Slow to change – Part 2

It is a commonly held belief that medicine (being inherently conservative with the lives of patients at risk) is quite slow to change.  It is often cited that it takes 17 years for research evidence to reach clinical practice.  While the estimate is problematic (Morris, Wooding, and Grant point out that three separate studies have demonstrated this 17-year lag, however, they were all “using different endpoints, different domains and different approaches”), this fits with our perception that it takes quite some time for medical practice to change based on new research.

If we set aside trying to determine a firm number of years for research to be put into practice, we can still see that there is a time lag between initial discovery and widespread use.  Some of this time is perfectly appropriate as new studies are done to confirm conclusions, and patients need to be followed over the course of years to reach conclusions.  However, some of the lag isn’t so benign.  Next time, we’ll take a look at some interventions that have been clearly confirmed to be beneficial, are not fully implemented in practice, and consider why this is so.

*As a side note, many people cite the discovery of H pylori as a cause of peptic ulcer disease being one of these discoveries that was too slow to translate into practice.  However, Atwood summarized this process back in 2004, noting that the timeline from initial discovery of H pylori (paper published in 1984) to a paper conclusively demonstrating lower recurrence rates of peptic ulcer disease in patients treated with triple therapy (1992), and unequivocal recommendation to treat patients with ulcers with triple antibacterial therapy by the NIH (1994) as wholly appropriate and necessary to allow for the trials to confirm findings and follow patients long enough to demonstrate benefit.*