Katy
How do you feel about the areas where little or new new research is being done (small cell lung cancer - my dad was told the treatment hadn't changed in 30 years or B12/Vit D where more work needs doing)
Some diseases attract more research funding than others and not necessarily based on greatest need. Great strides were made in HIV treatment I understand due to the extensive lobbying by patient advocacy groups and subsequent research funding. Similarly, breast cancer has attracted a lot of funding and a lot of new treatments have been developed. In some diseases it may be that the science just isn't there yet to enable new drugs to be developed, so more research is needed to understand the disease process first which creates a lag for subsequent drug development in that area.
I'm not aware of the B12/VitD research needs, but given these drugs have been around for decades there would be no incentive for a pharma company to conduct new research as the medicines will be off patent. This means that the pharmaceutical company would not benefit (as they wouldn't get more sales/profit) from conducting further research to extend the licence to new indications.
Or when you hear that someone prints out the NICE guidelines and takes them into the GP but the GP ignores them
NICE guidelines are evidence based guidelines that make recommendations that are suitable for the majority of patients with a specific condition. They are however a guide to clinical practice, and the GP, or other clinician, has to take many other factors into consideration, such as the age and overall heath of the patient, other conditions the patient has and other medicines the patient takes. The NICE guidelines include the following advice for clinicians to take the guideline recommendations in context (Source: www.nice.org.uk/guidance/cg146):
"The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible."
If I or a family member/friend experienced a GP ignoring NICE guidelines I would want to understand what factors meant that an alternative clinical management plan was considered more appropriate in this instance. And/or I'd see a different GP to get a second opinion.