Evidence-based medicine is ”the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” [wikipedia]
Big Data is “a collection of data sets so large and complex that it becomes difficult to process using on-hand database management tools or traditional data processing applications. The challenges include capture, curation, storage, search, sharing, transfer, analysis, and visualization. The trend to larger data sets is due to the additional information derivable from analysis of a single large set of related data, as compared to separate smaller sets with the same total amount of data, allowing correlations to be found to ‘spot business trends, determine quality of research, prevent diseases, link legal citations, combat crime, and determine real-time roadway traffic conditions.” [wikipedia]
The origins of the evidence-based social upheaval are now clear to see. Though not apparent at the time, key pieces of the spasm were beginning to move into place.
Big Data was the details of everyone’s behaviour on the web, their census data, their responses to online questionnaires, social graphs, their text groups. It was a mix of privately held, corporate, or government-held data about people. It was the easily and cheaply available compute power and the expertise to mine the datasets for nuggets of usefulness.
Big Data started out as a worry and an opportunity. The worry was that companies (and governments) would be able to glean a great deal of private information from the vast reams of supposedly anonymised data (as happened with the Netflix film recommendation competition data). The opportunity was mainly for companies to be able to sell more stuff by identifying and targeting susceptible subsets of customers, and for governments to chase innocent acquaintances of bad people.
So where did the data come from?
After getting away with what was not far from being murder for decades, misleading the medical world and therefore the public, Big Pharma came under sustained pressure (by Ben Goldacre and others) to publish details about all their tests, particularly the ones which did not show their new products in a good light. This was already a significant step but, subsequently, a particularly heinous, collective, long-running failure of responsibility with regards to non-disclosure of relevant medical information became public. A plea-bargain was struck to avoid a torrent of costly law suits. Every new medical product awaiting a license was required to have a detailed log of every test, all the raw data collected along the way, and the statistical manipulation of the data to produce the official test result. All the raw data of every medical test was now to be published online, and made freely and publicly accessible.
The UK government managed to overcome massive institutional and political inertia to produce an increasing portfolio of genuinely effective public access to online government services. Starting with the online payment of car tax, department after department opened up its services with a well-designed user experience, that actually worked. Flushed with the success of a large government IT initiative that had not overrun by 5 years and still failed, nor had experienced cost-overruns of £100+million, nor had made the headlines with calls for senior civil servants to have their honours and pensions revoked, the government took another, fateful, step forward. All government-held data about the public was made available and usable online.
The Boris Bike Scheme had been an obvious first candidate for this, but they had attempted to retain control of the bulk bike usage data, presumably for potential commercial reasons. Interested people did what they always do when faced with such an approach: they screen-scraped the bike scheme web pages and extracted the data that way, at the expense of significant capacity costs to the scheme. Eventually the BBS caved and provided easy, efficient access to the data.
Wikileaks had started out providing a route for whistle-blowers in the military and government security services to expose alleged wrong-doing. Each leak would make the news for a while, government spokespeople would get all frothy, legal threats would ring out, laws would be proposed, sabres rattled. When assessed objectively, however, these leaks did not really affect many people nor particularly change government or military behaviour. The big change came with the leaking of massive government and corporate-held datasets about the population. Initially, these so-called ‘lacklustre’ leaks were met with widespread indifference, not even making the headlines. Still, data activists continued probing the data and, significantly (but only as a side-effect), made the data available online to whoever else wanted to have a poke about.
The hacktivist group, Anonymous, stepped into the Big Data mix when they uncovered and published the full set of feeds from all UK council-controlled CCTV cameras. These feeds were unsecured and publicly visible if you had the correct URLs. The councils had been operating a security-through-obscurity policy on CCTVs and other monitoring schemes, i.e., if you didn’t know it was there you would not be looking for it and would not find it. Of course, once the obscurity is gone, you have no security, as the councils were now discovering. The security industry had long had a slightly different name for this kind of policy: “stupid”.
The damage was done. There were in fact at least 50% more CCTVs in operation than the privacy campaigners had known about, including all the speed cameras, even the supposed ‘empty’ ones. Rather than frantically remove some of the more contentious CCTVs, or reconfigure them with more secure URLs or hook them into the government-controlled, dedicated, dark fibre network, the UK government took the opportunity to step in and wrong-foot the regular privacy glitterati and make a magnanimous gesture, regain the moral high ground, avoid lots of awkward questions, and nip a potential privacy-related PR disaster in the bud, by formally publishing the links to all the CCTV cameras on one of the new government web sites. CCTV of the people for the people.
There were copious complaints at first - this was the UK after all. But ego surfing quickly trumped the lingering doubts of the privacy campaigners. Whilst there were privacy issues, at least the government did not have sole access to the feeds.
Using standard face recognition software, and by extending the Microsoft Kinect, it was possible to track yourself across multiple CCTVs, and splice together an almost continuous sequence of yourself moving about town every day. At first, people were delighted by the serendipity this revealed, where people’s paths had overlapped at various points during the day, albeit at different times. Some experimental dance troupes took this a step further and had individuals dancing at the same places but different times (pan-temporal), or different places but the same times (pan-locational), stitching together the CCTV footage into a single performance.
The UK census data had been online for a while, but was so thoroughly obfusticated and confusing that only the most-hardened of data journalists were brave or experienced enough to tread there. Their data was available in the form of reports that never quite answered any one question a real person might actually have. Two 6th form students as part of their General Studies A level (who knew something good would come out of General Studies?) reverse-engineered the myriad individual reports back into a coherent dataset of the nation, following a similar approach taken to DNA sequencing. The result, an easily queried, statistically useful dataset which pinned down most people in the UK to a place and a time.
The opening up of Facebook’s social graph helped reinforce the inter-connectedness of the data. With the CCTV feeds for physically co-located behaviour, and the Facebook and others (although not LinkedIn’s, since over 90% of links were between people who had never and would never meet) social graphs for online, socially co-located behaviour, the government datasets for historical trends, the Big Data genie was fully out of the bottle and was not going to go back in without a fight.
The Quantitative Selfers (Quants) had started out with themselves as subjects, recording the minutiae of their own, personal, sad little lives. They learned a few things, shared a few things, but generally kept it to themselves or their small communities. Whenever they piped up with advice for others, the vast, unthinking majority of people living happily sub-optimal lives waved them away.
But the world moved on. More data was becoming available in increasingly large and useful chunks. Cheap data-crunching firepower, such as Amazon’s Elastic Map Reduce was available and easy to use. Hunches could be checked. Data could be mined. Correlations revealed. Tentatively at first, but with the scope widening on a daily basis, Quants started identifying lots of strong links between certain life choices and long term health outcomes. And so the slide down the slippery slope of evidence-based improvement had begun.
The next step was to identify skin complaints, directly from the CCTV images. And the next, measure the distribution of body fat, and to look at posture and gait.
The fashion industry was able to quantify what normal people were choosing to wear, spotting the many dozens of nascent fashion trends bubbling up on a daily basis, identifying the fashion leaders who somehow predicted the bigger changes in fashion weeks in advance.
It wasn’t sufficient to publish these correlations and leave it at that. This wasn’t a matter of opinion. With the quantity and quality of data now available, these correlations had the status of facts. It would be wrong to keep this to yourself. It would be wrong not to spread the word. Quants switched from self-improvement to the improvement of all. They started evangelising.
This was no mere religion. This was not garbled, repeated mis-translations of ancient texts of hearsay and rumour written with the aim of retaining power over a large, weak-minded flock. There was no god, but there were consequences aplenty to pretty much anything we chose to eat, drink, or do. You literally could not keep this kind of information to yourself. Every new person in the know would start spreading the word.
“Evidence-based” became a mantra across government, in companies, in families, whole countries, in fact almost every grouping of people. Advice-giving followed hand in hand.
The bald fact was that evidence-based thinking worked. Who knew? When you took the politics and stupidity out of a topic, and just studied the evidence, it was often easy to identify the best action to take. The government was caught in the horns of an existential dilemma. If it was not seen to be basing its decisions on the evidence, it would be roundly denounced in the court of public opinion, but in following the evidence it was usually acting against its own political instincts.
Evidence-based meant the elimination of party politics. The various political parties managed to find (or manufacture) some points of contention, where the evidence was missing, weak, or misleading, and make grandiose stands on points of principle, but only for so long. Eventually some pesky evidence would come to light, one or other approach would be deemed the best, and that ended the argument.
There were abrupt changes on drugs, education, policing, taxation, immigration, and, yes, security - pretty much every aspect that a government cherished as being under its control. It was not mere coincidence that there was a corresponding reduction in drug-related harm, better educated children, more effective policing, and increased tax revenues. Commentators gently pointed out the coincidence, but left it at that. Things were improving in government and they did not want to give it any excuses to back out.
National productivity soared, then global productivity. Governments gave and received from each other suggestions based on satellite imagery, newly released datasets. Weak or despotic leaders frantically tried to seal the information borders. Only China succeeded.
Meanwhile, back at a smaller, personal scale, those giving unsolicited advice were soon referred to dismissively as ‘paperclips’. Etymologists argued for a while about whether that use of the word ‘paperclip’ meant it was a skeuomorph referring to its use by Microsoft as a ‘helpful’ assistant, or was merely a metaphor. Many many people, not all paperclips, advised the etymologists it did not matter and to get a life.
Among the ignorant majority (igmas), unsolicited advice was now expected and feared. It was unstoppable. Harmfully helpful. And passive aggressive was the new aggressive. Deliberately withholding useful advice for maximum “I told you so” value.
Attack was, as ever, the best form of defence. Those (many) igmas with clear symptoms of wrongful, avoidable indulgence collectively developed a portfolio of responses. With a bit of practice, you could identify the paperclip’s likely guilty behavioural secrets and hit them with advice before they could finish telling you the best way to stop putting on weight with the smallest change to your diet+exercise regime.
Such was the potency of these Paperclip Shield Portfolios, that some paperclips would deliberately trigger a riposte in order to get a hit of that craved-for advice. This was labelled by psychiatrists as Munchhausen by Wishful Thinking, and by the PSP wielders as “being a dick”. When it became apparent that some paperclips were in fact seeking out and benefiting from the PSPs, more advanced igma groups identified the symptoms of “being a dick” and deliberately offered fake, harmful advice.
Giving advice, it turns out, is addictive. But more than that, contagious. It is not sufficient to improve just one’s own well-being. There is a very strong urge to improve everyone else’s. Every new bit of provably effective lifestyle improvement just added fuel to the addictive fire.
Resistance to unfettered advice giving usually benefits from a form of ‘herd immunity’. As long as a certain percentage of the herd is immune (or vaccinated), it confers immunity to remaining weaker members of the herd, stopping the disease from spreading. The threshold for smallpox is around 84% (which was achieved and sustained worldwide and hence it was eradicated). The threshold for advice giving, however, is significantly higher, on a par with measles at 95%. That is to say, 19 out of every 20 people need to be immune to stop the disease spreading through the population.
As was shown with the MMR fiasco, a single person (the then-not-yet-struck-off-Dr. Andrew Wakefield) can trigger a big enough change in behaviour (parents not immunising their children out of fear) to cause the population’s immunity to dip below the threshold, in that case leading to outbreaks of measles among the young. Some died.
The new high quality evidence tipped a few waverers who would normally know better into becoming overt advice givers. At first they just infected their own family units, but the contagion soon burst out into wider social groups. And here, the true horror of advice giving became apparent. It can spread electronically. All the classic contagious diseases needed some form of physical contact to be spread, whether by touch, aerosols sneezed out, insect bites. But advice could travel by TV, by the internet, by text messages. It did not weaken over distance. One person could infect millions in just a few seconds.
The infection spread, and began to trigger strong reactions among the more resistant members of the population.
It was like your mother followed you everywhere, having read every book about everything, pointing out your many faults, and was in fact right all the time. This was bound to antagonise pretty much everyone pretty much all the time.
Crime levels dropped, significantly, within a few short years. Not because of better policing (although that did benefit hugely from a bit of evidence-based thinking, unfettered by political interference), nor from changes in the law. It was because of the nagging. Being convicted meant losing your right to choose not to be given life/work balance advice. Prison was like being surrounded by 50 people, all of whom were your mother, tutting sadly at your failings and pointing out the many ways in which you could become a better person.
Prison was most definitely not a soft option now. Even after the main public backlash against advice giving, it was agreed to suspend the requirement that punishment must not be cruel or unusual, and keep the relentless application of positive advice as a staple of prison life. Re-offending rates dropped close to zero. Sure, part of this was because the criminal world was applying its own evidence-based thinking to ways of avoiding being caught, but their heart wasn’t in it. The consequences of capture were so fearsome that, by and large, they stopped being criminals.
Even before the advice pandemic, there had been minor, spontaneous outbreaks of resistance to advice.
That meddling Jamie Oliver trying to force healthy eating on school children? All he got as thanks were podgy, sweat-pants-wearing parents pushing pies through the school railings to their darling pudgies. Camera crews queued up to catch the moment. Fame at last for the overweight and stupid, just for being themselves.
Young adult males (who else?) deliberately sought out risky or stupid practices. This reached its zenith with eyeball licking (yes really). An amazing range of unpleasant diseases now had an effortless route from one person to another. Interestingly, eyeball licking was only a modern slant on a much more ancient practice of eyeball scraping (yes, really).
Of course there already were a wide range of stupid and risky habits to choose from, such as smoking and drinking heavily. Although fewer people now did them, the remainder did them more vigorously. It became cool to deliberately do suboptimal things.
In an irony not lost on the more educated smokers (there were some), smoking itself was not immune to a bit of evidence-based advice. You could not simply be left to have a sad puff on your ciggie:
“You need to suck the smoke deep into your lungs, hold it, and slowly exhale through the nostrils for the best effects.”
“No, hold it the right way, that’s it, with the fingers over the pin pricks along the side.”
“The first puff should be half a lungful, sets the body up, then go the whole hog in the next puff. That’s it.”
“You can tell from the volume of smoke shooting out of each nostril if you have a cold on the way. Best take some vitamin C good and early, but with warmed water, don’t forget.”</blockquote> Body builders (never the brightest of candles) were among the most vulnerable. Body building is basically very hard work, which is enough to put off most normal people from trying. They already drank, ate, or injected anything that was even rumoured to increase muscle mass, ignoring the impact on their testicles. With the new evidence-based approach, sure enough effective techniques were uncovered. Hints and tips for effective quick fixes were spread in the gyms, usually in picture form. Bodies started bulging everywhere.
So dramatic was the change that XL became the new Medium in a matter of months. Clothing retailers appealed to the Retail Watchdog that it would cost a fortune to re-label all clothing with the new sizing. In a rare example of common sense, the retail watchdog agreed. With two announcements (one on PMQ and one on the Graham Norton Show) the word was out and tacitly accepted.
Accepted, that is, until new evidence emerged that our life span was reduced by excess musculature, even if it had been arrived at safely. Overnight the beefcake fad was over; so suddenly that people lost muscle mass too fast. By abruptly ceasing their hyper-efficient techniques for building muscle mass, they lost bulk and weight so rapidly their skin did not have time to naturally shrink over their reducing torsos. There were lots of thin flappy people. “Pull your flaps in” became a standard rejoinder to remind aggressive paperclips of the transience of their advice, and well as being an exasperated plea on crowded public transport when trying to sit in a seat between two former body builders.
Young adults of both genders started subverting the weight-loss advice being bandied about. Body Popping. A diet+exercise craze to oscillate your BMI between your ideal upper and lower bounds. With certain advanced techniques borrowed from the now discredited body builders, and actresses, it became possible to body pop from lower to upper and body poop from upper back to lower, all inside 4 weeks. In some clubs, the members started synchronising. Then a few clubs started to become elitist, only allowing new joiners who were in the correct BP phase, and would advertise accordingly.
Like the introduction of seatbelts which lead to drivers going faster because they felt safer, precise and accurate knowledge of the effect of every bad habit and combination of consumables led to deliberate risk-taking.
An assortment of cottage industries sprung up, supplying the elements now missing from people’s lives. You want shoddy service? We can oblige. In a while. If you’ll just hold on for 20mins. People queued up and paid extra to be messed about, to reminisce about the pre-paperclip days.
There was an underground movement that provided advice (there’s that word again) on how to subvert the relentlessly healthy produce on offer and create tasty, harmful, old school meals.
Different countries handled the outbreak of evidence-based advice in different ways.
Germany was pretty much there already, but in a way this helped them avoid the excesses of the newly quantified proselytisers.
Russians rejected it outright. They knew damn well it was all someone else’s fault, and all they needed was a strong leader to get things back on course.
There was an intriguing period when France was lauded by the Quants as having the ideal diet, particularly when compared with the UK. The French could have gone either way at this point: gloating, or rejecting. To their credit, the French as a nation almost immediately starting taking on a poorer diet to show solidarity with ‘Les Rosbifs’, their English chooms across la Manche who still insisted on eating roast beef way too often despite there being categorical proof that every slice of red meat took at least a day and a half off your life, and double that for roast beef.
The evidence-based juggernaut proved a blessing and a curse for Australia. Of all the meats consumed by humans, only rabbit seemed to be actually good for you, with no long term side effects (if you ate your greens as well). Their #1 most loathed pest had become the must-have meat on middle class dinner tables worldwide. Of course they couldn’t shoot the buggers any more, because the shot pellets would pollute the meat. Nor could they trap them because the stress hormones would affect the taste, and the gentile middle classes could not countenance food that had suffered. So, through gritted teeth, Australians became rabbit farmers. Burly ex convicts (5 times removed) wading knee deep through cavorting, tame rabbits, whilst trying to think happy thoughts. Feeling the love, the rabbits started breeding even more like the proverbial rabbits. Australia now had a massively successful export market.
With a bit of delicate spin (not expected and not looked for), Australian abattoirs kept the details of precisely how the rabbits were slaughtered away from the public gaze. There were (never substantiated) rumours involving the use of cricket bats and cries of “take that ya furry bastard” late into the night.
Damn that Ben Goldacre. Where’s he now to pick up the pieces from all the damage he’s caused. It turned out that no medicines worked anywhere near as effectively or comprehensively or cheaply as people making simple adjustments to their daily routines. By removing the behavioural impact on health, the actual, unavoidable diseases became much easier to study; much simpler to cure. All the major ailments tumbled before the might of clear evidence and a bit of chemistry. Soon, the only illnesses left visible were due to poor personal choices. There was no medicinal crutch that could fix people’s own self-imposed, self-inflicted health injuries. It was now truly the patients’ fault, as doctors had secretly known all along.
The Catholics had it right, but for the wrong reasons. Everyone is born guilty; that is, guilty of sloth, laziness, stupidity, poor dietary choices, taking the lift instead of the stairs. It all added up to a big, fat, religious “We told you so”. And so church attendance went from falling, to plummeting, and back up to merely falling. Somehow, despite the evidence-based approach heralding the utter destruction of the faith-based religions, they survived to manipulate the weak-minded another day.
If you slavishly follow an evidence-based route, you need to be prepared to go where it takes you.
The Daily Mail online had shown what people actually wanted in a website, by offering alternatives and noting which options people chose. Evidence is evidence and, well, people chose guilt-free porn, closeups of cellulite, indiscretions among celebs, and proof that foreigners are bad for the country.
People wanted to live longer, healthier, happier lives. But they also wanted to commit an occasional crime, to not pay taxes, to actually kill an animal, to drink heavily without getting hungover, etc. Once again, the internet was the medium of choice for dissemination of this dark advice.
By popular demand, Greggs returned to the UK high streets. Their revenue had dropped overnight to zero during the evidence-based years, but with the return of widespread and wilful ignorance about the health impacts of consuming copious sugar, fat, and cheap flour, their products were once again in demand.
And so, while governments continued to experience the cathartic joy that comes with acknowledging they have no control over their own policies, the evidence-based healthy living advice frenzy began to turn in on itself, moving away from actually fixing issues and towards how best to ignore them. It became much easier not to care than to actually do anything about them.
With a great sense of relief, people were able to step off the giddy roller-coaster of self improvement, and return to their former, more comfortable, less stressful, shorter, iller, fatter, uglier lives.