Covid-19 knowledge and the ‘bad expert’

 

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Paige Sweet and Danielle Giffort examine the cultural work involved in the production, circulation and validation of Covid-19 knowledge, via an analysis of the abject figure of the ‘bad expert’. 

Paige: Danielle and I recently published an article together called “The Bad Expert” in Social Studies of Science. Danielle, can you describe what the article is about?

Danielle: Paige and I spent several years researching our respective cases: the medicalization of domestic violence and the nonknowledge of psychedelic-assisted therapy. When we talked about our research with each other, we noticed some interesting similarities across what are seemingly disparate cases. We observed how, in both cases, interested stakeholders were strengthening new forms of expertise by robbing credibility from old and existing forms. They would achieve this by narrating cautionary tales about abject figures who embody that bad expertise–who we call the “bad expert”–and then performing the opposite of that reviled figure. The bad expert figure helps actors perform boundaries (as emphasized in the jurisdictional model of expertise) at the same time that it allows interested participants to bring tools and knowledge together to forge new stakes of expertise (à la the network model, wherein expertise is defined relationally and is characterized by extension into new domains). By focusing on the bad expert and the antithesis performances the figure engenders, we draw analytic attention to the technical and “subjective” aspects of expertise that are often overlooked in scholarly work on expertise to understand how arenas of expertise are reassembled in part through cultural labor.

Danielle: Do you think there’s a “bad expert” of the COVID pandemic?

Paige: I honestly don’t know. We certainly have lots of people claiming to be experts. And lots of credentialed experts who are loathed — or simply ignored — by people on the political right. In the U.S., we have two very public and opposite faces of the pandemic: Donald Trump and Dr. Anthony Fauci. Trump is of course “bad” but he’s not and never was a scientific insider — if anything, of course, he likes to fan the flames of public skepticism of science and expertise. In our paper, we talk about “bad experts” as actual experts, as insiders who have gone wrong in some way. Other scientists or stakeholders create a collective narrative about the bad expert and expel him from the boundaries of good, ethical, forward-thinking expertise. The bad expert is still technically an expert, just the wrong kind — failed. I don’t think we can put Trump in that category. And then there’s Dr. Fauci, who certainly hasn’t been expelled from the boundaries of expertise by his colleagues. Fauci has been vilified by the right, so perhaps for those whose algorithms are designed to see right-wing news, Fauci looks like a bad or failed expert. For those of us in a different algorithmic echo chamber, it certainly doesn’t look that way. I have to say, there are likely a whole host of charlatans claiming to have expensive cures and preventions for COVID, and those stories will surface and they will probably be devastating. Surely those figures will be made into some bad experts. Danielle, can you think of any bad expert figures during COVID times?

Danielle: Didier Raoult, a French microbiologist who heads the infectious diseases department of La Timone hospital in Marseille, comes to mind as a possible candidate for the status of COVID’s bad expert. Back in March 2020, Raoult controversially promoted the use of hydroxychloroquine, an anti-malaria drug, for treating coronavirus after reporting “favorable” results in a small sample of patients. Raoult’s claims were embraced by President Trump and Brazilian President Jair Bosonaro, who both publicly advocated the use of the drug to fight COVID-19. Meanwhile, Raoult’s findings have been heavily contested within the scientific community. His peers have questioned the study’s reliability and validity, arguing that Raoult failed to follow the standard clinical trial methodologies necessary to demonstrate the drug’s safety and efficacy. They’ve further charged that his insistence on the drug’s ability to treat coronavirus without appropriate scientific evidence is putting people’s lives at risk. In response, Raoult bemoaned the “dictatorship of the methodologists” that clings to randomized controlled clinical trial procedures and emphasized that his results and the way in which they were gathered contributed to saving lives.With Raoult, then, we are witnessing the “subjective,” cultural work involved in constructing a bad expert figure, where these scientific stakeholders are collectively weaving together a narrative about a fellow scientist insider to distinguish themselves from him and to reassert the boundaries of “good” expertise. We can also see the ways in which the bad expert himself resists those constructions and defends his “bad” expertise. The way in which this has been unfolding is especially reminiscent of my own case of psychedelic therapy that I write about in our article. I show how psychedelic researchers have constructed Timothy Leary as a bad expert by distinguishing their “good” methodologies from his “bad” ones as a means to bolster their own expertise on psychedelic treatment modalities. Meanwhile, Leary and his ilk of “bad experts” in psychedelic research would shoot back against these criticisms, claiming that it was the naysayers who were wrong. Ultimately, however, cultural and institutional conditions coalesced so that one side emerged as the winner, and Leary was cast off as psychedelic research’s bad expert. What’s different here, however, is the strong emphasis that scientists today are placing on ethics and what they see as experts’ obligations to prioritize public health and safety through a carefully crafted scientific method. So the problem for them isn’t just that Raoult failed to embrace conventional scientific methods, but that in his failure to do so, he is committing not just a scientific violation but also an ethical one because people might take up the scientifically (defined by these stakeholders as randomized controlled procedures) unproven treatment and risk severe side effects or perhaps worse. This debate, like the global pandemic it is engulfed in, is still ongoing, but the Raoult debacle does strike me as a good case for applying our concept of the bad expert.

Danielle: Do you think the concept of “the bad expert” can help illuminate what’s going on with science and expertise more generally during this time?

Paige: I think one thing that our article is committed to — along with many other scholarly works on expertise — is an understanding of expertise as relational rather than as something that a person or group can hold. Gil Eyal talks about expertise as a network, and I think we both find this really useful because it highlights the importance of what gets said, publicized, performed, and politicized in relation to expertise. In our article, we show that bad forms of expertise — dangerous, failed forms — get attached to a particular figure through performing the opposite of that figure, through performances of scientific credibility and narratives of scientific progress and caution. The production of expertise depends on cultural narratives and performances. COVID is a fascinating moment for understanding the relational production of expertise because we have an absolute proliferation of narratives and performances of expertise — and rather mundane or not-typically-thrilling forms of epidemiological and public health expertise are being catapulted to center stage and also deeply politicized during this exceptional time. It’s hard to tell what kind of narratives about good and bad forms of expertise are congealing amongst insiders, but from the outside, the public appears to be deeply divided about what these performances signify and what they should mean about public policy. Though, of course, stakeholders often insist that “good” public policy should proceed unproblematically “from science,” as if such an interpretation-free relationship between science and public policy were possible. Surely putting on such follow-the-science blinders does little to resolve these public divides.

Danielle: Absolutely. I think it also illuminates the tensions between the desire to stick to the lengthy, step-by-step hypothesis-testing model of clinical research that holds such legitimacy in scientific circles with the need to quickly yet effectively address pressing public health crises. In particular, I’m thinking about back in late March 2020 when the US Food and Drug Administration (FDA) approved an emergency use authorization (EUA) for two malaria drugs, chloroquine phosphate and hydroxychloroquine sulfate, to treat COVID-19. This decision was met with protest among members of the scientific community, who argued that the decision was motivated by politics as opposed to scientific evidence. This debate between scientific standards of evidence on the one hand and the public need for timely scientific solutions on the other isn’t new to the coronavirus pandemic. Sociologist Steven Epstein, for example, has described the tensions that arose during the early years of the AIDS pandemic as the researchers and people living with HIV who were hunting for an effective drug treatment struggled to balance stringent, lengthy methodological mandates with the understandable desire to quickly find a solution to quell the public health crisis. In that case, we saw challenges to and shifts in clinical research expertise as scientist “insiders” and “outsiders” sought to resolve the tension. In some ways, that tension reappears today as we search for drugs and other treatments to address the ongoing COVID-19 pandemic. And to bring this back to our concept of the bad expert and the example of the FDA (that, perhaps, is being constructed as some kind of bad expert figure at the meso-level), we see scientist insiders questioning members of the FDA, a scientific organization, for their EUA decision, and in the process, those insiders are creating a narrative about what is good and ethical expertise.

Paige: Speaking of insiders and outsiders, our article uses the concept of “antithesis performances” to describe how those seeking to change the culture of expertise perform the opposite of the bad expert. Is this concept useful for understanding expertise during COVID?

Danielle: I think we can go back to the case of Didier Raoult to talk about antithesis performances during COVID. Part of constructing a bad expert isn’t just creating narratives to distinguish between “good” and “bad” but it is about engaging in performances to expel that person from the expert domain. Regarding Raoult, in November 2020, a group of specialists part of France’s Infectious Diseases Society (SPLIF), filed a formal complaint with the national order of doctors in which they charged Raoult for violating multiple ethical codes. A hearing is planned to take place sometime this year. That hearing will be one site to see antithesis performances in action and to get a better sense of what scientist insiders are constructing as “good” expertise and what, exactly, they want to pivot away from. While this planned degradation ceremony of Raoult highlights the culture forms and practices of expertise, I’m not sure it totally fits with how we’ve developed the concept of antithesis performances in the sense that we were theorizing these performances as a technique for stakeholders to shift a culture of expertise. The pandemic is still unfolding, so it’s hard to be conclusive about anything at this point, but so far, I don’t see much in the way of attempts by scientist insiders to develop new forms of expertise. Rather, they are using existing forms, such as already-legitimated methodological approaches, to bolster their claims about coronavirus. So I can see how Raoult and other potential bad expert figures of COVID are being taken up to reassert boundaries, but I don’t think we are yet seeing the other important side of the bad expert and antithesis performances they engender: that this figure also allows interested stakeholders to forge new stakes of expertise. What do you think, Paige?

Paige: That’s an interesting question. Your example is perfect. One thing I’ve noticed from where I’m sitting is a divide between public health experts who are promoting a “harm reduction” approach to COVID shutdowns by encouraging people to continue gathering outdoors and participating in lower-risk activities to keep themselves socially engaged — versus a “zero risk” set of expert discourses that really is about refusing all social interaction in order to stay maximally safe during the pandemic. I think in some ways, the “harm reduction” side is performing a kinder and gentler type of public health expertise, eschewing forms of expertise that appear to be more detached from people’s needs and desires. Perhaps this divide between different types of public health expertise will prove to be significant going forward. I certainly think it’s significant from a public health messaging and political perspective — and I’m certain that grassroots activists like the feminists I analyze in our article will use these divides as a turning point to try to shift the culture of expertise more and more toward harm reduction.

Danielle: On the topic of public health messaging and news, what can we learn from our article that can help us understand the barrage of news about science and trust and expertise during this crisis?

Paige: One thing our article shows is that expertise is historically changing and that it is always embedded in politics. Understanding expertise in this way should give us pause when we’re tempted to make black-and-white claims about the nature of science and expertise in times of political crisis. The much-touted “end” of expertise could be seen instead as a moment to ask questions about what kinds of expertise we want informing public policy, about the public’s right to engage in and push back against public health expertise, about the inequalities that necessary public health measures will surely aggravate. This doesn’t mean endorsing some kind of bland epistemic pluralism that could have disastrous consequences for the pandemic. But it does mean asking tough questions about the various cultural repertoires and social conditions that elicit distinct kinds of engagement with science and expertise. To see expertise as a cultural style — as we propose in our article — also means, I think, asking critical questions about the class politics of science and public health policy on a larger scale, and I think COVID shines a pretty troubling light on those dynamics.

Paige L Sweet is an assistant professor of sociology at the University of Michigan. Her work focuses on gender/sexuality, gender-based violence, and the politics of health. Her book The Politics of Surviving: Domestic Violence and Traumatic Citizenship is forthcoming with the University of California Press. Twitter: @paigelsweet

Danielle Giffort is an assistant professor of sociology at the St. Louis College of Pharmacy. Her work focuses on the politics of health and social movements. Her book Acid Revival: The Psychedelic Renaissance and the Quest for Medical Legitimacy was recently published with the University of Minnesota Press.

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