National Plan Research Agenda for Sustainable _Research_Agenda_for... · PDF fileThe UMCs...

research agenda for sustainable health 5

national plan – research agenda for

national plan academic medicine,

biomedical science and healthcare research

Sustainable Health


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


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


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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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:

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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


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.

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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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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


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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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

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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?


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


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.

30 nfu

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).


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

32 nfu

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?





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.

36 nfu


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

89

100

90

38 nfu

kidney diseaseWhatcauseschronickidney

diseaseandhowcanitbe

detectedsoonerandthen

treatedonanindividualbasis?

Isanimplantableartificial

kidneyfeasible?

lung diseasesHowcanweimprove

ourunderstandingand

treatmentoflungdiseases?

Howcanweletlungs

regenerate?

stem cellsHowcanweuse

cells,stemcellsand

biomaterialstoengineer

andregeneratetissues

andorgans?





these questions.


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.


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

42 nfu


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

105

99

44 nfu

big dataHowcanbigdataand

technologicalinnovations

(e-health)contributeto

healthcare?Whyistheresolittle

researchwithalreadycollected

dataintheNetherlands?

innovative technologyHowcanweutiliseagreater

understandingoflifetoidentify

newtargetsformoleculartherapies,

antibioticsandantivirals?Howcan

weusethephenomenalincrease

inprocessingpower(innovative

technology)optimallyforhealthand

drugresearch?





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


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


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?

50 nfu

Manyquestionsaboutbio-imagingandmicroscopyweresubmittedtothe

DutchNationalResearchAgenda,including:

Advanced techniques: bio-imaging, microscopy and gentechnology

104





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.


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.

52 nfu

QuestionssubmittedtotheDutchNationalResearchAgenda:

Geneticsand tumours

81

85

geneticsHowwilltheknowledgeof

geneticsbeimplementedin

screeningforandtreatment

ofcommonandrare

diseases?

tumoursEachtumourisdifferent,so

howcanwecometounderstand

cancerwellenoughtodevelop

atreatmentforeachandevery

type?




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.


54 nfu

4 Principles


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.


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.

58 nfu

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


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.

60 nfu

5


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


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


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.


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

68 nfu

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


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

Print

EPS,Amsterdam

NFU-16.6456

www.nfu.nl

[email protected]

May,2016

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