This third pillar has three objectives, which I discuss in detail below. Broadly, they ensure that knowledge generated with Wellcome funding is accessible and usable, that it is used to influence policy and practice, and that it influences methodological and technological practice and advances.
With this pillar in particular, we recognise that using knowledge effectively is a team game, and one that involves a diverse and international squad with a wide range of skills.
The merits of a diverse approach to improving health have been emphasised recently by Richard Jones and James Wilsdon in their Nesta paper The Biomedical Bubble. It also emphasises:
- the importance of balancing investments in different areas of science and in different parts of the UK
- behavioural determinants of health
- public engagement
- the need to be more experimental in modes of funding
- research evaluation
- research culture, including reproducibility.
Much of this is very relevant to what we are aspiring to do in pillar three, and I’ll address the other points in my future discussion of pillar four, Promoting an environment in which research can flourish. So what do the three objectives mean in practice?
1. Ensure knowledge is accessible and usable
There is now an inexorable (I hope it’s inexorable) march towards truly open science, one outcome of which will be that knowledge will indeed be accessible and usable.
From my perspective as a researcher, I want to be able to click on any paper, at any time, from anywhere in the world, and see it immediately: no paywall, no messing around. I still get a frisson of pleasure when I get immediate access to a paper – and a feeling of intense irritation when I can’t.
Wellcome has led the way in this area for over 20 years, and continues to innovate. We were the first funder to introduce a mandatory open access policy, and as Robert Kiley and I discussed recently, we are now reviewing this policy to make sure it serves science as well as possible.
Robert has also contributed to a commentary calling on journals to publishing peer review reports. I hope that Wellcome will be one of the first funders whose policy embodies the principles of the European Commission’s Plan S, that "…research funded by public grants provided by national and European research councils and funding bodies, must be published in compliant Open Access Journals or on compliant Open Access Platforms".
To these ends, Wellcome’s Research Enrichment Fund provides support to allow grantholders to develop innovative ways to make their research open, accessible and reusable. Wellcome Open Research, based on the F1000 Research platform, allows researchers to publish their papers rapidly and completely transparently:
- referees’ reports are published
- referees are identified
- authors’ responses are published
- comments from registered users are also made available.
And, to allow credit where it’s due, referees’ reports are assigned a Digital Object Identifier (DOI), so that they can be cited and, if appropriate, contribute to a researcher’s CV.
In other areas, Wellcome’s Longitudinal Population Studies Strategy specifically highlights the need to "encourage the integration of LPS data from a variety of sources". The strategy includes efforts to make valuable resources, such as UK Biobank, ALSPAC and the China Kadoorie Biobank, easier to find, access and use.
2. Facilitate the use of knowledge to influence policy and practice
Scientific research can sometimes be difficult to understand and difficult to explain. It frequently raises more questions than it answers, and often the answers need to be put into context.
Take the recent kerfuffle about safe alcohol limits. A paper in the Lancet provided a meta-analysis of the risks of drinking that concluded: "We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero." In other words, there’s no safe level of drinking.
A sobering conclusion, but in the absence of context it took a brilliant piece by David Spiegelhalter to spell out the actual risks, which he did with his usual élan.
What this illustrates is the importance of making sure that knowledge is accurate, in context and succinct. As Wellcome’s Imran Khan and Farrah Nazir explain in their blog, the approaches we adopt need to take into account that what seems the easiest option for us might not work best for those outside Wellcome.
Using knowledge effectively to improve practice is something our Population Health team, led by Mary De Silva, does all the time. We support excellent research, introduce new schemes to address important problems, and work in partnership.
Last May, Clinical Senior Research Fellow Sinead Langan examined the health records of over 2 million people in the UK. She found that people with severe eczema have a 20% greater risk of stroke and a 70% increased risk of heart failure (Link found between severe eczema and heart problems, Guardian, 23 May 2018).
This is a good example of how population health research can be used to provide clues for basic science to investigate in detail. Is there a common biological pathway between eczema and heart failure? It can also be used to develop more effective interventions by targeting patients more appropriately, for example by monitoring people with severe eczema for potential cardiovascular events.
In low- and middle-income countries, health policy is not always informed by the available evidence. The HIGH-Res Award (Heightening Institutional capacity for Government use of Health Research) aims to help ministries of health to make better use of health research. It’s administered by the Alliance for Health Policy and Systems Research (AHPSR) with Wellcome.
To support the use of knowledge to influence policy, the Science team is working with colleagues in the Policy team to involve younger voices in policy discussions, organising events in the UK, and further afield in Spain and Estonia.
And Wellcome’s backing for understanding patient data and our introduction of priority areas (especially Our Planet, Our Heath) both contribute to discussions on policy. We have recently launched a new priority area in mental health. A further two areas are in development: Snakebites, and Data for Science and Health.
3. Influence methodological and technological practice and advances
We hope our new Leap Fund will encourage ambitious and multidisciplinary research which will lead to real technological advances. But we recognise that no single funding mechanism will achieve everything we want to do.
That’s why, as well as our core funding activities – schemes, centres, programmes and institutes – we are creating flexibility within our budget to allow us to respond to new and innovative ideas, and to adopt creative approaches such as the International Brain Laboratory and the Human Cell Atlas. I’ll be writing more about this in future blogs.
Another way we work to influence practice and advances is by getting experts together to reinvigorate the science. One example is our forthcoming nutrition science meeting. Another is a joint workshop at the Academy of Medical Sciences involving Wellcome, the MRC and NIHR, to explore research priorities for multi-morbidity in the UK and in low- and middle-income countries. Multi-morbidity is an under-investigated area which has the potential to advance our understanding and treatment of many high burden diseases. I think all this work will be enormously influential.
My next blog will focus on promoting an environment in which research can flourish. The importance of this can’t be overstated, both with respect to creating and using scientific knowledge effectively, and to strengthening research capacity.
As ever, I welcome your thoughts on any of the topics I’ve touched on this blog. You can email email@example.com, or contact me via LinkedIn or Twitter.