Why great therapies still fail to reach patients

Published 19 August 2026

Author(s): Isabel O’Brien

A great therapy can clear every scientific hurdle and still fail to reach the patient. Often, the difference is friction: a series of small barriers that can have major consequences

The alarm goes off at 6am. You need to be at the gym for 6:30. In theory, there is plenty of time. Then there is the small matter of getting out of bed. You have to find your shoes, fill your water bottle, make coffee and locate your keys. Perhaps it is raining. Perhaps, after all that, you decide that missing one session isn’t all that bad.

None of these is a serious obstacle. That is precisely why they matter. Friction is rarely a wall: it is a succession of small impediments between an intention and an action, each easy to dismiss until there are enough of them.

Speaking on the EMJ GOLD podcast, behavioural scientist Richard Shotton, Author, Hacking the Human Mind, describes friction as the accumulation of “seemingly trivial barriers” that can have a “disproportionate effect on behaviour”. The same applies after a medicine has cleared the scientific and regulatory hurdles. Access depends on what happens next, and every hurdle creates another opportunity for failure.