Fixed Ontologies and Authority Creep

I've been having a recurring conversation recently about what humanists can offer to the world at large.  How can we get out of the ivory tower and offer something that goes beyond a community of specialists. Some academics complain that policy-makers etc don't listen to the humanist perspective. In large part, this is due to the way we cloister ourselves into disciplinary echo-chambers, writing papers that are incomprehensible without years of specialist training. Ironically, moves to interdisciplinary and digital collaboration have only hardened the divisions between areas of specialty (at least according to comments by Katy Borner at IPAM last summer) - it's now easier than ever to collaborate with people who do exactly the same things you do. In any case, my answer has been that humanists need to actively engage with the outside world. Not to wait for them to come to us; to go to them.

What do advanced scholars of the humanities have to offer? We understand media, interpretation, and realms of meaning better than anyone else. We put in the time to learn languages (often dead ones), theories (often obscure ones) and develop a strong sense of context. Advanced scholarship in the sciences and technology involves intensive training in a particular paradigm. The power of this is the ability to think in depth and in detail within a particular ontology. The weakness is it builds in a type of blindness to the limitations of this particular disciplinary brand of knowledge.

By example - the medical profession. Doctors are highly trained, regulated and institutionalized. As a result, they are very good at certain things. However, there is a sort of mission creep - or perhaps "authority creep" - that comes with this level of expertise. Biomedical doctors are very good at treating acute injuries and many kinds of (bacterial) infections; they are generally not good at treating pain and other (viral) infections. But because viral infections look a lot like bacterial infections and pain often accompanies injury, these are also assigned to doctors' area of expertise. Frequently, for no particularly good reason, products will instruct you to "consult your doctor before using." This itself is the result of another profession's "authority creep" - lawyers.

But the big problem is not that doctors are bad at treating things like pain, obesity and the common cold. The problem is that most doctors do not recognize or admit that they are bad at them. This is a problem of operating within a fixed ontology without seeing its limits. Doctors are trained to look for a chain of causal factors that can be identified either in the laboratory or through double-blind experiments. This is very good at revealing certain types of causalities. We manifest symptoms of a cold when we are infected by certain viruses. At some level, the cold is "caused" by the virus. Therefore, the best solution is assumed to be preventing or curing viral infections. At some level, this understanding is useful. Things like hand-washing and other means of preventing exposure help us avoid infection by understanding the vector of transmission. But the overwhelming focus on the proximate vector of infection keeps us from recognizing other causal factors - stress, weather change, and so on - and from taking preventative or curative action at this level.

Obesity is an even stronger example of medical authority creep that distracts from more meaningful causes, and perhaps more meaningful solutions. Doctors deal with obesity because it is itself a physical ailment, and it leads to many more serious physical ailments - cardiovascular disease, diabetes, even cancer - that are more clearly within the medical realm (although these are generally things that bio-medicine treats decently - not badly, but not particularly well). The thing is, even as medical knowledge advances, people keep getting fatter.

This is because of the mechanistic view of the body that is omnipresent in bio-medicine. When you break it into individual mechanisms, it is clear why we get fat. We get fat because we eat food that is not used for energy or released as waste. Doctors have ever more fine-grained understanding of the mechanisms by which we put on weight. Ultimately, it reduces to some pretty simple points - if you eat too much - particularly of certain things like sugar (and maybe fat), and you don't exercise enough, you get fat. Thousands of diets have been based around this fundamental realization - instructing people to eat less of certain things, or less at certain times, or just less in general. And these diets have failure rates of essentially 100%. The proximate causes of obesity do not reveal the right way to treat it.

The thing is, obesity has other causal mechanisms - ones that are not easily incorporated into the biomedical ontology. Obesity has a strong spatial dimension:

and a strong social dimension. Some people have suggested these factors should be taken into account in fighting obesity, but most of the medical community remains focused on changing diet, exercise, or using drugs to target certain metabolic pathways. These approaches fail, and are fundamentally wrongheaded.

The specifics of this are somewhat of a side point (albeit an important one). It actually looks like things like zoning laws may be more important in fighting obesity than diet-and-exercise plans. This does not sit well with most doctors, because there is little room in their ontology of disease for spatial and social factors. This is one of the revelations that humanists and social scientists have to offer the world - a recognition of the limits of usefulness of disciplinary paradigms. Americans are getting shorter, something that is generally a good measure of general falling health and standards of living. This happened before, at other times when we were ostensibly progressing (such as the industrial revolution). If "better" understandings of obesity still lead to more of it, that seems like an occasion to reexamine what exactly "better" understanding means. And examining the boundaries of understanding is a job for humanists.