Statistics from Altmetric.com
To anyone undertaking laboratory or clinical research in the neurosciences a recent publication by the Wellcome Trust,1 the world's largest biomedical charity, is of great interest. Although specifically aimed at reviewing the quality of neuroscience research in the United Kingdom, an important goal was to identify the problems of neuroscientists, which are certainly typical of those encountered in neuroscience research communities across the globe.
Although everyone is aware of the tremendous financial burden imposed on society by neurological and psychiatric disease, the report usefully quantifies this cost. For example, in the United Kingdom these diseases accounted for 8% of all NHS costs in 1994, representing an estimated cost of £3.4 billion, undoubtedly an underestimate. In the United States the annual economic cost of Alzheimer's disease, depression, and stroke alone has been estimated to be US$174 billion. Not only is this burden, resulting from neurological and psychiatric disorders, set to increase in developed countries where there is steadily increasing longevity, it will also increase in the developing countries, where the shift in the age distribution of the population due to the progressive eradication of communicable diseases will lead to a greater proportion of the disease burden being associated with neurological and related disorders.
Has the response to this increasing burden of neurological and psychiatric disease in terms of research funding been appropriate? In the United Kingdom the main research funding sources are the Medical Research Council (£56.9 million in 1996–97), the Wellcome Trust (about £60 million in 1998), and to a much smaller extent but no less important, many other neurological charitable organisations. In the United States President George Bush heralded in the “Decade of the Brain” in 1990, which led to an NIH-wide real increase in spending of 22% between 1991 and 1995. Even as the decade comes to an end the 1998 budgets for the NIH show an additional and separate US$37 million allocated for research into brain disorders. The European Union launched their own “Decade of the Brain” initiative in 1992. However, although this initiative may have led to increased spending on brain research in the 4th Framework Programme (1994–8) and the current 5th Framework Programme, the neuroscience slice of the biomedical research cake is modest in comparison with the United States. The largest player in the field, however, is of course the pharmaceutical industry, which, it has been estimated, invested $37.3 billion in 1996 for research and development for cures or preventive therapies for neurological and psychiatric disorders.
What then are the main issues confronting neuroscience research today worldwide, according to the sample of neuroscientists surveyed for the report? Interestingly, one might have expected lack of funding to be considered the main issue, but it was second to a perceived lack of career development for young scientists. This mainly related to the young non-clinical neuroscientists, yet it surely also applies to the research training of neurologists and psychiatrists. The third commonest issue identified was the management load of the best researchers. All these problems are of course endemic to working within the United Kingdom university research system, rather than being specific to neuroscience research, but they probably extend beyond the United Kingdom.
The report also summarises the outcome of a workshop meeting to discuss the future of neuroscience research where the main points were:
The need for multidisciplinary research throughout neuroscience and for funding mechanisms to encourage multidisciplinary research programmes
The next incremental advance would be to study a further level of organisational complexity within a researcher's experimental system
The application of newly developed genetic technologies to neuroscience research
The need for high quality infrastructural support.
To return to the research training of clinicians in neurology and psychiatry, this differs from one country to the next, and even in the United Kingdom there is no consistency across medical specialties. Currently most junior doctors planning a career in neurology will undertake a period (2–3 years) of either clinical or laboratory based research after their senior house office posts in general medicine, and before they have even been appointed to a neurology specialist training post. In psychiatry, research is undertaken, often in association with a taught MSc course, during their specialist training. Both models have their advocates, but undoubtedly we are not maximising opportunities to promote the development of high calibre clinician scientists. To complete an MD/PhD and then follow it with 4–5 years of solid clinical neurology training is hardly ideal, leading as it does to a severance from research at a critical time for any trainee wishing to develop an academic career. Equally, is it really necessary for all trainees to undertake such a concentrated, inappropriately timed, period of research when most will become busy clinical neurologists in district general hospitals?
In the United States research training usually takes place after specialty training, during the subspecialty fellowship period, or for the elite by undertaking a combined MD/PhD programme at Medical School. In other European countries—for example, in Germany—research training is obtained as the trainees pass through their specialiy training, although often in their own time.
Is there then an ideal system to ensure a sufficient cohort of first rate clinician scientists in neurology and psychiatry? Probably not—indeed, flexibility in clinical and research training is what is required, and strategies imposed either by custom or by too rigid application of statutory regulation are unhelpful, yet are undoubtedly difficult to change. If we are to exploit the rapid expansion in our knowledge of normal and disordered brain function which has developed in the laboratory and transfer it to the bedside we need clinician scientists. Failure to develop more appropriate models of training and career development will undoubtedly slow down this vital transition.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.