Clinical research in scotland

1. Clinical Research in Scotland
John Savill
University of Edinburgh
and
Chief Scientist Office
Scottish Government Health Directorates

2. Scotland
• 5.3M people
• National Health Service
• Stable population
• “Sick man of Europe”; high rates
of “western” diseases

4. Scotland: The Clinical
Research Engine
• One-eighth of UK researchers
• One seventh of UK funding
• Outperformed rest of UK on quality
in RAE 2008
• Core strengths in clinical
translational research

5. Scottish Clinical
Research Strengths
• Neuroscience – stroke, schizophrenia,
bipolar, cognitive decline;
• Inflammatory diseases – rheumatoid, liver
cirrhosis, lung fibrosis and emphysema;
• Metabolic/vascular diseases – diabetes,
obesity, coronary artery diseases;
• Cancer – solid tumours and leukaemias
• Reproductive disorders – menorrhagia, pre-
eclampsia and infertility

6. Scotland’s Advantages in
Clinical Research
• Electronic Records Linkage – for 5.3M people
with a single, coherently structured health
provider.
• Collaboration - Aberdeen
- Dundee
- Edinburgh
- Glasgow
(St. Andrews)

7. Electronic Records Linkage
in Scotland
• Unique identifier: CHI number
• NHS Information and Statistics Division
(probability matching)
• 30-year coded historical datasets
(admissions, prescribing etc.)
• Disease registers (Diabetes – Andrew
Morris)
• 15-year follow up of WOSCOPS

8. Routine data for long term
follow up
• Primary prevention of
heart disease
• Screened 81,000 men
• 6,595 participated
• Role of statins in
CVD management

9. Log-rank p=<0.0001
Placebo
Pravastatin
WOSCOPS 15 year follow up
Data mining in action
Original
trial
Ford et al, N Eng J Med (2007) 357 1477-86

10. Scotland: Major Collaborations in
Clinical Research
• Generation Scotland £10M (CSO/SE)
• Translational Medicine Research Collaboration
£50M (Wyeth/SE)
• Scottish Clinical Research Excellence Develop-
ment Scheme £4M pa (CSO/NES/SFC)
• SINAPSE Imaging Consortium £40M (SFC £7M)
• Scottish Health Informatics Platform £5M
(Wellcome etc.)
• Scottish Translational Medicine Training Initiative
£3M (Wellcome)
• Scottish Academic Health Sciences Collaboration
£15M pa (CSO)

11. Research infrastructure
MRI
PET/SPECT
EEG/MEG
Shared expertise
Greater critical mass
Training
Cohesion
Optimise clinical trials
Industry
SINAPSE

12. Chief Scientist Office Budget
2008/09
Total: £66.9M
Research budget: £17.5M
- Grants
- Units
- Capacity Building and other programmes
Support for Science: £37.4m
Research Networks: £10M

13. Investing in Research,
Improving Health
Its ambition is to
“place Scotland at the international
forefront of clinical translational
research and the development of
systems medicine.”

14. Focus
• Patient benefit
• Improved population
health
• Economic benefit

15. 4 Main Aims
• Securing benefit
• Improving Population Health
• Valuing and Investing in NHS Research
• Building and Sustaining Skills

16. Dundee
Clinical Research Centre
Health Informatics Centre&Memo
CRUK laboratories
Glasgow
BHFGCRC
Biomedical Research Centre
Integrated CRF
Beatson Oncology Centre
Sackler Institute
Edinburgh
Wellcome CRF
Institute Med Cell Biol
Aberdeen
IMS
IAHS
CRF
• Purpose built basic biomedical research institutes.
• Integrated general clinical research facilities.
Regulatory
affairs
VPN
Affiliated
centres

17. + +
The Translational Medicine Research Collaboration “Shared
goals, complimentary strengths, shared risk and reward”
Umbrella agreement for shared and protected IP

18. The Scottish Academic Health
Sciences Collaboration
(SAHSC)

19. SAHSC: NHS Scotland’s new platform to
support research for patient benefit and
foster related economic development.
NHS Boards Universities
Grampian Aberdeen
Greater Glasgow & Clyde Glasgow
Lothian Edinburgh
Tayside Dundee
Scottish Enterprise

20. Aims of the SAHSC
• Speeding the development of stratified/
personalised medicine;
• Doubling the number of patients
participating in clinical studies by 2012;
• Increasing competitive clinical research
funding from UK sources by ~£25M pa; and
• Developing mutually beneficial partnerships
with Biotech and Pharma.
To improve the health and wealth of
the Scottish population by:-

21. The SAHSC Platform
• Clinical Research Facilities (nurses,
physiologists)
• Clinical Research Imaging Centres
(radiographers, physicists)
• Clinical Trials Units (pharmacists,
statisticians)
• Biorepositories (pathology staff)
• Electronic Records Research Portals
(informaticians)
Health Boards and CSO work together to
reconfigure by 2012 ~£15M pa of funding to
underpin ~280 fulltime posts in coordinated:

22. SAHSC: Serving Scotland as a whole
• 4 Nodes: cluster of Boards
local universities
• Networks: cancer
dementia
diabetes
medicines for children
mental health
primary care
stroke

23. Scotland: Addressing the
needs of Pharma and Biotech
• Single point of contact: National Research Scotland
Co-ordinating Centre, register of experts
• Feasibility: Information and Statistics Division
• Recruitment/ “Consent for Consent”: Primary Care
Research Network
• “Cooksey 2”: Scottish Medicines Consortium
• Clusters: e.g. Edinburgh BioQuarter

24. NEJM Oct 2007
National Approaches to Clinical Trials

25. • Meetings
• Mail
• Media
McKinstry B, Hammersley V, Daly F, Sullivan F
Recruitment and retention in a multicentre randomised controlled trial in Bells palsy: A case study
BMC Medical Research Methodology 2007, 7:15 doi:10.1186/1471-2288-7-15

26. Scotland: Addressing the
needs of Pharma and Biotech
• Single point of contact: National Research Scotland
Co-ordinating Centre, register of experts
• Feasibility: Information and Statistics Division
• Recruitment/ “Consent for Consent”: Primary Care
Research Network
• “Cooksey 2”: Scottish Medicines Consortium
• Clusters: e.g. Edinburgh BioQuarter

27. SCRM
Royal
Infirmary
Queen’s Medical
Research Institute
Chancellor’s
Building
Little France Site/Edinburgh BioQuarter

28. The Scottish Academic Health
Sciences Collaboration
*Broad, powerful, high quality
*Embedded in conducive NHS system
*Informatics as a USP
*Collaboration and partnership add value
*Keen to work with Biotech and Pharma
*Obvious UK cluster