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THE changing demographics of the medical research community and the administrative overload of grant applications and reviews is “killing innovation and high impact research by gifted people”, says a leading Australian medical researcher.
Professor John Mattick, executive director of the Garvan Institute, said the emphasis on reductionism in biomedical science was also hindering research on conceptual advances. He wants to “change gears” to be sure the most challenging questions are being explored by the most capable researchers.
Professor Mattick was commenting on research reported in the Proceedings of the National Academy of Sciences that found increasing investment in biomedical research had not yielded comparative gains in new therapies and life expectancy in the past 50 years. (1)
The researchers analysed the PubMed search engine to determine research output and US National Institutes of Health research investment, together with Food and Drug Administration-approved new molecular entities and US life expectancy.
“Increasing resource investments have led to an explosion in scientific knowledge, but the resulting gains in new therapies and improved human health have been proportionally smaller, as measured by [new molecular entities] and prolongation of life expectancy”, the authors wrote.
They attributed this growing gap between research input and output to several factors, including the prior elimination of easier research questions, increasing regulatory requirement and administration, overreliance on reductionism, and society’s shift from acute to chronic illness.
“Our results are best interpreted as a cautionary tale that will hopefully motivate new efforts to understand the parameters that influence the efficiency of science and its ability to translate discovery into practical applications”, they wrote.
Professor Chris Del Mar, professor of public health at Bond University, said research targeting clinician-generated questions was more likely to yield tangible benefits, but this type of research was largely missing in Australia.
He said research endeavours were overly focused on biomedical science, overlooking the development aspect of research and development that addressed clinician-generated questions.
“We seem to have got into the habit of assuming that the kind of research and development that you need in the health industry is benchtop research and looking for new molecules”, Professor Del Mar said.
“We need to find a way of funding research into clinicians’ questions. When you look at the kind of projects the NHMRC is funding, even for clinicians, they nearly always have an animal model or benchtop model in it somewhere. There is very little done on simple, pragmatic questions that are going to make a difference in the here and now.”
Professor Del Mar said Australia could learn much from the clinician focus of the UK’s National Institute of Health Research (NIHR). (2)
He said the NIHR collected research questions posed by clinicians and commissioned research to answer those questions.
“This is research that is not going to make money, but save money — to do things that are effective and not do the things that are not effective”, Professor Del Mar said.
Professor Mattick said the medical research community had been on an “incredible journey” since the elucidation of the double helical structure of DNA in 1953. But this reductionist phase, which had enabled the understanding of the molecular basis of cells, organisms and diseases, had limitations.
“Reductionism is not well suited to understanding human development and complex diseases”, Professor Mattick said. “It can be well applied to simpler conditions and inherited diseases … but more complex ones are difficult. So we have to change gears in the way we explore human biology and what’s going wrong in complex diseases like diabetes, osteoporosis, neuropsychiatric and neurodegenerative diseases because, frankly, in most cases we still don’t have a clue.”
Professor Mattick said he suspected that the changing demographics of the research community was also playing a role in the increasing disparity between research input and output.
“Fifty years ago, universities were smaller and the students, teachers and researchers were, by and large, at the gifted end of the spectrum”, he said. “As we have expanded tertiary education, which I think is a good thing, we have expanded the number of people in the system, so not only do we have more people competing for research funds, there has been a concomitant regression to the intellectual mean in the community that bids for and decides the distribution of research grants.”
Professor Mattick said the “rise of mediocrity” in the research sector was a big problem, adding that it was “not mediocrity that reinvents the future”.
He said an increased emphasis on personal, as opposed to project research funding could better funnel the resources for discovery research to the most gifted researchers, providing them with a more stable platform to pursue big questions with high-impact potential.
The Association of Australian Medical Research Institutes recently advocated for the enhancement of such funding as part of an NHMRC fellowship program review. (3)
2. NIHR
(Photo: wongwean / shutterstock)
Well its not surprising that a clinician thinks that the NHMRC should be funding more questions asked by clinicians. Where’s the evidence that this works to drive innovation?
And, clinicians driving development is a crazy argument. They mostly hinder it!
Agree we need more research on comparative effectiveness of existing medical practices and how to clsoe evidence-practice gaps as detailed in recent articles I with others have published in MJA in recent years. Disappointing that the we are still debating this issue when the call for action is clear.
Scott IA, Glasziou PP. Improving the effectiveness of clinical medicine: the need for better science. Med J Aust 2012; 196: 304-308.
Scott IA, Glasziou PP. Improving healthcare productivity: the need for better translation of science into practice. Med J Aust 2012; 197: 374-378.
Scott IA. Comparative effectiveness research – the missing link in evidence-informed medicine and healthcare policy-making. Med J Aust 2013; 198: 310-312.