Examination of Witnesses (Questions 488
- 499)
TUESDAY 8 MARCH 2005
DR JAMES
GOODWIN, DR
IAN NOWELL
AND PROFESSOR
ROBERT SOUHAMI
Q488 Chairman:
Good afternoon and welcome to the Committee. Many thanks for
taking the time to join us this afternoon. That is very much appreciated,
as is also the written evidence with which you are associated
either individually or on behalf of the organisations you represent.
These written papers have been circulated and we have made good
use of them, as you might discover in the process of the discussion
to follow. You are now online and this is going out via the internet
directly. Perhaps I can start with a general question and you
can introduce yourselves at the same time. Can I ask about the
research councils, because you see them and must watch them quite
carefully as the alternative providers and, in some cases, the
main providers of research money. They have spoken to us about
the priority they say they attach to research on the scientific
aspect of ageing. I wondered whether you had seen that priority
in action. Are they attaching priority? Is the volume of research
about right or at about the level you would expect to complement
what you also are involved in? Are the research councils doing
enough? Are there gaps or problems of coordination? This is just
an opportunity to reflect on the volume of research starting initially
with what the councils are responsible for and whether they are
providing sufficient priority and drive.
Dr Goodwin: James Goodwin. I am Head
of Research for Help the Aged, which is a large international
charity which supports research into all aspect of ageing. We
have good working relationships with all the research councils.
We also have a formal relationship with the National Collaboration
on Ageing Research which is funded by the research councils and
with its successor, the New Dynamics of Ageing. We are very well
placed to get a good perspective on the whole range of these services
and across the four research councils which are researching ageing.
Generally speaking, my view is that the funding levels for the
research councils are low in comparison with the research councils'
spending generally and also with international estimates of research.
For example, my estimate of ageing research funded by the research
councils is only about ten per cent of their total research. In
some cases, it is as low as two per cent and in some cases—for
example, the Medical Research Council—it is much higher
than that. In terms of volume of funding, we consider it to be
quite low. The central issue is not just funding at the present
time but the fact that there has been no sustained core funding
in the history of core funding for ageing over the last 30 years,
which they have in the United States. If we compare the research
councils investment on ageing, they have a sustained budget for
the last 30 years but the current budget is about $994 million.
If we compare that with the £12 million going into the New
Dynamics of Ageing, one can see straight away that there is quite
a discrepancy there.
The Committee suspended from 3.44 pm
to 3.54 pm for a division in the House Q489Chairman:
In terms of what you said quite specifically I wanted to ask whether
the National Collaboration on Ageing Research is a great loss.
How do we know that the new organisation will do better what it
was meant to do, because the research councils have pulled the
financial plugs on this?
Dr Goodwin: When
people ask me what are the main priorities for ageing research,
my answer is not that it is academic priorities which we must
decide in terms of where to go—for example, should there
be research into pensions or technology in older people? They
are more strategic and they would be the lack of investment in
ageing research, the fragmentation in ageing research and the
absence of strategic direction. The National Collaboration on
Ageing Research provided some of their areas and in terms of its
demise now those functions will be that much more difficult. The
National Collaboration on Ageing Research did succeed in producing
a multidisciplinary approach, although by many that is perceived
to be a vehicle for the EPSRC, to promote their areas. That is
not a view that I entirely share. In terms of what the research
councils expect, they expect these days good discipline, good
research in discipline and interdisciplinary research as well.
Both have to be provided. Now that the NCAR has faded, we need
to look at alternative bodies to provide strategic direction.
That is one of the recommendations I made in my written evidence.
At the moment, the only body to do that would be the Funders'
Forum on ageing research of which Help the Aged of course is a
leading member. In terms of gaps in ageing research, it appears
to me from our international experience that where you have a
high order of strategic direction the issue of gaps recedes to
some extent. We also have to look at the relationship between
gaps in research that we perceive and research capacity at present
in the research universities. For example, if we identify a gap
in the biology of ageing, there might not be the capacity in the
universities in the first place by which to exploit that, so we
need to identify that relationship. We need to consider deficiency
of funding so there may not necessarily be a gap. There might
be a deficiency of funding in which we need to build capacity.
Finally, it is method as well as area. We need to involve older
people more in the research process itself and we need to think
about translation aspects. In geriatric research, geriatric medicine,
consultants now have had their training reduced and they therefore
do not have to do any research. This is an issue that was raised
by the European Academy of Medicine for Ageing. It appears to
me that there are fewer and fewer academics involved in geriatric
research and therefore that makes translation from evidence to
practice that much more difficult. These are all general areas
on gaps which we should consider before we identify some of the
academic areas.
Dr Nowell: Ian Nowell
from Age Concern England. I am responsible for a division within
Age Concern which is innovation and strategy. Age Concern has
a federal structure so in England we have over 400 independent
Age Concerns. Our approach to research is somewhat different.
Age Concern England plays a lead role on public policy in terms
of ageing and older people. Our interest in research is very much
along that public policy agenda. We are looking at research which
is making an impact on policy and in terms of practice. Our interaction
with the research councils is probably not as extensive in terms
of Dr Goodwin's and Help the Aged's level of interaction. In terms
of gaps, some of those gaps are about services that local Age
Concerns are providing that are impacting on older people on a
day to day basis. We are particularly interested in looking at
the impact of preventative low level services. The gut feeling
is that they are important. They do have an impact. It is producing
sufficient evidence base to have an impact in terms of commissioning
bodies and policy. There are areas where we are seeing big gaps.
Age discrimination is now of particular interest. We are certainly
looking at age related prejudice. We have done some work with
the University of Kent. That whole area of stereotypes, the development
and the impact seems to have a great deficiency in terms of research.
Mental health is another area of particular interest to us which
I think we highlighted in our written response to the Committee.
We passionately support research into policy and practice. We
support the interdisciplinary approach in terms of research and
we very much welcome the New Dynamics of Ageing programme, building
on the Growing Older programme, giving a real collaboration between
the research councils and a real opportunity to have the different
disciplines coming together in a way which will have an impact
on older people.
Professor Souhami:
Robert Souhami, Cancer Research, UK. Your original question was,
were the research councils attaching priority to ageing research,
and on that question I need to step slightly to one side because
Cancer Research UK does not have an opinion on the funding of
ageing research in its general sense. What we are concerned about
obviously is cancer as a disease affecting the ageing population.
If we look at the pattern of research into cancer as it affects
an ageing population, both in terms of the therapeutics and the
social aspects of cancer such as screening, quality of life and
so on, the answer is clearly that both Cancer Research UK and
its partners do not invest enough specifically into the questions
of cancer as it affects an ageing population. The reasons for
that are quite complex and you will probably want to explore them
in a while. There is within the UK a very successful forum where
the funding partners get together. That is the National Cancer
Research Institute. In the National Cancer Research Institute,
the major funders of cancer are sitting and discussing the questions
of research priorities in cancer. Cancer Research UK is there,
the Department of Health is there, the Medical Research Council,
the Leukaemia Research Fund, Wellcome and so on. There is now
a national forum for considering issues which relate to research
priorities as they affect cancer. We have a pretty good idea of
where those therapeutic and other priorities are. If you were
to look at the generality of funding in cancer and say, "How
much of that is specifically devoted towards therapeutic and other
aspects of cancer as it affects an elderly population?" the
answer is a very small proportion. If you were to look abroad,
particularly to the US, to see whether cancer as a disease of
the elderly is picked out as a specific area for focused research
funding, you would find more in the US than in the UK or in other
European countries.
Q490 Chairman:
If my colleague, Lord May, were here I know he would want to
ask two supplementaries. We have spoken about the quantity of
research. What about the quality? Do you have any views about
what is happening in this country? The additional supplementary
is: if the quality is, however you assess it, high, low or indifferent,
how is that measured and are there any relevant bibliometric measures?
Dr Goodwin: It is
well recognised internationally, and Help the Aged has profound
international collaborations in ageing research. Some of the best
ageing research in the world is conducted in the United Kingdom.
Without naming names, if you went to the United States they could
pick out five or six leading researchers. That similarly applies
to Europe. That is notwithstanding the fragmentation of ageing
research in the United Kingdom. The kind of quality measures that
we go for are those which are acceptable to the academic community
in terms of high impact publications in peer review journals,
the acquisition of national and international funding, awards
of objective, academic merit and progress. The United Kingdom
in those areas performs very well in terms of ageing research.
What worries me greatly however is the sustainability of capacity
in ageing research. That is exemplified by an exercise in which
Help the Aged has just been engaged, which is to raise £20
million for a single ageing research project. We had 32 bids of
outstanding international merit for those and we were only able
to fund one. The combined worth of those was £420 million
and £20 million leaves the other £400 million under-funded.
There is good quality research in the United Kingdom, but it is
the question of sustaining capacity with adequate funding and
strategic direction.
Dr Nowell: It is
not so much the quality of the research but how the research results
are used. There is a great deficiency in terms of the dissemination
of the results. In terms of the impact on practitioners and on
organisations such as ourselves, we would welcome a far greater
emphasis on more thought, more resources, in terms of the dissemination
of the results that have been produced and the bringing together
of different results to address the issues. The participation
of older people and part of the quality is, how much impact is
it having? How much are they engaged? How much are they valuing
the research which is involving them in many instances?
Q491 Lord Turnberg: On
the business of cancer research networks, there is a model for
getting good research done in places where there are good researchers
and applying it to practice, which is something you were talking
about. Do you think that is a good model for research into ageing?
Do you think it is a good model to apply or to try?
Professor Souhami:
It is difficult to give a general answer. The cancer research
networks specifically are dealing with therapeutic research. In
so far as there is general therapeutic research to be done into
problems of ageing, comorbidity and the way in which it is managed,
yes, it has been a very successful model for cancer. Cancer has
a curious advantage there though. It will be interesting to see
how the other networks set up under the UKCRC umbrella fare. The
curious advantage for cancer is that before the networks were
set up it was already true that over 60 per cent of all the therapeutic
trials in the United Kingdom were in the field of cancer. The
reason why it has been the case for the last 40 or 50 years that
cancer has been so concerned about therapeutics is because of
the nature of cancer treatment. It is difficult, complicated,
expensive and toxic treatment. There has always been a very strong
desire amongst cancer clinical researchers to assess the value
of what they do. That has been a very strong motivation for these
networks working well. It is now the case in the UK that therapeutic
research of that kind is thoroughly embedded. I guess the answer
to your question is, for cancer, for therapeutic research, it
has been an excellent, palpably successful model. In so far as
those things could be translated to research, therapeutic or other
clinically related research questions in ageing, it is certainly
a model to consider.
Q492 Lord Soulsby of Swaffham Prior:
With respect to research capacity, what is the situation with
respect to the flow of people like research students, post-doctorals,
senior and junior fellowships in the field of cancer? Is it adequate?
The Committee suspended from 4.09 pm to
4.18 pm for a division in the House
Professor Souhami:
Yes. The mechanism of flow is adequate. The numbers of people
involved are not yet adequate, particularly in some shortage areas
such as in radiation research and in surgical research into cancer
and gynaecological research into cancer. I am talking about clinical
research now. This is not a problem unique to cancer. The question
of manpower shortage generally at the clinical level in therapeutic
research in cancer is an important one and depends very much on
the specialties one is talking about. As far as fundamental research
in cancer is concerned, on the whole that works pretty well. I
do not think at the moment there is a funding crisis which prevents
people of real talent being able to be supported in the basic
cellular pathology of cancer. I hope I do not sound complacent
about this but at that level funding does not seem to be the problem.
At the clinical end, there are problems in getting people through
into high class clinical research.
Dr Goodwin: In terms
of ageing research specifically, if I look across the portfolio
of researchers in the United Kingdom, very few enter gerontology.
Most of them train in other disciplines and they come to ageing
after that. The special initiatives of the research councils have
served to attract such individuals into research on ageing. For
example, SAGE, ERA, EQUAL and so on. The aim from that therefore
was that these researchers should become more senior and move
into response funding. This has often proved difficult. Because
we have stop/start funding of research in terms of ageing, it
is very difficult to maintain a flow of research, undergraduates,
graduates, post-doctoral fellows and so on. In four years, in
spite of a huge effort from ourselves, we have funded 16 PhDs,
21 fellows and 12 large, post-doctoral programmes in excess of
half a million each. That is indicative of the expense of this
and the difficulty made by the absence of strategic coordination
of funding.
Q493 Baroness Walmsley: Dr
Goodwin and Dr Nowell, could you explain how your organisations
promote research into the scientific aspects of ageing? Could
you also say to whom your organisation is accountable and where
the money comes from? Does it mainly come from individuals, from
companies or from grant awarding bodies?
Dr Goodwin: We have
four main priorities by which we promote research. They are by
directly funding research, by influencing the direction of research
nationally, by international collaborations and, fourthly, by
promoting dissemination. In terms of funding, we fund between
£3 million and £4 million a year in all issues of scientific
ageing. We have just completed a £20 million major gift appeal
which is going to the University of Edinburgh and we core fund
the University of Oxford's Institute of Ageing. In terms of influencing,
we have a formal working relationship with the National Collaboration
on Ageing Research. We play a leading role in the Funders' Forum.
We work closely with government departments, in particular the
Department of Health, the Department of Work and Pensions, less
so with the DTI Office of Science and Technology. We have many
influences across members of the Department of Health and planning
initiatives through Poverty Action in the DTI. Internationally,
we are members of the Research Agenda Committee of the United
Nations. We are consultant advisers to the International Association
of Gerontology and the European Academy of Medicine for Ageing,
and in the USA we have working relationships with the Alliance
for Ageing Research and the American Federation of Ageing Research.
Dr Nowell: In terms
of our approach to promoting research, it is partly commissioning
research and that is to inform our public policy work, our development
of services for older people through local Age Concerns. We very
much look to influence the agenda of research through partnerships
working for academic institutions and through some of the professional
bodies, the British Society of Gerontology in particular, the
BGS as well and other bodies. We also look to participate, disseminate
and support conferences, working very closely with the BSG. We
have been partnered jointly working with them to engage older
people in their annual conference which we felt was important
and is quite an interesting approach. We are also looking to develop
and disseminate information about the experiences of older people
themselves. We will commission work on the economic contribution
that older people bring. It is not all doom and gloom. Older people
make a very valuable contribution to their communities, both through
paid employment and through a whole range of unpaid activities.
In terms of accountability, for Age Concern England it is the
National Council on Ageing. It brings together local Age Concerns,
over 100 national bodies including Help the Aged, a member of
our National Council on Ageing, but also professional bodies,
retirement organisations and national bodies. That produces our
board of trustees. On funding, our resources which are commissioning
research that we are interested in, supporting the partnership
work not particularly a huge amount of money and in effect that
is part of our core budget. That would come through our fund raising,
our trading activities, which would generate unrestricted income
through which we will support those areas of activity. That is
the overview.
Q494 Baroness Walmsley: What
about companies? Do you not get any money from companies?
Dr Nowell: We will
attract money from corporates in terms of developing. Say, for
example, we have a strategy of technology in older people. That
is very much about developing internet taster sessions through
local Age Concerns. The money from Microsoft, Cable & Wireless,
BT and other corporates will be used not for research in the classic
sense. It will look at evaluation and what impact it is having.
If that is constituting research, in that sense, yes, we will
get some money from corporates but very much focused in Age Concern
England on working with and supporting local Age Concerns.
Q495 Lord Drayson: You
do not see any interest from companies doing applied research
to better understand the use of their technologies, their products,
for the older market place?
Dr Nowell: In terms
of the interest in the market place and universal design, for
example, the interest is not that huge. I do not think there is
an awareness of what the opportunities are of engaging with the
50-plus population. We have established an Age Concern research
service which is to get a better understanding through qualitative
and quantitative tools of the aspirations, the attitudes, the
needs and desires of the 50-plus population. I think the business
world is incredibly slow in responding to those opportunities.
We have a real battle because the digital divide is not a temporary
feature. Once all the baby boomers come through, that is it. The
impact on people who are not engaged is going to be so great in
terms of services that the problem is far greater. In terms of
numbers, we are not convinced that that challenge is going to
go away, but the development of products designed for that 50-plus
population, both hardware and software, is not impressive.
Q496 Baroness Finlay of Llandaff: This
question is for Professor Souhami. It relates to cancers and their
relationship to age and comorbidity. I would like to ask how much
research CRUK is supporting on the problems associated with comorbidity.
We know that life expectancy is going up. The incidence and prevalence
of cancer are going up. We know that DNA damage is associated
with ageing and liver disease. How much priority research that
crosses the boundary or the non-boundary between the two is occurring,
how much it is being supported?
Professor Souhami:
Taking comorbidity first, I have given Mr Collon the statistics
which back up what you are saying to show just how big the problem
is in terms of the cancer problem in the over 70s and how that
is going to grow. There are already 140,000 cancers occurring
each year in the United Kingdom over the age of 70. There is no
doubt that the relative survival diminishes greatly particularly
in the over 80 age group. The issues of comorbidity, and the research
done into it, are slightly complex. The way in which therapeutic
trials are set up inside the United Kingdom, and indeed in other
countries in the world, usually puts an upper limit to the age
of inclusion in trials, simply because of the toxicity of some
treatments. The question that you are interested in, though, is
how many studies and how many therapeutic investigations are done
specifically to put therapeutic questions which are applicable
to an elderly population rather than the generality of cancer
patients. The answer is very, very few, both in this country and
in other countries. Partly that is an opportunity question, how
many therapeutics one has which have low toxicity and where existing
comorbidities will not be important for patients. There are not
that many treatments that are out there that you can easily give
to people who may have heart disease, diabetes or vascular disease.
Just the same, that is not the complete explanation. Part of the
explanation is simply that therapeutics of cancer in the elderly
have not been a high priority in most developed countries in the
world. Getting the age of inclusion into therapeutic trials up
above 65 to 70 has been a slow process. Getting it from 70 up
to 75 will also be a slow process as people have to adjust their
mentality and think that there are trials which can be done which
should include patients of this age. Much of the research that
is being promoted in the US on therapeutics of cancer in the elderly
is to ask exactly the questions that you are asking: what are
the stumbling blocks which prevent the design and execution of
therapeutic studies in an elderly population with cancer? Is it
a question of comorbidity? Is it a question of late presentation?
Is it a question of doctors and health care professionals who
do not think about things in the right way? The truth is we do
not know the answer to that in different settings. Within the
UK, those questions are just as unanswered as they are in other
populations. There is a big gap there.
Q497 Baroness Finlay of Llandaff: Given
the large burden of disease which is there, what is CRUK doing
about addressing that, because that burden is going to get greater
over time?
Professor Souhami:
Correct. At the moment, there is no concerted plan of any of
the funding partners to alter the way in which therapeutic studies
are being created and engendered inside the United Kingdom. In
my view—and in the view of many people inside CRUK—it
is not because of a cultural bias; it is simply that people have
not placed this as the highest priority in their cancer therapeutics—the
NCRI and the funding partners of the NCRI could well make this
one of their priorities for considering research gaps inside the
United Kingdom in exactly the same way as they have done with
quality of life research in the United Kingdom in cancer, and
radiation oncology research in the United Kingdom in cancer. There
is an opportunity there for the funding agencies to reconsider
the kinds of therapeutic questions they wish to see addressed.
You put your finger on an extremely important point, in my judgment.
You ask secondly about the question of the interface between the
biology of cancer, the biology of ageing and DNA damage and repair.
There one is on slightly stronger ground. The lifetime exposure
to DNA damaging agents does not start or stop at a particular
age so the question of DNA damage and the repair mechanisms that
are responsible for keeping your DNA undamaged are applicable
at whatever age you are looking at. The issues of whether or not
there is a decreased efficiency in repairing DNA damage and the
other cellular processes which are important in the emergence
of a cancer as you get older are very under-funded in the UK,
not because of an objection to funding such studies; it is simply
a question of whether we have available model systems and scientists
who are thinking about those problems in the UK. If you look across
the Atlantic to the US, you find exactly the same problem. There
is quite a difficulty in knowing whether or not there are separate
problems to be addressed in cell biology of ageing with respect
to cancer that are quite different in nature from the cancer problem
generally. Although we do fund research directly applicable in
cell biology of ageing and other cellular processes that are equally
applicable to cancer and ageing, they are general cellular processes
which are important generally to cancer rather than specifically
because they are motivated towards an ageing population of cancer
patients.
Dr Goodwin: If I
could add some support to that argument, there are two issues
related to your question on comorbidity. One is to better understand
the ageing process. We know from research over the last 20 years
that ageing is the biggest single risk factor for age related
diseases. If we answer the question how does ageing predispose
us towards disease, we can produce the mechanisms which will produce
the interventions. Secondly, in terms of translational research,
it comes back to the question of adequately trained and adequate
numbers of geriatricians in research such that they understand
the translatability of evidence into practice.
Q498 Baroness Hilton of Eggardon: If
we could return to the organisations that support you and look
at government departments, I wonder what your relationship is
with various government departments. We have heard from them how
they view this whole issue. Do you have good contacts? Are they
receptive to your point of view, and what more could be done in
this respect?
Dr Nowell: We have
a range of good contacts with a range of government departments
on topics which are of mutual interest, very much set by their
policy agenda which often coincides with our policy agenda. In
many instances, it is a positive process. There are challenges,
particularly when there are cross-departmental initiatives. The
joining up may be there with us but it is often missing within
government. For example, the strategy for ageing which has been
developed and is about to appear at any moment has been quite
challenging for us to have a coherent input into that kind of
process. Some of the experience we have had working very closely
with the Department of Health, the Department for Work and Pensions
has been very positive, and working with a number of other parts
of government as well. The only bit that we have found a little
more challenging is to look at where their research interests
and agendas are before the commissioning stage. That we have with
some departments but I do not think with sufficient.
Dr Goodwin: Relationships
between government departments have improved considerably over
the last number of years on the formal and the informal level.
In terms of the formal level, we work closely with members of
the Funders Forum in terms of clear discussions about the issues
on the scientific agenda which we should be addressing to avoid
duplication and over-investment or even under-investment. In terms
of our special relationships, we work particularly closely with
the Department of Health, the Department for Work and Pensions
and, to a lesser extent, the Department of Trade and Industry.
In terms of achieving the strategic levels of spending and the
direction, that is a lot more difficult and somewhere where there
is scope for improvement.
Dr Nowell: One area
which is important is the interaction at a regional level with
those regional bodies, the development agencies, assemblies and
government offices. We have, with the English Regions Network,
developed a dual region for all ages and if we are looking at
the impact of changing demographics on regional strategies we
have found that to be a very productive way of getting ageing
onto agendas at regional and sub-regional level.
Q499 Baroness Hilton of Eggardon: There
is no problem about access to government departments?
Dr Goodwin: We have
always found them to be generally very responsive in terms of
the information those government departments would like to have,
in terms of the issues in the report in relation to older people
and so on. That is a reciprocal arrangement as well because we
like to discuss with the departments—and we do—what
their priorities are for scientific research on ageing. That is
something which we find increasingly easy.
Professor Souhami:
As far as CRUK is concerned, all our money comes from the public.
The science spend this year will be about £210 million. There
is not a question of having to work with other people to raise
money. There is an extremely important issue about how research
fits in and whether research findings are then easily taken up
by the National Health Service. One has to say that the relationships
with the Department of Health and other government structures
are very good. I would not like to have to deal with some of the
problems they have to deal with. On the issue of availability
of cancer treatments when they are new, have come forward and
we take part in their development, it is always very important
for us to make sure that organisations like NICE and so on are
seeing the evidence for what it is. On the whole, there is plenty
of opportunity to put your point of view. I do not think that
presents a particular problem for us.
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