Stronger European medical research
Authors: Trish Groves
Journal: BMJ (2008)

How can Europe produce medical research that will best increase its citizens’ health and its countries’ wealth? This debate will run on and on, of course, but a new white paper from the European Medical Research Councils (EMRC) provides important evidence on funding and conducting effective, relevant, and world beating research (box 1).1 Summing up the white paper in Frankfurt last month, Professor Liselotte Hojgaard, EMRC chair, quoted British physiologist Ernest Starling’s advice to the British Research Council in the 1920s, “get the best of men, give them the equipment you can afford, and leave them alone.”


Box 1 European Medical Research Councils’ recommendations for strengthening medical research in Europe

Implementation of best practice for funding and performing medical research—with distribution of funding based on excellence and evaluated by peer review


Strengthened collaboration and coordination of medical research in Europe through the EMRC and its membership organisations, via the European Commission, the European Research Council, and the learned medical societies


Revision of European Commission directives related to medical research


Implementation of equal opportunities for all researchers


A doubling of public funding of medical research in Europe within the next 10 years—to a minimum of 0.25% of gross domestic product





This white paper is one of several responses to last year’s green paper from the European Commission, which contained proposals on how to overcome the fragmentation of research activities, programmes, and policies across Europe.2 The EMRC’s response is a pragmatic and readable document that pulls together evidence on whether Europe is finding the best researchers and whether it is spending enough on research to give them the tools they need. It does not, however, advocate leaving these workers alone as Starling suggested. If research in basic science and clinical medicine is to be successfully translated into practice, all those responsible—peer reviewers, journal editors, authors of reviews and guidelines, policy makers, and researchers themselves—need adequate training, support, and evaluation. 

Many initiatives—such as the European roadmap for innovative research—are already in place across Europe for finding and training the best researchers in universities, laboratories, industry, and healthcare settings.3 The EMRC endorses the best of these and puts them—along with research ethics,4 sharing of research data,5 and effective information technology and other essentials—into its toolbox for best practice (box 2). It also warns that unequal opportunities for researchers will hold Europe back. The white paper highlights the relative paucity of women among leaders of publicly funded research and in scientific decision making, and it stresses that women are less likely than men to succeed when applying for research grants of equal quality.


Box 2 European Medical Research Councils’ tool box: “best practice” for medical research in Europe
Primary goals
All three to be facilitated by interdisciplinary research and public-private partnerships


Strong basic research


Strong clinical research


Strong translational research—bringing basic research knowledge into clinical practice and vice versa




Tools to reach these goals: people

Career track schemes with attractive possibilities for researchers taking advantage of cofunding strategy


European Medical Scientific Training Programme for physicians and scientists scaling up existing successful initiatives


The highest level of research ethics and no scientific misconduct




Tools to reach these goals: research infrastructure

Investment in national and European research infrastructure—covering the whole range from laboratory equipment in basic science laboratories and research facilities in hospitals, to the largest pan-European infrastructures, as outlined in the European Strategy Forum on Research Infrastructure’s roadmap


A call for proposals to directly support—on a highly competitive basis—a league of top performing biomedical research centres of excellence, integrated into regional clusters


More support for personalised medicine based on the human genome and molecular analyses of tumour markers


Intelligent and coordinated use of information technology


Review of European Commission and national regulations—for example, on biobanks—to facilitate collaboration across countries




Tools to reach these goals: research funding

Adequate research funding, distributed on the basis of scientific excellence and through peer review


Common criteria and methods for evaluating research outcomes




Tools to reach these goals: societal means

Globalisation and collaboration—sharing of research and results


Public engagement about medical research and its possible effects


Preparedness for the future






Is Europe providing the tools that its medical researchers need? With extra demands on health care that include an ageing population, emerging and rapidly spreading infectious diseases, and climate change, Europe needs to keep on its toes. But it is investing much less than the United States, which is facing the same challenges. In 2004, the US non-industrial sector spent twice as much as Europe on biomedical research (around 0.40% of gross domestic product compared with 0.17% in the EU15—the 15 countries in the European Union before the accession of 10 candidate countries on 1 May 2004—a difference that would have been greater if all EU countries were included) and almost three times as much when adjusted for the size of the two populations.1 The EMRC is calling for a doubling of public funding for medical research in Europe within the next 10 years and, at a minimum, spending the equivalent of 0.25% of gross domestic product.

Health research also has to compete within Europe for its slice of the science funding pie. The Seventh Framework Programme for Research and Technological Development doubled overall funding for science research to more than €50bn (£37bn; $73bn) between 2007 and 2013,6 but only €6.1bn of this will go to health research, with much more going to physics—participants at Frankfurt noted that particle accelerators are costly and physicists have a lot of influence in European policy. Competing with other scientific funding is a challenge in the US too, and Elias Zerhouni, director of the US National Institutes of Health (NIH), has said, “if we don’t find ourselves at the table discussing the role of medical research, we’ll find ourselves on the menu” (Stefano Bertuzzi, science policy analyst at NIH, personal communication, Frankfurt, 2007).

Underfunding for medical research disadvantages Europe’s citizens, the white paper argues, because medical research funding can yield up to a sixfold return on investment as a healthier population creates more wealth. But ways to evaluate the outputs and outcomes of research funding—including bibliometric analysis, retrospective case studies, surveys, peer review, and economic analysis—are still in their infancy, and the EMRC supports calls for common criteria and methods.7

Peer review largely determines which research is carried out and published, but it is a far from perfect tool. For instance, peer reviewers are biased towards American research,8 which might partly explain the 10% difference in citation rates for US and EU research. Moreover, we still know relatively little about the strengths and limitations of peer review, and the evidence base is mainly about peer review of journal submissions rather than grant proposals. Worse still, peer review is given little support. Reviewers’ workload is constantly increasing, yet they receive no specific training, no protected time, and no academic recognition for this work. Indeed, the Frankfurt meeting heard that grant giving bodies are running short of good reviewers who are willing and able to appraise lengthy proposals, and it concluded that peer review of grant proposals needs better scrutiny and evaluation and much greater support.

Some good news for Europe emerged from the EMRC white paper—the research euro is getting a bigger bang than the research buck. Although the EU is spending much less on research than the US, it is producing only one medical research paper less than the US per 10 000 inhabitants (3.9 papers v 4.9 in 2005).1 This says nothing about the quality of research, however, so the EMRC has also looked at citation rates. Between 1996 and 2003 40% of the world’s citations to biomedical publications were for research done in the EU15 countries, compared with 50% for work from the US. Given the big difference in funding, this reflects well on Europe. The challenge now is to keep on catching up.