We know that the structured and linear processes that produce research do not automatically change practice. It is possible to plan a research project and expect it to roll out logically and consistently from a good question, through a clear protocol, to the data collection and analysis, and finally to the publication report. From this point, the way in which research changes practice is not necessarily consistent and it does seem to take at least 5 – 10 years.
Let’s look at a few examples in everyday life. Now we accept that smoking causes cancer and is a risky activity for many chronic diseases. It was in the 1950’s that research started to show a pattern of association. You can read one of the landmark articles published in 1950 in JAMA titled Tobacco smoking as a possible etiologic factor in bronchiogenic carcinoma: study of 684 cases. This article compared 649 lung cancer patients with 600 controls, and found that lung cancer was 40 times higher among smokers. Richard Doll, a well known British scientist finally reported in the BMJ in 1994, his 40 years observing the death rates in male British doctors. He concluded that about half of all regular cigarette smokers will eventually be killed by their habit. Yet the pattern of banning smoking inside restaurants and workplaces only really took hold from the beginning of the new millenium, and at different rates in different countries.
More recently, there is debate about the safety of the diabetes drug rosiglitazone for patients who have underlying cardiac problems. You can read in the 2006 abstract of a Lancet article that cardiovascular event rates were much the same in both groups, although 14 participants in the rosiglitazone group and two in the placebo group developed heart failure. You don’t really need to understand the detailed statistics to realise that there might be a problem here. This drug was suspended by UK and European watchdogs in 2010. It is still available by prescription in USA.
In both of these cases and in others, there are many issues and players. Political, commercial and social issues impact on the way information flows to health professionals and to the public. It is tempting to say that there is no way to understand how and why people change their behaviour – but there is a science behind this – I will keep you posted!