Open source is the only way for Medicine

Chamberlen forceps (image credit: public domain via Wikipedia)

Medical Software now IS Medicine

Not long ago, clinical software consisted of simple systems for patient administration, databases for recording clinical information, and messaging. Nothing particularly exciting, and nothing particularly likely to make huge differences to clinical outcomes. One can easily see how these dull systems weren’t considered to be ‘part of medicine’ and not thereby subject to the scientific process and moral obligations of a medical innovation.

Medicine Was Open First

Medicine has historically always been an ‘open-source’ profession, even before the term open-source came into being. As an ancient profession, doctors have had ample opportunity over the millennia to experience the dangers of quackery, alchemy, and witchcraft which are the unavoidable sequelae of a lack of open sharing and open peer-review of developments in medicine.

Closed Source subverts the Scientific Process

Let’s try a thought experiment. If I was to announce that I had developed a new medicine, or surgical technique, or lab test, which I claimed had clinical benefits, then in order to be taken seriously I’d have to be able to prove that.

So, what happens when medical innovations are kept secret?

History gives us a particularly appalling demonstration of the human consequences of secret medical treatments — the Chamberlen family of obstetricians — who for around 150 years kept secret their development of obstetric forceps. During the time that the innovation was kept hidden from the rest of the world, it is likely that hundreds of thousands of mothers and babies died as a result of the lack of this treatment.

Open source for quality, safety, and speed.

Sharing knowledge means reduced duplication of effort — if knowledge is freely available to me as a clinician I don’t need to use my resources to create it all over again. Instead I can use my resources to create new knowledge which I can then also share, meaning we all benefit from two interventions rather than one. We all progress faster.

Public Money, Public Code

Quite a large proportion of medical research is publicly funded. This is taxpayers’ money which is used for developing medicine. Where this medical research results in development of software, data sets, algorithms, or any other technological feature, it’s imperative that these be open sourced, so that the the maximum taxpayer benefit is extracted from the investment.

Crimes Against Humanity

Ok, here we come to perhaps the bit where I’ve gone too far with my hyperbole. You decide. But I believe that based on all of the above argument, closed source clinical software is a crime against humanity.

Complicit….

As I make all these assertions about how clinical software should be developed and shared, and very hyperbolically state that who impede open sharing of clinical software may be committing crimes against humanity, I’m also aware that there are some among the medical profession who are complicit in this process of closed-sourcing medicine and developing proprietary clinical interventions.

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Marcus Baw

Marcus Baw

#HIT100 NHS GP | Clinical Informatician | Ruby & Python dev | co-founder NHSbuntu & openGPSoC | Freelance Health IT