Lack of Research Funding for Stroke

In the review ‘Worldwide underfunding of stroke research’ published in this edition of the IJS, Sarah Pendlebury brings together all the previously published data on levels of research funding for stroke vs. comparable conditions. The clinical burden and cost of stroke are at least as great as those due to coronary heart disease or cancer, and are projected to increase within the coming decades. Yet, in terms of both overall research funding and the number of career research posts, stroke has been seriously neglected. The comparisons with research funding for heart disease and cancer that Pendlebury has summarised are inevitably somewhat oversimplified, but the differences in funding are so extreme that they cannot be dismissed. If the available data from the United Kingdom, Europe and the United States are representative, then it is unlikely that research progress in stroke prevention and treatment will offset the projected increases in the burden of stroke in developed or developing countries. The high cost of not funding stroke research will become increasingly evident in the near future. What other issues need to be addressed to make a strong case for increased funding for stroke research? First, it is important to stress that stroke is highly amenable to research, despite the fact that stroke is certainly a more complex and heterogeneous syndrome than coronary heart disease, which so far has received greater funding and attention. In fact, over the last decade the potential for high-quality stroke research has far out-stripped capacity, in terms of both research manpower and project funding, and the number of important clinical questions that remain to be addressed is larger than ever. Second, irrespective of the scientific or ethical arguments for spending more money on stroke research, it makes economic sense to fund stroke research. In the United Kingdom in the later 1990s, for example, the total government and charitable research expenditure on stroke was about £5 million/year. This is equivalent to about 0.2% of the total estimated annual cost of stroke to the UK health services (£2.3 billion) at that timeFa remarkably low proportion of expenditure on R&D by the standards of any sector of the economy. It is interesting to consider why research funding for stroke has been neglected. Donations to stroke charities are clearly much lower than those to heart disease or cancer charities. This may be due to a lack of understanding of the nature of stroke by the public, or the common misconception that stroke is a disease that is confined to the very elderly. Yet, the relatively low level of contribution to stroke charities is paradoxical given that surveys usually find that stroke is the single condition that the people fear most. Charitable giving for stroke research might therefore be increased by more widespread advertising to explain to the public how great is the burden of stroke, and how extensive is the unmet research need. The lack of funding for stroke research from nondiseasespecific and governmental agencies is even more difficult to understand. Some funding for basic research is probably relevant to cerebrovascular disease, and there is a degree of overlap between stroke and other more generously funded areas of clinical research, such as coronary heart disease. However, advancement in the prevention and treatment of stroke should not have to rely entirely on fortuitous spin-offs from research in other areas. A common response from funding agencies to the accusation that stroke research is under-funded is that they do not receive enough high-quality applications for clinical research in stroke. If true, one explanation is the lack of an academic base from which applications can be made. Irrespective of the causes of underfunding of a particular research area, chronic underfunding will eventually tend to become self-perpetuating. If talented and ambitious young researchers see their senior colleagues struggling to obtain research funds, they are likely to change to research areas where funds are more readily available, or if they remain committed to the original area, they may not develop the confidence to apply for major grants. The broader lesson from the current state of stroke research funding is therefore that major disparities in funding by disease-specific charities have a considerable impact on the academic base. Again taking the United Kingdom as the example, the one senior stroke researcher funded by UK stroke charities cannot be expected to write as many high-quality grant applications as the 60 or so senior fellows and research professors who are funded by the British Heart Foundation. Unless governmental research funding agencies take these disparities into account, they will inadvertently exacerbate funding inequalities. There are, in fact, some signs that governmental funding for stroke research might increase. In the United States, the National Institutes of Health has undertaken to adjust research funding according to disease burden, recent changes in the structure of research funding in the United Kingom following the Cooksey Report promise the same, and the European Commission appears to be taking more interest in funding for stroke research. Whether these initiatives will translate into real increases in funding remains to be seen, but at least we are on the radar. Correspondence: Peter M. Rothwell. Email: peter.rothwell@clneuro.ox. ac.uk