Amid headlines raising concerns about the integrity of the Medical Research Future Fund, academics have called for more structured efforts to engage the public’s views on medical research priorities, “as the ultimate consumers of research”.
They also suggest the MRFF should be prioritising research to improve our health system, addressing questions such as how best to increase access to dental care.
Adrian Barnett and Philip Clark write:
The Medical Research Future Fund (MRFF) is a A$20 billion fund to support Australian health and medical research. It was set up in 2015 to deliver practical benefits from medical research and innovation to as many Australians as possible.
Unlike the other research funding agencies, such the National Health and Medical Research Council (NHMRC), most of the MRFF funding is priority-driven. It seeks to fund research in particular areas or topics rather than using open calls when researchers propose their own ideas for funding.
As the Nine newspapers outlined recently, researchers have criticised the previous Coalition Government’s allocation of MRFF funds. There is widespread consensus the former Health Minister had too much influence in the allocation of funds, and there was limited and sometimes no competition when funding was directly allocated to one research group.
The current Health Minister, Mark Butler, has instituted a review.
So how should the big decisions about how to spend the MRFF be made in the future to maximise its value and achieve its aims?
Assess gaps in evidence
Research priorities for the MRFF are set by the Australian Medical Research Advisory Board, which widely consults with the research sector.
However, most researchers and institutions will simply argue more funding is needed for their own research. If the board seeks to satisfy such lobbying, it will produce fragmented funding that aligns poorly with the health needs of Australians.
A better approach would be to systematically assemble evidence about what is known and the key evidence gaps. Here, the board would benefit from what is known as a “value of information” framework for decision-making.
This framework systematically attempts to quantify the most valuable information that will reduce the uncertainty for health and medical decision-making. In other words, it would pinpoint which information we need to allow us to better make health and medical decisions.
There have been attempts to use this method in Australia to help inform how we prioritise hospital-based research. However, we now need to apply such an approach more broadly.
Seek public input
A structured framework for engaging with the public is also missing in Australia. The public’s perspective on research prioritisation has often been overlooked, but as the ultimate consumers of research, they need to be heard.
Research is a highly complex and specialised endeavour, so we can’t expect the public to create sensible priorities alone.
One approach used overseas has been developed by the James Lind Alliance, a group in the United Kingdom that combines the public’s views with researchers to create agreed-on priorities for research.
This is done using an intensive process of question setting and discussion. Priorities are checked for feasibility and novelty, so there is no funding for research that’s impossible or already done.
The priorities from the James Lind Alliance process can be surprising. The top priority in the area of irritable bowel syndrome, for example, is to discover if it’s one condition or many, while the second priority is to work on bowel urgency (a sudden urgent need to go to the toilet).
While such everyday questions can struggle to get funding in traditional systems that often focus on novelty, funding research in these two priority areas could lead to the most benefits for people with irritable bowel syndrome.
Consider our comparative advantages
Australia is a relatively small player globally. To date, the MRFF has allocated around $2.6 billion, just over 5% of what the United States allocates through the National Institute of Health funding in a single year.
A single research grant, even if it involves a few million dollars of funding, is unlikely to lead to a medical breakthrough. Instead, the MRFF should prioritise areas where Australia has a comparative advantage.
This could involve building on past success (such as the research that led to the HPV, or human papillomavirus, vaccine to prevent cervical cancer), or where Australian researchers can play a critical role globally.
However, there is an area where Australian researchers have an absolute advantage: using research to improve our own health system.
A prime example would be finding ways to improve dental care access in Australia. For example, a randomised trial of different ways of providing insurance and dental services, similar to the RAND Health Insurance Experiment conducted in the United States in the 1970s.
This could provide the evidence needed to design a sustainable dental scheme to complement Medicare. Now that is something the MRFF should consider as a funding priority.
• Adrian Barnett is Professor of Statistics, Queensland University of Technology. He researches the research process, and is interested in how health and medical research can be improved to give a better return on investment. He is the president of the Association for Interdisciplinary Meta-research & Open Science.
• Philip Clark is Professor of Health Economics, University of Oxford
See Croakey’s series of articles, #MRFFtransparency