Health Committee on March 28th, 2007

[Dr. Alan Bernstein]

The comparisons are somewhat difficult, because there are different programs, et cetera. Our total budget, if you include the Canada research chairs, the networks of centres of excellence, and indirect costs, is approaching now $900 million. Per capita, the United States is still about fourfold beyond Canada in per capita terms. But also take into account that our mandate is much broader than that of the equivalent agency, the National Institutes of Health.

So on the one hand, we still have a long way to go; on the other hand, we've come a long way. Our budget has increased, I think quite remarkably, over the last seven years since CIHR was first launched. Certainly I am personally very grateful for that. I think the research community is.

So I think we're on the right trajectory. We have to stay the course; that would be my advice. We are building on excellence. I think the Council of Canadian Academies noted that health sciences broadly is an area of exceptional strength in this country. So we are building on strength, and I think we are building on what matters to Canadians, which is their health and their health care system.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Monsieur Malo.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you, Mr. Chair.

Thank you, sir, for being with us this afternoon.

Doctor, in your presentation, you told us that the Board of Directors of the Canadian Institutes of Health Research was presently discussing the best way to utilize the new funding allocated in the federal budget. Do I understand that these are funds that you were not counting on, that this money was unexpected and that, given that there presently is a debate, the members of the Board of Directors do not have a list of priorities?

[Dr. Alan Bernstein]

That's a very good question. Let me try to answer it.

We do at least two kinds of planning every year. One kind of planning of course involves strategic planning, the strategic priorities. The second kind is our budgetary planning, what our budget expenditure is going to be for the next year.

Because of the way we're funded, which is one year at a time, we have to assume, as we are doing our planning, that we will get no increase in our budget. To do otherwise would be I think irresponsible. Now, when we have our board meetings, we also discuss what happens if we get a small increase or if we get a large increase. We construct scenarios of various increases that the budget speech might contain.

When we actually get the real number, we have to revisit it. With an actual number we're no longer doing risk management. We're now doing real budgeting. I think you can appreciate, if you look at your own personal life and business life, that when we actually see the real number--let's say $37 million, in this case--we have to revisit how we're actually going to spend it.

So yes, we very definitely have strategic priorities. This is not a gift horse that we in the research community were not expecting. We were hoping for it. We desperately need it. Now we have to actually decide, in a responsible way, the best way in our judgment to allocate those funds.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Are you now in a position to tell this committee about the nature of that debate and the conclusions that could be drawn?

[Dr. Alan Bernstein]

I can't tell you what the conclusions are yet because we're not finished. It would pre-empt what council will be discussing, so it's not appropriate.

The nature of the debate divides along several lines. One line is what's the right proportion of allocation of our funds to our various programs? In broad strokes, our various programs are what we call the “open grants” competition. These are grants that researchers make to us in any area of health research.

The second bulk area is the strategic initiatives our institutes have developed and are developing with partners.

The third area is our commercialization programs and knowledge translation programs more broadly.

You'll appreciate that there are not necessarily clean lines between each of those programs. They overlap quite considerably.

The other consideration, independent of which program, is risk management for 2008-09 and future years. A major job of my colleague Jim Roberge is to advise council on this, because as we make commitments....

Research commitments are typically multi-year. When we commit, we typically commit for three to five years--on average, about four and a half years. If we fund a grant that you would apply to us for, you would get a grant for five years. And yet we get funded only one year at a time. We're constantly having to mitigate risk.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you very much, Mr. Bernstein.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Mr. Batters.

[Dave Batters, Conservative, Palliser, SK]

Thank you, Mr. Chair.

Thank you, gentlemen, for appearing before this committee. It's much appreciated.

I have three very general questions and one very specific one.

First, is primary prevention research a major focus of CIHR? I'm thinking of primary prevention of coronary artery disease as an example. Is that a major focus of CIHR? Because that seems to be the way in which medicine has progressed over the past number of years.

[Dr. Alan Bernstein]

I think the honest answer is that it's increasingly becoming a primary focus. I think it's the nature of both the science and where the public is--there's a convergence here--that there are opportunities for actually focusing on prevention. I can give you some examples.

I've alluded to two of the obesity projects we're funding. Those are primary prevention ones. We have a large investment in programs in tobacco prevention, smoking cessation, for example. We have a large program on occupational health and safety in British Columbia, called the Bridge program. It deals with prevention issues in the workplace. In Newfoundland we have a major program called SafetyNet. Researchers are working hand in glove with the fishing industry to deal with health and safety issues in the workplace.

[Dave Batters, Conservative, Palliser, SK]

So you'd agree that primary prevention efforts are probably the best way to contain costs of our health care system, ultimately?

[Dr. Alan Bernstein]

An ounce of prevention.

[Dave Batters, Conservative, Palliser, SK]

Absolutely, an ounce of prevention.

Second question: Do you do extensive research to identify the respective costs of primary versus secondary prevention? I know you talked a little bit in your introductory remarks about the costs of angioplasty, for example, versus primary prevention. It's obviously a corollary to the first question. Do you do substantial research to determine the differences between primary and secondary prevention in terms of cost?

[Dr. Alan Bernstein]

Again that's an excellent question. It's a new area of research for us that is in our expanded mandate, relative to that of the old Medical Research Council. So we have been building up this area of research, of both health economics and health care systems research generally, and cost issues are clearly a major concern there.

So I think the answer is yes, but it's not nearly at the level I think a country of our size needs to be at.

[Dave Batters, Conservative, Palliser, SK]

You may not have an answer for this question; it's a very general question. In your opinion--and I'd welcome an opinion from anyone who wants to answer--given the fact that maybe you haven't delved into this as much as you'd like, does your research show that prescription pharmaceuticals, on the whole, are a net cost or a net savings to our Canadian health care system?

[Dr. Alan Bernstein]

That's an extremely complex--

[Dave Batters, Conservative, Palliser, SK]

Extremely complex, extremely loaded question, but in your medical opinion, it's a basic question. We just talked about the value of primary prevention to the system. Prescription pharmaceuticals: net cost or net savings?

[Dr. Alan Bernstein]

To me it's not an either/or, number one; and second, there's no one answer, because it depends on what disease we're talking about. For example, one can talk about primary prevention of breast cancer. We are a long way away from primary prevention of breast cancer. In the meantime, women with breast cancer want a drug.

[Dave Batters, Conservative, Palliser, SK]

Okay, I understand. And within the question I have to say that there are certain conditions where drugs would be considered primary prevention. There are other conditions where drugs would be considered secondary prevention. For instance, drugs that are anti-hypertensives, before someone has had a heart attack or a stroke, that's primary prevention.

[Carolyn Bennett, Liberal, St. Paul's, ON]

No, that's secondary prevention.

[Dave Batters, Conservative, Palliser, SK]

Anyway, my last question is that you received an extra $37 million in this year's budget. Now, the Juvenile Diabetes Research Foundation didn't receive money in the budget, but I know that they plan to meet with CIHR for seed capital to help them in their search for a cure for juvenile diabetes. Given that Canada is a world leader in diabetes research, is an investment in or with JDRF something that will be seriously considered by CIHR?

[Dr. Alan Bernstein]

I already have met with the executive director of JDRF, and we have many partnerships with them. In fact, as you may know, I think the world-famous Edmonton protocol that was developed by scientists in Edmonton was funded jointly by JDRF, among other players--JDRF, CIHR, Alberta Heritage--so it really is illustrative of partnership in funding really great science.

[Dave Batters, Conservative, Palliser, SK]

But they're asking for additional money now. They were looking for $1 million from the Government of Canada. There was an envelope of money given to CIHR. Are you giving strong consideration to joining JDRF in their partnership to find a cure, sir?

[Dr. Alan Bernstein]

The answer is yes, but let's be clear: we don't give money to organizations; we give money to research. So I will not give money to JDRF, but what I will do and what we've been discussing--and we do this with hundreds of partnerships that we have, including with JDRF--is develop a joint research program that we're both interested in, and we'll call for proposals from the research community and jointly fund it.

[Dave Batters, Conservative, Palliser, SK]

I'm sure that will be great news.

Thank you, Mr. Chair.