The revolution re-visited: Clinical and genetics research paradigms and the productivity paradox in drug discovery

Hospitals and innovation: Introduction to the special section

“…Finally, two articles analyse the wider system in which hospitals are embedded. Gittelman (2016) analyses different research paradigms in biomedical research, especially related to genomics and clinical research, and discusses implications for hospitals and innovation. Kukk et al (2016) analyse the wider institutional work required by actors who want to implement innovations, through a case study of the personalised cancer drug Herceptin ® .…”

“…Hospitals are not just bridges and brokers in the development of innovations but also in wider collaborative processes of selection and adaption, although less is known about the costs and benefits of such open innovation processes within a wider system (Thune and Mina, 2016). There are also signs that the "close to the bedside" research and innovation paradigm which has been a key feature of hospitals has increasingly become dominated by a laboratory-based paradigm based on genetics and molecular biology, and questions are raised about whether the possibilities for combining the two paradigms in "translational research" are efficient or even possible (Gittelman, 2016;Miller and French, 2016;Lander, 2016). The case of the personalised cancer drug Herceptin ® is interesting because it shows how hospitals' current innovation activities extend beyond the traditional roles and help doing "institutional work" such as the creation of new markets and influencing regulation through political and media pressure together with firms and patient organisations (Kukk et al, 2016).…”

“…These paradigms do not simply denote different objects and methods of research (bench versus bedside) but more fundamental learning strategies, belief systems and institutional arrangements (Gittelman, 2016). The articles have discussed the paradigms of clinical research versus basic biomedical research (Lander, 2016;Ali and Gittelman, 2016), "care" versus "science" (Llopis and D'Este, 2016) and "innovation for healthcare benefits" versus "innovation for commercial benefits" (Miller and French, 2016).…”

“…But hospital research and innovation may also be seen to represent a specific experiential, practice-based and healthcare-oriented paradigm that is challenged by the perceived dominance and policy support of basic science and/or commercially oriented paradigms. One of the articles argues that the decline in the productivity of pharmaceutical R&D may partly be due to such a paradigmatic shift (Gittelman, 2016). It is also suggested that there may be a need to support more applied or user-oriented research (Lander, 2016).…”

“…Medical science is transforming, large firms partner with universities in new ways to form powerful political alliances (Kukk et al, 2016), and thousands of smaller firms within biotechnology and related areas (sometimes themselves spinoffs from hospitals-see French and Miller, 2012) produce ideas, compounds and kits that will require hospital engagement to be developed further (Gittelman, 2016). Policymakers expect hospitals to deliver high quality and increasingly cost-effective health and care services -which remains the central goal of the organisations -but also to contribute more widely to innovation and economic growth elsewhere.…”