Ifs and butts of an outcry

Jim Edwardson explains why he accepted a donation from British American Tobacco to fund research into Alzheimer's disease and why he would not do it again.

The Medical Research Council's neurochemical pathology unit at Newcastle General Hospital was severely criticised last week for accepting money from British American Tobacco.

Few scientists have contributed more to our understanding of Alzheimer's disease than my colleague, Elaine Perry. In 1976 Professor Perry and her group showed that the brain's ability to produce acetylcholine, a chemical messenger involved in signalling between nerve-cells, was severely reduced in Alzheimer patients. The loss was linked with the severity of both the dementia and of the microscopic brain damage that marks this disorder. The first, modest advances in our ability to treat Alzheimer's disease have come from the recent development of drugs which boost acetylcholine levels in the brain.

Our interest in smoking and Alzheimer's disease is directly linked to these discoveries. Nicotine acts on the brain by binding to acetylcholine receptors - protein molecules on the surface of the nerve-cell which normally combine with acetylcholine to trigger chemical signals within the cell. These so-called "nicotinic receptors" are concentrated strongly in a brain region that is essential for memory processes. It is also the first area to be affected by degenerative changes in Alzheimer's disease.

About 20 different studies have examined smoking among many other lifestyle and environmental factors that may modify the risk for Alzheimer's disease. The majority of reports suggest that smokers may be at reduced risk compared with non-smokers, although the evidence is highly controversial. Some experts believe that the findings simply reflect a "survivor effect", in that many smokers who would have developed Alzheimer's disease die before the age of risk.

However, several lines of experimental evidence suggest that nicotine can protect nerve-cells against certain forms of toxic damage. Brain nicotinic receptors are structurally different to those in peripheral tissues, offering the possibility of selective nicotine-like drugs, which target only the brain and afford protection against Alzheimer's disease.

Such lines of research are crucial. Alzheimer's disease and related forms of dementia affect over half a million people in the United Kingdom and the prevalence is rising as the population ages.

Three years ago this unit's future research programme was approved by the Medical Research Council's neuroscience and mental health board. While more than 80 per cent of the proposed work on acetylcholine and other chemical messengers in dementia is core-funded by MRC, the projects included a study to compare the brains of smokers and non-smokers for early changes associated with Alzheimer's disease. This particular aspect was to be funded by a United States-based pharmaceutical company but support foundered after a year. There was a real risk of losing staff and having to cut the project.

British American Tobacco supports a programme of more than ten health-related research projects in universities costing a total of Pounds 500,000 per annum. An initial approach seemed promising, especially since a decision could be made quickly - unlike the situation with most grant-giving bodies. I had several misgivings about accepting tobacco money. The chief was whether doubts would be raised about the impartiality of the research, notwithstanding the world-class reputation of Elaine Perry as an independent scientist. Another was whether the results might be used to promote smoking if evidence for a reduced burden of Alzheimer-type pathology was found in smokers.

I finally agreed that we should accept Pounds 147,000 over three years from BAT, for several reasons. The work was in danger of folding without early support. The funding arrangements were reviewed independently and agreed by senior colleagues at MRC head office. We had complete control over the research and resulting publications. The formal agreement stipulates that BAT may not make any reference to the findings without the written consent of MRC - something not likely to be given.

Even if our work clearly showed that smoking reduces the risk of Alzheimer's, a vast amount of evidence indicates that smoking is a serious cause of cardiovascular and other diseases which can contribute to brain damage. The study provides an opportunity to compare non-smokers and smokers in this respect, and is likely to be bad news for the latter group.

External sources of funding are reported in the MRC Handbook. The BAT contribution will be shown in the 1994-95 edition, later this year.

Meanwhile, it was listed in a report from Newcastle University's Institute for the Health of the Elderly, to which the unit is affiliated. In this form it reached Steve Connor, science correspondent for The Sunday Times, which, on August 25 ran a front-page story.

An unique antipathy exists between the leading opponents of smoking and the tobacco industry. Even before Mr Connor circulated details of our BAT grant for comment, good copy was guaranteed. "The revelationsI astonished and angered many cancer doctors and scientistsI", although only one was prepared to be quoted by name.

"Anger over tainted tobacco funds," declared the Independent next day and followed up the account with two further pieces. The Guardian, and The Times also joined in.

This week Susan Wonnacott of Bath University finds herself in the news, defending a similar decision to accept BAT funds.

I would not apply for tobacco money again. Our original decision was not wrong in any ethical sense. All public expenditure is underpinned in part by the Pounds 9 billion per annum which the Government raises in revenue from tobacco.

If the tobacco industry gave more of its huge profits for health research, rather than sports promotion or anything else designed to encourage smoking, this would be no bad thing.

My change of mind is a matter of policy. I do not wish to provide further opportunity for criticism of the MRC - a body which has contributed more to UK research advances in health and biomedical science than any other this century.

Jim Edwardson is director of the Medical Research Council's neurochemical pathology unit at Newcastle General Hospital.