicine, as well as to increase the
                                         power of state licencing boards in the face of
                                         potential government control [5].

                                            Rosemary Stevens makes a strong case for
                                         viewing these transformations in healthcare as a
                                         kind of national medical enterprise [6]. The
                                         intense desire for scientificity that historians have
                                         located in so many areas of early twentieth century
                                         life (from taylorism and scientific accounting, to
                                         sociology and economics) was certainly no less
                                         present in medicine, and formed some of the basis
5. See [Burrow7 7 ], chapter
4.
                                         for "standardization" such as the strengthening of
                                         hospital administrative staff and the
                                         implementation of "scientific accounting"[7].
                                         Science bred authority, authority allowed
                                         benevolent control, and everything from
                                         recalcitrant cancers in the mouths of presidents to
                                         the sewers beneath (or inside) Tamany hall were
                                         fair game for the simultaneous improvement of
                                         health, medical authority and national pride.
                                         These national infrastructural standards bear
                                         comparison, or geneology, because they occasioned
                                         similar debates about the nature of legitimate
                                         authority, the role of government in delegating the
                                         authority to standardize and oversee to
                                         administrative bodies, professional societies, and
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                                         corporate interests. The quantification of quality is
                                         necessitated as soon as the rule of law meets the
                                         demand for expertise. The standards are not
                                         "information technologies" as Alder might call
                                         them, but closer to Porter's trust in numbers— the
                                         beginings of an age of accountability unto
                                         accounting.

                                           Scientific Accounting is usually represented as
6.     Stev ens,  A merican              the beginning of "information technologies" in
Medicine, [Stev ens7 1 ] and
Sickness      and   Wealth,              healthcare, by virtue of the growth of the
[Stev ens89]
                                         standardized medical record it produced, and the
                                         subsequent possibility of comparison it created.
                                         Interestingly, there has been little historical work
                                         on previous schemes for measuring the efficiency
                                         of hospitals, especially in terms of the "outcomes"
                                         (a fraught word that, like "information technology"
                                         would be anachronistic here) of patients. However,
                                         a certain story circulates in the trade and business
                                         press of hospital administration in my fieldsites,
                                         about Ernst A. Codman. Codman is identified as
                                         the origin point of "outcomes measurement" [8].
                                         His standardization reforms, more familiar to a
                                         history of taylorism than of medicine, have become
                                         a kind of historical object lesson for contemporary
                                         efforts to measure patient outcomes. His desire to
7 . See Howell, Technology               record data, and to make it available to hospitals
in the Hospital [Howell95]
                                         and doctors rings common sensical to ears
                                         adjusted to the sound of mortality and morbidity
                                         rates. But as Millenson notes, his reforms had little
                                         financial impact at a time when the Flexner
                                         Report's blessing combined with the AMA's rating
                                         of med schools, usually meant massive
                                         endowments from Carnegies and Rockefellers, for
                                         which it was more lucrative to compete. Codman's
                                         failed attempts at reforms left him looking a little
                                         inhumane (which seems to have been exacerbated
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                                            by his tendency to make bets with his fellow
                                            doctors on who could achieve the best numbers).

                                              Over the twentieth century, both the medical
8. The Culprit here is
Michael Millenson's recent                  enterprise and the methods of measuring and
journalistic          history ,
Demanding             Medical               standardizing information have grown
Excellence, [Millenson97 ]. I
suspect that its popularity                 significantly. Bonnie Kaplan's study of the
among businessmen and
doctors has caused the                      computerization of medicine cites a persistent
Codman        sightings     to
substantially increase in the
                                            sense of "lag" in the perceptions of medical doctors
last few y ears.                            of the pace of this change, and the result that
                                            computerization is often used to justify certain
                                            policy changes in the name of improving quality
                                            and efficiency [9]. The education of doctors, and
                                            the specific languages of medical diagnosis and
                                            treatment have met the demand for
                                            standardization as a result. One of the most
                                            common calls for research in the early literature
                                            on computerization was for the creation of
                                            databases of medical knowledge and "clinical
                                            decision systems" [10].




9.      Bonnie      Kaplan's
dissertation [Kaplan??].
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                                             Clinical Decision systems are already a kind of
                                           classic problem for the ethnomethodologist and
1 0. The first major article to
call for the scientific use of
                                           the sociologist of work. Marc Berg's Rationalizing
computers       in   medicine              Medical Practice is an instructive introduction to
came in 1 959 in Science
from Robert S Ledley . In it               the localization of theories as tools and the
he initiates the justification
for computerization that is                difficulties of medical action that result.
based on the ov erwhelming
amount of data and for the                 Information cleaves to the theoretical in these
use of computers to help
doctors make diagnoses. It                 cases, as a kind of distilled scientific theory that
is    precient     and    v ery
emphatic: "Such a current                  doctors are trained to occasion. Of course, action
information-transfer sy stem
could giv e the phy sician                 in the medical domain has never been so simple,
instant reference, in his
office, to research results
                                           and it is only in cognitivist and behaviorist
taken        from      articles            accounts that it is represented as such, much less
published in hundreds of
journals, or perhaps direct                experienced as such. And yet, the scientificity of
from research laboratories
[Ledley 59].                               medicine, especially its use of statistics and
                                           probability, is its highest virtue, and the doctor
                                           that rejects it is rare. So the problem of
                                           standardization and classification becomes less a
                                           problem of showing that medical reality is messier
                                           than medical science, and more a pragmatist
                                           problem of adjusting available scientific measures
                                           and information to a constrained series of
                                           situations. [11]

                                             Today, the number and kind of standards is
                                           huge. Any given professional medical organization
                                           will offer a variety of practice guidelines, ethical
                                           guidelines, medical statements, care protocals,
                                           ethical positions, scientific statements, prevention
                                           guidelines— the list is nearly infinite [12]. Some
1 1 . See Berg, Rationalizing
Medical Work [Berg97 ] and                 are legally binding and intersect with
Star and Bowker, "How
things (actor net)work,"                   administrative and legal concerns for both
[Star96] which uses the
ICD-1 0 as ex ample in their
                                           patients and doctors, some are purely political
study of classification and                (statements on assisted suicide for instance), and
standardization.
                                           most are very specific protocols for doctors that
                                           represent a professional organization's customs,
                                           scientific opinions, in codified form. Then there is
                                           a range of technical standards and standard
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                                           nomenclatures that exist to help standardize
                                           things, machines, procedures, and language,

                                             The standards that govern the machines, or the
                                           components that make up the machines (for
                                           instance, those published by the National
                                           Electronic Machinery Association {NEMA}, the
                                           American National Standards Institute {ANSI} or
                                           the Institute of Electrical and Electronics
                                           Engineers {IEEE}) intersect uneasily with the
1 2. See, for ex ample, the
ethics     page     for    the             proliferation of standards, codes and
A merican       Psy chological
A ssociation,      or      the             nomenclatures of the medical field (The
accreditation pages of the
JCA HO, or the standards                   international classification of Diseases {ICD9,
page of the A CR
                                           ICD10}, the Logical Observation Identifiers,
                                           Names and Codes {LOINC™}, or Systematized
                                           Nomenclature of Human and Veterinary Medicine
                                           {SNOMED}) which are only partially integrated in
                                           the various attempts at systematic standards for
                                           storage, transformation and communication of
                                           medical information (The Digital Imaging and
                                           COMmunication standard {DICOM} and the
                                           Health Level Seven {HL7}). To complicate matters,
                                           most nomenclatures and codes, as well as several
                                           of the communication protocols are developed by
                                           specialty: ambulatory, acute care, pathology,
                                           radiology, nursing, pharmacy, dentistry, public
                                           health all have systems specific to them that are
                                           not designed to communicate with the others. And
1 3. A central resource for                of course, when a standard involves a specific piece
this univ erse of standards is
the Duke Medical School's                  of technology, such as a CT scanner, there are
Health             informatics
Standards page                             various corporate-owned formats and standards
                                           that must be included. The list is complicated
                                           enough to merit research groups devoted to
                                           standards, such as the one at Duke University
                                           Medical School, which appears to be at the center
                                           of the healthcare standards universe [13].
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                                             The original calls for standards have generally
                                           been made in the name of reducing the existing
                                           complexity of the healthcare industry. Ironically
                                           the field is so dense with standards that even the
                                           DUMC standards research group uses the Tower of
                                           Babel as its emblem. However, the metaphor of the
                                           Tower of Babel slowly loses its force as a warning,
1 4. I detail this change in               and becomes a myth of failure, in particular, of an
infrastructure and the call
for integration in chapters P              aging system of organization in healthcare. The
and Q.
                                           fact that standards have become important to all
                                           participants in healthcare not only as a technical
                                           sine qua non, but as a kind of disciplinary
                                           demand, a commercial imperative, or now,
                                           especially, a moral one (q.v. "quality of care"
                                           debates, accredidation agencies, the media life of
                                           the HMO-as-villain, stories of stupid mistakes and
                                           denials of care), signals that some other kind of
                                           convention has lost its power. Whatever it has
                                           been over the course of the twentieth century that
                                           has allowed the particular organization of
                                           healthcare in America to resist being dismantled
                                           (whether inertia, the prestige of the Hospital as an
                                           emblem of America, or the power of professional
                                           groups' interests), the demands for
1 5. Recent studies of the                 standardization today, always call for the
role of professional and
ex pert groups grapple with
                                           "integration" of healthcare [14].
the    question    of    their
legitimacy . See Boltanski,
Cadres,[Boltanski82],                        Formal nomenclatures, bodies of rules, and
Boltanski and Thev enot, De
la              justification,             software and communication standards are the
[Boltanski91 ] A bbott, The
system      of   professions               quotidian appeal of editorialists, journalists and
[A bbott88].
                                           doctor-engineers everywhere. These demands often
                                           take the place of an appeal to the medical
                                           authority of the doctor, or to the embodiment of
                                           standards of excellence in his person [15].
                                           Certainly these calls often supplement the calls for
                                           the improvement of medical education with the
                                           improvement of existing doctors retraining in
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                                           computer skills. If this distinction between the
                                           hierarchical, paternalistic authority of the doctors'
                                           standards (bearing a burden of history that must
                                           be reproduced through the customs and rituals of
                                           training and eductaion, themselves subject to
                                           standardization, which do not disappear, only fade
                                           in terms of power) [16], and the objectified rules
1 6. On medical authority ,
see      Robert        Pippin              for the standardization of medical concepts, terms
[Pippin96]. In the particular
case of authority with
                                           and procedures is allowed, then we can temporally
respect to technology in                   site the relations of scale and convention in
A cademic medical centers,
see     V ictor     Braitberg              healthcare.
[Braitberg97 ]


                                             Organizations (and specifically the Hospital) that
                                           once served as boundaries for this culture fall away
                                           and the primitive operators of healthcare become
                                           information and communication. The changes
                                           that Amicas identifies in rediology and radiology's
                                           confrontation with the internet are an example of
                                           this relationship between culture and standards,
                                           between scalability and location. The
                                           re-integration of healthcare's infrastructure as the
                                           internet (q.v. Chapter Q) is a response to a
                                           fragmenting national medical enterprise, and the
                                           examples of radiology, teleradiology and
                                           telemedicine are particularly important to
                                           understanding this transformation. The
1 7 . On the image of cultural             asynchrony of healthcare, its willful contradictions
authority ,    see    Deborah
Stone [Stone97 ], changing                 of traditionalism and progress, militate against a
politics of cultural icon. On
subjectiv ities and regimes of             simple break from the era of the cultural authority
representation,            see
Foucault, The Order of                     of physicians to the technical authority of
Things [Foucault7 3]
                                           standards. Yet the transition that occurs at the
                                           level of representation (the information and
                                           communication of images for the purpose of
                                           diagnoses) has a tangible effect on the
                                           configuration of before and after. It not only
                                           creates a new organization, it builds subjectivities
                                           that can negotiate that structure [17].

                                              In the radiology context, the standards are
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                                                 In the radiology context, the standards are
                                              equally complex, but at least enumerable [18]. The
                                              standards that govern the image, the diagnosis of
                                              the image, any manipulation of the image, and any
                                              kind of radiological treatment are governed
                                              primarily by the American College of Radiologists,
                                              first through an array of diagnostic standards
                                              (availble at the ACR website) and second through
1 8. There is no historical
work on the standards of                      the creation of the Digital Imaging and
radiological imaging, such
as DICOM            ex cept    for            Communications Standard (DICOM, in
industry occasionals and
society histories. There is an                collaboration with the National Electronic
introduction         to    DICOM
av ailable at the PSU DICOM                   Manufacturers Association (see more, below). It
page. In terms of more
general work on radiology                     would be false, however to suggest that they are in
and     radiology        imaging,
there are sev eral works that
                                              control of all the standards. Especially in the case
discuss history and social or                 of digital modalities introduced by commercial
cultural            implications.
Ultrasound is studied by                      companies into hospitals, the technical formats for
Ellen B. Koch [Koch93],
which is in a 'special' issue of              images were initially (and remain) proprietary.
Technology and Culture
dev oted         to       medical             Steven Barley's dissertation [19] on the entrance of
technology .         The      best
technical history of the                      digital imaging technologies in radiology describes
v arious modalities is by far
is Stev en Webb's From the                    how the change from film to digital imaging
Watching         of     Shadow s
[Webb90]. Others include                      affected the practice of producing reading and
Origins and Development of
Medical Imaging [Doby 97 ],
                                              diagnosing from such scans and it is useful as a
Ronald Eisenbergs general                     comparitive historical point. Barley describes what
treatment         [Eisenberg92].
Betty A nn Kev les' Naked to                  the introduction of new "modalities" did to
the Bone [Kev les97 ] tells
many       stories        without             radiology, at the time, he claimed "it is in the
obsessing the           technical
details        or        engaging             creation of new modalities that computers have
theoretical problems. Joel
Howell's Technology in the                    played their greatest role in radiology." Each
Hospital [Howell95] traces
the history of X-ray s briefly                modality— CAT, Ultrasound, PET, DSR— initially
in two hospitals in A merica
in the teens of this century ,
                                              produced data in its own format. This make sense,
but         prov ides           no            if we consider that until the mid eighties (and in
contex tualization by media
or medical history . The                      all of Barley's examples) the end point of imaging
early standardization of
X-ray s and the professional                  study was a film printed out for a radiologist to
struggles       that      erupted
between medical doctors                       use in diagnosis [20], the digital data doesn't need
and those doctors or staff
who became technicians by                     to leave the machine, and if it does (on a magnetic
familiarity might serv e as an
illustrativ e           historical            tape, for instance) it is under the assumption that
comparison          for    similar
present       struggles.       But            viewing it means putting it back into the same
Howell's focus on the
immiseration of doctorly
                                              scanner. Of course it is also Barley's point that the
subjectiv ity by standardized                 standards of diagnosis published by the ACR also
forms and tay lorizism in the
hospital is romantic at best.
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                                           changed as a result of the introduction of new
                                           technologies.

                                              However, the standards relevant to the question
                                           at hand are those that conquer distance. Short and
                                           Long. For the "modalities" of Barley's thesis the
                                           transmission of images is an afterthought. In
                                           digital terms, such modalities are imagined as
                                           self-contained, even if that self-containment
In terms of literary and
cultural      studies      Lisa
                                           includes a local network of workstations and
Cartwright's Screening the                 devices. Imaging in healthcare, conceived as
Body [Cartwright95] on the
filmic history of medical                  broadly as possible, has been primarily a film
imaging does a beautiful job
in identify ing precisely the              medium, born of photography and intimately
linkages between the film
and media history and                      connected to that world through corporations like
medicine. Much more detail
and continuity is filled in by             Agfa, Kodak, 3M, Polaroid. X-rays set the standard
the timeline with Brian
Goldfarb              included             early on. The work flow of examination, x-ray, and
Incorporations [Kwinter92]
that traces the twin histories
                                           diagnosis was built up and sedimented around the
through      the    twentieth              film. Consider then, the transmission of images in
century . There is an article
from       Literature      and             the case of film. The "communication" of film
Medicine by A llen Grov e
[Grov e97 ] on V ictorian                  images means simply moving them around by
imagination                and
radiographs. Joe Dumit's                   hand, or by taxi or by an individual hired
history and ethnography of
PET Scanning [Dumit99] is                  specifically to run films back and forth from a
without peer, and Wen-Hua
Kuo [Kuo98] has written an                 library or archive to a reading room or to doctors
ex cellent piece on the
struggles of doctors and                   offices. Even when the CT Scanner and Magnetic
radiologists              ov er
mammography . From the
                                           Resonance Imaging came onto the scene during
social science literature                  the 70's and 80's, the practice was to print the
comes       Stuart     Blume's
Insight      and     Industry              digital images onto film, as is evident from Barely's
[Blume92]and along with a
host of oter policy and                    dissertation. This allowed them to be viewed in the
innov ation             studies
constitute the bulk of                     same rooms, with the same technologies that had
studies of medical imaging,
and offers the kind of                     grown up around X-rays (viewing boxes, and the
assessment that play s in
policy circles in terms of                 big mechanical drums, cylinders and boards that
deciding on the cost and
benefit of new technologies.
                                           allowed radiologists to view several images next to
                                           each other and in rapid succession)[21].
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                                                Even today, when many hospitals are installing
                                             computed radiography (CR) stations for taking
                                             X-rays, such fully digital X-rays are still printed to
                                             film (as are the digital CT and MR scans), as a
                                             result of an institutional and organizational
                                             workflow that knows little of the digital
                                             communication of image and text. Massachusetts
                                             General Hospital, for instance, was still at full film
1 9. See Stev e Barley , The                 production until April of 1997. The transition to
Professional,            The
Semi-Professional, and the
                                             viewing digital images on digital screens is still not
Machines [Barley 84]                         complete [22]. In this site the entrenched
                                             conventions emplotted by one technology (x-rays,
                                             and their kin) serve as model and metaphor for
                                             subsequent innovations. The organzational
                                             theorist, or the sociologist would be at home here
                                             following workflows and watching the negotiations
                                             wrought by uneven technical constraints,
                                             professional identities, moral authorities. At the
                                             limit, however, moving digital images chip at the
                                             very boundaries of the organization that would
                                             contain these intellectual interlopers— challenge
                                             the very possibility of identifying a hospital as the
                                             locus of practice— as it does in my case.

                                               Enter telemedicine. Telemedicine has never been
                                             the sole province of any specific discipline or
20. This, of course, is
assuming the radiologist has                 professional society. It's history seems to be one of
not diagnosed it on the
scanner's screen itself, but                 isolated research projects of a variety of medical
this would require the
radiologist be in the room—                  specialties. Over the thirty years that it has existed
and it is Barley 's intention to
show that this and v arious                  in various forms, and in various places it has
other required technical
procedures         are     what              remained relatively obscure. One reason that
changed      the      respectiv e
statuses of the radiologist
                                             "telemedicine" has remained so unknown and so
and the technologist as a                    powerless has been its singular focus on the
result of the introduction of
these technologies.                          arbitrariness of the very powerful boundaries of
                                             the hospital. The boundaries of hospitals and
                                             specialties sedimented over a century are not so
                                             obviously removed even when efficiency, patient
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                                           care, and access claim self-evidence. This is the
                                           persistent frustration of telemedicine researchers
                                           [23].

                                             The irony of telemedicine should not be lost here.
                                           Those individuals who saw the potential of
                                           telemedicine in the 70's and 80's saw it as the
                                           possibility of transmitting images over long
                                           distances— between two organizations whose
                                           institutional connection (or lack of) was nothing
21 . To date, no studies hav e             more than a bureaucratic roadblock to the
appeared          of      the
technologies of v iewing,                  innovative researcher. The mundane problem of
collaboration, and diagnosis
that were inv olv ed in                    transmitting images from a CT scanner to a
reading       films—      the
infrastructure       of   the              physician's computer in an adjacent office was
workflow that is replaced by
the internet and the desktop
                                           ignored, in part because the problem was already
computer— especially in the                practically solved (by physically moving film
contex t of large teaching
hospitals that may hav e                   around, or by running a wire from the CT scanner
used them for teaching.
Smells like research.                      to the radiologists' workstation) and in part
                                           because it never would have had the sexiness
                                           necessary to generate research money. When
                                           interest in solving this problem met the internet
                                           something like telemedicine finally begain to
                                           appear at the back door, though without that
                                           name and at the expense of existing projects that
                                           called themselves telemedicine. This is precisely
                                           the fate of Partners Telemedicine at the MGH,
                                           where tele-radiology is conducted without their
                                           help, or oversight, because of the development of
                                           technologies like Amicas and its predecessors in
                                           R*Star and the company that became WorldCare.
                                           It is in this context that Adrian Gropper turns out
                                           to be a far better organizational theorist than any
                                           in the university, having identified precisely these
22. One reason regularly
giv en for this is the                     constraints of the film workflow and precisely the
resistance     that   (older)
radiologists working at MGH                capacity of the internet to supercede them [24].
hav e   to    changing the
workflow.        For      the
established       radiologist,
learning how to use a whole
new sy stem is unsuitable to
productiv ity or cuts into
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                                             Since the standards (or proprietary formats) that
                                           existed for the image capturing devices of the 70's
                                           and 80's treated them largely as stand-alone
                                           devices that would be installed one at a time in
                                           hospitals or clinics, even when images were moved
                                           around, they were moved from, for example, a GE
                                           CT Scanner to a GE CT Technician workstation, to
                                           a GE archive, to a GE film printer. The fact that
                                           GE didn't make all of these devices rarely posed a
leisure time, which means
that only those (y oung)                   problem for the customer: GE sold the whole
radiologists who are "early
adopters" learn to use the                 workflow to a hospital, along with software,
technologies,     and     they
rarely hold the key s to the
                                           training, service, repair and little lables that said
power that would allow                     'GE'. In many ways, this strategy reflects the era of
reorganization              to
accompany            technical             vertical corporate integration that went largely
progress. Whether the story
has truth to it is hard to                 unchallenged until the 70's, and for a relatively
discern, though I          did
witness my fair share of                   protected realm like healthcare, well into the 80's.
older    phy sicians     being
treated   like    idiots    by             Standardization in this context is therefore was
y ounger techs, radiologists,
or support staff.                          not an issue of compatibility at the level of image
                                           capture devices, and certainly not at the level of
                                           the image.

                                             In early 1983, the DICOM committee was formed
                                           by the ACR and NEMA. The original impetus,
                                           according to an article by Bidgood [25], was to
                                           create a standard that would allow an "interface
                                           between imaging equipment and whatever the
                                           user wanted to connect," and "a dictionary of the
                                           data elements needed for the proper image display
                                           and interpretation. The ACR's role, presumably
                                           was to specify those data elements. First published
                                           in 1985, it was designed primarily to standardize
                                           point-to-point transmission of images. We might
                                           assume thatsome version of telemedicine played a
23. Telemedicine is another
area with scant scholarship.
                                           part in justifying the development of the standard.
See Cartwright, Braitberg,                 According to Sean Doyle, it was largely a
Bashur, etc.
                                           quasi-academic effort to produce an extremely
                                           rigorous and complete standard concerning the
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                                        presentation, storage, and transmission of
                                        images— too rigorous for his tastes.
                                        Quasi-academic, Sean suggests, because it was
                                        clear to everyone involved that GE played an
                                        enormous role in getting the standard written. The
                                        original DICOM standard (Version 1.0 1985-88),
                                        because it began as an attempt to provide only
                                        point to point transfer, had no rules for using an
                                        existing network. In some ways this is telling: it
                                        signals the strength of the boundaries that existed
                                        around radiology, and around hospitals, that the
24. His diagram in the
                                        designers started with the assumption that users
Poly unsaturated                        would be in control of all of the layers, from
introduction, chapter C,
captures this precision.                application to the wires it ran over.

                                          Soon enough, however, the demands from users
                                        to connect to independent networks led the
                                        DICOM committee to begin work on defining the
                                        transmission of images using two protocols in
                                        addition to the point to point protocol of the first
                                        version: TCP/IP and ISO-OSI. That the standard is
                                        defined for both protocols reflects both its
                                        deliberate complexity, and the nature of the
                                        competition between these two standards
                                        (discussed in more detail below). According to
                                        Sean (perhaps with a dash of conspiracy theory, or
                                        perhaps just because he is an internet proselyte),
                                        the DICOM standard has resisted the inclusion of
                                        such "open" standards as TCP/IP because for large
25. Bidgood, et.al "Dicom:
A n Introduction to the                 companies like GE, such openess was viewed with
standard, av ailable at the
PSU DICOM page                          suspicion. Sean offers a brief description of how
                                        GE and its model of vertically integrated control
                                        affected hospitals:

                                              It was made really clear to me by this one engineer
                                              slash sales guy that it really wasn't in their interest to
                                              let other people connect to GE stuff. You know, if they
                                              could sell, like a tape drive that they got from HP and
                                              put a private label that said GE on it and then charge a
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                                                 lot more money for it, that was a lot more lucrative for
                                                 them. And he also said it was better for the customer,
                                                 because the components on the market weren't really
                                                 components, they really required a prime vendor like GE
                                                 to pull them all together and when things failed in a
                                                 hospital they wanted a single point of contact in the
                                                 hospital, they wanted to call GE. ANd if GE's gonna take
                                                 that call, they need to get the reimbursement, so I
                                                 thought what they did was rather extreme, but there is
                                                 some truth to their argument.

26. Sean is clev erer than
that, howev er, and notes                    The truth to this argument is that hierarchically
that there were alway s
blurred boundaries between                 organized firms supposedly manage failure better,
academia and industry :
"Y ou know there are a                     where a system of non-integrated firms each
number of academics who
hav e made it (I put                       focussing on separate parts would lead to chaos, or
'academic' in quotes there,
people     who    work     for
                                           worse a total lack of liability leading to moral
academic medical centers                   collapse (and, of course, all of these implications
that are funded by industry ,
y ou know they get grants                  depend on the status of the standards that would
and research monies and all
that), there are a number of               allow such an organization). Adrian Gropper and
people that really built their
careers on DICOM, and um,                  Sean Doyle would both disagree strenuously (with
y ou know for a lot of them
the motiv es were, they                    the benefit if hindsight from atop the internet).
really wanted things to be
open, but I think a lot of                 The success of large organizations in getting
them just didn't notice what
was happening on the                       technology to work and keeping it working has
internet, and right now it
looks like the thing they
                                           nothing to do with their hierarchical structure.
built their career on could                Large vendors promising total solutions are
cav e."
                                           Adrian's bugbear, especially in an era when the
                                           process of technology innovation has become
                                           increasingly cyclical, as parts of the network and
                                           computing infrastructure become
                                           "componentized" or "commoditized." To him, this
                                           is every reason for to users take control of their
                                           own tools. Sean continues this thought:

                                                 But now it's what seven years later? Components are
                                                 much more real. You know different SCSI devices from
                                                 different manufacturers really do work together.
                                                 Ethernet cards from different manufacturers, even at
                                                 MGH in 1990 or so, just putting different PC's on the
                                                 local net was problematic because different vendors
                                                 equipment worked very differently. So its not that
                                                 they're, that it's all nefarious motives, it's that the
                                                 world has become a much more open place, where
                                                 different devices and protocols are commodities.

27 . Of course, this raises an
entirely separate issue: is it
necessary        to      hav e
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                                             Sean realizes that there is a kind of temporal
                                           displacement that has driven corporations to try
                                           and resist the "componentization" of technologies.
                                           Speaking in 1998, however, Sean has little respect
                                           for corporations that simply resist the possibility
                                           of really improving healthcare by taking advantage
                                           of the openness and interoperability he sees
                                           everywhere. Though he maintains some cynicism
                                           about the hype of openness (from open standards
interactiv e
v ideoconfernecing          in             to open source, he sees the protocols of the
medicine? It was a question
that Dr. Kilborn repeaty edly              internet, like HTTP and HTML, as the very model
posed to me, by asking what
the          "v alue"       of
                                           of openness (and I would agree with him). His
v ideoconferncing was. By                  story emphasizes the university as the origin of the
the time I ended my stay
there, it was pretty much                  standard in order to suggest (and I disagree with
agreed that asy chronous
collaboration was superior,                him) that standards are more likely to be open if
and           that         the
v ideoconference, especially               corporate interests are not involved [26]:
between two doctors in two
different parts of the world,
and       giv en      doctor's                   The closest [to an open standard] was probably HTTP
notoruiously              bad                    and HTML and that's because it started getting defined
scheduling practices, was
definitely more difficult that                   outside of the commercial realm, you know it was like a
it was worth.                                    commercially trivial thing, there were like these
                                                 researchers trying to set up this global mind, you know,
                                                 to communicate around the world, and some of them
                                                 were really clever and they did a good job and they
                                                 were focussed on what they did and so you ended up
                                                 with something that actually worked...


                                             The objectives of the internet are obscured here,
                                           partially because Sean is arguing for its difference
                                           from the world of proprietary systems and
                                           industry standards, but also because, for many
                                           participants in the growth of the internet, its
                                           motives must remain pure (ARPA, for instance, is
                                           almost never mentioned, and disavowed when it
                                           is). Sean's division of the world into industry and
                                           academia is not firm, he constantly recognizes that
                                           the boundaries are thin and that hypocracy seeps
                                           in both directions, but it does serve to make a
                                           provisional distinction in order to understand how
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                                different organizations can use standards to
                                different ends:

                                      But with standards like DICOM, it's much harder,
                                      because those really are owned by industry groups,
                                      they didn't spring out of academia in the same way.
                                      Um, lots of people that pushed them were very
                                      academic folks and wanted to interconnect different
                                      things and get images for research purposes, but
                                      there's been so many games played with the
                                      committee, that it's hard to really know. For years GE—
                                      and GE is in some way the hero of DICOM, they're the
                                      ones who really pulled it together, made our company
                                      possible, and a bunch of other companies because it
                                      finally reached a certain level of standardization— for
                                      years they played with the standard too, they had a,
                                      you know with ACR/NEMA 2, they had a special card,
                                      everything was like Ethernet, same as ethernet, same
                                      resistance characteristics for the cable, lot of the same
                                      signaling stuff, but the plug was a different shape. And
                                      they did this, as far as I can tell, well the stated
                                      reason was that they didn't really trust ethernet and
                                      they wanted to have a medical protocol. But rather
                                      than adopt something off the shelf that worked really
                                      well, they said "In order to be ACR/NEMA compliant you
                                      need to have this card (which only GE makes)," I think
                                      it was a few years before anyone made it commercially,
                                      so all that it really did was it served to push things out
                                      to the future.


                                  The interplay of commercial and academic
                                interests is visible in the relationshp that the
                                DICOM standard has to networking capabilities.
                                According to Sean, HTTP, TCP/IP and HTML
                                were "commercially trivial" because they defined
                                networking as something that provided unlimited
                                interconnection, whereas the stake of a large
                                organizations is hierarchical top-down control,
                                and therefore, deeper and more control over the
                                movement of data. To return to the fact that the
                                DICOM 2.0 standard defined protocols for both
                                TCP/IP and ISO, it is conceivable that such a
                                choice was facilitated by industry concerns over
                                which standard would dominate, but also because
                                the standards represent two very different modes
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                                of standardization, and hence, two different forms
                                of political orgainzation.

                                  TCP/IP and OSI represent two worlds, or
                                perhaps, two ways of making the world one. These
                                two standards represent the political heart of the
                                difference between the 'open' chaotic,
                                quasi-libertarian ethic of the internet and the
                                'closed' hierarchical, authoritarian world of
                                healthcare-hospital organization and legitimate
                                government rule. Though, make no mistake, the
                                U.S. and other governments were involved in both
                                of these realms, neither was strictly commercial or
                                strictly unregulated. While the debate has crucial
                                technical components that serve to convince
                                advocates of one or the other (which hopefully, are
                                somewhat clear from chapter E, above), when the
                                technical details do not decide, the political and
                                theological debates peeek through. These debates
                                are not only rhetoric based on a dogmatic position,
                                but signal a much deeper conflict over the
                                constitution of the state and the market.
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                                  By 1999, the OSI seven layer model remains little
                                more than a model. In the section on international
                                standardization organizations (q.v. section H) the
                                relationship between modes of national and
                                international governance and particular types of
                                standardization— such as the OSI stack— are
                                explained briefly. If there is a connection between
                                ISO-OSI and a model of overly bureaucratic,
                                centralized, international state based control, then
                                the internet's standards and its standardizing
                                body, the IETF opposes that directly. The internet
                                and its TCP/IP stack appear to all onlookers as
                                The Way of The Future because it represents a
                                different mode of governance, not because it
                                represents a different technical configuration
                                (except to the extent that "it works" can be
                                invoked more readily in the case of the TCP/IP
                                protocol). But OSI as a model and protocol for
                                networking will not totally disappear. There will
                                always be "legacy" systems, and complex networks
                                that use the standard just for the sake of using it;
                                but then it will no longer be a standard, but an
                                anomaly.

                                  Only in the last five years has this fact emerged.
                                As an example, I take the activities of the Partners
                                Telemedicine Center, where it became clear that
                                there was a certain conflict between the desire and
                                the promise to use the internet, generated out of
                                an incessant and unavoidable hype all around, and
                                the training and explicit knowledge embodied in
                                the employees.
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                                  At Partners Telemedicine, there was only one
                                engineer— Tim O'Neil. Tim was in the peculiar
                                position, though probably typical of healthcare, of
                                having to know intimately both the technical and
                                economic details of the techology. In particular,
                                Partners' most successful endeavor--technically
                                and economically— during my tenure, was the
                                videoconfernecing network. Success in the form of
                                revenue, because much of the service provided was
                                the televising, to each other and to associated
                                clinics, of MGH and BWH grand rounds— for
                                which they could charge the individual
                                physicicians organizations for the service (nursing,
                                pediatrics, neurology, etc.). Tim's familiarity with
                                teleconferencing systems had brought him to
                                Partners in the first place. Tim trained in the Navy
                                as an electrical engineer, "electricity, electronics,
                                power plants, dish frequency regulators,
                                complicated high technology electronics." He
                                realized, along with a generation of people trained
                                in electrical engineering, that what used to be
                                "straight-up electronic systems work" was going to
                                digital networks: "I kept bumping into a
                                technology barrier in the systems I was using, no
                                industry systems, everything was going to the LAN
                                [Local Area Network], and nobody could do it
                                right." By 'nobody' Tim means primarily
                                telecommunications companies. Tim's training in
                                EE is circuit and signal based, not software-control
                                based, yet Tim recognized that the systems were
                                not so theoretically different:

                                      So I kept seeing what I was doing and I saw the
                                      correlation to information systems. And about three
                                      years ago I jumped ship to the information systems
                                      department of the government, federal [at] the VA.
                                      And at first, one of the first projects I got to work on
                                      was pretty neat, I saw a videoconferencing unit, and I
                                      said: I understand how all this works.
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                   Section Header




                       G. Stupid
                            An article from the field is used to explain some
                            things — modernity and progress are related to
                            standards for networks — differences between
                            Other Networks and The Internet are stressed —
                            questions are posed — a word becomes tiresome.



                                   Adrian gave me an article [Isenberg98] from an
                                ACM publication called netWorker, called "The
                                Dawn of the 'Stupid Network.'" The article briefly
                                emplots the history of telecommunications
                                companies as one of simple self-perpetuation.
                                High point: the invention of the stored program
                                control switch in the 1970's for "cost reduction and
                                reliability." The increased flexibility of using a
                                programmable switch led to innovative call
                                routing and billing services, the possibility of
                                competition (1984- that fateful year for
                                telecommunications) increased as the "intelligent
                                network" became commonplace. Isenberg
                                chastises the Telcos for "falling asleep at the switch
                                at the core of their network" while the "Stupid
                                Network" was taking shape. No futurology would
                                be complete without reference to George Gilder,
                                who is cited here to give credence to the idea of a
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                                              who is cited here to give credence to the idea of a
                                              stupid network. Gilder, prophet of the ever-new,
1 . The internet is therefore a
"v irtual network" to begin
                                              would not be Gilder if he were not hearalding a
with. The rise of the V PN                    new age by denouncing the conservatism and
(V irtual Priv ate Network),
therfore, is an interesting                   inertia of the status quo. But strangely, in this
addendum to this. The
V irtual Priv ate Network                     instance, stupidity is complex. Telco's are stupid
takes adv antage of this
v irtuality to encode data                    for making intelligent networks, while stupidity is
and ensure priv acy by still
using the internet. The                       made an engineering virtue by aligning it with
network is well specified
v irtually (i.e. in a software                simplicity. "In a stupid network control passes
application that a set of
people share) but can be                      from center to the edge, from the telco to the users
connected from any point
on the internet. Problems of
security ,     priv acy ,    and
ultimately , sov ereignty all
                                              with an abundance of processing power at their
migrate to the edges of the                   fingertips. The center of the network is based on
network. In the absent
center is only a sea of bits.                 plentiful infrastructure— cheap bandwidth and
The fantasies of jacking in,
or of The Matrix are                          switching— that is about as smart as a river. The
relav ant here: in one scene
in the latter, a character is                 water in a river, like a data object in a stupid
looking at "the matrix " on
sev eral screens, but all that                network, gets to where it must go adaptively, with
is shown is a series of green
characters spinning by at                     no intelligence and no features, using
illegible    speeds.      Keanu
Reev es asks why he looks at
                                              self-organizing engineering principles, at virtually
it that way , and the                         no cost." (26) This difference—and this is of
response is "that's the only
way to see the matrix ." Later                utmost importance here— is written off to
in the film, when Keanu
Reev es becomes The One,                      'culture':
he too begins to see the
matrix as only numbers.
Friedrich                Kittler's                  Eric Clemons, a professor at the University of
formalistic insistence on the
                                                    Pennsylvania's Wharton school of Business, makes the
reaity of numbers also takes
this form, as a kind of macho                       distinction between strategy and doctrine. 'Strategy,'
hermenaut who can read                              he says, 'is learning how to deal with dogs. Doctrine is
computer code in machine                            about belief: "Dogs don't do that."'" Telco doctrine,
or assembler, sometimes
                                                    formed in the age of monopoly and scarce
ev en in hex adecimal and
binary See Literature Media                         infrastructure, is rarely examined explicitly. When there
Information            Systems                      was only one telephone company, what Ma Bell did
[Kittler97 a]. Whoa.                                defined how things were. So today, even though the
                                                    new era of competition requires clear thinking and new
                                                    beliefs, telco culture inexplicably mixes doctrine and
                                                    strategy. (26)


                                                 Watch carefully how stupidity, culture, and
                                              business environments mix here. Telcos, those
                                              sleeping stupid giants, had it easy because the
                                              government helped turn their strategy into
                                              doctrine. But in the "new era" of competition, the
                                              simplest solution wins, stupid networks triumph
                                              over stupid telcos, because telcos live in a world of
                                              tradition and dogma. Enlightenment comes to us
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                                         tradition and dogma. Enlightenment comes to us
                                         once again: forget all those old beliefs and
                                         modernize with stupidity. The specific
                                         assumptions (strategies) that telcos made about
                                         the world, and then turned into doctrine,
                                         concerned the making of telephone calls. The
                                         assumption was that 9 out of 10 phone calls would
                                         be short, inexpensive connects, so that the
                                         "climate of scaricty" concerning infrastructure


                                         could be accomodated. So even though any given
                                         local exchange might have 10000 phone numbers
                                         to give out (826-000 to 826-9999), telcos count on
                                         only 10 percent of the possible connections being
                                         used at a time. "But should these assumptions
                                         change temporarily (e.g., an earthquake in
                                         California) or permanently (calls to AOL lasting
                                         several times longer than normal voice calls), the
                                         network hits its limit." (27) This is why, when the
                                         explosion of the web hit, telcos were left unable to
                                         meet the suddenly enormous demand on networks.

                                            So why is stupid better? According to Isenberg:
                                         abundant infrastructure, underspecification, and
                                         universal network protocol (IP, Internet Protocol).
                                         Abundant infrastructure obeys Moore's law, or
                                         better, providing massive increases in capacity
                                         with minor increases in cost. Rarely does anyone
                                         ever ask how this particular economy is possible (I
                                         imagine only an economic investigation of the
                                         location of manufacturing production, especially
                                         in chips, fiber optics, circuit board, etc. would
                                         uncover the conditions of possibility of Moore's
                                         law, but this is not my project), but it certainly
  Last Modified                          makes bank in providing cheap infrastructure.
  11-Sep-99 9:01 PM
  ckelty@mit.edu                         Such infrastructure is cheap because
  Go Back to the Start                   'underspecified': "The intelligent network is tightly
                                         specified for voice...The stupid network is
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                                underspecified—this means bits-in, bits-out...You
                                stuff bits in one end of the network, and they find
                                their way to the other end of the network. Packets
                                carry their address with them, and out they come
                                at the other end, right where you want them to be.




                                   Internet protocol (IP) is the most specific reason
                                for the rise of the stupid network. "To IP, it doesn't
                                matter if the underlying transport is circuit,
                                SONET, Ethernet, Bitnet, FDDI, or smoke signals...
                                IP neatly takes the provider of the physical
                                network infrastructure out of the value
                                proposition. No matter how intelligent a telco's
                                network might be, if it is running IP, its
                                intelligence is reduced to commodity
                                connectivity[1]." (29)

                                   But WHY is stupid better? The ultimate reason
                                rests with the hosanna of the new economy: "Users
                                gain end-to-end control of interactions, which
                                liberates large amounts of innovative energy;
                                innovative applications are rapidly tested in the
                                marketplace; and innovative companies attract
                                more capital and bright people."(27) "In contrast
                                the intelligent Network impedes innovation.
                                Existing features are integrally spaghetti-coded
                                into the guts of the network, and new features
                                must intertwine with the old."(29) Thus modernity
                                finds a new way to be more modern, innovation
                                replaces stagnation, and bright people and more
                                capital freely flow. BUT. And here is the heart of
                                the issue: "Intelligent Network advocates point out
                                that networks need to treat different types of data
                                differently."(30) This is the QoS issue. Medical
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                                data, especially sensitive or high bandwidth data
                                must be treated differently by the network itself
                                (here find Tim O'Neil's description, as advocate, of
                                how a network recognizes data and guarantees it)
                                in order that it can be reliably transmitted.
                                Someone must be in charge, some one must
                                specifiy, in the guts of the network, how different
                                data is to be handled; is your echocardiogram
                                going to take precedence over my pornography?


                                who will decide? Isenberg's response: "Right now,
                                they're absolutely right. (emphasis added)" (30).
                                "Quality of Service (QoS) is an intermediary step
                                in the journey from separate networks to a single,
                                simple Stupid Network." (30) We are at the heart
                                of a problem of how we recognize
                                communications: on the one hand, traditionalists,
                                the barbarian telcos advocate for treating
                                statements according to their meaning, data
                                according to its content. On the other, enlightened
                                modernists argue for treating all statements (data)
                                the same when in the world (on the network), and
                                letting the free individual decide on the value and
                                use of information. The former leads to stagnation
                                and sameness, the latter development and growth.
                                Isenberg's closing couldn't be more
                                straightforward on this cyclical point: "The Stupid
                                Network ensures the next paradigm-breaking,
                                market-making 'new thing.' The only question is
                                who will become the next Netscape, the next
                                Microsoft— or the next Ma Bell. And that's not a
                                stupid question."(31).
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                  Section Header
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                       H. It works...
                            The Internet Protocol is sought, and found! —
                            detail about the distinction between paper
                            standards and implementation standards is given
                            — standards processes of ISO and ITU compared
                            to those of ISOC — structure of ISOC and IETF
                            explored — emergence of W3C wondered about —
                            the politics of standards making is discussed and
                            critiqued — TCP/IP is compared to OSI.



                                   But wait, I have a stupid question.
                                Who, exactly, has promised us this new dawn of
                                simplicity? And how will it happen? How can we
                                establish that this difference between the
                                standards of the past— proprietary and
                                bureacratic— and the standards of the future—
                                open and stupid— how do we establish that this
                                difference is not simply one difference among
                                others? How do we establish that it is not simply a
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                                               choice that references some stability that reigns
                                               unseen over it, whether represented by culture or
                                               by science? Telecommunications, in its history, is
                                               essential to this change. Telecommunications as
                                               the apotheosis of what Bernard Siegert calls "the
                                               epoch of the postal system," i.e. the epoch of
                                               communication as control. We have already seen
1 . That is to say , the v ast                 the light of the stupid network shine progress on
field of historical and
theoretical       studies       of             the darkness of the telecommunications industry.
national         dev elopment,
colonial and postcolonial
                                               Recall that for stupid to happen, three things were
relations       within       and               necessary: abundant infrastructure,
between                 national
gov ernments,         and     the              underspecification, and IP. The first has an
relation of all of this to
technology makes ev en a                       obvious history entwined in national development
surv ey seem inadequate.
See         Headrick           on              projects— from trans-atlantic cabling to the
Telecommunications,
Taussig on medicine and                        wholesale the wiring of the planet to the grid of
nation, B.O.G. A nderson on
imagined communities, and
in        particular          the
relationship to the post and
the       public         sphere.
                                               telecom satellites circling the earth, it is emblem of
Habermas on the public                         modernity and control at a distance. The second is
sphere. A ll issues of Public
Culture,     A ppadurai        on              what allows software to migrate from the center to
Modernity          at      large,
Richards on the imperial                       the edges of the network, leaving an empty,
archiv e, this list could be
ex tended, but only at the                     homogenous space, imagined only as a realm of
risk of losing specificity
                                               flashes of light and waves of voltage, smart bits in
                                               a stupid river. The third gives the lie to the second:
                                               IP the Internet Protocol is a specific protocol that
                                               describes the manner in which such bits should
                                               discipline themselves, package and label
                                               themselves for their journey on any given medium.
                                               It is not the lowest level protocol, but it is a kind of
                                               de facto lingua franca. But my stupid question still
                                               stands: Where did this "universal standard" come
                                               from?

                                                 Lets answer by starting with standards as
                                               conceived of by Schmidt and Werle in
                                               Coordinating Technology [Schmidt98]:


2. ICA NN is the internet                            "Standards have only recently
corporation for A ssigned
Names and Numbers. In the
                                                     begun to..."(3)
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                                                   begun to..."(3)

                                                Schmidt and Werle's book looks at attempts at
                                             explicit international stanardization. Of its three
                                             case studies, only one—the facsimile (fax)
                                             standard— is familiar and successful. The other
                                             two can be read as counterparts to internet
                                             tecehnologies that have since come to dominate
                                             international information networks. Videotex was
gold rush of the last fiv e
y ears, domain names (such                   successful only in France as Minitel, and X.400
as      www.mcdonalds.com)
suddenly       became      v ery
                                             message handling remains a relatively unused
important to a number of                     standard for e-mail. The book is a valuable guide
ex isting        corporations.
Before this time, there was a                to the international regime of standardization,
scheme for hierarchical
names that would include                     even as its serves as an example of how the
not only top-lev el domains
like .com, .org and .edu but                 internet has bypassed any such official
also state and country . The
names were administraed
initially by Jon Postel and
the IA NA , and later by a
company chartered by the
                                             international regimes in favor of its own standards
NSF calle Network Solutions                  processes, explained below. Schmidt and Werle
Incorporated. The history
of the creation of ICA NN as                 begin by making analytic distinctions:
a response to concerns
about monopoly , and the
subsequent       trav ails    of                   "Analytically, three modes can be distinguished.
try ing to create a market in
domain names could be                              Governments may impose mandatory standards
v ery important for the                            hierarchically as binding solutions to coordination
future of other internet                           problems. In markets, standards can emerge as de
bodies such as ISOC. 3. RFCs                       facto or industry standards. Their diffusion is based on
can       be      found       at
http://www.rfc-editor.org/                         market leadership or on frequency-dependent
4. Offline at [Garfinkel98]                        bandwagon and imitation processes, in which the
                                                   number of actors attracted by a standard increases
                                                   with the number of those who have already adopted
                                                   the standard. A growing number of standards are
                                                   agreed on in committees, which, whether explicitly
                                                   institutionalized or less formal in nature, are dedicated
                                                   to the joint elaboration of standards. Typically, these
                                                   standards are voluntary consensus standards. (43)"


                                                The italicized words are powerfully self-evident
                                             and necessary discriminations for any attempt to
                                             understand the standardization of the world. We
                                             have seen this distinction implicit in many of our
                                             cases so far. We can read 'network effects' in this
                                             reference to markets, and we can sense the
                                             problem of healthcare between governments and
                                             committees in any given standardization effort. On
10.08.2010                      committees in any given standardization effort. On
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                                the one hand, they are necessary to understand the
                                political nature of standards and the relationship
                                to governance, on the other they obscure by
                                reference to a supposedly clean tripartite
                                distinction of politics, economics, and technology.
                                It is not the role of this analytic distinction to
                                question governence per se, but rather to assume
                                on good faith, that governence is conducted by
                                governments.

                                  Schmidt and Werle go on to explain that in their
                                case-study, telecommunications has always been a
                                national endeavor, rarely coordinated at a
                                supra-national level, and highly controlled by
                                national governments. Several projects of


                                nation-building also meet this criteria: railroads
                                and national highway systems, for example and
                                there can be little denying that such efforts,
                                including telecommunications, are tightly coupled
                                with the history of nationalism and colonialism,
                                and have historically served as one of many
                                measures of 'development' and national power. In
                                addition, international telecommunications
                                development has been part of the project of the
                                creation of an international order of secrecy,
                                diplomacy, war, and economic liberalisation. This
                                much must simply be assumed[1].

                                   Smith and Werle's work is an invaluable
                                reference for the complicated ecology that is the
                                world of standards organizations that have
                                developed in the international order. They begin
                                by identifying the epi-center of standardization:
                                ISO/IEC and ITU.
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  Last Modified
  11-Sep-99 9:01 PM
  ckelty@mit.edu

  Go Back to the Start

                                            ISO (pronounced eye-so, and not an acronym.
                                         According to ISO, whereas the acronym for the
                                         International Organization of Standardization
                                         would be different in each language, ISO, as in
                                         'isonomic', derived from the greek, reads the same
                                         in 'any' language. A small clue to the fact that
                                         international still means Euro-American, in
                                         particular, Hellenic Euro-American) began in
                                         1947, as an international organization "the object
                                         of which would be to facilitate the international
                                         coordination and unification of industrial
                                         standards." Today the group's membership is
                                         made up of about 90 countries, each represented
                                         through its own national standards body (such as
                                         ANSI in the US). The IEC (International
                                         Electrotechnical Commision), founded 1906,
                                         complements the functions of ISO. ISO's successes
                                         are familiar to everyone, a low-level
                                         recognizablility that drapes the globe:
                                         international paper sizes (A6, A4, etc.),
                                         international film speed codes, freight containers,
                                         screw threads, telephone and bank cards, and now
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                                the ISO 9000 management and quality control
                                standards that are required of any firm doing
                                business in the EU (aside: see transcript with Jan
                                Moe for some details on the difference between
                                ISO and FDA). ISO's stated goals are unashamedly
                                in support of the global neo-liberal consensus:

                                      Worldwide progress in trade liberalization
                                      "An industry-wide standard, internationally recognized,
                                      developed by consensus among trading partners,
                                      serves as the language of trade. "

                                      Interpenetration of sectors
                                      "No industry in today's world can truly claim to be
                                      completely independent of components, products, rules
                                      of application, etc., that have been developed in other
                                      sectors."

                                      Worldwide communications systems



                                      "Full compatibility among open systems fosters healthy
                                      competition innovation, improved productivity and
                                      cost-cutting. "

                                      Global standards for emerging technologies
                                      "In the very early stages of new technology
                                      development, applications can be imagined but
                                      functional prototypes do not exist. Here, the need for
                                      standardization is in defining terminology and
                                      accumulating databases of quantitative information. "

                                      Developing countries
                                      "Development agencies are increasingly recognizing that
                                      a standardization infrastructure is a basic condition for
                                      the success of economic policies aimed at achieving
                                      sustainable development. Creating such an
                                      infrastructure in developing co untries is essential for
                                      improving productivity, market competitiveness, and
                                      export capability. "


                                  Across the street from ISO in Geneva sits the
                                ITU (International Telecommunications Union),
                                one of the oldest international organizations,
                                which started as an international telegraph
                                convention in 1865. In 1947, the ITU became a
                                part of the United Nations, and in 1956, the CCITT
                                (Comité Consultatif International Télégraphique et
                                Téléphonique) was formed out of two earlier
                                groups that focused on standardizing
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                                groups that focused on standardizing
                                telecommunications. In 1992, after apparent
                                simplification and reorganization, the CCITT was
                                folded into the ITU-T, one of three sections that
                                now include "radiocommunications" (a spectrum
                                is haunting Europe...), telecomunications
                                development (working groups of the world...), and
                                telecommunications standardization (first draft as
                                tragedy...). According to Schmidt and Werle, "The
                                historic division of labor among the CCITT, the
                                ISO, and the IEC has been eroded because a clear
                                separation of technical domains has proved to be
                                unfeasible as information processing and
                                telecommunications rely to a considerable extent
                                on the same basic technology."(50) Thus the


                                recommendations of the ITU-T are often published
                                as ISO/IEC standards.

                                   Already, we can see that the analytic distinction
                                above is tenuous at best, since ISO is not a
                                government (national or international) agency, nor
                                simply a committee, given that its standards are so
                                widely obeyed, and in some cases mandated by the
                                EU, such as the ISO 9000 standards (for that
                                matter, ITU's legitimacy is uncertain as well, to the
                                extent that all international governing bodies'
                                legitimacy is tenuous). But the problem becomes
                                more difficult as Schmidt and Werle continue. In
                                addition to these three types of standards
                                (government, market, committee) they identify
                                standards created by "para-standardization"
                                bodies in an attempt to influence the decision
                                making of ISO and the ITU. Their examples
                                include the X/Open group, ECMA (the European
                                Computer Manufacturers Association) and the
                                various scientific and technical committees such
                                as those of the IEEE (Institute of Eletrical and
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                                Electronics Engineers). Para-standardization
                                committees are formed with particular interests
                                (in the case of ECMA and to some extent X/Open,
                                they were formed as a reaction to the dominance
                                in Europe of IBM), whose goals may not
                                necessarily coincide with those of ISO and ITU.
                                These groups are analogues of the american
                                administrative state's experts, fact-finders,
                                working groups, white-paper writers, and
                                recommendation-makers. In most cases they are
                                autocthonous groups, formed out of industry
                                cooperation for mutual gains, posing as expertise
                                for the purposes of steering technical decisions
                                past politicians but not politics. In some cases,
                                they may be advocacy, or consumer groups, but


                                perhaps with the recent exception of an ICANN
                                Watchdog group, few such groups have concerned
                                themselves with this level of detail [2].

                                   Schmidt and Werle include under this
                                "para-standardization" rubric— as one network
                                among others— is ISOC (the Internet Society) and
                                its standardization body, the IETF (Internet
                                Engineering Task Force). The Internet Society
                                explains the hierarchy:

                                      "At the technical and developmental level, the Internet
                                      is made possible through creation, testing and
                                      implementation of Internet Standards. These standards
                                      are developed by the Internet Engineering Task Force .
                                      The standards are then considered by the Internet
                                      Engineering Steering Group, with appeal to the Internet
                                      Architecture Board, and promulgated by the Internet
                                      Society as international standards. The RFC Editor is
                                      responsible for preparing and organizing the standards
                                      in their final form. The standards may be found at
                                      numerous sites distributed throughout the world, such
                                      as the InterNIC."
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                                   It might appear that ISOC's structure of
                                approval is complicated, however, a comparison
                                between the organization of ISOC and ITU/ISO
                                reads like a parody of bureacratic centralization.
                                The IETF meets three times a year, membership is
                                open to anyone, working groups post RFCs
                                (Requests for Comments) and then dissolve. In
                                contrast the description of the ITU-T/ISO is
                                hopelessly elaborate, with a set of bureaucratic
                                procedures, rules for membership and variety of
                                variously formal connections to ISO/IEC, national
                                standards organizations, and industry consortia
                                (the diagram in Schmidt and Werle's book, for
                                example, is maddeningly crisscrossed by boxes and
                                lines of various shades). The IETF publishes all of
                                its standards freely, and available at no charge,
                                uncopyrighted as RFCs. Until recently, the ITU's
                                standards were expensive and difficult for
                                individuals to obtain. According to Schmidt and
                                Werle, the definition of the standards must be kept
                                strictly separate from the implementation of the
                                standard, precisely the opposite of the IETF model,
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                                "rough consensus and runnning code" in which a
                                vote must be a clear majority, and must be based
                                on at least two working implementations of the
                                standard.

                                   Officially, the ITU/ISO and ISOC are not
                                competing organizations. Many aspects of the
                                internet technologies are governed by ITU/ISO
                                standards, e.g. the various character sets that
                                currently allow for the internationalization of
                                documents on the internet (recall my example of
                                the character for Apple, which is not included in
                                either ithe ISO-charsets or in the Unicode format).
                                But the fact that the ITU did not identify the IETF
                                or ISOC as committees that should be collaborated


                                with or consulted— until 1995— is a telling
                                oversight. In fact, it is the ITU and ISO's particular
                                relationship to standards that provokes Carl
                                Malamud's ire in his Exploring the Internet, in
                                which he contrasts the openess of the internet
                                standards process with the relentlessly mocked
                                bureacracy of the ITU: "In June of 1991, after
                                endless messages back and forth to Tony [of the
                                ITU], I had received a fax from the
                                Secretary-General asking me to post all ITU
                                standards on the Internet on an "experimental"
                                basis. I promptly booked a plane ticket to Geneva
                                for August to pry the data out of the cold clammy
                                hands of the bureaucracy."(5) Malamud's goal of
                                posting the ITU standards on the internet was
                                stifled by both ISO and ITU, and it serves him as a
                                repeatable lesson on the openness of the internet
                                over against the crypt of bureaucratic standards
                                organizations, inevitably associated with death
                                and decay.

                                   The internet standards and the procedure of
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                                creating and validating them that the IETF and
                                ISOC use date back to almost the beginning of the
                                internet. The first RFC posted in 1969 (RFC1,
                                "Host Software"), began a tradition of semi-formal
                                standardization that would develop within
                                universities (the first four nodes were UCLA, SRI,
                                UCSB, and University of Utah) connected to the
                                ARPAnet. What it is important to recognize is that
                                these RFCs often describe an implementation of an
                                existing protocol, something that should be tested,
                                is being tested, or has been proven to work. They
                                are not theoretical documents that attempt to
                                standardize a protocol in the absense of any
                                implementation, nor are they documents that
                                mediate between competing standards.


                                Theoretically, competing, redundant standards
                                could exist, and both be 'standard' by this
                                procedure— if there were working
                                implementations— both would be open, and both
                                would be usable. Over the 30 years since 1969,
                                over 2600 RFC's have been posted. Not all RFC's
                                are standards, most, in fact, are exactly what they
                                say they are: a request for comments. Some,
                                however, are published as the final word on a
                                particular internet protocol. Periodically, the
                                existing protocols and standards are themselves
                                published as an RFC (the most recent is RFC
                                2500). With 20 years of development as a
                                relatively small research and education network,
                                the standards had plenty of time to improve and to
                                sediment, sometimes as organic academic
                                projects, sometimes as responses to unexpected
                                uses of the internet. These standards became the
                                de facto standards for the internet not because the
                                IETF or the RFC process itself possessed sufficient
                                legitimacy to enforce them, but rather because
                                legitimacy came in that particular form
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                                unavailable only to internetworked software,
                                summed up in an oft-cited phrase from Dave Clark
                                "No kings, no priests, just a rough consensus and
                                running code."
                                In short: "It works."

                                      The following introductory text is quoted directly from
                                      RFC 2026: "The Internet, a loosely-organized
                                      international collaboration of autonomous,
                                      interconnected networks, supports host-to-host
                                      communication through voluntary adherence to open
                                      protocols and procedures defined by Internet
                                      Standards. There are also many isolated interconnected
                                      networks, which are not connected to the global
                                      Internet but use the Internet Standards. The Internet
                                      Standards Process described in this document is
                                      concerned with all protocols, procedures, and
                                      conventions that are used in or by the Internet,
                                      whether or not they are part of the TCP/IP protocol
                                      suite. In the case of protocols developed and/or


                                      standardized by non-Internet organizations, however,
                                      the Internet Standards Process normally applies to the
                                      application of the protocol or procedure in the Internet
                                      context, not to the specification of the protocol itself.
                                      In general, an Internet Standard is a specification that
                                      is stable and well-understood, is technically competent,
                                      has multiple, independent, and interoperable
                                      implementations with substantial operational
                                      experience, enjoys significant public support, and is
                                      recognizably useful in some or all parts of the Internet.
                                      (emphasis mine)


                                   As of RFC 2500, there were about 50 Internet
                                standards, 60 draft standards, nearly 400
                                proposed standards, and over a 120 experimental
                                protocols, another 100 informational protocols
                                and 50 historical protocols. Internet standards are
                                final and proven (they 'work'), draft standards are,
                                according to the IETF (RFC 2026): "normally
                                considered to be a final specification, and changes
                                are likely to be made only to solve specific
                                problems encountered. In most circumstances, it
                                is reasonable for vendors to deploy
                                implementations of Draft Standards into a
                                disruption sensitive environment." Proposed
                                standards do not receive this recommendation,
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                                standards do not receive this recommendation,
                                and are considered to be in the testing phase.
                                Informational Protocols are those that are
                                proposed for some service not intiated by the
                                working groups in the IETF or initially proposed to
                                the IETF. They may eventually be included in an
                                IETF standard, but in the meantime they are
                                published only "for the benefit of the internet
                                community." The description (RFC 2026) of
                                "historic protocols" register the playful,
                                occasionally recursive pragmatic IETF RFC
                                process: "A specification that has been superseded
                                by a more recent specification or is for any other
                                reason considered to be obsolete is assigned to the
                                "Historic" level. (Purists have suggested that the



                                word should be "Historical"; however, at this point
                                the use of "Historic" is historical.)" [3]

                                   The completed internet standards include all of
                                the low-level protocols for the most commonly
                                used services on the internet, including definitions
                                of IP for use on over 15 different kinds of physical
                                networks (e.g. ethernet, ARPAnet, wideband,
                                ATM, token-ring LANs, carrier pigeon etc). Among
                                these services are the basic protocols such as TCP
                                (Transmission Control Protocol), telnet, ftp (File
                                Transfer Protocol), SMTP (Simple Mail Transfer
                                Protocol), DNS (Domain Name System), SNMP
                                (Simple Network Management Protocol), PPP
                                (Point-to-Point Protocol), POP3 (Post Office
                                Protocol 3).
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                                   It is interesting to note that as of June 1999, the
                                standards for familiar world wide web services
                                such as HTTP (both 1.0 and 1.1), URI (Universal
                                Resourse Identifiers), URL (Universal resource
                                Locaters), and HTML 2.0 were all either proposed
                                standards (not yet approved for 'disruption
                                sensitive environments') or they were
                                informational protocols, published but not
                                approved. One reason for this is that a second
                                internet-related organization has come into
                                existence— The W3C (the World Wide Web
                                Consortium)— which has managed to assume
                                much of the legitimacy granted the IETF, but with
                                a very different structure of participation and
                                openness. The W3C allows only organizations to
                                join and has a much less explicit relationship to
                                the "recommendations" it produces than the IETF
                                or ISO/ITU. The W3C's recommendations for
                                HTML (HyperText Markup Langauge), CSS
                                (Cascading Style Sheets), HTTP (Hypertext
                                Transfer Protocol) and XML (eXtensible Markup
                                Language) are widely followed, but the process for
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                                participating is much more complex than that for
                                the IETF. In addition, these recommendations are
                                generally not as focussed on the implementation,
                                as on a normative standard which corporations
                                such as Netscape and Microsoft are trusted to
                                follow— more in line with the model of ISO and
                                ITU. Simson Garfinkel explores some of the W3C's
                                recommendations, including their proposals for
                                various privacy measures (such as the PICS
                                system) in a recent Technology Review article [4].

                                  The emergence of the W3C came with the first
                                wave of hype centered on the growing popularity of
                                the internet and the web, from about 1993 on. The
                                techno-libertarian hand-waving of Wired and the


                                promotion of the MIT Media Lab were two
                                important forces in this wave of hype. During this
                                time, Tim Berners-Lee was crowned the inventor
                                of the Web, and was invited to come to MIT's LCS.
                                Here, the W3C began in earnest. By virtue of being
                                the only recognizably legitimate organization
                                dealing with web standards (and how this
                                recognition occurs is mysterious and significant)
                                and by convincing several large software
                                companies like Microsoft and Sun to join, the W3C
                                has emerged as the standards organization for the
                                World Wide Web. Although I do not follow out the
                                implications of this, it is clear that the W3C
                                represents a departure from the mode of
                                governance of the IETF, towards that of ISO, and
                                away from standards and towards
                                recommendatiosn.

                                  To return to the question of standardization
                                posed by Schmidt and Werle, where the IETF is
                                consigned to a "para-standardization" role, it
                                should be clear that what is at stake is not the
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                                standard-making process per se, so much as its
                                legitimacy. For Schmidt and Werle ISO/IEC and
                                the ITU-T are the legitimate international
                                organizations of standardization, just as ANSI is in
                                the US or BSI in Britain, etc. by virtue of their
                                history and some unarticulated mechanism
                                through which national and international
                                legitimacy is produced and retained. In fact, it
                                may be the case that these two organizations, in
                                their various forms, have controlled a great deal of
                                the standardization of electronics and
                                telecommunications over the last 50 years, but this
                                does not necessarily explain their legitimacy.
                                Organizations that form outside of this legitimate
                                hierarchy are therefore presumed to be in


                                relationships of support, influence, or subversion,
                                but rarely as direct competition. The IETF,
                                therefore, is not simply para-standard, but
                                parasitic.

                                   Schmidt and Werle are well aware of the
                                political stakes of standardization: "Negotiating
                                standards among representatives of nations opens
                                the door to political considerations which are not
                                directed at technical questions of compatibility
                                but which tend to regard a national standard as a
                                strategic element in the global competition among
                                nations."(267) The political problem then becomes
                                a problem of strategy amongst representatives of
                                various nations, Schmidt and Werle discuss the
                                problems of "relative-gains" as the political
                                problem of this function of standardization as
                                international coordination. The technical content
                                of the standard may or not become an explicit part
                                of this discussion (Schmidt and Werle insist that it
                                doesn't), but its implementation surely does.
                                Schmidt and Werle misread this problem:
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                                "Politics remains blind to the technicality of
                                standards. It is activated when standardization
                                (most likely of a comprehensive technical system,
                                such as videotex, not of isolated components), has
                                gained considerable national political significance"
                                (271). This blindness is an artifact of the
                                assumption that the ITU and ISO are not
                                themselves subject the problem of standardization,
                                that is, it is assumed that there is widespread
                                acceptance of the ITU/ISO standardization
                                process as a neutral technical game, out of which
                                politics emerges when nations compete for
                                comparative advantage.

                                   This is clearly not the case. First, Schmidt and
                                Werle recognize that the process is actually
                                inter-organizational, not inter-national, and they
                                go on to suggest how standardization often reflects
                                national interests only through national support of
                                a given organization (corporations in America, for
                                instance, where almost all public utilities have
                                been privatized). As such, the technical content of
                                standards is the most important concern for
                                competing organizations (though Schmidt and
                                Werle insist that politics only emerges when
                                national concerns are aired), and whether this is
                                couched as a technical issues, or an economic one
                                (and the line is fiber-optic thin, since efficiency is
                                a chimeric techno-economic measure), this is still
                                a political issue in both constitution and effect. If
                                the actors do not represent it as politics, this is
                                disingenuousness, as we will see again in the case
                                of the open source movemnet. Second, the nature
                                of the standards process is fundamentally different
                                in the ISO/ITU world from that of the IETF, and
                                this fact is both political and technical at the same
                                time. Legitimacy and bureaucracy, and all of the
                                attendant histories they invoke (from socialism to
                                communism, from welfare states and social
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                            Section Header




                                I. Open Begin (An interlude in
                                fragments)
                                     A connecting interlude unravels — A section from
                                     Ellen Ullman's book Close to the Machine — a
                                     diversion on a piece by Robert Musil about doors
                                     and openness and design — an example of how
                                     programmed language has come to be expected,
                                     and how dissemination must be
                                     counter-programmed.



                                     It works.

                                The sales and finance people— the current office
                                occupants— had a dejected and distracted air about
  Last Modified
  11-Sep-99 9:01 PM
                                them. They didn't have much to do except sit
  ckelty@mit.edu                around and worry. Not so for the programmers. The
  Go Back to the Start
                                engineers continued working their endless days and
                                long weeks. The lead engineer went on sitting in his
                                charged way in his cubicle, his knees opening and
                                closing, opening and closing.
                                A merry kind of hysteria took over the
                                programmers. The situation was impossible, the
                                deadline was ridiculous, they should have been
                                completely demoralized. But, somehow, the
                                absurdity of it all simply released them from the
                                reality that was so depressing the rest of the
                                company. They played silly jokes on one another.
                                They stayed up late to see who could finish their
                                code first. The very impossibility of success seemed
                                to make the process of building software only that
                                much sweeter.
                                The lead engineer wanted me to come in every day
                                to see their progress. "Look," he said, "You just
                                select the device and drag it over to the location
                                tree—"
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                        "—and boom!" said another programmer, "It
                        updates. Just like in your specs."
                        "And the database is updated?" I asked.
                        "Done!" said the lead.
                        "And the multiple add," said a third programmer, a


                        young chinese woman who looked exhausted but
                        who was clearly having the time of her life, "look at
                        this." She typed in a few parameters and the screen
                        filled with information as the program cranked
                        away.
                        "Does it crash?" I asked.
                        "Only a little," she said.
                        "Twice yesterday," said the second programmer.
                        "No," said the lead, "once. Only once."
                        They arranged a demonstration of their work for the
                        entire company. They put out cake, ice cream,
                        champagne. The worried sales and finance people
                        did their best to be impressed.
                        In the middle of the demo, I realized how fortunate
                        we were to be enginneers. How lucky for us to be
                        people who built things and took our satisfactions
                        from humming machines and running programs. We
                        certainly wouldn't mind if the company went public
                        and we all got fabulously rich. But the important
                        thing was right in front of us. We had started with
                        some scratchings on a whiteoard and built this: this
                        operational program, this functional thing.
                        "And look," said the lead, demonstrating his
                        handiwork, "You just click here, drag here, and
                        click here—"
                        "And it works, "I said.
                        "Yeah," he said, exhaling the word in a long breath
                        of contentment, then standing back, exultant.
                        "Yeah, it works."

                        from Close to the Machine by Ellen Ullman

                   

                   



                            The open door...

                      In Robert Musil's short piece "Doors and Portals," [Musil87]
                      the door is eulogized: "Doors are a thing of the past."
                      Fragility and weakness have conquered, the door no longer so
                      much a portal as one thin wall among others. Eaves-dropping
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                    much a portal as one thin wall among others. Eaves-dropping
                    is no longer difficult, now even thought assails our ears.
                    Doors just aren't what they used to be. Private spaces are no
                    longer so, all the secrets are out, we can't even avoid them.

                    He goes on: "Still far more outdated than the door itself is the
                    frame. If you cast a glance past open doors, through a suite of
                    rooms, you'd think you were experiencing the nightmare
                    vision of a soccer forward faced by an infinite succession of
                    goal posts." Why not do without the frame, he asks? Unable
                    to stand meaningfully ajar, it only jars perception. It is but a
                    remnant: "The narrow wooden rim, lonesome, senseless, that
                    seems to come out of nowhere and is related only to the
                    window frame, is left as a remnant of the custom." Indeed,
                    doors are no longer the entrance to that most important of
                    publicly private spaces: these days we show our status in
                    other ways— cars, vacations, second homes. "And how then
                    should there be doors if there is no 'house'?!" In short, the
                    door no longer represents the house, literally or figuratively.
                    In its mundaneity there is a question of utmost importance.
                    Think, he asks us, of all the uses of the door— opening,
                    shutting, forcing, throwing out of, turning away from,
                    slamming— "this was an abundance of relations with respect
                    to life and they demonstrate that excellent mixture of realism
                    and symbolism that language achieves when something is
                    very important."

                    But, in sadness he says, "The great age of doors is behind us!
                    It may be very spectacular to call out to someone that you are
                    going to throw them out the door, but who has ever really
                    seen someone 'flying' out? We don't even slam the door in
                    anyone's face anymore, but rather refuse to receive the
                    telephoned announcement of an unwanted visit in advance;
                    and to sweep in front of one's door— that is, to mind one's
                    own business— has become an inconceivable suggestion."
                    What is left of this opening? What is the moral of this fable of
                    the doors? Musil closes: "It is the fading history surrounding
                    a hole that, for the time being, has still been left open to the
                    carpenter."
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                    What more rhetorical jambs and frames, knobs and latches
                    remain? Take out the door, let the carpenter contemplate the
                    hole in the wall, let design recreate something very

                    important; the residue left over will be simply and vaguely
                    that of openings and their varieties of closing. The content of
                    the image is powerful because the door is both real and
                    symbolic, boundary between public and private, inside and
                    out, family and society. An open door policy towards someone
                    draws them from the anonymous to the familial, across a
                    threshold. But this poignancy is none other than openness
                    and secrecy itself, even if the forms it takes today leave
                    permeable and useless the doors of tradition. Openness
                    appears everywhere as congeniality, inclusion, inspection,
                    and most importantly, trust. Openness is both spatially and
                    temporally a mode of fragility and a decisively secular
                    relationship to the world and the universe . Open houses offer
                    themselves inside-out for the satisfaction of the buyer. The
                    offen in Offentlichkeit pulls us agoraphobics out of head and
                    house and into the market of ideas, the public sphere where
                    we can no longer mind only our own business. Its opposites in
                    closure promise saftey or exclude, decide, prevent. Secrecy,
                    privacy, interiority, family, hierarchy, control. Closed books
                    are decisions made, closed minds are unassailable by
                    powerful logic, closure orders and satisfies expectations, it
                    makes the world whole again. The day is open, the night is
                    closed, and the signal was at one time, the door.

                    But the great age of doors is behind us! Musil writes in the
                    high modernist heart of pessimistic Vienna, and the
                    pronouncement sounds a subtle satire of our contemporary
                    bathos of the constant promise of new ages. And yet, to take
                    it seriously, to really understand that the age when the door,
                    both physically and symbolically protected us is really over—
                    what would that mean? Surely we are not beyond publicity
                    and privacy? Especially not open and closed. If the door, the
                    architectural sine qua non of the household, is really no
                    longer the door, where now is the decision made?
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                    longer the door, where now is the decision made?


                            On Anticipation


                       From a standard SEC filing for an IPO (available
                       from the SEC Edgar database):

                       Certain statements contained herein constitute
                       "forward-looking statements" within the meaning of
                       Section 27A of the Securities Act of 1933, as
                       amended (the "Securities Act") and Section 21E of
                       the Securities Exchange Act of 1934, as amended
                       (the "Exchange Act"). These forward-looking
                       statements can be identified by the use of
                       predictive, future-tense or forward-looking
                       terminology, such as "believes," "anticipates,"
                       "expects," "estimates," "plans," "may," "intends,"
                       "will," or similar terms. These statements appear in
                       a number of places in this report and include
                       statements regarding the intent, belief or current
                       expectations of the Company, its directors or its
                       officers with respect to, among other things: (i)
                       trends affecting the Company's financial condition
                       or results of operations, (ii) the Company's
                       business and growth strategies, (iii) the Internet
                       and Internet commerce and (iv) the Company's
                       financing plans. Investors are cautioned that any
                       such forward-looking statements are not guarantees
                       of future performance and involve significant risks
                       and uncertainties, and that actual results may differ
                       materially from those projected in the
                       forward-looking statements as a result of various
                       factors set forth under "Risk Factors" and elsewhere
                       in this report. The following discussion of the
                       financial condition and results of operations of the
                       Company should also be read in conjunction with
                       the financial statements and notes related thereto
                       included elsewhere in this report.
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                   Section Header
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                        J. Source and passion
                             Open source appears suddenly, frightens some —
                             opensource.org and the Free Software Foundation
                             are distinguished — Sean's words noted as the
                             experience of one 'hacker' — hacker authenticity
                             considered — the relentless myth of scientific
                             method is identified and dismissed as ideology —
                             Sean's experience a counter-proposal to the
                             scientific method myth — the excitement of
10.08.2010                              scientific method myth — the excitement of
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                                        learning and sharing identified as An Important
                                        Thing — Heidegger referenced.



                                               Sean gave me a book to read, published in early
                                            1999, called "Open Sources: Voices from the open
                                            source revolution" [Dibona99]. The book,
                                            published by O'Reilly & Associates, was a very
                                            strategic publication, aimed at capitalizing on the
                                            media interest that was being generated around
                                            the "open source software development model." In
                                            particular, the Microsoft anti-trust trial, the
                                            announcement by Netscape that the source code
                                            for Netscape 5.0 would be open, the existing and
                                            growing success of the Linux operating system, the
                                            Perl programming langauge and the Apache
                                            web-server, and the 1998 "Halloween Documents"
                                            [1]— revelations about Microsoft's concerns about
                                            Linux and Open Source Software development,
1.        The       Halloween
Documents were internal                     and including some sinister implications for the
Microsoft memos leaked to
Eric       Ray mond        that             internet. The book served Sean as a kind of
contained assessments of
Linux and Open Source                       validation of his software development ideals, and
Software,            including
nefarious      and     slightly             a spur to thinking about the business models
sinister recommendations
about the possibility of
                                            implied by the free availability of source code. It
"de-commoditizing                           puzzled me by virtue of the sudden 'discovery' it
protocols," i.e. turning open
internet     standards     into             named itself a part of.
Microsoft owned standards
by ex tending them and then
lev eraging the installed base
of windows users onto the
new protocols. They are
v ailable      here,       with
                                               The book is filled with short articles by software
commentary         by      Eric             developers who represent themselves as a
Ray mond and others.
                                            community devoted to the free availability of
                                            source code (if not precisely as the representatives
                                            of the community). Several of the articles are
                                            about the potential business models and strategies
                                            that are possible when source code is not
                                            proprietary. Several are reflections by developers
                                            responsible for important infrastructural software
                                            (oft-cited is BIND [Berkely Internet Name
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                                            Daemon], led by Paul Vixie, a popular, most say
                                            nearly ubiquitous implementation of the domain
                                            name server (DNS) that binds numerical addresses
                                            to their hostnames). Some, like Richard Stallman's
                                            and Eric Raymond's are recollections, with clear
                                            intentions of "setting the record straight"
                                            (differently straight in these two cases, included
2. See on this note, Langdon                together for diversity's sake). Still others are wacko
Winner's article about Wired
and      its    v iccissitudes              quasi-philosophocal meditations, like the selection
[Winner95].
                                            from Larry Wall, originator of the programming
                                            language Perl. The spectrum of positions on the
                                            availability and the control of source code is in fact
                                            quite diverse, owing more to a minimum of
                                            institutional specificity (.com, .edu, .org) that
                                            would formlize certain positions, than to any fully
                                            articulated positions.

                                               The book's appearance coincided with an
                                            sudden (that is, once the air waves were freed from
                                            the national tragi-comedy of the impeachment
                                            hearings) discovery by the media at large (CNN,
                                            New York Times, and myriad online outlets like
                                            Red Herring and Salon.com, along with tipsheets
                                            like Esther Dysons Release 1.0) of both the Linux
3. See Stev en Lev y , Hackers,             operating system, and the notion of 'open source'
A Few Good Men from
Univ ac, Hafner and Ly on                   as an organizing name for serveral different
Where Wizards Stay up late,
turkle, second self and life                internet technologies (as opposed to freeware or
on the screen, Michale
Fischer               Worlding
Cy berspace
                                            shareware, which has long been a familiar and
                                            related aspect of the history of the internet). This
                                            quite separate and new 'discovery' should have
                                            been a part of the long-standing, Wired-inspired
                                            techno-yuppie adulation of the neo-libertarian
                                            hacker-geek keyboard jockey and the technologies
                                            he so arrogantly represents (that is, the
                                            technologies that it is his duty to hide from the
                                            investor, in order to maintain control over
                                            cyberspace). But, as we know, this particular
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                                            spectacle of web journalism and techno-manifest
                                            destiny was less than concerned with the daily
                                            material problems of operating systems and
                                            network protocols (not to mention those of
                                            sweatshops, clean-rooms and home-work that still
4. The project was called
Mozilla, and it was one of                  remain invisible in America and on the internet)
the principle reasons for
Eric    Ray mond's sudden
                                            and more concerned with creating a consensus on
fame in this contex t, since                the inevitability of "cyberspace" and its best uses
the      management       of
Netscape       had     been                 for the creation of wealth[2].
persuaded somehow, to
believ e his claims in "The
Cathedral and the Bazaar"
which has since become the                     But something happened which made this
de facto locus classicus of
the       'open      source'
                                            discovery new. The closed circle of media
mov ement, q.v . section M                  reporting, the strategic press release, and the
below for more.
                                            rhetoric of revolution— these are all commonplace
                                            media manipulations. Interested history will
                                            inevitably proclaim that the "open source"
                                            development model had been successfully used for
                                            over a decade (maybe two) before the media and
                                            the commercial world at large finally stumbled on
                                            it, or finally woke up to it (much like the stories of
                                            the world's ignorance of the internet before 1993).
                                            But this will inevitably miss the somewhat
                                            miraculous retrospective creation of history
                                            accomplished by this 'community'.

                                               The term, "Open Source(tm)" was invented on
                                            February 3rd, 1998 to lexically segment one
                                            'community' of open sourcerers from another. The
5. This is y et another                     first group became opensource.org, the officially
ex ample of how charged
hermeneutic debates can be                  trademarked headquarters of open source
around technical names.
Compare        with      my                 associate prinicpally with Eric Raymond. The
introduction that traces
"telematics" and Daniel Bell's              other group, identified with Richard Stallman, is
emphasis on 'bold new
words'.
                                            called "The Free Software Foundation" {q.v.
                                            below}, and has existed since the early 1980's. This
                                            differentiation, the organization and the book that
                                            followed represent a significant event in the
                                            history of the commercialization of the internet, as
                                            well as a kind of end-point for the chaos of
                                            invisible sub-cultures that went by the various
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                                             invisible sub-cultures that went by the various
                                             names: hacker, cracker, pirate, geek, phreak, nerd,
                                             gnurd, etc. Of these varieties of life there are
                                             histories, myths, assesments aplenty [3]— enough,
                                             in any case to ensure the continued celebration or
                                             investigation of its complexity and diversity (such
                                             diversity as exists within 18-40 year-old white
                                             males). Yet it is the remarkable retrospective
                                             precipitation of the event by the media is most
                                             clearly visible in this case, the remarkable
6. The IBM 360, while it will
nev er earn a place in the                   clarifying effect of drawing borders, defining
Hacker Hall of Fame, was in
fact a significant risk for IBM
                                             authenticity and deciding on exclusions that may
at the time (announced in                    come intially from an individual (Eric Raymond,
1 964) as it proposed to offer
a family of processers, a                    for instance) but can quickly become history. The
precursor to today s open
architecture,      in     which              relationship between media and event, the
peropherals such as disk
driv es and input dev ices                   retrospective, amnesiac delerium of speculations
could be swapped into and
out of it, and an operating                  about the nature and history of 'open source', 'free
sy stem that ran on all
models. For bundling these                   software' and 'hacker culture', create this nature
innov ations together in one
price, IBM was awarded a
                                             and its history. No one will confuse the media with
twenty y ear anti-trust suit,                reality, but neither should we confuse history with
something almost nev er
mentioned in the media                       it; media and event meet in the desire of
cov erage of Microsoft's trial,
despite the presence of                      individuals to contribute to a past that only now
Franklin Fisher in both
suits. See Fischer, Folded,                  exists— a past that lives in hackers and
Spindled and Mutilated, for
details of the earlier suit                  hackers-manqué who both observe and
[Fischer83]. A nother story
is often told that IBM's                     participate, and most importantly, whose
operating sy stem for the
360 series functioned as a                   autodidactic ways authorize the historian, the
de facto open source project
because so many changes
                                             anthropologist, the lawyer, the businessman, and
were suggested, and ev en                    the hacker in each of them to speak with the
made on a customer by
customer basis. Changes
that were then incorporated
into the sy stem that was                    authenticity of experience, not credentials, about
subsequently          installed.
Frederick Brooks (See infra.                 this history. When the media begins to recognize
Chapter M, fn 2.) identifies
Microsoft, of all people, as                 certain of these figures with some regularity,
initiating the model of rapid
improv ement       based      on             begins to cite the same people citing themselves
customer feedback, in their
"Build ev ery night strategy ".
                                             citing the same people, only then do software,
See     the    afterword      to             organizations, foundations, names, and careers
[Brooks95]
                                             start to look official, long-standing, intentional.
                                             Open closes.

                                               Up to the publication of Open Sources
                                             (February of 1999), I had been busy tracing opens
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                                           (February of 1999), I had been busy tracing opens
                                           of all kinds: open systems, open standards, open
                                           networks, open formats, open societies, open
                                           doors, open markets and on down the open line.
                                           "Open" appears relentlessly as a kind of universal
                                           modifier that lends a quasi-academic feel to a
                                           project, and so lends itself to abuses of all kinds.
                                           The trick, of course was to figure out whether any
                                           of the promised opens were indeed actually, really,
                                           materially, politically, philosophically,
                                           economically, world-historically open. Of course, in
7 . See A nne Say re on                    the end, open is just the opposite of closed, no
Rosalind            Franklin
[Say re7 5], of course, the                more, no less, but research doesn't allow you to
canonical retelling of the
story , replete with missing               give that answer up front.
pieces and added glasses.




                                             In an interview with Sean in September 1998,
8. A nd one direction to
follow would be to articulate              the term 'open source' never appeared (though the
the necessary relation of
community       and    my th,              "Free Software Foundation" did), even though we
especially this my th, the
my th of my th, which is so                discussed the details of open standards and the
well articulated by Jean-Luc
Nancy [Nancy 91 ]. But this
                                           necessity for having both a standard and an
would be a digression,                     implementation (working source code). Netscape
which will wait...
                                           had made a commitment to what it was calling
                                           "open standards" and had announced its plans to
                                           make the source code for Netscape 5.0 freely
                                           available, but we didn't really talk about this either
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                                             [4]. Sean and I talked about his earlier history at
                                             the federal reserve board using the internet to
                                             teach himself UNIX and C programming, learning
                                             techniques and building large scale, high quality
                                             applications. We talked about how that sense of
                                             community has since disappeared, that
                                             communities are fragile and need guardians. Sean
                                             often repeats the phrase "giving back," as in, "it
                                             would be nice to give something back, since I've
                                             gotten so much."

9. Ly otard is a reference                     Later in March of 1999, while watching "the
here, but where he speaks of
'master narrativ es' i would                 history of open source" be constructed around a
replace    narrativ es  with
institutions, customs, and                   swirl of experience that knew no such label, and a
standards in a general sense
[Ly otard84].                                set of technologies that each had its own openness
                                             criteria, I asked Sean if he felt a part of the Hacker
                                             community that Raymond and the media now
                                             narrated so cleanly. Sean demurred:

                                                   C: I've been reading Open Sources... and one of the
                                                   things I wanted to ask you about was a more historical
                                                   question, was how close you feel to this particular
                                                   history, being an MIT graduate, how close you feel to
                                                   MIT hacker culture. I mean it's a story the that the
                                                   open source people like to tell repeatedly, especially
                                                   through Eric Raymond and his history of hacker culture.
                                                   S: well I'm afraid I'm really going to disappoint you
                                                   because you see, when I was MIT I really didn't do any
                                                   hacking at all. I was in the economics department and I
                                                   worked a little bit on Troll [an econometric modelling
                                                   language that Sean helped create]. Which was sort of
                                                   this thing at Sloan school.


                                                   C: But you weren't part of that while you were there.
                                                   That part I think I knew...
1 0.    Including      a    gift                   S: Well I worked with Troll the senior year and the year
ex change, which is not by                         after I graduated and then I left to go down to
any means opposed to a
market society , especially in                     Washington [To the Federal Reserve board] and that
Marcel     Mauss       or    in                    stuff was just running on IBM mainframes. And I sort of
Malinowksi— at least not                           knew a lot about the hacker culture, but was a little bit
until Lewis Hy de, Richard
                                                   distant from, because it, it seemed a little bit too self
Titmuss, Renee Fox and
others adopt the concept as                        referential. There just wasn't a lot of interest in the
an alternativ e to the market,                     arts or politics or stuff like that. It was very insular.
for instance, in giv ing blood.                    Maybe it was just the people that I met there but it
Cupidity knows gift giv ing
                                                   seemed a little bit exclusionary for someone like me who
well howev er, and it is the
impossibility of the gift that                     wasn't in computer science, who was really more
Derrida identifies as the                          interested in social things you know social justice that
                                                   sort of thing that I seem to have long... that I'm not
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                                                 sort of thing that I seem to have long... that I'm not
                                                 working on anymore. It was really, when I was at the
                                                 Fed in Washington and they switched over the research
                                                 division to a Unix network based on Sun workstations.
                                                 Then all of a sudden they needed a lot of software
                                                 written and I was writing a lot of statistical software
                                                 things and found software more interesting, but the
                                                 way I learned was through different usenet groups and
                                                 different mailing groups.


                                              Sean's modest honesty about the insular nature
                                           of the hacker "culture" that has so alluringly
trouble-maker in all of these              narrated itself as the hidden history of computing
instances [Derrida92].
                                           is a crucial corrective to the relentless
                                           self-aggrandizing focus on openness which serves
                                           as the moral background to this narration (on
                                           both sides of its self-produced splits). On the one
                                           hand, a disingenuous disavowal, because
                                           compared to someone like Tim O'Neil at Partners
                                           Telemedicine, Sean is infinitely closer to the
                                           internet, the usenet groups he learned from, the
                                           ethics of hacking elegant code, and a feeling for
                                           freeing information; even if Tim was presented
                                           with similar problems to solve (networking doctors
                                           together, developing ways to allow them to look at
                                           images and collaborate using them), his approach,
                                           given a very different background and formal
                                           training, would never touch the internet, or
1 1 . See Heidegger, "Question             anything not backed by a respectable corporation
Concerning        Technology "
and         "Science      and              with real people in it. On the other hand, an
Reflection," [Heidegger7 7 ]
and Michael Zimmerman on
                                           interested distancing, since Sean's frustration
Heidegger [Zimmerman90].

                                           seems to be political and ethical with respect to
                                           the kinds of inclusions and exclusions that the
                                           "community" of hackers represents. Even though
                                           the hacker ethic intends to resolve the gap between
                                           authenticity and community by filling it with
                                           software that doesn't suck, political differences,
                                           inevitably represented by a the choice of words [5],
                                           still produce exclusions based on authenticity (in
                                           this case, 'free software vs. open source'). Perhaps
                                           another troubled aspect of this history that Sean
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                                 pinpoints is the academic discip