It was not long ago when it was possible for physicians to keep up with the medical literature. A diligent physician who subscribed to the 3-4 leading journals in the field could manage to find the time to read through the titles of each monthly issue, and typically, read many of the abstracts. If a paper was particularly interesting, then you probably read through the main text.
Those halcyon days are gone. There are now dozens of journals that publish research that is relevant to a specific practice, and many now publish weekly. The average physician does not receive a physical copy of a journal at their office or home, but instead, receives email notifications of new issues. Some dutifully click on the table of contents, but they spend less than 30 seconds perusing the titles. And they rarely click on an actual manuscript -- before they go on to other emails.
In the past, physicians pretended to keep up with the medical literature. If they missed a recent relevant paper, they felt a bit guilty. Now, physicians do not even pretend. There is no guilt associated with "not keeping up." Everyone has conceded that they can't -- and won't -- be current in their medical reading.
How bad is it? Much worse that you think.
At a recent meeting of nearly 200 young physicians, I asked how many actually read an issue of any journal that was delivered to them, electronically or physically.
The answer: Zero.
Did they at least read the titles of the lead papers in the New England Journal of Medicine every week?
No one did.
Did they pick one journal in their field of interest and try to keep up?
Not a single hand went up.
Then I asked the most revealing question of all. When is the last time that you read any single paper on any topic from start to finish?
Silence.
Shaken, I asked why no one was reading any papers. The answer was: We don't know how to read them. And most papers will subsequently get contradicted by another paper published somewhere else. So it makes no sense to read any single paper.
If you think that these answers are unique to young physicians, think again. Currently, I devote all of my energies to one highly focused field (heart failure), and I typically read dozens of papers each day. And yet, it is impossible for me to keep up with every relevant paper. Instead, it is common for me to attend a meeting and hear about papers that I knew nothing about.
The situation is so bad that my research collaborators routinely send copies of their recent publications to a close circle of friends, just to make sure that someone knows about the publication of their work. This may sound like self-advertisement, but it is not. It is about avoiding oblivion.
To make matters worse, even impactful publications are not being read. Recently in this space, I posted an opinion piece about the CASTLE-AF trial, and many colleagues approached me at a national meeting to talk to me about the study. Most had really strong feelings about the study, one way or another. So in each case, I asked whether the person had actually read the original CASTLE-AF paper. Of more than 40 people, many of them opinion leaders in the field, only two claimed that they did, but neither could tell me what the main findings of the study were.
Top-tier medical research is really hard, but in the past, the effort was worth it if you could have an impact on thinking or on clinical practice. Now much of the literature is replete with data and analyses that are satisfying to the authors, but fall unnoticed as a tree in a deserted forest.
Nevertheless, many of us pride ourselves on our contributions to the medical literature. But if it turns out that authors are just participating in a tiny self-contained community whose members simply talk and listen only to each other, then what is the point?
Disclosures
Packer recently consulted for Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cardiorentis, Daiichi Sankyo, Gilead, Novo Nordisk, Relypsa, Sanofi, Takeda, and ZS Pharma. He chairs the EMPEROR Executive Committee for trials of empagliflozin for the treatment of heart failure. He was previously the co-PI of the PARADIGM-HF trial and serves on the Steering Committee of the PARAGON-HF trial, but has no financial relationship with Novartis.