First, consider this:
Anaesthetic and antiseptic offer an instructive contrast. Both were developed in the mid-1800s. Anaesthetic spread faster than a hula-hooping craze. Atul Gawande explained in the New Yorker, “within seven years, virtually every hospital in America and Britain had adopted the new discovery”.
Antiseptic, in contrast, took a generation to catch on. “The puzzle is why,” noted Dr Gawande, before conceding that it is not a puzzle at all. Anaesthetic solves an immediate problem: a patient screaming and writhing in agony. Antiseptic is a defence against an invisible killer, infection, that acts only with a delay.
Now read this:
The patterns are clear to the naked eye once pulled out of the mass of data: here’s a clinic that swiftly and sharply switched to the cheaper generic drug; here’s a clinic that never read the email. A follow-up study performs a similar analysis for statins.
What’s remarkable about all this is how unremarkable it really is. The diffusion of innovation could once only be studied in small settings and by taking considerable pains. But this is the 21st century: the NHS has made the data available to allow us to watch a good idea spreading across the nation, or not, almost in real time.
The author is clearly fixated on the idea that innovation in healthcare would diffuse because a “body” is recommending it’s use. There are numerous use case scenarios where the innovation won’t spread because it has been suggested.
For example, the use of single fraction versus the five or ten fractions for metastases. I have also recoiled in horror at the suggestion of my medical oncology colleagues for giving “single fraction hemostatic radiation”. It doesn’t work, most of the times and has an inconstant effect. Yet, these ideas are still being held sacrosanct across institutions and different countries. A lot also depends on the constrained interests as well as resistance to change.
Everyone wants to “best of the healthcare with the latest innovations” but fail to realise that there are competing factors at play to determine outcomes.