[PEN-L:28712] Re: Expertise

["Devine, James" <jdevine@xxxxxxx>]

Title: Re: Expertise

I'm all in favor of expertise, but the way to prove its worth is not to assert it and hope that people with similar expertise will be adequate judges. I know that economists, for example, aren't the best judges of economic expertise: if they were, Mankiw wouldn't be so successful. The economics "experts" are all of the same school, the neoclassical one.

Any group that claims to have expertise must be willing to listen to others. This is especially true when the group has some sort of power: for example, a lawyer (one kind of "expert") has much more knowledge of the law (and legal tactics, etc.) than his or her client does. This sets up a principal/agent problem situation, where the lawyer can take advantage. Since all or most lawyers are in a similar situation, they have a collective interest in preserving their power (like the Roman Catholic Church wants to preserve the power of its priests -- until push comes to shove). The population of clients must have some power over the bar association: this is one reason why it's a good idea to have more non-lawyers in the state and federal legislatures (in the US at least). We need some kind of expert outside the legal community to check and balance the power of the lawyers.

As for doctors, I think one of the big improvements in recent decades has been the rise of "patient power," the increase in the number of patients who are willing to ask probing questions, to "question authority."  This is encouraging the docs to abandon their high-and-mighty attitudes and to learn to _communicate_ with the patients rather than to pretend to be minor gods or goddesses. This process is incomplete and is being exploited by the drug companies in the US (in their TV ads telling patients to "ask your doctor about Prozac" or whatever) and sometimes gets involved with dubious folk medicine. But it's a good thing, because the docs are being pushed to treat people with respect. Horrobin, a psychiatrist and the author of THE MADNESS OF ADAM AND EVE (an excellent book, BTW), thinks that patient power is really important, especially in breaking the dubious psychiatric consensus about the nature of schizophrenia and to demand respect for schizophrenics. Also, I know that patients and their parents have been very important in the autism community -- helping the docs to dump the Freudian nonsense of Bruno Bettelheim and the like.

JD

-----Original Message-----
From: Michael Perelman
To: pen-l@xxxxxxxxxxxxxxxxxxx
Sent: 7/28/2002 9:28 AM
Subject: [PEN-L:28711] Re: Expertise

A book about Chinese health care, Away with all pests, describes how
cleaning people contributed to Chinese medicine in dialogue with the
doctors ...

On Sun, Jul 28, 2002 at 04:16:07PM +0000, Justin Schwartz wrote:
>
> Yoshie, you should get back to work.
>
> >>1) The straw men: Democray in this context does not mean that
everybody
> >>votes on the details of "how you run your shop". It does mean (and
> >>Schweickart agrees) that everybody in your shop gets a vote. That is
the
> >>in a hospital, not only doctors, but nurses, Xray techs,
receptionists,
> >>floor sweepers, nutritionists, cooks all get an equal say in running
the
> >>place - whether  via direct democracy, the election of a council, or
the
> >>choice of a manager answerable to an elected council. And democracy
also
> >>demands that priorities in terms of how capital is allocated also
are set
> >>democratically.
>
> As you know I support worker self-management. I am not sure that that
has to
> mean that the cleaning staff gets an equal say with regard to the way
the
> surgeons do their work, that's the same problem as the problem of the
demos
> that I mentioned. I assume that self-managed enterprises can work that
sort
> of thing out in an appropriate manner.
>
> >>
> >>2) Secondly, for the most part expertise does not mean a right of
decision
> >>making, but a right to advise. For example if I go to my doctor and
she
> >>recommends an operation, she has no right to order me to have that
> >>operation, I can refuse, and if the doctor knows what she is doing
suffer
> >>or die as a result. But the point is that choice is mine; the
doctor's
> >>expertise gives her only a right to advise, not to order. As lawyer,
you
> >>should be all to well aware that the same is true for lawyers.
>
> Depends. For doctorss and lawyers that is true. But I was not talking
about 
> the right of experts to make decisions, but to give their advice, and
act on
> it if it accepted--that is, to to their jobs--without unhelpful
intrusion by
> the ignorant. There are experts whose job it is to make decisions, not
give
> advice, as well. Teachers come to mind as an instance, as well as all
sorts
> of govt officials--judges are another. That's why we call them judghes
and
> let the end their opinions with the words, Enter Order.
>
> jks
>
> jks
>
>
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--
Michael Perelman
Economics Department
California State University
Chico, CA 95929

Tel. 530-898-5321
E-Mail michael@xxxxxxxxxxxxxxxxx