There are not many senior medical researchers in Britain who would list
the political upheavals of Paris in 1968 among their formative experiences.
There are fewer who read Czech poetry, or have their paintings exhibited
regularly in London and Edinburgh. But Michael Peckham does all three 鈥�
which makes him seem, on the face of it, an unlikely character to move to
Whitehall as the government鈥檚 new Director of Research and Development at
the Department of Health.
He may be an unlikely civil servant, but his qualities should stand
him in good stead for the job of producing a national strategy for the NHS鈥檚
science. A cancer researcher by profession, he has the appropriate academic
and medical credentials, the respect of his colleages, and a strong commitment
to the health service.
He also shows a healthy disrespect for the over-specialised, and is
as much at home with the nuts and bolts of medical practice as he is with
basic research in the laboratory. Curiously, his other life as a painter
could be part of the explanation: 鈥業f you鈥檙e an artist you have to take
the holistic view,鈥� he suggests. 鈥業 think it鈥檚 prevented me from retreating
into ultraspecialist activities.鈥�
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A striking feature of Peckham鈥檚 approach is this willingness to cross
cultures and boundaries, perhaps due in part to his early career in France.
鈥業f you penetrate one language and culture, it gives you the confidence
to try others,鈥� he says. In the late sixties, he was studying cell biology
at the Gustave-Roussy Institute in Paris, under Maurice Tubiana, who retired
last year. The events in the city at the time 鈥榟ad a profound impact鈥�, he
says.
As the first director of the NHS鈥檚 research and development, Peckham
is having to set his own goals. The post was established last year on the
recommendation of the House of Lords Select Committee on Science and Technology.
Although he has had his feet under the desk only since January, he has been
preparing for the job since last summer by meeting researchers and officials,
visiting institutes abroad and drawing up an initial draft of his plans.
How effective can he be in drawing Britain鈥檚 fragmented medical and
health science into a national framework? Can he raise the profile of good
research and weed out the poorest work? John Galloway at the Cancer Research
Campaign feels that there are only two relevant questions: has he got any
money, and does he have any teeth?
As far as money goes, Peckham has the existing yearly budget for research
in the NHS plus new money to pay for a support staff of more than 50 people
in the research programme at the Department of Health. The existing money
includes 25 million Pounds from the department, about 19 million pounds
from the NHS Management Executive, and a much smaller amount through the
Medical Research Council. Most of this is tied up in grants, salaries and
existing programmes, some of them five years long. In addition, there are
separate existing funds, worth more than 77 million pounds a year, to support
the clinical workload that research generates in hospitals.
Will all this be enough? It sounds very small in relation to the costs
of war, but so do most budgets. With his plans close to being finalised,
Peckham is diplomatic. Money is 鈥榓 challenge鈥�, he says. And while he accepts
that a lack of funds could be a serious obstacle to change, he does not
want to be 鈥榤esmerised by difficulties鈥�.
He feels that many people, both inside and outside the health service,
are not aware of the sort of research funds that are already present in
the NHS, and he would like to see these funds made more explicit. And he
wants to see a careful scrutiny to make sure that the existing money is
used to greatest effect. 鈥楤ut it is quite clear that in order to generate
the development side of the research, new funds would need to be made available,鈥�
he says. In the early spring, Peckham will meet the health minister, William
Waldegrave, to present him with a set of firm plans developed over the past
months. These plans will be costed, giving him the best possible chance
to make an effective case.
As for teeth, he certainly has them, in the shape of a seat on the NHS鈥檚
Management Executive. Initially, the post had been envisaged at a lower
level, but the Lords鈥� select committee pushed for this power.
Before he came to the department last month, Peckham was director of
the British Postgraduate Medical Federation in London, which coordinates
numerous research institutes. He was an oncologist at the University of
London and at the Institute of Cancer Research, based at the Royal Marsden
Hospital in Surrey. Colleagues think he is ideal for the new job, because
of the ease with which he communicates with different people and his breadth
of vision. His academic interests focus on cancers of young adults, particularly
lymphomas and testicular tumours.
The result of his planning so far is what he calls 鈥榯he R&D Initiative
for the NHS鈥� 鈥� something that he recognises must be visible and simple so
that he can present it 鈥榮uccinctly鈥� to boardrooms and to nonspecialist health
professionals, such as managers. The plans cover both medical research proper,
and what is known as health service research. This second field concerns,
for example, such questions as why there are regional differences in health
care, the costs and benefits of particular treatments, and ways to measure
more nebulous concepts like quality of life.
He wants to develop a network to devolve research in key disciplines,
such as epidemiology, health economics, statistics and medical sociology,
into the regions. The network would be national, seeking to assist collaboration
between the regions, but would also bring academics to work closely alongside
the clinicians 鈥榓t the coalface鈥� 鈥� where, he believes, many of the best
ideas originate. 鈥業 want to avoid creating ivory towers that might not benefit
the coalface,鈥� he says. One aim of the network would be to hasten the entry
of new research into clinical practice 鈥� a process that most researchers
have long felt to be much too slow. 鈥楴ovel therapies stay novel for too
long,鈥� says Peckham.
Although he is realistic about the need for focused research in specific
areas, he is also keen to avoid fragmentation. 鈥業鈥檇 like some sort of broad
template so that we can develop the initiative nationally.鈥�
Another of his plans is to have 鈥榯ask forces鈥� to coordinate research
into the major killer diseases, so that teams do not overlap each other
and duplicate work. There is already such planning in some areas 鈥� for example,
by the UK Coordinating Committee for Cancer Research. This body involves
the Medical Research Council, the major cancer charities and the Department
of Health. Another plan is to have a small set of advisory groups that would
act as 鈥榯hink tanks鈥� in certain areas. These groups, which would be multidisciplinary,
would aim to set priorities for research.
Bad research will not, one suspects, get an easy ride from him. 鈥楤ritain
can only support so much research,鈥� he says. Although keen to attract industry
into funding health science, he is profoundly opposed to companies setting
up 鈥榮lush funds鈥� that would cover the costs of a particular project. Given
such easy money, he says, researchers do not have to give so much thought
to their grant proposal, as they know that it will not face such a rigorous
peer review.
鈥業f you are in a very competitive situation it may cause you to think
very carefully about what you are doing,鈥� he says. 鈥榊ou may refine your
hypothesis. I think the availability of soft money short-circuits that process.鈥�
There is nothing more dispiriting, he says, than seeing a young doctor who
has spent years on a project and has no thesis to show at the end of it
because the project was ill-considered and ill-supervised.
Peckham is critical of past failures in clinical trials of new treatments.
鈥業 think the whole business by which novel therapies have been tested leaves
a lot to be desired,鈥� he says. 鈥榃e have not been as good as we could have
been in producing statistically valid trials.鈥� Nor has there been sufficiently
critical evaluation of programmes to screen for some diseases, he believes.
The obvious example is in breast cancer: researchers agree that there is
no evidence of any benefit in screening women under the age of 50 for breast
tumours, yet private health firms offer the service widely.
He is anxious that all demands for screening from pressure groups 鈥�
of doctors or patients 鈥� should be weighed carefully. For example, he says,
there have been strong demands from some groups to screen all pregnant women
for toxoplasmosis, an infectious disease that can damage the nervous system.
鈥榊et there is no valid scientific case for doing so,鈥� he says.
Ineffective screening is not just a waste of money. For Peckham, like
many researchers, there is the additional concern that it may bring people
more anxiety than help. He wants continued support for all the existing
research units that evaluate screening programmes, and for careful assessments
of the long-term outcomes of screening on the population. 鈥榃ith the increasing
emphasis on health promotion and screening we need to be more critical and
to regard intervention with the same rigour that we use to examine a new
drug in a clinicial trial,鈥� he says.
His critical approach to ill-conceived treatment and ill-considered
research may be one side of a coin. The other side is an unusually fresh
approach to new ideas, complementary therapies, and the kind of questions
that put most of the medical establishment into a cold sweat. For example,
he believes doctors should not underestimate the 鈥榲ery potent鈥� effect of
mind on body. And, perhaps because his time in France immersed him in French
culture, which takes the social sciences more seriously than Britain鈥檚,
he has plenty of respect for medical sociology. He would like to see, for
example, more acknowledgement that hospitals themselves have a strong impact
on people, and he thinks some study should be devoted to this.
On complementary medicine, he is open-minded 鈥� provided, like every
other therapy, it is properly evaluated. 鈥楾he question should not seek to
separate alternative therapies from orthodox ones,鈥� he says. 鈥業t should
ask, say, 鈥榃hat鈥檚 the best way of relieving low back pain?鈥� He is referring
to a study published last year in the British Medical Journal in which the
complementary therapy of chiropractic was compared with conventional physiotherapy
in the treatment of low back pain. Chiropractic performed best. The study
was one of the first randomised trials to measure the effectiveness of a
non-orthodox therapy.
Peckham鈥檚 interest may have been more than academic. At a meeting last
summer, he mentioned that he was suffering from a sudden bout of back pain
and had just visited an acupuncturist. His back was cured within a couple
of weeks 鈥� not, it turns out, as a result of the acupuncture but after a
bit of dancing while on holiday.
If we are to evaluate complementary medicine properly, he says, there
are several separate questions that must be asked. First, and obviously,
does it do anything for the sufferer鈥檚 disease? Secondly, and quite separately,
does it improve the patient鈥檚 quality of life? What is the cost? Some of
these areas may become blurred, he feels: for example, one feature of complementary
medicine that patients may prefer is simply the longer consultations that
its practitioners tend to give. 鈥極rthodox medicine needs that quality of
dealing with people,鈥� he suggests.
Peckham graduated from Cambridge in 1960 and went to University College
Hospital in London, where he worked with Gwen Hilton. He applied for an
MRC scholarship in clinical research at the Gustave-Roussy after seeing
the application papers in a friend鈥檚 office. 鈥楾he details of the scholarship
were sitting on his desk,鈥� he says.
When he left Paris, it was to go to the Royal Marsden. Sir David Smithers,
with whom he was to work, sent him a return air ticket. 鈥業 incorporated
the envelope into a collage which I鈥檝e still got,鈥� he says. He is struck
by what he calls 鈥榯he immensely accidental quality鈥� of events in his life.
Originally, he thought he would become a poet and it was 鈥榖y accident鈥� that
he became a doctor. 鈥楶aris was an accident too. Or at least, they look like
accidents, although they were probably not.鈥�
He is married to Catherine Peckham, an epidemiologist at the Institute
of Child Health in London, who is currently involved in a major coordinated
study of children with HIV around Europe. One of the Peckhams鈥� sons is a
poet, another is an environmental consultant, and the third is a doctor.
His profound affection for France has persisted. In 1984, he was offered
the directorship of the Marie Curie Institute in Paris 鈥� 鈥榯he greatest temptation
of my life鈥�. For personal reasons, he turned it down, but he is an enthusiastic
European, and is the president of the Federation of European Cancer Societies,
and on the councils of other international research bodies. He is also the
editor-in-chief of the European Journal of Cancer, launched last year.
His European contacts have given him ideas 鈥� such as the Dutch government鈥檚
research projects to look into the specific health needs of the country鈥檚
future. He is also convinced of the need to 鈥榮ell鈥� Britain鈥檚 medical tradition
abroad. 鈥極ur standards here are very high indeed,鈥� he says. Like others,
he recognises too that the NHS is unique in the West as a relatively uniform,
national, infrastructure that is ideal for clinical trials and other research.
But he wants doctors to learn more rigorously how to assess the effects
of their treatment, borrowing, for example, a scheme from Harvard in which
qualified doctors receive full training in research methods and statistics
so that they can evaluate their work.
What does he do for fun? Paint and draw, 鈥榓ll the time鈥�. He draws people
on buses and planes, and drew members of the Senate when he went to Washington;
he paints whenever he can. His images are striking human forms (though the
painting visible behind him is not one of his own). His most recent London
exhibition was at the Christopher Hull Gallery off Belgrave Square, but
he has exhibited since then in Edinburgh at Richard Demarco鈥檚 gallery. He
does not believe there is any overt connection between his paintings and
his medicine. But the act of confronting a piece of white paper 鈥� bringing
an idea into being 鈥� is similar for artist and scientist. He reads William
Carlos Williams (also a doctor), and the Czech poets, particularly Miroslav
Holub.
Between now and the early spring he will continue to consult people
and build up his plans for the crucial meeting with ministers. If they decide
to put some financial weight behind his thinking, Britain鈥檚 research in
medicine and health can expect a gigantic shot in the arm.