EDITOR, - John Gabbay and Andrew Stevens1 have misrepresented the process through which the Welsh Office's protocols for health gain were written. As a member of two of the panels, I disagree that informed consensus was actively “substituted for scientific proof.” The cancers protocol2 was the first one attempted; a technical document was commissioned from Professor Jocelyn Chamberlain to give a starting point; this was sought from outside the principality to ensure an impartial view. For the pain, discomfort, and palliative care protocol,3 the group members wrote a series of technical documents that were critically discussed by the group and externally reviewed by Dr H McQuay (Oxford) and Dr A Diamond (Bristol). The imposition of deadlines is always required to make a group function, but they did not inhibit consultation or discussion.

Unfortunately, very few medical outcomes have been subjected to rigorous scientific scrutiny. If the …