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Medical Research

My Lords, I am only too glad to echo the comments of other noble Lords in congratulating the noble Baroness, Lady Fritchie, on an excellent maiden speech and thanking the noble Baroness, Lady Hayman, for tabling a Motion on a subject of unusual importance. It is important not only for the well-being of patients but also, as we have heard, for any claim that we may have in this country to regard ourselves as a world-class force for progress in the medical sciences. There is so much to which we could point to validate such a claim: the standing of our universities in world league tables; the continuing keenness by pharmaceutical companies to maintain and build their research capacity in the UK rather than elsewhere; the vibrancy of our medical research charities, which account for at least 15 per cent of our R&D spend; the constant stream of medical advances which this country has pioneered over many years; and the NHS itself, as a platform for research. All these are rightly to be celebrated and nurtured. I feel able, at the opposition Dispatch Box, to acknowledge that there are areas in which the Government can hardly be faulted. I refer to their commitment to increasing the medical research budget year by year in the MRC and NHS and in securing broad agreement on how best to encapsulate the ethical underpinning of research in recent legislation. In measuring how high this country jumps in terms of medical science and research, we are lucky enough to begin with the bar set high, with a shared purpose to achieve the same successful outcomes. Ready as we may be to trumpet our successes, however, a debate such as this is, if nothing else, an opportunity to look closely at those aspects of our system that are working less well and where we may be falling short. The first issue I want to focus on is regulation. It is generally agreed by those in the research field, as well as on all sides in Parliament, that a strong regulatory framework for conducting basic and clinical research is indispensable. However, we are hearing from the medical community an ever-growing threnody that the burden of regulation has now reached the point where it is obstructively and unreasonably deterring doctors and university departments from initiating research programmes. The noble Lord, Lord Winston, has spoken about that today very eloquently, as he did on 27 April. Unfortunately he is not alone. There is the serious issue of multiple approvals for clinical trials, which, thank goodness, the Government look as though they are now addressing. Two years ago in this House we debated the Clinical Trials Regulations. We wondered then whether the persistence of the Minister, the noble Lord, Lord Warner, in trying to minimise the most burdensome effect of the directive would in practice prove fruitful. If we had doubts about that, we are now seeing them borne out. Take cancer. Two months ago an editorial in the BMJ reported about randomised trials of a new anti-cancer agent as follows:"““The Directive requires reporting of all suspected serious adverse events, regardless of whether they are caused by the underlying disease, chemotherapy or the investigational drug. Information on each such adverse event needs to be distributed globally to all investigators working on the molecule. The co-ordinating investigator has already received 219 faxes, each consisting of between two and 36 pages. The Directive also requires that each event is reported to local ethics committees, together with an ethical evaluation. So far these have been discussed in 14 sessions of the Tampere ethics committee””." That situation is being replicated up and down the country. The result is that the cost of conducting non-commercial clinical trials has risen dramatically. The business of managing authorisations requires more staff; insurance and indemnity costs go up; the cost of submissions to research ethics committees go up and so do the costs of pharmacovigilance. We get to the point where, for many investigator-initiated projects, the cost of regulation consumes the money allocated to do the research. If we are not careful, the flow of new therapies will simply dry up, especially those that, because of their complexity, pharmaceutical companies find unattractive. The answer is not to throw money at these problems. I found myself, in common with others, bemused by the Chancellor’s announcement that the budgets of the MRC and for NHS research were to be merged. The announcement was made without any prior consultation, and one has to wonder what lies behind it. The noble Baroness, Lady Hayman, set out several concerns, as did others. If it is intended as an oblique means of shifting significant money away from basic research and into translational research, I, with others, would want to sound a loud warning. Even if that is not the intention, it could be the effect. Translational research is vital, but we de-emphasise basic research at our long-term peril. We wish Sir David Cooksey well as he reviews these matters in the context of the strategy set out in Best Research for Best Health. I want to touch now on an issue that I do not think has been mentioned. No science base worth its name is possible without children at school pursuing science subjects to A-level and through to university, and without a sufficient supply of science graduates to teach them. The warning signals have been plain for a number of years now that we are simply not getting enough children to take up science seriously. In the past 20 years the number of pupils taking A-level physics has declined by 35 per cent The supply of physics teachers is diminishing with alarming rapidity, and nearly a third of them are in their 50s. What is to be done? The announcements in this year’s Budget of a programme of recruitment of new science teachers and of extra money for schools science were, of course, decidedly welcome. But if we look at what has gone wrong with this part of the school curriculum, we have to confront some pretty stark and unpleasant truths. Last summer the Oxford and Cambridge RSA did a survey of teenage children about their views on science lessons. Ninety-three per cent of them said that they did not regard science or scientists as being ““cool””. Over half thought that science lessons were ““boring and confusing””. When Save British Science did a survey recently, it found that in more than three-quarters of secondary schools, science practicals had been cancelled, and that by far the most common reason given for that was the rowdy behaviour of pupils. In fact, bad behaviour was seen as the single biggest problem for the teaching of science subjects, far above lack of equipment or class sizes. That poses a question mark over standards of discipline maintained in the classroom, but there is another question mark over the content of the syllabus. Dr Martin Stephen, High Master of St Paul’s, recently voiced his view that the attempts to make science GCSEs more relevant had left them ““unchallenging and uninspiring””. He said this:"““The new GCSEs are to real science what baby food is to steak and chips. They will bore the pants off many students, not inflame them with a new love of science””." Dr Stephen is by no means alone in these opinions. The message here is surely that more money for schools science, although very welcome, may not be the most important ingredient in the revival of science that we all want to see in this country. The danger is severalfold. A number of universities are making cutbacks in their science and medical departments. That not only leads to the erosion of particular disciplines in their own right but also has a damaging effect on the ability of a university to maintain cross-disciplinary excellence, which my noble friend Lord Colwyn did so well to mention, as did the noble Lord, Lord Bhattacharyya. Pharmaceutical companies are finding it increasingly hard to source home-grown science graduates with good degrees. The key issue here is the quality of graduates. Funding from award councils that has nominally been allocated for teaching medical students is calculated on the number of students being taught, as opposed to any real measure of the teaching quality. The incentives to provide the high-quality teaching essential for research are therefore lacking. One manifestation of that is the shortage of clinical academics. I do not propose to spend time speaking about that because, serious as the problem is—and it is extremely serious—not too long ago we had a very fruitful debate on that very subject, led by the noble Lord, Lord Turnberg. If there is an overriding key message that I would pick out it is that universities must not just be places where students are taught; they must also be centres of academic excellence. Without fostering and maintaining those centres of excellence, we are into a downward spiral in which the business of attracting and retaining good people, both to learn and to teach, will become ever harder. Indeed, that was the theme of the excellent debate about universities initiated by my noble friend Lord Patten on 27 April. For our science base to thrive, and for the UK to hold its own internationally in that sense, the expertise of our university faculties, pursuing learning and inquiry for their own sake, must be the benchmark we use above all others to measure success.