Offline: The unspoken dangers facing UK medical science

Abstract

Hope. Clarity. Certainty. Reassurance. Don't be fooled. Brexit is not over yet. The hard part is yet to come. And many medical scientists remain anxious. A professor at one of the UK's top universities frowned. He was born in Germany and moved to Britain (soon after receiving his PhD) where his field of research was thriving. He had recently offered a senior leadership role in his institution to another German scientist. She had declined his offer based on the worry that her team would not wish to move to a country that was exiting the European Union (EU). He was worried too. About his own position. He had just completed the arduous process of obtaining British citizenship to safeguard his future in the UK. He had secured German passports for his children to protect their opportunities in the EU. Britain is in crisis—politically paralysed, economically in decline. The possible effects of Brexit on medical research have alarmed scientists. Brexit and the bitter public debate it has provoked are conveying uncertainty to international partners of UK science. The Royal Society has tried to lay out the risks. 17% of all university staff originate from the EU. Unless future mobility of scientists is guaranteed, there is a real danger that science will be starved of essential human capital. Britain feels on the precipice of a catastrophe. An exaggeration? No. When Britain's Chancellor of the Exchequer, Philip Hammond, announced an additional £2·3 billion for research by 2021–22, medical science leaders universally expressed their delight. “I was pleased to see the Prime Minister's commitment…to supporting the UK's leading position within global science and innovation”, said one knighted professor. “This commitment will help to provide a financial magnet in the UK for retaining and attracting R&D talent and investment from around the globe.” What he omitted to say was that the infrastructure on which a flourishing medical scientific community depends is being slowly eroded. The National Health Service (NHS), a laboratory and incubator for new medical discoveries, is facing an acute-on-chronic funding crisis. Morale among the medical workforce is at rock bottom. Waiting lists are lengthening. Services are being stretched beyond what is safe for patient care. The talent pool from which the next generation of medical scientists will be drawn is atrophying. Social mobility is worsening. Inequalities are deepening. Child poverty is rising. Gains in life expectancy have stalled. The human foundation for Britain's success is being rapidly destroyed. Another professor described a recent meeting of the Medical Schools Council, the representative body of all medical schools in the UK. It had received evidence that a failed Brexit process would badly damage prospects for UK medical science. But when she suggested that medical school leaders should speak out more forcefully about these risks, a government scientist told her that these were not the “right words” to use. Last week, the Francis Crick Institute in London hosted its first Global Health Day. The theme was the UK's contribution to innovation in global health. Curing blindness and improving eye health with smartphones and surgical outreach. Building infrastructure for better water services to eliminate the effects of schistosomiasis in vulnerable communities. Using genome science to understand the epidemic of invasive salmonella disease in Africa. But how sustainable is Britain's leadership in global health? The UK's global health science community is already suffering from several deeply entrenched weaknesses. Solutions to the most complex problems in global health require interdisciplinary collaboration. But the architecture of UK science works against interdisciplinarity. The organisation of research funding, the siloed hierarchy of sciences in universities, and the narrow interests of scientific journals all disincentivise collaboration. And although the UK should be proud of its research talent, scientists are poorly equipped to translate their findings into practical policies. The fact is that the UK's science community is edging towards global exclusion. Victor Dzau, President of the US National Academy of Medicine, last week received an Honorary Fellowship from the UK's Academy of Medical Sciences. In his acceptance address, he emphasised that scientists had to do more to “stand up for science” and to “stand up for science in policy making”. And yet, in their gilded salons and candle-lit dining rooms, the leaders of British science quietly bow their heads in shame at their silence and complicity.