262455 Clinical expertise, scientific knowledge and trust: Epistemic and ethical challenges to managing the public's health

Tuesday, October 30, 2012 : 8:30 AM - 8:50 AM

Catherine Womack, PhD , Department of Philosophy, Bridgewater State University, Bridgewater, MA
The United State Preventive Services Task Force (USPSTF) released reports in 2009 and 2011 recommending changes in the use of mammography and prostate cancer screening, in opposition to well-entrenched clinical practices. Their reports were met by a fierce backlash from clinical practitioners and the public. Furthermore, clinical practices and recommendations have not shifted significantly in response to the reports.

These recently emerged conflicts provide an opportunity to look closely at how differences about what seem to be empirical matters can erode trust in clinician-researcher relationships, making it difficult to find agreement on critical issues of public health policy and treatment. Achieving consensus is important for several purposes, including: 1) determining effective treatments; 2) allocating limited healthcare resources so to maximize positive health outcomes and minimize unnecessary tests and procedures; and 3) maintaining the public's trust and participation in the healthcare system.

In this presentation I use tools of social epistemology to examine how divergent notions of evidence in these cases interacts with and is influenced by values, commitments, and priorities of the different parties involved. Bioethicists commonly use moral pluralism—the view that there are multiple accounts of what is valuable to humans—to explain and resolve values-based differences. However, by analyzing these cases from a position of epistemic pluralism—a system in which parties hold fundamentally different viewpoints about what counts as evidence—I show how we can accommodate both clinical and scientific modes of knowledge and find agreement on health policy and treatment.

Learning Areas:
Administer health education strategies, interventions and programs
Basic medical science applied in public health
Ethics, professional and legal requirements
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy
Public health or related research

Learning Objectives:
Differentiate between evidence as used by clinical practitioners and by research scientists. Apply tools of social epistemology to recent controversies from USPSTF recommendations for changes in clinical practices. Formulate ways to achieve consensus on issues in which different perspectives on knowledge result in conflicts over health decisions.

Keywords: Decision-Making, Consensus

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a professor of philosophy at Bridgewater State University and a published researcher in Public Health ethics.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.