Experts’ eye view

A field guide to expertsAndrew D Oxman, Iain Chalmers, Alessandro Liberati on behalf of the World Artifexology Group

Experts are common but not well understood. This guide introduces novice expert spotters to theessentials of artifexology—the study of experts

A field guide to expertsAn expert is a man who has stopped thinking—heknows!

Frank Lloyd Wright

Experts are a little understood family within thephylum Chordata. Many people mistakenly believethem to have well developed egos, winged words, anddull plumage. In fact, they typically have immatureegos (which explains their incessant self flattery), rudi-mentary wings (which is why they fly first class), andexotic plumage (to detract from their vulnerability).Despite their deficiencies, experts can be dangerous.Our brief field guide to artifexology (the study ofexperts) should help people to protect themselvesfrom the insidious influence of experts.

ApologiaAn expert is one who knows more and more about lessand less.

Nicholas Murray Butler

Who are we to write a field guide to experts? By itsvery nature, artifexology is a non-expert field of study.As soon as one becomes an expert in artifexology onebecomes the subject of one’s own studies, thus arrivingat a sticky end up one’s own cloaca. Unsurprisingly, weinsist that this guide has been written by amateurs foramateurs.

Characteristic vocalisations

Always listen to experts. They’ll tell you what can’t bedone and why. Then do it.

Robert Heinlein

Experts can usually be easily recognised by theirself proclamatory call. Characteristically, they ensurethat they are introduced to an audience by a fawningchairperson who refers to the many hundreds ofpapers and book chapters they have had published.Once installed on the declamatory perch, expertsenjoy listening to their own exotic calls to the exclusionof those deemed less worthy of attention. Theycommonly offer firm advice, with no reference to rea-son or evidence.

An expert’s call usually begins with a shrill“In my experience,” which develops into elaboratesong about obscure theories supporting his assertions.Experts inevitably refer selectively to research thatsupports their opinions and mercilessly trash researchthat does not support those opinions. They rarely, ifever, admit uncertainty, even when they have no ideawhat they are talking about. Displays of humility areunknown.

Although experts can be found in flocks, they pre-fer to sing to their audiences without competition.When experts are invited to multidisciplinary meetingsor other forums where their dominance is threatened,they respond with the recognisable call of “I haveimportant commitments abroad.”

Habitats

An expert is somebody who is more than 50 miles fromhome, has no responsibility for implementing theadvice he gives, and shows slides.

Edwin Meese III

Experts can be reliably found in their preferredhabitat of conferences in luxurious settings. Theyare extremely territorial. While vehemently protectingtheir own narrow areas of expertise, they are nevertoo shy to sing about life, the universe, andeverything. Experts never have conflicts of interest,and if asked about these, their feathers becomeruffled.Deeply tanned experts top the pecking order

MA

RT

INE

CC

LES

Informed ChoiceResearchDepartment,Norwegian HealthServices ResearchCentre, PO Box0130, Oslo, NorwayAndrew D Oxmanresearcher

James Lind Library,OxfordIain Chalmerseditor

University ofModena andReggio Emilia andAgenzia SanitariaRegionale, Bologna,ItalyAlessandro Liberatiresearcher

Correspondence to:A D Oxmanoxman@online.no

BMJ 2004;329:1460–3

1460 BMJ VOLUME 329 18-25 DECEMBER 2004 bmj.com

on 6 Decem

ber 2020 by guest. Protected by copyright.

http://ww

w.bm

j.com/

BM

J: first published as 10.1136/bmj.329.7480.1460 on 16 D

ecember 2004. D

ownloaded from

Guano as a guide to identification

You can always find some expert who will saysomething hopelessly hopeless about anything.

Peter McWilliams

Experts can easily be detected from theirdroppings, which are so abundant in the guidelinespromulgated by professional societies, the reports of“expert” committees, and editorials in medicaljournals. Two recent ecological changes have raised thedetection rate of expert guano. Firstly, guano hasbecome so highly prized by the pharmaceutical indus-try that experts are paid huge sums for its production.Secondly, the editorial policies of some journals havestarted to require experts to disclose who is paying forthe production of guano.

Endangered species

An expert is a man who has made all the mistakeswhich can be made in a very narrow field.

Niels Bohr

Although it comes as no surprise that expertsare confident of their survival, there are reasons tothink that they may be endangered. Firstly, because oftheir fierce territorial nature they constantly try toexpel each other from their nests. Secondly, mostexperts are males. Thirdly, many experts have CVsthat weigh so much that safe take off and landing isthreatened. Fourthly, experts have no mature forms.Finally, when experts reproduce they often devourtheir young. Because of their incessant displays ofoverconfidence they are generally assumed to havelarge egos, whereas their egos are unusually small.This explains their need to constantly puff up theirfeathers.

Experts are dangerous

I am an expert of electricity. My father occupied thechair of applied electricity at the state prison.

W C Fields

Given the diminutive size of their egos it might bethought that beneath their puffed up displays of arro-gance experts are cuddly, essentially harmless crea-tures. But be warned, they are dangerous. Examples ofdevastation and waste caused by well meaning butarrogant experts include bleeding patients to death(the first president of the United States, for example),placing leeches on a patient’s anus after stroke,injecting malaria into patients with neurosyphilis, pre-scribing hormone replacement therapy to millions ofwomen on the mistaken basis that this would reducethe risk of heart disease, spending billions of dollars ondirect observation of people taking pills for tuberculo-sis without knowing whether this would do more goodthan harm, killing tens of thousands of patients withmyocardial infarctions by giving them anti-arrhythmicdrugs, and failing to draw attention to the benefits ofeffective treatments, such as aspirin, � blockers, andfibrinolytics.

Experts are not directly responsible for these andsimilar disasters; they are caused by the misuse ofexperts. Expert opinions need to be handled with cau-

tion. The reasons for this are manifold. Firstly, expertscommonly disagree with each other, so there is alwaysa risk of listening to the wrong expert, which can beharmful, if not deadly. Secondly, experts’ behaviour dif-fers importantly from that of non-experts. Expertsdevelop strong opinions without looking at evidence.Even if they do look at it, they do so less systematicallythan others before arriving confidently at their conclu-sions. Thirdly, experts are often not up to date. Theirrecommendations sometimes lag 10 years or morebehind available research evidence. Fourthly, expertsare more aggressive than non-experts. Their values(which are rarely made explicit) commonly differ fromthose of the people on whose behalf they makedecisions. They sometimes refer to “patients’ values.”When they use this term, caution is needed in askinghow they got the values, as embarrassed experts can bevicious. This behaviour is most pronounced when theyare confronted with scepticism about their values—forexample, values related to screening, invasive proce-dures, or expensive treatments. Finally, most expertshave competing financial and other interests and typi-cally show strong preferences for the newest and mostexpensive technologies. When challenged, they singleout individual critics, claiming that they are enemies ofprogress.

Safe observation

An expert is a person who avoids small error as hesweeps on to the grand fallacy.

Benjamin Stolberg

Experts can be safely observed in several ways. Oneway is to ask an expert “Where’s the evidence?” Thiscan have the same effects as a scarecrow. If you wouldlike to avoid frightening experts away, a less drastic,although less safe, method is to distinguish betweenopinions and facts. As Charlie Brown said whenimpersonating an expert, “I am always certain aboutmatters of opinion.” By allowing experts to be certainabout their opinions, you may be able to observe themfor longer, but be careful that you do not confuse theiropinions with facts as this can be dangerous.

The most entertaining but riskiest way safely toobserve experts is by forming an expert committee,thus putting together a group of experts. We stronglyadvise that this is done in a room with one-waywindows because unless observers can mimic the arro-gant and obnoxious behaviour of the committee mem-bers, they are at high risk of being mistaken for a fieldmouse and being eaten alive.

Checklist

Where facts are few, experts are many.Donald R Gannon

Artifexologists usually keep a “life list.”The World Artifexology Group (WAG), an

exclusive organisation with only nine members, hasdecided on the following vernacular names for experts:Crow, Cuckoo, Dodo, Loon, Peacock, Pigeon, Turkey,Vulture.

Experts’ eye view

1461BMJ VOLUME 329 18-25 DECEMBER 2004 bmj.com

on 6 Decem

ber 2020 by guest. Protected by copyright.

http://ww

w.bm

j.com/

BM

J: first published as 10.1136/bmj.329.7480.1460 on 16 D

ecember 2004. D

ownloaded from

CrowType: Large and noisy expert.Often wrong, hence the expression“eat crow” (although crows havenever been known to do this)Plumage: Boring, conservativeties. Chunky around the belly,glossy hairVoice: Boasting and braggingHabitat: EverywhereMating habits: Multipleencounters (whenever possible) at conferencesMigration patterns: Generally insists onflying first class and staying in suites

CuckooType: Slim expert. Noted for their brood parasitismPlumage: Bow tiesVoice: Monotonous. Often says things that

are silly or foolish in a ponderous wayHabitat: LaboratoriesMating habits: Young trophy matesMigration patterns: Frequently invited to largeconferences—rarely invited back

DodoType: Large, flightless expertabout the size of a turkey.Now nearly extinct. Firstreported in 1598 by Dutchcolonists, who charac-terised them as sluggishand unafraid of makingfools of themselves. Unde-veloped speaking skills,including the telling of taste-less, sexist jokes to large,non-receptive audiences

LoonType: Large, duck-like expertPlumage: Bow tiesVoice: Says crazy, simpleminded things, in blackand white terms, oftenabout topics welloutside their narrow areas ofexpertiseHabitat: Large, expensive homes incolder regions of the northern hemi-sphere, paid for out of exorbitant consultant feesMating habits: Usually has third or fourthmateMigration patterns: Travels often, attendingconferences and meetings but havingnothing worth while to contribute

PeacockType: Large gallinaceous expertPlumage: Wildly colourful ties. Alsodistinguished by their long, erectile,iridescent tail feathers, which theyspread at every opportunity

Voice: Vain, often screeching, and selfconsciousHabitat: Prominently sit in the front rowof any meetings at which they are not

keynote speakersMating habits: Mates who seemdull (but usually are not); theirmain purpose is not to get in theway of the male’s spreading feathers

Migration patterns: Spend enormous amounts of time at grandrounds and local meetings that offer the expert feather-spreadingopportunities.

PigeonType: Plump, small headed expertPlumage: Boring, conservative ties

Voice: Cooing; tries to lull audienceinto a sense of security, but easilyfooled or cheated by other expertsHabitat: May give the mistakenimpression of sitting on the fenceMating habits: IndiscreteMigration patterns: Only found atconferences in large urban areasFeeding habits: Feeds on the wasteof researchersDroppings: Craps over everything

TurkeyType: Large, bald headed, North Ameri-can gallinaceous expert nowdomesticated and kept in many parts of theworld by large pharmaceutical companiesPlumage: Embarrassing ties. Brownish,iridescent feathersVoice: Gobbling. Naive. Frequently a flopHabitat: Expensive condominiums in thecity and large country estatesMating habits: Well kept mate and chicksMigration patterns: Always first class, paid forby the companyDroppings: Good for guano. Fertilisesstocks and shares

VultureType: A large, bald headed expert of prey

Plumage: Nondescript. All types of regular tiesVoice: GruntingHabitat: Academic institutionsMating habits: Takes advantage of students

Migration patterns: Soars at high altitudes, seekingcarrion

Feeding habits: Feeds on junior colleagues, unsuspecting associates, honorariums, and stock options

Any resemblance to persons, livingor dead, is purely coincidental

Species of experts

1462 BMJ VOLUME 329 18-25 DECEMBER 2004 bmj.com

Experts’ eye view on 6 D

ecember 2020 by guest. P

rotected by copyright.http://w

ww

.bmj.com

/B

MJ: first published as 10.1136/bm

j.329.7480.1460 on 16 Decem

ber 2004. Dow

nloaded from

Distinguishing experts

There are as many opinions as there are experts.Franklin D Roosevelt

Experienced artifexologists know how to distin-guish experts. Experts are classified into four mainplumage types: bow ties, regular ties, cowboy bootlaceties, and no ties. Bow ties almost always wear glasses,which they frequently take off and use as an affectationfor intelligence. An irony of bow ties is experts’ beliefthat they are being original by wearing a bow tie. Regu-lar ties are more varied and include embarrassing ties(normally hidden under waistcoats and flashed atinopportune moments), wildly colourful ties, andboring, conservative ties. Cowboy bootlace ties are rare,normally found only on the east coast of the UnitedStates. No ties are found in most regions, but are not ascommon as bow ties and regular ties.

Within each of the main visual categories, expertscan be divided into three subgroups: deeply tannedfeathers, slightly tanned feathers, and untannedfeathers. These categories closely reflect the peckingorder, with deeply tanned experts at the top. Anunusual feature of deeply tanned experts is the failureof their tans to fade in the winter months—the tans arein fact sometimes deeper owing to frequent migrationsto “continuing medical education” events in tropicalsettings.

The pecking order can be complex. A componentmeasure of status has been developed on the basis ofthe number of publications listed in the expertscurriculum vitae plus the average distance they travelto give talks plus the cost of tuition at the schools theyattended plus the numbers of honorary degrees andPhD students they have plus the total US$ value oftheir current grant support. Like most componentmeasures, this measure has not been validated.

After experts have been slotted into these main cat-egories, several factors can be used to aid identifica-tion:x Size of the curriculum vitaex Shape of the bellyx Behaviourx Flight (first class or economy)x Vocalisations (screeching, twittering, warbling orearly morning calls).

Endangered experts need your help!

The greatest enemy of knowledge is not ignorance, it isthe illusion of knowledge.

Stephen Hawking

Despite everything we have written, it is importantto realise that experts are an endangered species thatdeserves protection, so that future generations canexperience their presence and prescience. This guide,as with other field guides, is not written for expertsor the many critics of experts. It is written anddedicated to the many artifexophiles (lovers of experts)worldwide, including clinicians, policy makers, journalists,and the general public. Although it brings us great joy tooccasionally abuse experts, PLEASE DO NOT MISUSETHEM! Doing so can be dangerous for everyone.

We dedicate this guide to Richard Smith, a veteran spotter ofexperts and an inspiration.

Contributors: ADO, IC, and AL conceived the guide over severalpints of beer, plagiarised most of it from field guides to otherbirds, and made up the rest. David Sackett contributed to the funand drank his share of beer, but rendered himself ineligible forcoauthorship by confessing that he was an expert in tree fellingand chainsaw safety. None of us are willing to be guarantors.Martin Eccles was duped into painting several pictures for theguide, but the BMJ was too cheap to publish more than one ofthem, preferring to obtain additional material from anotherexpert illustrator (Malcolm Willett).Funding: We received no financial support for preparing thisguide, but hope that it becomes a bestseller so that we can fightover the royalties.Competing interests: As mere wannabe experts, we are jealousthat we are not enjoying the prestige and lifestyles of realexperts.Ethical approval: Denied by an expert committee.

If the world should blow itself up, the last audiblevoice would be that of an expert saying it can’t bedone.

Peter Ustinov

Summary points

Experts abound worldwide

They are poorly understood

They generate gobs of guano

A sign of the times

Seen on the door of a newly refurbished ward at aLondon hospital.Riccardo Di Cuffa senior house officer in otolaryngology,Simon Lloyd specialist registrar in otolaryngology(skwlloyd@blueyonder.co.uk),Susan Sarangapani specialist registrar in ophthalmology,department of otolaryngology, Northwick Park Hospital,Harrow HA1 3UJ

Experts’ eye view

1463BMJ VOLUME 329 18-25 DECEMBER 2004 bmj.com

on 6 Decem

ber 2020 by guest. Protected by copyright.

http://ww

w.bm

j.com/

BM

J: first published as 10.1136/bmj.329.7480.1460 on 16 D

ecember 2004. D

ownloaded from