Prompted by concern that the drug industry might reduce its investment in research in the United Kingdom, the chancellor of the exchequer asked the distinguished venture capitalist Sir David Cooksey to lead a review. Widespread consultation showed that it is not only the Treasury that is concerned about the current state of health research funding, organisation, and performance.1

Four principal criticisms emerged. Firstly (confirming the Treasury's view), the drug industry is frustrated by what it sees as increasing obstacles to gaining access to patients and over-regulation leading to unacceptable delays and extra costs. Companies claim that developing products and conducting research in other countries is increasingly attractive and an inevitable consequence. Secondly, those responsible for providing health services—politicians, managers, clinicians—as well as research funders are concerned at the delays in translating advances in basic science into clinical applications and then translating such innovations into routine practice. This is seen as reflecting an unsupportive culture in the National Health Service, institutional barriers, and perverse incentives, such as greater regard and reward for basic research than for applied research. Thirdly, the distribution of research funds does not always reflect the burden of disease in the UK, which reflects the lack of a transparent mechanism for determining research priorities. This is partly explained by the final concern that Cooksey identified—the lack of coordination and a supposed resulting …