APPENDIX 13
Memorandum from Professor Sir David Weatherall,
University of Oxford
1. BACKGROUND
I should preface these brief comments on the
future of the NIMR by stating that I have had no input into any
of the discussions that have been involved in this decision; rather,
I write simply as a concerned member of the biomedical science
community who is becoming increasingly worried about the deleterious
effect that this long drawn process is having on the morale of
medical research workers in the UK.
My only qualifications for presenting this evidence
are that, for the last 25 years, I have been closely concerned
with developing ways of facilitating the interaction of basic
scientific research with its clinical application. This has entailed
establishing what is now called the Weatherall Institute of Molecular
Medicine in Oxford, together with several other similar developments,
both in Oxford, other parts of the UK, and the USA. Since retirement
I have been involved in two other activities with similar objectives,
writing a major report for the World Health Organization, Genomics
and World Health, and several sections of a major work that is
being published under the auspice of the Disease Control Priorities
in Developing Countries project which is being sponsored by the
Fogarty International Center, National Institutes of Health (NIH),
USA, and the World Bank. Based on experience gained in these various
activities I thought that a few thoughts might be helpful to the
committee.
2. THE CURRENT
STATE OF
BIOMEDICAL RESEARCH
Over recent years there has been a major change
in the range and scope of medical research. Instead of a series
of watertight compartments it now stretches in a seamless fashion
from basic molecular and cell biology, through research at the
bedside, to epidemiology, health economics, and the social sciences.
To realise the full potential of some of the remarkable developments
in some of these fields, particularly the basic biological sciences,
it will be essential to try to bring them together in an integrated
fashion; while this was a problem for medical schools like Oxford
in the 1970s, my recent experiences with the WHO and with the
health economists at NIH and the World Bank have further highlighted
the relative isolation of each of these branches of medical research,
to their mutual detriment. Any planning for the future of biomedical
research must take this isolation and need for integration into
account.
3. ATTEMPTED
SOLUTIONS
As early as the 1980s it was clear that the
rapid developments in the field of molecular and cell biology
were going to have major implications for medical research. Yet
how could this totally new technology be integrated into a medical
school? As an experimental approach the Institute of Molecular
Medicine was developed in Oxford on the John Radcliffe Hospital
site. It was designed such that basic scientists who were interested
in the clinical applications of molecular biology could work together
with clinicians who would bring their own clinical research problems
into this environment. There seems little doubt that integrating
these disparate fields on the same site have helped to bring them
together. Basic scientists and clinicians have developed a mutual
respect, and, by insisting on communal social facilities, research
workers from different fields have developed valuable collaborations.
The particular advantage of this close juxtaposition of basic
science in a hospital setting encourages young doctors and scientists
from the hospital to attend seminars and to be stimulated at an
early stage in their development towards careers in medical research.
And it provides an environment where basic scientists can interact
more easily with clinicians and try to understand the complexities
of human disease. More information is available about the work
of the Institute on its website. Based on the success of this
development a second basic science institute, The Wellcome Institute
for Human Genetics, was established on the hospital site in Oxford
and, most recently, the Sir Richard Doll building has been developed
next door to it so as to bring epidemiology and molecular genetics
into juxtaposition.
Developments of this kind require a good understanding
on the part of the clinical staff of the importance of the applications
of basic science towards developments in patient care and hence
it is vital that, if such integrated centres are being established,
this is done in environments in which there are medical schools
with very good track records in clinical research. The other critical
issue which seems to have led to any success that the Oxford developments
have had is that, in setting up the different research groups
in the basic research institutes, there was already strong evidence
that there were related fields in research in a medical school
which would be synergistic with those in the Institute. This requires
very careful planning and the appointment of personnel who are
able to work with one another. Each major research group in the
Institute also has a "parent" department in the medical
school so as to increase the synergy between the clinic and the
research laboratory.
4. EXPERIENCE
IN OTHER
CENTRES
The STC will no doubt be familiar with what
has happened at the Addenbrooke Hospital site in Cambridge over
recent years. Although the Laboratory of Molecular Biology (LMB)
was next to the main teaching hospital, for many years there was
very little interaction between the two. However, following some
critical appointments in both institutions interactions gradually
evolved and this led to the subsequent development of the Wellcome
Trust Centre for Molecular Mechanisms in Disease which, in essence,
links together the work of the two institutions. To an outsider,
again this slow but excellent development relied on the coming
together of key persons with compatible research interests.
It is interesting to compare these developments
with various institutions in the USA. At about the same time as
the Institute of Molecular Medicine was established in Oxford
a similar project was set up at Stamford University. Here, there
was very little attempt to integrate the work with that of clinicians
and it has remained rather an isolated basic biomedical science
development. On the other hand, the more recently built Institute
of Molecular Medicine at Houston has integrated much more closely
with clinicians in the adjacent hospitals, and its early work
reflects this synergy.
5. DOES CLOSE
PROXIMITY OF
BASIC AND
CLINICAL SCIENCE
FACILITATE THE
APPLICATION OF
SCIENTIFIC DISCOVERY
TO ITS
USE IN
THE CLINIC?
From the examples sited in the previous sections
it does appear that the close approximation of basic and clinical
scientists in an appropriate environment allows the clinical sciences
to feed off the basic sciences. Indeed, it is becoming apparent
from experiences in Oxford that this kind of juxtaposition will,
in the longer term, have the effect of bringing together what,
currently, are totally disparate branches of science, such as
molecular genetics and clinical epidemiology and healthcare research.
In short, this kind of close interaction may well be the ideal
approach to developing research in medical schools of the future.
6. IMPLICATIONS
FOR THE
FUTURE OF
THE NIMR
To the outsider, it is not surprising that the
difficulties between the MRC and the NIMR have arisen. On the
one hand, the NIMR has a staff of, in many cases, internationally
renowned scientists who do not want the upheaval of being moved
and see no reason why they should be. This feeling may be re-enforced
in part by the belief among basic scientists, not unique to this
country, that clinicians are rather naïve about matters scientific!
The MRC, on the other hand, feel that medical science would be
served better if the NIMR were moved into juxtaposition with one
of the main London teaching hospitals. Presumably the reasons
for this decision include better possibilities for evolving translational
research for some of the reasons outlined in the previous sections,
long-term financial considerations relating to the current building
facilities for the NIMR, and other issues.
Although it is inappropriate for an outsider
to attempt to come down hard on either side of this complex argument,
based on my experience of trying to organise interactions between
the basic and clinical sciences it might be helpful if the STC
inquiry considered the following key issues.
(a) The NIMR has a very distinguished track
record and high standing in the international biomedical research
team; any move that is envisaged must ensure that it remains a
centre of excellence.
(b) Scientific interactions cannot be forced;
any move would need to be preceded by extensive discussions between
the clinical research workers of a potential parent institution
and the different scientific leaders at the NIMR. The potential
benefits of an amalgamation of this type will certainly not be
immediately obvious to either party, particularly the basic scientists.
In particular, and as discussed in Section 3, it would be important
to explore whether there were several research programmes in the
potential parent institution which were genuinely related to those
of the NIMR.
(c) The scientists at the NIMR would have
to be sure that the plant and facilities of any new building were
adequate for their work. Given the increasing costs of the basic
biomedical sciences because of the continuing changes in technology,
there may be considerable advantages in being embedded within
a university with respect to the availability of centralised equipment
and plant.
(d) To what extent are the different groups
at the NIMR already involved in translational research in collaboration
with clinical research groups? Would a move of this kind have
a deleterious effect on these programmes? To what extent are the
groups at NIMR carrying out work with a long term goal directed
at clinical applications or are the bulk of their programmes still
at the stage of basic biological mechanisms? In the latter case,
would the groups feel the threat of being forced to dilute out
their research programmes towards shorter-term goals? This is
a key issue that requires very sensitive investigation.
(e) For whoever is making the final decision
on this question, the economic issues will be extremely difficult
to sort out. There is no good way of measuring different organisational
approaches to scientific productivity in economic terms. So the
central issue is whether the MRC would be able to fund a new development
for the NIMR which would provide genuinely adequate facilities
for at least the bulk of their internationally competitive groups.
7. SUMMARY
Because of its mission, and given the importance
of close interaction between the basic and clinical sciences in
the future, the MRC has a good case for trying to integrate the
work of the NIMR more closely with a university medical centre,
as is now the case for its other major basic research institutions.
However, achieving this in a way which will not destroy the traditions
and international standing of the current NIMR will require extremely
careful planning and skills in managing the human aspects of the
development. From the public pronouncements, it is clear that
the scientists at NIMR have not been convinced of the potential
value of this development, even though it could be, in the long
term, an extremely exciting addition to the biomedical scene.
But it will only work if genuine synergies can be found between
the work of these scientists and their potential hosts; scientific
collaboration cannot be forced. Somehow these possibilities must
be got over to the scientists involved, and plans must be developed
such that by manoeuvres like a phased plan of transfer over several
years, their current work is not disrupted. If a scheme along
these lines can be developed, and if some of the key requirements
outlined in the previous sections can be met, and if the financial
implications are genuinely feasible, then it should be possible
to achieve an integration along the lines suggested by the MRC.
But it sounds as though the early stages of these discussions
did not take a number of these issues into consideration and hence
a large amount of groundwork will need to be repeated.
10 November 2004
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