Evidence of meeting #78 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was innovations.
A recording is available from Parliament.
Canada Research Chair on Innovations in Health, Professor, Department of Health Administration, Université de Montréal
It is difficult to have robust data, but 50% is a conservative figure. That means that 50% of innovative projects will fail. If we take, for example…
Liberal
Massimo Pacetti Liberal Saint-Léonard—Saint-Michel, QC
That also means that 50% of projects will succeed.
Canada Research Chair on Innovations in Health, Professor, Department of Health Administration, Université de Montréal
Yes, but it is a modest figure. The rate can go up to 70%. It depends on what we are measuring at the start of the project.
Liberal
Massimo Pacetti Liberal Saint-Léonard—Saint-Michel, QC
Are you saying that up to 70% of projects will fail?
Canada Research Chair on Innovations in Health, Professor, Department of Health Administration, Université de Montréal
Between 50% and 70% of projects will fail.
Liberal
Massimo Pacetti Liberal Saint-Léonard—Saint-Michel, QC
Okay.
On one page, there is a breakdown of expenditures. I am doing the math and I am confused. Twenty-one per cent of the funding comes from the federal government, 23% from enterprises and 27% from higher education. If I add those three figures, I end up with 71%. There is still 29% missing. Where does that portion of the funding come from?
Canada Research Chair on Innovations in Health, Professor, Department of Health Administration, Université de Montréal
Not all the sources are on the slide. I am sorry. I only listed the primary sources.
Canada Research Chair on Innovations in Health, Professor, Department of Health Administration, Université de Montréal
They are provincial.
Liberal
Canada Research Chair on Innovations in Health, Professor, Department of Health Administration, Université de Montréal
No. There are the provinces, as well as non-profit organizations and foreign sources.
Liberal
Massimo Pacetti Liberal Saint-Léonard—Saint-Michel, QC
That’s great, thank you.
Mr. Hoch, on page 4 in your presentation, at one point you were talking about needing more planning with innovators. I wasn't clear on who you plan with. Wouldn't it just be your customer? Who would your customer be? Wouldn't it just be your patient, or the hospital that delivers? It wasn't clear who you're trying to plan with.
Director, Cancer Care Ontario, As an Individual
I'll give you an example. Let's say there's a new drug that works with people who have a certain set of genetic material, and you need a test to see if they have the right genes for the drug to work.
Liberal
Massimo Pacetti Liberal Saint-Léonard—Saint-Michel, QC
Can I stop you there? Wouldn't you have done that before you even began your research?
Director, Cancer Care Ontario, As an Individual
Wouldn't I have done what?
Liberal
Massimo Pacetti Liberal Saint-Léonard—Saint-Michel, QC
Wouldn't you have already planned that before? You just don't wake up one morning and say, “Okay, I'm going to discover a drug and see who it's for and where we're going to get our test people from.”
Director, Cancer Care Ontario, As an Individual
I'd like to be polite to my basic science colleagues. Could you speak about whether it's all planned out in the lab?
Head, Radiation Physics Department, Princess Margaret Cancer Centre
Little is planned in the laboratory. This brings up an important point: the value of technological or even drug-based innovations really only gets understood once they're in the health care system—and not necessarily funded as general funding, but partly funded as a research activity.
Related to all these topics is the fact that the health care system itself is part of what figures out what's going to work. The message that I was bringing forward was that we need to understand how to measure. That's the HTA piece. At the same time, we have to understand how these technologies impact the processes that are active in health care. The health care system is the place where we figure out that something has value. If we don't have the players there to enable that innovation, then we're really undercapitalizing on the opportunity.
Liberal
Massimo Pacetti Liberal Saint-Léonard—Saint-Michel, QC
This is where I'm having difficulty understanding. If we're talking about a process, I can understand it being more difficult if you're trying to implement an innovative process, but when it comes to a drug, isn't that completely different? The drug is for a specific purpose. It's not as if all of a sudden the drug changes its purpose and it's for something else.
Head, Radiation Physics Department, Princess Margaret Cancer Centre
Let's say, for example, we start to use the drug in a clinical context. We recognize that there are differences in response across a population of patients, only observed once it's in the clinical context. In the process, though, we're a research hospital, we're collecting extra tissue from those patients. We analyze then, in retrospect...those tissues have different characteristics that predict for different outcomes with the application of that drug.
The next step is: who's going to make these tests as a routine activity of the use of that drug in the health care system? That iteration has to happen within the health care system. The problem is that the health care system is not really built to innovate. We've bolted the expectation on it, as demonstrated by this committee talking about this topic, but we're not actually built to innovate.
Director, Cancer Care Ontario, As an Individual
All I wanted to say was that if the drug needs you to be positive on the test, and the ministry funds the drug only for the people who are positive, someone needs to figure out how we're going to get the test paid for, which labs we're going to contract with, how we'll know for sure that they have it. There is some action that happens in the implementation area. In addition to that about drugs changing, it may be that when you do the studies, you study one type of patient. It might get funded for that type of patient, and then things might be more attractive to other patients.
Conservative
Conservative
Colin Carrie Conservative Oshawa, ON
Thank you very much, Madam Chair.
Perhaps to continue on that line, Dr. Jaffray, you mentioned that the system isn't really designed to innovate, and perhaps you and Dr. Lehoux could take a crack at this question.
It seems in this country there's a disconnect. We have academia and then we have industry. In the American system quite often, and I guess you spent some time down there, you can be an academic for half the day and then you can go work with industry.
We've heard of some of the steps we're taking forward, such as MaRS. In other places in the world, there are the Fraunhofer institutes. I was wondering if you could maybe give us an idea of why there seems to be this disconnect, and if maybe you see some practical solutions that could come from the government.
I know that where I went to school, Waterloo, there were co-op programs. You got kids out at an early stage working and interacting with industry right away.
Could you elaborate on why you think we don't have that connection in the country?
Dr. Jaffray, do you want to start, and then Dr. Lehoux?
Head, Radiation Physics Department, Princess Margaret Cancer Centre
Sure.
I would say we've transitioned over the past ten years, or maybe a little bit longer back. We do have good links between the academic and health care environments. That's quite remarkable, in this country, and I'd say that's a strong asset. We no longer have the ivory tower fear that we had 10 years ago. MaRS, as a symbol of that kind of thinking, has impacted this.
The committee members could comment on whether they agree with me, but generally speaking, there is a recognized understanding that you need academia, you need health care, and you need industry. And we have that. We have people who work fifty-fifty, teaching at the university, caring for patients, partnering with industry. That's active, and we've done our best to deal with all the REB ethics issues, conflicts of interest, and so on.
What I think we have not done, though, is we haven't given health care the expectation, clear mandate, and some kind of economy that drives innovation. In the U.S., the economy of health care is driven by referrals and competitiveness with your partner. We don't necessarily want those drivers here, but we need some kind of driver.
Hospitals can't roll over their budgets year over year. Why would I save money in my hospital if it's going to go away? The savings in this silo only really come out in another silo, so why would I save in this silo? We don't have a way to coordinate activities and give it to individual innovators to drive innovation that links across those.
If we can come up with some scheme...and I don't know what the scheme is, perhaps carbon credits for health care innovation? I don't know.
