New bottles, old wine: hidden cultural assumptions in a computerized explanation system for migraine sufferers

Sophisticated computer programs known as "intelligent systems" have been developed for use in medical settings for over two decades. Such systems explicitly encode information about task domains, problem attributes, and problem-solving strategies. They also embody tacit assumptions held by those who build them, reflecting meanings taken for granted in particular cultural and disciplinary arenas. This article examines assumptions built into the design of a patient education system for migraine sufferers, drawing upon extended participant-observation of the development process. Its designers view the system as neutral, but observation reveals that it embodies a physician's point of view. While intended to support migraine patients by offering useful information not given them by physicians, the system in fact offers information characterized by the same assumptions and deletions as that provided by neurologists. Thus, although intended to empower migraine patients, this system may actually reinforce rather than reduce the power differential between doctor and patient.