Elsevier

The Lancet

Volume 383, Issue 9912, 11–17 January 2014, Pages 156-165
The Lancet

Series
How to increase value and reduce waste when research priorities are set

https://doi.org/10.1016/S0140-6736(13)62229-1Get rights and content

Summary

The increase in annual global investment in biomedical research—reaching US$240 billion in 2010—has resulted in important health dividends for patients and the public. However, much research does not lead to worthwhile achievements, partly because some studies are done to improve understanding of basic mechanisms that might not have relevance for human health. Additionally, good research ideas often do not yield the anticipated results. As long as the way in which these ideas are prioritised for research is transparent and warranted, these disappointments should not be deemed wasteful; they are simply an inevitable feature of the way science works. However, some sources of waste cannot be justified. In this report, we discuss how avoidable waste can be considered when research priorities are set. We have four recommendations. First, ways to improve the yield from basic research should be investigated. Second, the transparency of processes by which funders prioritise important uncertainties should be increased, making clear how they take account of the needs of potential users of research. Third, investment in additional research should always be preceded by systematic assessment of existing evidence. Fourth, sources of information about research that is in progress should be strengthened and developed and used by researchers. Research funders have primary responsibility for reductions in waste resulting from decisions about what research to do.

Introduction

This report will be focused on the waste of resources resulting from decisions about what research to do. After exploring investment patterns, we consider waste that ensues when the needs of potential users of research evidence (ie, policy makers, patients, professionals making practice or personal decisions, and researchers and research funders deciding which additional research should be done) are ignored and what is already known or already being researched is overlooked. We conclude with recommendations for how to reduce waste when research priorities are set.

We have approached our task using the research categories suggested by Stokes:1 pure basic research (to advance knowledge), pure applied research (to increase immediate applicability of research results in practice and policy decisions), and use-inspired basic research (to both advance knowledge and increase applicability). Stokes created a schema to represent categories, which we have adapted (figure 1). He named the quadrant representing use-inspired basic research after Louis Pasteur, because Pasteur's basic research had been motivated by the need to generate evidence relevant to reductions in morbidity, mortality, and economic costs of infections in people and animals. In our adapted schema, we have retained Pasteur in his original quadrant, but replaced Nils Bohr (the nuclear physicist) with Marie Curie in the quadrant for pure basic research, because of the medical importance of her studies of radiation. We also replaced Charles Edison (inventor of the light bulb) with Richard Doll in the quadrant for pure applied research, because of Doll's work with Bradford Hill to identify smoking as a cause of lung cancer. We have named Stokes' previously unnamed quadrant the waste quadrant to take account of the many research projects that contribute nothing or very little to knowledge or to practice and policy. As Altman lamented in a much cited 1994 report,2 we need less research, better research, and research done for the right reasons—an issue that has since been revisited several times.3, 4

Recommendations

  • 1

    More research on research should be done to identify factors associated with successful replication of basic research and translation to application in health care, and how to achieve the most productive ratio of basic to applied research

    • Monitoring—periodic surveys of the distribution of funding for research and analyses of yields from basic research

  • 2

    Research funders should make information available about how they decide what research to support, and fund investigations of the effects of initiatives to engage potential users of research in research prioritisation

    • Monitoring—periodic surveys of information on research funders' websites about their principles and methods used to decide what research to support

  • 3

    Research funders and regulators should demand that proposals for additional primary research are justified by systematic reviews showing what is already known, and increase funding for the required syntheses of existing evidence

    • Monitoring—audit proposals for and reports of new primary research

  • 4

    Research funders and research regulators should strengthen and develop sources of information about research that is in progress, ensure that they are used by researchers, insist on publication of protocols at study inception, and encourage collaboration to reduce waste

    • Monitoring—periodic surveys of progress in publishing protocols and analyses to expose redundant research

Section snippets

Relative investment in basic and applied research

Global investment in biomedical research is increasing, reaching US$240 billion (adjusted for purchasing power parity) in 2010.5 Basic research is the principal beneficiary of this investment.6 More than half of the £1·6 billion in public and charitable investment in research in the UK in 2009–10 was allocated to basic research (table 1),7 a pattern that was also reported in the USA in 2012.8 This longstanding funding pattern is partly a result of assertions made many years ago by two

Ways to decide priorities for research

Funding decisions vary depending on whether priorities are set by researchers or funders solicit proposals addressing questions that they believe are important.21 Different models have been proposed for decisions about which high-risk basic research to support. They typically focus on funding of scientists rather than projects to allow maximum freedom of thinking and action.26 However, most research funding organisations do not follow this path—eg, of 35 944 awards made by the US National

Waste caused when potential users' needs are ignored

Waste results when the needs of users of research evidence are ignored. In 2011, Liberati said: “I have had the opportunity to consider from more than one perspective the mismatch between what clinical researchers do and what patients need. I am a researcher; I have responsibility for allocating funding for research; and I have had multiple myeloma for the past decade.”33 He emphasised the need for a new research governance strategy, adding that “Left to themselves, researchers cannot be

Waste caused when what is already known or being researched is ignored

In 2001, a major funder of research in the UK—the English Department of Health—emphasised that systematic assessment of what is already known or being researched is essential when decisions are made about what further research to do.56 Such assessment will identify what should be replicated, avoid unnecessary duplication, and result in research that addresses deficiencies in previous work.57 Although the point at which necessary replication becomes wasteful duplication can almost always be

Recommendations

Research funders and research regulators have the primary responsibility to address sources of avoidable waste when research priorities are set. We recommend four important ways to reduce this waste. First, more so-called research on research is needed to identify the factors associated with successful replication of basic research and translation to application in health care, and how to achieve the most productive ratio of basic to applied research. Ideas worthy of further examination are

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