Clinicians should stick to their area of expertise

Dr. Edmund Bruce-Gardner

I have been seeing a fair amount recently on the ongoing vaccination debate.  I am not going to stick my oar into that one, apart from to say that I feel there isn’t really a debate at all; two centuries of data show that immunisation works.

The area that piqued my interest was the number of people who do feel that they can weigh in to the debate. From lay persons to GPs, homeopaths to personal trainers, chiropractors, osteopaths, and the like, there are a lot of opinions going around. While I strongly encourage people to do as much reading as they can to inform themselves about issues such as these, my concern is that far too frequently, people are commenting outside of their area of expertise. 


Immunology, the science that studies the immune system (and hence vaccination and related technologies), is an incredibly complex discipline, one which we are only just starting to understand.  The immune system is also intimately related to the nervous system, the ‘command and control’ system for the body, which in turn is interlinked with the psyche (how we think, feel etc). 


That being the case, even immunologists, who spend their life's work researching the immune system, do not necessarily know exactly what is going on. Importantly, they are generally happy to admit the shortcomings of their knowledge about the underlying processes and interactions of the immune system, and suggest areas needed for future research.


So who should we listen to? 


It certainly does not make sense to take the 'expertise' of people such as myself, whose knowledge of immunology may consist of an undergraduate course or two. Who am I to suddenly start to claim expertise in why one should/should not vaccinate? I know just enough about immunology to know that I don’t know much about it!


This is where the relying on the consensus of the scientific community becomes really important. The important word in that sentence is ‘consensus’. The way that scientific knowledge moves forward is by suggesting an explanation (‘hypothesis’) for something we have observed about the world.  This hypothesis needs to be testable, that is to say, we need to be able to check whether or not it can explain what we need it to.  We do this through experiments. 

Now, not all experiments are created equal.  The ‘gold standard’ in clinical research is what is called the ‘randomised double blind’ controlled trial.  In this, there are groups who receive the treatment or medication (or whatever) that is being tested, and those who receive different treatments, or nothing at all. Neither the person receiving the treatment, or the clinician administering it, knows which group the individual is in.  This increases the likelihood that the results of the experiment are ‘objective’, or not biased.

As I said, not all experiments are created equal, and not all research is good.  There will always be people who have an axe to grind or a point to prove, and whether unconsciously or not, a lot of research reflects this bias. That is why the process of ‘peer review’ is so important.  What that means is that other experts in the same field examine the design of the experiment, and the data that are gathered, to decide whether or not the results of the experiment can be ‘trusted’.

Just because you have managed to find an article published in a scientific journal, does not mean it is ‘good science’.  A good example where this has gone wrong with regards to immunisation is the study published by Wakefield et al (1998) that indicated a link between the MMR (measles, mumps, rubella) vaccine and autism in children.  This study was retracted by the Lancet (the journal which originally published it) when it became clear that the main author was being funded by lawyers for families who were suing vaccine companies.  There were later claims of outright data falsification (about the biggest sin possible in the scientific community), and most of the study’s co-authors also retracted their conclusions.  In spite of all of this, and numerous subsequent studies that demonstrate there is not a link between autism and MMR, this original study is still quoted widely by proponents of the anti-vaccination lobby.

Just one person saying something is so does not make it so.  It is also the case that just because everyone says something is true, does not make it so. 

​However, if you have a ‘general consensus’ within the scientific community (who, let’s face it, hardly ever fully agree on anything!), it is much more likely to be correct than the view to which only one or two individuals subscribe.

Whew! What a long-winded way of saying that you should listen to the experts!

While experts can be – and are – wrong, those who are not experts are more likely to be.  If you are an osteopath, you are an expert in musculoskeletal conditions, not pharmacology and immunology.  If you are a radiologist, you are an expert in medical imaging, not reproductive medicine.

If any of your healthcare professionals recommend a course of treatment or an approach that lies outside their expertise, please ask them why they think that is the case, and check with another professional!! 

Always get a second opinion, whether from your GP or specialist.

And if you are a healthcare professional reading this blog, please feel free to give your advice, but qualify it!  I know that a good number of my patients ask me about areas of healthcare that quite frankly are not within my area of expertise.  It is extremely touching that they have enough faith in me to ask, and I will always answer to the best of my knowledge, but will preface my response by saying “This is not my area of expertise, so please consult your doctor/specialist etc etc, however my understanding is ... "

Mon 07/02/2017 - well, it looks like other people have the same concerns as I:  the Chiropractors Association of Australia (CAA) has previously come under fire for not unequivocally condemning those outlying practitioners who continue to sound off about an area not within their professional expertise, However, the CEO has just come out and stated that the organisation's new vaccine policy bars chiropractors from giving vaccine advise to patients, and requested that the Australian Vaccination-skeptics Network remove all links to the CAA website from theirs.

A response to this on a prominent anti-vaxx site had this to say, "It appears that [chiropractors] are rapidly becoming as uninformed as qualified medical doctors".**
I will overlook the overall sentiment of the comment (I have no idea about the knowledge base of chiropractors in general, let alone in historical vs. current context), but just note the contradiction at the end. "as uninformed as qualified medical doctors".  I would argue that being a qualified medical doctor is pretty much the definition of 'informed' with regards to vaccination.

** I will not link the site in question, because I don't want to give them more traffic than they already have!