Studying Those Who Study Us: An Anthropologist in the World of Artificial Intelligence

Rating:
Summary: Great collection which explores anthropology & AI
Review: Diane Forsythe was trained in both anthropology and artificial intelligence, and her work offers insights to both of these realms. It's a pleasure to have her work collected and published (posthumously) in this volume. Many of the issues which Diana Forsythe confronted implicitly and explicitly in her work are issues which are of ongoing concern for all anthropologists. Her concerns included the responsibilities, opportunities, and limitations that come with funding sources, and, not unrelated, the numerous challenges associated with `studying up.' Finally, Forsythe struggled with the difficulty of balancing her participant observation with social action.

Forsythe argued that `studying up' disrupts the `traditional fieldwork narrative,' and at the same time calls into question all that is familiar ground for anthropologists from an ethical and methodological perspective. Often, said Forsythe, this type of participation requires anthropologists to be experts not only in anthropology, but also to some extent in their area of inquiry. As a result, we may have similar skill sets and jobs to those we study, but we may also be competing against them for funding and/or workplace resources. This twist poses a complex ethical dilemma for which anthropologists do not readily have the answers. In addition, informants can read what is being written about them, which results in a new accountability and criticism as part of the research process.

The Medical Anthropology Quarterly article provides one example of the many challenges she encountered in her work. In it, Forsythe argues that computer programs are a product of the culture from which they emerge, and that her intent is to describe how this occurs. She says that the program which was designed to aid migraine sufferers espouses the physicians point of view, and it may in fact reinforce the divide in the doctor-patient relationship rather than improve it. Rather than developing the questionnaire from a social sciences perspective, she describes a team dynamic where a programmer understands this task to be a logical one rather than a social one, and so takes this on as his primary task. As a result, the questions in the tool are structured in such a way that they do not make room for issues like violence against women, which is potentially a major factor in the case of female migraine sufferers. She also says that the composition of the team included no nurses, and, although members of the team were migraine sufferers, they nonetheless spoke with their professional perspective throughout the process, and never with the perspective of a patient. She goes on to describe the nature of the program that was created, saying that it really only answers questions that patients would normally ask in the office, and that, as a result, it did not address any of the needs of the patient that were not addressed in clinic visits. Ultimately, then, the system reinforces the doctor's diagnosis, and provides little to no new information or insights to the patient. Through her description, she offers a set of issues and concerns which change the perception of the project and provide insight into the tool and its limitations.

Many anthropologists have attempted to answer the question of how to be sufficiently engaged and disengaged simultaneously. How can we - or can we - be agents of change in the world we study? Forsythe illustrates the challenges of finding paid work in non-academic anthropology, the complexities of studying up which may accompany that work, and the difficulties with being engaged in critical practice at the same time.

Rating:
Summary: Great collection which explores anthropology & AI
Review: Diane Forsythe was trained in both anthropology and artificial intelligence, and her work offers insights to both of these realms. It's a pleasure to have her work collected and published (posthumously) in this volume. Many of the issues which Diana Forsythe confronted implicitly and explicitly in her work are issues which are of ongoing concern for all anthropologists. Her concerns included the responsibilities, opportunities, and limitations that come with funding sources, and, not unrelated, the numerous challenges associated with 'studying up.' Finally, Forsythe struggled with the difficulty of balancing her participant observation with social action.

Forsythe argued that 'studying up' disrupts the 'traditional fieldwork narrative,' and at the same time calls into question all that is familiar ground for anthropologists from an ethical and methodological perspective. Often, said Forsythe, this type of participation requires anthropologists to be experts not only in anthropology, but also to some extent in their area of inquiry. As a result, we may have similar skill sets and jobs to those we study, but we may also be competing against them for funding and/or workplace resources. This twist poses a complex ethical dilemma for which anthropologists do not readily have the answers. In addition, informants can read what is being written about them, which results in a new accountability and criticism as part of the research process.

The Medical Anthropology Quarterly article provides one example of the many challenges she encountered in her work. In it, Forsythe argues that computer programs are a product of the culture from which they emerge, and that her intent is to describe how this occurs. She says that the program which was designed to aid migraine sufferers espouses the physicians point of view, and it may in fact reinforce the divide in the doctor-patient relationship rather than improve it. Rather than developing the questionnaire from a social sciences perspective, she describes a team dynamic where a programmer understands this task to be a logical one rather than a social one, and so takes this on as his primary task. As a result, the questions in the tool are structured in such a way that they do not make room for issues like violence against women, which is potentially a major factor in the case of female migraine sufferers. She also says that the composition of the team included no nurses, and, although members of the team were migraine sufferers, they nonetheless spoke with their professional perspective throughout the process, and never with the perspective of a patient. She goes on to describe the nature of the program that was created, saying that it really only answers questions that patients would normally ask in the office, and that, as a result, it did not address any of the needs of the patient that were not addressed in clinic visits. Ultimately, then, the system reinforces the doctor's diagnosis, and provides little to no new information or insights to the patient. Through her description, she offers a set of issues and concerns which change the perception of the project and provide insight into the tool and its limitations.

Many anthropologists have attempted to answer the question of how to be sufficiently engaged and disengaged simultaneously. How can we - or can we - be agents of change in the world we study? Forsythe illustrates the challenges of finding paid work in non-academic anthropology, the complexities of studying up which may accompany that work, and the difficulties with being engaged in critical practice at the same time.

Rating:
Summary: A Must-Read for Those Developing Online Health Systems
Review: I first met Diana Forsythe at the 1992 annual meeting of the American Medical Informatics Association. She was one of the few people I'd met who shared my interests in Information Technology's potential to empower patients.

Diana told me about a recent study she'd done in which the physicians caring for migraine patients had little idea of their patients' chief concerns and thus did a woefully inadequate job of dealing with their information needs. Most of the patients had never even asked their doctors the question that concerned them most during the long painful attacks they sometimes experienced-"could I die of this?" Since the doctors all knew that no one dies of migraines, they considered this a trivial and irrelevant concern and somehow discouraged questions about it.

Over the months that followed, Diana and I had several wonderful long conversations about the need to understand and rethink some of the tacit assumptions of current healthcare system as a necessary prelude to attempting to computerize it. And so, like many of her other friends and colleagues who had been impressed by her brilliance and touched by her intellectual generosity, I was heartsick, some years later, when I learned that she had drowned in a raging river while backpacking in Alaska.

A group of her concerned colleagues, worried that her remarkable articles and talks might be lost, banded together and convinced Stanford University Press to publish a volume containing her collected works. The book, long in preparation, has just been published. It is entitled: "Studying Those Who Study Us: An Anthropologist in the World of Artificial Intelligence, by Diana E. Forsythe (Stanford University Press, Stanford, CA, 2001 ISBN 0-8047-4203-0)

If you are a clinician or medical informatics professional interested in developing effective IT systems for patients, I strongly suggest that you order this book today. And when it comes, turn directly to Chapter Seven: "New Bottles, Old Wine: Hidden Cultural Assumptions in a Computerized Explanation System for Migraine Sufferers." This may be the most insightful paper ever written on the subtle difficulties that typically arise when doctors try to build IT systems designed to be used by patients.

To build effective online health systems for end-users one must combine the knowledge of a medical professional, the skills of a programmer/developer, the perspective of a medical anthropologist, and the wisdom of Solomon. And since Solomon is not currently available, an insightful social scientist like Diana-who can help us see our current healthcare practices from a 'man-from-mars' perspective-can offer invaluable insights.

Selected quotes & summaries:

"Both builders and users of [CHI] systems tend to think of them simply as technical tools or problem-solving aids, assuming them to be value-free. However, observation of the system-building process reveals that this is not the case: the reasoning embedded in such systems reflects cultural values and disciplinary assumptions, including assumptions about the everyday world of medicine."

"The system-builders systematically excluded the possibility that many of the migraines in female patients might be related to domestic violence, even though the ethnographers' interviews suggested that this was indeed the case."