Issue 3 / 3 February 2014

MUSCULOSKELETAL research is not viewed as “sexy”, affecting its ability to attract funding, say leading rheumatologists who have called for greater funding priority to be given to these disabling conditions.

Professor Lyn March, the Liggins professor of rheumatology and musculoskeletal epidemiology at the University of Sydney and Royal North Shore Hospital, said musculoskeletal (MSK) research was “not particularly sexy” because most people were more concerned about conditions that caused loss of life, overlooking the importance of quality of life.

However, Professor March warned the disability burden of MSK conditions would increase as the population aged and now was the time to take action.

“Many interventions are available that can make a difference yet they are not being implemented. The skills and expertise to conduct [the necessary] studies are definitely available in Australia, with many Australian researchers involved in trials. However, many of these are smaller trials that may not have a great impact. It is likely that this reflects the lack of sufficient funding”, she told MJA InSight.

Professor March’s comments came as a review of the scope and funding of MSK clinical trials in Australia, published in the MJA, found that NHMRC funding for MSK research was “disproportionately low” compared with the burden of these conditions. (1)

The authors said MSK conditions accounted for 27.4% of the total disability burden in Australia, but the NHMRC had funded an average of 5.8 new MSK trials a year in the past 5 years. This represented 0.8% of all project grants and funding, and 5% of NHMRC clinical trial funding.

Professor March said the government and the community must urgently address this imbalance in funding. “Clinicians and researchers need to consider priorities for interventions that will have the greatest impact and benefit to the health of the Australian population”, she said.

Professor Peter Brooks, leading rheumatologist and professorial fellow in the School of Population and Global Health, University of Melbourne, said common conditions such as back pain tended to be overlooked in research. “Back pain is not a sexy thing in a way; everybody gets back pain … so we tend not to give it quite the same accolades that we might give cancer or heart disease”, he said.

Professor Brooks agreed with the MJA authors that identifying evidence-practice gaps in MSK was likely to become even more important as health costs spiral.

“We very often know what to do, but we don’t do it,” Professor Brooks told MJA InSight. “There are still millions of dollars spent in Australia on x-rays in the acute phase of back pain, [but] there is no evidence that [this imaging] alters the way you treat back pain.”

Professor Nikolai Bogduk, conjoint professor at the University of Newcastle’s School of Biomedical Sciences and Pharmacy, said there were several confounders to the position taken in the MJA paper.

“There is no rule that says research dollars should be proportional to the epidemiology of disease because you could end up with the absurdity of trivial but common diseases attracting the bulk of the funding leaving nothing for other conditions”, he said.

Professor Bogduk said in Australia there was also a “psychosocial resistance to negative results”.

“Many things that are popular in contemporary practice lack a foundation. Should research [money] be spent to disprove [these practices] when all the established practitioners are not going to pay any attention to the negative results anyhow?”

Responding to the MJA paper, an NHMRC spokesperson said research into the national health priority of arthritis and MSK had one of the highest rates of successful funding applications.

Based on all applications received, which included clinical trials, last year’s awards to both arthritis and MSK were “on par with asthma and cancer”, the spokesperson said. “In 2013, we funded 20.5% of all applications in this area. In 2012 it was 26% and in 2011 it was 27.7%”, the spokesperson said. (2)

“The amount of money that is awarded for specific types of clinical trials is dependent on the numbers of applications received and the number of grants that are funded — no quotas are set for clinical trials, or particular types of clinical trials.”

1. MJA 2014; 200: 88-91
2. NHMRC research funding data sets

3 thoughts on “MSK not “sexy” enough

  1. john porritt says:

    Recently had severe polymyalgia. Could inability to get out of bed, shower, put on socks, comb hair, dress oneself, be occasions to develop sexiness ?

  2. Patrick Hanrahan says:

    The comment from the NHMRC spokesman would suggest that the issue is not so much a failure of the funding agencies, but rather a failure of academic rheumatology.

    Nick Bogduk raises very important issues which are applicable to all aspects of medicine, but especially interventional medicine.

    The funding agencies – the private health insurers and medicare – really do need to do an evidence based review of procedral medicine and withdraw funding for those clearly shown not to work, and disallow funding initiation without a suitable evidence base. They should also disallow funding for e.g. an intervention done by CT which could just as well be done more cheaply and safely under ultrasound, and the use of imaging item numbers which are used for unproven therapies like ozone injection.

    There is pressure to use new treatment by peers and patients, education is only part of the approach to this.

  3. John Quintner says:

    This is a very interesting discussion. As a rheumatologist and pain medicine physician, I tend to side with Professor Bogduk. We know that health professionals from all relevant disciplines are enthusiastically endorsing and using therapeutic interventions such as trigger point injections,  dry needling, prolotherapy, and lumbar zygapophyseal (“facet”) joint injections with corticosteroid preparations, without any scientific evidence to support the efficacy of these treatments.  Furthermore, as he points out, they have not shown a willingness to pay attention to any negative results from existing research.

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