Systemic bias in medical consensus: how flawed panels and lack of evidence can distort definitions and guidelines: the case of Vogt-Koyanagi-Harada disease : Perspective.
Jul 2026· Journal of Ophthalmic Inflammation and Infection· 0 citations
Medicine
TL;DR
The risks of poorly structured consensus processes are emphasized and safeguards are proposed to ensure scientifically rigorous and clinically useful recommendations to ensure scientifically rigorous and clinically useful recommendations.
Abstract
Background
The creation of diagnostic criteria for a disease is always challenging in medicine. Consensus meetings and expert's opinions are sometimes responsible for establishing useful and precise diagnostic criteria but, unfortunately, not all the consensus meetings are based on evidence-based conclusions.
Methods
A perspective analysis of the historical evolution of diagnostic criteria for Vogt-Koyanagi-Harada.
Results
We examine the historical evolution of diagnostic criteria for Vogt-Koyanagi-Harada disease, an autoimmune condition targeting melanocyte-containing tissues, primarily affecting the choroid and potentially involving the skin, ears, and meninges. Early diagnostic criteria proposed in the late twentieth century were considered inadequate, leading to an international consensus conference in 1999 and the publication of revised diagnostic criteria in 2001. However, these criteria contained major conceptual flaws, notably the combination of acute and chronic clinical features that rarely occur simultaneously. In addition, important diagnostic tools such as indocyanine green angiography were largely excluded due to prevailing local practices and skepticism regarding their use. These limitations hindered accurate diagnosis and delayed recognition of VKH as a disease with distinct acute-onset and chronic forms requiring different diagnostic frameworks and management strategies. Subsequent studies corrected some deficiencies but often generated complex criteria difficult to apply in routine practice.
Conclusion
We would like to emphasize the risks of poorly structured consensus processes and propose safeguards to ensure scientifically rigorous and clinically useful recommendations.
Diagnostic criteria for multiple sclerosis have evolved substantially since the Schumacher criteria were published in 1965. The most recent iteration, the 2024 McDonald diagnostic criteria, was recently released. Each revision has broadened the range of evidence that can support diagnosis while attempting to preserve specificity. The central question raised by the 2024 revision is therefore not simply whether the criteria are valid in principle, but whether they can be applied safely outside expert centres, where imaging quality, laboratory infrastructure and subspecialist interpretation vary substantially. In this review, we evaluate the 2024 criteria not only as a consensus document but as an intervention in clinical behaviour, with particular attention to misdiagnosis risk, operational feasibility and equity of implementation. In particular, we consider the role of the optic nerve and of the central vein sign and paramagnetic rim lesions in diagnosis, and how the criteria bring more diverse populations and presentations into consideration. We also review how the greater options available to achieve a diagnosis may introduce heterogeneity into diagnostic approaches, and what safeguards can be taken to minimise the risk of inappropriate application of the criteria and subsequent misdiagnosis (and inappropriate treatment). The review finishes by proposing how the changes introduced in this iteration might be refined, with more robust definitions on acquiring and interpreting the novel biomarkers.
Michael A. Foster, Charles Wade, Helen L. Ford et al.· Brain : a journal of neurolo...· 0 citations
INTRODUCTION
Cancer remains a leading cause of mortality and poses a significant public health challenge. Several non-specific symptoms (NSSs) often indicate non-serious disease but can also accompany malignancy even in the absence of organ-specific signs. Therefore, the aim of the study was to comprehensively delineate the association between the most common NSSs (weight loss, fatigue, pain and nausea/appetite loss) and cancer or non-cancer diagnoses.
METHODS
Database searches of PubMed and Embase were conducted applying search criteria to identify studies that investigated common NSSs in cancer patients diagnosed through rapid diagnostic centres (RDCs). The quality of the included studies was assessed using a modified Newcastle-Ottawa Scale (NOS). For each symptom, pooled relative risks (RRs) with 95% confidence intervals were derived using random-effects meta-analysis.
RESULTS
Eleven studies met the inclusion criteria. All studies were considered to be of high methodological quality. The most frequent disease locations for cancer entities included hematologic, lung and lower gastrointestinal. Together with miscellaneous, rheumatic, and musculoskeletal conditions, these were the most common for non-cancer diagnoses. Nausea/appetite loss showed a statistically significant association with cancer (RR=1.20, 95%-CI 1.07-1.35). Pain showed a non-significant association (RR=1.07, 95%-CI 0.75-1.53) with substantial between-study heterogeneity, and weight loss showed a non-significant inverse trend (RR=0.92, 95%-CI 0.84-1.02). Fatigue showed no association with cancer (RR=1.00, 95%-CI 0.85-1.18).
DISCUSSION/CONCLUSION
NSSs may be valuable for cancer risk assessment, but the associations remain modest. The complexity of patients' clinical presentations suggests that additional factors likely influence the cancer risk. Future research should examine symptom combinations and, where data allow, perform subgroup analyses.
Nicolai Sørensen, Matylda Kubacz, Birgitte Sandfeld-Paulsen et al.· Cancer Epidemiology· 0 citations
BACKGROUND & AIMS
The definition of sarcopenia has evolved substantially since its original operationalization as a muscle mass phenomenon. Multiple definitions have been proposed over the past decades, incorporating muscle strength and physical performance, yet no universally accepted diagnostic standard exists. This scoping review aimed to map and summarize the definitions, diagnostic criteria, assessment methods, and epidemiological patterns of sarcopenia in middle-aged and older adult populations.
METHODS
In order to capture the first 25 years of research, PubMed/MEDLINE, Embase, and Web of Science were searched from January 1998 to December 2023. Eligible studies were peer-reviewed articles that explicitly described how sarcopenia was diagnosed in populations with a mean or median age of at least 50 years. Data extraction was performed using a standardized chart, supported by a locally deployed large language model, with systematic dual-reviewer verification of all extracted data.
RESULTS
A total of 4,578 publications were included, yielding 5,241 sarcopenia-definition instances and more than 21 million cumulative participant records. Publication volume increased markedly over time. The literature was geographically concentrated in East Asia, Europe and North America. Nearly all definitions were categorized into one of five taxonomic groups: muscle mass combined with function, muscle mass alone, function alone, risk assessment tools, and clinical classification. Definitions combining muscle mass plus function were the most frequently used (54.5%), with EWGSOP and AWGS criteria predominating, followed by muscle mass definitions (41.9%). Mass-only definitions nevertheless remained prominent in specialties relying heavily on computed tomography, particularly oncology. Muscle mass was assessed in 96.3% of studies, most commonly via bioelectrical impedance analysis, dual-energy X-ray absorptiometry, and computed tomography. Handgrip strength and gait speed were the most widely used functional measures.
CONCLUSIONS
Sarcopenia research has grown rapidly, but remains highly heterogeneous in its operationalization. Although consensus definitions have supported a shift toward multidimensional assessment, methodological variability continues to limit comparability between studies. Until a unified definition of sarcopenia is globally accepted, literature should explicitly report the definition applied, the instruments and protocols used to assess each component, and the thresholds adopted in order to enable meaningful cross-study comparability.
H. Esperto, A. Ferreira, M. Veríssimo· Clinical Nutrition ESPEN· 0 citations
OBJECTIVES
This systematic scoping review provides an overview of the concepts, methodological approaches, and outcome measures used to evaluate diagnostic and therapeutic technologies for URDs.
METHODS
Searches covered countries where English, Portuguese or Spanish are official languages and were expanded to INAHTA and ICMRA countries using additional Roman-character languages. A search was conducted for official documents, reports, recommendations, and legal frameworks from health technology assessment (HTA) agencies and regulatory authorities in these countries. Data were extracted on URD definitions, primary sources, methodological approaches, and outcome measures used in HTA.
RESULTS
A total of 55 publications were included. The definitions of URDs varied, with most countries adopting a prevalence threshold of ≤ 1 in 50,000 people, while others applied stricter criteria (≤ 1 in 100,000). Conventional methods, such as randomized controlled trials, were seldom feasible, with evidence often derived from observational studies, historical cohorts, or real-world data. Innovative approaches, including matching-adjusted indirect comparisons (MAIC), simulated treatment comparisons (STC), and multicriteria decision analysis (MCDA), were increasingly employed. Outcome measures prioritized overall survival, quality of life, functional independence, and caregiver burden, with jurisdiction allowing more flexible cost-effectiveness thresholds or exceptional coverage criteria.
CONCLUSIONS
Despite heterogeneity, there is growing convergence on prevalence-based criteria and adaptive strategies for URDs, highlighting the need for robust patient registries, international data sharing, and HTA frameworks that incorporate severity, equity, and social value.
Raul Edison Luna Lazo, D. Gorski, F. Vilela et al.· Value in Health· 0 citations
Early and reliable diagnosis of multiple sclerosis (MS) is critical for initiating an appropriate disease-modifying therapy (DMT). The 2024 revisions of the McDonald diagnostic criteria incorporate novel fluid and imaging biomarkers aiming to facilitate an accurate and timely diagnosis. The aim of this point-of-view paper is to discuss the implementation of the 2024 McDonald criteria in the clinical routine setting in context of the German Health care system and provide consensus recommendations by an interdisciplinary expert panel. A multidisciplinary panel of nine experts in the field of diagnosis and treatment of MS convened to discuss the potential advances and challenges of the clinical implementation of the 2024 McDonald criteria and develop consensus recommendations. The panel identified implementation challenges regarding limited specialized resources for the suggested additional imaging markers such as the detection of optic nerve (ON) lesions, paramagnetic rim lesions (PRLs) and the demonstration of lesions with a central vein sign (CVS) as well as the implementation of kappa free light chains (kFLC) in Germany. We advocate a stratified diagnostic approach: cerebrospinal fluid (CSF) analysis remains essential. The consideration of ON lesions, PRLs and lesions with a CVS should be reserved for diagnostic situations in which the diagnosis cannot be established with conventional MRI protocols or other methods for examination of the optic nerve. To minimize misdiagnosis and to address the complexity of treating radiologically isolated syndrome, there is a necessity of continuous professional training and nuanced, patient-centered therapeutic strategies, especially for individuals with radiologically isolated syndrome but also for atypical presentations. In conclusion, the 2024 revisions of the McDonald criteria aim to facilitate an accurate and early diagnosis of MS potentially enabling earlier MS therapy initiation. However, the routine implementation, particularly regarding the new imaging markers, requires an expansion of resources and expertise limiting the general applicability in the German healthcare system.
M. P. Wattjes, Antonios Bayas, Stefan Bittner et al.· Therapeutic Advances in Neur...· 0 citations
Background and Objective: Studies examining the association between cancer diagnosis to treatment interval (DTI) and overall survival (OS) are important to help inform clinical practice guidelines. Recent international consensus-based recommendations defined best practices for this area of research and raised concerns about the poor validity and inconsistent methodologies in the available literature. Our objective is to systematically assess the quality of studies investigating the association between DTI and OS using consensus-based methodological recommendations. Methods: We are conducting a systematic review of observational studies published from 2020 onward that examine the association between DTI and OS in seven cancers with global relevance: bladder, breast, colon, rectal, lung, cervical, and head and neck cancers. We developed thorough search strategies to search Ovid MEDLINE, EMBASE, and Web of Science databases. Two rounds of screening will be performed in tandem using Covidence following predefined exclusion criteria and reliability procedures. Data extraction will be performed using Covidence with considerations for reliability and reconciliation. Methodological components will be evaluated against international consensus-based recommendations across domains including variable definition and measurement, cohort creation, confounder control, bias management, analytic techniques, and responsible data interpretation. Findings will be synthesized and presented using descriptive statistics. Anticipated Applications: This review will provide a comprehensive assessment of methodological validity and consistency in recent studies investigating the association between cancer DTI and OS. The findings will highlight areas for improvement and support wider adoption of the consensus-based recommendations to strengthen future research in this area (Jalink et al., 2025).
References: Jalink M, King WD, Anderson BO, et al. Recommendations for studying the association of the cancer diagnosis to treatment interval with overall survival: a modified Delphi process. Br J Cancer. 2025;133:1526-1534. doi:10.1038/s41416-025-03158-3.
V. Patel· Inquiry@Queen's Undergraduat...· 0 citations
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