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Page 2 of 7 Fouad et al. Metab Target Organ Damage 2024;4:20 https://dx.doi.org/10.20517/mtod.2024.26

INTRODUCTION
For years, if not centuries, the word “consensus” has been employed in a wide range of situations and fields.
[1]
It usually addresses different contentious circumstances in an effort to come to a consensus .
However, in science, reaching an agreement is more than just tallying heads, and decisions made by
consensus cannot be mocked for requiring absurdities like voting on the veracity or untruth of claims that
[1]
have previously been supported by evidence .
The undeniable fact is that everyone has an opinion, and there are millions of them out there and “expert”
[2]
opinion seems superfluous when evidence exists . Therefore, scientific consensus consists of cooperation
and synthesis of evidence in contrast to other settings, which are based on competition and the gathering of
opinions.

In such a way, it appears quite obvious, in many scholars’ opinion, that the debatable process undertaken by
the American Association for the Study of Liver Diseases (AASLD) and the European Association for the
Study of the Liver (EASL) to reach a consensus regarding the nomenclatures of fatty liver disease invalidates
its premises and, in a sense, the outcome seems predetermined, if not self-fulfilling. The details of the
limitations and controversies of this flawed process have been extensively analyzed in recent viewpoints and
are outside the scope of the present perspective article . Instead, the discussion in this process should have
[3,4]
moved forward toward deliberation of the scientific methodology and findings, rather than engaging in a
long and complex process aimed at bounding controversy through opinions.

These biases and limitations within the various aspects of this workflow have undoubtedly carried
important implications in real-world practice . The inspiring principle should be that all those who are
[3]
eventually affected by any given decision should have a say. What has to be avoided is that expert scholars
in the field and other scientific societies have limited access to influence outcomes of common interest. The
biggest criticism of this process is that it seemingly assumes “intellectual supremacy” and leaves no
consideration for any evidence-based alternative views. This is particularly true, considering that the
decision procedure has been used not as a simple suggestion but as a rigid cornerstone for future
publications in certain authoritative medical journals .
[5]
Additionally, specific prudence should be exercised when dealing with concepts such as stigma and
stigmatization, as these are typically subject to tremendous inter-cultural variations. While there is a
universal agreement on the stigma related to the word “alcoholic” in the term “non-alcoholic” , the same
[6]
adjective (e.g., fatty) that is deemed to be stigmatizing in a given culture may conversely be positively
[7]
evaluated in others and has been shown to have the same translation as steatotic in virtually all non-Latin
languages spoken by more than 5 billion people worldwide .
[8]
As similar debates have occurred in the past and will likely recur in the future, the potential unplanned
positive consequence of this debate over the redefinition of fatty liver disease [9-12] is that it can represent a
unique opportunity for democratization of science, thereby mitigating the risk of future power misuse.

This notion is exactly what has inspired our appraisal, and this perspective article presents a conceptual
framework for understanding the concept of democratization of science. While triggered in the context of
the controversy over the redefinition of fatty liver disease, the most prevalent liver disease that affects more
than a third of the global population , our conclusions likewise hold true for the far more expansive field
[13]
of politics surrounding ordinary academic participation in scientific decision-making. Our purpose is to