From bench to bedside to population

“The moment has been a long time coming,” declared Alan Langlands, sometime chief executive of the NHS in England. The moment he was referring to—the imminent emergence of a system of academic health science centres in England—was greeted last week with a conference held at Guy’s Hospital in London.

Arranged by King’s Health Partners, one of the aspirants to academic health science centre status, the meeting set out to review the hopes embodied in these (mostly) embryonic organisations. The culmination of several decades of fretting over what Sir Alan described in his opening address as the health service’s essentially “casual” relationship with research, the new centres are intended to close the gap between medical academia and the NHS.

It was the health minister Ara Darzi who in his High Quality Care for All: NHS Next Stage Review first announced the plan to foster a group of academic health science centres. Each, he said, would bring together a small number of health and academic bodies to encourage world class research. King’s Health Partners, for example, comprises Guy’s, St Thomas’, and King’s College Hospitals, King’s College itself, and the South London and Maudsley NHS Trust.

Not that research is the only intended beneficiary. The new centres are also supposed to boost the quality of teaching and care of patients. Neither the government nor Lord Darzi himself can grant health science centre status. This privilege belongs to a committee of international experts chaired by Ian Kennedy, the Healthcare Commission’s chairman. The committee has been rating all applicants on their track record and future potential. Their track record will include evidence of international standing in biomedical, clinical, and applied health research, of excellence in teaching, and of the quality of their patient care. Criteria for their future potential include vision, ambition, and likely benefits to the local community. The concept itself is not new, and working examples can be found from Harvard University in the United States to the Karolinska Institute in Sweden.

By way of illustrating the potential benefits of a health science centre, Simon Lovestone, professor of old age psychiatry at the Institute of Psychiatry, summarised his group’s work on the causes of Alzheimer’s disease. The group’s key finding has been that in the brains of Alzheimer’s patients a disproportionately large amount of a neuronal protein called tau is phosphorylated. The enzyme predominantly responsible for this phosphorylation is glycogen synthase kinase-3 (GSK-3). This may prove to be not only a useful marker of the disease but a clue to treatment. The search is already on for inhibitors of GSK-3.

This work, he told conference delegates, has occupied 15 years and taken place within four different organisations. If carried out within an academic health science centre it could surely have been completed more efficiently and perhaps more speedily. A single centre would have meant closer collaboration between different basic science departments and between basic and clinical sciences. Recruiting the patients needed for clinical studies would also have been simpler and quicker.

Less glamorous than research benefits, and also less straightforward to demonstrate, are the effects of the academic health science model on routine care of patients. Michael Klag is dean of the school of public health at Johns Hopkins University in Baltimore, one of the best known of the US academic health science centres. His university, he pointed out, is located in east Baltimore in the middle of an area of poverty. It fulfils its duty to the local population through its Urban Health Institute, through a corps of community health workers, and by setting up programmes devoted to childhood injury, cancer, and other conditions that are over-represented in the area. The academic healthcare professionals delivering and overseeing this work mostly do so within the context of research programmes. The staff get the papers; the people get the care.

Another of the aims of health science centres is to hasten the translation of research into clinical practice: from bench to bedside, as the slogan has it. The final speaker at the London meeting was Victor Dzau, president of the Duke University Health System in Durham, North Carolina. He likes to emphasise the importance of an academic centre’s mission to serve the local community by adding a third term to the slogan: bench to bedside to population.

One organisation in Britain, Imperial College London, together with St Mary’s Hospital and Hammersmith Hospital, has been describing itself as an academic health science centre since October 2007. Introducing the new grouping, its chief executive, Stephen Smith, foreshadowed the government’s own intentions by saying, “We must be good at discoveries and inventions, but then we must be positive and quick at introducing these advances into our healthcare system.”

For the benefit of Imperial College and any other coalition that might adopt the label of academic health science centre (AHSC) off its own bat, Lord Darzi has issued a stern warning that groups with “self-designated AHSC status” will still be subject to review by his international panel.