The Right to Repair Ourselves

Kim BellardGeoffrey Fowler wrote an interesting article in The Wall Street Journal: We Need the Right to Repair Our Gadgets.  He describes how manufacturers have made it difficult for us to fix our personal tech gadgets (The Guardian concluded the same earlier this year), and discusses how he's managed to overcome some of those obstacles.

As I was reading it, I kept thinking, boy, replace "gadgets" with "our bodies" and "manufacturers" with "health care professionals," and he could be talking about health care.

Mr. Fowler asks the central question:  "At issue: Who owns the knowledge required to take apart and repair TVs, phones and other electronics?"  He asserts: "We’re more capable of fixing technology than we realize, but the electronics industry doesn’t want us to know that. In many ways, it’s obstructing us."

Again, think of the parallels for health care.

This obstruction takes many forms.  Mr. Fowler claims that some manufacturers control repair plans, limit access to parts, or use digital software locks to prevent consumers from fixing problems themselves.  If you have an Apple product with a bad battery, too bad, because you can't replace it yourself.  Apple uses special screws to ensure you can't even open the case.  Maybe they're just trying to prevent reverse engineering, but I suspect the people engaged in that are far more capable of defeating this tactic than some poor consumer who just wants to put a new battery in.

It's not that the manufacturers want to do the repairs themselves, mind you; they just want to make it difficult enough that, when there is a problem, you'll just give in and buy a new device.

This strategy of "planned obsolescence" has been around for a long time.  It has often been applied to automobiles, with their annual model changes, but it goes much further.  Popular Mechanics, for example, lists eight products "designed to fail," including not just cars and consumer electronics but also software, video games, ink cartridges, textbooks, and light bulbs.

Mr. Fowler took on the task of fixing a friend's broken Samsung TV.  Samsung grudgingly referred him to an authorized repair shop, insisting that the repairs needed to be done by a "qualified" technician.  Not surprisingly, the estimate from the repair shop was awfully close to the price of a new TV, so Mr. Fowler took to the Internet.

He quickly identified the likely source of the problem, found the necessary (and surprisingly cheap) replacement part, and viewed an applicable YouTube video.  He also discovered several communities of self-repair enthusiasts, one of which claimed they can fix two-thirds of the broken consumer electronics they see.  That's not only averting a lot of spending on replacements, but also reducing e-waste.

If you're old like me, you might remember that if you had a PC in the 1970's, you probably built (and repaired) it yourself.  If you had a TV in the 1960's, you probably had to routinely replace its vacuum tubes (Millennials, go ahead and google them).  You didn't have to be an expert mechanic to do most car repairs yourself until the manufacturers starting putting in all those computer circuits in the 1980's.

You might also remember when going to the ER was a rarity, and that it took a lot for your family doctor to send you to a specialist.  There was much more of a tendency to fix problems at the lowest level of care,including wait-and-watch and/or self-doctoring for many common problems.  Today a low grade fever is likely to cause an ER visit and a dose of antibiotics.

The analogy of planned obsolescence only goes so far because, of course, we can't get new bodies (although we can get some new parts, like knees, hips, or organs).  In health care, the goal seems to be to persuade us to get more care, and more expensive types of care at that.  It's a self-perpetuating cycle.

Think back to Mr. Fowler's central question.  Who owns the knowledge necessary to "repair" our health issues?  For centuries physicians have held that knowledge close to the vest as part of their professional expertise.  In the world of the Internet, much of that knowledge is now available to consumers -- e.g., Pew's 2013 report found 72% of Internet users had searched for health information, and Google's enhanced health search results now cover 900 conditions in-depth.

Thought leaders like Eric Topol have called this the "democratization" of health care."  Dr. Topol doesn't just think it is good for consumers to have access to all this information but also calls for patients to "own" their own medical data, rather than the current situation where it is locked in the silos of each provider who treats them.

I think Mr Fowler would agree with Dr. Topol.

Similarly, I suspect that Dr. Topol would draw the same conclusion about health care that Mr. Fowler does with consumer electronics: we're more than capable of "fixing" ourselves for many health issues, but the health care industry doesn't want us to know that and, in many ways, does its best to obstruct us from doing so (see a prior post).

A new book -- The Patient's Playbook --  urges us to take control of our medical care, rather than simply letting it happen to us, and I couldn't agree more (I love the description "tiger patients" used in one review).  However, to me it is a little like advice on how to survive if I happened to get caught in a hurricane.  I'd want the advice, but I'd rather know how to avoid hurricane in the first place.

A variety of health apps are starting to break down the traditional barriers about what consumers can do versus what health care professionals need to do for them, and that's great.  I just hope the FDA is very thoughtful in their reviews of such apps, not only which apps need their approval but also not underestimating what consumers can do on their own.

There are certainly many people with complex health issues that require sophisticated treatment by medical experts.  However, that is not the vast majority of us.  I'm not advocating that we should do brain surgery ourselves, but there are a host of health actions for which we shouldn't need medical interventions.

We've built a health care system that is like a Indy race car -- very advanced, very good at its intended purpose, driven by expert drivers, and, of course, very expensive, but not well suited for everyday driving.   We need a health care system that lets us do more of that everyday driving when it comes to more routine health care.

Do-it-yourself health care, anyone?