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5.58 pm
Ms Jean Corston (Bristol, East): I congratulate the hon. Member for Broxbourne (Mrs. Roe) and her Committee on this excellent report: it is most welcome. It is high time Committees of this House gave specific attention to issues involving women. I pay tribute to the many hon. Members who have kept the subject alive in the all-party group and other forums. I also pay tribute to my hon. Friend the Member for Halifax (Mrs. Mahon), who cannot be here owing to an Inter-Parliamentary Union engagement. I know that she would have liked to be here.
In view of the fact that the Health Select Committee made reference to research, I am pleased to use this opportunity to raise a matter, about which the hon. Member for Broxbourne knows because I have written to her about it, and on which I was lucky enough to secure a debate during private Members' time on 14 June. It refers to research in breast cancer at the Bristol cancer help centre.
The study was published in The Lancet in September 1990. I do not intend to waste the time of the House in rehearsing all the arguments, because they are on the record; suffice it to say that the research purported to show that breast cancer patients attending the Bristol cancer help centre who were also having orthodox treatment were twice as likely to die and three times more likely to relapse than the controls who were having conventional treatment only. It soon became clear that the research was fatally flawed in its methodology and statistical analysis.
During a very helpful and constructive reply to the debate in June, the then Under-Secretary of State for Health, the hon. Member for Bolton, West (Mr. Sackville) said:
The funding bodies, the Imperial Cancer Research Fund and the Cancer Research Campaign, distanced themselves from the research quite early. The Imperial Cancer Research Fund said that no conclusions could be drawn. Its director general, Sir Walter Bodmer, said:
A great deal of correspondence occurred over the summer, and I received a helpful suggestion from the Under-Secretary of State for Health, Baroness Cumberlege, in a letter on 4 August. She acknowledged
that I had said that there was a need for an examination of how the two sets of patients compared, and that there should be an independent judgment of the validity of comparing the two groups. I asked whether the Department would recommend an independent statistician. The Minister helpfully suggested that I approach the Royal Statistical Society for assistance, and gave me its address.
I put that suggestion to the person responsible for the research, Professor Claire Chilvers. She said that she was not in a position to be able to give that consent so I went back to the Institute of Cancer Research. Professor Peter Garland of the institute said that it would not be appropriate to release the data to me as a third party. The question is, who is appropriate? To whom should the data be released?
Neither the centre nor the women involved want any follow-up research--it would be pointless and distressing--but there is a need to conduct a statistical analysis of the data. The issue raises questions about the nature of conduct in medical research, to which-- obviously--the Health Select Committee has made reference. I am sure that it is concerned.
In February 1991, the Royal College of Physicians published a very helpful document called "Fraud and Misconduct in Medical Research". It defined scientific misconduct at paragraph 2.7 as including--I stress the word
"including"--piracy, plagiarism and fraud. The fact that the word "including" was used suggests that the definition was not intended to be restricted to those factors.
The report continued, at paragraph 4.5, to say:
The United States Commission on Research Integrity has laid down the following criteria for breaches of research integrity: a misappropriation of data, misrepresentation of research findings, interference with results, and acts that compromise the integrity of the research process.
It seems that the medical research establishment faces a clear choice. There is either resolution of the matters to which I have referred or there is eventual regulation. Although I am sure that the establishment does not really want the latter, such an issue cannot remain unresolved. While it is unresolved, it represents an obstacle not only to good medical research on cancer, but to broader issues of health research and scientific discovery.
We are all, of course, conscious that large amounts of public money fund such research, so while it stays on the record, it is a stain on the character or reputation of an organisation. Frankly, I have been astonished by the number of health professionals who have said to me, "Oh, yes. We all know that that research cannot stand." Yet while that research is forming the body of scientific research and it is not retracted, that stain remains. Indeed, it calls into question the way in which people behave when they conduct scientific research.
I call on the Institute of Cancer Research to release the data. It has to be said that The Lancet, in which the study was published, has not published a retraction, although it would be right to add that the new editor is doing his best to draw together the interested parties in order to resolve the matter. It is important that the editor of The Lancet is able to make progress, so that a retraction can eventually be printed, subsequent to--I hope--independent statistical analysis.
Last night, at St. James's palace, the Prince of Wales held a reception in honour of the Bristol cancer help centre. He made reference to the research, and regretted the negative effect that it had had on the centre. Naturally, if such research stands on the record, charitable
foundations and others will find it difficult to make donations, given that it could be said that they were spending money on an institution that has damaged people's health. It is perfectly obvious that that is not case. The Prince of Wales praised the centre's holistic approach and the way in which it focuses on the whole person rather than the illness, the cancer.
I am pleased to say that the centre, which was facing closure this month, has succeeded in raising £267,000 to enable it to continue for some more time. It is very keen to preserve the principle that the care, advice and treatment it gives should be free, and it does not deserve to live under such a cloud. I hope that it will be possible for the matter to be resolved, because it will not go away. I know that other hon. Members, whose support I have appreciated over recent months, share my concern and want to assist me in ensuring that the public money put into that research was not wasted, and that the facts emerge from some statistical analysis.
I should like to turn specifically to a couple of items in the Select Committee report. Its first conclusion states:
In considering just a few instances of scientific research, one finds that it is pretty certain that, if one eats animal fat, one has a 30 per cent. higher chance of getting breast cancer. If one smokes, one has more chance of getting breast cancer--and any cancer. If one is a vegetarian, one is 40 per cent. less likely to die of cancer of any sort. I understand that that research comes from Dr. Margaret Thorogood.
I must declare an interest, because I have not eaten meat for 10 years. I do, however, eat fish. I do not want to advance any argument about vegetarianism. I am aware that there is other relevant research. For example, the King's college study tells us that the incidence of breast cancer is four times higher in people who are under stress.
Only this week, on 9 December, the British Medical Journal contains an article about a research paper on breast cancer. It states:
I understand that there was a United States-funded study of 50,000 Chinese subjects who were given vitamins A, C and E and selenium. They had a relatively low vegetable intake, but their cancer death rate declined by 13 per cent. after five years of that treatment. The United States Government have issued guidelines on diet and cancer since 1983.
Furthermore, the Cancer Research Campaign has conducted what could be described as an epic trial. The preliminary results are based on considering cancer in relation to dietary habits throughout Europe. They reveal pronounced variations. There is a far lower rate of cancer in Greece, where people eat a great number of vegetables. Holland and the United Kingdom came out worst. Our respective diets contain more dairy products, such as cheese, cream and yoghurt.
The Women's Environmental Network conducted research into pesticides and insecticides, specifically organochlorines. It found that, in countries where Lindane had been banned, the incidence of breast cancer in the youngest group had declined by about 24 per cent. I know that there are concerns about the reliance that can be put on that sort of research, but it is part of the scientific body of opinion.
There is also the research by Peto and Doll of 1975 and 1992, which found that diet is the greatest environmental factor. It has a contribution rate of 35 per cent., whereas smoking has one of 30 per cent. It cannot be said that research findings are not sufficiently understood to enable any attempt to be made to make improvements. We have quite good statistics.
It is important to consider, as hon. Members on both sides of the House have, the disparity between the incidence of breast cancer and mortality rates. For example, the incidence is higher in the United States, but mortality rates are lower than elsewhere.
It is important also to consider the findings of Dr. Stephen Greer, which might be dismissed by some. He classifies personality types, and goes on to consider how classification may influence survival. I know from medical professionals in my family that there is much interest in the profession about Dr. Greer's findings. He categorises people according to personality. Of those with what he describes as fighting spirit, 80 per cent. were alive after 13 years. Of those described as helpless and hopeless, only 20 per cent. were alive after that period. He describes those in between the two categories as demonstrating denial or stoic acceptance.
Those who come within the higher mortality rate tend to be more passive and compliant patients. Indeed, the word "patient" imports something about compliance and passivity. It suggests that the person is one to whom other people do things, rather than someone who is an equal partner in treatment, cure and survival.
The message is often given that people can do nothing to help themselves. Institutions such as the Bristol cancer help centre are vital in the way in which they encourage people to develop a fighting spirit and a belief that they can be part of their own cure.
Last night, I met people at St. James's palace who had been told 16 years ago that they had three months to live. I met a man who had had two thirds of his liver removed. He was told that there was cancer in the remaining third and that there was no hope for him. He is still alive nine years later.
The message is that people can live with cancer. A cancer patient should be seen as part of the healing process. The work of complementary practitioners, such as those at the Bristol centre, can be extremely valuable as an adjunct to the conventional treatment that is provided by the national health service. Their work is no threat to conventional medicine.
There is evidence that people want complementary treatment. More and more general practitioners want training in it. I hope that purchasing institutions will take note. It is important to take things in the round. We know that people say that they do not want to be a nuisance to
their doctor. They fear that, if they are assertive, they may not be treated well in future. I feel that a different attitude is required of some doctors.
Where it is the only route, the Bristol centre helps people to prepare to die. That is important. So often, people are sent home to die and told that they have three months and they must get on with it. On one occasion only, I came across a friend who had something to do with the Bristol centre. That was in the 1980s. She was dying with cervical cancer. She had had four cervical smears, and had been told that she was clear. It was suggested that she was hysterical. It turned out that she was right. By the time her rightness was acknowledged, it was too late.
"I have no doubt that mistakes were made".--[Official Report, 14 June 1995; Vol. 261, c. 758.]
"the research suffered from a disastrous mistake in the interpretation."
However, the Institute of Cancer Research, which organised the research, still stands by it, and has refused to release the data for independent statistical analysis.
"all institutions and responsible bodies must insist that raw data are kept available for inspection for 10 years".
That prompts the question: inspection by whom?
"It is clear that the aetiology of breast cancer is not yet sufficiently well understood to enable any systematic attempt to reduce mortality by primary prevention to be pursued".
Although that conclusion says "any systematic attempt", other factors of scientific literature ought to form part of our understanding; it would not be right to say that nothing that can be done.
"Key messages: life events have an important influence on physical health; women with breast cancer have more severe life events in the five years before diagnosis; the way a woman deals with stress may also affect the risk of breast cancer".
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