Comment
Laura Doss/Corbis
Building clinical research capacity in China: the National Clinical Research Centres
Published Online November 28, 2013 http://dx.doi.org/10.1016/ S0140-6736(13)62387-9
200
Over the past 5 years, China has increased its investment in scientific research by 20% annually, with funding of more than US$160 billion (1 trillion Renminbi) in 2012.1 In the Outline of the Twelfth Five-year Plan for National Economic and Social Development, the State Council declared that overall 2·2% of gross domestic product will be spent on scientific research.2 The Chinese Government’s funding for medical research has increased accordingly, resulting in notable achievements.3 However, investment differs between biomedical and clinical research. In 2011, government funding for biomedical research was about $1 billion (6 billion Renminbi), but only $250 million (1·5 billion Renminbi) for clinical research.4,5 The investment in clinical research has lagged at a time when such knowledge is needed to address China’s many health challenges—the growing burden of non-communicable diseases, soaring healthcare costs, a rapidly ageing population, and changes in health behaviours and local environments.3 To strengthen China’s clinical and population research capacity and build a sustainable infrastructure to support clinical research for patients’ benefit, the Chinese Ministry of Science and Technology (MOST) and the National Commission for Health and Family Planning (NCHFP) collectively established the National Clinical Research Centres programme in July, 2012.6 This programme will select the most outstanding clinical research centres in China that will benefit from substantial, long-term funding and policy support from the Chinese Government. MOST will invest $16 million (100 million Renminbi) in the first 13 centres by 2015 as the initial stage of the programme. The selected centres will not only produce high-quality science using rigorous methods but will also expand the national research capacity by creating sustainable research networks throughout the country to undertake multicentre and multinational clinical and population research. Multidisciplinary teams that include clinical medicine, computer science, mathematics, informatics, epidemiology, economics, sociology, and management science will be established in the centres. Additionally, the centres will promote international cooperation in health care. The aspiration is to create a mechanism to facilitate the exchange of ideas and knowledge to engage
with the global burden of disease and global health. The centres will further develop China as a base for clinical research and an exporter of medical knowledge for the good of the international community.6, 7 Cancer, cardiovascular disease, neurological disease (including cerebrovascular disease), respiratory disease, chronic kidney disease, and metabolic disorders constitute much of the current burden of chronic noncommunicable diseases in China3 and are the first priorities for the selected centres.6 115 hospitals applied for the National Clinical Research Centres programme. There was a 1-year evaluation process that followed international clinical research standards and set new standards in China. About half of the membership of the peer-review committees was from Hong Kong and outside of China.6,7 In August, 2013, MOST and NCHFP announced that 13 hospitals will form the first group of Chinese National Clinical Research Centres.8 From the start of 2014, centres will gradually expand to encompass gynaecology and obstetrics, gastroenterology, and other specialties, with MOST providing additional investment to fund these future centres. The 13 centres are mandated to formulate development strategies by 2015 and research plans by 2020. The centres will be rigorously evaluated every 2–3 years on the basis of the quality of their research activities and the relevance of the scientific evidence they generate for public health, clinical practice, and national policies in China. In addition, the strength of collaboration across centres and with international collaborators and stakeholders in different scientific fields will be considered in the evaluation. The results of the periodic evaluation will determine whether government funding to the centre is continued or terminated. The National Clinical Research Centre of Cardiovascular Diseases at Fuwai Hospital is an example of one of the selected centres. From 2014 to 2015 there will be $1·3 million (8 million Renminbi) investment from MOST, and Fuwai Hospital will provide 8000 m² of working space and a multidisciplinary team of more than 150 full-time personnel dedicated to this centre. Before selection as one of the National Clinical Research Centres, Fuwai Hospital had already led national and international clinical research www.thelancet.com Vol 383 January 18, 2014
Comment
projects, including the influential COMMIT trial, in which 1250 hospitals across China enrolled 45 852 patients with acute myocardial infarction.9,10 The launch of the National Clinical Research Centres programme represents a new era for China’s clinical research. It will aim to achieve the ultimate goal of improving health and health care through the power of science and its translation and application. The funding issued to the centres is just the beginning—a journey of a thousand miles begins with a single step.
2
Zhe Yang, *Lixin Jiang
7
Ministry of Science and Technology of the People’s Republic of China, Beijing, China (ZY); and Fuwai Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100037, China (LJ) [email protected]
8
ZY is the Deputy Director-General for the Department of Science and Technology for Social Development, Ministry of Science and Technology of the People’s Republic of China. LJ is Honorary Editor of The Lancet Chinese Edition. ZY thanks Weizhong Wang, Zhaofeng Zhang (Ministry of Science and Technology of the People’s Republic of China), and Harlan M Krumholz (Yale University, USA) for their contributions. 1
National Bureau of Statistics of China. National economic and social development statistical bulletin in 2012 (in Chinese). 2012. http://www. stats.gov.cn/tjgb/ndtjgb/qgndtjgb/t20130221_402874525.htm (accessed Nov 21, 2013).
3
4
5
6
9
10
The outline of the Twelfth Five-year Plan for National Economic and Social Development of the People’s Republic of China (in Chinese). 2011. http:// www.gov.cn/2011lh/content_1825838.htm (accessed Nov 21, 2013). Yang G, Wang Y, Zeng Y, et al. Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet 2013; 381: 1987–2015. Ministry of Science and Technology of the People’s Republic of China. Annual report of the state programs of science and technology development, 2007–2012 (in Chinese). 2012. http://www.most.gov.cn/ ndbg/ (accessed Nov 21, 2013). National Natural Science Foundation of China. Applying and funding report on National Natural Science Foundation (in Chinese). 2011. http://www.nsfc. gov.cn/nsfc/cen/ndbg/2011ndbg/05/index.html (accessed Nov 21, 2013). Ministry of Science and Technology of the People’s Republic of China. Notification of applying for National Clinical Research Centres (in Chinese). 2012. http://www.most.gov.cn/fggw/zfwj/zfwj2012/201207/ t20120717_95658.htm (accessed Nov 21, 2013). Ministry of Science and Technology of the People’s Republic of China. Official launch of the National Clinical Research Centres (in Chinese). 2013. http://www.most.gov.cn/kjbgz/201309/t20130903_109083.htm (accessed Nov 21, 2013). Ministry of Science and Technology of the People’s Republic of China. The namelist of National Clinical Research Centres (in Chinese). 2013. http://www.most.gov.cn/tztg/201306/t20130608_106459.htm (accessed Nov 21, 2013). Chen ZM, Jiang LX, Chen YP, et al; COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group. Addition of clopidogrel to aspirin in 45 852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005; 366: 1607–21. Chen ZM, Pan HC, Chen YP, et al; COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group. Early intravenous then oral metoprolol in 45 852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005; 366: 1622–32.
In appreciation of The Lancet’s reviewers, 2013 For many people, the new year is a time of writing thank you letters. Some letters are a joy to compose, others a burden. Few are more pleasurable to write and the thanks more heartfelt than this annual “thank you” from the editors of The Lancet to those 2698 experts who provided peer reviews for the journal in 2013. Your gifts of time and wisdom help authors and ourselves to bring out the best in research, ideas, and reviews to ensure that The Lancet’s content is of the highest quality and interest to readers. With increasing pressure on reviewers’ time and the widening commercialisation of scientific publishing, it is important to acknowledge the value that trusted
www.thelancet.com Vol 383 January 18, 2014
academic peer review adds to the scientific process. Because only a minority of peer-reviewed manuscripts are accepted by The Lancet, most peer reviews (like input from editors) will be of greatest benefit to authors and, ultimately, other journals. Nonetheless, the editors share the belief that genuine engagement by all parties in constructive peer review can improve the overall cycle of research and accelerate the application of new understanding to improve health outcomes. For this we thank you.
See Online for appendix
William Summerskill The Lancet, London NW1 7BY, UK
201
Laura Doss/Corbis
Building clinical research capacity in China: the National Clinical Research Centres
Published Online November 28, 2013 http://dx.doi.org/10.1016/ S0140-6736(13)62387-9
200
Over the past 5 years, China has increased its investment in scientific research by 20% annually, with funding of more than US$160 billion (1 trillion Renminbi) in 2012.1 In the Outline of the Twelfth Five-year Plan for National Economic and Social Development, the State Council declared that overall 2·2% of gross domestic product will be spent on scientific research.2 The Chinese Government’s funding for medical research has increased accordingly, resulting in notable achievements.3 However, investment differs between biomedical and clinical research. In 2011, government funding for biomedical research was about $1 billion (6 billion Renminbi), but only $250 million (1·5 billion Renminbi) for clinical research.4,5 The investment in clinical research has lagged at a time when such knowledge is needed to address China’s many health challenges—the growing burden of non-communicable diseases, soaring healthcare costs, a rapidly ageing population, and changes in health behaviours and local environments.3 To strengthen China’s clinical and population research capacity and build a sustainable infrastructure to support clinical research for patients’ benefit, the Chinese Ministry of Science and Technology (MOST) and the National Commission for Health and Family Planning (NCHFP) collectively established the National Clinical Research Centres programme in July, 2012.6 This programme will select the most outstanding clinical research centres in China that will benefit from substantial, long-term funding and policy support from the Chinese Government. MOST will invest $16 million (100 million Renminbi) in the first 13 centres by 2015 as the initial stage of the programme. The selected centres will not only produce high-quality science using rigorous methods but will also expand the national research capacity by creating sustainable research networks throughout the country to undertake multicentre and multinational clinical and population research. Multidisciplinary teams that include clinical medicine, computer science, mathematics, informatics, epidemiology, economics, sociology, and management science will be established in the centres. Additionally, the centres will promote international cooperation in health care. The aspiration is to create a mechanism to facilitate the exchange of ideas and knowledge to engage
with the global burden of disease and global health. The centres will further develop China as a base for clinical research and an exporter of medical knowledge for the good of the international community.6, 7 Cancer, cardiovascular disease, neurological disease (including cerebrovascular disease), respiratory disease, chronic kidney disease, and metabolic disorders constitute much of the current burden of chronic noncommunicable diseases in China3 and are the first priorities for the selected centres.6 115 hospitals applied for the National Clinical Research Centres programme. There was a 1-year evaluation process that followed international clinical research standards and set new standards in China. About half of the membership of the peer-review committees was from Hong Kong and outside of China.6,7 In August, 2013, MOST and NCHFP announced that 13 hospitals will form the first group of Chinese National Clinical Research Centres.8 From the start of 2014, centres will gradually expand to encompass gynaecology and obstetrics, gastroenterology, and other specialties, with MOST providing additional investment to fund these future centres. The 13 centres are mandated to formulate development strategies by 2015 and research plans by 2020. The centres will be rigorously evaluated every 2–3 years on the basis of the quality of their research activities and the relevance of the scientific evidence they generate for public health, clinical practice, and national policies in China. In addition, the strength of collaboration across centres and with international collaborators and stakeholders in different scientific fields will be considered in the evaluation. The results of the periodic evaluation will determine whether government funding to the centre is continued or terminated. The National Clinical Research Centre of Cardiovascular Diseases at Fuwai Hospital is an example of one of the selected centres. From 2014 to 2015 there will be $1·3 million (8 million Renminbi) investment from MOST, and Fuwai Hospital will provide 8000 m² of working space and a multidisciplinary team of more than 150 full-time personnel dedicated to this centre. Before selection as one of the National Clinical Research Centres, Fuwai Hospital had already led national and international clinical research www.thelancet.com Vol 383 January 18, 2014
Comment
projects, including the influential COMMIT trial, in which 1250 hospitals across China enrolled 45 852 patients with acute myocardial infarction.9,10 The launch of the National Clinical Research Centres programme represents a new era for China’s clinical research. It will aim to achieve the ultimate goal of improving health and health care through the power of science and its translation and application. The funding issued to the centres is just the beginning—a journey of a thousand miles begins with a single step.
2
Zhe Yang, *Lixin Jiang
7
Ministry of Science and Technology of the People’s Republic of China, Beijing, China (ZY); and Fuwai Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100037, China (LJ) [email protected]
8
ZY is the Deputy Director-General for the Department of Science and Technology for Social Development, Ministry of Science and Technology of the People’s Republic of China. LJ is Honorary Editor of The Lancet Chinese Edition. ZY thanks Weizhong Wang, Zhaofeng Zhang (Ministry of Science and Technology of the People’s Republic of China), and Harlan M Krumholz (Yale University, USA) for their contributions. 1
National Bureau of Statistics of China. National economic and social development statistical bulletin in 2012 (in Chinese). 2012. http://www. stats.gov.cn/tjgb/ndtjgb/qgndtjgb/t20130221_402874525.htm (accessed Nov 21, 2013).
3
4
5
6
9
10
The outline of the Twelfth Five-year Plan for National Economic and Social Development of the People’s Republic of China (in Chinese). 2011. http:// www.gov.cn/2011lh/content_1825838.htm (accessed Nov 21, 2013). Yang G, Wang Y, Zeng Y, et al. Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet 2013; 381: 1987–2015. Ministry of Science and Technology of the People’s Republic of China. Annual report of the state programs of science and technology development, 2007–2012 (in Chinese). 2012. http://www.most.gov.cn/ ndbg/ (accessed Nov 21, 2013). National Natural Science Foundation of China. Applying and funding report on National Natural Science Foundation (in Chinese). 2011. http://www.nsfc. gov.cn/nsfc/cen/ndbg/2011ndbg/05/index.html (accessed Nov 21, 2013). Ministry of Science and Technology of the People’s Republic of China. Notification of applying for National Clinical Research Centres (in Chinese). 2012. http://www.most.gov.cn/fggw/zfwj/zfwj2012/201207/ t20120717_95658.htm (accessed Nov 21, 2013). Ministry of Science and Technology of the People’s Republic of China. Official launch of the National Clinical Research Centres (in Chinese). 2013. http://www.most.gov.cn/kjbgz/201309/t20130903_109083.htm (accessed Nov 21, 2013). Ministry of Science and Technology of the People’s Republic of China. The namelist of National Clinical Research Centres (in Chinese). 2013. http://www.most.gov.cn/tztg/201306/t20130608_106459.htm (accessed Nov 21, 2013). Chen ZM, Jiang LX, Chen YP, et al; COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group. Addition of clopidogrel to aspirin in 45 852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005; 366: 1607–21. Chen ZM, Pan HC, Chen YP, et al; COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group. Early intravenous then oral metoprolol in 45 852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005; 366: 1622–32.
In appreciation of The Lancet’s reviewers, 2013 For many people, the new year is a time of writing thank you letters. Some letters are a joy to compose, others a burden. Few are more pleasurable to write and the thanks more heartfelt than this annual “thank you” from the editors of The Lancet to those 2698 experts who provided peer reviews for the journal in 2013. Your gifts of time and wisdom help authors and ourselves to bring out the best in research, ideas, and reviews to ensure that The Lancet’s content is of the highest quality and interest to readers. With increasing pressure on reviewers’ time and the widening commercialisation of scientific publishing, it is important to acknowledge the value that trusted
www.thelancet.com Vol 383 January 18, 2014
academic peer review adds to the scientific process. Because only a minority of peer-reviewed manuscripts are accepted by The Lancet, most peer reviews (like input from editors) will be of greatest benefit to authors and, ultimately, other journals. Nonetheless, the editors share the belief that genuine engagement by all parties in constructive peer review can improve the overall cycle of research and accelerate the application of new understanding to improve health outcomes. For this we thank you.
See Online for appendix
William Summerskill The Lancet, London NW1 7BY, UK
201
