Examination of Witnesses (Questions 300
- 302)
TUESDAY 14 DECEMBER 2004
PROFESSOR PETER
FENTEM, PROFESSOR
PETER WEISSBERG
AND PROFESSOR
KENNEDY LEES
Q300 Lord Mitchell:
Slightly different: it is referring to relationships with other
disciplines. What opportunities do you see to develop links with
complementary activity concerned with the aspects of ageing and
those related to other disciplines? How successful have any efforts
been to build such links? What problems have been encountered?
Professor Lees: Shall
I start, perhaps, with Lord May's question? Very briefly, because
I entirely support what Professor Weissberg said earlier. I think
in the 10 or 15-year period we will have stem cells, but not just
stem cells: there are drugs that are being developed, there are
compounds being recognised now, which do seem to be able to switch
back on the ability of neurones to re-grow, to encourage DENTRITE
growth and to encourage them to start signalling to each other.
It seems very likely that we will start work on these sorts of
things over the next few years, but knowing how long it will take
to get the right compound and to get these into clinical research
practice, will be 10 or 15 years. I think there is a real possibility
that we can encourage repair mechanisms in the brain.
Professor Weissberg:
If I can pick up on the same theme, I think one of the reasons
why it is crucially important we continue to do embryonic stem
cell research in this country is not because I think that they
are going to be providing a therapeutic tool themselves, but it
is by studying those cells that we are going to understand the
molecular mechanisms and molecular biology of tissue differentiation.
Once you start to understand that then you can start tripping
the switches by pharmacological means to induce a mature heart
cell to start dividing again, which it would not normally do.
It should be conceivable you can make it do that, it is just we
do not understand the process. So I think tissue engineering and
tissue repair is going to be the way over the next 20 years or
so to deal with these "degenerative" diseases.
Professor Fentem:
Picking something up right at the other extreme, if I may, Derek
Wanless has focused on the importance of lifestyle factors in
the development and progress of chronic disease. Older people
are likely to be major beneficiaries, but we really do not how
to deliver the messages effectively. We have always baulked at
sustained interventions in this field—witness the physical
activity taskforce and the obesity taskforce, which were dismantled
in 1994 and which would have put us in place splendidly in relation
to the problems that we now see out there. I think a big challenge
is going to be to implement Wanless. That will take 20 years.
Q301 Chairman:
Indeed, when you see the word "taskforce" and the word
"tsar" you worry it is going to be short-sighted and
short-term.
Professor Fentem:
Can I come to Lord Mitchell's question? I think there is undoubtedly
scope for collaboration between the BHF (my colleague), Diabetes
UK, Alzheimer's and Help the Aged. It may need some facilitating
but there certainly is scope for that. I think the climate for
collaboration is better than it has been. Some of it happens already,
facilitated by the research group themselves. I can give you an
example of the study by the European Prospective Investigation
into Cancer (EPIC), which is a cancer study taking place currently,
centred in Cambridge, working with a cohort of people in Norfolk.
As I said, EPIC is based essentially on cancer and lifestyle factors
in cancer, but that brings together Diabetes UK, the MRC, the
cancer charities of course, and ourselves. So I think that those
are the two mechanisms currently open to us. As charities we have
got to sort ourselves out but, equally, provided we do not inhibit
the teams of researchers that we support—and we do not—from
going to multiple charities for their funding, quite a bit is
possible. I could give some other examples but I think time prevents
that.
Professor Weissberg:
I presume that is what you meant by complementary activity, not
complementary medicine?
Q302 Lord Mitchell:
Yes.
Professor Weissberg:
I think I would sound one slight note of caution, and that is
that it is clear that we have limited resources, whether it be
patients or whether it be research resources, but we certainly
have a limited resource in terms of researchers in this country,
and we do need to do something to address that. I was at a meeting
this morning that is trying to do something about that. It is
important, therefore, that we pool our resources and we have collaborations,
and we talk to each other, but I would also just caution that
if we over-regulate and if we over-formularise the way in which
we do our research then we are going to stifle the slightly
off-the-wall, entrepreneurial approach which, often, may lead
to something which nobody has thought of. I think we must not
lose sight of the fact that there must be some blue skies research
in some of this; it must not all be directed at what we think
is going to be the obvious answer; we need to have the flexibility
to think laterally and take a punt at something which may not
seem that obvious at this stage. I am just slightly worried, the
way things are going, it is going to get harder and harder to
do that.
Professor Lees: The
other groups that I think we need to encourage collaboration with
are the funding bodies in other countries. At the moment, it is
possible that you can get funding for a multi-centre, multi-national
study from one country's body—the NHMRC in Australia—and
then struggle very hard to get the funding to do anything out-with
that country. We should be able, I think, to agree that if the
NIH in the United States funds a study then the MRC in the UK
will fund its element of that study. There are individual examples
where that is happening but there is not yet a system where one
application would cover the whole world. I think it would be much
better if we could, particularly for a condition like stroke where
truly international research is the only way forward.
Chairman: Those last
three comments sum-up a question I want to leave with you. All
of you have stressed that there are inhibitions to the right kind
of research, and indeed the development of clinical treatments.
You have mentioned briefly the international dimension of this
and how problematic that can be, for obvious reasons. You have
mentioned red tape and paperwork, you have mentioned the current
rules of the RAD and, dare I say, hospital managers. What I would
be very interested to know—and if you are able to produce
some examples, anonymously if necessary, that you could send to
the Committee that would be helpful—is where the inhibitions
come in. The red tape may be there for good reason but if it is
obviously not for good reason, again, examples of why and how
that is the case. Equally, if it is a matter of hospital managers
and budgets for that single hospital, what kind of mechanisms
could help override that in appropriate cases? I will leave you
with that question and it would be very useful to have some either
actual examples which can be quoted on the record, or, if they
are anonymised examples, that is fine, we understand. Indeed,
if it is a case of "Well, this is what would happen in the
following circumstances", that is also going to be helpful.
That being said, can I thank you very much indeed. This session
has overrun: that is due to the stimulus you have provided for
us, but we look forward to further input from you. Many thanks
indeed.
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