13. October 2017

Reducing avoidable waste in health research

If you have NOK 75 million to spend on health research, how should you design grant giving process?

Text and image: Published in Norwegian in Aftenposten, Oct. 7, 2017.

Wasted

In 2009 Iain Chalmers and Paul Glasziou documented that an estimated 85 per cent of all health research is redundant and that such wastage could have been avoided.

They made this claim in an article on “Avoidable waste in the production and reporting of research evidence” which appeared in the prestigious journal The Lancet.

Several factors account for the high proportion of squandered spending, but Chalmers and Glasziou found that new projects make surprising little use of earlier work in the same field.

A 2011 study took a closer look at how often published clinical studies referred to previous research on the same issue. In roughly half the cases, none or only one of the earlier studies were cited, regardless of the number of studies available.

Nor does the quality of a study have much influence on the frequency of future citations. On the other hand, work which supports the scientists’ own hypothesis is significantly more likely to be cited.

These tendencies increase the risk that research is duplicated unnecessarily. A 2009 publication took a closer look at studies on the use of aprotinin to reduce bleeding in heart surgery.

The authors concluded that 52 projects out of 63 were superfluous, and that more than 5 600 patients were subject to unnecessary placebo trials or other controls.

Attention

This problem is attracting increasing attention, and The Lancet published a special issue on it in 2014. Chalmers contributed an article which addressed how the amount of avoidable waste can be reduced by setting different priorities.

One conclusion was that “research funders and regulators should demand that proposals for additional primary research are justified by systematic reviews of what is already known.“

Systematic reviews are summaries of  existing knowledge compiled following a specific method. Systematic searches for research within a specific area (including unpublished projects) is conducted to provide . an overall view – and one which is as impartial as possible – of what the available research say.

This approach has become the gold standard for research on the effect of health interventions. That is because individual studies are vulnerable to errors, and a limited sample often provides a biased picture of the evidence.

The Kavli Trust choice of solution

The Kavli Trust is due to grant NOK 25 million this year for health research in the Kavli countries of Norway, Sweden, Finland and the UK.

That represents a modest sum in the wider scheme of things, but the desire to avoid waste is just as great. In cooperation with the Extra Foundation in Norway, the trust has accordingly made big changes to its allocation process for 2017.

Inspired by the articles by Chalmers, this kicked off with the trust board choosing an overall area of commitment – the mental health of children and young people – for its grants over the next three years.

A strategic scientific committee then reviewed updated systematic reviews to identify key evidence gaps. Twenty-two evidence gaps were identified.

However, not all such gaps have to be closed, and priorities therefore need to be set between them. Those who are hopefully going to benefit from the research results – patients, their relatives or health personnel – should have a voice in deciding which research questions are important to answer.

As a result, the knowledge gaps were submitted to six organisations for assessment and prioritisation. Finally, the 10 highest ranked evidence gaps were included in the call for research proposals. Thirty-one well-founded applications, all addressing established and relevant evidence gaps, were submitted by the deadline of 27 September 2017, and are ready to be considered for funding.

With renewed awareness of research funding and the establishment of a structured approach with the main objective of supporting useful research and reducing waste, the Kavli Trust is probably one step closer to ensuring that research is based on evidence gaps and that it is relevant to users. The upcoming assessment of the submitted proposals will reveal whether this process really does meet the trust’s objectives.

Scientific research is a resource under great pressure.The trust receives far more good project ideas than it can fund. As the studies cited above show, good arguments exist for taking greater control of the priorities set. The trust would accordingly urge all institutions and funders to give greater emphasis to securing systematic reviews and user priorities when determining what health research to pursue.

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