health research dilema in the UK

Britain’s Health Research and Development Dilemma

We are known as the most generous nation in the world, but have you ever wondered why?   There are over 160,000 charities in the UK, also the largest concentration in the world. I believe that the generosity of the British public has allowed our government to avoid its responsibilities in many areas but, particularly health. David Cameron in a recent interview even referred to the responsibility of charities for some areas of health care.

In Germany and France, for example the state takes responsibility for many of the functions that we have to rely on charities to support. Where our governments, of all colours, are able to reduce the funds required to properly support the NHS to as little as they can get away with politically, only because they know that charities will always try and support the shortfall.

We tend support charities that have supported us, family and friends for many reasons. We appreciate what they have done and what they represent, and a lot of charity fundraising events are great fun.

If a political party were to propose raising taxes to support all the charities that we rely on for support, research and ongoing care for most, if not all long term conditions, would we support them. Are we happier to support charities that provide these essential charities through choice rather than paying more tax to replace them.

More importantly, and this is the main theme of this article, even with the contributions of the charities the spend on research cures and treatments for expensive long term and fatal conditions the level of funding for Research and development is risible.

In a report by the by John Appleby of The King’s Fund, ‘Spending on health and social care over the next 50 years – Why think long term?’  (link to report here)

“The answer is as much political as technical. A great deal depends on one’s view of the role of the state and the individual, and how the balance might change over time. Will people be willing to pay the same or indeed increasing levels of taxes in order to fund public services adequately? Might the government be willing and able to increase borrowing to ensure the sustainability of valued public services such as health and social care? Or will there be a backlash against the role of the state, and an expectation that people should take greater personal responsibility for services that are currently paid for mainly through the public purse?”

I think this is unlikely that the state will address this, and so we will have to continue to support charitable services that really should be provided by the NHS. You could argue that it allows us to specifically support the charities that have supported us personally, rather than spreading the tax income amongst these services.

The major concern I have is regarding Research and Development. The expenditure on R&D, in the UK, Including Health has fallen below the EU estimates but why and what is the consequence of this to us.  Spending on medical research is not an expense, its an investment that in the long term will save money for the NHS. Let’s have a few statistics:

In 2012, the UK’s gross domestic expenditure on research and development decreased by 2% to £27.0 billion compared with 2011. Adjusted for inflation, in constant prices, research and development expenditure decreased by 3%.

Total R&D expenditure in the UK in 2012 represented 1.72% of Gross Domestic Product (GDP), a decrease from 1.77% in 2011.

International comparisons show that UK R&D expenditure in 2012 was below the EU-28 provisional estimate of 2.06% of GDP.

It’s a well established fact that British scientists have a reputation for doing more, in terms of papers and Nobel Prizes, with less, in terms of money, than those in other countries. Why is this important?, because the government justifies the cuts in their support of medical research by saying the money is needed in the NHS. This is typical Government short term thinking, money invested in research will reap much greater savings for the NHS in the future.

This quotation is from Simon Denegri’s lay review puts the issue into context.

Spend £1 on cancer research and get 40p back every year: what’s not to like?

“In recent years, research funders have sought to understand better the impacts arising from the money they spend on research. Often this impact has been expressed qualitatively. But is has proved more difficult to place a financial value on impact. The first report to do so was published in 2008 when I was the Chief Executive of the Association of Medical Research Charities (AMRC).

The report looked at the economic returns arising from government and charity funding of cardiovascular research, also testing the methodology to a more limited extent on mental health research. The study, undertaken by the Health Economics Research Group at Brunel University, RAND Europe, and the Office of Health Economics, found that for every £1 invested by the government and charities in cardiovascular research, a total annual return of 39p was generated each year in perpetuity. The figure for mental health research was 37p per £.

Now the study – commissioned by Cancer Research UK, Wellcome Trust, the Academy of Medical Sciences and the Department of Health – has been repeated in cancer and published as a paper in BMC Medicine to coincide with the All-Party Parliamentary Group on Medical Research reception.

The key findings in the study which are also published in report form as ‘Medical research: what it’s worth,’ are as follows:

The British public has funded £15b of cancer research over the 40 years to 2009 through taxes and charitable donations.

The time lag between investment in cancer research and it’s eventual impact to patients is around 15 years. This is similar to the figure obtained in the earlier study, and shows the long term nature of the payback from research funding.

Key cancer treatments and interventions have delivered the equivalent of £124b og health gains for UK patients in the 20 years up to the end of 2010.

The proportion of these benefits attributable to UK research was 17%.

Taking the spend, and allowing for the time lag and the proportion of benefits attributable to UK research, each £1 invested in cancer-related research by the UK taxpayer and charities generates returns of around 40p in every following year. Of this, 30p is the estimated benefit from research to the wider economy; the direct health benefits amount to 10p per annum for every £ spent. The overall annual rate of return is estimated to be 40%.

I am sure the study will be challenged by some and so it should.,Only through ever-greater scrutiny are we going to improve these
socio-economic models about research. But they seem of enormous value to me in trying to quantify the impact of money spent today, on society tomorrow. And if it makes policy-makers and newly-minted Ministers put their red pen away then all power to its elbow.”

The  reason that all governments feel they need to neglect research in favour of other concerns is that it is an investment in the future, requiring joined up thinking and all governments prioritise the now and ignore the future for election gains.

In March 19, 2015, Mike Fay in the Nottingham post discussed this

“But the long term gains in funding can be huge. When, in the 1960s, the Medical Research Council started funding a young academic named Peter Mansfield in the Physics Department at the University of Nottingham working on magnetic resonance, the results were only seen in science journals for a decade. But by 2003 his work had given us the medical MRI scanner in hospitals across the country, and Sir Peter had been rewarded with a knighthood and the Nobel Prize”.

A report produced in 2008 into the economic benefits of medical research Medical Research: What’s it worth? – Estimating the economic benefits from medical research in the UK by The Health Economics Research Group (HERG), Brunel University, Office of Health Economics (OHE), and RAND Europe

For the Medical Research Council, the Wellcome Trust and the Academy of Medical Sciences

http://www.wellcome.ac.uk/stellent/groups/corporatesite/@sitestudioobjects/documents/web_document/wtx052110.pdf

“Nevertheless, our ‘bottom-line’ best estimate suggests that for CVD ( Cardio Vascular Disease) the IRR (Internal Rate of Return) from the value of net health gains alone (ignoring GDP impacts) is around 9%. Most one way sensitivity analyses place the IRR within the range of 6–14%, but in the ‘pessimistic scenario’ the value of the net benefit was less than the cost of the investment whilst in the ‘optimistic scenario’ the IRR was over 25%. For mental health, our best estimate of the IRR from net health gains was around 7%. Most one-way sensitivity analyses place the IRR within the range from a situation where the investment exceeded the net benefits to a positive rate of return of just over 11%. In the ‘pessimistic scenario’ again the research investment exceeded the net benefits, but in the ‘optimistic scenario’ we estimated a return of around 16%.”

Im not the only person to notice this issue, a great post by Benedict on the Diabetes UK site also raises the issue.

“With all the money spent on treating diabetes, is it not about time that governments committed some more money towards research to help beat the rising tide of diabetes?

Let’s look at the figures:

Diabetes and its related complications cost the UK £9 billion a year.

 Drugs and supplies cost about £600 million

 Government research into diabetes amounts to about £50 million

So the government spends on research less than 10% of what it spends on drugs and supplies and if we compare the government spend on diabetes research with the total cost on the NHS of diabetes and its complications, we find the research spend is 0.5% of that figure –it doesn’t seem like very much.

Charity research commitments

One argument might be that there are charities which help to fund research, but how much do they contribute? The UK’s largest diabetes charity, Diabetes UK is aiming to invest £8.5 million pounds towards research which is scheduled to be split over 120 different research projects –an average of about £70,000 on each project.

Here are the projects that have the most funds allocated:

£1.2 million: Research into whether avoiding low blood glucose levels helps to regain hypo awareness

 £990,000: Research into effectiveness of a new structured education course for 11 to 16 year olds

 £790,000: Research into statins and ACE inhibitor use in children at a higher risk of cardiovascular problems

 £700,000: Research into a first-generation prototype of an ‘artificial pancreas’

I can’t help but feel a bit disappointed that there’s not something a little more ground-breaking.

It seems as though there’s no projects amongst these that top contributed to research projects that address type 2 diabetes either. That does seem a little strange.

Research for a cure

Compared with the research going on in the states, the research we’re doing looks pretty weak.”

Here is an article from Scienceogram ( a great resource if your interested in this subject) that puts it all in context.

 “Cancer kills almost a third of us, and yet we spend less than £5 per person per year researching it. (And it’s arguably the best-funded medical condition.)

Looking at other big killers paints a stark picture of the state of UK medical research funding. Let’s look at government spending on diseases, compared to the number of people killed by them.

Cancer Stroke Heart Disease Other
Causes of Death 30% 10% 15% 45%
Research spend per person per year £4.30 28p £1.30
Cost to UK economy £15 billion £3-4.4 billion £15 billion

 

Heart disease is responsible for around 15% of deaths, and yet we spend just £1.30 per person per year researching it. Stroke is the third most deadly individual condition, responsible for 10% of deaths; stroke research receives just 28 pence per person per year. So, astonishingly, these three conditions are responsible for over half of the deaths in the UK, and yet we invest less than £6 per person per year to try to understand their causes and find new treatments.

Medical research is a special case in science, because charities make a significant contribution—in fact, over half of UK medical research into cancer, heart disease and stroke is charity-funded. The combined figure for public and non-profit research into these three conditions is around £12.50 per person per year, which still seems feeble compared to their deadliness.

Looking at mortality statistics starts to give a sense of scale to measure up health research spending, but what doesn’t kill you can nonetheless have a huge effect on your quality of life. Therefore, it would be a mistake to concentrate all our research on the most fatal conditions. For example, dementia has a massive effect on quality of life, but the condition itself is rarely fatal. It affects one in six people over 80; we spend about 60p per person per year researching it.

The dementia challenge

In March 2012, the government pledged to double its contribution to dementia research, from 50p per person per year to £1, meaning that the total spend will be somewhere around £1.30 by 2015. While increasing spending is a laudable policy, compared to the economic cost of dementia, let alone the human one, this still seems slightly pathetic.

The suffering caused by illness should be reason enough to invest more seriously in looking for treatments. However, diseases also come with a significant economic cost. Firstly, there’s the substantial direct cost, in terms of health and social care for sufferers. Secondly, there are large indirect costs, such as friends and family members taking time off work to care for loved ones. The total economic impact of the four diseases mentioned is over £800 per UK citizen (split between everyone, not just patients) per year. This makes the combined £6.50 (£13 with charities) each we spend researching all four of these conditions look rather paltry.

This has been an interesting journey for me researching this issue, and believe me I did not have to try very hard to find this information and comments. I am not a scientist, doctor, economist or politician, but even I can see that this makes very little long term sense. This is a situation that will only get worse over time, if we don’t fund research we will continue to spend more and more on heath care. There is about to be an explosion of Diabetes and Alzheimer’s, to mention only two, and the costs are liable to be enormous.

The annual NHS cost of the direct treatment of diabetes in the UK will increase from £9.8 billion to £16.9 billion over the next 25 years. The predicted rise would equate to the NHS spending 17% of its entire budget on the condition, up from about 10% today.

The overall economic impact of dementia in the UK is £26.3 billion. This works out at an average annual cost of £32,250 per person.

The attitude of our government is tantamount to fire fighting, none of them have the courage to address this issue for fear of risking their political futures and in the end we will all have to face the consequences of this short sighted lack of joined up thinking.

We must invest in researching medical issues or we will not be able to keep up with the costs of treating the consequences. This issue is a ticking time bomb.

 

Source: Neil Fraser MD meditexts.com

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Posted in Alzheimers's, Asthma, Cancer, Diabetes, Epilepsy, Heart Disease, Mental Health, Motor neurone disease (MND), Multiple sclerosis (MS), Uncategorized | Tagged , , , ,

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