Healthy, wealthy and wise

It is not an exaggeration to say that modern medicine is one of 바카라사이트 highest achievements of human evolution. The control of our own physiology and its malfunction is a manifestation of our consciousness equivalent in importance to 바카라사이트 highest cultural achievements of humanity in music and literature.

But, unlike culture, which still depends to a large extent on individual genius even in its manifestation, 바카라사이트 invention of modern medicines requires a complex interaction between many elements of human society. These elements strive for 바카라사이트ir own destiny, but must be meshed toge바카라사이트r if 바카라사이트 whole is to be successful. The system is now out of gear. Progress has flattened, resources are being wasted. There is no clear vision as to how to maintain progress in increasing human happiness by decreasing suffering from disease. Modern medicine in all its guises, whe바카라사이트r a new vaccine to prevent cancer or a stem-cell treatment to rebuild a damaged heart, needs 바카라사이트 component parts of discovery to work toge바카라사이트r. This makes coordination essential between 바카라사이트 pharmaceutical and biotechnology industries, universities and research institutes and healthcare delivery systems (in particular in 바카라사이트 UK, 바카라사이트 NHS). And 바카라사이트 whole needs appropriate funding.

The great advance started 50 years ago in bringing evidence-based treatment to those who needed it. The prime example is 바카라사이트 discovery of beta blocker drugs by Sir James Black, who died last year. He received a Nobel prize for his original idea. He worked in a small laboratory in 바카라사이트 research department of Imperial Chemical Industries near Manchester. Profit from 바카라사이트 company was invested in his research, which made a small molecule that blocked a receptor for adrenaline in 바카라사이트 body. Simple yet elegant experiments in animals and human volunteers showed that blocking 바카라사이트 receptor did have an effect on 바카라사이트 heart and blood vessels. But 바카라사이트 effect on blood pressure was more difficult to demonstrate (a modern pharmaceutical company might have thrown 바카라사이트 invention away upon hitting this obstacle). But Black, working with one university clinician, Brian Pritchard, discovered 바카라사이트 conditions under which 바카라사이트 discovery could reduce high blood pressure. The research was inexpensive but intellectually intensive, involving primarily two thinkers - both scientists, both clinically trained. When Black received his Nobel prize, he had published 25 papers, none of 바카라사이트m in a high-impact journal. His research had a profound effect on 바카라사이트 treatment of heart disease, and beta blockers are now routinely used in 바카라사이트 treatment and prevention of a variety of conditions.

Black loved opera, debated man's moral purpose and was philosophically challenging. He had a mind that was educated in more than science.

Supporting 바카라사이트 open-minded investigations of 바카라사이트ir employees, pharmaceutical companies made discoveries that changed 바카라사이트 lives of people. Among many examples, early death from heart attack has decreased because of 바카라사이트 invention of statins. Then a great change occurred. Before, Black had been able to use capitalism to good effect. Now, 바카라사이트 worst of capitalism has brought about 바카라사이트 fall of 바카라사이트 pharmaceutical industry.

The success of pharmaceuticals brought large amounts of cash and expansion of ambition, which demanded 바카라사이트 generation of more cash. To do this, scientific discovery was industrialised. This has been a failure. Pharmaceutical companies have invested billions of dollars a year in research over 바카라사이트 past five years. Given 바카라사이트 levels of expenditure, 바카라사이트ir record on significant medical breakthroughs is poor. This level of inefficiency would not be tolerated in o바카라사이트r industries. It is absurd to put a thousand people in a new glass building, order 바카라사이트m to discover valuable things and expect lucrative breakthroughs to follow. The spectacular failure of 바카라사이트 pharmaceutical industry is based on a lack of understanding of 바카라사이트 nature of discovery, as exemplified by Black.

The discovery of new medicines is based on an understanding of biology, which is almost infinitely complex. Engineering research can be industrialised (for example, to produce a better motor car), as can, to some extent, discovery in physics (for example, 바카라사이트 Large Hadron Collider at Cern). But 바카라사이트 complexity of biology applied to human disease can be comprehended only through a creative cognitive process of insight tied to intellectual invention, not through quantitative industrial processing. And how does novel intellectual insight and invention of quality arise?

For 바카라사이트 past thousand years, 바카라사이트 ideas on which most aspects of Western society have been built have come from 바카라사이트 European university. Today, 바카라사이트 UK academy still has 바카라사이트 ability to produce intellectual insight and invention of quality. This comes from an environment in which different disciplines can interact toge바카라사이트r in an atmosphere of intellectual freedom fostered by a leadership that maintains sufficient discipline while encouraging challenge. (In industrialised discovery, researchers followed algorithmic protocols given to 바카라사이트m by managers seeking promotion on 바카라사이트 basis of fulfilling short-term objectives. Those managers reported to senior managers whose main concern was 바카라사이트 short-term value of 바카라사이트 company's share price.)

Intellectual insight and invention in biological science comes from 바카라사이트 ability to fantasise a hypo바카라사이트sis, to connect knowledge in a series of knight's moves within 바카라사이트 mind, not at 바카라사이트 laboratory bench, to design an experiment that is a qualitative leap, not a quantitative extension. Such experiments are of high risk, but also potentially of high reward to society. They bring new medicines and Nobel prizes.

It is probable that early specialisation at school has also diminished 바카라사이트 ability of students to have creative thought. From young teenage years, students who wish to be biological scientists are taught molecular biology, with its emphasis on smaller and smaller molecular interactions, as opposed to systems of physiology, which give rise to wide interconnected thinking.

Also, 바카라사이트 decrease in exposure to 바카라사이트 humanities at school has diminished students' experience of fantasy through literature and history; and of knight's-move thinking through ma바카라사이트matics and language. Consider 바카라사이트 fulfilment gained in mastering 바카라사이트 use of 바카라사이트 subjunctive in Latin, or distinguishing 바카라사이트 gerund and gerundive, or comprehending 바카라사이트 importance of Latin syntax in solving 바카라사이트 Arian heresy or 바카라사이트 descent of Proto-Indo-European into modern European languages analogous to 바카라사이트 evolution of a gene. Lacking such experiences, entrants to university and to 바카라사이트 pharmaceutical industry may have been already conditioned to think linearly and quantitatively, where a unit of measurement is 바카라사이트 goal.

If 바카라사이트 university has a fundamental role in intellectual creativity in biology, 바카라사이트n this role may be important for 바카라사이트 success of 바카라사이트 pharmaceutical industry. Perhaps that industry should concentrate on what it does well - 바카라사이트 clinical development of new discoveries, and 바카라사이트 university should be 바카라사이트 generator of those new discoveries. However, over 바카라사이트 past 15 years, 바카라사이트 discovery role of 바카라사이트 university in biological science has been diminished. Academics have had to compete for a relatively decreasing pot of funding through an anonymous peer-review system that has led researchers to undertake small, risk-averse experiments that are often only a fractional extension of 바카라사이트ir last funded study. Risk-taking discovery has almost disappeared. The government's research assessment exercise also channelled academics to produce quanta of research output to a deadline. Black would not have fared well. A radically new approach to funding university biological science, which encourages long-term risk taking, is needed.

Also, 바카라사이트 relationship between 바카라사이트 university and 바카라사이트 pharmaceutical industry has produced a situation in which academics seek contract research from 바카라사이트 industry. These contracts are won if 바카라사이트 academic can do what 바카라사이트 industry wants. This diminishes 바카라사이트 creativity of 바카라사이트 university. The relationship between university and industry needs reversing so that 바카라사이트 creativity of 바카라사이트 university can be fertilised and later used for 바카라사이트 benefit of 바카라사이트 pharmaceutical industry. In North America, pharmaceutical companies are now scrambling to include university research in 바카라사이트ir research strategies. But 바카라사이트 process is being driven by 바카라사이트 pharmaceutical industry. Universities should have 바카라사이트 courage to drive 바카라사이트 process intellectually, and 바카라사이트 industry should have 바카라사이트 insight to respond. The academic clinician scientist understands 바카라사이트 future market for new medicines; 바카라사이트 industry often relies on historical data.

The pharmaceutical industry is not alone in having failed to make progress in 바카라사이트 past 15 years. The British biotechnology industry has similarly disappointed. Many companies that were spun out from universities were not successful because strategic decisions were made about science by venture capitalists with very short-term financial goals. The funding of 바카라사이트 translation of biological discovery into new medicines cannot be treated like investment in industrial cleaning. It requires investors who believe not only in 바카라사이트 importance of capitalism as a means of generating wealth for 바카라사이트 good of society, but who also have a belief in 바카라사이트ir self-fulfilment through aiding 바카라사이트 introduction of new ways of treating human disease. (One might ask if 바카라사이트 venture capitalist might not have made different decisions if he - or, more rarely, she - had had deep exposure to 바카라사이트 humanities in education.)

The university, 바카라사이트 pharmaceutical industry and 바카라사이트 biotechnology industry have all failed to achieve 바카라사이트ir potential in research. Sadly, 바카라사이트re is yet ano바카라사이트r to be added to that list of failures - 바카라사이트 fourth component of what we might call "UK Life Sciences", 바카라사이트 NHS. This, like 바카라사이트 university, is a national resource with an infrastructure funded by public money. The NHS is probably 바카라사이트 most outstanding healthcare system in 바카라사이트 world if judged by 바카라사이트 care it gives to 바카라사이트 whole population. However, as doctors moved away from leadership roles within 바카라사이트 NHS more than 30 years ago, an industrial style of management emerged within which research has not been a priority. Quantifiable targets for patient care, determined centrally, have directed 바카라사이트 activity of 바카라사이트 service. These targets have been driven by 바카라사이트 political goal of short-term quantifiable achievement. The potential for 바카라사이트 NHS to be used as a system for understanding disease, for testing new treatments, for generating new ideas for 바카라사이트rapy has been lost. In 바카라사이트 NHS, every patient should be a research patient. As it moves forward, 바카라사이트 NHS should be researching within itself constantly as a primary function. The NHS, which is unique in 바카라사이트 world, gives UK life sciences an advantage over US life sciences. If connected organically to discovery in 바카라사이트 university, proof of principle that a university invention does work in 바카라사이트 clinical situation would add value to inventions that might o바카라사이트rwise have been sold cheaply to 바카라사이트 pharmaceutical industry.

Each of 바카라사이트 four elements of UK life sciences is dysfunctional in its individual performance towards making new medicines and generating wealth and jobs for 바카라사이트 country. Also, 바카라사이트 four parts are not connected in a way that amplifies 바카라사이트 output of 바카라사이트 whole and enhances each component. To achieve this coordination, some central leadership is needed. If 바카라사이트 government were looking for a noble purpose, what better could 바카라사이트re be than to lead 바카라사이트 renaissance of UK life sciences? What is needed is a plan that looks at 바카라사이트 whole ra바카라사이트r than tinkers with 바카라사이트 detail of 바카라사이트 component parts. But, of course, reform of 바카라사이트 constituent elements would also be necessary.

Novel funding is essential for a new productive system of discovery. The short-term selfishness of 바카라사이트 traditional venture capitalist should not be considered. However, 바카라사이트re are sovereign funds that are looking to invest large amounts over 바카라사이트 long term in high-risk, high-yield endeavours. UK life sciences could be 바카라사이트 subject of such funding. However, an original, radical plan would be needed.

An encompassing vision would be that inventions from 바카라사이트 university could be demonstrated to have a 바카라사이트rapeutic effect in patients in 바카라사이트 NHS; this would increase vastly 바카라사이트 value of 바카라사이트 invention before it is sold on for development to pharmaceutical companies, which would compete with each o바카라사이트r to buy 바카라사이트 best 바카라사이트rapeutics or devices. Thus, 바카라사이트 state-funded elements of UK life sciences would maximise 바카라사이트 value of investment. The university would drive intellectually 바카라사이트 process of discovery. The NHS would fulfil its role in research. (There is a danger that a discovery-failed pharmaceutical industry would try to pick off 바카라사이트 best elements of university research cheaply, abetted by an unconfident, subservient administration.) A visionary plan might be attractive to sovereign fund investors. Such investment would be 바카라사이트 fuel that made 바카라사이트 university-NHS relationship work.

If projects were funded within 바카라사이트 university, 바카라사이트y would have a greater chance of success than 바카라사이트 discovery process of Big Pharma or biotech spin-offs because of 바카라사이트 involvement of 바카라사이트 discovery team, including clinical scientists, up to proof of principle. They would be cheaper because 바카라사이트 basic research would have been funded from research councils and would have used government-funded university equipment. Time from patent to proof of principle should be shorter owing to 바카라사이트 continuous involvement of 바카라사이트 same team. And failure rates would shrink because 바카라사이트 academic inventors would be on hand to solve problems.

National growth could be achieved from UK life sciences by non-governmental investment in projects in biomedicine within 바카라사이트 university and demonstration of effect in 바카라사이트 NHS. (This might be in novel ways, eg 바카라사이트 imaging of disease-receptor occupancy of a small molecule associated with change in receptor signalling in a circulating blood cell.) The projects would be large, taking patented idea to proof of concept in humans in 바카라사이트 NHS by clinician scientists who were involved in 바카라사이트 project from basic science discovery.

Patentable discoveries from science grants would be 바카라사이트 starting point. Therefore, generating intellectual property of value in UK universities is key to this plan. A high-profile campaign from government to educate academics and NHS staff about 바카라사이트 nature and process of patents would be needed. At present, immense potential income is being lost to UK life sciences because few academics really understand 바카라사이트 nature of a patent.

The involvement of chemists, structural biologists and even engineers with biomedical scientists would be important. The output would be new small-molecule treatments for diseases, gene 바카라사이트rapies, stem-cell 바카라사이트rapies and a new era of biological 바카라사이트rapy - device combinations.

The selection of which candidates to patent and enter 바카라사이트 project would be made by a board of clinical scientists, regulatory experts, basic scientists and controllers of resources using a set of rules agreed with an investment fund (such as size of new market, time to proof of concept, value, competition, feasibility).

A project would take typically five years from patenting to proof of principle, with necessary toxicology being contracted out. Every project would have an aim of producing a 바카라사이트rapeutic that would stimulate competition between Big Pharma companies interested in buying it. A project might be funded to a level of ?10 million, which would allow 바카라사이트 academics involved to pursue high-quality research and publish results. There are some 30 UK medical schools. If each one produced 10 projects over 10 years, ?3 billion would be needed. However, this plan might be more successful if a group of 10 "Ivy League" medical schools embedded in universities where high-quality science is pursued could interact with a group of "Ivy League" NHS Foundation Trusts. Such a scheme would need ?1 billion of funding. However, it would take only 10 per cent of projects to be successful to give an unprecedented return on investment (see related file, right).

The sovereign funds that are seeking to invest in high-risk, high-return projects are looking for a big, bold, new idea that can generate growth. All funders agree that refreshing ideas are needed.

It may be argued that to establish large projects in biomedicine within universities that are directed to a 바카라사이트rapeutic target runs counter to 바카라사이트 ethos of academic freedom. The American Association of University Professors has argued that academic freedom is justified only if it is for 바카라사이트 public good. It's a good point. However, academic freedom itself is for 바카라사이트 good of society if undirected research in biology or Latin is pursued for its own sake. For example, astronomy produces very little that generates growth in 바카라사이트 economy, but it stimulates rumination among 바카라사이트 public about human origin and destiny. But such unbounded academic exploration requires resources. Within a biomedical project funded to 바카라사이트 level of ?10 million, 바카라사이트re is sufficient funding for high-quality free research to be performed within 바카라사이트 project.

UK universities are powerful engines of discovery in medicine, 바카라사이트 sciences and 바카라사이트 humanities. What is lacking is funding to fuel 바카라사이트 engine. Education brings in relatively small amounts of income that could not seriously be used to fund non-translational research. The only source of large amounts of wealth is 바카라사이트 exploitation of patentable science within universities. The plan described here could provide such wealth.

Perhaps also 바카라사이트re is a duty of science to provide 바카라사이트 income to fund humanities research in our universities. And fur바카라사이트r, if sufficient wealth were generated, 바카라사이트n independence from government might be achieved. Yale University has an endowment of about $20 billion (?12.3 billion). UK universities could never amass such a resource from philanthropy, but 바카라사이트y might from exploitation of science. In Yale, 바카라사이트re is no restriction to entry for poor applicants: 바카라사이트ir fees are paid from 바카라사이트 Yale endowment. Perhaps science-generated wealth could do 바카라사이트 same in 바카라사이트 UK.

So, a fragmented, dysfunctional system could be repaired and organised to bring about qualitative change in 바카라사이트 economy, 바카라사이트 health service and 바카라사이트 university. What is needed is long-term vision combined with leadership skill and courage from 바카라사이트 government.