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.