This article has been authored by Kevin Kallmes, CEO of Nested Knowledge.
In medicine, the rapid expansions in knowledge and therapeutic options has certainly benefitted patients but has made it more and more burdensome on physicians to keep up with the most cutting-edge science. Sometimes, a doctor simply knowing a newer treatment option can save the patient years of decreased quality of life, unnecessary medications, costs, time, energy and health. However, learning about these therapies and staying up-to-date is generally relegated to physicians’ free time. Physicians have shown their dedication in doing so, and the average physician now spends 15 hours a week just reading articles, and still cannot read—or even find—everything she needs to know to keep up with best practices.
A new therapy is born after years of research and knowledge generation. Generally, it is first tested in vitro and then in animal studies before inching its way to human clinical trials, where it is shown to be effective and safe. All these results are made available through scientific publications. However, before prescribing this new therapy, doctors need to know more details. How efficient is the new drug in comparison to an older drug? How safe is it compared to another drug when prescribed to a patient with a comorbidity? What does the long-term outcome look like? Unless they were themselves involved in developing the new therapy, doctors must hope that there is a recent network meta-analysis on their exact question, which is quite rare. In one representative examination of oncological literature reviews, meta-analyses covered 10-17% of relevant topics, and many of these were out of date. This lack of comprehensive, updated, easily findable reviews has serious costs to medicine, both in incomplete information availability and in the time doctors must take away from their practice simply to stay in the loop.
Interestingly, this knowledge gap from theory to practice does not imply a scarcity in research, but just the opposite. It highlights the effects of a broken communication system. Doctors are flooded with an avalanche of medical research publications every day. The volume of total publication is over 30 million studies indexed on PubMed and 32 million unique studies on Embase (growing by 6,000 per day). While the publication rate of indexed clinical meta-analyses on PubMed has also risen, this type of information synthesis takes intensive human effort, time and cost only to be outpaced by the outpouring of the next set of new therapies.
Clinicians spend over 15 hours/week, summing up to over 800 hours/year, reading the medical literature, according to one survey. Even this number is not sufficient, as the 800 hours translates to only 450 articles. Compare that to the number of studies published on PubMed even on relatively narrow topics: 7,135 studies on just coronary artery disease, 3,534 publications on acute ischemic stroke, or 20,005 on lung cancer alone. Conquering a single discipline is therefore nearly impossible, but even that is dwarfed by the responsibilities of primary care physicians. According to one study, “in fact, for a primary care physician to stay up to date, they’d need to read 17 articles a day, 365 days a year.”
Furthermore, if even subject-matter experts find it hard to be on top of all the advances in their fields, what about other decision-makers in healthcare? Insurance agencies, health policy makers, regulatory organizations, and even interested patients or family members are faced with the same quandary, except without the experience of combing the literature for relevant and informative research.
The problem is simple to describe, but hard to solve. The system of medical research communication is fundamentally fragmented. New therapies are just waiting to be adopted, new risks to be recognized, and new research ideas to be explored, but because of the barriers to finding the relevant research, in one place, quickly, every member of the healthcare delivery system must act on incomplete knowledge. It is time we transform our prolific research output into a paradigm that actually presents the research of interest without 800 hours of legwork per year. Then, we can finally let doctors do what they do best: practice medicine.