Health Committee on April 25th, 2013

[The Chair, Conservative, Joy Smith]

Yes, we do.

[Dr. Victor Ling]

If I could just simply walk you quickly through the PowerPoint presentation, that would be the easiest thing for me.

[The Chair, Conservative, Joy Smith]

It should be in your handouts, members.

[Dr. Victor Ling]

The very first slide is just to say who we are. We are the Terry Fox Research Institute. We are a virtual institute. Across Canada there are now about 55 organizations. All the major universities, cancer research centres and cancer hospitals across the country have agreed to be part of this virtual institute. The headquarters is in Vancouver, but we have a very small staff of five people. From there, we help to organize and direct the investments of the Terry Fox Foundation into various types of cancer research.

I don't have to explain to everybody why we need to control cancer in this country. We all would like the rate of cure for cancer to be improved and the number of people getting cancer to be reduced, etc. We also understand and know that a lot of innovations have been developed in Canada. There have been investments made in CIHR—which I was here all day for—and other areas, such as Genome Canada, Canada Foundation for Innovation. All these investments have been made to support the universities, and yet all of us appreciate that somehow at the consumer's level we don't think we see those investments.

I'll just give three examples, in cancer at least, of what we have experienced. We believe that genome science is very important. We believe the area of immunotherapy, using the immune system to attack cancer, is very important. There's a lot of work going on there. As well, the whole area of imaging is very important.

How do we actually advance cancer research in Canada? How do we actually do it? We can do it, I think, by applying these kinds of innovations, but I'm not here to tell you how to apply these innovations. There are very many innovations. I'm here to tell you about our experience at the Terry Fox Research Institute, where we find it actually challenging, and actually very instructive, as we move innovation to the clinical level. This is what we say: the kind of innovation we expect to see very rarely happens, and doesn't happen systemically. What is needed is for organizations to do pilot experiments to show that it can actually work before it is applied to our health care system.

What I'm really talking about is translational research. This is research that requires teamwork. It requires many organizations to come together.

The Terry Fox Research Institute was created in 2007 to focus on translational research. We support many team-oriented, multidisciplinary programs that are milestone-driven. I don't want to get you all hung up on the details of all this. I just want to tell you about one project we're doing. We have learned a lot of lessons from doing that one project. We did a project on detecting lung cancer early.

So here's the rationale for the Terry Fox early lung cancer detection study.

We know that in this country, and in every country in the world, lung cancer is a major killer. It has killed more people than breast cancer, prostate cancer, and colon cancer combined. It's not the most frequent cancer, but it kills more people than all these other cancers combined. We also know that if we detect lung cancer early enough, it can be cured by simple surgery. We all know that. But often by the time a person has lung cancer and they cough up blood, it's too late.

In the United States, they spent $250 million. In 50,000 people, they showed that if you can detect lung cancer early enough using a low-dose CT scan, the mortality rate goes down by 20%. That's huge. So where is the Canadian innovation? Well, we don't have $250 million. We certainly don't have it, and I don't think we can afford $250 million just to do screening in 50,000 people.

We decided that we needed to detect people with early-stage lung cancer much more efficiently than our American counterparts, and much more cheaply. So the team that came together developed a web-based questionnaire to improve the efficiency of detection.

You can view the questionnaire on the website. It asks a number of questions about smoking. How old were you when you started smoking? Are you still smoking now? On average, how many cigarettes per day do you smoke, etc.?

It also asks you to name the highest level of education you have completed. You might not think that question is relevant, but it has been shown that your level of education and your chance of developing lung cancer actually correlate, which is surprising. There are other things of that nature.

So we did this, and as this pie chart indicates, on average, for about five people in 100, we were able to detect early-stage lung cancer when there were actually no symptoms. The efficiency of doing this was at least three times better, or more, than in the United States.

This was done in Vancouver, Calgary, Toronto, Hamilton, Ottawa, Quebec, and Halifax. We have been able to show that across the country that level of efficiency is possible. This is through a lot of cooperation from everybody. It has been great. The 114 people who have gone through the tests and had their early-stage lung cancer detected and treated are grateful.

What have we learned from this project? We're going to do it tomorrow, right? Are we automatically going to put it in the health care system?

The answer is, no. We're not going to do that. We learned from this process how difficult it is even to launch a pan-Canadian project of this sort. There have been so many jurisdictions siloed, and ethics approval has to be received from essentially every hospital to participate. In fact, one hospital in Ottawa was not able to start this thing until about a year later than everybody else just because we had trouble getting ethics approval for this study. It's the administrative red tape, etc.

We also know that what we're trying to do is build a group of people interested in working on lung cancer, but in the past all these groups had been competing with each other. We had to build trust and collaboration and cooperation. Finally, of course, the health care system required that we do this to try to show that it was economically feasible.

What have we learned from this project? We have learned that Canadians can actually work together—it's amazing. When you give them a vision that they can work together on and do something important, people actually do work together.

The other point we've learned is that you can't plug and play. You can't import the technology from the United States and just put it into our health care system. It doesn't work that way. We really have to field test the innovation first to see where it is useful for our system.

The final point we've learned is that even though we have done well, all the people who came to the study came from large cities. Canada is not made up of people from only large cities. We have underserved communities, we have people in rural areas, and these kinds of tests also need to be available to them.

We need more innovation to reach those kinds of people. That is what we have learned. We have to think about using mobile units in northern Canada, perhaps, and things like that. These are the innovations we're thinking about.

Finally, on project number three, this Canadian innovation is actually recognized outside of the country—in Taiwan, for example. I know that John was there recently.

This is important for us. They've collaborated with us, and they are field testing this in their population. That will affect our population, because we're a country of immigrants.

I think the challenge remains that any innovation requires implementation at the health delivery level. We can invent everything we want at CIHR and Genome Canada, and invest in CFI, but if it doesn't get delivered, everything stops. Nothing happens.

[The Chair, Conservative, Joy Smith]

Dr. Ling, we are out of time. Thank you very much.

I guess we'll have one question.

I know you know Mr. Weston very well, and he's on the list next.

Go ahead.

[John Weston, Conservative, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

Thank you, Madam Chair.

It is a real honour to be here with you. This is the first time I have had the opportunity to be on the Standing Committee on Health.

This is a day for incredible coincidences. I just completed a document for my constituents that was exclusively delegated to health, and it's the first day I get to meet Dr. Ling, though we've spoken many times.

It's also the first day, Dr. Ling, that I actually pulled out my Terry Fox shirt that Judith Fox gave me before going to Taiwan, a carbon copy of which I presented to President Ma Ying-jeou in Taiwan. He is very supportive of the Terry Fox institute. He in fact led the Terry Fox run in Taiwan for many years until it had its last episode a few years ago. He wants to get it going again.

So I'm very pleased to meet you. On behalf of I think everybody here, we're all very proud of Terry Fox and his memory. We're delighted that you're part of extending that.

You talked about a virtual organization. It's pretty good that you've in fact attracted almost $600 million for a virtual organization and continue to innovate.

In a world where we tend to judge people and organizations on their experience, or their education, or their balance sheets, your emphasis is on collaboration—international. When I was in Taiwan, I learned of four scientists who are working with the Terry Fox institute, in Taiwan, on lung cancer, leukemia, and I believe, liver cancer.

To what extent are we Canadians innovating in the way we use our relationships, both in Canada and around the world? How much of a unique thing is that?

[Dr. Victor Ling]

I think Canadians are quite innovative. They're quite competitive in the area of discovery, of making great discovery. We're just not very innovative at applying the knowledge to the health care system.

Part of the problem is that I believe our health care system has very little incentive to innovate. Why? Where I live, the health care system takes all the money it gets from the federal government and elsewhere and applies it to just maintaining the system, not trying to improve the system.

It's not that people aren't interested. It's just that they need incentive. They need to have a designated dollar for the delivery level. We have innovation dollars at the front-end level, but we don't have innovation dollars to deliver innovation at the health care level.

[John Weston, Conservative, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

I'm new to this committee, but I think the topic is technological innovation. What I'm trying to get you to comment on is whether there's something special about the use of a dollar when people collaborate. Are we deriving more with less by doing what the Terry Fox institute is doing around the world?

[Dr. Victor Ling]

Absolutely. As scientists, we collaborate. We collaborate with Taiwan and we collaborate with other countries. That is very important. Collaborating with other people enriches our dollar, clearly, and as I said, because of immigration to Canada, whatever other countries do there helps us as well. It's a win-win for everybody.

The point I was trying to make is that often a lot of these discoveries are at the invention level, but at the application level.... We are buying health care at the retail level. We're buying drugs from the United States and from Europe. We're not developing here. We're buying diagnostic tests from the United States and elsewhere. We're not developing them here.

Why are we not? It's because our health care system does not have a mandate to develop the tests to actually show they work in our system. They work in the United States' system, and Taiwan was sure that their tests would work in their system, but we may be buying from them to apply to our system.

[John Weston, Conservative, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

Maybe I have time for a little more.

I know our chair is very keen on preventive health care. In fact she turns up to the parliamentary fitness swim on Thursday morning as a role model.

Do you have anything to say about preventive medicine, something that was brought up by the other doctors earlier today?

[Dr. Victor Ling]

Absolutely. I think prevention and a healthy lifestyle are the ideal situation. In Canada, we are wonderful. We have east coast to west coast. If you look at the gradient of health from east to west, the west is healthier than the east. You can see the lifestyle, diet, and habits change as you go across the country. So the data is there. There has to be some innovation. There has to be a will to try to change lifestyles.

[John Weston, Conservative, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

We have the Terry Fox run here on Friday, May 10, at the Delta Ottawa City Centre hotel. Would you like to say anything about that to this committee?

[The Chair, Conservative, Joy Smith]

I'm sorry, Mr. Weston and Dr. Ling, we're just over time.

I know Mr. Kellway has a quick question before the bells ring.

Mr. Kellway, could you give it a go?

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

Madam Chair, out of respect for Mr. Ling and to give Mr. Kellway a chance, I'm prepared to stick around for a couple of minutes so he can ask a question or two just to give him a chance.

[The Chair, Conservative, Joy Smith]

We're going to dismiss at 5:15, Mr. Lobb.

Mr. Kellway.

[Matthew Kellway, NDP, Beaches—East York, ON]

Thank you, Mr. Lobb. I appreciate that.

With all respect to all our guests. I appreciate your attendance today. You all had very interesting things to offer.

I wanted to ask Dr. Quint a question about workplace health, simply because I worked on this from a union side for so many years. I always understood the value of lifestyle changes and the wellness perspective and bringing that perspective into the workplace. If you go to Health Canada's website and you look at workplace health, you'll find a summary of decades of research on workplace health that talks about the issues of low worker control in combination with high demands imposed on workers. It talks about three times the incidence of heart problems, three times the amount of back pain, mental health issues, and five times the incidence of certain cancers.

So, Dr. Quint, I'm curious about whether in the course of your business you talk to employers about—

[The Chair, Conservative, Joy Smith]

Mr. Kellway, I'm sorry, the bells have started to ring now. Just very quickly could you give the question?

Dr. Quint, we're going to have to adjourn now.

Mr. Kellway, would you finish your question really quickly?

[Matthew Kellway, NDP, Beaches—East York, ON]

Sure. I was two words away from the end, I think, which was to say, what do you do to advise employers on healthy management techniques?

[The Chair, Conservative, Joy Smith]

Dr. Quint, could you please send that answer to the clerk and we'll distribute it amongst the committee members?

[Dr. Saul Quint]

Yes, I will.

[The Chair, Conservative, Joy Smith]

Thank you.

The meeting is adjourned.