Last week’s post asking historians to temporarily take a seat struck a chord with some readers. Toward the end, I mentioned that historians of science are, “by nature, skeptical of expertise.” This resonated with my fellow historians of science and medicine, but I suspect it may have caught some of the rest of you by surprise. Why would historians of science—of all people—distrust experts?
Speaking only for myself, I can say that I don’t have a problem with “experts” per se. I have a problem with “technocracy.” The distinction is meaningful and important, particularly in moments of crisis. The difference involves who gets to make decisions: the experts, or the people they advise. In a (functioning) representative democracy, elected representatives of the people seek advice on technical matters from experts before making decisions that will affect the populace. We give the decision-making responsibility to the elected officials, rather than the experts, because the elected officials are (in theory) accountable to their people. Experts, on the other hand, are accountable only to facts.
Given voting restrictions, gerrymandering, and the electoral college, the extent to which the United States actually operates (or has ever operated) as a democracy is an open question. And even if it were, the current administration is particularly uninterested in hearing the opinions of experts who disagree with them. Under these circumstances, calls to “put the experts in charge” seem natural, comforting, and wise. But that would still be a technocracy, and that would be bad.
Here are some things that (different kinds of) experts should be in charge of:
- Delivering health care
- Developing tests, drugs, and vaccines
- Disease surveillance/tracking the course of an epidemic
- Forecasting various types of risk associated with various types of responses
- Providing factual information to the public
Here are some things experts should not be in charge of on their own:
- Determining who counts as a “socially useful” person in case of care rationing
- Deciding how to pay for tests, drugs, and vaccines
- Implementing society-wide surveillance measures
- Selecting a society-wide response to an epidemic
- Deciding what information gets released to the public
See the difference? Experts are excellent sources of facts and recommendations, but they cannot and should not be “in charge” of deciding what to do with those facts and recommendations.
Here’s a concrete example. We know that demand for ventilators will outstrip supply. This is already happening in some locations, most famously, Italy, where doctors have made the gut-wrenching decision to withhold ventilators from older patients so they can be used on those more likely to survive. Late last week, various news outlets, including the New York Times and NPR, reported that hospitals across the United States are developing decision-making frameworks for the moment that a ventilator shortage inevitably arrives here.
Different experts are going to give different kinds of advice, depending on the problem you ask them to solve. Economists can tell you the most cost-effective way to treat an epidemic. Actuaries can provide you with life expectancy information for various demographics. Individual physicians can advise on a specific patient’s prognosis. Public health authorities can offer advice on optimal strategies to save the most people. And philosophers can opine about something called “social usefulness,” that takes into consideration whether saving a particular category of person (say, ICU nurses) offers more overall benefit to society than saving a different category of person (say, a landscaper).
It is not an exaggeration to say that which experts you put in charge determines who lives and who dies. Traditionally, hospitals in the United States turn to ethics committees when they encounter these (thankfully rare) types of decisions. An ethics committee generally includes a number of different kinds of technical experts as well as patient advocates, social workers, and religious authorities. Note no elected officials—a hospital is not a democracy—but also note no single category of experts. Note, as well, a seat at the table for those representing those most affected by the decisions (patients).
So, no. Let’s not “put the experts in charge” without specifying which experts, in charge of what, for how long. Instead, let’s say what I hope we all actually mean: Give the experts tools to do their job. Let their voices be heard. Respect their authority on the issues that they know about. Put them in places where they can have enough influence that we never have to make such terrible decisions again. Hold politicians who fail to heed their warnings accountable.
But let’s also commit to protecting the vulnerable even if that’s contrary to expert advice. Let’s commit to recognizing that all lives have value, regardless of their ability to generate profit or their “social usefulness.” If you hear someone suggesting that the deaths of hundreds of thousands or even millions of people with preexisting conditions or over age 50 might be a “reasonable sacrifice” for the economy, shut that shit down. This is not the expert advice or either an economist or an ethicist. This is the opinion of a human, writing to you as a human.
Be well.
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Recommended Reading: As a scholar of the Cold War, much of my thinking on the relationship between science, politics, and money was shaped by the science journalist Daniel Greenberg, who recently died at age 88. Here’s his obituary in the New York Times, and here’s another one in Science. This seems like a good time to revisit his work, especially his 1967 classic, The Politics of Pure Science.
Are You a Maker? Do You Sew? As you’ve surely heard by now, U.S. healthcare workers are facing COVID-19 without adequate personal protective equipment. If you have PPE to spare or have the skills to make some, you can get instructions and coordinate donations at #GetUsPPE.
Elsewhere on the internet: If you’re looking for some non-coronavirus reading, I reviewed Michael Gordin’s new Einstein in Bohemia for the Los Angeles Review of Books.