Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 160-166)

Professor Peter Burney, Professor Aziz Sheikh, Dr Graham Devereux and Professor John Warner


  Q160  Lord Colwyn: Do you think that complementary and alternative medicine has a role to play in the prevention of allergic disease? I am not going to allow any of you to say yes or no on that; I want to widen it a little bit. In my view, complementary and alternative medicine is about immune system enhancing. To my mind, that includes nutritional supplements, which Dr Devereux has talked about already, herbal medicines, ayurvedic medicines and, of course, the anti-stressors—chiropractic, osteopathic and acupuncture. Take it from there.

  Professor Warner: All one can say is that we have to work with evidence. We have talked all along about evidence, and the issue is, have these therapies undergone sufficient scrutiny with proper controlled studies to demonstrate that they have an effect? The answer is, for the vast majority, they have not. That does not mean we are closing our minds to the potential for them to have some benefits, but I think it is incumbent on the people who recommend them to do good studies to demonstrate that they are effective. That is the treatment side. I can say very emphatically on the diagnosis side—that is, where complementary practice is trying to diagnose allergy—it is utterly and totally without any validity, and in many cases has been shown to be totally bogus.

  Q161  Lord Colwyn: I will not take that up with you now, but I disagree with that.

  Professor Sheikh: I will not answer yes or no, but in relation to your question about preventing allergic disorders I think the answer is we do not know because the studies have not yet been done.

  Q162  Countess of Mar: Do they not have exactly the same problem as you have, in that they cannot get funding to do the studies?

  Professor Warner: That is true.

  Dr Devereux: Yes, exactly.

Chairman: I do not know if anyone on the Committee has any other questions they would like to put to our panel.

  Q163  Lord Rea: On nutrition, we should perhaps discuss the role of breastfeeding and weaning patterns: whether partial breastfeeding or total breastfeeding is best and what should be advocated.

  Professor Warner: It is a very difficult area. There is no doubt that exclusive breastfeeding for at least the first four months of life reduces the rates of early food allergy and eczema. There is rather less evidence that it has longer-term effects on the later allergic manifestations, but there is no doubt about those early ones. How long should breastfeeding go on, should it be partial, how rapidly should weaning occur—I think we just do not know. There is a current recommendation in many countries that in allergic families weaning should be slow, with a particular delay in the introduction of the allergenic foods. Actually, what evidence is now accumulating would suggest that that is totally wrong and that it is better to wean early on to allergenic foods and to diversify the diet quickly, and it may even be better to do so while breastfeeding continues because there might be factors in the breast milk which might help modulate the response to the foods as they are introduced. Again, research is required in order to establish what really is the best recommendation.

  Q164  Lord Colwyn: Introduce nuts and things in very, very tiny doses as early on as possible?

  Professor Warner: Yes, perhaps. The research needs to be done. I am not recommending it now.

  Professor Sheikh: In relation to the delayed weaning issue that has been advocated in the past, again, there has really been no firm evidence underpinning this, and currently with a three-month-old born into a high-risk allergic family at home, who is screaming at night because he is hungry, we are not following that guidance.

Lord May of Oxford: I thought this was a super session and I would like to go back very quickly to Lady Platt's question about funding. I share your reservations about wanting to direct things, but nonetheless I think our discussion has implications, maybe, for some of our later sessions. It seems to me there is a more general thing. The MRC does fund this work, the Wellcome Trust does fund this sort of work, but nonetheless I think it fair to say there is an understandable prejudice to want to do "high-techy, moleculary" things. I am always mindful of the dictum of Tukey—possibly the most distinguished statistician of his generation—who said: "Far better a rough answer to an important question than an exact answer to an unimportant question". I am not sure even if all the Committee quite realise that in the subject of immunology we have an unbelievably brilliant understanding of how—at the individual, molecular and virus level. Take HIV. We now have the individual HIV virus interacting with the individual immune system cell, and on that basis we can design anti-retrovirals to keep people alive, but we still have no agreed explanation for the pathogenesis of HIV. Most of the people working in the area somehow do not even realise that. It requires your understanding of many, many different viral strains interacting. It is a very complicated kind of question. I suspect, as we said earlier, the immune system is not programmed in our genes; it assembles itself, largely, in the first few years of life. Common sense suggests there are hugely important things to be done in understanding the interplay between these many things we have talked about, yet the kind of proposal you are going to put forward is not going to be a piece of precise, physics-like (for people who do not understand physics but think what physics is like) thing that finds favour. I would hope we might keep that in mind for some of the subsequent sessions because it is perfectly clear that I am going to come back to this when we start saying our recommendations. I thought it helpful to say it now.

  Q165  Chairman: Thank you. Do you have comments you would like to make?

  Professor Burney: May I make one comment which thoroughly supports that? I have sat on some funding committees and been faced with exactly that dilemma: that you have got some very good, very precise basic science that comes through that you know is going to find the exact answer, because if the lab is half good it will have no difficulty with the experiment, and you know it is a very good lab. Against that, you have got a more speculative bit of work that is going to advance general knowledge but is not going to give you the same kind of precise answer. It is a dilemma for the funders; I think we have to recognise that. The other thing, going back to your original question, is that the National Asthma Campaign has actually put quite a lot of effort into reviewing the areas that are important, and they have brought out regular documents saying what areas they think are most ripe for exploitation. I think they have done that with the Department of Health. The real problem is the total amount of funding in the area, and I think most of the evidence is that funding in the area of respiratory disease and this kind of allergy (not the high-tech immunology) is very low compared with other similar conditions.

  Professor Sheikh: One of the issues is that when you have relatively small pots of money for allergy what it can do is promote quite a lot of rivalry between groups. When you are vying against other disease areas, if there is that internal rivalry you are actually shooting yourself in the foot quite a lot of the time. If in your recommendations you can think of any ways of promoting more collaborative research—because some of these studies we are talking about will need very large numbers; they will need a collaborative ethos—and you can give some suggestions along those lines that would be very welcome.

  Q166  Chairman: You lead me into a question I have, which will be our last question this morning. You did speak earlier on about the charitable organisations that do not have research funding. I wonder whether they do not fund research partly because they do not feel confident in sorting out who to fund and partly because they feel that somehow patient information leaflets, and so on, are more important. Do you feel that some of those charities should be encouraged to be specifically fundraising towards an aggregated research pot over and above the pots that already exist?

  Professor Sheikh: I would certainly encourage that. One of the things we have had in respiratory medicine recently is the formation of a national respiratory research strategy committee which is bringing together different funders—government and charitable. Something similar in the allergy field would be a very useful way forward. Maybe I could ask John, because you sit on the Anaphylaxis Campaign as a trustee, I think.

  Professor Warner: Yes, I am a trustee of the Anaphylaxis campaign, and they have relatively limited resource. Rightly, because the campaign was established by families and patients with severe, acute allergy, the first effort is devoted towards helping people here and now with appropriate support and advice. As the funds increase then they have to move into supporting research. I think they are very aware of that, but actually the environment for raising funds from charitable sources is very different to what it was 10 or 20 years ago. It really is quite difficult for them to get funds these days.

  Professor Sheikh: I have got two proposals with the Anaphylaxis Campaign at the moment, trying to get some money to do work, but there is not any, unfortunately.

Chairman: Can I thank you for coming and giving us evidence today. If there is additional information that you would like the Committee to know about, that you think about when you go away, please do send them in and we will circulate them to the Committee. Thank you all very much indeed.

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