What are the limits of expert evidence-based analysis?
This piece was co-authored by Nason Maani, and his version is cross-posted here
We are largely rationalists. After all this essay—part of our ongoing Ideas about Ideas series—is being written from within universities where we spend our careers trying to understand data to identify fact. While we are both often working on social science contexts, our disciplinary training began in medicine and biomedical science, making us even more wedded to empirically grounded, expert-led, evidence-based analysis. There is no question that this approach has done enormous good and remains the foundation of science and what we do in universities. But are there limits to the insights that can emerge from such rationalism? What would a more honest public health look like if we acknowledged the limits of this approach?
If we look closely enough there are plenty of examples where public health hit a wall, not because the evidence was wrong, but because the question that dominated the questions of the moment was not one that any kind of study can settle. Think for example about the recent pandemic, where much animus and political division was cloaked in “what do the data say?” or “follow the science” when in fact what we should have been asking was “what should we do, balancing data and other things that we value as a society?”. Think of the opioid epidemic that was fueled in part by OxyContin marketing. It was in large part built on technocratic claims about addiction risk that turned out to be an ideology about pain medications masked as data. Or think about any number of academic debates where we preserve the peace by deferring to a methodological difference in perspective when in fact the foundational question was about what we were trying to understand in the first place. Technocratic thinking emerges when we treat the answer to societal questions as though they were merely technical questions. But so very few questions that matter to societies, certainly in health, are technical in nature.
Read more here