Some of the oldest works that have come down to us identifying the pathologies of expertise were written by the Pyrrhonist philosopher Sextus Empiricus. Although most of his works focused on these pathologies as they showed up in philosophy, he also wrote about how they showed up in other fields such as medicine, music, mathematics, and rhetoric. The surviving work that is the best example of this is known as Against the Professors (other translations of the title are Against the Learned, Against Those in the Disciplines, and Against the Mathematicians - the last being a common but bad translation). The book is a slog to read because much of the content is about now arcane and obscure expertise that was state of the art in the Roman Empire during the second century CE. The general principles Sextus used, however, are timeless.
Before going into those principles, it’s worth mentioning that one principle now popularly attributed to Sextus is actually not one of them. That principle is, “Those who talk should do and only those who do should talk.” This quote is now frequently misattributed to Sextus. The true source of the quote is Nassim Nicholas Taleb. Here’s the section in his book Skin In the Game where he implies this quote is from Sextus:
…science has been taken over by vendors using it to sell products (like margarine or genetically modified solutions) and, ironically, the skeptical enterprise is being used to silence skeptics.
Disrespect for the vapidly complicated, verbalistically derived truths has always been present in intellectual history, but you are not likely to see it in your local scientific reporter or college teacher: higher-order questioning requires more intellectual confidence, deeper understanding of statistical significance, and a higher level of rigor and intellectual capacity—or, even better, experience selling rugs or specialized spices in a souk. So this book continues a long tradition of skeptical-inquiry-cum-practicalsolutions—the readers of the Incerto might be familiar with the schools of skeptics (covered in The Black Swan), in particular the twenty-two-century-old diatribe by Sextus Empiricus Against the Professors.
The rule is:
Those who talk should do and only those who do should talk
with some dispensation for self-standing activities such as mathematics, rigorous philosophy, poetry, and art, ones that do not make explicit claims of fitting reality.
Sextus gave no rule that looks anything like that. But it is true that Sextus found fault with things that might be called “vapidly complicated, verbalistically derived truths.” I’d use terms such as “theory-bound” or “abstract rule laden.”
Sextus begins Against the Professors with a comparison between the two ancient philosophical schools known for critiquing expertise: the Pyrrhonists and the Epicureans. There was no need to mention other schools, such as the Stoics, Platonists, and Aristotelians. They were all in on expertise.
Epicurus’ criticism was that cultivating various kinds of practical know-how did not lead to wisdom. As such, it was a waste of time. The Pyrrhonists, however, do not take that position. Instead, they praise the acquisition of know-how cultivated from experience. The problems Sextus gives with expertise are:
Firm belief in theories, especially when that belief is allowed to take precedence over or beyond experience.
An insistence that the experts have the proper and correct criteria for making judgments.
Overconfidence.
Self-serving.
Fraudulance.
Treating ordinary people or others with insolence.
Given the variety of things in which one could profess expertise in during Sextus’ era, Sextus singled out only a few disciplines for critique. He says almost nothing about why these and not others, but the implication is that only certain fields had contracted these diseases of expertise. One field that he mentions as being outside his critiques is astronomy, excusing it because it was based on observations and had practical utility for navigation and agriculture. The infected disciplines were the ones as, Taleb says, tend to derive their “truths” verbalistically rather than through observation. Hence, at one end there’s expertise how to do things that just involve physical reality and at the other end there’s expertise about things that are just in people’s heads. The more that physical reality is involved, the more likely that expertise is real. The less it is involved, the more likely that the expertise is more a matter of persuasion than it is a matter of facts.
Further complicating matters is that expertise is not binary; it’s a spectrum. How much knowledge is required to make an expert is the same kind of question as how much sand is required to make a heap. Moreover, in any field, the issues range in difficulty from easy to impossible. There are pressures and incentives for experts to make pronouncements beyond their expertise. This is where overconfidence comes into play.
A problem that Sextus doesn’t mention but which can be derived from the ones he does mention is the tendency for experts to attempt to enforce groupthink, for self-serving reasons. Dissent from expert opinion is a problem. If there are a lot of dissenters, then one gets conflicting schools.
These problems with expertise are now far more important than they were in Sextus’ time. Our society is built on vast webs of know-how. When these diseases infect experts, calamity can result. Taleb’s books have good examples of this. The 2008 financial crisis was caused by over-confident, self-serving experts who firmly believed their theories, who disconnected themselves from facts, and who put pressure on everyone to go along. As the historian Wilfred McClay wrote in 2009 in his article, “What do Experts Know?”:
…we can learn a great deal from a remarkable — and admirably honest — confession by economist Robert Shiller, who had advised the Federal Reserve Bank of New York until 2004 but kept quiet about the dangerous housing bubble he thought he saw developing. "While I warned about the bubbles," Shiller said, "I did so very gently, and felt vulnerable expressing such quirky views. Deviating too far from consensus leaves one feeling potentially ostracized from the group, with the risk that one may be terminated."
In other words, the "communities of the competent" sometimes behave more like communities of the complacent, or communities of the conforming. What Shiller describes is a situation that was made intellectually and morally dangerous not by the fact of expert consensus itself, but by the illegitimate way in which the existing consensus was arrived at and preserved: by the fear that dissenting views could not be safely aired. The strong moral discipline that characterizes a rigorously truth-seeking scholarly community is exceedingly difficult to create, let alone to sustain. Yet without it, expert opinion is soon rendered useless. We see this scenario acted out again and again around important issues of great public moment, about which loud voices and lazy journalists declare that "all the experts are in agreement" and "the debate is over" and that those who dissent are "deniers." Nothing corrodes the spirit of science and truth-seeking more than this bullying dogmatism….
On the other hand, there’s the problem of too much differing opinion. Here’s Luke Burgis’ take on it, from his article, “The Cult of Experts.”
…expertise is now, in some sense, hidden from view: We are told to trust the experts because they have certain credentials or have been cited by other experts; we can’t see their expertise with our own eyes, as we may have been able to do in times passed. In our modern, secular society, each person is considered free to choose their own experts to follow. “Once we are deprived of transcendental guideposts we must trust our subjective experience,” wrote [René] Girard. The dilemma is that “whether we like it or not, we are little Cartesian gods with no fixed reference and no certainty outside of ourselves.” … The result is that experts are pitted against one another like warring gods, and there is not always an easy way to know which one is worth listening to. We can’t know which expert is superior in real time like we could see that Tiger Woods was the best golfer in the world during his prime. We must rely on intermediaries: the media, friends, markets.
Sextus gives some guidance on how to navigate between this Scylla and Charybdis:
How theory-dependent is the expertise? Experience, even when there’s no understanding of causality, is a better basis for decision making than theories that are not well-grounded in experience.
Who is getting to decide what is good? Beware of anything where the experts say they are the ones who should get to decide what is good and bad.
As our society becomes increasingly complex, we rely more and more on experts, making the problems with expertise that Sextus and others have pointed out increasingly important.
A good example of this increasing importance is in the field of medicine. Although doctors have been around since the days of ancient Greece, until the modern era, there wasn’t much that could be done. Handed down in my family is a book written by my ancestor James Cockburn Black, a self-taught part-time country physician who lived in the mid-1800s, in a time and place where it would take a day’s journey to reach anyone with substantively more expertise. The book contains then-state-of-the-art treatments for a vast array of ailments, but most of the treatments probably just worked using the placebo effect and the body’s natural efforts to heal.
Since then, medicine has greatly advanced, but it is still far from perfect. Early in my life, I experienced some instances of bad medical advice that have made me skeptical of doctors. As fate would have it, I ended up marrying a doctor - one who has her own Substack, circumspectly titled N of One, where she has published a companion article to this one. Over her career the deference to medical expertise has changed a lot. First it was the insurance companies questioning her treatment decisions. Then came the internet, empowering patients to question things they previously could not have known anything about.
Some physicians cannot tolerate what they see as an affront to their expertise. They will lash out at the patients for trusting Doctor Google over themselves. I have experienced this myself. I have a rare heart condition that I diagnosed myself with the aid of Doctor Google. I went to a cardiologist anyway, just to make sure. The cardiologist concluded that I had a “textbook case” of what I already thought I had. So far, so good. Then he said that he would prescribe the standard treatment.
That’s odd. Doctor Google had advised me there was no treatment.
The cardiologist said the treatment would be beta blockers to lower my high blood pressure and statins to lower my high cholesterol.
I responded, “I don’t have high blood pressure. I have never had high blood pressure.” At that, he looked at the data he had: two readings his staff had taken. Both were on the low side of normal. As the data did not correspond with his ideas, he took a blood pressure reading himself. It was lower than the prior two readings. He said, “okay, I guess we don’t need the beta blockers, just statins for your high cholesterol.”
I replied, “ I don’t have high cholesterol. I have never had high cholesterol.” Now, visibly annoyed with me, he pulls up my medical record, which informs him that I am correct. He became angry at me and said I should take statins anyway. I question this. He evades my question and tells me to go back to my primary care physician, have the test redone, and if unless my results were absolutely perfect to have him put me on statins. He then abruptly left the room.
Had I assented to his unwarranted “standard” treatments, I would have created a revenue stream for the doctor, due to the follow-up visits. But worse, it turns out that I also have problems with low blood pressure that have become more evident as I have aged, including an incident where I passed out, hit my head going down, got a concussion, and then an ambulance ride to the emergency room. Had I taken the beta blockers he was about to prescribe without consideration of what my blood pressure actually was, serious problems could have resulted.
As icing on the cake, I used to be a regular blood donor. Not anymore. Because my condition has a scary-sounding name, the Red Cross won’t let me give blood. Never mind that nobody there knows anything about my condition. It’s so rare my wife had never heard of it. Never mind that, except for the occasionally unpleasant symptoms, the condition is harmless. Never mind that I brought the Red Cross a letter from my physician detailing that my condition posed no risk in giving blood. Apparently, the Red Cross’s experts are experts in disregarding other experts in order to evade cultivating expertise in things they claim to be experts in so that they can make expert judgments based on how scary sounding a name is - an unsurpassable, expert achievement in deriving “truth” verbalistically.
It is perhaps no wonder that experimental artificial intelligence programs are already being shown to have better judgment than a large proportion of practicing physicians. As these systems are improved and deployed, it’s going to be interesting to watch what happens to the status and operations of experts.
also seen Against the Grammarians, which is how I came by circuit odd and various, to buying your book.
Sorry about Doctor Google leading to less compassion there... nut a good outcome.
Went to the doctor today (we have a similar system to Canada in Australia) post-check on new hypertension medication (after an appendicitis scare not connected). My GP is on leave, but the same notes with a new face, … now generally they do not have time to read the aged patients notes, so the new faces they are usually receptive to the patient's corrections, especially if they re-frame. No, not haemachromotosis, …see the haematology report from 3 years ago, 'we' tested the known marrow mutations but stopped at a hip biopsy because the high ferratine levels were inconsistent and it remains a mystery. Also I have a gut parasite no one worries about, as it lacks illness in the healthy... but now I am boasting.
Also in Australia the specialist will prescribe treatment but they will often shift the ongoing conversation and visits back to the GP (as well as initial prescription informed by their report).
I am sorry to hear about your negative experience with your Cardiologist. It’s my profession for 45 years & I can’t think of Physicians in Canada handling your case the way it was done. In our one payer system Physician behaviour is different. Because you can’t see a specialist without a family doctor referral, the person you describe would be out of practice in a short time. Your wife is a Doctor & it’s good to do Google search & she can help you navigate it.
All the best & don’t distrust doctors.