Resuscitating clinical research in the United Kingdom

Abstract

Clinical research in Britain is in decline. A new report from the Academy of Medical Sciences sets out the action urgently needed to revitalise it Our knowledge of the basic mechanisms of disease has increased greatly over the past 20 years. A substantial gulf remains, however, between basic discoveries and converting such discoveries into innovations that can be applied to patients. This translational barrier can be bridged only through clinical research. Concerned at the state of clinical research in the United Kingdom, the Academy of Medical Sciences established a working group to identify the problems and suggest solutions. The working group's report focuses on serious weakness in two key areas: experimental medicine and clinical trials (box). Up until the 1970s, the United Kingdom was internationally recognised for its contribution to characterising diseases by careful examination and testing in patients. However, the development of methods to investigate the molecular and genetic basis of disease has since shifted research away from the bedside and into the laboratory. The surge in activity in molecular science has led to a substantial reduction in both research and researchers in clinical science. Pressure on NHS beds and facilities in teaching hospitals is also pushing out clinical research so that the NHS now has limited capacity to evaluate the new tools that are emerging from academia and industry. Many of the methods used for large clinical trials, cohort studies, and meta-analyses were also developed in the United Kingdom. Application of these methods has had a big effect on the health of individuals and the NHS—for example, in showing the link between smoking and lung cancer and the benefit of statins in patients at risk of cardiovascular disease or stroke.1 2 Despite the clear benefits of such research, funding of trials is falling from all sources.3 …