This is an edited version of a speech about the challenges facing medical research given by outgoing National Health and Medicine Research Council (NHMRC) CEO Warwick Anderson at the National Press Club today.
It’s been a great privilege to have been the head of NHMRC for going on a decade. That’s four governments, six health ministers, a funding increase from A$437 million in 2006 to A$859 million today and tens of thousands of applications for funding. And when I finished in March, I was the longest-serving head of a major public medical research funder internationally!
We get more benefits than you might know from medical research – and we should get even more, and faster. A theme that you will hear is that we need always to be vigilant against vested interests.
All polls show that Australians overwhelmingly support government funding of medical research. I believe that people support medical research because it brings hope, hope for new treatments and cures for the diseases that they and their families suffer from.
Having successful innovative industries that rely on brains, knowledge and research is essential for our nation’s future. Think of this – the US government estimates that, though the Human Genome Project cost it $3.8 billion over 15 years, it has delivered $178 for each one of these research dollars to the US economy. So, by any measure, supporting medical research is an investment with an excellent return!
But so much more can be done to increase the value of medical research.
Translating research
We could make savings to the public and private purse if we could make better use of research.
Of course, the challenge goes well beyond individual pieces of research. To derive evidence-based conclusions from the world of health and medical research is a huge challenge. There are thousands of new findings coming out of the worldwide medical research effort daily.
How is an administrator or a practitioner able to keep up, make sense and adjust her or his practice as the evidence accumulates?
Turning the research into guidelines for policymakers and practitioners is currently done in an ad hoc, piecemeal fashion. Of the more than 1,000 clinical guidelines in Australia, only a minority have been developed with rigour and are demonstrably free of vested interests. This is an area that really calls for new approaches.
We need 21st-century ways of reliably “reading” this vast amount of literature and providing it in reliable digestible forms. We can’t afford to leave this work to commercial interests only.
Another way to more quickly and effectively gain patient benefit from research is to better connect the leaders in administering the health system and leaders in medical research, towards common aims. Health care is a very large industry, costing us in total around A$140 billion a year through Commonwealth and state government spending and out-of-pocket expenses.
Like any industry, health needs research and development to progress. In most industries, research and development are integral parts of the industry itself. But in health, here and most everywhere, we do something different; we separate research from the delivery of health care.
We fund health research mainly through the higher education system. We fund health care though a wide range of policies and mechanisms, but there is not a clear stream of support for research.
Fixing the workforce
Now I would like to turn to research itself, how I think it will need to change, and how self-interest could derail the changes needed.
First, let’s stop wasting half of the best talent in the country. Women are 60% of applicants for NHMRC’s Early Career Fellowship. But for the top, most senior fellowship, less than 20% of applicants are women. Why are women leaving research?
NHMRC recently surveyed all institutions funded by it to analysis their policies on retaining and promoting women in medical research. The results of the survey were disappointing – only two of around 70 institutions sent us policies that were comprehensive and practical.
Looking around at research leaders, less than 10% of medical research institute directors are women. Only one is dean of medicine at the Group of Eight universities.
So, I recently amended NHMRC’s policy to require institutions to have proper polices for the retention and promotion of women in medical research and to have these in place by the end of this year.
Research fragmentation
Next, I want to issue a challenge to the leaders in the medical research sector itself. I have spoken many times about my concern that the Australian medical research sector is too fragmented, with too many too small institutes.
Cracking the hard questions in health now requires teams, access to a range of equipment, facilities, disciplines and know how. Modern scientific equipment is expensive and it makes no sense to duplicate or under-utilise expensive equipment.
The current trend too is strongly towards international cooperation in order to tackle to big health issues. That’s why I made sure NHMRC joined a range of top-shelf international research consortia and collaborations, such as the International Cancer Genome Consortium and the Global Alliance for Chronic Disease research.
We are just 3% of the world’s effort. We must band together better to compete with the much bigger international players – whether they are established ones like Harvard and its teaching hospitals, or the massive new Crick Institute of the three big leading London universities or, more and more, with China, South Korea and even tiny Singapore.
Australia has more than 50 independent medical research institutes. Yet almost two-thirds of medical research is conducted at just seven universities and a further 17% at the sixth-largest medical research institutes. The remaining 20% or so is spread around more than three dozen other independent medical research institutes and more than 30 universities.
No doubt it is satisfying to be king of a small castle, but is it best serving Australia’s medical research effort?
Sticking to peer review
I am guessing that for many outside science, peer review is a little mysterious. But really, it’s pretty simple – it’s about getting the best possible experts judging the science of other scientists, and doing it fairly and without bias.
I see three challenges to peer review right now. The first comes from the political world. For example, in the US, the National Science Council’s peer review is under attack.