According to the Australian Institute of Health and Welfare, we gained over 25 years of extra life expectancy during the 20th century. These extra years have resulted largely from development of public health measures, vaccines and antibiotics that have reduced the impact of infectious diseases on a global basis. These interventions are the tangible result of medical research conducted by health care professionals and scientists worldwide. Over the last 100 years, there has been a slow but steady revolution in the way that medical research is conducted. What was once the province of hobby scientists, working alone in spare time and using their own funds, in lab space hidden away in hospitals and medical schools, has become a multi-million dollar business, conducted in large biomedical research institutes by professionally trained government and industry funded scientists and clinician scientists. Why has this change come about, and where is this leading?

The early drivers of medical research were the desire of the health care professions to ensure better health outcomes for their patients, and the curiosity of scientists about human physiology and pathophysiology, and these remain relevant today. However, as the technologies available for research have become more sophisticated, and the existing knowledge base more extensive, research has required more prior education, more sophisticated facilities, more collaboration, and more money. Further, the funding model for universities, the traditional trainers of researchers, has changed to one driven by quantity of throughput in addition to quality of output. In consequence, further drivers have emerged which have encouraged a more commercial and managed approach to research. These include desire of universities to maximise student numbers and research grants, government desire to see outcomes from research at affordable prices, and a growing “for profit” pharmaceutical industry hungry for the next blockbuster product, that might be expected to sell over $1billion per annum in the first years of launch. These drivers have increasingly led to focusing of research into institutes that can compete on a world playing field for resources and talent, and can afford the increasingly sophisticated infrastructure of the large scale “hypothesis free” approach to biology currently being practiced.

These drivers will likely continue to influence the conduct of medical research in the first decades of the 21st century, though some new ones have recently emerged. The supply of blockbuster drugs has largely dried up, at a time when many of the major successes of recent years…