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3. Panel stacking is a threat to consensus statement validity

Author

Kepp, K. P., Aavitsland, P., Ballin, M., Balloux, F., Baral, S., Bardosh, K., Bauchner, H., Bendavid, E., Bhopal, R., Blumstein, D. T., Boffetta, P., Bourgeois, F., Brufsky, A., Collignon, P. J., Cripps, S., Cristea, I. A., Curtis, N., Djulbegovic, B., Faude, O., Flacco, M. E., Guyatt, G. H., Hajishengallis, G., Hemkens, L. G., Hoffmann, T., Joffe, A. R., Klassen, T. P., Koletsi, D., Kontoyiannis, D. P., Kuhl, E., La Vecchia, C., Lallukka, T., Lambris, J., Levitt, M., Makridakis, S., Maltezou, H. C., Manzoli, L., Marusic, A., Mavragani, C., Moher, D., Mol, B. W., Muka, T., Naudet, F., Noble, P. W., Nordström, Anna, Nordström, P., Pandis, N., Papatheodorou, S., Patel, C. J., Petersen, I., Pilz, S., Plesnila, N., Ponsonby, A. -L, Rivas, M. A., Saltelli, A., Schabus, M., Schippers, M. C., Schünemann, H., Solmi, M., Stang, A., Streeck, H., Sturmberg, J. P., Thabane, L., Thombs, B. D., Tsakris, A., Wood, S. N., Ioannidis, J. P. A., Kepp, K. P., Aavitsland, P., Ballin, M., Balloux, F., Baral, S., Bardosh, K., Bauchner, H., Bendavid, E., Bhopal, R., Blumstein, D. T., Boffetta, P., Bourgeois, F., Brufsky, A., Collignon, P. J., Cripps, S., Cristea, I. A., Curtis, N., Djulbegovic, B., Faude, O., Flacco, M. E., Guyatt, G. H., Hajishengallis, G., Hemkens, L. G., Hoffmann, T., Joffe, A. R., Klassen, T. P., Koletsi, D., Kontoyiannis, D. P., Kuhl, E., La Vecchia, C., Lallukka, T., Lambris, J., Levitt, M., Makridakis, S., Maltezou, H. C., Manzoli, L., Marusic, A., Mavragani, C., Moher, D., Mol, B. W., Muka, T., Naudet, F., Noble, P. W., Nordström, Anna, Nordström, P., Pandis, N., Papatheodorou, S., Patel, C. J., Petersen, I., Pilz, S., Plesnila, N., Ponsonby, A. -L, Rivas, M. A., Saltelli, A., Schabus, M., Schippers, M. C., Schünemann, H., Solmi, M., Stang, A., Streeck, H., Sturmberg, J. P., Thabane, L., Thombs, B. D., Tsakris, A., Wood, S. N., and Ioannidis, J. P. A.

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.

Published
2024
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9. PROJET REBUILD THE EVIDENCE

Author

VAILLANT-ROUSSEL, H, primary, BLANCHARD, C, additional, MENINI, T, additional, CHARUEL, E, additional, PEREIRA, B, additional, NAUDET, F, additional, KASSAI, B, additional, GRENET, G, additional, GUEYFFIER, F, additional, CUCHERAT, M, additional, and BOUSSAGEON, R, additional

Published
2023
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22. Les niveaux de TIMP-2 et MMP-2 urinaires sont significativement associés au trouble de la compliance vésicale chez les patients spina bifida adultes

Author

Peyronnet, B., primary, Richard, C., additional, Bendavid, C., additional, Naudet, F., additional, Hascoet, J., additional, Brochard, C., additional, Senal, N., additional, Alimi, Q., additional, Voiry, C., additional, Bonan, I., additional, Jezequel, M., additional, Rigole, H., additional, Khene, Z., additional, Corlu, A., additional, Clement, B., additional, Siproudhis, L., additional, Bouguen, G., additional, Kerdraon, J., additional, Manunta, A., additional, and Gamé, X., additional

Published
2019
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24. Urinary TIMP-2 is significantly associated with poor bladder compliance and upper urinary tract damage in adult patients with spina bifida

Author

Peyronnet, B., primary, Richard, C., additional, Bendavid, C., additional, Naudet, F., additional, Hascoet, J., additional, Brochard, C., additional, Alimi, Q., additional, Khene, Z., additional, Siproudhis, L., additional, Bouguen, G., additional, Kerdraon, J., additional, Manunta, A., additional, and Gamé, X., additional

Published
2019
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37. [Is the court-ordered treatment indication by the expert based on a medical diagnosis?]

Author

Spriet , H., Abondo , M., Naudet , F., Bouvet , R., Le Gueut , M., Centre d'Investigation Clinique [Rennes] ( CIC ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Troubles du comportement alimentaire de l'adolescent ( UMR_S 669 ), and Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris-Sud - Paris 11 ( UP11 )

Subjects
[ SDV ] Life Sciences [q-bio], humanities, health care economics and organizations
Abstract

International audience; Court-ordered treatment was created in 1998, as part of a law against sexual offense recidivism. The creation of court-ordered treatment is based on the premise that many offenders have psychiatric disorders. If the court-ordered treatment is appraised as an effective way to prevent recidivism by the lawmaker, the preeminent role of psychiatry, in the prevention of recidivism has generated controversy in the psychiatric community. Few studies have been conducted on court-ordered treatment in France, and have concerned epidemiological measures. Court-ordered treatment leads to an extension of the expert's mission. In order to prevent recidivism, the interest of a treatment is a new part of the expert's mission. PURPOSE: The main purpose of this study was to assess the kind of diagnosis reported by the forensic psychiatrist who considered the court-ordered treatment as appropriate. METHOD: We led a descriptive and retrospective study among the experts' reports of 68 subjects followed by three psychiatrists. We categorized each diagnosis found in the experts' reports in reference to DSM-IV-TR axis I and axis II. As the expert has no obligation to refer to the DSM-IV-TR, we also considered the "no DSM-IV-TR categorized disorder" as a category. The primary outcome was the proportion of each diagnosis category in experts' reports, in which the forensic psychiatrist agreed with the indication of a court-ordered treatment. RESULTS: We analysed 123 experts' reports in which the mission was to diagnose a mental disorder and to assess the need for a court-ordered treatment. The expert agreed with the need for a court-ordered treatment in 112 reports. In those reports the diagnosis was "no disorder" in 27% of them, "no DSM-IV-TR categorized disorder" in 26% of them, "axis II disorder" in 24% of them, "axis I disorder" in 19% of them, and "association of an axis I and an axis II disorder" in 4% of them. DISCUSSION: The diagnoses were heterogeneous. Their associations with the need for a court-ordered treatment seem to be contradictory when considering the association between "no mental disorder" and "need for a court-ordered treatment" found in 27% of the reports. These paradoxical results led us to question the meaning of mental disorder and treatment.

Published
2014
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39. Medicamentos útiles e inútiles: ¿cómo definirlos?

Author

Bergmann, J.-F. and Naudet, F.

Abstract

La utilidad de un medicamento es difícil de determinar antes de que pasen varios años de utilización y debe diferenciarse de la actividad farmacológica, de la eficacia terapéutica o de la rentabilidad económica o social. La utilidad de un tratamiento puede percibirla un paciente o la sociedad, dependiendo de si el fármaco actúa sobre un síntoma o una discapacidad, o si disminuye una morbilidad, separando las acciones curativas de las preventivas. La medición de la utilidad se realiza, no tanto por la autorización de comercialización (AC) como por la evaluación del servicio médico prestado (SMP), que depende de la gravedad de la enfermedad, de la eficacia del medicamento, del lugar que ocupa en la estrategia y de la existencia de alternativas terapéuticas. La mejora del SMP (MSMP) tiene como objetivo situar la utilidad del medicamento respecto a otros tratamientos disponibles previamente e indicados para la misma patología. Por último, los datos de farmacoepidemiología y de farmacoeconomía permiten situar la utilidad social del medicamento. La evaluación de la utilidad se basa en la calidad de los ensayos controlados y de las medidas de eficacia, en la evaluación de la relación beneficio/riesgo y en la pertinencia clínica del beneficio terapéutico. Sin embargo, una eficacia farmacoterapéutica no garantiza siempre que un tratamiento sea aceptado por un paciente, que éste tendrá una mejoría y que, cuando se produzca la mejoría, el tratamiento sea verdaderamente su causa. Además, algunos medicamentos sin eficacia se perciben a veces como útiles por sus efectos inespecíficos. Por último, incluso un medicamento eficaz puede ser en gran medida inútil, por ejemplo, cuando causa problemas de seguridad. Por tanto, la utilidad de un tratamiento es una cuestión compleja que requiere un espíritu crítico y una reevaluación frecuente.

Published
2024
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50. Communicating scientific evidence: drugs for Alzheimer's disease as a case study.

Author

Kepp KP, Høilund-Carlsen PF, Cristea IA, Cumming RG, Daly T, Emilsson L, Flacco ME, Hemkens LG, Janiaud P, Johnsen KB, Lallukka T, Muka T, Naudet F, Revheim MR, Squitti R, and Thambisetty M

Abstract

This paper reviews the scientific evidence on new anti-amyloid monoclonal antibodies for treating Alzheimer's disease as a case study for improving scientific evidence communication. We introduce five guidelines condensed from the biomedical evidence literature but adapted to the short format of science communication in e.g. journal opinion pieces and newspaper articles. Given the major importance and recent confusion regarding the discussed drugs, with certain disagreements seen e.g. between FDA and EMA, the suggested guidelines may be useful to clinicians discussing with their patients and to scientists communicating the evidence in balance. More generally, we hope that the guidelines may help us to improve communication of scientific evidence on complex topics in opinion pieces in the scientific literature, in advocacy, and in media appearances.

Published
2025
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