Monday, March 28, 2005
The Tyranny of Expertise
I make my living being an expert in the field of environmental compliance for manufacturers in California. What makes me an expert? Years of experience, education, and the fact that a lot of people think I am -- that's it. Frankly, the fact that people think I am matters more than the other two criteria put together. That fact is true for expertise in almost any field.
Many people, including people I respect greatly and with whom I normally agree, are saying that last week's great debate (I refuse to name it out of respect for the still living) was overwrought. Those that do generally start with the assumption that the 'experts,' in that case doctors, are correct in their diagnosis of a "persisitent vegetative state."
This belies a gross misunderstanding of what consitutes a medical diagnosis. Most diagnoses are simply a label placed on a specific set of subjectively determined symptoms. In some cases there is a hard understanding of what is going on, like in the case of smallpox or polio. However, in most cases the symptomology is simply described, taxonimized, published, and bingo -- you have a diagnosis. Medical experts are just people that, 1) read the publications so they know what label goes with what set of symptoms and, 2) have some experience at properly detecting the often very subjective symptoms. In many individual cases the detection of symptoms is based almost entirely on the description of the patient. The words you use in describing how you feel to your doctor can make a difference in whether he thinks you have a cold, or have gone all the way over into the flu.
Do you see how incredibly subjective this is? Do you see how subject such a thing could be to one's religious devotions, moral convictions and political affiliations? That can never be more true than a diagnosis like "the lights are on, but no one is home," in other words "persistent vegetative state." The inherent subjectivity lies in the "no one home part."
Lord Kelvin said:
Oh, there are lots of attempts to do that, but they too are subjective. Take one criteria that might be used to quanitfy "someone home" -- response to pain. When a painful stimulus is presented, on a scale of 1 to 10, how does the patient respond? One man's 5 will be another man's 6. Try it amongst yourselves on something more simple.
Men -- on a scale of 1 to 10, rate Jennifer Aniston. Ladies do the same with Brad Pitt. What, you don't all agree? So who is right? Why the expert, of course! So who is the expert? The person with the most partners? (ewwww!) The one that makes his point the loudest? The plastic surgeon? Oh you think, that might work. Why?
Suppose the plastic surgeon was Rubens? He liked his women chunky style. Based on his paintings, he'd give Jennifer Aniston something below a 5. Not many guys around today would agree with that.
You beginning to get the point here? Expertise can be illusory, and it is often highly subjective.
So, in the end, I do not put much credence in what the medical 'experts' had to say. They know more medicine than I do, but I have the sneaking suspicion that the defintion of "persistent vegetative state" is fairly flexible and is, when the hype of expertise is stripped away, someone they think it is OK to let die.
I have broken a promise in writing this today, I think it is really disrespectful to put arguements like these in front of an actual person dying, something I do not want to do. But when I hear what I have been hearing from the more moderate on my side of the political spectrum, I just have to respond.
I don't think it is OK for the person in question to be allowed to die. They have to convince me, not just tell me, to get me to agree with them.
Update: Seems theJesusfreak starting asking the same questions I did and got some interesting answers.
Many people, including people I respect greatly and with whom I normally agree, are saying that last week's great debate (I refuse to name it out of respect for the still living) was overwrought. Those that do generally start with the assumption that the 'experts,' in that case doctors, are correct in their diagnosis of a "persisitent vegetative state."
This belies a gross misunderstanding of what consitutes a medical diagnosis. Most diagnoses are simply a label placed on a specific set of subjectively determined symptoms. In some cases there is a hard understanding of what is going on, like in the case of smallpox or polio. However, in most cases the symptomology is simply described, taxonimized, published, and bingo -- you have a diagnosis. Medical experts are just people that, 1) read the publications so they know what label goes with what set of symptoms and, 2) have some experience at properly detecting the often very subjective symptoms. In many individual cases the detection of symptoms is based almost entirely on the description of the patient. The words you use in describing how you feel to your doctor can make a difference in whether he thinks you have a cold, or have gone all the way over into the flu.
Do you see how incredibly subjective this is? Do you see how subject such a thing could be to one's religious devotions, moral convictions and political affiliations? That can never be more true than a diagnosis like "the lights are on, but no one is home," in other words "persistent vegetative state." The inherent subjectivity lies in the "no one home part."
Lord Kelvin said:
"When you can measure what you are speaking about, and express it in numbers, you know something about it.How the &*^% do we quantify "someone home?"
But when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meager and unsatisfactory kind."
Oh, there are lots of attempts to do that, but they too are subjective. Take one criteria that might be used to quanitfy "someone home" -- response to pain. When a painful stimulus is presented, on a scale of 1 to 10, how does the patient respond? One man's 5 will be another man's 6. Try it amongst yourselves on something more simple.
Men -- on a scale of 1 to 10, rate Jennifer Aniston. Ladies do the same with Brad Pitt. What, you don't all agree? So who is right? Why the expert, of course! So who is the expert? The person with the most partners? (ewwww!) The one that makes his point the loudest? The plastic surgeon? Oh you think, that might work. Why?
Suppose the plastic surgeon was Rubens? He liked his women chunky style. Based on his paintings, he'd give Jennifer Aniston something below a 5. Not many guys around today would agree with that.
You beginning to get the point here? Expertise can be illusory, and it is often highly subjective.
So, in the end, I do not put much credence in what the medical 'experts' had to say. They know more medicine than I do, but I have the sneaking suspicion that the defintion of "persistent vegetative state" is fairly flexible and is, when the hype of expertise is stripped away, someone they think it is OK to let die.
I have broken a promise in writing this today, I think it is really disrespectful to put arguements like these in front of an actual person dying, something I do not want to do. But when I hear what I have been hearing from the more moderate on my side of the political spectrum, I just have to respond.
I don't think it is OK for the person in question to be allowed to die. They have to convince me, not just tell me, to get me to agree with them.
Update: Seems theJesusfreak starting asking the same questions I did and got some interesting answers.
