Reprinted from CLINICAL RESEARCH, Vol. 26(3)113-115.

 

 

EDITORIAL
Seeking Technical Consensus
on Medical Interventions

 

 

The evolution of science has yielded a time-
tested process for the conversion of information
to knowledge, and knowledge to wisdom.
Involved are familiar and accepted phases:
posing the question, conducting the experiment,
preparing the report, receiving editorial review
and criticism, and (sometimes after considerable
delay) achieving publication. As the contribu-
tion passes into the literature, it diffuses into
general awareness and undergoes further evalua-
tion in a number of ways. Eventually it will
become grist for resynthesis along with other
knowledge. With even more time it may become
doctrine encased between the covers of authori-
tative texts.

The method is slow and tedious, but for good
reasons. There are limits to its acceleration and
one approaches cautiously any perturbation of
the dynamics of a system that seems almost to
derive from natural law.

Yet one hears arguments today for modifying
the traditional ways of handling information in
the biomedical sciences. For these older ways are
not particularly attuned to a rising demand for
wisdom—and better-quality wisdom, if you
please, served up with shorter delays—about
medical questions that have important social
dimensions. This demand is created by physi-
cians, planners, payers, politicians, patients, and
others who want authoritative opinions on
health technologies.

There is an inescapable need to enhance the
present highly informal but often haphazard
process for creating authority by increments of
opinion. Failure to do so can only result in
further uncertainty about medical inventions
that is either unnecessary or intolerable. Another
consequence will be the rise of ambitious
creations for “technology management.” which
may rely unduly on regulatory measures or
marketing controls. In this issue of CLINICAL
RESEARCH is an article describing a novel
exercise to hasten the search for consensus in the
old-fashioned way.

“National Institutes of Health Consensus

116

Development Panel: Statement of Recommen-
dations on Breast Cancer Screening” sum-
marizes the activities, conclusions, and recom-
mendations of an NIH-NCI panel convened to
examine issues and the state-of-the-art in breast
cancer screening, particularly through use of
mammography.

Recent findings have raised serious questions
about risks and benefits associated with mam-
mography as an aid to cancer case-finding.
Among interested scientists and clinicians, opin-
ions were sharply divided. The magnitude of the
issue was indicated by the fact that nearly
300,000 women were voluntary participants ina
government-sponsored screening program that
included the use of this technique.

Accordingly, in September 1977, a 16-member
panel—carefully chosen to include knowledge-
able clinicians, scientists, other experts, and
interested laymen—met in open session for three
days at Bethesda, Maryland. The panel reviewed
available data, heard the views of expert and lay
witnesses, and developed conclusions and rec-
ommendations. These represent the consensus
judgment of the panelists.

The proceedings reflect several imperatives
that must be met in attempts to hasten resolution
of scientific issues in this way:

—The need to select questions that are

susceptible of solution;

— The need for broad and open participation,
and a careful balancing of inevitable biases
among the presenters and deciders;

— The importance of making available a clear
record of deliberations;

— The need to explain conclusions in terms
suitable to the varied audiences with an
interest in the outcome;

— The need to achieve consensus on the gaps
in knowledge as well as on the advances;
and

— The desirability of confining the search for
authority within the limits of expertise
assembled.

It is this last concern that has led us to speak of

Published by Charles B. Stack, Ine., Medical Publisher © 1978.

)
SEEKING TECHNICAL CONSENSUS 117

a search for technical consensus. We believe that
the scientific community must avoid all preten-
sion of ultimate wisdom in these exercises. If we
lay out the state-of-the-art—what it is we know
and do not know from data scientifically
derived—we will serve medicine and society
through provision of a sounder base on which
further value judgments can be laid.

Further programs for consensus development
on controversial medical interventions are
planned and will be announced in CLINICAL
RESEARCH.

DONALD S. FREDRICKSON
Director

National Institutes of Health
Bethesda, Maryland