Health Committee on Oct. 18th, 2012

[Barbara Sabourin]

No, the percentage is down below 5% for us.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Five per cent would get priority review?

[Barbara Sabourin]

Yes.

Again, I'm sorry. I'm familiar with the drug side, but there are equivalent policies on both sides.

Last year, on the drug side, we got about 14 applications for a priority review. Of those—and I'm adding up numbers in my head—we granted six. The other eight were not granted.

[Ben Lobb, Conservative, Huron—Bruce, ON]

I have one last question.

The provincial budget for health care in Ontario is $48 billion, almost 40% of the province's total health care budget. Obviously, the delivery of care is a huge cost to all provinces, in the form of transfers and everything else.

What do you do, or can you do, to help reduce the costs of delivery of care, to find new ways? Research you've talked about, but also the delivery of care.

[The Chair, Conservative, Joy Smith]

I'm sorry, the time is up, so if you could just give a brief answer on that, please.

[Barbara Sabourin]

Okay.

We do a few things. I've already mentioned the priority review process, where we think something has a really significant opportunity to contribute to health care and health outcomes for Canadians. We also approve generic products. We do this in a way that respects the patent requirements and market exclusivity for brand-name products. Generic products, in general, are much lower cost versions of the products that innovators have developed.

[The Chair, Conservative, Joy Smith]

I know I cut you off, but we've had such nice answers. With the indulgence of the committee, Dr. Beaudet, I think you wanted to say something.

[Dr. Alain Beaudet]

I want to point out that we're working very closely with the provinces to set up what we call the patient-oriented research strategy. We want to develop mechanisms to support research that is focused on what we call intervention research—supporting interventions, evaluating interventions—and integrate in these evaluations a healthy economic aspect to ensure that we not only help the provinces make the right choices in terms of interventions that they use and refund, but also to ensure that we stop doing what's not working.

[The Chair, Conservative, Joy Smith]

I have to cut this off now. Thank you so much.

We'll now go into our five-minute round of Qs and As. We'll start with Dr. Morin.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you very much, Mr. Chair.

Ms. Sabourin, I have a question for you.

On your Internet portal, you provide an electronic health service for Aboriginal and Inuit communities. Could you tell us more about the services provided through this Internet portal?

[Barbara Sabourin]

I am sorry.

I cannot give you the information you're looking for. I'm here from the regulatory branch, which deals with the regulation of health products and foods.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Okay.

In that case, my question will be for Dr. Beaudet.

Just now you talked about personalized medicines and about identifying biomarkers that could help patients.

For example, before my grandfather passed away, he had Alzheimer's. Could you give us some concrete examples in reference to a patient who has or might have Alzheimer's? What would the process be and how could it be implemented?

[Dr. Alain Beaudet]

Let me give you a very clear example. Some types of breast cancer, for example, have receptors on the surface and they could be targeted by a drug. That does not apply to all types of breast cancer, but it does apply to some types of tumours. If some tumours have those receptors, they will respond very well to the drug and will be destroyed.

The problem is that we don’t want to give those drugs to everyone. If we did, it would be very expensive. In addition, most patients do not even have the receptors that allow them to react to the drugs. In those cases, they would experience all the side effects of the drug without benefiting from it at all.

The idea behind personalized medicine is to stratify patients and to ensure that we are developing drugs that are better targeted to patients who have a certain genetic history and who are going to respond to those treatments. By also conducting genetic tests, known as pharmacogenomics tests, we make sure to treat each patient based on their response capacity. We do not treat patients who would be likely to have more pronounced side effects because of their genetic make-up. So we have to reduce the side effects, target the treatment and, obviously, increase the capacity for treatment.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Could you tell us about the challenges in implementing this great innovation across Canada?

[Dr. Alain Beaudet]

We are only at the very beginning of this. It is starting to be implemented for cancer in particular. We are starting to see a number of types of cancer for which there are biomarkers and we know which tumour is going to respond to which drug. As a result, we can give such and such a drug to a patient who has a given biomarker. We believe that we can extend this approach to a large number of drugs, but the research is still in its infancy.

You referred to Alzheimer's. There is no personalized medicine for Alzheimer's yet because we do not yet understand the basic mechanisms responsible for the neurodegeneration that we see in Alzheimer's. Once we understand those mechanisms and we identify the genetic profile responsible for the onset of the disease or a predisposition, we will be able to have more appropriate treatments.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you.

I am going to change topics slightly. Let us talk about your research institute’s budget that is going to be cut by $15 million over the next three years. To what extent will those cuts affect the good work that you are doing?

[Dr. Alain Beaudet]

Let's be clear. Our grants and scholarships budget has in fact been reduced this year by $15 million, but the government reinvested $15 million into our budget for the patient-based research strategy. Therefore, our grants and scholarships budget was completely protected in the last budget.

You are correct, though, that additional cuts of $15 million are planned for next year. We will see what the budget will be for the next year.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

I think that, for the cuts planned for 2012-2013, we are talking about $15 million for your research institute, $30 million for 2013-2014, and another $30 million for 2014-2015.

[Dr. Alain Beaudet]

It involved $15 million recurring, and this loss has been compensated in a recurring manner. It won't be $30 million next year, but $15 million. This lost $15 million will perhaps be compensated. We'll see in the next budget.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you very much.

[The Chair, Conservative, Joy Smith]

Thank you very much, Dr. Morin.

Regarding your first question, on October 25 we will be having the first nations and Inuit health branch, and you might be able to save that question for them.

We'll now go to Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Madam Chair.

It's certainly an exciting topic to study. I do some work with juvenile diabetes and I remember hearing the stats on how new technology can save funds on health care costs, whether it's a blood monitoring system, which they said can save up to $150 million, or now the artificial pancreas that they've been working on in their trials in Hamilton and Waterloo. New technology can fundamentally shift our health system. It's great that we have this time to look at it in this committee.

I remember a few years ago we had an announcement with the neurological charities at the MaRS Centre. We did a tour of it, and I remember thinking what a wonderful enterprise it was. Could you touch on some of the new technology they're working on at the MaRS Centre?

[Dr. Alain Beaudet]

At the MaRS Centre, we're looking, first of all, at the area of brain research and new technologies in neuroscience.

Canada is doing well across the board. We're one of the top countries in the world in terms of the impact of our publications in that sector; and in certain areas, in pain research, for instance, we're on top. Coming back to specifics, there is no question that the brain is an area where a number of new technologies will be changing things in a major way in the years to come. You're probably referring to new imaging technologies, which have totally changed the way we can diagnose a variety of brain disorders, ranging from MS to brain tumours, and also the way in which we've been able to treat patients with certain disorders such as strokes.

To give you an example, CIHR, along with the Canada Foundation for Innovation, has just commissioned a study looking at the economic impact of a very simple imaging procedure, CT perfusion. We are looking at patients who have suffered a stroke, and looking at the impact of this technology, which gives us a sense of whether we will be effective in using a drug to dissolve the clot or whether we should treat the stroke by another method.

Through this imaging technology, we've been able to improve the outcome of stroke in a large number of patients, and the economic gains are nothing short of spectacular. To give you an idea, the return on investment is ranging between 89% to 130% on that technology alone. I'm talking about the joint investment by CIHR and the CFI. The economic returns in the health system that we're getting from that are tremendous, both in net economic benefits and in the additional quality adjusted life years for Canadian stroke sufferers. Tell me about an investment that will give me an 89% to 130% return in this day and age, and I'll be very happy to learn of it.

[Patrick Brown, Conservative, Barrie, ON]

It's certainly incredible.

I know we've put a lot of money at the provincial and federal levels into e-health and electronic records. I'm curious about the progress of that. When I go to my family doctor or the local hospital, it's still paper based. I know different provinces are at different stages in digitizing their records. We've made progress in many fields, such as the one you just mentioned and diabetes. It seems inconsistent that with my iPad or my phone I can change the temperature in my home or put my security system on, but the health care system still doesn't have the synchronization of health records.

[Dr. Alain Beaudet]

Look, you're totally right. We're lagging behind. Let's face it, let's admit it, and let's do something about it. I don't think it is a question of research. I think we have the technology. We're funding a lot of exciting new technologies, for instance, using new apps to access health records or monitor your blood pressure. The difficulty occurs in the lag between these discoveries and their implementation into the health care system. This is still quite a bit of an issue. We definitely have to support more of what we call knowledge translation initiatives to ensure that these discoveries are actually translated into use, because that's the medicine of tomorrow.