Health Committee on Feb. 7th, 2013

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Madam Chair, I'm not sure I'm going to take up all seven minutes that I have, so if I can pass the torch on to someone else, I will gladly do that.

I want to thank you all for being here, and our witness who has joined us through video conference. Much of your testimony is not dissimilar to what we heard at our last meeting. We had members from the Association of Faculties of Medicine of Canada with us. I want to briefly touch on something that they mentioned, which I think you've mentioned as well, and I'll ask you to comment on it.

At our last meeting we heard that there is a need to build a framework within hospitals to engage in procurement. We also heard that there are legislative barriers that keep that from happening. I know you talked about a burdensome or cumbersome regulatory environment that you function in.

I'm wondering if you can identify any legislative barriers that you would want to see addressed that might start us down that road of making it a little easier to do some of the things you want to do. I will throw that open to anyone.

[John Soloninka]

As you know, devices go through federal approval from Health Canada, but then they go through provincial approval because health delivery is a provincial jurisdiction. We're not going to change that.

I had the great privilege of running an analogous process, which ended up being called pCODR the pan-Canadian oncology drug review process. It's the same idea. Every province determines which cancer drugs they're going to fund, but Health Canada is the one that approves the drug to go on the market. In the past, each of the drug companies had to argue with each of the provinces to try to get their drug approved. Now with pCODR the same evidence package is used and referenced by all the different provinces. Without dramatically changing the world, we could do the same kind of thing. With respect to health care technology assessment, if an EXCITE review says that this is the greatest thing since sliced bread, then let's not have the other provinces redo it. Let's do it once, in B.C., or in Quebec, or wherever, and then let's have it used by the other provinces. That's just a recommendation.

[Brian Lewis]

To build on that, there are two parts to the regulations I was talking about. One of them is Health Canada approval. Health Canada is a world-renowned organization in terms of the quality of the work they do, but they are strapped at Health Canada and things end up taking longer and the approval time is relatively unknown. There is also cost recovery, which particularly damages the small organizations in terms of going to them. They put in, they pay their fee, and they don't know when their product is going to come out of the process. If we were able to help Health Canada with that, it would be a true benefit for the small organizations.

The second part was the health technology assessment. It seems that most provinces do that. Even nationally there is CADTH, and various hospitals are all doing their own health technology assessment. Everybody who understands health technology assessments to any degree gets it for pharmaceuticals. It's a lot easier. The system of utilization is so important for medical devices. There are differences. The sad part is we do have MaRS EXCITE and we do have OTACH, which are model processes in the world. We're not getting that to go across Canada and have other people adopting it. It's a bit of “it's not invented here”. It's a bit of a paradigm shift. We have 14 separate health care systems, so it's getting everybody to look together and ask how they can share these best practices and what works.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Dr. Treurnicht.

[Dr. Ilse Treurnicht]

Going back to the earlier question about the role the federal government can play, the federal government can be very helpful in funding some catalytic activity to foster those collaborations. Sometimes it's just a question of incenting people to not reinvent, but to learn about a process that is being proven in a certain jurisdiction and build on that work that can then be executed on behalf of the country.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Okay, thank you.

I want to follow up on the fact that you mentioned the $400-million venture capital fund that was announced on January 14 of this year and ask you to describe how this venture capital access plan might help address the issues that you have identified for us today in this industry.

[John Soloninka]

Madam Chair, my other colleagues and I had the privilege of providing input prior to the announcement of that fund. Sam Duboc from the fund had public presentations on how the fund is going to be rolled out. We won't go into detail on that, but everyone I've talked to thinks that the way it's being rolled out right now looks pretty good. As long as it plays out the way it's planned, it's going to provide for the building of partnerships between private and public sector venture money that will make the overall availability of capital freer. It will seed companies. It will invigorate other venture capitalists. It will be a flag on the map too; other countries in the world will see that Canada has this venture fund and will be more interested in coming here to potentially get their companies started. It's all good.

[The Chair, Conservative, Joy Smith]

Thank you, Mrs. Block.

We'll now go into our five-minute round for Qs and As, so we have to be a little more mindful of the time. We are going to adjourn just prior to a quarter after five to address some business that we have in terms of motions. We'll go in camera at that time.

Let's begin with Dr. Sellah.

[Djaouida Sellah, NDP, Saint-Bruno—Saint-Hubert, QC]

Thank you, Madam Chair.

I would like to thank our guests who are here with us, as well as Dr. Treurnicht, who is joining us by videoconference.

There are six medical technology clusters across Canada located in Vancouver, Winnipeg, Alberta, Halifax, Ontario and Montreal. I know that there are strong universities and hospitals in each region that are able to work with industry partners on research and development projects, as well as on clinical proof of concept studies.

What is the real role of organizations such as Health Technology Exchange or MaRS Discovery District in these medical technology clusters? Could you give me an example of how you contribute to one of these clusters, for example, in Ontario?

I would also like to know whether we could have other clusters across Canada. If so, what role would the federal government play in fostering the development of such medical technology clusters?

Thank you.

[The Chair, Conservative, Joy Smith]

Who would like to start with that?

[John Soloninka]

There's no question there are pockets of expertise across the country. If you look at the very successful medical technology clusters in the world, in Boston, Minneapolis, Zurich, Palo Alto, and so on, what you find is that the number of companies they have, the universities and other things, are in a much tighter geography than we have in Canada.

As you know, in Canada we're very diffuse along the border, very thinly spread. It turns out, just by happenstance of history, that Ontario, Quebec, Alberta, and so on, tend to have a high concentration of the medical technology companies. If you look at the number of companies necessary to get, as you say, the cluster dynamics, lots of interplay, lots of synergy, we have Ontario, Quebec, and some other pockets, but some of the smaller regions don't have enough volume to make them a true cluster.

However, we have very good capabilities now, where you don't physically have to be together. We have very good linkages electronically, collaboratively. Ilse Treurnicht is here by video conference right now, as an example. We have very good technologies. There is a world-class neurosurgery technology out of Dalhousie University called NeuroTouch. I'm working with a neurosurgeon in Toronto named James Rutka, who has worked on the development of that technology.

We have funded 26 companies. We work across the cluster in Ontario. We're actually working with Quebec as well. We have worked very hard with both capital and networking, connecting people who didn't know they were even doing complementary things and holding events to get them together. We are a private sector organization, but we're government funded, so there's lots that we can do.

With respect to the smaller regions, we connect them on like-minded projects, which I'm doing right now in neuroscience. We connect them together to make sure the pockets of expertise are taken into account.

Last, with respect to clinical trials, you can run clinical trials almost anywhere. Maybe it's in Montreal or Toronto that you might head a clinical trial, but you should be able to take pockets of expertise wherever and engage them in the development and testing of that technology.

Then there's use of the technology. There are great hospitals all across the country that could be adopters of technology. The federal government could say that it's great that it was developed in Montreal but they're going to test it across Alberta and B.C., or in Halifax, or wherever.

[The Chair, Conservative, Joy Smith]

I know five minutes is not long, but we're into the shorter round. I'm sorry.

Mr. Wilks.

[David Wilks, Conservative, Kootenay—Columbia, BC]

I thank the witnesses for being here.

My questions are probably to John and Ilse, and, Brian, please jump in.

There are a number of health technology assessment organizations in Canada, including those that are academic, government, and hospital-based, as well as the Canadian Agency for Drugs and Technologies in Health.

In your view, what steps could CADTH take to coordinate efforts in health technology assessment in order to avoid duplication of efforts and possible inefficiencies in the area?

[John Soloninka]

That's a very, very good question.

A huge number of health care technology assessments are done. Depending on how they're done, they may be theoretical exercises that have to be contextualized to every individual hospital, and because of that theoretical nature, they may not be immediately usable by people across the country.

Having said that, though, there are health care technology assessments that are contextualized. Is something that's done for the University of Toronto applicable to McGill? Probably. If you do it for a Toronto hospital, is it applicable to a tiny community hospital? No, it's not. If you do it for a tiny community hospital in Ontario, is it applicable to Alberta? Yes, it is.

I think there's an element of having to be much more careful to contextualize the HTA and to do it in such a way that it's easily transferable. That has not been the history, and that's why a lot of CADTH stuff has not been widely documented.

As well, the not invented here syndrome is very big. CADTH is seen as national, and in fact all the provinces see themselves as owning health care and not being ones to be dictated to outside of their own spheres. It's a challenge, but I think having a collaborative cross-provincial kind of thing, such as pCODR, the pan-Canadian drug review, would be a really good step towards trying to get it all used.

[Brian Lewis]

That's something that IHE is trying to do. We've actually sat with CADTH and talked to them. We have regular sessions. CADTH's expertise is in pharmaceuticals, in terms of a lot of work they've been doing, versus the work that's being done by OHTAC and by AACHT.

At IHE, which is Alberta-based, they're actually trying to pull the whole country together, because it's about the methodology that you see with OHTAC and with AACHT. It is the best methodology. But as John was saying, it's the not invented here aspect, it's the change management aspects of it. It's a bit of a paradigm shift for people.

We need to get there, and the more quickly we can get there, the better it's going to be.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Ilse, do you have anything to add?

[Dr. Ilse Treurnicht]

I feel quite strongly about this, and it goes to the previous question. I think we're sleepwalking through the global innovation challenges, unless we rethink our approach.

We have to make collaboration our competitive advantage. In the EXCITE process, it's been very encouraging that we could use eight different centres across Ontario that all have complementary sets of expertise and present them on a single tray to industry, which then actually makes it an absolutely world-scale set of evaluation assets. I think if we can forge these almost virtual density models....

Again, I think the federal government has a key role in being the catalyst to enable those collaborations. We need to set the tone that this is not about Nova Scotia versus so-and-so; this is about us, collectively, against the world. That's the game we're in. We need to be much more proactive about forging these collaborations on a scale that's globally relevant.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Thank you.

Do I have more time?

[The Chair, Conservative, Joy Smith]

You have 30 seconds.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Just quickly, John, you had mentioned the IRA program. In your view—or perhaps someone else could chime in on this—how could IRAP be adapted to better meet the needs of small and medium-sized enterprises looking to develop medical devices in Canada?

[John Soloninka]

I think I mentioned that one of the challenges for medical device companies is that 75% of the capital is spent on things like the clinical trials associated with their product, the evidentiary development for reimbursement for health care technology assessment, and so on.

These are not certification exercises. They are not. But currently, the way in which IRAP has been interpreted, it tends to be seen that way.

[The Chair, Conservative, Joy Smith]

I'll now go to Dr. Morin.

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

Mr. Lewis, I have a question for you. You mentioned earlier the funds that should be allocated to new technology.

That reminded me of the fact that as MPs, we do have a good-sized budget. For several years we did not invest in new furniture, such as new couches or new computers, because we preferred to spend the money we had on the workforce or to contact, through several ways, our constituents. For many years we didn't invest in replacing our furniture and computers until the government said, “You can have $5,000 per year to devote only to replacing the technology and furniture.”

I think you're right that the special fund could be a good thing, but what would be the sources of money for this fund? Would it be federal, provincial, private, hospital, local community? I don't think only the federal government should invest in that fund.

[Brian Lewis]

It's mostly provincial where that needs to come from, because that's where the delivery of the health care system happens.

What you have to do is develop a process, like MaRS EXCITE, that identifies devices that are disruptive, that are really adding value. When you go though the process of doing that, to pick those particular products.... There are over a thousand class III and class IV agents approved by Health Canada every year, so you're going to have to choose the products. As well, you're going to have to be realistic about it in terms of where it is.

It's to have money for those innovative therapies that are really going to add to patient health outcomes and reduce cost to the system or make things more effective. I think that is a provincial mandate.

[John Soloninka]

The federal government, however, could assist in lessening the not invented here issue. If it were to partner with a province to deal with the technology, that would encourage more collaboration across the other provinces, because it would not be just one province footing the bill and then other people benefiting.