We Know Accurately Only When We Know Little

Excerpt

Our title reflects a maxim penned by Goethe. It continues in translation to read ‘With knowledge doubt increases.’[1] The articles that appear in this issue stemming from a special symposium held in Banff (Alberta, Canada) in February 2009, describe our progress toward agreement on the concept of access with evidence development (AED).[2‐6] Goethe’s reflection summarizes the dilemma. Much of decision making in healthcare is based on the premise that certainty can be achieved through randomized controlled trials (RCTs) and translated into policy decisions on issues such as insurance coverage. Unfortunately, we have become increasingly aware of the constraints imposed by reliance on evidence based solely on RCTs, and the healthcare system is now shifting rapidly toward the acceptance of other kinds of evidence to support a more nuanced form of decision making that gives appropriate weighting to the perspectives of patients, their families and their healthcare providers.[7‐10] …