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Commentary on the paper by Hawkins and Law (see page 1107)
Advocacy can be a powerful force for change and those who work with children are the best advocates for the next generation. Drs Hawkins and Law have surveyed the pattern of research funding available for child and family health and have looked to see how this correlates with the government priorities for children set in the National Service Framework for Children and other government policy documents.1 Using a web based search of funding organisations they have found that the overall proportion of funding devoted to children is approximately 3%, and even lower proportions of funding are devoted to government priorities such as health inequality and adolescent services. By comparison the National Institutes for Health in the United States devotes about 11–12% of its budget to paediatrics.2
Children are not small adults. The research on adults will not necessarily be applicable to children. For example, they will have a different range of diseases and children have different responses to drugs.3 Some of this research is difficult to fund. There may be a reluctance to fund pharmaceutical trials on children as the commercial market for children’s medication is small and there may be ethical difficulties in recruiting control subjects for such studies. However in some cases it is the paediatric research that provides solutions for other age groups. With cochlear implants the research into congenital sensorineural deafness in childhood has pioneered the way for cochlear implantation to be considered in other age groups.4
In funding research there are many conflicting strategies and no one perfect answer. There has been a conflict between directing research from the “top down” and responding to research requests from those already in the field looking for “bottom up” funding. Top down money devoted to research will not always solve the problems that have been decided in government strategy. Thus research into health inequalities can provide the necessary information about the problem, but ultimately the solution is an economic or political one. Such discussions also draw attention to the conflict between applied and basic research. Basic research does not bring instant answers but ultimately has transformed our approach to medicine. The authors of the paper only included basic research if it was explicitly related to child or maternal health. How would they have rated the x ray crystallography that led to the discovery of DNA by Watson and Crick? It certainly did not set out to solve inherited disease in childhood but the ultimate spin off over many decades may be one of the most profound developments in paediatrics. It also shows how unpredictable scientific research can be. Those who want to plan medical research centrally might be surprised to read Roberts’ monograph on serendipity5 and to see how, as Pasteur put it, “chance favours the prepared mind”.
There are many sources of funding for medical research in the UK and we are fortunate to have a substantial proportion of charitable funding. It would be appropriate for the Department of Health to allocate its own research and development funding along the priorities laid down by the National Service Framework. However the charities, private sources of funding, and indeed other government bodies such as the research councils have their own independent governance and will correctly have their own priorities. The research councils and the major research charities have supported basic research and built a very strong bioscience base in the universities in the United Kingdom. Other charities supporting a specific disease have supported clinical research. This is particularly important where the current Research Assessment Exercise in our universities has often favoured basic research at the expense of clinical studies.6
In the accompanying paper by Hawkins and Law,1 almost half of the identified funding for child and family health research comes from the charitable sector. This may still be an underestimate as the authors were unable to locate the funding allocation from smaller charities by their web based search methodology. This shows the immense importance of charitable funding in the UK and this puts us in a favourable position compared with most European countries. Many charities will support a specific childhood disorder such as cystic fibrosis or spina bifida and will therefore devote almost 100% of their funding to child and family health research. This focus has helped those charities in their fundraising and reflects the public support for research into childhood disability.
We need a diversity of funding strategies so that more research ideas will fall on fertile ground and new ideas can be developed. It is wrong to assume that all research funding bodies should follow the governmental policy strategy. However, these authors have shown the level of government funding allocated for child and family health does not reflect the importance of children in our future. More clinical evidence is also required to ensure that the allocation of government healthcare funding for children provides the best possible value and outcome for children.
Competing interests: the author is Medical Director of Birth Defects Foundation UK
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