Evidence of meeting #78 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was innovations.
A recording is available from Parliament.
4:15 p.m.
Director, Cancer Care Ontario, As an Individual
So that leads to your next question—
4:15 p.m.
Director, Cancer Care Ontario, As an Individual
I wanted to also clarify that you could think about the pCODR as the cancer CADTH. I believe that CADTH is a fantastic first start. If we're going to encourage additional innovation, we are going to be met with additional challenges. It's my opinion, although I don't work for CADTH, that additional support will be necessary.
I do think that CADTH is a great step in the right direction. I am pleased as punch that the provinces came together and developed an additional HTA system for cancer drugs, and I think that if we get more and more exciting innovations we will need more assistance.
I hope that clarifies it.
4:15 p.m.
NDP
Libby Davies NDP Vancouver East, BC
If I may, I'll just quickly ask Dr. Jaffray this question. In terms of Techna, I know that it's quite new at 18 months, but when you say that you want to shorten the time interval from technology discovery to actual application, how do you actually do that? What does Techna do to shorten that time interval?
4:15 p.m.
Head, Radiation Physics Department, Princess Margaret Cancer Centre
It's very similar to what was raised by Pascale in her comments.
For health care, there's more technology in the world than we know what to do with. It's not matter of the next discovery. It's like raw material in terms of the capacity to bring new technologies forward, whether communication technologies or a novel intervention from a surgical perspective.
One of the things we realize is that companies bring those technologies to us and they see the health care system as quite impenetrable; it's extremely complex.What we do within Techna is pull together MDs who know the details of the intervention, administrators within the hospital, and people who have expertise in the technology to meet in a business-to-business way with the technology source and accelerate it into the environment.
4:15 p.m.
Conservative
4:15 p.m.
Conservative
Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON
Thank you very much, Madam Chair.
I thank all the witnesses for coming here this afternoon.
The first question I would have is for Dr. Hoch. How is that pronounced?
4:15 p.m.
Voices
Oh, oh!
4:15 p.m.
Conservative
Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON
Thank you very much. I thought it was a German pronunciation, but I guess I was wrong.
I guess I have a feeling similar to that of Madam Davies. I'm a little bit confused. Therefore, the first question I have may be more on general terms.
In your presentation, you stated that “there's not enough money to pay for everything” and you used the suitcase example. I understand, and I don't think that in the real world there is ever a situation when there's enough, in anything. If you were to determine how much is “everything“, if it's talking about money or needs, is it even achievable to determine what is enough?
4:15 p.m.
Director, Cancer Care Ontario, As an Individual
This is a very challenging question to answer. In health care we have a set of differences of opinion about what is enough. There is the perhaps strictly clinical opinion, based on the physician. There is the perhaps strictly patient perspective, in terms of “here's what I want”, and there is the strictly “I'm the payer” opinion.
I'm sorry. I'm not answering your question, but I suspect that if you were to ask the three different people, you would get three different answers.
4:20 p.m.
Conservative
Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON
The reason I ask this question is that it leads to me the second question. You mentioned health economics. How would you describe that? What would be the role of health economy in the proper distribution of the financial resources of the system?
4:20 p.m.
Director, Cancer Care Ontario, As an Individual
That's a very good question.
My perspective as a health economist is that I help people see how much extra they're going to have to pay and what they're going to get, so I describe this as positive analysis. It's seeing, basically in Consumer Reports style, that if we have a new drug, how much longer the patient is going to live with it and how much more it will cost. There's a second part called “normative”, wherein you actually tell people what they should do.
I feel that my role should be to give decision-makers information they can understand. If they think this is good value for money, they can make the funding decision. If they think “no, it's not”, that's okay. My role is to get them the information to inform the decision.
4:20 p.m.
Conservative
4:20 p.m.
Director, Cancer Care Ontario, As an Individual
As I mentioned, I work at the pharmacoeconomics research unit. My job is to create cost-effectiveness analysis of new cancer drugs or to critique cost-effectiveness analysis of cancer drugs. I then explain it to a recommendation committee and say, for example, “We're getting two more months of life with this new cancer drug. It's going to cost an extra $30,000. Let me give you more context: there's no other treatment for this type of disease and this is seen as a big breakthrough.”
I do this regularly, helping people understand the information, helping them evaluate the information, and helping them use it.
Does that answer your question?
4:20 p.m.
Conservative
Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON
Yes, of course.
For my last question, are you satisfied with how your information is received, generally speaking, or are you disappointed? Sometimes you may recommend the proper thing, but the committee might discuss it and say maybe it's not that great an idea.
4:20 p.m.
Director, Cancer Care Ontario, As an Individual
It's a wonderful question.
To be particular and exact, I feel I almost never make any recommendations. I try very hard to leave out my opinions. What bothers me a lot is when people don't understand what we are presenting as information. I've tried very hard to focus; instead of being complicated, I try to be clear in answering the question that the payer wants to know about.
I feel this is a missed opportunity. It is no mystery why many of the innovations are not being funded. It's because either the information to make that decision hasn't been collected, or once it has been collected it doesn't represent a wise investment.
To answer your question, I've tried hard to make myself understandable.
4:20 p.m.
Conservative
Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON
Thank you very much.
I have a question for Madam Lehoux. I'm sorry if I have mispronounced it.
In the beginning of your presentation you said that the new technologies are unpredictable.
Can you expand on this? I was a bit surprised. What exactly did you mean?
4:20 p.m.
Canada Research Chair on Innovations in Health, Professor, Department of Health Administration, Université de Montréal
I think I was referring to this vision by which people see innovation as something good that almost falls out of the sky and as something that is not manageable. “Unpredictable” or “unmanageable” would be the labels I'd use.
I think a lot of the upstream work when designing innovation can be steered and informed. There is a lot of input that can be brought early on in technology development that will avoid failures. With a lot of technologies that don't make it to the health care system, sometimes it's the system that is not responsive. Very often it's the technology itself that has been badly designed.
What I'm saying is that this is not unpredictable. With regard to some failures from a health services and policy research standpoint, experts in the field could probably say very early, from the business plan, “This is going to fail. This will not make it to health care. Providers will not use it. Patients will not benefit from it. Stop wasting your time.”
4:25 p.m.
Conservative
4:25 p.m.
Conservative
4:25 p.m.
Conservative
The Chair Conservative Joy Smith
It is, right now.
You might have another opportunity, and thank you for your very valuable questions.
We'll now go to Mr. Pacetti.
4:25 p.m.
Liberal
Massimo Pacetti Liberal Saint-Léonard—Saint-Michel, QC
Thank you, Madam Chair.
Thank you to the witnesses for appearing.
I'm not a regular member so this will be to clarify, to see if I understood some of the presentations.
Ms. Lehoux, at the beginning of your presentation, you said that the policy challenge is neither to increase the adoption of innovations nor to slow it down. Should innovation not be stimulated?
4:25 p.m.
Canada Research Chair on Innovations in Health, Professor, Department of Health Administration, Université de Montréal
No. In my view, the challenge is neither to increase it nor to slow it down. It is neither more nor less innovation that we need, but rather better innovation. Assessing technologies provides us with arguments that help us understand what it means to have better technology in terms of efficiency, safety and costs, but that is not enough.
To determine what better innovation is, we have to simply understand what is known as the burden of disease in epidemiological terms. We must determine whether our efforts make a difference in places where a real burden of disease exists, instead of having incremental innovations, as described by our colleague, that enable us to create another innovation without focusing on the crucial problems to which we have no solution right now.
4:25 p.m.
Liberal
Massimo Pacetti Liberal Saint-Léonard—Saint-Michel, QC
You said that 50% of new inventions are accepted. Is that correct? That many?