A million words of advice on medical research

There’s no need to feel sorry for Simon McKeon. He’s a successful banker, yachtsman, CSIRO Chairman, philanthropist and 2011 Australian of the Year amongst other things. But he does have a difficult job right now. Three hundred submissions to the Strategic Review of Health and Medical Research (“the McKeon Review”) have just been posted on line. At say, five pages each and maybe 750 words a page, that’s probably at least a million words of advice that Mr McKeon and his colleagues have to sift through.

Not all submissions are available to the public, and I certainly haven’t done an analysis but I’d make a bet that if one of those word cloud thingys was run over the submissions some words that would appear the biggest would be translation, collaboration, long-term, and maybe outcomes (or impacts; benefits – whatever is the current most popular term for “making a difference”). Obviously there is a large degree of consensus that the goal we want from our national investment in health and medical R&D is better health for Australians. That’s the easy bit of the review.
The hard bit for McKeon’s team is to recommend to Government how improved health outcomes are best achieved through R&D. The review team is charged to come up with a 10-year Strategic Plan. I don’t think they’ll be shy to do so. Perhaps even more importantly, the Government is likely to take the Review very seriously. Tanya Plibersek, the Minister for Health, has responsibility for medical research but Minister Mark Butler wrote and issued the terms of reference before his elevation to Cabinet. It doesn’t matter what you think of how the Government is travelling, these are both exceptionally talented people that are coming off major wins. They don’t have a record of sitting on reports. We could potentially see major changes implemented before the next election.

The crux of the submissions I’ve skimmed is the balance between generation of new knowledge and translation of that knowledge into health outcomes. How we get the balance right through peer review processes, securing career paths, collaboration through projects or centres, priority setting, commercialisation etc are all important but it is that balancing act that will likely define the McKeon Review.

I have a distinct preference for the pithy (read short) submissions. My favourites so far:

From The Magic Pudding Company:

The NHMRC funds three very different beasts – high-quality curiosity-driven research; research into major Australian health challenges; and commercial development – but assesses and reviews all three in surprisingly similar ways: peer-reviewed research excellence plus track record, with a fleeting glance at potential impact. This doesn’t work. We need three distinct pots. (Continue reading…)

and this one from Nicole Cloonan, a researcher at the University of Queensland:

Each year, approximately 80% of NHMRC applications are deemed worthy of funding, and yet only 20% are awarded. The ranking of these grants is largely random [1], and subject to intense and often unjust scrutiny, and success often requires that >50% of the research proposal has already been performed successfully.

If the selection process is at least partly random for the middle-road applicants (those that are neither “must fund urgently” or clearly unfundable), then why not capitalise on this and make it truly random. I would much rather put my business card in a fish bowl and accept the outcome of a lottery than worry about hostile Professor X shooting down my application at the last minute because I challenged his work at a conference last month. Researchers could get back to researching and innovating, whilst the hefty administration costs could be reduced to a mere $20 fish bowl and a work-experience kid to fish out the cards. I’ll personally chip in another $50 if you need a bigger bowl. (Full submission…).

Both submissions illustrate the difficulty of the task at hand for the McKeon reviewers – are we asking the impossible of our premier health research body to cover the entire spectrum of health innovation? How can we attract and keep talent without decent pay, conditions and some degree of certainty? (The CRC Association pointed to the success of the medical collaborations through CRCs and would like to see more; though we don’t believe it need be at the expense of knowledge generation. We don’t think Australia should try and do everything).

The answers won’t be easy or simple, but there is no doubt every Australian will ultimately be affected by them. So good luck to the Mr McKeon and his Review Panel: may a million words of advice enhance your wisdom.