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Patient participation in Health Technology Assessment (HTA)
HTA forms part of Evidence Based Medicine (EBM) as one of EBM's three different forms of evaluation (the other two being Randomized_controlled_trials (RCT) and Quality of Life (QoL)). EBM is the predominant paradigm in the developed world today; but it is at odds with a newer trend toward personalized medicine (PM).

First of all, there is a question of desirability: "Do patients want to participate in HTA?". Secondly, one must consider that HTA covers more than technology in the stricter sense. Instead it covers practically "any intervention", as the WHO defines health technology broadly as consisting of: "the application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures and systems developed to solve a health problem and improve quality of lives."

Therefore, after 20-odd years in which this trend toward HTA has played out, a look at the more controversial side of it appears appropriate.

Sociologist Andrew Webster puts a new twist on the problem when he complains "HTA is a technology itself that needs assessment." Webster continues with his "critique of HTA from within Science and Technology Studies (STS)" getting to the patient perspective eventually; he sees the problem in "a failure to recognise that evaluation is a contested terrain involving different sorts of evidence related to different sorts of context (such as the experimental derived from clinical trials, evidential, derived from existing clinical practice, and experiential, based on patients' experiences of an intervention".

Likewise Kelly et al. offer their perspective in an open access article, starting with historical background and gradually getting to the patient perspective. They recall how "In the UK, the HTA programme was specifically set up to counterbalance the commercial biases of the relevant industries and many HTA assessments are done on orphan drugs, diseases or procedures, or ones that offer no profit to industry (citing Raftery and Powell on their page 4). Especially relevant is the paper's section 3 headed "The importance of patient values in clinical decision-making".

The coverage of historical background by Kelly at al., page 5, contrasts the public good with the interest of the individual patient thus (with their original citations shown here in brackets): "From the moment Archie Cochrane linked questions of clinical effectiveness to cost effectiveness [17] and cost utility analysis was chosen as the basis for assessing value for money, EBM and HTA have been framed within the utilitarian philosophical tradition. Utilitarianism is premised on the view that actions are good insofar as they maximize benefit for the greatest number [51]. This is not necessarily congruent with what is in the best interest of an individual patient [34]."

A more optimistic perspective is to be found in such innovations as which strive to accomplish some of the goals as HTA earlier in the process of decision-making.
 * Food_and_Drug_Administration and
 * Adaptive Biomedical Innovation