The issues surrounding medical research

The College of Psychiatrists of Ireland, Spring Conference, Virtual Meeting, 25-26 March 2021

The College of Psychiatrists of Ireland held its second virtual meeting on 25-26 March 2021. The theme of the Spring Conference was ‘Science and Psychiatry,’ and featured many interesting speakers and presentations over the two days.
Prof Seamus O’Mahony recently retired as Consultant Gastroenterologist at Cork University Hospital. At the start of his presentation, he declared he was probably one of the first gastroenterologists to present at a College meeting. He spoke to the conference on the current state of medical research.

Prof O’Mahony qualified in 1983 – towards the end of what is known as “medicine’s golden era,” which he defines as the 1930s to the 1980s. During this time the DNA double helix, antibiotics, anti-tuberculosis drugs, antipsychotics, and vaccines against polio, influenza, pneumococcus, and measles were all discovered. The first randomised control trial was carried out. Smallpox was eliminated. Organ transplantation became possible. In fact, Prof O’Mahony, who
is also an author and Medical Independent columnist, stated that before the golden age, medicine had little to offer.
The medical-industrial complex also emerged during the golden age of medicine: The pharmacy sector, insurance companies, medical education, academic medicine, scientific journals, “big pharma,” tech corporations, and venture capitalists.

There was “huge optimism during the golden age”, Prof O’Mahony stated. It was assumed that the progress being made at that stage would continue at the same rate, indefinitely. However, although “dissenting voices were rare during the golden age”, there were some individuals who could see what was to come. Sir Macfarlane Burnet was a Nobel prize-winning virologist who released a book in 1971, which argued that the successes of the golden age were the treatment of infection, trauma, and malnutrition, and that this period was coming to a close. He predicted the diseases of the future would be those of old age and degeneration, and these diseases would not be conquered like infectious diseases. He was not wrong, according to Prof O’Mahony.

Although there has been progress in these diseases, he said it has been “far more incremental and far less dramatic” than the progress that was made in the golden age. Furthermore, over the years, the speed of new drug development has declined. Prof O’Mahony pointed out that before the pandemic, the World Health Organisation officially declared the lack of new antibiotics a crisis.

Prof O’Mahony informed conference attendees that what is “really remarkable” about the scientific publishing industry is its profit margin. Elsevier, the biggest scientific publisher, has a profit margin of 40 per cent on its turnover. This is “vastly greater” than other industries, such as banking, with a profit margin of just over 20 per cent, and car manufacturing, just over 10 per cent.

The model of scientific publishing was created by Mr Robert Maxwell, according to Prof O’Mahony. Mr Maxwell described scientific publishing as a “magic money tree”. The products, scientific papers, are given to the publisher for free. Researchers review and edit these papers free of charge and the product is then purchased mainly by government-funded institutes. “It’s a triple pay system,” Prof O’Mahony said.

“Predatory journals” have now also emerged – these journals will publish anything as long as you pay them. Prof O’Mahony said the number of these journals grew extensively during the pandemic. A “replication crisis” has also emerged in the scientific community; the results of most research studies cannot be confirmed or replicated when the study is repeated. In 2015, a symposium on the replication crisis was held in London –attended by the Academy of Medical Sciences, Biotechnology and Biological Sciences Research Council, Wellcome Trust, and the Medical Council.

The report that emerged from the symposium determined several factors contributing to the crisis: Irrelevance, poor design, poorly and overly regulated publishing bias towards positive studies, and most importantly, the “cultural” factor. Researchers work in a “hyper-competitive environment”, which requires publishing metrics to generate grant income.

Furthermore, most clinical trials are industry funded, often leading to skewed and biased results. Cancer trials are particularly “notorious” for using meaningless time points in order to get new drugs past licensing. He pointed out how the NHS Cancer Drugs Fund was set up in the UK to pay for drugs that had been turned down by the National Institute for Clinical Evidence and were awaiting approval. £1.27 billion was put into this scheme, and of the 47 drugs that it funded, only 18 per cent improved survival rates and only by an average of three months. Prof O’Mahony highlighted that this money would have paid for every hospice in the UK, which rely on charities for the majority of their running costs and many of which have had to close due to lack of funding, for 18 months.

Psychiatry is a field that struggles to receive funding, Dr O’Mahony told the audience. A report last year by the International Alliance of Mental Health Research Funders made the first global map of mental health research funding. It was found that $3.7 billion is spent on mental health research each year, while cancer receives two and a half times this. Most of this money is spent in high income countries on basic rather than clinical or applied research. Furthermore, despite the fact that self-harm and suicide account for more than half of all life lost due to mental illness, this area received one of the lowest levels of funding.

In Ireland, 6 per cent of the healthcare budget is spent on mental health services. He suggested that perhaps healthcare funding could be distributed more wisely.