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The Cancer Journal - Volume 11, Number 2 (March-April 1998)

editorial


Are experts serial killers?



I have occasionally taken part in the committees of scientific and technical "experts" which regularly decide priorities in biomedical research. By this I mean recommending a number of themes and subjects on which to concentrate resources. This is presented as a precise exercise in scientific policy-making. Their members are supposed to be chosen for their overall vision of the current state of biomedicine and their ability to deduce the most favourable orientations for the future.

As a young man, I was flattered to find myself among people endowed with such perspicacity. I naively believed that these experts, much more expert than myself, would be able to teach me how to foresee the future, or at least make reasonable propositions. I found this exciting. When I became older, less naive but still not very expert, I began to question my colleagues about how they reached their uninspiring consensus, full of molecular biology, biotechnology, neuroscience, cognitive science, numeric imaging, pharmacokinetics, interfaces with biochemistry, with computing, with the North, with the South, with the East and above all with the Westand so on. I began to wonder about their expertise, because the same themes and the same key words, sometimes randomly associated, seemed to issue from every committee and appear in every report, whether it be European, American, Japanese, Russian So much so that one could imagine that all the experts were reading the same text-books, and obtaining their information from the same sources, which are called, as you well know, Science, Nature, New England Journal of Medicine, The Lancet and a few others. When they encounter original ideas, experts are sometimes serial killers.

Nourished by a single culture, the experts whom I have had the privilege of knowing, probably a representative sample of the whole population of experts in biomedicine, could be divided into two groups: the believers and the sceptics. Just like the rest of us - the "inexperts", in fact. The believers declared themselves convinced that the themes that they had chosen arose from a de-novo selection process and, among those considered, they were undoubtedly the ones more likely to advance the frontiers of science. The sceptics, like myself, had their doubts, not about the interesting nature of the subjects chosen, but that the subjects which had be rejected from the list of priorities were uninteresting. Above all, the sceptics, who were far from being cynics, were surprised by the similarity of the programmes emanating from so many different committees. They could interpret this in one of two ways: 1) admit that the chosen priorities were not relative but absolute, objective and based on truth. No sceptic can accept such a dogmatic position; 2) consider that they were right to be sceptical, but how to make themselves heard by the deaf ears of the believers?

Strong in their certainties, as opposed to the divided sceptics, helped by an almost unchallenged continuity, the "real" experts (for how can a real expert have doubts?) are content. If medicine is not progressing as rapidly as the science they advocate, this is the fault of diseases like AIDS, multiple sclerosis and cancer, which resist when they should succumb, of patients who insist on wanting to feel better, of society which is not perfectly rational and, of course, of practising doctors who do not have the required knowledge.

However, the sceptical experts, dare I call them "impostor" experts, and above all the "also-rans", who do not sit on any ad hoc committees, who are left out of strategic thinking, who complain quietly but go along with the priority programme with a semblance of submission, could take the initiative and try to shake this self-satisfied unanimity. Until now, the surveillance of science and technology, comparative evaluation, an overall vision of results and tendencies, the geographical and geopolitical view, were all areas restricted to decision-makers. Information was difficult to get hold of and considerable manpower was necessary to sift through its volume and unearth the elements making up "scientific and economic intelligence". This real or supposed power depended on the ability to process a large amount of dispersed data.

In the space of a few years, the globalisation brought about by Internet means that many databases are available to anyone, with the opportunity to find, select and download large amounts of data (data mining). The problem is no longer getting information, although some remains inaccessible, but processing it to provide knowledge. Programmes for analysing textual and numerical data are now available for personal computers. The processing of data to obtain useful information (data milling) is now possible for the open-minded, with a little training, mostly in practice. In this respect, scientific culture, an element rarely found today, will come into its own because, after this computerised processing, a lively imagination will be required to assimilate the original and sometimes surprising elements which will emerge. The role of expert or committee member does not seem to be a good preparation for this activity. Therefore, we should expect to see gifted "amateurs" taking over from the accredited experts in the field of forward planning.

Jean-Claude Salomon

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