Thank you.
I would like to thank the committee for this opportunity to share my perspective on the challenges of innovating in health care in Canada. I'll begin by introducing myself to the committee—it places my perspectives in context—and will follow with three specific messages I would like to bring to the committee's attention.
I am an employee of the University Health Network. The University Health Network is a $1.7 billion per year health care delivery, education, and research company created through an act of legislation of the Province of Ontario. Some may be more familiar with the names of the hospitals that comprise the UHN, specifically, the Princess Margaret Hospital, the Toronto General Hospital, the Toronto Western Hospital, and recently the Toronto Rehab Institute. It is important to note that this company has about $300 million in a budget for research activity funded through peer-reviewed grants, industry collaborations, and philanthropy.
I am also a professor in the departments of radiation oncology, medical biophysics, and biomedical engineering at the University of Toronto. I trained in physics at the University of Alberta near where I grew up and specialized in the field of medical biophysics at the University of Western Ontario. I worked for eight years in a large academically oriented hospital in the United States.
I'm now responsible for the management of radiation treatment systems for more than half of the cancer patients in the Greater Toronto Area through my work at the Princess Margaret Hospital, the Southlake regional cancer centre, and the Carlo Fidani cancer centre in Mississauga.
I run a peer-review, grant-funded research program and have published over 150 scientific publications with a focus on addressing the challenges of treating cancer with greater precision and efficacy. My team contributes to the scientific literature, but simultaneously we're very active in the domain of medical technology commercialization. I hold a number of patents on novel technologies for cancer treatment, and have impacted hundreds of thousands of patients around the world with these technologies.
As an inventor and innovator in health care I recently led the creation of a new research organization within the UHN, which will resonate with the rest of my comments. This organization is called the Techna Institute.
The mandate of this organization is to bring a deep, tangible understanding of the health care system to the problem of integrating new technologies that promise to improve outcomes and/or bend the cost curve in health care. The board of the University Health Network supported the creation of this institute in response to the ever-accelerating rate of technological development and its anticipated impact on health care performance, best practices, and cost.
We have been formally operating for a period of 18 months and occupy an important niche at the intersection of novel technologies, deep health care know-how—motivation, practice, and process; in fact, the design that was just presented—and commercial activity.
I will begin my three pretty straightforward messages. The first message relates to the great importance of your assignment for this committee. Abraham Maslow, in his 1943 paper, talked about a theory of human motivation and presented a hierarchy of human needs. The first tier addresses physiological needs, and we're seeing, globally, a shift that's delivering on those physiological needs. The next tier is security, and fundamental to that security is health care and maintenance of health.
The rest of the world wants high-quality health care. In fact, it is expected the worldwide health care market will grow from just over $5.7 trillion U.S. today to approximately $20 trillion U.S. by 2030. This can be compared with the global automotive industry, forecast to reach only $1.7 trillion by 2015. Health care is becoming a massive global market.
The topic of innovation in health care in Canada should not be limited to the level of productivity, the cost, and the quality of care delivery to Canadians, but must address Canada’s capabilities to participate in one of the fastest growing high-technology and services markets in the world today. Missing the opportunity to be a competitive player in this massive market would be truly unfortunate given the magnitude of the existing investments in the health care enterprise in Canada. That's message number one: the global impact in terms of the broad market is something that we'll miss if we don't get innovation working well within health care.
My second message relates to a missing but key ingredient in Canadian health care. To put it bluntly, the system lacks an economy of innovation in health care. An economy comes to life when there are incentives and appropriate policies put in place. Our health care institutions are filled with some of the world’s greatest thinkers. Our academic clinicians are respected the world over for their acumen, their integrity, and their preference for evidenced-based practices. The quality of scientific medical research, engineering talent, and infrastructure is arguably world-class. Our multidisciplinary practice approach and patient-centred care philosophies create the opportunity to define the future best practices in medicine.
Given this raw material, what is preventing us from taking a global position in health care innovation and charging confidently into that large global market? What is preventing us from processing this raw material into product? What is preventing us from drawing new technologies into health care to solve problems?
The answer to this problem is not straightforward, but I think it is the problem. If we can build an economy for innovation in health care, then the rest of the pieces will come to life. We could ask many questions to find what kind of solutions would be involved. For example, does the health care system have the mandate to innovate or only to deliver? If it's not going to innovate, who is? If investment is needed, who would invest in that innovation? Where would you invest? Would you invest in a hospital? Is that an appropriate vehicle? What would be the nature of the returns: the savings, the efficiency gains, the quality? What are the incentives: intellectual property, licensing, academic yield?
In 2010-11, the Province of Ontario spent $44.7 billion on health, 40.3% of its total spending on programs. Based on current trends, this share is likely to expand to more than 44% by 2017-18. To think this activity is yielding nothing more than acceptable service is an incredible waste of the remarkable talent base and infrastructure we have created in Canada.
The Institute of Medicine in the United States released its Best Care at Lower Cost: The Path to Continuously Learning Health Care in America report in September 2012. This represents a major shift in thinking in U.S. health care. This combines the existing industry drive of that health care industry with integrated learning. No longer will Canada have the high ground on evidence. An economy of evidence development linked with investment for innovation that is the nature of U.S. health care will be a very difficult competitor in the global health care delivery market. We need to establish an economy of innovation to build Canadian health care.
My third and final message relates to the means by which health care innovation gets stimulated. There has been a lot of effort by our national and provincial research funding agencies to push the traditional academic research community to make their research more translational. This has done a great deal to ensure research grants have well-motivated introductory paragraphs. However, it is not clear that it's the best strategy to ensure discovery science reaches into the complex activities of health care. As pointed out by the previous speakers, process and design are key to bringing technology into health care.
In last week’s Globe and Mail, Dr. Tony Pawson of the Samuel Lunenfeld Research Institute in Toronto highlighted the concerns of some of the scientific community with a shift in funding to translational science. He is concerned that it weakens the quality of the basic science, as well as the yield. An alternative approach would be to invest directly in health care innovation that pulls the discoveries into health care as opposed to stimulating scientists to push their innovations into health care when they don't have the skills to do so. Funding directed at health care innovations that synergize with an economy of innovation health care would be more effective. In the current scheme, we run the risk of doing nothing well, undermining our track record of strong basic science, and failing to build an economy of innovation in health care.
In closing, I would like to thank you for the opportunity to present and look forward to responding to any questions you may have.