Variant Creutzfeldt-Jakob Disease

I suspect that the reason for the professor's opinion is that it is extremely difficult to detect the prion. However, there is a feeling—correctly—that the precautionary principle should be applied, although hopefully in a sensible manner. With that in mind, I draw the Minister's attention to the decision in April 2007 by the chief dental officer that dentists should not reuse endodontic reamers and files—by that, I mean single-patient use. This, I understand—I may be corrected—was derived from research on mice that were particularly susceptible to variant CJD. The basis of this thinking is that the removal of the prion from stainless steel reamers is difficult, as I think we all accept. Stainless steel reamers are cheap and so not a particular economic problem, even for dentists claiming that their fees are not large enough. Nowadays, however, most endodontists, or those doing serious amounts of endodontics, are using nickel titanium reamers. A number of specific designs are used in different techniques. Reputable nickel titanium reamers are expensive. I also understand that cleaning the prion off nickel titanium is much easier than taking it off stainless steel. Treatment for a tooth that needs endodontic treatment is therefore made very much more expensive. It is time-consuming if done properly, especially if molar root canal is involved. The unit of dental activity award for molar root canal is small, especially when compared with the alternative treatment, which is extraction using—surprise, surprise—stainless steel forceps, where the same prion difficulty would apply. That might explain the apparent increase in NHS extractions and reduction in NHS endodontics—I expect a letter from the British Dental Association telling me I am wrong. A number of questions arise. Many stainless steel instruments and burs are used in dentistry, including forceps. If the research on these susceptible mice was so conclusive, one questions why the chief dental officer chose those reamers and whether he thought about extending his ban further. Of course, if he did, he would have to face the problem of probability versus application of the ban versus cost. Should the ban apply only to stainless steel reamers? Should it not be applied to nickel titanium? In 2007 D-Gen and DuPont produced a new prion disinfectant called RelyOn prion inactivator to remove or de-activate the prion on instruments. I would be interested if the Minister could tell me—if not tonight, certainly in a letter—whether that product has been tested, because if so, it would be sensible to introduce its use into the new onerous disinfection and sterilization regulations that dentists are now facing, before the regulations are finalised. That would be better than landing it on a beleaguered dental practitioner after he has installed the equipment for major changes that are coming through. In 2001, the Department of Health allocated £200 million to modernise NHS surgical decontamination, along similar lines to that descending on dentists now. Attempts have been made to produce single-use instruments for some surgery, and I understand that plastic instruments were developed for tonsil surgery but proved a failure. New rules have also been brought in on contact lenses, and it would be interesting to see whether those would be applicable or useful. However, the way forward has to be blood transfusion filtering. Some 1.8 million blood units are donated in the UK annually, and SaBTO has recommended the immediate P-Capt filtering of all blood for children. In the Prime Minister's letter to me, on 11 February, following my question on this subject, he said that the introduction of the filter should be subject to the satisfactory completion of a clinical trial. I assume that he was referring to the ongoing—long ongoing—PRISM study. I understand that the study is way behind schedule. There are previous studies—I can draw the Minister's attention to them, if they are not in her notes—and, as I have said, the filter has a CE mark. I ask the Minister to move now on blood filtering, initially for children and then for all. If it is good enough for the Department of Health to use the precautionary principle for endodontic files after questionable thought, the same principle should be applied to blood transfusion filtering. Action on endodontic files is essentially fiddling around the edges. Blood transfusion filtering is central to reducing or stopping blood transfusion transference of prions, to the benefit of future generations. I am sure Health Ministers would not like to be named in what I will call an "If only we had" report in 20 to 40 years, when people are dying from variant CJD.