Task understand the state of global research into surgery and - - PowerPoint PPT Presentation

Task understand the state of global research into surgery and anaesthesia, focusing on underserved populations in low and middle income countries

Does research matter for surgery / anaesthesia?

At the cutting edge of impossible. Tex Heart Inst J, 2009, 36:453.

Surgeons & anaesthetists as general research leaders

5 10 15 20 25 30 35 40 45 50 1995-1999 2000-2004 2005-2009

% of faculty co-authoring general research papers1

• 1. Onomastic linkage study: USA (ACS et al); UK (Royal Colleges); WACS; France.

The Public Policy Challenge

Rest of talk will focus on research into the science and technology of surgery and anaesthesia

Who does surgery research? 35 countries account for 97.2% of all published research activity in surgery But surgery research

• nly accounts for 4.1%
• f global health

research activity

Scientometric analysis creation of algorithms (>230) & analysis of various Db of publications: WoS, PUBMED etc. Variety of analytical tools to study research activity

SURG frac count

Contributions to global surgical research in last 5 years (%) 8 middle income countries contribute

• nly 16.8% of surgical

research output Only 4.3% of research

• utputs specifically

‘relevant’ to underserved populations

Whose surgical research ‘matters’? Surgical research is dominated by high income countries conducting high income research

Active surgical clinical trials

(2013, with annual growth rates )

Data: WHO / ClinicalTrails.gov / India Reg / FR and UK CT registries

In comparison to medicines, surgery accounted for only 2.4% to 3.1% of total clinical trials activity between 2008-20121 High income countries account for 81% of activity, middle income 17% and low income (non-fragile) 2% Preliminary analysis shows over 73% of surgical clinical trials were only relevant to high income settings

• 1. Data reverse engineered frm USA Clinical Trials.gov

NEJM 2015, 372;11: 1031-42 & UK’s UKCRC Db

So why has it come to this? Less research active surgeons Less global research into surgery and anesthesia What research is undertaken is mostly focused on need of high income countries

Dominance of biomedical culture

Purushotham A & Sullivan R. Darwin, medicine and cancer. Annals Oncol 2010, 21: 199-203

Money matters: what are we investing in surgical research? In 2004/5 only 0.6% was surgery by 2009/10 dropped to 0.3%

• f a total annual budget
• f 12.35 billion USD1

Less than 2M USD funding surgical research in underserved populations

• 1. Analysis of USA (NIH) and UK (CRC) public funding Db

Culture of surgery as a barrier

• Smaller, single institution research
• 68% less international

collaboration

• 45% less national collaboration
• Low levels of research
• rganisation in MIC and almost

non in LIC

Group psychology cohort study on-going: personalities in surgery and medicine: a question of nature or nurture?

“Pharmacogenetics is dead and warfarin killed it””

Pulling s surgica cal r research ch b back ck from t the b brink….

Preparedness for surgical and anesthesia care

• Access to timely surgery
• Specialist surgical workforce density

Delivery of surgical and anesthesia care

• Surgical volume
• Perioperative mortality

Effect of surgical and anesthesia care

• Protection against impoverishing

expenditure

• Protection against catastrophic

expenditure

INDICATORS

The Commission has identified a plethora of key areas for research

Solving the surgical research crisis with some radical creativity

• 1. Building research training in LMIC
• 2. Research core funding as part of

capacity building from outset

• 3. Radical improvement in HIC &

some MIC research funders approach to investing in surgical research e.g. NATO, DoD, MoD & trauma surgical research in low resource settings