What should be the funding agenda?

This is part of the paper I had covered yesterday around why clinical research is not useful. Yes, it includes the myriad “systemic reviews” or the “practice changing guidelines” that you see on Twitter. Most presentations are also carefully reworded or “re-established” principles of what had long been known.

From here:

Blue-sky research cannot be easily judged on the basis of practical impact, but clinical research is different and should be useful. It should make a difference for health and disease outcomes or should be undertaken with that as a realistic prospect.
Many of the features that make clinical research useful can be identified, including those relating to problem base, context placement, information gain, pragmatism, patient centeredness, value for money, feasibility, and transparency.
Many studies, even in the major general medical journals, do not satisfy these features, and very few studies satisfy most or all of them. Most clinical research therefore fails to be useful not because of its findings but because of its design.
The forces driving the production and dissemination of nonuseful clinical research are largely identifiable and modifiable.
Reform is needed. Altering our approach could easily produce more clinical research that is useful, at the same or even at a massively reduced cost.

I’d quote the last slide/picture here:

In effect, instead of public funded risky research, it should move to industry instead. From the author:

Discovery research without prespecified deliverables—blue-sky science—is important and requires public support. However, a lot of “basic” investigation does have anticipated deliverables, like research into developing new drug targets or new tests. This research may best be funded by industry and those standing to profit if they deliver a product that is effective. Much current public funding could move from such preclinical research to useful clinical research, especially in the many cases in which a lack of patent protection means there is no commercial reason for industry to fund studies that might nevertheless be useful in improving care. Reallocation of funds could help improve all research (basic, preclinical, and clinical) (Table 3).

I couldn’t agree more.