In an Age of Anti-Intellectualism, What is the Value of Expertise?

Photo ID 25835385 © Travelling-light| Dreamstime.com Abstract The nature of the scientific enterprise is sometimes misunderstood by large sections of the public. Failure to understand how progress occurs within scientific disciplines can lead to nonadherence with expert recommendations, with devastating consequences. Why does the public put enough stock in scientific research and medical science to comply with certain research findings but are skeptical of others? Through careful attention to history, current socio-cultural contexts, scientific data, and knowledge development within professions, we argue in favor of greater public deference to expertise. Though we rely on a variety of examples rooted in medical science, our focus is on general conceptions of expertise and what might be learned from reflection on its proper role. We situate our analysis within the context of current discussions in philosophy, bioethics, and public policy around the idea of ‘wicked problems’. Introduction Expertise, broadly speaking, has come under serious attack in recent years.  The current presidential administration is engaged in large-scale dismantling of the scientific and public health infrastructure at a variety of federal agencies. This is happening concurrently with ongoing attacks on academic institutions. This should concern not just members of the scientific and academic community but also the public at large. Unfortunately, the nature of the scientific enterprise is sometimes misunderstood by large sections of the public.[1]  Although trust in science remains high among Americans, the level of trust contrasts sharply depending on one’s political affiliation.[2] There has been growing hostility toward science itself.[3] This can have devastating consequences when a failure to understand how progress occurs within scientific disciplines leads to ignorance of and even nonadherence to expert recommendations. How ought members of the public be persuaded to put enough stock in scientific research and medical science to listen to and comply with sound research findings but remain appropriately questioning of expert advice? For instance, recent polling data suggests that a majority of US adults are concerned that agencies such as the CDC will make decisions that are influenced by politics.[4] Through careful attention to history, current socio-cultural contexts, the role of expertise, and knowledge development within the scientific professions, we argue in favor of greater, albeit prudent, deference to expertise. Our hope is that lessons will be learned for better responses to future public health crises and other collective action problems that require public support to properly address them. We are careful to focus our efforts on the value of expertise, which is hard-won and takes years to cultivate. We situate our analysis within the context of current discussions of pandemics as ‘wicked problems,’[5] responding to potential critiques rooted in concerns about epistemic justice,[6] and suggest bioethics as a working model for addressing these concerns and bioethicists as potential leaders in future public policy discussions. The Authority of Experts The authority of experts has increasingly attracted the attention of ethicists. For instance, some ethicists have argued that we should be wary of the authority of experts because experts are human beings that may have conflicts of interest, speak outside their area of expertise (“epistemic trespassing”), or offer advice that is not useful.[7] Managing deference to the authority of experts has long been a challenge in the United States. The authority of experts has waxed and waned throughout the history of the United States. For instance, the authority of experts was under assault during the era of Jacksonian democracy in the early 19th century.[8] Licensure of professionals was repealed. Many irregular physicians practiced medicine. The prevailing ideology held that each individual could and should decide how to manage their own health. This was the state of affairs for much of the 19th century. But, with the rise of laboratory science and the demonstrable efficacy of the germ theory of disease, the authority of physicians grew. As chronicled in the classic book The Social Transformation of American Medicine, physicians enjoyed an unparalleled run of cultural and moral authority throughout much of the 20th century.[9] Today, health care professionals such as physicians and nurses typically hold the top rung in Gallup surveys of public trust (although they suffered a downturn as a result of COVID).[10] Public health experts have always struggled for the same level of cultural authority. Despite the successes of public health in the 20th century, medicine garnered the lion’s share of resources. Respect for those treating individual patients surpassed respect for public health officials, who offered prevention strategies and focused on infectious disease avoidance, vaccination, and food safety. It also surpassed those engaged in the practice of medicine in clinics and publicly funded venues serving individuals who were stigmatized – the poor, minorities, individuals with disabilities, individuals with mental illness or addiction, or immigrants. Public health journalist Laurie Garrett highlights the difference in a rather stark way by comparing the public health school at Harvard with the medical school building: “The medical school is all marble, with these grand columns….The school of public health is this funky building, the ugliest possible architecture, with the ceilings falling in….That’s America.”[11] During the COVID-19 pandemic, for example, the authority of public health and scientific experts came under withering attacks. President Trump dismissed the authority of scientific experts when the pandemic first started. Trust in expertise was further eroded by right-wing media personalities attacking figures such as Anthony Fauci. Ideally, public health and medicine should acknowledge mistakes and be transparent to the public. Robert F. Kennedy, Jr, the current head of the Department of Health and Human Services (HHS), has continued the administration’s undermining of science and expertise by promoting falsehoods about autism, vaccines, chemtrails and fluoride. Trust as precious social capital is diminished when officials in positions of power promote mistruths. It is this social capital of trust that is essential in preserving the authority of credible experts. Since no one is an expert in everything, we must have some level of trust in the expertise of certain individuals. But who merits our trust? With the vast amount of information available, it is increasingly difficult to determine who is trustworthy and who is not. We have witnessed a stratification of trust toward individuals and institutions based on income and education. For instance, more highly educated individuals tend to trust academic experts. And this trust goes beyond individual trust to institutional trust. The CDC has enjoyed a good deal of trust throughout its history. Yet even this agency has seen its trustworthiness diminish with its recommendations during COVID of school closings, mandatory vaccination, isolating, and masking. Institutional trustworthiness is historically more precarious than the trustworthiness of individuals, but both have been undermined in recent years. Historically, professional experts have grossly abused their authority. We have witnessed this with unethical experiments in Nazi Germany and human rights abuses in the US, including Tuskegee, Willowbrook, the Iowa ‘monster’ stuttering studies, Havasupai Tribe gene studies, and the Stanford prison experiments, among many others. Ordinary people rightly question the authority of experts when such a legacy of abuse exists. The COVID pandemic highlighted a great deal of disagreement among a variety of experts. Dr. Vinay Prasad, now in high office at the FDA, emerged as a staunch critic of mainstream public health measures, such as vaccine and mask mandates.[12] So did those who authored the Great Barrington Declaration.[13] Mark Battersby stated, “Disagreement among experts renders appeals to authority fallacious. But many of the interesting cases one deals with will involve conflict among experts.”[14] The pandemic reflected not only disagreement but the very undermining of the notion of expertise. Others have highlighted the role of anti-intellectualism in American life. Anti-intellectualism reflects a suspicion of experts and the expert class. The scholar and public intellectual Tom Nichols chronicled this phenomenon in his 2017 book The Death of Expertise.[15] It also harbors a suspicion toward ‘the academy,’ or institutions of higher education. (Nichols provides a stinging critique of the academy and its dereliction of promoting logical discourse and reason.) This kind of suspicion and mistrust has persisted throughout US history and has seen a resurgence in recent years with the election and re-election of Trump. Such attitudes support populist or even conspiratorial explanations for complex phenomena, such as the COVID-19 pandemic, chemtrails, and climate change. As Merkley and Loewen state: “People who are highly distrusting of experts are not simply willing to put aside their distrust of these sources to resolve the crisis and return to normalcy. Relaying information from experts is unlikely to be of use in persuading these individuals, even in times of crisis. Other communication strategies are needed.”[16] For many individuals who are distrustful of public health advice, their experience with COVID-19 may have only reinforced that distrust. Asymptomatic people or those with very mild symptoms led to the spread of the virus to vulnerable members of society who were more likely to experience severe COVID-19 complications. Thus, the failure to heed public health advice placed a significant burden on the US healthcare system,