APPENDIX 36
Memorandum submitted by Professor Stanley
Brown, Yorkshire Cancer Research Professor, University of Leeds
1. CONTEXT
1.1 Personal background. I am Director of the
Leeds Centre for Photobiology and Photodynamic Therapy and lead
a large multidisciplinary team (clinicians and scientists) developing
photodynamic therapy, a newly developing treatment for cancer
and other diseases. The project is unusual in that it requires
day-to-day collaboration between scientists and clinicians from
different specialties. The work has been successful in translating
basic laboratory studies into clinical practice, with many hundreds
of patients having been treated. The funding for our research
comes from a variety of sources, UK and international, academic
and commercial, but the bulk of the support is provided by Yorkshire
Cancer Research (of the order of £5 million over the last
10 years).
1.2 This submission is concerned primarily
with the need to maintain diversity in UK cancer research. The
term is taken to include diversity in location of the research,
diversity in source of funding, diversity in type of research
and diversity in the disciplines which are funded to carry out
the research. Such diversity argues against centralisation of
cancer research organisation. However, co-ordination of cancer
research and indeed cancer treatments is another matter and is
crucial.
2. WHY SHOULD
WE SUPPORT
DIVERSITY?
2.1 There are those who argue that because
the total UK spend in cancer research is rather limited, we cannot
afford to spread too thinly and that the research effort should
be under more centralised control than at present. This will generally
be argued by those who feel it should be under their own control
and they will usually be London-based. There is strong evidence
against this view.
2.2 If this view were to make sense, then
why carry out cancer research in Britain at all? We might as well
make a financial contribution to the Americans on the basis that
they have a much greater capacity and they would share the results
of the research with us. Of course, this should not happen. There
is ample evidence globally that quality of cancer treatment is
variable and that cancer treatment is better where research and
development is active. The same is true within the UK and even
within regions of the UK.
2.3 There is also an increasing element
of commercialisation of cancer research, for example invention
of new drugs, which can be protected for the benefit of UK institutions
and companies. Again, this is likely to flourish much more in
a diversified system, where researchers come from a wide variety
of backgrounds and are free to develop commercial ventures.
2.4 As a nation, we need to support cancer
research within all major regions of the country as a prime factor
in delivering good quality cancer care more uniformly. It would
be unwise to try to carry out, or even direct, the majority of
such research centrally.
2.5 It has proved impossible in the past
to predict where the major advances will come. We must therefore
support diversity in type of research. Again, it would be very
unwise to have a substantial part of the UK research effort being
dictated centrally.
2.6 A strong example of this is in my own
research, in the development of photodynamic therapy for cancer.
In this approach a drug is given which is itself harmless but
can be activated by light when the drug then becomes lethal to
the target tissue. By using a laser which can be directed very
accurately, only the drug in the tumour is activated and the tumour
is destroyed. Ten years ago, this field was in its infancy and
was not considered seriously by the two main cancer funders in
the UK. However, Yorkshire Cancer Research spotted that at Leeds
we had just the right combination of experience and expertise
to develop PDT. The Leeds Centre is now among the global leaders
in this fast-developing approach, which has just been approved
by the UK drug licensing authorities for general use. We have
taken many initiatives in training and in spreading the approach
to other parts of the UK, where additional research is being carried
out. Many hundreds of patients have already been treated, mainly
from Yorkshire, but increasingly widely throughout the UK.
2.7 An example of how such work can become
divergent is given by one our outpatients who came from Scotland
and was so pleased with the results of her treatment that she
donated funds to establish a photodynamic therapy research centre
in Scotland.
2.8 The above also argues strongly for diversity
in funding of cancer research. It is much easier to raise charitable
funding when there is a local focus and local benefit. We cannot
afford to be hidebound by people working at national level who
seem often to develop rather blinkered approaches.
3. CO-ORDINATION
OF CANCER
RESEARCH, ITS
QUALITY AND
TRANSLATION INTO
PATIENT TREATMENT
3.1 The above argument is against centralisation
of control in design and funding of cancer research in the UK.
However, the co-ordination of cancer research is a different matter.
3.2 Cancer research is global and, for the
most part, results are openly shared through the scientific and
medical literature, conferences etc. Scientists and clinicians
already have the ability and the incentive to carry on doing this,
but government can do much to "oil the wheels" with
promotion of national meetings, more assistance with travel costs
etc.
3.3 Nowadays, it almost goes without saying
that the quality of cancer research carried out should be of the
highest order. Fortunately, in the UK, there are sufficient high
quality applications for funding that quality should not be a
serious problem. However, it is important both for co-ordination
and quality, that cross representation on assessment panels and
external membership of such panels is encouraged.
3.4 Perhaps the most difficult area is the
translation of research into patient treatment. There has been
attention to this point in recent years through NHS research funding,
but much still seems to be left to drug companies. Certainly,
this is a question which needs to be addressed in conjunction
with a consideration of the research itself, but it is not likely
to be helped by over-centralisation in the control of that research.
4. CONCLUSIONS
4.1 This memorandum is deliberately very
brief and ignores the question of the overall level of funding
of UK cancer research which is demonstrably lower than many of
our "competitors". No doubt the Committee will receive
many compelling arguments that the level of funding should be
increased, but these will not be rehearsed here.
4.2 The concluding message is "organisation
and control of cancer research should not be over-centralised".
24 March 2000
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