More money for medical research
Authors: Alistair McGuire, Maria Raikou
Journal: BMJ (2006)

The United Kingdom has a remarkable record in research and development. In the past 50 years the UK has won 46 Nobel prizes. The health sector has long been part of this heritage with medical research and development (RD $32bn) in 2001.1 This spending has been below the average spend of our competitor nations (on average 2.1% of GDP). As in healthcare expenditure generally, where the pledge is to increase UK expenditure to levels comparable with the average in the OECD (Organisation for Economic Cooperation and Development), so with R&D, for the government is committed to increase funding for R&D to 2.5% of GDP by 2014, with an average increase over the next three years of 5.8%.1

The medical and health services research community is set to gain from this increase in research funding. It already commands a considerable share of general R&D funding within the UK. In 2003-4, R&D expenditure from non-commercial sources was approximately £2.5bn, and this was matched by slightly higher commercial spending on R&D (essentially by pharmaceutical companies).2 In absolute terms, industrial contributions were approximately £3bn, with approximately £250m of this channelled through university research and the rest largely in-house research. Within these aggregates we should also note the importance of charitable contributions, which funded £600m of university medical research. The Wellcome Trust alone contributes more to the UK university sector in the area of health care than does the whole of private industry. Moreover, the NHS itself remains a major contributor—in 2001 it spent £500m on research.3 Even without this increased funding the UK is already a major contributor to medical research.

Given that appeals for increased RD returns specified in terms of health benefits; and wider economic returns. The report presents an overview of the various methods that have been used to estimate returns to health care R&D, arguing that there is no simple metric in this field. For different objectives, different tools will be required, and various assessment tools are needed for basic and for applied research.

Even for the simplest objective to be evaluated, the scientific return, the report outlines the various problems that may arise through assessing return in terms of citation indices, case studies, systematic reviews of evidence, survey, and peer review. Here at least assessment tools exist. Assessment of health return is more problematic as many innovations are in the form of changes in process or techniques that cannot be patented, making it difficult for the private investor to capture any return. Three further issues are important. Firstly, counterfactual evidence: the measurement of R&D policy requires evidence on what would have occurred had the policy not been undertaken. In the case of R&D in the health care sector the obvious question is: given the impact of lifestyle and environment on health, what health gains would have been achieved even without technical advances in medical care? Secondly, how should spillover effects, either the medical advances imported into the UK or those exported from the UK, be accounted for? Thirdly, over what time span should the effects be measured? Health benefits may have an effect over generations, for example. The assessment of wider social benefit is even more difficult to quantify. Attempts to assess net return, gains in productivity attributable to a healthier workforce, and the societal willingness to pay for increased health have all been attempted. All have their flaws.

The conclusion of the report is that, in drawing on resources for R&D in this area, the scientific community, in the widest sense, has an obligation to attempt to justify the use of these resources. This can only be done though establishing accepted tools of evaluation and assessment. If the scientific community does not develop such tools they may be foisted on it—in much the same way that the research assessment exercise was foisted on the university sector. Most have argued that the research assessment exercise has been beneficial, but not without substantial cost. This report serves to remind us once again that for all benefits, this time in the form of increased resource for R&D, there are inevitably costs.