To the Editor.
—As participants in the National Institutes of Health's (NIH's) most recent Consensus Development Conference, "Gallstones and Laparoscopic Cholecystectomy," held September 14-16, 1992, we were disappointed by several aspects of its process and product.1 The conference consensus statement gives qualified support to the use of laparoscopic cholecystectomy, with the provision that the surgeon who performs the procedure possess the requisite training, skill, and experience. The statement offers patients no guidance, however, on what surgical training or experience should be considered adequate. The statement also notes surgeons' divided opinion on the use of intraoperative cholangiography but does not clarify the value of or indications for this procedure. As these examples suggest, the statement skirts controversy and confirms widely held views.2 Some reforms in the consensus development process could help avoid such results.First, NIH staff select the conference topics without systematically assessing the clinical practice community's needs