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UOA 6 - Epidemiology and Public Health

RA5a: Research environment and esteem

 

 

RESEARCH ENVIRONMENT AND ESTEEM (RA5a)

 Epidemiology and Public Health (UoA6) - University of Oxford

CTSU, CEU and part of DPH (all together since 2005 in the new Richard Doll Building)

 

 

Three research groups are included: the Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU); the Cancer Epidemiology Unit (CEU) and part of the Department of Public Health (DPH). The table below summarises each group's RAE2008 “category A” staff & all (A or not A) research activities. 

 

Table: Research staff and activities, 2001-2007. Included is research income directly from MRC, CRUK or BHF that is not administered by the University. Of the £86M, £40m is from MRC, charities, DH, EU or similarly peer-reviewed sources and £46M is from substantial and sustained pharmaceutical support to the University for independent conduct by CTSU of some of our large trials: this level of industrial support is continuing to increase.

 

Research

Group

Category A staff only

Number of grants

Research income

(expenditure)

Research students*

Peer-reviewed publications

A-CTSU

12

56

£68 million 

19

380

B-CEU

7

13

£16 million 

20

310

C-DPH†

2

4

£2 million

10

35

Total

21

73

£86 million

49

725

 

*Half these research students are enrolled for degrees at other institutions. 

 

Only part of DPH, as most DPH staff and research activities are included in UoA7-Health Services Research or UoA8-Primary Care.

 

 

Research strategy: reliable evidence on major ways to avoid premature death and disability

We generate and disseminate reliable evidence from observational epidemiology and from randomised trials that leads to practicable methods of avoiding premature death and disability. Most, though not all, of our studies are concerned with cancer, heart disease, stroke and other chronic diseases. These conditions account for most of the premature mortality and disability in the UK and in many other developed and developing countries. Study size is an important requirement for study reliability, and we initiate and conduct many of the world’s largest observational studies, trials and meta-analyses.

 

Research income:large-scale studies 

We spent £86M in 2001-7, mostly to support 6 large randomized trials (involving 130,000 patients),     10 large prospective studies (involving over 4 million people) and 13 major international collaborations (involving bringing into our Units data from hundreds of epidemiological studies [of possible causes of cancer or vascular disease] and from hundreds of randomized trials [of the treatment of breast cancer, leukaemia or vascular disease] for checking & reanalysis; and hosting regular collaborators’ meetings).

 

Some 2001-7 results were of immediate national & international public health importance, eg:

 -A greatly widened range of high-risk individuals could benefit from lower blood pressure (Lancet 2002;360:1903), from anti-platelet therapy (BMJ 2002;324:71 and Lancet 2005;366:1607) and from cholesterol-lowering with statins (Lancet 2002;360:7, 2003;361:2005 and 2005;366:1267).

 

 -The hazards of smoking and, particularly, the benefits of quitting had previously both been underestimated (BMJ 2004;328:1519). 

 

 -There are definite 15-year breast cancer survival gains from various types of radiotherapy, chemo-therapy and endocrine therapy, but also definite side-effects (Lancet 2005;365:1678 and 2005;366:2087).

 

 -Different types of hormone replacement therapy have very different effects on breast cancer incidence (Lancet 2003;362:419).

 

Our work is highly cited, has received many awards and is attracting capable new researchers

During 2001-7 our publications were cited over 20,000 times: 3 of the above references were selected by Thompson’s Essential Science Indicators as the most cited in their fields: statins & vascular disease; chemotherapy, endocrine therapy and long-term breast cancer survival; and HRT and breast cancer.

 

Many prestigious national and international awards, including the Queen's Anniversary Prize, Prince Mahidol Prize, King Faisal Prize, King Olav V Prize and various Royal Society and US honours. 

 

Ourmature datasets, excellent IT support, spacious epidemiological laboratories and reputation for influential research provide a stimulating environment that is attracting capable researchers from around the world. (All our DPhil students completed their theses within four years.)

 

Awarded £20M (2001-5) for the new Richard Doll Building that since 2005 has housed all CTSU and CEU and part of DPH. Now we at last have adequate premises, a major goal for the next decade is to train and support the next generation of independent researchers in epidemiology and public health.


STAFF, RESEARCH INFRASTRUCTURE AND ENVIRONMENT- Epidemiology & Public Health

 

The 21 category A staff in research groups A, B and C (total 19.4 FTE) included here are:

 

A-CTSU-Dr Derrick Bennett; Dr Louise Bowman; Dr Georgina Buck (née Harrison); Dr Robert Clarke;

               Professor Rory Collins;  Professor Sarah Darby;  Dr Jonathan Emberson;  Dr Martin Landray; 

               Dr Paul McGale;  Professor Sir Richard Peto;  Dr Carolyn Taylor;  Dr Gary Whitlock;

 

B-CEU  -Professor ValerieBeral; Professor Tim Key; Dr Bette Liu; Dr Paola Pisani; 

               Dr Elizabeth Spencer; Dr Richard Stevens; Dr Ruth Travis;

 

C-DPH  -Dr Lucy Carpenter; Professor Harold Jaffe.

 

The 21 RAE2008 ‘category A’ researchers listed above are small fraction of the 300 or so skilled staff working on epidemiology and public health projects in or near the Richard Doll Building. 

13 other CTSU & CEU senior scientists (10.8 FTE) make major contributions to research but are funded directly by MRC or CRUK, so by RAE criteria are not category A staff and thus are not included here (CTSU: Dr Jane Armitage, Professor Colin Baigent, Dr Jill Boreham, Professor Zhengming Chen, Professor Michael Clarke, Dr Christina Davies, Dr Sarah Lewington, Dr Sarah Parish and Dr Sue Richards; CEU: Dr Naomi Allen, Dr Jane Green, Dr Gillian Reeves and Dr Andrew Roddam). Also contributing to the local research environment are more than 200 IT, laboratory, administrative and other staff, visitors from abroad, other members of DPH (included in UoA7-8), and 25 enthusiastic students in our taught Global Health Sciences MSc course (many of whom stay on to do research). 

 

These large numbers of skilled support staff are required for our major on-going studies. For example, CTSU, CEU and DPH have ~50 programmers developing and managing their sophisticated IT facilities, ensuring convenient, efficient, secure storage and analysis of our large confidential datasets. Electronic user-friendly data entry and web-based data capture systems have been developed. As well, CTSU and CEU have their own laboratories, specially designed to facilitate cataloguing and storage of biological samples and development of analytical methods and techniques suitable for high-throughput, large-scale analyses (without compromising reliability or data quality). Many thousands of blood samples arrive each month for analysis or for cataloguing and long-term liquid nitrogen storage.

 

Interdisciplinary and collaborative research is typical; this is encouraged by our 2005 premises 

Senior members of CTSU, CEU and DPH collaborate on many national and international projects. Interaction between staff, including junior members and students, is facilitated by our communal café, Joan Doll Library and lecture theatre for our frequent lively seminars and discussion meetings.

 

In addition, we in the Richard Doll Building are immediately adjacent to similar numbers of researchers in the Wellcome Trust Centre for Human Genetics. With the recent appointment of Professor Peter Donnelly as Director of the Wellcome Trust Centre new collaborations are being established and a major expansion in genetic epidemiology is now in progress. The new (£60M) Institute of Cancer Medicine is opening (2007-8) immediately next door, and the new NHS cancer treatment centre of the Churchill Hospital is immediately over the road. These proximities will encourage further collaborations. 

 

Many studies involve NHS hospitals & clinics; their findings affect NHS practice, eg:

-Our vascular disease trials support several dozen dedicated clinics in NHS hospitals, and results from them (and from all our major trials) feed back into NICE guidelines and NHS treatment policies.

 

-We work closely on many aspects of cancer screening with the NHS Cancer Screening Programme (Director J Patnick CBE, whose only academic appointment is with us, in the University of Oxford).

 

-Our Million Women Study recruited participants through the NHS Breast Screening Programme in 1996-2001. Long-term follow-up of several hundred thousand hospital admissions annually in this prospective study utilises routinely collected NHS hospital admission data from throughout the UK. 

 

-UKBiobank, another prospective study we are closely involved in, is using millions of NHS records to recruit 500,000 people, and will also utilize millions of NHS hospital records for long-term follow-up.

 

Well developed staff structures; increasing numbers of early-career staff in training

Personal and professional development of staff and students is promoted and encouraged through a range of departmental and university-wide initiatives. The number of early-career staff and research students has increased substantially in the last few years, largely due to our new facilities and maturing datasets. As well as students registered for University of Oxford degrees in 2001-7, 24 others studied under our supervision, about half on UK public health training schemes and about half from developing countries. 


RESEARCH STRATEGY  (MAIN PROJECTS: 1. OBSERVATIONAL, 2. RANDOMIZED)

 

Research priorities are determined chiefly by national and international public health considerations. These generally involve studying causes of disease that, when their effects are reliably quantified, could be modified in many populations by cost-effective preventive measures. Likewise, emphasis is on treatments that, if reliably shown to be even moderately effective, would be cost-effective in many settings. We aim to study the causes and treatment of disease in a wide range of populations so that the findings are as generalisable as possible. These large-scale research projects typically require extensive collaboration between many investigators not just in the UK, but throughout the world.

 

 

1. LARGE-SCALE OBSERVATIONAL STUDIES

 

Many causal factors for cancer, vascular disease and other common conditions have already been identified and there is, perhaps, the perception that little more can be learnt, particularly for the established risk factors. Yet there remains substantial uncertainty as to how important many such factors are across populations, and how their relevance changes over time, eg:

 

There is an increasing realization, in large part from our work, of how large the future epidemic of deaths due to tobacco will be. If current smoking patterns persist, annual worldwide deaths from tobacco will increase from about 5 million in the present decade to 10 million in the 2030s. Moreover, the absolute long-term benefits of stopping smoking that we demonstrated recently (BMJ 2004;328:1519) had previously been under-estimated. Smoking-attributed UK male mortality has fallen 4 fold since 1970, mostly because large numbers of smokers quit (www.deathsfromsmoking.net).

 

Studies involving just a few hundred or a few thousand cases with a disease may suffice to identify a risk factor but, due to their inherent statistical uncertainties, do not generally suffice to assess reliably the shape of the dose-response relationship, the age-specific relationships, or any important modification of the relationships by other risk factors. Consequently, we have established a number of very large-scale prospective studies, case-control studies and international collaborations (see Tables 1-3).

 

1.1  Observational cohort studies

 

Ten major cohort studies (mostly prospective studies) were underway, involving over 4 million people in many countries (Table 1). Some were longstanding, others began only recently.

 

Table 1. Major cohort studies, 2001-7

 

Cohort name (country)

Recruitment

Participants

Category A investigators*

Porton Down Veterans Cohort (UK)

1949-1989

40,000

Carpenter [Venables, Doyle] Beral

British Doctors Study (UK)

1951

40,000

[Doll(deceased) Boreham] Peto

Hazards of breast radiotherapy (many)

1943-2003

>1,000,000

Darby, McGale, Taylor, Peto

China prospective study (China)

1990-1991

200,000

[Z Chen] Peto, Collins

EPIC-Oxford (UK)

1993-1999

67,000

Key [Allen, Roddam] Spencer, Travis

Million Women Study (UK)

1996-2001

1,300,000

Beral, Liu [ Reeves, Green] 

Chennai prospective study (India)

1998-2001

500,000

[Gajalakshmi] Peto, Bennett, Whitlock

Mexican prospective study (Mexico)

1998-2004

160,000

[†] Collins, Peto, Whitlock, Emberson

Kadoorie Study (China)

2004-2008

500,000

[Z Chen, J Chen, L Lee] Peto, Collins

UKBiobank (UK)

2007-2010

500,000

Collins, Beral, Liu, Landray

 

*Those named are only those included as Category A in UoA6 [except for Principal Investigators in square brackets]

 

[†Mexican Principal Investigators: Kuri, Alegre, Tapia-Conyer, Hernandez-Avila]

 


Highlights from observational cohort studies, 2001-7

       Results from the 50-year follow-up of British Doctors Study (BMJ 2004;328:1519) show the evolution of the adverse effects of smoking and of the benefits of stopping in different birth cohorts. New prospective studies of smoking and other factors of more than a million adults in the UK, China, India and other developing countries have been established.

 

       The Million Women Study involves 1.3 million UK women – one in every four aged 50-64 in 1996-2001. With almost 10 years follow-up it is providing reliable estimates on the relevance of lifestyle and other exposures to women's health. About 5% of cancers in middle-aged UK women are attributable to obesity (BMJ Online 6thNov 2007). Half the cohort had used HRT and current users were found to be at an increased risk of ovarian cancer (Lancet 2007;369:1705) and breast cancer (Lancet 2003;362:419). This report, showing that risk varied by HRT type, was selected by ISI in 2005 as the most cited recent paper on breast cancer. 

 

       CEU contributes 67,000 participants to the EPIC study of diet and cancer in 500,000 Europeans. Oxford researchers are leading the Europe-wide work on prostate cancer, which has demonstrated that prostate cancer risk increases with increasing levels of insulin-like growth factors (IgFs), possibly via the consumption of dairy products (Cancer Epidemiology Biomarkers and Prevention 2004;11:1441 and 2007;16:1121).

 

       Women with left-sided versus right-sided breast cancer are more likely to die from heart disease as a side effect of radiotherapy (Darby, McGale, Taylor, et al: Lancet Onc 2005;6:557). Prospective studies of breast radiotherapy hazards in more than a million women are being set up.

 

       Three major blood-based prospective studies have recently been established. In Mexico, where obesity and diabetes are more widespread than in the UK, a cohort of 160,000 has already been recruited (Int J Epi 2006;35:243), and in China recruitment of 500,000 is just being completed (Int J Epi  2005;34:1243). Both CTSU and CEU are closely involved in the design and co-ordination of UK Biobank, a prospective study of genetic and environmental factors recruiting 500,000 people during 2007-2010. 

 

 

1.2 Observational case-control studies

 

Table 2. Major case-control studies, 2001-2007

 

Study name (country)

Participants

Category A Investigators*

ISIS case-control (UK)

30,000

Collins, Peto, Clarke, Bennett, [Parish]

HIV and cancer (Uganda, South Africa, Malawi)

10,000

Carpenter, Jaffe, Beral

Household radon and lung cancer (UK)

15,000

Darby, McGale

Heart disease after radiotherapy (USA/Scandinavia)

>5000

Darby, Taylor, McGale

Smoking and adult mortality (South India)

80,000

[Gajalakshmi] Peto, Whitlock

Smoking, drinking and mortality (Russia)

80,000

[Zaridze, Boreham] Peto

PROCARDIS - family study of CHD (UK)

9000

[Watkins] Clarke, Collins

 

*Those named are only those included as Category A in  UoA6 [except for Principal Investigators in square brackets]

 

Highlights from observational case-control studies, 2001-7

       Large-scale case-control studies of all deaths in parts of China, India and Russia are in progress, documenting the effects of smoking and drinking on cause-specific mortality in those populations. In many parts of India the main disease by which smoking causes death is TB (Lancet 2003;62:507). 

 

       We have shown, for the first time, that antibody titres against both malaria and Epstein Barr virus are raised in childhood Burkitt lymphoma in Uganda (Int J Cancer Online 13thNov 2007).

 


1.3 Collaborative re-analyses of individual data from observational studies

 

We have established a number of collaborative re-analyses of individual data from observational studies - bringing into our Units, for checking and re-analysis, data from all studies worldwide that have addressed similar questions (though not necessarily in the same way). Our focus is on issues of public heath importance that could not be reliably answered by individual studies (Table 3). This work involves extensive collaboration and regular meetings with investigators from around the world. 

 

Table 3. Major collaborative re-analyses of data from observational studies, 2001-7

 

Collaboration

Total number of:

Category A investigators*

 

Studies

People

 

Hormonal factors in breast cancer

120

300,000

Beral, Peto [Reeves]

Prospective studies collaboration

61

1,000,000

[Lewington] Whitlock, Clarke, Peto, Collins 

Endogenous hormones & breast cancer

12

3000

Key [Reeves, Roddam]

Collaborative group on cervical cancer

25

50,000

[Berrington, Franceschi, Green, Peto] Beral

Collaborative group on ovarian cancer

44

60,000

Beral, Peto [Reeves]

International collaboration on HIV & cancer

20

100,000

Jaffe, Carpenter, Beral

Homocysteine studies collaboration

30

5000

Clarke, Collins

Endogenous hormones & prostate cancer

18

10,000

[Roddam, Allen] Key, Travis

Collaborative group on endometrial cancer

20

30,000

Pisani, Stevens, Beral, Peto [Reeves]

 

*Those named are only those included as Category A in UoA6 [except for Principal Investigators in square brackets]

 

 

Highlights from collaborative re-analyses of observational studies, 2001-7

       Our collaborative re-analyses of data from epidemiological studies of breast, ovarian and uterine cancer show oral contraceptives to be, on balance, somewhat protective against cancer, whereas HRT is a substantial net hazard. They have also resolved many controversies about the effects of family history, abortion, alcohol and tobacco on breast cancer (Lancet 2001;358:1389, Lancet 2002;360:187; Lancet 2004; 363:1007 and Brit J Cancer 2002;87:1234). 

 

       The Endogenous Hormones and Breast Cancer Collaboration has demonstrated the importance of circulating endogenous oestrogen levels in postmenopausal women and shown that they account for the observed association between increasing body mass index and breast cancer risk (JNCI 2002;94:606 and JNCI 2003;95:1218).

 

       The Prospective Studies Collaboration is providing reliable, unbiased estimates from one million adults of the age-specific relevance of blood pressure, blood cholesterol and body mass index to mortality. The blood pressure results show that, for heart disease and stroke, throughout the normal range of blood pressure, with no apparent threshold, 10mm Hg lower systolic blood pressure means about ⅓ lower vascular mortality in middle age (Lancet 2002;360:1903). This indicates that, among people with a history of vascular disease, even those with below-average blood pressure could benefit from blood pressure lowering treatments. The cholesterol results also shows strong effects at all ages, particularly for total/HDL cholesterol, and within the currently normal range, no threshold (Lancet 2007;370:1829).

 

 


2. LARGE-SCALE RANDOMISED EVIDENCE (TRIALS & COLLABORATIVE REANALYSES)

 

Just a moderate survival improvement in a common condition might affect millions of people. The best way to obtain reliable results about moderate effects is by getting large-scale randomised evidence, as large numbers helps avoid being misled by the play of chance, and proper randomization helps avoid being misled by biases. CTSU introduced and established the use of "mega-trials" - very large streamlined randomised trials - as well as large-scale meta-analyses of individual data from all relevant trials worldwide, to assess the effects of practicable treatments on mortality and major morbidity in common diseases. The mega-trials, independently conducted, but generally with substantial industry support administered through the University, typically randomize tens of thousands of patients (Table 4) and, as a result, have provided clear and reliable information about the effects of many treatments. 

 

Table 4. Randomised trials & collaborative re-analyses of individual data from trials, 2001-7 

 

 

Large trials conducted by CTSU (country)

 

Patients

 

Category A investigators*

COMMIT – clopidogrel and metoprolol in MI (China)

46,000

[Z Chen, L Jiang, L Liu] Peto, Collins

Heart Protection Study – statins & antioxidants (UK)

20,000

Collins [Armitage, Parish] Peto, Emberson

SEARCH – lipid & homocysteine lowering (UK)

12,000

Collins [Armitage] Bowman, Clarke 

ASCEND – aspirin & omega-3 oils in diabetes (UK)

10,000

[Armitage] Bowman, Bennett, Collins

ATLAS – 10vs5 years tamoxifen in breast ca (Internat.)

15,000

[Davies] Peto

HPS II-THRIVE – HDL raising (International)

20,000

Collins [Armitage, Chen] Landray, Bowman

SHARP – cholesterol lowering in renal disease (Internat.)

9000

[Baigent] Landray, Emberson

 

Collaborative re-analyses of worldwide evidence from randomised trials

Early Breast Cancer Trialists’ Collaborative Gp(400 trials)

350,000

Peto, Darby [Clarke, Davies] McGale, Taylor

Meta-analysis of leukaemia trials (50 trials)

15,000

[Richards] Buck

Anti-Thrombotic Trialists’ Collaboration (287 trials)

200,000

Peto [Baigent] Buck, Collins 

Cholesterol Treatment Trialists’ Collaboration (14 trials)

90,000

[Baigent] Buck, Collins, Peto

 

*Those named are only those included as Category A in UoA6 [except for Principal Investigators in square brackets]

 

 

Highlights from trials and collaborative re-analyses of trials, 2001-7

       The Early Breast Cancer Trialists’ Collaborative Group was established in 1985 and individual data on 350,000 women in 400 trials are now being analysed to assess the effects on long-term outcome of various types of radiotherapy, chemotherapy and hormonal therapy (eg 5 years of tamoxifen). Quinquennial updates and new analyses of the effects of various therapies on breast cancer recurrence and survival have repeatedly altered breast cancer treatment guidelines. This has contributed substantially to sharp decline in breast cancer mortality in the UK (by 35% in women aged 35-69 from 1990 to 2005) and in most other Western countries. Publications have been cited about 10,000 times since 1985. One of the two 2005 reports (Lancet 2005;365:1687 & 2005;366:2087) was selected by ISI as the most widely cited paper on clinical research in the last two years. 

 

       Preliminary results from our large ATLAS trial show that 10 years tamoxifen provides even better protection against breast cancer recurrence than just 5 years.

 

       CTSU is running several mega-trials of the effects of long-term treatments for vascular diseases. Its 20,000 patient Heart Protection Study and its subsequent meta-analysis of all statin trials worldwide showed that LDL-lowering statin therapy prevented coronary disease in a much wider range of people than had previously been thought, including diabetics, those with many different types of arterial disease and, importantly, even those with blood cholesterol levels below the UK average. Statins also reduce stroke rates. Long-term follow-up shows that these early survival gains persist and have refuted fears of an increased incidence of cancer (Lancet 2002;360:7; Lancet 2003;361:2005; Lancet 2005;366:1267; BioMed Central Medicine 2005;3:6) These findings greatly changed worldwide guidelines and practice.


Highlights from trials and collaborative re-analyses of trials 2001-7, continued

       New trials are now underway of more intensive LDL-lowering therapy in 12,000 UK patients with a history of heart attack. An international trial of lipid lowering in 9000 patients with chronic renal disease (Amer J Kidney Dis 2006;47:385) and a new trial of HDL-raising in 20,000 at high risk of vascular  events (HPS II) are being set up.  

 

       Meta-analysis of 300 anti-platelet trials shows treatment (eg with low-dose aspirin) is of definite benefit for a wider range of high-risk patients than just those with heart disease or occlusive stroke, but that it is still of uncertain net benefit for primary prevention (BMJ 2002;324:71). 

 

       CTSU staff have co-ordinated MRC leukaemia trials for decades, contributing to the substantial and continuing decline in mortality from leukaemia and lymphoma in children and young adults. Recent results have shown that late intensification of chemotherapy and improved steroid support further reduce recurrence and survival rates (Blood 2004;103:4408 and 2007;109:944). Ten trials are currently active.

 

 

 

IMPACT ON PUBLIC HEALTH

 

Because our studies are large they are uniquely reliable; because worldwide collaborative re-analyses involve all relevant researchers, findings are rapidly accepted and implemented, often having an immediate impact on health policy, behaviour or clinical practice, eg:

 

-Rapid dissemination of findings from our large trials and meta-analyses of emergency treatment of heart attacks resulted in greatly improved treatment, avoiding the use of ineffective interventions and increasing use of effective ones such as fibrinolytic therapy, aspirin and clopidogrel (Lancet 2005;366:1607).

 

-UK mortality from vascular disease at ages 35-69 halved between 1990 and 2005, in both men and women. Research in CTSU influenced the major causes of this: decreasing smoking, better treatment of acute episodes and increasing long-term use of effective drugs, particularly anti-platelet agents, blood pressure lowering therapies and statins.  

 

-The treatment of breast cancer has been transformed, helped by a succession of findings from CTSU’s Early Breast Cancer Trialists’ Collaborative Group. Improved chemotherapy and endocrine treatment together with earlier diagnosis has led to the large breast cancer mortality reductions at ages 35-69 since 1990. The recent halving of hormone replacement therapy use is already preventing many incident breast cancers.  

 

-UK mortality from cancer at ages 35-69 declined by about 30% between 1990 and 2005, in both men and women. The two main contributions to the decline are, in men, the large numbers who have stopped smoking and, in women, the improved treatment of breast cancer. Our research findings have done much to influence both these trends.

 

 


FUTURE RESEARCH

 

Medium-term and long-term research priorities are determined chiefly by UK and international public health considerations. We shall continue studying causes of disease that, when their effects are reliably quantified, could be modified in many populations by affordable preventive measures. Likewise, we plan to continue studying treatments that, if reliably shown to be even moderately effective, would be cost-effective in many settings. 

 

Genetic epidemiology is increasingly feasible, with genome-wide scans, falling costs, our proximity to the Wellcome Trust Centre for Human Genetics, our large prospective studies and central role in UK Biobank. New collaborations and new results will inevitably stimulate as yet unforeseen research. Future research projects will build on the cumulative methodological expertise of our previous work and will also provide opportunities for early-career researchers to establish their own research programmes.

 

Some of our research output in the next few years will involve continued follow-up and enhancement of the large observational studies, collaborative re-analyses and randomised trials that have already begun (Tables 1-4), eg:

 

-Our ongoing cohort studies will be updated with new exposure and outcome information.

 

-Our collaborative re-analyses will be regularly updated.

 

-Our ongoing mega-trials will mature and will provide new results of direct clinical relevance.

 

The availability of electronic linkage to medical and other records and the development of web-based systems for data capture offer enormous scope for enriching our studies in the UK, China, Mexico and elsewhere.

 

The range of hypotheses that can be addressed has been substantially widened by biological samples, including blood and, sometimes, tumour tissue. Our laboratory facilities permit streamlined, secure handling of extremely large numbers of samples. We are developing low-cost high-throughput assays, which are at least as accurate as standard methods, to analyse many tens of thousands of samples, and are already storing millions of specimens for subsequent analysis. 

                                                                                                                                        

As we have already received major new awards (not yet included in the 2001-2007 financial statistics) numbers of research staff and research students will increase in the next few years. They will introduce a range of new collaborations and new questions, within our broad research priorities.

 


CAPACITY BUILDING

Our new premises, maturing data sets and record of sustained funding will continue for many years to offer excellent opportunities. The active and intellectually stimulating environment and resources in and around the Richard Doll Building is attracting many enthusiastic early-career investigators. One of our major goals for the next decade is to recruit and train a new generation of independent researchers in epidemiology and public health.

 

Expanding numbers of research students and studentships

Before 2005 we were severely cramped, but with the move to the Richard Doll Building the number of research students is already increasing and will continue to do so over the next few years, due to the substantial improvement in our facilities and the maturing of datasets that took many years to develop. Two-thirds of the research students in 2001-7 were funded by UK charities, central government or Rhodes scholarships, and we expect this proportion to continue as numbers expand. All doctoral theses were completed in 4 years and all graduates have stayed with us or moved to good posts elsewhere. 

 

 

Sustaining research infrastructure and supporting staff development

The most tangible improvement since RAE2001 is that we are now much better accommodated in a new specially designed building with more space, modern offices, dedicated laboratories, and various meeting places. We are also larger - the total number of staff in CTSU increased from 135 to 185 between 2001 and 2007 and over the same period CEU staff numbers increased from 55 to 65. 

 

We have well developed internal staff structures. These involve career development of middle-level and early-career researchers, established teams of excellent study coordinators, able administrators, highly skilled computing/IT specialists, and much else besides. 

 

Personal and professional staff development is encouraged through a range of Unit, Departmental and University-wide initiatives[1], including: 

            -regular appraisal schemes to discuss training and development 

-the University’s annual merit review exercise 

-unit and departmental committees involving staff from all levels 

-day release and study leave

-seminars with internal and external speakers 

-regular open meetings to give staff the opportunity to discuss work 

-support to attend national and international conferences 

-opportunities to teach and supervise DPhil students 

-social interactions throughout the year 

-use of University sports facilities, including gym and swimming pool.

 

The professional development of contract researchers requires careful support and guidance. They are encouraged to suggest research possibilities and become co-applicants in research proposals, they have a nominated supervisor to help them seek external funding or new posts, and the University provides careers advice, redeployment opportunities, retraining, and priority in its recruitment process. Fortunately, however, we have succeeded in avoiding any redundancies as fixed terms expired.

 

We give special attention to retaining highly skilled researchers by adopting family-friendly policies, enabling staff to combine productive research careers with family life. These include part-time and flexible working. Category A researchers who benefited from this include Drs Bowman, Buck, Spencer and Travis, all of whom continue to be highly productive. Drs Liu and Travis are exceptionally able early-career researchers, first appointed in 2004, who have already done important research. 

 

One of our main priorities for the next decade is to stimulate, encourage and help train the next generation of effective researchers in epidemiology (including trials) and public health. 


ESTEEM INDICATORS, 2001-2007

 

-Over 60,000 citations to our publications, including 20,000 during 2001-7.

             “Hottest Research 2002-2003” – Science Watch, March/April 2004

             “What’s Hot in Medicine” – Science Watch, Sept/Oct 2007

 

-Queen’s Anniversary Prize for Higher and Further Education, 2006-2010, 

awarded 2005 to University of Oxford for research studies of CTSU

 

-Awarded £20M to construct the Richard Doll Building

JIF (MRC/Wellcome) £5M, CRUK £4.5M, University of Oxford £3.6M, 

British Heart Foundation £2.5M, Wolfson Foundation £2.5M

 

-Substantial effects on international treatment guidelines: breast cancer      

(US NIH Consensus Conference, 2001), vascular disease (statins) 

and menopausal symptoms (HRT)

 

Professor Valerie Beral, FRS

2001-Chair, DH Advisory Committee on Breast Cancer Screening 

2001-Member, Women's Heath Advisory Committee, Commission on Human Medicines

2002-Member, IARC Working Group on Breast Cancer Screening

2002-Member, WHO Expert Panel on Hormonal Contraceptives and Cervical Cancer

2003-Bradford Hill Lecture, LSHTM

2004-Member, IARC Monograph Group on HRT and oral contraceptives

2005-Donald Reid Memorial Medal, LSHTM

2005-Honorary MD, Aberdeen University

2005-Visiting Scholar, NCI, USA

2006-Distinguished Visiting Scientist, NSW Cancer Council

2006-Fellow, Royal Society

 

Professor Rory Collins

2002-FRCP, Edinburgh

2002-Cochrane Lecture, Green College 

2003-Bronte-Stewart Lecture

2003-Lars Werkö Lecture, Sweden

2003-Fernandez-Cruz Foundation Memorial Lecture

2004-Fellow, Academy Medical Sciences

2004-Pfizer Prize for Innovative Science 

2005-Wellcome Trust Study Design Expert Group

2005-Principal Investigator and CEO, UKBiobank

2007-Allyn Taylor International Prize

 

Professor Sarah Darby

2001-Steering Committee, Uranium Mining Studies, German Radiation Protection Commission

2002-Member, Radon subgroup, HPA Ionising Radiation Advisory Group 

2003-Member, US National Academy of Sciences Nuclear and Radiation Studies Board

2004-Member, WHO Expert Group on Residential Radon

2005-Member, IARC Working Group on Health Effects of Smoking Cessation

 

Dr Robert Clarke

2005-FRCP

2005-Honorary Fellow, Faculty of Public Health

 

Professor Harold Jaffe

2004-Assistant Surgeon General, US Public Health Service 

2004-Lifetime Scientific Achievement Award, CDC, Atlanta

2005-Member, Life Sciences Committee, HPA 

2006-Member, Populations and Public Health Strategy Committee, Wellcome Trust

2006-Member, US Institute of Medicine.

 

 

Professor Tim Key

2001-Member, DH Scientific Advisory Committee on Nutrition

2002-Member, WHO working group on diet, nutrition and prevention of chronic disease

2002-Member, IARC/WHO working group on fruits and vegetables & cancer prevention

2006-Member, FAO/WHO scientific committee on carbohydrates in human nutrition

 

Dr Martin Landray

2004-College of Experts, MRC HSPHRB 

2005-Member, Renal Association Clinical Trials Subcommittee

2006-Associate Editor, Nephron Clinical Practice

2007-Fellow, American Society of Nephrology

 

Dr Bette Liu

2005-Clarendon Scholarship

2007-Member, UKBiobank Record Linkage Advisory Group, 

 

Professor Sir Richard Peto, FRS 

2001-Prince Mahidol prize for Medicine

2001-Academician, Academy of Finland

2001-Lynn Sage Distinguished Award in Breast Cancer Research

2002-Order of Merit of the Republic of Poland 

2002-King Olav V prize, Norway 

2002-Membre Étranger Associé de l'Académie des Sciences, France

2002-General Motors Cancer Research Foundation-Mott prize for cancer prevention 

2002-Royal Medal, Royal Society 

2003-Distinguished Service Award, American Society for Clinical Oncology

2003-Honorary DSc, Southampton University

2004-Foreign Associate Member, US Institute of Medicine

2004-Visiting Professor, Johns Hopkins School of Medicine

2004-Lord Cohen Gold Medal, Royal Society for the Promotion of Health

2005-Honorary Fellow, LSHTM

2005-King Faisal International Prize

2005-Cutter Preventive Medicine Lectureship, Harvard School of Public Health 

2006-American Cancer Society, Luther Terry Award

 

Dr Carolyn Taylor

2007-Junior Research Fellowship Prize, Royal College Radiologists

 

Dr Ruth Travis

2005-Junior Research Fellowship, Wolfson College, Oxford

 

 

 

 

 

 

 



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