Examination of Witnesses (Questions 160-166)
Professor Peter Burney, Professor Aziz Sheikh, Dr
Graham Devereux and Professor John Warner
6 DECEMBER 2006
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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