[ej3]

I'm not sure I completely understand your comment, but I think hierarchy is a structure that is useful for a society when the exchange of information is naturally constricted. Accreditation, status and authority are strong signals in a setting with limited bandwidth, but when communication becomes more robust.. it's more attainable to construct a heuristic to find utility unique to a specific instance or situation. Aspects of what I think represents the best cancer Dr may not jive with what you think the best cancer Dr is (locality? alternative medicine? cost vs probable outcome?)

Hierarchies are still important, but now they're just training wheels in many instances.