NEWS

New Charity Chief Discusses His Fast-Paced Agenda

John Illman

When Paul Nurse, Ph.D., left his post earlier this year as chief executive of Cancer Research U.K., to become president of Rockefeller University in New York, there was much speculation about who would replace him as head of the world’s largest independent cancer research charity. So, many insiders were surprised at the appointment of Alex Markham, M.D., Ph.D., a relative unknown in the cancer research community.



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Alex Markham, M.D., Ph.D., was appointed chief executive of Cancer Research U.K. He took over the position in September.

 
His low profile will not last long. No other developed country depends on charity to fund cancer research as much as the United Kingdom. Between 1959 and 1979, the U.K. Charity Commission registered 340 new charities to promote medical knowledge and research. Yet between 1979 and 1993, there were 1,267 registrations, 290 in the cancer field alone.

In the last 20 years, cancer charity shops have become as much a part of main streets as banks and supermarkets, and Cancer Research U.K. is as much a brand name as Ford or Woolworth. Markham is charged with winning public hearts and minds—and their cash. Success could bring the glittering prize of a knighthood or a seat in the House of Lords.

In effect, Markham walked in through the charity’s back door, coming to his new position through the pharmaceutical industry. Cancer Research U.K. is the product of the 2002 merger of the 100-year-old Imperial Cancer Research Fund with the Cancer Research Campaign, previously the two largest cancer charities in the United Kingdom. The fact that Markham was not affiliated with either of the pre-merger charities may be an advantage.

So who is he? "He’s very approachable, very likeable," said Joanne Rule, chief executive of CancerBACUP, an influential consumer charity. "The buzz is that this is a very good appointment." Age 52, and from Manchester in the north of England, Markham retains a strong regional accent and is known for his good people skills. Starting out in the early days of molecular biology in the 1970s, he left his career in cancer research for the pharmaceutical industry at the age of 30 for medical school.

He said he switched because, although he could see the potential of molecular biology, he did not know enough about "disease targets and the fundamental problems of cancer." Returning to the pharmaceutical industry within a short time of obtaining his medical degree, he left it again to pursue cancer genetics research. He joined Cancer Research U.K. as chief executive from the University of Leeds where he was director of the Molecular Medicines Unit and a consultant physician.

Bob Williamson, Ph.D., now director of the Murdoch Children’s Research Institute in Melbourne, Australia, knew Markham in the 1980s as a young scientist who recognized the rich potential of molecular genetics long before most people and who "was always ahead of his time."

During that time, and even in the decade before it, the structure of the U.K. research grant system was fragmented and unstable because of fluctuations in the funding stream related to the state of the economy. Many young U.K. cancer researchers had short-term research grants from charities that discouraged people from pursuing careers that combined clinical oncology with active research. "It was unstable then and to a great extent it still is now," Markham said. "The level of insecurity for clinician scientists back in the 1970s and early 1980s has been hugely damaging to U.K. cancer research—their career structures were so nebulous and uncertain. What we didn’t do to train ‘wannabe’ clinical oncologists and ‘wannabe’ clinical radiologists came back to haunt us in the 1980s and 1990s. We probably didn’t have enough research orientated clinicians to push the cancer research agenda forward."

But Markham is optimistic about the future and hopes to bring U.K. cancer research to the cutting edge, judging by his early public pronouncements in his new role. Declaring Britain to be at "the forefront of progress" in the development of new therapies to revolutionize cancer therapy, he said: "We won’t do it overnight or alone, but I believe it is possible to have cancer under control in this country in the lifetime of my children’s children."

To old hands, such declarations sound familiar—part of the relentless cash-generating grind. But Markham, a man of boundless optimism, believes what he says. He is putting his faith in integration—the new war cry of U.K. cancer care research. Cancer Research U.K. is one example. The recently formed National Cancer Research Institute (NCRI), modeled on the National Cancer Institute, is another. Uniting all the major bodies involved in cancer research, the NCRI may repair the patchwork quilt that has characterized U.K. cancer research for 50 years or more, resulting in fragmentation and duplication.

Markham, chair of the NCRI for the next 2 years, said: "It’s only now that as a nation we speak with one voice in the international arena of cancer research. All the disease-specific charities have a voice within this forum—as does the (government funded) Medical Research Council and the Department of Health (the health arm of the government)."

The NCRI includes the National Cancer Research Network, which coordinates all clinical trials in the United Kingdom. One of its targets was to increase the number of new cancer patients taking part in clinical trials from 3% to 6%—a goal that has been achieved in a little over a year. Cancer Research U.K. is providing the peer review for study proposals; the Medical Research Council performs the data management, data monitoring, quality control, and capture of data at distant sites; and the state-funded National Health Service meets the clinical costs, Markham said.

The plan looks good on paper, but what about the many U.K. hospitals that are ill-equipped to support clinical trials? "We’ve managed to get an extra half a billion pounds for cancer care. In England and Wales we now have 34 cancer treatment centers providing integrated care for the first time, each serving a population of about one and a half million people."

"I’m not saying it’s a done deal," he continued. "We’ve bought the CT scanners, the linear accelerators, to an internationally accepted standard. What we can’t do just as easily is to go and buy the people to run them because they don’t exist. But training programs are now in place. This year we’re going to be training twice as many doctors as we were 10 years ago."

As far as strategy, he sees prevention as the first in a three-pronged attack against cancer, the other two being screening and new therapies. This could mark a radical departure for U.K. charity-funded cancer research, in which the emphasis has been predominantly on new treatments—developments that make newspaper headlines and fill charity collection tins. Prevention is less "sexy" and the social implications more complex. It was not so long ago that a highly confidential document circulating in government circles in Whitehall pointed out that preventive health care had dramatic implications in terms of the national pension bill.

"In the United Kingdom we have about a quarter of a million cases of cancer a year," Markham said. "If I were to sum up success in 10 years’ time, I say that instead of these 250,000 cases, we’d have halved that. We get bamboozled by statistics in cancer research, but the figure that sticks in my mind is that somewhere between 70% and 80% of cancers are preventable.

"The population is going to live longer and cancer is a disease of old age. Unless we do something on the preventative front, the incidence is going to grow and grow. We’ve just got to get stuck into the preventative agenda."



             
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