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I’m an expert in pediatric heart surgery.
You probably wouldn’t take my professional opinion about obstetrics and gynaecology very seriously.
And I don’t blame you for laughing in my face if I presume to offer technical advice and opinion about designing a microprocessor chip, or programming security software for a bank, or suggesting ideal disinvestment procedures for ailing public sector industries.
That’s because highly specialized, complex, multi-dimensional problems and issues take years and years of in-depth and focused experience and expertise to tackle, address and ultimately solve.
Even in as specialized a field as heart surgery (which is preceded by 5 years in medical school, and usually by another 3 to 5 years in general surgical training), there is a world of difference between ‘adult’ and ‘child’ specialists.
And the difference stems from more than just technical issues – crossing over into philosophical, strategic and social domains.
It takes a certain kind of mindset and reference frame to view treating an 85 year old patient so that he survives for another five years. It takes a radically different approach to plan therapy of a 5 year old girl, who is facing eighty-five years more of life.
So while any qualified cardiac surgeon can probably technically fix hearts in the young or old, it still takes a sub-domain of specialization and expertise to deliver meaningful and top quality care.
Such expertise can be acquired – but not vicariously, through someone else’s effort, or simply by accessing it through them. Sure, you can hire or employ specialists – but you cannot become one yourself through taking shortcuts.
And when one is already a specialist or expert in one area or domain, the ideology, principles and tactical moves that collaborate to engender success in that area are ported ‘as is’ (knowingly or not) to other areas as well – opening up a Pandora’s box of interesting possibilities… and potential disasters!
What set off this thought stream?
This last bit in one of Bill Gates’ Notes, about handling pandemics.
“There are new manufacturing approaches that reduce the lead time and increase the production rate, but government rules don’t allow the vaccine companies to use them yet because of safety concerns. Although governments are right to be conservative about vaccine safety, they have to find a way to help the vaccine industry…”
From the perspective of a business, this is absolutely sound advice.
From the perspective of a public health specialist, it might set off alarms.
From the perspective of a pediatrician who administers these vaccines to an individual child, this might seem heresy!
Ignoring or bypassing “safety concerns” has frequently created disasters on a scale far greater than any illness or inconvenience the “fast tracked” medications may have helped alleviate.
In retrospect, we know that the H1N1 pandemic wasn’t as dangerous as feared. But what if we had rushed ahead, manufactured vaccines unheeding of “safety concerns” – and ended up creating a tragedy of similar proportions?
Run a search on the Web for “Thalidomide” and you’ll get a heart-rending account of how a poorly evaluated pill to treat morning sickness in pregnant women led to the birth of thousands of children without limbs in the late 1950’s.
More recently, a COX-2 inhibitor (Vioxx) for pain relief was recalled (after a “billion dollar launch”) because of an increase in the risk for heart attack, thrombosis and stroke.
These, and dozens more, are case studies that any student of a related specialty would be intensely and intimately aware of – and therefore be governed by, even if subliminally, in any decision, opinion or advice on relevant issues.
A ‘novice’ trying to speed-learn everything on a highly technical, complex subject (or acquire the knowledge through meetings with experts) cannot be expected to ‘get’ every such nuance, nor blamed for any decisions or actions taken based on such ignorance or misinterpretation.
Also, behavior like this can be poignantly dangerous when the knowledge acquisition is desired in order to be personally involved “hands-on” in intelligent and informed decision-making.
It is that way for ’small’ decisions like deciding whether or not to dialyse your dad whose kidneys are shutting down, or opt for a coronary artery stent instead of open heart surgery, by trying to figure out the relative risks and benefits from a Google search.
And it is too when taking steps to make multi-million dollar decisions about funding research and preventive measures in a speciality like preventive health (or any other).
Business ethics are different from medical ethics for a reason.
And if you disagree with the basic premise of this message, I expect to hear from you asking for my ‘expert’ advice whenever you plan on investing your next million dollars. I’ve read quite a few books and talked with experts about that subject, y’know!
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