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VOLUME 3, ISSUE 2     PSYCHNEWS INTERNATIONAL          July 1998
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SECTION E: THE FIFTH COLUMN

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Note: The Fifth Column is a regular, independent column
written by Jeffrey A. Schaler, Ph.D.

For this issue, Dr. Schaler has invited his colleague,
Morris E. Chafetz, M.D., to contribute to the Psychnews as
a guest columnist.

Opinions and comments are invited. Please send them to
the PsychNews Int'l mailboxes: 
psychnews@psychologie.de and 
pni@badlands.nodak.edu
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                                            1
                      THE TYRANNY OF EXPERTS

                      Morris E. Chafetz, M.D.


     For most of my professional life, I have been involved in
the study of an emotionally charged subject:  people's relations
with alcohol beverages.  As a public servant and as a private
citizen, I have seen what emotional investment in a subject can
do to anyone's objectivity.  I have seen alcohol researchers
literally shout down each other with conflicting interpretations
of the same data.  I have seen the preliminary results of small,
uncontrolled research studies blazoned across the front pages of
newspapers as incontrovertible fact.  I have seen impressive-
looking but essentially meaningless statistical charts and
graphs accompanying major articles in prestigious scientific
journals.

     When it comes to subjugating objectivity to the service of
emotion, I've seen a lot of it done.  From time to time, I've
done it myself; but I didn't recognize the seduction when it was
done to me.

     If I, a physician, a psychiatrist, once head of a powerful
government agency, with long-time ties to the academic and
government worlds of science and statistics, can be so misled,
what about people who have not had such rigorous training?  How
do they make sense of the cacophony of voices giving conflicting
advice about every subject imaginable?  Health.  Nutrition.
Child rearing.  Alcohol. Drugs.  Safe food.  Pollution.  Who has
the answers?

     I believe this question is the most important one of our
day.  Many people believe someone does, in fact, have answers
that they do not possess.  Because they want to believe in that
magical "someone," they are defenseless against those who claim
to have special knowledge.  They are fair game for anyone who
offers them comforting certainties, unambiguous rules of
conduct, and ways to identify themselves within the complex,
fast-moving society we live in.  Awash in prescriptions and
proscriptions but lacking a means of judging the validity of
what they hear, they soon find themselves ruled by a tyranny of
experts.

     The people I call tyrants are people who overstep the
limits of their technical expertise and use their specialized
knowledge to dictate how others should live.  In our world of
instant communication, we know who these experts are.  Many are
scientists, public interest advocates, researchers, lawyers,
physicians, psychologists, social workers, government
bureaucrats, and others who, through our mass media, parlay
their credentials into power bases.  From these power bases,
they tell us what to eat, drink, and enjoy, how to relate to one
another, and how to live.

     The pronouncements of experts fill the moral and ethical
vacuum left by the demise of the extended family and the waning
of religious and political leadership.  In many areas where
basic values and personal views of the world once helped people
make choices, they now turn to experts for what they believe is
definitive information.  In a world reeling from the dizzying
pace of growth and change, being told what to eat, how much
sleep to get, and how to rear children gives people a semblance
of certainty that is difficult to come by anywhere else.

     Because the experts fill a genuine need for order in the
chaotic whirl of high-tech, high-speed living, some of us remain
stunningly blind to their pervasive, massive encroachment on the
prerogatives of our private lives, as well as to the possibility
that something besides pure benevolence motivates their actions.
Our innate self-protectiveness is disarmed but not broken.  That
characteristic American prickliness, for example, comes to the
fore when we learn that the video store's computer keeps a
record of all the videos we rent.

     The potential misuse of such information violates our
privacy and conjures up images of Big Brother and the "thought
police" of George Orwell's novel _Nineteen Eighty-Four_.  To me,
a far more chilling prospect is the surrender of our right to
choose in return for promises of happiness and harmony, as in
the fictional society described by Aldous Huxley in _Brave New
World_.  We are learning that the most powerful tyrant of all is
one who possesses the consent of the tyrannized.

     I believe we are in danger of surrendering our intellectual
and emotional liberty to those who would warn, advise, and guide
us, people who manipulate us with their specialized knowledge
and increasingly determine the political, moral, and social
climate of our country.  I fear the brave new world their tactics
threaten to bring upon us.  I want us to regain our right to
think for ourselves by withdrawing our consent to their
ascendancy.

     The irony of our surrender to the experts is that they
don't even deliver the peace of mind they promise.  Ask yourself
a simple question:  do you truly feel safer, saner, and more
secure because of everything you've been told by the health
experts, the environmental experts, the legal experts, the child
development experts, the crime experts, the alcohol experts?  Or
are you becoming more fearful?  More anxious about your health?
Less secure about your abilities as a spouse, a child, a parent?
Less confident about the future?


DEATH, FEAR, AND THE PROMISED LAND
     Most of us become aware of death at an early age, when a
relative or a pet dies.  At first, the concept of death may not
be fully understood; but in time, the realization that the
person or pet no longer exists in the physical world becomes
clear.  At that point we begin to make a personal connection
between death and ourselves.  Once we make this connection, we
devote much of our mental energy to strategies for avoiding
death.  These strategies manifest themselves in a variety of
ways.  Religion is a favored comforter.  It tempers the fear of
oblivion by promising the hope of an afterlife.

     Unquestioning faith in doctors and the power of medicine
has also been a favored balm for the fear of death.  With the
medical profession's seemingly intimate connection to the
mysteries of life and death, doctors have long enjoyed a god-
like aura.

     From the earliest shaman to today's neurologist, doctors
and their forebears have distracted us from the fear of death
with prognostication and medication.  Their job is often made
easier when pain and illness produce regressive (childlike)
behavior.  When we regress we are more vulnerable to the magic
of formulas and symbols.  What makes us easy prey to regressive
behavior is what Ernest Becker contends in his book _Denial of
Death_ (1973) that our greatest fear is the certainty of our own
death.

     When we are sick, most of us don't care to inquire how our
physician reaches the conclusion that we have X disease and not
Y disease.  We simply want comfort and certainty.  We want the
doctor to tell us we will not die.  We want to believe that the
miracle of technology and the wisdom of the doctor are great
enough to forecast the future and to control all the variables
that can affect our health and well-being.  But that can't be.
No one is that omnipotent.  Tragic examples abound of the
unabashed trust people put in doctors' omnipotence.

     The formulas we associate with good health do not always
contain the essential ingredients.  Just as we cannot foresee
the future, doctors cannot measure or control hidden variables
when they make their pronouncements.  But recent technological
advances have so intensified our fantasies about medical
omnipotence that neither doctor nor patient has a clear idea of
the limits of medical science.

     A life without limits is a life dominated by obsession.
The obsession with cheating death has turned our pursuit of
health into a sickness.  The impact of simple lifestyle changes
on our overall health has increased, not diminished, our
anxieties.  Ironically, we have become more susceptible than
ever to our fears.


WHAT DOES MEDICINE REALLY KNOW ABOUT RISK?
     Risk is a concept central to the power of the medical
experts.  They want to reduce our "risk" of illness.  But we
have to ask, on what basis do they establish the risk associated
with any behavior?  Consider the concern over cancer risk.

     Biochemist Bruce Ames, who developed the widely used Ames
Test to determine whether particular environmental chemicals
increase the risk of cancer, has repudiated the conclusions of
much of his earlier research.  Ames now believes that one of the
standard ways of testing carcinogenicity--giving rats megadoses
of the substance in question (called the maximum tolerated dose
or MTD)--ignores the fact that the body's reaction to a substance
depends on the dosage taken in.

     The body is efficient at neutralizing small doses of
carcinogens and other toxins, but it becomes overwhelmed when
large quantities are introduced all at once.  Megadoses may
approximate the amount taken into the body over the course of a
year or so, but ingesting a year's dose in an hour invalidates
the test and overstates the risk of cancer.

     Ames believes that MTD tests could label as lethal over
half of all chemicals, whether natural or manufactured.  The
newly founded panel on risk at the National Academy of Sciences
agrees in principle with his assessment.  As an example of the
excesses that can result when MTD testing is the primary method
of determining risk, consider the case of dioxin, the chemical
in Agent Orange.

     Dioxin was once pronounced "the most dangerous substance on
the face of the earth."  Yet dioxin now appears to be less
dangerous than was previously thought.  Reinterpretation of the
original animal studies shows that the danger was overestimated.
And the only study to definitively link dioxin to excess cancer
deaths found a slightly increased risk among 1,500 workers who
had been exposed to 500 times the federally designated
acceptable level--the highest exposure level in history.  No
increased risk of cancer was found in the same study among 3,500
workers who received an average of 90 times the acceptable level
of exposure.

     Sometimes risk is merely an artifact of our methods of
assessment. Consider the case of human papillomavirus, suspected
as a cause of cervical cancer because the virus has been found
in some women (11.5 percent) who develop the disease. Recently,
a new, more sensitive screening procedure has found the human
papillomavirus in 46 percent of women in routine gynecological
testing.

     Researchers may now have to rethink their ideas about risk
involving the virus and cervical cancer, since far more women
who do not get cancer carry the virus than women who do get
cancer.  It appears the risk of getting cervical cancer from
human papillomavirus went down when better testing was
developed.  That's the tyranny!


MANUFACTURE OF VICTIMS
     When tragedy strikes, being able to identify an "innocent
victim" as someone who is subject to the whims of fate--
dependent, unsuspecting, blameless--is a convenient label.  A
victim, therefore, presents no ambiguities and no confusing
questions of responsibility to weigh and feel troubled about.
The victim is innocent; therefore, someone or something else
must be responsible.

     When something bad happens to an innocent victim,
especially one from those groups society views as vulnerable--
children, women, and the elderly--our social guardians will feel
justified in venting their most primitive emotions.  I recall
the pure anger of a store owner in New Hampshire, for example,
when a four-year-old girl he didn't know was killed by a drunk
driver.  "Four years old," he kept saying, like a litany.  He
became angry with me when I asked whether it would have been
different if the person killed had been an adult.

     Victims also provide society with a simple way to think
about complex social problems.  When dealing with the problems
of drugs, crime, poverty, traffic fatalities, and other social
problems, our surrogate parents, the experts, seem to provide
easy and fast solutions.  Our social guardians focus their
expertise on devising protective social policies for innocent
victims, but neglect to deal with the underlying problems.  They
succeed in giving comfort in two ways.

     First, their agenda allows other people to distance
themselves from the plight of the victims.  Second, by making
the victim an emotional symbol, they can further their larger
agenda:  power and conformity.  They define the situation as
something that can be solved by simply finding and punishing the
person or thing they view as responsible.

     The manufacture of the label victim encourages a simplistic
view of the world.  It turns the world into good guys and bad
guys, victims and victimizers, the innocent and the culpable.
Life, however, is rarely that neat and simple. In seeing only
black and white and ignoring the gray under the guise of
protecting the innocent, great harm can be done.


THE ISSUE OF SMOKING
     I think the smoking-health issue illustrates how the
experts operate. First, the anti-smoking advocates attack the
advertising of tobacco products.  They firmly state (without
credible evidence) that advertisements make people take up
smoking.  In the mind of the anti-smoking advocates, people are
like dogs who respond mindlessly to suggestion.  It does not
take much thinking to see how such a conclusion--that people are
being manipulated into unhealthy behavior--would rile the public.
In the case of children, many people feel guilty enough to start
with.  The public health advocates with the help of some
children who are artful at manipulation, make it sound like the
hungry-for-the-dollar (standard practice in free enterprise)
business people hook children and others on smoking.

     Since children and adults are individuals possessing some
freedom of choice, the phenomenon of addiction is brought in.
There has never been a question in my mind that a person can
become addicted to anything, but I have yet to meet an addicting
substance.  An addicting substance means that anyone who uses it
cannot go without it.  I know of no such substance.

     Let me tell about my own smoking history. I was a pipe
smoker while in college and medical school because it was
fashionable to smoke a pipe.  And as a psychiatrist, smoking a
pipe helped me to control my tendency to talk too much.  I used
my pipe to keep my mouth shut, so I could listen to my patients.

     When I became a mover and shaker in government, pipe
smoking was impossible.  I had to move quickly and often.
Meetings, gatherings, and all the hullabaloo that comes with
power did not permit the leisure a pipe requires.  So I turned
to cigarettes and smoked three packs a day.

     As I approached the end of my tenure at NIAAA [National
Institute on Alcohol Abuse and Alcoholism], one of my sons bet
me twenty dollars that I could not go one year without smoking.
>From the day I left office, I did not smoke for one year,
collected the twenty bucks he owed me, and went back to
cigarette smoking, but not to three packs a day.

     People who were smokers and could not quit told me I must
not have been addicted.  In other words, if the facts don't fit
a preconceived model, you don't throw out the model; you
disregard the facts that threaten the model.

     It appears to me, therefore, that the anti-smoking
advocates think that at first children are hooked by advertising
and then when they grow up and become sensible adults, they
can't give up the habit because they are physiologically
addicted.  One question that the anti-smoking advocates have
never sought to answer is:  does the emphasis on cigarettes
being addictive prevent people who would want to from stopping?

     I have seen this kind of propaganda in alcoholism treatment
as well.  People who are recovering from alcohol problems are
told their only hope for recovery is total abstinence; if they
slip, they'll fail.  When they do fail it's because they have
been indoctrinated to expect to fail.  This corroborates my
contention that expectation is as strong a drug as most
substances.

     Whenever people worry about the effects advertising has on
children, I am reminded of the letter a young person wrote to
_The New York Times_, "We make our choices even though we know the
risks."  It's good to remember what Winston Churchill said:
"When I get the facts, I twist them to fit my position."
Churchill was telling us what the experts do, but he was
disarmingly honest about it.  Having said that, let us look at
what's happening in the tobacco industry.

     Public health advocates claim the industry tricks young
people to smoke through targeted marketing, advertising, and
promotion, and once manipulated (especially when they are not of
an age to know better) into smoking, they are physiologically
hooked.  But methods of manipulation can be artfully unfair,
insidious, and omnivorous.  Consider the phenomenon called
environmental tobacco smoke (ETS).

     Studies are legion that link the health risks of secondhand
smoke to cancer, sudden infant death syndrome (SIDS), heart
disease, and every other ailment imaginable.  These studies are
flawed because they cannot be controlled, yet they epitomize how
science is used to manipulate the public and policy makers.
There is no scientific methodology available I know of that will
give us the data to determine if a smoker does harm to a
nonsmoker.  Of course, scientists can come up with statistical
models that will provide numbers that will imply certainty where
certainty cannot exist.

     _The Washington Times_ on 27 November 1995 reported on a
new service that accuses government and anti-smoking groups of
making unsubstantiated claims about the health hazards of
second-hand smoke.  The Congressional Research Service claims
there is no scientific evidence to support the EPA estimate that
environmental tobacco smoke (ETS) causes over 3,000 lung-cancer
deaths among nonsmokers and 150,000 to 300,000 cases of
respiratory infection in infants and young children.

     Like the anti-alcohol advocates whose exaggerated findings
on FAS [Fetal Alcohol Syndrome] led the government to advise
pregnant women not to drink alcohol, nonsmoking advocates
continue to use unsubstantiated studies to induce the public and
policy makers to treat smokers as pariahs.

     Crucial to the accuracy of scientific study is controlling
for variables.  For example, if a person smokes X number of
cigarettes around a nonsmoker, the variables to control for
would be the setting, the ventilation system, air streams, depth
of inhalation and exhalation of both parties, emotional
strengths and weaknesses (which affect the immunological
system), and hundreds of other variables.  Even so the advocates
use the flawed studies on ETS to promote their cause, gain
power, and feel good about themselves.  No better illustration
exists than cigarettes to show the tyranny of the experts.


MYTHOLOGY OF SCIENCE
     Many of us have a rudimentary familiarity with the
scientific method. As children we learn that science is a way of
discovering new information about the world through direct
observation.  We are taught that science performs these
observations objectively.  Even though a scientific experiment
begins with a speculation or hypothesis about the outcome, the
goal of scientific experimentation is not the outcome, but the
truth.

     To a child, the idea of testing reality without having a
particular goal in mind sounds highly plausible.  Children
themselves are natural scientists.  When a baby plays with
matches, for example, his goal is not to light a fire but to
find out what these funny-smelling sticks can do.  When children
open a cabinet and pull out everything inside, they are
experiencing the pure joy of discovery.

     Most people's view of science is colored by their visceral
memory of this pleasurable and uncomplicated state of learning.
Even people who study science as adults often maintain a
childlike belief in the objectivity of science and in its
ability to sort out the confused messages of the world to find
truth.

     The basic tenet of science is objectivity.  In tests of new
drugs, for example, biomedical researchers use "double-blind"
studies so that neither the study participants nor the
investigators knows who is getting the real treatment and who is
getting the placebo.  Double-blinding is meant to insulate
studies from the expectations of those involved and from self-
fulfilling prophecies:  For example, the possibility that study
participants may consciously or unconsciously try to please the
researchers by espousing the desired response; and the
expectations of the investigators themselves, who may
consciously or unconsciously try to influence the study's
outcome to prove their hypothesis.

     Double-blinding is one of the procedures that makes science
appear "scientific" to everyone, including scientists
themselves.  But procedures like double-blinding are ultimately
part of the mythology of science--the powerful belief system that
puts science purportedly above the motivations of the human
heart.

     Even if scientists were not motivated like the rest of us
by personal needs and goals, science by its very nature cannot
be "objective" or "goal-less."  Confirming a theory by
observation requires the experimenter to devise procedures that
will favor the theory's plausibility.  Research on anything will
yield findings that are a reflection of, and limited by, its
procedures for observing or measuring.

     This principle is simple to understand. If I am color blind
and want to paint a picture of an autumn landscape, for example,
my painting will lack the distinctive red hues that characterize
certain maple trees.  If I am quickly sorting change in my
pocket by size and color, I may not notice that I have several
Canadian pennies or dimes among my American pennies and dimes.
Both of these deviations from "objective reality" are not
malicious:  in one case, I am prevented from seeing what I miss,
and in the other, I simply am not interested in the
distinctions.  These are what I call "inherent biases":  they
are not malicious but merely part of the limits of observation.

     Understanding the typical blind spots and inattentiveness
of the scientific experts is critical.  Science will always have
a role to play in interpreting the world, but not the role of a
soothsayer.


TRENDS OR TRUTH?
     The desire to see proof in trends is an ancient human
trait.  Human beings have always felt there were secret meanings
in coincidences.  If the rain came when a chant was sung at
sunset, for example, our ancestors believed chanting brought the
rain.

     Children are notorious for misjudging cause and effect.  I
know a family whose youngest child insisted on visiting the
restroom in every restaurant they went to.  It became a family
joke that the child had been in every bathroom in town.  Tired
of being teased, the little girl explained that she went to the
restroom not because she needed to, but because when she
returned to the table her food was always there.  She believed
that her absence from the table caused the food to arrive.

     Unlike the little girl's approach, the experts believe that
quantitative research in the sciences is a more sophisticated
way of looking for meaningful coincidences.  Powerful computers
add to the mystique of statistical correlations by evaluating
every quantifiable variable in an experiment or research project
and calculating the results to as many decimal places as
desired.  Often those results are accompanied by more numbers
announcing the "statistical significance" and "confidence
factor" for each conclusion reached.

     Albeit, these impressive numbers still only represent
correlations:  coincident facts that may or may not be related.
Because a basic characteristic of our minds is the tendency to
recognize and recall facts about things we already know, the
statistical correlations that interest us tell more about
ourselves and our preoccupations than they do about the subjects
we study.

     For example, when several studies found that young drug
experimenters in the 1960s and 1970s tended to use alcohol
before they used drugs, researchers concluded that
experimentation with alcohol leads to experimentation with
drugs.  The conclusion seems obvious because we are predisposed
to believe it.  We could just as well conclude that daily use of
alcohol leads to financial well-being, since a study of
Harvard's class of 1940 showed that those who drank every day
had higher incomes than occasional drinkers or nondrinkers.
Based solely on the data, we have no idea whether daily drinking
has anything to do with income status. Similarly, we have no
idea whether the prior use of alcohol had anything to do with
the subsequent use of drugs.

     Our minds are biologically programmed to recognize and
complete patterns.  For this reason, we are more likely to pay
attention to numbers that correspond to an existing belief
system.  For example, the National Academy of Sciences (NAS)
used a study showing higher rates of lung cancer deaths among
nonsmokers who lived with smokers to come up with an estimate of
3,800 lung-cancer deaths annually caused by passive smoking.
Since it has already been established that active smoking causes
some lung cancer, the conclusion about passive smoking seemed
easy to accept.

     But I later learned that the study did not take into
account participants' exposure to radon, a naturally produced
gas and the deadliest known environmental carcinogen.  Radon is
believed to cause 20,000 lung-cancer deaths annually.  So
despite the plausibility of NAS's conclusions, they can't be
relied on:  radon may have caused some or all of those 3,800
deaths.  Many other variables--obvious and measurable, not-so-
obvious and unmeasurable--can cause or prevent lung cancer.

     For many years, the tobacco industry argued that there was
no proof that cigarette smoking caused lung cancer-- just
statistical correlations.  The industryUs argument was deemed
self-serving and false:  there was strong test-tube evidence
that the chemicals in cigarette smoke could initiate cancerous
changes in lung tissue.  Yet their insistence that the
demographic and statistical data did not prove anything was
absolutely correct.

     The statistical analysis was highly suggestive and pointed
researchers in the right direction, but it did not prove--and
still does not prove--that cigarette smoking by itself causes
lung cancer.  As a matter of fact, the Harvard Health Letter of
August 1995 reports that 85 percent of smokers never (emphasis
added) develop lung cancer.


LIFE WITHOUT SELF-DELUSION
     We want what people have always wanted, protection from our
own fallibility, our own weakness, our own mortality.  This
desire helps to perpetuate our species.  Recently I was awed by
the raw honesty of my young granddaughter Maria, who glibly
summed up the human condition when she stated her life's
aspirations:  "I want to be a queen; I don't want to die; I want
people to do what I tell them to."

     Fortunately or unfortunately, I can't grant Maria her
wishes, nor can the experts.  Whatever advice, warnings, or
formulas we follow, no one can make us exceptional, immortal, or
omnipotent.  By accepting the tenet that the experts cannot give
us what we want, I hope we'll be able to give one another the
courage to live without self-delusion.

     Perhaps the greatest delusion of all is the notion that,
individually and collectively, the human race is teetering on
the brink of disaster.  My common sense tells me that despite
the barrage of news each day about the risks of daily life, and
despite our many serious social, political, ecological, and
economic problems, the earth and the human race are not on the
verge of extinction.  For every story that says we are running
out of time by irreparably damaging our planet, there's another
story that tells of an extraordinary scientific discovery a new
drug to treat a formerly intractable condition, a remarkable new
movement in painting or sculpture, a groundbreaking new book or
symphony or invention.

     Whatever goes wrong in the world, we will still retain our
most important asset: the infinite creativity and ingenuity of
the human mind.  I believe these ancient gifts that make man
rise above all other animals will steer us through the maze of
confusion fostered by the twentieth century's bewildering
succession of changes.  Our challenge will be to find new ways
to tap our wellspring of common sense and instinct for self-
preservation.  Meeting the challenge requires a commitment to
look to ourselves for our own answers, because the spoon-feeding
experts lead to our diminishment.

     Don't ask me how to proceed once you've made that
commitment, because I haven't a clue.  What I do know, however,
is that it is the journey not the destination that's important.
Our search will begin in earnest when we are willing to embark
on the journey.


FOOTNOTE (to title):
1.  This article is excerpted and adapted with the author's
permission from _The Tyranny of Experts:  Blowing the Whistle on
the Cult of Expertise_, published by Madison Books, N.Y., 1996.
ISBN 1-56833-064-2, $19.95 (USD), available through National
Book Network (800-462-6420 and http://www.univpress.com).



     Morris E. Chafetz, M.D., is the founding director of the
National Institute on Alcohol Abuse and Alcoholism in the U.S.
Department of Health and Human Services.  He is currently
president and founder of the Health Education Foundation, an
organization that relates health to lifestyle, in Washington,
D.C.  Email:  mecmd@erols.com


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