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Complex interventions are widely used in the health service, in public health practice, and in areas of social policy that have important consequences for population health, such as education, transport, and housing. They present a number of problems for evaluators, in addition to the practical and methodological difficulties that any successful evaluation must overcome. In 2008, the Medical Research Council (MRC) published revised and updated guidance to help researchers and research funders recognize and adopt appropriate methods. This chapter summarizes key messages for the evaluation of public health interventions, and discusses some of the issues that have been raised since the guidance was published.

This chapter traces the history of what Sir Peter Froggatt, Chair of the Independent Scientific Committee on Smoking and Health, writing in the 1980s, called the strategy of ‘systematic gradualism’.. This became the major public health and industry area of interest from the 1950s through to the 1970s. By this term, Sir Peter was referring to scientifically informed strategies aimed at reducing the risk and harm drawing on relationships with industry. Topics discussed in this chapter include the Medical Research Council's tobacco benefaction-funded research programme, the Tobacco Manufacturers Standing Committee and research, the work of the Harrogate laboratories, and research carried forwards within the Imperial Group.

During the early years of the 20th century the pathologists held sway. Their detailed post-mortem examinations of fetuses promised to provide answers about causes of death. But the relatively small samples they used and their inability to recognize a substantial minority of causes led to the recognition of their limitations. The epidemiologists took over. The availability of registration data coupled with the popularity of large, scientifically based population surveys encouraged the development of social obstetrics. Family background, maternal health, reproductive history, income, nutrition became, during the 1930s and 1940s, the key factors in attempts to explain the now obviously high levels of fetal mortality. This clash of research cultures can be personified by the figures of Dr John Ballantyne of Edinburgh and Professor Sir Dugald Baird of Aberdeen. Their work in pathology and epidemiology symbolizes the contrast between biological and sociological explanations. This chapter focuses on the 20th century, the high plateau of late-fetal mortality before 1940, and the sustained decline thereafter. It contrasts the pathological interpretation, via Ballantyne among others, and the epidemiological-sociological, via Baird. Through the series of Child Life Investigations sponsored by the Medical Research Council the pathologists stressed the need to better quality obstetric care from both physicians and midwives, while from the social obstetrics camp came pleas for a better quality of material life and lower, planned fertility.

When the war ended, the Galton Serum Unit was reconstituted at the Lister Institute in London. There, the Medical Research Council's Blood Group Research Unit, directed by serologist and geneticist Robert Race, was devoted to finding new blood groups and elucidating their genetics. Chapter 5 investigates the work of this lab, as it used the donors, samples, and regionally distributed infrastructure of the new peacetime National Blood Transfusion Service (NBTS) to study the serological properties and genetic inheritance of blood groups. Human blood had changed during the war: it was no longer simply an emergency treatment for shock, but was used in routine surgery, and during neonatal care. This chapter examines how the Research Unit used the regionally distributed NBTS, the NHS, and the bodies of donors and patients, to define new blood group variants and systems, and to turn blood into a more complex fluid, serologically and genetically. This is a story of postwar biomedicine built on relationships between laboratories, depots, hospitals, and public health authorities.

After antibiotics for TB were discovered and found to be effective in the late 1940s and early 1950s they were quickly introduced into the developing world. Kenya was one of the first places where antibiotics like isoniazid appeared in Africa. However, drug-resistant strains of TB quickly appeared as a result of inadequate monitoring of drug usage. To combat the problem of drug resistance the British Medical Research Council, at times with the aid of the WHO, ran several successful trials looking for a multidrug regimen that would be cheap and effective. The drug-resistance problem in Kenya, and elsewhere, might prove too much.

When the Second World War began, Fisher’s lab was co-opted by the Medical Research Council, renamed the Galton Serum Unit, and tasked with providing practical support for the new Emergency Blood Transfusion Service (EBTS). This chapter follows the Galton Serum Unit as it supported the new transfusion service, and made its wartime infrastructure serve genetic research. The EBTS—the establishment of which was driven in part by hematologist and depot director Janet Vaughan—comprised bottles, tubes, needles, sterilizers, refrigerators, transportation (crates and vans), institutions (the Post Office, blood depots, volunteer donor organizations, hospitals, and laboratories for blood processing and testing), and an extensive paper-based bureaucracy. A large cohort of clerks managed index cards, lists, letters, enrollment forms, donor cards, and labels, with which they managed people and blood. This chapter is about how blood-group research was shaped by these materials and networks, and how blood groups were negotiated between people with different interests. It is also a story about what can be done with paper—as scientists transformed the donor records of the transfusion services into the raw data of human inheritance.

Molecular genetics was an area in which elite British scientists and research institutions sought to compete on a global scale. Sickle cell anaemia and thalassaemia, genetic conditions strongly linked to specific racialized ethnic communities, offered British researchers an opportunity to leapfrog their US counterparts: here, the UK’s newly diverse population and less toxic racial politics represented a huge advantage. So too was the availability of the NHS as a source of universal healthcare, and the discretionary power held by research elites within it to mediate access to both specialist and general services in the name of research. Yet service provision to affected communities lagged behind research funding, emerging only in response to community activism. While sickle cell anaemia and thalassaemia were not significant sources of morbidity or mortality, their symbolism and scientific potential attracted clinical and political attention denied to other more mundane (and more prevalent) chronic conditions.

In the 1930s, a community of influential British biologists seized on blood groups in their attempts to reform the study of human heredity. This community included R. A. Fisher, Lancelot Hogben, J. B. S. Haldane, Lionel Penrose, and Julia Bell, all of whom were recruited by the Medical Research Council to a new “Human Genetics Committee,” which would direct and support MRC-funded research on human inheritance. This was a period of heated disciplinary dispute and intense interest in eugenics and race; the committee believed that blood groups could help turn the study of human heredity into a modern, mathematically rigorous science. Blood groups, they believed, would provide a crucial reference point for pinning down the genetics of more complex traits, such as “mental defect” and “intelligence,” and might even lead to the first maps of human chromosomes. They believed blood groups also had the potential to reform race science. Soon, Fisher was awarded funding by the Rockefeller Foundation for a new lab devoted to blood group genetics: the Galton Serological Laboratory, based at University College, London. This chapter outlines how and why these scientists singled out blood groups in talking of modernity, race, and reform.

The accidental way in which Perutz and Kendrew met and the influence of the brilliant, versatile physicist J. D. Bernal upon them and on the third Nobel Laureate chemist Dorothy Hodgkin are described. Perutz and Kendrew, each a member of Peterhouse (a Cambridge College), were also guided by W. L. Bragg of the Cavendish Laboratory in Cambridge, and later at the Davy-Faraday Research Laboratory, London where, in 1953, they became visiting scientists and adept in the popularization of science. The founding of the new subject of molecular biology and the objection to it by some biologists are outlined. The joint efforts of Perutz and Kendrew in establishing two new major research centres—the Laboratory of Molecular Biology in Cambridge and the European Molecular Biology Laboratory in Heidelberg—is outlined. A brief trajectory of their initial work on haemoglobin is also given.

As it makes the world go round, it is very unlikely you’ll have got this far in planning a research project without someone asking you about money. Unfortunately no research is free—even a project that seems to carry no costs whatsoever will suddenly seem quite expensive when costed by an R&D department. It’s very important, therefore, that you anticipate all costing issues and submit a sensible bid for your project, as it gives you significantly more credibility as someone who knows what they are doing. There are many ‘hidden’ costs of an apparently simple research project. Photocopying of questionnaires is often contentious; although it’s all NHS money for NHS research, the copying will be billed to an individual department and clinical departments with massive running costs are rarely happy to underwrite research costs. Staff planning has to be done exceptionally carefully to ensure that NHS clinical time isn’t being used on the project without permission from someone with sufficient authority to give it. This often does end up being a hidden cost, as the way round it is often simply to fund a session per week to cover the half hour per day spent on the project. These are, of course, just examples. Detailed breakdown of costing points to consider is given later in the chapter; use this section to prepare a good business case and you will impress from the outset. Aside from the fact that you need it to spend on your project, funding is often (maybe unfairly) seen as a guarantee of the quality of your work. The theory that paid-for research will be better peer reviewed than its public sector or charitable equivalent is somewhat naïve, especially when one considers what agendas could underlie commercial research, but it still abounds. The current climate for research funding is confusing but awash with opportunities. The last few years have seen the creation of national funding programmes and prioritized ‘themes’ with some quite substantial budgets, in addition to the traditional sources. The Medical Research Council (MRC) was brought about by Act of Parliament in the early part of the twentieth century, setting aside a penny per working person per year from the National Insurance scheme of the time to fund tuberculosis sanitoria and medical research.