Why do you often get confusing and contradictory messages from experts?
Why does medical expert opinion sometimes seem incorrect, outdated, or even contrary to the evidence?
1/ Medicine is really complicated. No one is truly an expert except in a tiny segment of it, at best.
Why does medical expert opinion sometimes seem incorrect, outdated, or even contrary to the evidence?
1/ Medicine is really complicated. No one is truly an expert except in a tiny segment of it, at best.
2/ When a car doesn't work a good mechanic knows what each part does. To know what's wrong. Doesn't need a randomized trial to know how to fix it.
Our body is not like a car. We don't know a fraction of how it works and what each part does. Human biology is still in its infancy
Our body is not like a car. We don't know a fraction of how it works and what each part does. Human biology is still in its infancy
3/ Medicine moves at speed of light. Keeping up to date is no small task. Even if you read all the latest information as they come in, you may have time to scan the headlines or abstract—
Not critically review it.
Not critically review it.
4/ Each expert comes in with their own perspective on whats wrong, what to fix, and how to fix it. That's natural. But based on their training, their tolerance for risk varies widely. What's ok for an oncologist alarms an internist and may be end of the world for a regulator.
5/ Given all this, today's expertise is deep but not wide. A basic science virologist worries about the COVID virus spike protein mutations, while an immunologist is reassured knowing that the immune response is quite redundant and will likely overcome that variant.
A regulator is alarmed about rare reports of vaccine induced cerebral venous sinus thrombosis and stops vaccinations, while the ICU physician who has seen the deaths of lots of people from COVID feels the risk benefit ratio overwhelmingly favors the vaccine.
An epidemiologist worries that the latest randomized trial results are only in preprint & haven't been peer reviewed, while an editor knows the limits of peer review, & recognizes that other experts in the same field do the job of peer review themselves when they comment on it.
A laboratory scientist worries about inexplicable errors that happened during the conduct of a randomized trial, while a clinical trialist knows how errors often happen despite best intentions, and which errors disrupt the integrity of the randomization. And which don't.
6/ Most of us recognize this, and that's why a team of experts is often needed, each bringing in a difference skill set.
The problem I think is failure to challenge. We defer to expertise. Which is desirable in public. But as part of a team, vigorous debate is key.
The problem I think is failure to challenge. We defer to expertise. Which is desirable in public. But as part of a team, vigorous debate is key.
7/ Assembling a team with broad spectrum of fields including fields unrelated to medicine is critical. Those who see patients face to face and provide care are needed. And experts within a team must not hesitate to challenge each other.
8/ None of this will stop contradictory or confusing views from being aired. But at least we will know that decisions at high levels have considered all due points of view.
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