Neurology in the aftermath of Brexit

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On June 23, 2016, UK citizens voted in a national referendum to leave the European Union (EU). Although this result is not legally binding, the new Prime Minister, Theresa May, has announced her intention to honour it. It will take time for the UK to leave the EU; however, the impact of the referendum is already being being felt by the neurological community across the whole of Europe. A major consequence of the vote to leave the EU is a pervasive uncertainty about the future. In part, that uncertainty comes from the mixed messages clinicians and researchers in the UK are receiving from the government. For example, although the UK government has already committed an investment of up to £150 million for a dementia research institute led by the Medical Research Council, their inability to guarantee free mobility for European workers—even for those already living in the country—will damage the ability of UK hospitals and laboratories to attract talented brain health professionals from Europe. An essential part of training for many young neurologists is provided by the opportunity to easily work abroad and learn varied perspectives on patient care from international mentors. This training and exchange of young clinicians and scientists, exemplified by the long-established interchange of ideas and experiences between neurologists at University College London in the UK and Salpêtrière Hospital in Paris, France, has been relatively easy and tremendously successful so far. However, if free movement between the UK and EU is restricted, this important exchange will be much more difficult, and the future of approximately 130 000 EU health and care workers in the UK's National Health Service will be threatened. With this in mind, many neurologists with permanent positions in the UK are already considering relocating to continental Europe. The long-term impact of the potential loss of these professionals is impossible to estimate. Leaving the EU will also jeopardise access to EU research funding. The ongoing Horizon 2020 programme (available from 2014 to 2020) is the biggest ever EU Research and Innovation programme, with nearly €80 billion of funding—including €8 billion for biomedical and health research. As the largest recipient of grants from the EU, the UK stands to damage its reputation for research excellence by potentially rendering its researchers ineligible for these funds, and putting future collaborations relying on these funds at risk. Neurological disorders do not stop at national borders, and clinical trials are most successful when they include investigators and patients from many countries, particularly when it comes to rare disorders like Huntington's disease or Duchenne muscular dystrophy. Recent advances in these disorders have been largely attributed to the formation of European networks—such as the European Huntington's Disease Network (EHDN) and TREAT-NMD Neuromuscular Network—that work together to develop effective treatment strategies and improve patient care. Networks like EHDN and TREAT-NMD show that it is essential to work across national boundaries to be able to accrue and interpret data on the scale necessary to make meaningful clinical progress. The long-term effects of Brexit will not only be felt by neurologists and brain researchers in the UK, but also by their counterparts across Europe. In addition to the potential loss of UK collaborations and training opportunities, the future role of the UK in guiding European clinical regulatory practices is unclear. Europe exists in a global healthcare market and having a single, strong voice has given the EU power and leverage in negotiating drug prices with pharmaceutical companies. According to the 2015 annual report of the European Medicines Agency, 23 UK-based experts were appointed as co-leaders in the assessment of new drug applications that year, more than from any other member country. The loss of such an active regulatory membership as the UK weakens that united voice, and opens the door for further fragmentation of the EU and its regulatory practices. In the face of such overwhelming uncertainty, the neurological community must stand together and make their voices heard, not just for the sake of their funding or careers, but to ensure the continued best care for patients. To this end, UK neurologists and scientists are giving individual and institutional testimony of the impact of the UK leaving the EU to Parliament's Science and Technology Committee, and their European colleagues are keeping the door open for continued collaboration, no matter the eventual political outcomes following the referendum. Our community must see past national borders and work continuously to promote European ideas, share data, maintain global networks, and preserve the historical ties that bind us together.