Select Committee on Science and Technology Written Evidence


Memorandum from Professor Sir David Weatherall, University of Oxford


  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.


  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.


  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.


  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.


  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.


  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.


  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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