Apatient tentatively enters the examination room. Adecision looms, and the patient waits with some trepi-dation. A doctor soon appears and pulls up a chair, preparedfor the discussion by having conscientiously reviewed themedical literature, examined the evidence-based systematicreviews, and highlighted the relevant information. The ensu-ing conversation reflects on the patient’s treatment goals andthe published information about the benefits and harms of theavailable options. The tension breaks with a decision, andplans for the next steps are put in place.Every day, patients and their caregivers are faced withdifficult decisions about treatment. They turn to physicians andother healthcare professionals to interpret the medical evidenceand assist them in making individualized decisions.Unfortunately, we are learning that what is published in themedical literature represents only a portion of the evidence thatis relevant to the risks and benefits of available treatments. In aprofession that seeks to rely on evidence, it is ironic that wetolerate a system that enables evidence to be outside of publicview. Those who own data, usually scientists or industry, havethe choice of what, where, and when to publish. As a result, ourmedical literature portrays only a partial picture of the evidenceabout clinical strategies, including drugs and devices. Expertshave recently drawn attention to this issue, including contribu-tions in this issue of our journal, but there is resistance tochange.

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