Doctores

 

Earlier this year, an exchange between Joe Rogan and Bill Burr on Rogan’s podcast went something like this:

Rogan: Do you want people to walk down the street with a mask on?

Burr: I don’t want to start this bullshit. I’m not going to sit here with no medical degree listening to you with no medical degree, with an American flag behind you smoking a cigar acting like we know what’s up better than the CDC… I watch the news every two weeks and “I’m like, mask or no mask? Still mask? Alright, mask.”

Rogan went the technocratic angle pointing out how the WHO notes that cloth masks have limited effectiveness and primarily recommends masks for those caring for covid patients. But I wish he had taken down the underlying assumption that mere laity may not question declarations from those with a medical degree or the CDC. 

Why is this important? Because there are at least a half dozen reasons why medical advice from doctors can and should be challenged, and not doing so can lead to prolonged sickness and excess mortality. In this example, clinging to masks over ensuring grocery delivery for the elderly and improved air filtering and ventilation in buildings (especially multifamily buildings housing hundreds of quarantined individuals) has gotten hundreds of thousands of people killed while prolonging pointless arguments. 

This assumption that we can’t question doctors or the CDC is silly for a handful of reasons both high-level and specific to doctors. Let’s start with high-level. 

First: Credentialed experts almost always disagree. So no matter what, someone’s always going to be disagreeing with an exalted doctor. 

Second: credentials are not a guarantee of superior knowledge, they are a confirmation that an individual has completed an approved course of study, test, or practical experience at some point in time. 

It’s rare that you see this barrier to criticism applied to other professions. One doesn’t typically see the argument that a New York Times columnist can’t criticize a Republican tax plan because the columnist isn’t an economist or a political scientist. Or that someone can’t give a training to coworkers without an education degree. 

Third: Knowledge evolves, and credentials typically do not. My credentials measure a broad base of knowledge I demonstrated at a point in time, not whether I retain that knowledge or stay abreast of evolving knowledge. Continuing education or recertification requirements are often a joke. 

Fourth and related: Books and the internet make relevant, accurate information widely available to everyone willing to do the research, credential or no credential. 

Fifth: Specialization. Degrees are typically broad, today’s world knowledge is highly detailed and focused on a much more specific niche within that larger domain. A degree in electrical engineering is no guarantee that the graduate knows anything about 15-minute interval smart meters. 

Sixth and perhaps most important: Credentialed experts have their own interests and biases. Left unchallenged, it’s natural for them to promote advice and policies that are best for them, truth be darned. 

Seventh: Credentials require time and money, and not everyone with the suitable knowledge has the time or the money. 

How many critical discoveries have been made by those without “proper” credentials or job experience? 

A New York Times columnist who has spent six months researching tax policy and speaking to a diverse array of experts on the topic is far better qualified to pass judgment on a tax plan than an economist who got a degree 20 years ago, works as a consulting manager, has never specialized in tax policy, and whose firm receives significant money from customers directly benefiting from the proposed tax plan. 

Which brings us to medical doctors. 

Most doctors are unlikely to have recent, detailed backgrounds in epidemiology and aerosol transmission. The Washington Post enjoys reminding Senator Paul of this on a regular basis. 

Many of the peer reviewed studies on masks and aerosol transmission are publicly available to anyone willing to carefully read them. If you’re reading the same studies the CDC is reading at the same time, who’s more knowledgeable? Do the CDC experts have hands-on experience treating covid patients and measuring aerosol transmission? 

And finally, doctors in this country are overwhelmingly biased in favor of pharmacological intervention, often overlooking or ignoring obvious, less costly, and more healthy solutions to medical problems. It is a significant reason why Americans pay more per capita for health coverage with the worst health outcomes of major high income countries. 

Doctors have been wrong all the time. Everyone has a story of a doctor declaring “x months left to live” for relative Y who went on to live for another several years beyond the doctor’s estimate. Doctors and experts once endorsed tobacco smoking, thalidomide, DDT, asbestos, PCBs, and indiscriminate prescription of antibiotics, all found to pose major health issues. 

I cannot tell you the number of times this has hit home for me personally. I went to a nurse practitioner several years ago when my throat was so swollen I could barely eat. The diagnosis was acid reflux and the immediate recommendation was to take omeprazole. The omeprazole worked, but my gut felt weird after taking it and it made no sense that I as a 29 year old man needed to take acid reflux medication for the rest of my life. Sure enough, I cut out both the omeprazole and my morning glass of orange juice and have had no problems since. You’re telling me I shouldn’t be questioning doctors after that experience? 

My wife struggled for years with bad and incomplete advice from doctors on how to deal with her Hypothyroidism before making dramatic changes to her diet and supplement regimen. It is certain that after five years of study and practical experience my wife knows more about digestion-related autoimmune disorders than most primary care physicians, endocrinologists, and pediatricians we’ve spoken with. This has been proven time and again in her conversations with those doctors. 

Which brings us back to the original question on masks. You don’t have to have an MD or a CDC job on your resume to figure out whether a certain type of mask does or does not block the spread of viral particles, and it is silly to suggest otherwise. Refusing to question the medical establishment will lead to stagnation of knowledge, sticking with failed approaches, and hubris on the part of doctors leading to more failed health initiatives. 

This isn’t to say throw out any recommendations made by a doctor. Only to say that doing sound research, asking hard, insightful questions, and challenging assumptions is how the evolution of scientific knowledge moves forward. Shutting that virtuous cycle off for the vast majority of society is going to do more harm than good.