What is an Expert?
As a person who has worked with consensus guidelines for many years, I am often asked “what is an expert?” What is the secret sauce we use to determine those chosen for inclusion in developing, writing, and publishing guidance that may lead to important changes in patient access. In the past my leadership on these issues has been successful, which has included work with many societies and organizations. This success does not always come with the absence of drama, or the turmoil of politics, so I thought I would take a moment to give some initial thoughts, which will be given in much greater detail in an upcoming editorial by Dr. Jason Pope, our past President and Senior Advisor to the Executive Board.
I thought an easy outline for this process would include grouping who is chosen based on category.
The Leaders of a Consensus: This group needs one very important characteristic. They should have extensive experience in the subject matter. For example, if the topic is Spinal Cord Stimulation, and your clinical experience is only a few implants a year, you should not, and in our system would not, be chosen to be a leader. Many times, we have heard people speak with gravitas, judge others on their practice, and then we discover the number of implants performed per year would certainly not give them experience to be a leader in a consensus but would barely make them competent. In the future, there should be a disclosure on the author’s experience with the procedure in question. Would you want someone to organize the clinically relevant points who has less experience than those in whom the paper was intended? Of course not.
Subject Matter Expertise: This group represents those who do not lead the consensus but are critical for accuracy in the issues to consider. For example, if you were creating a consensus guideline on basivertebral nerve ablation, you need experts who understand and have published on vertebrogenic pain, discogenic pain, and the options surrounding treatment for each. The subject matter experts are easier to determine, because the publication record serves as a reference point to the understanding of why they were chosen.
Specialty, Practice Setting, Location of Practice: The practice of interventional spine, the use of artificial intelligence, the management of peripheral nerve stimulation all are examples of the importance of diverse thought. For example, we may have a procedure where collaborative care is needed and, in those settings, we will choose those who represent different specialties. Other considerations may include site of service, location of practice, academics or private, and solo practice or large entity. In many papers, we will try to assure we have diversity in these processes to properly address the critical issues our members may face in daily practice to assure the new guidelines improve patient access when the data is supportive.
Career Experience: In choosing the participants of a consensus we have the experts who lead the project, we have subject matter expertise, we strive for diverse opinions, and lastly, we bring in early career physicians to do the work of literature review and early grading. These are the people who eventually lead these types of work in the future. I was the “early career” doctor in 1999 when Elliot Krames, MD, Sam Hassenbusch, MD, and Michael Cousins, MD gave me an opportunity. I felt it was my one shot or one opportunity to seize everything I ever wanted, and I did not just let it slip away.
Once we get this amazing group of people together, we develop rules and guidance for the project, including a grading system. Then we develop a conflict-of-interest policy, which includes a transparency and recusal agreement that no one grades or opines on areas where they hold consultation. We do this in an open honest way and assure that we do not allow those who have “no conflicts”, but go to Faculty dinners, have a room paid by the society and get the flight reimbursed to try to sway the process against honest and transparent physicians. There is no room for hypocrisy in our tent. Everyone else please join us, but not hypocrites who pretend to “find industry biased” but take their money via societies without disclosure. We welcome both the conflicted, who are often the most important key opinion leaders, and the non-conflicted who have chosen to avoid industry work. The end product becomes the guideline that in many cases impacts the access to care for those who suffer.
Transparency and recusal are the pillars of our ethos and critical to our impact.
So now you know. This is the soup and the ingredients. Look forward to many guidelines coming to publication soon under the ASPN umbrella. These guidelines will impact your practice.
Be safe out there my friends.