SANIOR PARS AND MAIOR PARS IN CONTEMPORARY AREOPAGES:

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SANIOR PARS AND MAIOR PARS IN CONTEMPORARY
AREOPAGES

• Medicine evaluation committees in France and the
  United States
• Philippe Urfalino
• Collective Wisdom
• May 22-23 2008 Collège de France

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How best to foster collective wisdom in
collectives of the wise?

• The question of the aréopages, the committees of
  sages, of wise, of experts
• Which have important decision to make for a
  social group

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1. WHAT IS AN AREOPAGE ? (1)

• 1. Aréopages are groups that deliberate to make
  decisions or advices that are applicable to a
  larger group.
• 2. Members of an aréopage are appointed rather
  than elected. They are appointed first and
  foremost for their competence
• 3. The collective work of the aréopage bears on
  to both the decision itself and argumentation to
  justify that decision.
• 4. Individual aréopage members have to practice
  the discipline of arguing their position in
  accordance with certain validity requirements

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1. WHAT IS AN AREOPAGE ? (2)

• An Argumentative discipline
• A. Justification reasons override motives
• B. The justification has to be substantial one
  reason does not suffice, an entire line of
  reasoning is required.
• C. The argumentation has to be appropriate this
  is specialized argumentation adapted to the
  matters of decision or advice.
• D. Contexual validity arguments have to be
  adapted to the case at hand

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2. The Problem of Such Committees (1)

• As uninanimity is scarce a collective
  decision-making rule is needed
• Voting is a good way to obtain a final point
• But Voting has an uncertain relationship with the
  quality of the collective decision
• the problem is
• how to articulate number and reasons ?
• How can votes be counted and weighed ?

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2. The Problem of Such Committees (2)

• The unstable solution of Western monastic orders
  for electing the head of the monastery
• mixing sanior pars and maior pars
• What was involved in this combination ?
• The split of collective decision process in two
  parts
• A hierarchical ordering principal

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2. The Problem of Such Committees (3)

•  WISE PART and MAJORITY PART 
• the splitting of the decision-making process
• On the one hand judgments and votes of
  participants
• On the other hand evaluation of these judgments
  and of the result conducted by a part of the
  participants or by others
• A hierarchical ordering principal
• Without universally shared criteria, determining
  the wisest falls to an instance endowed with
  authority

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2. The Problem of Such Committees (4)

• Two different examples of contemporary means of
  finding a compromise between wise part and
  majority part
• Two examples taken from the area of medicine
  evaluation
• The French drug approval committee
• The FDA and its advisory committees

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3. Decision-making by exhaustion of objections
the French case

• 3.1. Conditions for creating the French drug
  approval committee
• 3.2. The rejection of vote
• 3.3. Decision-making by apparent consensus
• 3.4. Decision by exhaustion of objections
• 3.5. Weakness of this decision-making rule

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3.1. Conditions for creating the French drug
approval committee

• Creating in 1978 for reducing between french
  medicine evaluation and those of other countries
• The committee composed of a new generation of
  physicians and experts (outside the
  administration)
• Between 1978 an 2000 approximately 30 members
  appointed for 3 years
• No reassessing of the committee evaluation inside
  the administration or the agency (since 1993)
• The committee makes the decision

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3.2. The rejection of vote

• From the beginning to now no vote but consensus
• Why ? A fear and two ideas
• Fear of contestation by pharmaceutical firms and
  medical milieu
• Voting is not appropriate for reaching a decision
  with strong epistemic nature
• Discussion on medicines can culminate in opinion
  convergence

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3.3. Decision-making by apparent consensus

• . What is decision-making by consensus if it is
  not a vote with unanimity rule ?
• Decision-making by apparent consensus
• - A specific sequence
• - Two major characteristics

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Decision-making by apparent consensusA specific
sequence

• 1) a member presents to the assembly the nature
  of the problem requiring a decision
• 2) the members discuss this presentation of the
  issue
• 3) a member synthesizes the discussion and
  indicates which option seems to him to have
  emerged out of it
• 4) at this point there are two possibilities
• a) no one speaks out against the consensus
  proposal just presented, that proposal becomes
  the decision, or
• b) at least one participant contests the
  synthesis proposal, in which case discussion
  starts up again until the same member or another
  one offers a new synthesis, which once again
  gives rise to situation a) or b)
• 5) if all successive consensus proposals are
  contested, the decision-making process for that
  particular problem may be postponed until the
  next meeting.

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Decision-making by apparent consensusTwo major
characteristics

• No systematic expression or counting of opinions
• Decision a proposal has not overt opposition
• Apparent consensus is not unanimity
• No explicitly rejection /visibly unanimoustly
  appoving
• Apparent consensus some of who remain silence
  silent do not approve but no longer contest

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3.4. Decision by exhaustion of objections (1)

• The contesting of the proposal could have two
  different status
• A rejection an unconditional veto right but the
  use of this veto right is conditional (ressources
  and negociation african palaver and
  international organizations)
• An objection a conditional veto, the objection
  has to be accepted, deemed valid by others, but
  the use of objection is not conditionned by
  ressources or licit negociation

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Decision by exhaustion of objections (2)

• The silence of a member facing a proposal of a
  decision reflects 3 situations
• He is convinced the proposal is the right one
• He doesnt know and delegates his judgement
• He is not convinced but he doesnt have a good
  argument

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Decision by exhaustion of objections
(3)combining sanior pars with maior parts

Facing a proposal of decision A virtually silent majority An  objecting  minority
Values the expressed opinion In favor of the proposal as it stands Against the proposal as it stands
Expressions Explicit approval Or No expression Explicit disppproval
Mental states, reasons and preferences Convinced Indeterminated delegation of judgment Not convinced but having no argument for a valid objection - not convinced and having an objection that one deems validable
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Decision by exhaustion of objections
(4)combining sanior pars with maior parts

• The splitting of the collective decision process
• The  objecting  minority judges the proposal
  and, by the way, the virtually silent majority
• The hierarchical ordering principal
• Prevalence of reasons on preference, of wisdom on
  number
• The  objecting  minority win if the argument is
  deemed valid
• Only two ways to express preference not
  contesting proposal or contesting it with an
  argument
• The proposal become decision if it had exhausted
  objections, not because it would have won
  everyones vote
• Unequal member influence is recognized legitimate

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3.5. Two weak points of this decision-making rule

• It tolerates delegation of judgement
• (as silence means approbation of the proposal)
• It presupposes a profound agreement on the
  evaluation approach
• (if not such agreement, no convergence on the
  validity of objection but convergence on
  objections is less difficult to obtain than
  convergence on positives judgements Cf.
  Scanlon)

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4. THE COLLECTIVE ADVISER

• The Case of the FDAs Advisory Committees

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4. THE COLLECTIVE ADVISER

• 4.1. Conditions for Creating the Advisory
  Committees
• 4.2. Voting Patterns The Strong Expert
  Convergence
• 4.3. The Public Balloting of the Collective
  Adviser
• 4.4. The Problematic Determination of Individual
  Will

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4.1. Conditions for Creating the Advisory
Committees

• Used systematically since the 1970s
• 3 factors
• Increasing complexity of technologies
• New legislations
• Growth of consumer activism and of critiques of
  agency decisions
• AC do not concentrated all the expertise the FDA
  keeps the final decision
• 18 AC for drugs with 11 menbers each

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4.2. Voting Patterns The Strong Expert
Convergence

• With the data of two studies of votes of several
  AC from 1998 to 2002 and from 2002 to 2007
• Of the 70 instances of voting
• 38 cases of unanimity
• 10 (7) of scores below a 70 majority

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4.3. The Public Balloting of the Collective
Adviser

• A. The ambivalent status of voting
• B. The moral force of majority rule

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A. The Ambivalent Status of Voting (1)

• The FDA wants voting on the questions that are
  the most directly linked to the decisions it must
  make
• It recognizes that the voting can not be detached
  from discussions and comments
• But it wants an Advisory committee to be a
  Collective Adviser

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A. The Ambivalent Status of Voting (2)

• Meanwhile, the voting does not need to reach a
  final point
• A voting without decision-making rules (no
  majority rule)
• The rare tie votes are not a problem
• Frequent tie votes would ruin the
  orientation-giving function of the advisory
  committees on FDAs decisions
• The concern for this orientation-giving function
  is demonstrated by the indirect presence of the
  majority rule

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B. The Morale Force of Majority Rule

• Advisory Committees do not have decision rule
  such as majority rule
• But majority voting has a political and morale
  force
• Controversies about the impact of conflicts of
  interest of AC members on their recommandations
  use the majority rule as criterion

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4.4. The Problematic Determination of Individual
Will (1)

• Some members have difficulties to answer Yes or
  no
• - a few  abstain 
• - some changes their vote
• - a few wants to see what the others vote
  before voting (It is impossible since 2007)

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4.4. The Problematic Determination of Individual
Will (2)

• The links between reasons and votes
• The vote is public, oral and with giving reasons
• Sometimes the vote is embedded in the reasons
• It then could loose is discrete nature
•  yes, but   yes minimally 
• The chairman has to unseal the vote from the
  discours  so it is yes