Evidence of meeting #49 for Health in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was research.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Jocelyn Downie  Canada Research Chair in Health Law and Policy, Professor of Law and Medicine, Dalhousie University
Jean Rouleau  Dean, Faculty of Medecine, Université de Montréal
Trudo Lemmens  Associate Professor, Faculties of Law and Medicine, University of Toronto
Peter Brenders  President and Chief Executive Officer, BIOTECanada
Clerk of the Committee  Ms. Christine Holke David

3:30 p.m.

Conservative

The Chair Conservative Joy Smith

Good afternoon, ladies and gentlemen, and welcome to the Standing Committee on Health. We're very pleased to have you here today.

Today each one of you will have five minutes to present. Following that, we'll go into a seven-minute Q and A, and I'll be very strict on the time because we do have another hour in which we're going into another piece of business that has to be done.

We have with us Dr. Jocelyn Downie. She's a Canada Research Chair in Health Law and Policy and a Professor in the Faculties of Law and Medicine. Welcome, Doctor.

We also have, from the Université de Montréal, Dr. Jean Rouleau, and he's from the Faculty of Medicine. Welcome, sir.

From the University of Toronto, we have Dr. Trudo Lemmens, Associate Professor, Faculties of Law and Medicine. Welcome, Dr. Lemmens.

From BIOTECanada, we have Mr. Peter Brenders, President and Chief Executive Officer. Welcome to you as well.

We will begin with Dr. Jocelyn Downie.

3:30 p.m.

Prof. Jocelyn Downie Canada Research Chair in Health Law and Policy, Professor of Law and Medicine, Dalhousie University

Thank you for the opportunity to speak with you today.

I am here to speak against the appointment of Dr. Bernard Prigent. Understanding the limits on the committee's jurisdiction, I will restrict my comments to the appointee's qualifications and competence to perform the duties of a member of CIHR's governing council.

Those who endorse this appointment point to innovation and commercialization mandates for CIHR and argue that according to these criteria, Dr. Prigent is eminently qualified. However, this misses three critical points.

First, Dr. Prigent's ability to bring his expertise in innovation and commercialization to the GC table is fatally limited by the fact that he is currently a Vice-President at Pfizer. A qualified candidate must not only have certain knowledge and skills but must also be able to use his knowledge and skills. This is a significant problem for Dr. Prigent.

To avoid both real and apparent conflicts of interests, he will need to recuse himself from all discussions and votes on innovation and commercialization in the pharmaceutical sector that have the potential to conflict or appear to conflict with the interests of Pfizer. For example, one of the jobs of the GC is to establish and terminate institutes. Pfizer's interests would definitely conflict with the public interest in a decision about whether to terminate an institute like the Institute of Health Services and Policy Research. That institute supports the kind of research that might show that a Pfizer drug is dangerous, identify the problems of ghost-writing by pharma, or argue for a change to the Canadian patent regime to make the production of cheaper generic drugs easier. To be ethical, Dr. Prigent will need to recuse himself from so many discussions as to not be able to be an active contributing member of the GC.

Second, commercialization is not CIHR's objective. Rather, it is but one means for realizing CIHR's objective, which is, in fact, “the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system”.

Third, not only are innovation and commercialization only a means to CIHR's objective, but they are not the only nor the most important of CIHR's statutorily mandated means of achieving its objective. The CIHR Act requires CIHR to meet its objective by, among other things, “promoting, assisting and undertaking research that meets the highest international scientific standards of excellence and ethics”. By contrast, “encouraging innovation, facilitating the commercialization of health research” is but one of 12 means available to CIHR.

Therefore, the criteria against which we must assess the qualifications of the appointee are not only innovation and commercialization; we must also ask whether Dr. Prigent is competent and qualified to pursue CIHR's objective. And is Dr. Prigent competent and qualified to pursue that objective using the prescribed means of the highest international scientific standards of excellence and ethics? It is here that this appointee's record does not withstand close scrutiny.

To be confident that the appointee is competent and qualified to meet the scientific excellence and ethics criteria for this position, we need to know that he does not endorse the actions of his employer where scientific excellence and ethics have been compromised. There being no public criticism by Dr. Prigent of Pfizer's and pharma's conduct in either of these realms, it is reasonable to assume that Dr. Prigent has adopted Pfizer's and pharma's culture and priorities.

With respect to scientific standards of excellence, one can point to the well-documented cases of selective positive reporting of the results of research studies. With respect to the improved health of Canadians, one can point to the health harms associated with Bextra and Celebrex. With respect to ethics, one can point to the fact that Pfizer recently agreed to a $2.3 billion settlement, including a $1.2 billion criminal fine, in relation to Bextra and other of its drugs.

Until Dr. Prigent criticizes all of this in a public forum, it is reasonable to conclude that he is neither competent nor qualified to sit on CIHR's GC.

Let me put it another way. Even if appointing a senior executive from Pfizer might serve some of the means of achieving the objective set out under the CIHR Act—namely, the innovation and commercialization means—unless he or she has publicly dissociated himself or herself from Pfizer's and pharma's misconduct, as Dr. Prigent has not, it actively undermines other means, most obviously those having to do with the highest international standards of scientific excellence and the highest international standards of ethics.

This appointment cannot--

3:35 p.m.

Conservative

The Chair Conservative Joy Smith

Dr. Downie, can I just point out that you're over time? Could you wrap it up now so we can get to the others?

Thank you.

3:35 p.m.

Canada Research Chair in Health Law and Policy, Professor of Law and Medicine, Dalhousie University

Prof. Jocelyn Downie

Certainly.

This appointee cannot be considered competent to perform the duties of a member of governing council because of this corrosive effect on CIHR's capacity to further scientifically and ethically excellent research and to improve the health of Canadians.

The appropriate action for this committee is to report to the House of Commons that it has examined the appointee and determined that he does not have the qualifications and competence to perform the duties of the post.

3:35 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you, Dr. Downie.

3:35 p.m.

Canada Research Chair in Health Law and Policy, Professor of Law and Medicine, Dalhousie University

Prof. Jocelyn Downie

I have one sentence left. Might I say it?

3:35 p.m.

Conservative

The Chair Conservative Joy Smith

Hurry then, please. I should have cut you off.

3:35 p.m.

Canada Research Chair in Health Law and Policy, Professor of Law and Medicine, Dalhousie University

Prof. Jocelyn Downie

This would be to act within your jurisdiction and would send a strong message to Canadians that you take your responsibility for CIHR seriously and that you vigorously support and will defend the primacy of the health of Canadians.

3:35 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you, Dr. Downie.

We'll now go to Dr. Rouleau, please.

3:35 p.m.

Dr. Jean Rouleau Dean, Faculty of Medecine, Université de Montréal

I appear today as an individual, as a physician and cardiologist and not as a member of the governing council of CIHR, nor as Dean of the Faculty of Medicine of the University of Montreal or as co-chair of the National Committee on the Future of the Teaching Hospitals of Canada.

As far as I can gather, there are two issues at stake with the nomination of Bernard Prigent to the governing council of the CIHR.

The first is that of the integrity and competence of Dr. Prigent. To me, this is clearly the most important issue at stake. To my knowledge, neither of these critical qualities associated with the nomination of Dr. Prigent to GC have been seriously questioned.

I have known Dr. Prigent for many years during which I have had the pleasure to work and exchange with him as a scientist and a committed member of our society.

I have always been impressed by his judgment, his great competence, his generosity, and the integrity he always brought to commitments he undertook, whether they be related to his job or as an individual contributing to the advancement of our society. At his first GC meeting two and a half weeks ago, it was clear to all members of GC that Dr. Prigent had the skills we had been seeking in order to better fulfill our mandate,and that he had the personal qualities we expect in all members of GC.

Many other people are just as concerned as I am watching demagogues confuse that which is most important, the skills, integrity and qualities of a person with the qualifications which that person brings to the CIHR's council in order to improve our ability to meet the needs of our society.

The second is whether a member of the pharmaceutical industry should sit as a member of GC. At this time there is a consensus that in order to better serve Canadians, the research community needs to develop win-win partnerships, one of which is with industry. This is seen to be necessary in order to bridge the growing gap between discovery of potential therapies and delivery of care to patients.

In his speech at our convocation this spring, Professor Braunwald, former chair of medicine at Harvard and editor of today's major textbooks in internal medicine and cardiology, pointed out that according to him, most of the top 10 developments in cardiology in the last 100 years were the result of a partnership between industry and academia and that this relationship is necessary. And you can visit our website and see the lecture.

This is why we, the members of CIHR, believe that the appointment of Dr. Prigent fills a chronic and significant gap in CIHR's governing council. The innuendos that underlie the brouhaha associated with Dr. Prigent's appointment are a concern for us as members of CIHR's GC. I could add that this worries a vast majority of the deans of faculties of medicine in Canada.

Demonizing the pharmaceutical industry to the point of being unable to accept the help of a Canadian citizen happy to serve his country is truly troubling.

For my two lawyer friends, finally, another troubling unspoken concern is that the other 15 members of GC and the leadership of CIHR just fell off a turnip truck and would be unable to recognize an intervention that is coloured by conflict of interest. Please remember that at this time the members of GC are nearly all members of the institutions that receive funding from the CIHR. We are all aware of this potential conflict of interest--

3:40 p.m.

Conservative

The Chair Conservative Joy Smith

Dr. Rouleau, could I ask you to address the committee, not the witnesses?

Thank you.

3:40 p.m.

Dean, Faculty of Medecine, Université de Montréal

Dr. Jean Rouleau

Yes.

We are all aware of this potential conflict of interest and hold one another to the highest ethical standards possible, as we will with Dr. Prigent.

Thank you for giving me the opportunity to express my views on this subject which I believe important for our society.

3:40 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you.

Mr. Lemmens.

3:40 p.m.

Prof. Trudo Lemmens Associate Professor, Faculties of Law and Medicine, University of Toronto

Madam Chair, members of the Standing Committee on Health, thank you for inviting me to elaborate on why the appointment of Dr. Bernard Prigent, Vice-President of Pfizer Canada and chair of the scientific committee of Canada's Research-Based Pharmaceutical Companies, in my opinion, is difficult to reconcile with accountable and independent governance of CIHR.

I want to specifically respond in my five minutes to the reasons given by Dr. Beaudet and Dr. Prigent for his ability and competence to function as CIHR governing council member.

First, you were told that Dr. Prigent's appointment is crucial for the realization of CIHR's commercialization mandate and in line with the practice of similar agencies. Some of these agencies do have similar representation, but many others with excellent commercialization records function eminently without it. The U.S. National Institutes of Health, which recently strengthened its conflict of interest guidelines and its independence from industry, pursues commercialization without a pharmaceutical executive on its board. The same is true for the Swedish, Norwegian, Finnish, and South African health research councils, and even for the U.K.'s Wellcome Trust. Members with different professional affiliations or special advisory committees bring public-private partnerships and technology transfer expertise to the governing bodies of these organizations without preferential treatment of one industry player.

Second, Dr. Beaudet praised the appointment as part of a strategy to align CIHR's agenda with industry. If this is so, the appointment actually risks undermining CIHR's ability to promote excellent health research that improves the health of Canadians. There is overwhelming evidence that strong influence and control by the pharmaceutical industry of drug research and development has created serious problems of over-prescription, over-consumption, and overemphasis on pharmaceutical treatment in health care and has also resulted in increased costs. As evidenced by legal proceedings and empirical research, these problems are in part caused by the fact that industry-funded research and marketing are often associated with bias, misrepresentation, and the hiding of important safety and effectiveness data. Competitive pressures and huge financial interests explain why troubling practices persist, notwithstanding multi-million-dollar fines. An appointment aimed at aligning CIHR's agenda with these interests clearly compromises its primary mandate.

Third, Dr. Prigent brings the financial interests of Pfizer and his industry with him when he sits at the governing council table. Claiming that he can leave these behind is ignoring his professional obligations towards Pfizer and its shareholders. It also flies in the face of empirical studies and much of the literature and recent reports on institutional conflicts of interest.

Fourth, the committee was also told that Dr. Prigent will not decide any specific research projects. He will, however, be involved in decisions about CIHR's overall agenda, which affects industry. The council might discuss how commercialization can best be achieved, whether through patents, open-source regimes, or non-exclusive licensing. The council might explore whether a new strategy should address the impact of patented medicines on pharmacare programs, such as the Quebec pharmacare program.

3:40 p.m.

Conservative

The Chair Conservative Joy Smith

I'm sorry, Dr. Lemmens, could you slow down just a little bit? The translators are having a bit of difficulty.

3:40 p.m.

Associate Professor, Faculties of Law and Medicine, University of Toronto

Prof. Trudo Lemmens

Okay.

Dr. Prigent might be involved in a conversation about whether a better governance system for research is needed, one with stricter conflict of interest guidelines and transparency rules. Such measures have to some extent been opposed by industry.

Conflicts will also particularly arise in the governance of the new drug safety and effectiveness network, hosted by the CIHR, which promotes much-needed independent research on the safety and effectiveness of marketed products. This research can lead directly to the withdrawal of a drug from the market, with billion-dollar consequences for pharmaceutical companies. Governing council might have to discuss the need to expand its mandate, increase its funding, or improve its connections with other CIHR initiatives.

Dr. Prigent will have to excuse himself, as has been pointed out, from discussions and decision-making in a large number of these areas, or CIHR's governing decisions will be tainted by conflicts of interest

In summary, the confirmation we received last week of Dr. Prigent's appointment is worrisome rather than reassuring. This appointment reflects a lack of appreciation of the very divergent roles and interests of industry and CIHR. It can affect the ability of this organization to carry out its mandate and threatens to undermine public trust in medical research in Canada.

I congratulate the members of this Committee for wanting to hear from researchers and medical practitioners, health policy experts and members of the public of whom more than 3,600 have signed the petition opposing this appointment.

I would like to mention that I have personally been contacted by many researchers I did not know who represent patient groups. Following this, I gave an interview in which I raised questions about this appointment. I think members of this Committee need to realize that the concern is shared not only by lawyers but also by many medical and health policy experts.

Thank you.

3:45 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you.

Go ahead, Mr. Brenders.

3:45 p.m.

Peter Brenders President and Chief Executive Officer, BIOTECanada

Hello. I am here today representing BIOTECanada. We're a national organization dedicated to the sustainable commercial development of biotechnology in Canada. We're governed by a volunteer board of directors and we serve a membership of over 250 companies and institutions and research organizations all working to build the bio-based economy in Canada.

Our 20-member board comprises representatives from all sectors in biotechnology, as well as knowledge and service providers and an academic representative. Pfizer and CIHR are both represented on our board.

But we asked to appear here today for one important reason. We fundamentally believe in the mandate of CIHR and support the recent appointment of Dr. Prigent to the governing council of CIHR. The appointment serves as an excellent example of the collaborative nature that discovery and development play in the pursuit of improving the overall health of Canadians.

The mandate of CIHR is very clear. It specifically outlines a commitment to improve the health of Canadians and to strengthen the health care system here in Canada. But to realize this goal we have to be globally aware, globally connected, and globally capable. Research does not translate into treatments in a vacuum. In fact, very little research ever gets transferred into practice. The life cycle of development has partnerships with academia, research institutions, governments, and industry throughout the entire process in order to reach the hands of doctors and their patients.

As other witnesses have indicated to you, other national and provincial research-based organizations have pursued this collaborative approach to their governance. The simple fact is that Canada cannot afford to do anything less.

I have the privilege, in my role, of helping to promote the remarkable calibre of scientific research and discovery Canada offers to the world. We have long earned a reputation for excellent science and research capacity throughout the world. National organizations such as the NRC, Agriculture Canada, and Health Canada, combined with dozens of Canadian academic institutions, have helped foster our world-class reputation for scientific excellence. We have a lot to be proud of and we have a lot to protect.

The creation of CIHR in 2000 was lauded as a milestone for Canada, and while it certainly was, we were in fact simply catching up to what other nations had done years and years before. Remember that the NIH, which we have heard mentioned already, was officially created in 1948. And in fact, there are industry representatives on some of the NIH institutes. The Wellcome Trust was established in 1936. And in France the French National Institute for Health and Medical Research was created in 1964. The creation of CIHR served as a catalyst for inspiring research and inspiring an industry, for building a network of leadership in human health, and it placed Canada in the global agenda of championing better health for its citizens.

One of our key focuses as an organization is to work to present policy recommendations to help Canada remain a leader in the global race in research and development. Every day I see examples of how the cycle of discovery and development is changing. The key trend, or I should say the key to success, lies in collaboration and partnership.

Genome Canada struck a partnership on stem cell research for Canada with California. The Michael Smith Foundation, in British Columbia, in October announced that the first-ever decoding of the genetic evolution of a breast cancer tumour was developed by the BC Cancer Agency.

We see the work of a number of other groups, like the University of Calgary researchers in the faculty of medicine, who are part of a seven-city program looking at early detection techniques for lung cancer, Canada's leading cause of cancer death.

The reason I mention these achievements and why it's relevant to the hearing is that each and every one of these was achieved by an organization whose leadership within their board included representation from Canada's private sector. Building a modern nation to care for its citizens in the 21st century means setting an agenda respectful of the environment needed to achieve its goal.

BIOTECanada itself has joined a coalition of other national organizations, including the Association of Faculties of Medicine of Canada, Canada's Research-Based Pharmaceutical Companies, the Health Charities Coalition of Canada, Canada's medical device companies, Research Canada, and the Association of Canadian Academic Healthcare Organizations. As a group, we collectively called on the Prime Minister earlier this year to help with policy engagement, setting an unprecedented global competition for state-of-the-art research capacity-building. Our research is in a global game, trying to sustain and build our capabilities. But we know that research alone will never offer the treatments, the diagnostics, or the medical technologies needed to improve our health outcomes. We need to collaborate. We need to understand the full ecosystem of taking research from bench to bedside.

Let's remember, who did we turn to as we built the global response to H1N1? Industry was the primary partner that governments around the world sought out in order to help develop a vaccine to protect their citizens.

This reminds me of a statement made a couple of years ago by Alex Azar, former U.S. Deputy Secretary of Health and Human Services, that when people hear of the next health threat or urgent need, they will demand quick results.

3:50 p.m.

Conservative

The Chair Conservative Joy Smith

Mr. Brenders, you're going over time. Can you wrap up now, please?

3:50 p.m.

President and Chief Executive Officer, BIOTECanada

Peter Brenders

Okay.

I think the vital potential in hitting these key results, and the speed out there, is going to reflect in the partnerships we have. The vital potential of CIHR will only be realized if they're enabled, as part of their mandate, to pursue leadership with global expertise. Dr. Prigent is one of those people.

3:50 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you, Mr. Brenders.

We'll now go to our first round of Q and As, with seven minutes--for both the question and the answer--per party.

We'll start with Ms. Murray.

3:50 p.m.

Liberal

Joyce Murray Liberal Vancouver Quadra, BC

Thank you, Madam Chair.

Thanks for coming to pitch your perspectives on this appointment. I appreciate that.

I'm hearing a strong defence of the idea, from some members of the panel, of having the private sector directly on the governing council; it fills an identified gap.

Are there other industry sectors on the governing council? Does everybody else already have a seat on that council and now it's time for the research pharmaceutical companies?

3:50 p.m.

Dean, Faculty of Medecine, Université de Montréal

Dr. Jean Rouleau

Well, Arnold Steinberg is a member. A number of members of the business community have been on the GC. We believe they have, as Dr. Prigent demonstrated very nicely at his first GC meeting, an expertise in organizations and in administration. Arnold Steinberg is involved with Infoway Canada.

So yes, other people with some experience in business are there.

3:50 p.m.

Liberal

Joyce Murray Liberal Vancouver Quadra, BC

I wasn't really hearing that all the other private sectors are indeed on the council. There's a gap here.

3:50 p.m.

Dean, Faculty of Medecine, Université de Montréal

Dr. Jean Rouleau

The GC has felt--