A new report from the UK is questioning the value of bio-medical research and has significant implications for the future direction of Australia’s Medical Research Future Fund (MRFF).
This is an important document in the context of the current consultation process for the MRFF, and should support individuals and groups seeking to broaden the focus of the fund to include more funding for prevention, health systems research and research into the social determinants of health and health equity.
Jennifer Doggett writes:
The MRFF was announced in the 2014-2015 Federal Budget and is the largest single funding initiative for health and medical research in Australia’s history. It has a capital target of $20 billion and earnings from this capital are used to support health and medical research, in line with the guidelines set out in the Medical Research Future Fund Act 2015, overseen by the Australian Medical Research Advisory Board (AMRAB).
While in principle the MRFF has a broad remit, the legislative and administrative arrangements for the fund lend themselves much more naturally to funding mainstream bio-medical research than research into other areas of health research, such as prevention and public health.
For example Section 24, restricts funding to: a medical research institute; a university; a corporate Commonwealth entity; or a corporation and the AMRAB members are almost exclusively from a bio-medical research background.
Current MRFF priorities
The current priorities for the MRFF cover a broad range of research areas, as follows:
- Strategic and international horizons: Antimicrobial resistance; International collaborative research; Disruptive technology
- Data and infrastructure: Clinical quality registries; National data management study; MRFF infrastructure and evaluation; Communicable disease control
- Health services and systems: National Institute of Research; Building evidence in primary care; Behavioural economics application; Drug effectiveness and repurposing
- Capacity and collaboration: National infrastructure sharing scheme; Industry exchange fellowships; Clinical researcher fellowships
- Trials and translation: Clinical trial network; Public good demonstration trials; Targeted translation topics
- Commercialisation: Research incubator hubs; Biomedical translation
These priorities could potentially encompass research outside of the bio-medical model, in particular priorities 4 and 5; however, in practice research targeting areas such as health systems, prevention, social determinants, early childhood and primary health care, has received much less funding to date.
The following extract from the MRFF shows the difference in funding levels between three projects within a conventional bio-medical model and three which focus on prevention and health systems.
Clinical Trials Activity: Rare Cancer, Rare Diseases and Unmet need $206.00m
Frontier Health and Medical Research $240.00m
Genomics Health Futures Mission $500.00m
Keeping Australians Out of Hospital $18.10m
Maternal Health and First 2,000 Days $17.50m
Boosting Preventative Health Research $10.00m
Currently, the government is undertaking a consultation process on the future of the MRFF. A consultation paper has been prepared to inform this process and a survey open to all stakeholders is is taking responses until 31 August 2018. The parameters of the consultation are broad and provide an opportunity to broaden the focus of the MRFF to include a stronger focus on research outside of the bio-medical model.
Two of the guidelines in the consultation paper that could be specifically referenced in submissions are the following, which state that future research funded by the MRFF should:
- Appreciate the focus on whole-of-system benefit, and stakeholders are encouraged to think beyond single disease or study self-interest.
- Recognise the importance of priority identification that promotes health and social justice, eliminates discrimination and protects access and equity.
The Biomedical Bubble
Individuals and groups intending to provide input into the consultation process may find a new report from the UK of relevance to their submissions. The Biomedical Bubble, published on July 12 and written by Richard Jones and James Wilsdon for the innovation foundation Nesta, argue that conventional bio-medical research is unlikely to provide the same benefits that it has in the past and that research funding should be directed into other areas of health research to achieve maximum impact. They write:
For too long, the pharmaceutical and biotechnology sectors have dominated policy thinking about translating research, but these sectors are in deep trouble, with R&D productivity plummeting and R&D investment falling. Meanwhile, much of the wider innovation needed for the NHS, public health and social care has been under-resourced.
The report analyses the outcomes of medical research undertaken in the UK over the past 15 years and finds that the focus on biomedical science has meant that this research investment has not necessarily translated into greater wellbeing.
The authors argue that this is partly because the major health burdens in the UK are less likely to respond to a purely biomedical treatment approach and that these areas, such as cardiovascular disease, mental health, injuries, and accidents, are under-researched. Like Australia, the UK spends only a small percentage of health and medical research funding on prevention and support for innovation in public health and social care.
The report also highlights a history of problems within the bio-medical research sector of research misconduct, questionable research practices, and a reliance on publication numbers as a metric of academic success which has led to research waste and lower productivity.
Regional funding inequities
A specific issue raised in the report which is relevant to the Australian research environment is the regional inequity in research funding. Jones and Wilsdon also point out that in the UK more than half of government and charity R&D is currently concentrated within a small area of high urban density, which increases regional disparities and enables a minority of researchers to control the research agenda rather than harnessing all the research talent available across the UK.
The report argues for a “radical shift of life sciences funding priorities, away from the biomedical bubble and towards the social, behavioural, and environmental determinants of health,” and an approach to funding which includes “a clear strategy to support the pharmaceutical and biotechnology industries and a separate research strategy for health and social care systems.”
It also recommends investing in facilities and research outside of geographical centres of research and prioritising funding for meta-research to provide evidence to evaluate how the research and innovation system is performing.
An analysis of the report published in The Lancet, states that “the golden age of biomedical research might be over… one reason could be that, because of increasing complexity of disease and multimorbidity in an ageing population, a research choke point might have been reached whereby investment might no longer correspond to better productivity.”
As the MRFF enters the second stage of its evolution, it is important that the findings of this important report are taken into account so that the substantial investment into health and medical research provides maximum future benefits to the Australian community.