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Tom Nichols’ new book The Death of Expertise: The Campaign against Established Knowledge and Why It Matters has direct relevance to many of the issues we are constantly grappling with on Science-Based Medicine. In a democracy, everyone has equal rights. Many people think that means they are equal to experts in knowledge and judgment. In medicine, as in most other areas of public discourse, we are faced with angry laymen who denounce intellectual achievement and scientific knowledge and who distrust experts.

People find ways to reject the evidence when it conflicts with their values and beliefs. When scientific evidence challenges their views, they doubt the science rather than themselves. New examples of this phenomenon can be found every day in the news and in the comments sections of the Science-Based Medicine blog, and trying to set those people straight has proven a mostly futile exercise.

The failure of higher education

Students have become consumers. High school seniors tour college campuses with their parents looking for the one with the best dorms, cafeteria food, and extra-curricular activities, rather than the one that will challenge them and provide the best education. Nichols says colleges are not only failing to provide to their students the basic knowledge and skills that form expertise, they are failing to provide the ability to recognize expertise and to engage productively with experts and other professionals in daily life. They are not being taught “critical thinking: the ability to examine new information and competing ideas dispassionately, logically, and without emotional or personal preconceptions.”

He says students are being treated as clients rather than students. “Many colleges have become hostages to students who demand that their feelings override every other consideration.” Students “explode over imagined slights” and “build about themselves fortresses that no future teacher, expert, or intellectual will ever be able to breach.” They want to be protected from ideas or language they find unpleasant. They are “demanding to run the school while at the same time insisting that they be treated as children.”

The internet

The Internet has provided people with an unprecedented abundance of information, but all too often it gives them the illusion of knowledge, encouraging them to believe they know as much as experts. They hear what they want to hear, and live in a bubble community of people with similar beliefs.

People do not come to the Internet so that their bad information can be corrected or their cherished theories disproven. Rather, they ask the electronic oracle to confirm them in their ignorance.

Nichols says,

…not only is the Internet making many of us dumber, it’s making us meaner: alone behind their keyboards, people argue rather than discuss, and insult rather than listen.

People “power browse” rather than actually reading. We see this all the time on Science-Based Medicine, where commenters criticize an article they obviously have not read carefully or understood. Sometimes I suspect they may just have read the title and seized the opportunity to jump on their particular soap box.

Journalism

The dissemination of “fake news” is an ever more common reality. Most people are very poor at evaluating the reliability of a news source and the truth of what is reported. When a layperson challenges an expert by saying “I read it in the paper” or “I saw it on the news,” it may mean only “I saw something from a source I happen to like and it told me something I wanted to hear.” At that point, discussion has nowhere to go; the real issue is replaced by the effort to untangle which piece of misinformation is driving the conversation. People are constantly barraged with facts and knowledge, but they have become more resistant to facts and knowledge. How did we arrive at this state of affairs? Nichols says, “technology collided with capitalism and gave people what they wanted, even when it wasn’t good for them.”

When the experts are wrong

In our increasingly complex world, we can’t possibly know everything; we have no choice but to trust experts. But sometimes experts get things wrong. Most of the time, their errors are identified and counteracted by other experts. This works so well most of the time that we are shocked when we read about an exception; for instance, when we learn that an incompetent doctor has killed a patient or that a researcher has falsified data. Laymen get exasperated when science “changes its mind,” for instance telling the public eggs are bad for them and then saying no, they’re OK to eat. But that’s not a failure of science, but rather an example of how science works so well in the long run by following the evidence and discarding false provisional conclusions as the evidence improves.

When experts’ errors, fraud, and misconduct are revealed, a layperson naturally asks how we can trust studies in any field. Nichols says that’s the wrong question to ask, because “rarely does a single study make or break a subject.” Single studies are often wrong, but the aggregate of all research is trustworthy. The scientific enterprise as a whole is self-correcting and leads to a consensus of experts that approaches the truth as much as is humanly possible.

The impact on government

Science is essential to rational public policy; it can’t make the decisions, but it provides reality-based information that can guide the decision-makers. Nichols says we have a President who sneers at experts and whose election was “one of the loudest trumpets announcing the impending death of expertise.” He argues that Trump’s campaign was “a one-man campaign against established knowledge.” He provides examples: Trump’s “birther” campaign against Obama, his quoting the National Enquirer approvingly as a source of news. Nichols says rather than being ashamed of his lack of knowledge, Trump exulted in it. “Worse, voters not only didn’t care that Trump is ignorant or wrong, they likely were unable to recognize his ignorance or errors.” He says the Dunning-Kruger effect was at work. It’s not just the things we don’t know (one in five adults think the sun revolves around the Earth), but the smug conviction that we don’t need to know such things in the first place.

He warns,

The relationship between experts and citizens, like almost all relationships in a democracy, is built on trust. When that trust collapses, experts and laypeople become warring factions. And when that happens, democracy itself can enter a death spiral that presents an immediate danger of decay either into rule by the mob or toward elitist technocracy. Both are authoritarian outcomes, and both threaten the United States today.

Conclusion: Hope for the future?

He says Americans no longer understand that democracy only means political equality. They tend to think democracy is a state of actual equality in which everyone’s opinion is as good as everyone else’s, on every subject. Feelings are more important than facts: if people think vaccines are harmful, it is considered “undemocratic” and “elitist” to contradict them.

He sees signs of hope. Experts are rebelling. He cites an angry doctor who asked patients, “Do you remember when you got polio? No, you don’t, because your parents got you [expletive] vaccinated.” He points out that without democracy and secular tolerance, nations have fallen prey to ideological, religious and populist attacks and have suffered terrible fates. But he ends on a hopeful note. He has faith in the American system and hopes that it will eventually establish new ground rules for productive engagement between the educated elite and the society they serve. I hope so too!

Posted by Harriet Hall

Harriet Hall, MD also known as The SkepDoc, is a retired family physician who writes about pseudoscience and questionable medical practices. She received her BA and MD from the University of Washington, did her internship in the Air Force (the second female ever to do so),  and was the first female graduate of the Air Force family practice residency at Eglin Air Force Base. During a long career as an Air Force physician, she held various positions from flight surgeon to DBMS (Director of Base Medical Services) and did everything from delivering babies to taking the controls of a B-52. She retired with the rank of Colonel.  In 2008 she published her memoirs, Women Aren’t Supposed to Fly.