I’ve been pondering a report written by my friend and Industrial Strategy Commission colleague Richard Jones (with James Wilsdon), The Biomedical Bubble. The report calls for a rethinking of the high priority given to biomedical research in the allocation of research funding, and arguing for more attention to be paid to the “social, environmental, digital and behavioural determinants of health”. It also calls for health innovation to be considered in the context of industrial strategy – after all, in the NHS the UK has a unique potential market for healthcare innovations. It points out the there are fewer ill people in the places where most biomedical and pharmaceutical research is carried out, thanks the the UK’sregional imbalances. It also points out that, despite all the brilliant past discoveries, the sector’s productivity is declining:
All of this seems well worth debating, for all its provocation to the status quo – and this is a courageous argument given how warm and cuddly we all feel about new medicines. I firmly believe more attention should be paid to the whole system from basic research to final use that determines the distribution of the benefits of innovation, rather than – as we do now – treating the direction of research and innovation as somehow exogenous and worrying about the distributional consequences. This goes for digital, or finance, say, as well as pharma. What determines whether there are widely-shared benefits – or not?
Serendipitously, I happened to read a couple of related articles in the past few days, although both concerning the US. One was this BLS report on multi-factor productivity, which highlights pharma as a sectors making one of the biggest contributions to the US productivity slowdown (see figure 3). And this very interesting Aeon essay about the impact of financial incentives on US pharma research. It speaks to my interest in understanding the whole system effects of research in this domain. Given that this landscape in terms of both research and commerce is US-dominated, this surely makes the question of how the UK spends its own research money all the more relevant? As The Biomedical Bubble asks:
I’m not sure the parallels with the US are as relevant as they might appear. Pharma is makes (I believe) a lower contribution to UK industrial output; the regulatory system and financial/non-financial incentives in both healthcare and pharma (NHS versus insurer; NICE; EMA vs FDA) are very different. This leads to a different research and healthcare landscape. The Aeon article, for example, points out how the UK has been able to foster investment in drugs for rare diseases.
In the UK, some of that investment comes from NIHR, and there are other examples of non-UKRI investment producing significant changes in the landscape such as the Catapult investment in cell and gene therapy. These aren’t really considered by The Biomedical Bubble which focuses on UKRI investment in biomedical science. This is important, but only a part of the picture. The Biomedical Bubble also focuses on classic small molecular drug discovery by big pharma rather than areas that are really developing such as cell and gene therapy where the UK is now second in the world for clinical trials (see e.g. https://ct.catapult.org.uk/sites/default/files/Copy%20of%20Clinical%20Trials%20Database2017%20FINAL%20A3.pdf). These differences could be really important and deserve some consideration.