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Panel stacking is a threat to consensus statement validity.

Kasper P KeppPreben AavitslandMarcel BallinFrancois BallouxStefan BaralKevin BardoshHoward BauchnerEran BendavidRaj BhopalDaniel T BlumsteinPaolo BoffettaFlorence BourgeoisAdam BrufskyPeter J CollignonSally CrippsIoana A CristeaNigel CurtisBenjamin DjulbegovicOliver FaudeMaria Elena FlaccoGordon H GuyattGeorge HajishengallisLars G HemkensTammy HoffmannAri R JoffeTerry P KlassenDespina KoletsiDimitrios P KontoyiannisEllen KuhlCarlo La VecchiaTea LallukkaJohn LambrisMichael LevittSpyros MakridakisHelena C MaltezouLamberto ManzoliAna MarusicClio MavraganiDavid MoherBen W MolTaulant MukaFlorian NaudetPaul W NobleAnna NordströmPeter NordströmNikolaos PandisStefania PapatheodorouChirag J PatelIrene PetersenStefan PilzNikolaus PlesnilaAnne-Louise PonsonbyManuel A RivasAndrea SaltelliManuel SchabusMichaéla C SchippersHolger SchünemannMarco SolmiAndreas StangHendrik StreeckJoachim P SturmbergLehana ThabaneBrett D ThombsAthanasios TsakrisSimon N WoodJohn P A Ioannidis
Published in: Journal of clinical epidemiology (2024)
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.
Keyphrases
  • coronavirus disease
  • sars cov
  • clinical practice
  • public health
  • depressive symptoms
  • mental health
  • physical activity
  • social support
  • climate change
  • health insurance
  • childhood cancer