The gap between medical discovery and implementation in the community represents a quality chasm in healthcare. It is an unfortunate truth that lives are significantly impacted by missing out on “what could be” for the sake of “what is.”
What causes the undeniable lag in time between the discovery of a protocol, treatment, medication, or procedure and its use in common practice? As we will discuss, the answer to that question is multifaceted.
While the reasons are various and each important to understand, the simple truth is that many estimates suggest it takes about 17 years for 14% of new research to translate into a practice that benefits the community at large. This is too long to provide effective, impactful patient care with the current rate of medical discovery. It is vital that we look at the reasons for this deadly chasm and educate ourselves on ways to overcome unnecessary delays to achieve the goal of a longer healthspan.
The Lag of Literature
Morris et al describes one major hurdle that must be crossed before bridging the research-to-patient chasm that currently exists: a lack of consistent understanding of the problem.
Essentially, in an attempt to study the time lag through literature review, it was determined that it was quite hard to pin down great data. Of 23 papers, the study found that few were comparable due to the use of so many different models and measures.
While it may seem difficult to glean how simple differences in papers studying time lags affects the patient directly, we can simply “follow the money” for a better understanding. Research and development investments are an integral piece of getting new technologies or resources to patients. The lack of a consensus on what causes these time lags can cause significant waste and inefficiency as companies continue to attempt to fix a problem they do not understand.
Developing tools and standardized ways of evaluating delays in research processes may help eliminate this hurdle altogether.
The Lag of Adherence
Various research suggests different pathways that evidence finds its way into practice but all seem to point to the same background story: Clinicians have a hard time completing the cycle of new processes.
Pathman et al provides a perfect example of this slow pathway in a study of physicians adherence to a new recommendation regarding the Hepatitis B and Pertussis vaccines being administered to infants.
Their four stages, from evidence to action, include clinician awareness, agreement, adoption, and adherence. The research concluded that for each stage, the percentage of clinicians who remained on the path to adherence was markedly lowered.
This is not the only reason adherence presents a major sticking point in getting innovative methods and tools to patients. Physicians in general can have a difficult time updating their practices.
There are voluntary and involuntary reasons your doctor might feel less than excited about new ideas in healthcare. The medical field in general tends to have a, “This is how it has always been done,” or a, “If it isn’t broken, don’t fix it,” mentality. Years of medical school, subsequent residency and fellowship, and the “passed down knowledge” format of medical education all lend to the stagnation of information.
This stubborn approach to adherence combined with a general lack of time and expendable energy amongst medical professionals is a major piece of the lag between innovation and practice.
Bridging the Chasm
All is not lost. There are those who see the chasm for what it is and are determined to build a bridge that reaches patients formerly lost to standard, outdated practices.
Boulder Longevity Institute (BLI) represents the understanding of the need to practice better medicine. Dr. Yurth, co-founder and Chief Medical Officer, saw how traditional models of healthcare were ineffective while working as an orthopedist in a traditional healthcare practice.
When describing the approach BLI takes to bridging the chasm, Dr. Yurth says, “We combine available research with our expertise to take the chance on efficacy.” With an eye toward safety, BLI balances research, knowledge, and action to offer clients cutting-edge, science-backed treatment options in a guided, clinical environment.
Waiting for research to align to the point of infallibility results in a state of frozen time. The need for complete certainty halts progress. This is evidenced in the estimated 17 years between discovery and usefulness.
It is time for those practicing medicine to realize that innovation can be both safe and fast. Closing the gap in translating research to use is imperative to providing truly effective healthcare. It is possible to bridge the chasm. We must start looking toward what medicine could be rather than what it has always been.
References
Balas EA, Boren SA. Managing clinical knowledge for health care improvement. In: Bemmel J, McCray AT, editors. Yearbook of Medical Informatics 2000: Patient-Centered Systems. Stuttgart, Germany: Schattauer Verlagsgesellschaft mbH; 2000:65-70.
Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011;104(12):510-520. doi:10.1258/jrsm.2011.110180
Pathman DE, Konrad TR, Freed GL, et al. The awareness-to-adherence model of the steps to clinical guidelines compliance. The case of pediatric vaccine recommendations. Med Care 1996;34:873–889.
