Translation frustration: When research doesn't reach

The pace of basic science is accelerating, but applying that knowledge to clinical trials is difficult. And findings often remain unavailable to in-the-trenches physicians.

By Victoria Stagg Elliott, AMNews staff. Nov. 1, 2004.

When John P.A. Ioannidis, MD, researched what happened to more than 100 major scientific discoveries published 20 to 25 years ago in the most significant scientific journals, he didn't find much.

All supposedly had the potential to become major medical developments. But according to his findings, which appeared in the January Journal of Translational Medicine, only five led to licenses for clinical use and only one made significant inroads into medical practice. Three-quarters had yet to be tested in a randomized trial.

"Lots of very good ideas get abandoned, and some are not given a fair shot," said Dr. Ioannidis, an adjunct professor of medicine at Tufts University School of Medicine in Boston. He is also chair of the Dept. of Hygiene and Epidemiology at the University of Ioannina School of Medicine in Greece.

While he notes that some of these innovations should never reach patients anyway, he is one of many who voice concern about the slow, bumpy and sometimes impassable road that scientific discoveries travel from the test tube to the clinical trial setting and finally to real-world medical practice.

The issue has repeatedly been the subject of medical society concern. Last June, for instance, the American Medical Association released a Board of Trustees report diagnosing a "bottleneck" in the translation of science into public health benefits.

Government agencies have also been involved in trying to improve the pathway. Last year, the National Institutes of Health released a "roadmap" -- a plan to change the structure of research in order to address some of the difficulties in transforming good science into good medicine.