Intended for healthcare professionals

Observations BMJ Confidential

Elias Mossialos: The politics of R&D

BMJ 2017; 358 doi: (Published 16 August 2017) Cite this as: BMJ 2017;358:j3756


Elias Mossialos, 56, is professor of health policy at the London School of Economics (LSE) and Imperial College London, inaugural head of LSE’s new department of health policy, and founder and director of LSE Health, a research centre with 60 staff that last year won a major role in a pan-European project on using big data to improve health outcomes. He has developed the Options Market for Antibiotics, an incentive scheme to stimulate research and development (R&D), and his recent research on cancer drugs found that one in three licensed in 2003-13 produced no overall survival benefit. Unusually for an academic policy expert, Mossialos has experience at the sharp end, having served as minister of state for the Greek government of George Papandreou in 2011.

What was your earliest ambition?

To study economics and politics. I ended up doing medicine first, but I eventually came back to them by combining my academic interests.

Who has been your biggest inspiration?

The late Brian Abel-Smith, who taught me not to get lost in the detail but always to keep it simple and see the big picture. And his contemporary, Walter Holland, who is still academically active in his late 80s and has encouraged me to ensure that my academic and policy work always has the potential to bring real change.

What was the worst mistake in your career?

Getting too close to the political processes we academics should criticise. However, I’ve learnt that what could initially be considered a compromise, if it isn’t prolonged, can become an advantage in terms of learning how politics works in practice.

What was your best career move?

Apart from joining the LSE and Imperial, it was helping to establish the European Observatory on Health Systems and Policies, an organisation to bridge the gap between science and health policy in Europe.

Who is the person you would most like to thank, and why?

My parents, for never opposing my life and career choices and always encouraging me. I try to do the same for my daughter.

To whom would you most like to apologise?

My family, for being away so much, particularly when working for the Greek government.

If you were given £1m what would you spend it on?

Half on scholarships for Syrian child refugees, and half split between the Childhood Trust and the Child Poverty Action Group.

Where are you happiest?

Watching the sun set over the sea somewhere in the Mediterranean, with family and friends.

What single unheralded change has made the most difference in your field in your lifetime?

The big data revolution. It poses social, ethical, policy, and medical challenges that, coupled with the rise of artificial intelligence and machine learning, are forcing us to find new ways of thinking about the future of medicine.

Do you support doctor assisted suicide?

Yes: I believe that patients should have as much control as possible over decisions on death—care, treatment, and place. Not tackling issues of patient control with empathy and engagement leads to a loss of dignity, which increases requests for assisted suicide.

What book should every doctor read?

Night, by Elie Wiesel. One of the most poignant books I’ve ever read, it illustrates that—like medicine—books can “invite sorrow, others joy, some both.”

What music would you like mourners at your funeral to hear?

Either Chopin’s polonaise in A-flat major (Op 53) or Rachmaninoff’s piano concerto no 2 in C minor (Op 18).

What is your guiltiest pleasure?

Eating a chocolate éclair in a cafe by the Seine.

What television programmes do you like?

I enjoyed The Fall and the recent French series Spin and The Bureau, and I never miss a Nordic noir.

What is your most treasured possession?

An Omega watch, which my father bought in 1949 when he was released after being imprisoned for his political views.

What, if anything, are you doing to reduce your carbon footprint?

Not enough, because of extensive travel, but I recycle everything I possibly can.

What personal ambition do you still have?

Three main ones: firstly, to continue to make a convincing case for investing in stimulating R&D for antibiotics: despite the proliferation of initiatives, we still see significant fragmentation, limited funding, and dominance of national perspectives. Secondly, I’d like to establish a fully funded masters course for African policy makers, as I believe that capacity building is key to improving health systems. Finally, I’ll continue to make the case for better medicines regulation, as markets and governments are both failing to tackle unmet therapeutic needs. Many big drug companies still spend more on advertising than on meaningful R&D.

Summarise your personality in three words

I’m an Optimist who sees the Opportunity in every Difficulty.

Where does alcohol fit into your life?

Usually after a bad day, rather than in celebration!

What is your pet hate?

Professional critics (particularly anonymous ones).

What would be on the menu for your last supper?

The menu doesn’t matter as long as it’s in Santorini, overlooking the caldera; or in Cape Town, up the mountain.

Do you have any regrets about becoming an academic?

I’m fortunate enough to have been a doctor, an academic, a politician, and a health expert—leaving no room for regrets.

If you weren’t in your present position what would you be doing instead?

While it’s tempting to think about “what ifs,” I prefer to focus on the next project.

View Abstract