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EDITORIALS: Nick Black The Cooksey review of UK health research funding BMJ 2006; 333: 1231-1232 [Full text]

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Cooksey and Dermatology Research Spending

Jonathan L Rees, Eugene Healy   (14 February 2007)

Cooksey and Dermatology Research Spending 14 February 2007
Jonathan L Rees, Grant Chair of Dermatology The University of Edinburgh, Level 1 The Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA, Eugene Healy Send response to journal: Re: Cooksey and Dermatology Research Spending	Sir David Cooksey’s(1) wide ranging report into the funding and organisation of health research in the UK has been broadly welcomed. Your editorial on this report(2) refers to Cooksey’s desire to introduce transparent mechanisms for determining research priorities. One method highlighted in the report was to link Disability Adjusted Life Year (DALY) scores from the WHO Global Burden of Disease (GBD) project with how research funds are allocated. As researchers with a primary focus on diseases of the skin we would highlight some limitations of this approach. First, the grouping of International Classification of Disease (ICD) codes for diseases of the skin used in GBD do not match onto either disease burden in the UK nor clinical or research groupings for skin disease. The summary figures (Charts 2.4 and 2.5 taken from the UKCRC Health Research Analysis 2006(3)) quoted in Cooksey do not therefore reflect the true burden of skin disease in the UK. Instead, we believe they seriously underestimate it. Second, there is little empirical evidence to justify the use of DALY in this context. If one were to take another measure of disease, such as personal spending on health, we suspect very different priorities would ensue. Finally, we believe the marginal benefit of health research spending needs to be taken into account. This means realising that some research questions may be more tractable and therefore that the return per unit investment may be greater in some fields than others. For instance, although the last MRC funded randomised clinical trial in dermatology took place over thirty years ago, subsequently a number of simple, relatively small studies with large effect sizes have changed clinical practice substantially (for instance the use of isotretinoin in acne vulgaris). Whatever the pattern of overall disease burden, research should be focussed onto areas where progress can be made with the greatest return per unit investment. References 1. Cooksey D. A review of UK Health Research Funding. London: Stationery Office, 2006. 2. Black N. The Cooksey review of UK health research funding. Bmj 2006;333 (7581):1231-2. 3. UK Clinical Research Collaboration: UK Health Research Analysis.2006 http://www.ukcrc.org/PDF/UKCRC_Health_Research_Analysis_Report.pdf Competing interests: None declared