Memorandum by The Bone and Tooth Society
1. BACKGROUND
Good health depends on physical activity. In
turn, physical activity depends on healthy bones and joints. Without
these, the health of our bodies is like a house built on sand.
Physical activity has declined in all sections of the community
and this has caused great concern because of the growing epidemic
of obesity, diabetes and other adverse health effects. Counteracting
the prevalent habit of sloth is rightly a major target for government
and NGOs. But the barriers to achieving increased physical activity,
particularly in older people have been neglected.
2. PERSPECTIVE
ON HEALTHY
AGEING
Older people suffer in increasing numbers from
crippling disorders of their bones and joints. An international
initiative, the "Bone & Joint Decade" is drawing
attention to the need to devote resources to tackling this. The
possibilities for community action based on existing knowledge
should be exploited now. But there has been a lack of attention
to the whole person in much of the current discussion. Thus, in
focussing on avoiding diabetes, it is often forgotten that obesity
is causally associated with degenerative osteo-arthritis, so that
many obese diabetics are in great pain if they try to increase
their physical activity. In these cases, the moment may have passed
for effective action, which should have been taken before the
development of the arthritis that typically begins in the 50s
in such people.
3. MISINFORMATION
LEADS TO
INACTION: THE
NEED FOR
RESEARCH AND
DISSEMINATION
Conversely, it is widely but mistakenly believed
that obesity protects against osteoporotic fractures, so that
expert advice about avoiding it can be conveniently ignored. There
is thus a big job of education needed to optimise the achievement
of good health in our "young old age". However, the
knowledge base is completely inadequate. New research can show
us how to achieve much better health than is now achievable. Rightly,
research funding organisations are moving on from large basic
projects such as sequencing the human genome to the task of connecting
up our new basic knowledge with clinical and public health priorities.
4. THE ROLE
OF THE
BONE AND
TOOTH SOCIETY
As a charity of 54 years standing whose objective
is to foster research and education that provides just this form
of connection as applied to the skeleton, the Bone & Tooth
Society is not only the world's oldest organisation in this field,
but one of its most influential and vigorous. We propose a more
strategic approach to public research funding in support of the
under-resourced research charities working in our area. We also
wish to draw attention to the alarming shortage developing in
clinical and basic scientists, which within 10 years will have
a huge impact on what is achievable in all health-related fields
if urgent action is not taken immediately. The Society has always
been greatly interested in the application of the physical sciences
in its field, on which it has been especially dependent for major
advances.
5. THE PRESENT
OPPORTUNITY
The government, admittedly with seemingly too
tepid enthusiasm, has recently supported the development of more
medical research that is directed towards translating the basic
science advances of the last decades into clinical advances (UKCRC).
What our Society feels strongly, based on our long-term experience,
is that good clinical research translates equally as well into
basic science advances as the reverse. The reverse in fact has
become a mantra with which to damn clinical research. It is almost
self evident to us that the study of disease shows us how to prioritise
our basic science, and this is particularly clear if seen from
an international perspective, based on experiences shared with
international colleagues working in countries that have more successfully
nurtured their translational and clinical research portfolios
over the last two decades. The recent UKCRC initiative, in support
of the Academy of Medical Sciences Report must be made the beginning
of a sustained push to restore a balance that is sorely needed
by the NHS as it struggles to find funds to treat too late what
should have been prevented.
Another positive development is the growing
prospect of a European Research Council. While this will clearly
be focussed on larger multi-national research projects, it should
be made to set a standard equally in restoring the quality of
scientific peer review and in establishing strategic directions
for most of our research effort, including ensuring translational
relevance. The broad sourcing of scientific opinion will spread
the task of scientific review beyond the present small UK circles
of reviewers, where conflicts of interest have become difficult
to either control or adjust for.
While there is clearly an important place for
curiosity-driven research, often this forms an over-blown response
to the difficulties of managing publicly-funded research that
government, through neglect, places effectively into the control
of their client base. University professors in charge of large
departments collectively have to have various strong commitments
to the status quo.
6. ACHIEVING
HEALTHY BONES
AND JOINTS:
A FRESH START
One particular need in our field is for the
better integration of science across disciplines. It is a nonsense
that it is so difficult to get engineers, physicists and biologists
to work with clinicians within the same grant-supporting system.
To some extent, this is being addressed with discipline hopping
awards, etc, but the real problem is that the cadre of scientific
assessors frequently includes none who can take a broad and informed
view of an application because none has a broad enough education,
whether it be in physical sciences for medics and biologists or
in biology for physical scientists. This sad, particularly British
situation is in part the consequence of over-specialisation in
schools and universities, with blinkering of the scientific horizon
a lifelong consequence.
Secondly, there has to be a new approach to
risk management of what is always a high-risk activity. It does
not make sense to pour money into activities just because money
was previously poured into them. This is to divert science funding
to try to salvage opinions and reputations. Yet there are few
safeguards. Future directions are too much in old hands or at
the mercy of young opinions that are coloured by the culture of
planned insecurity that has made of science an increasingly feudal
and even fearful activity.
Without changing everything at once, it seems
imperative that a large problem like the avoidance of forced immobility
with its disastrous health and financial consequences should be
thought through completely afresh. And if it became clear that
barriers to interdisciplinary collaboration had to be broken down
on something like a war footing for success to be likely, the
necessary degree of energy follow through and commitment should
be found from the very highest level of government to the bench
and research ward. It is a long time ago, but the great medical
research advances of WW2 driven by real energy and dedication
translated into enormous numbers of lives saved in Korea and after,
if not so spectacularly so in WW2 itself.
So far the Bone and Joint Decade has passed
rather quietly. Sometimes it is rather too quiet just before bombs
go off. Action now by the upper House might just be the stimulus
that can convert years of life into years of healthy life, before
we are all impoverished by the impossible task of sustaining too
many old Britons in a miserable wheelchair or bed-bound half-life.
October 2004
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