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[SOC]

Funny how 'consensus' was supported when used by the experts including those experts who wrote the ICCME of which very little if anything has been heard or talked about; and yet not so many months ago - it was ICCME or nothing - and the CCC was deemed second-best.

I dare say, you all feel, consensus is not so much a 'dirty word' when the experts you support wholeheartedly are thought to have employed it in support of the CCC, and yet perhaps even in this context the experts were making a 'compromise'.

In any forum, even one that seeks votes, it will ever be the greater vote that is deemed the consensus. I wonder who considered consensus in the context of the expert letter - was this term used within the letter or by those advocates who advanced the letter as a 'consensus' view? I forget.

[my bolding]
I think you might misunderstand the meaning of "consensus" in the context of committee-based decision-making. In consensus, everyone on the committee must agree with the published conclusions. It is most definitely not a majority opinion conclusion. The consensus is not what most committee members agree to, it is what all members agree to.

It's a great process when all participants are honestly working to find a common ground and that minimal common ground is an acceptable conclusion.

It fails dismally when
1) an extremist segment refuses to accept any conclusion but their own position
2) a minimalist solution -- one everyone can accept -- is insufficient for the purpose
3) an extremist minority, even one person, refuses to accept the conclusion without their own pet addendum issue included
4) an extremist minority, even one person, refuses to accept a point that everyone except them considers an obvious conclusion
and so on.

Developing a definition for ME/CFS is not a place where consensus has any likelihood of being successful. We don't want a minimalist definition that includes only the overlap between the BPS and the biomedical positions. What would that be? Six months of unexplained fatigue? Do they all agree on anything else?

We don't want the definition of the illness held hostage by those who insist that ME/CFS is a psychiatric condition and who won't allow for a definition that says otherwise. For example, it only takes one person on the committee refusing to allow immune research/data into the definition to keep it out, even if all the other experts agree it's important.

Consensus can work in certain situations. It sounds like our 50 experts reached a consensus -- they all agreed upon the content of the letter they signed. Similarly, the CCC and the ICC were agreed upon by all the committee members who developed the criteria. But in neither case were the committees trying to accommodate the beliefs and wishes of the BPS school.

While in theory, and in certain situations, I think consensus is a great method of decision-making, I've also left a couple of organizations that switched decision-making method from majority-rule to consensus because they became completely crippled and unable to achieve any productive forward motion. Every decision took 10 times longer to make and became so watered-down that it was utterly useless.

Obstructive people who want to maintain the status quo love the consensus method. All they have to do is continue to argue and refuse to cooperate and nothing happens.... or what happens is what they want because everyone else agrees with them just to get the whole damned misery over with. And I, for one, can see the BPS school playing just that game.

 

[alex3619]

When a group comes up with a model or agreed position, there can be consensus for that group. I think iirc that the CCC and the ICC were built using a consensus process, however the consensus was from experts very familiar with the science.

Endorsing the CCC was consensus as every expert signed, but it was consensus for that group. Ditto for the advocate letter.

For there to be consensus, everyone has to participate in the decision making, and everyone (or nearly everyone) needs to agree. That sometimes can happen with a democratic vote at the end of the process, but we do not usually see consensus in parliament or congress. It can involve compromise.

The CCC is not the most advanced definition. The ICC ME definition is. However it takes more than that to be accepted and used. One of those factors is time. Another is testing. Another is of course operationalization. The CCC has proved its worth over the last decade, in time I think the ICC will too. However this crisis came upon us too fast, and the science is likely to change in the next few years. Whatever definition we adopt could be obsolete by the time we finally adopt it.

One of the ways researchers deal with this is to use dual criteria in a study, and compare the groups. A doctor cannot do that however, at least not for administrative purposes. They do however have the flexibility to take multiple options into account.

This is not about consensus as such. Any government panel is likely to seek consensus. Its about how consensus is sought, what methodology they are using, and what expert knowledge they bring to the table. If they are close to a consensus and a deadline is approaching, then they vote.

The word doesn't mean much except to define a scope. Compare a shiny new red Lamborghini with a broken down old VW that has been around since the Vietnam War. Both are cars. One would not want to say they are equivalent however. Its the details that matter.

 

[justinreilly]

SOC's post brought some things to mind. If the contract goes forward, god forbid, We should urge our experts to be "extremists" or "radically" devoted to the good science, clinical experience and the truth and not agree to consensus either on individual patently untrue statements or points and/or on the whole definition and/or report if it is substantially crappy. And ask them to write dissenting opinions for which the process allows and I think are included in the report.

If the contract process goes forward, not participating in it or even resigning is not as good as staying on the panel and refusing to reach consensus if they put garbage in there.

Then the report could rightfully be considered to a great extent a failure on its own terms since it is a consensus process and there would be substantial non-consensus (if that's a word). Then it could be contrasted to the CCC and ICC, both successful consensus definitions by all experts panels and to the Expert Letter- a consensus, of now 50 experts, that CCC must be adopted now.

 

[Firestormm]

@Nielk @Bob @SOC et al.

Thanks for the comments. I am rather up to my ears in articles and work and upgrading my system to Windows 8 at present; so I will have to come back to you. My apologies.