Health care providers need information but many of their needs are not met. In many parts of the world, and particularly in developing countries, the textbooks used during training are often the only information health care providers have. Moreover, the textbooks are frequently out of date and there are limited, if any, opportunities for health workers to participate in continuing education. One landmark meta-analysis showed, for instance, that over 13 years elapsed between presentation of clear proof that thrombolytic drugs save lives after heart attack and the recommending of this treatment in the majority of cardiology texts and review articles. The cardiology authors simply could not keep abreast with randomized controlled trials appearing in nearly 100 different journals.
Clinical guidelines can be helpful or dangerous, depending on how they are developed.
Health workers who wish to increase their knowledge and understanding often have few opportunities to update what they learned after their basic training. Medical journals are few and far between in developing countries, and those mailed from developed countries are expensive and arrive erratically. In any case, information on a particular topic may be scattered in different papers in numerous journals, making it very difficult for health practitioners to get a good overview of all the data available on a given subject. Access to medical information over the Internet is only now beginning to increase. While a Medline search provides information that is easy to access for those with the relevant technology, the output is hard to synthesize.