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The Death of Expertise | Why People Ignore Facts and Dispute Science

Experts devote their entire lives to studying, researching, and contributing to the body of knowledge within their field. Collectively, they know more about their subject matter than anyone in the world. And yet, it seems that the opinion of an expert is increasingly losing value in today’s society.

More than ever before, individuals are doing their own research and coming to their own conclusions about complex scientific and medical issues such as vaccinations, diet, and climate change. We are seeing a growing wave of anti-rationalism as more and more individuals stay firm in their own beliefs, even if their conclusions are in disagreement with those of the experts. It is spreading the epidemic of misinformation, which threatens to weaken the very foundations of our democracy.

In a recent episode of Straight Talk MD, Tom Nichols, author of “The Campaign Against Established Knowledge and Why it Matters”, explains the psychology behind those who continue to believe they are right when the experts tell them that they are wrong.

The Dunning-Kruger Effect
Nichols explains that one reason a non-expert may dispute known science is that this individual feels empowered by a false sense of his or her own ability. This is a cognitive bias known as the “Dunning-Kruger Effect.” Simply put: the worse you are at something, the better you think are at it.

Nichols

“People who lack certain kinds of talents or certain kinds of knowledge simply cannot see where they lack that knowledge. […] They’re unable to see the lack in their own ability on these things. […] We all do it in various places, but when you probe the voters – when the voters say things like, ‘Well this Russia story, it’s just not important. Russia doesn’t affect anything.’ A more competent person says, ‘Look, I just don’t know that much about Russia,’ because most people don’t. But the incompetent person says, ‘Oh yeah I got that. I understand that. I’m on it.'”

“And that’s where the Dunning-Kruger effect comes in. Because that lack of metacognition, that lack of the ability to know, is what convinces you that actually you have this thing nailed, and it’s brutal in the political realm. It’s bad enough day to day in people’s lives, because again we all do that.”

Ego, Narcissism and Empowerment
However, this is not always caused by the Dunning-Kruger effect. Sometimes knowledgeable people with lots of experience will stubbornly cling to irrational conclusions that contradict mainstream scientific thought. Nichols also explains that Ego, Narcissism and feelings of self-empowerment play a large role in the death of expertise.

Frank Sweeny:

“You talk about the anti-vaxxer community, and this is the part that I did not know and it blew me away. It’s in a relatively affluent area outside of San Francisco. Marin County. […] And these people are largely educated. So what I don’t understand here is […] they are educated, and they’re actually rejecting known science and everything else. Why?”

Tom Nichols:

“It’s empowering and makes them feel like they’re in charge. The death of expertise and the campaign on established knowledge is one big primal howl of Americans of every class saying ‘you’re not the boss of me.’

I’ve been asked many times over the course of the past months since the book came out […] ‘Isn’t this just poor people, or dumb people, or uneducated people, or rural people, or is this mostly men, or is it women?’

It’s everybody. But the thing is that we all express it in different ways. These are educated suburbanites who are just educated enough to spend time thinking that they have a grasp of the scientific issues involved and vaccines. […] You know that old expression about a little learning is a dangerous thing? They’re almost worse off than the poor parents who say ‘Look, I don’t understand anything about this stuff. You’re telling me that this shot will keep my kid from getting sick? OK.’

Also poor parents are disempowered in this sense. If they want [their kids] to go to a public school, they have to get the shots. So this is a way of wealthy parents saying ‘We’re totally autonomous. Our children are special. My Poopsie doesn’t need a needle stuck in them.’

It’s all about ego and narcissism and empowerment, and it’s all expressed differently. The rich liberal wealthy parents of Marin County express this differently than the angry, rural, Indiana Trump voter who thinks that unemployment is really 42% because the president told them it is. But it’s the same phenomenon […] which is: ‘I’m fully empowered. I’m smart. I know things. The world is not out of my control. I can take charge in all this by making decisions, whether it’s not to vaccinate my kids or whether it’s to reject facts I hear from the Wall Street Journal’s page on unemployment statistics. I’m seizing control of my world, and saying that I’m in charge and you’re not the boss of me.’”

Debating the Irrational
Does this remind you of someone you know? Tom Nichols gives some advice on how to go about arguing with someone who refuses to accept scientific facts or follow a rational discourse.

Nichols

“You just have to be very patient, but you’re probably not going to succeed. I talked with my old friend. He said, ‘unemployment is out of control.’ I said ‘it’s four and a half percent in Massachusetts.’ He said, ‘no it isn’t.’ I said, ‘Well OK, let’s assume we’re wrong, and they’re lying, and it’s 8%. That’s still less than when we graduated from high school.’ He said, ‘No it isn’t.’

At some point, you just say ok.”

Want to learn more? Click to listen to the full interview with Tom Nichols.

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Medication Is An Incomplete Treatment For ADHD In Children

ADHD Medication ChildrenA 2015 report from the George Washington University Milken Institute School of Public Health finds that the number of diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) has risen by 43% since 2011. What the hell is going on?

In a recent episode of Straight Talk MD, author of “ADD Explosion”, Dr. Stephen Hinshaw, explains the various causes for this dramatic rise in ADD and ADHD diagnosis. He also discusses the treatment of ADD and ADHD in children, and explains how the healthcare system is set up to incentivize treating these disorders through medication alone, which is only part of a healthy and effective treatment for these disorders.

Sweeny:

“You outline how a combination of medication and behavioral therapy usually leads to the best outcomes for ADHD, but is our health care and mental health system even set up for this kind of treatment?”

Hinshaw:

“One of the policy changes back in the ’90s that led to a lot of the ADHD diagnosis was a change in authorization of Medicaid, which out here in California is Medical, where ADHD was a reimbursable diagnosis for doing, again a fairly cursory, but the assessment of it. There’s only one reimbursed treatment under Medicaid which is medication. There’s no reimbursement for family management training or doing a school consult which are the evidence based psychosocial treatments.

So medicine is reimbursed sometimes only, or exclusively, as a quick way to get at the symptoms.”

"So medicine is reimbursed, sometimes only or exclusively, as a quick way to get at the symptoms."

Sweeny:

“Medication means giving stimulants or something like that?”

Hinshaw:

“Stimulants are the primary medication for ADHD, and that’s confusing! Why would you stimulate a kid who seems already too active? The short story here is that the stimulants are SDRIs, selective dopamine re-uptake inhibitors. They stop dopamine once it’s squirted out from the first neuron in the chain from being taken back into that first neuron. It allows more dopamine to be active.

Dopamine is the neurotransmitter that gives you that sense of intrinsic reward. It helps you regulate your motor behavior. It has implications for learning, with the projections that go out to the frontal lobes (planning and organization). The medications do a good job in about 80% of cases, if you get the right kind of stimulant and the right dose, of keeping those symptoms in check, for as they are as long as they’re in the bloodstream, which is just a day at a time.

But what the medications, of course, can’t do is actually teach academics, or teach better social skills, or teach families how to discipline in a more consistent way. So almost by definition, it’s an incomplete part of a multimodal package that requires building skills in families and in schools and in the kids themselves, to learn in groups and learn how to interact socially better.

It’s those combination treatments that have the best chance of treating the whole child, and persisting in their effects longer than just medication alone.”

Want to learn more? Click to listen to the full interview with Dr. Stephen Hinshaw.

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What Are The Insurance Exchanges, And Why Are They Failing?

Healthcare insurance exchanges are failingThe 2016 presidential election has focused much attention on Obamacare. If you’ve been following the issue, you may have heard that one of Obamacare’s pain points is the implementation of the insurance exchanges. What exactly are the insurance exchanges?

In a recent episode of Straight Talk MD, Dr. Sweeny welcomed Ron Howrigon, a healthcare expert who has held senior management positions with three of the largest managed care companies in the U.S., including Kaiser Permanente, Cigna, HealthCare, and Blue Cross/Blue Shield. In this episode, Ron explains what the insurance exchanges are and why they are failing:

Sweeny

“Some people actually don’t even know what it means when people talk about the insurance exchanges. What is the importance of the insurance exchanges in Obamacare? What were they set up to do?”

Howrigon:

“The exchanges are a fundamental part of Obamacare. The best way, if you’re not familiar with the health care environment, is to think of them like Travelocity for insurance. It’s set up like an electronic marketplace, where individuals (you don’t have to be part of an employer group) could go online, compare policies from one carrier to another, and know that those policies were actuarially equivalent.

So, in other words, in order to be a bronze plan on the exchange you have to actuarially cover roughly 60% of all the predicted expenses. It is a fundamental part of allowing access to individuals to buy insurance in a marketplace, where they could understand it, it was easy to do etc. And it also created the vehicle for the federal government to subsidize the purchase of that insurance for lower income individuals.”

"The best way, if you're not familiar with the health care environment, is to think of them like Travelocity for insurance."

Sweeny:

“I looked back on your November 2013 article, when Obamacare was just being instituted, and at that time you actually predicted that the insurance exchanges would fail in 2017. That they would succumb to the death spiral. Did your prediction come true?”

Howrigon:

“I think for the most part it has. And, in some ways, the scary part for me is that it was worse than what I even thought it was going to be. And I thought it was going to be pretty bad. The evidence that we can see that it’s failing in 2017 is that all of the insurance companies have taken massive losses on the members that they’ve enrolled to the exchanges. And now we’ve got pretty much everybody – United, Aetna, Cigna, etc. – running away from those markets, dropping those markets and leaving that business.”

"We've got pretty much everybody - United, Aetna, Cigna, etc. - running away from those markets, dropping those markets and leaving that business."

Sweeny:

“It’s interesting when you think about the fact that what you’ve got is a marketplace, with 12 to 15 million customers, and none of the big insurance companies want to sell them their product because they know they’ll just lose money. Why are the for profit insurance companies losing so much money?”

Howrigon:

“You know it’s a lot of factors. The biggest factor is what we’ll call the ‘mix of patients’ or the ‘severity load of the patients’. We know, in this country, that 5 percent of the people consume over half of all the health care expenses in a normal population. We also know that the bottom bottom 50 percent of the people consume less than 5 percent of the health care.

In order for health insurance to work you’ve got to get an awful lot of those young healthy people to cover the very few sick people that are going to consume all of the cost. If that mix is off, if you get a slightly higher percentage of the the sicker people or a slightly lower percentage of the young healthy people, it doesn’t work financially. It becomes a real difficult problem. That’s happened in the exchanges. The mix has been much different than anybody thought it would.”

"They're having a hard time attracting young healthy people, and the people that they got are incredibly sick."

Howrigon:

They’re having a hard time attracting young healthy people, and the people that they got are incredibly sick. It makes sense when you realize that a lot of those people have gone a long time without insurance. So there will be a lot of pent up demand. A lot of uncontrolled disease states etc.

In addition, these people by nature are lower income. They make just enough money not to qualify for Medicaid, but don’t work in a high price job where you’d have insurance offered to you. Those people are going to have very different issues. They’re going to have a higher incidence of things like diabetes etc.

It’s a very difficult population. It’s a population that probably needs insurance almost more than anybody else, but one where the insurance companies can’t price their product such that they can make profit on it. None of those insurance companies are going to continue to provide insurance to people that they can’t make money on.”

Want to learn more? Click to listen to the full interview with Ron Howrigon.

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Can Human Growth Hormone Slow Aging and Help Us Live Longer?

pituitary-gland-and-growth-hormoneHuman Growth Hormone (HGH) is a hormone produced by the pituitary gland, and it is responsible for the growth and maintenance of tissues and organs in the body throughout our lifetime. Once an adult hits middle-age, the natural production of HGH slows, inspiring many scientists and researchers to speculate that there may be a link between HGH and the aging process.

For years, HGH boosters have been used as a treatment for various ailments, but claims of anti-aging properties have caused many to turn to HGH boosters in an effort to not only stave off their own mortality, but also the many wrinkles that come with it. How effective is this treatment? Is this the proverbial lightening in a bottle? According to Dr. S. Jay Olshansky, in Part I of “Quest for Immortality,” we aren’t quite there yet.

hgh_6mIn this episode, Dr. Olshansky references Dr. Alan Paul Mintz as one of the key pioneers in HGH and aging research. Claiming more energy, improved physical condition, and better sex, Dr. Mintz and his followers were rabid proponents of using HGH to slow aging, but Dr. Mintz admitted that he wasn’t certain if this treatment could be detrimental in the long-run.

Dr. Olshansky explains that Dr. Mintz’s research was based on a widely-cited study in 1990, which reported increased mental acuity, muscle mass, and improved libido in test subjects who were given HGH boosters. However, since that time, a number of researchers have cited that long-term HGH supplementation seems to be attributed to earlier death in both animals and humans.

With short-term side effects being so positive, we were curious about the mechanism that caused earlier deaths from long-term exposure to HGH supplementation. Dr. Olshansky explained that HGH causes all cells to grow rapidly, even the bad ones. So, as the test subjects displayed increased muscle mass, mental acuity, and libido, it is likely that many of the subjects were experiencing increased cancerous cell growth as well.

In the end, it appears that our natural shutdown of HGH production may actually be a protective measure which enables us to live longer. Thanks biology! If you’d like to hear Dr. Olshansky discuss Human Growth Hormone, Aging, and Immortality, you can check out the full episode here:

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Transgender, Transition

Dr. Johanna Olson-Kennedy visited the studio and shared her insight on transyouth care today. She examined the facts, complexities, and hardships for individuals with gender dysphoria and addresses the societal stigma. We transcribed an especially poignant section of this episode below.

(56:15)
“When conformity is at a premium in the middle school years, feeling different for any reason is horrible and so for a young person that has not socially transitioned yet, I always say that before you disclose your authentic gender, your secret is you’re trans. And after you socially transition and you’re presenting as your authentic self, your secret is you’re trans.

That’s ongoing and for a lot of people, secret equals shame. Living with shame on a daily basis is hard. It’s a big task and it shows up in a lot of ways. For older kids, there are questions like: who am I going to partner with? How am I going to tell people this truth about myself? And how am I going to talk about it? Who do I have to tell and when do I have to tell them?

There’s a common perception that people have and it comes from parents a lot as well, that if they don’t disclose this information, they’re lying to people. Actually you’re not, this is private information. You should have the right to disclose it or not depending on your situation and what feels right for you. There’s a constant ongoing thing that I hear that cisgender people feel entitled to know things about trans people that they have no right to know. Empowering young people to say, ‘Google it. You wanna know more about it? Google it. I’m not obligated to tell you my life story. I’m not obligated to tell you about my body. I’m not obligated to tell you about my genitals or any of those things.’

That’s a really important piece for both families and young people to have in order to be armed to move forward and feel better. At the end of the day, until we start celebrating trans identities, we really can’t expect young people to integrate trans identity into their core self with great happiness.”

This is only a brief preview of the valuable information that Dr. Olson-Kennedy shares. To hear the full podcast, visit iTunes.

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