On being heckled at a National Health Technology Conference: Patient participation and democratic discourse.

This article uses my experience of being heckled by patient advocates at a health technology conference in Canada as a springboard for discussing the politics of health technology assessment (HTA). While HTA is widely understood and practised as a scientific endeavour grounded in rigorous quantitative research methods, the socio-political aspects of HTA cannot be separated from the scientific. Integrating the social, political, and ethical dimensions of HTA into the practice of assessment means understanding how a technology will shift power relationships among actors, alter resource flows, and affect how knowledge is produced and circulated. I suggest these factors contributed to the hostile reception I received when I attempted to present a paper about the biased selection of patient advocates involved in Canada's main HTA agency. As India embarks on the challenge of establishing its own agency to support healthcare decision-making, and as patient advocacy groups rise in India with the support of the pharmaceutical industry, I offer this account as a cautionary tale to those shaping India's new agency.