The scientific basis of health services

Needs a better balance between original and evaluative research

The relation between science and health services has until recently been too casual, said Alan Langlands, chief executive of the National Health Service (NHS), at last week's London conference on the scientific basis of health services. The primary job of medical research has been to understand the mechanisms of disease and produce new treatments, not to worry about the effectiveness of the new treatments or their implementation. As a result many new treatments have taken years to become part of routine practice, ineffective treatments have been widely used, and medicine has been opinion rather than evidence based. “There has been,” said Sam Their, president of the Massachusetts General Hospital, “a failure of leadership in health research and too little investment in assessing new technologies.”

Yet in the United States the new congress is proposing to increase the $11.25 billion budget of the National Institutes of Health (primarily original research) by 5.7% and slash the $159 million budget of the Agency for Health Care Policy and Research (primarily evaluative research) to $64 million. This is a mistake: one of Britain's most prominent biological researchers Mark Ferguson, dean of the school of biological sciences in Manchester, said at last week's conference: “Development has been limited by the rate of discovery, but now it's limited by …