Medical Schools at Renowned Universities

Scotland’s four medical schools—Edinburgh, Dundee, Glasgow, and Aberdeen—have existed for centuries, and each enjoys a well-deserved prestigious reputation. However, they also had some of the cultural insularity and rivalry that this implies. Each institution has great talents, but due to size constraints, the individual university medical schools cannot compete on the world stage in ways to match their history or reputation. It became clear that they would accomplish far more through research collaboration. By joining forces through the TMRC they would be more competitive and better able to match efforts of larger research organizations.

National Health Service Trusts

The four National Health Service (NHS) Trusts in Scotland have coordinated their clinical patient work for decades, but work in a centralized manner yields a vital advantage: data management. Each of the approximately 5 million patients under these NHS trusts has a unique identification code, referred to as a Common Health Index (CHI) number, which links an individual to his or her complete medical history and to family members’ information, and is stored in a central database. This system enables hospitals and doctors to follow all patients, despite address changes, name changes due to marriage, immigration, and so on. The NHS Trust charters include a mandate to carry out clinical research, which can range widely from reducing incidence of bedsores and tackling infection in wards to developing protocols for effective treatment. The chief scientist of the NHS administers this.

With this powerful database, several broad research initiatives could be undertaken. One project that predates TMRC was spearheaded by Prof. Andrew Morris, who later became chairman of the TMRC, studied a disease cohort of 300,000 patients with diabetes to study genetic makeup and incidence of the disease among family members. Another project from 2004, 2 years before the TMRC initiative, “Generation Scotland,” was initiated by David Porteous, Professor of Genetics at Edinburgh University, to track diseases within families, to see if the manifestation of the disease in one individual patient remained an isolated incident or whether it could indicate causes for genetic or behavioral trends that affected family members.^*

The Originators of the Idea

The Scottish Government Health Directorate (SGHD) was fortunate to have a brilliant and dynamic chief scientist, Professor John Savill (now Sir John Savill). Alongside that role, he was also the head of the Medical School at the University of Edinburgh. These two organizations have different research missions. The SGHD drives public health strategy for Scotland, and is responsible for the Scottish NHS, whose focus is on clinical research, intended to benefit individual patients. Academia’s research generally focuses on precompetitive research.^† It was John Savill who looked to the Medicines Research Council,^‡ the Wellcome Foundation^§ and the separate medical schools for funding, in an attempt to create a critical mass to undertake the size and type of research projects that would better serve the market, and attract industry investment. Savill convinced the different parties to combine their resources—scientific talent, patient data, and clinical experience, funding, and physical facilities—to a more synergistic result.

Scottish Enterprise

SE is a regional development agency. Its mission is to create a platform for industrial and scientific growth and economic development for Scotland, and to better utilize the existing talent, infrastructure, facilities, and resources, including engaging the local small- and medium-sized company base and creating spinout companies from successful projects. SE’s aims were aligned with those of what was to become the TRMC. Headed by Chief Executive Jack Perry, SE offered crucial matching funds to develop the infrastructure needed to conduct the kind of world-class research that would attract investment from industry. In addition, they showed strong continued support as TMRC projects progressed: for instance, an initial £9.5 m ($14m) SE loan turned to a grant, with £2.7m ($4m) nonrepayable and £6.8m ($10m) repayable.

Wyeth Pharmaceuticals

With the arrival of Frank Walsh, head of Global Research at Wyeth (who is Scottish by birth and American by residence but never lost his accent!), essential input and funding materialized in support of projects for translational medicine. He had been looking for a strategy for streamlined collaboration with academic institutions and hospitals. Wyeth was interested in participation in the TMRC initiative because it was different: it effectively combined resources and cooperation of the medical schools, the NHS Trusts, and the SE. Therefore, Walsh succeeded in committing Wyeth to invest substantial funding (Figure 32.1).

So, all the stars were aligned: the timing was right, willing partners were ready to combine their efforts, and far-sighted champions had emerged to drive the initiative, “… and there was light.” The four stakeholders forming the TMRC were composed of the four Scottish medical schools, represented by their deans, four NHS Trusts;^* SE, represented by its CEO Jack Perry, and Wyeth.