Trust the Doctors to Deliver

The traditional model of company-led research can be rather slow to bring a drug or a product to market, and in many cases, the main reason can be summed up in one word: bureaucracy. There certainly can be a speed advantage when it comes to clinician-led research (CLR). However, not all CLR is equal, and there are good ways and bad ways of practicing it. Done right, it can be a fast, powerful, effective and credible means of developing a product and providing the clinical evidence that’s required to bringing it to market.

The critical aspect is independence: whenever a company performs in-house research, there’s always a perception of bias (rightly or wrongly) that the final result will be in favor of the company’s product. A better model is industry-funded CLR projects that are completely independent of company oversight. If the clinician describes the purpose of the study, it makes the results more appropriate to the community. To me, these results are more believable, and I find them more easily and immediately applicable to my patients too. In my view, the ‘translational’ aspect of clinical development is far easier with CLR.

I’m Director of the International Council of Ophthalmology’s fellowship program. We work with industry – in this case, Allergan – to fund research fellowships that support research that recognizes innovation advances, and the scientific understanding and clinical management of ophthalmic diseases. The award is open to ophthalmologists from all specialties and all countries. We have jury members for all of the subspecialties, and two best-rated applications from each subspecialty go to a final jury, and then a final decision is made who will get the $50,000 to do research in a different department for one year. And Allergan has no impact on the decision – and this is a really generous and a well-received gesture, and is an example of how I’d like to see all CLR funding work. I also think fellowship applications should come with a statement from the applicant’s program director that he or she is allowed to resume their previous position once they return from the fellowship – nobody wants someone to be in the position that their career ends because their former boss doesn’t want to give back their last position!

Andrew Carnegie once said of teamwork: “It is the fuel that allows common people to attain uncommon results.” If you don’t have a good team that’s ready, willing and able to do the tasks you delegate to them, then all the funding in the world won’t help you. My approach is to ensure that every member of my (160-strong) team is able to at least one thing better than me, to delegate, and when it comes to CLR, have an excellent, full-time study coordinator! It also helps if everybody involved is on the same level, and in the same place. At Saarland University, I am a clinical professor of the Department of Ophthalmology, but I’m at the same professional level as the electrical engineering professor of the Institute of Experimental Ophthalmology. We work closely together in the same building: he is on the fourth floor, I am on the first. If we need to meet to discuss something, he just comes down, brings some of his people, I bring some of my people, and we get on with the task at hand. If the clinician was at one location, and the research lab was 100 km away – I just don’t think that will work for the best. CLR, wherever possible, should be conducted under the same roof.

Of course, there will always be situations where a more traditional, company-led, internal approach might be a better option. But when it comes to speeding translation from bench to bedside, and generating data that’s credible to fellow clinicians, I strongly believe that independent CLR research is the best way to do this.