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Lord Parekh: My Lords, I thank my noble friend Lady Hayman for initiating this extremely important debate and congratulate the noble Baroness, Lady Fritchie, on her splendid contribution to it. I also compliment the Government on supporting a variety of important initiatives in medical research. I have in mind the Department of Health's document Best Research for Best Health. I also have in mind the idea of a single fund for the MRC and NHS health research, announced not long ago as part of the Budget. I know that the noble Baroness, Lady Fritchie, and my noble friend Lord Turnberg have some reservations about that, but I am inclined to share the view of my noble friend Lady Warwick
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that this may be one way of straddling, or at least undermining, the division that has developed between basic research and clinical research, about which I shall say something shortly. I am also very pleased that the Chancellor of the Exchequer has decided to contribute to medical research £1.2 billion a year from 2008. I especially welcome the appointment of Sir David Cooksey to decide how the money should be used.

If all those initiatives are to bear results, we need carefully to consider some of the structural problems that medical research seems to face in this country. I do not want to underestimate the enormous amount of research that is taking place, nor the fact that we are at the top among European countries and are second only to the United States. At the same time, there are certain obvious problems. I want to highlight five of them, which I think deserve some attention.

First, over the years a gap has developed between basic research or discoveries, on the one hand, and clinical research on the other. The recently set-up UK Clinical Research Collaboration, which brings together almost all relevant bodies, is a good initiative on which we need to build. But by itself, it is not enough. Simply throwing together people involved in basic science and clinical research will not generate a catalytic impact unless there is a constant movement between people engaged in clinical research and basic discovery.

Let us take, for example, someone involved in clinical research on asthma. He or she would benefit enormously from spending time in the universities where physiologists are involved in basic research on animal cells and animal tissues. It is important that basic scientists can effortlessly interact with and move into clinical research, because that is the only way in which the two groups of people engaged in two different kinds of research will be able to sensitise each other. Some interesting ideas on this have been expressed by people such as Professor Colin Blakemore. That deserves attention.

My second anxiety concerns clinical research itself. There are several reasons why, as several noble Lords have pointed out, clinical research has suffered over the years. There is an unsatisfactory career structure; there is insufficient flexibility in the balance between clinical and academic training; there is a shortage of properly supported staff; and, obviously, as several noble Lords have pointed out, there is the low status of clinical research. Obviously the Government's initiative in having 250 academic clinical fellowships and about 100 clinical lectureship training opportunities is to be warmly welcomed, but my feeling is that this is not enough by itself. We will need more. We will also need to find ways of bringing together clinical researchers in different areas and not simply letting them co-exist side by side. We will also need to attract talented individuals into clinical
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research because, given its low status, not very bright people tend to be attracted to it. We will also need to find proper career paths and raise the status of clinical research if we are to ensure that it flourishes as well as academic research has done in our country.

I want to highlight a third problem. The NHS is a wonderful environment for clinical research, but I am not entirely sure that this environment has been fully exploited. Various factors are responsible for this. The research culture in the NHS is rather limited, because the NHS seems to be geared mainly, or at least primarily, to dealing with patients. NHS trust managers are more concerned with their target culture than encouraging a research culture, and we have not devoted sufficient attention to devising incentives so that senior consultants and others do research rather than enter private practice or take early retirement. We would also find it useful to encourage GPs and hospitals doctors to spend time with those engaged in clinical and basic research.

My own feeling in this connection is that the way in which our medical graduates are trained needs to be looked at. Their training does not involve much research input, unlike at some universities such as Harvard and Yale, where I was privileged to spend some time and where students are encouraged to do both clinical research and a PhD, and where an MD involves not only clinical experience but also academic research. This combination of both research and clinical work is not sufficiently encouraged in our medical schools. Dr Anant Parekh, who is professor of cardiovascular physiology at Oxford University, tells me that, as a professor of medicine, he feels that research would be of enormous benefit if it were somehow incorporated into medical training as it is into the training of social scientists. People going into the NHS or other areas would then already have a research inclination.

My last point is that, although research is being done in all kinds of areas, we need to devote a little more time to collaborative research than we seem to have done, not only in the European Union but in developing countries. I can see several advantages to this. First—I am speaking here to a Labour Government—it would help us to establish research infrastructures in developing countries. It would outsource part of our work and therefore release our consultants and researchers for other kinds of work. It would also draw on the experiences of doctors and others working in those areas and who therefore have certain sensitive insights into how certain kinds of diseases occur.

I have a family foundation, and we have been encouraging exchange between doctors and others from Indian universities as well as British ones. It is very striking that these Indian doctors and research scientists bring with them certain intuitions, because they deal with a wide variety of diseases that no longer exist or no longer operate in the same way. These insights could contribute enormously to the kind of work that is being done here.
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I therefore very much hope that, while this enormous amount of money is being injected into medical research—I hope more will be injected—and as we devise new institutional structures, we will attend to some of the significant structural problems.

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Lord Winston: My Lords, I want to take issue with a number of things that have been said this afternoon by noble Lords, the first of whom is the noble Lord, Lord Turnberg. Although the life expectancy of some of us might be extended by 30 minutes, whenever I stand up in this Chamber, mine is shortened by at least 30 minutes, even if I am speaking for only five.

I congratulate my noble friend Lady Hayman on introducing this very important and timely debate and on her chairmanship of Cancer Research UK during the difficult transitional period which she mastered wonderfully. I absolutely agree with her about its relevance to basic blue skies research. But I fear that at that point I rather take issue with her and I wish to part company, to some extent. At the moment, one problem in research—to which I drew attention in the debate two weeks ago and which we have heard a little about already—is regulation. It is inhibiting blue skies research.

I told a story two weeks ago about the difficulty in getting a simple project to do stem cell biology through the HFEA, and it being peer reviewed—although on what basis I do not understand. Incidentally, I understand from the HFEA that it was sent out to two peer reviewers. Only one bothered to reply, which was completely inadequate scientifically. We rebutted all the points. That reviewer replied, but did not answer any of our points. That is a disgraceful example of how projects should not be reviewed. I do not understand why, when you are not applying for public funds or trying to publish, it needs to be peer reviewed. One would think that the HFEA should have the expertise in house to deal with a fairly simple project of that kind.

With due respect, it is interesting that the HFEA keeps saying that it provides the conditions for public confidence. One could argue that having a regulatory authority may raise rather than allay public fears, which is an issue on which I do not think that we have ever done any research. We produce the mantra but we do not have any evidence from social science research one way or the other. It is about time that we did, particularly as the noble Baroness talks about the public understanding of science. It should be the public engagement with science. The public understand the science very well. By and large, they trust what is going on in stem cell biology. There is not much doubt about that, but the issue is whether we have found the right mechanisms for listening to their views.

One problem is that on taking a consultation based on a website, which the regulatory authority does, you inevitably get skewed opinions. You get people who are representing their opinions from extreme ends—people like myself. I have an interest as someone
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involved with stem cell biology as a medical researcher and with a spin-out company at Imperial College. On the other side, you will have the people from the right to life movement who have strong views. But the broad public opinion, which is probably largely supportive, will also be largely silent. That is an issue, too, that the noble Baroness rightly raised with regard to animal research. It is sad that it takes so long to get a licence. As I pointed out two weeks ago, it took me 13 months to get a licence to inject six pigs with a completely painless gene construct which caused no damage to the pig.

I want to come back to a key issue. This House, together with another place, overwhelmingly voted strongly in favour of a very important development in biology; that of stem cell research. The HFEA says—we have heard it said in this Chamber today—that we lead in stem cell biology. That is a little bit of an overstatement. This morning I downloaded all the English publications on human embryonic stem cell research from, the medical index. There are now 14 licences on the HFEA website, although it seems to be nine months out of date, so there may be more. I am surprised that it is not updated more regularly. But most of the research projects have not yielded a single publication. Two units have managed 13 publications between them. The others have managed, altogether, just five. The number of publications from this country in stem cell biology, although this is an area in which we should be expert, is less than from Israel or Singapore, both of which have half the population of London. That is not a very impressive record. There is no question that clinicians are inhibited in this country from doing research by the regulatory frameworks. The HFEA is just one example. It happens throughout regulation with regard to ethics approval.

On the train yesterday I read the April issue of Human Reproduction, the leading and most high-impact journal in my field. That British journal contains some 35 publications, only three of which come from the United Kingdom; the rest are from other countries. That is rather astonishing. In part it may be because of commercial activity in the field, which is a problem, but I think it is also that we are finding it more and more difficult to attract clinicians to clinical research of any kind in this country. I fear that the regulatory framework may have something to answer for. In his speech I hope that my noble friend on the Front Bench will try to suggest ways in which we might speed up the regulatory framework. I think it is wrong for me to have seen published in Nature only a month ago research that I wanted to do over a year ago, but was not able because I have not been given permission to do it in this country. In the meantime, colleagues have conducted exactly the same experiment in the United States.

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