IN THE BUBBLE JOHN THACKARA - witz cultural

Conviviality 119
peer production of wellness and care. In the language of health policy, this
would be a shift from a biomedical to a biopsychosocial and epidemiological
model. The aim would be to empower patients to take responsibility for
their own well-being, facilitated by new forms of partnering and use of the
Internet.
A commons-based model would still involve teams of physicians and
nurses. One radically decentralized model already operating is Shahal
Medical Services, an Israel-based company with fifty-five thousand patientcustomers
who suffer from the usual array of cardiac, hypertensive, and
respiratory illnesses. The service also caters to elderly people and healthy
people with a high level of health awareness. Shahal uses online and wireless
services to organize therapy brought to the customer’s home (or wherever
the customer is). Customers measure body signals that are sent to a
monitoring center that is open twenty-four hours a day. These data are
linked to immediate consultation and advice based on symptoms, medical
history, and further real-time measurements. The system is designed
around proprietary software modules, a broad range of advanced end-user
devices, and protocols for the setup and maintenance of home care telemedicine
systems. According to writer Richard Normann, ‘‘The system creates
new linkages between end-customer-patients, the monitoring centre,
physicians, public authorities, and a fleet of mobile intensive care units.’’
The Shahal system spans the real and the virtual in an integrated way. 22
The use of the Internet by citizens to find health information is booming.
Sixty million Americans troll the Net in search of health-related information,
and research shows that nearly nine out of ten people want as
much information as possible from their doctor—good or bad—so that
they can participate in planning their own health care. Medical professionals
increasingly involve patients in evidence-based medicine—the
conscious, explicit, and judicious use of current best evidence in making
decisions about the care of individual patients. Multidisciplinary teams of
statisticians, health economists, academics, and health practitioners work
increasingly alongside service users and caregivers to sift through available
evidence and disseminate the results to clinicians. As Andrew Moore, editor
of Bandolier, one of the most popular evidence-based sites in the United
Kingdom, puts it, ‘‘There are six million research papers out there and
most of them are bollocks. We’re entering a new age of medicine where
the doctor and patient forge a therapeutic alliance.’’ 23