§ 4.23 p.m.
§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, with the leave of the House I should like to repeat the Statement made by my right honourable friend the Secretary of State for Health in another place. Before doing so I should like to declare an interest. My husband 1297 manages a dairy and beef producing farm. There have been cases of BSE, but we have no share in the farm's assets. The Statement is as follows:
"With permission, Madam Speaker, I would like to make a Statement about the latest advice which the Government have received from the Spongiform Encephalopathy Advisory Committee. The House will be aware that this committee which is chaired by Professor John Pattison was established in 1990 to bring together leading experts in neurology, epidemiology and microbiology to provide scientifically based advice on the implications for animal and human health of different forms of spongiform encephalopathy.
"The committee provides independent advice to government. Its members are not government scientists; they are leading practitioners in their field and the purpose of the committee is to provide advice not simply to government, but to the whole community on the scientific questions which arise in its field. The Government have always made it clear that it is our policy to base our decisions on the scientific advice provided by the advisory committee. The committee has today agreed new advice about the implications for animal and human health of the latest scientific evidence. Copies of the committee's advice, together with a statement from the Chief Medical Officer, which is based on that advice, have been placed in the Vote Office and the Printed Paper Office.
"The committee has considered the work being done by the Government surveillance unit in Edinburgh which specialises in Creutzfeldt-Jakob Disease. This work, which relates to the 10 cases of CJD which have been identified in people aged under 42, has led the committee to conclude that the unit has identified a previously unrecognised and consistent disease pattern. A review of patients' medical histories, genetic analysis, and consideration of other possible causes has failed to explain these cases adequately. There remains no scientific proof that BSE can be transmitted to man by beef, but the committee has concluded that the most likely explanation at present is that these cases are linked to exposure to BSE before the introduction of the specified bovine offal ban in 1989. Against the background of this new finding the committee has today agreed the series of recommendations which the Government are making public this afternoon.
"The committee's recommendations fall into two parts. First, it recommends a series of measures further to reduce the risk to human and animal health associated with BSE. My right honourable friend the Minister of Agriculture, Fisheries and Food will be making a Statement about those measures which fall within his department's responsibilities immediately after questions on this Statement have been concluded.
"In addition, the committee recommended that there should be urgent consideration of what further research is needed in this area and that the Health and Safety Executive and the Advisory Committee on 1298 Dangerous Pathogens should urgently review their advice. The Government intend to accept all the recommendations of the advisory committee in full; they will be put into effect as soon as possible.
"The second group of recommendations from the committee offers advice about food safety on the assumption that the further measures recommended by the committee are implemented. On that basis the committee has concluded that the risk from eating beef is now likely to be extremely small and there is no need for it to revise its advice on the safety of milk.
"The Chief Medical Officer will be writing today to all doctors to ensure that the latest scientific evidence is drawn to their attention. In the statement by the Chief Medical Officer, which we have placed in the Vote Office, Sir Kenneth Calman poses to himself the question whether he will continue to eat beef. I quote his answer. 'I will do so as part of a varied and balanced diet. The new measures and effective enforcement of existing measures will continue to ensure that the likely risk of developing CJD is extremely small'.
"A particular question has arisen about the possibility that children are more at risk of contracting CJD. There is at present no evidence for age sensitivity and the scientific evidence for the risks of developing CJD in those eating meat in childhood has not changed as a result of these new findings. However, parents will be concerned about implications for their children and I have asked the advisory committee to provide specific advice on this issue following its next meeting.
"Any further measures that the committee recommends will be given the most urgent consideration. As the Government have repeatedly made clear, new scientific evidence will be communicated to the public as soon as it becomes available".
My Lords, that concludes the Statement.
§ 4.29 p.m.
§ Baroness Jay of Paddington
My Lords, I thank the Minister for repeating that disturbing Statement. It is an indication of the seriousness with which the Government now take the situation that there are to be two Statements this afternoon—one from the Department of Health, and one on agricultural matters to which my noble friend Lord Carter will respond.
It is unfortunate that the Government have now to tell Parliament that the possibility of a link between BSE and strains of CJD cannot be ruled out. That is after a decade of what one might describe as confident, sometimes almost dismissive, denials of all connections. I imagine that all noble Lords will remember the picture of the then Minister of Agriculture, Fisheries and Food, Mr. Gummer, feeding hamburgers to his daughter. I wonder whether he would do that so cheerfully today.
Perhaps I may remind your Lordships that at the end of February this year there were 158,277 confirmed cases of BSE in Great Britain and there are suspicions that many more have not been reported. By comparison, 1299 the number of cases of CJD is extremely small but the numbers have doubled in the past decade. Even someone with the most rudimentary understanding of medical statistics and epidemiology, such as myself, recognises that that kind of trend must be taken seriously. After all, cross species infection is not a figment of science fiction imagination. It is familiar and clearly recognised in conditions such as rabies contracted from infected dogs and the plague contracted from infected rats. I remind your Lordships that only last year there was a major outbreak of plague in India. Nearer to home, every year there are cases of bruscillosis caused by contact with cows who have undulant fever. The examples closest to BSE and CJD must be the human disease kuru and scrapie in infected animals. In those conditions, a serious viral illness develops slowly after exposure to infected products. Concern about the BSE/CJD link is obviously compounded by the very long incubation period before acute symptoms of human disease (CJD) may become apparent. I understand that the latent period of disease can be 10 years or more so that there may already be a large pool of people infected but not yet showing the symptoms of terminal disease.
As the Minister said in the Statement, it is only since 1989 that abattoirs have destroyed the parts of animals such as spinal cords and brains which were thought to be where the virus was most likely to be virulent if it entered the human food chain. At the end of November last year it was reported that the Minister would legislate to prevent the use of bovine vertebral column in the production of mechanically recovered meat.
Today the public needs information and reassurance. So far the BSE/CJD saga has been a public relations confusion and disaster. Facts have leaked out, scare stories have been spread, there have been scientific and medical challenges and too rapid political denials. Clear, authoritative, consistent information is important to enable people to understand and assess their own risks. It would be most helpful if the Minister could start by giving your Lordships answers to some specific questions today. If that is not possible perhaps she will give us an assurance that they will be rapidly forthcoming.
First, the Secretary of State said in the Statement which the Minister repeated that:There remains no scientific proof that BSE can be transmitted to man by beef, but the Committee has concluded that the most likely explanation at present is that those cases [of CJD in younger people] are linked to exposure to BSE before the introduction of the specified bovine offal ban in 1989".Can the Government now give specific guidance on which offal products should he avoided today? Are they soups, sausages, pies and hamburgers? Are there any food manufacturers which the Government believe are particularly risky or are there any methods of preparing food which cause additional risk?
I am glad that the Government say that specific problems related to children will be the subject of specific advice later. We obviously welcome that because the Government are aware that there is grave concern about school meals and matters of that kind.
1300 Secondly, given the very long incubation period of CJD, can the Government give specific information on the potential risks to people who ate the products containing offal or similar products between 1986 when BSE was diagnosed and 1989 when the abattoir regulations came into force? While we welcome the Government, through the Chief Medical Officer, today sending scientific evidence to doctors, will they also make sure that specific guidance is given to the medical profession and local health authorities about identifying the early symptoms of CJD, including professional advice on early diagnosis?
Finally, we on these Benches had hoped that the Minister would tell us that there would be an inquiry into the whole affair and that we might all learn why such official complacency has been allowed to develop in the face of reputable scientific questions over a long period. Will the noble Baroness ask her right honourable friend to initiate such an inquiry and to make certain that those findings are reported to your Lordships' House?
The Statement announces a new research initiative and we welcome that. We are glad to hear that it will take place as soon as possible. Obviously, further knowledge in this field is absolutely vital. After all, we have no reason to be complacent about the appearance and spread of new diseases. The most notorious recent example is AIDS caused by the HIV virus. That lethal virus was not even identified until the early 1980s, yet today the Department of Health describes HIV infection as the greatest new threat to public health. Now public health may well be under a new and terrible threat. In spite of the commercial difficulties to the agricultural industry, which I know my noble friend Lord Carter will wish to address, and the political embarrassment to the Government, it is public health which must now be given the highest priority.
§ Baroness Robson of Kiddington
My Lords, I thank the Minister for repeating the Statement made in another place. I agree with everything that was said by the noble Baroness, Lady Jay, about the problem now facing us. I find most disconcerting the fact that the committee, when it considered the research work done at Edinburgh by the Government's surveillance unit relating to 10 cases of CJD which have been identified in people under the age of 42, recognises that this is a new strain of the disease and that the causes remain to be explained adequately. The committee states that those cases are likely to have been contracted before the 1989 ban. It states "likely" and there is no justification for that statement.
I, too, wish to ask the Minister some questions. The Minister in reading the Statement stated:Copies of the Committee's advice, together with a statement from the Chief Medical Officer which is based on that advice, have been placed in the Vote Office".Until one minute before the Minister rose to address your Lordships I was hoping to obtain the Chief Medical Officer's advice. I have not yet been able to do so. Perhaps, therefore, we shall be asking unnecessary questions because we have not had the opportunity to read his suggestions.
1301 In relation in particular to the investigation in Edinburgh of the 42 cases, I am worried about the statement that those people must have been infected before 1989. That gives me no sense of security. The increase in the number of cases is worrying because in 1994 there were 55 new cases of CJD, which is 13 more than in 1993. The noble Baroness, Lady Jay, pointed out that the incubation period is long. I am told by medical friends that it is even longer than 10 years and can be 20 years.
The other self-satisfying part of the Statement is that the committee offers advice about food safety. On the basis that the new measures it is recommending are implemented, it concludes that the risk from eating beef is likely to be extremely small. The statement, "The risk is extremely small" has continually been made by the Government. It is not a new statement.
The other disturbing question is whether children are at greater risk than adults. They must inevitably be at greater risk when we think about the time lag of incubation. I am pretty old. If I ate some infected beef today, the odds are that I would be dead before I developed CJD. But young children who eat it will have many years before them during which they could run the risk of developing the disease. Surely parents will be most disturbed about the findings when they are reported in the press tomorrow.
I believe that the last part of the Statement is tragic. I refer to the part where the Minister mentioned the implications for children and parents and said that the advisory committee had been asked,to provide specific advice on the issue following its next meeting".I have no idea when the committee's next meeting will take place. But, in the meantime, parents will be most concerned. In many ways we are discussing an interim report. What will happen in the meantime? Will the Chief Medical Officer, whose advice I have not seen, be making recommendations to local authorities on what to do about schools? Alternatively, are we going to allow local authorities to decide the matter, which means that some of them will serve beef in schools while others will decide not to do so?
Whatever we decide to do, the policy should have universal coverage. Moreover, what about health authorities and hospitals; and, above all, the general public? Many questions are raised in the Statement. It seems to me that, during the interim period before the new advice will be available, the disturbance among the general public will be very great.
§ Baroness Cumberlege
My Lords, I should like, first, to reply to the noble Baroness, Lady Jay. I really resent the comment that the Government are being complacent on the issue. We have always taken the matter most seriously since the disease was first discovered. The noble Baroness will know that we set up two scientific bodies in 1990 to safeguard public health—namely, the Spongiform Encephalopathy Advisory Committee and the National CJD Surveillance Unit. Both bodies have reported consistently to us; we have published reports; and we have tried to be as open as we possibly can on the issue. Of course, when one is open with the public, there will be some controversy. 1302 We know that research is not static and that it is always on the road to discovery. As new elements are discovered they are a subject of discussion.
The noble Baroness asked me about particular foods and what was and was not safe to eat. The best that I can do is to quote from the statement made by the Chief Medical Officer. I should like to apologise to your Lordships in that respect, and particularly to the noble Baroness. As she knows, I was in the Printed Paper Office trying to get that particular document released. I shall look into the matter and ascertain why that did not happen.
The message is consistent. There remains no scientific evidence that BSE can be transmitted to man by beef. In his statement, the Chief Medical Officer says that meat or meat products on the shelf or in carcass form do not need to be removed or destroyed. He goes on to say that there is nothing in the committee's advice to change the current advice on the safety of milk. As I quoted when repeating the Statement, perhaps one of the most testing questions is to ask the Chief Medical Officer whether he will continue himself to eat beef. As I quoted, he said that he,will do so as part of a varied and balanced diet".The noble Baroness, Lady Robson, asked specifically about children. At present there is no evidence for age sensitivity. The scientific evidence for the risks of developing CJD in those eating meat in childhood has not changed as a result of the new findings. However, as the Chief Medical Officer says in his advice to us, parents will be concerned about the implications for their children. That is why the advisory committee has been asked to provide specific advice on the issue.
The noble Baroness also asked when the committee would be meeting and when people would receive the advice. The committee is meeting over the weekend, so we expect that advice to be available very soon. The noble Baroness asked about the incubation period. From the advice that we have, we believe that it is between five and 15 years.
The message is consistent. The noble Baroness seemed disappointed that, again, we are saying that the risks are very small. However, it is a consistent message. The reason for bringing it to your Lordships today is that there has been a discovery in that there are 10 cases which we believe are a different variant of the disease. In our spirit of openness, we wanted to make your Lordships aware of that fact.
§ 4.45 p.m.
§ Lord Boyd-Carpenter
My Lords, I hope that my noble friend the Minister will be able to clear up what for me at any rate was not clear from the Statement. Can she say whether, as of now, the Government are advising parents and school caterers not to include beef or any other specific commodity in the diet of those for whom they are responsible? My noble friend indicated that there was an element of doubt, but is she aware that most parents are not prepared to risk doubtful commodities in the diet of their children? I suggest that it is up to the Government to indicate whether they 1303 would advise responsible parents and responsible headmasters not to include beef or any other article in the diet of those for whom they are responsible?
§ Baroness Cumberlege
My Lords, the Government do not wish to advise the general public in any way differently from the current advice; namely, that we advise schools that they should continue to serve beef for school meals. However, because an element of doubt is creeping in, we have asked the advisory committee to consider the matter. As I said, the committee will be doing so over the weekend. We expect further advice very shortly.
§ Lord Boyd-Carpenter
My Lords, will my noble friend the Minister answer the rest of my question about parents?
§ Baroness Cumberlege
My Lords, of course I understand the concern of parents. However, it would be totally wrong for the Government to issue some contrary advice—that is, advice that they do not give at present—without the scientific evidence to support it. We are searching for that evidence. As I said, we shall be advised very shortly. That advice will, of course, be given to parents.
§ Lord Winston
My Lords, with the greatest of respect, I do not want to say that the Government are necessarily being complacent hut, for several reasons, this strikes us as being a very complacent Statement. BSE and CJD are both puzzling disorders which are caused by a prion which is a curious particulate protein disorganisation which is not fully understood and, therefore, not easily traced in the usual way by looking, as one would, at other infections caused by viruses or bacteria.
However, one of the crucial questions—in fact, there are a number of questions which I believe are begged in the Statement—is that we need to know much more about the pattern of disease in the 10 cases which have just been reported. The highly significant fact is that they are under the age of 42. I believe that I am right in saying that CJD classically occurs in one or two per million of the population. It occurs mostly in older people, usually over the age of 60. What led us to recognise that the administration of growth hormone carried the disease to young children and what led scientists to recognise that there was a different disease was its sudden presentation between 10 and 20 years later in much younger people in their 30s and 40s.
The real question that we have to ask the Minister is: can she tell us whether or not the pattern of disease that has now been reported in Edinburgh is the pattern of disease seen in classic CJD, or is it the pattern of disease seen after the injection of growth hormone? Alternatively, are we seeing a new pattern of disease with a different kind of presentation and a different onset of dementia? If we are, I can tell your Lordships that we have a real problem. That is the essential issue. The problem is that the Statement does not give us information that we need.
1304 There are a number of matters that we need to know from the Minister. Have these patients had flu jabs? Have they been exposed to bovine serum albumen? Have they been exposed to hormones such as FSH or other exogenous proteins? We need the publication of the scientific evidence because that is how we shall judge whether or not it is a serious issue or a trivial one completely unconnected with offal or beef.
§ Baroness Cumberlege
My Lords, as a member of the medical profession, I am sure that the noble Lord will appreciate that the Government take advice from the medical and scientific community. We would not act without that.
As regards the individual cases, I do not have that detailed knowledge. However, I can tell the noble Lord that none of the 10 cases is the result of growth hormone or other medical interventions. These 10 cases come from the sporadic group. He will know that with this disease there are several groups, including iatrogenic, familial and GSS.
The committee and the other advisory committee which we set up, the National CJD Surveillance Unit, often submitted papers to the Lancet and to other learned medical journals. Perhaps they will do so in this case, but that is a matter for them; it is not a matter for me.
§ Lord Campbell of Alloway
My Lords, is there any recognisable symptom, apart from the onset of dementia, that a parent or anyone else can appreciate? Is there any effective antidote? If so, is the antidote or the treatment freely and generally available? I ask in ignorance; I really do not know.
§ Baroness Cumberlege
My Lords, this is, of course, a very rare conditions, As the noble Lord, Lord Winston, said, it is found in only one in a million; it is extremely rare. I am not sure whether it has ever been found in young children, but there have been cases in teenagers. The group being looked at involves those under 42. As my noble friend said, very often it is found in elderly people.
Not only dementia, but also an uncertain gait, and sight and speech impairment are physical symptoms of this disease. As regards an antidote, there is not one. There is not a test either. That is why it is a quite difficult disease to identify and to control.
§ Lord Ewing of Kirkford
My Lords, is the Minister aware that Sir Kenneth Calman, the Chief Medical Officer, is a man for whom I have the highest regard? However, it does no good for Sir Kenneth to say that he will continue to cat beef. That reflects shades of Edwina Currie saying that she will continue to have a boiled egg while telling the nation that eggs caused salmonella poisoning. I appeal to the Minister to use her not inconsiderable persuasive powers to stop public figures from making such statements which do not reassure the public. Millions of people will not rush into restaurants either tonight or Saturday night saying, "Sir Kenneth Caiman will have a steak so it must he all right for me to have one too". It does not work like that.
1305 Perhaps I may ask two practical questions. First, will the Government provide the resources necessary to fund additional research? Secondly, does the issue of food labelling have any implication for the consumer?
§ Baroness Cumberlege
My Lords, I really resent the comments made about the Chief Medical Officer. I share the noble Lord's view that he is a man of enormous integrity. However, the Chief Medical Officer on frequent occasions has been asked by the media whether he would eat beef. Therefore, as the media feel it an important question, it seemed appropriate that he should answer it straightforwardly in his statement.
The Government have set aside £4.5 million for research. That is in addition to the MRC and other funding bodies. It will be up to the research and development division to commission the research and to ensure that its protocols and submissions are speedily considered.
I do not believe that there are implications as regards food labelling. But that is a matter shared between the Department of Health and the Ministry of Agriculture.
§ Lord Harris of Greenwich
My Lords, first, perhaps I may return to the question asked by the noble Lord, Lord Boyd-Carpenter, about the position in relation to parents and local education authorities. What should a local education authority do tomorrow? Does it serve beef or not? As I understand the noble Baroness, so far as the Government are aware there is no particular risk as regards children. Notwithstanding that, the committee is having a weekend meeting to discuss that precise question. I do not wholly understand the logic of that position. Perhaps the noble Baroness will clear it up for us.
Secondly, the noble Baroness kindly said that she would look into the circumstances in which the statement of the Chief Medical Officer was not available in the Printed Paper Office. I hope that that will be done. I am sure that she will follow it up. It is very disturbing that a statement of this considerable public importance is not available to Members.
§ Baroness Cumberlege
My Lords, I agree with the noble Lord on the second point.
As regards advice to local authorities and parents, the scientific committee advising us has said that there is at present no evidence of age sensitivity. Those findings do not change the scientific evidence of developing CJD in those eating meat in childhood. The committee will, of course, provide further advice, as the noble Lord said. At this moment it sticks with its current advice.
§ Lord Lyell
My Lords, will my noble friend give me some advice on the plethora of figures? Do I understand that these cases involved people below the age of 42? Is there any significance in that specific age; and, if so, why?
§ Baroness Cumberlege
My Lords, most post mortems reveal a much greater incidence of Alzheimer's 1306 and other brain damage among older people. At present the research is with young people—the cases involved are under 42 years of age.
§ Lord Gladwin of Clee
Lords, it is not a question of whether the Chief Medical Officer will eat beef, or whether we will eat beef. Is not the question whether young children in schools should be given beef products and products made from offal? Is that not where the doubt arises?
§ Baroness Cumberlege
My Lords, I believe that I have answered that question several times this afternoon. There is at present no evidence of age sensitivity; and the findings do not change the scientific evidence of developing CJD in those eating meat in childhood. I think that that is quite clear. Clearly there is anxiety on this issue. That is why we have asked the scientific committee to consider the issue again and to come back to us with its findings. As I said, it will be meeting over the weekend.
§ Baroness O'Cathain
My Lords, will my noble friend clear up some confusion in my mind? The abattoir regulations were introduced in 1990. First, if those regulations have been strictly enforced from 1990 to the present day, should there be no worry for people eating beef now? Secondly, are the Government utterly convinced that the abattoir regulations are being strictly enforced?
§ Baroness Cumberlege
My Lords, the statement by the Spongiform Encephalopathy Advisory Committee is that the most likely explanation at the moment for the 10 cases .is that they are linked to exposure to BSE before the introduction of the ban in 1989. As to the second part of my noble friend's question, I shall leave it to my noble friend, who will pick up the agricultural issues in a moment.
§ Lord Blease
My Lords, has the Minister any information about the implications on the international scene? Has any information or have any statistics been brought forward on what is happening in EC countries or internationally? It is important for our business associations and for cross-Community relations that we should be aware of what is happening in other countries.
§ Baroness Cumberlege
My Lords, CJD is no more prevalent in this country than in other European countries. Indeed, it is no more prevalent in countries that do not have BSE. That is a telling statement.
Lord Bruce of Donington
My Lords, has the Minister any specific recommendation—I emphasise the words "specific recommendation"—as to the future use of beef offal?
§ Baroness Cumberlege
My Lords, the Government have taken action in removing the offal that was thought to be a carrier of the disease. As to my giving specific advice this afternoon, I would not do so. I want it to be based on the scientific evidence that we shall receive shortly.