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Dr. Liam Fox (Woodspring): I welcome the Secretary of State to his position and wholeheartedly wish him the health to enjoy his job, which I think all hon. Members would agree is one of the most difficult in the Government. I also thank him for making the statement available in record early time. That is most welcome.
Conservative Members welcome the White Paper and its contents and look forward to the proposals appearing in legislation. I welcome the expansion of genetic services having done some of my medical training at the Du Pont genetic centre in Wilmington, Delaware and look forward to the time when our facilities are up to that standard. It is also worth pointing out that genomic solutions are not necessarily expensive. In fact, if properly applied they may lead us to make better use of the resources that we have.
We welcome the proposals to deal with DNA theft and the need to maintain public confidence. We support the Government's view of the need to avoid discrimination against people on the basis of genetic characteristics and will examine detailed proposals for legislation constructively. We will, of course, support any increased research into cystic fibrosis.
However, in welcoming the White Paper as a whole, there are a number of caveats. We must not over-hype what genetics can do, especially in the short and medium terms. The technologies are emerging and are at an early stage. The full potential is not yet known. The mapping of the human genome does not mean that we know the function of all genes. The Secretary of State mentioned the ability to prevent disease. That will always be relative. He will be well aware of the equation of phenotype equals genotype plus environment. Environmental factors will always be an important aspect in illness, which will not simply be based on genetics.
Very few single genes can, or will ever, be identified that will predict with certainty that an individual will inevitably develop a specific condition. The majority, of single-gene defects, if not all, had been identified clinically—for example, haemophilia or sickle cell anaemia—long before gene mapping. Information obtained for research purposes must not be available for forensic, legal or any other purpose not related to that research, or we will find it difficult to maintain a research base in this country.
The Secretary of State rightly said that the genetic revolution would be of maximum benefit when free care for all was provided at the point of need, irrespective of income. However, it is wrong to portray the national health service and an American-style insurance system as alternatives. I am sure that Germany and Switzerland, with their social insurance systems, will be just as able as the United Kingdom—if not better able—to take advantage of the genetic revolution. To portray those options as alternatives is intellectually flawed, politically dishonest and deeply insulting to European countries with well-developed health systems.
There is a problem with the Secretary of State's analysis of insurance. He may be right that the case for private insurance would diminish, but some factors will increase in importance. For some individuals, the exclusion of certain risks may make them more attractive to insurers. The Government have imposed a moratorium, but offshore and online services are almost impossible to regulate, so they need to give more thought to that.
I should like the Secretary of State to deal with four specific questions. First, what is the Government's view about the extent to which intellectual property protection for gene-based inventions will play a role in stimulating the development of new health care products? Secondly, what are the Government's plans to extend counselling services, education and training as their programme develops and in what time scale? Thirdly, in pharmacogenetics, where doctors may be able to select individuals for particular drug use or avoidance, what changes do the Government think may be required in the legislation relating to the National Institute for Clinical Excellence? Finally, the Secretary of State said that the new offence of theft of DNA will apply in all circumstances, except as part of someone's medical treatment when consent is impossible to obtain.
What legal advice has he received in relation to people held under the Mental Health Acts who are not able to give consent in the normal way?
Dr. Reid: I thank the hon. Gentleman for his double whammy of congratulations on the early dispatch of the statement and my arrival at the Dispatch Box in my new capacity. In that context, I will attempt to make statements available early as far as possible in circumstances which, as he will accept, are sometimes pressurised, so that the Opposition have due time to consider the issues. I do not think that they should be matters of party political debate, although some of the consequences, which the hon. Gentleman raised, lead us into the arena of legitimate choices about the nature of our health system. May I also say that I was encouraged to present the statement early following your strictures on a previous occasion, Mr. Speaker, when I was in a different position?
I agree entirely with the hon. Gentleman, who brings to these matters a great deal of experience from his personal background and studies, that we must not over-hype the prospects and impact of the revolution in health care created by genetics. We should recognise the advances that can be achieved in diagnosis, treatment and, in some cases, potential cures. However, we must strike a balance between the euphoria that comes with new inventions and the magic wand fantasy that is sometimes created by commentators on the one hand, and the deep suspicion, lapsing into prejudice, of anything that involves scientific advance on the other. The hon. Gentleman is right about that.
As for intellectual property rights and patents in general, we all understand that they do not entail the ownership of a particular gene or gene sequence. They protect research into a particular application of a gene or gene sequence, and those intellectual property rights and, indeed, patents are necessary to encourage people to invest in a number of different areas. We recognise that but, of course, we must make sure that such rights do not inhibit the NHS from offering the applications that they want to offer the people of this country. For instance, we have been asked about testing people for a disposition to breast or ovarian cancer, and the implications for companies that may be carrying out research in that field. We will not be blackmailed in any way or pushed into stopping women who may be predisposed to certain forms of breast or ovarian cancer from taking the necessary tests, because we believe that we have a moral, legal and political responsibility to offer that application.
The hon. Gentleman raised the issue of counsellors. We need not just the physical investment of money and premises and the bringing together of technical knowledge but people, whether geneticists, genetic counsellors or others. We have made provision in the White Paper issued today for sufficient money to increase the number of genetic counsellors, and we intend that that should be a building block for the future. I agree with the hon. Gentleman about that.
On the point that the hon. Gentleman made about mental health patients, I should be obliged, given the short time for which I have been in post, if he allowed me to write to him about our legal advice on mental health patients. Obviously, there are some circumstances under which it is not possible to obtain permission—for
example, from victims of a road accident or people who are comatose or unconscious—but for the benefit of the victim of the accident or the patient, it may be necessary for identification or the purposes of administration of medical assistance, to take a sample for DNA testing without consent. However, on the specific issue of mental health patients, I should like to write to the hon. Gentleman.Finally, on the larger point made by the hon. Gentleman, there is a debate to be had on the implications for the nature of health care provision in this country of the potential predictability of an individual's health. I have already expressed my own view in the statement. It is undoubtedly true that there will be some individuals, as the hon. Gentleman said, who, because of genetic discoveries, treatment and potential cures, will be much better off under private health insurance than they otherwise would. That is surely the point—there will be some individuals who, because of the predictability of their future good health, will be much better placed in a sort of super-class, and there will be many individuals who, because they are predicted to suffer from bad health, will find it very difficult, if not impossible, to get private insurance or health cover. My own view is that recognition of that, together with changing circumstances, reinforces rather than detracts from the moral case for the national health service by underpinning it with scientific advance. I have no doubt at all about that. Time will tell whether our system will stand those tests better than the social insurance or private insurance systems elsewhere. However, I personally have no doubt not only that the NHS is as relevant as ever, but that with every passing year of medical discovery it is becoming more relevant to the people of this country.
Dr. Evan Harris (Oxford, West and Abingdon): May I, too, welcome the Secretary of State to his post, as well as thanking him for early sight of the statement and the accompanying White Paper? I should also like to congratulate the Government on the establishment of the Human Genetics Commission, which has already done valuable work in promoting public debate and consultation. It is also timely to take the opportunity to congratulate those involved in the human genome project, particularly from this country, and recognise the work of those involved in the discovery of DNA. I extend the Secretary of State's recognition of Crick and Watson to include the contribution of Rosalind Franklin, because far too often, history, including science history, is written by men.
The Secretary of State said that the new genetics will lead to the prospect of four new things. First, with reference to more accurate diagnosis, the current legislation surrounding pre-implantation genetic diagnosis, requires lengthy court cases and appeals—for example, in the case of the Hashmis—or requires people like the Whitakers to go abroad in order to have the prospect of saving the life of a sibling. Is the Secretary of State satisfied that the Human Fertilisation and Embryology Act 1990 is sufficient to meet the challenges 14 years on? Will he consider introducing new legislation to bring that Act, which has stood the test of time reasonably well, completely up to date?
The right hon. Gentleman mentioned the prospect of more personalised prediction of risk. Does he recognise the concern that exists about home testing genetic machines, and the prospect of vulnerable consumers being provided with information outside the context of advice that they require? The BBC suggested this morning that
- "Dr. Reid is likely to counter-balance this"—
- "by pledging new safeguards to minimise the risk of discrimination against people whose test result make for bad news",
- "place restrictions on the sale of over-the-counter testing kits for inherited conditions."
The Secretary of State spoke of the prospect of new gene-based therapies. That is an exciting prospect. I am a volunteer in a trial of a DNA vaccine for HIV. Does the right hon. Gentleman recognise that the prospect of such therapies being available in the developing world is much more limited, and that the Government need a policy to ensure that the benefits are available to deal with disease in the developing world? Concentration on such work must not detract from work on diseases that do not require genetic treatment or diagnosis and affect the poorest in the world.
The prospect of targeted prevention and treatment was mentioned. Can the Secretary of State reassure us that the new patient contract proposed by his party will not oblige patients to undergo genetic tests in order to register with a GP or to continue to get treatment from a GP?
We welcome the proposal to legislate to tackle DNA theft. I agree with the right hon. Gentleman's analysis of the inequity of insurance-based health care, but does he accept that other forms of insurance, the denial of which can drastically affect one's ability to go about one's business, is a real problem? Does he accept that the voluntary moratorium is insufficient? Can he not use the Bill that he proposes as an opportunity to legislate to prevent insurers requiring genetic tests before providing cover?
We welcome efforts for new gene therapies for diseases such as cystic fibrosis, but does the Secretary of State recognise that our transplantation laws are inadequate? Many people who could be cured by transplantation are urging the Government to update those laws to enable the maximum possible use, with consent, of available organs.
Finally, does the right hon. Gentleman agree that public education is important, particularly as the genetic field is the area where science often faces most strongly the forces of anti-science? In that context, does he accept that language is important, and that referring, as the White Paper does, to screening babies at birth, instead of using terms such as "high-risk identification", is not helpful in the debate, as it leads people to misunderstand the true potential and power of those tests? We need to keep the public on board. The White Paper is a good start, but I hope the right hon. Gentleman will accept that there is still more to be done.
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