We evaluate whether people will outsource their opinion on public policy to consensus conference participants. The ideal consensus conference brings together a representative sample of citizens and introduces them to the range of perspectives and evidence related to some policy. The sample is given the opportunity to ask questions of experts and to deliberate. Attitudes about each policy are queried before and after the conference to see if the event has changed minds. In general, such conferences do produce opinion shifts. Our hypothesis is that the shift can be leveraged by simply communicating conference results – absent substantive information about the merits of the policies discussed – to scale up the value of conferences to the population at large. In five studies, we tell participants about the impact of a consensus conference on a sample of citizens’ opinions for a range of policies without providing any new information about the inherent value of the policy itself. For several of the policies, we see a shift in opinion. We conclude that the value of consensus conferences can be scaled up simply by telling an electorate about its results. This suggests an economical way to bring evidence and rational argument to bear on citizens’ policy attitudes.

We challenge assumptions that have guided much research and policy aimed at understanding and reducing medical practice variation. Paramount is the focus on doctors as the cause of variation to the neglect of other possible influences. Some research literature suggests that patients, families, and the community context of practice may also influence treatment decisions. Failure to question present assumptions, despite weak evidence in support of them, may account for inability to explain persistent practice variation, develop appropriate implementable guidelines, or anticipate the effect on treatment decisions of greater patient involvement. In this paper, we discuss the weak response to the NIH Consensus Conference on early stage breast cancer because it may have reflected these problems. We urge a more complex and more empirical approach in explaining treatment choice and guidelines sensitive to the potential for value differences.

Objective: To assess the impact of guidelines on drug use issued by a consensus conference on polycythemia vera held in Paris in June 1993. 32Phosphorus (32P) was recommended for patients over 70 and/or at risk, whereas pipobroman and hydroxyurea were recommended for patients under 70.

Methods: A questionnaire was sent to all 119 departments of nuclear medicine in France 1 year after the conference to find out whether and how often they measured plasma volume and red cell mass (the recommended diagnostic tests for polycythemia vera). Time-series analyses were performed on sales of 32P, pipobroman (both virtually exclusively prescribed for polycythemia), and hydroxyurea over a 4-year span (January 1992–December 1995).

Results: The average number of plasma volume determinations per year did not change significantly after the conference (22 ± 26 before vs 21 ± 25 after). 32P and pipobroman sales were stable until July 1993, when 32P sales decreased while pipobroman sales rose steadily. Hydroxyurea sales increased over the whole period with no change in trend after the guidelines were published.

Conclusions: The guidelines apparently influenced clinical practice since sales of drugs that are specifically used to treat polycythemia vera showed clear changes in trend after publication of the guidelines. This type of study seems to be an effective way of assessing the impact of consensus conferences.