The book itself is not open access, but the lead editor also published a paper on the topic six years before the larger collection.[27] One of the issues for patient participation in HTA is that HTA has often been constructed as a scientific process which must remain free from the subjective input of patients. Likewise, Gauvin et al. report that their "analysis reveals that HTA agencies' role as bridges or boundary organizations situated at the frontier of research and policymaking causes the agencies to struggle with the idea of public involvement" (page 1518).[28]