The road to consensus: considerations for the safe use and prescribing of COX-2-specific inhibitors.
We describe a process which aimed to achieve consensus on evidence-based considerations for the safe prescribing and use of the COX-2-specific inhibitors available in Australia among a group of 31 clinicians and other health professionals, drawn from practice, academia and industry. Difficulties were encountered at several points: the composition of the working group was contentious; the evidence, drawn from large clinical studies, was criticised by some for problems of study design, data analysis and reporting; interpretation of study results was influenced by the interpreter's knowledge, skills and biases; and the formulation of the "Considerations" became more controversial as summary statements were contracted and simplified. Agreement on the final draft was achieved among 23 of 31 participants. Evidence-based practice guidelines are a welcome development in modern medicine, but the consensus required to produce them can mask important diversity of opinion.
Edmonds
John P
JP
University of NSW, Sydney. john.edmonds@unsw.edu.au
Day
Richard O
RO
Bertouch
James V
JV
D003245:Consensus Statements as Topic; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D003627:Data Interpretation, Statistical; D019317:Evidence-Based Medicine; D006801:Humans; D007527:Isoenzymes / Q000037:antagonists & inhibitors*; D008565:Membrane Proteins; D011451:Prostaglandin-Endoperoxide Synthases
D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D008565:Membrane Proteins; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases