Examination of Witness (Questions 1 -
19)
WEDNESDAY 1 MARCH 2000
DR DAVID
METZ
Chairman
1. Dr Metz, welcome to the Science and Technology
Select Committee to help us out on our inquiry into EQUAL. I wonder
if you could, as we always ask our witnesses, introduce yourself;
tell us a little bit about your organisation; and also perhaps
if you could tell us a little bit about what you see as AgeNet's
main achievements during its three years of existence.
(Dr Metz) Thank you for the opportunity
to give evidence to the Committee this afternoon. AgeNet is an
initiative whose purpose is to stimulate multi-disciplinary research,
which will lead to improvement of the health and quality of life
of older people. I have been Director of AgeNet since it got under
way three years ago. It is my experience, and that of the members
of the network, which contributed to the memorandum of evidence
that I submitted. I should perhaps stress that this evidence is
not intended to reflect the views of the sponsors and funders
of AgeNet, many of whom submitted their own evidence. The remit
I had, as Director of AgeNet, was to stir up activity in a field
which by its nature is multi-disciplinary and spreads from the
biology of ageing processes at cellular level, all the way across
to (let us say) the economics of pensions. These areas interact
because clearly the progress we make in the area of basic biomedical
science will affect, in due course, the health in older people;
and it will also affect the cost of long-term care and public
finances; so making these connections across these areas was the
main aim. We have done it by arranging workshop meetings. We have
run over 20 so far. The characteristic of an AgeNet workshop is
to bring together people who would not normally meet. People tend
to operate within their profession or scientific disciplines and
our aim has been to mix them up and get cross-fertilisation. The
purpose of that has been to encourage people to work together
in new research partnerships, and to bid for funding to run new
multi-disciplinary projects. In addition, we run an active website,
an e-mail based discussion group, and we have built up a database
of over a thousand researchers, users of research findings and
people with a policy interest. So that is the basis for the evidence
I have set before the Committee, and I would be very happy to
answer your questions.
2. The EQUAL initiative was announced in 1995.
We might have expected it to have made some impact by now. How
effective do you believe it has been in meeting its objectives?
(Dr Metz) As you said, it was announced in 1995. It
has manifested itself through three research programmes organised
by the Research Councils. None of these have yet got to the point
where the research generally has been completed, but in all cases
this has got under way. It is quite hard to assess the impact
of EQUAL in terms of the deliverables of new research findings,
which might be employed in technology development or policy or
service development. On the other hand, clearly what has happened
is that there has been a stimulation within the broad area of
ageing research and, to some extent, some attraction of new people
into the field, and encouragement to those who had already committed
themselves to it.
3. Is there anything we can learn from other
countries? Obviously this increasingly ageing population is a
problem facing other countries as well. Are they tackling this
better than we are?
(Dr Metz) I think different countries manage their
research in this area in different ways, reflecting the general
way in which they organise research. In this country we have the
Research Councils, which you will be familiar with, and it turns
out that four of these Research Councils have active programmes
in the area of ageing. Inherently there is a degree of fragmentation
and that is unavoidable given the way we have organised our Research
Councils. In contrast, one can think of the United States where
they have the National Institutes of Health. Within that they
have the National Institute on Aging. That National Institute
is basically a funding body and encompasses all the kinds of research
that the four United Kingdom Research Councils handle. So in the
United States you have a more coherent structure, in my view,
for funding, which can take a more strategic view. In the European
Union we have under the Fifth Framework Programme, for the first
time, a Key Action, as it is called, on the ageing population.
Again, this has brought together the whole range of scientific
approaches, so one has the contrast between the United Kingdom
model, in which there is a degree of fragmentation of research
funding, and other models in which it comes together.
Dr Gibson
4. You say the States do it in a different way
because they have a different structure. What is the added value
which they have produced, which we have not, or Europe, in this
area of endeavour?
(Dr Metz) It is hard to make a comparison because
of the sheer scale of the United States' effort, as you will be
familiar with, particularly in the biomedical sciences. The sense
I have, looking at their programme, is that they are able to take
the broad view and look at the interconnections between the different
areas of ageing research. It becomes the responsibility of a single
person who is Head of the National Institute on Aging.
5. What have they done for the ageing population?
What advantages have there been in that? It is very important
if we ask for national institutions to develop things. What have
they actually done? They have had this experience for several
years. Everyone still goes to Florida, you know!
(Dr Metz) I think it is hard to put one's figure on
it and say, "This is what they have achieved and we have
not." But, of course, one is mainly looking to the future.
The need to enhance effort on research in this area is one which
is increasingly being perceived, given the demographic trends
over the next half century. So I would say that the United States
has got off to a good start. We are more at the starting line
but have a lot of potential. The European Union has also made
a start. It is what one is going to achieve which is important
rather than what one has achieved thus far.
Mr Jackson
6. A comment on that last discussion. The contrast
between the fragmentation of the British system and the more organised
structures in other parts of the world: the argument for the fragmentation
has traditionally been that there has been more bottom-up initiative
diversity, and that depends on maintaining a lively university
sector, which I think we will be able to continue to do. I just
wondered if you could say a little bit about—because we
all have an interest in this question—what are the main
areas, the main subjects, the main topics, which you think AgeNet
will be exploring?
(Dr Metz) AgeNet is a time-limited project, which
will shortly come to an end in terms of what we are going to do.
Perhaps that is not the main point this afternoon.
Dr Jones
7. I think we are talking about EQUAL rather
than AgeNet
(Dr Metz) Yes. I set out in my memorandum what I saw
to be the main structure for organising research. To think in
these terms: in the area of the basic biology of ageing there
is a lot of exciting work going on, which I would be confident
in due course will have an impact on human health, although the
gestation period will be quite long. We have to think about the
timescale quite a lot. We have to think about the doubling of
those, say, over the age of 75 over the next fifty years. All
of those who will be 75 in 2050 are alive already. We really do
have a long timescale. Within that timescale I would be confident
that advances within the area of basic biology of the kinds supported
by the BBSRC would actually make an impact. In the area of the
age-associated diseases the paradigm is the work going on on Alzheimer's
disease in the United States, Britain and Europe, and going on
in industry as well as academia. My judgment is that the momentum
here is that there will be real pay-offs. There are Nobel Prizes
to be won. There are blockbuster drugs that can be developed,
given the scale of old age dementia. In contrast, there are other
areas of age-associated disease which receive rather little attention.
AgeNet has run workshops on osteo-arthritis and age-related macular
degeneration, loss of vision in old age. It is my judgment that
these are relatively under-supported areas which would benefit
from more input. Then there is a group of conditions one puts
under the heading of "frailty", the more complex conditions
of old age which are less amenable to a disease orientated approach,
yet there is a real need on the part of the geriatricians, the
nurses, and the therapists, to improve practice through evidence-based
approaches; and to generate the evidence one needs research programmes
of the right kind. There are methodological problems here. There
are problems of getting financial support in an area where we
need to do more. Then there is the notion of healthy ageing. The
fact that many people live to an old age in good health, at least
until close to death, and we need to understand much more about
the determinants of healthy ageing. We can, through public health
type approaches, encourage more general health in old age. Again,
that is an important area which is under-researched. We know about
some things. We know, for example, about the importance of physical
exercise as a means of improving health in old age. We think that
mental exercise would improve mental health but we are much less
clear about how to do it and what impact we might expect. In terms
of delivery of health care—health services research relevant
to the needs of older people, where the needs are increasingly
for treatment of chronic conditions as opposed to acute conditions
and how the health service should handle this—this again
is an important area of research where interest is beginning to
grow but from quite a small base. Then we have the ways in which
we can modify the environment, both the physical environment through
new technology, and the social environment through a whole variety
of interventions. I am just skating across the whole field very
quickly. What I would stress is the enormous range of professional
and scientific disciplines that have to be brought to bear, and
the clear importance of inter-disciplinary, multi-disciplinary
work. One of my anxieties about the fragmentation of research
funding is that this fragmentation tends to create barriers to
multi-disciplinary research which I think would be a pity.
Mr Beard
8. I understand what you have been saying but
what I am not clear about is what AgeNet or EQUAL have brought
to this. Many of the things you have been talking about, in terms
of Alzheimer's disease and arthritis research and healthy ageing,
those issues have been talked about for an awful long time. What
exactly has EQUAL and AgeNet brought to this scene in the period
you have been in existence?
(Dr Metz) EQUAL has brought some additional funding
through the Research Councils—not a lot but some.
Dr Jones
9. Because they have given it a higher priority?
(Dr Metz) Yes. That is right. What AgeNet has done
is to try and bring together people from different professional
backgrounds, different disciplinary backgrounds, to make progress
in the 20-odd areas of workshops that we have run. I would not
argue that the impact of either EQUAL or AgeNet in the years these
have been going has been particularly great, but a start has been
made on what is a long-term and increasingly important problem.
Mr Jackson
10. May I pick up here. When I launched EQUAL
in 1995, the name that I was using was Extending the Quality of
Active Life. I think there is a temptation to focus it on the
purely medical side. As my colleague Nigel Beard is saying, obviously
there has been research into Alzheimer's for as long as we have
realised that Alzheimer's is an identifiable problem, if not necessarily
an understandable problem in terms of how we deal with it. To
what extent do you think the stress on the ability to be active
in life when one is ageing has come across to a wider research
audience?
(Dr Metz) I think the Engineering and Physical Sciences
Research Council's programme is particularly relevant here because
they have not gone much into the medical side. For example, we
and they ran a workshop meeting, together with the Design Council,
on design for old age, with a particular focus on the notion of
inclusive design. The notion that one can design the world in
a way that allows people with developing disabilities to be more
active. For example, the design of the bottle top of this
kind of bottle (indicating) is an important consideration.
You want to design it in a way that people with developing arthritis
and limited ability to exercise torque can actually open it, as
opposed to designing it for the average younger man which in the
past is what has happened. As a result of this workshop, the EPSRC
had a core of proposals on the topic of Design for Old Age,
Design for All. I was pleased at the number of people who
attended the workshop, who actually succeeded in winning funding.
We shall see what comes from this programme. So that is one area
where the notion of activity in old age is particularly relevant.
I would not say that would be true for the Biotechnology and Biological
Sciences Research Council's programme, which is on the science
of ageing, the science at cellular and molecular level. It probably
will be relevant to the Economic and Social Research Council's
programme Growing Older, which is currently getting under
way, and looking down the list of 30-odd projects most of these
are of practical application to the issue of an active old age.
Dr Turner
11. What has EQUAL done which could not have
been done in any other way? Can you point to any other research
which has been produced, which has been specifically generated
as a result of having EQUAL instead of leaving the Research Councils
to get on with the age-related work that they are doing already?
(Dr Metz) The best example of work which has been
done, which would not have been done, is in the area of the Engineering
and Physical Sciences Research Council's EQUAL programme, because
that Research Council would not naturally be in the area of ageing
in the way that the MRC or the ESRC or the BBSRC would be. Indeed,
the EPSRC's programme, in The Built Environment, and in
Design for Rehabilitation, is funding work that would have
been difficult to get funded through their normal grant mechanisms.
This is because to the panels concerned with the award of grants,
work of this kind would have seemed a bit non-central, a bit non-core
to the work of that Research Council. By setting up a specific
programme you give some protection, particularly to multi-disciplinary
proposals. Some of the best proposals involve engineers working
with gerontologists. That would seem a bit odd to a regular panel
of the Engineering and Physical Sciences Research Council, but
not to the panel that the Council set up to manage the grants
under the EQUAL programme.
12. Do you think that EQUAL has been able to
unlock the resources that otherwise would not have been available?
(Dr Metz) My judgment is that the scale of resources
is quite modest and was found by the Research Councils within
the normal ebb and flow of funding decisions. So I would see EQUAL
as no more than a start, a move in the right direction, but one
which I think ought to be built upon.
13. In addition to encouraging multi-disciplinary
research and collaboration, have you been successful in involving
the private sector? Can you give some examples where you have
done that?
(Dr Metz) It is never easy to involve the private
sector at the best of times. There are certainly examples within
the Medical Research Council's LINK programme, called Integrated
Approaches to Healthy Ageing, which involved pharmaceutical
companies and academic researches. But, of course, pharmaceutical
companies are well practised at working with academics; and it
is not entirely clear whether that particular research programme,
although it is relevant to ageing, in fact has resulted in work
that would not otherwise have been done. In the area of engineering,
of medical engineering and bio-engineering, we attempted to get
the involvement of industry. We ran a workshop to try and bring
in industry to get funding under this LINK programme. Although
it was reasonably well attended, I have to say that following
up the outcome we could not identify any new projects which were
funded. One of the problems is the small size of the companies
involved in this sector. Again, a problem of fragmentation.
14. What about the future? Can you think of
targets that it would be useful to set for EQUAL in the future
and how would you wish to see those assessed?
(Dr Metz) I am not sure about targets. I would favour
a more strategic approach on the part of Government and the public
sector research funders to the needs of an ageing population.
I would favour it because, as I have indicated, the timescale
is quite long and the breadth of disciplines is wide. In that
situation it is hard to rely on the normal processes carried out
within individual Research Councils, or individual Government
Departments, to be sure that in aggregate these will come out
to be about the right thing for the United Kingdom in scale and
balance and in priority. So while targets could come out of the
strategy exercise, my feeling is that that kind of exercise would
be desirable, whether or not you identify particular targets at
the end of the day.
15. What about the end-users of EQUAL's work?
How do you think they feel about it and how much have they been
involved?
(Dr Metz) One nice thing about the Engineering and
Physical Sciences Research Council programme was a specific requirement
to involve users in each project. I thought that was a good feature.
Apart from that, it is hard to put one's finger on the involvement
of users. One class of users which is important is Government
Departments, because in the era of an ageing population many Government
Departments ought to be interested in the implications of population
ageing for their policies and functions and ought, therefore,
to be interested in research that would generate the knowledge
which would help them form those proposals. I would not say, as
yet, that Government Departments have really got on board this
initiative but hopefully in the future they will do so.
Dr Gibson
16. In terms of the balance of research that
goes on into ageing and so on, the molecular biologists are going
to win out, are they not? You mentioned the Nobel laureates. That
is where it is going to happen. All that kind of research is the
sexy area. So how are you going to balance in this? You are going
to lose, are you not? The European Commission has the same trouble.
Molecular biologists are omnipotent. All the other things just
do not matter. Forget the arts block. It is irrelevant.
(Dr Metz) Within the Fifth Framework Programme Key
Action, the managers of that programme have said that they have
struggled to keep that balance by, in a sense, protecting the
less obviously scientifically attractive areas. That would be
part of developing the strategic view. One would attempt to assess
the burden on society of an ageing population and what might be
done through research-led innovation to counter that. While the
attractive parts of molecular biology of ageing would need to
be funded because there might be very big pay-offs there, one
would also want to see work on rehabilitation, on the built environment
and such matters receive a reasonable amount of money. One would
want a process of evaluation that attempts (albeit comparing apples
and oranges) to say something about the benefits. I myself am
a believer in some kind of cost benefit analysis when it comes
to assessing applied research. The benefits are the benefits to
society that arise from implementing research findings on a wide
scale.
17. Is that happening?
(Dr Metz) No.
18. Why not? How would you redress the balance
in this country?
(Dr Metz) I would encourage the Office of Science
and Technology to continue with the EQUAL initiative but to develop
it into a more coherent, more strategic view of research cost
and benefits, as seen from a public sector perspective. It would
encompass the work of Research Councils—and the Office of
Science and Technology is the purseholder for them—but it
could cover the interests of other Government Departments, both
as funders of research and users of research findings. In particular,
it should include the National Health Service because the National
Health Service is a major funder of research and has been reviewing
its programme on age-related research; and, of course, it is the
major user of research findings. I believe one ought to try and
bring all that together and reach a broad view.
19. It is a challenge.
(Dr Metz) Yes, it is a challenge.
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