Contested medical authority: epistemic displacement and algorithmic mediation in health

Abstract

The growing availability of biomedical knowledge does not guarantee recognition of the authority of those with the professional competence to interpret it. This paradox poses new challenges for collective health in societies shaped by digital platforms and artificial intelligence. This essay proposes the concept of epistemic displacement in health to understand the redistribution of recognized authority from the attending physician to sources outside the clinic. Through a theoretical articulation of the sociology of professions, Latin American collective health, communication theories and studies on algorithmic mediation, it develops a five-domain model: the clinical relationship, algorithmic mediation, sociocultural context, socioeconomic and institutional conditions, and personality as a possible moderator. It argues that illness representations, communicational mediations and the conditions of care shape the legitimacy attributed to different health sources. Epistemic displacement is not necessarily equivalent to misinformation, loss of trust or treatment abandonment. It concludes that the challenge is not to restore medical obedience, but to strengthen the social and institutional conditions that make it possible to recognize, negotiate and share health authority without disregarding people's autonomy.