Health Research Opportunities
One of the key recommendations from the 2006 Review of UK health research funding by Sir David Cooksey was to establish “… an agreed and understood set of health research priorities for the UK that target the biggest and most important health challenges for the UK over the coming decade.” The Government’s Office for Strategic Coordination of Health Research (OSCHR) is coordinating a multi-stage project with the overall objective of identifying and prioritising UK health research opportunities over the next decade.
The first stage was for the Department of Health in England, in conjunction with the other UK Health Departments, to undertake a review to understand the impact of diseases and illnesses on the UK population and economy. This review took place in 2007 and was published on the Department of Health website in June 2008.
To identify areas of scientific opportunity, the MRC convened a meeting of senior academics, industry researchers and users of research in December 2008 at Mar Hall, Renfrewshire
The meeting was hosted by the Chief Scientist Office, Scottish Government Health Directorates. The exercise addressed the merits of investing in research (early or late stage) in different areas based on need and scientific opportunity; and focussed on cross-cutting fields and mechanisms as well as specific diseases.
Extensive debate and discussion identified that the key opportunities for maximum impact in health research over the coming years would be the application of a new and developing research approaches across a range of diseases and disorders. The Mar Hall Group identified 10 areas where focusing on a strategic research approach was most likely to lead to significant advances in health outcomes.
- 1. Stratification of phenotype
- 2. Regeneration and replacement
- 3. Tracking response to intervention
- 4. Measure, understand and modify environmental and inherited influences on health
- 5. Exploitation of world leading position in hypothesis-generating science to deliver improved health
- 6. Early detection of the opportunity for effective intervention
- 7. Primary prevention
- 8. Behaviour modification
- 9. Understanding the burden of illness
- 10. Development of new interventions
1. Stratification of phenotype
As the understanding of many disease clusters increases, the current definition or classification of a condition may not represent the emerging complexity of a particular disease. This potential research opportunity area seeks to exploit the value of stratification of disease phenotype to improve human health. The use of specific objective measures to define disease boundaries would improve diagnostic and treatment strategies, increasing our understanding of exposure to risks, symptomatology, and aetiology of particular diseases. Using stratification of disease severity by stage, rather than pathological or anatomical subtype, in clinical trials may also improve the development of treatment strategies, tailored to individual needs.
- Examples of applications: disorders of mental health, cancer, inflammatory diseases such as asthma
Note: Examples of research areas where this approach might be adopted are provided for illustrative purposes only and are not a complete list of where these strategic approaches may impact.
2. Regeneration and replacement
The aim of this potential health research opportunity area is to improve health research across the boundaries of gene manipulation, gene therapy and stem cell transplantation, through to the use of better technologies for medical prostheses and devices. The area focuses on the repair, replacement or regeneration of cells, tissues, organs or systems to restore impaired function or establish normal function.
- Examples of applications: restoring vision or motor function, cell-based therapies, alternatives to blood, biomaterials
3. Tracking response to intervention
This potential health research opportunity area identifies the prospect of tracking responses to interventions, addressing the need to develop surrogate markers of efficacy and toxicity, surrogate markers to elucidate mechanisms or targets and validated end-points. This health research theme includes the development of long-term markers for different disease strata and the use of imaging technologies to track responses to particular interventions. The research theme includes the use of appropriate adaptive clinical trial designs to better utilise data collected throughout a particular study to make decisions or modifications to that trial.
- Examples of applications: biomarkers, validated end-points, adaptive trial designs, toxicity, imaging
4. Measure, understand and modify environmental and inherited influences on health
This potential health research opportunity area aims to improve our understanding, measurement and modification of hereditary predisposition and environmental factors which influence health. This could encompass better understanding of the gene-environment interactions, genotype stratification and atopy.
- Examples of applications: allergy, diabetes and obesity, addiction, depression, infertility, cancer, osteoporosis
5. Exploitation of world leading position in hypothesis-generating science to deliver improved health
The UK is at the international leading edge of hypothesis-generating biomedical science, and boasts a wealth of epidemiological resources. This potential research opportunity area aims to exploit these strengths, promote the interaction between laboratory and population health sciences, and further our understanding of the biological relevance of rich genetic and epidemiological data.
- Examples of applications: Wellcome Trust Case Control Consortium for genetic studies, population cohorts, e-records
6. Early detection of the opportunity for effective intervention
Early detection of disease, especially in high-risk individuals, offers the opportunity for effective intervention. This simple premise is applicable to all modifiable diseases. The potential research opportunity area aims to promote research into screening, diagnosis, and secondary prevention of diseases to improve health.
- Examples of applications: ischaemic heart disease, cancer, schizophrenia, dementia, renal failure
7. Primary prevention
Primary prevention covers all activities designed to reduce the instances of an illness in a population and thus to reduce, as far as possible, the risk of new cases appearing. The potential research opportunity area aims to decrease morbidity and mortality through improving primary prevention strategies, methodologies and implementation.
- Examples of applications: infectious diseases (including healthcare associated infections, emerging threats, cervical cancer), intentional and unintentional injuries
8. Behaviour modification
The potential research opportunity area aims to influence behaviour at the individual and population level to improve health. Modification of both risk and practice should, where possible, be based on the understanding of biological and societal factors. Individual based modification may also be aimed at the practitioner, for example addressing the overprescribing of antibiotics or poor hand-washing practice.
- Examples of applications: lifestyle choices, alcohol and substance abuse, obesity, infection control
9. Understanding the burden of illness
The improved understanding of the burden of illness should lead to the effective management of illness. This potential research opportunity area focuses on increasing our understanding of the burden of illness to the individual and society. This research area aims to better meet the needs of patient populations which do not have a definable disease or those who present at the level of primary care and represent a significant economic and health burden. Greater understanding of the burden of illness includes better quantification of health outcomes.
- Examples of applications: somatic pain, irritable bowel, low back pain, mood disorders, breathlessness
10. Development of new interventions
The final potential health research opportunity seeks to exploit the high quality science in the UK that aims to identify novel targets for therapeutic intervention through better understanding of underpinning disease processes. This would encompass drugs, devices, small molecules and biologicals.
- Examples of applications: protein kinases as targets in diabetes, inflammation and cancer.
This work has been used to inform the development of the MRC’s new Strategic Plan 2009-2014 Research Changes Lives which will be published on 10 June 2009. The Mar Hall health research opportunities agenda has also been used to inform Government thinking about realisable major goals in health research over the coming years.
Please join this discussion by adding your views on what the key research opportunities over the next few years might be and where health research can significantly impact on health and wellbeing.
You can contribute by sending your comments by email to;
health.research.opportunities@headoffice.mrc.ac.uk
The deadline for receipt of comments is 17 April 2009.