From Dr Ian Hampson, PhD University of Manchester Viral Oncology Laboratories, Institute of Cancer Studies.
In my 30 years of cancer research I would be a wealthy man if I had a pound for every time I have been asked when is there going to be a breakthrough! The answer to this question is complex and depends on what you define as a ‘breakthrough’. For example, 50 years or more ago your overall chances of survival were poor if you got cancer. Today, however, survival has virtually doubled for some of the most common cancers in the UK. Progress could have been much more rapid however but for the combinations of legal, clinical and financial practices which are responsible for the current stagnation of cancer-related clinical trials and the blocking of scientific discovery within the UK.
In my previous article on these pages, A Call for a new approach to Cancer Research Funding, I discussed what is wrong with the way that Cancer Research is funded.There are other significant factors that contribute to the inertia surrounding the development of new Cancer treatments in the UK. Foremost among these are the current restrictions imposed on clinical practices and the massive costs associated with carrying out clinical trials in the UK.
The 1939 Cancer Act plays a significant role in these restrictions. The Act makes it an offence, except under specific conditions, to publish advertisements that “offer to treat any person for cancer or to prescribe any remedy or even to give advice in connection with the treatment thereof”. The expression ‘advertisement’ includes any notice, circular, label, wrapper, or other document, and any announcement made orally or by any means of producing or transmitting sounds. The Act provides exceptions in making material available to registered medical and nursing personnel and pharmicists, and for material produced by hospitals and local authorities. In short, to reiterate Lord Saatchi’s point in his 3 June article in The Times on the subject of his Medical Innovation Bill, trying to cure cancer could land you in court!
Doctors are themselves restricted from trying out unconventional Cancer therapies for fear of malpractice lawsuit. They currently have no choice whatsoever but to follow the so-called ‘evidence-based best clinical practice’, even when the case is hopeless. In his recent Daily Telegraph interviewLord Saatchi is very clear about his opinions of this practice and how it influenced the treatment his wife received for the ovarian cancer that killed her. Pointing out that one in 10 cancer patients, (15,000 each year), die from the current toxic cancer drugs and radiotherapy treatment, Lord Saatchi is introducing aMedical Innovation Bill in the House of Lords, calling for a change in the law to enable doctors to try out innovative and unconventional therapies without fear of legal reprisals.
Moving to the cost issues of carrying out clinical trials in the UK, you would be forgiven for thinking that this would be cheaper in UK than in other countries, given that the cost of diagnosis and patient care is provided by the NHS. Wrong! The UK is actually one of the most expensive places in the world to conduct clinical trials.The reasons for this is set out by Helen Townsend, head of clinical trials at the international healthcare company Novartia UK, in her illuminating article Breaking down the barriers that force up UK medicine development costs. I totally agree with her and have my own personal experiences to back this up.
I can best illustrate these by referring to a clinical trial I am currently conducting on a new non-surgical, self applied treatment for early stage cervical cancer. This involves local application of a drug normally given orally for the management of HIV. If the trial is successful it could revolutionise the treatment of early stage malignant disease of the cervix. During the planning stages of this trial, I approached people within the NHS to ask the cost of diluting one of the orally administered available froms of the drug by 1 part in 5, using a diluent that is already present in the original oral formulation. I was staggered when I was given a price of approximately £18,000. In addition we were also expected to pay patient recruitment costs and to pay the doctor to treat them in the trial, even though the NHS already covers this. In the light of these prohibitive costs we opted to work with a clinical ex-student of mine who is now an Obstetics and Gynaecology Consultant in Kenya. Unlike the UK, cervical screening is not provided for free in Kenya and yet it worked out much cheaper to set this up from scratch in Nairobi so that we could identify Kenyan women at risk and treat them accordingly. I note in passing that cervical cancer is the most common women’s cancer in Kenya and other sub-Saharan African nations, where it is a killer.
Links to relevant articles: A call for a new approach to Cancer Research funding 1939 Cancer Act Daily Telegraph interview Lord Saatchi Lord Saatchi’s Medical Innovation Bill Breaking down the barriers that force up UK medical costs