Thursday, 9 March 2022 — Dr. Malcolm Kendrick
The COVID19 pandemic has thrown an issue into sharp focus that I have been observing for many years now. What is an expert? The simple answer is someone who has expertise. Deep knowledge of a subject that has been gained by spending many years researching, reading, speaking to colleagues, and suchlike.
However, that is clearly not enough. I have spent years researching cardiovascular disease. I have written papers about it, written books, given lectures… but I have never been referred to, by any in mainstream medical research at least, as an ‘expert’. I am very much something else. A maverick, a denier, zealot a … [insert insult of choice here].
I used to joke that there must be a secret expert exam that you have to pass in order to be called an expert. Or perhaps it’s a bit like the Freemasons. Someone has a quiet word in your ear to sound you out. Then asks if you would like to join the international brotherhood of ‘experts.’ Dedicated to something, or other.
Very soon, after the COVID19 pandemic struck, Imperial College Business School had this to say on experts:
‘In 2016, when Michael Gove made his famous statement that “people in this country have had enough of experts”, it seemed experts and expert knowledge were on their way out. The opinion of populist politicians and online influencers were deemed much more relevant to decision making than the findings of scientists or the theories of economists. From the antivax movement to newly resurgent creationists, the spirit of the times was very much against the expert. Science and its evidence-based rationality were in retreat and the trend seemed unstoppable.
Fast-forward four years and the world is suddenly a very different place. Experts like Imperial College London’s Neil Ferguson, and Peter Piot from the London School of Hygiene & Tropical Medicine are now central advisors to government and the profiles of experts are the material of front-page stories. With the arrival of a global pandemic, experts are back – and with a vengeance!
So, what has changed? And what can we learn from the recent success of the experts who are shaping government policy on coronavirus? First, the experts who are currently leading the government’s policy response to the pandemic are not just experts, they are leaders. They know that simply understanding a topic deeply and having something to say on an issue is not enough.’ Etc. etc, glory glory Imperial College 1.
I found the final sentence interesting. ‘They know that simply understanding a topic deeply and having something to say on an issue is not enough.’
In short, to be an expert you must also be a leader? I think this is probably true …. You certainly have to be at the top of some organisation or other.
Anthony Fauci for example. He was held by the mainstream media to be the number one expert about COVID19. His position unassailable – or at least it was. He was, and remains, the head of the National Institute of Allergy and Infectious Diseases. He remains the Chief Medical Advisor to the President.
Did he know more than anyone else about Sars-Cov2? Was this even a requirement? Tricky, as this was a completely new virus. Was he the perfect man for the job? He most certainly ticked all the expert boxes – so he should have been the ideal man? Hire that man right now…
Of course, there are those who have been far more sceptical about the value added by experts – to anything. David Sackett, who was a driving force behind the Evidence Based Medicine (EBM) movement – and who was also a very good man – wrote an article in 2000 entitled ‘The sins of expertness and a proposal for redemption.’
Here are a couple of sections. I suggest you read the entire article; it is not very long:
‘Is redemption possible for the sins of expertness? The only one I know that works requires the systematic retirement of experts. To be sure, many of them are sucked into chairs, deanships, vice presidencies, and other black holes in which they are unlikely to influence the progress of science or anything else for that matter.’
‘But there are still far more experts around than is healthy for the advancement of science. Because their voluntary retirement does not seem to be any more frequent in 2000 than it was in 1980, I repeat my proposal that the retirement of experts be made compulsory at the point of their academic promotion and tenure.’ 2
In this paper he refers to an earlier piece, written in 1983, where he first called for the retirement of all experts. Having voluntarily ‘retired’ himself as an expert in the field of ‘compliance with therapeutic regimes’. As he added:
‘I received lots of fan mail about this paper from young investigators, but almost none from experts.’
Some twenty years later he ‘retired’ himself again. This time as an expert in the field of evidence-based medicine, some would say the expert. He believed he had attained too much power and status and was therefore distorting everything around him.
As with all other acknowledged experts, he found that junior researchers deferred to him, and simply would not question him. He came to the conclusion that the very presence of an expert impaired scientific progress. [Of course, of all the experts in the world, he was the one that should not have retired].
In his opinion, experts crystallised into barriers to the progress of new ideas, and most other forms of innovative thinking. Their primary role became an immovable pillar, supporting the existing status quo. Of course, this expert problem has been recognised by many others … For example, Max Plank, in his famous quote:
‘A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.’
‘Science advances one funeral at a time.’
So, who you going to call? If, that is, you are a government, and there is a pandemic? You do what everybody does. You call on the established experts. Leaders who sit at the top of the pyramid.
Those professors garlanded with honours. Opinion leaders. Even the mighty key opinion leaders (KOLs). No need to look elsewhere. All the expertise can easily be found, right? And the experts all know each other, so they can also recommend their expert friends – the ones they know and get on with.
A few years ago, there used to be an expression in business, which went something like this: ‘you never get fired for hiring IBM?’ Why not? Because IBM was huge, and they had the reputation of being the major players in IT solutions.
No-one would ever ask you to explain why you hired them. You just did. IBM was also bloated, cumbersome and vastly expensive – containing about as much innovation as a squashed cabbage. Which eventually caught up with them… eventually. Now, you tend to hire another massive company … GE, or suchlike. IBM still exists, but it came very close to the edge.
Of course, everyone needs expertise. If you want to build a bridge, then hire an architect and engineers who are capable of designing and constructing one that does not fall down. This requires skills and knowledge that take years to attain. True, validated, expertise.
Equally, if you want someone to replace your hip, find an anaesthetist and an orthopaedic surgeon, and their team of experts. Don’t pop down the local Botox clinic and hope for the best.
However, if you find yourself in a situation never seen before, where no-one really knows what to do … Then you will find experts are always going to propose doing only what they have always done. What they already know. As used to be said of generals, that they always started off any new war, using the exact same tactics that were being used at the end of the last war. Which never worked. Things had moved on … they hadn’t.
I do find it ironic that when the pandemic started, the key advisor to Boris Johnson was Dominic Cummings? The great ‘disruptor,’ the man who wanted to break apart the ‘cosy establishment’ and replace it with new thinking, and innovation. Here from the article: ‘Dominic Cummings: A model of disruptive leadership?’ [Sub-header. “The best way to spot those at the vanguard of disruption is by their unpopularity”].
The underlying problem is widespread institutional inertia that serves to contain rather than facilitate change. Leaders soon realise that being truly disruptive carries risks that either they, their board-level superiors, or those they lead find hard to tolerate. Few therefore follow through on good intentions, the common default being safety first…
Rightly or wrongly, Cummings believes the UK is being held back by a cosy establishment that stands in the way of reform. He openly disdains convention, as when deliberately bypassing traditional campaigning methods to sell Vote Leave’s ‘Take Back Control’ message, even if this means sailing close to the ethical wind.
You can tell that Cummings hits raw nerves because criticism of his modus operandi is laced with attacks on everything from his personal manner to his dress sense. But you wouldn’t bet on him lasting much longer in the Whitehall machine. The quicksand of inertia has a habit of swallowing disrupters in organisations a lot less complex and cunning than that of government … [Good call]
Change rhetoric might tell us that we need more people prepared to break the mould but our recent political experience indicates that having the will to disrupt rarely guarantees success against stubborn guardians of the ‘same old, same old’. 3
Well, as everyone in the UK knows, Dominic Cummings is now history. Disruptor no more. However, in February/March 2020 he was still very much in place – and he had Boris Johnson’s ear, as his most trusted advisor. You might have thought, therefore, that the scientific advisory group for emergencies (SAGE) would have contained a disruptor or two.
But no, we got the exact same old, same old. The well-established experts. The Chief Medical Officer, the Deputy Chief Medical Officer, the Chief Scientific Officer, the chief of this, the professor of that.
The great problem is that this ‘same old same old’ was going to have an in-built, and almost pathological resistance to risk – of any sort. In this case, by risk, I mean doing anything that is slightly different. Anything that may open you up to criticism. This is the main reason why the SAGE doomsday predictions have never matched reality.
Just as you never got fired for hiring IBM. If you are an epidemiologist, you never get fired for modelling a worst-case scenario. If you say there will be six thousand Omicron deaths a day – in the UK alone – yet the highest number reached was three hundred. Then are safe. This is the approved, standard direction of error.
On the other hand, if you said there would be three hundred deaths a day and it ended up at six thousand… all hell breaks loose. To quote Professor Graham Medley, who chaired the SAGE modelling group.
‘Professor Medley said one of the ‘worst things’ would be for the modellers to under-predict the approaching wave.
He told MPs: ‘The worst thing for me as chair of the committee is for the Government to say “why didn’t you tell us it would be that bad?”, so inevitably we are going to have a worst case that is worse than reality.’ 4
…inevitably we are going to have a worst case, that is worse than reality’… Roll that idea around for a moment or two. I did, and this was my interpretation. ‘Inevitably, our models will always be worse than the worst thing than can ever happen.’ Ergo, our models are designed to be utterly useless and inaccurate. A great way to plan your response?
Any decent disruptor would have questioned the assumptions underlying this ‘worst thing’. A disrupter would flip the question on its head. The worst thing, surely, would be to drive the Government into a massive over-reaction that could lead to such things as … thousands of deaths from undiagnosed cancers.
Or patients dying of heart attacks, terrified to attend hospital. Or care homes being flooded with COVID19 positive patients, because the hospital had to be cleared out. Or a tidal wave of mental health problems in children and adolescents. Or an increase in domestic abuse. Or … keep going, there are many damaging things that were caused by lockdown.
They would also have questioned the massive financial cost of extended lock-downs. The new hospitals that could not be built in the future. The much-needed healthcare staff not being hired – because we have run out of money. The inability to pay inflation matching pay rises, leading to staff resignations and loss of morale. The drugs that can’t be paid for, and on and on.
They would have remined those on the advisory board that this was not a zero-sum game. Every COVID19 death prevented, no matter how much it costs, is not necessarily a positive. There will be major, damaging, downsides to your actions, and these have to be taken into account.
However, if you stuff your advisory body with established experts you will get what you got. A group of people whose primary motivation is to ensure that they cannot be blamed for making a mistake. They will ‘hire IBM’. They will battle to maintain the status-quo. ‘Think of how terrible things would have been if we had not driven lock-downs on the entire country for weeks and months.’
Disruptor: ‘Look at how badly wrong your predictions have been, and the enormous and widespread damage you have caused. The cost of which may never even be known.’
Yes, as you can probably gather, I am not a great fan of experts. Of course, I do love expertise… and I love doing things as well as possible. At least those things that have been proven to work. I love innovation, and new thinking. Different ways of looking at the world.
What I hate, what we should all hate, is that any attempt to shift the status quo seems doomed to fail:
‘Change rhetoric might tell us that we need more people prepared to break the mould, but our recent political experience indicates that having the will to disrupt rarely guarantees success against stubborn guardians of the ‘same old, same old’.
When COVID19 arrived, we needed disruptors, new ways of thinking, and acting. We needed clear sighted innovators. What we got, predictably, inevitably, depressingly, were ‘experts’ to lay their cold, dead, hands on the situation. Experts desperate never to be ‘wrong.’ Having first decided what wrong meant. In this case it meant never, ever, underestimating the number of COVID19 deaths.
At this point I feel the need to quote David Sackett once more: I repeat my proposal that the retirement of experts be made compulsory at the point of their academic promotion and tenure.
Hear, hear. ‘Do I have a second for this proposal?’