Professor Bruce Neal

Professor Bruce Neal has just stepped up into the top role of executive director at The George Institute for Global Health Australia.

The limbic spoke to him about what the new position means for him personally and whether it signals any change in direction for the Institute.

Ongoing success

Professor Neal is quick to point out the Institute is in great shape so it’s a case of steady as it goes for the most part and ensuring that their past success continues

“I’ve been at The George Institute since the beginning so I’ve got a fairly strong sense of what’s going on and I’ve had a fair bit to say in terms of what is going on. There is no intent for wholesale change,” he said.

But that doesn’t mean the Institute isn’t evolving.

It’s probably best known for its large-scale clinical trials of new therapies “that have changed the care of literally millions of people who have diabetes or high blood pressure or dyslipidaemia”.

High impact publications under this Better Treatments theme include those from a program of work on SGLT2 inhibitors.

There is also growth in the work around Better Care including primary care, electronic decision support and task shifting for non-communicable disease management in low to middle income countries.

“And then there is the third stream of Healthier Communities – and that’s probably the area where we want to grow things the most.”

“That is trying to think more about, for example, the food policy or injury work that we do which is much more based in trying to change how government operates or how industry operates and brings in a whole other stream of work around public health.”

“The government is talking a prevention agenda in the way that it hasn’t for the last few years and trying to figure out how to engage with that and support that to the max as well will be real opportunity for us over the coming years.”

“It’s something we badly need in Australia. I’m quite excited about it.”

More than just trials

Professor Neal said one of the most important developments at the George Institute over the last 20 years has been the realisation that just generating new scientific discovery is not enough.

“We went from thinking we’ve done it – we’ve done the trial – and then going oh, we’ve got to get it into guidelines and then actually realising that getting it into guidelines isn’t enough if government or insurers don’t actually reimburse it.”

“And so we have progressively been getting more sophisticated in terms of the way we think about actually getting discoveries into practice. Now, the work we are doing with government and electronic decision support tools and health insurance – that to me is really starting to take us into a new realm where there is the potential to have at least as much impact from these very different discoveries we can make compared to the discovery we make in the RCTs.”

“We’ve also taken quite a business type approach to some of the work and the polypill would be an example where the idea was there, we did some early trials but then what we have recognised is that if we are actually going to get this to scale and make it real, we need to go out and raise investment dollars from venture capital and get them to understand the potential here and get them to invest with us in vehicles that are going to keep pushing the agenda forward.”

“But again, we’re thinking very much not just about the discovery but how we are actually going to get this manufactured at scale, get this marketed, and how to get it used particularly in some of the lower to middle income countries we are working in.”

Global connections

With entities in China, India and the UK, the Institute does indeed have a global approach and mindset, which brings both challenges and opportunities.

Part of their commitment is about translation – doing research in lots of jurisdictions, which is then hopefully applicable in more jurisdictions.

Professor Neal said they also learnt that being based in Sydney made it difficult to attract the best people.

“So we have been looking at models where we can maybe have people on one to two days a week who are located in different geographies around the world and how can we make that work.”

The advantages of making it work means the Institute benefits from that international expertise and the flow-on such as access to more research sites and overseas funding schemes.

Professor Neal admits the new position means he will have to pull back on being quite so involved in a number of the projects.

“What I’ve got to do is spend a little bit more time with a broader view and providing support to the breadth of activity at the Institute.”

“But equally I’m not to lose that really strong research focus that I’ve had because I really enjoy that. I think I can bring real value. I just have to figure out how to do it in a different way.”

He will stay involved with a large project looking at the effects of salt reduction on stroke risk in 21,000 people in China – research that he is highly invested in and that is coming to a close over the next 6-12 months.

Local support

His long-term colleague and former executive director at The George Institute Professor Vlado Perkovic was recently appointed Dean of Medicine at the University of NSW.

Given their strong working relationship over many years, Professor Neal sees the potential to leverage off each other, provide more opportunities and further strengthen the links between the George Institute and UNSW.

As well he’s keen to grow the Institute’s development and philanthropy base.

“We’ve been around for 20 years now and we are just getting to that point where people know us… the lack of profile we have had has been a challenge to us in achieving what we want to.”