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RESEARCH that has resulted in dramatic advances in the management of patients with cystic fibrosis, increasing life expectancy by more than 20 years, demonstrates the importance of a close connection between the laboratory and the clinic.
This kind of research, often referred to as translational research, ferries research questions and answers back and forth between the bedside and laboratory bench. For it to happen, you need clinician-researchers and laboratory scientists working together.
When it works it is brilliant, but it requires enlightened investment from both hospital and research funding agencies. Now it is under threat in the US.
Hospital-based research in the US is feeling the pressure of reduced federal funding for the National Institutes of Health. Simultaneously, money received by hospitals from paying patients is decreasing as health insurance is becoming less generous.
A recent article published in Science Translation Medicine records the distress of 19 leaders of academic health centres from Pennsylvania to Columbia to Yale and Case Western Reserve.
The message from these senior hospital and academic leaders is also important in Australia. Here, the formalities of translational research development are just beginning.
The NHMRC has announced the first four Advanced Health Research and Translational Centres. These centres have much in common with the hospital-based academic centres in the US.
However, the Australian centres come with no specific funding, so the challenges in making them work well are even more acute than for their American counterparts.
Three actions stand out in the Australian setting to secure the future of translational medical research practised in major academic hospitals.
First, while research is a relentlessly competitive enterprise in which there are no stars for coming second, research in our major hospitals should have the improvement of patient care front and centre.
This is not to ignore blue-sky research or luck as important elements in research progress. Rather, it is to define a clear goal that can justify spending money allocated to hospitals for health care on research.
This is not the problem it was a decade ago: I recall a time when the word “research” was purged from state and territory health department lexicons. That has changed dramatically for the better.
But health departments have every right to expect that the research they support — several hundred million dollars of it in NSW alone each year — should be translational, taking ideas for research from the clinic and applying the findings from the lab in the care of patents.
Second, appropriate business models must be developed by the financial managers of hospitals and research agencies to give security to the clinical research enterprise.
This means taking career development — especially of young researchers — seriously and budgeting for 3‒5 years of support; otherwise, we will have no future translational research workforce. The negotiations between hospital managers and state health departments necessary to achieve these business models will be tough but the gains from success will be huge.
Third, Australia needs a fresh approach to financing medical and health research in general. Currently, we still do not perceive the economic or health benefits from investing in the intellectual reserves of young researchers. It is absurd that so much potential research creativity is lost to the nation and to the world because of short-term budgeting in the health and academic portfolios. Only about 20% of new research proposals are funded.
A medical research future fund, as mooted in the 2014 and 2015 federal budgets, would be an excellent start. Nevertheless, we need more in the “present” fund as well.
Massive advances in the management of the chronic disorders beckon to us through contemporary research portals, including cancer therapies and transplantation science.
An Australian summit on how to fund translational research in Australia’s academic health centres is urgently needed. If we make it an international event, who knows, we may attract several high-flying young American clinician research scientists permanently to our fair shores!
Professor Stephen Leeder is emeritus professor at the Menzies Centre for Health Policy at the University of Sydney. Find him on Twitter: @stephenleeder
There are many constraints preventing clinical research currently. These of course include lack of time and no compensation but other insidious disincentives also exist. Firstly, if a researcher believes in a new treatment, the use of a control group means that, in his/her mind, half of the group are missing out. The next is the complexity of modern medical practice, where combination therapy is almost always practiced with the view to reducing doses and therefore side-effects of any one particular drug.
In intensive care medicine this dilemma was addressed many years ago in trauma patients by stratifying the severity of the patients by the use of the ‘Apache’ scoring system. Each intensive care unit could then embark on a process of refining their treatment and benchmarking their results against other units as controls.
If other methods of severity stratification were developed, many other areas of clinical practice I believe would open up to research. Clinicians would give their best to their patients , as they usually do and then benchmark their results with their peers.