The Minister of State, Department of Health (Baroness Jay of Paddington): My Lords, the choice of treatment regimes for HIV and AIDS patients is a matter for discussion between the patient and the doctor. As your Lordships will understand, records of individuals' treatments are of course confidential. Information published from recent clinical trials currently indicates that so far the use of combination retroviral drugs is delaying the onset of AIDS and increasing survival. There is relatively little scientific analysis available about the types of treatments which have been used by long-term survivors.
Earl Baldwin of Bewdley: My Lords, I am grateful to the noble Baroness for her reply. Is she aware of evidence from surveys and indeed clinical trials suggesting that what long-term survivors may have in common is that they have mostly rejected conventional drug treatment and have embraced a range of unorthodox therapies including lifestyle changes? Would she not agree that if that is substantiated it has enormous implications for the direction of future research as well as for public policy?
Baroness Jay of Paddington: My Lords, I am of course aware that a number of people with HIV and AIDS have enjoyed great personal benefits from their use of what I suppose one might call complementary alternative therapies. The problem is that the scientific analysis of such therapies is difficult because a number of different therapies are used and individuals tend to change from one to another. It is the case, of course, that money is being spent on R&D programmes in this area and the NHS R&D programme has recently identified two specific topics which are being funded. They are the evaluation of manipulation therapies in the treatment of back pain and acupuncture for the management of pain in primary care. I realise of course that they are not directly related to HIV and AIDS, but I hope that they indicate to the noble Earl that interest in these subjects is being taken by the programme.
Baroness Jay of Paddington: My Lords, I agree with the noble Baroness that what seems to be most successful in achieving long-term help for people who are HIV positive is a combination of what one describes as orthodox treatment and other less orthodox methods. Data from some of the clinical trials--the multinational Delta trial is probably the most substantial--show that there is a relative reduction in mortality of about 30 per cent. when a combination--the so-called "cocktail"--of anti-retroviral drugs is taken. As I said to the noble Earl, there is not adequate scientific knowledge on the question of complementary therapies.
Lord Thurlow: My Lords, as research is so important, will the noble Baroness do all that she can to induce the research council to allocate a less derisory proportion of funds to complementary medical research because some of the results seem very promising?
Baroness Jay of Paddington: My Lords, I agree that research is the foundation of evidence-based medicine. The noble Lord, Lord Thurlow, and I have spoken often about the matter in the past. I shall do everything I can to look into the question of whether adequate funding is going into this area. As I said, I am encouraged by the fact that the NHS research and development programme itself has taken up specific questions of complementary medicine. There is evidence that where complementary medicine has improved the general health of individuals with HIV it seems to have a positive effect on the immune system, which makes it easier for people to fight opportunistic infection.
Lord Eatwell: My Lords, is my noble friend aware that while the triple combination drugs have had an enormous effect both in reducing the transition from HIV to full-blown AIDS and in reducing death rates from AIDS, most of those effects have been enjoyed abroad? In the United States and France, for example, the transition rates from HIV to AIDS are down by one-half whereas in the United Kingdom the figure has increased. In those countries also the death rates from AIDS have been reduced by one-half but barely reduced at all in the United Kingdom. Can the Minister say what is the Government's explanation for this rather poor record?
Baroness Jay of Paddington: My Lords, I believe the point is that the combination therapies have been only recently introduced into this country. As the noble Lord will know, there are trials in only the most limited areas, particularly in London, of up to three years using the particular forms of combination therapy to which
Baroness Cumberlege: My Lords, the Government will be aware, as, I am sure, will the noble Baroness, because she is an expert in this area, of what has been the experience in France--referred to by the noble Lord, Lord Eatwell--where people are living longer and where, through the combination therapies, there is evidence of improved survival. Can the Minister say whether her Government will continue the good work of the previous government in funding such therapies?
Baroness Jay of Paddington: My Lords, the noble Baroness was kind enough to say that I know a great deal about HIV. She knows a great deal about NHS funding; that individual funding decisions about individual therapies are taken by local health authorities; and that specific AIDS grants are given to health authorities for treatment and care. I am sure that those authorities which have the greatest problems will look at the issue.
Lord Wright of Richmond: My Lords, can the Minister say anything about exchanges, not only with the countries to which the noble Lord, Lord Eatwell, referred, but also with the World Health Organisation and those countries, particularly in Africa, which have been particularly afflicted by this disease?
Baroness Jay of Paddington: My Lords, the clinicians who are experts in this area in this country are very aware of the problems faced by people in the third world and particularly in Africa. One of the problems in dealing with the large numbers of people with HIV infection in sub-Saharan Africa is the expense of the combination therapies to which the noble Baroness, Lady Cumberlege, referred.
Lord Stoddart of Swindon: My Lords, can my noble friend say what is the latest figure for the total cost of treating HIV and AIDS? Can she say how much we are spending on research, care and treatment centrally; how much local authorities are spending; and whether there are any plans to increase or decrease those amounts?
Baroness Jay of Paddington: My Lords, on the overall question of funding, a total of £199.6 million has been allocated for AIDS treatment and care in 1997-98, which represents an increase of over 7 per cent. on the previous year. That is seen as a contribution to the new and expensive combination therapies. As I said in answer to the noble Baroness, Lady Cumberlege, local funding is a question of discretionary funding to individual health authorities and emphasis is given to those who have the greatest need.
Earl Baldwin of Bewdley: My Lords, may I press the noble Baroness a little further and refer back to the question of long-term survival and what patients may or may not have done to stay well? Is it not the case that
Baroness Jay of Paddington: My Lords, I believe that the noble Earl is right and that there has not been a long-term scientific retrospective study of survivors. That is simply because it is difficult to ascertain at what point you would begin to study them, as it were--if that is not a convoluted way of putting it--in order for them to be part of any scientific trial. The scientific evidence that there is suggests that those who have survived are those who have been involved at the cutting edge of medical developments and who have been exposed to the original Zidovudine treatment and then the triple combination therapy. As I hope that the noble Earl will understand, there is evidence that where complementary medicine has been added, people have done very well.
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