Horizon 2020 (H2020) is now up and running, and has funded its first new acute stroke project, PRECIOUS . The EU funding regulations enforce a multi-country, multi-culture approach across a large consortium and this is clearly beneficial for promoting the take up of best practice and the move to standardised and effective procedures. In addition, the gains in research dissemination and researcher networking afforded by EU collaborations are significant. But what happens when these cultural benefits come up against what is best for science, or stroke patients themselves?
Recently at the first ever ESO conference, Professor Werner Hacke, the top-rated stroke researcher worldwide, gave a thought-provoking talk. At issue were the reasons why large trials often fail and the key ingredients of trials that do succeed. Hacke’s account was that large trials that fail are often industry sponsored; they combine regions that differ in medical systems, reimbursement expectations, hospital infrastructures and trial investigator experience. He also added that; they include centres selected by CROs and not by the central trial steering committee; and that they are influenced too much by marketing, leading to broad inclusion criteria, long trials and optimistic treatment effects.
Hacke claimed that in comparison, the majority of successful trials were investigator driven and publically funded; they had protocols designed by the investigators and were led by a steering committee; they included a small number of centres often concentrated in fewer countries; they selected subsets of patients with high response rates and, overall, were small in patient numbers. When a trial does work, it is often revolutionary in its effect on survival rates and outcomes.
So how should we progress? Looking forward, as national research budgets come under pressure, the EU budget increase in H2020 will seem even more attractive and competition is likely to increase (as indeed it has over the first 18 months of H2020 compared to the previous framework). It is therefore even more important that the EU chooses the best proposals and does so via transparent evaluation methods of a high and reliable standard.
Unfortunately, the feedback from many academics is that with the success rates so low (often fewer than 5%), coupled with unwarranted comments in evaluation reports, there is a growing feeling that the benefits of funding are not worth the costs of writing new proposals.
This sentiment must be resisted. Not only are many of the successful traits from Hacke’s list intrinsic to EU funded work (e.g. public funding and investigator control), but recent work funded the Stroke Association has shown that stroke research is hugely underfunded, relative to its impact on society. The need for increased engagement with Horizon 2020 is stronger than ever. Our dedicated staff and colleagues at Innovate UK and the NHS European Office can advise and help with idea development, consortium formation and proposal submission.
The EU is flexible in its approach and willing to listen and learn from what has worked before in stroke research. We must give them every opportunity to do so by continuing to submit high-quality proposals. Funding world-class research into stroke is the only way we will help to conquer this devastating condition.
Action on Stroke Month is the Stroke Association’s annual awareness-raising month that takes place every May. This year, the charity is focusing on working-age stroke.