Examination of Witnesses (Questions 460
- 468)
TUESDAY 7 DECEMBER 2004
SIR RICHARD
SYKES, PROFESSOR
PATRICK VALLANCE
AND SIR
IAIN CHALMERS
Q460 Jim Dowd: Was there a high mortality
rate?
Professor Vallance: At student
level, those are the things we have done. I think it has changed
perceptions of students as to how you evaluate evidence. There
is an ongoing problem with many doctors that perhaps they are
not trained in evaluation skills, and also, coming back to the
point about marketeers, sometimes data is presented in a way that
is complex to disentangle, and people find that awkward. I do
not think many doctors are well equipped to undertake those analyses.
Q461 Mrs Calton: Would you say the
sort of practice that you now have when teaching students is widespread,
or is it isolated?
Professor Vallance: It is patchy.
It is becoming more common. I think it could be developed further.
Q462 Mrs Calton: What assessment
have you made that the teaching is effective in influencing outcomes?
Professor Vallance: The evidence
we have relates to the questions we set in exams and assessments.
I do not have prescribing data to show it is valuable; but there
are anecdotal examples of individuals which clearly have been
influenced by them, and which link with the work that the unit
is doing and the James Lind Alliance.
Q463 Mrs Calton: It would be helpful
if we had more evidence that this was a useful activity. Certainly
the information we received in Australia was that the influence
of the pharmaceutical industry on prescribers was extreme, and
that those prescribers were not always aware of the influences.
Professor Vallance: I think that
some prescribers are poorly equipped to evaluate the evidence
before them. The way evidence is presented is sometimes extremely
complicated, with composite end-points wrapped up as though they
all meant the same thing, and relative risk being presented when
actually it is absolute risk. Simple things could be done, for
example, for every medicine trying to evaluate as best you can—although
it is not always easy to do it—the numbers you need to treat
to gain a beneficial effect and the numbers you need to treat
to get a harmful effect. Those two standardised numbers could
be quite helpful if everyone were to "buy in" presenting
in that way.
Sir Iain Chalmers: When the evidence
is strong and you know that it is strong, you can change practice
very fast indeed. For example, I referred a moment ago to treating
women with Epsom salts rather than far more expensive drugs when
they have eclampsia, because the cheaper drugs are better. That
evidence was generated completely outside this country in Latin
America, Africa and India, and it changed British obstetric practice
overnight. Similarly, a study that was done recently, which raised
questions about the use of steroids given to people with acute
brain injury, was recently published in the Lancet. It
shows that this practice, which has been going on for about three
decades, has been killing tens of thousands of patients. I am
very clear that that will stop pretty dramatically now. The essence
of the issue is that if there is strong evidence, patients and
clinicians will take notice.
Q464 Dr Naysmith: I would like to
ask a peripheral question to Sir Richard. Going back to Dr Taylor's
question, when you talked about the importance of the pharmaceutical
industry to the country and the research that was done and so
on. During that you mentioned the importance of university research.
I have heard you say in the past that academics in this country,
particularly scientists, are very poorly paid, and this is one
of the things that—not just pay but conditions of service—which
reflects on it. People used to come to this country—firms—to
do their research, partly because of what was happening, and it
still happens now—I am getting to the punch line! You have
been managing director of one of our really important university
science orientated universities for a couple of years: have you
managed to do anything about that? Do you still think the conditions
for young scientists in this country could be improved, particularly
if you want a pharmaceutical industry, and have you managed to
do anything about it?
Sir Richard Sykes: There has certainly
been a big change with this Government. We can go back now to
the late 90s. This Government has recognised that there are a
significant number of issues within universities in terms of teaching
and research, and they have changed that quite significantly.
There has been a lot of money put into infrastructure so that
you build better laboratories and facilities. There has been more
money for paying people better salaries. You can always argue
that you need more, but I would say today that the top universities
are in a much better condition than they were 5-10 years ago.
That is improving all the time, and I know the Chancellor will
probably say something else about it again today. There is a recognition
that we have to put money into these places if we are going to
drive the economy. It is critically important. To me, this is
a very, very big issue. We must keep tracking inward investment
on the basis that we do have a very big industry.
Q465 Dr Naysmith: You think there
has been an improvement and things are getting better.
Sir Richard Sykes: Yes, there
is no question about that. The NHS has stood outside this whole
biosciences process, and that is totally unacceptable. This is
a jewel in the crown. If we could bring all this together, no
other country can do this because they do not have this system.
If we could bring all these parts together during a period when
there will be some dramatic developments in those areas, then
I think the UK becomes a very attractive place for businesses
to come and operate.
Q466 Chairman: Do any of the witnesses
have anything further to add? Is there anything within our terms
of reference that you feel we ought to have covered which we have
not covered within this session?
Sir Iain Chalmers: There has not
been enough disagreement among your witnesses, and I just want
to introduce one note of disagreement! It has been estimated that
between a third and a half of the increase in life expectancy
during the last 50 years, and an increase of five years of life
free of morbidity, has been achieved by what has gone on in healthcare.
That is a fantastic record. The promise of post-genome medicine
is that is going to do better than that. We ought to take with
a little pinch of salt some of the promissory notes that we have
had from Sir Richard. I also want to make the point that the smaller
the thing you study in academia, the higher your status. People
interested in clinical research are way down at the bottom of
the pile!
Q467 Chairman: I think I should give
Sir Richard the right of reply, especially as he is a Yorkshireman!
Sir Richard Sykes: I think we
expect too much. We sequenced the genome a few years ago, and
we now have 300 genomes; but what we need is a thousand human
genome sequences. That will happen because the technology is changing
dramatically. Until we get that information and until we start
to collate it and understand what is going on, we are competing
against hundreds of millions of years of evolution. We cannot
do it in five years. It takes time and it will take 10-20 years
to see the benefit of those, but it will come.
Q468 Chairman: Professor Vallance,
have you anything to add, or are you happy to sit and let them
get on with it?
Professor Vallance: There are
things coming through. I agree with Iain about healthcare, but
things like treating heart attacks with block-busting drugs—there
has been a huge change in practice, and a vaccine against cervical
cancer viruses holds out huge promises for the future, so I am
slightly more optimistic.
Chairman: Thank you for your evidence.
It has been a very interesting session.
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