Interdependencies among clinical research fundersBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4892 (Published 14 August 2014) Cite this as: BMJ 2014;349:g4892
- F D Richard Hobbs, head of primary care health sciences
- 1Nuffield Department of Primary Care Health Sciences, New Radcliffe House, Radcliffe Observatory Quarter, University of Oxford, OX2 6NW
The United Kingdom may have finally emerged from its longest economic slump in more than a century,1 but further deep cuts in government spending are expected in an attempt to reduce the country’s deficit.
Rather than cutting acute healthcare services, a raid on medical research budgets may seem more palatable to government ministers. So would such a step matter, beyond its obvious impact on academic researchers?
This question was explored in a recent report commissioned by Cancer Research UK,2 which is responsible for around a third of the £1bn (€1.26bn; $1.7bn) a year awarded by UK medical charities to researchers.3
Based on a series of systematic reviews and bibliometric analyses of research published in 2011, augmented by interviews with senior cancer researchers and funding representatives, the report draws several conclusions.
Firstly, it reconfirms the relative global importance of medical research in the UK,4 at least in cancer research. As a country, Britain continues to punch well above its weight, with 7% of all cancer papers in 2011 originating from the UK. This is an important finding. The UK has protected its health research budget since 2008 (although not adjusted it for inflation), and until 2015-16 on the basis that such funding should attract inward investment to the UK via commercial science funders.5 This report cannot test this assumption, but at least it suggests that the high quality and high volume of clinical research relative to our modest academic base has been maintained: UK research funders generally, as a minimum, get high relative value for their investment.
Secondly, the report finds evidence for substantial “interdependence” among cancer research funders. Two major sets of interdependencies are identified—financial and institutional. Where research papers acknowledged the funder (surprisingly only half of papers), multiple funders were identified, with a mean 3.3 funders per paper, including an industry sponsor in 18% of cases. This is a measure of the complexities of undertaking large scale medical research today. Funding is needed for direct research costs (for example, the short term project research team), the “supervision” time that principal investigators need to provide, the staff costs of those on fellowships and studentships, and the infrastructure support for the work that has to be maintained across studies. It is also needed for the institutional overheads needed to provide an enduring academic environment (identified at 22-24% by cancer research funders). Each of these cost components may be supported by different funders, but all are needed to deliver the research.
The report doesn’t discuss the impact on the viability of the entire research project of dropping the funding of one element, but the risks of such an eventuality seem to be high. The report calculates that activity falls disproportionately faster than funding, at least in the short term—a 1.3% productivity loss for every 1% reduction in funding. However, this is based on limited and old data.6
Intriguingly, the report also provides data that debunk the belief, beloved by funders, in “economies of scale.” Apparently, these do not operate much beyond research teams composed of six to eight people, except when expensive equipment is needed. Academics who structure research groups might be surprised that teams of around eight might be most cost efficient.
The other major interdependency is among institutions. Cancer research is increasingly complex, and two thirds of publications now rely on collaborations (43% international). Importantly, the report also found that a few institutions were extremely productive—a core of 26% of organisations (only 2% of the total number of organisations publishing) were responsible for more than 72% of output. Such a critical mass is probably replicated in clinical areas other than cancer. Importantly, it wasn’t just a volume metric either, a bibliometric analysis of citations suggested that papers that acknowledged a research funder and that came from the core institutions were cited more often too.
Finally, the report suggests that donors to UK medical charities seem relatively unswayed by government policies towards research funding. Such passivity is probably a good thing; individuals mainly donate to causes “that mean something to them.”7
All sounds like a pack of cards? The government should maintain investment in clinical research. The metrics for British cancer research (yes—that is Scotland, Wales, and England) show it to be a national success story.
Cite this as: BMJ 2014;349:g4892
Acknowledgments: The author’s post is part funded, through supervision sessions, by the National Institute for Health Research (NIHR) School for Primary Care Research, NIHR Oxford Biomedical Research Centre, and NIHR Collaboration for Leadership in Applied Health Research and Care Oxford, but underwritten by Oxford University (and therefore partly by the Higher Education Funding Council for England). Research part funded by the above, plus the Medical Research Council, Wellcome, NHS Support for Science, and industrial NIHR Health Technology Assessment sponsors of equipment or research conduct or dissemination (Roche Diagnostics, Omron, Microlife, Bayer, Pfizer/BMS, BI, and Amgen in the past three years).
Competing interests: I have read and understood BMJ policy on declaration of interests and declare no interests beyond those acknowledged above.
Provenance and peer review: Commissioned; not externally peer reviewed.