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Commenting on a user's question:
It could be argued knowledge is top-down in the sense that the knowledge must first be legitimized by credible sources (i.e., typically science, politics, etc.) before it is dispersed through the social system (generally disseminated to us through the mass media/social media channels, which are run by the upper social echelons of society). In The Birth of the Clinic, Foucault draws upon the medical gaze and how it is used to objectify people from a position of power (since the clinic was a power institute found in society itself, similar to other power institutes like schools, prisons, etc.). The important aspect is how power is used to control people through this legitimatized knowledge, swaying us towards a common social consensus where we then keep ourselves under control while also outcasting Others who do not conform and assimilate to the general status quo.

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