title: Should Committees That Write Guidelines and Recommendations Publish Dissenting Opinions?
abstract: Medical guidelines tend to convey a sense of unanimity of opinion that may not reflect the deliberations of the experts who wrote them. Using, as an example, an analysis of the recently published recommendations on administering pneumococcal conjugate vaccine to adults, the present article raises the question of whether official recommendations and guidelines should include dissenting opinions, analogous to decisions issued by the US Supreme Court. The argument that such a policy would lead to confusion in our profession is addressed in 2 ways: (1) the current system, in which different professional societies publish conflicting recommendations, as in the case of breast or prostate cancer screening, can be far more confusing, and (2) in the long run, greater transparency will lead to more thoughtful and higher-quality medical care. Perhaps the most important point of this paper is the suggestion that it is far better to bring dissent into the recommendation process than to act as if it is not there.
authors.affiliation: Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine; and Medical Care Line (Infectious Disease Section), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. Electronic address: Daniel.musher@va.gov.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Musher
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D002487:Centers for Disease Control and Prevention, U.S. / Q000592:standards*; D034462:Dissent and Disputes; D006801:Humans; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011643:Publishing / Q000592:standards; D014481:United States
chemical_list: D022242:Pneumococcal Vaccines