60
ƒ celebrates
years of healthcare
Member of the Global
Group
60
This short booklet
interweaves ƒ’s
story with that of the
breakthroughs in medicine that
we have witnessed over the last 60 years
– events that have significantly changed
the shape of medical care and improved
the public’s well-being. The past has
been eventful but even more exciting
times lie ahead and our story ends with a
glimpse of the possibilities being
explored by scientists as they study ‘the
blueprint of life’ or human genome.
Whilst the future of medicine lacks clarity,
one thing is certain - ƒ’s role
as a healthcare provider will remain as it
was when we began in 1940. We want to
ensure that we provide you with access to
the latest proven medical developments. It
is this vision that has secured
ƒ’s growth from a small,
one-policy company to one of the UK’s
leading healthcare specialists with nearly
2 million people benefiting from our support.
access to prompt, quality medical
treatment in the comfort of private
facilities. A dedicated Personal Advisory
Team is on hand to deal with your day to
day needs and our award winning health
information service, Health at Hand,
means that a team of medical
professionals is there to answer your
health concerns around the clock.
Building upon our heritage, we have
recently become part of The Global AXA
Group of companies. This means we are
now even better placed to ensure that
you receive all the care and support you
need now and in the future.
So, our 6oth anniversary is cause for
celebration: both for the several million
members for whom we have secured the
best in healthcare and for all our staff
whose support and dedication over the
years has been instrumental to our success.
I hope you find this an informative and
enjoyable read.
Putting our members first is something
we aim to do every day – we have always
listened to you so that we can better
understand and respond to your needs
and expectations.
As a result you can enjoy the peace of
mind that should you fall ill you have
Mark Adams
Managing Director, ƒ
0years
our History
1940 London Association for Hospital Services incorporated (LAHS).
Trading name - Hospital Service Plan.
Average weekly subscription for a single person was a shilling.
1943 Covering 3,100 members, in and around London.
1948 NHS founded.
1950 LAHS extends coverage to rest of UK, insuring 22,000 members.
Impact of NHS effects company’s growth, but not for long...
1960 121,000 members covered.
1962 As subscriptions reach over 100,000, LAHS changes trading name to
Private Patients Plan (PPP).
1963 First medical insurer to introduce full refund on weekly private
room charges.
1970 367,000 members.
1971 Continues to trade as PPP but changes company name from LAHS to
Provident Association for Medical Care Limited.
1975 Sets up charity to support the development of charitable hospitals and
medical research, The Eynsham Trust, (later named ƒ
Medical Trust).
1979 Launches first low-cost plan, Private Hospital Plan.
Introduces membership card and direct settlement of hospital bills.
1980 689,000 members.
1983 Company name changes to Private Patients Plan.
Launches Retirement Health Plan - first chance for over 60s to get
private cover.
1990 Pioneers Managed Care in the UK, helping manage the cost of
healthcare on behalf of corporate customers and their employees.
Membership reaches 1,790,000.
1993 Acquires Denplan, with its focus on preventive dental care.
1995 Relaunches company as ƒ with new look brand to support
customers through providing personal healthcare for life.
1996 Changes from provident status to allow greater investment and
flexibility in delivering quality healthcare.
Joint Venture of Access 24 (now wholly owned) leads to the
introduction of Health at Hand, our 24 hour health information service.
1997 Introduces network of recommended hospitals chosen for their quality,
value and range of services.
1998 ƒ joins the Guardian Royal Exchange Group (GRE).
ƒ Medical Trust receives the proceeds of the sale.
1999 Global AXA Group acquires GRE - ƒ becomes its
specialist UK healthcare provider, covering almost 2 million members.
2000 16th September, ƒ turns 60.
40
the
Forties
For the free world, 1940
was one of the most
momentous years in
history: Dunkirk, the Blitz. Britain stood
isolated against the Nazi onrush.
Strangely against such a backdrop, an
organisation called the London
Association for Hospital Services was
incorporated in the City of London. The
not-for-profit company was limited by
guarantee, had no share capital and an
office with four full time staff in Old
Jewry. Its purpose was to offer subscribers
health insurance to cover medical
expense costs. The maximum pay-out in
any one year to cover hospital and
nursing fees was £105. It is incredible to
think that the weekly allowance for a
hospital stay in those days was £6. Today,
with an average overnight charge of over
£200, the cost of a week’s hospital stay has
escalated to around £1400 – and this does
not take into account the cost of treatment.
This was the start of ƒ. In 1962
the Association adopted the name Private
Patients Plan because it better reflected the
company’s purpose. It went on in 1996 to
become ƒ limited with almost
two million customers. Recently it became
part of the Global AXA Group.
It may seem surprising that private
medical cover should have been initiated
eight years before the NHS came into
being. But both were a response to the same
patchy provision of and access to medical
services throughout the country. With no
need to nationalise hospitals, the private
initiative got off the ground much quicker
than the NHS and was boosted further by
the backing of the medical establishment –
the medical royal colleges, the British
Medical Association and the King’s Fund.
Initially, the NHS initiative failed to attract
such widespread support.
Against this background of turmoil in
healthcare provision began a series of
events that were to transform people’s
health. Medical advances since 1940 have
outstripped those of the previous 2000
years. The rate of progress was then
completely unforeseeable even if arguably
the greatest public health “doctors” had
already done their work – for example,
Victorians such as Joseph Bazalgette, who
built the London sewers.
It was another pioneer of the Victorian
era, Alexander Fleming, a microbiologist
who made perhaps the greatest medical
discovery of all time. It was also one of
the luckiest. In 1929 Fleming, returning to
work at St Mary’s Hospital in London
after his summer holiday, noted a mould
growing on a laboratory dish. The mould
was impeding a disease-causing
bacterium that the microbiologist was
0’s
growing for experimental purposes. As a
result Fleming went on to show that the
mould, which he dubbed penicillin, was
effective against a host of bugs.
Although it took Fleming’s skills as a
microbiologist to realise the properties of
penicillin, its discovery was pure coincidence.
Fleming was famously lucky that the mould
from a fellow scientist’s work “floated through
the window” and alighted on the laboratory
dish that he had failed to put away in an
incubator before leaving on holiday. His
holiday occurred during an unseasonably
cool period in London – ideal conditions for
growth of the penicillin.
The importance of temperature at first
evaded scientists who tried to recapture
Fleming’s work. When it was reproduced,
quantities were pitifully small. Attempts to
synthesise the drug failed. It seemed there
was to be no magic weapon against
tuberculosis, pneumonia, blood poisoning,
gangrene, gonorrhoea, syphilis and scores
of other fatal and non-fatal diseases.
Not until 1941 was the first human treated
with penicillin. The treatment ultimately
failed because there was insufficient
amounts of the medicine to cure a septic
wound – a scratch from a rose bush – in a 43year-old policeman. But the extraordinary
powers of antibiotics were clear.
In the grimmest days of the war, remarkable
self-belief drove two men to capitalise on
Fleming’s discovery. The biochemist
Howard Florey and Ernst Chain, a young
Jewish pathologist who had fled Nazi
Germany, turned their laboratory in Oxford
into a mould-growing factory. They grasped
the full significance of Fleming’s work and
exploited it to mankind’s benefit. All three
received the Nobel Prize in 1945.
Antibiotic power arrived in time to save
soldiers wounded in the latter part of the
Second World War. Penicillin was like gold
dust. The film of Graham Greene’s The Third
Man, based on the scarcity of the life-saving
drug in post-war Vienna, rang with authenticity.
Today, the overwhelming power of
antibiotics can be shown in bacterial
meningitis. If a bug breaks into fluid
surrounding the brain, the prognosis can
be very serious, even fatal. A single cell of
the invading bacterium can divide every 20
to 30 minutes. This could give rise to over
30 billion new cells within 12 hours.
Children are most at risk so it is hardly
surprising that a meningitis scare alarms
parents as nothing else. The key to survival
is rapid diagnosis and injected antibiotics.
The new medicines did more than offer
treatments for venereal disease and
tuberculosis. TB cases in 1913 numbered
117,000 – the early 1950s saw the total fall to
6,000. Antibiotics were so effective they
liberated researchers to concentrate their
efforts elsewhere. From the midpoint of the
20th century, medical science could switch
its attention to other, more perplexing, fields.
50
the
Fifties
Merely a decade after its
conception, ƒ
experienced a time of
consolidation. The private medical
insurance market faced collapse as the
NHS’ pledge of ‘free medical treatment for
all’ left subscribers questioning the need
for private cover. The market had to
reinvent itself and as a result private
medical insurance came to be seen as an
exclusive product that offered a more
upmarket alternative to the NHS.
In contrast to the uncertainty confronting the
medical insurance market, Max Perutz,
former director of the Laboratory of
Molecular Biology, was pretty far-sighted
when he described 1953 as a miracle year. “The
Queen was crowned; Everest was conquered;
DNA was solved.” To the man in the street, the
first two events probably meant a lot more
than the last. Unravelling the structure of
deoxyribo-nucleic acid was one of the most
far-reaching events of the last century. But in
practical terms, the short and medium term
effects were going to be non existent.
To a nation still getting used to the end of
food rationing, the mysterious world of
Crick and Watson was never going to
capture the attention commanded by the
Canvey Island floods, and Roger
Bannister’s four-minute mile in 1954.
Francis Crick, an English physicist and
James Watson, a young American scholar,
climbed a veritable Everest within their
molecular research unit at Cambridge
University. They famously showed that the
atomic structure of human existence was a
“double helix” which perpetually divides
and re-divides to build human life.
Nine years after their seminal work, the
pair was awarded the Nobel Prize for
Medicine. Maurice Wilkins, of King’s
College, London, who developed x-ray
diffraction, was also honoured. Diffraction
is directing x-rays at matter so that its
atomic structure can be interpreted from
patterns on a photographic plate. This
breakthrough enabled Britain to lay claim
to winning the race to identify DNA. The
double helix was so stunningly complex
that it was twenty years before any
practical use was to be made of it.
The impact of Crick and Watson’s work is
now evident in the frantic activity of
biotech companies to patent applications
of human genes and cell organisms. These
companies can already design drugs to
mimic the body’s natural hormones and
immune “defence” components. A child
destined to be stunted because he lacks a
natural chemical will grow to near average
height through daily injections of
0’s
genetically-engineered growth hormone –
a product guaranteed free of potentially
harmful contaminants. Likewise, a
diabetic receives pure insulin.
In 1985, researchers able to decipher the
genetic blueprint of viruses were to
provide an extraordinary turn-around in
the bleak outlook for AIDS patients. The
blueprint enabled them to pinpoint
molecular targets and design drugs to hit
them. The result a decade later: the
protease inhibitor. Young patients, who
feared they would never see outside their
hospital ward, were discharged as the
disease became a manageable condition
that could be treated at home.
About half of the 8,000 known
human diseases are passed from
generation to generation.
Geneticists cannot yet cure
these disorders. But a spin off from Crick
and Watson is that pre-natal screening
can be offered to mothers-to-be. Common
conditions can be identified early in foetal
development and the mother can choose
whether she wishes to continue with the
pregnancy. Medical diagnostics, too, are
heavily reliant on genetics.
Yet scientists are barely scratching the
surface of gene therapy, where the first
targets will include cystic fibrosis and
Huntington’s chorea. Scientists have now
completed the draft map of the three billion
molecules in man’s genetic make-up – the
human genome is the instruction book
on the building and running of the
human body. The immediate goal is gene
therapy, the ability to correct a faulty gene
in the patient by introducing a good one
into the patient’s cells.
Whilst Watson and Crick’s work took
place behind a closed labratory door,
other doors were quite literally opening
for many patients with mental disorders.
In both Britain and America, in-patient
populations of mental hospitals peaked
in 1954. Tens of thousands of people were
incarcerated in an aimless existence.
Many suffered from schizophrenia, a
condition still affecting one in 100
people. Crude, apparently cruel,
treatments included psychosurgery and
electroconvulsive therapy.
Modified social attitudes and a drug
called chlorpromazine changed all that.
Chlorpromazine was the first of six drugs
introduced in the 1950s that transformed
psychiatric practice, and steadily emptied
the big Victorian institutions – which
some years later were sold off as
prime-site property.
Among these new drugs was a
would-be schizophrenia drug, imipramine.
It did not work. Instead, it became the first
tricyclic, a major class of antidepressant.
0
6
the
Sixties
If the 1960s created a
revolution, as The Beatles’
song urged, the revolution
in science was no less dramatic. One fed on
the other. In the “swinging” decade –
typified by mini-skirts and the Mersey
sound – the world saw many concrete
achievements. The US outstripped Russia’s
sharp early lead in the space race,
culminating in 1969 with Neil Armstrong’s
giant leap for mankind. Donald Campbell
took the world land speed record in 1964.
That year saw the death of Ian Fleming,
another Briton who liked fast cars, and
unsurpassed creator of spy mythology. On
the car theme, Jim Clark won the world
motor racing championship in 1965 but
sadly was killed three years later. England
won football’s world cup.
The social and scientific revolutions came
together with synergistic effect. The
contraceptive pill arrived as the phrase
“free love” gained currency, although
hindsight suggests that more relaxed
sexual attitudes did not become widely
established until later.
To develop a pill voluntarily taken by 70
million women a day, a pill that gives
women control over their fertility – that is
a revolution. It freed half the population
from fear of unwanted pregnancy.
It was the study of hormones in the US in
the 1920s and 1930s that formed the
groundwork for the development of the Pill.
Understanding hormones was also to
provide the key to treating infertility. Often
results exceeded requirements. In 1968
fertility drugs led to Britain’s first sextuplets.
In addition, hormone research put the
pioneering pair, Robert Edwards and
Patrick Steptoe, on the trail of finding a
way in which women with blocked
fallopian tubes, but healthy ovaries and
womb, could have a child. The idea was to
fertilise egg and sperm on the laboratory
bench. Their efforts were not rewarded for
10 years. To enormous subsequent fanfare,
Louise Brown, the first so-called test-tube
baby, arrived in 1978. Today, the best
fertility clinics claim success at the first
attempt in half of in-vitro fertilisation
cases. In the jargon of the clinics that is “a
50 per cent take-home baby rate per cycle.”
At this time medical science not only
assisted couples in planning their ideal
family, it presented surgeons with
groundbreaking surgical techniques.
A hundred years ago when doctors
considered transplanting organs, they had
to surmount two problems. First, the
question of supply of organs – ironically,
0’s
due to the number of successful
transplants, this has become more dificult
as demand for such treatment has
increased. In the early 1950s, French
surgeons used kidneys from executed
criminals. Second, the problem of rejection,
which although it has diminished is even
now far from completely solved. So it was a
stunned world that learned in 1967 of the
South African surgeon Christiaan Barnard
who had performed the world’s first heart
transplant. The recipient of the heart, Louis
Washkansky, 59, lived for 18 days. Although
an incredible achievement the case
exemplified the problems of rejection. The
patient died from pneumonia because
drugs designed to stop rejection of the
organ by suppressing his immune system
exposed him to infection.
The following year in
Britain, the surgeon
Donald Ross –
unforgettably pictured waving the Union
flag – performed the same operation. But
it was not until the development of new
immunosuppressive drugs that
transplantation became a credible option.
Today, multi-organ transplants, costing
more than £250,000, have been upstaged
by the intricate microsurgery involved in
transplanting a hand.
Kidney transplants are almost routine,
but not to the recipient. In Britain, about
15,000 people are on renal dialysis,
underlining a worldwide crisis in organ
supply – a testimony to the transplanters.
The waiting list for kidneys is expected
to lengthen as the population ages. The
cost of dialysis has always been a huge
factor, typifying the insatiable demands
placed on healthcare systems. Even in
the late 1960s, limitations on NHS
services were beginning to fuel demand
for private care. ƒ, for
instance, had a total of 90,000
subscribers in 1965. That total then
doubled over the following eight years.
Before it got off the ground in 1948,
supporters of the NHS argued that it would
improve public health and reduce demand
for services. Public health has improved but
the notion that demand would decrease
looks laughable today as the public, more
informed of the latest medical advances,
becomes increasingly sophisticated in their
expectations of the service.
70
the
Seventies
X-rays are such a useful
tool in medicine that they
are massively over-used,
according to a recent inquiry. But if
doctors are “snap happy” in using internal
scanners, it is because they offer an
unsurpassed tool for diagnosing disease
or checking their work.
The German physicist Wilhelm Rontgen
could claim to be the first man to see through
solid matter with his discovery of x-rays more
than 100 years ago. The implications for
medicine were plain. And so were the
limitations. Conventional x-rays work because
different organs in the body absorb rays at
different rates, producing an outline on the
plate which can be assessed by the radiologist.
The snag is that numerous organs get in the
way, hindering interpretation. Solution: move
the x-ray tube and plate in opposite directions
while the picture is being taken so that only
the centre is in focus. This technique –
tomography – was conceived in the 1920s.
It was of little practical use because the
diagnosing doctor was presented with a
“slice” through the body that was only
meaningful when scores of additional
slices could be co-ordinated to give a
three-dimensional picture. If ever a job
called for a computer, this was it. Godfrey
Hounsfield devised a way of storing
information from each picture. He wrote a
programme to co-ordinate 28,800 bits of
information to produce the world’s first
brain scanner in 1971.
The computerised tomography (CT) scan
secured Hounsfield the Nobel Prize in
1979. He worked for EMI – the British
company, better known for producing
The Beatles’ music – and could not
have funded the project without its
pop business.
So the 1970s started with a CT scanner
and decimal currency (also 1971). In the
US, the word Watergate (1973) became
synonymous with political corruption.
In Britain it was lack of water that made
the news as drought measures included
the advice to bath with a friend. It was
also the era of Monty Python, Red Rum’s
Grand National hat-trick (1977) and Seb
Coe’s three minute, 48.95 second world
record mile.
In the early 20th century, the idea of
eradicating disease across the face of the
globe must have seemed the stuff of
science fiction. Yet through the 1970s,
smallpox, one of the most feared
epidemic diseases of all because of its
ability to kill, disfigure and maim people
of all ages, was systematically “bottled up”
0’s
in geographic pockets. In 1979 the World
Health Organisation declared the world
rid of smallpox. Such a victory has never
been paralleled, although there are hopes
of similarly erradicating poliomyelitis. If
the battle against polio is also won, it will
be the second global triumph for
campaigns of mass immunisation. The
principle discovered by the English
physician Edward Jenner in 1775 – that
exposure to a modified infective agent
can impart immunity – has become a
mainstay of modern public health.
Just as the 1970s marked a
global high point for
smallpox vaccination, so the
western world benefited from
public health measures
against other diseases. In England and
Wales in 1977 there were only 14
reported cases of polio, compared with
3,200 in 1956. Numbers of cases of polio
have always fluctuated, as with other
infectious diseases. Yet here was
testimony to public health measures: of
the 14 cases, all but three of the
sufferers had not been immunised. The
efficacy of mass immunisation is
evident today in a combined vaccine
against measles, mumps and rubella.
Provision of a vaccine is one thing,
organisation of health services
something else. Across the world
presently, two million children are dying
each year from diseases that could be
prevented by vaccination.
In Britain in the 1970s, health provision
headed the political agenda. Genuine
and long-standing disagreements about
the extent to which private medicine
should interlock with the public service
came to a head towards the middle of
the decade. The government sought to
ban private paybeds from state hospitals.
However, the British Medical Association
exerted its powerful union influence,
paybeds remained but charges sharply
increased. This forced many medical insurers
to introduce financial limits on benefits in
the interest of containing premiums. In
contrast, ƒ continued to
operate a full refund policy for hospital
charges. In 1979, ƒ pioneered
an inexpensive scheme through which
subscribers could get private care if an NHS
operation was not available within six weeks.
A royal commission on paybeds, reporting
in 1978, stressed the mutually beneficial
nature of ties between private and public
medicine. Economists continue to argue
that this is the sensible way forward. The late
1990s saw one in 10 private beds occupied
by a state-paid patient. A comparable total
of private patients a year – 100,000 – were
operated on in NHS private wings, providing
some cash-strapped NHS hospitals with
useful extra income.
0
8
the
Eighties
Many elderly people will
recall the drama of
appendix removal as a
teenager. They would have
been solemnly told to
expect at least two weeks in hospital
followed by several weeks’ rest. People now
undergoing the same operation might be
in hospital for two days. Similarly, women
undergoing hysterectomies or men having
prostate surgery can count on sharp
reductions in the length of a hospital stay.
These are commonplace operations. But
there was nothing commonplace in the
way “keyhole” surgery and a new breed
of gentler anaesthetic combined in the
1980s to help ease patients through
surgery. Instead of cutting an
inches-long incision to remove a benign
tumour in the stomach, for instance,
surgeons would inspect the diseased
area through an endoscope. The
miniature probe carrying a fibre-optic
light and camera relays pictures to a
television-style monitor. The surgeon
operates via tiny instruments inserted
through a small secondary incision.
Surgeons have been heard to remark that
the skills needed for keyhole work are
more akin to those of a computer-games
player than the traditional manual
dexterity needed in open surgery. Several
incidents where keyhole surgery failed
spawned a range of computer generated
“virtual” patients that allowed doctors to
train in this new technique in safety.
Australian tennis star Pat Cash bore
witness to the advances in surgery when
in 1986 he entered Wimbledon only three
weeks after leaving his appendix in a
London hospital. Playing contrary to
medical advice, Cash still reached the
quarterfinals and won the championship
outright the following year. Another
indication of how anaesthetics have
improved was hip surgery on the Queen
Mother in 1998. Twenty years earlier such
an operation would not have been
contemplated because anaesthesia would
probably have been fatal in a 97-year-old.
Perhaps the biggest milestone in
anaesthetics was the British discovery of
halothane (first used in 1956). Today, more
than three million people a year in Britain
have surgery and deaths from anaesthesia
are very rare. Bouts of vomiting after
surgery are unusual when once they were
common. But perhaps the biggest gain is
that subtle anaesthetics permit lengthier
operations – for instance, more than 2,000
heart transplants a year are performed in
the US alone. Without modern
0’s
anaesthesia, these patients would not
survive surgery.
The 1980s was also the decade that
questioned any assumption that advances
against disease would continue inexorably.
AIDS arrived early in the decade,
spreading fear in all communities. Here
was an apparently easily transmitted
disease without cure. By late 1985, the
legendary Hollywood tough guy, Rock
Hudson, was a fatality. He is one of many
prominent figures, including Freddie
Mercury, to succumb.
The first line of defence against AIDS
came in public education. The second in
Wellcome’s AZT (zidovudine), the first
drug available against the virus (1987).
Resources comparable to getting man on
the moon were poured into AIDS research.
Knowledge accumulated. But another
breakthrough in life-saving terms did not
come for nine years when the UK arm of
the Swiss-company Roche introduced the
protease inhibitor Saquinavir (1996).
It was also the Thatcher
boom decade. City workers,
at least according to the
press, became champagneswilling Yuppies. House prices went
through the roof.
So did demand for private medical insurance.
By the end of the 1980’s, ƒ had
reached 800,000 subscribers. Business
postings abroad became increasingly
common and ƒ launched
an Overseas Health Plan.
Overall, it was a decade of rising then
ebbing fortunes. It started with the
wedding (1981) of Prince Charles and Lady
Diana Spencer, and ice-dancers Torville
and Dean winning Olympic Gold (1984).
But in 1985, Britain’s longest surviving
heart-transplant patient, Keith Castle,
died, six years after the operation. The
term Black Monday passed into the
national vocabulary with the stock
exchange crash (1987) and later the house
market crash (1989). In 1988 junior health
minister Edwina Currie pointed to an
equally unthinkable possibility – that
chicken eggs could be contaminated with
salmonella. Mrs Currie lost her job, but
she was right. It was the moment that
food hygiene scares got on the front page
and have, more or less, remained there to
the current day.
90
the
Nineties
Through the 1990s
scientists across the world
collaborated in one of the
greatest tasks of all time. By the arrival of the
new millennium, they were close to mapping
the entire human genome, detailing every
gene that makes up mankind.
It was not a human, but Dolly the sheep,
that made the greatest medical and ethical
impact of the decade. Dolly, the world’s first
cloned mammal, was born in 1996.
Researchers at the Roslin Institute in
Edinburgh and the biotech company
PPL Therapeutics eschewed all thought of
fertilising eggs with sperm. Instead, they
extracted eggs from ewes and then
removed all the genetic material from
within. Direct electric current then fused
empty eggs with cells from another ewe,
stimulating cell division and growth. One
of these became Dolly, who thus derived all
her genes from a single source and became
an exact match of the cell-donor ewe.
Implications for many aspects of medicine
are vast, not least for the prospects of
producing replica organs for transplantation.
Dolly was not publicly unveiled until 1997
when a leader of the project was asked
why a sheep was chosen to become a 20th
century icon. “Because in Scotland they
are very, very cheap,” he replied.
Reproduction of the old fashioned variety
became a possibility for impotent men
with the introduction of Viagra. Amid
widespread evidence that men who did
not need it were using the drug, sales
broke all records and manufacturer Pfizer
became the darling of Wall Street.
Viagra was termed the classic lifestyle
drug – medicines designed for a specific
purpose – that could also be used to
facilitate particular (not necessarily healthy)
ways of living. Functional foods, which could
fill you up and might aid health, entered the
shops and the national vocabulary.
Alarms were raised (1992) about breast
implants. In 1995 came the trials of O J
Simpson and Rosemary West, then the
Dunblane massacre (1996). Prince Charles
and Diana divorced that year and in
August 1997 the Princess died in a car
crash. Diana was widely mourned.
These were high profile events. One medical
advance barely got a mention. This was the
development of a new range of antiinflammatory painkiller. The medicines
could be a Godsend for those who suffer
joint stiffness – “wear and tear” of the major
joints or osteoarthritis. Sufferers of joint
inflammation – rheumatoid arthritis – could
similarly benefit. Control of pain and
0’s
inflammation is key in both these
conditions. Patients have relied heavily
on non-steroidal anti-inflammatory drugs
(NSAIDs). The oldest such drug is aspirin,
perhaps the most useful medicine of all.
It has been in common use for 80 years.
The chief worry is tummy upsets and
bleeding in the stomach, a potentially
lethal side effect. NSAIDs work by
blocking an enzyme, known as Cox
(or cyclooxygenase). Cox triggers a
chemical chain that can cause
inflammation. The trouble is that in
inhibiting the enzyme, the drugs also
thwart production of fatty acids that
protect the gut, liver and other organs.
For years scientists have
been researching the
problem, which has the
potential to affect 30
million people in the
Western world who daily take drugs such
as ibuprofen. Breakthrough came in 1991
with the discovery of a second Cox
enzyme. This version, dubbed Cox-2, was
shown to be concentrated in inflamed
sites, while Cox-1 was not. So
pharmaceutical companies raced to find a
molecule that would selectively stop
Cox-2 and leave alone the other enzyme.
By the end of the 1990’s companies were
lining up to get Cox-2 inhibitors through
the licensing authorities amid growing
claims of major advance. The new drugs
may not have captured public
imagination, but have huge potential for
millions if optimism is borne out. Three
in four people over 60 suffer osteoarthritis.
As life spans increase, the actual number
of cases can only increase. Paradoxically,
good medical care raises expectations and
therefore increases demand for treatment.
This is one of the factors affecting medical
insurance costs. For over 60 years,
premium increases have regularly
outstripped inflation. Yet despite a market
described by economists as very
competitive, ƒ established
one of the best growth records. As the
century’s end approached, ƒ
covered almost a third of the 6.5 million
private medical insurance subscribers
in Britain.
Private medical care had become a
£2 billion-a-year industry, as the bigger
insurers promoted hospital “networks” to
contain costs and monitor care standards.
ƒ now comes under the
umbrella of insurance giant AXA, whose
own philosophies of putting the customer
first reinforced ƒ’s
supportive approach.
21c
among scientists can perhaps best
gauge the significance of the event.
Expectations can only rise when Sir
Robert May, the Government’s chief
scientific adviser, compares the draft
publication of the ‘blueprint of life’ in
importance to man landing on the moon
and Charles Darwin’s Origins of Species.
Sir Robert foresees a biotech revolution
“as important and far reaching as the
industrial revolution.”
Lucy age 6
John Harris, a leading member of the
Government’s Human Genetics
Commission, sees the genome project as
ushering in an era of human immortality,
in which we could live for 1,200 years.
Instead of worrying about our health, the
priorities will be seeing off new
generations chasing our jobs and living
space – and perhaps our sexual partners.
In an ageless society, would an affair
between a 150-year-old woman and a
30-year-old man be so unrealistic?
the Future
Ask anyone to reflect upon world events
witnessed during their lifetime and many
will cite wars, disasters, political scandal,
royal occasions, space exploration, media
technology, even fashion and music. Very
few are likely to recall major breakthroughs
in medical science.
26 June, 2000 saw the work on mapping
the human genome unveiled. For all the
excitement it created, the divisions
Yet equally bright minds point out that
the genome project could cause as many
problems as solutions, such as the
creation of designer babies. Sceptics say
that any practical benefits are 20 to 40
years away.
Gene therapy – replacing a faulty gene
with a sound one to correct ‘simple’
genetic disorders such as cystic fibrosis –
has not worked so far. In the USA,
laboratories striving to this end have
closed and remaining ones are notably
less optimistic about the future, as the
1
st
century
distinguished British scientist and
commentator Steve Jones points out.
"The first problem is transplanting the
good gene into the patient. This might be
relatively easy in a lung disorder, say,
where the airways give access. But
diseases in internal organs such as the
heart offer no easy route. Another
obstacle is that in most diseases bundles
of genes, rather than a single gene, are
implicated. These bundles shift and
change between families and races
making diagnosis and any possible
treatment still more difficult."
But here we have the way ahead. The huge
strides in genetics will exert a fairly
immediate impact on health, but this will
be indirect, as pharmaceutical companies
tailor their products to individual
patients. Humans are as different in their
responses to treatment and reactions to
drugs as individuals are in appearance.
John Bell, Nuffield professor of clinical
medicine at Oxford University, says the
first "widespread clinical application" of
the vogue discipline will be in identifying
patients who respond to particular
therapies as well as identifying those who
are unlikely to respond or are likely to
suffer damaging side effects.
Professor Bell, writing in the British
Medical Journal, gives the example of
blood pressure drugs. Their effectiveness
varies widely patient to patient. "Similar
problems exist with the use of most
therapies in patient populations, all
arising because of genetic variation."
Tailoring drugs may well lower the
barriers raised by government regulators.
A heart drug lethal in those with a certain
genetic make up, could be a lifesaver for
others. It would be licensed accordingly.
Ending today’s haphazard prescribing may
not have the popular appeal of cloning
one’s own organs – a spare knee joint for
the skier, a spare liver for the heavy drinker
(both very possible). But the impact on life
spans is likely to be considerable. This
could happen within a few years.
In a similar vein, genetic testing on
individuals before they develop diseases –
a sort of mass screening – could cut death
rates. Asthma and diabetes are among the
likely candidate conditions. But cancer is
the disease where, ultimately, genetics
will have the greatest impact of all.
Emily age 12 3/4
The Future
...21st
century
Beyond genes, scientists predict drugs to
beef up bone density for women after
the menopause. Rapid advances in
fertility are likely to be restrained only
by ethical committees. Vaccines against
common sexually transmitted diseases
are on the horizon.
The view from the dentist’s chair will be
more comfortable. The drill is on the way
out as dentists use a mix of two
substances – sodium hypochlorite and
amino acids – to scrape off decay. If that
doesn’t work a stream of fine aluminium
oxide particles can be fired at the tooth.
Teeth whitening will become common and
a vaccine against decay is expected to come
in to widespread use: it has already been
tested at Guy’s Hospital, London. Further
away, growth factors, substances used to
stimulate local cell renewal, could reinforce
gums to stop teeth falling out, just as they
could also be used to regenerate heart
muscle after a heart attack. Treatments for
baldness will improve. So we will have a
good head of hair above regular smiles as
we ponder our extended lives. Or will we?
As Roy Porter, the distinguished medical
historian points out; doctors have in the
past been strikingly unsuccessful in their
predictions. Every planned advance seems
to throw up unforeseen complications.
What if growth factors, for instance, get
out of hand, effectively introducing cancer?
The last 60 years is testament to how quickly
pioneering medical discoveries gather public
demand to become readily accepted health
care treatment. The future often mirrors the
past – it is not unrealistic to imagine
effective treatment of more diseases and
those treatment methods will become more
sophisticated. Advancement, however, is not
without a price – the more complex the
treatment, the higher the cost. Whilst
scientists gaze into their respective crystal
balls and debate the true nature of the future
of health care, the forecasters most in
agreement are economists. They predict that
there will be more and more spending on
healthcare as a greying population seeks to
exploit ever more costly scientific advances.
ƒ customers can be certain
that, whatever the future brings, the
benefits of their healthcare cover will
continue to provide effective proven
medical care.
Natasha age 8
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