Panel stacking is a threat to consensus statement validity.

Kepp, KP; Aavitsland, P; Ballin, M; Balloux, F; Baral, S; Bardosh, K; Bauchner, H; Bendavid, E; Bhopal, R; Blumstein, DT; Boffetta, P; Bourgeois, F; Brufsky, A; Collignon, PJ; Cripps, S; Cristea, IA; Curtis, N; Djulbegovic, B; Faude, O; Flacco, ME; Guyatt, GH; Hajishengallis, G; Hemkens, LG; Hoffmann, T; Joffe, AR; Klassen, TP; Koletsi, D; Kontoyiannis, DP; Kuhl, E; La Vecchia, C; Lallukka, T; Lambris, J; Levitt, M; Makridakis, S; Maltezou, HC; Manzoli, L; Marusic, A; Mavragani, C; Moher, D; Mol, BW; Muka, T; Naudet, F; Noble, PW; Nordström, A; Nordström, P; Pandis, N; Papatheodorou, S; Patel, CJ; Petersen, I; Pilz, S; Plesnila, N; Ponsonby, A-L; Rivas, MA; Saltelli, A; Schabus, M; Schippers, MC; Schünemann, H; Solmi, M; Stang, A; Streeck, H; Sturmberg, JP; Thabane, L; Thombs, BD; Tsakris, A; Wood, SN; Ioannidis, JPA

Panel stacking is a threat to consensus statement validity.

Kepp, KP Aavitsland, P Ballin, M Balloux, F Baral, S Bardosh, K Bauchner, H Bendavid, E Bhopal, R Blumstein, DT Boffetta, P Bourgeois, F Brufsky, A Collignon, PJ Cripps, S Cristea, IA Curtis, N Djulbegovic, B Faude, O Flacco, ME Guyatt, GH Hajishengallis, G Hemkens, LG Hoffmann, T Joffe, AR Klassen, TP Koletsi, D Kontoyiannis, DP Kuhl, E La Vecchia, C Lallukka, T Lambris, J Levitt, M Makridakis, S Maltezou, HC Manzoli, L Marusic, A Mavragani, C Moher, D Mol, BW Muka, T Naudet, F Noble, PW Nordström, A Nordström, P Pandis, N Papatheodorou, S Patel, CJ Petersen, I Pilz, S Plesnila, N Ponsonby, A-L Rivas, MA Saltelli, A Schabus, M Schippers, MC Schünemann, H Solmi, M Stang, A Streeck, H Sturmberg, JP Thabane, L Thombs, BD Tsakris, A Wood, SN Ioannidis, JPA

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Publisher:: Elsevier
Publication Type:: Journal Article
Citation:: J Clin Epidemiol, 2024, 173, pp. 111428
Issue Date:: 2024-09

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Field	Value	Language
dc.contributor.author	Kepp, KP
dc.contributor.author	Aavitsland, P
dc.contributor.author	Ballin, M
dc.contributor.author	Balloux, F
dc.contributor.author	Baral, S
dc.contributor.author	Bardosh, K
dc.contributor.author	Bauchner, H
dc.contributor.author	Bendavid, E
dc.contributor.author	Bhopal, R
dc.contributor.author	Blumstein, DT
dc.contributor.author	Boffetta, P
dc.contributor.author	Bourgeois, F
dc.contributor.author	Brufsky, A
dc.contributor.author	Collignon, PJ
dc.contributor.author	Cripps, S
dc.contributor.author	Cristea, IA
dc.contributor.author	Curtis, N
dc.contributor.author	Djulbegovic, B
dc.contributor.author	Faude, O
dc.contributor.author	Flacco, ME
dc.contributor.author	Guyatt, GH
dc.contributor.author	Hajishengallis, G
dc.contributor.author	Hemkens, LG
dc.contributor.author	Hoffmann, T
dc.contributor.author	Joffe, AR
dc.contributor.author	Klassen, TP
dc.contributor.author	Koletsi, D
dc.contributor.author	Kontoyiannis, DP
dc.contributor.author	Kuhl, E
dc.contributor.author	La Vecchia, C
dc.contributor.author	Lallukka, T
dc.contributor.author	Lambris, J
dc.contributor.author	Levitt, M
dc.contributor.author	Makridakis, S
dc.contributor.author	Maltezou, HC
dc.contributor.author	Manzoli, L
dc.contributor.author	Marusic, A
dc.contributor.author	Mavragani, C
dc.contributor.author	Moher, D
dc.contributor.author	Mol, BW
dc.contributor.author	Muka, T
dc.contributor.author	Naudet, F
dc.contributor.author	Noble, PW
dc.contributor.author	Nordström, A
dc.contributor.author	Nordström, P
dc.contributor.author	Pandis, N
dc.contributor.author	Papatheodorou, S
dc.contributor.author	Patel, CJ
dc.contributor.author	Petersen, I
dc.contributor.author	Pilz, S
dc.contributor.author	Plesnila, N
dc.contributor.author	Ponsonby, A-L
dc.contributor.author	Rivas, MA
dc.contributor.author	Saltelli, A
dc.contributor.author	Schabus, M
dc.contributor.author	Schippers, MC
dc.contributor.author	Schünemann, H
dc.contributor.author	Solmi, M
dc.contributor.author	Stang, A
dc.contributor.author	Streeck, H
dc.contributor.author	Sturmberg, JP
dc.contributor.author	Thabane, L
dc.contributor.author	Thombs, BD
dc.contributor.author	Tsakris, A
dc.contributor.author	Wood, SN
dc.contributor.author	Ioannidis, JPA
dc.date.accessioned	2025-05-19T05:45:32Z
dc.date.available	2024-06-10
dc.date.available	2025-05-19T05:45:32Z
dc.date.issued	2024-09
dc.identifier.citation	J Clin Epidemiol, 2024, 173, pp. 111428
dc.identifier.issn	0895-4356
dc.identifier.issn	1878-5921
dc.identifier.uri	http://hdl.handle.net/10453/187416
dc.description.abstract	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.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier
dc.relation.ispartof	J Clin Epidemiol
dc.relation.isbasedon	10.1016/j.jclinepi.2024.111428
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	01 Mathematical Sciences, 11 Medical and Health Sciences
dc.subject.classification	Epidemiology
dc.subject.classification	4202 Epidemiology
dc.subject.mesh	Humans
dc.subject.mesh	COVID-19
dc.subject.mesh	Delphi Technique
dc.subject.mesh	Consensus
dc.subject.mesh	SARS-CoV-2
dc.subject.mesh	Conflict of Interest
dc.subject.mesh	Reproducibility of Results
dc.subject.mesh	Pandemics
dc.subject.mesh	Humans
dc.subject.mesh	Reproducibility of Results
dc.subject.mesh	Consensus
dc.subject.mesh	Conflict of Interest
dc.subject.mesh	Delphi Technique
dc.subject.mesh	Pandemics
dc.subject.mesh	COVID-19
dc.subject.mesh	SARS-CoV-2
dc.subject.mesh	Humans
dc.subject.mesh	COVID-19
dc.subject.mesh	Delphi Technique
dc.subject.mesh	Consensus
dc.subject.mesh	SARS-CoV-2
dc.subject.mesh	Conflict of Interest
dc.subject.mesh	Reproducibility of Results
dc.subject.mesh	Pandemics
dc.title	Panel stacking is a threat to consensus statement validity.
dc.type	Journal Article
utslib.citation.volume	173
utslib.location.activity	United States
utslib.for	01 Mathematical Sciences
utslib.for	11 Medical and Health Sciences
utslib.copyright.status	open_access	*
dc.date.updated	2025-05-19T05:45:30Z
pubs.publication-status	Published
pubs.volume	173

Abstract:

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.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/187416