Who Qualifies as an “Expert” And How Can We Decide Who Is Trustworthy?
This article is part of the magazine, "The Future of Science In America: The Election Issue," co-published by LeapsMag, the Aspen Institute Science & Society Program, and GOOD.
Expertise is a slippery concept. Who has it, who claims it, and who attributes or yields it to whom is a culturally specific, sociological process. During the COVID-19 pandemic, we have witnessed a remarkable emergence of legitimate and not-so-legitimate scientists publicly claiming or being attributed to have academic expertise in precisely my field: infectious disease epidemiology. From any vantage point, it is clear that charlatans abound out there, garnering TV coverage and hundreds of thousands of Twitter followers based on loud opinions despite flimsy credentials. What is more interesting as an insider is the gradient of expertise beyond these obvious fakers.
A person's expertise is not a fixed attribute; it is a hierarchical trait defined relative to others. Despite my protestations, I am the go-to expert on every aspect of the pandemic to my family. To a reporter, I might do my best to answer a question about the immune response to SARS-CoV-2, noting that I'm not an immunologist. Among other academic scientists, my expertise is more well-defined as a subfield of epidemiology, and within that as a particular area within infectious disease epidemiology. There's a fractal quality to it; as you zoom in on a particular subject, a differentiation of expertise emerges among scientists who, from farther out, appear to be interchangeable.
We all have our scientific domain and are less knowledgeable outside it, of course, and we are often asked to comment on a broad range of topics. But many scientists without a track record in the field have become favorites among university administrators, senior faculty in unrelated fields, policymakers, and science journalists, using institutional prestige or social connections to promote themselves. This phenomenon leads to a distorted representation of science—and of academic scientists—in the public realm.
Trustworthy experts will direct you to others in their field who know more about particular topics, and will tend to be honest about what is and what isn't "in their lane."
Predictably, white male voices have been disproportionately amplified, and men are certainly over-represented in the category of those who use their connections to inappropriately claim expertise. Generally speaking, we are missing women, racial minorities, and global perspectives. This is not only important because it misrepresents who scientists are and reinforces outdated stereotypes that place white men in the Global North at the top of a credibility hierarchy. It also matters because it can promote bad science, and it passes over scientists who can lend nuance to the scientific discourse and give global perspectives on this quintessentially global crisis.
Also at work, in my opinion, are two biases within academia: the conflation of institutional prestige with individual expertise, and the bizarre hierarchy among scientists that attributes greater credibility to those in quantitative fields like physics. Regardless of mathematical expertise or institutional affiliation, lack of experience working with epidemiological data can lead to over-confidence in the deceptively simple mathematical models that we use to understand epidemics, as well as the inappropriate use of uncertain data to inform them. Prominent and vocal scientists from different quantitative fields have misapplied the methods of infectious disease epidemiology during the COVID-19 pandemic so far, creating enormous confusion among policymakers and the public. Early forecasts that predicted the epidemic would be over by now, for example, led to a sense that epidemiological models were all unreliable.
Meanwhile, legitimate scientific uncertainties and differences of opinion, as well as fundamentally different epidemic dynamics arising in diverse global contexts and in different demographic groups, appear in the press as an indistinguishable part of this general chaos. This leads many people to question whether the field has anything worthwhile to contribute, and muddies the facts about COVID-19 policies for reducing transmission that most experts agree on, like wearing masks and avoiding large indoor gatherings.
So how do we distinguish an expert from a charlatan? I believe a willingness to say "I don't know" and to openly describe uncertainties, nuances, and limitations of science are all good signs. Thoughtful engagement with questions and new ideas is also an indication of expertise, as opposed to arrogant bluster or a bullish insistence on a particular policy strategy regardless of context (which is almost always an attempt to hide a lack of depth of understanding). Trustworthy experts will direct you to others in their field who know more about particular topics, and will tend to be honest about what is and what isn't "in their lane." For example, some expertise is quite specific to a given subfield: epidemiologists who study non-infectious conditions or nutrition, for example, use different methods from those of infectious disease experts, because they generally don't need to account for the exponential growth that is inherent to a contagion process.
Academic scientists have a specific, technical contribution to make in containing the COVID-19 pandemic and in communicating research findings as they emerge. But the liminal space between scientists and the public is subject to the same undercurrents of sexism, racism, and opportunism that society and the academy have always suffered from. Although none of the proxies for expertise described above are fool-proof, they are at least indicative of integrity and humility—two traits the world is in dire need of at this moment in history.
[Editor's Note: To read other articles in this special magazine issue, visit the beautifully designed e-reader version.]
Podcast: New Solutions to Combat Gluten Sensitivities and Food Allergies
The "Making Sense of Science" podcast features interviews with leading medical and scientific experts about the latest developments and the big ethical and societal questions they raise. This monthly podcast is hosted by journalist Kira Peikoff, founding editor of the award-winning science outlet Leaps.org.
This month, we talk Anat Binur, the CEO of Israeli/U.S.-based biotech company Ukko. Ukko is taking a revolutionary approach to the distressing problem of food allergies and gluten sensitivities: their scientists are designing and engineering proteins that keep the good biophysical properties of the original proteins, while removing the immune-triggering parts that can cause life-threatening allergies. The end goal is proteins that are safe for everyone. Ukko is focusing first on developing a new safe gluten protein for use in baking and a new peanut protein for use as a therapeutic. Their unique platform could theoretically be used for any protein-based allergy, including cats and bees. Hear more in this episode.
Watch the 60-second trailer
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Kira Peikoff was the editor-in-chief of Leaps.org from 2017 to 2021. As a journalist, her work has appeared in The New York Times, Newsweek, Nautilus, Popular Mechanics, The New York Academy of Sciences, and other outlets. She is also the author of four suspense novels that explore controversial issues arising from scientific innovation: Living Proof, No Time to Die, Die Again Tomorrow, and Mother Knows Best. Peikoff holds a B.A. in Journalism from New York University and an M.S. in Bioethics from Columbia University. She lives in New Jersey with her husband and two young sons. Follow her on Twitter @KiraPeikoff.
Can a Non-Invasive Magnetic Helmet Treat Brain Cancer?
Glioblastoma is an aggressive and deadly brain cancer, causing more than 10,000 deaths in the US per year. In the last 30 years there has only been limited improvement in the survival rate despite advances in radiation therapy and chemotherapy. Today the typical survival rate is just 14 months and that extra time is spent suffering from the adverse and often brutal effects of radiation and chemotherapy.
Scientists are trying to design more effective treatments for glioblastoma with fewer side effects, and a team at the Department of Neurosurgery at Houston Methodist Hospital has created a magnetic helmet-based treatment called oncomagnetic therapy: a promising non-invasive treatment for shrinking cancerous tumors. In the first patient tried, the device was able to reduce the tumor of a glioblastoma patient by 31%. The researchers caution, however, that much more research is needed to determine its safety and effectiveness.
How It Works
“The whole idea originally came from a conversation I had with General Norman Schwarzkopf, a supposedly brilliant military strategist,” says David Baskin, professor of neurosurgery and leader of the effort at Houston Methodist. “I asked him what is the secret to your success and he said, ‘Energy. Take out the power grid and the enemy can't communicate.’ So I thought about what supplies [energy to] cancer, especially brain cancer.”
Baskin came up with the idea of targeting the mitochondria, which process and produce energy for cancer cells.
"This is the most exciting thing in glioblastoma treatment I've seen since I've been a neurosurgeon, but it is very preliminary,” Baskin says.
The magnetic helmet creates a powerful oscillating magnetic field. At a set range of frequencies and timings, it disrupts the flow of electrons in the mitochondria of cancer cells. This leads to a release of certain chemicals called Reactive Oxygen Species, or ROS. In normal cells, this excess ROS is much lower, and it's neutralized by other chemicals called antioxidants.
However, cancer cells already have more ROS: they grow rapidly and uncontrollably, so their mitochondria need to produce more energy which in turn generates more ROS. By using the powerful magnetic field, levels of ROS get so high that the malignant cells are torn apart.
The biggest challenge was working out the specific range of frequencies and timing parameters they needed to use to kill cancer cells. It took skill, intuition, luck and lots of experiments. The helmet could theoretically be used to treat all types of glioblastoma.
Developing the magnetic helmet was a collaborative process. Santosh Helekar is a neuroscientist at Houston Methodist Research Institute and the director of oncomagnetics (magnetic cancer therapies) at the Peak Center in Houston Methodist Hospital. His previous invention with colleagues gave the team a starting point to build on. “About 7 years back I developed a portable brain magnetic stimulation device to conduct brain research,” Helekar says. “We [then] conducted a pilot clinical trial in stroke patients. The results were promising.”
Helekar presented his findings to neurosurgeons including Baskin. They decided to collaborate. With a team of scientists behind them, they modified the device to kill cancer cells.
The magnetic helmet studied for treatment of glioblastoma
Dr. David Baskin
Initial Results
After success in the lab, the team got FDA approval to conduct a compassionate trial in a 53-year-old man with end-stage glioblastoma. He had tried every other treatment available. But within 30 days of using the magnetic helmet his tumor shrank by 31%.
Sadly, 36 days into the treatment, the patient had an unrelated head injury due to a fall. The treatment was paused and he later died of the injury. Autopsy results of his brain highlighted the dramatic reduction in tumor cells.
Baskin says, “This is the most exciting thing in glioblastoma treatment I've seen since I've been a neurosurgeon, but it is very preliminary.”
The helmet is part of a growing number of non-invasive cancer treatments. One device that is currently being used by glioblastoma patients is Optune. It uses electric fields called tumor treating fields to slow down cell division and has been through a successful phase 3 clinical trial.
The magnetic helmet has the promise to be another useful non-invasive treatment according to Professor Gabriel Zada, a neurosurgeon and director of the USC Brain Tumor Center. “We're learning that various electromagnetic fields and tumor treating fields appear to play a role in glioblastoma. So there is some precedent for this though the tumor treating fields work a little differently. I think there is major potential for it to be effective but of course it will require some trials.”
Professor Jonathan Sherman, a neurosurgeon and director of neuro-oncology at West Virginia University, reiterates the need for further testing. “It sounds interesting but it’s too early to tell what kind of long-term efficacy you get. We do not have enough data. Also if you’re disrupting [the magnetic field] you could negatively impact a patient. You could be affecting the normal conduction of electromagnetic activity in the brain.”
The team is currently extending their research. They are now testing the treatment in two other patients with end-stage glioblastoma. The immediate challenge is getting FDA approval for those at an earlier stage of the disease who are more likely to benefit.
The Future
Baskin and the team are designing a clinical trial in the U.S., .U.K. and Germany. After positive results in cell cultures, they’re in negotiations to collaborate with other researchers in using the technology for lung and breast cancer. With breast cancer, the soft tissue is easier to access so a magnetic device could be worn over the breast.
“My hope is to develop a treatment to treat and hopefully cure glioblastoma without radiation or chemotherapy,” Baskin says. “We're onto a strategy that could make a huge difference for patients with this disease and probably for patients with many other forms of cancer.”