Transcript of a speech given to open the inaugural NHMRC Research Translation Faculty Symposium, Melbourne, 24 October 2012.
The Minister for Health, the Hon Tanya Plibersek, sends her apologies.
She indicated to me at last week’s grant announcements that she is at one with the goal of the Research Translation Faculty and that she looks forward to hearing about the outcomes of today’s symposium.
NHMRC’s new Research Translation Faculty is a major strategic initiative for health and medical research translation in Australia.
Thank you for accepting our invitation to become a member of the Faculty, and offering to contribute to NHMRC policy and strategies in research translation, including advice on evidence gaps in health policy and practice, and research needs to close these gaps.
Your input will enable NHMRC and the Australian health and medical research community to play a stronger role in ensuring even stronger evidence-based health care in this country.
Why we need a Research Translation Faculty
- The creation of knowledge through research underpins improvement in Australia’s health service delivery and intervention.
- However, it is widely acknowledged that there is a gap between discovery and implementation of knowledge from research.
- This gap slows the uptake of the benefits from research, for patients and for the operation of the health system.
- Closing this gap is a daunting task exacerbated by the volume of research that is available and the need to sometimes change commonly accepted beliefs and behaviours.
Historical look: Origins of the Research Translation Faculty
“Research must be actively pursued and developed and as fast as new knowledge is acquired it must be applied.” – Commonwealth Minister for Health, William (Billy) Hughes about the NHMRC,1936
- NHMRC is well known as Australia’s major funder of health and medical research.
- It is perhaps less widely appreciated that NHMRC is equally committed to ensuring that the results of research are translated from the bench to the bedside, to accelerate the uptake of high quality research findings into practice to improve health outcomes.
Over the last 10 years or more, NHMRC has established a wide range of funding initiatives that support the translation of clinical research by building capacity and fostering collaboration between the research community, clinicians and policy makers, including:
- Centres of Clinical Research Excellence
- Partnerships for Better Health - Partnership Projects and Partnership Centres
- Clinical Program Grants
- Practitioner Fellowships
- Translating Research Into Practice Fellowships.
- NHMRC also encourages research translation through its work in clinical and public health guidelines, including setting standards for the development of high-quality, implementable clinical guidelines in Australia.
- Translating research into improved clinical practice and policy is a high priority for action in the NHMRC’s 2010-2012 Strategic Plan and under the NHMRC Act (1992).
- The establishment of this Faculty is evidence that this commitment will only be strengthened when our new Strategic Plan is announced in the near future.
NHMRC is committed to:
- supporting the translation of research into clinical practice;
- improving the quality of clinical practice guideline development;
- assisting health decision makers to implement quality evidence from research; and
- improving the integration of research, professional education and patient care.
- The NHMRC Strategic Plan sets out a number of major health issues likely to arise, including:
- Indigenous health and well-being
- Ageing and health
- Chronic disease
- Mental Health
- Global health
2. More effective research translation enables the NHMRC to better address these issues.
The ‘Towards a national network to enhance leadership in research translation and implementation’ workshop
- Held on 20 April 2011
- Attended by over 100 senior clinical researchers funded by the NHMRC
Objectives for this workshop were:
- To bring together senior leaders in the translation of research into clinical practice to discuss how to gain further benefit for Australia in the implementation of research evidence into clinical practice
- To develop a plan for expanding Australia’s capacity to implement evidence from research into clinical practice, within existing funding schemes.
- To consider whether a national network of research leaders in this field might be established by NHMRC, supported by NHMRC staff at NICS.
- To inform a post-workshop discussion document for wider consultation.
- At the time, NHMRC had a view to create a Research Translation Network.
Ideas for what this network would do included:
- Input into NHMRC Council from centres of clinical research excellence and clinician researchers on key issues in research translation.
- Facilitate research sector involvement in health reform agenda e.g. collaborative work with Lead Clinicians’ Groups and ACSQHC.
- Focus for leadership through NHMRC by researchers in building a research informed, self-improving health system.
- Assist NHMRC in leadership in evidence implementation.
Progress of the Research Translation Faculty
- One year on, around 7,000 invitations were sent on 17 August 2012 to eligible NHMRC researchers – present company included.
- In the first few days, nearly 2000 researchers had accepted this invitation and joined the Faculty.
- More than 2,500 researchers have now joined the Research Translation Faculty.
Early analysis of the first 1770 members (based on the Research Grants Management System), indicate that expertise in the broad research areas are:
- Basic science (36%)
- Clinical medicine and science (34%)
- Public health (16%)
- Health services (6%).
Examples of NHMRC-funded research translation
Ten of the Best Research Projects 2012 examples:
CIA: Professor Marshall Lightowlers
University of Melbourne
NHMRC Research Fellowship
$739,574 (2006 – 2010)
- Professor Lightowlers and his team produced vaccines for two potentially fatal parasitic diseases: neurocysticercosis and hydatid.
- The team are now working to improve one of the vaccines so it can be delivered in one dose instead of two.
- This is an important goal given these diseases affects some of the poorest countries in the world.
CIA: Dr Dina LoGiudice
Royal Melbourne Hospital, Royal Park Campus
Western Australian Centre for Health and Ageing
NHMRC Strategic Award
$1,081,062 (2007 – 2010)
- This research produced a culturally appropriate tool for assessing dementia in older Indigenous Australians.
- Next steps include developing appropriate models of care for this cohort, living in remote Indigenous communities, and ways of preventing the disease.
CIA: Professor Richard Osborne
NHMRC Career Development Fellowship
$462,290 (2006 – 2010)
- Professor Osborne and his team developed a new model that better prioritises those on waiting lists for hip and joint replacements
- This model has been implemented in all Victorian public hospitals – with the rest of Australia to come.
Examples from ANZICS speech:
CIA: Professor Bala Venkatesh
University of Sydney
A randomised controlled trial of the effect of hydrocortisone on mortality in critically ill patients with septic shock.
- This study aimed to find out whether adult patients admitted to the Intensive Care Unit with septic shock who are given hydrocortisone compared to placebo, will have an improved rate of survival 90 days later.
- About a quarter of people who suffer septic shock that is not rapidly reversed, will die.
- There is no agreement amongst doctors around the world about whether treatment with or without low dose steroids improves the overall recovery and survival in patients with septic shock.
CIA: Professor John Myburgh
George Institute and the University of New South Wales
- Showed that saline solution worked just as well as albumin as a fluid replacement treatment in critically ill patients.
- Result of the research was that it eased some of the pressure on albumin supplies and contributed to cost savings for ICUs here and overseas.
Project Grants 2012 round:
CIA: Professor Kate Leslie
The influence of anaesthetic depth on patient outcomes after major surgery
- The aim of this trial is to determine if a lighter general anaesthesia is associated with improved one year survival compared with deeper general anaesthesia.
CIA: Dr Trevor Leong
University of Sydney
A randomised phase III trial of preoperative chemotherapy and radiotherapy vs preoperative chemotherapy alone for gastric cancer (the TOPGEAR trial)
- This study will test whether chemoradiotherapy is superior to chemotherapy alone as adjuvant therapy.
NHMRC Funding Announcement 19 October 2012
- Last week, I joined the Minister for Health, the Hon Tanya Plibersek MP, in announcing NHMRC grants across seven of our schemes.
- Within that announcement of more than $580 million of new research, was more than $129 million dollars for 159 grants for clinical trials research.
- This is an increase over last year’s funding of $76 million.
This year’s clinical trials funding included:
- 102 Project Grants for more than $100 million,
- 20 Early Career Fellowships and
- 16 Career Development Fellowships valued at over $5 million.
NHMRC support for clinical trials initiatives
- Clinical trials give tens of thousands of patients access to new and innovative treatments and play a vital part in the fight against disease.
- NHMRC provided $484 million for grants relating to clinical trials in the last ten years.
- Recent NHMRC support for clinical trials initiatives include:
$2.1 million over five years for the administration of the NHMRC Clinical Trials Centre and the expansion of the centre’s Australia New Zealand Clinical Trial Registry (ANZCTR).
- Over the past 23 years, 60,000 Australasian patients have been recruited by the NHMRC Clinical Trials Centre for clinical trials on cardiovascular disease, cancer and neonatal disorders.
Launch of the Australian Clinical Trials website on 11 October 2012.
- Benefits for clinical trials sector: draws together information on many aspects of clinical trials such as the regulatory process, commonly used clinical trial registers and clinical trial networks.
- Benefits for participants: facilitates easier access to relevant information on how to participate in a clinical trial.
- The website was built by the NHMRC supported by $40,000 in funding by the Department of Industry, Innovation, Science, Research and Tertiary Education.
- The website is a foundational step towards fulfilling one of the recommendations of the Clinical Trials Action Group report.
Examples of NHMRC-funded clinical trials
The Adelaide ASPREE trial has now leveraged $50 million in US funding to prevent adverse events in aged people through low daily doses of Asprin.
- Prof John McNeal from Monash University is working to develop a Warfarin suitability index that will assist prescribing doctors to identify patients at a higher risk of adverse events whilst on warfarin therapy.
- The findings suggest several approaches to improve the safety of Warfarin use amongst community-based patients, highlighting the importance for treating doctors to assess regularly psychosocial characteristics of their patients.
Next year, the results of the second Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT2) will be announced.
- This study of treatment for stroke will provide definitive evidence of the balance of risks and benefits of early intensive blood pressure lowering in intra-cerebral haemorrhage, the most serious form of stroke. A total of 140 hospitals from 23 countries have participated in the study.
NHMRC support for comparative effectiveness research
- Comparative effectiveness research is crucial to ensure that we continue to evaluate the treatments that have previously been tested.
- Comparative Effectiveness Research can identify potentially ineffective, or even dangerous, treatments from being used in the health system.
- NHMRC is now spending around $30 million on comparative effectiveness research, up from $2 million in 2004.
- This research is working to contribute to the reduction of costs in an overburdened health system.
NHMRC and the Clinical Trials Action Group
- On 3 March 2011, the Australian Government released the CTAG report ‘Clinically Competitive: Boosting the Business of Clinical Trials in Australia.’
- This report contains 11 recommendations designed to deliver a first critical step in reforming the clinical trials environment.
- The release of the report was the culmination of a project that began in 2009 when the Pharmaceutical Industry Working Group (PIWG) agreed to create a working group on clinical trials to address priority areas.
- PIWG also sought to explore the best ways to improve the international competitiveness of the Australian clinical trials environment.
Responsibility for implementing the CTAG recommendations lies primarily with three government agencies:
- the National Health and Medical Research Council (NHMRC);
- the Department of Health and Ageing; and
- the Department of Innovation, Industry, Science and Research and Tertiary Education (Department of Innovation and Industry).
- The CTAG report recommends developments in E-health to benefit clinical trials and work has begun on determining just how these developments can streamline the use of clinical data and information.
- Technology has long been a significant driver in health care in Australia and there is a real opportunity to harness the development underway in the e-health sector to improve and streamline information needed for clinical trials.
- As I mentioned earlier, the success of the clinical trials sector relies upon the collaboration of many different players.
- NHMRC has begun the process of bringing the different clinical trial networks together and making the process of collaboration and information sharing much easier.
- To assist this effort, NHMRC has run two workshops over the last six months for trial networks and will continue supporting new initiatives to build on the important work that the clinical trial networks do.
Harmonisation of Multiple Ethical Review:
- NHMRC has also been developing a national approach for the single ethical review of multi-centre human research.
- A key plank in the National Approach to single ethical review, formerly known as the HoMER initiative (Harmonisation of Multicentre Ethical Review) is NHMRC’s National Certification Scheme for the ethical review processes of institutions.
- To date, 43 institutions have been certified under the NHMRC’s National Certification Scheme.
- While it is largely public sector institutions whose ethical review processes have been certified, those of a number of Universities, Private Hospitals and Medical Research Institutes have also been certified.
- NHMRC will continue to raise awareness of, and by so doing increase the uptake of, the National Approach in non-public health sector institutions
- With this reform, ethical review and approval for multi-centre clinical trials will be significantly sped up.
- This can improve the start-up time of research, not to mention removing additional administrative work.
- The NHMRC has developed a range of guidance material, including a web portal, for this national approach to single ethical review.