Dieticians’ Understanding of Coeliac Disease:
An Empirical Investigation of Interactional
Expertise.
Robert Evans1, and Helen Boyce2
1 Centre for the Study of Knowledge, Expertise and Science
(KES), Cardiff School of Social Sciences
http://www.cardiff.ac.uk/socsi/expertise
2 Health Services Research Unit, Dept. Of Public Health,
University of Oxford
Overview

The Imitation Game



Imitation Games with Coeliacs

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Key Ideas
Software and data
Hypotheses
Aggregate Results
Successes, Failures and Interactional
Expertise
Conclusions

What next?
Imitation Game
Two Kinds of Expertise


Contributory expertise: enables those who have
acquired it to contribute linguistically and practically
to the community through the expertise is
sustained. The most common usage of the word
‘expert’.
Interactional Expertise: expertise in the language of
a specialism in the absence of expertise in its
practice. Like contributory expertise, it requires the
tacit-knowledge acquired by immersion in a form-oflife (i.e. socialisation). It enables individuals to talk
as if they had contributory expertise even though
they lack practical or craft skills.
Collins and Evans (2002)
Embodiment and Expertise
http://bmrc.berkeley.edu/courseware/cs298/spring99/w9/slides/sld006.htm
Modern Imitation Game
R1
‘once a week’
R2
‘not very often, when
they need doing’
Male pretending to
be female
Female judge setting
questions
R2 is female ‘because I expected
How
do women
you
the man
tooften
believe
are
pluck
your eyebrows?
more
regulated
in their beauty
regime than they actually are
Female answering
naturally
Coeliac Disease
Coeliac Disease

Autoimmune condition
affecting approx 1 per
cent of population




Intolerance to gluten
Usually accompanied by
symptoms but only
confirmed by blood test
Leads to damaged
intestine and reduced
uptake of nutrients
Treatment

Life-long gluten-free diet
From
1998
Research Questions






Judge is coeliac
Target expertise is
‘living with coeliac
disease’
Dieititian has to
pretend to have coeliac
disease
Prediction: Judge will
succeed in identifying
dietitian
Reason: disciplining
expertise
Outcome = Identify
Condition


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

Judge is coeliac
Target expertise is
‘living with coeliac
disease’
Dieititian has to
pretend to have coeliac
disease
Prediction: Judge will
NOT succeed in
identifying dietitian
Reason: interactional
expertise
Outcome = Chance
Condition
Imitation Games
with Dietitians
Sample and data

Coeliac sample recruited



Dietitian sample recruited by

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Snowball sample via family and friends
Facebook and Yahoo groups for people living
with Coeliac disease
Direct email to online directory of freelance
dietitians
Direct email to NHS depts
119 Imitation Games in total


12 ‘Phase 1’ games
107 ‘Phase 2’ games
Aggregate results and recoding
Key:
Coeliac = correct identification of contributory expert
Dietition = incorrect identificaton / dietitian ‘fools’ judge
Identification Ratio
40
26
106
53
13
IR = 0.11
Comparisons across topics
IdentificationRatio
Ratio
Identification
Chance
Identify Conditions
Conditions
1.00
1.00
0.80
0.80
0.60
0.60
0.40
0.40
0.20
0.20
0.00
0.00
0.73
0.86
0.68
0.44
0.33
0.05
colour blind
blind
-0.20
-0.20 colour
0.13
0.00
-0.01
-0.13
pitch
blind
sexuality
sexuality
religion
religion
Topics
ID Ratio
Mean IR for ID
condition approx 0.6
Know
Net Don't Know
Mean IR for Chance
condition approx zero
Comparisons between dietitians
Dietitians Knowledge -- success
Dietitians Knowledge

Eating Out
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All dietitians demonstrated some interactional
expertise e.g. difficulties at social events, need
to plan ahead, bring ‘emergency supplies’
Could be common knowledge?
Emotional aspects

Only dietitians with higher levels of
interactional expertise were explicitly
acknowledged as getting this right e.g. stress
caused by being seen as ‘fussy eater’
Dietitians Knowledge -- Mistakes
Dietitians’ Knowledge

Dietitians Identified by

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Mistakes – not careful enough to avoid crosscontamination, reading labels, not an allergy
Limited identification – bringing own food does not
always make you feel part of the crowd, gluten-free
baking is not easy!
Wrong discourse – Coeliac disease is not a ‘problem’
Stylistic factors – use of examples often persuasive;
clinical or advisory style often a giveaway
Repair work

Some really bad answers ‘excused’ by judges who
think dietitian is ‘newly diagnosed’ patient
Conclusions
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Overall outcome is chance condition
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Caveats


Dietitians have interactional expertise
Level of interactional expertise varies
Need control group of lay persons
Imitation Game as comparative method

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with different health professionals
with different illness or health issues
with different training / education
Imitation Game References
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Collins, Harry and Robert Evans (2002) ‘The Third Wave of
Science Studies: Studies of Expertise and Experience’, Social
Studies of Sciences, 32 (2): 235-96.
Collins, Harry and Robert Evans (2007) Rethinking Expertise,
Chicago, IL: The University of Chicago Press.
Collins, Harry, Robert Evans, Rodrigo Ribeiro and Martin Hall
(2006), ‘Experiments with Interactional Expertise, Studies In
History and Philosophy of Science, Volume 37, No. 4 (Dec
2006), pp. 656-674.
Evans, Robert and Harry Collins (forthcoming, 2010)
‘Interactional Expertise and the Imitation Game’ in Michael
Gorman (ed) Trading Zones and Interactional Expertise:
Creating New Kinds of Collaboration, Chicago, IL: MIT Press