The Curious Side Effects of Medical Transparency

Essay by Danielle Ofri: “Transparency, Pozen told me, “invites conceptual confusion about whether it’s a first-order good that we’re trying to pursue for its own sake, or a second-order good that we’re trying to use instrumentally to achieve other goods.” In the first case, we might feel that transparency is an ideal always worth embracing, whatever the costs. In the second, we might ask ourselves what it’s accomplishing, and how it compares with other routes to the same end.

“There is a standard view that transparency is all good—the more transparency, the better,” the philosopher C. Thi Nguyen, an associate professor at the University of Utah, told me. But “you have a completely different experience of transparency when you are the subject.” In a previous position, Nguyen had been part of a department that had to provide evidence that it was using state funding to satisfactorily educate its students. Philosophers, he told me, would want to describe their students’ growing reflectiveness, curiosity, and “intellectual humility,” but knew that this kind of talk would likely befuddle or bore legislators; they had to focus instead on concrete numbers, such as graduation rates and income after graduation. Nguyen and his colleagues surely want their students to graduate and earn a living wage, but such stats hardly sum up what it means to be a successful philosopher.

In Nguyen’s view, this illustrates a problem with transparency. “In any scheme of transparency in which you have experts being transparent to nonexperts, you’re going to get a significant amount of information loss,” he said. What’s meaningful in a philosophy department can be largely incomprehensible to non-philosophers, so the information must be recast in simplified terms. Furthermore, simplified metrics frequently distort incentives. If graduation rates are the metric by which funding is determined, then a school might do whatever it takes to bolster them. Although some of these efforts might add value to students’ learning, it’s also possible to game the system in ways that are counterproductive to actual education.

Transparency is often portrayed as objective, but, like a camera, it is subject to manipulation even as it appears to be relaying reality. Ida Koivisto, a legal scholar at the University of Helsinki, has studied the trade-offs that flow from who holds that camera. She finds that when an authority—a government agency, a business, a public figure—elects to be transparent, people respond positively, concluding that the willingness to be open reflects integrity, and thus confers legitimacy. Since the authority has initiated this transparency, however, it naturally chooses to be transparent in areas where it looks good. Voluntary transparency sacrifices a degree of truth. On the other hand, when transparency is initiated by outside forces—mandates, audits, investigations—both the good and the bad are revealed. Such involuntary transparency is more truthful, but it often makes its subject appear flawed and dishonest, and so less legitimate. There’s a trade-off, Koivisto concludes, between “legitimacy” and “the ‘naked truth.’ ”..(More)”.