Intended for healthcare professionals


The Cooksey review of UK health research funding

BMJ 2006; 333 doi: (Published 14 December 2006) Cite this as: BMJ 2006;333:1231

Cooksey and Dermatology Research Spending

Sir David Cooksey’s(1) wide ranging report into the funding and
of health research in the UK has been broadly welcomed. Your editorial on
this report(2) refers to Cooksey’s desire to introduce transparent
for determining research priorities. One method highlighted in the report
to link Disability Adjusted Life Year (DALY) scores from the WHO Global
Burden of Disease (GBD) project with how research funds are allocated. As
researchers with a primary focus on diseases of the skin we would
some limitations of this approach.

First, the grouping of International Classification of Disease (ICD)
codes for
diseases of the skin used in GBD do not match onto either disease burden
the UK nor clinical or research groupings for skin disease. The summary
figures (Charts 2.4 and 2.5 taken from the UKCRC Health Research Analysis
2006(3)) quoted in Cooksey do not therefore reflect the true burden of
disease in the UK. Instead, we believe they seriously underestimate it.
there is little empirical evidence to justify the use of DALY in this
context. If
one were to take another measure of disease, such as personal spending on
health, we suspect very different priorities would ensue.

Finally, we believe the marginal benefit of health research spending
needs to
be taken into account. This means realising that some research questions
may be more tractable and therefore that the return per unit investment
be greater in some fields than others. For instance, although the last MRC

funded randomised clinical trial in dermatology took place over thirty
ago, subsequently a number of simple, relatively small studies with large
effect sizes have changed clinical practice substantially (for instance
the use
of isotretinoin in acne vulgaris). Whatever the pattern of overall disease

burden, research should be focussed onto areas where progress can be made
with the greatest return per unit investment.

1. Cooksey D. A review of UK Health Research Funding. London: Stationery
Office, 2006.

2. Black N. The Cooksey review of UK health research funding. Bmj

3. UK Clinical Research Collaboration: UK Health Research

Competing interests:
None declared

Competing interests: No competing interests

14 February 2007
Jonathan L Rees
Grant Chair of Dermatology
Eugene Healy
The University of Edinburgh, Level 1 The Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA