In the Telegraph today Lord Saatchi writes: ‘If it works for Ebola, it can work for cancer’
How do the conditions imposed by the WHO on ZMapp compare with the conditions set in the Medical Innovation Bill?
It is hard, when confronted with pictures and reports detailing the Ebola outbreak in Africa, not to shake one’s head in pity. What medical facilities there are, we hear, are overwhelmed by the scale of it. So it is extraordinary to learn that Liberians dying of Ebola have better access to groundbreaking, potentially life-saving new treatments than do people dying of cancer here in Britain.
The Ebola treatment in question is ZMapp, an experimental serum which has not been tested on humans in medical trials, but was none the less given to two American doctors – Kent Brantly and Nancy Writebol – who were infected while working in Liberia. Both have now made a full recovery. Three infected African medics who have received ZMapp in Liberia are also reportedly doing well. Now a British doctor, infected with Ebola while working in Sierra Leone, is to be returned to this country for treatment at the Royal Free Hospital in north London.
The reason that such patients are able to receive ZMapp is because an ethics panel at the World Health Organisation has decided that, given the magnitude of the Ebola outbreak, a departure from standard evidence-based treatments is justified. Potential treatments that have shown promising results in the laboratory but have not been evaluated for safety and efficacy in humans are, in certain conditions, now acceptable on both ethical and evidential grounds, the WHO says.
Few doubt that the gravity of this outbreak of Ebola, which has killed about 1,500 so far, requires a response by all means necessary. Yet in Britain today the toll of another disease – cancer – is 100 times higher, and access to such experimental treatments is not available, even for those desperate patients beyond the help of current medicine.
Some 150,000 British citizens will die from cancer this year, making it the number one cause of untimely death. And while the disease may have a different name, our response should be the same as with Ebola – doctors should be encouraged to try new treatments, and be protected when they do so. Importantly, the Medical Innovation Bill, now before Parliament, will allow doctors and their patients in Britain to try treatments that have not been tested or fully trialled.
Inevitably, there are objections that the Bill’s restrictions and conditions placed on doctors are too lax – that they can play fast and loose with vulnerable, dying patients. So it’s worth looking at the conditions imposed by the WHO on ZMapp to see how they compare with the conditions set in the Medical Innovation Bill.
First: lethality. On Ebola, the WHO panel agreed that the threat posed by Ebola, with its “high case-fatality rate” was sufficient to warrant the use of experimental therapies. The Medical Innovation Bill is explicitly designed to achieve the very same result. This is why the Health Secretary, Jeremy Hunt, said about the Bill that “the Government should do whatever is needed to remove barriers that prevent innovation which can save and improve lives. We must create a climate where clinical pioneers have the freedom to make breakthroughs in treatment.” The Secretary of State wisely asked Sir Bruce Keogh, the medical director of the NHS, to devise the legislative safeguards to be included in the Bill.
Secondly, ethics: the WHO rightly sets a high ethical standard for use of ZMapp, including “transparency about all aspects of care, informed consent, freedom of choice, confidentiality, respect for the person, preservation of dignity and involvement of the community”. The Bill echoes this ethical standard, requiring informed consent of the patient, or the patient’s representative, and full transparency. Indeed, the Bill goes further than the WHO guidelines, stating that in order to depart from the existing range of accepted medical treatments, a doctor must also obtain the views of at least one other relevantly qualified doctor, carry out a full risk assessment, and obtain any other consents required by law.
And, of course, while the WHO offers guidelines, the Medical Innovation Bill is backed by the full force of the law.
Finally, WHO guidance requires that all data generated by the use of ZMapp should be collected and shared. If scientific progress is to be made through such experimental use of untested treatments, results must be available to the scientific community. The Bill will secure this. The University of Oxford has offered to create a database to register innovative medical interventions under the Bill and to collect and share the data from them, so that they may inform and inspire clinical trials. As Sir John Bell, Regis Professor of Medicine at Oxford, said: “There will be no cure for cancer until real doctors with real patients in real hospitals are allowed to innovate.”
So those of us who have cheered the use of an untested drug to help apparently hopeless cases in Liberia should cheer the Medical Innovation Bill. It will help medical science progress, aid researchers in their hunt for cures for fatal diseases – and offer hope to the 300,000 Britons who will be diagnosed with cancer this year.