14901 - Reflections of an editor on research and practice?...

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Reflections of an editor on research and practice? Richard Smith Editor, BMJ Granada, May 2002 www.bmj.com/talks
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What I want to talk about The disconnect between practice and research A rough history of health research in Britain A vision of how to improve the connection The relation between disease burden and volume of research Setting research priorities
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What I want to talk about Where does innovation come from? Peer review of research Measuring the value of research Disseminating research How to get from research to change? Conclusions
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The disconnect between practice and research Research is usually funded by the Ministry of Education, whereas health care and public health is funded by the Ministry of Health Research is run by researchers who value basic science, discovery, and original questions, thinking, and methodology The answering of practical questions is seen as dull, unoriginal, and “unimportant in scientific terms” Nobel prizes go to the discoverers of molecular mechanisms not those who work out the most cost effective method for treating incontinence
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The disconnect between practice and research There is often no mechanism to transmit the questions of practitioners (and patients) to researchers Scientists are wary of directed research: “only scientists can know what is scientifically important”; “directed research leads nowhere” The results of research do not seem valuable to practitioners The idea that doctors are scientists is a myth
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The disconnect between practice and research Most practitioners are not competent researchers Nor are practitioners sophisticated consumers of research “Practice is one thing; research another. I make decisions based on my experience and what clinical experts advise” Health policy makers sometimes boast that they don’t use research results Evidence based practice is a force for change, bringing research and practice together
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The disconnect between practice and research It must be “evidence informed” practice not “evidence tyrannised” practice But we realise that fewer than 5% of studies in medical journals are both valid and relevant to clinicians or policy makers; in most journals it’s less than 1% We have good evidence on perhaps 10% of treatments and a smaller percentage of questions about diagnosis, symptoms and signs, and prognosis Evidence needed for health management and policy is even weaker
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A rough history of health research in Britain 1900s--independent researchers 1930s--Medical Research Council (MRC) begins 1940--Pharmaceutical companies begin to do a great deal of research 1980--MRC begins some health services research 1986--House of Lords realises that the National Health Service has almost no research capacity
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A rough history of health research in Britain 1990--NHS research and development directorate established vision is a “knowledge based health
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14901 - Reflections of an editor on research and practice?...

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