© 2001 by Oxford University Press
Journal of the National Cancer Institute, Vol. 93, No. 9, 670-672,
May 2, 2001
© 2001 Oxford University Press
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New Cancer Institute Sets Out to Coordinate, Promote Research
The British government announced in April the creation of a new cancer research institute to coordinate all research funded by government, charities, and industry and to promote greater collaboration across Europe.
The National Cancer Research Institute plans to double the number of patients recruited into clinical trials within 3 years. The organization hopes that this effort will be aided by the recent National Health Service announcement of its commitment to having 1,000 more cancer specialists by 2006. Now, cancer specialists see three to four times as many patients per year than their European counterparts.
Officials hope that doubling the number of patients in clinical trials will be good medicine not only for the patient, but also for Britain’s balance of trade surplus. Pharmaceuticals are the nation’s third biggest export, after gasoline and power-generating machinery. In April, the Association of the British Pharmaceutical Industry announced record sales in 2000 of more than £7 billion (about US $10 billion).
A task force report released in March by Prime Minister Tony Blair, and jointly published by the government and the ABPI, points out that in 1997 pharmaceutical research and development accounted for 23% of all spending on manufacturing research and development in the Untied Kingdom.
But future growth in cancer research here has been perceived to be at risk. The perception is fueled by the lack of investment by the state funded National Health Service in new cancer medicines, considerable delays in the development and approval processes of new medicines, and concern about the costs of British clinical trials.
"It’s quite clear that there has to be a significant improvement before pharmaceutical companies will again consider the United Kingdom as a first choice," Richard Tiner, medical director of the pharmaceutical association, warned last year.
Enter Dr. Richards
No one is trying harder for patients and government than Mike Richards, M.D. Recently appointed as England’s first national cancer director, he is the author of the National Cancer Plan—and a man with a lot to live up to. The Labor government has hailed his plan as the "first comprehensive strategy" against cancer, and he has the support of the British oncology community.
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"There has been concern about pharmaceutical companies moving out of Britain and that the U.K. is not a good market," he said, acknowledging the pharmaceutical industry’s grievances. "Companies want to do research in countries where there’s going to be a subsequent market. This is absolutely understandable and I believe the commitments we’ve made will radically change practice."
According to recently published figures, Britain was spending in 1996 only £95 (US $36) per 100 people in the population on anticancer medication, compared with £205 (US $294) in Germany, £279 (US $400) in France, and £1705 (US $2444) in the United States. But U.K. cancer services are to receive an additional £280 million (US $401 million) in 2001/02; £407 million (US $583 million) in 2002/03; and £570 million (US $817 million) by 2003/04.
These commitments will be directed toward the National Institute for Clinical Excellence, which was set up to evaluate new technologies and to issue guidelines to prevent long delays in bringing innovative therapies to the NHS. Promoted as a potential solution to rationing, poor medical practice, and the absence of a sensible mechanism to introduce new drugs, NICE is currently appraising 13 chemotherapy drugs licensed over the last 7 years.
These agents have been subject to the infamous "postcode lottery"—literally prescribing by ZIP code. Postcode prescribing has meant, for example, that patients with ovarian cancer living within one health authority have received first-line platinum/paclitaxel therapy, while others in neighboring authorities have been denied it on grounds of cost.
"What the government has been quite clear about is that the government will ensure that funding is provided for these drugs if they’re approved by NICE," Richards said. "I think this will change the industry’s perception of the U.K."
NCRI Marks ‘New Era’
It remains to be seen what impact the extra cash will have on the NCRI. Paul Nurse, Ph.D., director general of the Imperial Cancer Research Fund, Britain’s third biggest charity and Europe’s largest independent cancer research body, welcomed the NCRI as marking the beginning of a new era.
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"Coordinating cancer research strategy should help us to catch up with progress being made by colleagues in the rest of Europe and the United States," he said. "However, the NCRI is very much a virtual institute—it brings no significant extra resources to cancer research and will rely on the funding, staff, and infrastructure provided by charities such as the ICRF. The charitable sector spends between £160 million and £200 million (US $229 million and $286 million) on cancer research, and for far too long the government has relied on cancer research charities to fund the majority of research."
According to one estimate, the British government spends between £112 million and £170 million (US $160 million and $286 million) on cancer research. (The large discrepancy between the two figures is accounted for by different interpretations as to what constitutes expenditure on "research" as opposed to administration or infrastructure. Either figure is roughly 10 times less than that spent in the United States.)
Richards accepts that the NCRI will be a "slimline organization" and dismisses any idea that the United Kingdom will ever compete with the United States on a dollar for dollar, pound for pound basis. The United Kingdom, he points out, has only one-fifth the population of the United States, but he believes that his U.S. colleagues agree that the NHS is "a wonderful platform" for research and collaboration.
He explained: "The vast majority of cancer patients are treated within the NHS and we have cancer registration covering the entire country—we know who gets what cancer and what happens to them. I think people in the United States would agree they have a much more fragmented system. We’ve got a lot of problems to sort out, but we have a highly committed clinical workforce devoted to research."
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