Research as altruism

Australia needs more clinician–researchers, backed by the Medical Research Future Fund and a less time-consuming and more secure funding process, says director and CEO of the Burnet Institute, Professor Brendan Crabb, AC

It's not unusual for an Australian medical researcher to spend 3 months of every year writing grant applications to initiate or keep alive the projects that drive this country’s reputation for innovation and development.

Is that process too difficult? Does it take up too much of a researcher’s time that could be spent on the real work?

Professor Brendan Crabb, AC, director and chief executive officer of the Burnet Institute for medical research, thinks so.

“It should be hard”, Professor Crabb tells the MJA.

“It needs to be competitive. It needs to be tough. This is an international playing field — there’s nothing local about health and medical research. If you’re not doing the best stuff in the world, you can’t be in it.

“There isn’t anyone who thinks, though, that we haven’t gone too far.

“We run the risk now, and we’re already seeing it, of our top people, or otherwise really talented people who should be choosing health and medical research as their career, saying ‘I don’t think so’.”

They’re doing that because they have other options, he says, or, if they choose to do medical research, they’re choosing to do it somewhere other than Australia, “where the funding is a little more secure”.

The success rate in the National Health and Medical Research Council (NHMRC) project grant scheme is now down to about 15%, half of what it should be, says Professor Crabb.

“You don’t want it to be easy to get grants, but you certainly don’t want it to be almost impossible, or a lucky dip.”

The alternatives to moving overseas to conduct research are to get out of the research field, or to spend a large chunk of time preparing grant applications.

“Grant applications are a good thing — they help you hone things and plan what you’re going to do very carefully, but again, it’s too much”, Professor Crabb says of the time commitment needed to craft a successful grant submission.

A molecular biologist by training, Professor Crabb’s research career focused on malaria, especially in the development of vaccines and new treatments for the disease.

He is immediate past president of the Association of Australian Medical Research Institutes and is the current chair of the Victorian chapter.

He teaches at the University of Melbourne and Monash University and took on the job as CEO of the Burnet Institute 7 years ago.

Almost 2 years ago, the final report from the Strategic Review of Health and Medical Research, led by Simon McKeon, AO, was published, and highlighted a growing crisis of diminishing numbers in Australian research. The amount of research being done by Australian medical practitioners was diminishing.¹

Among other factors, the McKeon Review found that the problem lay with inadequate funding set aside for clinician-directed research, the apparent income disparity between work in the clinic and in the lab, and the lack of a clear career pathway for those wanting to combine the two.

Its recommendations included increasing the number of NHMRC practitioner fellowships to 1000 over 10 years and embedding research training as part of education and accreditation in order to support dual researcher–practitioner education pathways.

As far as Professor Crabb is concerned, there are still “nowhere near enough” clinician–researchers in Australia, but the situation has improved since the 2013 review.

“The McKeon Review had tremendous traction and those recommendations are starting to trickle through”, he says.

“The problem has been recognised, some of the solutions have been identified, but we still have a major challenge to implement that.”

The answer comes down to two things — “money and policy”, he says.

“We think we’ve got the policy, or at least the framework that will address that issue.

“We don’t yet have the money and the Medical Research Future Fund (MRFF) … would obviously provide those funds.

“So I don’t think we’re far off having a circumstance under which it is much more attractive for clinically oriented people to do more research.”

Professor Crabb coauthored a Perspective in the 16 February issue of the MJA that was strongly supportive of the MRFF, regardless of the political environment.²

“Australia has one of the best and most efficient health care systems in the world, underpinned by past and current research, and the potential to do much more is exciting”, Professor Crabb and his coauthors wrote.

“The MRFF offers us a way to achieve this potential, and the evidence shows that all Australians stand to benefit.”

So why should medical students, trainees and registrars consider taking on such a difficult and potentially frustrating career in research?

“It will make them better doctors, for a start”, Professor Crabb tells the MJA.

“They don’t need to have any great vision of what they can contribute to research.

“There’s no way to really understand the research paradigm and what it brings unless you actually have a go at it.

“The more clinicians or people in training for clinical work do some research, even if they have no intention of making that a mainstay of their career, the better they will be at their job.”

But it’s more than a self-interested pursuit, he says.

“The second reason [for doing research] is that the research that actually is done benefits enormously from people who are at the coalface.

“When the very same person who is seeing patients is actually going back into the laboratory or into field-based research — I don’t think you need to be tremendously psychoanalytical to realise that that is a really good circle.

“It makes the research very focused on the problems that are really there.

“Thirdly, [clinician–researchers] are among the most talented, if not the most talented people in the country, therefore they should do the research and the research will benefit enormously from that talent.”

When Professor Crabb took on the directorship of the Burnet Institute in 2008, it was a merging of two research leviathans — the Macfarlane Burnet Institute for Medical Research and Public Health and the Austin Research Institute — both with their own well respected research agendas.

Professor Crabb and his executive wanted to give the new entity a single focus. Rather than a disease, the focus would be on a group of people — the poorest, most marginalised, and the most vulnerable people locally, nationally and internationally, with a focus on our own Asia–Pacific region.

“That’s really changed everything for us”, he says. “We look at everything through that prism.

“You don’t have to look very far to realise that these things — [the health and wellbeing of society’s most vulnerable populations] — impact on us all.”

Medical research has an altruistic edge to it, and that, Professor Crabb says, is perhaps its most attractive quality.

“It’s the right thing to do. It creates an economically better world, a safer world, a world in which you as the donor would be healthier.”

It’s that bigger picture that intrigues Professor Crabb and, he hopes, will similarly lure future generations of clinician–researchers.

“Every year, despite all you’ll see, the world is actually getting better”, he says.

“And that paradigm of the better off supporting those who are less fortunate is what’s delivered that. And primarily what’s delivered that is innovations in health.”

1. Strategic Review of Health and Medical Research – Better health through research http://www.mckeonreview.org.au
2. Cunningham AL, Anderson T, Bennett CC, et al, Why Australia needs a Medical Research Future Fund. Med J Aust 2015; 202: 123-124.

The full interview with Professor Crabb is available as a podcast and video in the multimedia section at www.mja.com.au/multimedia