From Twilight of the Elites (Christopher Hayes, 2012) p104-7
…
She’d be so loaded up with questions that I thought the doctors must hate her. To my eyes at the time, she seemed like a real pain in the ass. “Mom!” I wanted to say, “they’re the experts.”
But that’s precisely why the relationship between doctor and patient is so loaded. We confer significant amounts of money and status on doctors in exchange for access to their expensive and specialized knowledge. But doctors are also human: They make mistakes, they vary greatly in skill and acuity, and they can be disastrously wrong. A recent study of Medicare patients suggested that nationally about 180,000 people a year experienced an event during hospital stays, such as the improper administration of medication, that contributed to their deaths. That’s sixteen times as many as are killed by drunk drivers.
So patients have to negotiate between two extreme poles. At the one end there is simple and absolute acceptance of doctors’ pronouncements. History is littered with one horrifying story after another of where this can lead. In 1935, during the peak of the polio epidemic, a Philadelphia pathologist named John Kolmer tested a live-virus vaccine on ten thousand children, assuring their parents it was riskless. Ten children would later develop paralytic polio from the vaccine; five died. As recently as December 2004, Tenet Healthcare paid $395 million to settle litigation with 769 patients who had accused Redding Medical Center of performing unnecessary heart surgeries which led to paralysis, strokes, heart attacks, and at least ninety-four instances of wrongful death.
On the opposite pole, there is the total rejection of medical authority. This is a strain that runs through American history, connecting the spiritual visionary Mary Baker Eddy to the booming business of quackish fad diets, dietary supplements, and snake oils of various kinds. The Crisis of Authority has produced a particularly virulent strain of this kind of rejectionism, as millions of parents refuse to have their children vaccinated because they believe — against the evidence and a broad and durable medical consensus – that vaccines cause autism and other conditions.
Medical authority may have a specific and acute effect on our private lives, but our relationship to it is fundamentally similar to other kinds of social authority that structure our public life. The average citizen has no earthly way of knowing whether a foreign nation indeed possesses weapons of mass destruction. In order to form an opinion, a citizen turns to institutions that are sources of authority on the topic: government pronouncements and the media’s reporting on the issue.
In all these cases, we think of trust (or its opposite) as dependent on knowledge. We compare what someone says to what we know to determine if they are truthful. If they are, we are inclined to trust them. We compare what the doctor says about a dosage to what the pharmacist and books on asthma recommend. When a mechanic tells us he’s fixed our car, we listen to make sure the troubling rattle is, indeed, gone. It is through iterations of this process that we establish the bonds of trust in authority. When the doctor is proven right, we come to trust the doctor; when the mechanic gets it right, we can rely on him, and on and on.
But not only is it the case that trust is dependent on knowledge, the converse is also true: knowledge is dependent on trust. Let’s return to the example of my mother and my brother’s doctor. In order for her to evaluate the doctor’s performance, my mom consulted a medical manual about drug dosages. Implicit in that was a fundamental trust in the book itself. Who’s to say that the author of the book was any more trustworthy than the doctor? Perhaps the information in the book was outdated. Even more insidiously, perhaps the author had a major undisclosed contract with a drug company that skewed her advice. My mom could, instead, have consulted another doctor recommended by a friend, but then she would have been relying on her trust of her friend and her friend’s judgment. Maybe she’d find that the books she reads and the other doctors she talks to suggest the dosage prescribed by her pediatrician is too high. This seems persuasive, but it simply means she’s choosing to trust medical consensus over her son’s doctor, and history has shown time and time again that the medical consensus at any given moment is far from infallible.
There is no way to extricate ourselves from this web of mediation. What we actually know firsthand is minuscule: the feel of the spring air on our skin, our own private daydreams and phobias. Outside of these tiny warrens of private knowledge, we have to depend on what others say. “The bulk of our knowledge — perhaps virtually all of it — depends on others in various ways,” writes political philosopher Russell Hardin. “We take most knowledge on authority from others who presumably are in a position to know it.” To know something is to have heard it from a trusted source. Trace the chain of knowledge a few links and you inevitably find it attached to some bedrock of institutional authority. Without these anchors, our basic knowledge structure threatens to drift away.
Imagine a weary sailor coming home to port in the midst of a brutal storm. Along the horizon he sees the burning lights of dozens of lighthouses. And yet he knows from experience that some are so old they’ve receded miles inland as the shore has grown. Others are simply fakes, put out by sadists and rivals. To be a citizen in these strange times is to perpetually find oneself in that poor sailor’s perilous state. We know that danger lurks in the darkness, but we don’t know if we have the means to avoid it.
Which brings us to the most destructive effect of the fail decade. The cascade of elite failure has discredited not only elites and our central institutions, but the very mental habits we use to form our beliefs about the world. At the same time, the Internet has produced an unprecedented amount of information to sort through and radically expanded the arduous task of figuring out just whom to trust. .
Together, the discrediting of our old sources of authority and the exponential proliferation of new ones has almost completely annihilated our social ability to reach consensus on just what the facts of the matter are. When our most central institutions are no longer trusted, we each take refuge in smaller, balkanized epistemic encampments, aided by the unprecedented information technology at our disposal. As some of these encampments build higher and higher fences, walling themselves off from science and empiricism, we approach a terrifying prospect: a society that may no longer be capable of reaching the kind of basic agreement necessary for social progress. And this is happening at just the moment when we face the threat of catastrophic climate change, what is likely the single largest governing challenge that human beings have ever faced in the history of life on the planet.
At exactly the moment we most need solid ground beneath our feet, we find ourselves adrift, transported into a sinister, bewildering dreamscape, in which the simple act of orienting ourselves is impossible.
Tgk1946's Blog 