Genomic Medicine: S&T Committee Report

Lord Taverne Excerpts

Wednesday 9th June 2010 Lords Chamber

[Lord Taverne]

My Lords, the committee’s inquiry into genomic medicine was a very wide-ranging inquiry into a very important and highly technical subject. It is a subject in which I am a layman and, even after hearing a large and impressive array of expert witnesses, I cannot claim any but the most superficial knowledge of the issues involved. Fortunately, we had a very learned and able chairman, who handled our inquiry with great skill, expertise and charm. We had an excellent expert adviser and splendid supporting staff, and many of the committee members had valuable experience and knowledge of their own. All I can do in my speech is to contribute some rather general observations.

A basic question that we face is: how likely is genomic medicine to produce substantial benefits in the short to medium term, say in the next five years, in the treatment of disease? Experts differ on this. If benefits are many years away, the case for the urgent implementation of our recommendations is obviously weakened. An independent response from the Foundation for Genomics and Population Health and Cambridge University’s Centre for Science and Policy, for example—two pretty heavy-weight bodies—was rather dismissive of the short and medium-term prospects for benefits to the nation’s health. It is agreed that staggering progress is being made in the sequencing of human genomes. There is also no doubt that there has already been a major impact on single gene disorders, such as Huntington’s disease, and single gene subsets of some common diseases, but these are rare diseases and affect only a tiny proportion of the population. However, it is argued, when it comes to genetic tests for common diseases, that the gain to clinical utility in the short or medium term will be small, and a great deal more research as well as trials will be needed before we can be confident of the benefits that genomic medicine can bring to a wider section of the population.

The critics of our report are similarly cautious about the prospects for substantial early developments of pharmaceutical drugs that are tailored to individual needs or about how much knowledge can soon be gained of adverse side effects of particular drugs in individual cases. At first, I was somewhat sceptical about the claims of early prospective benefits—big benefits for tiny cohorts, tiny benefits for the big cohorts—but I believe that the balance of the evidence that the committee heard clearly leads to a more optimistic conclusion.

There is an impressive list of examples in paragraphs 2.16 to 2.30 on pages 17 to 20 of our report, and further developments have since added to them. Genetic variants, for example, with only a very small effect on risks, may enable us to identify new pathways for diseases, opening up the prospect of substantial benefits in treatment. Single nucleotide polymorphisms, which are associated with breast cancer, could identify women with a much bigger risk of breast cancer. Microarray measurements of gene expression in tumour tissue could separate women who have breast cancer into low-risk and high-risk groups, which would allow some to avoid chemotherapy and lead others to be treated more aggressively than they might have been. The Breast Cancer Campaign recently sent us a letter, which I am sure other members of the committee have had, showing that it is confident of real progress in identifying patients’ risks and the treatment of breast cancer.

A large number of people with a particular mutation who had diabetes in the first few months of life could be taken off insulin even after 30 years, and we heard that there are reasonable prospects of identifying new genes that will lead to the stratification of patient groups. A witness from the Pfizer group told us that the effect of pharmacogenomics and targeted medicines is being felt in every aspect of research and development in the pharma industry. Better drug treatment for individual patients will follow. Indeed, the Human Genetics Commission thought that new developments were most likely to come into clinical practice in the short term from pharmacogenomics. I believe that our committee’s optimism was amply justified by the evidence. Moreover, progress in the field is changing so fast that for once a more optimistic view is more likely to be justified.

What will happen now? The most important item in the Government’s response is probably the establishment of a human genomics strategy group. This seems a reasonable reaction if it is properly funded and staffed, but what chance is there in the present financial climate of proper funding for this body and for our other recommendations that need government money, albeit fairly modest sums?

I realise that everyone argues that their pet cause must be exempt from pending cuts. Cuts are for other people. I remember this well from my time in the long distant past as a Treasury Minister at a time of severe cuts in government spending way back in 1968 after the 1967 devaluation. However, I hope that the new Science Minister, David Willetts, will be able to demonstrate to his colleagues, as I believe is the truth, that our long-term prosperity depends more on our science base than on almost any other factor. The Government should think big and bold. Let us suppose that we were after all to phase out Trident in the Strategic Defence Review. Trident was designed to protect us from Soviet missiles in a different era, and its present justification is at the very least somewhat vague and lacks intellectual rigour. Let us also suppose that half the billions saved were diverted to increase the science budget. We could be firmly established as the leading nation for science in Europe. We could realise a vast potential for innovation in the industries of the future: a potential that is there to be realised if we effectively exploit the exceptional quality of our science, especially in the fields of biology, biotechnology and modern medicine.

The committee was told, I believe correctly, that genomics was one of the highly important areas of future development and that we were among the leading nations in the field—certainly in the academic field. It would be a tragedy if the Treasury’s axe were applied proportionately to science generally, and to developments such as genomics in particular, as to all other parts of government spending, and if the relatively small extra expenditure for which our report argues became part of the sacrifices that all government departments will have to accept. Frankly, I sometimes doubt whether most Cabinets—this Cabinet may be an exception—really understand the absolute importance of science. David Willetts was a good choice as Science Minister, and he is probably our best hope.