The answer is 17 years, what is the question: understanding time lags in translational research

Zoë Slote Morris, Steven Wooding, Jonathan Grant · Journal of the Royal Society of Medicine · 2011 · medicine · 10.1258/jrsm.2011.110180 · record morris2011-the-answer-is-17-years-what-is-the
tag layer · index · concepts · authors · עברית
Where this record's text came from. 2026-08-23 and 2026-08-25 schema-0.3 passes: every quote verified as an exact substring of the staged text and anchored at merge time; concept terms verified present; every edge endpoint an existing node.
11 quotations on this page contain a reference number where the paper printed a superscript. This journal style prints citations as raised numerals — parameters12,13 — and the extraction flattened them into the line, so the sentence reads parameters 12 , 13 . The digits are citation markers and not part of what the author wrote. The quotes keep them for the same reason they keep every other extraction fault: a quote is reproduced exactly or it proves nothing.
This record’s own method is review, and the tags below follow from that. A review’s findings, quantities and statistics are things stated IN this paper, and some of them report results obtained elsewhere. No tag on this page names a different author. Measured across every review in this corpus, 81% of a review’s tags carry no citation at all — most of them are the review speaking. The corpus does not adjudicate the rest: read an unmarked tag as a claim this paper makes, not necessarily one it made first.
How to read this page. The article itself is not reproduced here — this paper is not cleared for redistribution, so what follows is the tag layer alone. The evidence sentences are withheld with the article. The table at the foot lists every tag the record carries; each row names the facet it belongs to, and the whose words column says whether the tag records the paper's own wording or the tagger's sentence about the paper. Every tag links to each other paper in the corpus carrying it. The machine-readable edition of the same thing is the TEI file beside this one, where the tags live in standOff, and the article is at its publisher via the link below. When we have changed our mind. Some entries in the table begin with a word in capitals and the reason for it. EVIDENCE CORRECTED — the finding still stands, but we had quoted the wrong sentence from the paper, and the quotation has been replaced with the right one. RETRACTED — the entry itself was wrong; it stays on the page, marked, with the reason, rather than being deleted. WITHDRAWN AND REPLACED — the entry was wrong, and a corrected version of it appears in the entries below. Each mark carries its own reason, in brackets, because the reasons differ from one entry to the next. An entry we have WITHDRAWN is removed from this page and kept in the record, with its reason. A line reading Audit and a date is a later re-reading of the entry against its whole sentence: DOUBTFUL means it was kept, and the reason says what is loose about it. Quotation marks inside the tagger's sentence. Where a tag is the tagger's own sentence, a phrase in quotation marks inside it is borrowed from the paper — the tagger's wording around it is not. The paper's own sentence is the evidence quote for that row; on this page it is withheld with the article, and the article is at its publisher. Nothing inside quotation marks anywhere on this page is ours: if it is quoted, it is the paper's. Whose words a concept carries. A concept entry records a term the paper itself uses, so the term, the sense given for it, and its evidence are the paper's own words, quoted where the paper fixes them. This is the opposite of a sense entry in the tag table, which is the tagger's sentence about how the paper uses a term. Where a concept entry could not be grounded in the paper's words, the entry says so on its own row.

Tags on this paper

Every tag the record carries, each linking to every other paper in the corpus that carries it. A tag appears here whether or not its words occur in the article — the spans below are only the ones a sentence in this paper licenses. Of the 9 concept tags on this paper, all 9 are grounded in a quoted sentence. All carry the tagger's gloss of what the term means in this paper, which is not something the article can license.
time lags durations of activities and waits Type 1 translation bench to bedside difficulty of measuring longer lags convergence of average lags publication to guideline development to commercialization positive results time lag Type 2 translation start point and endpoint an average whose spread is four times the effect it reports review
Method, as described: a non-exhaustive multi-strategy review - formal search, backward and forward citation tracking, targeted journals - with a data-extraction template recording each study's start date, end date, range, mean, median, topic and country

Legend

relation to other workclaim_relationshow this paper stands to another: agrees, contradicts, extends, qualifies
claim typeclaim_typethe shape of the claim: existence, mechanism, method, critique, prediction, null
concept edgeconcept_edgesan asserted relation between two concepts, with the sentence asserting it
conceptconceptsan idea the paper works with, quoted where the paper uses it
content tagcontent_tagsa finding, definition, quantity, statistic or variable named in the paper
contributioncontributionwhat the paper claims to add
controlcontrolsan experiment run to eliminate a rival explanation
limitationlimitationswhat the paper says its evidence cannot support
mechanismmechanismshow the reported effect is said to come about
methodmethodhow the paper produced its evidence
object of studyobject_of_studywhat the paper is about — the thing it investigates
phenomenonphenomenonthe effect or regularity under study
research questionresearch_questionthe question the paper sets itself
sensesensesa distinct use of a term, quoted where the paper fixes it
transfertransfersa method or concept carried in from another field

The paper

The full text is not reproduced here. This article is not cleared for redistribution, so the page carries the tag layer only. Its evidence sentences are withheld; the grounding status remains with each tag, and the article itself is at https://doi.org/10.1258/jrsm.2011.110180. The reading view exists for the papers whose licence permits it.

Every tag on this page

claim_relations 3 · claim_type 1 · concept_edges 4 · concepts 9 · content_tags 16 · contribution 1 · controls 3 · limitations 4 · mechanisms 12 · method 1 · object_of_study 1 · phenomenon 1 · research_question 1 · senses 4 · transfers 1

Relations on this page carry a quotation for the claim. Where a relation was separately evidenced — and so tested against the vocabulary for its type — the row says so; 4 of 4 relations here carry that mark. The rest are the tagger’s reading of the sentence quoted beside them.

facettagfieldconf.whose words
object_of_studyA NUMBER IN UNIVERSAL CIRCULATION, WORKED BACKWARDS TO THE DEFINITIONS UNDERNEATH IT - '17 years' for research to reach clinical practice, reviewed across 23 studies that measure different starts, different ends and different things
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object_of_studythe paper's words
research_questionwhat was actually measured to produce the time lags that health research policy is built on, and whether the figures can be compared or added at all
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research_questionthe paper's words
contributiona conceptual model of the translation pipeline with every reviewed study's start point and end point mapped onto it, and the finding that the studies are not measuring the same quantity
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contributionthe paper's words
claim_typecritique
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claim_typethe paper's words
phenomenona literature that converges on one figure for a quantity it has never defined, and a policy apparatus that spends against that figure
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phenomenonthe paper's words
methodreview
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also in: review
methodthe paper's words
mechanismsTHREE STUDIES AGREE ON 17 YEARS, AND THE EXPLANATION OFFERED IS ABOUT THE INSTRUMENT RATHER THAN THE WORLD: `Using different endpoints, different domains and different approaches, Balas and Bohen and Grant et al. both estimate the time lag ... BEING 17 YEARS ... It is surprising that 17 is the answer to several related but differing questions. Is this coincidence or not? One possible reason for the convergence is the difficulty of measuring longer lags ... which provides a ceiling to such estimates.` Agreement between measurements is read as a property of the ruler, which is the strongest form of `an instrument's first output is itself`
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mechanisms[0]0.85the tagger's words
mechanismsAND THE CANONICAL 17 IS WRONG BY SIX YEARS ONCE ITS ASSEMBLY IS ACCOUNTED FOR: `Balas and Bohen calculate an average of 17 years from original research to practice formed from adding together a number of single studies of different phases including one that estimates a lag of 6-13 years. Accounting for this changes their estimate of the time lag between journal submission to use in practice from between 17 years to 23 years.` The most-quoted figure in translational research, restated as 23
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mechanisms[1]0.85the tagger's words
mechanismsAND THE NUMBER SETS A NATIONAL RATE OF RETURN: `This level of benefit was calculated using an estimated lag of 17 years. Varying the lag time from 10 to 25 years produced rates of return of 13% and 6%, respectively.` An internal rate of return on thirty years of UK cardiovascular research moves by a factor of two on the choice of a definition nobody in the literature shares. This is the clearest case in the corpus of a definitional choice with a monetary consequence
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mechanisms[2]0.95the tagger's words
mechanismsAND THE STUDIES ARE NOT MEASURING ONE QUANTITY: `Much of the literature on lags focuses on dissemination and publication in peer-review journals in particular as these are the most measureable ... the variation in choice of proxy measures means that studies are almost never measuring the same thing, making valid aggregation and generalization difficult.` The proxy was chosen for being measurable, not for being the thing - and the consequence is that the figures cannot be added
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mechanisms[3]0.95the tagger's words
mechanismsAND A STATISTIC THAT CHANGED ITS NAME IN TRANSIT: `Decullier et al. report `MEAN` LAGS, and Dwan, in reporting Decullier et al., in their review refer to `MEDIAN` LAGS. NEITHER REPORTS DISTRIBUTIONS. Ranges - or even interquartile ranges as large as 221 YEARS - are seldom reported.` A mean becomes a median between a paper and its reviewer, and neither publishes the distribution that would settle it
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mechanisms[4]0.85the tagger's words
mechanismsAND AN AVERAGE THAT HIDES A RANGE LARGER THAN ITSELF: `clinical trials with null or negative results `ON AVERAGE` took `JUST OVER A YEAR LONGER` to be published than those with positive results. This average is associated with A range of six to eight years for studies with a negative or null result, compared with four to five years for those with positive results. Comparing the slowest negative publication with the fastest positive publication MAKES A potential difference of four years - half of the maximum lag.` The headline is one year; the spread is four
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mechanisms[5]0.85the tagger's words
mechanismsAND THE FIELD'S HABIT IS NAMED: `There is a clear trend in the literature to seek a single answer to a single question through the calculation of an average. The variation found in the literature suggests that this is not possible (or even desirable), and variation matters. Moreover, many of the published `averages` are derived from adding an empirically derived mean duration for one section of journey from one point in time, in one topic, and adding it to other parts without reflection.` A summary statistic assembled from incommensurable parts
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mechanisms[6]0.95the tagger's words
mechanismsAND THE TERM ITSELF MEANS DIFFERENT THINGS TO DIFFERENT PEOPLE, ON THE RECORD: `Woolf has argued that `TRANSLATION RESEARCH MEANS DIFFERENT THINGS TO DIFFERENT PEOPLE` and this is reflected in the various models and definitions found in the literature. However, as translational research also `SEEMS IMPORTANT TO ALMOST EVERYONE` there would seem to be benefit in trying to unify models and definitions.` The two halves of the problem in one sentence: maximum importance, minimum agreement
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mechanisms[7]0.95the tagger's words
mechanismsAND ONE OF THE TWO PHASE NAMES IS FLAGGED BY ITS OWN USERS AS CONFUSING: `Type 1 translation, also somewhat confusingly called `BENCH TO BEDSIDE`, refers to the conversion of knowledge from basic science research into a potential clinical product for testing on human subjects` - while Type 2, `research into practice`, is the one that actually reaches the bedside. The metaphor names the wrong end of the pipeline
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mechanisms[8]0.95the tagger's words
mechanismsAND THE GAPS THE POLICY TARGETS ARE THE LEAST WELL DEFINED PART: `Conceptual models typically include `TRANSLATIONAL GAPS`, which describe the movement from one phase of research to another. Each of these is also associated with delays, although precisely what and where these gaps are, and how long they are, is again not consistent in the literature. Policy measures to expedite the translation process typically focus on these gaps.` Intervention is aimed at the part with no agreed boundaries
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mechanisms[9]0.95the tagger's words
mechanismsAND THE VARIATION SURVIVES INSIDE A SINGLE TOPIC: `examining research relating to advances in neonatal care, Grant et al. traced research papers back through four `GENERATIONS` of publication. They found `the overall time between generations 1 to 4 RANGES FROM 13 YEARS (for artificial surfactant) TO 21 YEARS (for parenteral nutrition). The other three advances TOOK 17 YEARS to develop through four generations of citations`.` One method, one clinical area, five interventions, and an eight-year spread
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mechanisms[10]0.95the tagger's words
mechanismsAND THE LAG RUNS IN BOTH DIRECTIONS: `it took six years for a review of evidence supporting the use of thrombolytic drugs to result in a standard recommendation, whereas prophylactic lidocaine was used widely in practice for 25 years based on no evidence of effectiveness.` A field whose central complaint is that evidence reaches practice too slowly, with a case of practice arriving twenty-five years AHEAD of any evidence at all
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mechanisms[11]0.95the tagger's words
limitationsONLY ONE STUDY MEASURES THE THING EVERYONE QUOTES THE NUMBER FOR: `Table 1 also points to two substantive gaps in knowledge: the time lag involved in and between discovery and development (T1), and the time lag between publication to practice. Only one study has `IMPLEMENTATION` into practice as its endpoint.` The `17 years to reach clinical practice` figure rests on a single measurement of reaching clinical practice
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limitations[0]0.95the tagger's words
limitationsAND THE AUTHORS PUT THEIR OWN SEARCH'S WEAKNESS FIRST: `Despite our attempts to be comprehensive, however, we are aware that studies of time lags in health research are widely distributed and not easily identified using formal literature searches and we may have failed to capture relevant studies.` The Methods say the same before the results: `Our search was not intended to be exhaustive`
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limitations[1]0.95the tagger's words
limitationsAND THE MODEL THEY BUILD IS LINEAR AND THEY SAY SO: `Clearly this model can be critiqued for being linear and we acknowledge the considerable literature that challenges this notion and accept that research translation is a messy, iterative and complex process ... At the same time, we would argue that for the purposes of understanding and conceptualising time lags the model is appropriate.` A simplification defended by its purpose rather than its accuracy
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limitations[2]0.95the tagger's words
limitationsAND THE LAGS ARE NOT STABLE OVER TIME, SO A FIGURE ALSO HAS A DATE: `Pulido noted a difference of 0.9 years or 0.3 years from acceptance to publication in 1992 and 1982, respectively. DiMasi reported a slight shortening of the approval process between 1991 and 2003. Tsuiji and Tsutani reported reduced lags in the drug approval process in Japan following a change in policy to try and expedite it.` A quantity that moves when policy moves, quoted as a constant
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limitations[3]0.85the tagger's words
transfersthe 17-year translation lag is a figure produced by an economic calculation of the returns to medical research, including spillovers to the wider economy
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transfers[0]0.95the tagger's words
controlsmapping each reviewed study's start point and end point onto one conceptual model before comparing any figures
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eliminates: adding or averaging intervals that do not denote the same quantity · outcome: held
controls[0]0.85the tagger's words
controlscombining formal search with backward and forward citation tracking and targeted journal searches, after 'a formal search yielded few relevant papers'
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eliminates: missing a scattered literature that database indexing does not group · outcome: partial
controls[1]0.95the tagger's words
controlsreporting the range and the distribution alongside any average
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eliminates: a headline figure that conceals a spread larger than itself · outcome: failed
controls[2]0.85the tagger's words
conceptstime lags
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also in: time lags
concepts[0]0.95the paper's words
conceptsdurations of activities and waits
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concepts[1]0.95the paper's words
conceptsType 1 translation
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concepts[2]0.95the paper's words
conceptsbench to bedside
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concepts[3]0.95the paper's words
conceptsdifficulty of measuring longer lags
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concepts[4]0.85the paper's words
conceptsconvergence of average lags
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concepts[5]0.85the paper's words
conceptspublication to guideline
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concepts[6]0.85the paper's words
conceptsdevelopment to commercialization
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concepts[7]0.85the paper's words
conceptspositive results
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concepts[8]0.85the paper's words
senses`translational research` - `means different things to different people` (Woolf) and `seems important to almost everyone`; the paper's response is to build a model rather than to pick a definition
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senses[0]0.95the tagger's words
senses`Type 1 translation` / `bench to bedside` - basic science to a clinical product FOR TESTING; the metaphor points at the bedside and the phase stops well short of it
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senses[1]0.95the tagger's words
senses`time lag` (as used across the 23 studies) - the interval between ANY two markers a study chose: ethical approval to publication, publication to guideline, chemical synthesis to FDA approval, trial registration to publication
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senses[2]0.85the tagger's words
senses`17 years` - three separate estimates of three different intervals, whose agreement the authors suggest may be A CEILING EFFECT of citation indexes rather than a fact about research
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senses[3]0.85the tagger's words
claim_relationscritiques → Balas and Bohen's 17-year estimate, assembled by adding single studies of different phases; corrected here to 23 years
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claim_relations[0]0.85the tagger's words
claim_relationscritiques → the practice of reporting a single average time lag at all - 'The variation found in the literature suggests that this is not possible (or even desirable)'
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claim_relations[1]0.95the tagger's words
claim_relationsextends → Trochim et al.'s 'process marker model', which the authors endorse as the framework for the operational markers their review says are missing
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claim_relations[2]0.95the tagger's words
concept_edgestime lags —operationalised-as→ durations of activities and waits
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the relation itself is separately evidenced · strength of the relation: 0.95 · note: 'Understanding time lags requires…' The operationalisation is the whole argument: 23 studies each picked two markers off an unstated model, and the figures cannot be added because the models were never the same · the relation stated: a lag is only measurable once a conceptual model names the activities and the waits between them - which is why the paper builds the model before reviewing the figures Audit 2026-09-28: DOUBTFUL - read against its full span and kept, but the span says a conceptual model is needed so that durations can be measured; operationalised-as is loose.
concept_edges[0]0.95the tagger's words
concept_edgesdifficulty of measuring longer lags —causes→ convergence of average lags
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the relation itself is separately evidenced · strength of the relation: 0.85 · note: 'ONE POSSIBLE…' Weight 0.85 because the authors offer it as 'One possible reason' and do not test it. But the shape is the finding: agreement between independent measurements read as a property of the instrument rather than of the world · the relation stated: the ceiling on observable lags - citation indexes, records, recollection - is offered as a reason three studies of three different intervals all report 17 years Audit 2026-09-28: DOUBTFUL - read against its full span and kept, but the span offers this as 'one possible reason' for the convergence; hedged.
concept_edges[1]0.85the tagger's words
concept_edgesType 1 translation —renamed-across-fields→ bench to bedside
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the relation itself is separately evidenced · strength of the relation: 0.95 · note: `Type 1 translation, also somewhat confusingly called `BENCH TO BEDSIDE`, refers to the conversion of knowledge from basic science research into a potential clinical product for testing on human subjects.` Type 2 - `research into practice` - is `THE ONE CLOSER TO THE NOTION OF THE BEDSIDE`. A metaphor naming the wrong end of its own interval, which matters because the two names are used interchangeably in policy and the intervals they denote are different lengths · the relation stated: the same phase carries a technical name and a metaphor, and the paper flags the metaphor as confusing because the phase stops at testing rather than at the bedside
concept_edges[2]0.95the tagger's words
concept_edgespublication to guideline —contrasted-with→ development to commercialization
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the relation itself is separately evidenced · strength of the relation: 0.95 · note: 'SOME STUDIES REPORT…' A late sub-step of the pipeline exceeding a long earlier stretch of it - which is only possible because the two figures come from different studies of different things, and is exactly why the paper says they cannot be added · the relation stated: some studies report the publication-to-guideline step as LONGER than others report the whole development-to-commercialization stretch
concept_edges[3]0.85the tagger's words
content_tagsthree estimates converge on 17 years, possibly because longer lags are hard to measure, which caps such estimates
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content_tags.findings[0]0.85the tagger's words
content_tagsAND THE CANONICAL FIGURE IS WRONG BY SIX YEARS: `Accounting for this changes their estimate ... from between 17 years to 23 years`
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content_tags.findings[1]0.85the tagger's words
content_tagsAND THE FIGURE SETS A NATIONAL RATE OF RETURN: `Varying the lag time from 10 to 25 years produced rates of return of 13% and 6%, respectively`
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content_tags.findings[2]0.95the tagger's words
content_tagsAND THE STUDIES ARE NOT MEASURING ONE THING: `studies are almost never measuring the same thing, making valid aggregation and generalization difficult` - the proxy was picked for being `the most measureable`
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content_tags.findings[3]0.95the tagger's words
content_tagsAND A MEAN BECAME A MEDIAN IN CITATION: `Decullier et al. report `MEAN` LAGS, and Dwan, in reporting Decullier et al., ... REFER TO `MEDIAN` lags. Neither reports distributions`
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content_tags.findings[4]0.85the tagger's words
content_tagsAND ONLY ONE STUDY MEASURES WHAT THE NUMBER IS QUOTED FOR: `Only one study has `IMPLEMENTATION` into practice as its endpoint`
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content_tags.findings[5]0.95the tagger's words
content_tagsAND THE LAG RUNS BOTH WAYS: thrombolytics took `six years` to reach a recommendation, `whereas prophylactic lidocaine was used widely in practice for 25 years based on no evidence of effectiveness`
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content_tags.findings[6]0.95the tagger's words
content_tagsthe interval between any two markers a study chose - `Decullier et al. and Stern and Simes measure time between ethical approval and date of first publication; Grant et al. and HERG et al. look at PUBLICATION TO GUIDELINE; Sternitzke looked at ... `CHEMICAL SYNTHESIS` TO FDA APPROVAL; Ioannidis ... TRIAL REGISTRATION and several milestones to publication`
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also in: time lag
content_tags.definitions[0]0.85the tagger's words
content_tags`Type 1 ... refers to the conversion of knowledge from basic science research into a potential clinical product for testing on human subjects. Type 2 translation, `RESEARCH INTO PRACTICE`, tends to refer to the process of converting promising interventions in clinical research into healthcare practice`
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content_tags.definitions[2]0.95the tagger's words
content_tags`Type 1 ... refers to the conversion of knowledge from basic science research into a potential clinical product for testing on human subjects. Type 2 translation, `RESEARCH INTO PRACTICE`, tends to refer to the process of converting promising interventions in clinical research into healthcare practice`
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content_tags.definitions[3]0.95the tagger's words
content_tags`formed from adding together a number of single studies of different phases`
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content_tags.quantities[0]0.85the tagger's words
content_tagsthe same thirty years of UK cardiovascular research, valued twice over on the choice of one undefined interval
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content_tags.quantities[1]0.95the tagger's words
content_tags`Ranges - or even interquartile ranges as large as 221 YEARS - are seldom reported`
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content_tags.quantities[2]0.85the tagger's words
content_tagsone method, one topic, and an eight-year range under a single average
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content_tags.quantities[3]0.95the tagger's words
content_tags`clinical trials with null or negative results `ON AVERAGE` took `JUST OVER A YEAR LONGER` to be published ... a range of six to eight years ... compared with four to five years ... makes a potential difference of four years - half of the maximum lag`. The reported quantity is 1 year; the quantity it is drawn from spans 4
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content_tags.statistics[0]0.85the tagger's words
content_tagsthe two free parameters of every figure in this literature - `the start point and endpoint of the time lag measured in each study were mapped onto specific stages in the conceptual model`, which is the only way the 23 studies could be compared at all
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content_tags.variables[0]0.85the tagger's words

Interpretive choices

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