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Saturday, April 04, 2020

The cult of expertise

During the pandemic, public officials have consulted medical experts on social policy. Expert advice is often indispensable. There are, however, limitations on expert advice:

1. Epidemiologists seem to be the primary consultants. That's fine up to a point. But it can lead to tunnel vision. For instance, an ER physician has a legitimate viewpoint but his professional experience is hardly a representative sample of society in general. 

2. There may be lack of consensus among experience in the same field.

3. Medical science is highly specialized and interdisciplinary. There are many medical specialists in cognate disciples with relevant expertise.

4. Outside of medicine, there are experts on growth curves. They know how changing a variable here or there can drastically change the projection.

5. There are other areas of expertise directly germane to the crisis. Take economists.

Likewise, psychologists, sociologists, and historians. Economic collapse will lead to joblessness, homelessness, higher property crimes, substance abuse, clinical depression, suicide, and general social unrest. 

6. And it shouldn't be confined to the "experts". Small businessmen ought to have input on policies that adversely impact the local (state, national, and international) business community. 

7. Experts can be highly politicized. Indeed, an entire field can become highly politicized. 

2 comments:

  1. Good points!

    I'd add:

    1. Scientists (e.g. virologists). They know the virus.

    2. Pharmacists and pharmacologists. For drug development and the like.

    3. Public health officials (e.g. MPH).

    4. Epidemiologists can be drawn from a number of base disciplines. Physicians can be epidemiologists (e.g. John Ioannidis). Scientists can be epidemiologists (e.g. Mark Lipsitch). Mathematicians can be epidemiologists (e.g. Adam Kucharski). Public health officials can be epidemiologists (e.g. MPH with an emphasis in epidemiology). And so on and so forth. It's quite interdisciplinary in this respect. At least as far as I'm aware, they each have to be quite knowledgeable about statistics. And I presume they might bring a different perspective to how they model and forecast the epidemic in part depending on their base discipline. That has its advantages and disadvantages.

    5. Among physicians, perhaps the most directly relevant to the coronavirus would likely be infectious disease physicians for obvious reasons and critical care physicians (aka intensivists) since that's where the sickest patients end up. Of course many other physicians are essential too (e.g. hospitalists care for the hospitalized but who can stay on the floor or wards and don't need the ICU, radiologists to interpret imaging, some anesthesiologists and emergency physicians may have fellowships in critical care and can help out in the ICU).

    6. By the way, I did a post on experts last month. I cited three broad categories - i.e. physicians, epidemiologists, and scientists - but I didn't intend to be comprehensive. It's just the experts I follow (which may reveal my own biases!).

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  2. I think the speed of the pandemic caught most governments flat footed. We can cite poor planning, political infighting, budgetary constraints, etc., but it appears to me that the world has found itself engaged in a proverbial Chinese Fire Drill, pun intended.

    Maybe it's unreasonable to have expected any government or society to have been prepared *for this specific event*, but surely it's inexcusable that there wasn't even a play book apparently.

    A degree of readiness, basic risk management and contingency planning are fundamental responsibilities of those in leadership. This extends all the way down to the family level, it's not a novel concept.

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