On condition of anonymity

 The Statesman  (30 September)

During our school days, handwritten notes were a popular means of communication between students during monitored study periods which required a strict silence and a full focus on the homework for the next day.

Our teachers, who invigilated these periods, seemed to have eyes in the back of their heads, for many such notes being passed around were

deftly intercepted by them.The writer of the note was admonished and often given a mild punishment too. 

 

Over time, note senders adapted to the risky terrain by omitting to sign their names. They reasoned that anonymity conferred safety. Contrary

to their calculations, the situation worsened. The teachers punished the entire class. They seemed angrier in general, especially about the fact that the notes were unsigned. 

 

The values the teachers held dear made them deeply uncomfortable about any person not taking responsibility for something they expressed. They reckoned that a person should be able to stand by what they stated. Owning your words forced you to consider carefully what you wanted to say and also, how you wanted to say it.

 

The only time anonymity was somewhat appreciated, was when someone hesitated to take the credit for something good. Whether for an elegant poem, an impactful quote or a kind donation. In fact, true philanthropy in those days was supposed to be done discreetly so as not to cause any embarrassment to the beneficiary. Like white lies, 'white anonymity' could thus sometimes be acceptable.

 

Our teachers of old, would however, be dismayed at the high level of anonymity, accompanied by a lack of transparency that pervades every aspect of our lives today, ranging from everyday social media communications to economics to politics. 

 

In the cyber world, people hide behind false identities, and artificial intelligence bots are programmed to masquerade as humans.

This anonymity is very unwelcome as regular social media users can be bullied with few consequences for the culprit. Much of the trolling on social media happens via anonymous handles. Hiding behind a veil makes people reckless. Should all social media users be forced to identify themselves customarily, incidences of harassment would reduce substantially. The tremendous resources that are currently utilised in investigating  unwelcome speech would be cut down. Tracing identities of trouble makers would not be necessary as it would be plain for everyone to see who is at fault.  

 

Apart from bullying, the cyber user is open to manipulation as well. This is on account of the non transparency to the public of the company’s algorithmic designs and principles.The manipulation is insidious and here is how it plays out : users of several popular SM platforms choose topics and handles to follow. However, non-transparent algorithms regulate the content that comes on view. So, if for example, a user ‘likes’ a couple of photos of cuisine, their feed will be flooded with images and content related to delectable delicacies, even though they are not following any chefs or have not selected food as a chosen topic of interest. The critical issue here is, explicit permission has not been given to anybody, leave alone an anonymous bot, to ‘curate’ our lists for us. This curation is across sites e.g. the ‘percentage matches’ of movie viewing sites.  Nowadays, the ‘word of mouth’ of family and friends is increasingly getting replaced by ‘word of bot’. All this targeted meddling discourages deeper deliberation, making users mentally lazy. They are ready to go with the manipulated ‘flow’ and become statistics for money generation apart from getting more deeply hooked to their screens.

 

Also, certain types of conversations get amplified by these programmed algorithms and others not. They are designed to pick out 'leanings' (such as right or left leaning) rather than meaningful conversations (such as climate change or gender equality for instance). So instead of the popular mediums of communication being used to bring about impactful change, they accidentally or deliberately end up increasing the polarisation of thought and bring more divisions in society. 

 

 

Were it widely known what instructions computer algorithms for social media have been programmed with and under whose direction, checks and balances could be put in place.

Currently, there are few truly effective external checks. Whistleblowers from social media companies have highlighted how some company bosses take cyber safety feedback from in- house as well as outsourced professional experts poorly; their main focus being on hooking followers and garnering profits through selling user information. It is ironical that there are 'weapons inspectors' to stall the build up of arms and ammunition in countries but no such stringent safety checks for algorithm creation. Whereas creation of new platforms of communications among people can be conducive to inclusion and social cohesiveness, manipulation of people’s minds can inculcate addiction and lead to mental breakdowns. Behind the scenes manipulation of content can give an unfair advantage to businesses and political parties.

In fact, the alarming negative power of anonymity was demonstrated  recently, when a prominent journalist in India was arrested on the basis of an FIR lodged by an unknown handle. It could well have been a bot. It was indeed sobering to think that artificial intelligence could actually get a human into jail, no questions asked. It took the police several months to identify some face behind the handle, retrospectively, long after the journalist was released on bail.

 

In case no anonymity was allowed on any platform, enormous resources would be saved. Cyber police could free up a large proportion of the hours spent in uncovering hidden identities. Like the traffic rules which prevent owners from driving cars with blackened windows, similar rules of transparency would work wonders for cyber traffic!

 

Beyond anonymous words, lie anonymous transactions. In a country  where representatives are elected on manifesto promises of transparency, the electoral bonds - donations to political parties - are opaque. This has been challenged long back by an NGO but the case still languishes in court. Hidden political donations encourage corruption at the highest level as rich businessmen can influence policy and pull strings in the govt. through these 'gifts'. Scientists and professionals are obliged to make financial disclosures before giving their medical or technical opinions.This helps others decide for themselves whether there could be a personal bias in the professional’s recommendation of a particular drug or technology. For example, such a suspicion (albeit fairly unfounded) of bias by pharmaceutical companies also happens to be one of the reasons for a huge pushback against Covid vaccinations in some countries. Strangely enough, although govt decisions impact lives and livelihoods on a large scale, the elected representatives have not seen fit to similarly disclose to the public as to who or what is influencing their actions. 

 

At the level of the state, the veil of non transparency has traditionally  surrounded the working of the intelligence services of any state. Thus there is limited recourse to justice when there is lack of skill and planning leading to substantial ‘collateral damage’. It is not uncommon for hundreds of civilians to lose their lives as a result of botched up operations with little accountability of the state.

Contrast this with officials who have to wear their badges when dispensing their state duties. In the sad case of George Floyd who lost his life unnecessarily and wrongfully in a police encounter, justice could be dispensed as the officer's identity was known. 

 

It is clear that non- anonymity in speech and social media and transparent processes in social life enhances responsibility and accountability, saves resources and money and reinforces the good value systems of old. Our teachers sure knew what they were talking about!

 

Regulating Doctors

 

The Statesman (8 July 2022)

A comprehensive bill by the National Medical Commission that provides renewed guidelines for the expected professional conduct of medical practitioners and some standardization of healthcare is under consideration now. Suggestions have been invited on the draft of recommendations.

Previously, what has been followed are the medical conduct and ethics guidelines notified by the Medical Council of India in 2002. For dissatisfied patients there are robust grievance redressal mechanisms. Perceived gross negligence by medical practitioners attracts criminal lawsuits. Lesser medical malpractices by doctors attract fines in civil consumer courts. Quacks, i.e., conmen masquerading as doctors, are dealt with strongly and have no connection with the medical world.

The new bill draft suggests five levels of disciplinary action which can be taken by state and central medical commissions against erring doctors. The first level termed ‘reformation’ includes counselling for minor administrative or procedural lapses and advisories can be issued to doctors to attend generalized or specialized workshops on medicine/ethics/other. The second level of punitive action allows suspension of a medical practitioner up to one month. It is to be employed in those instances where there is no evidence of direct harm by the doctor.

To my mind level one and two are completely superfluous and should be done away with. They vitiate the enabling atmosphere and peace of mind doctors need in order to give their very best to the patient. Officially rapping doctors on their knuckles for minor transgressions makes them feel they never transitioned from school to responsible adulthood. It would also unnecessarily add to the work of the officials of various medical commissions, distracting them from bigger issues.

There is much self-correction built into the medical profession. Teachers and mentors keep tabs on those working with them and regularly point out the finer aspects of the profession to their junior colleagues. Almost all doctors belong to professional bodies or work at hospitals/registered clinics that follow prescribed norms (without which they don’t get a licence) so there are regular audits, reminders and well-worn guidelines.

As far as level two is concerned, even the country’s judicial system at large finds a person innocent until proven guilty. It is worrisome that even when the examining officials are sloppy or unsure about the doctor’s attributability, they will still be able to penalize this cohort of sought - after professionals.

Level three and four prescribe longer suspensions from work -up to 3 months and 3 years respectively. In this case there has to be evidence of direct harm caused by the doctor’s actions. Level 5 seeks to debar medical professionals permanently for grave negligence. The last three categories make sense. For actions of the doctor that result in direct grave harm to the patient there should definitely be thorough investigations and full accountability. This is already being ensured through judicial recourse.

Overall, there plenty of reassuring checks and balances in the medical profession. Difficult entrance exams cull out people with fine brains and the ability to work hard. Long arduous years of study, tough competitive exams for getting into a speciality and doctors’ inherent desire to be cutting-edge ensures they remain abreast of developments in their field. Many institutions have doctors working in units or teams and hence collective decisions are made after thorough discussions. A doctor’s reputation is closely linked to the patient getting healed successfully and there is heavy competition in the private sector.

No doubt, medicine is a vocation where quality of life and prevention of death are at stake, so it is always under scrutiny. However, the actions of many other professionals have a deep impact on our lives and therefore this umbrella of accountability has to be widened to include them. Doing this would ensure standardization of care in a holistic manner across professions and not just single out the medical community for having to labour under a plethora of rules.

For example, wrong conclusions arrived at in courts of law have sent many an innocent person to jail. We read about influential rapists who are given bail and then hurt and threaten their victims. Many illiterate people are not able to understand the court proceedings but this doesn’t translate into a reprimand for their lawyer. The court enjoys many honorific titles and can penalize someone who is deemed to have held the court in contempt. Judges have the freedom to ‘interpret’ the laws according to their own understanding. Their judgements cannot be scrutinized on merits per se. There is no judicial ombudsman or grievance cell where the public can ask for review by senior judiciary/ legal peers when an occasional judgement seems illogical or absurd. Citizens can certainly appeal a lower courts’ judgement in a higher court. However even if a judgement is overturned the lower court is not held accountable. Despite laws being well defined, their interpretation is rather ‘fluid’. Imagine the outcomes if doctors were allowed their own ‘interpretations’ of medical textbooks!

Similarly, police reforms are long overdue. A recent report in the paper described how eight people were wrongly arrested by the police for fomenting trouble in a crowd. They were released after their families submitted categorical video evidence of their absence from the scene. It is sobering to think that the police can round up anyone they suspect without due process or accountability and the individual then has to run from pillar to post to free themselves. Of late the police seem to have become a weapon for politicians to bully the public with. Policemen deviate further day by day from their friendly ideal of ‘with the public, for the public always’. The tragic death a few years ago of a dentist’s daughter in Noida, made headlines for long. Despite police thronging the house that day for the express purpose of discovering clues, they failed to pick up an enormous clue – another lifeless human body in the same house! The body being discovered only the next day -the blundering nature of the investigation became equally sensational. Citizens have to live with the spectre of tardy arrests, delayed FIRs, poorly written chargesheets and faulty evidence collection. However, there are no well laid out procedures for police officers to be held directly accountable to the public for poor quality of services rendered.

Politicians imagine they are special and above reproach. From broken manifesto promises, horse trading and jumping parties after elections to hogging all the resources and security, the list of misdemeanours is endless. Political decisions that decimate the environment (for short term ‘development’ gains for a few businessmen) are contributing to global warming and sending our planet hurtling towards a collapse. Poverty, prices and unemployment are surging everywhere. Yet there is no provision to change the representative for non- performance and even the most unpopular ones are allowed to complete their full term.

Doctors are probably the only professionals today that agree to double work shifts - OPD during the day and emergency night duty – in rotation with colleagues. The fact that the world has been through a pandemic where doctors have worked overtime, suffered great emotional and physical burnout and risked their lives for others must never be forgotten. The population is still reeling from ill-health, emotional, financial and mental stress brought on by this pandemic. Patients do need the strong reassurance that doctors provide.

However, doctors can function well as pillars of support if their worth is well recognised and they get appreciation rather than overzealous regulation. Also, rather than the national focus being selectively sustained on doctors’ conduct, it should be holistically broadened to include accountability from all professions. This is the most sustainable way forward.