Abstract
The effects of the UK’s prospective exit from the European Union are in hot dispute. Arguments for and against continue to be keenly contested except, that is, when the conversation turns to science and medicine. Here, the loudest voices and most prominent arguments suggest that the decision taken by the public will cause harm.
One such argument is around the future of the European Medicines Agency, which is based in London but is expected to relocate to mainland Europe. Our editorialists from Italy are mindful of this change but argue for a deeper reform of the work of the agency.
Livio Garratini et al. identify a central flaw in the Agency’s operations, whereby approval for drug safety and efficacy rests with the agency but assessment of cost-effectiveness is devolved to individual countries. A better approach, and Brexit is an opportunity to take it, is for the Agency to take on both activities, allowing countries to better negotiate drug prices to make new drugs more affordable for the benefit of citizens of the European Union. 1
Another fear is loss of European research grants, which places the next research assessment exercise, planned for 2021, in distant but sharp focus. In August, an independent review of the Research Excellence Framework, chaired by Lord Stern argued for fundamental reform.
Three recommendations stood out. First, researchers should not be able to take their research excellence scores with them when they ‘transfer’ between universities. Second, universities should be prevented from manipulating the denominator, which allows them to falsely inflate their productivity. Third, the assessment exercise should measure the social and economic effects of research.
All of these will bring opposition, challenges to implementation, and the debate will be intense. UK research grants of £2 billion per annum are at stake. The prospect of losing European research grants is very real. Change will be resisted and, indeed, changing institutional culture and behaviour tends to be slow.
The future is ever uncertain but less daunting if we learn from the past. Take duty of candour, for example. Claire Hilton reminds us of Barbara Robb’s campaign to improve care at a London hospital in the 1960s and 1970s. 2 National Health Service employees knew what was happening to patients, including swearing, hitting and roughly handling the elderly. A member of staff who complained about this behaviour was moved off patient care and asked to clean copper pipes in the bathroom.