Welsh Government
Everyday care in Wales made possible through research

Everyday care in Wales made possible through research

21 June 2018

Without research there wouldn’t be treatments like IVF or devices such as pacemakers – and we certainly wouldn’t know that smoking causes cancer.

Over the last 70 years of the NHS, research has given us things that we might take for granted today but they all started out as ideas, and through diligent testing we now have solid evidence that they work – or in some cases cause us harm.

We’ve seen some big changes that have become a part of everyday care in Wales; from aspirin and penicillin through to radiotherapy for cancer patients.

So what exactly do we know about research, what are public perceptions like and how have research methods developed over the decades?

Busting myths about research

One of the first things to note is that research can come in many different forms; it’s not always about testing new drugs in clinical trials.

Quite often, taking part in research only takes a few minutes of your time – like filling in a questionnaire at your GP surgery; giving permission to researchers to look at your medical notes; or maybe giving a blood sample.

All of this is research.

However, according to figures from the National Institute for Health Research, 38% of adults think all trials involve testing a new drug while 27% believe trials only take place in hospitals.

Where it all started

In 1747, James Lind changed history when he performed the first known clinical trial. On board the HMS Salisbury, he took 12 men with scurvy, divided them into six pairs and experimented with different remedies.

Two of the men – who were treated with oranges and lemons – made a pretty impressive recovery and that’s how the cure for scurvy was discovered.

Fast forward to the 1970s and another research career was starting, also on board a ship.

“My early career years were as a medical officer in the Royal Navy,” said John G Williams, a professor of health services research at Swansea University Medical School.

“We saw a lot of sailors with indigestion, due to ulcers, usually duodenal ulcers. We had great difficulty in treating those patients, all we could offer them was antacids like Rennie’s.”

Through the trial of a new drug, researchers – including Professor Williams – found out they could block acid secretion in the stomach.

“That was a great breakthrough, a great step forward because here was a condition that we could now treat and heal the ulcers,” commented Professor Williams.

But the questions and answers didn’t stop there.

Further research discovered a bug in the stomach that was able to survive by coating itself in ammonia; it was the ammonia that was irritating the stomach lining and causing the ulcers.

“We subsequently learned that by eradicating that bacterium you could cure the disease, not only heal the ulcer,” added Professor Williams.

Stopping another Thalidomide disaster

Over the decades, there have been big changes in the way research is carried out.

In the late 1950s, Thalidomide was licensed in the UK and given to pregnant women to treat morning sickness, but the drug caused thousands of babies to be born with defects.

“That drug wasn't properly researched before it was released for that particular indication, the vomiting in pregnancy,” said Professor Williams. “It led to these disastrous outcomes that only emerged when people realised what was happening. If there had been proper research first then that would have been avoided.”

“Research is now much better regulated,” added Professor Williams. “We have the concept of good clinical practice (GCP), which is a framework that sets out all the aspects of research to conduct it properly. Any clinician undertaking research has to be trained in GCP.”

GCP regulations ensure people taking part in studies are properly protected, including their rights, safety and wellbeing, as well as ensuring the data that’s gathered is credible.

Challenges of future research

According to Professor Williams the current “gold standard” of research is a randomised controlled clinical trial but he thinks cost and pressure on resources will make that a challenge for the future.

He believes “data is the new currency” in the research world and thinks we will see a shift towards the routine collection of reliable data instead.

“Fortunately we now have the possibility of using the data that is increasingly being collected in the course of healthcare to answer questions that previously have been answered by conventional trials,” he said.

HealthWise Wales, our national research study, is doing just that. People volunteering to take part in the study are invited to fill in questionnaires about their health and lifestyle, and they’re asked to give permission for their medical records to be accessed.

By combining the answers collected in the questionnaires, with information from patient notes, researchers hope to answer the big questions about health and social care in Wales.

“We do need the data to be accurate,” concluded Professor Williams. “We need it to be collected in a way that it can be analysed and we need patients and the public to be happy for us to do that.

“If that all comes together then we can start to answer many questions, more quickly and probably more effectively because we will have larger volumes of data than we would normally get with conventional trials.”

Further information about HealthWise Wales can be found here