2015 General Election, Andy Burnham, Democracy, Diabetes, Ed Miliband, Health, Healthcare, N.H.S., National Health Service, New Labour, Opinion, Politics, Professor Doug Melton, Public Health, Regenerative Medicine, Research and Development, Revolution, Stem Cell Research, Technology, Type 1 Diabetes, UK Regenerative Medicine Platform, Viacyte
The UK Shadow Secretary of State for Health.
The Labour movement is hurtling headlong into next year’s general election with its most vivid and appealing policy entirely wrong. Protecting the National Health Service is no longer revolutionary; it is no longer even particularly progressive. You eventually reach a point where your most venerable ideal is not ageing but simply rotting. In 2014, defending the NHS is no longer good enough. We should be demanding a whole world more from the Labour movement and from our political leaders.
The NHS is today the supreme political ideal, as stirring as the Union Jack was supposed to be, as rosily conservative as John Major’s “long shadows on cricket grounds, warm beer… old maids bicycling to Holy Communion through the morning mist.” For an institution which enjoys such universal popularity, the NHS always appears to be strangely fragile. It is forever tottering along on its last legs. It seems to be privatised anew every time the clocks go back, and the Tories are always scheming, as energetically as Wile E. Coyote, to flog it off, run it down, break it up, and inflict their inevitably “swingeing” cuts.
And so we turn to watch Labour traipse on to the stage, the designated defenders of the NHS. They are the party of the NHS – indeed the NHS is in their DNA! The struggling NHS is now the only injustice to which a Labour politician can respond with sentimentality. Looking around Britain’s deindustrialised landscape without seeing either problems or solutions, the shadow minister’s eyes finally rest on an underfunded hospital. Why look, it’s a miracle! Like a concrete Virgin Mary they’re weeping! Thank goodness, because if it wasn’t for the NHS they would just be unassertive Tories, helpless before the vagaries of roaming capital.
Perhaps the most significant line in Andy Burnham’s Labour conference speech this September was that his health policy offers “proof that all parties are not the same.” You can sense the relief in this line and the fierceness with which his political faction will cling to it. Burnham’s speech made good and evil as easy to identify as they are for children in a pantomime. “The public NHS, protected with Labour. Not for sale. Not now, not ever.”
Let us pause and listen to those two words ringing their dire toll. “Not ever.” What is so frustrating about our politicians’ dedication to the NHS, and their commitment to pumping billions into it, is that for the first time in its history the NHS is realistically faced with redundancy. It is now more than theoretically possible to cure many of the diseases which are treated on the NHS. And the greatest obstacle to this revolutionary change is that a fraction of state expenditure is devoted to research and development into regenerative medicine, when compared to the amounts spent on maintaining the existing bureaucracy. Last year’s combined English and Scottish NHS budgets came to about £104 billion. In the same period, the UK Regenerative Medicine Platform received (out of a different budget) a drop from the state’s ocean: £28 million.
Yet it is not merely that we should shut down a few groaning old hospitals and transfer their funding to some plucky new research laboratories. The very model of the NHS is systematically inadequate for delivering revolutionary healthcare. It admittedly possesses advantages over the healthcare systems of other nations. Industrialising stem cell technologies for the masses will necessitate extensive collaboration between experts of all different colours. Indeed, this explains the alphabet soup of research councils which are already stewing together under the Medical Research Council led 2012 Strategy for UK Regenerative Medicine. A centralised public healthcare system makes such a collaboration easier than in, say, a state such as California (which is investing $3 billion into “seeding” regenerative therapies).
The sticking-point in the UK is that private capital will be often excluded. For pharmaceutical companies, not all lines of research are equally viable, regardless of the magnitude of their potential benefits. Cultivating stem cells to replace animals or human participants in clinical trials is an approach which it is in the clear interests of big pharma to fund. Reconnecting the two halves of a patient’s spine with their own olfactory ensheathing cells requires no new medical product. Our dilemma seems clear-cut. Would research into regenerative medicine take off if the majority of future NHS surgery was allocated to private companies, allowing them a means of profiting from autologous therapies? Or should the state assume sole responsibility for the enormous costs of devising regenerative surgical procedures?
For an enthusiast rather than an expert, it is so far impossible to predict which therapy or technology will prevail. Whatever acquires priority will still arrive with related but entirely separate infrastructure requirements. And within this wider context, Labour’s campaign to preserve existing facilities in the face of budget cuts is no longer brave or difficult, but grotesquely irresponsible.
We might have to abandon the fortress and all of our sentimental home comforts in order to win the war. Put it this way: I suffer from Type 1 diabetes and if a politician announced that in the future I would have to purchase my own insulin, I would at first respond with the sort of strangled noises about prized public assets which Andy Burnham had made during his speech. But if that same politician insisted that my sacrifice would help to pay for future diabetics to be cured outright, then this would suddenly become a political narrative that I could buy into. I might feel that I was sharing in something bold and ambitious, a historical project which would leave a considerable dent in human ignorance.
What I am proposing is a healthcare covenant. It could be means-tested or it could apply to all but the most debilitating medical conditions. Nonetheless, the principle that the present generation should make sacrifices to help future ones is a lot more exhilarating than a story which involves clapped-out hospitals being kept chugging along.
Diabetes is a timely example because of (at least) two recent forays into this frontier. Harvard University’s Professor Doug Melton has grown millions of insulin-producing cells in vitro from embryonic stem cells and he has shown that they function in the bodies of mice. There is as yet no means of guaranteeing that these cells would survive an assault from the human immune system. On the opposite coast, the San Diego start-up Viacyte is in the process of inventing an artificial pancreas; a project which has secured millions of dollars of venture capital funding. The device’s membrane is meant to deflect antibodies, whilst allowing insulin and glucose a free passage.
It is early days for both projects and both are essentially still appealing for funding and scientific recognition. But should they prove to be successful we might compare them to the work of two late nineteenth century inventors who have designed carriages with internal combustion engines. Until the appearance of industrial car manufacturers, an oil industry, motorways, streetlights, petrol stations, driving authorities, and traffic regulations, these two cars remain rickety, crackpot contraptions.
Of course, it does not devalue the inventors’ ingenuity to point out just how useless their inventions are without the vast infrastructure which is needed to transport them into our lives. It is just that the revolution is not contained within the invention.
The NHS currently spends £27 million a day treating Britain’s three million diabetics, not only by providing insulin but by inflicting the medieval punishments that come with the later stages of the condition (eyes gouged out, legs cut off). Some obese patients can be already cured of Type 2 diabetes with weight-loss surgery. The manufacture of synthetic pancreases, and the surgery needed to implant them, would become rapidly cheaper when to scale. The nationwide costs of treating diabetes (£10 billion per annum) would duly nosedive. Clinics would be axed, the prescription drugs (which are gratis for UK diabetics) would be immediately superfluous, and less labour would be lost to the economy through disability and premature deaths. Furthermore, as wealthy diabetics descended upon the UK from all around the world, healthcare would become a billion pound industry and our chief export.
So why aren’t our politicians talking about this? Why doesn’t Ed Miliband stand for election next May on the pledge that he will cure diabetes? This would be my sort of election. UKIP would announce that every pint-swigging British patriot will receive an infinite supply of new 3D printed livers. Perhaps some fringe party would introduce a manifesto pledge to deliver immortality.
For this article to go back to reality might not involve going very far. But to step out of science fiction and back into the realities of regenerative medicine, a limitation of this field is that the science remains depoliticised.
Perhaps the public assume that the funding is adequate, that the regulation is suitably stringent, that pharmaceutical companies are naturally eager to invest, and that paternalistic experts somewhere can be relied upon to usher in changes when the time is right. But supposing that none of this is the case. Supposing that the funding is a shoestring, that the regulation is suffocating, that pharmaceutical companies don’t wish to cure diseases that they already make a killing from treating, and that the paternalistic factor is too politically cowardly to fight for the new technology. Depoliticising regenerative medicine leaves us with an assumption that there are no choices about its opportunities and risks. Or even worse, that these choices are none of our business.
In our democracy, regenerative medicine should be at the very forefront of public discourse. There is a danger that we are being left behind in history, comforting ourselves with the lazy belief that things will simply take their course. You’ll be aware of the 1865 UK Locomotive Act, which stipulated that motor cars had to be preceded (like every good revolution) by a man waving a red flag. We are still at this stage with regenerative medicine, stuck in a failure of the imagination about how far and fast the new technology can go. If the Labour movement wants to outlive paralysis and Parkinson’s disease, then it should be providing leadership, the more ambitious the better. It should also aspire to outlive its precious NHS, or to at least cheer on the phoenix which will shake off its ashes.