Besides my day job working on ClearHealth and FreeB I have decided to do something else to advance GPL software in medicine. I am happy to announce I will be using this site to publish articles, letters and other information advocating the use of the GPL license in medicine. The first thing I am publishing there is the site credo, which argues that only the GNU General Public License should be used in medical software. I have attached this short paper to this post, read on for the full text. Regards, Fred Trotter
Current versions of this article can be found hereThis site exists because medical software should be released exclusively under the GNU General Public License. The GNU General Public License (or GPL) exists because Richard Stallman felt that software should not be used to control people. The Gnu Public License is an attempt to write a license that explicitly prevents one person from controlling another with software. Stallman’s arguments are especially compelling for software in medicine. This credo begins where Stallman’s arguments ends so reading his work is recommended. Stallmans writings are available from, or in his book ‘Free as in Freedom’.

Proprietary software licenses are used to exert inappropriate control over people. As a result these proprietary software licenses are immoral. There are obviously levels of immorality in proprietary software licenses. Any proprietary software license is immoral, but some instances of it are worse than others. Stallman and his organization, the Free Software Foundation, have certain software projects that they consider critical, such as operating system software. This focus is justified because some software licenses have different implications in different areas. For instance proprietary software in video games is just a little wrong, like a white lie. Whether to use the Microsoft XBOX in not really an important issue. However, Microsoft’s operating system should be avoided whenever possible in favor of GPL alternatives. As this credo continues, the reasons for these distinctions will become more obvious.

Just like operating systems it is critical that medical software be released under the GPL. Releasing medical software under a proprietary license is very wrong, like lying to a priest. There are always consequences when a proprietary (non-GPL) software is used in the place of GPL software. In medicine, these consequences mean lost lives. To understand why this is true, we must examine how exactly proprietary licenses are so damaging. We must understand the full implications of the proprietary licenses.

The freedom that the GPL provides that is denied by proprietary licenses is unfettered access to the source code for the medical application. Proprietary licenses dictate that the right to modify the source code is reserved to the software vendor. The long term result of denying medical institutions access to the source code for medical applications is that medical providers are denied access to patient data. Some of this patient data is critical, and when it is lost it can result in tragedy for the patient.

Without full access to the source code the medical institution is prevented from improving, maintaining or simply changing the software in any way that the software vendor does not approve of. Only the software vendor is allowed to make changes, and the vendor can arbitrarily set the prices for these changes, or simply refuse to make them.

Normally companies are prevented from abusing their customers by the free market. If you get frustrated with your telephone company you fire them and hire another one. The fact that you can do this keeps your telephone company from abusing your relationship. However these economic forces only impact proprietary medical software vendors before a sale is made. Often a proprietary medical software vendor will sell the software at a very reasonable cost. However, years later the vendor changes the costs of upgrades or support. Because these upgrades include critical bugfixes, or federally mandated changes, institutions are forced to upgrade at phenomenal costs. This money, used simply to maintain their current functionality, could have been spent improving healthcare.

The software vendor can make such arbitrary demands because the medical institution cannot migrate to a new system. Even if a new medical application to replace an existing system is economical, the current system often contains critical patient data, that would cost millions to migrate to the new system. Because they cannot afford to migrate, it is often impossible for medical institutions to refuse the demands of their software vendors. Even then medical institutions stuck in a bad vendor relationship are the lucky ones, some are abandoned by the vendor altogether.

Because the license prevents anyone but the vendor access to the source code, only the original software vendor can support the software. Typical software licenses provide no rights for the customer in the event that the software vendor is bought-out, or in the case that the software vendor goes bankrupt. These two events represent massive changes in the way the vendor supports the software. The most terrifying result of this is abandonware, which happens when a software company refuses to or becomes incapable of supporting the software. When a video game is abandoned people can just stop playing it, or ignore any problems. When your Electronic Health Record is abandoned, what happens when a system containing life critical data regarding 2 million patients becomes incapacitated?

These problems, collectively, can be referred to as ‘vendor lock-in’. The software license traps the medical institution, marrying it to the software vendor for better or worse, usually worse. Please understand that these problems are not theoretical! They are real world issues effecting thousands of medical institutions. Among other things this site will document issues created by proprietary software licenses in medicine.

Generally this site will be used to promote the use of the Gnu Public License in medical software. Essays discussing specific problems related to intellectual property in medical software will be published here. Open letters to various players in the medical IT field will also be published here. Specific issues created by proprietary software licenses in medicine will be documented here. The site will be generally used to provoke discussion, thought, and hopefully, change.

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