Evidence of meeting #115 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was diseases.
A recording is available from Parliament.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Mr. LePage or Dr. Edwards, would you comment?
President and Chief Executive Officer, Genome Canada
I was thinking about this and expecting a variation of this question. When we started, we were thinking about brain drain, with 2,000 human genome programs going gangbusters. It wasn't pretty. If you look at it today, using the example of a hockey scene, we have a team, and we get into the quarter finals every year. We're really at quite a good level now. If we want to get to the next level up, in the finals every year, we're not quite there, but we're close.
I would say with the kind of budget proposal we put forward, maybe it should be 30% above where we are right now. Where we are is a good place, but the best place is another step up. It's not a massive.... It might be a little different in the broader system.
Aled, do you have any thoughts on this?
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you.
Dr. Yusuf, you were indicating you wanted to add in.
Distinguished University Professor of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, As an Individual
Yes. There are two numbers I'll give you. One is that to be as competitive as the U.K., the U.S., Japan or Australia, we'd have to increase our national health research funding by 50%. Second, we'd have to redistribute the money so that more money goes into clinical trials and population research. The ratio has to change.
I don't think we can ever replace industry funding, but I also want to point out that a large number of clinical trials are needed to fund things that industry is not interested in—for example, appropriate diet, or the best way to improve our health care system. These are not drug-related questions; they're systems-related.
There will always be a need for government funding, and at the very least we need to increase our funding by 50%.
Liberal
Conservative
Marilyn Gladu Conservative Sarnia—Lambton, ON
Thank you, Chair, and thank you to our witnesses.
I'm going to start with Dr. Yusuf. I'm very interested in trying to see how we can support having more clinical trials in Canada. I have heard some people say that one of the things that may impact clinical trials is the changes to the PMPRB drug approval process that will make the process longer and take away price certainty, possibly for about three years.
You mentioned that Canada's at 3.3% in its spend on clinical trials, compared to the U.K. and the U.S. at 11%, so of course one obvious action is to put more money in, and that's the amount, but are there other barriers that we should address in order to encourage more clinical trials in Canada?
Distinguished University Professor of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, As an Individual
That's a very good question. We have to triple the amount we put into clinical trials to be comparable with other countries.
Second, right now to get a clinical trial started after you get funding, you have about 100 separate steps. For a large clinical trial, those steps cumulatively add up to about a million dollars. For an academic investigator to do that is difficult. Industry has the resources and the manpower to do it.
Third, we need to leverage money from industry. By having more money in the pot from public sources, we can come up with a mechanism of 2:1 funding: For every $1 the government puts in, we could leverage $2, and most of that $2 would come from outside the country. We have raised about $1.5 billion over the last 25 years from a variety of sources, with 80% of the funding coming from industry, yet we've answered questions that are related to public health. That's leveraging.
The last point is what you mentioned—that we'll have to wait and see whether prolonging patent life will lead industry into putting more money into research in Canada. I think it's more likely that there's more public health money that could be leveraged.
Conservative
Marilyn Gladu Conservative Sarnia—Lambton, ON
Very good.
Dr. Edwards, I was interested to hear that you had a company that was coming to the second stage of a clinical trial, and then it was sold to a Swiss company. It's not the first time I've heard of people doing clinical trials in Canada and then selling the company elsewhere. What is it that Canada could have done to encourage you to keep that as a Canadian company, creating Canadian jobs?
Chief Executive Officer, Structural Genomics Consortium
I prefer not to answer it that way. It's a business. I have investors.
In my job, I don't agree with any of this. I run a charity, but when I was doing that, I had to make money for the investors, or the guys who ran the company had to make money, and that was the best deal on the table. This company was going to fund the subsequent clinical work, which gets expensive. The investor pool we happened to have at the time wanted.... When you take venture capital, they have to pay back their investors, and if you're at the end of the cycle, they are interested more in cash than in building. That's how business works.
Conservative
Marilyn Gladu Conservative Sarnia—Lambton, ON
I'm a Conservative, so I'm all about profitable business, but I'm trying to figure out where the shortcomings are in Canada. It sounds as if one factor might be venture capital available from Canadian sources to invest in your company when they see that you're coming to something good and that's where they need to get involved. Is that one factor?
Chief Executive Officer, Structural Genomics Consortium
It could be, but remember what I said first. That is the model, and if we follow that model—which I no longer do—it will lead to unaffordable pricing, so again, we have that tension, right? If we increase the VC funding in Canada and build lots of little biotechs, all the professors would be driving Ferraris. Somebody is paying for it, and it's us. This is going to achieve a breaking point maybe in about five years; I don't know.
Then why not invent a different way of inventing new medicines? There's still going to be as much economic payoff; it will just be in a different way, and we'll have savings in the health system.
Conservative
Marilyn Gladu Conservative Sarnia—Lambton, ON
Good. If we take these ideas and expand them into the rare disease area, where you're talking about a very small population, what kind of a model are you recommending then to actually produce the drugs? Is it like a Breaking Bad lab that does rare diseases, or what are we talking about?
Chief Executive Officer, Structural Genomics Consortium
No, I think you could license the regulatory protection that Max came up with, which is that it guarantees 10 years of right to sell, and you can license that right to a factory. There is no reason on the planet that industry has to invent medicines. Industry has to manufacture and distribute and market, but we've evolved the system to the point where they invent because it's more convenient for us, and the price we pay is at the back end. We think it's expensive and that industry should do it, but there's no law of physics that says that industry has to do all of this research stuff. They don't do it efficiently. The ROIs on research are going to be negative soon.
I just think we need to rethink this part, and why not Canada to do it? I mean, we don't have a strong pharma sector here, so it's not as if we're killing our goose that lays the golden egg to do this.
Conservative
Marilyn Gladu Conservative Sarnia—Lambton, ON
Mr. LePage, I know that genomics is expanding, that you're a leader in the world. What do you think the federal government should be doing in this area to create an environment to be even more successful?
President and Chief Executive Officer, Genome Canada
Well, as all the speakers have said, I think that part of the role of public policy is to create a research ecosystem. That is one of the fundamentals of a thriving community. I would say that ecosystem includes funding for public health research and public-good activity. If the government doesn't do it, certainly industry is not going to do it. I think we have generally done quite a good job. I think the next challenge for us is to be a bit more ambitious. We're actually quite good at this. I think we need to push it further, frankly, and dream bigger dreams.
October 16th, 2018 / 9:45 a.m.
Conservative
Marilyn Gladu Conservative Sarnia—Lambton, ON
Oh, well, all right; I'm going to go to Dr. Fowke.
What would you recommend the Canadian government do to better achieve health research and come to commercialization?
Professor, Department of Medical Microbiology and Infectious Diseases, University of Manitoba, As an Individual
I think a couple of things could be done. Continued support and growth of basic biomedical discovery research, I think, is important. As was pointed out, you never know where it's going to end up, but it's improving knowledge, and that has resulted in development of antibiotics and a number of other approaches that have saved health care dollars.
The other is that there could be a focus on repurposing existing drugs. I think that the development of brand new drugs takes a long time and has to go through a number of hurdles. If we used drugs that are already very well characterized, but used them in new ways and new approaches that are scientifically validated, I think that's a way of shortening that pipeline.
Liberal
NDP
Christine Moore NDP Abitibi—Témiscamingue, QC
Thank you very much, Mr. Chair.
Our study is looking at ways for the public to benefit more from health research. How are research results transposed? Is it done effectively?
Mr. Fowke, I was particularly interested in your study. I assume you were talking about Aspirin 80 mg.
In an ideal world, based on your findings, should the guidelines be quickly changed so that people at risk of contracting HIV are prescribed Aspirin 80 mg? After a few years, we could see if this will have had a significant impact on the population at risk.
Professor, Department of Medical Microbiology and Infectious Diseases, University of Manitoba, As an Individual
We are talking about a baby dose of Aspirin, 81 milligrams. It wouldn't be our recommendation that everyone who is at low risk of acquiring HIV take aspirin. This would be a focused intervention for people who are at extremely high risk—for example, sex workers or others who face extreme risk. We would advise them to take a number of approaches, including using condoms, reducing the number of partners and using antiretroviral drugs, as well as taking aspirin.
Some people don't have antiretroviral drugs available, and others aren't in a position to negotiate the use of a condom, so maybe an aspirin would be something they could use that would be available and not stigmatizing. Each person would have to decide which was the best approach for them. I would not recommend that anyone use aspirin as their sole HIV prevention. It would reduce risk, but it wouldn't eliminate it.
NDP
Christine Moore NDP Abitibi—Témiscamingue, QC
That's not really what I meant. I was talking about people at risk. The translation may not have reflected my thoughts well.
When we talk about people at high risk, we're talking about people for whom this drug could be prescribed, in addition to all the other measures. Often, these people aren't covered by any drug insurance. It is very difficult to get people to take medication preventively, especially when they don't have insurance coverage, since taking these medications makes no difference in their daily lives.
Could having universal drug coverage help to conduct research and then apply the results? Wouldn't that make it more likely that people will take the prescribed medications, especially if they are at high risk and don't have any insurance coverage?
Professor, Department of Medical Microbiology and Infectious Diseases, University of Manitoba, As an Individual
That's an excellent point. Most people around the world who are at risk of HIV, for example, are extremely poor. They don't have private insurance coverage. Governments could make the decision to invest in very inexpensive generic drugs that would help prevent some of these diseases. Individuals also, if they're counselled properly, may decide that an aspirin is a couple of cents a day, so people could invest that in their own health care. It's something within reach. Both government funding of these approaches, as well as individual funding if the bar is low enough, are accessible.
