Study on the state of biomedical research in France.
The report presents the findings of an independent study commissioned by France Universités to SIRIS Academic to analyse the current state of biomedical research in France, using a bibliometric in-depth analysis.
The full report is available here. What follows is an executive summary presenting the main analyses and conclusions.
he state of biomedical research in France has been debated repeatedly over the last decade. It has been examined, its difficulties exposed and recommendations for change advanced, most recently in the context of the preparation of the law for multiannual programmation of research (LPR) in 2019 .1
In the wake of the COVID-19 pandemic that exposed further weaknesses in the system, the performance and organisation of the French biomedical research have been placed under even higher scrutiny, pushing discussions further. As a result, in 2021 the Academie of Medicine and Pharmacy published a two-volume report2 summing up the state of the debate along two main lines: 1) there is indeed a decline of French biomedical research; 2) this decline is mainly attributable to i) the lower share of research funding to biomedical research in France with respect to international peers; ii) the fragmentation of structures, fundings and actors in the research system; iii) a lack of alignment between Universities and University Hospitals (CHUs).
This fragmentation and multitude of structures and funding, as well as the misalignment between Universities and CHUs , is perceived as having a strong3 negative impact on the ability to do translational research and engage in multidisciplinary and interdisciplinary research, with consequences on advanced patient care and therapeutic innovation. Although this perception is strongly supported by experts from the sector, there was a lack of evidence that could substantiate it, namely due to the difficulty in addressing quantitatively and robustly issues such as interdisciplinarity, as well the separate contributions of the different actors.
In light of this reality, France Universités commissioned an independent study aimed at bringing additional arguments and evidence to this debate, based on a bibliometric analysis of publications. The study, conducted during 2022, shed light on two main aspects:
This executive summary report provides an overview of the most important conclusions. It is intended to further inform ongoing discussions among all relevant stakeholders over the current state of biomedical research in France and possible future actions to take at national level, namely on a reflection on the role and expected contribution of the universities and CHUs as well as more broadly on the setting of a biomedical research national strategy. The study assesses the validity of some of the existing assumptions and perceptions and provides additional evidence-based insights on where the issues may be arising.
The question of France’s overall performance and positioning in biomedical research has been discussed and analysed multiple times, most recently by Terra Nova and Alain Fischer , whose conclusions are in line with previous reports. The present study4 aims at refining and completing this discussion, by providing precise data and analysis to validate or inform key assumptions and hypotheses. This section provides an overview of the main conclusions and identifies discussion points that arise from them.
Both the proportion and the growth of biomedical research in France are lower than in other comparable countries. If France does not prioritise biomedical research by increasing investment to the levels of competing countries, then it is crucial to rethink French biomedical research policy by better aligning decisions and priorities with those taken at a European level by other EU27 countries.
Since research thematic specialisation is obviously a zero-sum game (France is less specialised in biomedical research with respect to the UK, and the UK is less specialised in physics than France), this brings up the question of whether this choice is a good long-term strategy and what the consequences are for the country. More widely, it underlines the fact that it probably makes sense to consider Europe as a whole and explore intra-European complementary areas of specialisation.
French research is concentrated in classical fields rather than in cutting-edge areas. This increases the risk that French biomedical research will fall further behind competing countries, especially in emerging fields with strong input from the social sciences such as public health, and applied sciences such as bioengineering. Furthermore, French research appears to be more uneven than elsewhere in terms of its scientific impact.
It is useful to explore the topics and areas of specialisation and multidisciplinarity within a given country’s portfolio , since it shows where it may have a competitive edge5 at a European or global level and where it stands to contribute and impact the most. In this regard:
The organisational complexity of the French biomedical research system appears to have a negative impact on the capacity at steering research policy and addressing major national priorities. This seems, at least in part, linked to a difficulty in aligning CHU research priorities with that of universities and a broader issue in terms of primary affiliation identity of joint CHU-University academic staff, as well as the scientific impact of the research performed at the CHUs.
The dichotomy in the impact of research just mentioned could be the result of the11 diversity of practices and types of research being developed in Universities and CHUs, and across the different sites. Several factors can influence this: the different practices normally seen in fundamental vs clinical research, and specifically within clinical research, factors such as the type of clinical research taking place (e.g clinical case studies) or the prioritisation of excellent research by institutions. The higher proportion of publications in lower tiers could be indicative of a low or/and uneven focus on (excellent) research.
Biomedical research that originates from both clinical and fundamental research functions in a continuum, requires coordination and exchange between all the institutions/groups that perform these types of research, which is naturally complex. In France, this relies on a triad of actors: Universities - CHUs - Research organisations (such as Inserm).
One of the main intuitions of the actors is that France’s under-performance is largely due to organisational complexity, which dilutes efforts and diminishes efficiency. There is also the idea that the CHU model, once quite successful, is in need of revision to allow higher quality research, namely translational clinical research.
By analysing the institutions behind French biomedical research publications, with a special focus on the Universities-CHUs relation, this study attempted to see whether evidence supports these perceptions:
Overall, this study tested one main assumption and raised one additional main question (that can be subdivided in two more specific questions):
Three broad conclusions can be reached:
1 C. Boitard, B. Clément, P. Debré, L. Degos, D. Houssin, P. Netter, au nom d’un groupe de travail, « Rapport 19-05. Contribution au projet d’une loi de programmation pluriannuelle de la recherche », Bull. Acad. Natl. Med. 2019, 203, 394
2 A. Migus, R. Ardaillou, P. Berche, C. Boitard, B. Clément, P. Couvreur, P. Debré, P. Netter, au nom d’un groupe de travail bi-académique de l’Académie nationale de pharmacie et de l’Académie nationale de médecine, Rapport 21-06. Réformer la recherche en sciences biologiques et en santé: partie I, le financement; A. Migus, R. Ardaillou, P. Berche, C. Boitard, B. Clément, P. Couvreur, P. Debré, P. Netter, au nom d’un groupe de travail bi-académique de l’Académie nationale de pharmacie et de l’Académie nationale de médecine, Rapport 21-07. Réformer la recherche en sciences biologiques et en santé: partie II, l’organisation.
3 In France, with the Loi Debré of 1958, hospitals became legally joined to the universities of their region, through the medical faculties, officially leading to the creation of the Centre Hospitalier Universitaires (CHUs), university hospitals tasked with delivering teaching, research and patient care.
4 La recherche médicale en France, bilan et propositions | Terra Nova
5 High dedication means a high volume of research on a certain topic(s); while specialisation indicates research for which the country produces more in comparison to other comparators (a defined baseline).
6 Research with contribution of topics in fields within Health and Life Sciences
7 Research with contribution of topics in fields outside of Health and Life Sciences
8 However, it should be noted that 1) this conclusion is based on a whole country analysis and does not give higher granularity and 2) this analysis does not assess production and performance of specifically and only translational research, for methodological reasons.
9 As reference, the Netherlands distinguishes itself as the most competitive country of the benchmarks, and has 55.7% of its publications in Top 1-10% Scimago journals.
10 A further step forward in measuring journals' scientific prestige: The SJR2 indicator (https://www.scimagojr.com/files/SJR2.pdf)
11 As measured by the capability to publish in top tier journals (Scimago journals). It should be noted that this is only one measure of impact (does not give the full picture of the impact of research in a country) and particularly dependent on research´s global visibility and recognition. It was chosen in this analysis as it permitted a robust and accurate comparison at an international level.
12 It should be noted, however, that both CHUs and Universities are much larger contributors of research and therefore there may be very different practices taking place within each of the “ institutions”.