§ 3.12 p.m.
§ Mr. D. M. Keegan (Nottingham, South)
My first task is to apologise to my hon. Friend the Parliamentary Secretary to the Ministry of Health for delaying his enjoyment of the Whitsun Recess. I know that his interest in this subject is probably as keen as mine and that he will not begrudge the time which it takes him to reply to a debate on so important a medical topic.
It was nearly two years ago that I first raised this question in the House. I think that it was the first debate ever held in this Chamber on the subject of multiple sclerosis. I got a most sympathetic and useful reply from the then Parliamentary Secretary, and I only hope that the answers I get today to my queries will be as useful as where those on the last occasion.
I hope to be forgiven for being slightly repetitive in the matter if, first, I say a few words about the nature of this most intractable disease. It is probably the commonest of all nervous diseases in the country today and the average number of sufferers at any one time is estimated at between 40,000 and 50,000 people. It has an annual death rate of about 1,500. Every year, about 800 die from the immediate causes of multiple sclerosis and another 700 die from the disease as a contributory cause, bringing the death rate to a very substantial figure. This is a problem which, I am sure, everyone would wish to be solved as soon as possible.
When one considers that other diseases which are so much better known to the public receive so much more attention but are much less in their incidence, one wonders why the disease of multiple sclerosis is so little known to the community at large. For instance, I believe that approximately 200 to 300 deaths a year are due to poliomyelitis. That is an endemic disease and one which no sufferer of multiple sclerosis would wish to minimise, but the problem of multiple sclerosis is very much more serious and much more intractable.
I want to give a brief description, so far as it lies within my power, of the effects of this disease. It is one which 1651 attacks people in the prime of life. The most common age group in which it is found is between the ages of 25 and 40. While, perhaps, it is slow to take effect, it is a disease which is invariably fatal. It may take as long as twenty to thirty years to run its course and during that time the sufferer can look forward to nothing better than a life of increasing debility and disablement. It is almost characterised by its frequent remissions and onsets, so that the degree of disability is never accurately known to the patient or to his medical advisers. This makes the question of employment incredibly difficult to the sufferers.
Many of the people suffering from the disease find themselves in the chronic sick wards of hospitals, and in the last Adjournment debate which we had on the subject it was said that attention would be paid to the problem of the hospital care of sufferers from the disease. Many of them now find themselves for years in the geriatric wards of hospitals where their only companions, as far as patients are concerned, are the old and senile. This, I think, has a demoralising effect on the people suffering from the disease. If anything can be done to assist the young chronic sick in this way, I am sure that it would meet with the gratitude of all affected.
I think that I can give some useful statistics on the matter, because a survey has been made in the particular hospital group by a very excellent young almoner named Miss Whittaker. She made a survey of the number of chronic young sick suffering from nervous diseases. It was found that five-sixths of the people in these wards suffered from nervous diseases and of one-third of the total most suffered from multiple sclerosis. This gives some idea of the extent of the problem.
The main object of this debate is to bring up to date, I hope, what was said two years ago. At that time I mentioned only briefly the question of research into this very serious disease. The Parliamentary Secretary said:The need for further research on multiple sclerosis is fully realised, but it is the intractible nature of the problem rather than lack of funds which hampers progress at the moment. If I can put it more simply, it is lack of bright ideas and not of cash which is holding us back."—[OFFICIAL REPORT, 7th June, 1957; Vol. 571, c. 1671.]1652 Since then a good deal has happened which brings the question of research into the causes and effects of the disease much more to the fore.
I propose now to refer to a leading article in the Lancet of 28th March, 1959, which, after a lengthy and, I may say, to me, almost completely mysterious article which uses many long words which I do not properly understand, ends with the following crystal-clear statement:An expanding vista of research into the pathology of the demyelinating diseases is now opening for any investigator who is prepared and equipped to cultivate the new experimental techniques. Perhaps the Ministry of Health, whose then Parliamentary Secretary, winding up a debate on multiple sclerosis, suggested that 'it is lack of bright ideas and not of cash which is holding us back', may be persuaded to reconsider its view.That article is of recent date, and what I wish to say now must not in any way be interpreted as an attack on the Ministry. As far as I can ascertain them, the facts are these.
The total allocation for medical research given to the Medical Research Council in the year 1958–59 was £3,137,000. In 1959–60, it will be £3,518,000, a slight increase. But over the last three years the amount allocated for research into multiple sclerosis has remained at the figure of £5,000. Of course, money is not the only limiting factor in this question. It is obviously wrong for a lot of money to be spent pursuing wrong ideas, but now that we have a very authoritative statement by one of our leading publications in medical matters stating that an expanding vista of research is opening up before us on this question of multiple sclerosis, it surely behoves the Ministry, which represents the Medical Research Council, to see that a great deal more money is provided for the purpose of investigating this horrible disease.
I am told that the two excellent centres in this country, Leeds University and the Pathological Department of Guys Hospital, in London, are only awaiting the infusion of money to be able to conduct a great deal more research into this matter. Use of the electron microscope for studying changes in the myelin sheath has made certain fields of inquiry probably very much more fruitful than we thought they would be several years ago. If the Parliamentary Secretary 1653 cannot give an undertaking that the amount of money granted for this purpose will be increased, I hope that he will bear this matter very much in mind, because without money we can do nothing.
It is interesting to note that the Multiple Schlerosis Society, about which I spoke at some length two years ago, and whose work is characterised by such humanity in this field, is prepared to spend £35,000 on any likely avenue of research into this disease. Surely if the pennies, sixpences and shillings of subscribers and well wishers of the people who have the disease, or who have friends affected by this disease, can amount to a fairly formidable sum like this, it is not asking too much that the Government should at least come in on a partnership basis and contribute something like the same amount to the benefit of research in the future. The Medical Research Council ought to be given more money for this purpose. It is clear that there is a vista of research which can be pursued and ought to he pursued. More money is needed for this task.
I will not finish this debate without saying that there are other aspects of the disease which are extremely important. Everybody knows the nature of cancer. tuberculosis, and poliomyelitis, and some of the main causes of them. Very few people know what multiple schlerosis do not, nor would any sufferer from this disease, wish for the spotlight of cheap publicity to be turned on this disease. That would be wrong, but, at the same time, there are inestimable advantages to be gained when there is a proper community relationship between public knowledge and the sufferers of this disease. It is partly for this reason that I have brought this matter to the attention of the House again
So much can be done if one knows what the problem is. That is why the Multiple Sclerosis Society was formed. It was formed to give day-to-day assistance in practical ways to sufferers of this disease and to their families who are acutely affected when one of their number is suffering from this disease. It may be that the few words I have to say this afternoon and the Parliamentary Secretary's reply will find their way into the organs of publicity and bring about a closer understanding of this disease and its incidence, and will get some public 1654 sympathy for the sufferers of it. It is hard for any society to exist unless its work is well known. I hope, therefore, that there will be some increase of enthusiasm for the work of voluntary bodies who assist these people.
I do not wish to take up too much time, but surely there lies in the heart of every person, and particularly the sufferers from this disease, a hope that in due course something will be done, a cure will be found, same knowledge will be obtained, which will, if not for the person himself, for those who come after solve the terrible problem of this frightening disease. The prospect which faces a sufferer of multiple sclerosis is horrible—a lingering, crippling disease and eventual death. Provided that there are useful ideas to exploit and people capable of working on research on this disease, effort should not be spared to make certain that we do not lose any opportunity to pursue this matter to the full.
I ask the Parliamentary Secretary to encourage in what way he can research into this extremely horrible and frightening disease.
§ 3.25 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Mr. Richard Thompson)
My hon. Friend the Member for Nottingham. South (Mr. Keegan) has done a service on this occasion, as he did two years ago, by drawing attention to the nature of this difficult and intractable disease, the incidence of which he accurately described, the cause of which, unhappily, we do not know and a cure for which has not yet been found. I propose to devote most of my speech to the aspect of research, which mainly interested my hon. Friend.
My hon. Friend referred to the question of hospital services for sufferers from this terrible disease. Patients with multiple sclerosis form a high proportion of the younger chronic sick patients in hospital. As he suggested, it is, clearly, undesirable for them to be nursed, perhaps for many years, in the company of elderly or senile patients. On the other hand, there are comparatively few younger chronic sick, and to gather them into fair-sized groups to be looked after on their own would mean moving many of them far away from their families and homes. 1655 My right hon. and learned Friend the Minister of Health has asked regional hospital boards to find out how many younger chronic sick patients there are in each of their areas and to consider whether they could be grouped together in one or more hospitals. In this way my right hon. and learned Friend hopes that sufferers from multiple sclerosis, and other diseases which disable patients comparatively early in life, may be nursed in congenial company.
I also read the article in the Lancet about the myelin sheath to which my hon. Friend referred. As a layman, I found it difficult to follow in an intelligent manner, although I think that I have the drift of the argument. A good deal of work on multiple sclerosis is in progress in this country, both under the auspices of the Medical Research Council and otherwise. So far, the treatment of the disease has proved a particularly intractable problem, but some progress has been made in fundamental research into its pathology.
Many studies have been directed towards the identification of a specific casual factor, such as a virus infection or nutritional deficiency, but conclusive results have not been obtained. My hon. Friend will know that Russian research workers have reported the isolation of a virus, closely related to the rabies virus, in cases of disseminated sclerosis and have prepared a vaccine from it. But these workers do not claim that treatment with it has unqualified success. No controlled clinical trials of its value have ever been reported.
We took an interest in this, and in July, 1958, Professor Dick, of Belfast, who had visited Russia and was associated with a Medical Research Council inquiry, sent a letter to the British Medical Journal, jointly with Professor Shubladze, one of the originators of the vaccine, saying that they thought it necessary to reinvestigate and characterise the original isolates of the virus because recent experiments had shown that the strain in current use was similar to rabies virus. In other words, they had some doubts about its efficacy.
Social and geographical studies have suggested a variation in the incidence of the disease. For example, a recent survey shows a striking difference in incidence 1656 between two different areas of Scotland. The reason for this is not known, although it has been suggested that racial differences or dietary factors may be involved.
There is no evidence that hereditary factors play an important part, or that any significant change in the overall incidence of the disease has occurred in this country in recent years. The well-known tendency in this disease to spontaneous improvement, which occurs for varying lengths of time—to which my hon. Friend referred—makes it particularly difficult to assess the value of the different remedies and methods of treatment. To date, no treatment has been found which has any fundamental effect upon the progress of the disease.
Promising results were reported from Canada a few years ago, where patients were treated with isoniazid, but they have not been so far repeated in this country. Recent work at Oxford suggests that an immunological disorder may be implicated. Work supported by the Medical Research Council at Guy's Hospital Medical School, and recently reported in the Lancet, on the fundamental structure and biochemistry of the myelin sheath has revealed a promising line of possible research into the fundamental pathology of the demyelinating—awful word—diseases.
At present, the main effort of the Medical Research Council is being concentrated on this fundamental work, in the hope of finding out the exact nature and cause of demyelinisation, that is, the form of degeneration of parts of the central nervous system which leads to the appearance of symptoms of the disease. Work is in progress now on the structure and biochemistry of myelin and its metabolism. It has been shown, by the use of radioactive isotopes, that lipid compounds in the myelin sheath of the nerve remain there indefinitely once they are laid down in the embryo.
Other approaches to the problem include the investigation of the biochemical and pathological changes in the cerebrospinal fluid; the experimental growth of isolated nerve cells in tissue culture; and a study of the factors affecting myelination in the central nervous system of the developing chick embryo. Experimental work is also being undertaken on the production in animals of demyelinisation 1657 by means of organic compounds found in certain bacilli.
It is estimated that about £8,000 will be spent during this financial year by the Medical Research Council in supporting work of this kind at Guy's Hospital, at the Institute of Clinical Research, at the Department of Neurology of the Middlesex Hospital, at the National Hospital for Nervous Diseases, and at Leeds University. It is hoped, as has always been intended, to expand the work at Guy's Hospital.
Another aspect of the problem which may in future be reinvestigated with advantage, now that new techniques of virus research are available, is the theory of virus causation of the disease which may have been inadequately evaluated before modern methods and apparatus were evolved. Research of this nature is being carried out at Queen's University, Belfast. Independent societies, such as the Multiple Sclerosis Society, to which my hon. Friend devoted some part of his speech, have also provided funds for work at King's College Medical School, Newcastle-on-Tyne, on a survey of the disease in North-East England and for further projects here and at other centres.
Research is also taking place with the support of university and hospital endowments and with aid from regional hospital boards, as other centres such as the Middlesex Hospital, the Queen Elizabeth Hospital, Birmingham, the Maida Vale Hospital for Nervous Diseases, Leeds University and the Royal Victoria Hospital, Belfast. The Nuffield Foundation has made two substantial grants to the Departments of Neurology and Neuropathology of the United Oxford Hospitals for the investigation of immunological reactions of the central nervous system, of £15,660 to be used over three years, and £10,700 to be used over two years.
It has always been stated that it is the intractable nature of the problem 1658 rather than lack of money which hampers progress, and that remains true. I do not want my hon. Friend to think that that is a shield, as it were, for not devoting adequate resources to this work. It is not. Promising lines of research can be assured of adequate support. I want to make that quite clear. It should he noted that part of the fundamental work to which recent reference was made in the Lancet is supported by the Medical Research Council and that it has always been envisaged that this work would be expanded as necessary. In addition, no suitable application for a research grant for work in this field has been rejected by the Council in recent years.
I want to leave my hon. Friend with this thought in his mind: it would be the greatest mistake to suppose that the total effort which is being directed into this intractable and baffling disease is in any sense to be measured by the figure of £8,000 allocated in the Medical Research Council's budget to research projects specifically related to it. In the National Health Service there are many specialists, among them about 70 consultant neurologists, who, every day, are at grips with this problem through their dealings with individual sufferers. It could well be that at any time one of them might by chance or design elucidate a promising line of approach which may provide the vital clue to the cause of the disease. Should such a clue be found, there is no doubt that the appropriate financial support would be forthcoming from official sources to enable it to be effectively followed up.
That, I think, rather than some undertaking in terms of money, when at present we are not quite certain how we might spend it, is the kind of reassurance which my hon. Friend seeks today in the debate, which I hope he will feel has been valuable and has served some of the purposes which he had in mind.