H.M. Higgins, J.N. Huxley, W. Wapenaar, M.J. Green

The clinical beliefs (expectations and demands) of veterinarians regarding herd-level strategies to control mastitis, lameness, and Johne's disease were quantified in a numerical format; 94 veterinarians working in England (UK) were randomly selected and, during interviews, a statistical technique called probabilistic elicitation was used to capture their clinical expectations as probability distributions. The results revealed that markedly different clinical expectations existed for all 3 diseases, and many pairs of veterinarians had expectations with nonoverlapping 95% Bayesian credible intervals. For example, for a 3-yr lameness intervention, the most pessimistic veterinarian was centered at an 11% population mean reduction in lameness prevalence (95% credible interval: 0-21%); the most enthusiastic veterinarian was centered at a 58% reduction (95% credible interval: 38-78%). This suggests that a major change in beliefs would be required to achieve clinical agreement. Veterinarians' clinical expectations were used as priors in Bayesian models where they were combined with synthetic data (from randomized clinical trials of different sizes) to explore the effect of new evidence on current clinical opinion. The mathematical models make predictions based on the assumption that veterinarians will update their beliefs logically. For example, for the lameness intervention, a 200-farm clinical trial that estimated a 30% mean reduction in lameness prevalence was predicted to be reasonably convincing to the most pessimist veterinarian; that is, in light of this data, they were predicted to believe there would be a 0.92 probability of exceeding the median clinical demand of this sample of veterinarians, which was a 20% mean reduction in lameness. Currently, controversy exists over the extent to which veterinarians update their beliefs logically, and further research on this is needed. This study has demonstrated that probabilistic elicitation and a Bayesian framework are useful for evaluating the diversity and strength of veterinarians' clinical beliefs. The wide variations observed have implications for designing future projects. Although many factors influence disease control, nonetheless the heterogeneity in beliefs also raises concern over the extent to which a broadly consistent approach is currently being achieved; it supports the argument for more randomized clinical trials and for national programs to control nonstatutory endemic diseases.