Medical software's free futureBMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7267.976 (Published 21 October 2000) Cite this as: BMJ 2000;321:976
All rapid responses
The Peruvian Congress contains at least one congressman who has
grasepd the essential points, and this letter of reply to Microsoft's
response to a bill in congress is one that should be valued by anyone who
is faced with the usual UFD (Fear, Uncertainty, Doubt) that is raised at
suggestions of Free (Libre) Software in public life.
Since the Web may be voltile in include a trnaslated text below:-
A letter from Dr. Edgar David Villanueva Nuñez, Peruvian
Congressman, in response to a complaint from a General
Manager for Microsoft in Peru.
Lima, 8th of April, 2002.
JUAN ALBERTO GONZÁLEZ
General Manager of Microsoft, Perú
First of all, I thank you for your letter of March 25 2002
in which you state the official position of Microsoft
relative to Bill Number 1609, Free Software in Public
Administration, which is indubitably inspired by the desire
for Peru to find a suitable place in the global
technological context. In the same spirit, and convinced
that we will find the best solutions through an exchange of
clear and open ideas, I will take this opportunity to reply
to the commentaries included in your letter.
While acknowledging that opinions such as yours constitute a
significant contribution, it would have been even more
worthwhile for me if, rather than formulating objections of
a general nature (which we will analyse in detail later) you
had gathered solid arguments for the advantages that
proprietary software could bring to the Peruvian State, and
to its citizens in general, since this would have allowed a
more enlightening exchange in respect of each of our
With the aim of creating an orderly debate, we will assume
that what you call "open source software" is what the Bill
defines as "free software", since there exists software for
which the source code is distributed together with the
program, but which does not fall within the definition
established by the Bill; and that what you call "commercial
software" is what the Bill defines as "proprietary" or
"unfree", given that there exists free software which is
sold in the market for a price like any other good or
It is also necessary to make it clear that the aim of the
Bill we are discussing is not directly related to the amount
of direct savings that can by made by using free software in
state institutions. That is in any case a marginal aggregate
value, but in no way is it the chief focus of the Bill. The
basic principles which inspire the Bill are linked to the
basic guarantees of a state of law, such as:
Free access to public information by the citizen.
Permanence of public data.
Security of the State and citizens.
To guarantee the free access of citizens to public
information, it is indespensable that the encoding of data
is not tied to a single provider. The use of standard and
open formats gives a guarantee of this free access, if
necessary through the creation of compatible free software.
To guarantee the permanence of public data, it is necessary
that the usability and maintenance of the software does not
depend on the goodwill of the suppliers, or on the monopoly
conditions imposed by them. For this reason the State needs
systems the development of which can be guaranteed due to
the availability of the source code.
To guarantee national security or the security of the State,
it is indispensable to be able to rely on systems without
elements which allow control from a distance or the
undesired transmission of information to third parties.
Systems with source code freely accessible to the public are
required to allow their inspection by the State itself, by
the citizens, and by a large number of independent experts
throughout the world. Our proposal brings further security,
since the knowledge of the source code will eliminate the
growing number of programs with *spy code*.
In the same way, our proposal strengthens the security of
the citizens, both in their role as legitimate owners of
information managed by the state, and in their role as
consumers. In this second case, by allowing the growth of a
widespread availability of free software not containing *spy
code* able to put at risk privacy and individual freedoms.
In this sense, the Bill is limited to establishing the
conditions under which the state bodies will obtain software
in the future, that is, in a way compatible with these basic
From reading the Bill it will be clear that once passed:
-the law does not forbid the production of proprietary
-the law does not forbid the sale of proprietary software
-the law does not specifiy which concrete software to use
-the law does not dictate the supplier from whom software
will be bought
-the law does not limit the terms under which a software
product can be licensed.
What the Bill does express clearly, is that, for software to
be acceptable for the state it is not enough that it is
technically capable of fulfilling a task, but that further
the contractual conditions must satisfy a series of
requirements reguarding the license, without which the State
cannot guarantee the citizen adequate processing of his
data, watching over its integrity, confidentiality, and
accessibility throughout time, as these are very critical
aspects for its normal functioning.
We agree, Mr. Gonzalez, that information and communication
technology have a significant impact on the quality of life
of the citizens (whether it be positive or negative). We
surely also agree that the basic values I have pointed out
above are fundamental in a democratic state like Peru. So we
are very interested to know of any other way of guaranteeing
these principles, other than through the use of free
software in the terms defined by the Bill.
As for the observations you have made, we will now go on to
analyse them in detail:
Firstly, you point out that: "1. The bill makes it
compulsory for all public bodies to use only free software,
that is to say open source software, which breaches the
principles of equality before the law, that of
non-discrimination and the right of free private enterprise,
freedom of industry and of contract, protected by the
This understanding is in error. The Bill in no way affects
the rights you list; it limites itself entirely to
establishing conditions for the use of software on the part
of state institutions, without in any way meddling in
private sector transactions. It is a well established
principle that the State does not enjoy the wide spectrum of
contractual freedom of the private sector, as it is limited
in its actions precisely by the requirement for transparency
of public acts; and in this sense, the preservation of the
greater common interest must prevail when legislating on the
The Bill protects equality under the law, since no natural
or legal person is excluded from the right of offering these
goods to the State under the conditions defined in the Bill
and without more limitations than those established by the
Law of State Contracts and Purchasing (T.U.O. por Decreto
Supremo No. 012-2001-PCM).
The Bill does not introduce any discrimination whatever,
since it only establishes *how* the goods have to be
provided (which is a state power) and not *who* has to
provide them (which would effectively be discriminatory, if
restrictions based on national origin, race religion,
ideology, sexual preference etc. were imposed). On the
contrary, the Bill is decidedly antidiscriminatory. This is
so because by defining with no room for doubt the conditions
for the provision of software, it prevents state bodies from
using software which has a license including discriminatory
It should be obvious from the preceding two paragraphs that
the Bill does not harm free private enterprise, since the
latter can always choose under what conditions it will
produce software; some of these will be acceptable to the
State, and others will not be since they contradict the
guarantee of the basic principles listed above. This free
initiative is of course compatible with the freedom of
industry and freedom of contract (in the limited form in
which the State can exercise the latter). Any private
subject can produce software under the conditions which the
State requires, or can refrain from doing so. Nobody is
forced to adopt a model of production, but if they wish to
provide software to the State, they must provide the
mechanisms which guarantee the basic principles, and which
are those described in the Bill.
By way of an example: nothing in the text of the Bill would
prevent your company offering the State bodies an office
"suite", under the conditions defined in the Bill and
setting the price that you consider satisfactory. If you did
not, it would not be due to restrictions imposed by the law,
but to business decisions relative to the method of
commercializing your products, decisions with which the
State is not involved.
To continue; you note that:" 2. The bill, by making the use
of open source software compulsory, would establish
discriminatory and non competitive practices in the
contracting and purchasing by public bodies..."
This statement is just a reiteration of the previous one,
and so the response can be found above. However, let us
concern ourselves for a moment with your comment regarding
"non-competitive ... practices."
Of course, in defining any kind of purchase, the buyer sets
conditions which relate to the proposed use of the good or
service. From the start, this excludes certain manufacturers
from the possibility of competing, but does not exclude them
"a priori", but rather based on a series of principles
determined by the autonomous will of the purchaser, and so
the process takes place in conformance with the law. And in
the Bill it is established that *no-one* is excluded from
competing as far as he guarantees the fullfilment of the
Furthermore, the Bill *stimulates* competition, since it
tends to generate a supply of software with better
conditions of usability, and to better existing work, in a
model of continuous improvement.
On the other hand, the central aspect of competivity is the
chance to provide better choices to the consumer. Now, it is
impossible to ignore the fact that marketing does not play a
neutral role when the product is offered on the market
(since accepting the opposite would lead one to suppose that
firms' expenses in marketing lack any sense), and that
therefore a significant expense under this heading can
influence the decisions of the purchaser. This influence of
marketing is in large measure reduced by the bill that we
are backing, since the choice within the framework proposed
is based on the *technical merits* of the product and not on
the effort put into commercialization by the producer; in
this sense, competitvity is increased, since the smallest
software producer can compete on equal terms with the most
It is necessary to stress that there is no position more
anti-competitive than that of the big software producers,
which frequently abuse their dominant position, since in
innumerable cases they propose as a solution to problems
raised by users: "update your software to the new version"
(at the user's expense, naturally); furthermore, it is
common to find arbitrary cessation of technical help for
products, which, in the provider's judgement alone, are
"old"; and so, to receive any kind of technical assistance,
the user finds himself forced to migrate to new versions
(with non-trivial costs, especially as changes in hardware
platform are often involved). And as the whole
infrastructure is based on proprietary data formats, the
user stays "trapped" in the need to continue using products
from the same supplier, or to make the huge effort to change
to another environment (probably also proprietary).
You add: "3. So, by compelling the State to favour a
business model based entirely on open source, the bill would
only discourage the local and international manufacturing
companies, which are the ones which really undertake
important expenditures, create a significant number of
direct and indirect jobs, as well as contributing to the
GNP, as opposed to a model of open source software which
tends to have an ever weaker economic impact, since it
mainly creates jobs in the service sector."
I do not agree with your statement. Partly because of what
you yourself point out in paragraph 6 of your letter,
regarding the relative weight of services in the context of
software use. This contradiction alone would invalidate your
position. The service model, adopted by a large number of
companies in the software industry, is much larger in
economic terms, and with a tendency to increase, than the
licensing of programs.
On the other hand, the private sector of the economy has the
widest possible freedom to choose the economic model which
best suits its interests, even if this freedom of choice is
often obscured subliminally by the disproportionate
expenditure on marketing by the producers of proprietary
In addition, a reading of your opinion would lead to the
conclusion that the State market is crucial and essential
for the proprietary software industry, to such a point that
the choice made by the State in this bill would completely
eliminate the market for these firms. If that is true, we
can deduce that the State must be subsidising the
proprietary software industry. In the unlikely event that
this were true, the State would have the right to apply the
subsidies in the area it considered of greatest social
value; it is undeniable, in this improbable hypothesis, that
if the State decided to subsidize software, it would have to
do so choosing the free over the proprietary, considering
its social effect and the rational use of taxpayers money.
In respect of the jobs generated by proprietary software in
countries like ours, these mainly concern technical tasks of
little aggregate value; at the local level, the technicians
who provide support for proprietary software produced by
transnational companies do not have the possibility of
fixing bugs, not necessarily for lack of technical
capability or of talent, but because they do not have access
to the source code to fix it. With free software one creates
more technically qualified employment and a framework of
free competence where success is only tied to the ability to
offer good technical support and quality of service, one
stimulates the market, and one increases the shared fund of
knowledge, opening up alternatives to generate services of
greater total value and a higher quality level, to the
benefit of all involved: producers, service organizations,
It is a common phenomenon in developing countries that local
software industries obtain the majority of their takings in
the service sector, or in the creation of "ad hoc" software.
Therefore, any negative impact that the application of the
Bill might have in this sector will be more than compensated
by a growth in demand for services (as long as these are
carried out to high quality standards). If the transnational
software companies decide not to compete under these new
rules of the game, it is likely that they will undergo some
decrease in takings in terms of payment for licences;
however, considering that these firms continue to allege
that much of the software used by the State has been
illegally copied, one can see that the impact will not be
very serious. Certainly, in any case their fortune will be
determined by market laws, changes in which cannot be
avoided; many firms traditionally associated with
proprietary software have already set out on the road
(supported by copious expense) of providing services
associated with free software, which shows that the models
are not mutually exclusive.
With this bill the State is deciding that it needs to
preserve certain fundamental values. And it is deciding this
based on its sovereign power, without affecting any of the
constitutional guarantees. If these values could be
guaranteed without having to choose a particular economic
model, the effects of the law would be even more beneficial.
In any case, it should be clear that the State does not
choose an economic model; if it happens that there only
exists one economic model capable of providing software
which provides the basic guarantee of these principles, this
is because of historical circumstances, not because of an
arbitrary choice of a given model.
Your letter continues: "4. The bill imposes the use of open
source software without considering the dangers that this
can bring from the point of view of security, guarantee, and
possible violation of the intellectual property rights of
Alluding in an abstract way to "the dangers this can bring",
without specifically mentioning a single one of these
supposed dangers, shows at the least some lack of knowledge
of the topic. So, allow me to enlighten you on these points.
National security has already been mentioned in general
terms in the initial discussion of the basic principles of
the bill. In more specific terms, relative to the security
of the software itself, it is well known that all software
(whether proprietary or free) contains errors or "bugs" (in
programmers' slang). But it is also well-known that the bugs
in free software are fewer, and are fixed much more quickly,
than in proprietary software. It is not in vain that
numerous public bodies reponsible for the IT security of
state systems in developed countries require the use of free
software for the same conditions of security and efficiency.
What is impossible to prove is that proprietary software is
more secure than free, without the public and open
inspection of the scientific community and users in general.
This demonstration is impossible because the model of
proprietary software itself prevents this analysis, so that
any guarantee of security is based only on promises of good
intentions (biased, by any reckoning) made by the producer
itself, or its contractors.
It should be remembered that in many cases, the licensing
conditions include Non-Disclosure clauses which prevent the
user from publicly revealing security flaws found in the
licensed proprietary product.
In respect of the guarantee:
As you know perfectly well, or could find out by reading the
"End User License Agreement" of the products you license, in
the great majority of cases the guarantees are limited to
replacement of the storage medium in case of defects, but in
no case is compensation given for direct or indirect
damages, loss of profits, etc... If as a result of a
security bug in one of your products, not fixed in time by
yourselves, an attacker managed to compromise crucial State
systems, what guarantees, reparations and compensation would
your company make in accordance with your licencing
conditions? The guarantees of proprietary software, inasmuch
as programs are delivered ``AS IS'', that is, in the state
in which they are, with no additional responsibility of the
provider in respect of function, in no way differ from those
normal with free software.
On Intellectual Property:
Questions of intellectual property fall outside the scope of
this bill, since they are covered by specific other laws.
The model of free software in no way implies ignorance of
these laws, and in fact the great majority of free software
is covered by copyright. In reality, the inclusion of this
question in your observations shows your confusion in
respect of the legal framework in which free software is
developed. The inclusion of the intellectual property of
others in works claimed as one's own is not a practice that
has been noted in the free software community; whereas,
unfortunately, it has been in the area of proprietry
software. As an example, the condemnation by the Commercial
Court of Nanterre, France, on 27th September 2001 of
Microsoft Corp. to a penalty of 3 million francs in damages
and interest, for violation of intellectual property
(piracy, to use the unfortunate term that your firm commonly
uses in its publicity).
You go on to say that: "The bill uses the concept of open
source software incorrectly, since it does not necessarily
imply that the software is free or of zero cost, and so
arrives at mistaken conclusions regarding State savings,
with no cost-benefit analysis to validate its position."
This observation is wrong; in principle, freedom and lack of
cost are orthogonal concepts: there is software which is
proprietary and charged for (for example, MS Office),
software which is proprietary and free of charge (MS
Internet Explorer), software which is free and charged for
(RedHat, SuSE etc Gnu/Linux distributions), software which
is free and not charged for (Apache, OpenOffice, Mozilla),
and even software which can be licensed in a range of
Certainly free software is not necessarily free of charge.
And the text of the bill does not state that it has to be
so, as you will have noted after reading it. The definitions
included in the Bill state clearly *what* should be
considered free software, at no point referring to freedom
from charges. Although the possibility of savings in
payments for proprietary software licenses are mentioned,
the foundations of the bill clearly refer to the fundamental
guarantees to be preserved and to the stimulus to local
technological development. Given that a democratic State
must support these principles, it has no other choice than
to use software with publicly available source code, and to
exchange information only in standard formats.
If the State does not use software with these
characteristics, it will be weakening basic republican
principles. Luckily, free software also implies lower total
costs; however, even given the hypothesis (easily disproved)
that it was more expensive than proprietary software, the
simple existence of an effective free software tool for a
particular IT function would oblige the State to use it; not
by command of this Bill, but because of the basic principles
we enumerated at the start, and which arise from the very
essence of the lawful democratic State.
You continue: "6. It is wrong to think that Open Source
Software is free of charge. Research by the Gartner Group
(an important investigator of the technological market
recognized at world level) has shown that the cost of
purchase of software (operating system and applications) is
only 8% of the total cost which firms and institutions take
on for a rational and truely beneficial use of the
technology. The other 92% consists of: installation costs,
enabling, support, maintenance, administration, and
This argument repeats that already given in paragraph 5 and
partly contradicts paragraph 3. For the sake of brevity we
refer to the comments on those paragraphs. However, allow me
to point out that your conclusion is logically false: even
if according to Gartner Group the cost of software is on
average only 8% of the total cost of use, this does not in
any way deny the existence of software which is free of
charge, that is, with a licensing cost of zero.
In addition, in this paragraph you correctly point out that
the service components and losses due to down-time make up
the largest part of the total cost of software use, which,
as you will note, contradicts your statement regarding the
small value of services suggested in paragraph 3. Now the
use of free software contributes significantly to reduce the
remaining life-cycle costs. This reduction in the costs of
installation, support etc. can be noted in several areas: in
the first place, the competitive service model of free
software, support and maintenance for which can be freely
contracted out to a range of suppliers competing on the
grounds of quality and low cost. This is true for
installation, enabling, and support, and in large part for
maintenance. In the second place, due to the reproductive
characteristics of the model, maintenance carried out for an
application is easily replicable, without incurring large
costs (that is, without paying more than once for the same
thing) since modifications, if one wishes, can be
incorporated in the common fund of knowledge. Thirdly, the
huge costs caused by non-functioning software ("blue screens
of death", malicious code such as virus, worms, and trojans,
exceptions, general protection faults and other well-known
problems) are reduced considerably by using more stable
software; and it is well-known that one of the most notable
virtues of free software is its stability.
You further state that: "7. One of the arguments behind the
bill is the supposed freedom from costs of open-source
software, compared with the costs of commercial software,
without taking into account the fact that there exist types
of volume licensing which can be highly advantageous for the
State, as has happened in other countries."
I have already pointed out that what is in question is not
the cost of the software but the principles of freedom of
information, accessibility, and security. These arguments
have been covered extensively in the preceding paragraphs to
which I would refer you.
On the other hand, there certainly exist types of volume
licensing (although unfortunately proprietary software does
not satisfy the basic principles). But as you correctly
pointed out in the immediately precding paragraph of your
letter, they only manage to reduce the impact of a component
which makes up no more than 8% of the total.
You continue: "8. In addition, the alternative adopted by
the bill (i) is clearly more expensive, due to the high
costs of software migration, and (ii) puts at risk
compatibility and interoperability of the IT platforms
within the State, and between the State and the private
sector, given the hundreds of versions of open source
software on the market."
Let us analyze your stament in two parts. Your first
argument, that migration implies high costs, is in reality
an argument in favour of the Bill. Because the more time
goes by, the more difficult migration to another technology
will become; and at the same time, the security risks
associated with proprietary software will continue to
increase. In this way, the use of proprietary systems and
formats will make the State ever more dependent on specific
suppliers. Once a policy of using free software has been
established (which certainly, does imply some cost) then on
the contrary migration from one system to another becomes
very simple, since all data is stored in open formats. On
the other hand, migration to an open software context
implies no more costs than migration between two different
proprietary software contexts, which invalidates your
The second argument refers to "problems in interoperability
of the IT platforms within the State, and between the State
and the private sector" This statement implies a certain
lack of knowledge of the way in which free software is
built, which does not maximize the dependence of the user on
a particular platform, as normally happens in the realm of
proprietary software. Even when there are multiple free
software distributions, and numerous programs which can be
used for the same function, interoperability is guaranteed
as much by the use of standard formats, as required by the
bill, as by the possibility of creating interoperable
software given the availability of the source code.
You then say that: "9. The majority of open source code does
not offer adequate levels of service nor the guarantee from
recognized manufacturers of high productivity on the part of
the users, which has led various public organizations to
retract their decision to go with an open source software
solution and to use commercial software in its place."
This observation is without foundation. In respect of the
guarantee, your argument was rebutted in the response to
paragraph 4. In respect of support services, it is possible
to use free software without them (just as also happens with
proprietary software), but anyone who does need them can
obtain support separately, whether from local firms or from
international corporations, again just as in the case of
On the other hand, it would contribute greatly to our
analysis if you could inform us about free software projects
*established* in public bodies which have already been
abandoned in favour of proprietary software. We know of a
good number of cases where the opposite has taken place, but
not know of any where what you describe has taken place.
You continue by observing that: "10. The bill demotivates
the creativity of the peruvian software industry, which
invoices 40 million US$/year, exports 4 million US$ (10th in
ranking among non-traditional exports, more than
handicrafts) and is a source of highly qualified employment.
With a law that incentivates the use of open source,
software programmers lose their intellectual property rights
and their main source of payment."
It is clear enough that nobody is forced to commercialize
their code as free software. The only thing to take into
account is that if it is not free software, it cannot be
sold to the public sector. This is not in any case the main
market for the national software industry. We covered some
questions referring to the influence of the Bill on the
generation of employment which would be both highly
technically qualified and in better conditions for
competition above, so it seems unnecessary to insist on this
What follows in your statement is incorrect. On the one
hand, no author of free software loses his intellectual
property rights, unless he expressly wishes to place his
work in the public domain. The free software movement has
always been very respectful of intellectual property, and
has generated widespread public recognition of authors.
Names like those of Richard Stallman, Linus Torvalds, Guido
van Rossum, Larry Wall, Miguel de Icaza, Andrew Tridgell,
Theo de Raadt, Andrea Arcangeli, Bruce Perens, Darren Reed,
Alan Cox, Eric Raymond, and many others, are recognized
world-wide for their contributions to the development of
software that is used today by millions of people throughout
the world. On the other hand, to say that the rewards for
authors rights make up the main source of payment of
Peruvian programmers is in any case a guess, in particular
since there is no proof to this effect, nor a demonstration
of how the use of free software by the State would influence
You go on to say that: "11. Open source software, since it
can be distributed without charge, does not allow the
generation of income for its developers through exports. In
this way, the multiplier effect of the sale of software to
other countries is weakened, and so in turn is the growth of
the industry, while Government rules ought on the contrary
to stimulate local industry."
This statement shows once again complete ignorance of the
mechanisms of and market for free software. It tries to
claim that the market of sale of non- exclusive rights for
use (sale of licences) is the only possible one for the
software industry, when you yourself pointed out several
paragraphs above that it is not even the most important one.
The incentives that the bill offers for the growth of a
supply of better qualified professionals, together with the
increase in experience that working on a large scale with
free software within the State will bring for Peruvian
technicians, will place them in a highly competitive
position to offer their services abroad.
You then state that: "12. In the Forum, the use of open
source software in education was discussed, without
mentioning the complete collapse of this initiative in a
country like Mexico, where precisely the State employees who
founded the project now state that open source software did
not make it possible to offer a learning experience to
pupils in the schools, did not take into account the
capability at a national level to give adequate support to
the platform, and that the software did not and does not
allow for the levels of platform integration that now exist
In fact Mexico has gone into reverse with the Red Escolar
(Schools Network) project. This is due precisely to the fact
that the driving forces behind the mexican project used
license costs as their main argument, instead of the other
reasons specified in our project, which are far more
essential. Because of this conceptual mistake, and as a
result of the lack of effective support from the SEP
(Secretary of State for Public Education), the assumption
was made that to implant free software in schools it would
be enough to drop their software budget and send them a CD
ROM with Gnu/Linux instead. Of course this failed, and it
couldn't have been otherwise, just as school laboratories
fail when they use proprietary software and have no budget
for implementation and maintenance. That's exactly why our
bill is not limited to making the use of free software
mandatory, but recognizes the need to create a viable
migration plan, in which the State undertakes the technical
transition in an orderly way in order to then enjoy the
advantages of free software.
You end with a rhetorical question: "13. If open source
software satisfies all the requirements of State bodies, why
do you need a law to adopt it? Shouldn't it be the market
which decides freely which products give most benefits or
We agree that in the private sector of the economy, it must
be the market that decides which products to use, and no
state interference is permissible there. However, in the
case of the public sector, the reasoning is not the same: as
we have already established, the state archives, handles,
and transmits information which does not belong to it, but
which is entrusted to it by citizens, who have no
alternative under the rule of law. As a counterpart to this
legal requirement, the State must take extreme measures to
safeguard the integrity, confidentiality, and accessibility
of this information. The use of proprietary software raises
serious doubts as to whehter these requirements can be
fulfilled, lacks conclusive evidence in this respect, and so
is not suitable for use in the public sector.
The need for a law is based, firstly, on the realization of
the fundamental principles listed above in the specific area
of software; secondly, on the fact that the State is not an
ideal homogoneous entity, but made up of multiple bodies
with varying degrees of autonomy in decision making. Given
that it is inappropriate to use proprietary software, the
fact of establishing these rules in law will prevent the
personal discretion of any state employee from putting at
risk the information which belongs to citizens. And above
all, because it constitutes an up-to-date reaffirmation in
relation to the means of management and communication of
information used today, it is based on the republican
principle of openness to the public.
In conformance with this universally accepted principle, the
citizen has the right to know all information held by the
State and not covered by well- founded declarations of
secrecy based on law. Now, software deals with information
and is itself information. Information in a special form,
capable of being interpreted by a machine in order to
execute actions, but crucial information all the same
because the citizen has a legitimate right to know, for
example, how his vote is computed or his taxes calculated.
And for that he must have free access to the source code and
be able to prove to his satisfaction the programs used for
electoral computations or calculation of his taxes.
I wish you the greatest respect, and would like to repeat
that my office will always be open for you to expound your
point of view to whatever level of detail you consider
DR. EDGAR DAVID VILLANUEVA NUÑEZ
Congressman of the Republica of Perú.
Competing interests: No competing interests
If your institution has Information Systems Department with a
programming staff, as many large hospitals have, you should realize that
they could not exist without "source code". The purchase of systems that
includes the source code allows customization for improved performance,
functionality, and interfacing with other systems.
The real production environment is the last and best place to iron
out problems in the code. No test environment will truly simulate the
real world data or real "creative" users.
If you only get executables when you purchase software, you are
completely at the mercy of the vendor. You have even lost control of your
budget in some cases. It is rare that the end-user will anticipate every
need that they will encounter in their work and communicate that to the
software vendor/creator on the first request. Major items are frequently
left off because the needs analysis is not done correctly before purchase
or implementation. Major rewrites are then mandated. Costs can
skyrocket. Deadlines are missed. If you need anything added, you have to
get out the corporate wallet and pay and pay and pay. We can be talking
amazing numbers of dollars here. This was supposed to be a plan to
conserve money at first (usually).
One size does NOT fit all in the healthcare industry !
That means you are looking to purchase custom or customizable software.
This is expensive. Vendors who do not include source code may say that it
will be less expensive for you to purchase from them. This has not been
true in my experience. The initial cost is often lower but the follow up
costs are still high. Proprietary software that does include the source
is typically more expensive up front but cheaper to maintain, upgrade,
customize, or integrate with other systems.
Open-source has the advantages of the source-including packages, and
it is lower in its initial cost. It is not cost free. You must shop and
carefully consider what you need and can maintain, just as you would with
closed-source "proprietary" software. I also believe that open-source
projects do not usually advertise themselves as being better or more
complete than they really are. They can never sell you vaporware because
you can see the source whenever you want.
Unfortunately, since open-source projects operate with a lower
budget, you often have to look for them a little harder than for higher-
priced (with advertising budgets) software.
Government projects are another place where open-source code
applications are generated. Since the "public" are funding the creation
of this software, it is public property. Excellent applications from this
area often are overlooked.
If you want to deliver the highest quality information in the most
cost-effective manner, you should at least include open-source in the list
of options to consider.
Competing interests: No competing interests
The example of the mount command for a CD ROM on Linux is correct,
however if you choose to use one of the GUIs for Linux (descendants of the
X-Windows system that predates MS Windows, and like all these interfaces
originally derived form the Xerox Palo Alto Research Centre work) then you
will find that the mounting and unmounting is hidden from you in normal
KDE on SuSE for instance - www.suse.com
meanwhile in Windows - as soon as you get into serious use, it is
back to the black screen to check network connectivity and typing in
commands no less abstruse than mount.
For instance, it is just possible that some reader may find a use for
Disable Dial-In Access (Windows 9x and NT)
It's possible for users to setup a modem on a Windows machine,
and by using Dial-up Networking allow callers to connect to the internal
network. Especially in a corporate
environment this can cause a major security risk.
Value Name: NoDialIn
Data Type: REG_DWORD
Data: (0 = dial-in enabled, 1 = dial-in disabled)
As for the supply of support technicians and engineers - apart from
the fact that the generation who learned to run computers before MS are
still around, in general anyone who is good at programming or supporting
in one operating system will be able to switch to another.
And anyone who is not good at it, another large and pressing problem,
will be no worse.
It is entertaining to place a Linux workstation in an office, with a
modern GUI showing, and see how long it is before anyone notices that the
interface is not Windows. Try it.
Competing interests: No competing interests
Editor - Douglas Carnall (BMJ 21/10/00 p976) is correct when he says
that the NHS is having problems with software procurement. However his
view of "open source" development is too rosy. Any large datahandling
project is a huge undertaking and needs expert developers who need to make
a living. The NHS simply does not employ these people in quantity and it
seems unlilely that developers working elsewhere will program for
altruism's sake. Like all open source projects these developers would
gain income from support, leaving us just as tied in to their system as
any other and still paying for the system. Free software is free as in
"speech", not as in "beer".
The idea that having the source code would allow us to "fix" problems and
take over the system's development is again optimistic. Reading code
written by another developer (even if it is well structured and lavishly
commented) is very, very difficult. Bugs are as likely to be introduced
The real problem with lots of the software used in the NHS is, frankly,
that it is badly written. We have turned to software developers needing
so much, so quickly, that large numbers of low ability programmers are
able to make money with low quality software. The ubiquity of Microsoft
Windows (tm) as a desktop operating system with its visual development
tools has meant that it is frighteningly easy to turn out, say a database,
with little or no knowledge of good system design. Often such systems
work well in the author's setting, with the constant support and tweaking
that brings, but they are incapable of configuration for a
different site with different requirements.
The real cost of a data system is the cost of collecting and inputting the
data, its real value the information that you can get out of it.
The cost of licensing software is trival in comparison.
The real software problem is that we need better programmers, lots of
them, and we need to pay for them.
Conflict of interest
The writer writes free Windows Software, largely for fun.
Competing interests: No competing interests
Editor - The call of Douglas Carnall for the use of free software
like Linux in the National Health Service made a very interesting point
(1). I am sure that Dr Carnall’s
opinion is based on his experience that clearly indicates a deep
knowledge of computer systems and languages. The problem with the use of
this form of software will rise in small health departments and practices
and remote hospitals where there is already inadequate computer support.
Even with the proprietary windows system, there are often problems related
to crashes during which medical secretaries experience difficulties in
getting support for the relatively low-tech use of computers in getting
access to patients’ data systems or even undertaking simple word-
processing of GP letters.
There is much less support and training for free software compared with
proprietary software like Windows (2). It might be practicable to use free
software in large academic medical departments where there is more
computer support and more technically computer literate professionals.
Problems will rise in small district hospitals and GP practices with
little or no in-house computer support. The free operating systems need
familiarity and knowledge of the text-based language like Dos. A recent
article in the Guardian supplement Online (3) gave good examples of the
difficulties and problems associated with the use of one of the most
famous free operating systems– Linux. In addition to the problems with the
lack of familiarity and knowledge with the language of this software there
were problems in the
interface with other software applications particularly those related to
networks and Internet access (3). The Guardian article gave an example of
the typed instructions needed in Linux to access the computer CD rom drive
which is: mount –t iso9600/dev/cdrom/mnt/cdrom/. For medical practitioners
with little computer training, these instructions might be more
technically demanding than the windows point-and click easiness.
W. K. Abdul-Hamid,
Linden Centre, Woodlands
Way, Chelmsford, Essex CM1 7LF.
Computer Service Manager,
West Thames College, London Road,
Isleworth, Middlesex TW7 4HS.
1. Carnell, D. Medical software’s free future. Open Collaboration
over the Internet is changing development methods. BMJ; 321:976.
2. Stutz, M. Getting Help With Linux. Linux Journal, No:53. August
3. Willmott, N. Linux is cooking in my kitchen,. Online, p 9. The
Guardian, Thursday October 26 2000.
Competing interests: No competing interests
All of Steve's comments are perfectly valid, but what is neglected is they are equally valid for proprietary software. The primary difference with open source in this respect is, should your current vendor prove less than adequate, you are free to take your project to someone else in the same way that you can take your car somewhere else if your local car dealer proves less than satisfactory.
Do remember that "open source is not magic pixie dust" and bad software and bad management can happen anywhere, however your options for recovery in such situations is significantly less when the software sources are open.
Competing interests: No competing interests
I went to a meeting today with our local Health Authority regarding
future IT for our practice and many others around. I was excited about the
possibilities raised by your editorial regarding free software and a
common platform for all. I was hoping to hear that some common sense
was going to spread around. But unfortunately nobody knew about this
meeting you mentioned. Even more, nobody seemed to have read the
I have to doubt there is going to be any movement from existing software
suppliers. We are going to continue been ripped off by this companies that
are able to promise many facilities in their software and maintenance
packages when ultimately you get a product below minimum standards without
a proper back up.
What is even worse is that because it is a very competitive market, and
companies are taking over one each other, new programs can become obsolete
on the day of delivery, as it happened to our practice: Two days after
installation we were told we have to move again to a different platform as
our new software was not going to be supported by their new owners, as
they have got already different programs to offer. And time has shown us
that the program we believed to be optimal is unstable, unreliable, and a
source of discontent for our staff.
I am pretty sure if the Government were interested in a better NHS,
where electronic communication and sharing of information could improve
standards, they should have created an IT division to create a unique
package for everybody. It should have been cheaper, and less traumatic for
the health professionals to adopt. The current situation only improves the
pockets of the many different companies sharing this vast market of
hospitals and practices, unable to share information because each program
data has to be read by the program that produced it. It can not be shared.
The Government can blame GPs of been reluctant to change , but he is the
one to blame for the mess that surrounds us.
A software program could or could be not a Linux, a Windows or an Apple,
but some standards are needed that are not in place:
-all database should be in the same format, and different programs,
different interfaces could transmit data from one practice to another when
a patient moves practice (not a few pages of small print that you can not
-practices should be able to have two different programs to read the
data, so when the main one is crashed, at least the possibility is there
to see (if not to change) what is going on. Ideally the computer should
not crash, but it seems to ask for too much nowadays. NHS does not have
the same code of practice than airport control towers.
-a paperless NHS can not take place unless all communication between
primary and secondary care is done electronically and we are far beyond
that. Trying to get all letters from hospital scanned is a waste of human
resources. In the same way, it should be possible to get the data for a
single patient to be transmitted to a laptop or a floppy to be read
elsewhere (GP doing a visit, patient moving area, ...)
-security at present standards is poor and needs tightening. If I
were a Dr Shipman with my current system I could easily get prescriptions
as signed by someone else and falsify the signature, so I were not
In summary, the message for the the Government should be: Give us the
chance to feel we are improving the National Health Service, that we are
cost-effective, that we are not moved backwards and forwards, that our
staff is not trained and retrained unnecessarily, and GPs will be more
than keen on adopting the IT revolution.
We need to see the light at the end of the tunnel, but at present we
are just weathering the storm.
1 Carnall D Medical Software's Free Future BMJ 2000;321:976 (21
Competing interests: No competing interests
I think Douglas Carnall's fine editorial has done a lot to raise awareness on the problems posed by proprietary medical software, problems that will only worsen with the shift to more complex and network-oriented architectures.
We are also trying to make a point on those issues in Switzerland. See for example http://www.medecin.ch/article.php3?sid=20 for a note (in french language) about a medical documents secure transfer project based on closed-source software (unfortunately this project is receiving EU financing BTW).
As noticed in many places, some of the people with decision-making abilities in those domains do not seem to be fully aware of the raised stakes (and implicit costs) related to their choices in licensing and architectures. Yet open sourcing the key components of networked medical IT architectures seems more and more the best answer to prepare the way for a truly competitive market in terms of medical software.
A. M. Klohn
Competing interests: No competing interests
As a researcher in medical education, I wholeheartedly agree with the points made by Dr Carnall about the benefits of free software. I would like to emphasize the importance of open standards as pointed out in some of the comments. Such standards and free software go hand in hand. This is exemplified by the internet itself, which was a "free software" effort before this term came into its current usage.
Some important practical benefits seem to be overlooked because they derive from the "free beer" rather than the "free speech" aspect of software freedom. Since no license fees need to change hands, the choice of a solution can be based purely on its technical merits. Decision makers do not need budgetary control. Transaction overheads can be saved, and (possibly most importantly) the financial risk of acquiring a partially adequate or inadequate solution is reduced.
My own project aims to establish a framework for integrating medical images and text to create educational resources. It is based heavily on free software (Apache-Cocoon). Code resulting from the project will be available under the GNU General Public License.
Competing interests: No competing interests