Examination of Witnesses (Questions 120-139)
PROFESSOR GORDON
MCVIE,
PROFESSOR ANDREW
MILLER AND
PROFESSOR SIR
PAUL NURSE
WEDNESDAY 16 JANUARY 2002
120. Absolutely.
(Professor Sir Paul Nurse) As a single organisation
we can take a responsible approach to that and I think it is something
we need to act as, that is Cancer Research UK should act as the
major source of independent information about cancer within the
UK. That is another new initiative that we will do. We have both
been doing it separately but we see ourselves as the gold standard
to which the public will look. Furthermore, we can act as the
focus for work in the rest of the world, looking at best practice
in the rest of the world, and I think this is a major new initiative.
I wonder if I could take the opportunity, since I am speaking,
of going back to an earlier question about personnel and the limitations
and the problems there. I would just like to bring up another
issue which I think is of real concern. Often the interface between
basic research and understanding and the clinic works through
the pathologist. There is a real difficulty with shortages of
pathologists at the moment, it is absolutely dire. That is now
compounded with all the fall out as a consequence of Alder Hey
which is now making this sort of research very difficult to actually
manage. I think this needs to be brought to your attention because
it is possible that some of the knee jerk reactions as a consequence
of Alder Hey, if not properly handled and managed, will lead to
real difficulties, I think, in the future in carrying out this
sort of research. I think it is something one should be aware
of.
Dr Turner
121. Can I just add a rider to that? Do you
think that the difficulty that has been experienced in the Medical
Laboratory Scientific Service, especially with recruitment because
until last year starting salaries for graduates were less than
£8,000—
(Professor Sir Paul Nurse) Disgraceful.
122. Is this a major contributory factor to
the problem you have just outlined?
(Professor Sir Paul Nurse) It is an utter disgrace.
Utter disgrace. Nothing more to be said.
Chairman
123. You do not want to add to that in more
vehement terms, Professor McVie?
(Professor McVie) I do not have the vocabulary that
my colleague does.
Dr Turner
124. I am sure both Gordon and Paul will remember
that one of this Committee's most cherished recommendations in
its report that we are reviewing was the National Cancer Research
Institute. We were looking to this to improve the co-ordination
of cancer research efforts in the country and expand upon them
and stimulate expansion. How effective do you think it has been
so far?
(Professor McVie) Chairman, I have hinted that I am
pleased with how we have got on.
(Professor Sir Paul Nurse) I think we are actually
pretty optimistic. It got us all together. It is virtual, let
us make that quite clear. It is not bricks and mortar. It has
put together databases on what is going on. That has allowed certain
holes, or will allow holes, to be recognised. This is, of course,
of great interest to us too. We have had some early successes.
For example, an initiative funded mostly by Cancer Research UK—it
has to be said—with a major contribution from the MRC and
Government funding on prostate cancer which was identified as
a shortfall, so that was very good. I think I can say, and both
Gordon and myself sit on this, it has been a very good atmosphere
in this grouping. It is tackling the problems and it is a shift,
and maybe even will turn out to be a seismic shift in the way
that Government works with charities. Normally they are really
rather separate and what we have here is a proper single umbrella
with different bodies as equal partners who are actually tackling
the real problems. I think it could be very good and certainly
it started reasonably well.
125. That is very reassuring to hear although
there appears to be some impression—it was conveyed to us
that there is some impression—that it has not yet had a
great impact out there in the country.
(Professor McVie) Sure.
126. Do you feel that there needs to be anything
done to raise the profile of the Institute to increase its impact?
(Professor McVie) It has only had a director for three
months, I think. I think we all attended the press launch and
there was one member of the press there. It was not the hottest
potato on that day.
127. We love it.
(Professor McVie) Basically I think it has proven
its capacity to react to a situation quickly. The prostate cancer
story was remarkable. We had identified this big gap across the
country in prostrate cancer research funding. We decided what
the priorities were. We issued a call for application for project
grants. We got the grants in. We peer reviewed them internationally
and we awarded the grants within six months. Now, the Medical
Research Cancer has never ever achieved that in its entire history
and that was driven by the fact of this process. Sitting at the
table is also the Department of Health. The attendance has not
always been spectacular from one or two of the devolved governments
but I think they are catching on now that this is very, very important.
The reason we are not seeing very much at the sharp end yet is
because it takes a little while for things to filter down through
the research pipeline to the patient. I think also the important
issue which we debated, and you quite frustratingly failed to
debate in the United States, was the pharmaceutical industry's
contribution. They are now sitting there and they are active and
if anybody is the specialist in getting something to the consumer
it must be they. I think it is just a little bit early. I am really
quite confident that we can make an impression on delivery of
cancer care because we have everybody there and they are all committed
and they are all paying up.
(Professor Sir Paul Nurse) You mentioned profile.
Do remember, you see, we are all constituent bodies so in actual
fact what you are going to see on the street is funding from Cancer
Research UK, which is probably two thirds of the spend of the
MRC or the Department of Health. In fact, in some ways, by setting
it up as a virtual Institute, it will never have, I would say,
a very high profile, but that does not mean it does not make a
difference.
128. Obviously both your organisations separately
are major players. Do you think you will have increased clout
now that you have joined forces? By the way, you have not shown
us the ring.
(Professor Sir Paul Nurse) Ah. We will not exchange
until the 4th February, we are being coy. Of course, it has got
to make a difference. We have not emphasised this yet but I think
this is a really important shift because we are now the biggest
grouping. We will have considerable influence and we can really,
I think, have a major impact on what the Government is doing here.
We are coming in, we are working in collaboration, we are not
in a competitive situation, that is the nice thing about this,
yet we have our clear agendas. I think this is one of the real
benefits of having Cancer Research UK: the ability to influence
Government research spend and to lobby them over issues that really
matter. In this respect, of course, we may find ourselves working
together more in the future than perhaps in the past. I am talking
about your body and ours.
129. You have rightly pointed out, Sir Paul,
that the Institute is a virtual construct. In fact, we did suggest
that there should be a physical presence. We were never suggesting
replication of Bethesda, a little ambitious, but at least some
small physical centre for administrative purposes. Are you happy
that it is evolving or being set up on a virtual basis? Do you
think that there would have been perhaps extra advantage and focus
to have been gained by having a physical centre, however modest?
(Professor Sir Paul Nurse) If it is going to remain
as its present role, that is the new money that is going into
it in the sense of running it is relatively small, we are paying
two-thirds of the total but it is relatively small sums, then
it could have its own bricks and mortar or it could be located,
as it is at the moment, in the MRC or go into Cancer Research
UK. I am personally rather relaxed about it. If, on the other
hand, very significant funds were going to go through this route,
and I mean very significant, we are talking about tens of millions—
This new institute we are opening up in Cambridge for 300 workers,
which is not that big, Lincoln's Inn Fields where I come from
is 500, that will cost about £15 million to run a year. If
we are going to make something big these are tens of millions
of pounds. Then, of course, there might be a need for a physical
presence but otherwise it is just going to confuse, I think, because
it will look rather silly, if I may suggest, compared with the
major institutes from Cancer Research UK. Unless the Government,
because that is where the only money can come from if it wants
to re-badge it, is going to put in 20 million or something, I
do not think it makes much sense. Of course, if you can persuade
them to put in 20 million we would be delighted to work with them.
Chairman
130. Wait until they have sorted the railways
and a few other problems.
(Professor Sir Paul Nurse) Or we can run it for you
if you wish.
Dr Turner
131. When we were taking evidence for the report
I think some of us felt a bit hesitant about the commitment to
cancer research on the part of the Medical Research Council, we
felt that they were not really quite pulling their weight. They
are the host organisation as far as staffing is concerned and
such physical accommodation as the Institute has. Are you totally
happy with the MRC as the host? Do you think it is the most appropriate
host organisation for the institution?
(Professor McVie) The plan is, in fact, for the chairmanship
to rotate. My understanding is that the secretariat will move
with the chairman. I think the Medical Research Council took the
first chair and it will rotate in a year and a half's time. I
think that would seem to even things up. I think that is a good
solution pro tem. The other possible source of a lot of money
could be the Department of Health because it would make a lot
of sense, in my view, for the Department of Health to take this
early warning that we are able to produce in terms of things coming
down the line from the lab to the clinic and fast tracking it
and evaluating that and so on. I cannot think of a better structure
to do it than within the National Cancer Research Institute. In
fact, there could well be a lot more money coming in to the right
hand end of it, evaluating the care delivery bit, in the future
rather than the MRC. I share your hesitation about the wholeheartedness
of the Medical Research Council's commitment and I derived great
amusement from seeing how they managed to sell the added money
they have put into cancer research from a variety of interesting
illustrations, which I have no doubt they tell the cardiac people
is also for cardiac research. I would very much like to see us
blazing a trail in terms of establishing a fast track mechanism
for getting research findings into the health service. No fast
track exists, it never has done. It was built as if there would
never be any research that mattered but now there is lots of cancer
research that has delivered and is getting stuck in the system.
132. Do you think that the institute is going
to be able to deliver this for the first time?
(Professor McVie) I think so. The framework is there.
(Professor Sir Paul Nurse) The MRC Executive has been
very supportive of this and that is very good. The criticism that
they do not do enough for cancer research is, quite frankly, out
of the existence of us. If there are priorities and they see the
charitable sector is picking it up, one suspects it will not always
get to the top of the agenda. Having said that, there has been
very considerable support for this and there is support for making
these cancer research initiatives work. If you have such a powerful
body as ourselves I suspect that it is only human nature that
they will tend to back off a little bit.
Chairman
133. And, Professor McVie, a National Cancer
Act to give it some official backing, do you think?
(Professor McVie) We did not quite see eye to eye,
my partner and me, last time. We have not had time amongst our
merger discussions to sit down and discuss the benefits of a National
Cancer Act. My view is entirely unchanged from a year and a bit
ago, I do believe a National Cancer Act would be an excellent
idea. I think that the country needs clear positioning on things
like tobacco and things like lifestyle links to illness, not just
cancer. The obvious mechanism for extra funding for specific bits
of cancer research is from Government straight to the National
Cancer Research Institute. The mechanism for distributing the
money is now there. The MRC have indeed come on board and we are
sharing the Trials Committee work and the deliberation and the
peer review, it is all working out fine. Now we have the receptacle
for any more money that Government could, through a National Cancer
Act, as they do in the United States, vote directly for something
that constituents want.
(Professor Sir Paul Nurse) As always, Gordon is very
persuasive. I had reservations. I come to it perhaps more as a
basic scientist. So much medicine, different types of medicine,
cardiology, cancer, whatever, is underpinned from a similar understanding
in biologies that my concerns were we might distort too much by
separating one part of it away from the rest of the medical research
initiatives in the country and I was bothered, although I would
be rather happy to see it in the cancer field, that we might then
see a whole spate of these things because the same logic could
equally be applied elsewhere and that might cause problems. However,
this will be a very interesting point for us to debate and I certainly
would not say that my position is entrenched, and of course I
know very much there are strongly held opinions among this Committee
as well, or certain Members of this Committee. I think this is
something that we have to talk about with our organisation and
perhaps will be happy to discuss with you at a later date.
134. I think there is a Mental Health Act, for
example, is there not?
(Professor Sir Paul Nurse) There is a Mental Health
Act. What I am thinking of here is the major diseases. If we end
up with one for each we have got to take that on board before
just taking it piecemeal. Maybe there is a case for it, maybe
we should do that, but I think that is the natural, logical implication
of doing that. We have to be aware of it before making that step.
Chairman: That is for the future obviously.
We will keep the pressure on.
Mr Hoban
135. Can we talk about the National Cancer Research
Networks. There are 32 that have been set up across England. What
difference, if any, have they made to your work?
(Professor McVie) They have not made much difference
yet because they are starting within our centres and we are doing
the work anyway. The great advantage of the network is going to
be that it will involve all cancer centres, I think there are
34 in total, in England which are not yet linked into the trials
network, they are not able to put patients on to cancer trials
because they do not have core funding from Imperial Cancer Research
or the Cancer Research Campaign. I think that when that has all
happened, and I believe we are half way there to getting the 34
sorted, then we will have a really major force for getting patients
on to clinical trials and we know that they will do better on
clinical trials. At the present time we have not noticed much
difference because we have just started doing this. I think it
will come very good and probably another year will be needed to
get that right. The background work done under Peter Selby's leadership
for the trials network has been terrific. He has just stepped
down as the Clinical Director of Research at the Imperial Cancer
Research Fund. The translational network, the centres have not
yet been announced but I know which ones they are and they have
already got funding from Imperial Cancer or the Cancer Research
Campaign and they are being co-ordinated by David Kerr. Again,
that work is going on fine and they are ahead of their deadlines
and their targets. That is all fine. This is early days. I see
these as mechanistic tools with which you do the work. That is
what they are, they are infrastructure. Clearly it is very welcoming
to see the Department of Health sharing some of the infrastructure
costs of doing clinical trials and that should lessen the burden
on us. Again, we have not noticed that burden lessening to date.
We have yet to see lowering of the costs of doing clinical trials
in those centres but we will be taking that up with the National
Cancer Research Institute.
136. What level of funding do you expect or
would you want the Government to make to meet some of that infrastructure
cost and research cost?
(Professor McVie) The total budget, I think, will
have to grow probably three or four fold within the next two or
three years as these centres come on line. I think the priming
budget was enough, I think it was about ten million for the whole
thing.
(Professor Sir Paul Nurse) Twenty.
(Professor McVie) I think that was probably enough
to get the translational centres and the trial centres linked
up. I cannot believe that these networks should not be the sort
of paradigm for other kinds of trials in cardiac medicine and
in Alzheimer's and in a variety of other things. I think what
they are doing there they should be looking to do for all the
other disease types where research trials are being carried out.
I think this is the first time out, and it will probably be a
little bit more expensive. I think the Government could save money
by making each hospital share the infrastructure, the data managers,
the statistical inputs, the hardware and so on for different kinds
of trials. I think you are looking at considerably escalated costs
over the next four or five years. We will certainly be doing our
bit to share those costs. We have committed ourselves to partnership
and I think that is only proper. We have to wait and see whether
that all materialises.
(Professor Sir Paul Nurse) If this works, this network,
then we would double the numbers of cancer patients in trials.
This is a very significant increase, of course, it would be higher
than any other country, far higher than the US, just to make this
absolutely clear. But, of course, what it will lead to, and this
is of course what we are trying to see, is more higher quality
clinical research, trials research. That will require extra money
to carry out that work. What Gordon is referring to is the fact
that if we now have a good network which will catalyse this work
there will be demands on us to provide that money to do those
trials. Now those demands may be very high, higher than we can
meet, and it could be that when we are looking in succeeding years
that we are not just simply looking at the infrastructure supports
which have been put in place now, but the money to support trials.
We have, of course, committees that look at this, we will be working
with the MRC. I see that is where there is going to be a pressure
point and the need that Gordon is referring to is the ability
to fund new trials within the network.
(Professor McVie) Mr Hoban, the system does work because
we have tested it in Wales. The Campaign with the Welsh Assembly
has shared the cost 50:50 of setting up a Welsh Cancer Trials
network. This national network is only England, there is a Scottish
Cancer Trials and a Welsh one. It is very confusing because it
is buried in the National Cancer Research Institute which is UK.
In Wales over three years we have seen the doubling of the number
of patients in clinical trials and we have site visited them with
the Welsh Assembly about seven or eight months ago. We have each
agreed to double again the funding of that network, it has been
so successful. We know it works and it is now really getting the
English network up and running and functioning. I think this is
really imaginative.
137. We talked earlier about smaller charities
and the involvement of those charities in cancer research. What
role do you see small local charities playing in the very centres
to be set up as part of the National Cancer Research Network?
(Professor McVie) In the Cancer Research Campaign
we have already merged with two smaller charities regionally based,
one is in Newcastle and one is in Bradford. The local fund raising
mechanism has been kept in place to fund young talent spotted
coming through the system either in the laboratory or in the clinic.
It is very difficult getting on to the bottom of the research
ladder whether you are a clinician or whether you are a scientist.
Getting the first money is very difficult. Knowing the best people,
Andrew Miller talks about the importance of getting young talent,
well, how do you know who they are? They are all right once they
have a track record but how do you get the track record? In Newcastle
we have set up fellowships with the money raised there for young
people to come in and once they have established some sort of
track record then they are more likely to compete and win money
from Cancer Research UK. I think there are local initiatives,
also, such as funding trials nurses where they do not exist, information
nurses where they do not exist, data managers, the right kind
of options and opportunities for local charities to plug into
the system and I am sure that will happen.
138. Are you concerned that your merging might
crowd them out of the National Cancer Research Centre?
(Professor McVie) No.
(Professor Sir Paul Nurse) I think we will help them
actually. One of the problems with smaller charities is often
there is a lot of enthusiasm and commitment locally but often
they find difficulty in making the proper assessment of the quality
of work they are supporting. That is a very, very serious issue.
I think we, as Gordon has already mentioned in an answer to an
earlier question, can help there by providing the proper reviewing
procedures. Personally, I feel that rather than crowding them
out we will be able to help make a more effective operation. There
is a real risk that the smaller charities may waste money by not
funding the best research. That is a very serious problem. What
we have to do is to be able to work out ways of working with them
so they do not feel threatened, because they have major contributions
to make in addition, but where they are supporting the quality
work that is needed if they are going to really make an impact.
Bob Spink
139. Mark Hoban's earlier questions on networks
and clinical trials leads me on to the area that I would like
to explore, the core issue of cancer registration. The GMC's guidance
on confidentiality has caused severe problems for cancer registration,
data collection and the ethical approval of cancer research. Has
that impeded any of your research programmes and, if so, what
can we do about that?
(Professor Sir Paul Nurse) As you know, this is a
major issue. It is concerning our researchers, our epidemiologists.
I am getting lots of lobbying and there are lots of other bodies
who are lobbying about this issue too. I am afraid I am not a
sufficient expert to say specifically myself what is now required.
What I am aware of is that there is quite a lot of confusion out
there and it is not quite clear what the present situation in
fact is. We have to be very careful about this because we have
opportunities with cancer registries which can be thrown away
by legislation which does not take account of all the needs. I
am answering the question rather vaguely because I am afraid I
am not on top of it but this is an important issue and we must
not get it wrong.
(Professor McVie) Chairman, I do not think the position
has changed one bit really, in fact it has just got worse because
of the GMC's intervention with a completely muddled and-ill-informed,
ill-researched position. I think we are verging on chaos. I still
believe, as I did the last time, that you are correct. I think
you said that the Government should introduce legislation to include
the registration of cancer as a legal requirement. I totally support
that. We will do all we can to help in that area. This is one
of the single biggest threats to the whole business of evaluation
of whether either cancer research works or cancer care works.
It is as simple as that, it could be devastating.
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