TY - JOUR
T1 - A good “doctor” is hard to find
T2 - Assessing uncredentialed expertise in assisted injection
AU - Brothers, Sarah
N1 - Funding Information:
I gratefully thank Rene Almeling, Loïc Wacquant, Robert Heimer, Ricky Bluthenthal, Jess Lin, Jan Palombo, and Kaveh Khoshnood for many helpful comments and suggestions. This work has benefited from presentations at the American Sociological Association Conference, the Center for Comparative Research Workshop at Yale University, the “Expertise from Margin to Center-Science, Politics, and Democracy” Conference at Columbia University, the “Order, Chaos, and Everything in Between” Sociology Conference at the New School for Social Research, the National Harm Reduction Conference, the Society for the Social Studies of Science Annual Meeting, and the Yale Medical Anthropology Working Group. I thank Terry Morris and the participants who generously shared their experiences. This article is based on work supported by the P.E.O Scholars Award, the Yale Club of San Francisco Summer Research Grant and the National Science Foundation Graduate Research Fellowship under Grant No. DGE1122492 .
Funding Information:
I gratefully thank Rene Almeling, Lo?c Wacquant, Robert Heimer, Ricky Bluthenthal, Jess Lin, Jan Palombo, and Kaveh Khoshnood for many helpful comments and suggestions. This work has benefited from presentations at the American Sociological Association Conference, the Center for Comparative Research Workshop at Yale University, the ?Expertise from Margin to Center-Science, Politics, and Democracy? Conference at Columbia University, the ?Order, Chaos, and Everything in Between? Sociology Conference at the New School for Social Research, the National Harm Reduction Conference, the Society for the Social Studies of Science Annual Meeting, and the Yale Medical Anthropology Working Group. I thank Terry Morris and the participants who generously shared their experiences. This article is based on work supported by the P.E.O Scholars Award, the Yale Club of San Francisco Summer Research Grant and the National Science Foundation Graduate Research Fellowship under Grant No. DGE1122492.
Publisher Copyright:
© 2019 Elsevier Ltd
PY - 2019/9
Y1 - 2019/9
N2 - This article examines how laypeople assess uncredentialed expertise in a high-risk practice: assisted injection, in which one person injects another with illicit drugs. In metropolitan areas in the US, about 2.3% of the population injects illicit drugs. Injection assistance is common and recipients of injection assistance are at high-risk for injury, overdose, and infection. Yet little is known about how injection recipients attempt to reduce these risks by assessing their injection provider's expertise. Drawing on ethnographic observations and interviews from 2015 to 2018 with 59 people who inject drugs in San Francisco, California, this article examines how people who need injection assistance assess injection provider expertise. It finds that people use an informal hierarchized decision-tree approach of three measures of trust to assess expertise: strong personal ties, referrals, or professional rhetoric. Using measures of trust to assess expertise minimizes some forms of risk by increasing the chance that injection providers are motivated to help them. However, this strategy offers little protection against technically unskilled providers. Moreover, it may increase health risks because people employ few self-protective strategies in trust-based relationships. This research offers new insights for theorization on expertise and trust in social contexts where high-risk skills are in demand. This approach also has implications for public health research and interventions for reducing risks related to lay medical practices, particularly those in assisted injection.
AB - This article examines how laypeople assess uncredentialed expertise in a high-risk practice: assisted injection, in which one person injects another with illicit drugs. In metropolitan areas in the US, about 2.3% of the population injects illicit drugs. Injection assistance is common and recipients of injection assistance are at high-risk for injury, overdose, and infection. Yet little is known about how injection recipients attempt to reduce these risks by assessing their injection provider's expertise. Drawing on ethnographic observations and interviews from 2015 to 2018 with 59 people who inject drugs in San Francisco, California, this article examines how people who need injection assistance assess injection provider expertise. It finds that people use an informal hierarchized decision-tree approach of three measures of trust to assess expertise: strong personal ties, referrals, or professional rhetoric. Using measures of trust to assess expertise minimizes some forms of risk by increasing the chance that injection providers are motivated to help them. However, this strategy offers little protection against technically unskilled providers. Moreover, it may increase health risks because people employ few self-protective strategies in trust-based relationships. This research offers new insights for theorization on expertise and trust in social contexts where high-risk skills are in demand. This approach also has implications for public health research and interventions for reducing risks related to lay medical practices, particularly those in assisted injection.
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U2 - 10.1016/j.socscimed.2019.112446
DO - 10.1016/j.socscimed.2019.112446
M3 - Article
C2 - 31377500
AN - SCOPUS:85069933406
VL - 237
JO - Ethics in Science and Medicine
JF - Ethics in Science and Medicine
SN - 0277-9536
M1 - 112446
ER -