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This Bill is very important, as the scientific world has changed


By Charlie Chan, Consultant General Surgeon, Nuffield Health

In spite of medical advances over the last 50 years, many people across the world still die prematurely from cancer, heart disease, lung disease, and terrible degenerative diseases like muscular dystrophy and motor neurone disease.

For many of these people, the options for treatment and run out quickly, with no prospect of improvement in quality of life or life expectancy. For some, but not all, exploring new treatment in a responsible manner is something that the individuals may wish to do, if only to benefit future generations.

This Bill is very important, as the scientific world has changed. The last generation has seen an enormous change in our fundamental understanding of diseases and their processes.

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This has been underpinned by the massive changes in laboratory research, genetics, 3-D printing, and regenerative medicine. This knowledge could not have been foreseen over 50 years ago, when the Bolam case was first heard.

This new knowledge has been underpinned by the vast improvement in computer technology, which has benefited all parts of society. When treating patients and diseases, doctors and scientists are waging a conflict on 2 fronts.

The frontline remains the one of the individual patient, with the doctor at the bedside or in the operating theatre. Behind-the-scenes, there is a continuing intelligence campaign underpinned by scientific research in the laboratory.

100 years ago, communication between the front and Intelligence Corps might well have been done by carrier pigeon. Now, information exchange occurs rapidly in real-time between GCHQ and troops in Afghanistan. In medicine however, this communication or translation of new scientific knowledge to the bedside remains slow.

We are fast approaching and era when scientific research may outstrip our ability to deliver this to the patients. Hence, we need to address a new way to deliver innovative treatments.

That is not to say that the standard clinical trial model is dead. There is still much merit in the randomised trial as a paradigm. It is vitally important that the development of new standard treatments for large numbers of people is underpinned by solid statistical analysis and estimation of perceived benefits.

However, a new process for innovative treatments may provide many new hypotheses for new trials, which can then cement new techniques and drugs.

There are some colleagues who rightly have concerns that a change in the law may constitute a charlatan’s charter. However, the Bill contains safeguards to ensure that there is no quackery. All standard and trial treatments need to be exhausted, there needs to be logic behind the proposed treatment, and this treatment needs to be agreed within the peer group, prior to discussion with the patient.

The agreement within the peer group will need to be done in a timely manner. There is a significant challenge for the profession to establish a framework for such peer group discussions, which may occur on the local level or through a National Specialty Association.

However, it is well recognised that this must be something that can be done quickly for patients treated in a district general hospital by local consultants, as well as those managed in large teaching hospitals.

Some of my colleagues would strongly support some form of central data collection.

A central data repository to be analysed on a regular basis, in order to establish whether any putative innovative treatments have any merit for further investigation in large clinical trials.

This might be located in an academic university department, so that this might be independent of central government control.

The future is extremely exciting. Basic scientific research has enhanced greatly our fundamental understanding of many diseases, such as cancer.

This understanding of the basic diseases means that some new biological drugs may have multiple applications across different cancer types. It makes logical sense to exploit this basic science knowledge, particularly to benefit those patients with rare diseases, for whom a standard clinical trial may be impractical or financially non-viable.

Advances in regenerative medicine, particularly in the USA, now mean that organs can be printed in a matter of hours or weeks.

This will herald a completely different way in which we might manage people with cardiac, kidney, or liver disease.

We must grasp this opportunity to change things for future generations, otherwise these scientific advances may be for naught.

About the author:

Charlie Chan is a Consultant General Surgeon with a special interest in breast disease, skin cancer, and soft tissue tumours. He also has a varied practice in general surgery. He has extensive research interests, and is currently involved on the Trial Management Group for 4 large UK breast cancer trials.

On average, he performs 30 to 40 major breast reconstructions a year, as well as numerous cosmetic breast procedures. Amongst his breast cancer patients, he is normally able to conserve the breast in 70-75% of his patients. AIong with his colleagues in Cheltenham, James Bristol and Fiona Court, he is one of only a few surgeons in the UK who are trained in the new Breform™ cosmetic breast operation. He has contributed to numerous articles in the national press (Sunday Telegraph, Daily Telegraph, Daily Mail) as well as the local press and BBC Radio Gloucestershire.

He has written breast cancer guidelines for the Association of Breast Surgeons, organised national cancer surgery meetings for the British Association Of Surgical Oncology, and reviews oncology education across Europe for the Accreditation Council of Oncology in Europe.

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