Tom Nichols has written a long, but thought provoking piece on our relationships with experts. While slanted towards matters political, there are many aspects that relate to health care, research, and the fraught topic of Evidence Based Medicine (EBM). Nichols points out that experts can be dismissed and derided, or equally, placed on an all-knowing, all-seeing pedestal of unquestioned trust. Social media can magnify this effect by orders of magnitude – accelerating to warp speed a rise to the top of the influence heap with a timely claiming of a trust me I’m a [insert profession here] moniker, and providing a quantitative proxy for ‘expertise level’ via likes, thumbs, retweets or followers – a hyper-connected version of Do you concur? But what social media can build, it can also tear down – dismissing a dissonance inducing argument is as easy as labelling an opponent a guru, or an “expert” – with the scare quotes being the operational part.
Nichols carefully dissects our regular interactions with experts, beginning with the notion of trust, and the tendency to forget to put some boundaries around our confidence in experts:
…This daily trust in professionals is a prosaic matter of necessity. It is in much the same way that we trust everyone else in our daily lives, including the bus driver we assume isn’t drunk or the restaurant worker we assume has washed her hands. This is not the same thing as trusting professionals when it comes to matters of public policy: to say that we trust our doctors to write us the correct prescription is not the same thing as saying that we trust all medical professionals about whether the US should have a system of national healthcare. To say that we trust a college professor to teach our sons and daughters the history of the Second World War is not the same as saying that we therefore trust all academic historians to advise the president of the US on matters of war and peace.
For these larger decisions, there are no licences or certificates. There are no fines or suspensions if things go wrong. Indeed, there is very little direct accountability at all, which is why laypeople understandably fear the influence of experts.
Where does it all go wrong?
Nichols also explores how experts can go wrong – in ways both innocent and nefarious:
How do experts go wrong? There are several kinds of expert failure. The most innocent and most common are what we might think of as the ordinary failures of science…
Science is learning by doing. Laypeople are uncomfortable with ambiguity, and they prefer answers rather than caveats. But science is a process, not a conclusion.
…Other forms of expert failure are more worrisome. Experts can go wrong, for example, when they try to stretch their expertise from one area to another. A biologist is not a medical doctor but, in general terms, a biologist is likely to be relatively better able to understand medical issues than a layperson. Still, this does not mean that anyone in the life sciences is always better informed than anyone else on any issue in that area.
Finally, there is outright deception and malfeasance. This is the rarest but most dangerous category. Here, experts for their own reasons (usually careerist defences of their own shoddy work) intentionally falsify their results. Such misconduct can be hard to detect specifically because it requires other experts to ferret it out; laypeople are not equipped to take apart scientific studies, no more than they are likely to look closely at a credential hanging on a wall to see if it is real.
An Abagnalegation of responsibility?
A brief aside in the piece reminds the reader that not all experts are, in fact, experts and raises a key point worth considering.
People lie brazenly about their credentials. This is the kind of bravura fakery that the real-life ‘Great Pretender’, Frank Abagnale, pulled off in the 1960s – later popularised in the movie Catch Me If You Can (2002), including his impersonation of an airline pilot and a medical doctor.
In the movie Catch Me If You Can, Abagnale impersonates a range of experts, fooling other real experts with charm, a quick wit, and just the right level of judicious vacuousness in everything he says. And herein lies a vital question – just who is responsible for keeping experts in check? Licensing and and accreditation boards would seem to be an easy answer, and the peer-review process in scientific publishing is supposed to ensure a kind of self-regulation, but relying on these others is an abnegation of the responsibility of each individual to question, to critique, and most of all to think.
Clinicians and therapists of any kind can rightly claim to be experts in their respective fields (although levels of expertise may vary…) and the Aeon piece is a sobering reminder of the collective responsibility to walk the fine line between respecting others in a field; their knowledge, qualifications, expertise and experience, while questioning (and why not do it with kindness and care) everything they say, post, tweet and share.
You could start with this post; in the comments below (but remember the kindness and care bit!)
In tennis they talk about a player being “In the zone”. At that moment he or she are really on fire delivering extrodinary levels of skill, wiping their opponent off the court with relative ease. The moment that the player realises that they are “In the zone” they no longer are and their game falls apart.
Hopefully, we all seek to be experts, to be in the zone but the moment that we think we are game over …….
It’s a bit like thinking that if anyone knew what went on in my head, they would run a mile. Each profession has high levels of ignorance and are protective of the public finding out the truth. Also those who have the biggest personalities, shout the loudest and claim to be “the expert”are often the most ignorant, but unfortunately the best paid and attract followers who seek to emulate their power/wealth. So the ignorance cycle continues.
I have worked hard to be as good as I can but this does not translate into material gains, something I accepted some years ago. In fact being evidence based puts me at odds with colleagues and often patients.I am coming to the conclusion that patients are seeking magic, not the truth. We love myths and metaphors and perhaps the bull…….s get better results because they build a myth around themselves.
Expert is such a horrible sounding word!, Early in my career the experts were the clinically based guru types who had written books and also members of the medical profession. Then the experts became the researchers, often clinically immature, who dominated the conferences and now I note another group of experts emerging – those adapt at social media and blogging. Not sure where I fit in here but I would hate to be called an expert. Some knowledge and experience in a small sector of rehab would do me.