Select Committee on Science and Technology Written Evidence

Memorandum by The Bone and Tooth Society


  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.


  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.


  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.


  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.


  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.


  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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