Evidence of meeting #46 for Health in the 39th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was price.
A recording is available from Parliament.
Conservative
Rick Dykstra Conservative St. Catharines, ON
We are higher. As my colleague is wondering, what percentage might that be?
Chairperson, Patented Medicine Prices Review Board
We could get those numbers for you, but we are higher. We think the reason is that there is much more competition in the United States.
Conservative
Rick Dykstra Conservative St. Catharines, ON
You don't have a figure off the top of your head. Would you prefer to come back to the committee with a hard figure.?
Chairperson, Patented Medicine Prices Review Board
We can certainly look it up and get it to you.
Conservative
The Chair Conservative Rob Merrifield
They will get us the information.
While you're looking it up, I want to say thank you very much for coming. We found it very interesting, and I believe the questions reflected that.
We may want to have you back when the report is published. We may have some comments in regard to the report and what we do or do not see there.
Ms. Priddy, if you have a couple of quick questions, I'll allow it.
NDP
Penny Priddy NDP Surrey North, BC
I only have one question.
I apologize for my absence, but I was speaking to the very important Bill C-42, on the proposed quarantine act put forward by the Ministry of Health. I knew you would want an articulate speech on that.
I gather from some earlier discussion that what you hear about drug costs usually comes from the pharmaceutical plans, such as the insurance plans or from the provincial government plans or agencies. Of course the questions I get are obviously from individual constituents.
Within the government, where is that responsibility and what is happening? If we're hearing from provincial plans that it's too expensive, I'm hearing from constituents that it's too expensive, and I can see some people here in the audience today who represent people who can't afford some of the medications they're prescribed, how is it addressed, knowing that you have two groups of people? Where does it land inside government? Who picks it up and says we should do something with this? What is it?
Chairperson, Patented Medicine Prices Review Board
The easy answer is that we regulate the prices only as they leave the factory gate. As I said earlier, there are a lot of add-ons between the factory gate and the actual consumer. Those add-ons we have absolutely no jurisdiction over. We can have an idea of what the add-ons are, but we have absolutely no authority to change it.
So if your druggist decides he's going to charge an excess amount, then presumably he has freedom to do that. Then the provincial drug plans negotiate with the pharmaceutical companies.
Conservative
The Chair Conservative Rob Merrifield
That takes us into a subject that we'll be approaching next in committee, when we come back.
I want to thank you for coming. We'll dismiss you now and put you on notice that when your report comes out, perhaps we would entertain it as an opportunity to bring you back.
Thank you very much.
Executive Director, Patented Medicine Prices Review Board
The answer to the earlier question is that the foreign-to-Canadian price ratio for the United States is 0.65 for generics.
Executive Director, Patented Medicine Prices Review Board
The U.S. prices are 65% of Canadian prices, so about two-thirds less.
Executive Director, Patented Medicine Prices Review Board
Or no, it's about one-third less.
Chairperson, Patented Medicine Prices Review Board
A significant difference.
Conservative
The Chair Conservative Rob Merrifield
Yes, a significant difference.
Again, thank you very much.
We'll go now to Dr. Bernstein.
Dr. Bernstein, you're no stranger to this committee, or no stranger to health care in Canada, as CIHR chairperson and president. We want to thank you very much for being here. We look forward to your presentation with regard to the estimates. We will follow it with our series of questions.
The floor is yours.
Dr. Alan Bernstein President, Canadian Institutes of Health Research
Thank you very much, Mr. Chair.
It is a pleasure for me to be here before the committee once again.
I was last here in May of 2005, when the committee recommended my nomination as CIHR president for a second five-year term.
Thank you.
I would like to start by acknowledging and introducing two officials, who are my colleagues, with me here today: Jim Roberge, CIHR's chief financial officer; and Dr. Pierre Chartrand, CIHR's vice-president for research. I may ask them to answer any of your tough questions that come up today.
On Monday I spoke to the Canadian Club in Toronto. I spoke there about the revolution that's taking place in health research; about the importance of research generally, and particularly health research, to Canada's future; and about the exciting new opportunities for improving health.
These changes are resulting in changing views of human health and health care in the 21st century, and it was in the context of this changing landscape that CIHR was created in June 2000 by Parliament. Since then, we have moved quickly and deliberately from our origins as a largely reactive biomedical granting council to an outcomes-driven, excellence-based strategic research organization capable of capitalizing on and leading this revolution. I think it's fair to say we are no longer a granting council.
Today we have 13 health research institutes, each led by an internationally recognized scientific director, and each advised by 13 institute advisory boards, each made up of 18 individuals from across Canada and abroad. Over the last year, many of our scientific directors have appeared before this and other parliamentary committees to assist in developing evidence-based policies to address the health challenges facing Canadians.
For example, Dr. Diane Finegood, who is no stranger to this committee, the scientific director for our Institute of Nutrition, Metabolism and Diabetes, has discussed the latest research and knowledge translation activities on obesity, including, importantly, childhood obesity—and of course I will come back to that.
Dr. Anne Martin-Matthews, the scientific director of CIHR's Institute of Aging, spoke on the implications of Canada's aging population on all kinds of things, including the health care system.
Dr. Rémi Quirion, who's the scientific director of our Institute of Neurosciences, Mental Health and Addiction, has appeared on issues such as autism, fetal alcohol syndrome, and mental health.
As you may know, CIHR has a strategic plan that was the culmination of broad national consultations with health researchers and other stakeholders. Within that plan, each of our institutes has their own strategic plan from which research agendas have been implemented on everything from obesity, to wait times, palliative care, aboriginal peoples' health, training the next generation of researchers, health in children, cancer, and environmental issues.
Beyond our development as an organization, the creation of CIHR has had a profound effect on Canadian health research, and increasingly and most importantly, on Canadians. Today, CIHR-funded researchers are working in all health-related disciplines, from the biosciences to engineering and bioinformatics, to the humanities and the social sciences.
We are leveraging CIHR funding through many important new partnerships, both within Canada and internationally—and I'll mention one shortly—which have contributed well over $500 million in the support of common national and international priorities in health research.
New programs in knowledge translation and innovation, such as CIHR's “Knowledge to Action”, “Proof of Principle”, and “Science to Business”, have been developed to fill key gaps in the pipeline from academia to the health system, to the clinic, to the marketplace, and to Canadians.
New companies and new health policies are already in place because of these new, innovative programs. School children in Saskatoon and Kahnawake are involved in intervention and research focused on diet and diabetes research. I was very pleased that you mentioned the work going on in Kahnawake in your recent report that came out two days ago.
As another example, Amorfix Life Sciences was recently nominated, and actually received, a Technology Pioneer 2007 award by the World Economic Forum in Davos, the only Canadian company selected for that award. Amorfix builds on the CIHR-funded discoveries of Dr. Neil Cashman at UBC and Dr. Marty Lehto at U of T. Amorfix's business plan is to help in early diagnosis and treatment of diseases such as Alzheimer's disease.
Just yesterday, the New York Times, as well as virtually every Canadian newspaper, ran on the front page a story on CIHR-funded research comparing the efficacy of coronary stents versus drugs for heart disease. Today, in the Vancouver Sun, the Minister of Health for British Columbia, George Abbott, announced that on the basis of that research, he was going to re-examine the need for doing angioplasties for coronary heart disease.
We did a back-of-the-envelope calculation this morning, and let me just walk you through some numbers.
We spent $2.7 million over six years on that trial. That was a partnership with U.S. partners, who invested $22 million in that trial. These are the calculations: Canada does roughly 80,000 angioplasties a year, and they cost roughly $10,000 per angioplasty; so conservatively, if we could prevent only one-third of those, we would save roughly $300 million a year for Canada's health care system.
I am sure the reason the Minister of Health in British Columbia is looking at that is first because of safety issues around stents, and second because of cost issues.
Today about 30% of our funds are going to strategic initiatives that directly respond to health challenges of high priority to Canadians. These initiatives are developed and led by our 13 institutes after very broad consultation with various stakeholders and our built-in multi-partnerships with other federal departments, provincial health research agencies, the provincial and territorial ministries of health, international partners, as I've just alluded to, industry, and the health charities.
These initiatives are timely. They align with government's broader agendas and priorities. They are built on Canada's scientific strengths, and they promise to drive urgently needed improvements in Canada's health care system.
For example, after consulting with many stakeholders, our Institute of Nutrition, Metabolism and Diabetes declared obesity to be its priority area. As a result, we now spend about $20 million a year to support research, in all its translations, looking at all aspects of obesity, from the social and cultural issues to the genetic, physiological, metabolic, behavioural, and psychological.
I know that this committee is also interested in pharmaceutical policy--we just had a discussion on that--an area in which we have invested almost $20 million since 2000. For example, we fund Dr. Steve Morgan at the University of British Columbia, who has developed a very innovative drug utilization atlas that is an important first step in understanding and containing rising drug prescription costs. It is an atlas, like zip codes right across the country, of drug costs from area to area. This atlas reveals differences in the pattern of drug utilization across Canada and is providing a powerful tool for ministries as they move to contain rising drug costs.
In 2006 we embarked on a significant and comprehensive evaluation by a prestigious international review panel. That panel applauded CIHR for what's been accomplished to date, noting that Canada is setting an example to the world.
I'd like to turn some attention now to our main estimates for 2007-08.
Our main estimates have increased by a net amount of $36.9 million over last year. The CIHR grant vote has increased by $35.7 million over the previous fiscal year, and the CIHR operating expenditure vote has increased by $1.2 million.
The increase is partly due to the increase of the CIHR budget by $17 million, as presented in the 2006 federal budget, $16.3 million of which is allocated to our grants and awards for 2007-08 and $0.7 million, or $700,000, of which is allocated to operating expenditures.
Other budgetary grants and award increases include $11.6 million for Fabry's disease, $2 million for the federal initiative on HIV/AIDS, an incremental increase in the Canadian graduate scholarships program of $5 million, and new funding for pandemic preparedness research and training of $3.8 million.
Furthermore, CIHR is very grateful to have received a budget increase of $37 million in the recent federal budget of 2007. Our governing council is now deliberating on how to best allocate those funds.
As I have outlined, impressive gains have been made by health research. However, there is still a very formidable list of diseases, conditions, and health system issues for which there are no cures. More research is necessary to understand their origins and progression. Nature and social change also continually provide new challenges to our health: the emergence of new diseases like AIDS and SARS; the re-emergence of tuberculosis; cancer; obesity--again highlighted by this committee; the growing dilemma of dementia in the elderly; and autism. Most importantly, or equally importantly, building an evidence-based, sustainable, and accessible health care system is obviously a high priority for Canadians.
I know this committee is also very concerned about the epidemic of obesity among young children, and I congratulate you on your report that was released a few days ago. To me, obesity is a perfect example of the alignment of the government's concerns and CIHR's research and knowledge translation agenda. It illustrates and demonstrates the importance of solid research evidence to drive changes in policy, in practice, and in individual behaviour. That's why I think your support of CIHR and of health research has been and, I think, will continue to be so important.
Thank you. I'll be very pleased to take your questions.
Conservative
The Chair Conservative Rob Merrifield
Thank you, everyone, and particularly Dr. Finegood for her testimony before the committee with regard to what we feel is a very important study or report. It was very valuable to us as we sat to deliberate the recommendations we came up with. If you'd pass that on to her, we'd certainly appreciate that.
We now will open it up to questioning, starting with Ms. Carolyn Bennett.
Liberal
Carolyn Bennett Liberal St. Paul's, ON
In the main estimates, it looks as though your spending will increase by about $40 million, or 4.4%, over the next year. There seems to be a difference between funding health research and funding health research and trainees. Dr. Bernstein, I would like you to explain to the committee what the differentiation is there, and also in light of the fact that most of us are hearing in our ridings from research institutions that are very worried that some of their best and most promising researchers have been turned down. They're worrying about the situation we were in, in 1998, when we were worried that people would be going elsewhere to get funded.
President, Canadian Institutes of Health Research
Okay, there are two questions there, Dr. Bennett. Let me try to answer each of them.
Regarding the first one, about trainees, although in the main estimates it looks as though we're decreasing the amount of funding going to trainees, in fact the reality is otherwise. The reason it looks like that is that we're getting considerably more money through the Canadian graduate scholarship program, which is not shown in the main estimates for CIHR. Most of our students are actually funded through grants, so the more grants we fund, the more graduate students and post-doctoral fellows are actually being supported. Also, for our strategic training initiative, the same is true. In fact, we've actually more than doubled the number of trainees since we started, because we recognize the importance of young people to research and to the future.
Turning to the second part of your question, you're absolutely right: we're not able to fund a very large and growing number of outstanding and excellent grants. I commented on that the last time I was in front of this committee. I think there are a number of factors that are contributing to that. I think one is the tremendous expansion in the health research enterprise in this country that has taken place, and is still taking place, since we started. Virtually every major university and teaching hospital is building new facilities. Health research is unquestionably the most exciting area of science today, so young people are being attracted to it. Our broader mandate, relative to the old Medical Research Council, means that we are funding areas of research that the old MRC never would have funded before. So all of that together has meant that we're simply not able to fund a lot of really outstanding grants.
Liberal
Carolyn Bennett Liberal St. Paul's, ON
The other thing we're hearing from the researchers is that they don't really have the expertise, or that they'd actually rather be researching than trying to find partners and avenues for commercialization. Do you think there is a sort of one-stop shop to help the researchers of this country do commercialization in a better way? What would be the next step, do you think, in terms of getting some of these great discoveries to market?
President, Canadian Institutes of Health Research
There are a couple of parts to your question. Let me try to answer each of them.
For almost all of our programs, we don't require partnerships. We actually line up the partners ourselves. We would go to the Juvenile Diabetes Foundation, the Heart and Stroke Foundation, or a drug company and would line up the partnerships for our programs. That's the first part of the question.
The second part is about commercialization. Commercialization is a complex issue. It involves many players in a complex ecosystem. It involves venture capital, the local institutions, physical facilities for actually setting up a company, management expertise, seed capital—all kinds of things.
What we have tried to do initially is ask what our role is in that very complex ecosystem. I think our roles are several-fold. First is to fund the research—if you will, to put the oil in the ground so that it actually makes sense to have a pipeline—and secondly, to provide some early seed capital, almost, to allow some of that research to move down toward something that is commercially of interest.
We started a new program—I didn't mention it in my talk—called the proof of principle program. The proof of principle program or POP has been extremely well received by the research community and by industry as an extremely innovative program. The intent of that program is not to fund more research, but to add more value to the research, so that the researcher can go out and find a commercial partner. We don't require a partner for the POP program.
Another program, just as an example—which I did mention—is “Science to Business”. Again I think it's a very innovative program. We've recognized that there aren't enough people in this country who are familiar and comfortable both with science and with business. These are two silos. With science to business, what we're doing is taking young graduates with a PhD in research and science and in partnership with business schools in Canada providing them with an MBA, provided it's in biotechnology. That started two years ago.
I've met, actually, with a number of these students at the Rotman School in Toronto and at the Ivey School in London, Ontario. It's just a fabulous group of young people. I think as we develop a cadre of these individuals who can straddle both worlds, it'll go a long way to solving some of these ecosystem issues I've been alluding to.
Liberal
Carolyn Bennett Liberal St. Paul's, ON
If you were going to dream in technicolor about where this would go, what would be the next step for health research in Canada, and what would be the role of government?
President, Canadian Institutes of Health Research
Other than money.... We're building on strengths here. Both the budget statement and Advantage Canada, which came in the fall—
Liberal
Carolyn Bennett Liberal St. Paul's, ON
Maybe you could say, rather than “other than money”.... Can you remind us about public dollars spent on health research in Canada versus public, government dollars spent on health research, say, in the United States or other countries?