Thursday, 28 January 2016

Speeding up time-to-clinic

One thing I'm struck by, the more I work on medical projects, is how long everything takes.  Now, partly this is a a reflection on tempo of academic research, and partly it's that these projects are challenging.  But, frustratingly, in many cases there isn't a good reason - could often happen much faster, if we put our minds to it.

That begs the question of how we can more rapidly translate medical research into the clinic, where it can actually help someone.

One major limiting factor is the time it takes to get the resources to get a new project off the ground. If you need grant funding, the proposal itself can take months to put together, especially if you need to generate pilot data.  Then the process of your submitted proposal being assessed will take months more, with the associated chance of rejection in most cases.  And by the time a funded project gets started, hires the relevant people etc, over a year will have passed since you were first in principle ready to get started.   There are now funding streams which try to speed things up, but more are needed.

This couples to another problem, that medical research is often very expensive.  It's hard for funders to dole out a research grant quickly if it's for millions of pounds.  They have a responsibility to the public/their donors/etc to ensure the money is used wisely.  It is much easier for a funder to fund compact projects costing £100k than it is to dole out multi-million pound grants.  Cheaper ways to do the research would help accelerate this process.

Then there's the research project itself.  This can take a lot of time for all sorts of reasons.  And I'm afraid that academics are often very bad at focusing on getting stuff done promptly.  This is a mistake if one is concerned with maximising the value-per-unit-time one creates.  At every stage, delays creep in because people are busy etc.  If it takes a month to arrange a telecon to discuss something, that's 8% of a year wasted.  Such delays add up.  And I think academia can lack urgency, which in medical research is another mistake.  If one aspires to develop something that can save 100 lives a year, a delay of 12 months has killed 100 people...

And even once all of the above is dealt with, we may well not even have begun the process of translation.  There needs to be evidence that the research outcomes will work in the clinic (as opposed to a research lab), there needs to be a way of turning the research into a product that can then be deployed (e.g. commercialisation).  Perhaps this even needs to be built into the research project from the word go, so the definition of a successful project is that something new has been deployed to the clinic.  If all you've done is draw some conclusions and write a paper, maybe who cares?

Every single one of these steps is slow, ponderous, and flaky.  What exactly a better system looks like isn't (yet) clear, but  I'm pretty sure we want something a lot closer to an exponential organisation.

So, what should we do about all this?

Well, even a simple consideration of process optimisation would help.  For example:

1.  Remove all unnecessary steps.  If there is some funding already in place (e.g. for pilot studies), the whole grant-application step can sometimes be avoided.  If infrastructure is already in place (e.g. for data acquisition, sample collection), there is no need to have to build it.

2.  Parallelise as many steps as possible.  If we have a hundred candidate biomarkers for a disease, why not set up a project that can systematically test them all at the same time.  And for clinical trials, multi-arm, multi-stage trials end up being hugely efficient in terms of treatments tested per unit time.

3.  Make each remaining step as fast as possible.

How hard can it be...?