Think "medical research," and there's a good chance you'll draw up images of drug trials aimed at investigating and ultimately producing chemicals tailor-made to address a given ailment. Indeed, a healthy chunk of medical research is focused on producing new pharmaceuticals. But a new study in the United Kingdom suggests that neither patients nor their doctors are particularly enthusiastic about that work—they'd prefer less research on drugs and more on managing their health, and on physical and psychological therapy.
While it's no big surprise that patients, physicians, and medical researchers disagree on what scientists should study, it's surprisingly hard to find evidence on how those groups' priorities differ. Americans, for example, generally support both basic and applied scientific research, but scientists and pollsters don't seem especially interested in finding out what the general public's goals are in medicine or any other discipline.
The majority of research priorities focused on understanding the effectiveness of such treatments as psychotherapy, physical therapy, and changes in diet and exercise.
That's not to say that there's a shortage of opinions on the matter, or that scientists should do whatever doctors, patients, or politicians want. But it might at least be nice find out what those interests are, right?
That's what a team of researchers led by Sally Crowe thought, anyway. Crowe and colleagues Mark Fenton, Matthew Hall, Katherine Cowan, and Iain Chalmers looked at data collected by the James Lind Alliance, an organization that creates what they refer to as "priority setting partnerships" between clinicians and their patients to identify what those outside the research community believe should be the focus of academic and commercial research.
JLA priority setting partnerships begin by asking patients and the people who care for them what questions about a given medical condition they'd like to see answered by science—in particular, what potential treatments they'd like to see researchers evaluate. Following an online vote to determine a shortlist of a few dozen topics, small discussion groups work to develop a top-10 list of priorities.
Drawing on 14 such lists covering everything from tinnitus to schizophrenia, the team identified the kinds of treatments people hoped researchers would examine. The majority of research priorities—59 percent—focused on understanding the effectiveness of such treatments as psychotherapy, physical therapy, and changes in diet and exercise. Only 18 percent of JLA-determined priorities concerned pharmaceuticals, while 23 percent focused on more intrusive treatments such as surgery or radiation therapy.
Those numbers don't line up with research that's actually underway, however. A look at 1,682 studies registered with the World Health Organization's International Clinical Trials Registry Platform found that 37 percent of academic and government studies were set up to evaluate pharmaceuticals, while just 32 percent focused on non-drug, non-surgical treatments. The divide was even more extreme for commercial studies, 86 percent of which concerned pharmaceuticals.
"[R]esearch on drugs is preferred by researchers, evaluation of non-drug treatments is preferred by patients and clinicians," the researchers write, and leadership and incentives would be needed to change that. "The current research 'system' and culture is not geared to bridging the mismatch we have documented."
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