Health research policy in the European Union
http://www.100md.com
《英国医生杂志》
Drastic revision is needed
"Health" is the number one theme in the first outline proposal of the European Union's seventh framework programme of research (FP7) for 2007-13.1 Translating this indication into actual "research for the health of Europeans" will require a drastic policy revision with relation to the current (FP6, 2002-6) research programme, which is severely lacking in a population dimension2 and champions "the traditional mix of basic science and biomedicine" that is deemed wholly inadequate to support health systems by the World Health Organization's ministerial summit on health research.3
This revision requires four main changes: in conception, content, procedures, and resources. The programme's conception must incorporate a simple but crucial idea: "From the population to the population." Research prompted by health problems in a population must provide results that are relevant and applicable in that population. This goes against the common misconception—transparent in the sixth research framework—that a solution to a biological or clinical problem found at, say, the molecular level can be equated to "the" solution of the problem for a population. Ignoring population oriented research is not only naive but delays effective actions to improve health or to avert harm to health, as epitomised by the stories of the adverse effects of hormone replacement therapy4 and of cyclo-oxygenase 2 inhibitors.5
The content must be guided by an epidemiological approach to health and disease, developing population based investigations on genetic, environmental, social, and economic determinants through the many different coordination mechanisms between countries that are envisaged in the "European research area."6 This multiplicity should help to implement a clear, coherent research strategy for all citizens' health rather than be the sum of studies plugged into projects conceived primarily in biological or biotechnological terms, often with industrial production development as the key objective (a motive resurfacing in some national commentaries to the first outline of the seventh research framework7). The strategy should be centred on generating knowledge in forms that can be used to improve the performance of European health systems, globally and in all components, from measures to prevent diseases or treat those that are not yet preventable to key societal determinants of health. Evaluation of all types of health related interventions is essential, including large randomised trials of preventive measures on diet, exercise, or other lifestyle changes (that do not attract investments by the pharmaceutical industry) for which the positive innovation of "large" projects introduced by the sixth framework should be adapted specifically.
The procedures need to be improved substantially. Currently they tend to favour applicants who are resourceful in writing project proposals that are cumbersome in form but airy in substance, with diffuse talk about collaboration, management, and "European added value," rather than giving precise and achievable scientific objectives. This is profoundly anti-educational for younger researchers as it penalises the ability to compete on scientific grounds through rigorous professional peer review and encourages fundraisers who can "talk the talk" but not necessarily "walk the walk." Procedures should in an orderly fashion connect the distinct roles of the political, scientific, and administrative elements in the programme's formulation and implementation. Once political decisions are fixed on the recently proposed general themes of the seventh research framework,1 the key responsibility should be transferred to active, fully competent researchers from all relevant biomedical, epidemiological, and social areas. They should formulate the call for proposals' topics within the health theme(s) and evaluate the merit of submitted projects with the administrative and technical support of EU staff. Topics should not be specified too narrowly, to allow selecting the best quality projects through competition. In health systems research, high quality studies require as much imagination and rigour as in any other kind of research: limiting the proposed European Research Council8—a welcome instrument to improve the scientific governance of EU funded research—to the basic sciences reflects an obsolete hierarchy of first and second class sciences that also demands urgent revision.
At the level of resources, four requirements stand out. Firstly, adequate funding—say, at least 20% of the total life sciences allocation—should be assigned to a well identified "health systems research" section of the programme. Secondly, appropriate provisions should be made for large and complex megastudies as well as for smaller, agile investigations exploring new hypotheses in which only some of the 25 EU countries participate. Thirdly, the programme should embody mechanisms to allow adequate time—conditional to positive periodical evaluations on a competitive basis—to do population based studies, usually longer than experimental or clinical studies: mechanisms such as the European Strategy Forum on Research Infrastructure9 may be appropriate, in particular for "life course"10 investigations of disease development. Fourthly, substantial investments in education and training, formal and on the job, should be targeted specifically to strengthen competence in all population health sciences.
Hopefully these proposals will find a way into the new EU programmes: short of this, the EU research "for health" will miss its target and remain by and large a well intentioned misnomer.
Rodolfo Saracci, professor
Department of Epidemiology, Institute of Clinical Physiology, National Research Council, via Trieste 41, 56126 Pisa, Italy
(saracci@hotmail.com)
J?rn Olsen, professor
Danish Epidemiological Science Centre, Vennelyst Boulevard 6, 8000 ?rhus C, Denmark
Albert Hofman, professor
Department of Epidemiology and Biostatistics, Erasmus University Medical Center, PO Box 1738, 3000 DR Rotterdam, Netherlands
Competing interests: None declared.
References
European Commission. Proposal for a decision of the European Parliament and of the Council concerning the seventh framework programme of the European Community for research, technological development and demonstration activities (2007 to 2013). www.cordis.lu/en/src/g_062.htm (accessed 10 May 2005).
Saracci R. Public health and epidemiological research: a blind spot among the European Union priorities? Int J Epidemiol 2004;33: 240-2.
The Mexico statement: strengthening health systems. Lancet 2004;364: 1911-2.
Various authors. Hormonal replacement therapy. Int J Epidemiol 2004;33: 445-67.
Lenzer J. FDA advisers warn: COX 2 inhibitors increase risk of heart attacks and stroke. BMJ 2005;330: 440.
European Commission. Europa-research. Future European Union research policy. http://europa.eu.int/comm/research/future/index_en.cfm (accessed 10 May 2005).
European Commission. European research area. www.cordis.lu/era/concept.htm (accessed 10 May 2005).
European Commission. European research area. ERC debate. www.cordis.lu/era/concept.htm (accessed 10 May 2005).
European Commission. ESFRI-European strategy forum on research infrastructures. www.cordis.lu/era/esfri_home.htm (accessed 10 May 2005).
Kuh D, Ben-Shlomo Y. A life course approach to chronic disease epidemiology. Oxford: Oxford University Press, 1997.
"Health" is the number one theme in the first outline proposal of the European Union's seventh framework programme of research (FP7) for 2007-13.1 Translating this indication into actual "research for the health of Europeans" will require a drastic policy revision with relation to the current (FP6, 2002-6) research programme, which is severely lacking in a population dimension2 and champions "the traditional mix of basic science and biomedicine" that is deemed wholly inadequate to support health systems by the World Health Organization's ministerial summit on health research.3
This revision requires four main changes: in conception, content, procedures, and resources. The programme's conception must incorporate a simple but crucial idea: "From the population to the population." Research prompted by health problems in a population must provide results that are relevant and applicable in that population. This goes against the common misconception—transparent in the sixth research framework—that a solution to a biological or clinical problem found at, say, the molecular level can be equated to "the" solution of the problem for a population. Ignoring population oriented research is not only naive but delays effective actions to improve health or to avert harm to health, as epitomised by the stories of the adverse effects of hormone replacement therapy4 and of cyclo-oxygenase 2 inhibitors.5
The content must be guided by an epidemiological approach to health and disease, developing population based investigations on genetic, environmental, social, and economic determinants through the many different coordination mechanisms between countries that are envisaged in the "European research area."6 This multiplicity should help to implement a clear, coherent research strategy for all citizens' health rather than be the sum of studies plugged into projects conceived primarily in biological or biotechnological terms, often with industrial production development as the key objective (a motive resurfacing in some national commentaries to the first outline of the seventh research framework7). The strategy should be centred on generating knowledge in forms that can be used to improve the performance of European health systems, globally and in all components, from measures to prevent diseases or treat those that are not yet preventable to key societal determinants of health. Evaluation of all types of health related interventions is essential, including large randomised trials of preventive measures on diet, exercise, or other lifestyle changes (that do not attract investments by the pharmaceutical industry) for which the positive innovation of "large" projects introduced by the sixth framework should be adapted specifically.
The procedures need to be improved substantially. Currently they tend to favour applicants who are resourceful in writing project proposals that are cumbersome in form but airy in substance, with diffuse talk about collaboration, management, and "European added value," rather than giving precise and achievable scientific objectives. This is profoundly anti-educational for younger researchers as it penalises the ability to compete on scientific grounds through rigorous professional peer review and encourages fundraisers who can "talk the talk" but not necessarily "walk the walk." Procedures should in an orderly fashion connect the distinct roles of the political, scientific, and administrative elements in the programme's formulation and implementation. Once political decisions are fixed on the recently proposed general themes of the seventh research framework,1 the key responsibility should be transferred to active, fully competent researchers from all relevant biomedical, epidemiological, and social areas. They should formulate the call for proposals' topics within the health theme(s) and evaluate the merit of submitted projects with the administrative and technical support of EU staff. Topics should not be specified too narrowly, to allow selecting the best quality projects through competition. In health systems research, high quality studies require as much imagination and rigour as in any other kind of research: limiting the proposed European Research Council8—a welcome instrument to improve the scientific governance of EU funded research—to the basic sciences reflects an obsolete hierarchy of first and second class sciences that also demands urgent revision.
At the level of resources, four requirements stand out. Firstly, adequate funding—say, at least 20% of the total life sciences allocation—should be assigned to a well identified "health systems research" section of the programme. Secondly, appropriate provisions should be made for large and complex megastudies as well as for smaller, agile investigations exploring new hypotheses in which only some of the 25 EU countries participate. Thirdly, the programme should embody mechanisms to allow adequate time—conditional to positive periodical evaluations on a competitive basis—to do population based studies, usually longer than experimental or clinical studies: mechanisms such as the European Strategy Forum on Research Infrastructure9 may be appropriate, in particular for "life course"10 investigations of disease development. Fourthly, substantial investments in education and training, formal and on the job, should be targeted specifically to strengthen competence in all population health sciences.
Hopefully these proposals will find a way into the new EU programmes: short of this, the EU research "for health" will miss its target and remain by and large a well intentioned misnomer.
Rodolfo Saracci, professor
Department of Epidemiology, Institute of Clinical Physiology, National Research Council, via Trieste 41, 56126 Pisa, Italy
(saracci@hotmail.com)
J?rn Olsen, professor
Danish Epidemiological Science Centre, Vennelyst Boulevard 6, 8000 ?rhus C, Denmark
Albert Hofman, professor
Department of Epidemiology and Biostatistics, Erasmus University Medical Center, PO Box 1738, 3000 DR Rotterdam, Netherlands
Competing interests: None declared.
References
European Commission. Proposal for a decision of the European Parliament and of the Council concerning the seventh framework programme of the European Community for research, technological development and demonstration activities (2007 to 2013). www.cordis.lu/en/src/g_062.htm (accessed 10 May 2005).
Saracci R. Public health and epidemiological research: a blind spot among the European Union priorities? Int J Epidemiol 2004;33: 240-2.
The Mexico statement: strengthening health systems. Lancet 2004;364: 1911-2.
Various authors. Hormonal replacement therapy. Int J Epidemiol 2004;33: 445-67.
Lenzer J. FDA advisers warn: COX 2 inhibitors increase risk of heart attacks and stroke. BMJ 2005;330: 440.
European Commission. Europa-research. Future European Union research policy. http://europa.eu.int/comm/research/future/index_en.cfm (accessed 10 May 2005).
European Commission. European research area. www.cordis.lu/era/concept.htm (accessed 10 May 2005).
European Commission. European research area. ERC debate. www.cordis.lu/era/concept.htm (accessed 10 May 2005).
European Commission. ESFRI-European strategy forum on research infrastructures. www.cordis.lu/era/esfri_home.htm (accessed 10 May 2005).
Kuh D, Ben-Shlomo Y. A life course approach to chronic disease epidemiology. Oxford: Oxford University Press, 1997.