Dr. Dipesh Navsaria: On experts, soils and toilet plumes

Dr. Dipesh Navsaria: On experts, soils and toilet plumes

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Bathroom stalls

Our world is filled with experts of one sort or another, and these days it feels even more so. To a certain extent, we can often tell who obviously unqualified experts are. The more challenging situation is the expert who does, at first glance, seem to be qualified.

It’s a very human tendency to trust the expertise of people who are espousing what we already want to believe, a phenomenon called “confirmation bias.” This can be so strong that it leads to some interesting assertions. I remember long ago being told by an anti-vaccine activist that "DOCTOR" so-and-so stated certain things. A few moments with Google revealed that this touted “expert” had a Ph.D in… geology.

This is not to denigrate geologists, but I don’t think you should be making decisions about immunization science and public health based on a geology background. Certainly some skills cross over (statistics, basic interpretation of scientific literature), but the discipline-specific knowledge is clearly not the same. This person’s expertise around immunizations is no more valid than mine would be on the subject of geomorphology, even if I do know what Wisconsin’s official state soil is. (Antigo Silt Loam, if you’re wondering.)

For a more current example, take toilet plumes — if you’re not familiar, this is the concept that a flushing toilet causes aerosolized particles to enter the air and, in theory, spread viruses and bacteria. Recently, a scientist developed computer models showing that COVID-19 could, theoretically, be spread this way. No real world data, no actual cases, just computer models. It was picked up by a number of newspapers and, yes, you guessed it, people started fixating on toilet plumes.

We humans like new, novel things, so we’ll gravitate to that which is different. As someone who is often described as an “expert” on a number of pediatric-related topics, I often ruefully point out that an expert is "someone from out of town, with slides." I’ve given talks in places which my hosting colleague could easily have given, but somehow being from “out of town” imbues whatever I say with far more gravity.

So how do we know who to believe? It’s not always easy, and one of the difficult yet true parts of science is that data can sometimes point to opposing answers. However:

One, what is the nature of the claim made? If it’s at odds with what’s already known, recall that extraordinary claims require extraordinary evidence. TV shows aside, most advances are evolutionary, not revolutionary. Question it carefully if it seems altogether novel.

Two, how was the information found? A theoretical computer model is less valid than a laboratory experiment, which is less valid than a real-world study. Concepts that have sounded great have often had weak results in the lab, and are often negligible in the real world. That’s not to say that the foundational work isn’t important, but it’s also not the last word.

Three, don’t be swayed merely by the trappings of authority. I find it strange when I see physicians wearing scrubs or white coats outside of clinical settings, as if they just stepped out of an operating room or hospital ward. (I’ve done it, but only very rarely.)

Four, is the track record of their work actually in this field? I’ve seen far too many pronouncements about real-world infection control precautions made by people who study only viral genetic sequencing, but nothing about how viruses spread. The word “virus” in your work doesn’t always make you an expert in all aspects of viral disease.

Finally, those who are trained as “generalists” excel at thinking about the “big picture,” and will often have the best handle at synthesizing information and creating meaningful answers. I may be biased, but amid this pandemic, that has been far and away our fantastic public health professionals. From the federal and state levels down to the counties and local jurisdictions, they’ve been working tirelessly to keep us all as healthy as possible, through long days, conflicting information, and difficult-to-balance factors.

From Safer-at-Home orders to toilet plume answers, I salute my colleagues in public health. We see you.

Dr. Dipesh Navsaria, MPH, MSLIS, MD, FAAP, is an associate professor of pediatrics at the University of Wisconsin School of Medicine and Public Health and also holds master’s degrees in public health and children’s librarianship. Engaged in primary care pediatrics, early literacy, medical education, and advocacy, he covers a variety of topics related to the health and well-being of children and families.

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