Personal Beliefs and Professional Positions

Hobbits are by nature fun-loving folks who firmly believe in the sacred value of liberty. The freedom to choose is a fundamental right hard-wired into every hobbit’s brain; unless that right is circumscribed or taken away by law. For example, you are not at liberty to choose whether to wear a mask or not once you step out of your home.

So this hobbit firmly believes that everyone has the right to choose for oneself to be vaccinated or not, and one’s children as well. We should also be allowed to choose what vaccines we want to be vaccinated with as long as the vaccines have been approved for use. Of course, with choice, comes responsibility. We have to face the consequences of our choices, be they good or bad.

Among doctors, there is a wide range of opinions and beliefs when it comes to Covid-19 vaccination. As individuals, they are entitled to their personal beliefs. And they are entitled to make choices and decisions arising from these beliefs. A doctor can choose to be vaccinated or not. We cannot take that right away from an individual, just because he happens to be a doctor.

But things may get a bit edgy when you propose a position to the public in your capacity as a doctor on something related to healthcare or a medical service or product. This hobbit believes you should be evaluated and judged in your professional capacity as a doctor.

In short, as an individual you can have almost complete liberty in choosing your personal beliefs, but not so when as a doctor, you choose your professional positions.

Take the recent two incidents involving a few doctors for example. Last month, 12 doctors penned an open letter on the risks of Covid-19 vaccination for children. They asked that traditional “killed” virus vaccines be used on children instead of the mRNA vaccines. 11 of the 12 doctors subsequently retracted the letter, including the author of the letter. The letter was addressed to “all parents deciding to vaccinate or not to vaccinate their child”. Many experts have since spoken out debunking the contents of this infamous letter.

In their retraction, these 11 doctors said “We like to withdraw all our humble ponderings, as some of our thoughts may be misunderstood by some laypersons. We will henceforth ponder in a more professional and private forum”.

This hobbit shares the same concern as the eleven doctors who retracted when it comes to “laypersons” – they need to be protected. Within the medical profession and the boundaries of civility, fellow doctors can discuss and argue different positions and viewpoints about certain contentious topics in medicine. In our careers as doctors, we have all seen robust discussions between learned colleagues on many subjects at different fora, ranging from the simple grand ward or morbidity and mortality rounds to international scientific and medical meetings.

Some positions forwarded by some doctors at times can be based on the most flimsy and unmeritorious of assumptions, but these arguments and propositions will be quickly disposed of by the majority of their peers armed with better knowledge and experience.

Unfortunately, this luxury of discernment frequently does not happen when the public is involved, simply because the public lacks the requisite knowledge to discern on highly technical matters.

It is for this reason that medical advertisement is tightly regulated in Singapore. Other than Over-The-Counter (OTC) Drugs, one is NOT allowed to advertise medicines to the public. You will not see advertisements like what you see in USA for example, where one will see many prescription drug advertisements targeted at the public.

However, in Singapore, advertisements involving prescription drugs can be found in materials that are mainly meant for doctors, dentists, pharmacists and nurses. For example, advertisement and marketing materials for prescription drugs can be found in the SMA News or SMJ.

The underlying logic here is that these professionals (and the students being trained for these professions as well) have the capacity to discern the issues therein. Hence the advertising restrictions targeted at these groups can be more relaxed. The piece of legislation called Medicines (Advertisement and Sale) Act reflects this thinking.

Well, it appears that three of the 11 doctors are now having another go at trying to dissuade people from getting vaccinated at mRNA vaccines even when they had said they wanted to “ponder in a more professional and private forum”. There is now another open letter by five doctors (of which three are from the original group of 11 doctors who retracted earlier on) asking the vaccination to be delayed for adolescents, especially males. Again, the experts have come out to debunk their argument which is based again on the most rickety of scientific foundations. Seriously folks, even though one death is too many, you cannot formulate a public health vaccination policy based on one death in which causality to mRNA vaccines is not even established.

The unwanted effects of these two episodes by a few doctors are:
• many members of the public are getting confused
• the vaccination programme is undermined
• experts have to make the effort to repeatedly debunk unmeritorious arguments forwarded by just a few doctors. A waste of their time and purportedly causing insomnia to one of the experts.

It is true that we have imperfect and incomplete information about Covid-19 and the vaccines. But the hard truth is that we still need to make decisions now based on imperfect and incomplete information where the benefits outweigh the risks to a community. And we certainly cannot make or defer making decisions based on theoretical possibilities that are NOT backed up by current data or extensive experience.

If you think about it, these doctors, in the process of publicly lobbying certain positions, are also trying, indirectly or directly, to persuade and advise the public to also believe what they believe – that mRNA vaccines should not be used.

This kind of persuasion can be likened to offering a form of health education or medical advice. Of course health education is part of the service a doctor is expected to give in a professional capacity. But this education must be of a certain quality befitting a doctor, since the public places a certain premium on information offered by doctors.

The Medical Registration Act, Section 53 (1)e states that if a doctor is found by a Disciplinary Tribunal “to have failed to provide professional services of the quality which is reasonable to expect of him” then he can possibly be punished.

To this hobbit these “professional services” would include unsolicited health education and medical advice where there is no pre-existing patient-doctor relationship. Doctors indirectly influencing the public to take or not take vaccines through the public lobbying of authorities to take a certain public health policy direction would also constitute health education and giving of medical advice.

This brings us back to be the principle that both the individual patient and the public need to be protected. We all make mistakes as doctors telling patients wrong things once in a while. But when there are repeated attempts by the same people to forward a position that is neither backed up by current scientific evidence nor an opinion from a respectable body of peers then something needs to be done.

To sum up, everyone is entitled to their opinion as individuals. Every doctor is also entitled to his profession opinion in the course of an academic or professional discussion with his peers; just be prepared to defend the opinion and failing which, understand well in advance that that position may be demolished within the medical community.

But every doctor is NOT entitled to push his professional opinion or position to the patient or the public when the position is not supported by science or a respectable body of peers. That would be unprofessional if not irresponsible.

After all, being licensed to practise medicine doesn’t mean you are licensed to practise quackery as well.

What this hobbit would really want to see is that these doctors (who are trying so hard and repeatedly trying to dissuade people from taking the mRNA vaccines in some way or the other) to meet in a professional forum with a few members of the MOH Expert Committee on Covid-19 Vaccination. The two sides can argue their case in a Zoom meeting and thousands of doctors can login to this meeting to decide for themselves which side has the stronger case. Perhaps the SMA or Academy of Medicine can organise such a forum. Stop this “open letter” business that can potentially muddle the minds of the public; meet up and argue your case out professionally doctor to doctor, based on scientific research and evidence, and let your peers judge you. If you really know your stuff, you should be able to convince a big segment of a learned audience who can then take up your case and promote your cause.