Knowledge makes decision-making: examples of medical knowledge.
Access to knowledge does not make easier decision-making in contemporary society even if it is crucial to access to specialised knowledge especially in the area of medicine. In fact, the excess of information could entail confusion as knowledge may have different sources. For example, in medicine, various forms of knowledge can be identified from conventional medicine to complementary medicine or to common sense. This diversity could be a source of progress as well as a source of uncertainty and confusion as shown for example when a mother tries to take a decision about the fact her child should, or should not be, vaccinated.
It shows that if access to specialised knowledge, when possible, makes decision-making easier, it also entails more confusion as sources of information could conflict in such a way that for example, a lot of people evoke a presumed “golden age” during which decisions was easier to be taken as only the doctor, the expert, had the knowledge. He was the expert.
So it is important to understand what sort of knowledge can be accessed in medicine in contemporary society and essentially in western countries, how this knowledge has been socially constructed through the three last centuries and what are the consequences of accessing to this knowledge. But before to go further, I will define what knowledge is and more particularly what specialised knowledge is.
Knowledge is “an organized and systematic collection of information, arguments, skills, practices and understandings” (Goldblatt, D., 2004). That means that knowledge is plural, explicit or implicit, and can change over time. It is socially constructed through language, institutions, social change and conversely knowledge participates to the social construction of a society. As any social construction, knowledge evolve with human history; what seems to be the truth at one time could be found obsolete as new knowledge emerges. This is the case with medical knowledge.
Going back to the 17e century and until the second half of the twentieth century, two sources of medical knowledge were complementary: One of the sources is a recognized and institutional one, possessed by the doctors and to which access was limited for some categories of people: For example, women were excluded to the access to this knowledge since 1491 (Fox Keller, 2004). Also, poor people could not access to this knowledge for economic reasons. They used a non-officially recognized medicine based on plants and folk remedy, not based on scientific approach but essentially on tradition. This is the second source of knowledge. For the body of doctors, from the seventeen century onwards, this subjective knowledge could not be trust as for them medical knowledge is assimilated to scientific and objective knowledge, e.g. “a set of techniques that seem to offer a way of producing objective and reliable knowledge of the world” (Goldblatt,D.). It is based on experiments to prove that results of such experiences can be reproducible and thus reliable. It is based also on logic objectivity and experiments, making a strong case in favour of scientific knowledge compared to common sense.
For example, scientists use blinded (or double blinded) experiments which are ‘experimental methods where the participants are not aware of the actual design or even theory behind the experiment” Goldblatt, D.). Francis Bacon, philosopher who lived in 1561-1626 described the method used in science as pointed out the efficiency of the method of induction. It is a method of arriving to a reliable conclusion by collecting data about the material world and by repeating experience.
This way of producing knowledge has been challenged by social philosophers and social scientists.
For Karl Popper, in the 30s, scientists should be sceptical and adopt a continual questioning position. He rejected the inductivist approach of the scientists based on observations which can be only partial and whose results depend on the observer as well as the conditions in which the experiment is realized. He also held that scientific theory, and human knowledge generally, is irreducibly conjectural or hypothetical, and is generated by the creative imagination in order to solve problems that have arisen in specific historico-cultural settings.
For Thomas Kuhn, philosopher and historian, in The Structure if Scientific Revolution, in1962, sciences do not progress on a linear way but through crisis; at one point of time, scientists develop paradigms, “e.g. a set of assumptions, laws and methods that are accepted by fairly large scientific communities and a set of standards for how the inquiry is conducted” (Woodward, K. and Watt, S) but a paradigm is replaced by another one.
From the above-mentioned historical evolution, two remarks can be made. First it appears that doctors and scientists disagreed between themselves and new theories challenged the former one; recently the quantum theory brought a totally new perspective in sciences; secondly, they scientific approach on which is based conventional medicine has been challenged by philosophers or social scientists such as Michel Foucault or Evelyn Fox Keller.
For Michel Foucault, knowledge is produced through the language, practices, medical and scientific discourse which makes possible to say something but restricts what you can say. Power and knowledge are inextricably linked. Even if Foucault’s theory presents weaknesses such as the marginalization of people’s experience of their own bodies and an over-emphasizing of social aspect at the expense of natural one, its main added-value is to show the links between knowledge and its instrumentalisation for questions of power. Evelyne Fox Keller points to the way in which claiming the superiority of objective science ignore the values that are implicit in decisions about what to investigate, how to deploy resources and what counts as relevant and useful. She describes the benefit that could accrue from a more inclusive and fluid understanding of scientific knowledge. For her, the knowledge is not gender neutral and so it is the access to the knowledge.
The fact that conventional medicine, and its specialized knowledge was challenged by doctors themselves, then by social scientists makes decision-making more difficult because other phenomenon occurred in contemporary societies which added confusion and uncertainty.
New means of communication occurred and extended: Media, Internet, making public more and more informed. People started to be informed about disagreements between scientists, about the fact that conventional medicine cannot bring a clear and unique answer to disease and that complementary medicine can bring solutions to illness as valuable as conventional medicine.
In the 70s, new knowledge emerged under the influence of humanists who challenged the hegemony of the scientific and chemical approach in medicine. The term Illness was not confused anymore with Health to which doctors gave the negative definition of absence of disease Alternative therapy emerged in the 70s due to the resistance to the constraints of the medical model (Ursula Sharma, 1995). A holistic approach of the individual was adopted, challenging the idea that the mind is separated from the body. (Smith, B. and Goldblatt, D.)
And women, thanks to feminist movements, access to medical universities.
Due to these various factors, access to knowledge in medicine is possible for more people in the Western countries, even if the language used by the doctors is not often easy to understand. Decision-making should be easier. Therefore, this is not the case for several reasons: first people do not trust the doctors anymore as disagreements and mistakes they make are largely publicized through the media. It is also difficult to decide between traditional medicine and alternative therapy which claim to be more natural. Different knowledge seem to conflict. In the video, “Mother knows best”, the mothers received a lot of advice, mixing scientific as well as common sense and complementary health. The mothers receive a lot of various advices making decision difficult for them.
In conclusion, it appears that access to specialized knowledge does not make decision-making easier in contemporary society especially in medicine. The traditional approach which was dominant in the seventeen century was challenged by the doctors themselves and one scientific theories were replaced by other ones as discoveries were made. Also under humanist and feminist movements, alternative therapies and popular culture became more important in the 70s.
The emergence and the extension of new means of communication as well as the fact that people are more educated made the access easier.
The result is that the decision-making is harder as people receive different messages and do not know what source on information to trust. For that reason, they often refer to a supposed “golden age”, when few sources of knowledge were available.
Woodward, K. and Watt, S. (2004) “Science and Society: Knowledge in Medicine”, in Goldblatt, D (ed.), Knowledge and the Social Sciences: Theory, Method and Practice, London, Routledge/ The Open University.
Smith, B. and Goldblatt, D. (2004), “Whose Health is it anyway?” in Hindcliffe, S. and Woodward, K. (ed.), The Natural and the Social: Uncertainty, Risk, Change, London, Routledge/ The Open university.
Woodward K., Goldblatt,D. and Kiloh,M DD100 Block 5, Audio 9B, Key Questions- a Discussion., The Open university
DD100 DVD, TV Programmes and Study Skills, Mother Knows Best? Produced by the BBC for the Open University