The democratization of knowledge:

Anyone can know anything

History records many examples where the authentication of knowledge and the means of its dissemination have been used as tools for exclusion and control, rather than inclusion or human betterment.

Religious organizations throughout the ages have been notorioius for establishing priesthoods which jealously guard religious knowledge from lay people.

Professional organizations are formed ostensibly for the purpose of promoting the development of the profession for the common good, and enhancing or upholding quality standards. Such arrangements can easily turn into monopolies that work against the public interest.

Large organizations have used their size and financial resources to monopolize air-time and claim to have a monopoly on knowledge.

In computing firms, the law of increasing returns suggests that the winner-take-all nature of the computing business leads to monopolies and the ability to impose knowledge on customers and clients.

Now that new technology makes sharing potentially easier and cheaper than ever before, it is vital that the tools be used in a spirit of inclusion, and for the public good.

This phenomenon is particularly notable in the spontaneous formation of global communities of interest in the field of medical problems. Patients who were once at the mercy of doctors who had unique access to esoteric medical knowledge now find themselves able to contact other doctors and patients and explore their particular subject, gather new data, discover new leads for treatment, and learn how to cope with side effects. The emerging communities are global in nature. A patient in the US may be able to learn from a doctor in China or a suffering patient in Argentina and vice versa. The sufferers of rare diseases, where perhaps only a few victims exist around the world, can now make contact with each other and share experiences (see example below).

Large organizations will be subject to the same phenomenon. If large organizations ignore the emerging democratization of knowledge, they will do so at their peril. If they claim to own or establish a monopoly of knowledge, actual or de facto in the guiese of web portals or knowledge management,, they are likely to find that the technology of communication on the World Wide Web is more powerful, and will lead to a backlash among their clients and partners.

The same principles will apply to public sector organizations. The openneess of the World Wide Web ensures that a multiplicity of alternatives voices and opinions are available to the public. There is no natural monopoly of portals, and a variety of them grow spontaneously in any country as soon as people start publishing web pages (it is a genetically inherited trait of hyper-text) and therefore government or inter-government portals are usually not required at all and can unfairly compete with self-sustained initiatives.

To exploit the power of the World Wide Web, collaboration and openness need to become the dominant principles of operation.

Medical dialogues on the web: an example

Sample inquiry on the web 12 June 2000 23h20:

Can someone help me? My wife, a 40 year old non-smoker, with no family history or apparent risk factors, got diagnosed for stage IV lung cancer with metastases to the brain, ovaries and liver exactly one month ago. These were based on full body CAT scans followed by a liver biopsy. We were completed confounded by the diagnosis, and she has since been on radiation and has had one round (2 sessions ) of chemotherapy. When we looked at the results of the blood tests done last week (June 8th) we found that the WBC, RBC and platelet counts were low, as we expected, but the 3 tumor markers (AFP, CA, CEA) are very much within normal range. I was really confused by the results because I had expected an elevated score on the tumor markers. How could there be such an agressive and advanced cancer, but no elevated reading on the markers ? Any thoughts or suggestions are welcome.

Actual reply 13 June 2000 18h33

Alpha feto protein is a fairly specific marker. It is elevated in patients with a primary tumor arising in the liver (malignant hepatoma) and in patients with germ cell tumors. I wouldn't expect an elevation in other tumor types.

CEA is often, but not universally, elevated in cancer patients. The percentage of patients with an elevated CEA varies with the exact type of tumor (it's histology, site of origin, etc.) and ranges between 35% and 70%. Thus a negative CEA isn't uncommon.