Escape the biomedical bubble

Cristina Roure

One of the most recurrent citation in clinical management is the Porterian concept of health value, which must be established based on the interest of the patient and not the rest of agents, read professionals, managers, researchers, administration, biomedical industry, etc. According to this concept, the ultimate purpose of research and innovation in health should be to provide maximum benefit to patients and society. However, as I commented in my last blog post, I often prioritized research and the real needs of patients, but society goes in different ways.

Theresa May, the former Prime Minister in the UK, announced the commitment, by 2027, to dedicate 2.4% of the GDP of the United Kingdom to R&D, which represents a figure never seen and an excellent opportunity for the health sector, which is one of the most powerful in British industry. To get an idea of ​​the magnitude of this commitment, it’s worth knowing that, according to data from EUROSTAT, Europe, the United Kingdom and Spain, in 2016 they dedicated 2.03, 1.69 and 1.19% of GDP, respectively, to R&D.

Despite this, Richard Jones and James Wilsdon expose in their report "The biomedical bubble" why in the UK, research and innovation need a greater diversity of priorities, politics, places and people. In the past, health R&D suffered various biases that would have diverted it from its primary objective, so they propose a review of its priorities and policies to recover the balance lost before this great opportunity.

According to the highly recommended report, in recent years, the results of the investment of public funds in R&D in the health sector have not met expectations:

• The investment is excessively focused on biomedical aspects related to biotechnology and the pharmaceutical industry and not so much on other major health determinants today as the modification of behaviours, social or environmental elements, which have a significant impact and an even more substantial influence on the health and well-being of people.
• The social return on investment of public funds, both in financial results and in employment generated by the R&D of the biomedical sector, has been drastically reduced in recent years.
• The funds concentrate in particular areas of the country, also generating a problem of inequality and wasted talent of researchers who are, where appropriate, outside the so-called golden triangle formed by Oxford, Cambridge and London.
• Investment priorities are often due to the search for the academic success of individual researchers rather than real needs, which is a new source of waste of funds and inefficiency.

In other words, the substantial public investment made has not had the desired impact on the health and welfare of the population, nor on the prosperity of society.

According to Jones and Wilsdom, "This biomedical bubble distracts attention and resources in other ways that are surely more effective in improving the health and well-being of citizens." They propose to take advantage of the opportunity offered by the new impulse to the investment announced to deflate the bubble and rebalance the system by placing greater emphasis on areas that have been classically underfunded, more related to social, digital, environmental and global health determinants, and incorporating a new perspective of greater diversification and pluralism in the establishment of the new priorities.

Surely this image is not exclusive to the British case and could be applied to any other country in our environment, but on May 3rd 2018 the official launch of the UK Research & Innovation (UKRI) was announced with the headline "Balance and effectiveness of Research spending and innovation". This body integrates the seven pre-existing research councils and will be responsible for administering a budget of more than 6 billion pounds currently, and more in the future, for R&D, as well as setting priorities and providing policy coherence of research to obtain the maximum return for society and people in the United Kingdom in the coming years. In its strategic document, the UKRI undertakes to review the priorities by opening an inclusive, transparent and evidence-based debate.

New times imply new health challenges and just adapting the patient care model is not enough. It’s also necessary to address the transformation of the R&D model to ensure that the investment provides the expected return in health to people and prosperity to society. The expectations are high, and the challenge is complex, but we’ll be attentive to how the UKRI faces the difficulties of escaping from the biomedical bubble in which not only the United Kingdom but the entire western society is immersed.