Research Intelligence - Collaboration is an essential procedure
Researchers, industry and NHS must deliver results, Academy of Medical Sciences' head tells Paul Jump
For Sir John Tooke, this is an "exciting and important" time to be taking over the presidency of the 14-year-old Academy of Medical Sciences - but he is also aware of the need to ensure that the discipline lives up to the political faith placed in it.
University College London's vice-provost for health began his five-year term as the academy's fourth president at the end of November, just 11 days before the government published its ambitious life sciences strategy.
The strategy seeks significant improvements in the translation of the UK's research excellence in life sciences into new drugs and medical technologies. Central to this is an effort to improve links between universities, industry and the National Health Service via, among other measures, a £180 million fund to help bridge the "valley of death" between discovery and commercialisation. There will also be a new assumption - subject to consultation - that patients' data will be made freely available to researchers unless they explicitly opt out.
Such measures are music to Sir John's ears. In an interview with Times Higher Education, he lamented the UK's historical failure to leverage its "key advantage" of a nationalised health service for both research and medical practice.
"It would be a tragedy if we can't realise that ambition," he said.
Sir John admitted that official reluctance to revive previously unsuccessful attempts to build an integrated IT network for the NHS was a major obstacle. But he was confident that a system that could "interrogate" data from the NHS' existing networks was possible.
He also queried whether patient groups that opposed making data available to researchers were really acting in patients' best interests.
"In my experience the vast majority of patients wish to see their data used for research purposes, with suitable anonymisation and checks and balances," Sir John said.
Forging closer ties between industry and the academy would be important, according to Sir John, because of the ructions created in the pharmaceutical industry by the dwindling supply of new "blockbuster" drugs, which have historically been lucrative.
He said the deeper understanding of disease mechanisms would herald a new era of personalised medicine in which academic expertise would be vital to help companies carry out earlier proof-of-concept studies. Such studies would allow quicker decisions about whether breakthroughs promised substantial improvements in health outcomes - understood not merely as precluding more expensive treatment but also in terms of impact on the wider economy, such as boosting a patient's employability.
"The harsh reality is that the biggest driver of the divergence of the cost of drugs and the ability of health services to afford them is the adoption of drugs and devices of marginal incremental benefit," Sir John said.
Academic input would be crucial to a debate about what "value" in treatments "really means", he said.
Risk and reward shared
Sir John is happy with the idea of industry and the academy working more closely together because both sectors sought "the faster development of effective treatments for the benefit of patients".
"In the spirit of true partnership, both the risk and the reward need to be shared," he noted.
But he admitted that mutually derogatory stereotypes had historically blighted efforts to build constructive working relationships and increase "permeability" of careers between industry and the academy.
"Academics are suspicious of the profit motive, but without the profit motive we wouldn't get the level of investment required and we would not have made all the advances we have," Sir John said.
"Industry says academia is sometimes less than rigorous about meeting its obligations in contractual relationships and overstates its ability to deliver and [overstates] the value of what it protects under patent - not understanding the level of investment required to move something down the value chain."
He admitted that there was still "a lot to be learned" but suggested that exchanges of PhD students and postdoctoral researchers could be a good place to start.
Sir John also thought that it should be made easier for medical practitioners to engage in research. He noted that clinicians who are at least "research-aware" are in a better position to evaluate the relevance of new discoveries, while hospitals that carry out research are more likely to adopt "evidence-based practice".
Current barriers to clinicians conducting research include the inflexibility of postgraduate medical training, which makes it difficult for trainees to take time out of their service commitment for research. There are also regulatory hurdles that even full-time researchers find onerous to negotiate.
Tackling rare diseases, in particular, would also require new levels of interdisciplinary and consortium-based approaches, according to Sir John. To get the most out of the UK academy, it should be viewed as an integrated whole. And while there could be only a small number of centres with "comprehensive strength", Sir John said that it was also crucial to "embrace" the considerable talent in regional centres such as the Peninsula Medical School in Devon, of which he was the inaugural dean.
Shadow cast by NHS reforms
He was optimistic about institutions' willingness to collaborate, having been struck, since moving to London in 2009, by the "very good working relationship" between academic health sciences centres in the capital.
Sir John was conscious of the danger that, in an era "dominated by impact and economic demands", blue-sky science could lose out. But even though fundamental scientists should become "more alert to the significance of their findings" for "unmet health need", he did not believe the "era of purely curiosity-driven research" was over. "World-class" work in this category should receive continued funding because "we can never be certain whence the clinical significance will derive".
Sir John was concerned that collaboration between industry and the academy could be hampered by the potential VAT cost for academic research facilities that host "significant commercial activity". There was also a danger that the life sciences strategy could be derailed by the proposed NHS reforms, which will see commissioning transferred to GPs.
"I am conscious of how difficult it was to make primary care trusts attend to...research and education," he said. "The [government's stated] commitment to these being at the core of the NHS is reassuring, but we will have to be vigilant that those intentions are lived out."
If they are not, Sir John said that the Academy of Medical Sciences would not be afraid to speak out. "The academy has achieved a profile that is impressive considering how new it still is, and a lot has come from its ability to secure alignment between various sectors and institutions in terms of medical science policy issues," he said.
"I am very keen that we should remain future-focused and resist any temptation to become an establishment organisation."