Feature: Bedside manor
12 January 2007. By Ian Jones
At some point, effective research on human health has to involve people who are unwell. So it needs special places that have been equipped for doctors tending the sick or injured to work alongside researchers trying to improve treatment. This can be tricky to arrange. Hospital planners incline to spend their budgets on wards, day rooms, operating theatres and laboratories for routine tests. Research funders are more used to assessing requests for DNA sequencers or more powerful MRI scanners than beds. Putting both together needs extra effort and money.
This is the thinking behind an £84 million investment announced in the summer of 2006, which will give a nationwide boost to the network of UK centres for experimental medicine.
The money, from a consortium of funders led by the Wellcome Trust, builds on an earlier initiative to establish new centres for patient-oriented research. In 1997, five purpose-built Wellcome Trust Clinical Research Facilities (CRFs) were approved. The new centres, in Birmingham, Cambridge, Edinburgh, Manchester and Southampton, were designed to improve translation of the results of basic biomedical research into treatments and techniques that are provably effective in the clinic.
Specifically, the CRFs provided new sites for collaboration between basic and clinical scientists, and for training a new generation of clinical researchers. The CRFs' running costs were found by the Department of Health (England) and the Scottish Executive.
A review of the first CRFs in 2004 highlighted a number of successes. All the facilities had established sound organisational platforms and were contributing to a steady stream of published outputs. More broadly, though, the CRFs are having wider influence, becoming recognised regional centres of clinical research excellence. They act as beacons of best practice for governance and ethics, have developed strong collaborative links with local NHS research and development offices, and have created local educational programmes targeted at clinical researchers in their areas. One notable feature has been the development of a strong network of nurse managers around the CRFs, as well as a growth in nurse-led research.
Phase 2
Now, more funders have joined the consortium to strengthen and extend the network. The new awards will fund buildings, equipment and staff at four of the five existing CRFs, and also support bench-to-bedside initiatives in London, Oxford, Belfast and Newcastle in the UK, and in Dublin (see box below). They will complement the strengths in treatment and record-keeping of the NHS with a well-equipped set of sites for patient-centred research.
The scheme also marks a breakthrough in cooperation between research sponsors. The UK Clinical Research Collaboration (UKCRC) now includes the Wellcome Trust, the British Heart Foundation, Cancer Research UK, the Wolfson Foundation, the Medical Research Council (MRC), the health departments in England, Northern Ireland, Scotland and Wales, and the Health Research Board of Ireland.
The UKCRC's role in these awards is part of a larger effort to build up experimental medicine in the UK, which includes a £35m investment by Cancer Research UK and the UK health departments in experimental cancer medicine centres, as well as a new experimental medicine research scheme recently launched by the MRC.
According to Professor Edward Holmes, Vice Chancellor of Health Sciences at the University of California, San Diego, and Chair of the Wellcome Trust Scientific Advisory Committee for Experimental Medicine, "There is something really interesting and exciting happening in clinical research in the UK at the moment. The degree to which different organisations have worked together on this important initiative is unique."
Where the money is going
The Cambridge CRF at Addenbrooke's Hospital has received support for an MRI scanner and a new nutrition and appetite laboratory. This will make it easier to provide and observe test meals for studies of, for example, genetic disorders and obesity.
The University of Dublin receives funding for a new CRF at St James's Hospital, which will specialise in neuropsychiatric disease, cancer, and infection and immunity - taking in conditions such as inflammatory bowel disease, hepatitis and HIV infection.
The Edinburgh CRF was awarded funds to buy and operate a new-generation MRI scanner. This will advance work on inflammation in cardiovascular and central nervous system conditions and work on metabolism in a range of tissues.
The University of Oxford will be installing a new imaging suite as part of a clinical research centre at the John Radcliffe Hospital. It will specialise in investigations of patients admitted as emergency cases after heart attacks or strokes. The goal is to acquire better understanding of the chain of events in the blood system leading to such crises.
Queen's University Belfast and partner institutions will establish a Northern Ireland CRF. This centre, to be part of the Royal Group of Hospitals Trust, will focus on cancer, nutrition and metabolism, and vision science.
The Newcastle Campus for Ageing and Health has received funding to build and equip a new Clinical Ageing Research Unit. Priorities will include work on dementia and cognitive decline, and basic mechanisms of cell and tissue damage during ageing. Among its aims is improving early diagnosis of dementia and testing treatments to slow progression of symptoms.
The Manchester CRF will expand to enhance its work on biomarkers for cancer prognosis and will install a new MRI scanner. This will involve building a database of existing and future samples from patients for further analysis.
The Birmingham CRF also receives an award, for new building work and staff to develop research on gene- and cell-based therapy for cancer and immune diseases, as well as on heart disease, high blood pressure and obesity.
In addition, there are new awards to four centres in London, which was not home to one of the original CRFs. Imperial College receives funding to expand clinical research at Hammersmith Hospital. The centre focuses on drug development and early clinical trials. Immediate plans include trials in Alzheimer's disease, Parkinson's disease, arthritis and cancer.
King's College London has been awarded support for neuroimaging and development of treatments for mental illness, in a new centre to be located at either the Institute of Psychiatry or the Maudsley Hospital. The centre will also study drug addiction and use of stem cell therapy for neurological disease.
University College London was awarded funding to develop work at the newly opened University College London Hospital.
Finally, the Institute of Cancer Research receives support to add a new MRI scanner to its imaging suite at the Royal Marsden Hospital in Sutton.
The actual amounts of each award are currently under negotiation. The total sum awarded is likely to be about £84m.
