The Medium is the New Health Care Message

In a recent post on his MEDINNOVATIONBLOG Dr. Richard L. Reece suggests that McLuhan's theories help us understand the problems facing hospitals today. Citing the practice of NCI, a medical consulting firm under the direction of Brian Klepper, Ph.D., to use visual aids to enhance discussions of these operational issues, Dr. Reece notes that:

"To me what’s different and innovative about the NCI approach is its talk show approach. This approach consists of integrated videos featuring three expert guests talking on a single topic; a seasoned talk show moderator; a mini-documentary based on one of Brian’s visits and directed towards the audience of interest; and a closing video by Brian summing up the implications of what has been said.

Under the rubric of “Taking an honest look at healthcare,” these videos are presented to health care conference audiences on subjects like comprehensive cancer care, proactive pay for performance programs, quality management, greater efficiencies, and rationalizing supply chain costs.

The Medium is the Message

NCI with Brian as its executive video producer is on the right track. To use John Naisbitt’s words, “a visual culture is taking over the world.” In a culture dominated by video games, TV, Internet images, cell phone and Blackberry pictures, and YouTube, this visual approach has profound and broad implications beyond health care. Naisbitt lists eight manifestations of a visually dominated world.

1. The slow death of the newspaper culture
2. Advertising – back to a “picture is worth thousands of words”
3. Upscale design of common goods.
4. Architecture as visual art
5. Fashion, architecture, and art
6. Music, video, and film
7. The changing role of photography
8. the democratization of the American art museum

In health care, visual forms of communication – animation and voice-guided online interactive programs featuring illustrations and simple language- may soon replace or at least supplement powerpoint presentations. Everyday Americans listen to 25 million powerpoint talks, and many, including myself, are growing weary of bullet points. Subconsciously, whether we’re aware of it or not, many of us now may be wearing bullet-point protective vests. Many will welcome straight talk, clear pictures, and moving images to tell the story."

Dr. Reece implies that, by substituting visual images for text, our transition to secondary orality (although he doesn't use this term) will help us understand and resolve many of the problems hospitals face today concerning funding and operational procedures. I'm not sure how well this would work, but I agree that using some of McLuhan's intellectual tools might help us better frame the nature of the health care crisis. We can apply McLuhan's tetrad to the medium of the hospital to shed some light on the question:

Hospitals:

Enhance healthcare efficiency by concentrating health care providers and resources in one location.

Obsolesce personal care skills. Medical students must take special courses in "bedside manner" and other "cultural competencies" in order to compensate for their intense technical training. In earlier times, the family doctor would have developed these interpersonal skills along with his/her medical skills.

Retrieve the "witch doctor." Complex diagnostic technologies, procedures and treatments make medicine seem like magic. This encourages "secondary orality" thinking and the view of the doctor as savior.

Reverse into ineffective healthcare institutions due to the over application of medical diagnostic technologies, fiscal starvation, bureaucratic inefficiencies, insurance and lawsuit pressures and medical professional "diagnostic blinders" caused by over-specialization and the pursuit of profit.

A picture may be worth a thousand words, but I'm not sure why visual forms of communication will be superior to Powerpoint bullets in and of themselves. Should we be encouraged that secondary orality modes of thought will influence discussions concerning the delivery of healthcare services? Without an exploration of the hospital institution as a medium, the discovery of solutions to the current health care crisis may be elusive.

"A Model Media Ecologist" Video

(Update below)

In one of my first posts I published the lyrics from "A Model Media Ecologist," a video I produced in 1976 while a Ph.D. candidate in the Media Ecology program at New York University.

Under the tutelage of professors Neil Postman, Terry Moran and Christine Nystrom, it was the practice in the 1970's at New York University's Program in Media Ecology Conferences for each doctoral class to pick one member to deliver a "State of the Class" address.

At the fall 1976 conference my "Class of 1977" decided to do something different. I had access to a Sony A/V 3650 1/2-inch, reel to reel, black and white recorder and a camera, and so instead of one class member giving a 30 minute address, each of us in the Class of '77 prepared up to five minutes on video tape of our own personal metaphor for "What is Media Ecology?" A Model Media Ecologist was my contribution. (I still have the complete video of the Class of '77 if anyone is interested.) I sang it to the tune of Gilbert & Sullivan's "A Modern Major General."

You'll notice there is no mention of personal computers (the Macintosh was just a gleam in Steve Job's eye), nor CD's, DVD's, nor even video discs. That's an IBM Selectric in front of me. On the shelves behind me is the complete LP collection of NYU's Loeb Student Center. (Younger bloggers can ask their parents to describe what an LP was.) These were primitive times and we were all pioneers!

As Lance Strate notes on his Blog Time Passing

...it truly would have been a shame if he [Neil Postman] had changed the curriculum earlier, and Bob Blechman had not produced the brilliant music video (from a time before there were such things as music videos)

So it might be proper to say that I was MTV before there was MTV. I was YouTube before there was YouTube. I'm also delighted at the global attention my YouTube entry has attracted. Little could I imagine way back in 1976 that posting my video on an Internet site would engender an audience of 54 (viewings as of last count)!

In your face LonelyGirl!

I'm proud to say the Casey M.K. Lum has included the lyrics of A Model Media Ecologist at the beginning of his history of Media Ecology, "Perspectives on Culture, Technology and Communication The Media Ecology Tradition" published by Hampton Press. No, I don't get any royalties, although I think I should.

Here, finally, is the original video!

A Model Media Ecologist

Update: As of Sunday, April 1 there have been 171 viewings of this video on YouTube. It is remarkable that simply posting an ancient piece of video on a web site could garner such international attention. It is truly a demonstration of the power of the Internet that anyone can tap into this new international mass medium and achieve such widespread influence!

"My Consumers, Are They Not My Producers?"

We are witnessing a shift in the recording industry from an emphasis on music as product to one of music maker as performer. An article from today's Wall Street Journal (subscription required) notes:

Jeff Rabhan, who manages artists and music producers including Jermaine Dupri, Kelis and Elliott Yamin, says CDs have become little more than advertisements for more-lucrative goods like concert tickets and T-shirts. "Sales are so down and so off that, as a manager, I look at a CD as part of the marketing of an artist, more than as an income stream," says Mr. Rabhan. "It's the vehicle that drives the tour, the merchandise, building the brand, and that's it. There's no money."

The music industry, an oligopoly where a few gatekeepers control revenue streams, is undergoing involuntary democratization due to new digital technology and the Internet. Industry leaders believe that their declining sales are due to illegal file sharing and other forms of piracy. The issue here isn't piracy. The issue is the collapse of the the artificial environment within which we have been fed our music since the early years of the 20th century.

As Lisa Gitelman documents in her recent book "Always Already New," early phonograph producers created the record listening public by cannibalizing talent and revenue from the various live music circuits of the time. Performing artists no longer needed to travel to concert halls around the country to make a living. Concerts became a marketing device to sell records. This business and consumption model influenced the development of radio, film and television in the United States.

We are returning to an age when touring artists will earn their income from live performances, and this time around they will use CDs to market their concerts. Incomes for most may decline, but the most popular performers may still earn more in a year than I will see in my entire life.

It may also be that the trends affecting the music industry will impact the business models governing television and film.

The music industry has found itself almost powerless in the face of this shift. Its struggles are hardly unique in the media world. The film, TV and publishing industries are also finding it hard to adapt to the digital age. Though consumers are exposed to more media in more ways than ever before, the challenge for media companies is finding a way to make money from all that exposure. Newspaper publishers, for example, are finding that their Internet advertising isn't growing fast enough to replace the loss of traditional print ads.

The enormous popularity of YouTube and other similar web services demonstrates a pent-up desire of many to create and control distribution of their own works.

As James Joyce wrote in his opus Finnegans Wake: "My consumers, are they not my producers?"

The Blogging Double Bind

(Updated Below -- Updated Again)

You may have noticed that I've added advertising to this blog. I have applied to become an Amazon Associate. Assuming I am approved, I will receive a small percentage for all sales that click through the ads posted on the left. Reading through the Amazon rules and regulations it appears that I can't game the system by clicking through for my own purchases. I must rely on you, my loyal readers, to click on the boxes to the left and purchase thousand or hundreds of thousands of dollars worth of merchandise from Amazon.

My purpose is to earn enough revenue to retire and begin living the style of life to which I'd like to become accustomed. Unfortunately, I am caught in the blogging double bind. In order to generate traffic, I need to post new material on a frequent basis. If I retire, I can assume that traffic on this blog will decline and therefore ad revenue will fall off.

As a student of the effect of advertising on our culture, I should point out that by making a purchase through Amazon you are not just purchasing a book or DVD. You are purchasing a place for yourself as part of that corporate entity called "Amazon." Putting on the Amazon corporate mask connects you with the power and identity of something much larger than yourself, just like wearing the Nike "swoosh" or the Coca Cola "Coca Cola." When you show off your copy of Lance Strate's recent book, Echoes And Reflections: On Media Ecology As a Field of Study, you can say that it's not just any copy of the book. It is a copy you purchased on Amazon.

I can prominently feature any authors, books or DVDs I discuss in my postings and generate some sales. Let's see. For a $25 book I will earn about $1. So if 1000 readers click through and buy Paul Levinson's latest book, The Plot to Save Socrates (in hard cover of course), I will earn at least $758 (the percentage I earn rises with volume of sales in ways I don't quite understand).

UPDATE: I have been told that I shouldn't get my hopes up for generating substantial revenue, that the title of this post should really be "Sense and Non-Cents."

This is a shame. I was hoping to become one of those people who earn substantial income while working at home in my pajamas.

In light of this, I think that it make sense to mention in this blog only books that retail for $100 and above. That limits me pretty much to coffee table books and some textbooks, mainly medical.

UPDATE II: I'm in! I'm officially an Amazon Associate! You can start clicking away while you finish reading this update. I'll wait.

A Tetrad on Blogging

Here is one take on a blogging tetrad:

Blogging enhances “many to many” communication. As a medium, blogging allows me to get my message out to many without the need of access to television, radio, print or film production facilities. Blogging also allows me to receive messages from many sources.

Blogging obsolesces one to one or many to one communications. Telephone chats and television binges are replaced by blogging connections.

Blogging retrieves the habits of 18th letter correspondents or diarists. Though this varies widely, at the minimum blogging requires that we capture and express our thoughts via the keyboard. Some bloggers go much further than that.

When pushed to an extreme, blogging reverses into total narcissism. I write only to myself, for myself. I put myself into the blogosphere, and seeing my own image, become entranced.

I’m sure there are many other ways McLuhan would have analyzed blogging using his tetrad tool.

Welcome Media Ecology Bloggers!

(Updated below)

I've added two prominent Media Ecologists to my list of "other blog sites." Both Paul Levinson and Lance Strate are among the original founders of the Media Ecology Association and many-times published authors. Both are public intellectuals who champion the Media Ecological approach to media analysis and social commentary.

Paul's site, simply called "Paul Levinson the blog", is actually more of a portal, leading to other Paul Levinson blog sites, to descriptions of his Media Ecology and science fiction works and a comprehensive history of his career and multiple media-based productivity. Scholarly articles, books, podcasts, YouTube links of his television appearances and much more all are here. Of particular note, Paul is releasing his science fiction novel, The Silk Code in the form of podcasts, performed by Shaun Farrell. Also available is the first chapter of his latest novel The Plot to Save Socrates, performed by the author himself.

Lance Strate is new to blogging, and states in Lance Strate's Blog Time Passing that "The Unexamined Blog is Not Worth Blogging." Well, maybe. Lance comments that blogging may be the highest form of narcissism, and while I tend to agree, I wish I had said it first on my blog. Anyone who has read my blog regularly (Hi Mom!), knows already that I take my narcissism very seriously.

Lance's most recent writing (outside of blogging) is Echoes and Reflections: On Media Ecology As a Field of Inquiry. Using the echo as a metaphor for all media, but also as a window into the thought processes involved in autism, Lance lays deep foundations for the study of Media Ecology, and any regular readers of this site (Hi Mom!) would profit by a reading. If you don't have the time to read it at the moment, I recommend buying it anyway.

Update: By posting these comments I in no way oblige Paul or Lance to cross-link to this blog. No, not at all. Really.

YouTube! YouTube! A Pirate's Life for Me!

I'm all for intellectual property (and I hope some day to have some,) but it seems to me that movie studios, like the music business before them, are responding in the worst possible way to the current threats to existing modes of media distribution posed by the Internet and digital recording technology. Computer wizards will always find ways around DVD watermarking or anti-piracy technology, just as our usual criminal elements will continue to traffic in any money-making opportunities they can create.

My suggestion, (and I'm available to consult or provide, for a price, written commentary on this) is that movie studios immediately embrace this new method of distribution. After all, what are the studios really selling? Is it an oft-told tale? A particular fashion or style? A group of consumer products portrayed in the film? A pretty face within the star system?

Just as Marshall McLuhan in the 1960's informed GE that they were in the "information" not the "light bulb" business; I would tell the movie studios that they aren't really selling a particular movie. They are primarily selling a way of seeing the world and being in the world, and coincidentally, a group of products that represent that viewpoint and that lifestyle.

The movie studios are too hung up on the story content, which, if surviving manuscripts are any guide, hasn't changed all that much since prehistoric times. They are also blinded by the incredible rewards of the existing distribution system, where they are the few gatekeepers to an entire medium. The digital age has done away with this celluloid oligopoly.

How do the movie studios embrace the new digital distribution environment? They may have to abandon the blockbuster mentality as a means for supporting their other creative misjudgments. Smaller returns for smaller projects mean smaller risk, but also smaller incentives to pirates and hackers.

Just as cable has created niche television, movie studios should explore the profit potential of niche cinema distributed digitally. YouTube anyone? Big budget movies won't disappear overnight, but the lesson of the recent history of the music industry is that consumers want to be producers, that there is a huge pent-up demand that cheap recording and editing technology is addressing, and that the coming change cannot be contained by stronger constraints, whether technological or legal.

The Internet is now determining our media biases. Intellectual property, copyright legalisms and print-based exclusivity will soon be a fond relict of the past. Movie studios can embrace this new digital paradigm or they can continue to resist it, at their peril.