The Wrong Experts

We are, what, almost two years into the COVID-19 pandemic and it’s taken this long for anyone else to come around to the view that I’ve had since March 2020. In this case it’s Aaron E. Carroll and he expresses the situation pretty well in an op-ed at the New York Times:

Caring for an individual and protecting a population require different priorities, practices and ways of thinking. While it may sound counterintuitive, to heal the country and put our Covid-19 response on the right track, we need to think less like doctors.

I can speak to both ways of approaching health problems. As a physician, I was trained first and foremost to think of the individual in front of me. When seeing a patient, I take a long history, consider all relevant personal information and weigh the benefits and harms of any treatment decision I might take. As the chief health officer of Indiana University, I need to make population-wide decisions that take into account the needs of the university as a whole, not any one person.

Physicians tend to be conservative in their practice of medicine. We fear a bad outcome disproportionately and will do almost anything to prevent it. Although doctors often credit the threat of being sued for the practice of defensive medicine, extra tests and procedures are often ordered because making a mistake would be devastating, both to the patient and to our own understanding of ourselves as healers. This mentality also leads to the thinking that every test and treatment must be the best. Physicians cannot tolerate anything less, because we are who will be held to account if anything goes wrong.

But blown to the scale of a whole country, that kind of focus on individuals has often led us in the wrong direction during the pandemic. Much of my frustration at the response to Covid is that too many officials in senior positions at the Food and Drug Administration and the Centers for Disease Control and Prevention seem to be thinking this way — if something isn’t close to perfect or doesn’t maximize the safety of each individual person, it’s not worth it at all. Some of the greatest initial and continuing failures of public health policy have stemmed from this view.

He goes on to provide several specific examples. My own preferred example is the use of testing. Nearly all testing for COVID-19 has been diagnostic testing rather than epidemiological testing. Dr. Carroll’s explanation of that, presumably, is that there has been too much “thinking like doctors” and not nearly enough thinking like people responsible for the public health.

I think that one of the gravest problems of the modern day is that generalists are undervalued while specialists are becoming progressively increasingly specialized. Add to that the tendency to think of technocracy as “putting people like me in charge”, e.g. to a lawyer technocracy means putting lawyers in charge of everything, to a physician it means putting physicians in charge of everything, and to an economist it means putting economists (with the appropriate political views, natch) in charge, and you not only greatly reduce our ability to respond to challenges you set the stage for a major decline in confidence in experts.

And I haven’t even touched on the ethical issues involved. Another post, perhaps.

3 comments… add one
  • steve Link

    Its really the politicians who need to make the final decisions. We will always have specialists. You need to solicit opinions from them and figure out how to use that information but you never let the specialists make final decisions. The problems with public health issues is that many politicians dont understand health issues so they farm out all the decisions, especially if that is popular with their voters. Or, just as bad or worse, they dont understand or dont like them so they ignore them, especially if that is popular with their voters.

    Could we just let everyone decide for themselves. As long as their decisions dont affect anyone else I dont see why not for the most part. But when it does we are left with the people we elect to make decisions. Since the primary goal for most seems to be re-election we dont actually get much leadership.


  • I agree with that comment almost completely, steve.

  • Grey Shambler Link

    Not that Dr. Steve is wrong about the structure and political motivations of leadership, what I worry about is that people will think another type of structure would be preferable.
    How can you defend a Republic when the Chinese have done so well in stifling their pandemic?
    (For now).

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