Health: Allergy (Science and Technology Committee Report)

My Lords, the whole House will be grateful to the noble Baroness, Lady Finlay, for introducing the debate with such authority and for having chaired the inquiry so skilfully. We all learnt a lot. Like the noble Lord, Lord Haskel, I do not feel myself as qualified as some of the great experts we have on the committee. I cannot say, however, that I feel I have the same qualifications to speak that he feels he has speaking from those Benches to urge the Government from behind, but I agree with him that this is an issue of concern for the wider public. The committee has articulated the concern that was apparent to me as a lay member. I shall deal with the research issues arising from this allergy epidemic. We have already heard that we have one of the highest prevalences of allergic diseases in the world. The costs for the National Health Service are rising. We have already heard what the figures might be, but let us just say that the direct cost to the NHS is around £1 billion while primary care prescribing costs are around 11 per cent of the total drugs budget. Something like 17 million working days have been lost due to asthma alone, at a cost of another £1 billion—you can just talk about round billions with these figures. The most startling thing of all for me—I say again that I start from a position of total ignorance on this subject—is that we do not seem to know why the incidence of allergy and allergic disease is rising. As the noble Lord, Lord Haskel, reminded us just now, it is clearly linked to some aspect of the more prosperous living conditions we have enjoyed since the 1960s. Dramatic increases were seen between 1964 and 1980, and there have been continuing increases since then. In Germany following reunification, and in other parts of Eastern Europe, there has been an increase in the incidence of allergic diseases right across the former Iron Curtain countries. It seems that there is a critical window of exposure in the first year of life during which the child’s immune system can be influenced, and their risk of allergic disease substantially reduced. Yet once children pass their first birthday, the same factors that would have prevented them from becoming allergic no longer operate, implying that any intervention to change the prevalence of allergy would have to target that very early phase of life and not be brought in some five years later. There is still uncertainty on whether avoidance of specific allergens during pregnancy is desirable, or whether exposure to some allergies in appropriate contexts actually helps to protect children. A lack of research into the development of the immune system and the establishment of allergy means that the scientific community is still not able to answer fundamental questions, such as whether peanut avoidance protects the child from peanut allergy. To answer such questions, we need broader studies; as the noble Baroness, Lady Finlay, said, long-term cohort studies are required. Those are not easily funded and do not produce specific conclusions. As Dr Egner of the Royal College of Pathologists advised us, "““In a competitive research environment, it is a brave person who goes into a messy area with no clear outcome””." Professor Burney, who is a Professor of Respiratory Epidemiology and Public Health, said that it was a dilemma for those funding research to choose between good, basic science that will, "““find the exact answer””," And, "““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 answers””." The majority of research funding, from the research councils and other public funding streams, focuses on the basic allergy mechanisms; indeed, this research is strong in the United Kingdom. We have research groups that are world leaders in research into the underlying mechanisms of allergy and allergic diseases. High-quality research of that nature in this country has significantly advanced our understanding of the molecular mechanisms of allergy. Where we fall down is in funding, adequately, epidemiological research and research into the development of the immune system. Research in academia is hindered because of that separation between clinical work and the research centres. If the recommendations of our report help those specialist allergy centres it would certainly help enormously to bridge the gap, as it is difficult at present for the academic researcher to access patients’ data from general practitioners. Indeed, those are sometimes impossible to obtain. Without access to a good, representative sample of the population at reasonable cost, epidemiological research is hamstrung. In supplementary evidence, recorded on page 60 of the second volume, Professor Burney explains how the patients’ data are now regarded as confidential and access is denied—in marked contrast to such countries as Germany where data are more accessible. The professor said: "““Under the current rules, because we cannot have access to the names and addresses until the patients have replied to say that they are willing to participate, we are unable to help with any of this process. For a busy general practice this is an all but impossible task and it is amazing that we have any volunteers””." He went on to ask, not unreasonably, for permission to use names and addresses of patients registered with GPs, together with their dates of birth and gender, providing; first, that the programme of work—including the letter of invitation to participate and the questionnaire—had ethical committee approval and, secondly, that the staff were adequately trained and had honorary contracts with the health authority or trust. Professor Burney ended his letter to the committee, "““The irony is that a properly designed and well vetted study to improve our knowledge of public health is forbidden, but any company can ring me up at home and conduct surveys or try and sell me whatever they please. If your committee were able to find a solution, this would be greatly and widely welcomed””." We address this issue in paragraph 7.26, which states: "““It is imperative that further research should focus on the environmental factors, such as early allergen exposure, which may contribute to the inception, prevention or exacerbation, of allergic disorders. Long-term cohort studies are a vital part of this research … We look to the … Office for Strategic Coordination of Health Research to improve the co-ordination and funding for these types of projects””." The Office for Strategic Co-ordination of Health Research arose from the Cooksey review which addressed this issue, which has been a problem for so long that the Medical Research Council undertakes research into it, as does the National Health Service. But before the Cooksey review the two lacked co-ordination. This is a challenge, if ever there was one, for the new Office for Strategic Co-ordination to try to ensure that there can be an exchange of data and a seamless join between the two funding research streams. The Department of Health claims to be increasing its support for research into the environmental factors that contribute to allergic disorders. It would be encouraging if the Minister could add his support not just for increased funding but for putting in place improved co-ordination so that researchers can be granted adequate access to the relevant data that they ask for.