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Haemophiliacs: Hepatitis C and NHS Treatment

Lord Morris of Manchester asked Her Majesty's Government:

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The Minister of State, Department of Health (Baroness Jay of Paddington): The Haemophilia Society has made representations concerning the establishment of a special payment scheme for those haemophiliacs infected with hepatitis C through National Health Service treatment and their dependants. My right honourable friend the Secretary of State for Health also met representatives of the Society on 10 September last year to hear their accounts of the effects on the lives of those with haemophilia, and their families, of contracting hepatitis C. We have received similar written representations in respect of other patients who contracted hepatitis C through NHS treatment.

We have given a commitment to give full and careful consideration to this whole issue and that is what we are currently doing.

Relative Risk Factor

Earl Howe asked Her Majesty's Government:

    Whether they will indicate in broad terms what epidemiological significance should be attached to a relative risk factor:

    (a) of between 1.0 and 2.0; and

    (b) of between 2.0 and 3.0

    in the assessment of an illness and its possible causes.[HL1188]

Baroness Jay of Paddington: Relative risk provides a measure of the strength of association between a factor and an illness. It is an important way of measuring increases or decreases of risk over time or between different groups by comparing the incidence of an illness or hazard within a population to some baseline (for example if drinkers are twice as likely to suffer from a particular disease as compared with the general population, a factor of 2 may be cited). A stronger association--of greater than 2--is more likely to reflect causation than is a weaker association--of less than 2--as this is more likely to result from methodological biases or to reflect indirect associations which are not causal. The significance of any such number does though need to be considered in context and from a number of viewpoints.

First, there is a statistical significance: in other words, what confidence is there in the number itself. This will depend on the quality and extent of the available data. Scientists usually express these by giving a confidence interval: rather than by saying that the relative risk factor is 2, they will say that (for example) one can be 95 per cent, certain that it lies between 1.6 and 2.4.

Even when the strength of an association is precisely determined, it is insufficient in itself to confirm a direct causal link between possible cause and an illness. The

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strength of association is only one of several criteria which must be considered in the assessment of causation. Other criteria include:

    the cause must precede the effect;

    the biological plausibility of the association--is the association consistent with other knowledge, e.g., experimental evidence?;

    the consistency of the finding--is the same result obtained from different studies using different methodologies elsewhere;

    the presence of a "dose-response" relationship--an increased response to the possible cause being associated with an increased risk of developing the illness.

All these factors would be taken into account in trying to pinpoint cause.

The practical significance of risk factors, also needs to be considered and depends on how great is the underlining risk. Doubling a very small probability (risk)--say one in 10,000,000--still results in only a very small risk of illness. Doubling a risk of, say, one in 100 could--depending on its nature--be more serious.

In practice, scientific judgments will be made and debated on a case-by-case basis. The Government can draw on the expertise of independent scientific advisory committees which are constituted to provide balanced judgment on the questions covered above.


Viscount Long asked Her Majesty's Government:

    How many cases of human tuberculosis were diagnosed in each of the following years:

    (a) 1940;

    (b) 1950;

    (c) 1960;

    (d) 1970;

    (e) 1980; and

    (f) 1990.[HL1181]

Baroness Jay of Paddington: The total annual corrected notifications of tuberculosis in the United Kingdom for the years requested are as follows:

    1940: 55,049

    1950: 61,192

    1960: 28,381

    1970: 14,183

    1980: 10,488

    1990: 5,899. Source: the Chief Medical Officers' Annual Reports, Scottish Centre for Infection and Environmental Health, Scottish Office Information and Statistics Division and Office of Population Censuses and Surveys Communicable Disease Statistics. (In England and Wales, from 1982 onwards the system has enabled

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    notifications associated with chemoprophylaxis to be excluded, so that data may not be strictly comparable.)

Access Committee for England

Lord Swinfen asked Her Majesty's Government:

    Whether the Access Committee for England is about to be closed; and, if so, what support they can offer to prevent its loss.[HL1189]

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Baroness Jay of Paddington: We understand that in a letter dated 16 March the Chairman of the Access Committee for England (ACE) informed the Prime Minister and other Government Ministers of ACE's closure on 31 March 1998. A recent inter-departmental review concluded that the Government should not continue funding ACE's central administrative costs from 1998-99. This is in accordance with a policy of time-limiting core grants, of which voluntary organisations have been made aware.

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