Wim Weber on the implementation of research in European clinical practice

Wim WeberOn May 11, in the centre of Berlin, the European Science Foundation presented “Forward Look – implementation of medical research in clinical practice.” Forward Looks are consensus reports with a long term view of research and they aim to define research agendas at national and European levels. This one was developed under the tireless and pragmatic leadership of Liselotte Højgaard, professor of nuclear medicine in Copenhagen, and chair of the European Medical Research Councils. For a document produced from the corridors of EU bureaucracy it is surprisingly readable and practical. Its 76 pages are condensed into 10 recommendations, from which three key issues emerge: patient participation, rigorous reporting, and guidelines.

The occasion was fittingly held at the European School of Management and Technology at the Schlossplatz in Berlin, Germany: the square has had various names and appearances through successive German rulers’ implementation exercises, the present one being a year long archeological excavation. Six prominent speakers gave their perspectives on the report.

Annette Grüters-Kieslich, dean of the Charité Medical School in Berlin, gave us a historic overview of her institute. It produced 10 medical Nobel laureates, but despite this success she told us that, in implementation, patience is still a virtue. “People complaining about the pace of this, should realise that it took decades to find a cure for tuberculosis after Robert Koch discovered its cause, and even now that time frame has not come down very much,” she reminded us. It is exactly this time lag that the present Forward Look aims to shorten. As spending on research is not likely to be increased, it makes sense to try to put existing knowledge into practice faster. The following speakers did indeed make it clear that things have not improved much since Robert Koch’s discovery.

Iain Chalmers took an aim at mis-spent time and money for research, both for too much and for too little: “Why did we need 65 trials to show that aprotinin does indeed decrease peri-operative transfusion, and why did we take 35 years to find out that steroids do not work, and are even harmful,  in head trauma?” he asked.

Patience is also required in implementing better reporting of clinical research, as Trish Groves, deputy editor of the BMJ, told us. In 1986 R J Simes called for registration of clinical trials, and the EU has only just recently opened up access to its obligatory trials registry EUDRACT, through a new portal.   

Moving further down the implementation pathway Stig Slørdal, cardiologist and dean of the medical faculty in Trondheim, Norway, showed a sobering slide from the AHRQ 2006, illustrating that for most disorders large fractions of patients do not receive guidelines adhering medical care, “… and that does not even take into account that certain disorders are rising dramatically.” Here he was referring to obesity, which he paradoxically described as “aiming at a moving target…”

Günther Ollenschläger, internist, and head of the German Medical Guidelines Institute, gave us a systematic overview of the German guidelines development process, which is impressive and thorough. He cautioned about the lack of oversight of European guidelines development, “as some are afraid that this process is more prone to conflicts of interest.” The guidelines developing community is very active and will convene for their next annual congress in Berlin.

Finally, Ruxandra Draghia-Akli, director of the Health Directorate at the Research DG of the European Commission, gave us the policymakers’ angle: funding for research in Europe is only ¼ of that in the USA, and China will surpass us in a few years. The European Commission proposes major changes to EU research funding to make participation easier and provide better value for money.

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Wim Weber is the european research editor, BMJ