World Report
UK medical research gets political
www.thelancet.com Vol 385 April 11, 2015
out the cross-party interest in supporting health and life sciences. “These are all extremely important platform initiatives, and much of it is non-partisan”, he said of the aforementioned programmes.
“‘The UK has a unique advantage with our NHS having records of 60 million plus people...this has huge potential for asking research questions, while maintaining public confidence.’” At the moment, he is overseeing the Accelerated Access Review of Innovative Medicines and Medical Technologies, which also has cross-party support. “This aims to speed up access to the latest innovative drugs and technologies for NHS patients, looking at the whole pathway for adoption and the role of statutory bodies such as NICE [National Institute for Health and Care Excellence] and the MHRA [Medicines and Healthcare Products Regulatory Agency].” Freeman was elected as the member of parliament (MP) for Mid Norfolk in 2010, and was appointed Government Adviser on Life Sciences later that year. As the momentum behind the role grew, in 2014 he became the world’s first Minister for Life Sciences, with responsibilities across the Department of Health (DH) and the Department for Business, Innovation and Skills (DBIS). In his own words, Freeman’s mission is, “to harness 21st century life and health sciences innovations to firstly, get more health for each pound spent, and secondly, in a way that attracts more health-care investment to the UK”. He highlights that a fundamental opportunity now exists with genomic data to profile a drug much earlier
and effectively speed up the research and development (R&D) process, dramatically expediting getting the right drugs to the most responsive patients. “This is of huge value to industry, which would help us renegotiate prices”, said Freeman. Nicola Perrin, Head of Policy at the Wellcome Trust, reinforces that big data is a prime research focus both now and in the foreseeable future, not least because of extensive efforts relating to the 100 000 Genomes Project—a government initiative that aims to sequence 100 000 whole genomes from NHS patients by 2017—and its huge potential to transform how genetics is incorporated into the NHS for patient benefit. “The Wellcome Trust see big data as very important. The UK has a unique advantage with our NHS having records of 60 million plus people”, she stressed, adding that, “this has huge potential for asking research questions, while maintaining public confidence. We need the linkages between different datasets. The huge diversity of our UK population, its size, and the quality of the records means that it should be a key focus.” The Medical Research Council (MRC) also sees bioinformatics
For the joint statement by the four UK National Academies see https://royalsociety.org/~/ media/policy/Publications/2015/ building-a-stronger-futureresearch-innovation-growth.pdf
Dan Dunkley/Science Photo Library
With the UK general election less than a month away, the National Health Service (NHS), education, immigration, the economy, and jobs all take centre stage as political parties campaign and manifestos start to unfold. But less obvious to many is a common theme that underpins all these areas: medical research. As expected, at this stage of campaigning, claims and promises are being made left, right, and centre, in every sense. However, what is most striking about the stance of political parties towards medical research is the degree to which most of them actually agree. In a nutshell, and with occasional reservation, big data, personalised medicine, translating scientific advances into patient benefit, increasing funding, and supporting a steady stream of bright minds from home and abroad to support future research are clear priorities for nearly all of the parties. Even a cursory glance at the recent history of the UK biomedical research scene shows the laying down of some solid foundations over the past decade or so. The current Coalition Government’s Strategy for UK Life Sciences was established in 2011, the Biomedical Catalyst Fund, providing responsive and effective support for the best translational life science opportunities arising in the UK, launched in 2013, as did Patent Box, which reduces corporation tax to 10% for income from patents to try to make the UK an attractive base for companies. Prior to this, the Labour Government created the Office for Life Sciences in 2009, the National Institute of Health Research (NIHR) in 2006, and Academic Health Science Centres in 2007. The Conservative Minister for Life Sciences, George Freeman, pointed
Adrian Roots
Ahead of the general election on May 7, the UK’s political parties seem to be largely in agreement about what the priorities for medical science in the country should be. Becky McCall reports.
1381
Si Barber/Bloomberg via Getty Images
World Report
Parties support the harnessing of NHS records for research to benefit patients
as a priority area. Since 2013, the MRC has invested a total of £90 million to boost resources in medical bioinformatics, ultimately aimed at supporting the safe use of biological and patient data for medical research. Sir John Savill, Chief Executive of the MRC, has said that he believes, looking ahead, bioinformatics would come of age over the next few decades. He pointed out, in an interview with The Lancet in 2013, that the UK is “in a world-leading position with 60 million people essentially contained in terms of health and treatment to provide the resource to develop this important new field, and I hope MRC will play a leading part in it”. But ethical issues related to accessing and using big data have led to some false starts. In 2014, care.data was launched by NHS England as part of a commitment to using big data to improve the delivery of public sector health care. However, the general public rejected the plans because of the way in which the communications campaign addressed legitimate public concerns over privacy. The mishandled communication in this case has not been lost on Labour, as Jamie Reed MP, Shadow Minister of Health, explained. “The government’s botched implementation of the care.data scheme has eroded a lot of trust with the general public”, he 1382
notes. “The scheme could provide a lot of benefit to a lot of people, but the government couldn’t offer protections of selling data off to private companies; insurance companies were boasting that they could put up premiums using the data.” He adds that Labour wants to see care.data work for people, allowing researchers to discover new, more effective treatments and to make real breakthroughs in science, which is in line with the Coalition’s aims. However, “to do this, we need to demonstrate to the public that their data, their privacy, will be protected”, said Reed.
“‘We want to bring the most talented individuals to Britain, some of whom will go on to pioneer the ground breaking, innovative techniques that underpin future treatments for a plethora of conditions.’” Earlier this year, NHS England relaunched care.data. Using big data in this way epitomises a drive to integrate biomedical research into the practice of health care and ensure translation into patient benefit. According to Freeman, “without integration, industry will continue to see us as a very slow adopter of technology, and failing to embrace smart diagnostics, devices, and drugs, and spending too much money on late-stage treatments in hospitals”. Reflecting these concerns, Freeman highlights that NHS England has recently launched 29 vanguard areas across the UK, which involves testing innovative ways of diagnosing and treating the big widespread diseases that cost the system so much money. He hopes this will demonstrate that the UK is a country to start investing in. “This makes available something very unique—using a resource only the NHS has.” That the NHS offers unique excellence in health care worldwide, and should be leveraged for research
and patient benefit, was agreed by all parties. “The skills, resources, and expertise are already here, we just need to capitalise on it”, said Reed, adding that, “the research opportunities within it are incredibly attractive to people around the world”. However, Reed noted the need to speed up the process for new clinical trials. “If we want to cut the time it takes to get regulatory approval to start a clinical study, then we will need to support the Health Research Authority’s work to streamline research approval and maintain its investment to ensure that the second year of its programme of work can go ahead”, he said. “We’ll also need to ensure that the improvements set out in the European Clinical Trials Regulation are realised in its implementation and that it is enacted in a timely manner, so that these improvements can begin to benefit patients.”
Attracting talent Another key issue that reverberates around the various political parties and the research institutions alike: immigration and attracting the best foreign research talent to the UK. In late 2014, the Home Secretary put forward plans for foreign graduates to be forced to leave the UK at the end of their study visa and apply for a work visa if they wish to return. Perrin points out that the Wellcome Trust have “real concerns that if there is too much emphasis on reducing immigration it sends a message that Britain is closed for business and this has a knock on effect on recruitment of global talent”. She puts a finer point on this by relating the recent frustrations experienced by some researchers in obtaining short-term visas, which is discouraging some of the best talent from applying for jobs in the UK. Echoing these concerns, the Scottish National Party Deputy Leader, Stewart Hosie, points out that the biggest threat to research in all fields www.thelancet.com Vol 385 April 11, 2015
is UK immigration policy. “We must be able to attract and retain world-class talent; therefore, we want the ability to reintroduce the post-study work visa in Scotland.” The Liberal Democrats’ Health Minister Norman Lamb pointed out that his party wishes to continue to welcome international students from around the world to UK universities. “We want to bring the most talented individuals to Britain, some of whom will go on to pioneer the ground breaking, innovative techniques that underpin future treatments for a plethora of conditions.” Likewise, Labour’s Reed acknowledges that the government’s plans to deport students after completion of their studies is stifling progress. “It sends out the wrong message. We want the experts to be based here, not train here and then take their talents elsewhere; that would be self-defeating.” Recent responses from the political parties to letters sent by the Campaign for Science and Engineering found that in Wales, Plaid Cymru does not believe the current migration laws are fit for purpose. “We would also re-introduce a post-study work visa for 2 years for students who have qualified from Welsh universities, so that they can use their skills to contribute to the Welsh economy”, they said, adding that, “we will work to ensure that Wales improves its share of health research funding, attracting high quality researchers”. The UK Independence Party, which has a strong stance on immigration, did not respond in time to a request for comment for this feature.
Budget constraints Reinforcing the point about the UK potentially missing out on the best brains in science, Moira Whyte, Registrar at the Academy of Medical Sciences, highlights that budget restraints as well as immigration issues might be responsible. A recent www.thelancet.com Vol 385 April 11, 2015
joint statement, Building a Stronger Future, by the four UK National Academies (the Royal Society, the Academy of Medical Sciences, the British Academy, and the Royal Academy of Engineering), to which Whyte contributed, emphasises that in real terms, between the years 2010 and 2015, the science budget will have cumulatively eroded by £1·1 billion and this threatens a resurgence of the exodus of leading UK scientists to the USA seen in the 1980s when cuts were made to research and innovation here. In fact, according to the joint statement, overall departmental R&D spending in government has declined dramatically from 0·5% of gross domestic product (GDP) in 1981 to 0·15% today.
“‘...bearing in mind the timescale of medical research, it would be very useful to have a strategy that goes beyond one general election. We need a level of continuity.’” However, Whyte profusely praises the research ecosystem in the UK comprising a mixture of governmental, charity, and private funding. “I think government funding is crucial for keeping UK research flourishing, so charitable and private funds are leveraged, and we operate in a very mixed economy.” “Also crucial is the joint funding support of MRC and NIHR as well as the balance between DBIS and DH”, Whyte notes, adding that the recent Research Excellence Framework mapped very strong performances in medical research in UK universities, as well as finding that much of the successful research translated into health and wealth gain originated from government funding. The concern for funding levels was also echoed by the Green Party. “We want to see proper support and funding for this research area in the UK, this includes a commitment of 1% of GDP spent on research”, said
Mischa Keijser/Corbis
World Report
Rosa Elswood, policy officer for the Green Party of England and Wales. Plaid Cymru says they would press for Welsh universities to get more UK-based research funding and would provide a subsidy to students resident in Wales who wish to study in Wales, while the Alliance Party of Northern Ireland would increase investment in science and research through the UK Research Councils. All the political parties, the Academy of Medical Sciences, and the Wellcome Trust agree that key to success in medical research is understanding that it is “a long-term game. You can’t expect a return after a year”, says Perrin. “The more emphasis on long term, well-coordinated, stable support, the better.” Whyte agrees, welcoming discussion of intentions for 2020 by the government, but highlights that, “bearing in mind the timescale of medical research, it would be very useful to have a strategy that goes beyond one general election. We need a level of continuity.” Indeed, among all the claims and counterclaims that come and go around general election time, maintaining a consistently strong and productive base for health and medical research should, by necessity, remain a fundamental tenet of any party’s policies after the election is long gone.
Becky McCall 1383
UK medical research gets political
www.thelancet.com Vol 385 April 11, 2015
out the cross-party interest in supporting health and life sciences. “These are all extremely important platform initiatives, and much of it is non-partisan”, he said of the aforementioned programmes.
“‘The UK has a unique advantage with our NHS having records of 60 million plus people...this has huge potential for asking research questions, while maintaining public confidence.’” At the moment, he is overseeing the Accelerated Access Review of Innovative Medicines and Medical Technologies, which also has cross-party support. “This aims to speed up access to the latest innovative drugs and technologies for NHS patients, looking at the whole pathway for adoption and the role of statutory bodies such as NICE [National Institute for Health and Care Excellence] and the MHRA [Medicines and Healthcare Products Regulatory Agency].” Freeman was elected as the member of parliament (MP) for Mid Norfolk in 2010, and was appointed Government Adviser on Life Sciences later that year. As the momentum behind the role grew, in 2014 he became the world’s first Minister for Life Sciences, with responsibilities across the Department of Health (DH) and the Department for Business, Innovation and Skills (DBIS). In his own words, Freeman’s mission is, “to harness 21st century life and health sciences innovations to firstly, get more health for each pound spent, and secondly, in a way that attracts more health-care investment to the UK”. He highlights that a fundamental opportunity now exists with genomic data to profile a drug much earlier
and effectively speed up the research and development (R&D) process, dramatically expediting getting the right drugs to the most responsive patients. “This is of huge value to industry, which would help us renegotiate prices”, said Freeman. Nicola Perrin, Head of Policy at the Wellcome Trust, reinforces that big data is a prime research focus both now and in the foreseeable future, not least because of extensive efforts relating to the 100 000 Genomes Project—a government initiative that aims to sequence 100 000 whole genomes from NHS patients by 2017—and its huge potential to transform how genetics is incorporated into the NHS for patient benefit. “The Wellcome Trust see big data as very important. The UK has a unique advantage with our NHS having records of 60 million plus people”, she stressed, adding that, “this has huge potential for asking research questions, while maintaining public confidence. We need the linkages between different datasets. The huge diversity of our UK population, its size, and the quality of the records means that it should be a key focus.” The Medical Research Council (MRC) also sees bioinformatics
For the joint statement by the four UK National Academies see https://royalsociety.org/~/ media/policy/Publications/2015/ building-a-stronger-futureresearch-innovation-growth.pdf
Dan Dunkley/Science Photo Library
With the UK general election less than a month away, the National Health Service (NHS), education, immigration, the economy, and jobs all take centre stage as political parties campaign and manifestos start to unfold. But less obvious to many is a common theme that underpins all these areas: medical research. As expected, at this stage of campaigning, claims and promises are being made left, right, and centre, in every sense. However, what is most striking about the stance of political parties towards medical research is the degree to which most of them actually agree. In a nutshell, and with occasional reservation, big data, personalised medicine, translating scientific advances into patient benefit, increasing funding, and supporting a steady stream of bright minds from home and abroad to support future research are clear priorities for nearly all of the parties. Even a cursory glance at the recent history of the UK biomedical research scene shows the laying down of some solid foundations over the past decade or so. The current Coalition Government’s Strategy for UK Life Sciences was established in 2011, the Biomedical Catalyst Fund, providing responsive and effective support for the best translational life science opportunities arising in the UK, launched in 2013, as did Patent Box, which reduces corporation tax to 10% for income from patents to try to make the UK an attractive base for companies. Prior to this, the Labour Government created the Office for Life Sciences in 2009, the National Institute of Health Research (NIHR) in 2006, and Academic Health Science Centres in 2007. The Conservative Minister for Life Sciences, George Freeman, pointed
Adrian Roots
Ahead of the general election on May 7, the UK’s political parties seem to be largely in agreement about what the priorities for medical science in the country should be. Becky McCall reports.
1381
Si Barber/Bloomberg via Getty Images
World Report
Parties support the harnessing of NHS records for research to benefit patients
as a priority area. Since 2013, the MRC has invested a total of £90 million to boost resources in medical bioinformatics, ultimately aimed at supporting the safe use of biological and patient data for medical research. Sir John Savill, Chief Executive of the MRC, has said that he believes, looking ahead, bioinformatics would come of age over the next few decades. He pointed out, in an interview with The Lancet in 2013, that the UK is “in a world-leading position with 60 million people essentially contained in terms of health and treatment to provide the resource to develop this important new field, and I hope MRC will play a leading part in it”. But ethical issues related to accessing and using big data have led to some false starts. In 2014, care.data was launched by NHS England as part of a commitment to using big data to improve the delivery of public sector health care. However, the general public rejected the plans because of the way in which the communications campaign addressed legitimate public concerns over privacy. The mishandled communication in this case has not been lost on Labour, as Jamie Reed MP, Shadow Minister of Health, explained. “The government’s botched implementation of the care.data scheme has eroded a lot of trust with the general public”, he 1382
notes. “The scheme could provide a lot of benefit to a lot of people, but the government couldn’t offer protections of selling data off to private companies; insurance companies were boasting that they could put up premiums using the data.” He adds that Labour wants to see care.data work for people, allowing researchers to discover new, more effective treatments and to make real breakthroughs in science, which is in line with the Coalition’s aims. However, “to do this, we need to demonstrate to the public that their data, their privacy, will be protected”, said Reed.
“‘We want to bring the most talented individuals to Britain, some of whom will go on to pioneer the ground breaking, innovative techniques that underpin future treatments for a plethora of conditions.’” Earlier this year, NHS England relaunched care.data. Using big data in this way epitomises a drive to integrate biomedical research into the practice of health care and ensure translation into patient benefit. According to Freeman, “without integration, industry will continue to see us as a very slow adopter of technology, and failing to embrace smart diagnostics, devices, and drugs, and spending too much money on late-stage treatments in hospitals”. Reflecting these concerns, Freeman highlights that NHS England has recently launched 29 vanguard areas across the UK, which involves testing innovative ways of diagnosing and treating the big widespread diseases that cost the system so much money. He hopes this will demonstrate that the UK is a country to start investing in. “This makes available something very unique—using a resource only the NHS has.” That the NHS offers unique excellence in health care worldwide, and should be leveraged for research
and patient benefit, was agreed by all parties. “The skills, resources, and expertise are already here, we just need to capitalise on it”, said Reed, adding that, “the research opportunities within it are incredibly attractive to people around the world”. However, Reed noted the need to speed up the process for new clinical trials. “If we want to cut the time it takes to get regulatory approval to start a clinical study, then we will need to support the Health Research Authority’s work to streamline research approval and maintain its investment to ensure that the second year of its programme of work can go ahead”, he said. “We’ll also need to ensure that the improvements set out in the European Clinical Trials Regulation are realised in its implementation and that it is enacted in a timely manner, so that these improvements can begin to benefit patients.”
Attracting talent Another key issue that reverberates around the various political parties and the research institutions alike: immigration and attracting the best foreign research talent to the UK. In late 2014, the Home Secretary put forward plans for foreign graduates to be forced to leave the UK at the end of their study visa and apply for a work visa if they wish to return. Perrin points out that the Wellcome Trust have “real concerns that if there is too much emphasis on reducing immigration it sends a message that Britain is closed for business and this has a knock on effect on recruitment of global talent”. She puts a finer point on this by relating the recent frustrations experienced by some researchers in obtaining short-term visas, which is discouraging some of the best talent from applying for jobs in the UK. Echoing these concerns, the Scottish National Party Deputy Leader, Stewart Hosie, points out that the biggest threat to research in all fields www.thelancet.com Vol 385 April 11, 2015
is UK immigration policy. “We must be able to attract and retain world-class talent; therefore, we want the ability to reintroduce the post-study work visa in Scotland.” The Liberal Democrats’ Health Minister Norman Lamb pointed out that his party wishes to continue to welcome international students from around the world to UK universities. “We want to bring the most talented individuals to Britain, some of whom will go on to pioneer the ground breaking, innovative techniques that underpin future treatments for a plethora of conditions.” Likewise, Labour’s Reed acknowledges that the government’s plans to deport students after completion of their studies is stifling progress. “It sends out the wrong message. We want the experts to be based here, not train here and then take their talents elsewhere; that would be self-defeating.” Recent responses from the political parties to letters sent by the Campaign for Science and Engineering found that in Wales, Plaid Cymru does not believe the current migration laws are fit for purpose. “We would also re-introduce a post-study work visa for 2 years for students who have qualified from Welsh universities, so that they can use their skills to contribute to the Welsh economy”, they said, adding that, “we will work to ensure that Wales improves its share of health research funding, attracting high quality researchers”. The UK Independence Party, which has a strong stance on immigration, did not respond in time to a request for comment for this feature.
Budget constraints Reinforcing the point about the UK potentially missing out on the best brains in science, Moira Whyte, Registrar at the Academy of Medical Sciences, highlights that budget restraints as well as immigration issues might be responsible. A recent www.thelancet.com Vol 385 April 11, 2015
joint statement, Building a Stronger Future, by the four UK National Academies (the Royal Society, the Academy of Medical Sciences, the British Academy, and the Royal Academy of Engineering), to which Whyte contributed, emphasises that in real terms, between the years 2010 and 2015, the science budget will have cumulatively eroded by £1·1 billion and this threatens a resurgence of the exodus of leading UK scientists to the USA seen in the 1980s when cuts were made to research and innovation here. In fact, according to the joint statement, overall departmental R&D spending in government has declined dramatically from 0·5% of gross domestic product (GDP) in 1981 to 0·15% today.
“‘...bearing in mind the timescale of medical research, it would be very useful to have a strategy that goes beyond one general election. We need a level of continuity.’” However, Whyte profusely praises the research ecosystem in the UK comprising a mixture of governmental, charity, and private funding. “I think government funding is crucial for keeping UK research flourishing, so charitable and private funds are leveraged, and we operate in a very mixed economy.” “Also crucial is the joint funding support of MRC and NIHR as well as the balance between DBIS and DH”, Whyte notes, adding that the recent Research Excellence Framework mapped very strong performances in medical research in UK universities, as well as finding that much of the successful research translated into health and wealth gain originated from government funding. The concern for funding levels was also echoed by the Green Party. “We want to see proper support and funding for this research area in the UK, this includes a commitment of 1% of GDP spent on research”, said
Mischa Keijser/Corbis
World Report
Rosa Elswood, policy officer for the Green Party of England and Wales. Plaid Cymru says they would press for Welsh universities to get more UK-based research funding and would provide a subsidy to students resident in Wales who wish to study in Wales, while the Alliance Party of Northern Ireland would increase investment in science and research through the UK Research Councils. All the political parties, the Academy of Medical Sciences, and the Wellcome Trust agree that key to success in medical research is understanding that it is “a long-term game. You can’t expect a return after a year”, says Perrin. “The more emphasis on long term, well-coordinated, stable support, the better.” Whyte agrees, welcoming discussion of intentions for 2020 by the government, but highlights that, “bearing in mind the timescale of medical research, it would be very useful to have a strategy that goes beyond one general election. We need a level of continuity.” Indeed, among all the claims and counterclaims that come and go around general election time, maintaining a consistently strong and productive base for health and medical research should, by necessity, remain a fundamental tenet of any party’s policies after the election is long gone.
Becky McCall 1383
