World After Capital: Getting over Privacy (Intro)

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NOTE: This is part of a series of excerpts from my book World After Capital. Today’s section introduces the idea that privacy is a strategy for freedom that has real downsides if we want to enter the Knowledge Age. In case you missed it, I posted a talk last week that summarizes my case for getting over privacy.

Getting Over Privacy

Copyrights and patents aren’t the only legal limitations slowing down the Digital Knowledge Loop. We are actively creating new restrictions in the form of well-intentioned privacy regulations. Not only do these measures wind up restricting Informational Freedom but more fundamentally privacy is incompatible with technological progress. Instead of clinging to our current conception of privacy we therefore need to understand how to be free in a world of widespread information sharing. Put differently: privacy is not a value in and of itself, rather it has been a strategy for and protecting freedom. To get over privacy and stay free we need to expand Economic Freedom, Informational Freedom and Psychological Freedom.

Before getting into the arguments to support this position, let me first note that countries and individuals already today are taking dramatically different approaches to the privacy of certain types of information. For example, Sweden and Finland have for many years been publishing everyone’s tax return [113]. And some individuals, including the CIO and Dean for Technology at Harvard Medical School [114], have published their entire medical history on the Internet. This shows that a world which embraces strategies other than privacy to safeguard individual freedom is eminently possible and exists in parts already today.

To better understand this perspective, consider the costs and benefits to individuals and to society from keeping information private with the costs and benefits of sharing it widely (potentially publicly). Digital technology is dramatically shifting this cost/benefit trade-off in favor of sharing. Take a radiology image as an example. Analog x-ray technology produced images on a physical film that had to be developed could then be examined by someone holding it up against a backlight. If you wanted to protect the information on it, you would put it in a file and lock up that file in a drawer. If you wanted a second opinion, you would have to get that file out of the drawer and have it sent it to you or the other doctor by mail. That process was costly, time consuming and error prone (the film could be lost in the mail, or the wrong film could be sent, etc.). The upside of analog x-rays was the ease of keeping the information secret; the downside was the difficulty of putting the information to use for your benefit.

Now compare analog x-rays to digital x-ray images. You can instantly walk out of your doctor’s office with a copy of the digital image on a thumb drive or have it emailed to you or put in a Dropbox or shared via some other way made possible by the Internet. Thanks to this technology, you can now get a second opinion nearly instantly. Not only one, you could get two or three. And if everyone you contacted directly is stumped, you could post the image on the Internet for everyone to see. Some doctor somewhere in the world may go, “ah, I have seen that before” even if “that” is incredibly rare. This in fact has happened repeatedly on Figure 1, a USV portfolio company, which provides an image sharing network for medical professionals.

This power comes at a price: Protecting your digital x-ray image from others who might wish to see it is virtually impossible. Every doctor who looks at your image could make a copy (for free, instantly and with perfect fidelity) and then send that to someone else. The same goes for others who might have access to the image, such as your insurance company.

Now, critics will make all sorts of claims about how we can prevent unauthorized use of your image using encryption. But as we will see, those claims come with important caveats and are dangerous if pursued to their ultimate conclusion (preview: you cannot have general purpose computing). So in summary: The upside of a digital x-ray image is how easy it makes it to get help; the downside is how hard it is to protect digital information.

But the analysis hardly ends there. The benefits that accrue to your digital x-ray image go well beyond just you. Imagine a huge collection of digital x-ray images all labeled with diagnoses. We can use computers to search through those images and get machines to “learn” what to look for. We know that such systems can be built given the recent progress with deep learning. And these systems, because of the magic of zero marginal cost, can assist with and eventually provide future diagnoses for free. This, you may recall from the section on technological deflation in healthcare, is exactly what we want. How rapidly we make progress with that and who controls the results will depend heavily on who has access to digital x-ray images.

If we went to the extreme and made all healthcare information public, we would dramatically accelerate innovation in diagnosing and treating diseases. At present, only large pharma companies and a few university research projects can develop new medical insights and drugs, since only they have the money required to get many patients to participate in research. Many scientists are forced to join a big pharma company, leaving the results of their work protected by patents (pharma companies have repeatedly lobbied for the ability to keep such information strictly for themselves). Even at universities, the research agenda tends to be tightly controlled by department heads and access to information is seen as a competitive advantage. While I understand that we have a lot of work to do to create a world in which broad public sharing of health information is compatible with freedom, this is the direction we should be embarking on.