Experts: hired lackeys – & moon made of cream cheese.

It is a bit of a tough gig being an “expert” these days.

Not so much in what I do, of course. It is not as if there is all that much controversy – or interest – surrounding the Delta-like cells of the crayfish hepato-pancreas, or whatever it is people like me spend their time fiddling about with. Even if I were to put on my work website that I was a “world-renowned expert in cell physiology”, or whatever, it would raise few hackles, although the thirty people worldwide that actually read my papers would have a quiet snigger at my delusions of grandeur.

The wider world, I predict, would be unconcerned.

- until I start commenting about alternative medicine, or CoQ10, or homeopathy, at which point I will get accused by people I have never met of being in the pay of “Big Pharma”, or, as our nearly four yr old, Junior Aust, says, ”Evil Farmer”.

For the record, the biggest “payday” I have ever had from Big Pharma was a free lunch (once) in AstraZeneca’s nice staff cafeteria at Alderley Park. Other than that, nothing – not even a small consultancy fee. *sigh*

But it is quite different for experts in things like medicine… the stakes are high, and some people nowadays seem to think that all “Experts” are corrupt tools of Shady Corporate Interests, or of “the Medical Establishment”.

So what really makes “an expert”?

It is a truism of science that the more you know about something, the more “expert” you are. For this reason, the average person who reviews scientific papers for a serious scientific journal – an “expert reviewer” – will be someone who has a degree, a PhD, several years’ worth of postdoctoral research experience, and preferably does, has done, and often supervises other people doing, work very similar to the stuff they are reviewing.

The point is that you have to know the subject, and the type of work, and how it is done, inside-out to see the errors, if any. And also to see where the authors may have finessed things slightly by comparing things that are not strictly comparable, and so on.

The result is “expert peer review” – a fully-informed expert opinion on a particular piece of research, or on the latest meta-analysis.

You know you are an expert in this sense because other experts decide that you are. For instance, proper high-end science journals (and this does not mean all the thousands of journals you can find listed on Pubmed) are picky about their expert reviewers, as it is on these peoples’ rigor that a journal’s standards depend. It is for this reason that scientists sometimes list, on their professional CVs, the journals they review work for.

Conversely, I think we can say it a safe bet that the venerable Journal of Physiology is not going to be asking Sir Cliff Richard to review the next paper about whether antioxidants help older athletes get less post-exercise muscle pain.

Sir Cliff is not, whatever the food supplement industry appear to think, an expert.

However, not all public statements about research, especially medical research, or its interpretation, come from the experts.

Indeed, on many issues expert opinion is vastly outweighed by comments from what one might politely call “advocacy groups”. These include, but are not limited to, patient groups.

This presents interesting problems. One in particular is: can one trust the messages emerging from such groups?

And if we say no, are we saying that only real experts should be allowed to have a view?

Context is critical (again)

Well, let’s stay with the profile of an expert, and their ability to interpret the evidence. This ability to interpret research is a question of degrees of relevant knowledge. But it also depends critically on being able to put the research in the proper context – that is, having the background to know things relevant to the research that are not explicitly written down in the paper.

This is something scientists, and doctors, are taught in varying ways. But they are taught it. For instance, take a PhD viva (the oral examination that follows the submission of a PhD Thesis and constitutes – hopefully – the last stage of getting a doctorate).

In the viva, you do not get asked about just the experiments in your PhD thesis.

You also get asked about other experiments in the literature that bear on whatever question or questions you are seeking to answer. You get asked about the broader background area, and where your work fits it. You get asked about the key theories in the area that underpin and lead up to your work, and how strongly the experimental evidence supports them. And you get asked why Dr Y’s experiment got a different answer to yours, particularly in terms of analyzing the differences between your experimental design and Dr Y’s. Was the answer different because the patient blood samples in your experiments came from women aged 16-20 who volunteered for a specific study, while Dr Y’s were from women aged 18-30 who had been sampled for a study into something else? What are the potential ways that that could make your study populations different and thereby explain the different answers you got? Is there other evidence to support any of these potential explanations?

…and so on, and so on.

And apart from being taught it, this “contextual knowledge” is also acquired bit-by-bit over years in research, or medicine. It forms one useful kind of accumulated experience.

The reason I am harping on about this is that many advocacy groups include, or even employ, people who have read a lot of medical and scientific studies, and sometimes consider themselves experts. But their expertise often lacks a critical dimension: they commonly do not understand all the background. And I mean “background” here in a very broad way; I am including not only “the broader science in this field” and “earlier studies like this”, but also “the underlying assumptions of the work”, “the ways in which studies like this can be biased” and – very critically – “the ways in which statistics and statistical testing work in relation to this kind of experiment”

From the above, you can see that there are a lot of different levels of understanding that one can have in relation to a scientific topic.

Which is NOT to say that you cannot have an opinion unless you are a full-on “academic ninja” expert. I mean rather that you should try to recognize the limits of your knowledge, and understand that other people will inevitably know more (or less) about it than you.

[This goes, incidentally, for doctors and scientists, obviously including me. I know more than some people, and less than others, and this is subject-dependent. I know, for instance, more about acid-base balance than most physiologists. But I know less than a hospital doctor, who in turn knows less than a real “acid-base ninja”, like an anaesthetist or intensive care specialist]

Of course, in the public arena, many or even most people seem to not be too good at this “grading” of their level of knowledge.

To take an example…

As an illustration, take the controversy over home birth. Dr Crippen over at NHS Blog Doctor is currently taking a shot at some midwives in Kent (these midwives are independent of the NHS and charge for their services). They ran a home delivery for a mother with a long string of “risk factors” that would have lead any obstetrician, and probably most NHS midwives, to conclude that the mother would have to be bonkers to want a home birth. Dr Crippen is angry because the independent midwives seem to be unaware of the dangers, continually referring to the caution of the mainstream doctors and midwives as “shroud waving”.

The case described by Dr C is pretty extreme, judging by what my medical advisor (Mrs Dr Aust) tells me. But home birth is a contentious issue all around.

And in homebirth, a battle is being fought over precisely what the statistics tell you about whether home birth is more dangerous than giving birth in hospital, and by how much.

The doctors I have asked are unanimous; home birth is more risky for both mother and baby, they say, mainly for the obvious reason that if something does go seriously pear-shaped, you want to be in a hospital.

This extra risk, the doctors concede, may be slight and acceptable for ultra-low-risk normal births under ideal conditions, that is, where the overall (absolute) risk of something going pear-shaped is very small. However, the more “non low-risk” the pregnancy (i.e. the more factors there are suggesting an increased chance of complications) the relatively riskier home birth becomes. And if conditions are not “ideal” (for instance less experienced midwife, long drive from nearest maternity hospital in case of pear-shaped-ness, etc), then that all adds to the risk that is being taken.

For what it’s worth, among all the female doctors with children Mrs Dr Aust and I know, we have never met a single one, in any specialty, who opted for a home delivery.

But the home birth groups dispute the above view, and also the idea that the doctors, and even the hospital midwives, are speaking from expertise rather than ”medical paternalism”. The home-birthers feel they should have the right to choose home birth. They also point to published analyses that say that for low-risk deliveries, home birth is no more dangerous than hospital birth. Typically, a fierce and detailed argument then ensues about exact which figures do (or don’t) mean what different people say they mean. If you want to see this in action, try the discussion thread following Dr Crippen’s post

So – who to believe?

I won’t give my own opinion, for the following reason: I am not an expert in the relevant areas.

However, I think I can say who I would regard as “an expert” on the question.

It is, as ever, a question of “degrees of expert knowledge”. Who are the people most likely to know all the studies, all the background, all the factors influencing the trustworthiness or otherwise of individual studies, and all the hidden catches in comparing different patient groups and studies?

Well, for me, it’s no contest – the answer is that I would put Professors of Obstetrics & Gynaecology (O&G), or experienced hospital O&G consultants, at the top of the expert scale for this particular issue, and Joe and Joanna Public at the bottom.

The advocacy group people, even if they have scientific or medical backgrounds, would rate well below the Professors and consultants, at least for me. This is both because they have a clear agenda going in, and also because they mostly lack the full background necessary to interpret the evidence properly. I would thus be suspicious about whether any message they were putting out was strictly accurate. And my personal bete noire, journalists with no training in science or statistics, would rate pretty damn low on the expert scale, though we hear a lot from them on this issue (for a particularly misleading recent article see last week’s Guardian here).

Personally I think there is a lot of danger in folk who cannot see that there are people who know more than them (or even concede that such people probably exist) when looking at this and other issues to do with interpreting research. To repeat it again, you have to be aware of how much you know, and how much you don’t, if that doesn’t sound too Donald Rumsfeld.

Where to find the good stuff…

Plus, once you have established you don’t know enough, you also have to know where to get the information that you are missing, and from whom.

To give one example: let’s take a family doctor who has heard something about all the homebirth discussion, but hasn’t read all the recent studies, and is confronted by someone who insists that they have read that the statistics say home births are as safe as hospital births.

The doctor knows he or she needs reliable information. Luckily they know that, say, a Cochrane review written by an O&G Professor would be the place to go for the goods. And they would almost certainly rate this higher in their “evidence hierarchy” than a review in a lesser scientific journal penned by the chief advisor of a charity that promotes home births. They would certainly rate published journals studies higher than figures quoted on websites that have never been through peer review.

That is not all there is to it, of course. Our hypothetical doctor might read the two reviews side-by-side, comparing what they said about individual studies, and thus improving their understanding of how research in the area is interpreted.

Where to put your trust?

Now, this is fine if you have relevant expertise and know what to do, and where to go for information.

But: how does this discussion about the nature of experts help Joe Public when he or she is confronted by the need to make a decision? Or in the case of prospective parents and the home birth issue specifically, who should they get their messages from?

As I see it this reduces to – who can you trust to have an expert view on this, and communicate it to you without a hidden agenda, whether ideological or financial?

My answer for childbirth, having been through it as a prospective parent, would be the obstetricians and hospital midwives. Because it is their business to know the facts, and also their professional responsibility to try and get the best outcome for you and your unborn child.

In contrast, I would not expect to get anything like a dispassionate view from a homebirth advocacy group, even when they say they are “quoting the studies”.

The trouble is that there is so much propaganda about, much of it masquerading as journalism – see e.g. the Guardian article linked to above – that it must be incredibly difficult for people to know who to believe.

The danger is that they will make the decision first, based on irrational fears or on preconceptions that may be mistaken. And they will then get this uninformed decision reinforced because there will be some information, somewhere, that agrees with and applauds their choice, even if their choice is objectively ill-advised.

To me this parallels other “reality meets preconceptions” problems in health like the MMR vaccine saga. Once people have bought into the idea that “the doctors / experts / government aren’t telling me everything” - or that the doctors are pushing a particular agenda , “medicalising birth” or “pushing drugs and vaccines for Big Pharma” – then the patients / parents are cast adrift amid a sea of misinformation. They – or perhaps I should say we, since I am a patient too – are at the mercy of lots of advocacy agendas, all too commonly armed with prejudice, misguided certainty, and masses of misused stats.

Experts under fire

So just how did we end up doing this to professionals and experts? Have we, as a society, decided that their opinions are just another optional paid-for add-on?

Experts and professionals certainly are sometimes mistaken. They sometimes do not explain enough. They certainly do not get enough help from professional explainers explaining science and medicine. They are, rather too often for my taste, hung out to dry by Governments who pick them up and dump them as a matter of political expediency. And finally, experts are at times guilty of digging their own holes to fall into – e.g. by doctors trousering large consultancy fees from pharmaceutical companies.

But is that enough to dump expert views entirely? Do we really think all mainstream experts are incompetent and arrogant? Or that self-interest is their only motivation?

Personally I am happy to let the pilots fly me, the anaesthetist anaesthetise me, and the lawyer tell me what is, or isn’t, legal. And I am also aware that you can’t believe everything you read – though on the whole I believe it more if the writer is a real expert, and is not trying to sell me something.

But it sometimes seems, these days, that I am in a minority on both counts.

It is a worry.

PS Sorry for the long and boringly unfunny ramble. Hopefully there will be more satirical snarking next time.

Quote of the day: “I can live with doubt and uncertainty and not knowing. I have approximate answers and possible beliefs and different degrees of certainty about different things… It doesn’t frighten me.” – Richard Feynman

18 Responses to “Experts: hired lackeys – & moon made of cream cheese.”

  1. gimpy Says:

    Interesting essay Dr Aust. To be honest I do sometimes wonder if those with expertise have put themselves at a disadvantage with those who do not by engaging with them on equal terms. It is quite common in the media to give equal air time or column space to what are described as opposing views for the sake of balance. Often these opposing views come from, on one side, consumer/supplier advocacy groups fronted by laymen and on the other a genuine real life living breathing expert. The views of the expert are gernally treated as being equivalent of those of the layman with the viewer or reader being asked to decide between the two. Of course this is nonsensical as the viewer or reader will be even more ignorant than the layman. Of course resolving this isn’t as simple as the expert stating that as s/he is the expert then their opinion counts while others do not, this may be true but apparent arrogance is never a good debating strategy.

    I suppose my solution would be to require experts not to debate with laymen but to inform them. Media appearances should see the asking of questions of experts and the experts responses and sometimes even debate between experts. But get rid of the nonsense about equivalence of opinion between experts and laypeople.

  2. dvnutrix Says:

    Thank you for writing this, Dr Aust. On a related issue, I’ve been wanting to write something about the infiltration of science by use of pay-to-publish, nominally-peer-review-but-in-practice-we-publish-anything-and-everything papers. It is getting remarkably popular with Scientology front groups, one present egregious example is a paper praising the efficacy of the Narconon programme. Another is that dreadful paper from the MLM vitamin company that purported to find that the more supplements that you take, the healthier that you are. The danger with these publication venues is that they are not flagrantly the sort that you skewered and depicted as cargo-cult in your very fine Jnls of Alt Med piece.

    Add that to the presentation of science in mainstream media as if it is no more that PoMo ‘that’s just your opinion’ and ‘one week they say one thing, the next another’ and it’s no wonder that there is a general feeling of ‘a plague on all your houses’.

    I have no idea what a package of solutions would look like to resolve these issues. I, too, worry.

  3. Claire Says:

    Picking up very briefly on just one of your many fine points: while many patient groups do an excellent job in supporting people, making the case for better services etc. there has been for some time concern that some advocacy groups have closer ties to pharmaceutical companies than is desireable – cf. http://www.newscientist.com/channel/health/mg19225755.100

  4. Claire Says:

    And on the question of doctors’ financial relationships to pharmas, disclosure should be made. Something that, reportedly, didn’t happen here: http://www.slate.com/id/2190775/ – ” Are doctors shilling for Big Pharma on public radio”

  5. jdc325 Says:

    Excellent stuff Dr Aust. I was somewhat surprised that you ended this post with an apology for a ‘long and boringly unfunny ramble’, as it did not read that way to me. I thought you finished with some cracking ‘expert analogies’ – I certainly would not like to be flown by an ‘alternative pilot’.

    This paragraph in particular struck a chord –
    “Personally I think there is a lot of danger in folk who cannot see that there are people who know more than them (or even concede that such people probably exist) when looking at this and other issues to do with interpreting research. To repeat it again, you have to be aware of how much you know, and how much you don’t, if that doesn’t sound too Donald Rumsfeld.” – this reminded me of the Kruger and Dunning paper and also seems to link in to dvnutrix’s comment regarding the PoMo idea that each opinion carries as much weight as the next.

    ‘Tis but a short step to accusations of fascism (or microfascism) – see http://www.badscience.net/?p=284 or http://www.plos.org/cms/node/99 for discussion of the Holmes paper.

    Peer-review? Fascistic. Evidence-Based Medicine? Fascistic. The guy who fought fascists in the 30s? Fascistic.

  6. draust Says:

    Thanks for the kind words, guys. I just thought it was a bit of a rambling essay with no clear conclusion! A typical academic product, in other words.

    Gimpy and Dvn – agree about the inherent problems of presenting things. The illusion of “balanced coverage” has a lot to answer for.

    I do think “debate radio” works much better than “debate TV”, which is almost always a complete bear-pit of shouting idiots. I think the shouting is effectively encouraged by the TV producers, who don’t want intelligent debate when Jerry Springer-lite Shout-o-rama is doubtless a better ratings-getter. I am with David Attenborough all the way about the dumbing down of intelligent programming over the last decade or so. I still live in hope that some producer will give Ben Goldacre a series, a bit like a more science-y version of Penn and Teller’s Bullshit show.

    I think single experts in the “rubbish vs. science, you the viewer decide” can do something, but they have to be very well-drilled and media-savvy to get the wider message across, i.e. that they are there representing a vast body of evidence, while the other side is representing little–to-no evidence and a ton of Man-in-the-Pub (Man/Woman In-the-Healthfood-Store?) opinion-izing. Some talking heads are better at this than others. It also helps a lot to have a presenter who can at least tell, and better still care about, the difference between reality and nonsense,

    Claire – agreed on both counts. One of the most annoying things about doctors who sell out to the PharmaCos is that they undermine all the other doctors (and scientists) who are doing their best to be honest. It undermines confidence in the whole of science and medicine. I wish the PharmaCos would wise up to this too. If a drug is actually good, and fills a real unmet need, it largely sells itself as doctors will want to put their patients on it – the advertising, and data-tweaking, and cheating is all greatest for the drugs where the benefit is highly marginal. They should simply do it honestly, and if they make a bit less profit, que sera sera. But then I’m a hopeless idealist.

    Sadly, as long as there are sales to be had, and shareholders to be paid dividends, I doubt the PharmaCos can be rewired. But as a scientist it is the PharmaCos’ tame doctors and (less often) scientists that really depress me.

    Also agree that patient groups often tread a dangerous line. Some, like one or two of the ME groups, are basically a clearing house for Alt bonkers-ness and loathing of mainstream medicine. And don’t get me started on Electrosensitivity. But even the mainstream ones sometimes lose the plot. Few things have depressed me as much recently as the sight of the Alzheimer’s Society lined up alongside Pfizer and Eisai’s fairly transparent attempt to neuter NICE and sell not-much-good-at-all “cognitive enhancers”. I feel the Alzheimer’s Soc were used by the two PharmaCos, with their connivance, for commercial gain. If the people in charge at the Alzheimer’s Soc can’t see that then they have no business running the show, IMHO. For a good look at this one you can read a real consultant psychiatrist’s take on it here.

    jdc – of course I agree about the po-mo microfascism line. Scientific debates are not about who has the best rhetoric, or props, or jokes, or the most baying supporters in the audience. They are about whose ideas are nearer to the verifiable physical reality.

  7. imamedicalstudentgetmeoutofhere Says:

    One day I want to be an expert on something. It might have to be something really specific and useless though.

  8. draust Says:

    Well of course if you end up a consultant something-or-other, you will be an expert by most standards.

    On the “specific and useless” aspect, it’s one of the charms of science in particular that you can find people who are experts in the weirdest and most obscure things, like fossilized dinosaur poo. How cool is that?

    It also bears saying that you simply don’t know if a complete biomedical science “specific and useless” backwater will suddenly become important and super-fashionable.

    An example: I know a guy who spent his late 20s and most of his 30s working on amino acid uptake from the blood in various organs of the body. It was solid work, but was widely regarded in the trade as being pretty uninteresting. When I met him he had been doing this for at least a decade. He and his colleagues routinely had a tough time persuading the funding agencies it was interesting enough to be worth putting money into. I mean, who cared about arginine uptake?

    And then c. 1990 nitric oxide (NO) suddenly became the flavour of the year, central to vascular biology etc etc. The precursor for NO production is arginine So pretty much overnight arginine uptake from the blood into cells became scientifically ultra-hot, and the British Heart Foundation showered my buddy with grant money. He surfed the wave and is now a Professor of Vascular Physiology.

    His take from this is usually “Keep plugging away – every dog has his day.”

    Richard Feynman, as so often, had a good take on this. He wrote to one of his ex-students who was wondering why (the ex-student) was plodding along in research as an anonymous cog:

    “The worthwhile problems are the ones you can really solve or help solve, the ones you can really contribute something to… …No problem is too small or too trivial if we can really do something about it.”

  9. Claire Says:

    This definitely qualifies as Extreme Nitpicking, but, while I sympathise with the intention of the pilot/expert analogy, I don’t find that it actually relates completely successfully to healthcare and medicine. The experiences of being a passenger on a plane and receiving/seeking medical treatment are essentially different: the former is of necessity a passive experience (passengers cannot have any meaningful input into flying a plane), the latter often (not always e.g. emergency medicine) more consultative or collaborative in nature – I don’t think even the most ardent supporter of scientific medicine would endorse doctors, however expert, simply dictating to patients. Even very experienced doctors sometimes get things wrong; second opinions can legitimately be sought and sometimes questioning is appropriate. These days, patients are encouraged to think of themselves as ‘stakeholders’ in their own health/ medical treatment and, even, as ‘Expert Patients’. I don’t think even Michael O’Leary in cost-cutting overdrive would envisage ‘Expert Passengers’.

  10. Dr Aust Says:

    Fair comment, Claire. The pilot / medical expert analogy does work better as an analogy for some things in medicine than others, e.g. pilots and anaesthetists (or ICU docs) are a good analogy for various reasons, while psychiatrists and pilots would not be.

    I wasn’t so much meaning as in “you the patient / consumer can have no relevant input into the discussion” as “you the patient / consumer need to have an awareness of where your knowledge or understanding is insufficient to make an informed choice, or to tell which factors should weight the decision most, and know who to ask for help”. Or in the terms you put it, one needs to understand that being a “stakeholder” is not the same as being knowledgable.

    The danger of “empowering” people and telling them “YOU, the consumer, must choose” is that you run the significant danger of asking them to make decisions about things they simply don’t know or understand enough about to make really rational choices. I know this meets one definition of “respecting autonomy”, but in some ways it wouldn’t meet a definition of “fully informed consent”, as it may be largely uninformed. For instance, if people don’t understand statistics (and most don’t), they will either ignore them in reaching the decision, or simply fixate on the (mis) quoted stat that supports the view they already arrived at (see e.g. homebirth).

    And with the expert patients, I would suspect that part of their expertise is knowing precisely where their expertise ends…!

    There is an argument to be made, I think, that the Thatcherite and post-Thatcherite “we are all individual consumers of services for everything, with choice in all things” mantra actually hides a kind of disempowerment: people are overwhelmed with the imperative to make choices about loads of things they really don’t want a choice in. The result is that people give up and feel paradoxically powerless.

    Personally I think people could do with less choice, but to be focussing on making choices about the things that really matter, of which healthcare is one. But we still need “expert advisers” to help us make the decisions, particularly in guiding us to sufficient understanding to make the decision sensibly. And to repeat my central point, once we start buying into the idea that the experts are another brand of salesmen, where on earth do we go for informed advice?

  11. Claire Says:

    Thank you for this detailed, thoughtful answer (to my arguably over-finicky cavil!). Being aware that there are limits to one’s knowledge and that others have more expertise and knowledge which makes their judgements more authoritative – what a grown up idea! Choice, empowerment and autonomy can of course be good things, but without realism and modesty regarding the limits of one’s knowledge they have the potential to mislead.

    I regularly lose the will to live when listening to things like ‘Any Answers’ on Radio 4 – there are some callers with insight but depressingly many eager to broadcast their ignorance and prejudice. On the other hand, I have met a few people who could be regarded as genuine experts in their medical fields, and what I find striking is how ready they are to say that they don’t have all the answers; and how painstaking and careful they are when speaking about issues they justifiably feel they have a good handle on.

  12. Sharon Says:

    Great post!

    As I extended my formal education, one important lesson I received was just how much more there always is to know in even a small area of specialisation. I gained an appreciation for people who are experts.

    For medical matters, there has to be a collaboration between the patient and doctor in discussions, but the patient must understand that the doctor really does know more about medicine than the lay person, unless the doc becomes a quack that is. Doctors sometimes are wrong about certain individual conditions; e.g. I have heard of and read some examples of docs and others making outdated assumptions about autism. But not every doctor can be expected to know the latest research on everything! I’d still want a doctor telling me what to do if my child becomes ill or injured. My OH is a doc, and he will always take the advice of other consultants about areas outside his own speciality.

    I know how Claire feels about listening to radio phone ins, and that on Radio 4 is one of the less awful examples too! For some reason, local radio phone ins seems to bring out the really stupid, deluded, bigoted and smug.

  13. Woobegone Says:

    Excellent article! It strongly reminded me of this :

    http://www.sciam.com/article.cfm?id=scientists-know-better-than-you

    Do you know of Harry Collins?

    One point I’d make –

    “Who are the people most likely to know all the studies, all the background, all the factors influencing the trustworthiness or otherwise of individual studies, and all the hidden catches in comparing different patient groups and studies?

    Well, for me, it’s no contest – the answer is that I would put Professors of Obstetrics & Gynaecology (O&G), or experienced hospital O&G consultants, at the top of the expert scale for this particular issue, and Joe and Joanna Public at the bottom.”

    I suspect that Joe Public is actually better informed about a given topic than people who know lots of facts about it, but try to fit them into a certain agenda, that is to say many (but by no means all) “interest groups”. The public may know next to nothing about something, but this is better, in most respects, than being seriously misinformed about it. Simple ignorance is easily remedied with education but misplaced convictions are much more durable…

    Likewise, a member of the public knowing nothing about the background, assumptions and “tacit knowledge” common to epidemiologists and immunologists, might be *better* placed to evaluate the evidence about vaccine safety than someone who has read lots of papers but who has a deeply false set of assumptions (e.g. someone for whom all papers which disagree with them are a priori judged to be either fraud or flawed.) The average person would, I suspect, just take most published research at face value, which is wrong, but less wrong than rejecting it outright.

  14. draust Says:

    Thanks for the appreciative comments, guys. Always good to know there is an audience…! Been snowed under this week hence the late reply.

    Claire - I have given up listening to vox pop programmes of any kind as they just make me cross / despairing, or both. I love Radio 4, which is an oasis of grown-up rationality amid a media maelstrom of crap, but I turn off Any Answers when it comes on. As Sharon says, local radio phone-ins are particularly brain-numbing, but Radio 5 is barely any better, and the presenters on Radio 5 (particularly the insufferably self-satisfied Nicky Campbell) are practically as aggressively ignorant and opinionated as the people who phone in.

    You are right about real experts often being quite down-to-earth and modest people. One of the characteristics of the best doctors in particular is that they “wear a lot of knowledge lightly”, and don’t lord it over others who know less (whether patients or colleagues!) by copping a high-handed attitude. In fact, I reckon the ability to do this is one of the key identifiers for the really top-notch ones. This certainly holds true for many of the medics I have worked with in research.

    Woebegone - thanks for the link to the Harry Collins piece. I had never come across him before, but he talks a lot of sense, e.g. about “tacit knowledge”. It makes a change to come across any sociologist looking at science and scientists who does not start from a position of post-modernist relativism.

    The one point where I would disagree with Collins’ analysis is in his critique of people like Richard Dawkins, and equating what Dawkins does in speaking about religion to what (e.g.) the creationists do in speaking about science.

    Dawkins, and other scientists who run into trouble with creationists like P.Z. Myers, mostly tend to get into statements about religious questions via spending their time rebutting religion-inspired nonsense from the “other side”. This nonsense commonly purports to be “a contribution to scientific debate” but is actually religious ideology clothing itself spuriously in scientific camouflage, like Intelligent Design (ID). I might personally find Dawkins a bit shrill – I take a more Stephen Jay Gould-ian view of religion and religious belief myself – but I can see why, after years of having to listen to clergymen and the ID lot talk ill-informed rubbish about evolution, Dawkins was tempted to give a definitive counterblast and set down his views on religion in The God Delusion.

    Reading The God Delusion I was reminded of a teacher of mine way back in the 1st yr of secondary school. This teacher was both our maths teacher and our “form teacher” (who took the register). The school had a policy that the form teachers in yrs 1and 2 also had to cover the one weekly Religious Education (RE) class. My 2nd yr form teacher the following year (coincidentally also a maths teacher) was fairly clearly a devout Christian, but the 1st yr one, looking back, was less obviously but fairly certainly a thorough non-believer. The thing that comes back to me is him setting us the following RE homework exercise:

    “Suggest alternative non-supernatural explanations for the Twelve Plagues of Egypt”

  15. Claire Says:

    Despite (or maybe because of?) my antipathy to radio vox poppery, I did become addicted to R4’s ‘Down the Line’, hosted by former hospital radio DJ Gary Bellamy.

    Reviewed here: http://www.guardian.co.uk/media/2006/may/12/bbc.radio

    Though the fact that the BBC needed to make explicit that it was a spoof did make me concerned about our collective IQ!

  16. The “toxins in vaccines” crowd are still with us « Dr Aust’s Spleen Says:

    [...] including a couple of notoriously awful papers – read the post for more. The dangers of self-styled experts and cargo-cult science are, of course, topics familiar to readers [...]

  17. Carole Caplin Is Persuading Us of The Merits of Biocare’s Supplements? « Holford Watch: Patrick Holford, nutritionism and bad science Says:

    [...] of misinformed jackdaws was enlivened by Dr Aust’s intervention and his musings on the nature of expertise. We speculated as to what had prompted Carole Caplin’s extraordinarily [...]

  18. James Says:

    After reading http://draust.wordpress.com/2008/05/08/experts-hired-lackeys-moon-made-of-cream-cheese/, I thought this might be a useful resource for your site:

    http://www.biomedsearch.com

    The site is free, and perhaps the most comprehensive biomedical site on the web. It has all PubMed and MedLine documents, plus mililons more including full-text journal articles and a large database of theses and dissertations.

    And, you don’t have to register but if you do you can use portfolios to save documents, share documents (and comment on them) between users, and set up automatic alerts.

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