5.3 The expert patient
Shifting notions of expertise also feature in the ESRC report. While the medical establishment lined up to proclaim the safety of the MMR vaccine, the anti-MMR voices in the media were mainly provided by parents of autistic children. The unquestionable sincerity of these voices conferred upon them a high level of authority compared with the unemotional scientific evidence given by medical experts.
The continuum between lay expertise and scientific expertise is becoming increasingly blurred. Access to specialist data is no longer the preserve of an academic elite. The internet has meant that swathes of information are instantly available at many people's fingertips. As the volume of accessible information grows, so do the problems of evaluating that information. Doctors and health visitors provide a crucial link in this regard.
The medical profession is somewhat polarised on the concept of an ‘expert patient’. The legitimising of patient views (or, more accurately, parent views in the MMR debate) is seen as a backlash against ‘medical paternalism’. This is the idea that doctors patronise their patients by assuming that they know more about a condition than those living with it. Opponents of this view insist that lay people can never acquire the medical expertise necessary to discriminate between corroborated scientific evidence and rumour, conjecture and superstition. Proponents hold that patients' expertise does not undermine medical authority but helps doctors to understand a condition from a patient's perspective. A government-sponsored expert patient programme encourages patients with chronic illnesses to better self-manage their conditions, recognising that compliance with medication regimes is much more likely if patients have collaborated with their doctors in deciding on treatment (Shaw and Baker, 2004).
The expert-patient scenario described here, in which doctors and patients benefit from mutual expertise, does not ‘scale up’ to the type of media coverage in which patient or parent is often pitted against doctor or scientist. The implication in such coverage is that their expertises are equivalent and comparable. Although views from both lay and medical perspectives are valid in their own right, they are different in scope and focus. Once again, there is potential for tension between the scientific community and the public.