Is it the Doctor Who Decides?

In October 2009, Professor David Nutt, chairman of the Advisory Council on the Misuse of Drugs (ACMD), expressed an opinion contrary to that of the government of the time. What compelled the then Home Secretary Alan Johnson to sack Professor David Nutt over this?  Why did scientists get so frustrated when Professor David Nutt was dismissed?  This event raises many issues about decision-making in science and technology.

In modern life, many decisions require scientific and technological knowledge. These include macro-decisions, such as whether to ban certain drugs, approve new medicines, build nuclear power-plants, and so on. There are also micro-decisions such as which medical treatment to provide to each patient, and home hygiene.

Are scientists the only people who should be making these decisions? This was believed to be the case in the past, and is still considered to be so by a significant number of people. These people grant special authority to science and scientists. Both the overreaction of Alan Johnson and the frustration of scientists are rooted in the authority of science.  Politicians fear the authority of scientists, while scientists fear losing this authority.

However, the sociology of scientific knowledge (the study of science as a social activity) has revealed that scientific knowledge is not itself authoritative truth and can't be separated from society. It means that decisions involving scientific knowledge require the input of both scientists and non-scientists alike.  What are the specific roles of these two groups in the decision-making process?    

The key role of scientists in the decision-making process is to provide expert scientific knowledge.  There are two potential problems with this. Firstly, who are the experts? Not every biologist is an expert of, say, mad cow disease.  It is often very hard to distinguish experts who can fully contribute to the decision-making process from non-experts who simply possess relevant knowledge. Secondly, even experts cannot always provide solid scientific knowledge within the required time-frame.  For example, action is already being taken to mitigate climate change although it will take decades to establish a globally reliable climate change model.

When it comes to experts, non-scientists also have important roles to play in the decision-making process. Patients or their relatives, though academically unqualified, may be able to provide valuable contributions. A good example of this is "Lorenzo's Oil", a movie based on a true story, in which the parents of an Adrenoleukodystrophy patient discover a new treatment for the disease.  Farmers who can contribute to the GM debate, not as consumers and producers but as farming experts, are another example.  These groups of people are known as experience-based experts.

Lay people, without such experience-based expertise, are also important stakeholders, if they are or potentially will be affected by the decisions being made. For example, people living near a prospective nuclear power plant should have the right to participate in relevant decision-making. People not living in that area may also be important participants. After all, we live in a democracy where the general public has the right to contribute. We have the right to present our views on research and development priorities, energy policy, environmental policy and so forth, in our local area, our country and our world.

Finally, politicians, administrators and managers are literally decision-makers; that is their job. They meet experts and gather up-to-date knowledge. They meet lay people and gather their opinion. They are primarily responsible for the decisions. Although they try to make the right decisions, they are often forced to make a decision with insufficient knowledge because scientists have not yet reached a consensus.
We cannot set clear guidelines for the roles discussed above since they are case-dependent and can change over time.  However, in the same way that juries make decisions based on evidence provided by a number of different sources, it is not only a politician or a doctor who decides, instead all of us should cooperate to make sound scientific decisions.