Consensus and Controversy in Neurologic Practice

IN RECENT years, consensus has emerged as a powerful tool for evaluating the appropriateness of selected applications of new technologies in medical practice and for setting the standards of practice in defined situations. As used in this context, the concept of aconsensusreflects the extent to which there is agreement among experts in matters of opinion and thus represents the collective viewpoint of workers in a certain field. The consensus process has been shown to be highly sensitive to evidence derived from biomedical research: the better the empirical evidence, the greater the consensus.¹ As presently used, however, the consensus process assumes that the patterns of responsibility for practicing neurologists and other physicians follow directly and exclusively from the development of a consensus founded on the best available biomedical evidence in the peer-reviewed literature. The general question of importance for clinicians is whether standards of good medical practice