Some aspects of PPI have been seen critically; in addition to those under HTA below, examples of general critical voices include a group of U.S. researchers presenting a framework in 2013 and a young Canadian speaker in 2018. The former warn that clinicians, delivery systems, and policy makers cannot assume that patients have certain capabilities, interests, or goals, nor can they dictate the pathway to achieving a patient's goals.[1] The latter sees multiple potential conflicts of interest in the current arena of PPI.[13]