In Ireland right now, there are 300 research projects under way that could help treat or cure illnesses. Several good discoveries have been made recently too – a single injection to repair damaged hearts, for example, and a trojan horse probiotic bacteria that can find cancer tumours and deliver anti-cancer drugs directly to them.

Then there was the first sight-restoring cornea-limbal stem cell transplants – a real scientific break-through. Add to that a potential new drug to control epileptic seizures and software to help GPs avoid prescribing inappropriate medications to patients. The list goes on …

These discoveries were all overseen by the Health Research Board, the lead agency in Ireland responsible for supporting and funding health research, information and evidence. Projects receive anything from €100,000 to €2.5m of funding, depending on the project.

AN OPTIMISTIC AREA TO WORK IN

Dr Mairead O’Driscoll is interim CEO as well as director of research strategy and funding and likes the optimistic nature of working with the agency.

“There’s a feeling that problems can be solved, that there is a solution out there,” she says, “that new therapies can be found and diseases understood better. It’s good to give a shout out to all the people who work in this area – not just doctors, scientists and research nurses, but also all the allied health professionals like midwives, physios and psychologists. It’s very much a team effort and there’s a lot of home-grown talent out there.”

FOLIC ACID – STAND OUT DISCOVERY

Asked for her stand-out discovery in the 30 years of the HRB’s existence, she says folic acid. “In my opinion, that discovery made the biggest difference: the fact that taking folic acid before and in the early stages of pregnancy prevents up to 70% of all neural tube defects such as spina bifida.

“Many people may take this for granted but, in fact, it came about through years of research carried out by a team in the HRB, Trinity College and the National Institutes of Health. Taking folic acid is a simple measure with a focus on prevention; but the research behind it is rooted in good science and, as a public health measure, it prevents a huge amount of unnecessary suffering.”

HOW IT WORKS

Mairead has been working with the HRB for 15 years and manages the external funding arm of the agency, which has three functions. “We fund health research in Ireland through our universities, through all their associated health institutions and teaching hospitals. We also manage some health information management systems in the areas of mental health, disability and drugs. Providing the Department of Health with the evidence service they need to make policy is also part of our remit,” explains Mairead. There is a lot of competition for HRB funds, she adds, and projects are funded for one to five years.

ONLY 20% OF APPLICATIONS FUNDED

“On average, we only fund 20% of projects that apply,” she says. “Typically, 40% could be funded. In any given round we are turning away projects. The thing in terms of research is that people always think of the silver bullet, the discovery, but usually what happens is that one thing builds on another and, over a long time, they come through.”

International, independent experts vet the applications, and researchers are supported in several ways, she says, including training in research methodology, for example.

“We might also buy out a bit of somebody’s time to work on research too. It’s all about building a system of health research: investing in people, projects and also providing facilities in hospitals and universities.”

DO DOCTORS HAVE TIME FOR RESEARCH?

But with consultants working flat out in an under-pressure health service, how do they get the time for research?

“A lot of clinicians will have joint appointments. For instance, they will have time to do their clinical work and usually have time set aside for teaching and research. But, in practice, many find this difficult,” she says.

“Service demands often crowd everything else out, so medical doctors, particularly, often find it difficult to do research. What happens is that a senior clinician could be the principal investigator, the lead on a particular project, but he/she will be supported on that by more junior staff or by a wider team of researchers, health professionals and scientists.”

Research is often a labour of love for health professionals, she says. “They are frequently driven by interest in their subject but, increasingly in Ireland, if you want to become a consultant you have to be up-to-date with research and be ‘research active’ also.”

WHY INVEST IN HEALTH RESEARCH?

Investing in research is a very long game, but if you don’t invest, you don’t see benefits, she says. “It can take many years to see the benefits. In the short term you’re competing for resources with the immediate problems of today’s health system, which obviously needs resources, but it’s about taking a long-term view.

“We are not always good at doing that, but in research you have to. In the past there might have been a view of ‘Why bother? Let other countries invest in all the research and then we’ll just pick it up after,’” explains Mairead.

However, it doesn’t work like that for two reasons, she states. “The first is that research and healthcare go hand in hand, so if you want the best care it is always delivered in more research-intensive settings. If your hospital or practice isn’t up to date, then you’re probably not going to get the best care or get access to the best treatment. Also, it’s difficult to retain highly skilled health professionals in a country if they are not able or are not working in a research-active environment.”

ISSUES FOR HEALTH RESEARCH BOARD

Funding is always an issue, the acting CEO says. “If you look at what we get – €45m out of a total of public health funding of €14bn – what we invest in Ireland in terms of health research is much less than the OECD average.

“Research tends to be seen as a luxury, or something that’s added on or – even at worst – sometimes a hobby for people; but it’s not like that at all. That’s the second big challenge we have: how to embed research more effectively into the health system, so people see it as part of care. For example, the HSE doesn’t have a budget line for research at the moment – there is no reference to research in its service plan...” CL

>> On the cutting edge

SINGLE INJECTION to REPAIR HEARTS

Professor Noel Caplice and his cardiac colleagues at UCC, have shown, in a trial – the first of its kind in the world – that low-dose insulin-like growth factor, injected into the heart to repair damage to the muscle, improves remodelling for heart attack patients.

If future bigger trials are successful, the growth factor could benefit anyone who has suffered a large heart attack – and reduce ongoing care costs in the HSE.

John Nolan from New Ross, Wexford, became one of the patients in the trial, after suffering a heart attack in December 2014. “I feel I was blessed to be asked to be involved; I had confidence that good would come from it,” he says.

USING BACTERIA TO treat TUMOURS

When cancer spreads in the body, tumours can be hard to find, but bacteria can locate them. Researchers at University College Cork, led by Dr Mark Tangney, have engineered Trojan-horse, easy-to-swallow probiotics (bacteria) that find and destroy tumours. Preparations are underway for clinical trials of the cancer-targeting bacteria in humans.

RESTORING SIGHT

Patrick Godfrey recently had the first cornea-limbal stem cell transplant in Ireland and his sight has been improved as a result. The transplant provides a new outer layer of stem cells on the cornea, which allows light to enter the eye and potentially restore vision. It was conducted by Mr William Power, consultant ophthalmic surgeon at the Royal Victoria Eye and Ear Hospital.

Five months on from the operation Patrick says that the treatment has made a huge improvement to his sight - and quality of life.

“I’m able to read the newspaper with ease now, go to a football match and see what’s happening and I’m gradually getting back to driving a car again.”

A new treatment to Ireland the operation represents the culmination of a collaboration between many Irish researchers, scientists and clinicians.

Acknowledgement for these stories: Claire O’Connell, science writer, HRB.

Software to avoid prescription mistakes

In all, 33% of people aged over 70 are prescribed one or more potentially inappropriate medicines, according to a study at the Health Research Board Centre for Primary Care Research. These medicines may be expensive, unnecessary and result in side effects.

To help doctors and pharmacists make good decisions, researchers there have developed computer software that can help prescribers choose the most appropriate medicines for patients.

In a randomised trial, the decision-support software reduced the prescribing of potentially inappropriate medicines, particularly high-dosage gastrointestinal drugs called proton-pump inhibitors (PPIs). Professor Tom Fahey says: “Maximal dose PPI drugs are widely prescribed at a large cost to the health budget. We have shown that with this decision-support software we can reduce the prescribing of these medications by GPs at safest dosage.”

“Results like these are a perfect illustration of why the HRB has invested so much in building Ireland’s capacity to conduct clinical trials,” says Dr Mairéad O’Driscoll, interim chief executive at HRB.