Tracing the path of 37,050 studies into practice across 18 specialties of the 2.4 million published between 2011-2020

  1. Moustafa Abdalla  Is a corresponding author
  2. Salwa Abdalla
  3. Mohamed Abdalla
  1. Harvard Medical School, United States
  2. University of Toronto, Canada


The absence of evidence to assess treatment efficacy partially underpins the unsustainable expenditure of the US healthcare system; a challenge exacerbated by a limited understanding of the factors influencing the translation of clinical research into practice. Leveraging a dataset of >10,000 UpToDate articles, sampled every 3 months between 2011-2020, we trace the path of research (37,050 newly added articles from 887 journals) from initial publication to the point-of-care, compared to the 2.4 million uncited studies published during the same time window across 18 medical specialties. Our analysis reveals substantial variation in how specialties prioritize/adopt research, with regards to fraction of literature cited (0.4%-2.4%) and quality-of-evidence incorporated. In 9 of 18 specialties, less than 1 in 10 clinical trials are ever cited. Further, case reports represent one of the most cited article types in 12 of 18 specialties, comprising nearly a third of newly-added references for some specialties (e.g., dermatology). Anesthesiology, cardiology, critical care, geriatrics, internal medicine, and oncology tended to favor higher-quality evidence. By modelling citations as a function of NIH department-specific funding, we estimate the cost of bringing one new clinical citation to the point-of-care as ranging from thousands to tens of thousands of dollars depending on specialty. The success of a subset of specialties in incorporating a larger proportion of published research, as well as high(er) quality of evidence, demonstrates the existence of translational strategies that should be applied more broadly. In addition to providing a baseline for monitoring the efficiency of research investments, we also describe new 'impact' indices to assess the efficacy of reforms to the clinical scientific enterprise.

Data availability

We used the citation lists of all UpToDate articles published between 2011-2020. While all these citation lists are/were publicly available, we recognize the amount of work and effort required to collate and pre-process this data. As such, we have made publicly available the entire dataset used in this analysis to all readers at:

Article and author information

Author details

  1. Moustafa Abdalla

    Department of Surgery, Harvard Medical School, Boston, United States
    For correspondence
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-2481-9753
  2. Salwa Abdalla

    Department of Computer Science, University of Toronto, Toronto, Canada
    Competing interests
    The authors declare that no competing interests exist.
  3. Mohamed Abdalla

    Department of Computer Science, University of Toronto, Toronto, Canada
    Competing interests
    The authors declare that no competing interests exist.


The authors declare that there was no funding for this work.

Reviewing Editor

  1. Jennifer Flegg, The University of Melbourne, Australia

Publication history

  1. Received: August 5, 2022
  2. Accepted: February 13, 2023
  3. Accepted Manuscript published: February 28, 2023 (version 1)
  4. Accepted Manuscript updated: March 1, 2023 (version 2)


© 2023, Abdalla et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.


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  1. Moustafa Abdalla
  2. Salwa Abdalla
  3. Mohamed Abdalla
Tracing the path of 37,050 studies into practice across 18 specialties of the 2.4 million published between 2011-2020
eLife 12:e82498.

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