The evolving science of translating research evidence into clinical practicePDF
ACP J Club. 2007 Jul-Aug;147:A12. doi:10.7326/ACPJC-2007-147-1-A12
To the Editor
Dr. Scott has provided a nice summary of the barriers to implementing research guidelines (1), although it seems to me he misses 1 important point: The psychology of skepticism, and how skepticism is learned by practitioners. I'll illustrate what I mean by this in the field of new drugs. I think we can agree that the literature about new drugs and their use makes up a considerable proportion of any issue of a major medical journal or continuing education conference. New drugs are extensively studied, and information about their importance and potential benefits is widely disseminated to practitioners. Skepticism is often learned by doctors after the drugs have been released and lauded: Vioxx, Rezulin, Baycol, Avandia, the bisphosphonates: All wonder drugs on release; a couple of years later, you wonder—how did this occur?
Research guidelines are tainted by association in many practitioners' minds. Drug studies and well-meaning guidelines are often published side-by-side in the same journals. If so many brilliant scientists, so many well-meaning professors, get things so very wrong on p. 1000, how can we tell that the article on p. 1010 is indisputably right? How did the system of health care research blend into the machinery of health promotion, and how does that lead to error? The problem, it seems to me, is in the promotion. Doctors look at guidelines and their promotion as an industry not unlike the drug industry. I think we practicing physicians often ask ourselves, “For my patients, wouldn't it be safer to wait a year or two, to see if the impact of that which is being promoted matches its promise? These patients are, after all, in my care.” Fortunately, “caution” is a byword of the way many doctors practice.
Donald Venes, MD
Sutter Coast health Center at Brookings Harbor
Brookings, Oregon, USA