I recently blogged about undisclosed risks of medical treatments. For example, sleeping pills are associated with a big increase in death rate. Patients are rarely (never?) told this. One reason risks are undisclosed is ignorance: Your doctor doesn’t know about them. Another likely reason is that you and your doctor have different goals. If a treatment harms you, your doctor is not harmed, in all but a few cases. If you refuse a treatment (such as a surgery), your doctor may make less money. This pushes doctors to overstate benefits and understate costs.
This is the simplest case for personal science: You care more about your health than any expert ever will. The experts have advantages, too (such as more experience with your problem) so it is not obvious that personal science will be better than expert advice — you have to try it and find out. When I started to study my acne, I was stunned how easy it was to improve on what my dermatologist had told me.
A recent article in The Atlantic (“The Insourcing Boom”) describes a similar revelation at General Electric. GE executives wondered if they could build a certain water heater (the Geospring) just as profitably in America as in China. They looked at it carefully:
The GeoSpring in particular, Nolan says, has “a lot of copper tubing in the top.” Assembly-line workers “have to route the tubes, and they have to braze them—weld them—to seal the joints. How that tubing is designed really affects how hard or easy it is to solder the joints. And how hard or easy it is to do the soldering affects the quality, of course. And the quality of those welds is literally the quality of the hot-water heater.” Although the GeoSpring had been conceived, designed, marketed, and managed from Louisville, it was made in China, and, Nolan says, “We really had zero communications into the assembly line there.”
To get ready to make the GeoSpring at Appliance Park, in January 2010 GE set up a space on the factory floor of Building 2 to design the new assembly line. No products had been manufactured in Building 2 since 1998. . . .
“We got the water heater into the room, and the first thing [the group] said to us was ‘This is just a mess,’ ” Nolan recalls. . . . “In terms of manufacturability, it was terrible.” . . . It was so hard to assemble that no one in the big room wanted to make it. Instead they redesigned it. The team eliminated 1 out of every 5 parts. It cut the cost of the materials by 25 percent. It eliminated the tangle of tubing that couldn’t be easily welded. By considering the workers who would have to put the water heater together—in fact, by having those workers right at the table, looking at the design as it was drawn—the team cut the work hours necessary to assemble the water heater from 10 hours in China to two hours in Louisville.
In the end, says Nolan, not one part was the same.
So a funny thing happened to the GeoSpring on the way from the cheap Chinese factory to the expensive Kentucky factory: The material cost went down. The labor required to make it went down. The quality went up. Even the energy efficiency went up. . . . The China-made GeoSpring retailed for $1,599. The Louisville-made GeoSpring retails for $1,299.
That’s what happened when designers and manufacturers were no longer so far apart. As far as I can tell, the designers at GE had no idea such big improvements were possible, just as I was shocked how easy it was to do better than my dermatologist.
There are dozens of ways to bring the incentives of doctor and patient closer together but that would be like trying to bring the Chinese workers and GE designers closer together. Personal science is much easier. No one besides you needs to change. It corresponds to insourcing: insourcing responsibility for your health.