It is perhaps an understatement to say that expertise has undergone something of an assault in recent years. Under the post-truth condition, experts and their knowledge have been under attack from politicians, commentators, and ironically those who oppose politicians and the state. It seems that expert bashing suits the purposes of anyone who wants to defeat orthodoxy for their own ends and, or to win the argument (Fuller 2020). One thinks of course of the COVID-19 pandemic, and so my mind is drawn inevitably to publications here on SERRC which question the science on vaccines and much more. Articles cautioning governments against ‘epistemic arrogance’ and advising ‘epistemic humility’ weren’t exactly ubiquitous during that time, but they also left their mark on me. … [please read below the rest of the article].

Image credit: Routledge

Making Sense of Expertise: Cases from Law, Medicine, Journalism, Covid-19, and Climate Change
Reiner Grundmann
Routledge, 2022
210 pp.

Epistemic Modesty

I confess to being an Enlightenment sucker. Thus, I write this review with epistemic humility much in mind. Indeed, inverting that concept, I suggest that we ought to show some modesty in questioning expertise, particularly science. I believe in science and technology, and the people who I see as having earned their credentials.^[1] Academia and the professions are hierarchical after all,^[2] as is society. It would be strange if other people with qualifications in their own fields didn’t know more about a subject than I do, although we will find out if my hunch is correct or not by the end of this review.^[3] So, it’s both pleasing and frustrating to read Reiner Grundmann’s Making Sense of Expertise which offers new definitions of expertise, and indeed, a conceptual framework to understand and define it.

Intriguingly, Grundmann uses a musical metaphor to differentiate between the two positions on expertise I’ve just outlined: my own uncritical pro-expert stance against the critical, withering attacks of the anti-expert brigade. Grundmann uses the Beatles’s ‘Hey Jude’ to represent my position and Jimi Hendrix’s rendition of ‘Star-Spangled Banner’ to represent the irreverent, parody-like questioning from a not entirely on-board Greek chorus. Grundmann describes how the long coda in ‘Hey Jude’ articulates the mantra of the expertise protectorate. I see how Jimi Hendrix’s withering guitar chords evoke the dissonant chords of the anti-expert lobby, but the Beatles metaphor is slightly lost on me.^[4]

Perhaps given the damage the anti-expert, often far-right conspiracy theories are arguably doing to expertise, the Clash’s ‘Clampdown’^[5] would be more appropriate—the song warns of the dangers of working for, with dark forces—the implication is that perhaps it’s better to ‘get running’^[6] or better still, resist, hold the line, as the lyrics of the Clash song state. However, given that we live under the post-truth condition, in which words are lost in a ‘Tower of Babel’^[7] like world of ‘alternative facts’, perhaps Killing Joke’s song ‘Requiem’^[8] would be more appropriate. The lyrics go something like this ‘when the meaningful words, when they cease to function, when there’s nothing to say, when will it start bothering you?’ The implication of these few words will become obvious to the reader as my review traverses the expanded concept of expertise that Grundmann sets out in his book.

Indeed, Grundmann’s very technical and theoretical book is divided into three parts. Part 1 puts forward a conceptual framework for the analysis of expertise and experts in contemporary society. Part 2 examines several empirical cases in this conceptual framework. Part 3 discusses the implications for society of Grundmann’s analysis in which he introduces a new typology.

Whether to agree on the inclusion of categories such as journalism and commentators in a discussion on experts and expertise which includes the new category of ‘specialist’^[9] will be up to individual readers. Grundmann also includes AI—artificial intelligence in his new framework as he argues no work on expertise would be complete without out it, and indeed, I have discussed this very subject and the issues surrounding it here on SERRC in the past.

Interestingly, in the blurb written by Nico Stehr at the beginning of this book, we are told Grundmann clears up the confusion surrounding expertise particularly in the areas of climate change, which is Grundmann’s area of expertise, and of course, around COVID-19. This is reassuring to hear; however, one wonders in the post-truth age this is possible: the misinformation and conspiracy surrounding both of these existential threats surely requires that we delineate expertise in order to fight these. Presumably this is in part why Grundmann tackles these two fields of expertise together in a comparison of similarities and differences (98).

The real rationale is of course to unravel and then reconstruct what expertise is. I’ll let you know at the end of this review if Grundmann does this with humility as I define it above or deconstructs expertise as many have during the pandemic, because as Grundmann states in his introduction (1-3) the reason expertise has evolved is because of the constant questioning of its validity. I’ll also tell readers whether this book does in fact ‘make sense of expertise’ (author’s emphasis). However, due to the limitations of space in this review I intend to focus on Grundmann’s concept of expertise and his account of COVID-19.

Critical Reviewing: What is Expertise?

Before I begin this review in earnest, I want to address some thoughts raised by an article by Adam Riggio (2023). Riggio said that as writers we can all too easily fall into the trap of finding fault in the books we review, but I am minded that if there are inconsistencies in argument and research then we should address these however uncomfortable this feels, in the spirit of dialogue.

Of course, in this case it might feel quite galling for an expert on expertise and who is situated in the field of Science and Technology Studies (STS) to have his book reviewed by a sociologist who is more engaged in political life, in academe and out and engaged in a cultural critique.^[10] As readers of SERRC will know, Grundmann has written extensively on expertise and, climate change. Perhaps this gets to the crux of the matter regarding my own argument: Am I qualified to assess Grundmann’s own expertise? I’ll return to these thoughts at the end of this review. Thus, in reviewing this book I make my intentions transparent at the outset. I am interested to what degree Grundmann supports expertise in what seems to be an exercise in extending its definition, albeit through other terminology.

A Very Generalized Concept of Expertise

In chapter one, ‘A General Concept of Expertise’ (9-18) Grundmann takes us through what seems like a panoply of ‘specialisms’ (author’s emphasis) which apparently render all forms of knowledge cognitive or practical as expertise. Grundmann (9) first makes a distinction between cognitive and practical knowledge in a section called ‘Knowledge-based expertise’. However, Grundmann conflates knowledge, skills and experience, and this is where my own social science-based definition of expertise (as Grundmann refers to this understanding) deviates from Grundmann’s much more generous understanding of expertise. I have usually equated expertise with Grundmann’s definition of cognitive knowledge which he defines as factual, credible or certified knowledge. However, Grundmann says all forms of knowledge are relational (perhaps ‘relative’ would be a better word), citing sportspeople and across examples where skill and experience are performed to different degrees.

Grundmann then writes about the ‘capacity to act’ concept developed by Nico Stehr and the ‘instrumental’ (author’s emphasis) use of knowledge. Grundmann talks about how this is the capacity to do some good in the world or at least make a difference and this is where I take issue with the inclusion of so many categories of expertise because if we are all experts, even with different degrees in the capacity to act then what does the term expert really mean, in other words, what power does the traditional expert retain in society?

Perhaps of more significance in this section, Grundmann talks of the process of negotiation between experts and presumably people with publicly available knowledge (citizens and commentators) and, again presumably their own experience. To illustrate my own understanding of Grundmann from a lay perspective, (although I do not completely concur with Grundmann here) I just want to give some recent personal examples of expertise interacting with lay and public knowledge and indeed, the sometimes conflictual nature of this.

Medicine via Education: A Challenge to Medical Expertise

Recently, a friend was taken into hospital. Before going to hospital there ensued a dialogue between family, my friend’s private carers and non-emergency and emergency handlers via telephone calls. At all stages this involved dialogue and negotiation between all, based on cognitive knowledge, qualified personnel and the family who were asked for and provided their opinions, which were based on knowledge and experience of my friend’s medical condition. As my friend’s condition worsened, she was taken into hospital. We visited her in the Emergency Department after paramedics had driven them to hospital while taking their blood pressure and administering an ECG using their portable kit. We left them in the capable hands of the highly qualified nurses and doctors at 7 p.m. Or so we thought.

At 11:30 p.m. the phone rang. It was a consultant from the Emergency Department. To cut a long story short, she obviously had very little information at hand about my friend and required everything from the information immediately surrounding her admission to hospital by paramedic ambulance but wanted to establish her ‘baseline’, her normal daily function capability. Only we could give this vital information to enable the consultant to make a critical potentially life-saving decision about treatment and medication of which she was unaware. This expert, ‘specialist ‘needed our knowledge and experience, which included our now quite comprehensive knowledge of medication to carry out her sophisticated treatment of my friend We also suggested the possibility that my friend might be suffering from a urinary tract infection (UTI) which the consultant hadn’t considered. Whether this should have been necessary is a question for another time and place.^[11]

What is interesting is the nexus between expertise, specialists and the public: Grundmann’s typology, which is represented in a table on page 11 of Grundmann’s book and this very general concept of expertise which is perhaps expressed in my anecdote above. That is the negotiations between experts and citizens. The category of commentator might well come into play here in the context of a critique, because as I indicated above, whatever difficulties and pressures medics are under they are presumably trained well-enough to be aware that an elderly woman might be suffering from a UTI—urinary tract infection. In fact, as well as writing in some depth about Latour (20–21) Actor Network Theory (ANT), also articulated above, and just to widen the concept of expertise even further, Grundmann invokes Berger and Luckmann’s Social Construction of Reality,^[12] which of course in the context of a discussion on medicine and expertise has the effect of diminishing the notion of expertise.

Indeed, the saga of my unwell friend grew more concerning in exactly this way. A ‘specialist’ in gerontology and in cardiology and strokes (cardio-vascular disease) decided that in his professional expert ‘opinion’ (author’s emphasis) my unwell friend had been incorrectly prescribed two drugs together Apixaban, an oral anti-coagulant and Clopidogrel, an oral anti-platelet drug. My friend had been prescribed these two drugs to take together after her last stay in the same hospital and this dual therapy had been confirmed as being correct by her local general practitioner and pharmacist.

However, this specialist had not heard of this treatment and said it wasn’t something they did at that hospital because of the risk of bleeding particularly after falls. This is despite the clear evidence available to all that this is a recognised therapy for those at risk from heart attack and TIA’s—trans ischemic attacks.^{[13], [14]} Moreover, his position flew in the face of our and his own most recent knowledge of my friend’s condition: she had fallen three times in a week but not suffered any internal bleeding.

What can we deduce about expertise in this instance? I’ll leave the reader to ponder this and point them to chapter 9 of Grundmann’s book (110), ‘The Challenge to Medical Expertise’, which I must confess to the reader I only read in detail after writing the above anecdote.^[15] Grundmann actually discusses how lay people can become citizen experts (scientists) as they challenge medical authority. I’ll return to this significant issue of disagreement with the knowledge of experts in my conclusion. First however, I want to revisit the notions of epistemic humility and epistemic arrogance which are perhaps hiding in plain sight in this section

COVID-19, Ideology, Incompetence and the Saving Grace of Vaccines

I alluded to conspiracy theories at the outset of this review which centre round the pandemic and climate change. It is interesting and alarming that at this moment in the UK there is row-back by conspiracy theorists, who champion the opportunities the post-truth condition offers them, against every aspect of the pandemic, from mask-wearing to lockdown to the epidemiological data post-pandemic.^[16] This includes the inversion of data showing how incidences of heart attack and stroke have increased in those who suffered severe infection.^{[17], [18], [19]} Conspiracy theorists are having a field day reversing the data to argue vaccines have caused these. If there is an overriding reason to welcome Grundmann’s book it is the opportunity to redress the balance.  So, it is in this context I review Grundmann’s writing on COVID-19.

First a word of warning to readers. Grundmann’s writing remains objective and theoretical despite the emotive nature of the pandemic. In other words, you won’t find much controversy here except for what I perceive as a missed opportunity to rehabilitate expertise in the context of the failings of many governments at the outset of the pandemic when lives were lost as warped ideological beliefs on for example, herd immunity took precedence over the obvious impending existential emergency. I am of course referring to the UK here as I write from this country’s perspective.

Thus when Grundmann appears, as he does in chapter 8, ‘Covid, Expertise and Society: Stepping Out of the Shadow of Epidemiology’ to me to give a very generalized and negative account of the global epidemiological models governments took up and used during the pandemic, along with non-pharmaceutical interventions (NPI’s), in other words, vaccines combined with social distancing and mask-wearing, he effectively redacts much of what science—expertise had known and warned of for many years. A cursory watching of Netflix’s Pandemic would confirm this. Public institutions and private science hubs worked furiously to keep track of each new emerging virus. There was no doubt a pandemic would come; the only question was when and where it would emerge.

The evidence for this and more importantly in the context of this discussion, scientific and medical development is clear (Honigsbaun 2019; Hewitt 2022). I don’t propose to go into this in detail here because of limitations of space, and because I have previously written on SERRC about the way science and medicine follow a Kuhn- and Popper-like dialectical movements in the discovery of bacterial infections, viruses and treatments to combat these. The process, as Honigsbaum (2019) argued, is never ending.

Thus, when Grundmann talks about the biomedical model being the only game in town, and that this is insufficient, he neglects many of the scientific triumphs of the pandemic, not least the rapid development of vaccines, which were the saving grace of the pandemic, and the identification of variants of concern. Grundmann’s take on this triumph is really quite negative as he talks depressingly of how vaccines aren’t a 100 per cent effective and can’t keep up with the mutations of SARS-CoV2. It is clear from even cursory research, as I’m sure Grundmann knows, that the development of vaccines goes on.^{[20], [21]} I don’t think science and medicine claimed they were the panacea for the COVID virus. As with influenza, vaccination research and practice is a constant requirement.

Grundmann also seems to neglect the very obvious differences between governments across the world in their approach to COVID-19 and the mistakes made, save for saying different governments took different approaches. For example, he neglects Sweden, where the government refused to introduce lockdown or recommend the wearing of masks, and the UK where government incompetence and epistemic arrogance led to thousands of unnecessary deaths, and New Zealand where a COVID elimination strategy was enforced. The notion of ‘following the science’, which was the mantra of the UK government who clearly did not always follow it, was not a universally applied strategy by any means.^[22]

I also take issue with Grundmann when he mentions SAGE (99),^[23] the British Scientific Advisory Group on Emergencies in the context of the Omicron variant surge of COVID-19 in 2022. Grundmann talks of this advisory body as though they were uninformed or naive regarding the threat of Omicron as it emerged in South Africa. Grundmann suggests that SAGE panicked over this mutation which turned out to be highly transmissible but not as deadly as Delta. As Grundmann knows only too well, there is no scientific evidence to suggest new mutations of SARS-CoV2 will grow weaker. Grundmann also talks of citizen science as he emphasizes the predominance of the bio-medical model. I would say first that the vast majority of citizens obviously played the biggest role they could in the pandemic by testing and queuing for vaccinations. Moreover, behavioural scientists also contributed to knowledge and strategy during the height of the pandemic. This was particularly evident with regard to the wearing of facemasks. A behaviour that many medics in the UK did not at first endorse.^[24]

Finally in this section I’d like to take issue with Grundmann’s treatment of ‘Long COVID’ or Post-COVID Syndrome. After a mostly quantitative and dispassionate section on the differences and similarities between climate change and COVID in which Grundmann uses carbon zero as a metaphor for the apparent desire of the global epidemiological community with regard to the pandemic, Grundmann continues on explaining that Long COVID is pretty much a citizen science concept, which although understandable given the number of high-profile sufferers, doesn’t really do the condition justice. Again, a quick Google search shows the scientific research available on this condition.^{[25], [26]} Grundmann makes Long COVID sound more like the contested chronic fatigue syndrome.^[27] It is obvious by now to the reader that I have sung the coda to ‘Hey Jude’ throughout this section.

The IPCC: Lessons on Climate Change

In chapter 7, ‘The IPCC: A Chameleon of Expertise’ (67) Grundmann seemingly departs from his opening chapter on a general concept of expertise to engage in a lengthy piece on a definition of exactly that. Grundmann presents the IPCC—the United Nations Intergovernmental Panel on Climate Change—as a body that is all things to all people when it comes to the advancing apocalypse that is the global Anthropogenic climate emergency. Grundmann presents a picture of the IPCC as a body that has oscillated on its position, warning on one hand of the impending danger from global warming, on the other saying that things aren’t that bad, to constructing itself as the authoritative voice that conveys a message of hope.

In short, Grundmann argues the IPCC acts as the oracle on climate change. One could say then that the IPCC is performing as a Greek chorus does, echoing the words of the main actors and the varying discourses on the crisis. Given that climate change has, and to an extent still is contested, this might be a very appropriate metaphor for the contested narratives, which Grundmann focuses on. If readers are tempted to think of songs to mirror these different stories, in the same vein as Grundmann’s musical metaphor they are more than welcome to do so.

The recent COP summits have drawn negative commentaries in the media,^[28] as it seems that the purveyors of fossil fuels have at least won a stay of execution. We all remember the disgrace of the conspiracy to discredit those who warned of climate change; a cabal of vested interests firmly located in the fossil fuels industry. However, if we look at IPPC’s website,^[29] we see what appears to be an independent body with, not surprisingly given Grundmann’s presentation, a plurality of scientific contributors. One must wonder how the world might have been today had experts, along with many other NGO’s not been so fatally undermined by the conspirators, and had governments taken notice of the dire warnings.

Conclusion

Sad to say, one must wonder if in this case expertise wasn’t defeated.^[30] I must confess here that I know Reiner Grundmann slightly. I taught with him very briefly some years ago. As soon as I knew I’d be reviewing his book, I remembered a conversation that took place in his office. There had been another inexorable advance towards climate catastrophe, and Reiner was of the opinion that the public wouldn’t be swayed until it was too, or nearly too late. How right he was. Perhaps we ought to take a leaf out of the Clash’s songbook after all: ‘You don’t owe nothing, so boy, get running/It’s the best years of your life they want to steal’.

There is much, much more to Grundmann’s book and for those with an academic interest in expertise it will be a point of reference. However, for an old romantic cynic like me it doesn’t quite hit the right notes. We have seemingly passed the point of no return in so many senses. It has however, been therapeutic, as it confirmed my role as a knowledge active citizen scientist: I wasn’t going mad when confronted with conflicting views from some in the medical profession. Perhaps then, and despite what I said in my introduction, I have a foot in both camps, so to speak, or rather I whistle the tunes of the Beatles and Hendrix simultaneously. Finally, I also said in my introduction, I’d let the reader know if Grundmann had made sense of expertise and/or redefined it. I suppose it never occurred to me that expertise could encompass so many specialisms. What this expansive definition does to the established and vital institutions and organizations under the post-truth condition, we can discern from our experience of climate change and of course, the pandemic.

References

Fuller, Steve. 2020. A Player’s Guide to the Post-Truth Condition: The Name of the Game. New York. London.

Honigsbaum, Mark. 2019. The Pandemic Century: A History of Global Contagion from the Spanish Flu to COVID-19. London: Penguin Random House.

^[1] Grundmann states that my definition of expertise which refers to ‘science’ is one that the discipline of Science and Technology Studies (STS) used to find preferable. Of course, the word ‘discipline’ might once have conferred the notion of expertise.

^[2] In fact, Grundmann discusses the hierarchical, asymmetric power position of experts in society in chapter Six, ‘Expertise and Economics’, which contains sections called ‘A Critique of Expertise’ and Methodological Individualism and Political Individualism’, 58–61.

^[3] Indeed, in his introduction Grundmann discusses the power that experts have or once had to unquestionably pronounce on their particular fields of knowledge.

^[4] In fact, plagiarizing ‘Hey Jude’, football fans in England hum the coda as ‘Nah, nah, nah -nahnahnah!’ in the style of a victory chant when their side has won. What this tells us about the outlook for the pro-expertise camp I leave to the reader to deduce.

^[5] https://youtu.be/_lt4O-EHNnw.

^[6] In other words, the lyrics of ‘Clampdown’ imply we can work with a system which is arguably increasingly shifting to the right, or we leave in the vein of Albert Hirschman’s Exit, Voice, and Loyalty (1970) thesis. Admittedly, this argument can of course be applied to both sides of the expertise debate.

^[7] See: https://www.britannica.com/topic/Tower-of-Babel.

^[8] See the Killing Joke’s song ‘Requiem’: https://youtu.be/U7WPI4TJImo.

^[9] I am reminded of a recent TV news magazine program during which one of the presenters defended a deliberately provocative story, which he precipitated, during which he said he simply reported what he was told. This isn’t the case with all, and particularly serious investigative reporters, however it does beg the question of whether journalism ought to come near to even being described as a ‘specialism’, unless of course we are parodying the word ‘specialism’. In fact, Grundmann seemingly uses the term ‘specialist’ as a cover all, including, teachers, doctors and pilots. One might have expected these professions to simply hold the epithet of ‘expert’.

^[10] Ironically the cultural critique I am engaged with maintains the status quo in terms of expertise; I stated above I believe in science and technology. However, the Clash’s ‘Clampdown’ also contains the lyrics:

Kick over the wall ‘cause governments to fall
How can you refuse it?
The fury of the hour, anger can be power
Do you know that you can use it?

The Clash were a left-leaning band.

^[11] The National Health Service (NHS) in the UK is under severe strain at the present time, due to post -pandemic pressures, years of underfunding and strikes protesting at the former and latter, that is understaffing, lack of resources and, wages which do not recognise these issues.

^[12] See Chapter 3, ‘The Power of the Professions’, 32.

^[13] https://www.acc.org/about-acc/press-releases/2019/03/17/09/05/apixaban-p2y12-inhibitor-no-aspirin-safest-patients-afib-acs.

^[14] There are often two or more schools of thought in medicine and indeed other professions. For example, in the prescribing of anti-biotics for urinary tract infections where some doctors recommend immediate and continuing intervention with broad spectrum drugs to combat a possibility severe infection before establishing its exact nature, where others recommend caution in prescribing until the infection is identified.

^[15] When conducting a review, I find it is useful to use anecdotes and to position then to illustrate the author’s theories and concepts. In this case I intuited that Grundmann would was in fact heading in this direction in his book on citizen science. Perhaps I’m writing in my role as a citizen expert/scientist here.

^[16] https://www.heraldscotland.com/opinion/23228584.not-well-mask-dont-selfish-idiot/.

^[17] https://www.standard.co.uk/topic/andrew-bridgen.

^[18] See this article in The Conversation: https://theconversation.com/even-mild-covid-raises-the-chance-of-heart-attack-and-stroke-what-to-know-about-the-risks-ahead-190552.

^[19] See George Monbiot’s article in the Guardian: https://www.theguardian.com/commentisfree/2023/jan/26/covid-roulette-clean-air-ventilation-long-covid.

^[20]  https://www.nature.com/articles/d41586-023-00220-z.

^[21] https://www.science.org/content/article/powerful-new-covid-19-vaccine-shows-90-efficacy-could-boost-worlds-supply.

^[22] In fact, it is argued that New Zealand did follow the science. However, their geographical position meant that the risk of COVID entering the country before a full vaccination program had even begin paid off. Eventually however, COVID arrived, despite the fierce opposition of anti-vaxxers and anti-lockdown conspiracy theorists.

^[23]  By no means did the UK government ‘follow the science’ at all times during the pandemic. The controversy over this was and is well-documented in the serious UK media.

^[24] https://www.socialsciencespace.com/2020/12/what-the-psychology-of-mask-wearing-can-encourage-their-use/.

^[25] https://www.nature.com/articles/s41579-022-00846-2.

^[26] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid-long-haulers-long-term-effects-of-covid19.

^[27] Of course, citizen science feeds back to medics and science on the condition of Long COVID, however it is clear that this is recognised medical condition and that its symptoms are in fact more serious than Grundmann describes in his book.

^[28] https://www.theguardian.com/commentisfree/2023/jan/16/fossil-fuel-destroyed-cops-un-compromised-cop28.

^[29] https://www.ipcc.ch/about/engage_with_the_ipcc/.

Categories: Books and Book Reviews

Tags: COVID-19, Des Hewitt, epistemic arrogance, expertise, experts in contemporary society, Nico Stehr, Reiner Grundmann, SERRC 8/2/2023