Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 460 - 468)



  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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