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

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.