In The Technium, Kevin Kelly's "Better Than Free" post should be a wake-up call for Open Source project leaders, in particular those in the healthcare arena. I first got wind of his post via The Edge, and when it popped up again in Seth Godin's blog, I had to stop and take a look.
This super-distribution system [the Internet] has become the foundation of our economy and wealth. The instant reduplication of data, ideas, and media underpins all the major economic sectors in our economy, particularly those involved with exports -- that is, those industries where the US has a competitive advantage. Our wealth sits upon a very large device that copies promiscuously and constantly.
Yet the previous round of wealth in this economy was built on selling precious copies, so the free flow of free copies tends to undermine the established order. If reproductions of our best efforts are free, how can we keep going? To put it simply, how does one make money selling free copies?
I have an answer. The simplest way I can put it is thus:
When copies are super abundant, they become worthless.
When copies are super abundant, stuff which can't be copied becomes scarce and valuable.
When copies are free, you need to sell things which can not be copied.
Well, what can't be copied?
A great question. Fortunately, Kelly has an answer ready, though I think he left out one important point.
Kelly goes on:
There are a number of qualities that can't be copied. Consider "trust." Trust cannot be copied. You can't purchase it. Trust must be earned, over time. It cannot be downloaded. Or faked. Or counterfeited (at least for long). If everything else is equal, you'll always prefer to deal with someone you can trust. So trust is an intangible that has increasing value in a copy saturated world.
There are a number of other qualities similar to trust that are difficult to copy, and thus become valuable in this network economy. I think the best way to examine them is not from the eye of the producer, manufacturer, or creator, but from the eye of the user. We can start with a simple user question: why would we ever pay for anything that we could get for free? When anyone buys a version of something they could get for free, what are they purchasing?
Kelly mentions eight categories of characteristics of things that are "better than free", i.e., things you will pay for even when free alternatives are available.
Immediacy -- Sooner or later you can find a free copy of whatever you want, but getting a copy delivered to your inbox the moment it is released -- or even better, produced -- by its creators is a generative asset... Beta versions are often de-valued because they are incomplete, but they also possess generative qualities that can be sold. Immediacy is a relative term, which is why it is generative. It has to fit with the product and the audience. A blog has a different sense of time than a movie, or a car. But immediacy can be found in any media.
Cancer sufferers looking for a relevant clinical trial are often in a race against time. Immediacy is key to an audience like this - it can be a life-and-death matter.
Personalization -- A generic version of a concert recording may be free, but if you want a copy that has been tweaked to sound perfect in your particular living room -- as if it were preformed in your room -- you may be willing to pay a lot... Aspirin is free, but aspirin tailored to your DNA is very expensive. As many have noted, personalization requires an ongoing conversation between the creator and consumer, artist and fan, producer and user. It is deeply generative because it is iterative and time consuming...
Software that adapts intuitively to the way you use it is rare, in commercial as well as Open Source products. Figure out how to do this well with your project, and end users will rapidly become addicted to it.
Interpretation -- As the old joke goes: software, free. The manual, $10,000. But it's no joke... The copy of code, being mere bits, is free -- and becomes valuable to you only through the support and guidance. I suspect a lot of genetic information will go this route. Right now getting your copy of your DNA is very expensive, but soon it won't be... the copy of your sequence will be free, but the interpretation of what it means, what you can do about it, and how to use it -- the manual for your genes so to speak -- will be expensive.
In the case of healthcare systems, both of Kevin's examples apply paradigmatically.
Authenticity -- You might be able to grab a key software application for free, but even if you don't need a manual, you might like to be sure it is bug free, reliable, and warranted. You'll pay for authenticity...
Kevin's explanation suggests that he is conflating authenticity with a quality I would call "functional trust", which I address as part of the addition I suggest below to Kelly's list of "better than free" characteristics.
To me, authenticity in the context of healthcare means that the Dx and Tx I receive as a patient is based on the judgment of a qualified provider rather than an imposter or a poser. There's a possibility of an overlap with "trust" here, but I don't see it that way -- I might trust a person I know to be an imposter or poser, if I feel I can recognize when they are or are not acting in that sort of bogus persona. On the other hand, I might not trust a qualified healthcare provider; authenticity is a necessary component of trust in this respect, but not sufficient as such.
Accessibility -- Ownership often sucks. You have to keep your things tidy, up-to-date, and in the case of digital material, backed up. And in this mobile world, you have to carry it along with you. Many people, me included, will be happy to have others tend our "possessions" by subscribing to them... The fact that most of this material will be available free, if we want to tend it, back it up, keep adding to it, and organize it, will be less and less appealing as time goes on.
This is the characteristic relied on by the nascent but growing market for portable electronic health and medical records.
Embodiment -- At its core the digital copy is without a body. You can take a free copy of a work and throw it on a screen. But perhaps you'd like to see it in hi-res on a huge screen? Maybe in 3D? PDFs are fine, but sometimes it is delicious to have the same words printed on bright white cottony paper, bound in leather. Feels so good. What about dwelling in your favorite (free) game with 35 others in the same room? There is no end to greater embodiment... And nothing gets embodied as much as music in a live performance, with real bodies. The music is free; the bodily performance expensive...
To me, an example of this characteristic that is relevant to the Open Source community is the need to produce extensions to software systems that embed themselves in personal electronics such as PDAs and cell phones, and soon to all sorts of sensors and actuators inside and outside one's own body. Software that tells you what to do is useful, but systems that do it for you as well as or better than you could do it for yourself are invaluable. Think medication administration for an elderly home-bound patient, for example.
Patronage -- It is my belief that audiences WANT to pay creators. Fans like to reward artists, musicians, authors and the like with the tokens of their appreciation, because it allows them to connect. But they will only pay if it is very easy to do, a reasonable amount, and they feel certain the money will directly benefit the creators...
Hmmm... I'll take your word for it, Kevin. Could you be hinting that we should click on one of your blog's Google ads? ;-)
Findability -- Where as the previous generative qualities reside within creative digital works, findability is an asset that occurs at a higher level in the aggregate of many works. A zero price does not help direct attention to a work, and in fact may sometimes hinder it. But no matter what its price, a work has no value unless it is seen; unfound masterpieces are worthless. When there are millions of books, millions of songs, millions of films, millions of applications, millions of everything requesting our attention -- and most of it free -- being found is valuable.
I wrote a Master's thesis on this subject, which I can't go into here, but the implications for healthcare generally should be obvious, and so also for Open Source heathcare system providers. Can your system be found by those who need it? Does your system make necessary information and affordances findable by your end users? A remarkable number of commercial systems (healthcare and otherwise) have such murky user interfaces that it is a wonder that anyone finds anything.
One More Characteristic...
This list already covers a lot of ground, but I would add one more characteristic: Durability.
Durability -- Software that is clever and useful is a joy to find; to find that it is still working a month, year, or decade later is a pearl of great price. Functional trust (ie. reliability, etc.) fits into this category, but as a continuum rather than a single point in time.
Great food for thought - thanks, Kevin!