Dr Trudie Lang leads the Global Health Network which is a forum to help clinical researchers with trial design, methods, interpretation of regulations, and general operations. They are conducting methodology research to identify the real barriers and issues involved in non-commercial trials, with the aim of developing best practice guidelines.
The Global Health Network is a successful and growing online science park comprised of varied research communities for different health research groups and cross-cutting health topics. It is built for the research and wider health community by researchers and public health practitioners themselves. It is a trusted source of quality information, education and research tools.
Ultimately, medical research must translate into improved treatments for patients. At the Nuffield Department of Medicine, our researchers collaborate to develop better health care, improved quality of life, and enhanced preventative measures for all patients. Our findings in the laboratory are translated into changes in clinical practice, from bench to bedside.
Q: What is the Global Health Network?
TL: The Global Health Network is a vehicle for helping researchers in developing countries do more, and better, studies. It’s a mechanism for providing equity to access research, because there’s not nearly enough research in developing countries, for a myriad of reasons. The Global Health Network helps people find each other to work in collaborations, and it’s also a working space. It's all about sharing knowledge, methods and tools. We’re quite good a sharing data now, in research, but unless we share the methods by which we collected that data, we can’t really move forward. For people wanting to do research, where there isn’t any research yet, it’s really helpful for them to find other researchers – to collaborate and also learn from what other people have done. If people can share their methods and tools then it can speed up research and save duplication. So many things we do in research are actually very similar, it doesn’t matter if we’re working on malaria or tuberculosis or even cancer or diabetes we use the same methods largely. So if we can share those (methods) we can speed up research in different areas and especially in developing countries. So that’s what it’s all about really.
Q: What are the issues when setting up clinical trials in developing countries?
TL: Well there are several. The main ones are obviously around skills and access to research because people are fearful of research – they don’t really understand it and see it as this huge scary thing that they can’t possibly engage in because they’re a small health unit, in the middle of Uganda or somewhere. But actually, we need research in so many different areas and it can be very straightforward and pragmatic research, such as looking at different hygiene practises in maternal health. The things that make it difficult are giving people the skills and resources, and the confidence, and the mandate, to engage in research even in the first place. To see that it can be very straightforward and simple things, just collecting quite simple data often. Then, obviously you’re working in quite difficult settings a lot of the time, very isolated communities, hard to get to, and laboratories are a long way from the patients quite often – you might be working in areas of conflict or difficultly, especially in disease outbreaks or emergency situations, the environment can be very challenging. Probably the most significant issue that people most often talk about are the sort of ethical and social difficulties of working in very vulnerable populations. Vulnerable because obviously there is a huge discrepancy between the wealth of the participants and the wealth of the researchers, vulnerable because they’re illiterate and they live in rural communities. We do a lot of work on understanding how to engage with communities, how to explain what research is, to make sure they really understand what’s being asked of them.
Q: What are the most important lines of research that have developed in the past 5 or 10 years?
TL: I think a lot of what we’re doing with the Global Network is about research methodology itself. Our group is trying to bring research skills and resources and improve the methods of how research is done in these settings. We do quite a lot of work on giving people skills and training in how to do research but also, as part of that, we’re looking at where there are difficulties in putting research in place, and where the barriers are in understanding how things can be made better. Because we do a lot of clinical trials in these settings, and that’s true across the department, for the whole of Tropical Medicine in Oxford, there are lots of actual trials that we do and we try and learn from those. What we’ve found in the last few years is that what we’re doing is really cutting edge, we’re doing trials very well and very diligently and we’re working to all the national guidelines and regulations. We’re finding very sensible ways of doing these studies, and actually, those mechanisms that we use to do research in these settings can be applied just as easily in London or Washington or Paris. So we’re trying to share what we learn about our research methodology with other sectors, because it’s absolutely essential that clinical research is made more simple, less cumbersome and less expensive across the globe, not just in developing countries.
Q: Why does your line of research matter, why should we put money into it?
TL: Clinical research has definitely gone global and there’s more and more research happening in places like India and China and Africa, which is great and it brings investment in research skills to those regions. But we need to make sure that the whole spectrum of research is happening, not just drug trials and vaccine trials for commercial purposes (of course that’s needed), we also need to do the more pragmatic research addressing, maybe, disease management questions for things like maternal health, malnutrition – not so much commercially viable, but very important for disease burdens in those regions.
Q: What are your plans for the future?
TL: We’re trying to engage much more with everybody that’s involved in clinical trials. There’s a lot of focus often on the clinicians, and that’s fine, but there are not that many clinicians in many of the places we work in, and often it’s not the clinicians who ever see the participants. In things like maternal health, malnutrition, and much of the childhood related big burdens of disease – we need to be working more with nurses, midwives, frontline healthcare workers. We need to teach them about research and why it’s important to gather data, make thinking about research part of their normal daily processes, and how it can help them improve the outcomes of the patients they work with.
Q: How does your research fit into Translational Medicine within the Department?
TL: Within this Department in Oxford we’ve got a huge amount of activity in Tropical Medicine and Global Health. Right from the laboratory and the earliest points in the line of science, from discovering molecules and interventions, through to testing interventions in the field, then on to public health and intervention – making sure that these changes make the biggest impact possible in health outcomes. Where we fit into that is bringing it all together really, and providing a mechanism for disseminating all that progress, and also finding collaborators, making the clinical trials a reality in the field, supporting them, and making sure they have all the tools and resources they need to do those studies.