Blog | Wednesday, July 25, 2012

Who do ya trust?


A reporter emailed me last week to ask my opinion about a publication from the United States Preventive Services Task Force about obesity. I e-mailed back something bland. I found the recommendations eminently reasonable but was unsure if they could be applicable in the everyday clinical environment.

But of course I was going to be in general agreement; the manuscript came with the imprimatur of the USPSTF. Far be it from me to second-guess a manuscript that's authored by folks who have immersed themselves in the field, actually read and thought about the 15 or 20 references, and responded to comments by the lay public ranging from thoughtful to nutso.

Why did the reporter want my opinion? Because I'm a poly-diploma'd doctor at a fancy medical school who has his name on scientific papers and is interested in evaluating evidence in a careful way. Not because I'm more expert on obesity than your average academic internist.

So the question rears its head: how can a non-expert evaluate the work of an expert? A healthy dose of skepticism is needed. Or even more, we need experts who point out that most experts are wrong.

But we need the other side of the coin too. We need to be able to trust, because we can't check everything ourselves. This isn't just a question of epistemology (How can we know something we can't see with our own eyes?) but a question of emotional reliance. Sure we can't trust everyone. People bought and paid for by Big Pharma, for example, why should we trust them?

But if structures are in place to ensure some trustworthiness, we can believe. There is a balance to be struck between radical skepticism on the one end and drooling credulity on the other. Otherwise we could never make any decision at all.

Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews. He is also a poet, journalist and translator in Yiddish and English. This post originally appeared at his blog.