LAUSR

The concept of an ideal observer, advanced by Green,1 proposes that a truth exists beyond the distortions created by our preconceptions and prejudices, and that it can be discerned by a “fully informed, imaginative, impartial and calm observer.” Our current ethos depends profoundly on the presumption that an objective reality can be perceived and described by an unbiased and knowledgeable person. My prior exploration of this concept focused on the lack of an ideal observer in the planning, execution, and interpretation of clinical trials.2 This article explores the difficulties of finding an ideal observer in our efforts to identify trustworthy, reliable, and unconflicted experts. We are obsessed with conflicts of interest, and we should be. When we seek experts, we want them to be ideal observers, but we know that their guidance may be imperfect. We accept imperfections if they are related to a lack of wisdom or experience, but we are repulsed if they are because of financial involvements that benefit the expert. We are comfortable if an expert speaks wrongly because of ignorance but not because of self-interest. Being deceived is acceptable if it is innocent but not if it is motivated. How can we discern whether a motivation to distort or deceive exists? If we were travelers in a strange land and asked for directions, we would be annoyed but not aggrieved if we received the wrong guidance from another (presumably equally ill informed) visitor. Yet, we would be offended if the poor advice …