|Authorisation of Human and Veterinary Medicines
Dr. Stephen Ladyman (South Thanet): The hon. Gentleman is making some sensible remarks, but does he share my concern about what we see on the shelves of shops selling those products? Often no overt claim of efficacy is made on the packaging, but such a claim is made by implication, by word of mouth or in articles in the press. How can the position be clarified?
Dr. Harris: That is very difficult, and may be outside the scope of this short debate. What worries me is reading in a newspaper ''Taking this can help''. Well, it might help, but so might going for a swim in the Thames.
Let me make two more points, both of which also apply to conventional medicines. First, I think the Government have missed a trick with the National Institute for Clinical Excellence. There is a huge number of conventional products out there which are being used by the NHS day in, day out. If we looked at those products with the benefit of what we know now, we would find that they had no beneficial effect whatever—that taking them would merely involve the risk of adverse effects. There is huge scope for the Government to investigate some of the conventional products on which we spend money. Do they have any effect? If not, they should be unlicensed, as they are being sold on the basis of their efficacy.
Secondly, there is the difficult issue of the therapeutic margin. It would be astonishing if any drug, let alone every traditional herbal drug, were both very good for you and completely safe. That is not the way in which molecules work in physiology. They work in a much more difficult way: their therapeutic effect is often matched, or accompanied, by an adverse effect. I am always sceptical when I hear of a drug that
Column Number: 31is wonderful and completely safe, and has very little in the way of adverse effects. I am extremely sceptical when I hear of such products from the pharmaceutical industry. We should feel the same scepticism when we hear such claims about complementary medicines.
Those arguments also apply to the issue of ingredients versus products. When certain drugs are repackaged, or reformulated, their bio-availability—the ease with which they are absorbed in the body—can change simply because of the way in which they are ingested. What could previously have been considered a safe dose may no longer be safe. Perhaps it does not pass through the liver and is not metabolised or broken down initially, or perhaps it goes through the hepatic portal vein and is hepatotoxic. It is not easy to be certain that if the ingredients are all right, their formulation is also all right.
When the Government propose regulations such as this and try to make a scientific case, they should do a bit more than directing people to an MCA website. I think there is a medical and scientific case, although I do not think it is free of problems; but I believe that the Government should reach out to Members of Parliament and to the public by demonstrating that there are valid scientific concerns. They should not simply say, ''It is a matter for the MCA; look at its website''. They should identify themselves with the Department of Health's document setting out the scientific and medical problems associated with the products we are discussing.
Dr. Murrison: We have the impression from many organisations and lobby groups that we have not had enough time for consultation. I claim for my constituency an organisation that has already been claimed by the hon. Member for Bolton, South-East (Dr. Iddon) for his—the Health and Diet company. More specifically, however, I claim its parent company, Nutricia. It is
I am getting that impression from the industry, and also from individuals.
Indeed, there seems to be little support for the proposals at all. We have heard that the British Herbal Medicine Association is supportive, but that is qualified by the fact that many of its members are not happy. More particularly, we understand that the Chinese Medicines Association, the Council for Responsible Nutrition, Consumers for Health Choice, the National Association of Health Stores, the Health Food Manufacturers Association and the Ayurvedic Medicines Association are unhappy with many parts of the proposals.
The most convincing material that has passed across my desk—there has been a lot of it; all hon. Members will have received a lot—came from a constituent on my patch. If I may crave your
Column Number: 32indulgence, Mr. Chidgey, I shall read it out. My constituent says:
the European directive—
Mr. Swire: I, too, am in receipt of many letters from elderly constituents—East Devon has one of the highest pensioner populations in the country. For many people, alternative medicine and herbal remedies prove a highly effective way of keeping them, at the end of the day, out of NHS waiting lists. Is my hon. Friend concerned, as I am, that the whole process that we are debating is undermining people's belief in such alternative sources of medicine and that it will do precisely the reverse of what is intended—throw them back on to the NHS?
Dr. Murrison: My hon. Friend makes a very powerful point. That group of products certainly occupies an increasingly large share of the market. Many of those products are probably useful and of benefit to people. At the end of the day, if people think that they are of benefit to them, who are we to say otherwise?
One aspect that has not been discussed today is education. That is very important.
The Chairman: Order. I should be grateful if Members would refrain from entering into private debates while others are speaking.
Dr. Murrison: I am grateful, Mr. Chidgey.
Education on that range of products is important. It would be naïve to suppose that the regulations, even as drafted, would cover the great panoply of products that could possibly be regarded as medicinal. I simply cannot conceive that that is the case. We must educate people to be aware that taking products that have not been tested and surveyed in a proper scientific fashion could conceivably carry health risks.
Medicines come with a guarantee, in that they have been studied and investigated, and we can say with a high degree, although not an absolute level, of confidence that they are safe to take. However, given the multiplicity of combinations, it would be very difficult to say that the products that we are discussing will definitely be safe. We cannot give people that guarantee, but if this legislation were passed and we were to give those products some sort of stamp of approval, we would need to educate people about what that would be telling them. The stamp of approval is not absolute and will not give people the same guarantee that the Medicines Control Agency gives medicines as we currently understand them.
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We must give some focus to education on this range of products. I see little evidence that that is happening at the moment. Certainly, nothing is coming to me from Ministers to suggest that we are making inroads there. We must educate not only consumers, but professionals. I am always amused by the get-out clause that if one is in doubt about a product one should consult one's doctor. Very often, one's doctor is the last person to ask because, particularly in that field, doctors simply do not know. Often, their only recourse is the national poisons unit, a telephone consultation organisation that one can phone up to establish in broad terms the safety or otherwise of a substance. We should give more support to professionals to allow them to advise on the safety of the multiplicity of products available to consumers.
Mr. Tredinnick: I congratulate the Under-Secretary of State for Health on taking over this brief from her hon. Friend the Member for Pontefract and Castleford (Yvette Cooper). Having kept on eye on these matters in the House for the past 15 years, I should like to offer her some advice, building on some of the remarks made by the hon. Member for Bolton, South-East.
The Minister is dealing with an explosive issue. I watched her face as my hon. Friend the Member for North-East Hertfordshire asked a string of relevant questions and was thinking that we have been here before. I remember the then right hon. Member for Perry Barr, who is now Lord Rooker, being arraigned on MLX249—the Under-Secretary of State for Environment, Food and Rural Affairs is nodding. Before that, we had the terrible debacle over vitamin B6 and the idea, which was blown to pieces, that we should reduce the dose from 100 mg to 20 mg.
An inextricable expansion in demand is meeting a perceived restriction in supply. Although the Under-Secretary of State for Health stresses the safety issue, as my hon. Friend the Member for Westbury (Dr. Murrison) said so eloquently, most elderly people see the expansion of choice as a lifeline. It brings down their golf handicaps, but more importantly it keeps them alive. Given that public perception, demand is dramatically on the increase.
The Minister used the example, which has been used many times, of aristolochia—a difficult word to pronounce. The case in Belgium involved the wrong type of aristolochia being prescribed to the wrong people in the wrong dose. However, one bad case does not make good law. I have given many examples in the House of how conventional medicine kills a large number of people every year. For example, hundreds of people die from aspirin over a period of time.
The Minister will recall a Westminster Hall debate in which I stressed to her the importance of combination medicines. We looked at Chinese medicine and had a bit of fun. We talked about how the Chinese list their combinations as a chief, a deputy, an assistant and a messenger, which, as we said in that debate, is like the Whips Office. The same argument applies to this issue because we are talking about the right, which is in danger of getting bogged down in all kinds of regulation, to mix and match minerals, herbs
Column Number: 34and other substances, and we will see a restriction on the number of products in the herbal medicines market.
We have not even touched on the vitamin and supplements directive, which at the last count will take 300 nutrients off the shelves because only 30 products will go through the hugely expensive hoop of being proven as medicines. The Minister's brief is dangerous, and she has a lot of work to do in coming to terms with those complex issues.
The hon. Member for Bolton, South-East and I were astonished to find ourselves between the lions underneath Nelson's column in Trafalgar square one Sunday, having marched from Marble arch to Trafalgar square at the head of an angry crowd. It is quite an experience talking in Trafalgar square and it is quite an experience chanting, ''Tony, we want the right to choose''—we could be heard in Downing street. The Minister should see the straws in the wind such as the press releases from Sir Cliff Richard and Sir Paul McCartney. A lot of people out there are tooling up for war, and it will be serious. There will be not only correspondence, but marches and rallies. People see a way of life being destroyed, so do not underestimate the issue.
|©Parliamentary copyright 2002||Prepared 18 June 2002|