In Vitro Fertilisation: 40th Anniversary
Earl of Selborne Excerpts(6 years, 3 months ago)
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The Earl of Selborne (Con)
My Lords, I join other speakers in thanking the noble Baroness, Lady Deech, for giving us this opportunity to review the progress of IVF over the last 40 years. Previous speakers have reminded us of the timeline of the developments, from Louise Brown’s birth in 1974 to the commissioning of the Warnock report, of which my noble and learned friend Lord Mackay reminded us, and of course the passage of the Human Fertilisation and Embryology Act, with my noble and learned friend again playing a central role. We then move on to the Human Fertilisation and Embryology (Research Purposes) Regulations 2001 and the more recent debates on mitochondrial donation. The most recent date in this timeline is when the regulator gave permission for the use of gene editing in research in 2016. It is to that subject that I want to devote my remarks today, looking forward rather than back to the timeline of the last 40 years.
The noble Baroness, Lady Deech, referred to the very informative Nuffield Council on Bioethics report, Genome Editing and Human Reproduction, which came out in July this year. This should be read in the context of its previous report of 2016, Genome Editing: an Ethical Review. We should be grateful to the council for these detailed reviews of the ethical issues arising from interventions which are becoming ever more feasible in a research context and for which, at some future date, legislation will be required, whether to enable or to restrict its application in clinical practice—if one were a betting man one would say it would have to do both, in fact. The debates we had in 2015 on mitochondrial donation demonstrated how important it is—however well-intentioned and desirable the objectives may be—for these new technologies, which allow precisely targeted alterations to DNA sequences, to be the subject of wide debate, both in Parliament and more widely in society as a whole, before any legislation is contemplated to allow the new technology to move into clinical practice.
Gene editing without doubt has the potential to reduce the prospect of a future child inheriting a genetic disorder. Of course, there are also potentials unrelated to the avoidance of medical diseases and disorders. These give rise to completely different ethical and value considerations. I repeat that in the United Kingdom, since 2016, genome editing has been approved for use in research but remains illegal for reproductive purposes. It is difficult at present to predict with any confidence whether the cases in which we might influence inherited characteristics by genome editing will one day be widespread or relatively rare. The Nuffield Council on Bioethics helpfully identifies three kinds of closely related concerns in anticipation of the arrival of prospective new technologies. Again, this is very familiar to your Lordships because we have had these debates on mitochondrial donation and other areas where new technologies change the potential.
The first concern is that we sleepwalk into a new order as a result of technological momentum arising from pursuing the aims of science without an adequate consideration of their broader social and moral context and implications. The second concern is over function creep, whereby a technology expands its repertoire to encompass closely associated purposes, often for reasons of economic efficiency. There can often be benefits, but there may also be underlying values that need to be properly considered. The third concern is that the introduction of a new technology will lead us on to a slippery slope: we may see dangers ahead but can find no plausible reason, once an initial, innocuous application is conceded, to resist this expansion into more controversial areas.
The Nuffield Council’s conclusion, as the noble Baroness, Lady Deech, reminded us, as to whether human genome editing would ever be ethically acceptable is that interventions of this kind to influence the characteristics of future generations could be ethically acceptable if, and only if, two principles are satisfied. The first is that such interventions are intended to secure, and are consistent with, the welfare of a child who may be born as a consequence. The second is that such interventions would uphold principles of social justice and should not provoke or exacerbate social division or marginalise or disadvantage groups in society. Of course, that encompasses a very wide concept and calls for a broad, inclusive societal debate concerning the desirability of such interventions. The debate we are having in this House on the 40th anniversary of the first baby born using IVF is an appropriate opportunity to draw attention to the need for genome editing’s role in the field of human reproduction to be the subject, in coming months and years, of just such a wide-ranging debate, not least in your Lordships’ House.
Drug-Resistant Infections
Earl of Selborne Excerpts(8 years, 3 months ago)
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The Earl of Selborne (Con)
My Lords, the House will be most grateful to my noble friend Lord Lansley for giving us the opportunity to debate the report and recommendations of the review on antimicrobial resistance, chaired by my noble friend Lord O’Neill, to whom we are all greatly indebted.
In the short time that antibiotics have been available to clinicians, the United Kingdom has played a leading role in their development, and indeed in the development of diagnostics, vaccines and other products vital for the prevention and treatment of infection. I say “short time”, because the first clinician to witness the miraculous potential of penicillin was Charles Fletcher, in February 1941, when he was working as a research student for Professor Howard Florey—later of course Lord Florey, and a Nobel Prize winner along with Sir Alexander Fleming. Professor Florey gave him the task of testing whether it was safe to give penicillin to patients. Told to find the worst case of bacterial infection in the Radcliffe Infirmary, he chose an Oxford policeman who had been infected after a scratch on this face due to contact with a rosebush. After four days of treatment, he was on the way to making a full recovery—it was totally remarkable. But then of course the penicillin supplies ran out, as there was no industrial process for producing this material, and the patient relapsed and never recovered.
As my noble friend reminded us, Sir Alexander Fleming and others warned us of the danger of resistance, which he was aware of soon after his epic discovery of the antibiotic properties of the mould Penicillium notatum way back in the 1920s. It remains a total mystery to me, incidentally, how apparently rational people around the world can witness the remorseless advance of resistance within microbes and yet reject the concept of Darwinian evolution; there it is, in all its clarity.
Now, thanks to this highly influential review, commissioned by our Government, the United Kingdom is continuing its leading role in developing strategies on a global scale to meet the challenges of rising drug resistance. Like the noble Lord, Lord Rees, I pay tribute to the role of Dame Sally Davies in keeping this on the agenda both nationally and internationally.
At the World Economic Forum at Davos in January, the global pharmaceutical industry signed up to what was described as the declaration on combating antimicrobial resistance, which called on Governments around the world to do more than just issue statements of intent and to take concrete action, in collaboration with the companies that had signed up, to support investment in the development of new products to meet the challenges of rising drug resistance. The review has suggested one-off payments to firms that develop drugs that meet predefined criteria of unmet needs, to be paid on top of sales revenue. Not surprisingly, the 85 companies that signed up to the declaration at Davos supported that proposal, and said that if Governments offered them money they would do everything they could to earn it.
Clearly, the business model of expecting new antibiotics, or other products developed at great cost, to be funded by sales is doomed to fail—there is bound to be a market failure. These new products need to be kept as a last line of defence against so-called superbugs and held in reserve for the most difficult cases. Any incentive to maximise sales would be perverse in the extreme. We have heard already about the issues of the irresponsible use of antibiotics in agriculture. One such new treatment is colistin. Last year, genes resistant to this new treatment were discovered in hospital patients in China, and the agricultural use of colistin is thought to be responsible.
If, in the words of the Davos declaration, we are looking to Governments for concrete action, the first priority for our Government in the UK must be to run out a model for the UK that delinks payments for antibiotics from the volume of sales. If such a model could be piloted by, say, 2017, that would be concrete action indeed. It would also be a great stimulus to British innovation, which remains a world leader in the field. That does not apply just to large pharmaceutical companies; quite modest-sized companies are involved as well.
The review calls for the establishment of a global innovation fund for early-stage and non-commercial research, a highly important recommendation and potentially of great significance to all companies that are innovating in this area, particularly to small firms that struggle to comply with the funding arrangements of organisations such as Combating Bacterial Resistance in Europe, the Innovative Medicines Initiative and other funding sources.
The appalling story of colistin-resistant bacteria, attributed to agricultural use, emphasises the importance of the review’s recommendations on antimicrobials in agriculture, on which it published a report in December 2015. The review says that,
“in some parts of the world antimicrobial use is far greater in animals than in humans; in the US, for instance, more than 70 percent of medically important antibiotics are used in animals … Much of the use of antibiotics in animals is not therapeutic … Instead, significant volumes are used either prophylactically amongst healthy animals, to stop the development of an infection within a flock … or simply for growth promotion”.
That is a scandalous state of affairs.
The review proposes three broad interventions to take bold global action to substantially reduce the use of antibiotics in agriculture. This is a global issue; to be fair to the EU, in some ways it has led the field from what was an appalling situation, not just in livestock production but in fish farming, which was absolutely scandalous. We need global action. The proposals in the review were, first, to set global targets to reduce antibiotic use in food products; secondly, the rapid development of minimum standards to reduce antimicrobial manufacturing waste released into the environment—that is a pause for thought; can you really imagine antimicrobial waste being released into the environment? It has happened—and, thirdly, improved surveillance and monitoring to check progress against global targets, which was referred to earlier.
The pharmaceutical companies that signed up to the Davos declaration accepted their responsibility in delivering at least some of these measures, alongside the Governments, who also have to deliver. However, I am not persuaded that the language of the declaration, prepared by the global pharmaceutical industry, is totally appropriate. It calls for,
“more judicious use of antibiotics in livestock”.
That does not sound very robust. The overuse of antibiotics in livestock husbandry is not just injudicious; it is scandalously irresponsible. Immediate action by the companies that sell such products is urgently required, as well as by those Governments who allow it.
The ball is now in the court of the G20 Finance Ministers. As my noble friend said, we have to move from statements of intent to concrete action. We look forward to the United Nations high-level meeting on 21 September. The members of the review team, led by my noble friend Lord O’Neill, have potentially done a wonderful service for patients around the world in setting out its list of 10 specific actions to be followed up by Governments. It is now time for their wise advice to be followed by concrete and timely actions.
Health: Zika Virus
Earl of Selborne Excerpts(8 years, 10 months ago)
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The Earl of Selborne
To ask Her Majesty’s Government what is their assessment of the World Health Organisation’s warning on the spread of the Zika virus.
The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, we welcome the WHO recommendations, and the Government are considering our response. PHE’s experts are liaising closely with WHO and other agencies to understand the developing evidence and give the best advice possible. Given the serious implications of a link with microcephaly, the current travel advice is highly precautionary. Those travelling to affected areas should review this advice, pregnant women should consider the need to travel and all travellers should take scrupulous bite avoidance measures.
The Earl of Selborne (Con)
I thank my noble friend for that reply. It is helpful to know that there is a rapid response call for research applications aimed at tackling the Zika virus. Does my noble friend agree that the immediate priority is to eliminate the species of mosquitoes which spread the virus? Will the Government support field trials with Latin American nations into the release of genetically modified non-replicating mosquitoes, as recommended by the Science and Technology Committee in December?
Lord Prior of Brampton
My Lords, I think we are the second biggest contributor of funds to WHO and have just contributed £6.2 million to its emergency contingency relief fund. I think that the work that we have done in the UK on developing genetically modified mosquitoes to combat this disease and other diseases spread by mosquitoes will almost certainly play a very major part as we go forward.
Regenerative Medicine: S&T Committee Report
Earl of Selborne Excerpts(10 years, 9 months ago)
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The Earl of Selborne (Con)
My Lords, the whole House will be grateful to the noble Lord, Lord Patel, who speaks with great authority on the subject and was a fellow member of the committee. He speaks as a very distinguished professor in this area; I speak as a layman, but one who learnt a lot during the course of this inquiry into a fascinating area of very fast-moving technology and science.
This is a highly appropriate subject for a Select Committee report. Where science moves so fast, the regulatory framework will inevitably lag behind and it is a challenge for Administrations to ensure that there is the appropriate regulatory framework and fiscal support for what everyone will recognise has enormous potential. The technology has enormous potential in the longer term to produce new treatments for the plethora of diseases mentioned in paragraph 18 of the report, which lists Parkinson’s disease, cardiovascular disease and diabetes. I am sure that many people will wish to add to that list.
In the shorter term, a number of treatments can be seen coming over the horizon or are indeed almost available. One example, in paragraph 15, is a therapy which seeks to reverse the damage caused by a stroke. Given an ageing population—which is common to pretty well every developed economy—given that healthcare as practised at present with the tools available to us is forecast to require ever larger proportions of our economic resources and given the international interest, let alone our own national interest, in novel and innovative treatments that may have great economic and social benefits, there will be enormous rewards to those countries that put in place successful policies to promote these opportunities.
As the noble Lord, Lord Patel, reminded us, we have a strong science base at present and we need alongside it a suitable regulatory framework which gives confidence to patients, investors and, of course, the scientists and those conducting trials. We will need to ensure that public funds can complement funding from other sources, such as charities and commercial interests. We will have to negotiate the so-called valley of death, which is the difficulty, so often experienced in this country, in commercialising research findings. That is being addressed by the Cell Therapy Catapult, about which more anon. We will have to ensure that we make best use of those advantages derived from the National Health Service. The noble Lord, Lord Patel, reminded us that we have the great advantage of access to much valuable data on a scale not available to some of our competitors.
The Government have identified regenerative medicine as one of their eight great transforming technologies. Other reports, as well as our own, have alerted the Government to the critical importance of identifying barriers to development. The Government’s own report of July 2011, Taking Stock of Regenerative Medicine in the United Kingdom identified,
“steep technological, regulatory and strategic barriers to realising regenerative medicine’s significant potential”.
Our report emphasised the frustration that some scientists and clinicians have experienced negotiating the various regulatory hurdles. The Government response recognised the need for regulatory simplification in the long term and help to get through the existing minefield—perhaps I should call it labyrinth—in the shorter term. The establishment of the Regenerative Medicine Expert Group, tasked with developing a regenerative medicine delivery readiness strategy and action plan, is certainly a positive response to the report and is to be welcomed. However, at the risk of seeming grudging in my praise for the Government’s response, I draw attention to the rapidly changing international competition for recognition as a global leader. We refer in our report to the high level of investment in the United States and to the rapid progress in countries such as China and India.
Since we published our report, Japan passed legislation in November last year that revised its pharmaceutical affairs law, with the intention of establishing Japan as a global leader in regenerative medicine while continuing to protect patient safety and confidence. Last month at the World Economic Forum in Davos, the Japanese Prime Minister made it clear that this legislation redefines the regulatory framework and gives the opportunity for new therapies to move more rapidly from an early-stage clinical trial towards conditional approval, which enables the product to be brought to market and therefore to obtain reimbursement for the product in an accelerated manner. In the light of such responses from our competitors, it may well prove necessary to look more fundamentally at our own regulatory framework, as indeed we recommended.
On pages 42 and 43 we say that we will revisit the regulatory aspect of the inquiry to ensure that progress has been made. I am absolutely sure that it will be essential to monitor progress, although we all hope that the Regenerative Medicine Expert Group can facilitate simplification without, at least for the present, the need for further legislation.
I want to say a word in support of the catapult centres in general and the Cell Therapy Catapult centre in particular. For years we have complained in this country that we allow others to reap the rewards of commercialising scientific research. The previous Administration are to be congratulated on asking Hermann Hauser to make recommendations on how we should address this long-standing problem. He concluded that what was missing from the United Kingdom’s innovation landscape was a network of centres working at the commercialisation stage of technology, matching scientific research to industrial needs. His recommendation was that we should follow the model of the Fraunhofer institutes in Germany.
One of the seven new catapult centres is the Cell Therapy Catapult established in 2012 through the Technology Strategy Board and is designed to create a world leading cell therapy industry in the United Kingdom through innovation and collaboration. It is early days and we do not yet know how successful the centre will be—we will not know, probably, for a decade or so—but meanwhile we should allow the centre to build up its dedicated cell therapy teams, bringing together scientists, investors, manufacturing interests, regulatory experts and other interested parties from around the world. We must resist all temptation to interfere or change—it will need a good long period for bedding down—but it must be a highly appropriate subject for a catapult centre.
What is now needed is continuity of funding and support from us all. This catapult centre is exactly what is needed if we are going to emerge in the next decade as a global leader in this exciting sector.
Olympic Legacy (S&T Report)
Earl of Selborne Excerpts(11 years ago)
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The Earl of Selborne (Con)
My Lords, the Committee will be most grateful to the noble Lord, Lord Krebs, for the way he introduced this debate and for chairing the inquiry. I served on that committee and was enormously interested and impressed by it, particularly at the seminar that started our deliberations where I learnt a lot about the quality of the sport and exercise science and medicine in this country. It seemed very timely with the Olympics just about to start to have an inquiry into the extent to which the two objectives set out in paragraph 1 of our report were being delivered.
I will confine my contribution this afternoon to the second of those two objectives: how can the R&D base,
“be translated into treatments and preventative interventions to improve the nation’s health?”.
After all, if one thinks about it, the justification for spending public money on sport and exercise science must ultimately rest on its role in improving national health. That is not to say that winning more medals is not a perfectly laudable objective; it is clearly good for national morale and we should be proud about it. However, Dame Tessa Jowell, who we quote on page 8, paragraph 3, was right when she said that the goal of increasing participation in sport was,
“not just about increasing participation in sport for the sake of it … it was also to tackle one of the most serious health epidemics facing the UK, that of obesity”.
When you realise that the Department of Health had put an estimate on the direct and indirect cost of physical inactivity in England among our population at large at approximately £8.2 billion, you realise that we are talking of sums that concentrate our minds wonderfully.
We have not gone into behavioural change. It is one thing to estimate the cost but one knows how difficult it is for the most observant commentators to change even their own behaviour, let alone that of other people. Nevertheless, it is clear that this goal is well worth achieving, and if sports and exercise science and medicine can impact on the population at large and reverse what is, in the case of obesity, an epidemic that has been running for many years, it will be something well worth attempting. As well as mentioning obesity, as the noble Lord, Lord Krebs, reminded us, Tessa Jowell could have mentioned the 20 other chronic conditions identified as lending themselves to prevention or alleviation through physical activity. So we seek to increase participation levels in sport and exercise for all ages in order to capture the health benefits for the population at large.
The Government must be given credit for having put together a number of cross-departmental initiatives, listed at paragraph 45. They involve, of course, the Department of Health, the Department for Transport and the Department for Education. It was a bit of a surprise, I have to say, that the then DCMS Minister, when giving evidence to us, said that,
“the baseline for ... the whole sport plans, is driving up participation in sport; it is not a bigger drive on the nation’s health”.
That does not make a lot of sense. We all agree that we want more people to participate. Why? I think we all recognise that it is because there are going to be those benefits. I say again that it is perfectly reasonable for UK Sport—a DCMS arm’s-length body, as the noble Lord, Lord Krebs, reminded us—to spend government money and, for that matter, lottery money on promoting the agency’s primary objective of winning more medals in competitions. I am all for that. UK Sport also receives money from third parties that are not subject to the same commitment to share the benefits that derive from public funds. With commercial organisations there may well be a confidentiality clause, and I recognise that. However, it should be a condition of receiving public funds for there to be an obligation to promote the sharing of the research findings that I mentioned in order that the wider public might benefit. That is not happening; the links between some of the elite research, other athletic research and the wider public are not as strong as one would have hoped.
For healthcare professionals plenty of information is available. We have heard about the Chief Medical Officer’s guidelines on physical activity. However—I repeat what the noble Lord, Lord Krebs, told us—there does not seem to be an effective mechanism for promoting this information, the guidelines and other advice, to the medical professionals. Surveys show that their knowledge of the guidelines is, frankly, disappointing. At paragraph 36 we point out that Sport England told us that exercise prescription should “sit alongside” pharmaceutical and surgical interventions. Yet GPs have no incentive to prescribe exercise; I can quite see that many GPs say that that is all very well but it is most impractical for them to tell some of their more obese patients to go out and take exercise. What they want is a prescription. Nevertheless, as a layman, I am fairly confident that in many cases a prescription which simply said “Go out and take more exercise” would be a jolly sight more effective than a surgical or pharmaceutical intervention.
If you think about the quality and outcome framework, there are incentives to GPs to do this, that and the other. One incentive is to list those of their patients who fall into the category of obese, but the incentive is to put them on the list, not to take them off it. Once they are on the list, GPs get paid for keeping them there. That is not exactly an incentive for them to tell their patients how to get below the magical figure at which they are considered obese. Clearly the quality and outcome framework needs to be revised. Adding physical activity to the quality and outcome framework, as Sport England suggested, might be a good start. It would save a lot of money—I am quite confident of that. You would perhaps even make a very modest dent in the culture change we are looking for so that people recognise that exercise can help solve some of the problems that we are facing as an ageing and ever more obese population. We need to raise the profile of physical activity.
We have heard that there are up to 20 different chronic conditions which could benefit from physical activity, and I shall not repeat them. I am surprised, as a complete layman, how little understanding there appears to be of why physical activity can help with so many of those conditions, including, for example, mental health problems, cancer, type 2 diabetes and the like. This is clearly a field of great potential interest and benefit and one where sports and exercise medicine has a unique contribution to make alongside the medical and biological sciences. It would be enormously helpful if there could be much greater collaboration in order to ensure that these helpful insights are captured. However, as I said earlier, that will happen only if we have a culture where research findings—particularly those funded by the public—are made available to the wider research community and, through that, to the public at large.
NHS: Association of Medical Research Charities Report
Earl of Selborne Excerpts(11 years, 5 months ago)
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The Earl of Selborne
My Lords, I start by congratulating the noble Lord, Lord Turnberg, on giving us the opportunity to discuss this most important report. I pay tribute in his absence to my noble friend Lord Willis, who is chair of the AMRC. As everyone does, I strongly endorse the case made so powerfully by the report to ensure that every patient has the opportunity to take part in research. However, my plea today is really about ensuring the realisation of the potential of the vast amount of data held by the National Health Service.
The scope of the National Health Service’s database is one of its greatest assets. The potential of these huge datasets, which could be drawn on for research, is much greater than the present rate of exploitation. That is not to say that there is not some excellent work being done. I draw attention to the press report which came out when the survey was published, as referred to by the noble Lord, Lord Turnberg. Professor Peter Weissberg, medical director of the British Heart Foundation, stated that:
“It’s vital we create a system where researchers have better access to patient data so we can use it to help find new life-saving treatments for heart patients”.
After “heart-patients”, read “and every other patient”. We should take great lessons from the example of 10 years ago, when the Medical Research Council and the Wellcome Trust established the UK Biobank to support the investigation of risk factors for the major diseases of middle and old age. The recruitment of more than half a million men and women aged between 40 and 69 was successfully achieved, with a great deal of support from the public, and their health has been monitored long-term. When the House of Lords Science and Technology Select Committee published its report on genomic medicine four years ago, it quoted the evidence of the Wellcome Trust Sanger Institute:
“The UK Biobank initiative has set a gold standard for ethical principles and guidelines concerning the large population studies”.
In other words, there was recognition that there was a need to protect patient privacy and to reassure the public that their concerns about the data being abused or misused were being adequately and most properly addressed. The procedures for ensuring the protection of personal privacy were considered exemplary. Yet Professor Collins of the UK Biobank told the Select Committee that if he were able to make one recommendation, it would be to remove the bureaucratic obstacles to using health records to improve the health of people in the United Kingdom. The report came out just after the Information Commissioner at the time, Richard Thomas, and Sir Mark Walport, now the Government’s Chief Scientific Adviser, had conducted a data-sharing review in 2008. This review concluded that,
“the complexity of the law, amplified by a plethora of guidance, leaves those who may wish to share data in a fog of confusion”.
What has changed over the last four years? First and foremost, the technology has changed. The ability to collect, store, share and integrate ever greater volumes of data has advanced exponentially. However, our ability to unlock more of the vast database that is available from the National Health Service has not matched these advances in technology. We are still not using these data to their full potential, to ensure that research findings are transferred to clinical and therapeutic use. The huge datasets that could, with public support, be drawn from the National Health Service and which could underpin new and exciting opportunities for the diagnosis and treatment of disease are still waiting for full exploitation.
The biobank has been an outstanding example of what can be achieved. When the public are effectively engaged, there is overwhelming support for their own data to be used to support the public good. It is therefore essential to reassure the public that their data will be handled safely. This requires effective systems and good communication among practitioners, researchers and patients—and, indeed, among all healthcare professionals. The UK Biobank has shown that this can be done.
Health: Pancreatic Cancer
Earl of Selborne Excerpts(12 years, 8 months ago)
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The Earl of Selborne
My Lords, every Member of the Committee will be enormously grateful to the noble Lord, Lord Aberdare, for making this debate possible. I am sure we all congratulate him on his speech. Pancreatic cancer is indeed the poor relation. It is disheartening to find what little progress has been made over 40 years compared to the great successes in most other cancers.
I shall confine my remarks to the need for earlier diagnosis and try to explore some of the reasons why it is difficult to achieve at the moment. Pancreatic cancer is usually diagnosed late in its progress, making surgery very much harder to accomplish. With earlier diagnosis, there is a small chance that the progress of the disease can be slowed down, thereby prolonging life and there is a possibility that the patient may be fit enough to take part in clinical trials. Again, with later diagnosis sometimes clinical trials simply are not an option.
The difficulties of early diagnosis cannot be denied, though. Like the noble Lord, Lord Aberdare, I stress that I am a complete layman, but I recognise that there are no simple tests and indeed that many patients do not experience symptoms until the cancer has spread from the pancreas. Sometimes, however, families are able to recognise with hindsight that a range of symptoms had manifested themselves which, had they led to a diagnosis some time earlier than was eventually the case, might have given some more hope for treatment and trials. Often this manifested itself in more frequent visits to GPs and to hospital before potentially triggering an emergency presentation like jaundice.
The barriers to early detection have been well set out by Pancreatic Cancer UK’s Study for Survival. Its informative summary notes that GPs themselves record that there is a lack of sufficient information and knowledge about pancreatic cancer’s signs and symptoms, a lack of sufficient formal evidence relating to them to support the development of effective referral guidelines, and a lack of access to risk assessment tools to support GPs to identify patients with a pancreatic cancer concern.
We need to develop tools, such as a risk assessment tool, and to improve access to diagnostics. Doctors should always include the possibility of pancreatic cancer in their index of suspicion when presented with a patient with symptoms that do not seem to add up, and should always be ready to refer the patient to a consultant for investigation in such circumstances and without delay.
Health: Oral Cancer Detection
Earl of Selborne Excerpts(13 years ago)
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Earl Howe
Yes, we are continuing to invest in tobacco control activities. The noble Baroness will know that in March, we published our tobacco control plan for England, which sets out a range of action points. We are running marketing communications campaigns, with a campaign currently on television. In the new year, we will be making Quit Kits available through pharmacies across England; in the spring, we will run a campaign to highlight the risks of exposure to second-hand smoke and to encourage smokers to make their homes and family cars smoke-free.
The Earl of Selborne
Will the Minister tell us whether the tobacco industry is giving full support to this campaign?
Hospices and Palliative Care Services
Earl of Selborne Excerpts(14 years ago)
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The Earl of Selborne
My Lords, I join others in thanking my noble friend Lord Bridgeman for introducing this debate and giving us the opportunity to talk about the future of hospices and palliative care. Like my noble friend Lord Bridgeman and the noble Baroness, Lady Masham, I make a plea for the cause of palliative care in the community. I declare an interest as a patron of a charity called Hospices At Home TLC, which operates in Hampshire, where I live, West Sussex and Surrey. Developed from the palliative nursing service and funded by the Big Lottery, it provides help for adults with a limited life prognosis and their family and carers.
As my noble friend Lord Bridgeman reminded us, surveys consistently show how many people would prefer to have support at home and to die at home if that is feasible. Of course this requires the relevant level of care in the community to be provided. My noble friend mentioned that the significant figure of £160 million could be saved, but specialist therapies, specialist medical equipment, volunteers working alongside nurses and bereavement counselling are the sort of services which are being provided by charities and the hospice movement.
There are difficulties, some of which arise from the interface with the primary care trusts. Sometimes they are not always aware of their own criteria for qualifying for continuing care in the community. While the gold standards framework aims to improve the organisation and quality of care for everyone in the last years of life, it is often when a patient is placed on the palliative care register that patients and families and carers are not able to understand just what support, and further support as the condition changes, is available within the primary care trust area. I simply make a plea that everyone involved with the primary care trusts not only understands for themselves the criteria for support but makes them accessible in a way that everyone else can understand. We need to move towards a national cover for palliative care services in the community. We are enormously lucky in our area to have just such a cover.
Nanotechnologies and Food: Science and Technology Committee Report
Earl of Selborne Excerpts(14 years, 5 months ago)
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The Earl of Selborne
My Lords, the whole House will be grateful to the noble Lord, Lord Krebs. It is not easy to explain just how small a nanoparticle is, but I think he put that into perspective. I am enlightened to know that you can get 300 million nanoparticles on the head of a pin; that is a useful bit of information. Noble Lords will gather that we were very well served by our Chairman; I was very privileged to serve on this sub-committee. The noble Lord, Lord Krebs, with his experience at the Food Standards Agency, could not have been better equipped to undertake the chairing of this really quite complicated but very important subject.
I see this report in a historical context. History, I suppose, is a rather rough description when this science, as noble Lords heard, is very recent, but in 2004, as the noble Lord, Lord Krebs, reminded us, the Royal Society and the Royal Academy of Engineering produced a very helpful report that set out the ground rules for how this new technology might be underpinned by appropriate research. You cannot, after all, regulate a new industry unless you have adequate research and understanding of just what is happening. Later, there was the report from the Council for Science and Technology in 2007, and the Royal Commission on Environmental Pollution in 2008 reported on novel materials. All these reports have been very significant, and there is clearly much expectation in them of nanotechnologies. We dealt only with food, which is a relatively narrow area, but the 2004 report anticipated—correctly, as it turned out, because we are already seeing it—that nanomaterials in a wider context were likely to become commonplace, and recommended that research into health, safety and environmental impacts should keep pace with predicted developments. This research is so important, again as the noble Lord, Lord Krebs, very helpfully pointed out, because, when you start using materials at this scale, they simply do not behave as you would normally expect them to. His example of melting silver with a hairdryer, as opposed to at 960 degrees Celsius normally, demonstrates that you are talking about something that is not as you would expect.
The other conclusion I came to after reading this report was that there is every reason to believe that nanotechnology, provided that health and safety issues can be addressed and quantified, will be put to some extremely helpful uses in the food industry. We are not yet there, but as we have heard already, if you can reduce salt and fats in foods, nanotechnology has obvious advantages. I recognise that ice cream with many times less fat is an extraordinarily marketable commodity; I would certainly be very interested in that. Better packaging and materials, increased shelf life, the reduced use of active ingredients and agrochemicals; it seems to me perfectly reasonable to anticipate these and many other applications.
The 2004 report, which got off to a good start a debate that is beginning to flounder, suggested that,
“the UK Research Councils assemble an interdisciplinary centre … to undertake research into the toxicity, epidemiology, persistence and bioaccumulation of manufactured nanoparticles and nanotubes, to work on exposure pathways and to develop measurement methods”.
The then Government did not adopt this recommendation. They continued to fund research into nanotechnologies through the established channels of grants through Research Councils UK and government departments, usually in response mode but with publicly funded nanotechnologies research co-ordinated through the Nanotechnology Research Coordination Group. When that body started out in November 2005, it published a helpful report that identified 19 research objectives grouped into five areas—we are talking of all nanotechnologies here—one of which was human toxicology.
It is disappointing to find that Defra sponsored a report last year that reviewed how many of these research objectives had been fulfilled by the Nanotechnology Research Coordination Group. The answer, particularly on the issue of human toxicology, is that a substantial amount of work remains to be done. The Defra review states that there have been,
“no systematic studies on the potential of different kinds of nanoparticles to get into the blood, the lymph or the brain”.
Our report comments—rather restrainedly, I think:
“We find this conclusion worrying”.
The Medical Research Council was assigned responsibility for research objective 11, which was to undertake:
“Research to establish a clear understanding of the adsorption of nanoparticles via the lung, skin and gut and their distribution in the body … identifying potential target organs/tissues for toxicity assessment”.
The Defra review concluded that,
“a … largely un-researched area is ingestion as a route of exposure … Given the potential for this route to expose very large numbers of individuals … the lack of activity in this area is surprising”.
This time our report comments:
“We find this lack of progress extremely concerning”.
It is not as if we have not had warnings in the interim. In 2007 the Council for Science and Technology’s report also drew attention to the Government’s slow progress on health and safety research, and said that this was due to an overreliance by government on responsive mode funding rather than directed programmes by government departments to deliver the necessary research. That is logical, is it not? If you wait in responsive mode and there happen to be no research workers applying for research funding in this area, you will not get your gaps filled. You need a bit of direction occasionally. That simply has not happened, which is why there is concern.
I ask my noble friend the Minister not for more money—that would clearly be unreasonable—but simply for the considerable sums of money that are spent on nanotechnology research to be partially reallocated, even in small measure, so that the health and safety issues are adequately addressed. The amount of money that we are talking about is very small compared with the development of these new technologies.
In 2007-08 I chaired a working group of stakeholders charged with drafting a voluntary code on good practice for organisations involved in the supply chain for nanotechnologies. The group included research organisations such as the Royal Society through to retailers, trade unions, consumer groups, and of course companies interested in nanotechnologies. We produced a draft nano code that was accepted with a degree of enthusiasm by all the stakeholders. The repeated mantra in all this was “Transparency, accessibility and accountability”—you cannot repeat it too often. Never hide from the public any shortcomings in the scientific knowledge—there are always some. Never try to persuade the public that the risks are less than might otherwise be thought. Be honest. This is something that the Food Standards Agency got off to a good start with after so many food scares when the regulatory authority was the Ministry of Agriculture, Fisheries and Food.
It is disappointing to find that this fundamental lesson does not appear to have been adopted by the food industry, either here or in America. The noble Lord, Lord Krebs, talked about the food industry not putting its head above the parapet. Somebody has to put their head above the parapet. I understand why the food industry would like a ringmaster—someone to co-ordinate the dialogue—but it is absolutely essential that such a dialogue takes place. It is essential that all stakeholders participate. It would be fine if the Food Standards Agency could be the ringmaster, but my main plea is that this public dialogue should be engaged in quickly.