BBC BLOGS - Fergus's Medical Files

Archives for April 2011

Stem cell patent row

Fergus Walsh | 18:00 UK time, Wednesday, 27 April 2011

Who is Yves Bot and why does he have the stem cell community in Europe up in arms? One of eight Advocates-General, he is there to provide impartial advice to the European Court of Justice. Last month he issued a complex opinion on patent law regarding embryonic stem cell research. You can read his opinion here.

The Advocate General appears to argue that it is unethical to allow patents to be derived from research involving human embryonic stem cells. Here is a very brief extract from his opinion:

"I consider that an invention must be excluded from patentability, in accordance with that provision, where the application of the technical process for which the patent is filed necessitates the prior destruction of human embryos or their use as base material, even if the description of that process does not contain any reference to the use of human embryos."

The prospect of a ban on patents in this area has many scientists deeply worried. The International Society for Stem Cell Research said the Advocate General's view may "impede the development of new therapies".

There are thousands of scientists working on stem cells around Europe. In order for potential breakthroughs to be taken from the discovery stage and translated into new treatments, they need a huge amount of resources. This inevitably involves partnership with industry. Patents are important because they allow the pharmaceutical industry to protect their investments.

13 stem cell scientists have written to Nature expressing "profound concern" at the Advocate-General's opinion. At the Science Media Centre this morning, several of them gathered spoke of their shock and astonishment at Mr Bot's legal opinion and said it threatened to wipe out the bio-industry in Europe. The group included "Dolly the Sheep" creator Sir Ian Wilmut and Professor Pete Coffey who is in the final stages of planning the first UK trial of human embryonic stem cells as a potential treatment for blindness.

The scientists argued that the removal of patent protection would have a major impact on the UK economy. Professor Austin Smith, director of the Wellcome Trust Centre for Stem Cell Research in Cambridge said it would have a profound effect on this emerging area of technology.

It was a surprise to hear that it was Greenpeace in Germany which began the court action which led to Mr Bot's opinion. A spokesman told me that the organisation was not opposed to all stem cell research and also said that the opinion of the Advocate General was not clear cut.

The European Court is expected to make a final ruling in a couple of months.

Pancreatic cancer vaccine trial

Fergus Walsh | 21:03 UK time, Thursday, 14 April 2011

There is rarely positive news about pancreatic cancer. It has the worst survival rate of all common cancers - worse even than lung cancer. Patients are usually diagnosed late when the cancer is inoperable. Typically, patients often have less than six months to live, and unlike other cancers, there has been little improvement in long-term survival in the past 40 years.

So it is heartening to report on a late stage trial involving hundreds of patients with advanced pancreatic cancer. You can see my TV report here. It is not a new form of chemotherapy, but a vaccine trial. Most vaccines are used to prevent infection, but therapeutic cancer vaccines aim to treat disease by stimulating the immune system to recognise and target the cancer.

The TeloVac trial involves more than 50 hospitals, is funded by Cancer Research UK and coordinated by Royal Liverpool University Hospital. It is a Phase 3 trial, which involves comparing the new treatment to standard therapy, and is essential before any new therapy is licensed.

The scientists and doctors involved in the TeloVac trial are keen not to raise the expectations of patients. In earlier small-scale trials, some patients did have a prolonged life-expectancy of several months. But until the results of this major trial are known it won't be clear whether this was anything to do with the vaccine.

But the idea of using the immune system to fight cancer is taking hold. Cancer Research UK pointed to two examples in the past year. Firstly, a vaccine using cancer cells mixed with a patient's own immune cells, was shown to be capable of prolonging survival in patients with advanced prostate cancer. Called Provenge, it is now licensed for use in the US. Scientists also found that an antibody, ipilimumab was able to prolong survival in patients with advanced melanoma, a deadly form of skin cancer.

The doctors in Liverpool are delighted with the take-up of the TeloVac trial, which is almost finished recruiting the 1,110 patients needed. I met three of the participants, Rhona Longworth, Joan Roberts and Charlie Williams. All had advanced pancreatic cancer and were having treatment at the Linda McCartney Cancer Centre. All showed determination and good humour in the face of this devastating disease.

They told me the vaccine had few side effects and they remained hopeful, both for themselves, but also for others in the future, who might benefit from their participation. My thanks to them and all the nurses and staff involved - I'll keep you informed about how the trial is going.

The gloom about pancreatic cancer was not lightened today by the results of a survey of patient experiences. Nearly one in four (24%) of pancreatic cancer patients surveyed said they visited their GP three or four times before being diagnosed with the disease compared to 17% of patients with other cancers. Forty-nine per cent of pancreatic cancer patients reported their health getting worse while waiting to see a hospital doctor, compared to 22% of all other cancers.

Professor Sir Mike Richards, National Clinical Director for Cancer said "This data clearly demonstrates that the treatment of pancreatic cancer patients is worse than patients affected by other cancers." Pancreatic Cancer UK, a national charity, expressed huge concern and said the patient experience needs markedly to improve.

How thick do you spread your butter?

Fergus Walsh | 18:06 UK time, Wednesday, 6 April 2011

Do you remember exactly what you ate yesterday? How thick do you spread your butter? I ask because 500,000 adults in Britain are being surveyed on their eating habits. All are participants in UK Biobank, a huge medical research programme funded by the Wellcome Trust, the Medical Research Council and the government.

You won't easily forget if are one of the 500,000. On enrolment all of us underwent a battery of medical checks. We also donated genetic material which will be stored for several decades. Scientists hope the project will lead to improved diagnosis and treatment for a host of conditions, from dementia to heart disease and cancer.

Which brings me to the food survey. Like other participants I was sent a comprehensive online questionnaire designed to detail every morsel I consumed yesterday. There was a long list of vegetables, from carrots to aubergines, next to which I had to tick the box marked "none". Other items included alcohol - one medium glass, and butter on bread - spread not thinly nor thickly, but just right to my taste. I imagine a researcher raising an eyebrow after seeing that I had at least three portions of "hard cheese". But then again one portion is listed as being "the size of a small matchbox" - hardly a mouthful!

There were also a couple of questions on physical activity. Sadly, it was not a day that I cycled 50 miles, but I did do some light exercise, thank goodness - namely running for a train and lugging heavy camera equipment around a hospital.

So what is the point of it all? The researchers at UK Biobank already know about my weight, eyesight, lung function, hearing, grip strength, bone density, not to mention sexual history and lifestyle. Then there are the samples of blood, urine and saliva in storage in a massive freezer near Stockport.

"Asking additional questions about diet and physical activity over the internet is a very simple way to add considerable detail to the resource," said Dr Tim Sprosen, UK Biobank Chief Scientist.

"This makes it more valuable to scientists when finding out how lifestyles influence our chances of developing a wide range of ailments, or working on better prevention."

So over the next 30 years as the 500,000 participants age, the researchers will have a huge amount of data to sift through and find out many more genetic and lifestyle factors which influence health.

What about how thick I spread my butter - is that really useful, or prying on a man's breakfast habits just a bit too much? Dr Sprosen said: "The type and thickness of a spread on bread can be important in determining fat consumption, especially if the individual eats lots of sandwiches. What we put on our bread, or jacket potato, can be as important as the meal itself in terms of nutrition, and often this is overlooked." Oh, ok then.

Don't worry if you are a UK Biobank volunteer and have not received your food survey yet - they are being sent out over the next couple of months. Later this year the team plan to ask participants if they will wear a watch-sized accelerometer or motion sensor for a week. As a gadget lover, I can't wait. And that surely will be the week that I exercise a lot and spread my butter more thinly.

Midwife shortages costing lives

Fergus Walsh | 00:00 UK time, Friday, 1 April 2011

Spare a thought this Mother's Day for women around the world who don't have access to the kind of care on offer in the UK to pregnant women. Whilst maternity services in Britain do sometimes fall short, it is unusual for women to give birth without any skilled help. Deaths in childbirth here are rare.

A report from Save the Children, timed to coincide with Mother's Day, has highlighted the alarming shortage of midwives in the developing world. Entitled "Missing Midwives", it says nearly 48 million women - one in three - give birth each year without expert help.

Save the Children says that of the 1,000 women and 2,000 babies who die each day, most succumb to easily preventable birth complications. For example it says more babies in poorer countries die from lack of oxygen at birth than from malaria. It estimates that 42,000 lives a year could be saved if there was someone present who could dry and stimulate a newborn baby to help it breathe.

Some of the comparisons are staggering. For example, the NHS employs 26,825 midwives and there are 749,000 births a year in the UK. By contrast Rwanda has 46 public midwives and there are 400,000 babies born each year.

I remember filming in a brand new maternity hospital in Sierra Leone a few years ago. It had no ultrasound scanner and no intensive care unit. The two doctors there provided care for a population of nearly 300,000. Despite the lack of staff and equipment, it was saving many lives.

Rather than relying on traditional birth attendants, often with no training, local women were being encouraged to attend ante-natal clinics. The birth attendants were being offered medical education and in the meantime were being paid by the hospital for each woman they persuaded to give birth at hospital.

The shortage of midwives is part of a wider problem - a massive shortfall of trained healthcare workers. Midwives and doctors cannot be created overnight. Even with political will, co-operation and funding, it is an issue which will take many years to put right.

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