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7945 SIP AUTUMN 09 5/10/09 10:21 Page 1 sip Autumn 2009 Medical Testing SCIENCE IN PARLIAMENT Designs for Life Nanotechnology Carbon Capture and Storage The Journal of the Parliamentary and Scientific Committee www.scienceinparliament.org.uk
7945 SIP AUTUMN 09 5/10/09 10:21 Page 2 ‘ Now more than ever we need to celebrate our country’s achievements in science and we need to foster new generations that understand, appreciate and practise scientific method. Hurrah for the Science Museum!’ Stephen Fry Actor, writer, comedian, presenter www.sciencemuseum.org.uk
7945 SIP AUTUMN 09 5/10/09 10:16 Page 3 sip The Government has listened; the HoC Science and Technology Committee SCIENCE IN PARLIAMENT is re-established and meets for the first time in October. It will have the same Chairman and membership as the Innovation, Universities, Science and Skills Committee had, which it replaces, although the Whips will need to do a bit of work to fill the vacancies that exist. On 23 September I attended the joint 10th Anniversary Celebration of the University of Manchester Incubator Company (UMIC) and 5th Anniversary Celebration of the University of Manchester’s Intellectual Property Commercialisation Company (UMIP). However their success is measured this ’portfolio of incubators, based around the Manchester city region, catering for companies in the medical/life science and high technology The Journal of the Parliamentary and Scientific sectors’ has been remarkably successful. Congratulations to all those Dr Brian Iddon MP Committee. pioneers who were brave enough to launch the first Manchester Chairman, The Committee is an Associate Parliamentary bioincubator in 1999, one of the first of its kind. Editorial Board Group of members of both Houses of Science in Parliament Parliament and British members of the The requirement for Full Economic Costs (FEC) in research grants in the UK European Parliament, representatives of appears to be shifting some industrial research money away from British scientific and technical institutions, industrial universities to universities abroad. In any case, what are our Vice-Chancellors organisations and universities. doing with this money currently? When the call comes, will they be able to produce it to keep their laboratories and workshops at the cutting edge, which was the reason for requiring FEC in the first place? As we enter the final straight leading to the General Election the dominant discussion appears to be how each party will address the need for cuts to pay for the debts caused by the ’credit crunch’. Will the science budget remain ring fenced, even if Labour can earn a fourth term? In talks with academics and other professionals in the education and health sectors I get the impression that they are looking for cuts now. For example, the Science in Parliament has two main objectives: University and College Union tell me that they are engaging in some 1. to inform the scientific and industrial vigorous discussions with some of our Vice-Chancellors, who are proposing communities of activities within Parliament of a scientific nature and of the progress of significant ’restructuring’ in their universities. relevant legislation; According to the Trans Atlantic Think Tank for Toxicology at John Hopkins 2. to keep Members of Parliament abreast of University in Baltimore the cost of REACH compliance may be six times scientific affairs. previous estimates and use twenty times more animals. It comes as no surprise therefore that animal rights activism is on the rise again. Novartis employees have been targeted recently in France and Switzerland, with renewed demands that the company severs its links with Huntingdon Life Science. CONTENTS BIOETHICS AND DEMENTIA 2 CARBON CAPTURE AND STORAGE – POTENTIAL HAZARDS OF Professor Albert Weale WILL IT WORK? 20 NANOTECHNOLOGY 38 SCIENCE AND ENGINEERING AT THE Addresses to the P&SC by Charles Hendry MP Professor Vicki Stone and Dr Rob Aitken HEART OF A FUTURE CONSERVATIVE and Dr Andy Read SUSTAINABLE ELECTRICITY, GOVERNMENT 3 ERGONOMICS AT 60 – TRANSPORT FUELS AND HEAT 40 Adam Afriyie MP A CELEBRATION 24 Gordon Taylor STRIVING FOR EXCELLENCE 4 Reg Sell HOUSE OF COMMONS SELECT Sir Alan Langlands POSTCARD FROM AUSTRALIA 26 COMMITTEE ON SCIENCE AND Robert Freer TECHNOLOGY 42 REGULATING FORENSIC SCIENCE QUALITY STANDARDS 6 CHINA – SCIENCE AND INNOVATION 27 HOUSE OF LORDS SCIENCE AND Andrew Rennison Dr David Bacon TECHNOLOGY SELECT COMMITTEE 43 THE GRAND OPENING OF YOUR MIND8 SCIENCE AND EDUCATION AT THE HOUSE OF COMMONS LIBRARY Dr Michael Dixon EDEN PROJECT 28 SCIENCE AND ENVIRONMENT SECTION Professor Sir Ghillean Prance 44 KEW’S MILLENNIUM SEED BANK 10 Simon Linington BRITISH INDIAN OCEAN TERRITORY 30 PARLIAMENTARY OFFICE OF SCIENCE Professor Charles Sheppard AND TECHNOLOGY 45 MEDICAL TESTING – DO WE WANT SELECTED DEBATES AND MORE OR LESS OF IT? 12 DESIGNS FOR LIFE 32 PARLIAMENTARY QUESTIONS AND Addresses to the P&SC by Professor Michael Baum THE PARLIAMENTARY AND SCIENTIFIC ANSWERS 47 and Professor Karol Sikora COMMITTEE 34 EURO-NEWS 54 NANOTECHNOLOGY – SHOULD WE BE EPSRC IMPACT! 35 WORRIED? 16 SCIENCE DIRECTORY 55 Addresses to the P&SC by Dr Alec Reader, ROYAL SOCIETY OF CHEMISTRY LINKS PARLIAMENTARY AND SCIENTIFIC Dr Mike Fisher and Dr Stephanie Lacour DAY 36 COMMITTEE NEWS 63 SCIENCE DIARY 64 Science in Parliament Vol 66 No 4 Autumn 2009 1
7945 SIP AUTUMN 09 5/10/09 10:16 Page 4 OPINION BIOETHICS AND DEMENTIA: A CHALLENGE FOR SCIENCE Hope, Professor of Medical However, these criteria alone are Scotland but not in England or Ethics at Oxford, spent almost not enough to make sure that Wales. The Council will be two years considering the there is a fair distribution of discussing these findings with difficult dilemmas that people research funding between the the major funders of research with dementia, their carers and needs of very different parts of and others in the coming weeks. healthcare professionals have to the population. We concluded face on a day-to-day basis. that the major research funders THE FUTURE OF DEMENTIA CARE These include: should explain more clearly how and why they divide their The report ties in with current • deciding when and how to research funds between areas of policy discussions. A Green communicate a diagnosis; Professor Albert Weale FBA research that have the capacity Paper ‘Shaping the Future of Chair of the Nuffield Council on • balancing a person’s safety to benefit very different groups Care Together’, published in Bioethics and Professor of with their need for of the population. If necessary, July, sets out long-term reform Government, University of Essex independence and freedom; they should take active steps to proposals on how we as a support and encourage society provide care for older Chairing the Nuffield • deciding what is in the best researchers to carry out high- people. To help them prepare interests of the person with Council on Bioethics, a dementia, for example when quality research in dementia. for future debate around adult position which I was making decisions about their More research into the care, Parliamentarians and other honoured to take up experience of living with policy makers are invited to care and treatment; dementia and how people with discuss the issues raised by in January 2008 for • recognising that the needs of caring for people with dementia dementia can be supported to five years, is an the person with dementia may live the best possible lives is at the Council’s annual exciting and unique sometimes conflict with the particularly needed. ‘Bioethics in Parliament’ event in opportunity for needs of others, especially the Houses of Parliament. The carers; RESEARCH event, to be held on 10th someone like me who PARTICIPATION • tackling discrimination against November 2009, is supported by works on social values Evan Harris MP, Brian Iddon MP, people with dementia; and People with dementia who and public policy. Earl Howe and Lord Harries of understand what is involved in a • deciding what priority to give Pentregarth, and will entail It allows me to debate particular research project to dementia research. presentations and debate, cutting-edge issues in science decide for themselves whether and medicine, and to do so with The Working Party published or not to take part. Those who followed by a drinks reception. some of the most interesting its report Dementia: ethical cannot decide for themselves For more information contact (and pleasant) people in the issues in October 2009. It found may be able to take part as long Catherine Joynson at UK. Eminent lawyers, scientists, that there are many ways in as a number of legal cjoynson@nuffieldbioethics.org. clinicians, journalists and which we can work together as requirements are met. We Over the next two years the philosophers are brought a society to help people with concluded that more should be Council will be considering the together. After a thorough dementia, and their carers, have done to make it easier for those rise of genetic testing and online process of consultation and a better quality of life. who have expressed a wish to medicine; the implications of deliberation, the Council take part in research to do so. advances in biofuels; and the publishes reports that aim to RESEARCH PRIORITIES For example, clinical trial donation and use of bodily clarify bioethical issues and One important conclusion networks, which bring together material such as gametes, blood, influence the development of was that the amount of funding doctors and people with tissue and organs in medical policy. available for dementia research dementia who want to take part treatment and research. At a appears low, given both the in research, should be time when the biosciences THE ETHICS OF number of people with encouraged; and the possibility present us all with challenges DEMENTIA dementia and the effect of giving welfare attorneys the and opportunities, all those on Most recently, the Council dementia has on people’s lives. power to decide if a person with the Council hope that their work considered the ethical dilemmas Research funding bodies rightly dementia should take part in will be of public benefit and raised by dementia. An expert choose to fund research that is research should be considered. advance the public Working Party, ably led by Tony important and high quality. At present, this is possible in understanding of bioethics. 2 Science in Parliament Vol 66 No 4 Autumn 2009
7945 SIP AUTUMN 09 5/10/09 10:16 Page 5 OPINION SCIENCE AND ENGINEERING AT THE HEART OF A FUTURE CONSERVATIVE GOVERNMENT I was delighted to join with Second, with the latest Science and engineering members of the Innovation, machinery of government belong at the heart of Universities, Science and Skills changes, science now competes government policy, and I am Committee to campaign for a for attention in a bigger deeply conscious of the new science and technology department than ever before. contribution they will make to a committee. And it was With both the Science Minister future Conservative government. enlightening to speak at the and the Secretary of State That’s why I am taking action recent Parliamentary Links day in tucked away in the Lords – now to raise the profile of the support of the annual exchanges distant from the usual STEM subjects in the between MPs and professional Commons scrutiny – I will Conservative Party. Adam Afriyie MP scientists. certainly look to the select At this year’s party committees for help in holding These events reminded me conference I will be launching ministers to account. that Britain is not just a nation of the Conservative Friends of bankers and borrowers. We also Third, Parliament will Science. The idea has been have a proud scientific tradition. continue to rely on its select greeted warmly and The expenses scandal That tradition deserves committees and organisations enthusiastically, and we’re shook Parliament to its recognition in public life on such as POST to underpin the delighted that Simon Singh has core. The fallout has more than merely historic rigour of scientific debate. In the agreed to say a few words at grounds. course of the next Parliament, the reception. The group will been extensive, and MPs may be required to tackle a provide a forum for there are now I have hopes that the new range of tricky issues. This could Parliamentarians, party activists, justifiable calls for Science and Technology involve anything from the corporate and individual change. Committee will rise to that presence of nano-particles on members to debate scientific challenge like its predecessors. the high street to the use of issues and inform policy. And it One area of In fact, there are at least three genetic information by insurers. will enable members to help Parliamentary activity reasons why the committee will So Parliament will need a promote the STEM subjects retains its vitality: probably gain influence over the dedicated, cross-departmental alongside the many science. Over the coming months and years. select committee to weigh up organisations already active in course of the year it First, the policy focus is quite the evidence and deliver sound the field. has been a pleasure to rightly shifting away from the recommendations. Effective policy is based on work with POST (the failed economic model of the This cross-departmental role sound evidence. That’s why Parliamentary Office of past decade. Attention is quite is critical. Science is not science and engineering matter. rightly turning to the role that Science and restricted to just one Whitehall The Conservative Friends of science and innovation can play Technology) to in rebalancing our lop-sided department. Whether it’s social Science will be making a strong develop a programme economy. Effective scrutiny of science in the Home Office or case for science and engineering of science literacy climate science in DECC, at the heart of Conservative government science policy will ministers, officials and policy-making. training for new be essential in the years to Parliamentarians all depend on Conservative MPs. come. reliable scientific advice. Adam Afriyie is the Conservative MP for Windsor and Shadow Minister for Science and Innovation. . . . events reminded me that Britain is not just a nation of bankers and borrowers . . . Science in Parliament Vol 66 No 4 Autumn 2009 3
7945 SIP AUTUMN 09 5/10/09 10:16 Page 6 STRIVING FOR EXCELLENCE I have taken on the Chief categories in England has recent data show that the UK Executive’s role at the Higher increased from 1.57m in 1998- arts and humanities community Education Funding Council for 99 to 1.99m in 2007-08. The publishes nearly as many England (HEFCE) at a testing higher education participation scholarly papers as the US – time – universities and colleges rate increased by two 33% of the world’s output is face very tough financial percentage points to 43.3% from the UK versus 37% from conditions and yet they are between 1999-2000 and 2007- the US in the period 2006- crucial to delivering the country’s 08. 2008. twin aims of a vibrant economy Universities in England are FUTURE CHALLENGES and a just society. HEFCE has a autonomous, self-governing Sir Alan Langlands FRSE key role to play in promoting This strong position achieved bodies. They derive income Chief Executive, high quality, cost effective in recent years is at risk from Higher Education Funding Council from multiple sources and the teaching and research to meet intense competition from many for England overall turnover for 2007-08 the needs of students, the other countries, reductions in (the most recent year for which economy and society. This growth in public spending, full figures are available) was needs sustained investment and threats to university income and £19.4bn. HEFCE funding in that of course university funding will fluctuations in the financial and year was £7.37bn. HEFCE be centre stage when the fees property markets affecting therefore funds about 37% of review gets under way later this endowment funds and the the total activity in universities. year. In the mean time, it is redevelopment of our This level of investment – important to galvanise the campuses. In these times of coupled to the Government’s intellectual, financial and physical hard choices, Government, the long-term commitment to assets in higher education to universities, employers, the science and publicly-funded best effect, striving for excellence Research Councils, HEFCE and a in all that we do. research, and the introduction of wide range of representative variable fees – has enabled UK bodies need to work together to VITAL STATISTICS universities to maintain their build on the international HEFCE recurrent funding for international competitiveness standing of higher education. At 2009-10 is £6.4bn – including whilst supporting the the very least this means striking £4.7bn for learning and Government’s policy of a new balance between public teaching, and research widening participation in higher expenditure and student/ allocations of £1.6bn. We also education. employer contributions, provide non-recurrent funding of There are 17 UK universities developing a sustainable system £1.5bn including capital in the world’s top 100, 14 of of student support and, even allocations of £1.2bn. Separate which are in England. The UK with some further arrangements exist in the rest of played host to 284,260 improvements in efficiency, the UK, vested in the Higher international students in 2007- recognising that quality may well Education Funding Council for 08 and the UK share of have to be protected at the Wales, the Scottish Funding international trade in higher expense of increased volume Council and the Department for education is stable at 11%, the and new initiatives which fall Employment and Learning in second-highest country share outside our core mission of Northern Ireland. HEFCE funding behind the United States. With higher education and research. has grown by 60% in real terms 1% of the world’s population, since 1998-99 and the total ACTION NOT WORDS the UK achieved 12% of the number of students in all world’s scientific citations, and The debate about higher education funding will take its course over the next twelve to twenty-four months but there is . . . With 1% of the world’s population, the UK achieved plenty to do in the mean time and I envisage that HEFCE, 12% of the world’s scientific citations. . . universities, colleges and other partners will work hard to ensure that the quality of 4 Science in Parliament Vol 66 No 4 Autumn 2009
7945 SIP AUTUMN 09 5/10/09 10:16 Page 7 teaching continues to be trusted RESEARCH IN HIGHER for the future, that we maintain EDUCATION excellence in research and that we work with others for positive The plurality of funding for . . . higher education has proved university-based research, from economic and social results. public and other sources, is a to be an asset at national, QUALITY AND major strength of the UK regional and local level – STANDARDS system. HEFCE funding, The quality and standards provided as one leg of dual generating value of £55bn to support, enables institutions to achieved in higher education the economy. . . maintain a dynamic and have been in the spotlight over responsive research base of the past year with no shortage world-leading quality. This of media comment about enables ground-breaking basic admissions criteria; the role of research, with the potential to the Quality Assurance Agency WORKING WITH OTHERS benefit 50,000 people and drive future innovation and for higher education; and 11,700 businesses. Universities respond quickly to changes in In return for all this public concerns about a dumbing- and colleges have also the external environment. investment higher education has down of academic standards. demonstrated an ability to Challenges include: proved to be an asset at The House of Commons stimulate new markets through national, regional and local level Innovation, Universities, Science • maintaining the balance programmes which are co- – generating value of £55bn to and Skills Select Committee and between funding for curiosity- funded by employers. In 2008- the economy, and promoting a high level sub-committee of driven research and for work 09, employers will be funding important health and social HEFCE have recently reported. targeted on identified national £7m towards the course costs benefits. The emerging consensus is that needs and priorities. The of 6,000 FTE on top of HEFCE’s there is no evidence of systemic leading funders (HEFCE, the HEFCE, working with BIS £17m. We expect this to failure in the present UK Research Councils, the encourages close working increase to the target of 35,000 arrangements, but that some NHS and major charities) are relationships between higher entrants by 2010-11. improvements need to be committed to working together education and business, public made. and engaging with industry to services and the voluntary AND FINALLY……… achieve this sector. The higher education Over nearly twenty years I Action is required to ensure innovation fund (HEIF) has have worked for about half my that: • developing the new research been used to establish an time in and around Whitehall excellence framework – the • the QAA has a more public- institutional infrastructure for and half as the Principal and REF – to assess the quality of facing remit, re-assuring the commercialisation, innovation Vice-Chancellor of a University. research outputs, their impact non-expert and adopting a and enterprise. Universities and My task now is to help broker on the economy and society more flexible approach in its colleges generated £10.3bn in the partnership between and the vibrancy and audit methodologies value from users in the period Government and universities professionalism of the research 2001-07; and the return on the and colleges to ensure that we • applicants, students, parents environment. A consultation HEFCE investment has been make best use of public money and employers should have document on this new evidenced at between £4.9-£7.1 and have the high level skills ready access to information approach to assessment has for every £1 of HEIF. and the research base we need about programmes of study just been published Higher education also plays a for long-term success. I doubt if and what is expected of • continuing to develop the life will be dull…………. students who undertake these fundamental role in delivering infrastructure and human programmes the knowledge and skills capital required to support required in a rapidly changing • the external examiner system industry collaborations, Sir Alan Langlands was formerly the economy, through the supply of Principal and Vice Chancellor of the (a key part of the system of technology transfer and inward University of Dundee (2000-2009) graduates but increasingly self-regulation and peer review investment and Chief Executive of the NHS in through flexible higher education England (1994-2000). He also has at institutional level) should be Strong basic research is a designed around the needs of a particular interest in the scientific reviewed and sharpened up basis of health services and he cornerstone of Britain’s success employers. Universities have chairs the boards of UK Biobank – HEFCE and universities will and, over time, it can make a real shown that they can respond a major genetic epidemiology study also maintain their commitment difference to our everyday lives. It quickly to business needs, funded principally by The Wellcome Trust and The Medical Research to promoting study in science, is valued by industry and by leveraging an additional £31m Council – and the Health technology, engineering and society but it will continue to on top of HEFCE investment of Foundation, a UK-wide charity mathematics – boosting need long term commitment, £25m to offer rapid support for committed to improving the quality of healthcare. He is also a co-opted demand and provision to meet time and money. There are no business and graduates through member of the Office for the the needs of employers and short cuts on the journey from the Economic Challenge Strategic Co-ordination of Health Research. new industries. the laboratory to the marketplace. Investment Fund. The fund will Science in Parliament Vol 66 No 4 Autumn 2009 5
7945 SIP AUTUMN 09 5/10/09 10:17 Page 8 REGULATING FORENSIC SCIENCE QUALITY STANDARDS What are the challenges I These three facets do not nothing but help and support face as the Forensic Science operate in isolation but are, for from the forensic science Regulator? This is a common the vast majority of forensic community and from wider question and one that I science, interdependent and in stakeholders such as the Crown regularly ponder on as my terms of oversight and Prosecution Service. I have the role matures and the assessment benefit from a benefit of continuous and challenges become clearer; I single process that is designed constructive advice from my stepped into the role in to assess all three, more on this Forensic Science Advisory February last year and always later. Council, the Association of knew it would take time to Forensic Science Providers, and In England and Wales we Andrew Rennison MSc unravel all the issues and the Forensic Science Society as now have a commercial supply Forensic Science Regulator challenges to be faced in a well as expert advice from the market with the police operating changing forensic science many and varied members of procurement frameworks landscape. My principal task is the specialist groups I have leading to contracts with a to set and monitor quality established to work on different number of commercial standards for forensic science aspects of the standards suppliers. We also have the used in the investigation of framework. Naturally there are police and other law crime and prosecution of issues to be debated and enforcement bodies providing offenders in England and different views to consider, aspects of forensic science Wales. From the outset it was which is why consultation is so services through their own in- clear that any standards had important. I like to think that I house resources. In Scotland to be UK-wide so we have am able to reach all those that and Northern Ireland all forensic reached agreements with the want to be consulted and that science services are provided by Scotland and Northern Ireland their views are heard. the police and government authorities to work together laboratories. Suffice to say that But why do we need a new such that any standards we we have different supply models standards framework? develop can and most likely with a mix of police, state and Historically, and prior to the will be adopted in those commercial provision, all of commercial market for forensic jurisdictions. which, in my view, should science, achieving quality and In setting quality standards I operate within a single quality standards at the laboratory level want to be sure that standards framework. was one of the responsibilities organisations have effective of the Chief Scientist of the The notion of a single quality quality management systems, Forensic Science Service (FSS). standards framework for all UK that their forensic science The FSS was a leading member forensic science is, to me, an practitioners are competent and of the European Network of obvious one. I am pleased to that the science methods they Forensic Science Institutes say that in developing such a use are valid and fit for purpose. (ENFSI) set up in 1995 to framework I have received establish common quality standards for European forensic science laboratories. I applaud the work done by ENFSI and the . . . The notion of a single quality standards framework for role the FSS played in setting all UK forensic science is, to me, an obvious one. . . high standards for state, and now the commercial laboratories, across the UK, all of which are accredited by the United Kingdom Accreditation 6 Science in Parliament Vol 66 No 4 Autumn 2009
7945 SIP AUTUMN 09 5/10/09 10:17 Page 9 Service (UKAS) against the general and understandable standards recommended by concern is that of the costs ENFSI. I also applaud the work associated with assessment by undertaken by the Custodian of UKAS against the standards the National DNA Database to leading to accreditation. UKAS set high standards for the use of are by far the best equipped . . . A challenge has been to DNA technology used to supply organisation for this role and develop a standards framework DNA profiles to the database. By save me the expense and working closely with UKAS the logistical problems of that meets the needs of the UK Custodian improved on the establishing a compliance team. ENFSI standards such that all UK Accreditation by UKAS covers in criminal justice systems and to DNA laboratories are accredited depth and in a single process achieve the support of all and constantly assessed against the three aspects I covered what I think are world class earlier: organisational stakeholders. . . standards. competence, the individual competence of practitioners and However, much of what we the validity of the science they term as ‘forensic science’ is use. conducted outside of the report following that review new framework and have laboratory environment, for When I arrived in post we recommended a standards received broad support. We are example police crime scene had the Council for the model that did not include currently considering the examinations for forensic Registration of Forensic CRFP; the report is available on excellent and varied responses evidence, and some law Practitioners (CRFP) as a body my website as are the we received following enforcement bodies have small setting and monitoring responses I received following publication and will have a final in-house forensic laboratories; competency standards for publication1. The net result is version available for publication most police forces have individual practitioners. that the police, whose staff by the end of this year. fingerprint development Established in 1998, with full made up the majority of the laboratories using process and government support, CRFP had A challenge has been to registered pool, decided to methods to develop and a role to assess the competence develop a standards framework withdraw from CRFP. This in turn enhance finger and palm prints. of individual practitioners and to that meets the needs of the UK led to significant funding Most of this work does not register those that were found to criminal justice systems and to problems and the CRFP board operate within the same be up to standard in their work. achieve the support of all were left with no choice but to accreditation based standards CRFP had, since its inception, stakeholders. There is still fine cease trading (CRFP operated as framework that the larger failed in its targets to register the tuning to be done, but with the a company limited by laboratories do. The police do majority of forensic practitioners continued support I have guarantee). In my view, operate ISO 9001 quality and to become self-financing. received so far and with the supported by other stakeholders management systems for their CRFP made no assessment of continued involvement of the and in advice I gave to Ministers, fingerprint analysis with some organisational competence or of broad range of experts and losing CRFP caused no risks to forces extending this to cover all the validity of the science used practitioners that we rely on we the criminal justice system. their forensic science work. I am by individual practitioners. Their will have a world leading quality grateful for the on-going support role was reviewed by the Home We are now moving from an standards framework for forensic and advice I receive from the Office in 2004; Ministers then ad hoc and largely unco- science. The UK has a proud police lead on forensic science, decided to continue with grant- ordinated approach to quality reputation for innovation and Chief Constable Chris Sims, also in-aid but with a very clear and standards to one based on use of science in the from the Chief Executive of the stipulation that this was to end a single coherent framework, in investigation of crime and the National Policing Improvement by March 2010 as CRFP turn with a single compliance prosecution of offenders. The Agency, Chief Constable Peter registered more practitioners assessment mechanism. An most obvious and best example Neyroud. Both recognise the and achieved self-financing. example of the lack of co- of this is DNA technology. As the need for a standards framework When I started in my work CRFP ordination was the competence new model for the supply of that includes the police. Mr Sims had registered about 3,000 assessment of senior scientists forensic science services recently wrote to all chief people making up about 35% within the laboratories that was continues to develop we can be constables to explain my of the current forensic duplicated through UKAS assured that a new and up-to- proposed standards framework practitioner population and was accreditation and CRFP date quality standards and received general support unlikely to meet the targets set registration, added to which the framework is also developing. but with some requests for in 2004; soon after I started junior scientists were covered by further work to understand the they wrote to Ministers seeking accreditation but were not 1 http://police.homeoffice.gov.uk/ impact, in terms of costs and further funding at which point I eligible for CRFP registration. I operational-policing/forensic-science- regulator/ benefits, for the police if they was tasked with reviewing the have published the standards I move to adopt the standards. A registration of practitioners. My propose to be the basis for this Science in Parliament Vol 66 No 4 Autumn 2009 7
7945 SIP AUTUMN 09 5/10/09 10:17 Page 10 THE GRAND OPENING OF YOUR MIND THE SCIENCE OF • we explore the deep sea to catastrophe. It has never been NATURE understand how environmental more important to understand changes affect this important our planet and to engage as Our science, taxonomy and ecosystem many people as possible with systematics, underpins all of the appreciating and protecting the natural sciences and is a vital • we study mosquitoes to help natural world. This is why we part of the nation’s science prevent such diseases as opened our state-of-the-art capability. We also work on more malaria and Dengue fever Darwin Centre on 14 September, applied science, such as the • we study nanoparticles to named after Charles Darwin to control of parasitic diseases, support safe use of this mark his bicentenary and sustainable mineral extraction revolutionary technology Dr Michael Dixon celebrate his work that continues and forensic entomology. We are Director, by the Museum as we look from supporting the development of • we study comet dust to trace Natural History Museum the origin to the future of innovative technologies in the origins of the solar system species. emerging areas such as the use • we are working with the first of nanoparticles. Darwin Centre is a hub of Indian space mission to reveal world-class scientific research, Our science is firmly rooted in the geological history of the For more than 200 allowing visitors to marvel at the the collections themselves. We Moon. amazing diversity of life on our years, scientists at the are focused on six main lines of Next year, the Museum and planet, to view our science in Natural History enquiry: our science will be centre-stage action, understand the extent Museum have been • assembling the Tree of Life as we, with support from Defra, and research use of our exploring and studying will run the 2010 International collections and to explore the • the relationship between Year of Biodiversity UK the natural world, natural world for themselves. genetic diversity and Partnership that aims to promote using our incredible environment and evolution wider understanding of our The visitor experience in this internationally • how large-scale geological impacts on our planet. new London landmark will begin in the spacious atrium, where important collection of processes have influenced people can orientate themselves over 70 million evolution THE DARWIN CENTRE while admiring the views into the specimens to address • what determines biological Today we are facing a large- wildlife garden and the the big questions of diversity scale biodiversity crisis and enormous cocoon towering our time, such as potential environmental above. The climate change wall • the relationship between tracing the origins of biodiversity and ecosystem our solar system or functioning monitoring and • the interactions between hosts assessing the impact and parasites and their impact of climate change. on disease. Until now, most of this We have active research work has happened programmes that look at providing answers to behind the scenes contemporary issues, for without many people example: knowing that we are • we study Madagascar’s tree more than a beautiful ferns to find out how climate building with historical change impacts the world’s specimens on display. precious rainforests 8 Science in Parliament Vol 66 No 4 Autumn 2009
7945 SIP AUTUMN 09 5/10/09 10:17 Page 11 specimens. More than 200 THE ANGELA MARMONT role to play in assisting the scientists will be working in the CENTRE FOR UK generation of and distribution of Cocoon and the adjoining BIODIVERSITY vital knowledge. multidisciplinary facilities, carrying Housed on the lower ground Since free admission was out their research in the floor of the Darwin Centre, the reintroduced in 2001, we have molecular and imaging labs or Angela Marmont Centre for UK welcomed over 25 million specimen preparation areas. Biodiversity will become the visitors to the Museum and Through viewing decks, video leading national venue for the expect that with the opening of and intercom, visitors will be able collaborative study of UK natural the Darwin Centre we will to see and interact with some of history. The Museum receives receive a record 4 million visitors our staff – opening up the around 30,000 public enquiries this year. hidden world of scientific each year and visitors will be The Darwin Centre is a bold research. There is no other encouraged to bring their finds statement about our ambitions museum in the world that brings to the new centre, where and a demonstration of our the public and scientists together dedicated staff will guide them ability to deliver large, complex in this way or on this scale. is an interactive collage of through the reference material projects. It is also an excellent screens displaying films, and collections. Much of the example of using public funding THE ATTENBOROUGH Museum’s UK collections will be specimens and images to allow to leverage wider support for STUDIO available for amateur naturalists users to explore the reality of public benefit. climate change in their lives. Based on the research and to study, including 4,200 drawers Visitors can also collect a free collections of the Museum and of butterflies and 6,200 drawers We would like to express NaturePlus card, which uses new the legacy of Sir David of flowers. This access will offer thanks for the invaluable support barcoding technology to enable Attenborough’s filmmaking, the new opportunities for the UK’s and contributions we have them to save video clips, images new Attenborough Studio will many wildlife groups and received from many and weblinks throughout their journey through the Darwin Centre and access them on line back home or in the classroom. THE COCOON At the heart of the new Darwin Centre is a 65-metre- long, eight-storey-high cocoon that safeguards many of the Museum’s treasures, including from our Entomology and Botany collections – 17 million insects and 3 million plant combine scientific expertise, societies and will nurture, inspireorganisations and individuals, public dialogue, film and and excite naturalists of all ages.including: the Department for interactive media in a venue Culture, Media and Sport, the specially built to create a truly THE FUTURE Heritage Lottery Fund, the accessible environment. Excellence in applied science Wellcome Trust, the Weston Pioneering technology will allow depends on support for pure Foundation, the Cadogan family, visitors to engage in real time science, like taxonomy and Professor and Mrs Anthony link-ups with Museum systematics. We believe that with Marmont, GlaxoSmithKline, and researchers around the world, or an informed and engaged public, the Rufford Maurice Laing influence projected 3D images in science can fully play its crucial Foundation. our interactive film Who do you role in boosting competitiveness, The Darwin Centre will think you are? A free, daily enhancing our quality of life and change perceptions of what programme of screenings, ensuring a sustainable future. In museums of natural history can discussions and events will a time when humanity is facing be and I hope you are able to include films specially created by massive environmental visit us in the near future, so you the BBC Natural History Unit to challenges, like climate change, can personally explore this celebrate wildlife filmmaking. we and our peer institutions magnificent addition to the have an even more important Museum. Science in Parliament Vol 66 No 4 Autumn 2009 9
7945 SIP AUTUMN 09 5/10/09 10:17 Page 12 KEW’S MILLENNIUM SEED BANK: A VITAL RESOURCE FOR AN UNCERTAIN WORLD Simon Linington A week is a long time one is planned. It needs modest in politics. But seeds financial support and, to achieve this, it needs to build on the can span even human political support received to generations with ease, date. a feature that gives us Seed banking is a simple and a vital opportunity to robust technology. For seeds of prepare now for the most species, drying greatly ‘perfect storm’ of increases longevity. This drying is environmental often carried out in a low problems predicted by humidity room at cool temperatures. Additional cooling the Government Chief of the dried and hermetically- Scientist. sealed seeds further increases storage life, though there are Dr Paul Smith, Head of the Millennium Seed Bank, sharing his seed For most plants, on which all diminishing returns as the knowledge with the partners life depends, seeds provide a temperature drops. Many banks 1803 who was ‘relieved’ of Britain today. Furthermore, the means of surviving this storm. such as Kew’s Millennium Seed them by British privateers. The fact that we take these benefits By ‘banking’ them now, future Bank have cold storage rooms seeds passed via the Admiralty so much for granted would generations will be able to draw running at domestic deep to the Tower of London and perhaps have shocked on the widest range of plant freezer temperatures; others use eventually into the current someone with an existence diversity and fashion plant-based cryo-storage in liquid nitrogen. National Archives where they more obviously bound to plants, solutions to problems of human But just how long can these were recently discovered and much as it is still in large parts well-being thrown up by a seeds live under bank sent to us to attempt of the Developing World. Of dramatically changing world. In conditions? By extrapolating germination. Their germination is course, things may go full circle. this, its 250th anniversary year, from experiments that speed up an exceptionally rare event for With human population racing the Royal Botanic Gardens, Kew seed ageing, there is good seeds of such antiquity. towards seven billion, finite has successfully conserved seed evidence that many of the MSB agricultural land and increasing from 10% of the world’s collections will still be Storing seeds for two water shortages, food insecurity flowering plant species. The germinated two hundred years centuries will enable us to is likely to spread. We may Millennium Seed Bank Project, from now. Added to this, we bridge a phenomenal period of quickly retreat two hundred which is led by Kew and have even germinated seeds technological, sociological and years in this respect. Therefore, international in its scope, has that were collected in the environmental change, the we will need to be able to call achieved this significant Napoleonic era and stored conclusion of which is difficult to on every botanical reserve milestone on time and within under much more adverse imagine. Over the last two available to create new crops budget. It is a conservation conditions than those offered in hundred years, there have been and to put new genes into initiative of which the UK should the state-of-the-art MSB, though huge improvements in human existing crops. Rightly or be very proud. While a admittedly, few of them wellbeing as a result of greater wrongly, we are already tremendous start has been germinated. These 200-year-old access to plant diversity, in returning to plants as a made, a great deal more needs seeds found their way to us which Kew has played its part. renewable source of fuel. to be done if we are to make a after a remarkable journey. They An early Nineteenth Century Commodity shortages would real impact on the erosion of were in the possession of a Briton would be staggered at the certainly reawaken latent plant diversity. A new ten year Dutch merchant on passage out variety of fruit, vegetables and awareness of the human project that builds on the current from the South African Cape in plant-based drugs available in 10 Science in Parliament Vol 66 No 4 Autumn 2009
7945 SIP AUTUMN 09 5/10/09 10:17 Page 13 survival value of many plants Project was launched with a seed collecting work, mainly in seed banking operation lean and and could drive an grant of close to £30 million dry vegetation, has brought focused, a challenging target has unprecedented wave of from the Millennium together each nation’s been set of bringing the species conservation and innovation. But Commission. The matching conservation priorities in a way stored up to 25% of the world’s by that time we may have funding for this landmark project that has helped deliver the flora by 2020. Obviously, already depleted the botanical came from the Wellcome Trust, project’s species target. At the difficulty of locating and resources that can help us Orange plc, Kew itself, the public heart of targeting have been collecting new species increases adapt. Plant diversity is being and many others. A fine new endangered, endemic (for which with the law of diminishing eroded by habitat loss due to facility, the Wellcome Trust countries have a unique returns. Additionally, and in line urbanisation and agriculture. Millennium Building, was built at responsibility) and locally with Kew’s Breathing Planet Climate change may exacerbate Wakehurst Place with a large economic species. The capacity- Programme, the new project will this erosion and has led to the underground storage vault, building activities have centred focus on using the collections prediction that up to two thirds processing and research on training both here and sustainably including on the of all plant species may stand laboratories, public interpretation abroad, and assistance with the repair of damaged habitats. on the abyss of extinction by the designed to show the design and equipping of partner Demonstrating new uses of end of this century. We cannot conservation process unfolding, seed banks. The latter species drives the financial rely on conserving plants where and residential accommodation encourages ex situ conservation imperative to conserve. We have they grow. Therefore, off site (ex for visiting scientists. It was in the country where the plants a unique chance to do situ) conservation is necessary. opened by HRH The Prince of grow; consequently, Kew’s something about the gathering Of the techniques available, only Wales on 20 November 2000. storage role is one of safety storm. There is still significant seed banks allow us to conserve Simultaneously, Kew worked duplication. Underpinning this plant genetic diversity left in the billions of genetically different with the voluntary sector to project is an unparalleled seed wild but it won’t be there for individuals for hundreds of years collect samples of most of the research programme that seeks long. We have the drive, and relatively cheaply. UK’s seed-bearing species; a to improve the effectiveness of expertise (Kew alone has over world first for a national flora storage and our ability to recover 500 person years of seed Long-term seed banks were that encouraged other countries the full genetic potential of the banking experience), the first established for crop diversity to follow suit. collections by breaking seed technology and partners to in the middle of the last century. dormancy. This can be a major make a huge impact. With a Work by Kew and in Spain in the In addition to the priceless problem with seeds of wild price tag of £77 million, fund- 1960s showed that this seeds conserved and the species and there is still much raising is proving difficult in this technique could be applied to a thousands of samples to be learnt. Such new data will time of financial stringency. much wider array of wild species distributed for unique research not only benefit seed banks but However, it is money that must and, in 1974 Kew created a and habitat restoration, perhaps horticulture, agriculture and be found if the world is to have seed bank for wild species at its the greatest legacy of this habitat restoration. the tools to thrive in an Wakehurst Place garden in West unique project has been the uncertain future. It would be a Sussex. From the early 1980s international co-operation The safeguarding of so many fitting tribute to this country’s the bank focused on plants from engendered. In some countries plant species by the partnership foresight if the people of the the world’s dry lands which had partnerships have been is both a major achievement 23rd century looked back to this received little attention from catalysed between institutes that and responsibility. But there is moment as the one when their conservationists and yet which have never worked together so much left to be done. Kew is botanical legacy was secured. supported nearly a fifth of the before. The partnership now now galvanising support for a world’s people, providing comprises 128 institutes in 54 successor project that will start everything from local foods and countries. Furthermore, there is in January. In order to keep the medicines to building materials now collaboration that is and fencing. In the early 1990s independent of Kew – a sure a challenge was made by Kew’s sign that the network is Trustees to expand sufficiently established. In 16 of these the work to make a significant countries a major collaboration impact on the problem of has been established with genetic erosion and species loss. botanical, forestry and The result was a plan for the conservation agencies based on seed collection of 24,000 legally-binding agreements that species in ten years. Kew had clarify the expectations of both recently established a strong parties and cover collecting, fund-raising foundation and, capacity building and research. fortuitously, the UK was These agreements helped preparing to celebrate the exemplify the implementation of Millennium. In December 1995 the 1992 Convention on A scientist putting the collected seeds into the vault at the Millennium the Millennium Seed Bank Biological Diversity (CBD). The Seed Bank Science in Parliament Vol 66 No 4 Autumn 2009 11
7945 SIP AUTUMN 09 5/10/09 10:17 Page 14 MEDICAL TESTING - DO WE WANT MORE OR LESS OF IT? Meeting of the Parliamentary and Scientific Committee on Tuesday 16th June 2009 BREAST CANCER SCREENING SHOULD ROUTINE SCREENING BY MAMMOGRAPHY BE REPLACED BY A MORE SELECTIVE SERVICE OF RISK ASSESSMENT/RISK MANAGEMENT? biases of screening that give a “Breast screening: the facts—or opportunity and we have false impression of benefit and maybe not” by Peter C Gøtzsche witnessed a drop in mortality of secondly the over-detection of and his colleagues from the 30%-40% both in the age group cancer “look-alikes” that if left influential and independent, that are invited for screening undetected might never threaten Nordic Cochrane Centre.1 (>50) as well as for the younger a patient’s life. The survival from woman. So perhaps the correct In this paper they describe a cancer is measured from the number might be 1:3,000. (See synthesis of all the papers that time of detection until recurrence table 1). describe both the benefits and and death. If a frame shift in the Absolute value screening harms of screening using chronology of the disease due to 10,000 women for 10 years absolute benefits (ie number Michael Baum screening occurs, then survival is assuming two estimates of needed to screen) rather than Professor of Surgery Emeritus and automatically extended even if relative risk reduction and visiting Professor of Medical RRR, that makes it easier for the ultimate outcome is the assuming that unscreened Humanities, University College women to comprehend and London same; this is called lead-time symptomatic women receive the conclude as follows. If 2000 bias. Next, bearing in mind that best of modern therapy. women are screened regularly the interval between screens is for 10 years, one will benefit Whatever the number, that INTRODUCTION anything from one to three years, from the screening, as she will one woman who benefits from a it is inevitable that the fast The majority of lay people avoid dying from breast cancer. decade of screening has a life of growing tumours with a bad could be forgiven for believing (The independent United States infinite worth and if screening prognosis will appear during the that one of the mainstays in the Preventive Services Task Force were as non-toxic as wearing a intervals whilst the slow growing fight against cancer is “early derived a similar number in seat belt there would be no case tumours with a good prognosis detection”. In the vanguard of this will sit around until found by 2004.2) However even the to answer. However there is a campaign, the NHS screening figures 1:2,000 might be an downside and that is the mammography; this is called programme for breast cancer over-estimate. Remember these problem of the over-diagnosis of length bias. There is also another (NHSBSP) by mammography data were derived from the trials “pseudo-cancers”. 3, 4, 5, It is subtle bias that can be described has been lauded as a triumph. If as the “self selection” bias. In that that were mostly started in the deduced by the Cochrane report nothing else the introduction of 1970s and reported in the late that for every life saved 10 women who accept invitations this programme has improved 1980s. Since then improvements healthy women will, as a for screening might be the service for the diagnosis and demographically different to in treatment, such as the consequence, become cancer treatment of all women with adoption of tamoxifen and patients and will be treated those who ignore the invitation. breast cancer of any age and any The only way to account for adjuvant chemotherapy, have unnecessarily. These women will stage. However we cannot narrowed the window of have either a part of their breast these biases is to consider all the remain complacent and continue clinical trials of screening versus uncritically with a service based no screening and look for the TABLE 1 on a limited number of trials that pooled results described in terms 10,000 women 25% Relative 15% Relative are more than 20 years out of of mortality ie the number of aged 50 screened risk reduction 6 risk reduction1 date. Our understanding of women dying in the screened for 10 years (HR 0.75) (HR 0.85) breast cancer has moved on group compared with those Cancer incidence since then and as a result our dying in the control group rather (2 per 1,000/year) 200 200 attitude to screening is worthy of than case survival. The results are a fresh look. then described as relative risk Cancer deaths reduction (RRR) or hazard ratios without screening at THE ILLUSIONS AND (HR). There is in fact a modest median follow up 5 years 9 20 20 DELUSIONS OF “EARLY advantage to screening looked DETECTION” Cancer deaths with upon in those terms, (RRR 15% screening (20 X HR) 15 17 Let us start by considering two or HR 0.85) as described in the separate but related issues; firstly recent publication in the BMJ; Absolute benefit 5 3 12 Science in Parliament Vol 66 No 4 Autumn 2009
7945 SIP AUTUMN 09 5/10/09 10:17 Page 15 or the whole breast removed, rarely wound healing carries on of an integrated programme. The recruitment into RCTs for the and they will often receive too long and leaves an ugly first step is to set up a facility treatment of cancer that is the radiotherapy and sometimes keloid scar. Virchow, the father of nationwide for risk assessment major contributor to the dramatic chemotherapy. modern pathology, himself once using one of the modern fall in breast cancer mortality in described cancer as the wound computer programmes. Women the UK over the last two AN EXPLANATION FOR, that never heals. Prolonged would then be offered, not decades. If we can now add to AND THE NATURE OF, latency followed by catastrophe compelled to accept this service. this the prevention of the disease THE OVER-DIAGNOSED should not be all that surprising. Initially a practice nurse could and a risk adjusted screening CANCERS administer this questionnaire but programme then everyone is a Screening for breast cancer is IS THERE A REASONABLE it would be quite easy to transfer winner. now adopted as an unequivocal WAY OF MODERNISING this to a web- based programme References good by most of the members THE NHS SCREENING for the computer literate [1] “Breast screening: the facts—or maybe of the EU. Invitations for PROGRAMME THAT members of the community. not”, Gøtzsche PC et al BMJ 2009, 338; screening promote this activity by ENHANCES THE BENEFIT From the read-out an initial triage 446-448 being economical with the truth.6 AND REDUCES THE could be agreed. Those at the [2] U.S.Preventive Services Task Force. One of the uncomfortable truths HARM? most extreme end of the risk Screening for Breast Cancer: spectrum could be invited to a Recommendations and Rationale. Ann concerns the over-diagnosis of Since 1997 when I resigned Intern Med 2002;137: 344-6. both in-situ and invasive breast from the NHSBS committee I clinical genetics consultation. At the other extreme those with a [3] Rate of over-diagnosis of breast cancer cancers in screening have publicly expressed my 15 years after end of Malmö populations.3,4,5 Over-diagnosis concerns on the issue of low risk might be reassured and mammographic screening trial: follow up of breast cancer doesn’t mean informed choice for women given lifestyle advise on diet, study. Zackrisson S, Andersson I, Manjer J false positive rates but the invited for screening. I take no alcohol, tobacco and exercise and Garne JP, BMJ 2006;332:689-92 detection and treatment of particular pleasure in the fact that that might not only impact on [4] “Should I be tested for Cancer?” cancers that left undetected NHS has at last accepted the the risk of breast cancer but also H.Gilbert Welch, University of California on the more important risks of Press, 2004, ISBN 0520239768 would never threaten a woman’s point and agreed to rewrite the life and with which she would letters of invitation. cardio-vascular disease.7 Those in [5] Incidence of breast cancer in Norway between could then be invited to and Sweden during introduction of live, in blissful unawareness, until My concern is that they will a special clinic for the second nationwide screening: prospective cohort she died naturally of old age. We study. Zahl PH, Strand BH, Maehlen J. repeat the mistakes of the past if step. At this clinic women of say had always assumed that there BMJ. 2004 Apr 17;328(7445):921-4. we leave this task to those with a 45 or older would be invited to was an over-diagnosis of duct [6] Screening and choice: Informed choice conflict of interest. Furthermore have a mammogram. Those with carcinoma in-situ (DCIS), some for screening: implications for evaluation. it’s not for me to prejudge what radiological abnormality at this of which had the potential of Les Irwig, Kirsten McCaffery, Glenn Salkeld, level of benefit and what level of stage would be investigated in Patrick Bossuyt: BMJ 2006;332:1148- progressing to an invasive and harm might influence the the accepted way. In addition 1150, life-threatening phenotype. average woman to accept the those who were pre-menopausal [7] Bunker JP, Houghton J and Baum M; However, there is now clear invitation. For this reason I think might be offered prevention with “Putting the risk of breast cancer in evidence that anything between there are two related areas of tamoxifen and those who were perspective”. BMJ, 1998; 317:1307–1309. 10% and 50% of invasive research. First, the development post-menopausal could be [8] Prevention of Breast Cancer in cancers detected and treated of an information pack that offered entry into the IBIS II trial, Postmenopausal Women: Approaches to radically as a result of screening, Estimating and Reducing Risk: Steven R. includes decision aids. This could a study comparing tamoxifen would never threaten life.1, 3,4,5 Cummings, Jeffrey A. Tice, Scott Bauer, be used in a person preference with arimidex for the chemo- Warren S. Browne, Jack Cuzick et al; J Natl As a result the overall study where well women might prophylaxis of breast cancer. A Cancer Inst 2009;101: 384 – 398 mastectomy rate rises after any be offered sliding scales of recent paper in JNCI supports the country implements screening in [9] Howell A, Cuzick J, Baum M, Buzdar A, benefits and harms to find the validity of this approach.8 Dowsett M, Forbes JF, Hoctin-Boes G, contrast to the message in the point at which screening is Houghton J, Locker GY, Tobias JS; ATAC NHSBSP leaflet, “breast cancer the facts” that implies that judged acceptable. These data CONCLUSION Trialists' Group. might then inform the next area Results of the ATAC (Arimidex, Tamoxifen, screening saves breasts. It To carry on regardless is no Alone or in Combination) trial after of research on more efficient completion of 5 years’ adjuvant treatment doesn't. I would therefore like to longer acceptable, neither is ways of using scarce resources in for breast cancer. Lancet. 2005 Jan 1- argue that some of these screen political spin the answer. Women the NHS such as risk 7;365(9453):60-2. detected “cancers” if left are now getting smarter. assessment/risk management. unperturbed, would not progress However the changes I have in to a disease with lethal potential. The beauty of a risk mind are not nihilistic but In other words there are latent assessment/risk management constructive. The NHSBSP has conditions, which under certain approach is that it provides a indirectly lead to the provision of conditions might progress, platform for the management of the best specialist services for the remain stable or even regress. all women in an attempt to diagnosis and treatment of Other biological processes reduce all causes of mortality as symptomatic breast cancer in the behave in a similar way. Wound well as mortality from breast world, riding on the back of the healing starts with the knife and cancer where mammographic screening units. The centralisation ends when it needs to, although screening is only one component of care has lead to the rapid Science in Parliament Vol 66 No 4 Autumn 2009 13
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