Evidence and Consensus

In only ten years, the consensus conference, developed in the United States, has become important worldwide as a means of assessing the application of medical technology to clinical practice. Canada recently held its first consensus conference, on indications for cesarean section. As the article by Lomas et al¹in this issue ofTHE JOURNALdescribes, research-based evidence played a critical role in this conference. The authors conclude that the evidence was well integrated into the consensus statement and that it served to modulate the degree of consensus achieved on the various issues before the conference. These conclusions prompt reflection on the role that empirical evidence has played in consensus development in the United States. See also p 3001. Donald S. Fredrickson, MD, then director of the National Institutes of Health (NIH), originated the consensus development process in 1977 with a public confirmation of the agency's responsibilities for promoting efforts