The Death of the Medical Expert?
Other medical specialties and specialists have also been targeted. For example, one blog devoted to Lyme disease categorizes some infectious disease specialists as "Lyme literate" and others as callous deniers of chronic Lyme disease. And in the realm of rheumatology, the condition known variously as chronic fatigue syndrome (CFS), fibromyalgia, or myalgic encephalomyelitis ME) has been the focus of intense controversy. For example, the ME/CFS Worldwide Patient Alliance argues that "...many physicians in the U.S. [and] abroad don't know how to treat patients with CFS" -- the presumption being that other doctors do know how to treat this condition. (In fairness, this Website also quotes a number of physician "experts" on the need for better research on ME/CFS).
My aim here is not to dissect the particular theories and arguments of these nonphysician advocates but, rather, to call attention to the changing public perception of medical expertise. Of course, it has been obvious for some time that the days of Marcus Welby and Ben Casey are long gone -- and there are some positive aspects of this cultural transformation. When I was growing up in the late 1950s, the physician was 1 or 2 notches down from the Deity. Even my famously skeptical and opinionated mother would usually defer to our family doctor's expert opinion, even though it meant exposing her beloved children to those "new-fangled" antibiotics. Medical care was often paternalistic, if not patronizing; and patients were, if anything, too trusting and "compliant" in the face of the doctor's ex cathedra pronouncements. (Some physicians of a certain age might recall these as "the good old days.")
Perhaps it was only a matter of time before the field of medicine succumbed to cultural trends that spread from Europe to the United States in the 1960s, usually grouped under the rubric of "postmodernism." Though the term resists any simple definition, postmodernism, at its roots, was a movement directed against "expertise." More specifically, postmodernism held that there are no objectively demonstrable truths; rather, there are only various perspectives or "narratives" that cannot be privileged as uniquely or objectively true.
Recently, psychiatrist Dr. Robin Weiss argued that science itself has been targeted by a kind of postmodern nihilism. As Weiss put it, there is a "disturbing trend" in which:
Politicians unashamedly issue proclamations tantamount to declaring, The world is flat. Climate change is a hoax. Vaccines cause autism. Intelligent design should be taught in biology class alongside evolution. The United States has the best health outcomes in the world.... If politicians no longer agree that sound scientific knowledge is valid, our nation's health will suffer..."
I believe these postmodern trends have helped undermine the traditional authority and expertise of the physician, as have more recent allegations of medicine's collusion with "Big Pharma" -- a charge that has hit particularly hard at psychiatry. (When I cited published studies to rebut the sociologist who claimed, "...it may be best to avoid drugs in the treatment of depression," his immediate retort was to ask which of these studies were sponsored by a drug company.) But, in my view, these factors alone don't account for the "everybody is an expert" phenomenon that we have seen in the past 15-20 years. And here, credit -- or, as I see it, blame -- must fall at least in part on the Internet.
It is simply a fact that nearly anybody can set up a very professional-looking blog with a custom domain or have their writings appear on an existing "blog spot." In many cases, these blogs have acquired credibility and cachet far beyond the professional training and expertise of the blogger -- particularly in the case of medically related blog sites. For example, in one study of Internet Websites providing information on infant sleep safety, pediatric researchers found that individuals' blogs and Websites had very low rates of medical accuracy (25.7% and 30.3%, respectively). This has certainly been my experience in dealing with many individual blogs claiming to provide accurate psychiatric information.
The democratization of knowledge, epitomized in the ease of obtaining information on the Internet, certainly has its virtues. The public has access to a wider range of views and positions than ever before, and the opportunities for interchange and feedback are unparalleled in our cultural history. But the dark side of this "brave new world" is the postmodern view that there are no truths -- or worse yet, that anyone who claims to possess the truth is as much an expert as anyone else. In the medical realm, this may lead to disastrous health outcomes. Or, as the Taoist classic, the Tao Te Ching, dryly puts it: "Not to know, yet to think that one knows, will lead to difficulty."
Suggested Reading
Ghaemi SN. What do we want our diagnoses to do? Why our current psychiatric diagnoses are postmodernistically arbitrary. Psychology Today, December 20, 2010. http://www.psychologytoday.com/blog/mood-swings/201012/what-do-we-want-our-diagnoses-do Accessed August 5, 2013.
Pies R, Thommi S, Ghaemi N. Getting it from both sides: foundational and anti-foundational critiques of psychiatry. AAPP Bulletin. 2011;18. http://alien.dowling.edu/~cperring/aapp/BulletinVol18No2.pdf‎ Accessed August 5, 2013.
And It's Not Just Psychiatry
Other medical specialties and specialists have also been targeted. For example, one blog devoted to Lyme disease categorizes some infectious disease specialists as "Lyme literate" and others as callous deniers of chronic Lyme disease. And in the realm of rheumatology, the condition known variously as chronic fatigue syndrome (CFS), fibromyalgia, or myalgic encephalomyelitis ME) has been the focus of intense controversy. For example, the ME/CFS Worldwide Patient Alliance argues that "...many physicians in the U.S. [and] abroad don't know how to treat patients with CFS" -- the presumption being that other doctors do know how to treat this condition. (In fairness, this Website also quotes a number of physician "experts" on the need for better research on ME/CFS).
My aim here is not to dissect the particular theories and arguments of these nonphysician advocates but, rather, to call attention to the changing public perception of medical expertise. Of course, it has been obvious for some time that the days of Marcus Welby and Ben Casey are long gone -- and there are some positive aspects of this cultural transformation. When I was growing up in the late 1950s, the physician was 1 or 2 notches down from the Deity. Even my famously skeptical and opinionated mother would usually defer to our family doctor's expert opinion, even though it meant exposing her beloved children to those "new-fangled" antibiotics. Medical care was often paternalistic, if not patronizing; and patients were, if anything, too trusting and "compliant" in the face of the doctor's ex cathedra pronouncements. (Some physicians of a certain age might recall these as "the good old days.")
Perhaps it was only a matter of time before the field of medicine succumbed to cultural trends that spread from Europe to the United States in the 1960s, usually grouped under the rubric of "postmodernism." Though the term resists any simple definition, postmodernism, at its roots, was a movement directed against "expertise." More specifically, postmodernism held that there are no objectively demonstrable truths; rather, there are only various perspectives or "narratives" that cannot be privileged as uniquely or objectively true.
Recently, psychiatrist Dr. Robin Weiss argued that science itself has been targeted by a kind of postmodern nihilism. As Weiss put it, there is a "disturbing trend" in which:
Politicians unashamedly issue proclamations tantamount to declaring, The world is flat. Climate change is a hoax. Vaccines cause autism. Intelligent design should be taught in biology class alongside evolution. The United States has the best health outcomes in the world.... If politicians no longer agree that sound scientific knowledge is valid, our nation's health will suffer..."
I believe these postmodern trends have helped undermine the traditional authority and expertise of the physician, as have more recent allegations of medicine's collusion with "Big Pharma" -- a charge that has hit particularly hard at psychiatry. (When I cited published studies to rebut the sociologist who claimed, "...it may be best to avoid drugs in the treatment of depression," his immediate retort was to ask which of these studies were sponsored by a drug company.) But, in my view, these factors alone don't account for the "everybody is an expert" phenomenon that we have seen in the past 15-20 years. And here, credit -- or, as I see it, blame -- must fall at least in part on the Internet.
It is simply a fact that nearly anybody can set up a very professional-looking blog with a custom domain or have their writings appear on an existing "blog spot." In many cases, these blogs have acquired credibility and cachet far beyond the professional training and expertise of the blogger -- particularly in the case of medically related blog sites. For example, in one study of Internet Websites providing information on infant sleep safety, pediatric researchers found that individuals' blogs and Websites had very low rates of medical accuracy (25.7% and 30.3%, respectively). This has certainly been my experience in dealing with many individual blogs claiming to provide accurate psychiatric information.
The democratization of knowledge, epitomized in the ease of obtaining information on the Internet, certainly has its virtues. The public has access to a wider range of views and positions than ever before, and the opportunities for interchange and feedback are unparalleled in our cultural history. But the dark side of this "brave new world" is the postmodern view that there are no truths -- or worse yet, that anyone who claims to possess the truth is as much an expert as anyone else. In the medical realm, this may lead to disastrous health outcomes. Or, as the Taoist classic, the Tao Te Ching, dryly puts it: "Not to know, yet to think that one knows, will lead to difficulty."
Suggested Reading
Ghaemi SN. What do we want our diagnoses to do? Why our current psychiatric diagnoses are postmodernistically arbitrary. Psychology Today, December 20, 2010. http://www.psychologytoday.com/blog/mood-swings/201012/what-do-we-want-our-diagnoses-do Accessed August 5, 2013.
Pies R, Thommi S, Ghaemi N. Getting it from both sides: foundational and anti-foundational critiques of psychiatry. AAPP Bulletin. 2011;18. http://alien.dowling.edu/~cperring/aapp/BulletinVol18No2.pdf‎ Accessed August 5, 2013.