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Medical Research

My Lords, I congratulate my noble friend on obtaining this debate on a subject that other noble Lords have demonstrated is extremely important. Although I was only briefly a full-time academic, I have initiated or taken part in a number of medical research studies over the years. I have also served on several inquiries of your Lordships’ Science and Technology Select Committee that touched on medical research. The first was nearly 20 years ago and was on research and development in the National Health Service. It resulted in the appointment of the first director of research and development in 1991. So this topic is not unfamiliar to me, although it has required some homework to absorb recent developments. The basis of my remarks will be the Department of Health document Best Research for Best Health, which was published in January this year, and two articles in the current British Medical Journal. The Department of Health’s document is very positive and outlines plenty of ideas for the future of medical research in the National Health Service. It preceded the Budget Statement announcing a single medical research budget, but I gather it will slot into that framework—with its pros and possible cons, which have been outlined by my professional and noble friends Lord Turnberg and the noble Baroness, Lady Murphy. Best Research for Best Health, while very optimistic in tone—a characteristic of government reports, of course—is honest enough to draw attention to some serious difficulties that need to be overcome if its proposals are to become reality. For instance, in the annex, on page 40, it states:"““Major change within the NHS has left clinicians under great pressure, with training and research too often taking a back seat . . . There has been a decline in the overall number of medical academics from 4,000 in 2001 to only 3,500 today. The number of clinical lecturers has declined by 30 per cent over the same period. Because of other priorities, universities appear reluctant to support those clinical academics that do exist””." Surely, that is another way of saying that they do not have the money. By way of explanation, the report states that:"““Between 40 and 50 per cent of clinical academic posts are funded by the NHS rather than by universities””." It would not be surprising if cash-strapped universities wanted that trend to continue. On this point, I ask my noble friend if the Government intend to fund the expanding number of clinical academics needed for the new strategy through the National Health Service rather than the HEFC? There is little in the report that addresses workforce planning for medical science, a problem emphasised in the briefing that I received from Universities UK for this debate. I am sure that that will be amplified by my noble friend Lady Warwick. As my medical and dental academic friends have pointed out today and on other occasions, the number of medical students has continued to increase while the pre-clinical and clinical academic workforce declines. There are plenty of able minds among those entering medical schools who would succeed in a clinical academic career, given the right training. But soon there may be too few clinical scientists to train them to the high standards that we are used to. That has already happened in a few specialities, such as pathology. At the moment, the shortage of doctors opting for careers in research and teaching is largely due to the absence of a clear career pathway. Some of the problems involved have been addressed by suggestions in the Walport report. It would be interesting if the Minister could say whether any progress is being made. The Government must play an increased part and not leave the training of clinical scientists to the medical research charities, excellent though their work has been. I declare an interest in that my son obtained his PhD while he was holding an ICRF clinical fellowship. Will the Minister say anything about the new primary care research network proposed in the document? How will this build on current academic general practice units in medical schools or the research support given by the Royal College of General Practitioners? There is rich potential for GPs to become more research-oriented and to acquire the research mindset mentioned by my noble friend. They could also become better trained in epidemiological and clinical research methods. If this network works well, it could be very important, as a huge gain could be had from using the lists held by every general practitioner. That resource is only just beginning to be tapped. The two BMJ articles which I mentioned address different but relevant areas. The first, written by a Greek research team, analysed a series of frequently cited medical research papers and found that, during a recent decade, the proportion of industry-funded studies significantly increased in relation to publicly funded studies, particularly randomised drug trials. This occurred although the majority of authors worked in a public/university setting. The authors state:"““Clinical research””—" that is, industry-funded clinical research—"““is dictated by the need to promote products of industry . . . academics may have indeed lost control of the clinical research agenda . . . Many important questions in clinical research have no connections with specific products and thus would not be supported by industry””." This was alluded to by the noble Baroness, Lady Fritchie, in her excellent maiden speech. In other words, it is easier to obtain industry funding for research than it is to obtain public funding, but it comes at a price. This situation is likely to continue owing to the huge imbalance in available research funds between the public sector and industry. I shall just skim through the second article. A team led by the London School of Hygiene asked 3,000 people whether privacy was important in gathering information to be used for epidemiological studies. Eighty-eight per cent said that it would not be a problem for them. Only 8 per cent said that it would. Eighty-one per cent said that registration of all cancer cases should be made compulsory as in Scandinavia. Concerns expressed about the need for informed consent or anonymity may have reflected the views of a minority. This does not mean that the minority view must not be taken into account, but it suggests that the great majority of the population would not wish excessive attention to confidentiality to interfere with gathering data essential for medical research.