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Medical Research

rose to call attention to medical research and its science base in the United Kingdom; and to move for Papers. The noble Baroness said: My Lords, I am delighted that the noble Baroness, Lady Fritchie, from among a distinguished speakers list, has chosen today to make her maiden speech. I am sure that we all look forward to hearing her. I am delighted, too, that my noble friend Lord Sainsbury will reply from the Front Bench. He has made an outstanding contribution in his term of office as Science Minister, and I look forward to hearing from him later. I shall speak today about the record and the reputation of medical research in the United Kingdom, and about the resource and regulatory underpinning necessary to ensure continuation of that success. I should declare my interests as a member of the Human Fertilisation and Embryology Authority and chair of the Human Tissue Authority, both of which have regulatory responsibilities in respect of research governance. Before that regulatory role, my connections with medical research have always been from a patient perspective, both in various roles in the NHS, where I ended up chairing a trust hospital, and in the charity sector, where, for three years, I chaired Cancer Research UK. From that patient perspective, as well as from the perspective of United Kingdom plc, it is important that we respond to the call of the noble Lord, Lord Patten, in this Chamber a couple of weeks ago, who said that we must,"““continue to blow the trumpet about the importance of . . . R&D in this country””.—[Official Report, 27/4/06; col. 278.]" In the words of the Government’s 2006 Science and innovation investment framework:"““Health R&D is an area of marked UK strength. In addition to the obvious public health benefits, the quality of the UK’s health research base, including medical research, is an important factor in retaining and growing R&D investment from the pharmaceutical industry, already the UK’s largest contributor to private R&D, with over £3.3 bn of investment each year. It has a growth rate of 4–5 per cent per year—exports in 2004 were £12.3 bn . . . the UK’s biotechnology sector is the largest in Europe and second globally only to the US””." This year we overtook the United States for the first time when the UK gained top place among the G8 nations in the productivity of its biomedical and pre-clinical research—so, a proud record. But back to patients: Professor Raymond Tallis, in his fascinating book Hippocratic Oaths, analyses the benefits that ““scientific medicine””, as he calls it—the relatively recent discipline of an evidence and research-based approach to therapeutics—has given to man, ““the medicine-taking animal””. He looks in particular at the contribution to increases in life expectancy made by science, as against those of the broad social advances which gave so much, particularly in the early years of the 20th century, in education, sanitation, housing, nutrition, and health and safety at work. He concludes:"““Whilst scientific medicine is not acting alone, its contribution—once the foundation stones of public hygiene and the welfare state are in place—is proportionately greater””." As a nation we have reaped benefits from the home-grown scientists and doctors, from Sir Richard Doll’s work—as groundbreaking and important today as we debate the Health Bill as it was when he first made the connection of tobacco with cancer—from Charnley’s hip replacements, and from Sir Peter Manfield’s discovery of MRI. Tallis was looking particularly at the spectacular advances in life expectancy in developed nations in recent years, but medical research can and does make a tremendous contribution in the developing world, even when the infrastructure that we take for granted is lacking. There have been achievements like the virtual eradication of river blindness in west Africa, the transformation—which I have had the privilege to see—in the lives of HIV/AIDS patients in Africa when antiretroviral drugs become available freely to them, and the possibilities opened up by the hope of a vaccine against cervical cancer. The effects of medical research in our country are felt well beyond these shores. But for us as individuals and as funders of the National Health Service the challenge is about extending not only life expectancy, but healthy life expectancy. I know that many patient groups are very anxious that publicly supported research should be directed at areas which may not be in the forefront of scientific excitement but really matter to patients day in and day out, areas that have been neglected in the past—improvements in pain control in palliative care, and researching the combination of chemotherapy drugs that will give patients 18 months’ survival with a good quality of life rather than 12 months. They are anxious too, like the Alzheimer’s Society in its briefing for today’s debate, that what is discovered and known on evidence to be the best treatment is put into practice across the board and in all areas. The responsibilities of NICE in this area are particularly important. Moreover, there is the importance of clinical academics, an issue that has been discussed many times in your Lordships’ House. The recent pledge to fund £2.5 million in this area is welcome, but I do not believe that we can emphasise too much the importance and benefit of having practising clinicians with a research mindset, and to give that research activity the respect it deserves. Professor Iain Chalmers believes that one of the biggest problems is the low status of clinical research. He said:"““The fact is that the smaller the thing you study in biomedical research, the higher your status—so prions have a high status and people who study whole societies have a very low status””." But of course we need people who study both. There is a very precious baby here that must not be thrown out with the bathwater, and that is the blue-sky, abstruse, intellectually challenging science which is not directed at a specific end, and where the eventual destination of a line of inquiry is completely unknown. One of the most fascinating challenges and difficult dilemmas that I faced when I was at Cancer Research UK was how to strike the right balance in funding decisions between, to put it very simplistically, giving brilliant scientists the resources to go away to see what they came up with, as against responding to specific research applications from scientists and doctors already working in a particular field, or considering areas that were under-researched but where there was no demand for funding, such as surgery, which is tremendously important to cancer patients. Where the applications did not come through, we had to consider how to set about capacity-building and stimulating high-class requests in such areas. That was exactly the challenge that the Chancellor just put to Sir David Cooksey when he asked him to consider the best arrangements for delivering the full spectrum of publicly supported health research, and from the Nobel prize-winning research conducted by the Medical Research Council to the NHS’s world-renowned work on health technology assessment. The budget proposals for that new single fund for health research have been broadly welcomed, but, as I am sure my noble friend is aware, there are issues about which the research community has concerns. In particular, the community wants reassurance about the transparency of decision-making and of how we will safeguard the Holdane principle of independence from Ministers in day-to-day decision-making, and about how we will ensure that effective partnerships continue with the medical research charities, given their enormously important investment—about £700 million a year—in medical research. I know that there is also concern about infrastructure costs within the NHS in a programme grant-giving regime and ensuring that teaching and research hospitals are properly funded. I want to highlight another concern. Government strategy states:"““Few, if any, other countries have a health service that provides researchers with the potential to access virtually the entire population for an integrated system of primary, secondary and tertiary care. It is a unique selling point for public sector researchers, charities and private organisations””." It is from that unique selling point, that invaluable base, that the National Cancer Research Network, established in 2001, trebled the proportion of cancer patients coming into clinical trials, putting us ahead of Europe and the US. The UK Clinical Research Collaboration hopes to replicate that across the board. My concern is that the increasing fragmentation of provision within the NHS through independent treatment and diagnostic centres and the use of the private sector, where the impetus for research is hard to see, should not dilute that unique resource and integration on which clinical trial success so crucially depends. To move from resources to regulation, the Health Minister, Rosie Winterton, recently said that,"““the UK is seen as a world leader in embryonic stem cell research, and this is largely due to the effective regulations that control it””." That is right. It is possible to strike a balance and provide a regulatory framework that supports rather than hamstrings researchers. If we get the regulation right, and take the public with us—that takes us into the area of the public understanding of science, which is another whole debate, about which the noble Baroness, Lady Greenfield, has spoken in this House—we can provide a framework that both gives public confidence and allows research to flourish. There are difficult areas here, to which we have to face up, and difficult balances to be struck. I especially welcome the AMS’s recent report, Personal data for public good, which highlights some of those balances. Things can go terribly wrong if we lose public confidence. I was a Minister responsible for GM crops during the time of the greatest public concern about the issue. It is frightening when the ability to have a rational debate is taken away from you in a wave of public feeling without any proper underpinning of communication. The communication of risk is an area that we have discussed before but which is of tremendous importance. We need to be smarter in how we deal with European legislation. We need to get in earlier on decision-making. We need to ensure that the specific characteristics of UK research, such as its large charitable sector, are fully recognised. Finally, we just have to take a more robust approach against the seemingly constant desire to gold-plate. Finally, perhaps I may say something else about what is necessary for the sector to flourish, and pinpoint another area of effective regulation. That is in the field of animals used in scientific procedures. I very much welcome the Government’s action in legislating in this area through the Serious and Organised Crime Act and the police’s willingness to investigate and prosecute those who use threats, intimidation and violence. I also applaud the efforts of the Research Defence Society and others to bring together patients groups, medical charities, citizens and researchers to speak up for research. Transparency is a very powerful weapon in this area. We have nothing to be ashamed of in our regulatory framework, and the public recognise the importance of the work that is done. The Motion refers to the science base as well as to medical research, because it is clear to anyone who has worked in this area or read anything about it that medical research needs a science base that goes far wider than conventional biomedical disciplines if it is to continue to succeed. As a trustee of Kew Gardens, I immediately think that plant scientists can make a contribution to medical research. Others, I am sure, will speak of physics and of chemistry. Then there is information technology—I have learnt a new phrase today, ““pervasive computing””—which will be tremendously important in health service research in the future. The mechanical sciences can also help with different delivery systems for medicines, as can statisticians, social scientists, ethicists and philosophers, whom we need to help us to grapple with the ethical and social dilemmas and implications of medical advances. Above all, we need co-operation and cross-fertilisation between those different areas. That point was brought home to me yesterday when I read the obituary in The Guardian of James Ambrose, the radiologist who helped to pioneer CT scanning. He was approached by Godfrey Hounsfield, a physicist who had never done any medical research and worked for a record company but was interested in this area. Their collaboration ended up with Hounsfield getting the Nobel prize in 1979. Ambrose’s contribution was less grandly recognised, but without the partnership of the two—the clinician and the scientist—millions of patients would have been the poorer. As politicians, we have the opportunity to play our part by creating an environment where the educational, financial and regulatory framework is one in which those sorts of partnerships and discoveries can continue to benefit patients and the public in the future. I beg to move for Papers.