Exploratory Study on the Future of Nephrology 2007

Transcription

1 Exploratory Study on the Future of Nephrology 2007 Summary Exploratory Study on the Future of Nephrology 2007 By Arjen Rienks Version: 29 October 2007 Summary version: 4 February 2008 Content 1. Introduction 2. Interviewees 3. Summary 4. Appendix: Information Text 1

2 1. Introduction The Dutch Kidney Foundation (Nierstichting Nederland) is a major sponsor of scientific research into renal disease and renal failure. Research primarily takes place within a programme that evaluates subsidy applications in an open competition. In 2007, this Open Research Programme included three subsidy rounds, each with a EUR 750,000 budget. This programme forms the foundation s Biomedical Scientific Research Programme (Biomedisch Wetenschappelijk Onderzoek, BWO) together with the Kolff Programme for personal support of researchers and a number of top-down projects, including the Nephrological Winter School for young researchers and the Implantable Artificial Kidney. The goals of the BWO are the promotion of renal research in the Netherlands and improving the quality of the research field. The Dutch Federation for Nephrology (Nederlandse Federatie voor Nefrologie, NFN) and the Kidney Foundation have been receiving worrying reports of possible threats to the position of renal research in the Netherlands. Examples include the departure of the heads of the nephrology departments at the University Medical Centres (UMC) within a relatively brief timeframe and the major efforts required to recruit young, talented researchers. General societal trends doubtlessly play a role, but there may also be effects that only or primarily affect nephrology. In order to gain greater insight into the research field and Dutch renal research, an Exploratory Study on the Future of Nephrology 2007 was conducted. Open interviews were conducted with nineteen researchers and nephrologists using data collected from the field about signals and trends (see the information text for interviewees in the appendix). Overall, the interviews began with problems, moving on to directions for nephrology then the role of the Kidney Foundation, bringing up the points mentioned in the information section. The interviews also focused on the topics the interviewee felt were important. Interviewees were drawn from the UMCs and various thematic research areas, supplemented by a number of individuals outside the academic nephrology world but with a clear connection to it. The results can be found in this report, presented as accessible interviews with point-by-point summaries. A brief summary and analysis of the findings follows in the final chapter. First and foremost, the report is an internal publication for the Kidney Foundation and the NFN with very limited circulation. It is a starting point for the discussion of threats to and new directions for renal research and the foundation s research policy. 2

3 2. Interviewees 1. Professor S. Florquin, AMC Amsterdam, Pathology 2. Professor R.T. Krediet, AMC Amsterdam, Nephrology 3. Professor M.M. Levi, AMC Amsterdam, Head of Internal Medicine 4. Professor P.M. ter Wee, VUmc Amsterdam, Nephrology 5. Professor P.E. de Jong, UMC Groningen, Nephrology 6. Professor G.J. Navis, UMC Groningen, Nephrology 7. Professor J.W. de Fijter, LUMC, Nephrology 8. Professor A.J. Rabelink, LUMC, Nephrology, Chairman of Nierstichting WR 9. Professor J.W. Cohen Tervaert, Maastricht Academic Hospital, Immunology 10. Professor K.E. Leunissen, Maastricht Academic Hospital, Nephrology 11. Professor J.H.M. Berden, UMC Radboud Nijmegen, Renal Diseases 12. Professor V.V.A.M. van Slobbe-Knoers, UMC Radboud Nijmegen, Clinical Genetics 13. Professor J. Wetzels, UMC Radboud Nijmegen, Renal Diseases. 14. Professor A.J. van der Heijden, Erasmus MC Rotterdam, Paediatrics 15. Professor W. Weimar, Erasmus MC Rotterdam, Nephrology 16. Dr W.H. Boer, UMC Utrecht, Renal Diseases 17. Professor H.J.G. Bilo, UMC Groningen Internal Medicine, Internist Isala clinics 18. Professor J.J. Weening, Tergooi Hospitals Blaricum & Hilversum, UMC Radboud Nijmegen, Pathology 19. W. Geerlings, MSc, Chairman of the Kidney Foundation Board of Directors, member of MC Haaglanden Board of Directors 3

4 3. Summary Conclusions and recommendations The major threat to the Dutch Nephrology field is a lack of fresh new research talent and the difficulty of replacing top researchers when they leave. The difficulties of obtaining funding for renal research apparently play a key role in this. The scientific output of Dutch renal research in top nephrological journals has increased over time; there is clearly nothing wrong with the quality of the work being done. Heading off these threats is an important task for nephrology. A role for the Kidney Foundation in the form of a new stimulus is desired, but precisely what this stimulus should be remains unclear. Given the available resources and the problems mentioned, the Kidney Foundation s task is to implement the ideas into policy in such a way as to maintain broad support for initiating new plans in the research field. The two main spearheads identified in the interviews are: (1) strengthening the basic infrastructure, and (2) concentration and focus. These are not necessarily incompatible, and can support each other in a two-pronged approach. This is essential if broad support is to be maintained. However, it also represents a financial challenge. Conclusions The biggest threat is the lack of young talent and a lack of new top researchers. The image and attractiveness of renal research is probably largely determined by the presence of an inspiring head researcher and an interesting research programme. Financing renal research is more difficult. The publication output from renal research is good and increasing. Recommendations Develop a substantiated vision for research and research policy. Make sure the kidney patient remains central to the efforts. Develop new stimuli for renal research. A key goal is the encouragement of talented young researchers and grooming of new top researchers. Perform a thorough cost-benefit analysis of new plans and ideas; carefully weigh advantages and disadvantages. Help tap new funding streams as an intermediary. Strive for broad support and a two-pronged approach. Promote the concentration of paediatric nephrology. Promote both spearheads for mutual reinforcement: Strengthen the basic programme to create an internationally renowned Dutch research field and encourage talent (Kolff Programme and Open Research Programme). New initiatives: stimulate top research centres at a basic level (but do not focus on a single research centre for the whole of the Netherlands) or strengthen specific thematic research areas by means of a themed subsidy round or by providing focused support for strong research groups or lines of inquiry. Preconditions: Competition and objective evaluation of plans Temporary nature of additional investments The importance of translational research Involvement of the UMCs 4

5 The interview results Threats to Dutch nephrology. Many UMC Nephrology department heads departing within a relatively short timeframe, sometimes without clear appointment of a successor. Financing for renal research has decreased. Finding and holding on to talented young researchers has become more difficult. Opinions vary regarding the image of nephrology and renal research. Clinical patient-related research and translational research were mentioned as types of research that do not occur frequently enough. A number of interviewees felt that the culture within Dutch nephrology is too focused on competition rather than cooperation between groups. The role of UMCs varies. Paediatric nephrology is under a great deal of pressure, and seems to be withdrawing into patient care. Direction for the future of nephrology. Overall, two spearheads can be identified. Concentration and focus: based on the idea of forming a small number of nephrological research centres with a strong focus within (or superimposed upon) the current structure (centres of excellence, centres of expertise). This will likely lead to more and better research and attract the young talented researchers required for the continuation of renal research in the Netherlands. Necessary requirements: competition, objective assessment (preferably by an international advisory council), maintenance of the basic programme and building on existing structures, the importance of translational research and implementation of results. Aiming for a single research centre for the whole of the Netherlands is widely considered to be unadvisable. The Netherlands as a research space: based on the idea that the existing structures in the Netherlands form a single research space, but that greater cooperation within a network of eight research departments is required for further development. The goal is the creation of a national infrastructure with the reputation of being focused on international research, as well as local scouting for research talent. This will ultimately benefit both renal research and patient care. Each centre can maintain its own area of interest within this structure. The finely meshed network and fully fledged academic departments will guarantee the quality of the research, training and ultimately care. Direction for renal research. There was no broad agreement on this point. The following themes were mentioned frequently: Transplantation and transplant tolerance Dialysis and quality of life Regenerative medicine and cell therapy Physiology and causes of renal disease, genetic causes The complex surrounding metabolic syndrome and diabetic renal disease Secondary prevention Clinical patient-related research and translational research The role of the Kidney Foundation. The importance of a substantiated vision on research was mentioned frequently; clear ideas, ambitions and goals based on reliable information from research and the field. A new additional stimulus from the Kidney Foundation and the examination of the possibilities were mentioned several times. However, there was no agreement with regard to the nature of this stimulus. Opinions tended to fall under one of the two previously mentioned spearheads. 5

6 Strengthening basic programme (Open Research Programme and Kolff Programme): Personal funding: foreign fellowships, draw more medical doctors into research, appointment of special professors Stricter requirements for research: translational research, clinical patient-related research, implementation of results Potential new initiatives: Concentration and focus in new research centres: only under strict conditions with objective assessment of plans in open competition An additional thematic round in open competition (for example a themed top research round on the subject of transplant tolerance or regenerative medicine) The focused stimulation of selected strong groups or lines These investments would be temporary additional investments evaluated objectively in competition. Development of research space: Stimulation of new funding streams, the Kidney Foundation as an intermediary: industrial partners, support of EU funding applications, nephrological networks. Stimulate national infrastructure: cooperation, registration and the importance of largescale research projects. 6

7 Publication output A small-scale study of PubMed-indexed publications was conducted. Publications with explicit mention of a Dutch research institute in the PubMed record in five top nephrological journals were counted over a ten-year period. The linear trends indicate that scientific output from Dutch renal research published in the top five journals has undergone both relative and absolute growth. The publication frequency of between 3.5 and 4 per cent is probably over-proportional (estimated, eg. relative to population sizes of the US, EU and Japan). Figure: absolute number of Dutch publications in five top nephrological journals Figure: relative number of Dutch publications in five top nephrological journals. 5 4,5 4 3,5 3 2,5 2 1,5 1 0,

8 4. Appendix: Exploratory Study on the Future of Nephrology - Information Text for Interviewees The Kidney Foundation aims to promote the quality of life of renal patients. Scientific research into the causes and treatment of renal disease is a key part of its activities. The Kidney Foundation's goal is to promote the quality of nephrological research and the nephrological field and to guarantee this for the future. The Kidney Foundation is receiving signals from the field that the position of nephrology in the Netherlands is at risk of deteriorating in the future. Additionally, plans for repositioning nephrological research in the Netherlands are being developed. That is why the Kidney Foundation established an explorative study on the future of nephrology. A consultation of the field will be performed through interviews with researchers and key figures in Dutch nephrology. The goal is to gain insight into current thinking in the field. The results will help form a starting point for a discussion of the future of nephrological research in the Netherlands and the Kidney Foundation's future policies. Questions: What obstacles are there for the future of nephrological research in the Netherlands? In which direction should nephrological research in the Netherlands be headed? What are the necessary conditions? What is the role of the Kidney Foundation? Signal subjects Retirement and departure of key scientific figures The place of nephrology within the UMCs Research themes and innovation The image of Nephrology, attractiveness to young talent The position of translational and clinical nephrological research The competition between nephrological research project submissions and nonnephrological research groups Technology transfer and implementation of research results Ideas for repositioning Concentration of research in a limited number of places (centres of excellence/expertise) Focus on a small number of innovative research themes Linking nephrology with one or more other fields Setting up a specialised research school for nephrological research The exploratory study will result in an internal report containing the interviews and an analysis of ideas about the future of nephrology in the Netherlands gathered from the field. The interviews in this report will not be anonymised. Circulation will be limited to the interviewees, the Supervisory Board, Executive Management and the scientific advisory councils of the Kidney Foundation. The Kidney Foundation will contact the parties concerned prior to any widening of the report's circulation or reuse of material in the report. The Kidney Foundation will not engage in further distribution or reuse without prior consent. 8