At the same time, the science of evidence-based practice has been both challenged and advanced. What are some of the challenges? Several national leaders in the movement to promote the dissemination of evidence-based practices convened to attempt to articulate the substantial concerns of six stakeholder groups: consumers, family members, practitioners, administrators, policy makers, and researchers. Consumers and families, whose self-help interventions have not been subjected to rigorous research, worry that the absence of evidence for these interventions will be mistaken as evidence for the absence of effectiveness. Such interventions were created outside the biomedical infrastructure and its brand of science and hypothesis testing. Consumers and families also worry that an effective program could be closed for lack of evidence of its effectiveness. Consumers and providers worry that poorly conceived treatment algorithms that are based on evidence-based practice could lead to the absence of individualized treatment plans and lead to "cookbook" medicine. Consumers also worry that the outcomes that have driven the studies that underpin evidence-based practice—symptoms and relapse—do not sufficiently weigh the outcomes that consumers value, such as quality of life. Practitioners worry that research findings have limited relevance to practice—that is, the efficacy-effectiveness gap. For example, the findings of randomized clinical trials that screen out patients with substance abuse may not be relevant to the patients they routinely treat, because up to 50 percent of patients abuse substances. Providers also worry that they have limited time for new training. Finally, administrators and policy makers often worry about resources. Overall, the group expressed concerns about the limits of science, funding shifts that would eliminate or reduce valuable practices, increased costs, feasibility, and unintended shifts in power and control (8).