Panel stacking is a threat to consensus statement validity.
Kepp Kasper P, Aavitsland Preben, Ballin Marcel, Balloux Francois, Baral Stefan, Bardosh Kevin, Bauchner Howard, Bendavid Eran, Bhopal Raj, Blumstein Daniel T, Boffetta Paolo, Bourgeois Florence, Brufsky Adam, Collignon Peter J, Cripps Sally, Cristea Ioana A, Curtis Nigel, Djulbegovic Benjamin, Faude Oliver, Flacco Maria Elena, Guyatt Gordon H, Hajishengallis George, Hemkens Lars G, Hoffmann Tammy, Joffe Ari R, Klassen Terry P, Koletsi Despina, Kontoyiannis Dimitrios P, Kuhl Ellen, La Vecchia Carlo, Lallukka Tea, Lambris John, Levitt Michael, Makridakis Spyros, Maltezou Helena C, Manzoli Lamberto, Marusic Ana, Mavragani Clio, Moher David, Mol Ben W, Muka Taulant, Naudet Florian, Noble Paul W, Nordström Anna, Nordström Peter, Pandis Nikolaos, Papatheodorou Stefania, Patel Chirag J, Petersen Irene, Pilz Stefan, Plesnila Nikolaus, Ponsonby Anne-Louise, Rivas Manuel A, Saltelli Andrea, Schabus Manuel, Schippers Michaéla C, Schünemann Holger, Solmi Marco, Stang Andreas, Streeck Hendrik, Sturmberg Joachim P, Thabane Lehana, Thombs Brett D, Tsakris Athanasios, Wood Simon N, Ioannidis John P A
Journal of clinical epidemiology · 2024 · PMID 38897481 · 인용 19
Consensus statements can be very influential in medicine and public health. Some of these statements use systematic evidence synthesis but others fail on this front. Many consensus statements use panels of experts to deduce perceived consensus through Delphi processes.
We argue that stacking of panel members toward one particular position or narrative is a major threat, especially in absence of systematic evidence review. Stacking may involve financial conflicts of interest, but nonfinancial conflicts of strong advocacy can also cause major bias. Given their emerging importance, we describe here how such consensus statements may be misleading, by analyzing in depth a recent high-impact Delphi consensus statement on COVID-19 recommendations as a case example.
We demonstrate that many of the selected panel members and at least 35% of the core panel members had advocated toward COVID-19 elimination (Zero-COVID) during the pandemic and were leading members of aggressive advocacy groups. These advocacy conflicts were not declared in the Delphi consensus publication, with rare exceptions. Therefore, we propose that consensus statements should always require rigorous evidence synthesis and maximal transparency on potential biases toward advocacy or lobbyist groups to be valid.
While advocacy can have many important functions, its biased impact on consensus panels should be carefully avoided.