In 2018, UK Innovation Foundation NESTA commissioned a report by Richard Jones and James Wilsdon entitled ‘The Biomedical Bubble’. It argues for more diversity in UK research, the ‘biomedical bubble’ refers to the situation where groups are closed off from alternative views and ‘where supporters of biomedical science create reinforcing networks, feedback loops and commitments beyond anything that can be rationalised through cost-benefit analysis’.p6 Past biomedical research investments returned strong dividends in term of health and economic growth due to drug development, this is no longer so and many new drugs have to compete with existing therapies or where development struggles for conditions where the mechanism of disease remains unclear. The authors consider that the bubble draws resources away from alternative ways of improving health – e.g. preventative measures that consider social, economic, environmental and behavioural determinants of health outcomes; how to obtain large scale behavioural change; how to reduce variations in the quality of care; and, how to prioritise research on care versus research on cure (e.g. for dementia).p22
The authors are clear about who should own priority setting:
‘Primary input … needs to come from clinicians, patient groups and carers. Businesses are important, both as potential providers of solutions, and as beneficiaries of any new opportunities that innovations should give rise to, but they don’t own the problems, and neither do academic researchers.’p57 The report contains a whole chapter called: ‘Places – how biomedical science exacerbates regional inequality’. For the UK it is suggested that inequalities in public research and development spending drive regional economic inequality and biomedical research is the most unbalanced: 55% goes to London, Oxford and Cambridge. Policies that make ‘excellence’ the sole criterion for funding will naturally lead to concentration, creating ‘a winner takes all dynamic.’p41 This also means research is concentrated on the healthiest parts of the country.p39 The authors consider ‘The regional polarisation of research puts science in greater danger of being seen as captured and led by remote elites’p45 and hence people in regional areas feel it has little to do with them – and become alienated. The UK system is very different, but NSWRHP will be seeking through its work to reduce such potential alienation and ensure rural clinicians and consumers benefit from participation in clinical research.