From implementation to learning: the importance of a two-way dialogue between practice and science in healthcare

Improved food storage and particularly the widespread growth of refrigeration over the current century, with its consequent indirect effects on dietary habits, have been repeatedly advocated as one of the reasons for the substantial decline in gastric cancer rates observed during the last few decades in developed countries (Doll & Peto, 1981; Howson et al., 1986). Most of the evidence, however, is indirect, and chiefly based on time trend comparisons between frequency of electric refrigerators and gastric cancer rates. In Japan, for instance, the use of electric refrigeration increased rapidly in households between 1960 and 1970, approximately when gastric cancer rates started to decline (Howson et al., 1986). The