Power, Expertise and Truth

A group of deep thinkers has a piece in BMJ about how to combat the anti-vaccination movement. For reasons that have never been entirely clear to me, anti-vax propaganda has been around since the invention of vaccination by Jenner. But these folks have a sociological premise that new communication technology and social media have undermined traditional expertise, which they discuss in the language of "power."

Old power works like a currency. It is held by few. Once gained, it is jealously guarded, and powerful people have a substantial store of it to spend. It is closed, inaccessible, and leader driven. It downloads, and it captures.

New power operates differently, like a current. It is made by many. It is open, participatory, and peer driven. It uploads, and it distributes. Like water or electricity, it’s most forceful when it surges. New power is exploited not by hoarding but by channelling.

Voices like that of [anti-vaxxer Shanelle] Cartwright have impact because they have worked out how to use new power effectively and at speed. While opposition to vaccination has existed for as long as vaccination itself, what we now see is an unprecedented ability to organise power around that counter narrative. Its most influential figures have none of the expertise or professionalism of the old power world but they have all the efficiency of spreading their message in a new power way.

The challenge for many health professionals is that they have grown up—and shaped their careers—inside a system that takes the opposite approach to that of Cartwright and her allies. In the health and care world, power is still closely held. You are what you can hoard up. Expertise is downloaded from on high. The enduring stereotype of the doctor with his or her illegible prescriptions, insulated by arcane language, knowing what’s best for his or her patients, touches on a truth: most of the institutions in health and care were built on old power models and mindsets.

I think this is both insightful and misleading. It is true that the dominant model of medicine in the past was paternalistic -- actually patriarchal since almost all physicians were men. Doctor knows best, and the patient's responsibility was to accept that and follow doctor's orders. Nowadays we're supposed to do things differently. Physicians have expertise, but that doesn't mean they know what's best for a particular patient. There are tradeoffs among the costs, benefits, and risks of medical intervention and we now expect physicians to explain these to patients and come to a shared decision. This doesn't necessarily happen most of the time, but it's the ideologically preferred mode.

The problem with using the language of power in the way these writers do is that, while Cartwright and her followers indeed feel empowered by their rebellion against expertise, they aren't really. That's because they are just plain wrong and they're putting their children and others at risk. The thing about the "old power" of expertise is that it's power lies in being right about the facts, at least more often than people without expertise. (Yes, scientific beliefs do get overturned, but that doesn't mean you should reject them all.)

This very disturbing CNN story reports on the metastasizing flat earth movement. Yes, it's true. Apparently 1/6 of U.S. adults aren't sure the earth is (approximately) spherical. There are flat earth conferences happening all over the planet, and hundreds of thousands of followers of flat earther social media. But why do people believe something so preposterous?

"People, in essence, are just trying to understand the world," says Daniel Jolley, a senior lecturer in the psychology of conspiracy theories at the UK's Northumbria University. "And they're looking at the world in a gaze where they're biased in their thinking."

"They may have distrust towards powerful people or groups, which could be the government or NASA, and when they look towards evidence that makes sense to them ... this world view (is) endorsed," he says. "It's difficult to break out of that mindset."

Scientists have also noted that a social motive draws people to conspiracy theories -- the desire to "maintain a positive view of the self and the groups we belong to," as social psychologist Karen Douglas of the University of Kent says.

 Well I don't trust the government right now either but I don't have to in this case. Believing that the earth is flat isn't going to liberate me from oppression. Maybe I would take comfort in thinking that I'm smarter than Einstein after all but I don't think that's what this is about. You should make up your mind about questions that entail value and aesthetic issues yourself, but you should do so based on accurate factual knowledge. And for that, you need to trust your own expertise when you happen to have it, and that of other real experts when you don't. That's empowering.