“If I were on a mountain top and looked down on Western Australia’s research centres, I might see five or six faint little lights. By collaborating, we can produce one light that is much more clearly visible. We are not trying to take away autonomy or identity of any one institution but we are saying if that institutions work together for an enhanced product, that’s to everyone’s benefit.”
In what is now the post-Stephen Hawking era, the outgoing Executive Director of the Western Australian Health Translation Network (WAHTN) Prof John Challis’ cosmological aspirations for the Perth medical research community and WATHN’s role in connecting them is not only apt, it’s also looking increasingly achievable.
The WAHTN was formed in 2014 to encourage collegiality and co-operation among the state’s universities, hospitals and research institutes because, anecdotally, local health and medical researchers were growing increasingly despondent by the westward flow of NHMRC and other funds slowing to a trickle at the South Australian border.
John, a Cambridge and Oxford-trained biomedical scientist, arrived from Vancouver in 2013 to take up the position of Pro Vice-Chancellor for Health and Medical Research at the University of Western Australia. He took the view that the state’s health and medical research sector would grow only in a piecemeal fashion if siloed research groups continued to compete (unsuccessfully as it was turning out) for scarce research dollars.
He had most recently led the Michael Smith Foundation for Health Research in Vancouver which did for researchers there what he hoped the WAHTN would do for the WA fraternity.
Collaborators not competitors
“Local universities are starting to realise that they are not each other’s competitors. They have to lift their sights. I’ve worked at Harvard and Toronto, and if we’re not playing at that level of excellence then we’re not really in the game,” he said.
“So once research institutes start looking up and out, it’s not a stretch to think that maybe our ability to play that game is enhanced by collaborating through shared platforms – a clinical trials and data management centre at Curtin, or phenome centre based at Murdoch and Fiona Stanley Hospital. That’s what is starting to happen and that’s a win for the sector and, most importantly, the people of WA who are benefiting from better, evidence-based medicine.”
“Research becomes less about individual egos, and more about better and more equitable health for the people of WA. We mustn’t lose track of that.”
All this may have been little more than fine sentiment if not for the commitment of the WA Labor Government and the staunch support of Health Minister Roger Cook, who has made good his pre-election promise to repurpose the state’s future fund to a medical research future fund.
“The $1.1-$1.3 billion future fund capital will generate about $33m a year. That’s huge and what’s needed to recruit some of the best clinical-research people to ensure that WA can participate in developing and delivering the best care to WA patients,” John said.
Success attracts success
This state-based funding will give local researchers some stability and sustainability, which in turn will make WA projects more attractive to those distributing money from the $20 billion national medical research future fund and the NHMRC.
That’s the logic, but the hard work needs to continue to keep the local institutions open and ready for such a future.
To give some idea of the state government’s commitment to research, the Michael Smith Foundation received from its provincial government about $35-45m a year for a population twice the size of WA.
“The commitment from the WA government is significant. The Michael Smith Foundation uses these funds to recruit and unify research teams so they can become more competitive for Ottawa (the national capital) dollars. In WA’s case, it’s to draw dollars from Canberra or the NHMRC,” John said.
“Already we’re seeing the $60m interest payments from the $20b national future fund flowing through. In the next few years that should grow to about $130m and then $600m a year. That’s really getting up there and will make Australia very competitive.”
“The other important consequence of the WA future fund is the message it sends internationally that the WA government is serious about health and the health of its population because it is investing in building a culture where medical practice is based on solid evidence. They’re not just saying that in words, they are putting cash on the table. That becomes hugely important when you want to retain and recruit the best.”
“Research is expensive but it can be self-sustaining and it’s the role of the WAHTN to help local organisations achieve that. Our core activities are to catalyse new research and new initiatives; facilitate the conduct of translational research; and unify partnerships and partners across the network.”
Finding the right team
“We firstly need to attract physicians and allied health workers interested in being at the international cutting edge, who want to explore new concepts and new ways to better treat patients and who want to combine clinical practice with research. We need to understand disease so we can diagnose and treat earlier and better.”
“The key aim must be to keep people out of hospital.”
“We know that for every $1 invested in health research you get $5 return in terms of population health and productivity. Then, of course, there is commercialisation of innovation outputs.”
John uses Murdoch University Professors Steve Wilton and Susan Fletcher’s work on Duchenne Muscular Dystrophy as not only an example of researching and developing a treatment that will change the lives of affected individuals across the world but also developing technology that can unlock treatments for other diseases, which will improve outcomes exponentially.
“Developing a drug is one thing, creating the technology they have come up with, is quite remarkable. The object of the exercise is preventing disease, but if you can’t prevent, you need to find a treatment and to do that you have to maintain currency.”
With the interim report of the Sustainable Health Review suggesting that WA needs to spend much more on preventative strategies to stem the flow of patients into our hospitals, John argues that prevention of disease underpins the research culture.
He cites the cohort studies which have put WA in the research sights of hundreds of international researchers for decades. He explains that WAHTN has established a WA Cohorts Network so that studies such at the Busselton, Raine, Health in Men, Fremantle Diabetes and ORIGINS among others can work together in some key areas.
It’s good to share
“These studies are all in different stages of maturity so WAHTN asked them how we could help. They told us they needed opportunities for data sharing and biobanking, if they could be assured of the quality, harmonisation and standardisation.”
“The potential of sharing data and biosamples across cohorts is enormous.”
“This takes a change in mindset and it’s my role to enable and facilitate that change. You can’t force people to collaborate but you can create a supportive environment and hopefully colleagues will see that coming together is an opportunity worth pursuing.”
WAHTN has a number of training workshops for researchers, from good clinical practice principles to data management and informed consent. Some are online, some are face-to-face and its those workshops that incubate collaboration.
In June last year, WAHTN was accredited as one of seven NHMRC Advanced Health Research and Translation Centres (AHRTC) in Australia. It puts WA among the national players and puts some of the local innovations in front of a national audience.
The AHRTCs have national projects funded by the Commonwealth Future Fund – around indigenous health, data sharing, management and security, and the development of new innovative health care systems. John co-chairs a workshop on consumer and community involvement in research, which he suspects, though the project is still running, will show WAHTN’s consumer networks lead the country.
Well-respected health consumer advocate Anne McKenzie heads us the consumer network at WAHTN and is building on her work with WA and Telethon Kids to create a state-wide program, sponsored by Lotterywest, which will effectively mean all research projects will have consumer and community input at the outset.
Consumers shape focus
“Consumer advocates will help shape the questions research will ask, how it will be done and even be involved in the review of grant applications. The Cancer Council has been doing this for a while now,” John said. “It will mean that when research findings are ready to publish, they won’t just appear in esoteric scientific journals, they will also be understandable and relatable to a community that has been an integral part of the research pipeline.”
Having consumers at the table is also having an impact on how clinicians and scientists communicate, which John says is no bad thing.
“It focuses a researcher having to understand what issues concern consumers and what they want from research. It makes a researcher think and communicate differently. It’s a researcher’s job to ensure consumers understand.”
As research institutes start talking to each other constructively and the funding environment becomes less combative and more supportive, universities are opening their minds and doors to collaboration.
A clinical trials and management centre supported by the WA Department of Health and facilitated by WAHTN is being established at Curtin University by Prof Christopher Reid, a cardiovascular epidemiologist and clinical trialist with a specific interest in quality improvement and outcomes research. The management centre will serve as a resource for all researchers wanting to do clinical trials.
“Professors Steve Webb and Peter Thompson along with Chris Reid have been fantastic at running a seminar series rotating around the partner institutes and hospitals giving researchers developing a clinical trial support and advice,” John said.
Openness improves chances
“That’s a huge change. People are prepared to open themselves up to constructive commentary from their peers and it is bearing fruit. Peter Thompson told a team meeting that this year we could anticipate 3-4 trials to be submitted for NHMRC grants through the new WA centre. We are at last starting to get some structure.”
As John prepares to depart WAHTN as executive director – and former Chief Medical Officer Prof Gary Geelhoed readies to step in – he is not leaving the local scene. He will continue as a consultant particularly around the establishment of a southern research hub based at Murdoch University, Fiona Stanley Hospital and Perkins South.
Murdoch University with Prof Rob Trengove directing, is leading a consortium of all five WA universities, UNSW, Telethon Kids Institute, Perkins Institute, Imperial College London and the WAHTN to establish the Australian National Phenome Centre at Perkins South. It has received more than $7m from the Australian Research Council, Lotterywest and partner institutions.
The centre, which will open in 2018, is developing and delivering metabolic phenotyping services.
“This is all about personalised medicine, ensuring that before a person is treated with a particular drug, we determine if it is the right drug for the right patient at the right time. This is a huge improvement for the patient and has the potential to offer significant dollar savings,” John said.
“The era of trial and error is rapidly passing.”
So too, it would seem, the era of crossed purposes and parochialism. Next stop, breaching the Federal-State divide.