A Science for the Art of Consensus

Abstract

Editor's note: How is it that different people of good intent can look at the same data and draw opposing conclusions? The recent National Institutes of Health Consensus Development Conference on screening mammography for women ages 40 through 49 is a prime example of this dilemma: The conference was convened to weigh information on the effectiveness of screening this age group and to see if an across-the-board recommendation for mammography was warranted. The panel, composed of non-federal medical and public health experts and patient representatives, concluded that no recommendation should be made that would apply to all women in this age range. A minority report was produced by two panel members who thought otherwise. Several weeks later, on the basis of virtually the same data, the National Cancer Advisory Board, the principal advisory body to the National Cancer Institute, recommended in favor of screening women in their forties. Public reaction was polarized in the ensuing confusion.

In this issue, we publish the full text of the consensus statement, as well as the minority report (pages 1015-26). We have also included the following Commentary by Dr. Sackett to illuminate the nature of this kind of dilemma, one bound to arise many times at the interface of scientific inquiry and the formulation of public policy.