HC Deb 04 June 1959 vol 606 cc497-506

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Brroman-White.]

10.3 p.m.

Mrs. Eveline Hill (Manchester, Wythenshawe)

I want to raise the question of migraine, a complaint which affects far more people than is generally realised. In a National Health Service every effort must be made to prevent illness, otherwise it is a national illness service and not a health service.

In the treatment of diphtheria and cancer tremendous strides have been made, and in the treatment of tuberculosis the new drugs have helped tremendously, but they are killer diseases and because of that they attract attention and publicity. Migraine, the subject of this debate, is one of those complaints which makes one want to creep away silently and hide until the devastating attack has passed over. Then one waits in great uncertainty for the next attack. We are asking for science to help—and not silence.

Migraine is not merely a severe headache; it is something very much more than that. It affects men, women and children—women in the ratio of three to one as against men. Comprehensive figures of this complaint are not available, but an estimate has been made, based upon a recent small investigation carried out by a doctor, that, on the average, between 150,000 and 200,000 people have to take from one to three days off in bed each week because of this devastating disease. That means a loss of time from their jobs, and disruption in their homes and in their social lives.

It may be contended that these figures do not agree with the morbidity statistics obtained from general practitioners, published last December in a Stationery Office report, which showed migraine consultations at 1.2 per cent. The reason for this debate is that other investigations, by a consultant who has made an intensive study of this complaint over the years, have proved that many so-called cases of severe headache are, in fact, migraine, and, therefore, the figures cannot show the true state.

Many cases which have attended London hospital clinics and have received no benefit have eventually found their way to the Putney Migraine Clinic, to be treated there by this specialist and to receive considerable benefit. In fact, from 80 per cent. to 90 per cent. of these cases have improved, and some have been completely cured. The service at this clinic, which is run by voluntary means, is limited to the time the specialist can spend there, because all his services are given free. Since the clinic was opened in 1950 he has dealt with about 2,000 cases involving about 150,000 supervision consultations.

I want to make it clear that the patients who find their way to this clinic do so on a certificate from their general practitioners, and that this is an honest-to-goodness clinic, with no quackery about it General practitioners know of the work done there. This treatment can be given by the specialist privately at his rooms, and if people can afford to pay the fee and also to pay for the hospitalisation which is essential at the beginning of the intensive course of treatment, many more can benefit. What we are asking, however, is that the whole question should be investigated, so that the treatment can be given under the National Health Service and benefit can be obtained by a much greater number of people—in fact, all people who are eventually found to be sufferers from migraine. We want this service to be made available all over the country.

Further, it is highly desirable that the skill of the specialist should be widely known. I am sure that that can be done if the Ministry will investigate the subject, so that the specialist's technique can be passed on to other people, who can treat cases in a similar way. The specialist is not anxious to retain all the knowledge in his own hands for his private cases; he is anxious that all people should benefit under the National Health Service.

Even as far back as 1949 letters were sent to the Ministry asking about a clinic for this complaint, just as we have clinics for rheumatism and other complaints. Questions have also been asked in the House. Information about this form of preventive treatment was published in the Lancet as far back as 1942 and has never been disputed in the medical world. In fact, confirmatory publications have appeared in the Nova Scotia Medical Bulletin and the British Medical Journal as recently as 1956.

It is interesting to note that recently an R.A.F. man, who was appealing against the refusal of a pension, was eventually successful in gaining one because of migraine on the evidence of this specialist. It was agreed that migraine was an attributable disease. We are not asking for money for the Putney Migraine Clinic, as some people may have thought from the letters circulated yesterday. We ask that there should be this investigation which, as far back as 1954, in answer to the hon. Member for Sowerby (Mr. Houghton), the Minister said that he would be interested to make; and for which the chairman and the members of the committee running the clinic and the doctor offered every facility.

Alas, nothing whatever has happened. So in the intervening period, only those people fortunate enough either to have read a book on the subject written by the doctor, or those who have come into contact with someone who has received treatment have been able to obtain assistance.

I am sure that hon. Members have friends or relatives, or know of constituents, who suffer from this frustrating complaint. It may be that hon. Members themselves may be sufferers, or there may be members of the staff of the House who suffer from it. If the investigation is made and more people take advantage of this treatment I am certain there would be a saving in the drug bill. Unfortunately, there is a small percentage of sufferers who can obtain no help, but there are others who can keep going on drugs which may cost them as much as £50 a year. So I say that there is a chance of some saving in the drug bill. What matters much more is that greater happiness should be created among these people and better health afforded to a large number of sufferers.

I believe that this should be the purpose and an obligation of the National Health Service. I trust that the Minister will take the necessary steps to ensure that we may know something more about this treatment. In a debate of this kind we cannot go into a lot of technical details, but I hope that what has been said will prove a means of helping people to receive additional treatment through this type of technique which the specialist has taught himself over the years. I do not wish to say more, because I know that there are other hon. Members who desire to speak.

10.14 p.m.

Mr. Douglas Houghton (Sowerby)

I wish to support the request of the hon. Lady the Member for Manchester, Wythenshawe (Mrs. Hill) for the Minister to report on investigations which I hope have been made into this treatment, and to give any help which he can to the many sufferers from this depressing complaint. I live with it; my wife is a chronic sufferer. I hold no brief for this clinic, because my wife did not derive any benefit from the treatment given there. But I understand that many people have benefited, and as a cure for some may prove of no benefit to others, I hope that the Minister will have something to report.

I did not pester the Minister further, because I was subsequently in constant touch with our lamented colleague Mr. Richard Fort, who was a member of the Medical Research Council. From time to time he brought me reassuring news of the researches that were in progress.

I am glad that the hon. Lady has raised this matter. There are many silent sufferers from this complaint. Much efficiency is lost and much unhappiness is caused. These attacks used to be called "bilious headaches." People failed to appreciate what a tiresome and depressing complaint this can be. It drives people mad. People can have 48 hours of constant sickness and splitting headache and nothing can be done to relieve it. The ordinary private practitioner merely shakes his head and says: "We do not know the cause or the cure". Normal pain-killers leave it completely untouched. The migraine can set up secondary reactions of a most distressing character.

I implore the Minister to regard this as a very serious feature of the health of the nation, especially among women, and particularly women who have brainwork to do and who suffer from the nervous tensions of modern life. I implore him to give us news tonight, if he can. If he cannot, I beg him to take a message to the Minister of Health that this is a matter which the House presses upon the Minister, upon the Medical Research Council and the clinics, to carry out any possible research and investigation that can be done, and to undertake it with will and determination.

10.17 p.m.

Mr. Reader Harris (Heston and Isleworth)

I hope that the Parliamentary Secretary will excuse me if I endeavour to put my points very shortly.

I support my hon. Friend the Member for Manchester, Wythenshawe (Mrs. Hill) and the hon. Member for Sowerby (Mr. Houghton) because I am one of those who are not satisfied that enough attention has been paid to this disease which, I understand, affects in greater or lesser degree about 5 million people and causes about 180,000 to spend one or more days a week in bed.

It may be that enough is being done, but I am not satisfied on the point at the moment, in view of the statistics which have been produced, and much evidence that the general practitioner, as the hon. Member for Sowerby said, is inclined to wash his hands of the matter. So are hospitals, if they find an intractable case. Many of these cases are intractable and so they simply wash their hands and say, "We can do nothing for you." I am not satisfied that there is sufficient realisation in official quarters that there is a difference between headache and migraine and that the two may need different treatments. I am not satisfied that enough is being done to cure the disease as distinct from merely ameliorating it.

My impression is that the modern drug which contains ergot will stave off a migraine or minimise it slightly. It may, in certain cases, cause the attack to come on less frequently but it is not a cure. The Eileen Lecky Migraine Clinic, in Putney, does not make any exaggerated claim, but it can prove that in about 25 per cent. of the cases there has been a complete cure and that in about 70 per cent. of the rest there is sufficient improvement to warrant going on with the treatment. Even this clinic has to admit that in about S per cent. of the cases it can do nothing.

I would ask my hon. Friend the Parliamentary Secretary to tell us what the Medical Research Council is doing about this matter. Is he satisfied that it has examined this treatment sympathetically and impartially? Doctors, being only human, are from time to time a little jealous about new treatments. The Medical Research Council is right to be extremely cautious about any new remedy or therapy that is produced, but has it looked into it and into this treatment? If it has done so, what is the Council's advice to the Minister on it?

I believe that I am right in saying that this is a hormone treatment and that there may be dangers in it. I do not know. The treatment has been published in official journals, but I understand that nobody has ever disproved it or has said anything against it. When a new therapy or remedy is propounded members of the medical profession are often ready to pull it to pieces and to argue against it if it is not sound. I believe that there have been no arguments adduced against this treatment.

Much lack of confidence is caused by the failure of the Ministry to carry out a promise given by the Minister of Health, in answer to a Question asked by the hon. Members for Sowerby in 1954, that he would cause an investigation to be made into the clinic at Putney. Those concerned with the clinic know of no such investigation having taken place. It would allay much dissatisfaction and misgiving if one were to be made. The day may come when there should be an expansion of such clinics, but, first, can we have the matter looked into and the results published?

10.21 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Richard Thompson)

I am obliged to my hon. Friend the Member for Manchester, Wythenshawe (Mrs. Hill) for raising this matter this evening. As she rightly said at the beginning of her remarks, migraine is a widespread and distressing complaint which, perhaps, does not attract all the publicity and notice it would attract if it were a killer or crippler. I can well see that, while we are all very thankful it is not, that circumstance by itself may make sufferers feel that it does not, in all circumstances, get the attention it perhaps deserves.

We have been talking about research and what is being done about looking into the causes and appropriate treatment for this complaint. One of the difficulties about research on migraine is that it is a transient illness in which no pathological lesion has been demonstrated. However, it is known to be associated in some cases with a temporary change in the cerebral blood vessels. Although this fact is known the cause of the change is still obscure, since the precipitating factors of an attack are numerous and vary as between one person and another.

It is probable, therefore, that migraine is a set of symptoms occurring as a result of several quite different causes. Special attention has, therefore, been given by research workers at London and provincial hospitals to studying the causes of headache since such investigations may produce information about the causes of the particular type of headache which occurs in migraine.

Work on the causes of headache has included investigations into the anatomy and physiology of blood vessels in the brain which may be affected in migrainous headache, the sensory nerve pathways concerned with the appreciation of pain from the head and blood vessels, alterations in the circulation of the cerebro-spinal fluid and related ophthalmological disturbances.

The clinical aspects of the condition have also been extensively investigated in many neurological departments. I think that the hon. Member for Sowerby (Mr. Houghton) may have been referring to something with which our late colleague, Mr. Richard Fort, was concerned when he spoke of examples of what was going on. There are clinics at the National Hospital for Nervous Diseases, Queen Square, and at King's College Hospital, where a special study has been made of patients with migraine.

A number of different drugs have been tested clinically, but none has been found to be significantly better than the present accepted remedies, which may be varied according to the patient's particular case. Similar results have been obtained by workers in America. We are in touch with what has been going on there. On the research side, then, the picture is a little disappointing. It has so far been unrewarding, but to continue study on the lines described appears to offer the best prospect of success.

Turning to the particular question raised by hon. Members of the value of the functions being discharged by the Putney clinic and our attitude to those activities, I should like to say, first, that it is not and never could be the function of my right hon. and learned Friend actually to prescribe a particular line of treatment or to differentiate between one method of treatment and another.

In all these clinical matters we must rely on the medical profession itself, where adequate information is made available to them. I am sure that it has been in this case, because the specialist who is associated with this clinic has published a book on his findings well known in the profession and he is, indeed, a frequent contributor to the medical Press. Therefore, the profession itself is able to judge from the information which is available on the validity of the claims which are made. It is in a position to evaluate these claims and, if thought fit, to adopt any promising method of treatment advocated in them.

Dr. J. Dickson Mabon (Greenock)

The hon. Gentleman has said that various researches have been conducted in various institutions. Can he say categorically whether the particular therapy advocated by this consultant had, in fact, been carried out by a research team to assay its actual value in practice? That is a point about which many of us would like to know. Has the Minister information about that specifically?

Mr. Thompson

Perhaps I can help the hon. Gentleman by saying that the specialist concerned has published results which show that he has had a number of successes, but his reports are not based on controlled clinical trials and, therefore, it has been impossible to make a wholly objective assessment of their value.

Mr. A. Blenkinsop (Newcastle-upon-Tyne, East)

The point which we are interested in is that these controlled investigations should be carried out before we can judge. Has there been any opportunity of carrying them out?

Mr. Thompson

What we have done is to consider, in relation to everything else that investigation elsewhere has thrown up, the particular claims made by this doctor from his own experience in the treatment of this disease. On the basis of that, our medical advisers are not satisfied that we have here an effective and workable alternative to the other lines of treatment which are being followed elsewhere. While we do not deny for a moment that this doctor has a great reputation in this field, it is not for my right hon. and learned Friend to instruct doctors in the National Health Service that they must adopt any particular methods of treatment.

May I say a word about a point which was raised when my right hon. Friend the Member for Enfield, West (Mr. Iain Macleod) was Minister of Health, in reply to a supplementary question of the hon. Member for Sowerby on 22nd July, 1954. He said then: I shall be very glad to look at the particular experiment to which the hon. Gentleman refers, but there is a good deal of work going on, mostly under the Medical Research Council."—[OFFICIAL REPORT, 22nd July, 1954; Vol. 530, c. 1535.] I think that the hon. Gentleman will appreciate that he or his advisers can evaluate what is known to have been done in the clinic without necessarily making a present, on the spot investigation. That, in fact, is what has happened.

As I have said, this doctor's conclusions have been published and studied, and there is no secret about them. But on the basis of the information available about this interesting experiment it does not appear that there is any way in which my right hon. Friend could usefully intervene. Doctors are, of course, free to refer their patients to this particular clinic, as my hon. Friend the Member for Wythenshawe has said. Indeed, much of the treatment prescribed there is carried out by National Health Service doctors, and the cost of the drugs involved is, of course, met under the Health Service.

I do not dispute for one moment that migraine is a distressing and quite widespread condition, but it would be very wrong to conclude that nothing was known or being done about it and that the researches and good work going on at Putney were the only impact being made on this matter. We shall, of course, continue to keep ourselves informed of all the developments in this connection. As I said at the beginning of my remarks, the causes of migraine have not yet been ascertained by research. Unfortunately, no one method of treatment is, so far as we know, of general application.

The full facilities of the National Health Service are available to sufferers from this illness either through their family doctors or at out-patient clinics staffed by consultant neurologists, and there is no reason to suppose that these services are in any way inferior to those provided outside the National Health Service.

10.31 p.m.

Dame Irene Ward (Tynemouth)

I tried to follow what my hon. Friend said, but the real point is how, for instance, do doctors treating patients suffering from migraine in the North of England know about the clinic at Putney and how can general practitioners in the North recommend patients to this clinic?

What has not been made clear is that though all these experiments are going on they do not seem to have been very successful, yet in this clinic there have been a number of successes. Why should persons suffering from migraine have to await the results of all these clinical investigations throughout the country whereas if they were recommended to this clinic by the National Health Service they might be given relief?

The explanation given by my hon. Friend is entirely unsatisfactory. I think that it is the job——

The Question having been proposed after Ten o'clock and the debate having continued for half an hour, Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at twenty-seven minutes to Eleven o'clock.