Recommendation without experts? Epistemological implications in the development of screening guidelines

Area of Science:

• Medical guideline development
• Evidence-based practice
• Epidemiology

Background:

• Current controversies in mammographic and cervical cancer screening guidelines.
• The role of Human Papillomavirus (HPV)-DNA testing in screening.
• Debates on the inclusion of subject matter experts in guideline creation.

Purpose of the Study:

• To analyze the necessity of disease epidemiology, natural history, and pathogenesis knowledge for robust recommendations.
• To question the exclusion of topic-specific experts from guideline development.
• To highlight the importance of content expertise in interpreting evidence.

Main Methods:

• Analysis of existing controversies in cancer screening recommendations.
• Epistemological examination of evidence assessment in guideline development.
• Exploration of the role of conjectures in scientific interpretation.

Main Results:

• Methodology alone does not guarantee sound evidence assessment.
• Excluding subject matter experts can lead to biased interpretations.
• Scientific knowledge relies on demonstrable conjectures to interpret evidence.

Conclusions:

• Content experts familiar with disease epidemiology, etiology, and interventions are crucial for sound recommendations.
• Guideline development must integrate methodological rigor with subject matter expertise.
• A balanced approach is needed to avoid prejudice and conflicts of interest while ensuring comprehensive evidence interpretation.