Last month, I travelled to a small industrial estate a few kilometres outside Reading, where I spent three hours undergoing a series of medical tests. I am not ill, and I am not aware of any serious underlying health conditions or significant risk factors that I should be concerned about. I was not being treated, instead I was participating in a medical research project, that aims to gather data about the health of a large number of people over a lengthy period of time.
Biobank was established in the UK between 2006 and 2010 and has a cohort of just over half-a-million volunteers, who were aged between 40 and 69 when they joined the project. This makes it the largest and most detailed research study that traces the long-term health outcomes for people in the Western world, with vast amounts of data on biological, environmental, and lifestyle factors that impact the development of a range of diseases and health conditions. I joined in 2009, and at the outset I went through a series of tests to get baseline data on my health. These included blood and urine samples, measures of blood pressure, my weight and height, a series of online cognitive tests – the sorts of memory and pattern recognition exercises that teenagers now do for standardised testing – together with some lifestyle questions about diet, exercise, sleep patterns, and my own perceptions of my degree of social interaction or loneliness, and my levels of happiness. Since then I have been asked several times to complete online questionnaires on various aspects of my health and my sense of well-being, and on a couple of occasions I have also worn a wristband containing a small tracking device for a week, which measured my movement and activity.
Last month, I become one of the one hundred thousand people who have undergone a series of scans, include MRI scans of the chest, the abdomen, and the brain. Once again, the nurses took measurements and samples, repeating the tests that had been done sixteen years ago, and I was asked to spend two blocks of time, around 30 minutes each, completing online questionnaires and cognitive tests, similar to those I had done previously. I can easily understand that there is value in seeing how my reaction times, memory, pattern recognition ability and the like have changed as I have grown older, and value in comparing my views about my diet, my exercise regime, and my sleep patterns to what I said previously. Once my data is aggregate with that of thousands of others, general conclusions about aging processes and the maintenance of good health could be reached. Some of the questions were ambiguous and difficult to answer clearly, for example, my diet varies quite widely week to week, depending on the time I have to cook and the company I keep, so it is hard for me to describe a standard weekly pattern of food consumption. And my sleep patterns tend to reflect my work patterns, which nowadays are rather variable.
The highlight of my visit last month were my two MRI scans, when I twice spent 30 minutes lying in a large hollow machine, as images were taken, first of the internal organs and bones of my upper body, and later of my brain activity. I had never been in an MRI machine before and while I had anticipated the possibility of mild claustrophobia, or feeling rather uncomfortable lying very still for half an hour, neither of these worries materialised. By far the worst element of the experience was the noise of the machines as they moved around me, generating a variety of curious sounds, some quite loud, repetitive and unsettling. For a while I wondered if I was auditioning for the role of Harry Palmer in a remake of The Ipcress File, although I was strapped to a horizontal, movable shelf rather than a chair. I comforted myself with the thought that I probably have the cooking skills for the role.
On reflection, it was an interesting way to spend half-a-day, with nothing too painful, difficult, or overly stressful involved, just clicking on a key pad to answer questions, or lying still while the machines did their work. What makes the research project interesting is its scale – the large number of participants providing data over many years – which generates an important database of information for research scientists to use to try better to understand the causes and the progression of diseases, and the features of the body, the environment, and the patient’s lifestyle which best help protect against disease. In the past thirteen years, more than 18,000 peer-reviewed research papers have been published in academic journals, making use of the data. This represents is a very major contribution to the prevention of illness and the provision of health care. The funding from the project has come from the UK government and from a range of health charities, and the public benefits of the work seem both significant and obvious.
Projects such as Biobank are a familiar part of social policy in Western countries, where taxes raised by the government are used to fund long-term research that is of clear social value. The underlying premiss is that the advancement of knowledge will support the introduction of policies and technologies that will improve quality of life and living standards for all members of society. There is, for sure, one serious question to be asked about the way the costs of research are borne and the way benefits are distributed, and a rather different question concerning the way in which research priorities and spending are determined. Medical research that leads directly to the prolongation of the lives of rich Westerners is more likely to be funded than research that prevents the early deaths of poorer people in the Global South, even though there might be a fairly straightforward argument that the indirect benefits to the West of improved health in the South are very significant.
Historically, the advancement of knowledge was not always seen to be an unqualified good, in particular when the results of research suggested the need to make changes to what people believed about the way the world worked or the way society was organised. The classic case in the West is perhaps the church based opposition to the development of natural science in the seventeenth century, whether the Catholic resistance to the work of Galileo or the Calvinist resistance to the work of Descartes. But there have been other instances, where powerful groups were unwilling to change their behaviour despite strong evidence that their practices were counterproductive. On a recent visit to Budapest, I was reminded of the story of Ignaz Semmelweis, which provides a good example of why improved knowledge does not always produce rapid improvements in medical practice. The lesson here is that while it is true that better knowledge makes possible a better society, there will always be those who prefer the current, worse society in which they themselves are highly favoured.
We are familiar with many dispiriting stories about large companies that suppress new knowledge that might lead to better social outcomes simply because it would also lower their profitability, or which continue to market products and services long after they discover that they have harmful effects on their customers. We also know about governments that adopt policies which are clearly not in the best interests of their citizens because they have doctrinal reasons for supporting certain policies, despite the evidence that shows their damaging effects. Knowing something to be true is not, of itself, sufficient reason for companies and governments to act on this knowledge. The social interests of the many need to be mobilised if they are to secure the benefits of the growth of knowledge.
The obvious current example of this problem is the refusal of many governments around the world to take seriously the vast amount of research that demonstrates the urgency of changing the way in which energy is produced and consumed, if we are to prevent serious and lasting damage to the world’s climate patterns and, consequently, it habitability. It is as if health ministries around the world were giving away free packets of cigarettes and encouraging all citizens to take the filters out before smoking forty per day. Self-harm on a global scale is rare, but in the case of climate change the damage to human well-being will take many generations to put right. As I lay in the MRI scanner, thinking about how I was, in a very modest way, contributing to the advancement of medical knowledge, I probably should have spent more time asking myself how I could contribute to the application of knowledge more widely to public policy. Acquiring knowing is simply not enough, we need to learn to put knowledge to more productive uses.