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4 nfu
research agenda for sustainable health 5
national plan – research agenda for
national plan academic medicine,
biomedical science and healthcare research
Sustainable Health
6 nfu
research agenda for sustainable health 7
Preface
Summary
1. Introduction
2.TheUMCs’contributiontosociety
3.ThechallengesandfutureofDutchhealthresearch
4.Principles
5.Educationasthebasis
6.Toconclude:themajorchallenge
Sources
Abbreviations
Notes
Colophon
Index9
10
13
17
23
55
61
65
67
68
69
70
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research agenda for sustainable health 9
PrefaceHealth and healthcare are trending topics. Many of the questions submitted to
the Dutch National Research Agenda1 were about health. The Netherlands is
also concerned about its healthcare system. A great deal can be done already,
but better and often expensive treatments are added continuously. Science
stands for nothing, but how can we keep everything that is or will become
possible affordable? Will we soon spend a quarter of our household incomes
on care?
Everyone is convinced that care provision cannot grow indefinitely. The
sustainability of our system is under pressure. Therefore, prevention,
preventing disease by improving health literacy, healthier lifestyle, early
detection of disease risks and new personalised treatments will be high on the
research agendas in the coming years, and this can contribute substantially to
healthy ageing, which is of social and economic importance. The role of science
as a driving force behind sustainable and innovative care is therefore more
important than ever.
The transition to sustainable healthcare requires all stakeholders in healthcare
to join forces. This National Plan describes the approach of the Dutch University
Medical Centres (UMCs), of course in close collaboration with universities
and other knowledge institutions. This plan constitutes an elaboration of the
Dutch National Research Agenda in the areas of academic medicine, biomedical
science and health research. The National Plan will be developed further
based on the National Research Agenda ‘route workshops’ 2, particularly in
the areas of health research-prevention-treatment, personalized medicine and
regenerative medicine.
Scientific collaboration and innovation are the key to utilising the available
resources as efficiently and effectively as possible. This is the only way to
realise sustainable care. In addition, this is the only way for Europe to keep
performing above average and to keep excelling at the international
scientific top.
Mr.JosAartsenpresidentNFU
Prof.dr.MarcelLevichairmancouncilof
medicinedeans
Prof.dr.PancrasHogendoornchairmanworkinggroup
NationalPlanSustainableHealth
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Sustainablehealthisthecommongoalofthe
eightDutchUniversityMedicalCentres(UMCs).
Sustainablehealthentailskeepingpeoplehealthy
atreasonablecost.Itisalsoaboutkeepingour
healthcareaccessible,affordableandhighquality.
Anditentailstrainingthebestmedicaldoctors
andotherhealthcareprofessionals.Collaboration
ofstrategicpartnerssuchashealthcare
organisations,insurancecompanies,public
authorities,industry,healthcareprofessionals
andcitizensisessentialtoachieveasustainable
healthcaresystem.Thecompletechainfrombasic
researchtoamorepersonalisedapproachof
preventionandtreatment,aswellasthefinancial
implications,willdetermineifwecanbringthe
sustainablehealthgoalcloser.Sustainabilityis
essentialbecausehealthcarecostswillbecome
irresponsiblyhighifpoliciesarenotchanged.
Inaddition,thenumberofhospitalpatientswill
becometoolargetobehandledbyhealthcare
professionalsandwewillnotbeabletodeliver
appropriatecaretothegrowinggroupofvulnerable
elderlypeople.Recentscientificdevelopments
offergreatopportunitiestoforcebreakthroughs
inthecomingyears.TheNetherlandscanmakea
majorcontributiontothis.
TheUMCsareinanexcellentpositiontoreach
thesustainablehealthgoals,togetherwiththeir
partnersinpatientcare,educationandscientific
research.Firstandforemostthisisbecauseofthe
uniqueDutchconstructofaUniversityMedical
Centre,withshortlinesofcommunicationbetween
fundamentalbiomedicalresearchandclinical
applications,andastrongfocusonthetranslation
betweenthetwo.TheUMCs’strongcompetitive
positionininternationalscientificresearchinthe
LifeSciences&Healthsector(LSH)isbasedonthis
hallmark.TheUMCscancontributetothebroad
implementationofscientificknowledgebyvirtue
oftheirnetworksinhealthcareandprevention.
Valorisationisanotherimplementationformof
biomedicalknowledge.TheUMCsareincreasingly
consideringthistranslationtothemarket,with
importantsocietalandeconomicconsequences.
TheUMCsalsoexcelinevaluatingnew
developmentsinefficiencyandcost-effectiveness.
core themes of the research agenda
Sustainablehealthwillbefacilitatedbysocietal,
scientificandtechnologicaldevelopments.
Relevantsocialdevelopmentsincludeanincreased
healthliteracyandempowermentofpatients,
aswellasnewconnectionsbetweenprevention,
work,sports,healthcareandhousing.Biomedical
researchisproducingincreasinglydetailed
knowledgeabouttheaetiologyandcourseof
diseases.Thiscreatesopportunitiesforpreventing
disease and preventing chronicitythroughearly
interventionindiseaseprocesses.Relevant
technologicaldevelopmentsincludeeveryday
ICTsolutions(e.g.,thesmartphoneisthebasis
formanye-healthapplications),high-quality
datastructures(requiredbecauseofthebigdata
revolution),butalsotheincreasinginteraction
betweentechnologyandbiologyinmeasurement
tools,imagingtechniquesandorgans-on-a-chip.
Personalised medicine(patient-centred)and
personalisedhealth(focusingonhealthycitizens)
willrevolutionisebothhealthcareandprevention
inthecomingyears.Detailedknowledgeabout
Summary
research agenda for sustainable health 11
thesignificanceofmeasurements(biomarkers)
facilitatestailoredtreatments,withmoreeffect
andlessside-effects.Knowledgederivedfrom
biobanksandbigdataisthemostimportant
foundationforpersonalisedmedicineand
personalisedhealth.
Thebroaddevelopmentandimplementation
ofpersonalisedmedicineandhealthrequires
collaborationbetweentechnologicalknowledge
institutes,universities,UMCs,industry,patient
organisations,insurancecompaniesandsocietal
partners.Ifthesedevelopmentsfulfiltheir
promises,theDutchhealthcareandprevention
systemwillbecomesignificantlymoreefficient
andeffective.
Regenerative medicine–repairingtissues
andorgansusingstemcells,biomaterialsor
biochemicals–mayhelpelderlypeopletolive
independentlyforlonger,requiringlesscare.This
fieldalsorequiresadditionalresearchtotranslate
thefirstsuccessstoriesintowidelyapplicable
techniques.Thisconcernsbasicresearchin
thefieldofstemcells,tissueenvironment
(extracellularmatrix)andbiomaterials.Inaddition,
itconcernsappliedresearchwiththeaimto
produceandevaluateartificialtissuesandorgans.
Atpresent,large-scale facilities for storing
human samples (biobanks) and for storing and
exchanging dataarecrucialdeterminantsofthe
progressofthelifesciences.TheNetherlands
FederationofUMCs(NFU)hasalreadystarted
andsupportedmanyinitiativesinthese
areas,includingthecollaborativebiobanking
infrastructureBBMRI-NL2.0andtheNFU
programmeData4lifesciences,incollaboration
withtheDutchTechcentreforLifeSciences(DTL),
SURF(ICTpartnershipofDutcheducationand
researchinstitutes),theNetherlandseScience
Center,theCenterforInformationTechnology(CIT),
andothers.However,thecontinuityandlong-term
fundingoftheseinitiativesisapointofconcern.In
general,thevariousinfrastructureshavebecome
essentialtothelifesciences.Thishasprompted
theNFUtoexplicitlycallattentiontosustainable
infrastructuresintheNetherlandsandinEurope.
Collaborationandcoordinationarebecoming
increasinglyimportantinthiscontext.
Educationrequiresspecificattention,i.e.,
educationofstudents,trainingofmedical
specialistsandgeneralpractitioners,continuing
educationoftheseprofessionalsandeducation
programmesforresearchersandotherhealthcare
professionals.TheUMCsaredirectlyinvolvedinall
theseformsofeducation.Theyregardeducation
asanimportantopportunitytofurtherimprove
healthcarequalityandtoimplementthescientific
developmentstowardssustainablehealthcare
inpractice.
Thestepstowardssustainablehealthcare
describedherearealreadyinfullprogresswithin
theUMCsandtheirpartnersintheNetherlands
andabroad.ThisNationalPlanshowsthesteps
requiredinthenearfuturetoensurethattheDutch
healthcaresystemandeconomycanbenefitfrom
thesepromisingdevelopments.
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research agenda for sustainable health 13
TheDutchhealthcaresystemisfacingsignificantchallenges.ThepopulationoftheNetherlandsis
ageing,whiletheworkforcedecreases.Thecountryisexpectedtobehometo4.8millionpeople
over65by2040.Sincemostchronicdiseasesmanifestthemselvesinthesecondhalfoflife,this
resultsinanincreasingpressureonahealthcaresystemthathastocopewithlessmanpower.
Greatprogresshasbeenmadeinunravellingtheaetiologyofdiseases,makingnovelandsuccessful
treatmentsavailable.However,thesetreatmentsmaybeexpensive,thuscontributingtotherisingcostof
care.Thenatureofdiseasesisalsochangingasaresultofimprovedpaediatrictreatmentoptions(inthe
caseofrarediseases,e.g.,juvenilerheumatoidarthritis,cysticfibrosisandoncologicaldiseases).Moreover,
allageclassesareincreasinglyaffectedbydiseasesofaffluence,e.g.,metabolicsyndrome,diabetes,
arthritisandcardiovasculardisease.Inaddition,thenumberofpeoplewithmentalhealthproblems
increases.Wearealsoconfrontedwithunpredictablediseases,suchasinfections,thatcouldhaveamajor
impactonsocietybecausetheyarespreadingmuchmoreeasilythanbeforeduetoincreasedtravellingand
migrationofpeopleandduetoincreasedantimicrobialresistance.
1 Introduction
chronic disordersWhataretheconsequencesof
chronicdisorders,stressand
disability,andwhatisthebest
waytocopewiththem?
unexplained symptomsCanwegainabetter
understandingofthefactors
thatplayaroleintheoccurance
andpersistanceofmedically
unexplainedphysicalsymptoms,
leadingtobettertreatments
ofthem?
intestinal disordersIntestinaldisorders,in
particulartherelationship
betweengutfloraand
health:whatcanwedoto
benefitourgutflora?
affordableHowcanweachievethe
bestpossiblehealthcare
quality,whilekeeping
itaffordable?
Examplesofquestionssubmittedtothe
DutchNationalResearchAgenda:
76
94
8086
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research agenda for sustainable health 15
Thesustainabilityofourhealthcaresystemis
underpressure;everyoneisconvincedthatcare
provisioncannotgrowindefinitely.Therefore,
prevention(i.e.,preventingdiseasebyimproving
healthliteracy,encouraginghealthylifestylesand
earlydetectionofhealthrisks)willbehighonthe
agendainthecomingyears.Preventionwillalso
contributesubstantiallytothebroadlysupported
socialandeconomicimportanceofhealthyageing.
Dutchresearchandinnovationholdastrong
positionintheinternationalLifeSciencesand
Health(LSH)sector.Internationalrankings
reflectthestrengthofDutchbiomedical
research.Thissectoroffersgreatopportunities
forfurtherdevelopmentofaneffectiveand
sustainablehealthcaresystembecauseofits
uniquecombinationofknowledgeandskills.
TheDutchknowledgeinstitutes(i.e.,UMCs,
universities,universitiesoftechnology,applied
researchinstitutes,collaboratingtop-clinical
educationhospitalsanduniversitiesofapplied
sciences),scientificinstitutes(e.g.,Netherlands
CancerInstitute,HubrechtInstituteandother
institutesoftheRoyalNetherlandsAcademyof
ArtsandSciences‘KNAW’andtheNetherlands
OrganisationforScientificResearch‘NWO’)and
healthfunds(e.g.,DutchCancerSociety,Dutch
HeartFoundation,LungFoundationNetherlands
andDutchArthritisFoundation)arestrategically
well-positionedtomakefastandefficientprogress.
Crossoverswithcloselyrelatedsectors,suchas
Agro-FoodandHigh-TechSystems&Materials,
offeradditionalopportunitiesforpromising
innovations.
Lastyear,theso-called‘DutchNationalResearch
Agenda’wasdrawnupbyaknowledgecoalition
consistingofVSNU,KNAW,TNO,TO2,VNO-
NCW,MKB-Nederland,NWO,VHandtheNFU.
Thisresearchagendacontainstheresearch
questionsthatacademicresearchwillfocuson
inthecomingyears.Theagendawasbasedon
citizens’questionstoscience1.Theagendais
anelaborationofthe‘2025VisionforScience,
choicesforthefuture’ofNovember2014,inwhich
theDutchgovernmentexpresseditsscientific
ambitions.TheDutchNationalResearchAgendais
relatedtothe‘topsectorpolicy’2,thesecondflow
offundspolicy3andthefundingprogrammesof
theNetherlandsOrganisationforHealthResearch
andDevelopment(ZonMw).Manyofthequestions
submittedtotheDutchNationalResearch
Agendawererelatedtohealthandhealthcare.
TheUMCsaccountformorethan90%ofthetotal
Dutchacademicscientificoutputwithinthelife
sciences(NOWT,2010).Therefore,theywilltake
responsibilitytofurtherelaboratethehealthtopics
ontheDutchNationalResearchAgenda.
Tothisend,theNFUhaspreparedthepresent
NationalPlan.Theplanshouldguidethe
developmentofacademicmedicineaswellas
biomedicalandhealthcareresearchwithinthe
UMCsinthenextfiveyears.Italsoaddressesthe
developmentofthelifesciencessectorasawhole.
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2The UMCs’ contribution to society
research agenda for sustainable health 17
TheNetherlandshaseveryreasontobeproudofitseightUMCs.Thecombinationofhigh-quality
scientificresearch,patientcareandeducationwithinoneorganisationisunique.Manycountries,
includingBelgium,NorwayandIreland,haveshowninterestinapplyingthisDutchmodelintheir
owncountry.
Thestronginterrelationshipbetweenscience,patientcareandeducationwithintheUMCsenablesthem
todeliverthebestpossiblecare,applyingthelatestinsightsinhealthcare.ThewayinwhichUMCsare
organised,whichisuniqueintheworld,makesitpossibleforasingleinstitutetocoverthewholespectrum
frombasicexploration,throughtranslationalresearchandpatient-relatedresearch,toclinicalapplications.
Thisisanimportantsourceofcarerenewal.Conversely,observationsinpatientsmaygeneratenew
hypothesestobeexploredwithbasicorexperimentaltranslationalresearch,increasingourknowledge.This
isafruitfulapproach:theDutchUMCsrankamongtheworldleadersinscience.Internationally,theyarein
thirdplace(CWTS,2012).Takentogether,theUMCspublisharound40%ofthetotalDutchscientificoutput.
TheyarethusmajorcontributorstotheNetherlands’knowledgeeconomy.
96
98
102
diagnosticsHowcanweimprove
diagnostics,treatment
andvaccinesforimmune
disordersandinfectious
diseases?
fundamental researchHowcanweimprovethe
translationoffundamental
biomedicalresearchinto
thedevelopmentof
newdrugs?vital and healthyHowcanwedevelop
newdrugsandother
treatmentsthatwill
keepusashealthy
andvitalforaslong
aspossible?
Examplesofquestionssubmittedtothe
DutchNationalResearchAgenda:
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research agenda for sustainable health 19
TheUMCshaverecentlyincreasedtheir
cooperationinNFUcontextintheareasof
patientcare,education,scientificresearchand
infrastructuralinvestments.TheUMCshavejointly
investedinbiobankssuchasLifeLinesandthe
StringofPearlsInitiative5,inbioinformaticsand
datahandling,andintranslationalandclinical
research.Thisreinforcesinnovativeresearch
and,asaresult,itstrengthensthescientificand
economiccompetitivenessofTheNetherlands.
economically relevant
TheimpactoftheUMCsontheDutcheconomy
isconsiderable:eacheuroinvestedinthejoint
UMCsresultsinfoureuroaddedvalue.Withatotal
numberofabout70,000employees,theUMCs
aremajoremployers,oftenthebiggestintheir
region.TheUMCnetworkgeneratesatotalimpact
of20.4billioneurosaddedvalueanditsupports
morethan215,000jobsacrosstheNetherlands
(BiGGARreport,2014).Thisincludesemployees
thatworkinandinthedirectvicinityoftheUMCs,
theUMCs’expenses,themoneythatemployees
spendinthelocaleconomy,theUMCs’projects,
aswellasexpensesofstudentsandstudent
employmentoutsidetheUMCs.Public-private
partnershipsareimportant:manyUMCsconstitute
theheartofacampuswithahighdensityof
innovativecompanies.ThesectorLifeSciences
&Healthcontributes2.5%totheDutchgross
nationalproductandthusmakesasubstantial
contributiontotheDutcheconomy.Thebasicand
moreappliedresearchwithinUMCsisanimportant
prerequisitetoachieveinnovations.Therefore,the
UMCsparticipateinthetopsectorsAgri&Food
andHighTechSystems&Materialsinadditionto
thetopsectorLifeSciences&Health.TheUMCs
alsoactivelycontributetotheKnowledgeand
InnovationAgendas2016-2019ofthetopsector
policyoftheDutchgovernment.
Publichealthprotectionandhealthpromotionare
otherwaystoimprovepublichealth.TheUMCs
canplayaroleinincreasingtheeffectivenessof
publichealthmeasures,byproducingknowledge
aboutbehaviouralfactors,socialdeterminants,
environmentalfactors,screeningprogrammes,
organisationalconditions,healtheconomics,and
globalhealthandnursingresearch.
networks
Collaborationamonghealthcareprovidersisthe
keytohigherquality,morecomfortableandmore
cost-effectivepatientcare.Tothisend,theUMCs
haveformednetworkswithotherhealthcare
providers.Thesenetworkshaveorganisedproper
careforspecificpatientgroups,e.g.,oncological
networks.Thenetworksperformappliedresearch
tofurtherimprovetheirpatientcare.They
promoteknowledgeexchangeandtheirresearch
programmesmakeuseofthestrongscientificand
infrastructuralbaseoftheUMCs.Thecommon
threadofthesenetworksissharedresponsibility
forimprovingthequalityandcost-effectiveness
ofcare,andpromotinginnovation.Thepatient’s
wishesplayacentralroleinthis.
Thesenetworksalsoformthebackboneof
educationandtrainingofhealthcareprofessionals.
UMCsandeducationhospitalscollaboratein
so-called‘EducationandTrainingRegions’,for
exampletotrainmedicalspecialists.Inaddition,
thenetworksfacilitateinternationallycompetitive
clinicalscientificresearch,coordinatedbytheUMC
andconductedwithintheassociatedhospitals.
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Thisenablesresearcherstorapidlycompile
largegroupsofpatientsforresearchpurposes.
Furthermore,theDutchMinistryofHealth,Welfare
andSporthasannouncedtheimplementation
oflocalhealthandpreventionnetworksto
fightantimicrobialresistantmicroorganisms.
Theselocalnetworkswillrequireallhealthcare
institutionswithinaregiontocollaborate.The
UMCsconnecttheinstitutionsandtakealeading
roleinalmostallhealthcareregions.
education
TheUMCs’educationprogrammesandthe
trainingofgeneralpractitioners,medical
specialistsandotherhealthcareprofessionals
areimportantpillarsofthequalityoftheDutch
healthcaresystem.Scientificresearchinthe
UMCscontributessignificantlytothequalityand
timelinessofmedicaleducationandtraining.The
newgenerationofphysicianswillberesponsible
forthequalityoflifeofmillionsofpatientswho,as
aresultofdemographicchange,willhaveahigher
averageage.Theseolderpatientswilldisplaymore
complexdiseasesandtheywilloftensufferfrom
multiplelong-termconditions(multi-morbidity).
TheNetherlandsInstituteforSocialResearch
haspredictedthattherewillbeaboutonemillion
patientswithmulti-morbidityintheNetherlands
by2040.Furthermore,healthismorethanthe
absenceofphysicalillnesses.Manyconditions
substantiallyaffectthepatient’ssocialand
societalfunctioning.Chronicpaediatricdiseases
alsorequirespecialattentionbecausetheyoften
resultinlife-longdisabilityorimpairmentinsocial
functioning.Inadditiontowiderattentiontothe
non-physicalaspectsofdisease,theprevention
oflifestyle-relateddiseasesthroughbetter
informationaboutdietandlifestyleusingnew
formsofknowledgetransfer(i.e.,healthliteracy)
willgainimportanceindailymedicalpractice.
Futuremedicaldoctorsshouldbepreparedto
usenewtechnologiesforearlydiagnosis,genetic
analysisandtheimplementationofbigdatain
medicalpractice,inordertoachievepersonalised
medicine.Therefore,theUMCs,universities
andtrainingnetworksstriveforexcellenceand
continuousinnovation,inallphasesofmedical
trainingandinrelatededucationprogrammessuch
asbiomedicalsciences,healthsciences,dentistry,
biomedicaltechnology,nanobiology,clinical
technologyandbioinformatics.
social relevance
Publicandpoliticalattentiontothesocietal
relevanceofscientificresearchhasgrownin
recentyears.TheKNAWdiscernssocietalquality,
impactandvalorisationascomponentsofsocietal
relevanceinits‘Guidetotheevaluationofsocietal
relevanceofscientificresearch’(Eric-publication
1001,2010).ItisevidentthattheUMCsperform
highlysociallyrelevantwork.Forinstance,the
UMCsconductalargenumberofaccreditation
auditseveryyeartoarriveatoptimal,sensibleand
cost-effectivehealthcare.Inaddition,translating
laboratoryandclinicalfindingsforthebenefitof
patientsandthemarketarehighontheUMCs’
agendasandtheseareconsideredcoretasks.
High-qualityscientificknowledgeisoftenalso
economicallyrelevant.Itiswithgoodreason
thattheDutcheconomyisincreasinglyreferred
toasa‘knowledgeeconomy’.TheUMCsare
involvedinsettingtheagendasofthetopsectors
LifeSciences&Health,Agri&FoodandHigh
TechSystems&Materials.Knowledgeinstitutes
liketheUMCshaveasocietalresponsibilityto
contributetoeconomicallyproductiveinnovations.
Economicexploitationisanexcellentwayto
ensurethatinnovativeknowledgeisusedto
research agenda for sustainable health 21
thebenefitofpatients,intheformofimproved
prevention,diagnosis,ortreatment.Naturally,
thegreatestcareistakentoconsiderthepossible
tensionsbetweencommercialapplications,
scienceandclinicalpractice.Tothisend,the
NFUhasestablishedguidelines(www.nfu.
nl).AnotherexampleistheInnovativeMedical
DevicesInitiative(www.IMDI.nl).Inthisinitiative,
research,careandindustryjoinforcestoenhance
thesustainabilityofhealthcarewithnewmedical
products,servicesandknowledgenetworks.
Fromthisstartingpoint,theinitiativeaimstogive
impetustotheDutcheconomy.
TheUMCshavetheexpertisetoidentifyinteresting
findingsandtoassisttheiremployeesinpatenting
these.TheseactivitiesareorganisedinTechnology
TransferOffices,oftenincollaborationwith
universities.TheUMCs’entrepreneurialclimateis
good,buttherearestillchallengestoovercome.
Entrepreneurshipimpliesgettingfreedomand
trust,takingcalculatedrisksandshowingcourage.
ThisrequiresamoreactiveroleoftheUMCs,i.e.,
providingrolemodels,sharingsuccessstories
andactivelycallingattentiontoentrepreneurship
ineducationprogrammes.EachUMCappliesthe
latterinitsownway,especiallywithinthePhD
trainingprogrammesofthegraduateschools.
TheUMCsareagreatsourceofspin-outs;they
strivetopreserveandstrengthenthesespin-outs.
Moreover,theUMCscurrentlyareattheforefront
ofongoingtransitionsinhealthcare,e.g.,the
transitionfromclassicaldrugsto‘biologicals’,
thesteptowardspersonalisedmedicine,to
self-managementthroughe-health,thepotential
ofregenerativemedicineandgenomics,and
oftechniquesforearlydiseasedetectionusing
biomarkers.Finally,theUMCscriticallyevaluate
theaddedvalueandcost-effectiveness
ofinnovations.
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Sustainablehealthisacommonobjective,relatedtotheeightUMCs’societaltask.Sustainable
healthentailskeepingpeoplehealthyatreasonablecost.Itisalsoaboutkeepingourhealthcare
systemaccessible,affordableandhigh-quality.Collaborationofstrategicpartnerssuch
ashealthcareorganisations,insurancecompanies,publicauthorities,industry,healthcare
professionalsandcitizensisessentialtoachieveasustainablehealthcaresystem.Thecomplete
chainfromfundamentalresearchtoamorepersonalisedapproachofpreventionandtreatment,as
wellasthefinancialimplications,willdetermineifwecanbringthesustainablehealthgoalcloser.
Recentscientificandtechnologicaldevelopmentsoffergreatopportunitiestoforcebreakthroughsin
thecomingyears.TheNetherlandscanmakeamajorcontributiontothis.Themostimportantthemes
thatwillplayacrucialroleinthedevelopmentofasustainablehealthcaresysteminthecoming
yearsarelistedbelow.TheyseamlesslyfitintotheroutesoftheDutchNationalScienceAgenda2:
3The challenges and future of Dutch health research
A Healthcareresearch,preventionandtreatment
B Personalisedmedicine
C Regenerativemedicine
D BigdataandData4lifesciences
E Large-scaleresearchinfrastructure
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research agenda for sustainable health 25
healthcare research, prevention and treatmentDiseasepreventionwillexperiencean
unprecedenteddevelopmentintheyearstocome.
Asaresult,moreattentionwillbegiventopublic
health,prevention,lifestyleandcare,diagnostics
inchildrenandadolescents,andrevalidation.
Ourfuturehealthcarewillincreasinglyrelyonthe
identificationandcorrectinterpretationofthe
earliestsignsofdiseasesusceptibility,aimedat
preventingdiseaseandseriousconsequenceson
anindividualbasis.Itwillalsofocusonsecondary
prevention,i.e.,preventingdiseasedevelopment
afterasuccessfultreatment,forinstancediabetes
incancersurvivors.Thegoalistoidentify
innovativesolutions.Inaddition,thegoalisto
explorehowthepopulation’shealthylifespan
(‘healthspan’)canbeextendedorhowchronically
illpeoplecanbehelpedtofunctionsustainably
independent.Insightinbasicmechanismsof
diseasedevelopmentiscrucial.Therefore,research
thatprovidesthisinsightshouldbedeveloped
further.Thisincludesimprovedinsightinbiological
processesandtheperturbationsthereinthat
causedisease.Italsoincludesriskassessment
andaddressingdiseasecauses,suchasgenetic
predispositionandexposuretoadversefactors
(e.g.,food)whichmaygiverisetochangesin
healthstatus.Imagingtechniquesarecrucialfor
medicaldoctorsandscientiststounderstand
healthanddiseaseatthemolecular,cellularand
organlevel.Biobanks(especiallyforpopulation
research)canprovideessentialdataforveryearly
diagnostics.Theycanalsoprovidecluesonhowto
preventpeoplefromfallingill.
Healthcareconsumersthemselveswillcontribute
tothesedevelopmentsthroughe-healthand
m-healthapplications,whichwillbecrucialto
achievesustainablehealth.Efficientlydeploying
availableopportunitiesandactivelyinvolving
thepublic,patients,thehealthcaresectorand
thesocialsectorwillopenavenuestowardsa
sustainablehealthcaresystem.Inthisrespect,
itwillbecrucialtoevaluatethe‘newways’
andhealthcareinnovations,includingboth
the‘MedTech’or‘devices’andothertypesof
innovations,e.g.,healthcaretransitions,task
rearrangements,e-healthandapps.Evidence-
basedpractiseisthemottohere.
3A
Manyquestionsaboutpreventionweresubmitted
totheDutchNationalResearchAgenda.Thesehave
beenclusteredintheroute‘Healthcareresearch,
preventionandtreatment’:
Prevention
75
82
84
72
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preventionHowcanwepromote
healthandprevent
diseasethrougha
healthylifestyle
andbehaviour?
sports, exercise and nutritionHowcanweusesports,
exerciseandnutritionto
promotegoodhealthand
whatwillbetheeffects?
overweight and obesityHowcanwebetter
understandandprevent
theproblemofoverweight
andobesity?
degenerationHowdoesthecentral
nervoussystem
developandhow
canwecounteract
neurodegeneration?
research agenda for sustainable health 27
As an example. At present, the UMCs are
conducting the following research in collaboration
with other institutes and universities, to answer
these questions.
obesity and lifestyle
Preventionofoverweightandobesityisand
willremainextremelyrelevantforchildren,
adolescents,adultsandelderlypeoplealike.
Alargenumberofpreventionprogrammesand
guidelineshavebeendevelopedinrecentyears,
withavarietyofpreventionmessagesandtarget
groups.However,theseprogrammeshaveonly
verylimitedsuccess.Itisimportanttogain
insightinthemethodsandconditionstochange
behaviour.Therefore,researchoneffective
methodstoinfluencelifestyleremainsnecessary.
cardiovascular disease
Theunderlyingprocessesthatleadto
cardiovasculardiseaseareincreasinglywell
understood.Itispossibletoradicallyreduce
morbidityandmortalityfromcardiovascular
disease.Oneapproachisearlydetectionofrisk
factorsbeforediseasesymptomsappear,followed
bytargetedinterventions.Anotherapproachis
theimplementationofgeneticmarkers,improved
cardiovascularimagingmodalities(imaging
markers)andnewbiomarkersinblood.Thisis
beingexploredbytheCVONconsortia,among
others.Researchonindividualriskfactors
willobtainacentralpositioninthenextfew
years.Forinstance,chronickidneyfailurecan
causecardiovascularproblems,soresearchon
biomarkersthatcanpredictkidneydamageis
needed.Biobankscontainawealthofinformation
thatcanhelpunderstandmechanismsanddefine
biomarkers.Asaresult,novelmarkerswillbe
measuredandindividualtreatmentswillbeoffered
alreadyatayoungage(10-to-20-yearolds).
oncology
TheNetherlandsmakesanimportantcontribution
tointernationalcancerresearch,intheareaof
diagnosticsandtreatment,aswellasinmore
basiccancerresearch.Canceristheresultof
aninteractionbetweencongenitalriskfactors,
lifestyleandenvironmentalexposures.The
appearanceofatumourisprecededbymanyyears
ofgradualderailment.Aswithcardiovascular
disease,inthefuture,individualswillbeableto
receivepersonalisedadvicetoreducetheircancer
risk.Ifsomeonedevelopscancer,moreinsightin
riskfactors,familialfactorsandpossibilitiesfor
earlydiagnosiscanbelifesaving.Thisisbecause
curingcancerismainlypossiblewhenthetumour
canbecompletelyremovedatanearlystage.In
thisway,thegrowingscientificknowledgecan
stronglyreducetheindividualandsocietalburden
ofcancer.
neurological disorders
Thenumberofpatientswithaneurodegenerative
diseaseisincreasingasaresultofpopulation
ageing.Neuraldeclineisagradualprocessthat
isincreasinglyunderstood.Interventionswillbe
mostsuccessfulwhenstartedearlyinthisprocess.
Therefore,itisofgreatimportancetofindnew
methodstodetectadeclineinbrainfunctioning
atanearlystage.Forinstance,scientistsare
currentlysearchingforindicatorsthatcanpredict
Alzheimer’sbeforeaseveredeclineindaily
functioningarises.
psychiatric disorders
Psychosis,depression,panicdisordersand
compulsivedisorderscanbetreatedeffectively.
Nevertheless,amajorimprovementhasnotyet
occurredinthefieldofpsychiatricdisorders.Oneof
thereasonsforthislackofprogressisthefactthat
psychiatricpatientsareoftentreatedatarelatively
28 nfu
research agenda for sustainable health 29
latestage.Thisisundesirablebecausechronic
psychiatricdisordersareassociatedwithhigh
societaldropout,somaticmorbidityandpremature
mortality.Likethedisciplinesdiscussedabove,
psychiatryalsostrivestowardsearlierdetection
(e.g.,inschizophreniapatients)andinsightinthe
underlyingpathophysiology(e.g.,stress-related
disorders).Inaddition,thefieldaimstoofferthe
mostappropriatepreventiveinterventionsor
treatmentsmuchearlier,therebypreventingafirst
ornextdiseaseepisodeorchronicity.
infectious diseases and medical
microbiology
Inadditiontoexistinginfectiousdiseases,so-
called‘emerginginfections’aremanifest,e.g.,
Qfever,SARSandtheMERScoronavirus.Some
existingdiseasesareoccurringmorefrequently,
whetherornotatepidemiclevels(e.g.,Ebola).
Thenumberofimmunologicallycompromised
elderlypatientsisincreasing,partlyasaresult
ofpopulationageing.Inthisrespect,the
increaseinantibioticresistanceisaworldwide
concern:by2050,theadditionalmortalitydue
tountreatableinfectionsmaybehigherthan
mortalityfromtumoursifourantimicrobial
resistancestrategyisnotchanged.Thespread
ofantimicrobialresistantmicroorganismsand
multi-drugresistantorganismsincreasinglycauses
healthcare-associatedinfections(e.g.,sepsis,
postoperativewoundinfections,pneumoniaand
urinetractinfections).Innovativeresearchon
thepreventionoftransmissionandspreading,
detectionandnewtreatmentmodalitiesofmulti-
drugresistantorganisminfectionswillbekey
topicsinthenextfewyears.Thedevelopment
of‘smart’antibioticsanddrugdeliverysystems
thatsparethehealthymicrobiomeisrelevant
forthesustainabledevelopmentofinnovative
drugs.Thehuman,veterinaryandenvironmental
sectorareallinvolvedintheaetiologyandspread
ofantimicrobialresistance,makingaOneHealth
approachnecessary.
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Personalised medicine
Personalised medicine tailors
treatments to individual patient
characteristics. Every person
is unique, not only in behaviour
and appearance, but also in body
composition. Therefore, the same
drug may have different effects in
different patients. Personalised
medicine facilitates a better, faster
and cheaper treatment of diseases
(NWO, 2011).
research agenda for sustainable health 31
personalised medicineAtpresent,stepsaretakentoindividualisemedical
treatments,aimedatthelargestandfastest
healtheffectsatthelowestcost,i.e.,treatments
tailoredtotheindividualwithaslittleundesired
side-effectsaspossibleratherthanstandard
treatments.Personalisedmedicinewillradically
revolutionisehealthcare:improved,personalised
treatmentsassociatedwithcostreduction.
Biobanksofferunprecedentedopportunitiesto
developbetterdiagnostics,treatmentsandcures.
Thebiggestchallengeinpersonalisedmedicine
istheanalysisofthevastamountofdatathat
isorwillbeproducedbyeachindividualand
itscorrelationwithdiseaseparameters.This
includesgenomesequencing,microbiomestudies,
biomarkersinblood,andimaginginpsychiatry,
oncology,cardiovasculardisease,diabetes,
obesityandneurologicaldiseases.
Itconcernsthecompletecascade:fromgenetic
factors,throughavarietyoffactorsandomicsthat
3Bplayaroleintheendphasewhereproteinsand
peptidesexerttheireffects,tothedailyfunctioning
ofpatients.Otherchallengesareageing,multi-
morbidity,thesteptoimplementpersonalised
medicineinclinicalpracticeandtoanchoritinthe
reimbursementsystemofhealthinsurers.
TheNetherlandsholdsastrongpositioninthearea
ofpersonalisedmedicinetheinternationalLSH
sector.Thesectoroffersgreatopportunitiestothe
Dutchknowledgeeconomybecauseofitsunique
combinationofknowledgeandskills.TheDutch
universities,knowledgeinstitutesandscientific
institutesarestrategicallywell-positionedtomake
fastandefficientprogress.Biobankscollaborate
closelywithinBBMRI-NL2.0.Inaddition,thereare
multiplecollaborationsbetweentheUMCsandthe
HubrechtInstitutetodeveloptechnicalapplications
suchas‘organs-on-a-chip’.Newopportunities
forpublic-privatepartnershipsarewaiting.Large
technologycompaniessuchasPhilipsandIBMare
focusingincreasinglyonhealthcaretechnology.
ThesameappliestodatagiantslikeGoogleand
Microsoft.Crossoversareemergingbetween
thetopsectorLifeSciences&Healthandthetop
sectorHighTechSystems&Materials.Jointagenda
settinginvolvingallstakeholdersisneededto
maximizetheopportunitiesandbenefits
forpatients.
Multipledevelopmentsarenecessaryfor
personalisedmedicinetodeliveronitspromise.
First,itisimportanttoactivelyinvolvepatients,
patientorganisationsandhealthcareprofessionals
inthedevelopment.Second,varioustypesof
researchmethodsshouldbelinked,e.g.,imaging
andmetabolomics.Inaddition,thewaytonew
preventivetreatmentsandproductswillbeopened
bythelinkwithtechnologicalinnovationsand
buildinganITinfrastructurethatmakesexisting
resourcesaccessibleandinterpretablefor
stakeholders.Thisiscurrentlyrealisedthrough
Data4lifesciencesincollaborationwithBBMRI2.0,
DTLandEATRIS.
Manyquestionsaboutpersonalisedmedicinewere
submittedtotheDutchNationalResearchAgenda.
Examplesare:
Personalised medicine
95
85
88
81
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biomarkersHowcanwepersonalise
healthcare,forexampleby
usingbiomarkers?
cardiovascular diseaseHowcanwepredict,prevent
andtreatcardiovascular
disease(atherosclerosis,
heartfailure,heart
arrhythmiaandthrombosis)
atanearlystageandatan
individuallevel?
geneticsHowwillthe
knowledgeofgenetics
beimplementedin
screeningforand
treatmentofcommon
andrarediseases?
tumoursEverytumourisdifferent,
sohowcanwecometo
understandcancerwell
enoughtodevelopa
treatmentforeachand
anytype?
research agenda for sustainable health 33
As an example. At present, the UMCs are
conducting the following research in collaboration
with other institutes and universities, to answer
these questions.
oncology
Oncologyisoneofthemedicaldisciplinesin
whichpersonalisedmedicineisalreadyapplied
frequentlyindiagnosticsandtreatment.Ithas
becomeincreasinglyclearwhyastandardcancer
treatmentdoesnotproducethesameresultin
allpatients.Thegeneticcompositionofatumour
determinesthesuccessofatreatment.More
techniquesarebecomingavailabletoidentify
complextumourcharacteristics,atthelevel
oftumourbiopsies(DNAandRNAanalyses),
blood(measuringmarkers),andtumourlesions
(molecularimaging).Targetedcancerdrugsexist;
thesetargetaspecificmolecularmechanismina
specificpatient.Itbecomesincreasinglypossible
toidentifysubgroupsofpatientsthatarehighly
likelytobenefitfromaspecifictreatment.Patients
thatarenotexpectedtobenefitfromacertaindrug
willnotreceivethetreatment;thissparesthem
fromunnecessaryside-effectsanditsavescosts.
Immunetherapyisanapproachthatiscurrently
showingimpressiveeffects.Thistherapytriggers
thepatient’simmunesystemtoattackcancer
cells.Expertspredictthatatleasthalfofallcancer
treatmentswillconsistofimmunetherapyten
yearsfromnow.Alargenumberofnewdrugsthat
actviatheimmunesystemareindevelopment.
Thesedrugsareoftenproducedusingthepatient’s
ownbodycells.However,scientistshavenotyet
foundagoodmethodtoidentifypatientsthatare
likelytobenefitfromimmunetherapy.
cardiovasculare disease
Prematuremortalityduetocardiovascular
diseasehasbeenstronglyreducedinthepast
fewdecades.Nevertheless,thereisstillalotto
improveindiagnostics,treatmentandsecondary
preventionofcardiovasculardisease.Thisisof
extraimportancebecauseoftherisingprevalence
ofchroniccardiovasculardisease(e.g.,heart
failure)asaresultofimprovedhealthcareand
ageingofthepopulation.Theexponentialincrease
inknowledgeaboutthebiology,physiologyand
pathologyofthecomplexcellularprocessesin
vesselwallsandcardiacmusclefacilitatesnew
riskstratificationsandtherapies.Genetherapyis
beingdeveloped.Geneticmodifiers,imagingof
heartdysfunctionandnewbiomarkersinblood
willimprovediagnosticandtreatmentstrategies
forheartmuscledisorders.Pharmacogenetics
shouldresultinriskstratificationandtherapy
thatareoptimisedfortheindividualpatient.A
multidisciplinaryapproachwithintegrationfrom
benchtobedside(i.e.,translational)isafirst
prerequisiteforaneffectiveimplementationand
evaluationofnewconceptsandtherapies.
psychiatric disorders
Researchinthepastdecade(e.g.,withinthe
nationalprogramme‘MindPower’(inDutch:
‘GeestKracht’)hasledtoasubstantialincreasein
knowledgeaboutriskfactors,individualsymptom
development,therapeuticrelationship,aetiology,
gene-environmentinteractionsanddisease
pathwaysofpsychiatricdisorders.Thecombination
offactorsthatleadstodiseaseisuniquetoeach
patient.Therefore,a‘onesizefitsall’approachis
notsufficient.Thereareopportunitiesformore
personalisedand–asaresult-morepreciseand
effectivetreatmentinpsychiatryaswell,i.e.,
personalisedmentalhealthcare.Thisrequires
abetterknowledgeoftheunderlyingdisease
processes,thetransitionsbetweendiseasestages,
34 nfu
theoverlapanddifferencesbetweendisorders,
theaetiologyofsymptom-symptomassociations
andthefactorsthatdeterminethecreationofan
adequatetherapeuticrelationship.
lung diseases
LungresearchisfocusedonpulmonaryP4
medicine(preventive,predictive,personalised,
participatory).Treatmentistherebynotonly
focusedonspecificpatientcharacteristics
(scientificperspective),butalsoonthepatient’s
specificneeds(patient’sperspective).Weneeda
betterunderstandingoftheprocessesunderlying
lungdiseases(i.e.,betterphenotyping)inorder
toimplementP4medicine.Inaddition,lung
researchisincreasinglyfocusedoncommon
mechanismsunderlyingdifferentdiseases,rather
thandisease-specificmechanisms.Thiscalls
forabroadandmulti-disciplinaryapproachthat
transcendsdiseases.Bigdataanalysisofexisting
andnewdatabasescreatesopportunitiestodetect
previouslyunknownmechanisms.Thesameholds
forcreatinga‘virtualbiobanklungdiseases’
throughfrequentsamplingoflifestyle,personal
anddiseasecharacteristics.Thismayresultin
stratificationoftheindividualhealthriskwith
tailoreddiagnosticandtherapeuticinterventions.
Forinstance,lungtreatmentwithe-healthand
e-monitoringbasedonphenotype(e.g.,biomarker)
canpreventundesiredside-effects(i.e.,precision
management).
infection and immunity
Inthenextfewyears,antimicrobialtherapy
researchwillfocusonoptimisingantibiotic
therapy,developingalternativetreatments,using
biomarkersanddevelopingmoderndiagnostics
suchasmoleculardiagnosticsforbothbacteria
andbiomarkers.Inaddition,researcherswillfocus
ondevelopingpoint-of-careteststocharacterise
bacteria,virusesandhostresponses.Amore
holisticapproachtoinfectiousdiseasesuses
geneticmarkers,personalmicrobiomeanalysisand
monitoringofinterventions.Thiswillresultinnew
insightsandtherapeuticstrategieswithorwithout
theuseofantibiotics.Immunologicalresearchhas
madegreatprogressinrecentdecadesandthe
Netherlandshasplayedaprominentroleinthis.
Thehostdefenceagainstinfectiousdiseasesis
increasinglywellunderstood.Inaddition,itismore
andmoreclearhowgeneticandenvironmental
factorsdetermineindividualdifferencesinhost
defence.Thisknowledgehassuccessfullybeen
appliedtomoreeffectivelytreataderailedimmune
response(e.g.,inthecommondiseaserheumatoid
arthritis).
rare diseases
Bydefinition,thenumberofpatientssuffering
fromaspecificrarediseaseissmall.However,the
totalnumberofrarediseasesissubstantial,and
asaresult,thetotalnumberofpatientssuffering
fromararediseaseisalsosubstantial.Large
stepshavebeentakenintheareaofraredisease
therapyinthelastfewyears.TheDutchMinistry
ofHealth,WelfareandSporthasappointed
DutchandEuropeancentresofexpertiseforrare
diseases,givingadditionalimpetustoresearch
onrarediseasetreatment.Patientsandpatient
organisationsareimportantpartnersindiagnosing
andtreatingrarecongenitaldisordersthat
manifestimmediatelyafterbirth(e.g.,PKU,cystic
fibrosis)andrarediseasesthatmanifestinadults
(e.g.,ALS).Patientsareorganisingthemselves
moreandmore,forexamplethroughwebsites
suchasPatientsLikeMe(patientslikeme.com).
Patientexperiencesandexpertiseareincreasingly
incorporatedinscientificresearch.
research agenda for sustainable health 35
36 nfu
research agenda for sustainable health 37
regenerative medicineRegenerativemedicineorreplacementmedicine
entailsregenerationofcells,tissuesandeven
organs.Regenerativemedicineutilisesthebody’s
ownmaterial(e.g.,stemcellsorheartcells)to
preventorcuredisease.Regenerativetherapies
havealreadybeenusedinearlyclinicaltests
andinlaboratorysettings,e.g.,totreatbroken
bones,cartilagedefects,severepressureulcers,
burns,blindness,deafness,heartdamage,nerve
damage,Parkinson’sdisease,metastaticcancer
anddisordersoftheliver,kidneys,heartand
lungs.Regenerativemedicinewillpossiblylead
tolifeextension,becauseitallowsforrepairing
damagecausedbyageing.Itisamultidisciplinary
field,particularlyintheareaofchronicdiseases.
Thisisdemonstratedbythefollowingexamples:
cartilagecelltherapyforthetreatmentof
osteoarthritis,betacelltherapyforthetreatment
ofdiabetes,cardiacprogenitortherapyforthe
treatmentofheartfailure,andbioengineeringand
mesenchymalstemcelltherapyforthetreatmentof
renalfailure.
Itisexpectedthatregenerativemedicinewillbe
thestartingpointformanynewtypesofmedical
treatment.Sinceregenerativemedicinerepresents
anemergingmultidisciplinaryfieldofresearchand
clinicalapplication,newinsightsintoscientific
issues,newpartnershipsandneweducationaland
financingfacilitiesareneededbeforethis‘new’
medicinewillbecomebeneficial.
Weneedinsightinthecomplexityoftissuestobe
abletoregeneratethem.Isolation,differentiation
andproliferationofstemcellsarecriticalfactors
here.Inaddition,abetterunderstandingofthe
cellularresponseinthetissueenvironmentand
theinteractionbetweenmaterialsandthistissue
environmentisofgreatimportanceforthefurther
developmentofregenerativemedicine.Knowledge
oftheextracellularmatrixisamajorinspiration
here.
Supportingtechnologiesarerequiredtoperform
efficacyandsafetystudiesinadditiontobasic
science.Examplesofsuchtechnologiesare
biomarkers,imagingtechniques,high-throughput
technologies,in vitroandin vivomodelsystems,
bioreactorsandminimallyinvasiveadministration
tools.
Thedevelopmentofnewandadaptationofexisting
technologiesinvolveshighcosts.Priorityshould
begiventosustainablyclosingtheknowledgegaps
inbasicresearchandenablingthedevelopmentof
expensivesupportingtechnology(KNAW,2010).
Inregenerativemedicine,fundamentaldisciplines
(e.g.,cellbiology,materialsscienceandchemistry)
collaboratewithmoreapplieddisciplinessuch
ascelltherapyandimplantationtechnology.
Involvementofsocialsciencedisciplinessuchas
lawandethicsareimportantforastrong
publicsupport.
3C
Questionsaboutregenerativemedicinesubmitted
totheDutchNationalResearchAgenda:
Regenerativedisease
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100
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38 nfu
kidney diseaseWhatcauseschronickidney
diseaseandhowcanitbe
detectedsoonerandthen
treatedonanindividualbasis?
Isanimplantableartificial
kidneyfeasible?
lung diseasesHowcanweimprove
ourunderstandingand
treatmentoflungdiseases?
Howcanweletlungs
regenerate?
stem cellsHowcanweuse
cells,stemcellsand
biomaterialstoengineer
andregeneratetissues
andorgans?
research agenda for sustainable health 39
As an example. At present, the UMCs are
conducting the following research in collaboration
with other institutes and universities, to answer
these questions.
neurological disorders
Brain-on-a-chipisanimportantandpromising
newresearchtechniquewherebraintissueis
reconstructedusingstemcelltechniques.This
canthenbeusedforresearchinrealisticmodels,
e.g.,totestdrugs.Atpresent,thefieldisworking
atthelevelofstemcellsororganoids,butthis
willexpandrapidlyasaresultofthecollaboration
betweenfundamentalcellbiologists,clinicians
andpharmacologists.Relatedtothis,research
onstemcelltherapyisalsoimportant.This
researchrequiresspecificsafetymeasuresandthe
technologyisexpensive.
transplantation medicine
TheNetherlandsplaysapioneeringroleinthefield
oftransplantationmedicine.Variousinnovations
thathavesignificantlyincreasedtheglobal
survivaloftransplantedpatientsinrecentdecades
havebeenrealisedwithintheDutchUMCs.The
developmentoforganperfusiontechnologyisa
newstepthatshouldhelpsolvetheenormous
problemoflongwaitingtimes.Thistechnologycan
repair(‘regenerate’)organsthatweredisapproved
fortransplantation,renderingthemusable.
Dedicatedmachines‘resuscitate’organs,allowing
damagedlungs,liversandkidneystorecover.In
addition,organscanbekeptforlonger,allowing
moretimetofindasuitable‘match’.
40 nfu
Data infrastructure
A data infrastructure is a generic solution for
a specific aspect of scientific data handling,
intended to lighten the load of researchers. It
enables researchers to make optimal use of
the diverse possibilities of IT technology. An
infrastructure can take many forms: it may
comprise an online catalogue of samples in
a biobank, a standard method with which
data in an electronic health record is made
available, privacy regulations, the way
in which IT is organised at UMCs, a data
stewardship manual (HANDS, see www.
data4lifesciences.nl), a generic way to
exchange data or an expert who supports a
researcher with data issues.
research agenda for sustainable health 41
big data and data4lifesciencesTheUMCsofferaninfrastructurethatisvery
suitableforresearchbycombiningacademic
hospitalswithassociatedmedicalfaculties.The
Netherlandsisstronglypositionedinthefieldof
(medical)bigdata.Collaborationbetweenthe
UMCshasbeenstrengthenedinrecentyears.By
collecting(clinical)dataandbiomaterialsatNFU
levelandbypoolingtheavailableinformationand
materials,advancementsaremadeinscience,the
treatmentofpatientsandproductdevelopment.
Thelatteriscrucialforstrengtheningtheeconomic
positionofthepharmaceuticalandbiotechnology
industriesintheNetherlands.
Thehigh-qualityinfrastructurethatisneeded
tomeetthedatarequirements,transcends
thecompetenceofindividualresearchers
and,increasinglyalsothecompetenceofthe
individualUMCs.In2013,theNFUstarted
theData4lifesciencesprogramme(www.
data4lifesciences.nl)withseveralpartners(e.g.,
DTL,SURF,eScienceCenter,CIT).Thisprogramme
aimstodevelopastrategytoestablishanational
datainfrastructurefortheDutchlifesciences.
ThestartingpointofData4lifesciencesisthat
researchdatashouldbeFAIR(Findable,Accessible,
InteroperableandReusable)andmadeavailable
inascalable,distributedenvironment.The
computationalcapacityrequiredtoprocessthe
datashouldcomefrombothnationalandUMC-
associatedcomputingfacilities.
TheData4lifesciencesprogrammeissetting
upaninnovativeresearchdatainfrastructure
within,for,byandbetweentheUMCsandtheir
partners.Urgentreasonsforadaptingthecurrent
infrastructurearetheupcomingEUprivacy
regulations,theimplementationofnewelectronic
healthrecords,andmorestringentrequirements
forthequalityofdatamanagementandreusability
ofdatabyimportantresearchsponsors(e.g.,NWO,
ZonMwandKWF).
Theenvisagedhigh-qualitydatainfrastructure
Data4lifesciencesistodeliverwillconsistnotonly
oftechnicalfacilities(hardandsoftware),but
alsosystemsandprocessesforqualityassurance
andtherequiredexpertiseofresearchersand
administrators.Data4lifesciencesensures
administrativecoordination,connectinglocal
facilitiesandexpertisenetworkstonationaland
internationalinfrastructuresandviceversa.
3D
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research agenda for sustainable health 43
Thetechnologicalrevolutioningeneticsand
imaging(e.g.,MRI,CT),amongotherareas,have
resultedinanexplosivegrowthofresearchdata.In
addition,thesedataarealsoextremelycomplex.
Moreover,personalisedmedicineresearchrequires
largecohorts(i.e.,groupsofpatientswithsimilar
characteristics),e.g.,allmenbornbetween1940
and1950.Suchcohortscanonlybecompiled
throughcollaboration.Researchersarethus
confrontedwithmuchmorecomplexdata,butalso
withstringentrequirementsintermsofprivacy,
quality,managementanddatasharing.
ThejointactionoftheUMCsstrengthenstheir
competitivepositioninEuropebyconnecting
torelevantpartsoftheESFRIRoadmap,
includingBBMRI2.0andELIXIR.Thecurrentdata
infrastructureprovidesagoodstartingposition,
butthispositioncanonlybemaintainedifthe
UMCs,theirpartnersandthegovernmentpersistin
strivingtokeeptheinfrastructureuptodate.This
isaprerequisitetoattractsubstantialsustainable
funding,totakefulladvantageofnewEuropean
programmes,andtoretaintheNetherlands’leading
positioninEuropeanresearch.Moreover,European
infrastructuresplayanincreasinglyimportantrole
intheacquisitionofnewresources.TheUMCs
anduniversitiesareresponsibleforthequality
ofresearchdataandthecarewithwhichthey
arecollected,stored,processedandarchived.In
addition,theyareresponsibleforcompliancewith
therelevantregulationsonprivacyprotectionand
patientsafety.Ahigh-qualitynationalinfrastructure
isthusrequired.Data4lifescienceswillplayan
importantroleinthis.
Atpresent,theDutchfundingsystemforbiobanks,
cohortsandbigdatafacilitiesisnotorganised
optimally.Statefundingisinsufficientand
occasionalimpulsesarerareandoftenmarginal.
Thatisalarmingbecausethesefacilitiesarethe
rate-limiting-stepforthespeedandefficiencyofLife
Science&HealthresearchintheNetherlands.
Manyquestionsaboutbigdataweresubmittedtothe
DutchNationalResearchAgenda,including:
Big data
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big dataHowcanbigdataand
technologicalinnovations
(e-health)contributeto
healthcare?Whyistheresolittle
researchwithalreadycollected
dataintheNetherlands?
innovative technologyHowcanweutiliseagreater
understandingoflifetoidentify
newtargetsformoleculartherapies,
antibioticsandantivirals?Howcan
weusethephenomenalincrease
inprocessingpower(innovative
technology)optimallyforhealthand
drugresearch?
research agenda for sustainable health 45
As an example. At present, the UMCs are
conducting the following research in collaboration
with other institutes and universities, to answer
these questions.
biobanking
AspartofNWO’sNationalRoadmapforLarge-
ScaleResearchFacilitiesprogramme,aplanhas
beencreatedforajointapproachtobiobanking.
InadditiontotheeightUMCs,theNational
InstituteforPublicHealthandtheEnvironment
(RIVM),DutchCancerInstitute(NKI)and
severaluniversitiesparticipateinthisplan.The
Netherlandsleadsthewayinthisfieldandhas
collectedmanybiobanksandcohorts.BBMRI-
NL2.0connectsthese,creatinglargercollections
andnewresearchopportunities.Apointto
considerhereistheinteroperabilityofdataderived
fromdifferentcollections.BBMRIpromotessuch
interoperability.BBMRI-NL2.0’smissionisto
createtheinfrastructurenecessarytorealisea
nationalbiobankresearchfacility,whichwillbe
invaluablefortranslationalresearch.Thatimplies
linkingadditionaltypesofresearchmaterialsuch
asimagingandmetabolomics,involvingsocietal
stakeholderssuchaspatientorganisationsmuch
moredirectly,andbuildingtheITinfrastructure
thatmakesexistingresourcesaccessibleand
interpretableforallstakeholders,suchasthe
catalogueofbiobanks.
infectious diseases
Seriousinfectiousdiseasesareassociatedwithan
impairedimmuneresponse,involvingfactorssuch
aspathogenvirulence,geneticfactors,epigenetic
factors,chronicco-morbidityofthepatient,as
wellasthetypeofimmuneresponse.Researchon
thecomplexinteractionbetweenpathogenand
hostrequiresproperclinicaldocumenting,and
biobankingofpathogensandpatientmaterial.
Prominentexamplesinthefieldofinfectious
diseasesaresepsisandmeningitis.Inrecent
years,substantialinvestmentshavebeenmade
insystemsbiologyanalysisofpathogenandhost
factorsinordertousethenewknowledgeforthe
developmentofpersonalisedmedicine.
oncology
Knowledgederivedfrombiobanksisessential
forfurtherprogressinthepreventionand
treatmentofcancer.Bycollectingdatafrom
largenumbersofpatientsandtumours,itwill
becomeclearwhichapproachwillbeeffectiveto
treattumourswithspecificcharacteristics.There
aredifferencesbetweenpatients.Inaddition,
tumoursevolvethroughoutthecourseofthe
disease.Asaresult,datafromseveralsources
areneededinadditiontonormalbiopsies,e.g.,
molecularimaging,liquidbiopsiesandother
biomarkersinblood.Incombinationwithclinical
dataontreatmentoutcome,thisproducesavast
amountofinformationperpatient.Thenextstep
istosummarisethisdataintoclinicallyuseful
conclusionsandtotranslatethefindingsinto
clinicaldecisiontools.Here,theexpertiseof
computationalbiologistsandbioinformaticsis
indispensable.Thisisanotherareaofincreasing
collaborationbetweenUMCs,technicaluniversities
anduniversities.
lung diseases
Biobanksareessentialintheprocessofresearch
towardspersonalisedmedicine.Becauseofthe
scarcityofcellsandtissues,a‘virtualbiobank
forlungdiseases’shouldbesetup,aimingfor
nationwideavailabilityofbiobankinformationfor
research,combinedwithappropriateclinicaldata.
46 nfu
BBMRI-NL
EPI12
biomaterial and datacollections
NeCEN bio imaging
EATRIS
DTL Data4lifesciences
MCCA
design of multidisciplinaryexperiments
internationalreferencedata
all resources for data stewardship and analytics: e.g, bioinformatics, informatics, biostatis-tics, computational (systems), biology, e-science, ICT, ...
information &insight
e-health &quantifiedself data
modelsystems
all resources to measuree.g. genomics, transcriptomics, proteomics, metabolomics, bioimaging, microscopy, quantified self, lifestyle, nutritional studies
research project
research objective
health
research agenda for sustainable health 47
large-scale research infrastructureTheambitionandvisionoftheNFUistoestablish
aresearchinfrastructureforpersonalisedhealth
andpersonalisedmedicine.TheUMCsandtheir
partners(universities,ministries,topsectors
andprivateparties)aimtodevelopanational
infrastructureforscienceandinnovationprojects,
focusedonpersonalisedhealth(forcitizens)and
personalisedmedicine(forpatients).Anumber
ofyearsago,theNFUhasjoinedforceswith
relevantstakeholders(ZonMw,ministriesandtop
institutes)toestablishalargeinfrastructureforthe
LifeSciences&Healthdomain.
ItisclearthatLifeScience&Healthresearch
willbetechnology-drivenanddata-intensive
inthenearfuture.Theeconomicandsocietal
impactoftheDutchlifesciencesfieldislarge,
asisalsoevidentfromthelargenumberof
health-relatedquestionssubmittedtotheDutch
NationalResearchAgenda.Theimportance
ofanexcellentresearchinfrastructure,which
enablesustoremaininternationallycompetitive,
iscorrespondinglylarge.NFU’s‘Committeeon
ResearchInfrastructures’managesandprioritises
inthisprocess.Membersofthiscommittee
includerepresentativesofallUMCs,research
infrastructureswithintheESFRIroadmapsand
nationalroadmaps,NKI-AVL,DTLandZonMw.
Thecommitteeactivelyengageswiththerelevant
ministriesandtopsectors.Thisapproachhas
alreadyresultedinafocusedNFUapplicationinthe
Roadmapround2014.Therelationshipwith
theESFRIRoadmapwasmadeexplicitin
theapplications.
Thefigureonpage46showsvariouscomponents
oflifesciencesresearch,relatedtothemajor
researchinfrastructuresinthecurrentroadmap.
Fundingshouldcomefrom, inter alia,the
investmentgrantNWOLargeandNWO’sNational
RoadmapforLarge-ScaleResearchFacilities
programme.TheEuropeanStrategyForumon
ResearchInfrastructures(ESFRI)isakeyplayerthat
providesstrategicadviceoninteraliaeightresearch
infrastructuresinthefieldofhealth(including
BBMRI,ELIXIRandEATRIS).Anationalcoordination
teamhasbeenappointedtomanagetheentire
spectrumoflargeinfrastructuresfortheredlife
sciences.Thisteamsetsthelifesciencesinvestment
agendatomaximisethereturnofscarceresources
intheNetherlands:thegoalistoeffectively
distributemoneyandtomakemoreresources
availablefortranslationalresearch.Atpresent,the
followingmajorlifesciencesinfrastructuresareon
theNWOroadmap.
BBMRI-NL2.0:
BBMRI-NL2.0istheinnovativeintegrationof
threecomplementarynationalinfrastructuresfor
personalisedmedicine:BBMRI-NL1.0(biobanking),
EPI2(populationimaging),andCTMMTraIT(IT
fortranslationalresearch).BBMRI-NLhasbeen
activelypromotingandorganisingcollaboration
3E
48 nfu
research agenda for sustainable health 49
andstandardisationbetweenDutchbiobanksfor
morethansixyears.BBMRI-NLrepresentstheDutch
biobanks,includingPALGA(pathologyconsortium),
largepopulationcohorts(e.g.,LifeLines,ERGO,
NTRandLLLS),andclinicalcollections(e.g.,String
ofPearlsInitiative,HEBONandKOALA).BBMRI-
NL2.0aimstobringtogetherallrelevantbiomedical
researchinfrastructuresinastreamlinedand
efficientsystem.
EATRIS:
EATRISaimstobridgethegapbetweenmedical
scientificresearchandclinicalapplication.This
internationalcollaborationiscrucialforpatients.
ItisimportantthatEuropeanmedicalresearch
safelyandquicklyfindsitswaytothepatients
whoneedit.EATRISfacilitatesthisprocess,
focusingontranslationalresearch.Morethan
70prominentacademicinstitutesareinvolved
inEATRIS.Theymaketheirknowledge,facilities
andclinicalresearchopportunitiesavailableto
researchers.TheycomefromFinland,Italy,Czech
Republic,Denmark,France,Norway,Spainandthe
Netherlands.
EPI2:
TheEuropeanPopulationImagingInitiative(EPI2)
isaninfrastructureforlarge-scaleimaging.Itoffers
standardisation,protocols,centralisedstorage
facilities,validatedimageanalysisandbiomarker
referencedatabasesforpopulationandclinical
imagingresearch.EPI2isapartofBBMRI-NL2.0.
NL-BioImaging AM:
NL-BioImagingAdvancedMicroscopy(NL-
BioImagingAM)isadistributedadvanced
microscopyfacilityintheNetherlands.Itboosts
biomedicalandlifesciencesresearchbyproviding
accesstostate-of-the-artmicroscopytechnologies
thatenablethedirectvisualizationofdynamics
ofmoleculesandtheirinteractionsinsideliving
cellsandtissues.Thisinformationisessentialfor
e.g.elucidatingmechanismsofcarcinogenesis,
understandingtheprogressionandmolecularbasis
ofneurodegenerativedisorderslikeAlzheimer’s
disease,andforhigh-contentdrugscreening.NL-
BioImagingAMisstronglyconnectedtotheeight
UMCsintheNetherlandsandtotheESFRIEuro-
BioImagingroadmapinEurope.
NeCEN:
Dutchelectronmicroscopyisstrong.Forceshave
beenjoinedintheNeCENconsortium.Thenew
cryo-electronmicroscopeoffersopportunitiesfor
pioneeringresearch:itispossibletovisualisethree-
dimensionalmacromolecularcomplexes,resulting
inimportantinformationaboutthefunctioningof
livingcells.Thisopensuppossibilitiesformany
scientificfieldswhereinformationonthestructure
ofmoleculesisnecessaryforfurtherdevelopment.
Mouse Clinic for Cancer and Ageing (MCCA):
ThepurposeoftheMCCAisthreefold.First,it
providesresearcherswithmousemodelsforcancer
andageing,derivedfromseveralroutinelyused
strains.Second,theMCCAisabiobankwherea
widerangeofmicetissuesarestoredandmade
availabletoresearchers.Third,theMCCAprovides
geneticallymodifiedmice(custom-made)to
researcherswhowanttostudyageingandcancer.
advanced techniqueshowcanwedevelopminimallyinvasivetechniques
andinterventionsforthediagnosis,prognosisand
treatmentofpatients?
Candiseasessuchasdementia,cancerand
cardiovasculardiseasebedetectedearlier
andtreatedwithhigh-techdiagnosticimaging
techniques?
Howcanweincorporatethemostadvanced
microscopytechniquesinminiaturetoolsfor
minimallyinvasivediagnosisandtreatmentof
disease?
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Manyquestionsaboutbio-imagingandmicroscopyweresubmittedtothe
DutchNationalResearchAgenda,including:
Advanced techniques: bio-imaging, microscopy and gentechnology
104
research agenda for sustainable health 51
As an example. At present, the UMCs are
conducting the following research in collaboration
with other institutes and universities, to answer
these questions.
oncology
Itisincreasinglyclearwhyastandardcancer
treatmentdoesnothavethesameeffectinall
patients.Scientificresearchhasdeliveredthe
insightthatthemolecularcharacteristicsofa
tumourpartlydeterminetreatmentsuccess.
Moretechniquesarebecomingavailabletomap
complextumourcharacteristics,atthelevel
oftumourbiopsies(DNAandRNAanalyses),
blood(measuringmarkers),andtumourlesions
(molecularimaging).
Therearealsoimportantdevelopmentstowards
bettertumourdiagnostics,inordertobeable
tomaketherightchoicesforthebestandmost
sparingsurgery,radiotherapyandsystemic
therapy.Itisexpectedthatradiationoncologists
andsurgeonswillincreasinglybeabletospare
healthytissue,partlyasaresultofmore3D-guided
integratedradiotherapy,thedevelopmentsof
heavyparticleradiation(protons)andminimal
invasivesurgery.Itisexpectedthatbetter
prognosticmarkerswillleadtolessburdensome
treatments.
neurological disorders
Cognitivedeclineisacommondenominatorof
manyneurological(neurodegenerative)aswell
aspsychiatricdisorders.TheNetherlandsisvery
stronginthistypeofresearch,inparticularin
applyinginnovativeneuroimagingtechniques.
Imagingtechniquescanhelprevealbrain
processes.Nationalcollaborationhasastrong
addedvaluehere.
genomics
Theopportunitiesforpreventionandearly
treatmentofdiseaseincreasewithourincreasing
knowledgeofthegenomeandtherelationships
betweengenesanddiseases,partlyasaresult
ofbiobanks.Thiswillincreasetheaveragehealth
level.Theexpectedtreatmentresponseand
susceptibilitytoside-effectscanbeestablished
beforethestartofatherapy.Inaddition,new
healthpromotionstrategiesbecomepossible.This
offersopportunitiesformoretailoredtreatment
andpreventionofdiseases(personalised
medicine).Eventually,itwillbepossibleto
offerpreventive,diagnosticandtherapeutic
interventionstailoredtotheindividualandhisor
herhealthriskprofile,acrossthecontinuumfrom
healthtodisease.Forhealthyindividuals,thiswill
involvelifestylerecommendationsandotherforms
ofprevention.Forpeoplewithhealthproblems,
thiswillinvolveestablishingspecificsubtypes
ofdiseases,aswellastargeteddiagnosticsand
prognostics.Forpatients,itinvolvesselecting
medicationandothertherapyformsbasedon
predictedresponses(tailoreddrugtreatment,
pharmacogenetics).However,wearenotthereyet.
Itisnecessarytoinvestinimprovingthequality
andinterpretationofgenomesequencingdata.
Inaddition,weshouldinvestinincreasingour
knowledgeaboutgeneticvariationandimproving
medicalprofessionals’knowledgeaboutgenetics
andNextGenerationSequencing(HealthCouncil
oftheNetherlands,2015).Itisalsoimportantto
preservetheconcentrationofclinicalgeneticcare
withintheUMCsandtoincreaseitscapacity.
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QuestionssubmittedtotheDutchNationalResearchAgenda:
Geneticsand tumours
81
85
geneticsHowwilltheknowledgeof
geneticsbeimplementedin
screeningforandtreatment
ofcommonandrare
diseases?
tumoursEachtumourisdifferent,so
howcanwecometounderstand
cancerwellenoughtodevelop
atreatmentforeachandevery
type?
As an example. At present, the UMCs are
conducting the following research in collaboration
with other institutes and universities, to answer
these questions.
cardiovascular disease
Atpresent,researchonbasiccardiovascular
processesneedsanincentive.Thereisaneed
forgoodfunctional‘read-outs’toestablish
malfunctioningofvesselsandtheheartmuscle.
Thisisimportantinpreventingmorbidity,which
willbeincreasinglyimportantinthefuture.
Therefore,researchshouldfocuson:personalised
predictions,earlydetection,genomics,bigdata
analysisforearlydiagnostics,patternrecognition,
reliablepredictionandtargetedtreatment.The
earlydiagnosticsandthetranslationtothe
individuallevelarethenextstepstobetaken.
rare diseases
Moreandbetterdiagnosticmethodsare
developed.Moreresearchisneededonthe
implementationofnewgenetictechniques
(includingexomeandgenomesequencing)and
in vitromodels(suchasstemcellorganoids)into
routinerarediseasediagnostics.Inaddition,more
researchshouldbeperformedontheeffectsofthe
observedgenevariants(usingbothbioinformatics
andfunctionalstudies).Thesedatashouldbe
publishedinglobaldatabases.
research agenda for sustainable health 53
54 nfu
4 Principles
research agenda for sustainable health 55
TheNFUwillusethefollowingprinciplestoguideitsstepsinthecomingyears,e.g.,in
thedevelopmentoftheDutchNationalResearchAgendaandData4lifesciences,inthe
utilisationofresourcesfromtheNationalRoadmapforLarge-ScaleResearchFacilities,
initsinvolvementinthetopsectorsandtheelaborationofthe‘2025VisionforScience,
choicesforthefuture’.
56 nfu
innovation through
connection.
Theinnovationengineinthe
healthcaresectorisfuelledby
linkingcare,researchandbusiness.
Thatiswhereopportunities
andpossibilitiesarise:incross-
pollinationandsmart,sometimes
unexpected,connections.
strengthening excellence.
Dutchmedicalscienceandhealth
researchisinternationallyleadingin
manyareas.
from basic research to
clinical application under one
roof.
ThewayinwhichUMCsare
organisedisuniqueintheworldand
enablesasingleinstitutetocover
thewholespectrumfrombasic
exploration,throughtranslational
researchandpatient-related
researchtoclinicalapplications.
Giventheexcellentcooperation
betweenbasicresearchandclinical
researchwithintheUMCs,the
Netherlandsiseminentlyableto
translateresearchfindingsinto
theclinic.
making knowledge available
widely and quickly.
Intheinterestofpatients,
knowledgeandexpertiseare
shared,bothwithinregional
networksandbetween
theUMCs.
inking education, research,
patient care and valorisation.
UMCsarehealthcareinstitutions
aswellasresearchinstitutes.
Moreover,theyareanenginefor
healthcareinnovation.Theyhave
amajoreconomicimpactthrough
knowledgevalorisation.
definition of health economic
regions and budgets,
whereUMCsgenerateknowledgein
theregionalnetworkandinnovative
companiesgeneratecapitalfrom
thisknowledge,whichinturn
canpartlyflowintheregional
knowledgecycle(knowledge
innovationengine).
increasing efficiency through
concentration and division of
labour.
Concentrationisrequiredto
effectivelylinkbasicandclinical
researchonrarediseases.Where
relevant,partnershipsaresetup
andcooperationistakingplace.
collaboration between umcs.
TheUMCsdependincreasingly
onexpensiveinfrastructureand
arecollaboratingincreasinglyin
thisrespect.TheUMCshavealso
joinedforcesinthefieldofquality
assurance.Thereisconcertedaction
towardsthenationalgovernment
andEuropeinasmanycontexts
aspossible.Inaddition,theUMCs
collaboratetopromoteDutch
medicalknowledgeandskills
internationally.
research agenda for sustainable health 57
strategic partnerships.
Atpresent,medicineandhealthcare
arestronglystimulatedbythebasic
sciences,suchasbiotechnology,
moleculargeneticsandphysics.
Innovationandtechnologyare
indispensabletobringpersonalised
healthandmedicinetomaturity.
Particularattentionshouldbegiven
tobioinformaticsbecauseofthe
largeamountsofdataproduced
bypersonalisedhealth.Data
managementandanalysis(big
data),aswellastoolstoevaluate
decisionsandinterventionsare
alsoessentialhere.Translating
allnewscientificinsightsinto
betterprevention,diagnosticsand
treatmentofdiseaseswillbethe
grandchallengeforthecoming
decades.Tothisend,newstrategic
partnershipsareneeded.
synergy is achieved
bybeingresponsive,responding
toinitiativesinandfromsociety,
eitherfromthenationalgovernment
orfromtheEU,international
associations,industry,patient
organisationsorotherwise.
promotion.
Optimalinternationalpositioning
andstrivingforexcellencein
researchrequiresimagebuilding
andcollaboration.
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As an example. Several of the above principles
entail collaboration. Hence, several examples of
partnerships are described below.
oncology
Cancercareissuccessful,butalsocomplex,highly
specialisedandexpensive.Thiscallsforadifferent
organisationofcancercare.Tothisend,theUMCs,
NKI-AVLandthePMCfollowtheAmericanexample
ofComprehensiveCareNetworks(CCN).Thisis
inlinewiththeFieldAgendaOncologicalCare,
whichwassetbytheNFU,NVZ,SAZ,STZ,IKNL,
NFKandSONCOS,inwhichhighlyspecialised
oncologycentrescooperatewithotherrelevant
careproviders.IntheDutchcounterpartofCCN,
theUMCsandgeneralhospitalshaveformed
comprehensiveregionalcarenetworks.The
networksprovidedirectiononcooperationin
diagnosticsandtreatmentandoncontactswith
healthinsurersandthegovernment.TheUMCs
andNKI-AVLprovidethenetworkswithexpert
knowledgeforoptimaldiagnosticsandtreatment,
aswellasastronginfrastructureforresearchand
innovation.Careprofessionalswithinanetwork
collaborateonvariousdiagnosticgroups,basedon
agreedprotocols.Inthisway,thecareforpatients
withspecificformsofcancerisconcentratedina
limitednumberofhospitals.Asaresult,cancer
patientscannotbetreatedineveryhospital,but
theywillgetthebestpossiblecare.
infectious diseases and medical
micriobiology
AttheEuropeanlevel,theconsortiumCOMBACTE
(CombattingBacterialResistanceinEurope)
isactiveunderthebannerofIMI(Innovative
MedicineInitiative).Theaimofthisprojectisto
accelerateantibioticdevelopmentbydesigningand
implementingnewwaystoperformclinicaltrials.
OneofCOMBACTE’sactivitiesisthedevelopment
ofaEuropeanclinicaltrialnetworkforstudies
of,forexample,newantibiotics(CLIN-Net).In
2015,researchersfromallUMCsexpressedtheir
intentiontojointlysetupclinicaltrialswithin
theDutcharmofCLIN-Net(SION:Foundationfor
InfectiousDiseasesResearchNetherlands).In
additiontoCOMBACTE,theNetherlandshosts
severalWHOcollaboratingcentresinthefieldof
infectiousdiseases.TheNetherlandsCenterfor
OneHealthisanotherpartnershipinthisarea.
Inaddition,therearemajorframeworkprojects
forinfectiousdiseasesandantibioticresistance
intheyears2015-2020.First,theJPI-AMRfor
researchinEuropeandtheframeworkproject
research agenda for sustainable health 59
EU-Interreg-VaalongtheDutch-Belgianand
Dutch-Germanborders(deutschland-niederlande.
eu).Thetopics‘OneHealth’and‘epidemiologyand
controlofantibioticresistance’havebeenexplicitly
mentionedasfocusareasintheEU-Interreg-Va
innovationprogramme.IntheDutch-Belgian
borderregion,theprojecti-4-1-Healthisactive.
IntheDutch-Germanborderregion,twoprojects
areactive:health-i-care(towardscollaboration
betweenknowledgeinstitutesandSMEs)and
EurHealth-1Health(towardscollaborationbetween
knowledgeandcareinstitutionsandinstitutions
inthehuman,veterinaryandenvironmental
sectors).Bothprojectsaimtoimproveourcontrol
ofinfectionsandresistance.Furthermore,thereare
researchprojectsonOneHealthandenvironmental
antibioticresistanceincollaborationwiththetop
sectorWaterandWaterJPI.
neurological and psychiatric disorders
Since2010,Dutchbrainandcognitionresearch
hasbeenorganisedinanationaltaskforce,the
NationalInitiativeBrainandCognition(www.
hersenenencognitie.nl).Thisumbrellaorganisation
managesnationalinitiativesinresearch,
neuroimaging,fundraising,marketingandPR.
Theinitiativeincludesadedicatedprogram
ofNWO/ZonMw,theFESprogrammeBrain&
Cognition,severalnationalcoordinationstructures
andapartnershipinBBMRI-NL2.0.Itisalsoan
interlocutorofthetopsectors.Takentogether,
theNationalInitiativeBrainandCognitionhas
generatedEUR80millionforresearch,mainly
throughpublic-privatepartnerships.
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5
research agenda for sustainable health 61
TheUMCsandthetrainingregionsmakeanimportantcontributiontothefutureofDutchhealthcare
througheducationandtraining.Futuremedicaldoctorsareconfrontedwithanincreasinglyelderly
population,achangingpaletteofpatients,applicationoftechnologyinhealthcare,medically
literatepatientsandso-calledglobalhealthissues.Preventionandearlydiagnosticsplayamore
prominentrole.Healthcarewillincreasinglydealwiththeentirelifecourse,i.e.,‘healthyageing
startsatconception’.Thiscallsforadifferenttypeofhealthcareprofessionalaswellasadequate
moderneducation,whichremainsattractiveforfuturephysiciansandresearchers.Itrequires
anticipatingnow,tobeabletodelivertherighthealthcareprofessionalinthenearfuture,alsofrom
thepatient’sperspective.
TheUMCstakecareoftheinitialbasicmedicaltrainingandthecontinuouseducationofmedicalspecialists.
Theyalsoorganiseongoingtrainingactivitiesformedicalspecialistsandotherhealthcareprofessionals.
TheUMCsarecrucialfortrainingadequatelyqualifiedotherhealthcareprofessionals,andforthetrainingof
biomedicalresearchers.
Education as the basis
62 nfu
Educationandtrainingservepatientsandsociety
andalwaysgohandinhandwithpatientcareand
scientificresearch.Newinsightsandknowledge
fromscientificresearcharedisseminatedthrough
educationandtraining.TheUMCscollaborate
attheregionallevelwithgeneralhospitalsand
othereducationalinstitutions(suchasapplied
universities)intheTrainingandEducationRegions.
TheUMCsaimtoensureefficiencyandcontinuity,
realisingthetrainingofqualifiedhealthcare
professionalsthroughouttheircareerand
providingacompletelearningenvironment.
Thereisanintensivecollaborationwith
theregionalindustry.Learning,innovation
andmarketingconvergeatthecampuses.
Naturally,thereisacloserelationshipbetween
medicaleducationandtherelatededucation
programmessuchasbiomedicalsciences,bio-
pharmacy,healthsciences,dentistry,biomedical
engineering,nanobiology,clinicaltechnology
andbioinformatics.Continuousinnovationisalso
importantwithintheseprogrammes.Crossovers
areincreasinglyoccurring,startingfromthe
complexsocietalissuesthatincreasinglydemanda
multidisciplinaryapproach.
Theinterestinmedicaleducationexceedsthe
numberofavailableplacesforstudents(2,850
studyplaces).In2015,selectionatUMClevel
wasimplementedinalleducationprogrammes
inanticipationoftheintroductionofselection
insteadofdrawinglotsinacademicyear2017-2018.
TheUMCswillfurtherrefinetheirdecentralised
selectionproceduresinthenextfewyears,partly
basedonresearchontheeffectsofselection.In
thetrainingprofile,appropriatemethodsshould
contributetothematchbetweenstudentand
education.However,thesuccessrateofstudents
isalreadyhighandtheUMCsattractmany
internationalandPhDstudents.
In2012,thereport‘MedicalEducationinthe
Netherlandsin2012,StateoftheArtReport
andBenchmarkreportofthereviewcommittee
Medicine2011/2012’(QANU,Utrecht2012)
formulatedfuturedevelopmentsasfollows:“It
isevidentthatmedicaleducationwillhavea
differentappearanceinthefuturethaninpast
decades.Healthcareandthemedicalprofession
arechangingrapidly.”Thiscallsfor,asthe
reportindicates,morestandardisationand
individualisationinsteadofuniformpathsforall
students,moreandbetterintegrationbetween
basicsubjectsandtheclinic,astrongertraining
in‘habitsofinquiryandimprovement‘and
professionaleducationwithafocusonethicsand
professionalvalues.
TheUMCsaimtomodernisetheireducational
curriculumcontinuouslyandadaptittothe
changingneedsofsociety.Thegoalistoincrease
thequalityandefficiencyofhealthcare,e.g.,
byofferingmorevarietyintraining,intermsof
contentandduration.EachUMCdoessoinits
ownway.Inaddition,‘éducationpermanente’is
optimised,i.e.,continuouseducationandtraining
ofhealthcareprofessionals,includingfellowships.
TheUMCsalsostudytheirowneducation
programmesinordertopursuitevidence-based
education.ThisisamajorstrengthoftheUMCs
anditwillbeapermanentpriority.Thechallenges
research agenda for sustainable health 63
forthefuturelieinstrengtheningtheeducational
continuum,combiningtheprofessionsofscientist
andmedicaldoctor,themultidisciplinaryapproach
andachangingcareerpath.
Thefuturescenariosforeducationandtrainingare
asfollows:
· Themedicalspecialistadvancedtraining
willbecomemoreflexibleandwilladaptto
changingdemands(e.g.,geriatrics);
· Themedicalspecialistwillincreasinglybe
freedofsimplertasks,allowinghimorher
tofocusoncomplexhealthcareissues.The
interactionwithotherprofessionalsand
patientswillbecomeincreasinglyimportant
(intermsoffiletransfer,whodoeswhat,what
areresponsibilitiesandchecks);
· Costsavingswillbeachievedduetodecreased
effortsspentbymedicalspecialistsonless
complexhealthcareissuesandtasks;
· Discipline-transcendingeducationwillbecome
moreefficientbecauseitwillbespreadacross
multipledisciplines;
· Studentsandresearcherswillbeworkingin
thecontextofinternationalnetworks:Dutch
studentsperforminternshipsabroadand
foreignstudents(bothmastersandPhD)come
totheNetherlandsforeducationandresearch;
· Studentswillhaveincreasingopportunitiesto
profileanddifferentiateatmedicalschool.
Byelaboratingandimplementingthesefuture
scenarios,theUMCscontributetothedebateon
thefutureofhealthcareintheNetherlandsand
worldwide,startingfromthecontentofmedical
training,i.e.,carethatisdeliveredbymotivated
andskilledprofessionals,ofexcellentquality,and
accessibleandaffordableforthosewhoneedit.
TheFrameworkforUndergraduateMedical
Education2009describesthecollectivenational
goalsofinitialmedicaltraining.EachUMCdecides
onitsownroadtowardsthesegoalsandthere
isroomfordifferentiationbetweenUMCs,so
studentscanmakeaninformedchoiceforacertain
traininglocation.Thisuniqueconceptbears
fruit:evaluationsandinternationalcomparisons
showthatthequalityofDutchmedicaltrainingis
high.Newevaluationsofourmedicaleducation
programmeswilltakeplacein2017.Thiswill
provideinputforanewversionoftheFramework
MedicalEducation,tobecompletedin2019.This
willcoveratleastthefollowingtopics:societal
developments,changesinhealthcareprofessions,
thechangingroleofthedoctor,theconsequences
oftheincreaseduseofnewtechnologiesandthe
growthofsmall-groupteaching.
64 nfu
ThisNationalPlanhasaddressedtheDutchUMCs’centralresearchthemes:researchon
prevention,personalisedmedicine,regenerativemedicine,theoptimaluseofbigdatathrough
Data4lifesciencesandalarge-scaleresearchinfrastructure.Newtechnologies,researchand
treatmentstrategies,suchasregenerativemedicineandgenomics,requireopportunitiesand
investments.Biobanks,cohortsandbigdatafacilitieswillconstitutethe‘ratelimitingstep’in
thetransitiontosustainablehealth.Educationwillcomealonganditwillensurethatfuture
healthcareprofessionalsareequippedfortheirjobs,alongwithpatientsandthosearound
patients.Theurgencytocomeupwithajointstrategytokeephealthcarecostswithinlimits
inthelongtermispresentmorethanever.
6To conclude: the major challenge
research agenda for sustainable health 65
66 nfu
ThisNationalPlandescribestheUMCs’course
forthecomingyears.Thethemeswillbetakenup
energeticallyandinaccordancewiththeprinciples
listedinchapter4.Choiceshavetobemade
tomakesciencetheengineofsustainableand
innovativehealthcare.ThisappliestotheNFUand
theUMCs,butalsotosocietyandthepartnersof
theUMCs.
TheNFUwillusetheprincipleslistedinchapter
4toguideitsstepsinthecomingyears,e.g.,in
thedevelopmentoftheDutchNationalResearch
AgendaandData4lifesciences,intheutilisationof
resourcesfromtheNationalRoadmapforLarge-
ScaleResearchFacilities,initsinvolvementinthe
topsectorsandtheelaborationoftheScience
vision.
elaboration in route workshops
Intheshorterterm,theDutchNationalResearch
Agendawillplayaspecialroleintheelaboration
ofthisNationalPlan.TheUMCswilltakethe
initiativetofillinthedetailsforthethemes
ofhealthresearch-prevention-treatment,
personalisedmedicineandregenerativemedicine,
incollaborationwithallstakeholders.Tothisend,
theUMCSwillorganise‘routeworkshops’inthe
firsthalfof2016.Theseworkshopsaimtoconnect
underlyingcomplexissuesandstakeholders
andtoforgenewpartnershipstofurthershape
existingresearchagendas.Inaddition,theNFU
willcontributetorouteworkshopsbasedonthe
themesof‘bigdataandData4lifesciences’and
‘large-scaleinfrastructure’.
Thedescribedtransitiontosustainablehealth,
preventionratherthancareandmorepersonalised
medicinewith‘moreimpact,lessburden’requires
joiningforces.ItalsorequiresprofilingofUMCs,
universitiesandresearchinstitutions.Itcalls
forawidelysupportedjointoptimalstrategyof
allpartnersinhealthcare,inordertodeploythe
availableresourcesasefficientlyandeffectivelyas
possible.Thisistheonlywaytorealisesustainable
health.Inaddition,thisistheonlywayforEurope
tokeepperformingaboveaverageandtokeep
excellingattheinternationaltop.Itrequiresa
concertedeffortofallsocietalpartiesthathavea
roleinsustainablehealth.
research agenda for sustainable health 67
BiGGAREconomics,2014.Economic Impact of
University Medical Centers in the Netherlands.
CWTS(CentreforScienceandTechnologyStudies),
2012.Bibliometric study on Dutch academic
medical centers.
Eric-publication1001(EvaluatingResearchin
context),2010.Guide to the evaluation of societal
relevance of scientific research (inDutch).
HealthCounciloftheNetherlands,2015.Next
generation sequencing in diagnostics(inDutch).
KNAW(RoyalNetherlandsAcademyofArtsand
Sciences),2010.Well underway. Opportunities for
regenerative medicine in the Netherland (inDutch).
NFU(NetherlandsFederationofUMCs),2014.
Position paper NFU, The NFU and EU health
research beyond 2020 Sustainable health;
delivering health at a reasonable cost.
NOWT(NetherlandsObservatoryofScience
andTechnology),2010.Science and Technology
Indicators (inDutch).
QANU(QualityAssuranceNetherlands
Universities),2012.Annual report (inDutch).
O’NeillReport:Antimicrobialresistance:Tackling
the crises for the health and wealth of
nations (pdf).
Sources
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CCN CentersforCardiologyNetherlands Cardiologie Centra Nederland
CIT CenterforInformationTechnology Centrum voor Informatie Technologie
DTL DutchTechcentreforLifeSciences
IKNL NetherlandsComprehensiveCancerOrganisation Integraal Kankercentrum Nederland
KNAW RoyalNetherlandsAcademyofArtsandSciences Koninklijke Nederlandse Academie van Wetenschappen
KWF DutchCancerSociety(DCS) KWF Kankerbestrijding
MKB-Nederland RoyalAssociationMKB-Nederland
NFU NetherlandsFederationofUniversityMedicalCenters Nederlandse Federatie van Universitair Medische Centra
NKI-AVL NetherlandsCancerInstitute-AntonivanLeeuwenhoek
NVZ DutchHospitalAssociation Nederlandse Vereniging van Ziekenhuizen
NWO NetherlandsOrganisationforScientificResearch Nederlandse Organisatie voor Wetenschappelijk Onderzoek
PMC Paramedicalcenters Paramedische Centra
SAZ CollaborativeGeneralHospitals Samenwerkende Algemene Ziekenhuizen
SONCOS FoundationforCollaborationinOncology Stichting Oncologische Samenwerking
STZ CollaborativeTopclinicaltrainingHospitals Samenwerkende Topklinische opleidingsZiekenhuizen
SURF CollaborativeorganisationforICTinDutchhighereducationandresearch
TNO NetherlandsOrganisationforappliedscientificresearch Toegepast Natuurwetenschappelijk Onderzoek
TO2 FederationofInstitutesforappliedresearch]
UMC UniversityMedicalCenter universitair medisch centrum
VH NetherlandsAssociationofUniversitiesofAppliedSciences Vereniging Hogescholen
VNO-NCW ConfederationofNetherlandsIndustryandEmployers
VSNU AssociationofresearchuniversitiesintheNetherlands Vereniging van Samenwerkende Nederlandse Universiteiten
ZonMw NetherlandsOrganisationforHealthResearchandDevelopment
Abbreviations
research agenda for sustainable health 69
1Until1May2015,allDutchcitizenscould
submittheirquestionstoscienceonthewebsite
wetenschapsagenda.nl.Thequestionshavebeen
assessedforusefulnesstotheDutchNational
ResearchAgenda.Inconsultationwiththe
stakeholders,theyhavebeenclusteredinthemes.
TheresultingagendawaslaunchedinNovember
2015.TheDutchNationalResearchAgendaseeks
connectionswithexistingresearchagendassuch
astheEuropeanHorizon2020programme.In
theshortandmediumtermtheDutchNational
ResearchAgendawillbetranslatedintothe
profilesofuniversitiesanduniversesofapplied
sciences,theprogrammingoftheknowledge
coalition’spartners,thedirectioninwhichthe
nationalresearchinstitutesdevelop,andinto
investmentsinlarge-scaleresearchfacilities.See
www.wetenschapsagenda.nl/national-science-
agenda/?lang=enformoreinformation.
2’Routeworkshops’willtakeplaceinthefirst
halfof2016.Theseworkshopsaimtoconnect
underlyingcomplexissuesandstakeholdersand
toforgenewpartnershipstofurthershapeexisting
researchagendas.
3IntheDutchtopsectorapproach,industry,
scienceandgovernmentworktogethertomaintain
sustainableeconomicgrowthandtotacklesocietal
challenges.Thisuniqueformofcollaboration
isdesignedtopromoteinnovation,toattract
talents,andtoensureasolidpositionforthe
sectorsintheinternationalcontext.Thetopsector
approachfocusesontheninesectorsinwhichthe
Netherlandsisagloballeader.Pleasefindmore
informationonwww.topsectoren.nl.
4Dutchacademicresearchfundingcanberoughly
dividedintothreeflowsoffunds.Thefirstisstate
funding(i.e.,directgovernmentfunding).The
secondflowoffundsconsistsoffundsfromNWO
andKNAW;theseareawardedtospecificresearch
projects(i.e.,indirectgovernmentfunding).The
thirdflowofconsistsofforinstancecontract
researchand‘collectingbox’funds(i.e.,contract
researchfunding).
5TheParelsnoerInstitute(stringofpearls)isa
chainofbiobankswherepatientdataandmaterials
arecollectedforresearchintospecificillnesses.
Bycombiningthesedataandmaterialsfromthe
UMCs,abiobankcanofferuniqueopportunities
forresearchintotheseillnesses,forimprovement
ofpatientcareandforthedevelopmentofnew
products.(www.parelsnoer.org)
Notes
70 nfu
Editors-in-chief
Prof.dr.P.C.W.(Pancras)Hogendoorn
Prof.dr.M.M.(Marcel)Levi
Editors
Prof.dr.P.C.W.(Pancras)Hogendoorn
Prof.dr.M.M.(Marcel)Levi
Prof.dr.ir.J.(Hans)Brug
Prof.dr.F.(Folkert)Kuipers
Prof.dr.F.(Frank)Miedema
Prof.dr.A.J.J.A.(Albert)Scherpbier
Prof.dr.P.A.B.M.(Paul)Smits
Prof.dr.J.(Jaap)Verweij
Editors-in-chief and coordinators
Drs.M.J.(Marjo)Knapen(tekst)
Dr.M.(Melanie)Schmidt
This National Plan was written based on
interviews with and comments from:
Prof.dr.A.T.F.Beekman
Dr.E.P.Beem
Prof.dr.M.J.MBonten
Prof.dr.H.R.Büller
Prof.dr.G.Croiset
Prof.dr.D.A.J.P.Denys
Prof.dr.J.T.vanDissel
Prof.dr.M.D.Ferrari
Prof.dr.A.J.Gelderblom
Prof.dr.D.E.Grobbee
Prof.dr.N.L.U.vanMeeteren
Dr.I.Meijer
Prof.dr.T.vanderPoll
Prof.dr.K.Putters
Prof.dr.A.J.Rabelink
Prof.dr.C.M.A.vanRavenswaaij-Arts
Prof.dr.F.R.Rosendaal
Dr.E.F.CvanRossem
Prof.dr.P.H.M.Savelkoul
Prof.dr.J.C.Seidell
Prof.dr.Ph.Scheltens
Prof.dr.I.Sommer
Prof.dr.S.Sleijfer
Prof.dr.J.vanderVelden
Prof.dr.M.C.Verhaar
Prof.dr.E.G.E.deVries
Prof.dr.F.A.Wijburg
R.H.P.Wouters
Translation
L.(Linda)vandenBerg,WashoeLifeScience
Communications
Photography
ThankstoSabineLokhorst,RemcovanKesteren
andtheUMCs
Layout & illustrations
Terralemon,Amsterdam
EPS,Amsterdam
NFU-16.6456
www.nfu.nl
May,2016
Colophon