Reproduction Research: Why Medical Research Matters - Making babies in the 21st century public forum

Presentation to the Making babies in the 21st century: We need to do it better public forum organised by The Society for Reproductive Biology, 25 August 2013.



Thanks for that introduction and I’m absolutely delighted to be invited to this meeting with a combination of people from the community; from dedicated clinicians and from the research community itself. It’s great especially I think at meetings like this to have strong and involved people from the community, because as I remind researchers, it’s the community in whose name we do research and it’s the community who funds our research – so we have to remember that as the centre of all we do.

That isn’t to say, of course, that researchers – and looking round the room I think there’s quite a few of you, I recognise a few especially over there – but this is a very… Medical research is a career that is actually at the end of the day a very altruistic career. I had a conversation a couple of months ago with a 35 year old bloke who works at a merchant bank and uh, over a beer said, ‘I don’t understand why my cousin who works at one of the universities in the city does what she does. She’s on one of your fellowships right? And she’s earning one twentieth of what I’m earning working for a bank.’

And I think the only answer to that is because people who work in medical research want to do good things for the community. Yes it’s fulfilling when things go well and they don’t always go well, but at the end of the day it’s very altruistic, so thinking about it what I said back to him was something along the lines that people who work in medical research want to relieve the suffering of fellow human beings and I think Sandra gave a good example of the sort of… You know, suffering can be a very wide range of things that we human beings experience. Still so much left to do… If medical research was over it would be terrific because we’d have solved all humankind’s health problems and every day I get reminded about the way NHMRC underfunds a particular area, but that does remind me that there’s so much left to do.

This week it was John [ed: Aitken]. Last week it was Ita Buttrose who in public said how poorly we do in dementia research because there’s such an urgent need, and of course there is an urgent need. There’s an urgent need in so many other areas. We also do research because unless we do, our whole system’s going to be unaffordable in the future. When I say that to people they say, ‘but what about all those expensive things, Warwick?’ Well, you know nothing is more expensive than chronic, complex disease, so we need ways to prevent and cure that. But we’re going to have to use research in a different way too, more and more in the future.

At the moment our taxes go on procedures and products for which there isn’t much evidence of their effectiveness and we’ve got to use research much more, shall I say it, clinically – much more as a scalpel to cut away from the public purse things that we currently support. And can I just remind you that if you have private health insurance governments subsidise that and you can get reimbursement – I hope you don’t – but you can get reimbursement for use of quite a wide range of complimentary and alternative medicines which there’s no evidence base for their effectiveness at all, so your tax is at work on that too.

Then finally of course, we do medical research because we’re curious about ourselves. About ourselves as human beings, and that’s perhaps part of altruism, but it’s really at the heart of why people get into health and medical research. But there are lots of challenges, the first one is obviously money and again I’ll remind people that at the end of the day this is the community’s money through their taxes and so there are decisions by government on behalf of the community on how much they spend. In Australia we probably depend on government funding for research more than most other countries and so there’s a lot of work to be done I think in the philanthropic area, but also in the private sector, to build up other forms of funding for research in this country.

The other challenge that researchers face is that research is more and more multi-disciplinary, often involving some basic scientists, some clinical science and health economists, a psychologist and so on and so that makes life more complex. It makes it more complex for us trying to work out what to fund but also more complex for researchers.

Research is also international. We are about three percent of the world’s health research effort and so since I’ve been CEO of the NHMRC we’ve joined quite a large number of international consortia in a wide range of areas, particularly the Global Alliance for Chronic Disease, because we need to contribute overall to international research and of course our research has to be as good as anywhere in the world and I’m going to show you at the end it’s probably better actually.

The other big challenge is what we glibly these days call ‘translation’ which is probably better talked about as how you get research from the research environment – the laboratory or a computer or whatever it is – from the research environment to benefit patients. And often the pressure is put on there for that to be done by researchers, but researchers aren’t skilled in moving things along through government decision-making processes, so that’s a very big partnership between governments, enlightened ministers like Jodie Mackay was when she was Minister for Health and medical research, health bureaucrats – and I use bureaucrats in a good way because I’m now one – and clinicians and professional organisations and funding decisions and so on. Very complicated, but something that at last I think we all see how important it is.

The final point I wanted to make is the pressures there are on researchers. It’s mostly a short term contract you have from your employing organisation. Many of you will be clinicians with duties to patients and so on or academics with duties to undergraduate and postgraduate students and I’m an ex one… and I still have so much respect for those of you who juggle those many, many responsibilities in your professional lives.

But look back to the community for a moment because one of the really important things that we do as researchers, not only to make sure we involve community in decision-making, but we maintain the trust of the community in what we do and that’s why the NHMRC for nearly half a century now in both human and animal research, have sponsored guidelines for the ethical conduct when using human beings or using research animals in research. In recent times there has also been the Australian Code for the Responsible Conduct of Research, which is a jointly owned with the ARC and Universities Australia which sets out both the principles and practices that should be inculcated, should be developed and learned and made into the general culture of doing research, but also a way to investigate when things do go wrong when people are alleged to not have adhered to what we all hope is the general way in which researchers do their work.

A couple of other things in this area too: about three years ago we made a decision that all NHMRC funded research, when published, needed to be openly available to the community; so-called open access process. Again, the people pay for the research and so they ought to be able to get easy and certainly free access to the work that’s been published using the public funding. We encouraged that for a couple of years, now we’re serious, and like the National Institutes of Health, now require people to put their research in an open access repository.

Fortunately in this country the universities were funded a few years ago as part of the Excellence in Research for Australia (ERA) process to develop repositories, so we’ve got the basic bit there and we’re currently working with the National Library of Australia to collect all that and publish in a single… or have it available in a single portal for this country. And the final thing in this sort of concept of trust – we also are embarking on the revision of the ART Guidelines for Australia, they’re about six or seven years old. We updated them briefly on the research side when the 2007 revision of the Embryo Licensing Act was updated, but we’re doing the clinical part at the moment. I’m going to get to the low success rate and why we’re unfair on reproductive science in a moment John, so it’ll be alright. But I just want to say one other thing on the trust side.

You know, it’s remarkable in a way that the distribution of public funds in science is left to peer review. When you think about it we get to decide as researchers how to spend the funds and that’s how it should be. Don’t get me wrong – I’m completely supportive of that. But if you think about it for a moment, what does that mean really? Well it means I think that we’ve got to be really, really careful and bring every competency that we can to the peer review process. Peer review is really about a competition of ideas; people putting ideas to us and using other peers to decide which are the best ideas to fund. So when you think about it that way, it’s obvious that must be fair, that it must be free from bias, it must be relevant to the people who gave the funds in the first place: the public. And that’s why we take so much trouble at the NHMRC about peer review.

Sometimes people criticize it; it’s all too complicated it’s all too much work etc. etc., I make no apologies for that. We simply have to bring every quality process we can to make sure that we use that money sensibly and that the people can trust scientists to make decisions about what science is to be done. I’ve written about this before and it’s an obvious comment, but I’m plagiarising Winston Churchill here. As he said, just as democracy is the worst form of government except for all the rest, peer review is the worst way to identify ideas and people to fund except for all the alternatives. Alright now – onto some statistics about funding reproductive sciences.

So we’ve spent way too much over the last… no, I’m sorry, I’m just joking! So we’ve spent on behalf of the people of Australia over $300 million on reproductive-related research and I’m using definitions here as the Australian Bureau of Statistics does on over 800 research grants over that period of time.

This is how it breaks down. If you look at... here are some years, 2000-2006-2010. Look down here, in 2004 applications… in 2006… 132 applications, last year 246 applications. So, 246 is five percent of all applications to the National Health and Medical Research Council. If you put five percent in and the cancer people put forty – so used to this argument and I’m sorry to pick on you, but you did ask for it, mate, really – so in general proportionally, the areas that get funded are proportional to the application numbers. So what I usually say to people is that one thing that the sector can do for itself is to try and build up capacity and capability in the sectors and think not just about NHMRC’s project grants, which most people do, but some other ones – and I’m going to finish on our newish partnership grant.

So that’s the first thing. The second thing is, you look at the funded rate. There mightn’t be many applications but you do damn well… so the success rate here is almost twice the national average. So I think there’s not a lot of evidence of discrimination against reproductive biology. In fact, I have been heard to boast really about the quality of Australian science in this particular area; there’s no doubt that it’s a very strong area of Australian research with some great long time leaders in the field and you heard some of their names today.

So just to put that in perspective again, the same three years the number of applications, the number funded, the funded rate – you call it the success rate I call it the funded rate – because there are many successful grants that are not funded. So as you can see over this entire period, reproductive sciences generally run at a higher success rate than overall. Now some of you have been in Canberra the last couple of weeks helping us with peer review so I can’t tell you the 2013 results at this stage.

So what about the quality? This is some bibliometric analysis that we do at frequent intervals. About every five years we get an independent review of the citation performers of Australian health and medical research: general and biblio breakdown. But the one that we’re about to release hasn’t quite yet is the five years from ‘05-‘09 and then looking at the citations of those papers from ‘05 through to ‘10. Now you know citations are not impact – citations are recognition by other scientists of science. By no means the whole story here, but very important. And it does mean we can compare Australian science with others, so over this period of time there’ll be there’ll be 70 000 journal publications in health and medical research generally for all of Australia. Now, relative citation impact I won’t define except it’s defined for the whole world as number one so if we’re 1.17 overall for Australia, that’s 17 percent above world average. For those grants with NHMRC funding, 1.6; 60 percent above the world average. So peer review works and for the field of paediatrics and reproductive medicine which is one of the areas, just over 1000 publications over that period of time linked to NHMRC funding with again an ICI of 1.63… so a little bit better than overall to the general field and way, way above the international average.

I haven’t shown this on this slide, but if you look at just the top 1 percent of cited papers around the world – so take all the papers in the world – look at the top 1 percent cited. Australia does exceptionally well and NHMRC 2.5 percent of papers published acknowledging our funding… 2.5 percent are in the top 1 percent. So there’s no doubt that Australian health and medical research is a quality area.

Now this is my last slide. One of the funding schemes that we’ve introduced in recent years, this initiative called Partnerships for Better Health. These are the project grant scheme… there’s a Centre scheme where there are four centres rolling out and there’s going to be a new initiative in this area shortly… but this is the opportunity for organisations with research questions to identify a bunch of researchers and come to us for some co-funding. It’s a system where there are no restrictions on who the partnering organisation can be. So a lot of non-government organisations, some private sector organisations including in the health area and State and Territories; in fact, 140 overall. And I’ve just listed some of those 140 there to give you an idea of the great diversity of these co-funding organisations. It’s a scheme that’s primarily open all the time; you can apply any time. Well, we close it occasionally to do a bit of peer review and open it again, but we have several rounds a year so I think it’s an area where particularly the community sector can, by identifying great researchers and bringing some support to the table, get the questions of particular interest to them identified and funded – provided of course that peer review comes up with the answer.

So let me just say again how pleased I was to be invited, given Sarah Meachem invited me, you know what invited means there, “invited”, with a hand behind the back. But, no – Sarah, thanks. Again, can I say to the society how terrific it is to have this sort of session which is about all the mix of people that are important in health and medical research. Thanks very much.