The fact that an opinion has been widely held is no evidence whatever that it is not utterly absurd.
(Bertrand Russell, Marriage and Morals)
The idea that scientific evidence should back medical practice seems obvious. Yet, evidence based medicine was only formally described in 1992. The goal of evidence based practice in medicine is to systematically synthesise the latest and best scientific knowledge available in order to establish the standard of care in clinical practice. Thus far, however, this has been difficult to implement, the root cause of which is the gap between research and medical practice.
Two Decades for the Way Into Practice
The ultimate goal of research is to apply results towards resolving problems. In fact, research valorisation is often cited as a major criterion by funding agencies and translational research has been on the rise. And yet, there is a large discrepancy between scientific progress and its implementation in medical practice. Researchers would perhaps be appalled to know that it takes close to two decades for their research to ultimately make its way into medical practice. That means, the cutting-edge medical therapy available today would have been described in scientific literature at the start of the current millennium. Our ‘latest in medicine’ now was likely common knowledge to scientists when the human genome project ended, the Columbia space shuttle disaster occurred, Apple launched iTunes, and finding Nemo was released. Seems like a long while back, doesn’t it?
A variety of reasons are given for this long gap between research and practice: financial hurdles in translating research into practice, communication gaps between scientists and stakeholders, lack of public health awareness, etc. One important factor is that research outcomes are often applicable to very specific situations, tested under controlled environments and these are not broad enough to be of relevance to the more complex real life situations. Another issue is that often we have conflicting results. With contradictory research findings available, what are clinicians to do?
Meta-analyses are scientific reviews that compare and quantify treatment outcomes to identify the one that is most efficacious. Thus, meta-analyses allow a concrete manner to define the treatment of choice given multiple options. However, meta-analyses can only compare specific therapeutic outcomes. Therefore, for other research studies, the problem of synthesising scientific evidence to resolve contradictory findings still exists. Moreover, even if results could be compiled in an objective and empirical manner, we still have the problem that these results address a very specific situation. That is, there will be only incremental progress in clinical practice if we were to compile scientific studies for each and every narrow clinical scenario. More importantly, it is impractical to expect individual clinicians to synthesise research pertaining to specific scenarios.
To address broader real life clinical problems, and constantly update the standard of care – for research is a continuous process and new knowledge can challenge an existing scientific consensus – one needs an advisory body that oversees clinical practice updates. Such a body would not only review research regularly and update practice guidelines, but would also ensure that the same standard of care is practiced by all clinicians. But this is a complicated and expensive process.
COVID-19: Record Time Durations
Perhaps the most important factor in determining the length of the research-practice gap is the urgency with which research needs to be translated for practical use. A case in point is the Covid-19 pandemic. Research results have been adopted rather quickly and new tests, medications, as well as vaccines for Covid-19 were developed and approved in record time durations. Can all this be attributed to the gravity of the situation or the large number of stakeholders – the entire world in fact (save Antarctica, till recently)?
However, haste makes waste. The rapidity with which public health has had to deal with Covid-19 may have led to some mistakes. For example, early on during the pandemic, it was advised that masks should be avoided, despite the fact that masks prevent air-borne diseases. Next, there was confusion regarding the transmission of Covid-19. So, while a very short research-practice time gap is possible, it could lead to situations where medical opinion makes an abrupt 180 degree turn. This only frustrates the public, causing them to lose faith in both science and medicine.
It is suggested that the research practice gap can be closed by a deeper understanding of the factors that hamper translation of scientific research. That scientists and clinicians must communicate more effectively with each other and with patient populations to improve implementation of evidence based medicine. However, we must pause and consider what an ideal research practice gap would look like – one that ensures promising new treatments are available for patients soon enough, but not too short that errors and mistakes are made in the haste to adopt new practices.