HEAL Committee Meeting

STANDING COMMITTEE ON HEALTH

COMITÉ PERMANENT DE LA SANTÉ

EVIDENCE

[Recorded by Electronic Apparatus]

Thursday, December 2, 1999

• 0911

[English]

The Chair (Mr. Lynn Myers (Waterloo—Wellington, Lib.)): Ladies and gentlemen, we'll call this meeting of the health committee to order. As you know, the order of the day is Bill C-13, An Act to establish the Canadian Institutes of Health Research, to repeal the Medical Research Council Act, and to make consequential amendments to other acts as required.

I'm sorry for the late start. As you know, there are often members who have conflicting schedules, but we will nevertheless begin, based on the numbers here. We have a number of witnesses to hear today.

Some information has been distributed to members. Again, because of some of the conflicts with respect to timing, some of them are in English only. What we'll do very quickly is to have those translated so that they meet the requirements of both official languages. We'll do that expeditiously and in keeping with what our practice is.

I want to make two announcements. First, you will recall that Mr. Martin had requested—and it was a unanimous motion of this committee—that the Minister of Health appear before the committee at some point prior to December 6 with respect to the supplementary estimates. The clerk, as was requested and directed, has contacted the office of the minister. Unfortunately, he's unable to attend. I wanted to note that.

However, based on Bill C-13, prior to December 10 when we want to report it in the House, the minister has said that he will think about appearing before the committee, maybe on December 8, so we'll wait to hear from him in terms of whether or not he is available to appear before the committee with respect to Bill C-13.

Having said that, we have a number of witnesses, all of whom have taken the time to be here today, and some of whom, I understand, have to leave early, so we want to get this moving expeditiously to allow for their schedules.

Having said that, Dr. Steinbach, vice-president of the Vision Health Research Council of Canada, would you would lead off?

Dr. Martin J. Steinbach (Vice-president, Vision Health Research Council of Canada): Thank you.

My comments were prepared in advance and copies have been circulated, so if there's anybody who doesn't have a copy, I have extras available.

Honourable Mr. Myers and members of Parliament, I'm honoured to be able to address the committee this morning as it discusses the merits of Bill C-13 and the establishment of the Canadian Institutes of Health Research.

My interest in this bill comes from 31 years as an active and federally funded basic science researcher in vision health in Canada and my current positions as vice-president of the Vision Health Research Council of Canada; director of the vision science research program at the Toronto Western Hospital; professor of ophthalmology at the University of Toronto and director of that ophthalmology research program; and as a professor of psychology and biology at York University and a founding member of its Centre for Vision Research.

The Vision Health Research Council is a private organization of vision health professionals and scientists from across the country who share an interest in improving vision health research. Its president is Dr. Jean Réal Brunette, a distinguished ophthalmologist from Sherbrooke, Quebec. Its board of directors includes optometrists, ophthalmologists, basic scientists, and representatives from industry, charitable, and professional organizations. It is the only such organization in Canada, and I am authorized to speak on its behalf.

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We enthusiastically support Bill C-13 and all of its ramifications. While our support is general, the committee should understand that our examples of the reasons for support come from the area of science and health care that we know the best, that is, vision and eye research and health care.

The CIHR's mandate includes excelling in the creation of new knowledge and its translation into improved health for Canadians.

It is clear to us that the vision health of Canadians can be improved through a CIHR by, first, improved funding of basic and translational research.

The funding for vision health research is about $14 million per annum across Canada. This is a very small amount. The U.S.A. funds vision health research federally, through the National Eye Institute of the National Institutes of Health. Its current budget is $400 million U.S., or about $600 million Canadian. At the usual Canada-U.S.A. comparison ratio of 1:10, it suggests that $60 million Canadian would make us comparable. The enhanced budget for the CIHR will address these discrepancies in vision health research as well as all the other areas of health research that have suffered from years of underfunding.

Second is the development of research capacity and encouraging interdisciplinary research. The Vision Health Research Council has identified almost 300 basic and clinical researchers in vision science across Canada. These scientists are scattered in many different departments and institutions and, in many cases, are already engaged in cross-disciplinary research. Their number and the cross-fertilization, as well as reversing the brain drain, can only be improved by the support of peer-reviewed excellence that the CIHR will provide.

Third, addressing emerging health threats: the aging population of Canada will lead to a crisis in the vision health of its citizens. If we do not act soon to ameliorate the underlying causes, this crisis will come. We cannot do anything about growing older, but we must do something about the increased risks of glaucoma, macular degeneration, and diabetic retinopathies—especially prevalent in our native Canadians—amongst other age-related causes of blindness and vision loss.

The Canadian National Institute for the Blind registers 10,000 new clients every year. That number will surely grow. Targeting research in basic and clinical aspects of these and other blinding eye diseases, as well as educating our citizens about the needs for earlier diagnosis, are aspects of the CIHR that will enhance the health of all Canadians.

Fourth, international collaborations will be enhanced. The director of the National Eye Institute of the NIH has written to us about the opportunities that collaboration through the CIHR could provide. Dr. Carl Kupfer, in the attached letter, describes in this quote,

...the enormous potential for contribution to the field of vision research and vigorous collaboration in achieving our common goals and objectives. The benefits for the citizens of our two countries, and indeed those of the world, will be more rapid progress in alleviating the suffering caused by blindness and visual disability and improvement in visual health on a global scale.

In closing, though my examples were about the vision health of Canadians, the same arguments about benefits could be made for many other health areas. The CIHR is a splendid example of a far-reaching vision for revitalizing health research in this country. Its benefits will be felt and seen for generations to come.

Thank you for your attention and for allowing me this opportunity to speak, Mr. Chairman.

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The Chair: Thank you very much, Dr. Steinbach, for those opening comments.

Now, here's what we do in this committee. We're going to hear from each and every one of you and then, of course, we'll throw it open for questions. We'll proceed accordingly.

Dr. Yip, from the University of Toronto, is vice-dean of research.

Dr. Yip.

Dr. Cecil Yip (Vice-Dean of Research, Faculty of Medicine, University of Toronto): Thank you, Mr. Myers, for this opportunity for me to appear before the committee.

I hold the position of vice-dean of research in the Faculty of Medicine at the University of Toronto. As well, I'm also the holder of the Charles H. Best chair in medical research, in memory of Dr. Charles Best, the discoverer of insulin together with Dr. Banting. I'm also a full professor in the Banting and Best Department of Medical Research as well as the Department of Physiology. I wear many hats in my daily work.

I'm here to speak on behalf of the health research community at the University of Toronto. This health research community in Toronto is the largest in the country. Probably now we're ranked number four in research in North America. The community in Toronto includes the University of Toronto and the eight fully affiliated teaching hospitals and their research institutes. There are more than 1,800 active researchers in the broad area of health research in Toronto, each one of them with research funding from external sources, including the federal granting agency and other charitable foundations in the country.

I myself, in my capacity as vice-dean of research in the faculty, have worked very closely with members of this community over the last two years during the establishment and the formation of the concept of CIHR, so I know them well. I have heard from them and I have consulted with them. I believe I can speak on their behalf.

First, I'd like to say a few words about myself. I have been a researcher at the University of Toronto for more than 30 years. I came to Canada in 1964 from the United States after receiving my PhD. I was the first example, perhaps, of the reverse brain drain. I stuck around in Canada, in Toronto, since 1964 instead of returning to the U.S. because I truly believe there's a future here in Canada. For more than 30 years I have received uninterrupted research funding from the Medical Research Council, so you might say that I'm a product of the system of medical research in this country.

Personally I have experienced the frustration of not being able to compete with my friends, my colleagues, in the United States because of the research budget constraints in Canada. In my capacity as the vice-dean of research, I have a very good picture of the same frustration experienced by the broader health research community. The frustration has not been helped by seeing our neighbours to the south having their large health research budget annually increased by leaps and bounds. Our health researchers have not been able to excel, to develop their original ideas, and even if they could develop them, they would be taken away and not be brought to fruition in Canada because of the budget constraints.

The creation of the Canadian Institutes of Health Research, CIHR, as embodied in Bill C-13, is changing all of this for the better. There is now a high degree of optimism among our researchers. CIHR is a bold and innovative approach to support and link the broad spectrum of health research, from the basic science to clinical research to population health, and then to consideration of research in the broader sense of ethics and effects on society.

The linkage is transformative, in that CIHR will force collaboration among these sectors towards a common goal, that is, to improve the health and wellness of Canadians. To achieve this singular objective, CIHR will very significantly increase the financial support for health research in Canada. This increased resource will be utilized much more effectively through the creation of CIHR.

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To excel and to match or be better than the accepted international standards of scientific excellence, we need to have the best researchers. The best are attracted to a vibrant research environment that has a critical mass and funding stability, an environment that enables them to do what they do best, and that is research. It is my belief that CIHR, together with the other federal programs of research support—namely, the Canada Foundation for Innovation and the recently announced 21st century chairs of research excellence—have begun to create such an environment. Here I see that there is a three-pronged approach by the government to enhance the research effort in this country.

In Toronto we're beginning to see evidence of this. The University of Toronto academic health sciences complex is creating a centre for cellular and bimolecular research with funding from the Canada Foundation for Innovation and matching funds from the Province of Ontario. This research centre will carry out basic research on biological functions through the application of molecular, genetic, physical, and information or discipline to NIH data obtained from the sequencing of the human genome.

With the ultimate goal of translating the research results into the design and delivery of a new generation of pharmaceutical and therapeutic agents, we have begun to recruit the best to come to join the centre in Toronto. Those we have now recruited are former graduates of Canadian universities who moved to the U.S. to gain further training. They heard of CIHR. They wanted to return to Canada because they believe there's now a future for them in Canada and because they are convinced that the Government of Canada has made a serious and high-priority commitment to support health research. It is because of this conviction that we in Toronto have been able to recruit them against strong competition from the universities in the United States.

While the Canada Foundation for Innovation and the Province of Ontario are providing the funding for the infrastructure of the centre, the 60 to 70 researchers in our centre will be looking to CIHR for support of their research.

The objective of CIHR as embodied in Bill C-13 includes the expectation that the CIHR will exercise:

leadership within the Canadian research community and fostering collaboration with the provinces and individuals and organizations in or outside Canada that have an interest in health or health research.

One of the guiding principles of CIHR is also:

to recognize and support the central role that universities and associate health science centres play in education, training, and creating interdisciplinary opportunities.

The creation of the centre in Toronto is a good example. I believe there are similar examples happening now in Canada.

In the worst of times with inadequate research funding, Canadian health researchers can be proud of what they have accomplished. Now, in the best of times to come, signalled by the creation of the CIHR and complemented by other federal research support programs, I believe the health research community in the country will truly excel.

In closing, I would like to again offer, on behalf of the large health research community in Toronto, our support of Bill C-13. Thank you very much.

The Chair: Thank you very much, Dr. Yip, for those opening comments. Again, I'm sure there will be questions later on.

Let's move now to the University of Ottawa Heart Institute, Dr. Tofy Mussivand. Dr. Mussivand is of course with the Faculty of Medicine. Doctor, if you would, please.

Dr. Tofy Mussivand (Professor of Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa Heart Institute): Good morning, Mr. Chairman and ladies and gentlemen. I'm Tofy Mussivand. I'm wearing several hats—but I'm not going to bore you with those—of a professor, a developer, a hospital worker, and a janitor all together. I'm not politically correct, so please be patient and forgive me if I make comments that may sound negative.

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First of all, we do support Bill C-13. We also support initiatives for the improvement of medical research in Canada.

However, underneath those two supports, we'd like to bring to your attention some areas that we feel are maybe overlooked. I call them orphans. As I said, if some work is being done, for example, at Industry Canada or MRC, we support that as well. However, I'm trying to emphasize some of the areas we believe need more attention.

The goal of medical research has been defined, reviewed, and finalized, but what I'm going to say is really my simple-minded goals for medical research: number one, to improve health care delivery for all Canadians, and number two, to allow Canada and Canadians to successfully compete in a global market.

The first goal, which is to improve health care, does not necessarily depend entirely on domestic R and D funding. In other words, there are things we could bring. For example, if there's a vaccine for AIDS or other diseases, we could bring it in, as we have done in the past. So the health of Canadians doesn't depend solely on all the research being done in Canada.

Although we support it, I wanted to make a distinction between the first goal and the second goal. We believe we must be successful in the global market, and that success not only means excellent research but also excellent commercialization. This is important. Unfortunately, in the past this has not been really a focused area.

Canada has done excellent work in the areas of basic molecular and cellular research and pharmaceuticals.

There are some areas that have not been emphasized. Again, I call them orphan areas. Examples are multidisciplinary and applied research, medical devices and biomedical engineering, and pre-commercial R and D funding. We consider that for research done in Canada or anywhere else in the world, first you have to form an idea, then prove the concept, and then try to get this to be used in Canada and abroad. At this time we believe some of those areas, especially applied research and medical devices, have been overlooked.

Just to give you some statistics on medical devices, the global market for medical devices is $120 billion per year. There are 500,000 medical devices used every day and 25,000 new ones every year. Biomedical-related occupations increase at the rate of 22% a year. Unfortunately, Canada has a substantial trade deficit in this field of over $2 billion per year. We are suggesting that support for medical research, especially in an area that has been kind of overlooked, be increased.

With regard to biomedical engineering research and development, there was a similar problem in the U.S. They have taken steps for the NIH to improve that. Recently they've established an Institute of Biomedical Engineering and Imaging. We are suggesting such a group or institute be formed.

I'd like to spend one minute on pre-commercial R and D. We believe there is a major gap in the funding. Just because the word “commercialization” means to take whatever we do, whether it's basic or applied research, and compete with the best in the world, that doesn't mean dirty money. It means very good, clean money.

We have an example in Canada, and that's the Canadian artificial heart program. The Canadian artificial heart program began in 1989. We obtained some support from Industry Canada and the provincial government. However, unfortunately the support was not forthcoming from medical research. But it was not their fault. The reason was that they could not put this in a proper slot. There was no funding for such devices.

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Today, the Canadian artificial heart is posed to be one of the most successful undertakings of research in Canada. With a global market of over $25 billion, we expect Canada to tap at least 5% to 10% of that market, meaning that there will be a huge income for Canada. We also believe there are similar things that will happen in other areas.

Therefore, in conclusion, in addition to our support for CIHR and Bill C-13—we believe they are enhancing both of the goals that I indicated—we would like to recommend the establishment of an institute for medical devices and biomedical engineering, with a specific budget; and the establishment of an effective program for pre-commercialization or for pre-commercial R and D.

Thank you for your attention.

The Chair: Thank you very much for those comments, Dr. Mussivand. Again, as I said, I'm sure we'll have some questions for you in a moment or two.

We'll now move to Ms. Sholzberg-Gray. As you know, she is the president and chief executive officer for the Canadian Healthcare Association.

Ms. Sharon Sholzberg-Gray (President and Chief Executive Officer, Canadian Healthcare Association): Thank you.

The Canadian Healthcare Association, the CHA, appreciates this opportunity to appear before the Standing Committee on Health to discuss Bill C-13.

CHA is the federation of provincial and territorial hospital and health organizations committed to preserving and strengthening Canada's health system. Through our membership, we represent regional health authorities, hospitals, and health care facilities and agencies that employ approximately 1 million health care providers and serve Canadians across the country. These organizations are governed by trustees who act in the public interest.

CHA represents a broad continuum of care, including hospitals, long-term care facilities, home and community care agencies, community health services, public health, mental health, addiction services, children, youth and family services, housing services, and professional licensing bodies. The Canadian Healthcare Association is the national voice of this health network.

All of our members benefit from and participate in health research, including biomedical research, applied clinical research, health systems research, and population health research. CHA believes that while improvements are necessary to support biomedical and applied clinical research in Canada, it is also crucial to support the further development of health systems research and population health research. Therefore, some of my comments today will focus on the impact of Bill C-13 on health systems research and population health research.

Our concerns reflect those raised by our members and by the Network for the Advancement of Health Services Research, also known as NAHSR. CHA has been an active participant in this coalition, and I've appended the NAHSR evaluation framework to my speaking notes for your reference.

Overall, the Canadian Healthcare Association is very supportive of the development of the Canadian Institutes of Health Research as outlined in Bill C-13. This legislation is an important foundation for the needed transformation of health research in Canada. We applaud the legislation's aim to create the CIHR as a flexible mechanism that will continually align health research funding with changes in the manner in which health problems and opportunities are identified, understood, and addressed. Indeed, ten years ago population health was just beginning to emerge as a significant field of research, so flexibility is the key to enabling health research to be responsive to scientific discoveries and management and organizational realities within the health care system.

CHA is also encouraged by the stated objective of the CIHR, specifically as outlined in clause 4 of the legislation, which includes:

(c) forging an integrated health research agenda across disciplines, sectors and regions that reflects the emerging health needs of Canadians and the evolution of the health system and supports health policy decision-making;

(d) encouraging interdisciplinary, integrative health research through the creation of Health Research Institutes that...

(ii) include bio-medical research, clinical research, research respecting health systems, health services, the health of populations, societal and cultural dimensions of health and environmental influences on health and other research as required, and

...

(h) promoting the dissemination of knowledge and the application of health research to improve the health of Canadians.

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While CHA supports the overall thrust of the proposed legislation, we have identified several concerns. These concerns are related to the primary focus of the CIHR, the proposed governance and management structures, the reference to commercialization of health research in Canada, and the need for transparency and accountability.

In terms of the primary focus of the CIHR, I mentioned earlier the CHA's support for many parts of the CIHR objective as stated in the proposed legislation. However, in our opinion, a key and overriding mission is missing. While the notion of improved health for Canadians is embedded within the opening paragraph of the CIHR objectives in clause 4, CHA recommends that the objective be reworded or reworked, with a focus on improving the health of Canadians.

For example, we suggest a vision statement to the following effect:

The vision of the CIHR is to improve the health of Canadians by enhancing the effectiveness of health services and products, and strengthening the Canadian health care system. AND

The objective of the CIHR is to realize this vision by excelling, according to internationally accepted standards of scientific excellence, in the creation, dissemination and adoption of new knowledge, by

—and then paragraphs (a) through (l) would follow.

This rewording and refocusing of the CIHR vision and objective will provide a necessary balance between public policy objectives and research agendas.

The Chair: Will you excuse me, Madam Sholzberg-Gray? Can I interject for a minute? You're presenting a little too fast for the translation.

Ms. Sharon Sholzberg-Gray: Oh, okay.

The Chair: If you can, please slow down ever so slightly.

Ms. Sharon Sholzberg-Gray: Thank you, Mr. Chairman. I actually was concerned that you'd cut me off before I finished.

The Chair: No, we're very flexible here, and we want to hear everything you have to say.

Ms. Sharon Sholzberg-Gray: On CHA's concerns with respect to the proposed governance and management structures, we're concerned specifically about the dual role of the president and the chairperson, the term of office of the president, and the lack of specificity in the appointment criteria of the governing council.

As outlined in subclause 9(1) of Bill C-13, the CIHR president and chairperson of the governing council are one and the same person. This flies in the face of many governance and management models that stress transparency and accountability. CHA has not been able to ascertain why the government is suggesting this model. If, in the short term, there is a legitimate reason for needing or wanting these positions to be one, CHA would like clarification as to why. For the long term, we're recommending that the wording of the legislation be changed, stating that either immediately or following the initial five-year term, these two positions shall be filled by different people.

With respect to the term of office for the president, CHA supports the opportunity for the president to be reappointed after the initial five-year term in order to allow for continuity and stability, but suggests that after ten years it may be beneficial to have different leadership. Therefore, CHA is recommending that the president be appointed to no more than two consecutive five-year terms.

The appointment criteria for the governing council state that these women and men will “reflect a range of relevant backgrounds and disciplines.” CHA is recommending that these criteria be more specific, including reference to the following: proportional representation of the different fields of health research, including biomedical research, clinical research, and research respecting health systems, health services, and the health of populations, societal and cultural dimensions of health and environmental influences on health. This will enable the CIHR's decisions and activities to reflect a wide range of needs, issues, and perspectives.

In addition, CHA recommends the inclusion of consumer or public representation on the governing council and other decision-making and priority-setting bodies of the CIHR.

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With respect to commercialization of health research, CHA recognizes the significant opportunities available both domestically and globally for the public and private sectors to benefit from the commercialization of health research in Canada.

However, we feel strongly that a cautionary note is needed to stress that private-public partnerships in research related to the health of individual Canadians and the structure and management of our health care system must ultimately be in the public interest and must not compromise the objectivity of the research, the provision of appropriate treatment and care, or the development of needed public policies. Therefore CHA recommends that wording be added to paragraph 4(i) to recognize the spirit of this cautionary note.

In terms of the need for transparency and accountability, CHA is encouraged to see the requirement for a public annual report by the CIHR. We understand that this will include CIHR's accountability to adequately and appropriately carry out its mandate and its responsibility for administering funds.

As suggested in the NAHSR evaluation framework, a fundamental value of the CIHR governance structure must be transparency. This is echoed in the preamble of the bill:

Whereas Parliament believes that health research should... be characterized by a transparent approach that facilitates accountability to Canadians.

To further strengthen this transparency and accountability, we recommend that Bill C-13 include the provision for a parliamentary review every five years. Given what is at stake in terms of innovation, global competitiveness, the health of Canadians, the effectiveness of the health care system, and the amounts of money that will be involved—we hope they'll be even larger amounts than those predicted now—a regular parliamentary review seems necessary and appropriate.

In conclusion, CHA is cautiously optimistic about the establishment of the CIHR. This note of caution is based on a sense that biomedical and clinical research, as important as they are, will continue to overshadow other crucial areas of health research in Canada. We want emphasis to be placed on all aspects.

The details related to the governance, structures and processes of the CIHR will be developed within the context of this broad, flexible and enabling legislation. It is hoped that the details will support a balanced approach to and support of all fields of needed health research.

CHA and our members look forward to working with others to implement and support the Canadian Institutes of Health Research.

Thank you for the opportunity to appear before today, Mr. Chairman.

The Chair: Thank you very much for those comments and those recommendations. We appreciate them greatly.

Let's move on to the Association of Canadian Teaching Hospitals. Present with us today is Mr. Murray Martin, president and CEO of the Vancouver Hospital and Health Science Centre.

Mr. Murray Martin (President and Chief Executive Officer, Vancouver Hospital and Health Science Centre, Association of Canadian Teaching Hospitals): Thank you very much for the opportunity to present today.

The Association of Canadian Teaching Hospitals consists of Canada's 35 largest teaching and research hospitals. Each hospital is formally affiliated with one of Canada's 16 universities with a medical school. Our 35 members account for over $20 billion in annual operating expenditures in the Canadian health care system. Annually, through our affiliated research institutes or other research structures associated with our members, we conduct 70% to 80% of the health research funded by the Medical Research Council of Canada.

It is quite apparent to the public that teaching hospitals are actively engaged in training doctors, nurses, pharmacists, social workers, and other health care professionals. Less obvious are the reasons as to why teaching hospitals play such a major role in health research, and why they believe this role to be so fundamental to achieving their mission. The answer to these questions is simply the reality that leading-edge clinicians cannot remain leading-edge very long unless they are actively engaged in research. Our research activities are heavily supported by the very successful efforts of our hospital foundations and the national disease-specific foundations, such as the Heart and Stroke Foundation, the Canadian Cancer Society, and others, along with federal funding.

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The goal of all of our hospitals is to provide Canadians with the highest quality of health care possible. To do this means we wish to train and retain the brightest minds to work in our hospitals. Our best have the world as their workplace and have in the past been constantly recruited away, particularly to the United States.

To retain these individuals, our members last year unanimously endorsed a substantial increase in federal funding for health research as their number one funding priority. This endorsement does not negate the many other financial challenges facing the health care system in Canada, but was made in the belief that the most serious issue was to retain our clinician scientists. Those are the individuals who for decades have allowed the quality of our services to equal those anywhere else in the world.

Our members also unanimously endorse the now approved substantial increase in research funding to be directed through the proposed Canadian Institutes of Health Research. We believe strongly in the notion of creating national networks of researchers working through institutes to create the critical mass necessary for major advances in health research.

We believe in the notion of moving to a new paradigm whereby the stove-pipe approach to research of the past is replaced by the new multi-dimensional models of researchers working together in a far more collaborative manner than in the past.

We recognize that at the international level Canada is a relatively small player. For this reason, we must best maximize our small critical mass to be successful at the international level.

The Canadian Institutes of Health Research will very much complement the previously created Canadian Foundation for Innovation, CFI. There's no doubt that CFI has created tremendous momentum across Canada that has led to highly competitive processes to expand our research infrastructure.

This first step, so necessary to expand our overall research activities, has now led to renewed optimism and excitement amongst our researchers. For the first time in many years they believe there may be an opportunity for a researcher to have a productive research career in Canada.

I believe the momentum is so great that there will be the need to also give serious consideration in the near future to add to CFI funding at an enhanced level. Both CFI and CIHR have the potential to create a whole new economic engine for Canada. This has the potential of not only bringing enhanced health care for Canadians but improving their financial prosperity.

It is the hope of our members that the announced funding increases for health research will simply be the start toward an eventual goal of health research in Canada being raised to the same per capita level as other G-7 countries.

To make this happen, it is recognized that with the creation of CIHR the ball will now be in the court of our researchers to prove to Canadians that their increased investment in health research will contribute in a significant way to bettering the health of Canadians. We believe Canadian health researchers are poised to meet this challenge and we support the passage of Bill C-13 in its drafted form.

Thank you very much.

The Chair: Thank you, Mr. Martin.

We want to now move back to Dr. Fernand Labrie, who's director of the CHUL Research Centre, representing the University of Laval.

Merci, Monsieur. Welcome.

[Translation]

Dr. Fernand Labrie (Director, Research Centre for the University of Laval Hospital Centre; Director, Department of Physiology and Anatomy, University of Laval): Thank you very much. I apologize for missing the presentations made by a few colleagues because of the Canadian transportation system, which is not your responsibility.

Thank you for inviting me to appear before this committee to discuss Bill C-13, which will be amending the Medical Research Council Act and will be drawing the curtain on the MRC after 40 years, replacing it with the Canadian Institutes of Health Research.

As a researcher and as a director of both the Research Centre for the University of Laval Hospital Centre and the University of Laval Department of Physiology and Anatomy, I would like to give my full support to this bill which will enable Canadian health research to be more effective and better suited to the needs of the world as a whole and Canadian society in particular.

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I'd like to say a few words about my past experience. I have been conducting research for more than 30 years and I have been the Director of the Research Centre for the University of Laval Hospital Centre since 1981. There are now 180 researchers and 1,100 employees, including 400 graduate students, who are at the Research Centre. In the Quebec City region, the Centre is the second largest employer, after the government. Contracts and grants are worth about $45 million per year.

My research has focussed primarily on hormones; what is known as endocrinology. Cancer of the prostate is what affects men more specifically. We have developed treatments that are now used throughout the world and we were the first to extend the life expectancy of people afflicted with this type of cancer.

We are currently focussing our efforts on breast cancer. We have a product that is in phase 3 of the clinical study and it has been assessed as an excellent product in this sector. We are also doing research on the hormonal side of menopause. These are all areas that are very important for Canadians. Along with my colleagues, I have produced more than 900 publications and delivered 1,300 addresses at conferences. We have, therefore, been working very hard over the years.

As for the institutes themselves, I, together with a group of colleagues, have suggested that we create a research institute for diabetes, obesity, nutrition, endocrinology and reproduction, which would be called DONER in both French or English. We hope that this institute will be approved, because it would allow us to conduct multidisciplinary research—this is the advantage that health research institutes offer—ranging from basic research to clinical research, and would include health services, research into the health of populations, as well as research dealing with social and cultural issues. Such an institute would allow us to work in co- operation with the Canadian Diabetes Association, the Association québécoise du diabète, the provincial and federal governments, and also Health Canada, which has important activities in this sector.

I'd now like to discuss a few general items which I feel are very important and which have already been pointed out.

Up until now, funding for health research in Canada has been relatively low, if not to say very low. In the research sector, we should not draw comparisons between cities and provinces; instead, we should be drawing comparisons at the international level. On a per capita basis, the United States, with its factor of 7, invests a great deal more into health research than Canada. Perhaps we could say that the Americans are investing too much, but perhaps it is we who are not investing enough. We have experienced a major problem over the years because the budget has not been increased adequately. We were told that the budget would be increased by 3%, but 3% of something that is standing at 10% of what it should be is not very realistic. We hope that this new organization for institutes will enable us to rectify the problem. My colleagues mentioned earlier that we should even be doing more than what is planned.

In the research sector, money is not the only factor, however, no money means that you don't get the researchers that you need and it becomes almost impossible to be competitive.

Mention was made earlier that the university hospitals were spending $30 billion per year on health. In Canada, as you all know, the figure is $75 billion. As in any other sector, the best way to save money is to manage as effectively as possible. In order to get the most out of the $75 billion that are currently being spent in health in Canada, we have to conduct high calibre research that will ensure that we have access to the best techniques and medication.

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Secondly, peer review must be maintained for the Institutes of Health Research. We have already talked about this matter. This is an extremely important aspect and we must not yield any ground when it comes to this. The only way to do research that is recognized internationally is to ensure that the work is assessed by peers, international peers. It is essential that the same criteria apply to all institutes.

In Canada, approximately 10% of health costs are related to drugs or medical instruments, representing about $7 to $10 billion. We are known to be importers of these goods. We import from 80% to 90% of these things. This is, to some extent, a question of national pride as well as an economic question. We must develop research that is competitive and which will enable us to apply basic research, to produce our own drugs and medical instruments and to sell them to others, something we must do in our field. We have always imported. The time has come for us to export. Obviously, in order to do this, we must increase both the quality and quantity of our research which, up until now, has been truly deficient.

This will also give us an opportunity to increase clinical research, which is also sadly lacking in Canada. We will be able to use our basic research in order to do applied research.

As others have mentioned, it is very important that we keep our best brains in the country. Over the past week, we calculated how many researchers we have lost from our research centre. These researchers went to the United States or other places where they were offered better salaries and better financial support. What really concerns us is the fact that graduate students, who have been trained in Canada, and who have pursued post-doctoral studies abroad, decide to accept positions with our neighbours rather than come back home.

Over the past five years, there have been 58 such cases. This is a tremendous number. Thirty-four post-doctoral researchers or researchers who had completed all of their training, instead of coming back to Canada, went to the United States for the most part, with a few going to Europe, 13 researchers from our centre left, and 11 researchers who were not with our centre but who had been offered positions decided not to come to the Laval University Hospital Centre, to my sector.

This is quite a scary situation. It is not alarming, but it does indicate the tremendous value of obtaining financial support for research that is competitive with what is found elsewhere in the world, in the more developed countries, in the United States, our closest neighbour.

There is also the question of university positions.

To summarize, we are being offered a unique opportunity to think about what is going on in research, to assemble all of the research disciplines together and to obtain the co-operation of both universities and government subsidizing organizations in order to ensure that Canadian research is truly competitive and of international calibre, to ensure that we are able to keep the best brains at home and to instill pride in the quality of medical science produced by Canada.

Thank you for your attention.

The Chairman: Thank you very much, Dr. Labrie, for your comments.

We will now ask questions. Ms. Gagnon.

Ms. Christiane Gagnon (Québec, BQ): Thank you for the information you have shared with us this morning. I can see that a few of you are expecting to harvest the financial manna that will probably be available shortly. There is no need to convince us why we should establish such institutes in order to create a network of the various research disciplines in the health sector. Our objective is to live longer and in better health, and research is there precisely to do that.

I was particularly sensitive to what Ms. Sharon Sholzberg-Gray was saying earlier, on behalf of the Canadian Healthcare Association, with respect to the mandate to be given to the research institutes. Her comments spoke to our concerns, as members of the opposition, when it comes to matters of transparency and the mandate. I think that we should add, to the bill, certain specifications with respect to the mandate to be given to the president and the governing council.

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I would like to hear from you, the researchers, on this aspect of Bill C-13. We know very well that research is important, but there is also this matter of management that will be put in the hands of appointed people. We in the opposition would like to make a few adjustments to improve Bill C-13. We are going to give our approval with respect to the principle underlying the institutes, but I would like to hear one of you, perhaps Dr. Labrie, who comes from my region, talk about his concerns. We must ask ourselves whether or not the mandate specified in the bill will encroach on issues that come under provincial jurisdiction. It's quite a delicate issue. We have to understand the scope of the mandate of these health research institutes.

Dr. Fernand Labrie: Before answering the question, I would like to understand your particular concerns.

Ms. Christiane Gagnon: I'm concerned about the fact that the mandate is not clear. For instance, the governing council will decide which disciplines and which projects it will support. We are currently involved in a process where everyone wants to have his part of the pie, but the governing council of the Research Institutes will have the mandate to assess all these things and make decisions. As Ms. Sholzberg-Gray said earlier, it is important that this mandate cover several fields.

Dr. Fernand Labrie: I will answer your question, and my colleagues will surely do so as well. All of the researchers are recommending that there be a very high calibre peer review system. Consequently, it will not be the president of the Institutes or even the governing council who will be deciding whether or not such and such research project should be funded. Personally, I have never seen a board of directors for a granting council make decisions that are different from those made by the review committees. The best insurance that the best research will be subsidized, regardless of who is sitting around the table, will be the peer review. These are people who come from Canada and from abroad and who say that such and such a research project has been rated number one, another has been rated number two and so on until you reach the project that has been rated sixth. I think that this process will be based solely on this procedure. It will be based on excellence. If other factors were introduced, we would be jeopardizing the quality of the research. No researcher would want to cast doubt on that. Consequently, this process will guarantee that only the best research projects are subsidized. In the past, only a small portion of the best were subsidized. We still have a long way to go.

Provincially, and this applies particularly to Quebec, I understand that people are very open-minded. Quebec has always been the province that has invested the most in research. If, finally, we were to obtain a subsidy level that was more comparable... We still have a long way to go, as you know, before we catch up with the United States. I think that Quebec as well as all the other provinces would be happy. This forms the basis for our society. The government says, and everyone knows this now, that knowledge is the basis for quality of life, the basis for health, for the economy, for everything. We are losing our best people because we do not have, here in Canada, the conditions needed to keep them. We have to stop the hemorrhaging as quickly as possible.

The Chairman: Thank you very much, Dr. Labrie. Do you have another question?

Ms. Christiane Gagnon: You pointed out that there was a problem with health equipment. Because of the cutbacks made to the Canadian Social Transfer, our health institutions, our hospitals, have had problems maintaining the health network. Research has been deficient for a long time and we're happy to see that more money will be injected into this sector. However, we are also going to have to put more money into the health network to ensure that the research is applied directly. Are you not concerned when you see our health networks forced to operate with so little money at present? Seven billion have been slashed from the budget over the past few years. Shouldn't we be putting pressure on the government to ensure that our hospitals are able to provide better care for our people, which is our primary objective?

[English]

The Chair: Madam Gagnon, you're going down the road of a more political question, and while I respect whatever answer the witnesses want to give with respect to that, I want to indicate that really the question being asked is a political one.

Now, you're free to answer whatever you think is appropriate.

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Ms. Sharon Sholzberg-Gray: I'd be willing to answer it if you like, having just appeared before the finance committee two days ago in the pre-budget hearings and asking for more money for the delivery of health services.

We understand there's a link between research that has to be carried out by medical research, clinical research, also health systems research and population health research, and the efforts of bringing the latest technology, the best medications to the public. That can't be done without an appropriate amount of money on the service side of it. We've made our case, and I think other people in this country have, for an increase in the federal transfer to the provinces for the delivery of services. But of course that's a totally different subject from research, which we hope comes out of a different budgetary pot and is not part of the transfer payments. I think both have to be enhanced in order to achieve our objectives.

The Chair: Thank you very much.

Yes, Doctor.

Dr. Tofy Mussivand: I'd like to add to what was mentioned earlier. Medical devices research or any other research, whether it's medical or engineering or social, we would like to suggest, as my colleague indicated, should stay independent. Once you get the governments involved, whether it's the provincial or federal government, with research or decision-making as to how to give the funding, to which research or which institute, we will have problems, Mr. Chairman.

Therefore I'd like to suggest we stay away from any politics; we go to the research, get the research, because research doesn't accept boundaries. The AIDS virus doesn't understand Quebec or U.S. or Europe; it goes everywhere. Chagas disease goes everywhere. So the researchers have to address the issue without any political concern.

The Chair: Thank you very much. That's a good observation; I appreciate that.

Mr. Jackson, please.

Mr. Ovid L. Jackson (Bruce—Grey, Lib.): Thank you very much, Mr. Chairman.

I'd like to thank all our guests for being here this morning, to share with us, to try to improve this legislation to make sure we deliver the best services to all Canadians and indeed, in some cases, probably the world.

We always try to compare ourselves to the United States, and one of my observations is on one of the things I think we lack in the academic community. You tend to want to be away from politics and you want to have your head in the clouds and you don't want to get involved, but the fact of the matter is that in politics, you know, we will change. What's going to happen is that some people fund you, some people don't, some will change the priorities, and all this kind of thing.

I accept your peer review techniques and so on. My observation has been that in the case of the United States, for instance, part of their success, the reason they have about 50% to 60% of the knowledge base as compared to ours, which is only 3%, is not that their standard systems are different; we may not like it, but they're still the best capitalist system in the world. Part of that is because in their ivy league universities what I think they've done is they started off like we did—perhaps Canada and the United States started off with the basic stuff, but they moved ahead of us because they commercialized some of their operations. They go around the world and get the best brains, they steal the brainpower from all over the world, and that's part of what makes them good.

What I hear from a lot of scientists is “You guys give us the money and then take off.” What I think you have to do is not only get the money from us, but when you develop intellectual property, some of that money has to come back; it just can't go to the university and the researcher, you know. Dr. Mussivand, for instance, is trying to develop a heart, along with Dr. Keon, and it's very successful, and it's something that needs a lot of help. You can't get that critical amount of money just from the government. We could give you all of our budget and it probably still wouldn't be enough. You have to grow as well.

My question is this, Mr. Chair. I know that in your regulations you have clear rules of engagements; that's how you keep from getting sucked in by some private company. But I'd like to know, from all of you, how would you enhance your budget by using the research we develop in Canada, from the basic thing right up to commercializing? I think that's an area I haven't heard anything about.

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The Chair: Just before you answer that... Mr. Jackson, how tall are you again? You're what, six foot four or six foot five?

Mr. Ovid Jackson: Six foot five.

The Chair: And you're talking to them about heads being in the clouds?

Voices: Oh, oh!

Mr. Ovid Jackson: I just want to challenge them, Mr. Chair.

The Chair: Yes, I know.

Dr. Mussivand, if you would.

Dr. Tofy Mussivand: First of all, we concur that specially applied research needs to be used as quickly as possible for human welfare. We also concur that governments cannot support all the research funding.

The example he gave is the artificial heart, an undertaking in the U.S. The U.S. NIH and the government have spent $500 billion on the development of an artificial heart over the last 45 years.

I'm a proud Canadian and I was working at the Cleveland clinic. Like you, I was a reverse brain-drain or drain-brain, or whatever it's called. I returned to Canada and I was amazed at the lack of any support in that area.

I also want to suggest that we did raise funds. We raised $60 million in the capital market, 80% from outside of Canada, for a Canadian artificial heart. We also made arrangements with Industry Canada. We actually obtained a loan from them. I used to joke with Mr. Manley that he was like a loan shark, asking 7% interest; that's too high. Eventually we agreed on a loan arrangement.

I do agree with your comments that research should not be an indefinite pit of obtaining money with no return. We believe that applied research especially, medical devices and things like that, should go to market, be successful, and repay government in some way. That could be either through taxes, because we employ lots of people, through revenue coming from external export, or other forms.

We do believe and recommend that there should be some return, whatever you wish to call it. However, I still maintain that the independence of scientists is extremely important. Can you imagine what would happen if Conservatives, NDPs, and Liberals became sick and came to the Heart Institute and we had a bias against or for one group or the other? We have to deal with all of these without any bias.

Mr. Ovid Jackson: I understand that a lot of the things you do don't necessary have a payback. We have the Ottawa knee institute, we have the Ottawa ankle institute, and the payback is hundreds of millions of dollars. They're not using X-ray machines.

We don't necessarily want the money back. What I'm saying is that whatever money you make, plow some of it back into the institute. That's where the growth has to occur.

Mr. Tofy Mussivand: I agree.

Mr. Ovid Jackson: You have to find a way to do that rather than just saying it goes to the university, it goes to the scientists, and you're going to get the rest of the money from the government.

The Chair: On this point, we want to hear from Dr. Yip and Dr. Labrie as well.

Dr. Cecil Yip: Thank you very much, Mr. Chairman. I would like to make some general observations in response to Mr. Jackson's comments.

I think the issue is not that the government should be paying all the money to support all the research, and we keep on coming back for more and more.

Let me describe for you a scenario. What we're talking about here is the whole enterprise of research in any area. You can look upon it as a triangle, a pyramid. At the bottom of it is the basic research, which occupies a large height of this pyramid. In the middle is what we call the transitional or application phase. That has a small section of this pyramid. Right at the tip of it is application and development.

Intellectual property would be the only area of interest to business, to commercial companies. That's at the tip of this pyramid. They are not interested in funding the lower three-quarters of that basic research because it is a very long process from there to the tip of the pyramid. No company in its right mind can justify to the shareholder putting a lot of money into the bottom of the pyramid and waiting for 15 years for a return. They want a short period of return.

• 1020

The second point I'd like to make is that I think we are facing a difficulty here in Canada. For example, in biotechnology we have a lot of intellectual property being developed, but the receptor capacity is already reaching its limit. We don't have enough receptors out there. Therefore the receptor will have to be found outside of Canada.

Many universities that I know of, in particular the University of Toronto, have a very clear process of intellectual property development, disclosure of discovery leading to licensing patterning, and taking this out to seek venture capital investment.

We have to remember that the support for basic research in all the sectors has to be government. It cannot be private and it cannot be business, because it would have an inherent bias. The only thing we can do is have government support basic research without any bias, for the benefit of the whole country. Once you get development, then the buyer comes in, the company that's interested in making money.

I think we need to understand this. Intellectual property can be licensed and can spin off to companies. In each institute at the University of Toronto, there is a revenue-sharing arrangement with the discoverer and with the company after the company takes it on to develop it as a product. That revenue comes back to the institution, but it is in comparison to the amount of funding that is required to support research. At the moment, that is really not very significant.

The Chair: Thank you very much.

On that point, let's hear from Dr. Labrie and then Mr. Martin.

Dr. Labrie, s'il vous plâit.

Dr. Fernand Labrie: I appreciate your language because I agree with it. In addition to the benefits for health, we are talking about money too, and it should come back as much as possible.

In terms of saving the cost of the health care, it's kind of easy to do because there is $75 billion there. Making goods that can be exported is also terribly important in this field, as in any other one.

I will give you the example of our research centre, which is $45 million. Of that, $18.7 million comes from grants from governments and $24.6 million comes from contracts. That makes a total of $45 million. Just in income taxes, $17.7 million is coming back. You invest $18.7 million and $17.7 million comes back every year. So you spend $1 million, you invest $1 million, and 80% of the contracts are outside money, new money not used before. For $1 million, you get $19.7 million. That's money coming back to the community. That's one example.

To achieve this kind of thing, we must admit that in Canada the success of transfer of technology has been poor all across the board. There are two reasons for this. One is the basic research, as alluded to by Dr. Yip very clearly and very truly. We need to have something to sell in order to sell something. If you are investing sometimes less than you're asked to, if you want to do the same thing, you need to be lucky to come out with something better. You need to be seven times more intelligent or work seven times more. Either of the two is difficult to achieve. This will be kind of taking the slack and coming back to where we should be.

Also, the attitudes in Canada towards commercialization have to change: spending money is nice, but making money is a bad thing. That needs to change at many levels, for the good of everybody. Researchers in general are not against it, but the structure of many things is kind of difficult. The paradigm must change a lot. In Canada today, there may be something like $5 million to $7 million in royalties coming back to universities. That's ridiculous. It almost doesn't exist. So things need to change a lot.

Your question is valid. We'll do our best to change it. We don't want to get money from the government just for nothing. We want to have it keep researchers, the good ones, in Canada. Today we are losing them. If we want to be competitive, we need to put something in there. That's the source of the economy; wealth and health also come from that.

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The Chair: Merci beaucoup.

Mr. Martin, please.

Mr. Murray Martin: I have always found researchers in Canada to be some of the most entrepreneurial individuals I've ever met. I think in part they've developed that attribute as a method of survival in terms of getting money from various sources, etc.

I also think there is a tremendous willingness to want to see research that originates in Canada actually go through the transformational process into products that are developed and manufactured in Canada. It leads to wealth generation for everyone. But it is a very complicated process. The usual process involves a product moving through an incubator stage. There's difficulty getting funding support for that. It involves access to venture capital.

In British Columbia there's been a number of initiatives. On our own hospital site we have a medical device development centre intended as an incubator site for small biotech companies. We are actually working on the development of a very major biotechnology centre on our hospital campus.

But there are multiple factors, frankly, including even the tax system, and it's not uncommon in British Columbia to see very successful ventures created and then moved across the border into Seattle. I think the will is there, but there are a lot of complexities involved in making it work.

The Chair: Thank you very much.

[Translation]

Dr. Patry, do you have any questions?

Mr. Bernard Patry (Pierrefonds—Dollard, Lib.): We always have questions, Mr. Chairman.

To begin with, I would like to thank all of the panellists this morning. There was a very good exchange of ideas.

[English]

I have a few comments and a question for you, Mrs. Gray. Your brief is very good. With regard to your summary of recommendations, however, I want to know a little bit more. CHA recommends the inclusion of consumer and public representation, but it's my understanding that it's already there with the MRC, and because this will be a continuity of the MRC, it should be applied. So that's one of the questions.

As well, we all agree with transparency and accountability. You say we should do a review every five years. We do a lot of reviewing in Parliament, and it consumes a lot of time. Because the mandate is so clear here, I just want to know why we should have a review every five years.

Dr. Mussivand, yesterday we heard from Dr. James L. Turk, executive director of the Canadian Association of University Teachers. They say we should not touch anything in this bill in terms of commercialization; we should do research and put away commercialization. A couple of other witnesses, Dr. Gordon and Dr. Poulin, also told us this.

In your comments, you looked at what they're doing in the United States with their effective and targeted program, and you would like to address pre-commercial Canadian R and D funding. I would ask you to elaborate a little bit on this.

[Translation]

Dr. Labrie, I'm pleased that you're here this morning. I'm always happy to see you and I'm pleased to see that you have more than understood. You have already gone quite far with your DONER. You have understood how the various health sectors are interrelated. This was really what we were striving to do with these health research institutes.

[English]

Those are my questions.

Ms. Sharon Sholzberg-Gray: I guess I can start.

First of all, you asked about the appointments to the governing council of the CIHR. You noted that the CIHR is replacing the MRC, and the MRC had public representation. But that's not what it says in this bill. It says it's displacing the MRC. There is going to be a new body entirely called the CIHR. The CIHR has a much broader mandate than the Medical Research Council. As I've noted in my brief, it's going to deal with not only biomedical and clinical research, which are very important, but also population health and health systems research.

It says in this bill—and I can only read what I read in the bill—that:

The Governor in Council shall consider appointing women and men who reflect the highest standards of scientific excellence and women and men who reflect a range of relevant backgrounds and disciplines.

That's very worthy, I think. We'd want to be assured that they represent proportionally all the mandate areas of the council. But we think it somehow would be strengthened by asking also that there be a public and consumer voice on the governing council, and it's just not clear in this legislation that this would be the case. Even though MRC may have had that practice in the past, it's not in this bill—

Mr. Bernard Patry: I agree with you.

Ms. Sharon Sholzberg-Gray: —and we'd like it to be.

• 1030

In general, with respect to governance, I guess we're concerned about process. I think it's very clear that everyone around the table absolutely supports a peer review process in terms of approving projects and whatnot, but it's also clear that it is this governing council—it's very important—that's going to actually determine which institutes shall exist or not exist or be terminated or never be started. So those appointments are very important.

In addition, of course, we're going to have a permanent president and CEO who reports to the governing council. We were concerned about the fact that this president and CEO would report to a governing council of which he or she would be the chair.

I mean, I'm a president and CEO, and there's a chair to whom I report. We're thinking that governance process should be examined.

So we have a number of suggestions, including limiting the term to two five-year terms. Even the extremely capable president of the University of Toronto, for instance, decided that after ten years he needs to look into new things and have a renewal.

We're happy to see that another outstanding person also has been repatriated to this country. I guess things are looking up in that regard.

Those are the kinds of things we're trying to bring to the attention of the committee, especially the understanding that the CIHR goes beyond the mandate of the former MRC, that it does have a broader range of interests, and that those interests have to be in the governing council.

Mr. Bernard Patry: Thank you.

The Chair: Dr. Mussivand:

Dr. Tofy Mussivand: First of all, I'd like to thank you for your question. Really, this gives me an opening to make one or two comments.

I want to go back and indicate that doing research and applying the results for the good of humanity is not wrong, is not dirty, and must be pursued. As my colleague indicated, you have to change your paradigm. In Canada, unfortunately, we have this perception that if research is commercialized, the end result is not good. That has to be changed. Otherwise, Canada pretty soon will be a third world country in the research area.

We have to invest, invest, invest without a return? Can you imagine? That's what you're saying. If we continue that, I don't know care which country it is, we're going to go broke, because it can't be endless.

South of the border, major institutes—Stanford, MIT, Boston, Berkeley, and many others—have for decades been doing excellent research, commercializing it, and getting major returns back to investors. As my colleague indicated, governments that invested basically $1 million were returned $17 million.

I have another example. The Canadian artificial heart obtained a total of $4.5 million from the federal and provincial governments. Ladies and gentlemen, today we have brought over $60 million to Canada, of which $23 million has gone back in the form of taxes to the governments.

In other words, for $4 million, you have received already $23 million. If anybody claims that this is not caused by commercialization, then something is wrong in their understanding of it.

The Canadian artificial heart is going to save lives in Canada and abroad. It has already paid back the investment made by the Canadian and provincial governments. It is not dirty. In fact, thousands of patients are writing to doctors in Canada asking us when this device will be available worldwide. We have established eminence for Canada not only on a scientific research basis but also commercially.

We respect all of our colleagues who were here yesterday, and we respect their views, but we have to talk to them and you have to talk to them. We have to exchange information and change the paradigm from just research for research purposes to research for utilization purposes.

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Thank you.

The Chair: Thank you very much. That puts it into context nicely.

Dr. Labrie.

Dr. Fernand Labrie: No.

The Chair: Okay, thank you very much.

Mr. Charbonneau.

[Translation]

Mr. Yvon Charbonneau (Anjou—Rivière-des-Prairies, Lib.): I have several questions to ask you, and my questions are intended particularly for Dr. Labrie, who is well-versed in medical research and funding.

Some people have said that the people of Quebec represent 24% of Canada's population and that we receive just about 33% of the budget. Others have told us that we receive from 12% to 14%. What figure is closest to the truth?

Mr. Bernard Patry: This is not a political question.

Dr. Fernand Labrie: These people are surely not talking about the same thing because, otherwise, the two figures would be identical. In mathematics, things are simple. As far as health care and the Medical Research Council are concerned, I think that the first figures are more or less accurate. We do, therefore, receive a little bit more in per capita terms. I think that we should refer to other research areas, including engineering, agriculture and so on and so forth. There are many federal institutes in Ontario; they are close to Quebec but they are not in Quebec. As far as health is concerned, I believe that we get our share.

Mr. Yvon Charbonneau: In debating the Health Research Institutes, I felt that the appropriate figures to quote were those ones.

Mr. Fernand Labrie: Yes, I believe that those are the proper figures.

[English]

The Chair: Thank you very much. That's good clarification.

I want to get back to scientific research and peer review, if I might, and I'll direct my question to any or all of you. You've stated that here today, in terms of its importance, and it's stated a number of times in Bill C-13. I wonder whether the process and the significance of these may differ between, for example, the biomedical, the clinical, the health services, and the population health. Do any of you have any views on how the individual institutes will manage the processes that are necessary to ensure scientific research and peer review?

Dr. Yip.

Dr. Cecil Yip: The issue of peer review has been very hotly debated during the formation of CIHR. In the structure that is being considered, where you have a central review mechanism plus a review on a separate allocation of budget at the institute level, I think the concern is that in this review committee, this review process, the broad spectrum of expertise should be present. Not just the biomedical, not just the clinical, but the other health research areas, the population health, and so on, should be present with their own peers, at their own quality, to pass assessment on applications. That is very fundamental.

I think there has been a misunderstanding that health research proposals will be evaluated by a committee that consists entirely of the biomedical people. I don't think that's the way it's being conceived in the structure of the CIHR peer review system. Clearly the two kinds of research are not measured the same way, because for the biomedical ones there's a quantitative measurement you can apply, whereas in the population health it is what we would call a qualitative measurement that would have to be applied instead of quantitative measurement.

The Chair: Would anyone else like to comment on that? Dr. Labrie.

Dr. Fernand Labrie: I would like to support exactly what he said. What we would like to have is uniform peer review for all the disciplines.

I would add one thing. With the institutes we are talking about, people think the peer review system should be done centrally, not in each institute, so the peer review would be the same for everybody, not only different disciplines but also across the institute. So you have one peer review for all. That's very important.

The Chair: And all researchers would understand that. They would understand that there is this level of consistency.

Dr. Fernand Labrie: Yes, absolutely.

The Chair: It wouldn't mean different things to different people, based on who or where they are.

Dr. Fernand Labrie: It's terribly important that this be the first priority. This has been discussed a lot. Some don't like it, but it should be like this if you want Canadian money to be spent optimally.

The Chair: Okay.

Dr. Martin Steinbach: I would add that peer review is the key to the system. There has to be good peer review for this to work.

The Chair: Okay, excellent. We appreciate that.

Mr. Jackson.

• 1040

Mr. Ovid Jackson: I have a question for Madame Sholzberg-Gray. How does your mission differ from what's in Bill C-13? I think you said it was clause 4.

Ms. Sharon Sholzberg-Gray: Yes. I think basically you wanted to divide the objective into two parts and have some kind of vision statement saying that at the end of the day, the vision of the CIHR is to improve the health of Canadians by increasing the effectiveness of health services and products and strengthening the Canadian health care system. That's just a general vision and the objective of CIHR, and I think it's incorporated in various parts of the bill, including the preamble and the objective.

The objective is to realize that vision by excelling according to internationally accepted standards of scientific excellence in the creation, dissemination, and adoption of new knowledge. Basically, I guess we wanted to link the improvement of health more specifically to the kind of research we were doing.

Mr. Ovid Jackson: Thank you.

The Chair: Thank you very much.

Ms. Sharon Sholzberg-Gray: I'm sorry, there was one other thing.

We didn't only want to create new knowledge; we wanted to make sure it was disseminated and adopted—in other words, used. That's where the health systems aspect came in, and those are the extra two words that I have right here, in bold, in front of me.

Mr. Ovid Jackson: Okay. I hope the researchers have noted of that.

The Chair: Yes, we've taken note of that. Thanks very much.

In the absence of any other questions, I want to thank each and every one of you for being here today. Some of you have travelled great distances for this committee, and we appreciate that. Your testimony was most helpful, and we look forward to moving quite expeditiously on this bill. Thanks very much.

We're back at 11 o'clock. I hope we can get started a little bit earlier than that. We're going to take a break of five minutes or so, and then we'll reconvene. So we'll adjourn at this point.

Thank you.

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• 1058

The Chair: Ladies and gentlemen, we'll reconvene this health committee. As you know, we're dealing with Bill C-13, concerning the Canadian Institutes of Health Research.

I have just a couple of announcements before we get into our witnesses. First, as you know, this is a working lunch, and there is some lunch here, so if any of you at any point need some sustenance, please feel free to do that.

Second of all, we have briefs from the various presenters today. At least a couple that I'm aware of are in English, and there's one en français. They haven't yet been translated, but with the committee's permission, we'll distribute those, and of course we'll get them translated, as is our policy, into both official languages as soon as we can. There's always a problem with tight timelines and scheduling, but nevertheless we do operate on a policy of both official languages, and of course we'll get those as fast as we can.

What we propose to do today is listen to all four of you, at which point there will be some questions from the committee members. Why don't we begin by doing that right away?

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First on my list, from the Cégep de Jonquière, is Michel Perron.

[Translation]

Mr. Perron, please.

Mr. Michel Perron (Director, ECOBES Research Group (Study of Living Conditions and Population Needs), Jonquière Cégep): Thank you, Mr. Chairman.

I was both pleased and anxious to accept the invitation to participate in this work session. As the Director of the Research Group on Living Conditions and Population Needs, the ECOBES Group, in Saguenay—Lac-Saint-Jean, I have been very interested in following the development that led to the government of Canada's decision to table Bill C-13.

Over the past year, I have had an opportunity to meet several times with Mr. Allan Rock, the Minister of Health, during his visits to our region, and I was able to talk to him and to several other researchers from the health sector about certain concerns with respect to the establishment of Health Research Institutes.

The creation of CIHRs has generated and is still generating a great deal of interest in Saguenay—Lac-Saint-Jean. For reasons that I will explain this morning, the people of Saguenay—Lac- Saint-Jean fervently hope that the researchers in the region are in a good position to compete in the selection process for the institutes.

Saguenay—Lac-Saint-Jean is a dynamic region when it comes to health research. The region boasts several centres or research groups working in the health field. I would like to list them briefly here and, if I may, I would like to name them. There is, first of all, the Corporation de recherche et d'action sur les maladies héréditaires (Research and action group for hereditary illnesses), the CORAMH, chaired by Dr. Daniel Gaudet; the Groupe de recherche et d'intervention sur les dyslipidémies, le diabète et l'arthérosclérose (Research and intervention group for lipidosis, diabetes and arteriosclerosis) at the Saguenay Hospital Centre, also under the direction of Dr. Daniel Gaudet; there is the Clinique des maladies neuromusculaires (Neuromuscular disorders clinic), chaired by Dr. Jean Mathieu; the Institut interuniversitaire de recherches sur les populations (Interuniversity institute on population research), the IREP, which has been chaired for a long time by Dr. Gérard Bouchard of the University of Quebec in Chicoutimi; the Groupe de recherche en génétique et éthique du Québec (Genetics and ethics research group of Quebec), chaired by Dr. Melançon, who will be speaking to you today, and, finally, the Groupe d'étude des conditions de vie et des besoins de la population (Research group on living conditions and population needs) which I have chaired since 1982, and which is located at the Jonquière Cégep.

As a result of the efforts made by the researchers associated with these centres and their various partners, we have produced a considerable body of knowledge about the population of the Saguenay region, about its health history and even its biosocial history, which has very few equivalents in Canada and even in the world.

In particular, mention must be made of the networking and collaboration between the researchers from several different disciplines and sectors: biomedical research, clinical research, research on the social and cultural aspects of health, which characterize the scientific output of the Saguenay—Lac-Saint-Jean region.

The establishment of CIHRs has, moreover, generated a great deal of interest and hope in Saguenay—Lac-Saint-Jean, a hope that was recently strengthened when Minister Allan Rock publicly announced his department's support for an international conference, to be held in Jonquière in June 2000, on genetic health factors.

Indeed, if there is one health sector where the expertise appears to be particularly promising in the region, it is undoubtedly our understanding of genetic health factors for the population.

Genetic factors have been acknowledged, for a long time, as being factors that contribute to the state of health of individuals and populations. In the past, we have focussed primarily on research related to prevalence, prevention and testing for genetic disorders such as cystic fibrosis and neuromuscular disorders. Sometimes these hereditary disorders affect newborns, sometimes children, sometimes adults.

More recently, researchers have begun studying the complicated nature of genetic factors linked to much more frequent diseases such as diabetes, asthma, cancer and cardiovascular disease. This opens up new avenues in terms of monitoring, prevention and genetic testing and, as a result, pertains more to the community in its entirety.

I would now like to talk to you about the importance of consolidating scientific expertise in regions such as Saguenay—Lac-Saint-Jean. The clauses in Bill C-13 show us that the government intends to deal with health issues that affect various Canadian populations, particularly those in the regions, and to promote, in particular, the integration of researchers and to foster interdisciplinarity. If I may, I would like to emphasize this point.

In order to strengthen and develop high-calibre scientific output in the various regions of Canada, such as Saguenay—Lac- Saint-Jean, we must invest in the potential and expertise of the people in the regions.

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Given that specialized resources are somewhat scarce, we must, first and foremost, make major investments to ensure that particular conditions are provided.

Three of these conditions would seem to be essential to enable scientists and groups conducting research in the more remote regions of Canada to compete successfully in the selection process.

The first condition is the need to encourage and strengthen university affiliation between hospital research centres or other centres in urban areas and researchers in the regions.

Second, support should be provided for training qualified researchers from the regions and there should be incentives for keeping them in touch with regional health issues, and even encouraging them to pursue a career in the regions.

My third point is the need to recognize the original and pertinent contribution made by researchers working in the more remote regions of Canada in advancing knowledge on specific aspects of the health of Canadians. The progress and discoveries made in the fields of community genetics and genopathies, hereditary diseases, in the Saguenay—Lac-Saint-Jean region are a good example for the whole of Canada and the rest of the world.

Please let me raise one last point regarding Bill C-13, that is, the transfer of knowledge to Canadians.

If there is one thing that I have learned from my experience in doing research in the region, specifically in the field of community genetics, it is the need for a better understanding of how various groups of Canadians acquire scientific knowledge. With the exception of paragraph 4(h) of the current bill, which is general in nature and speaks of "promoting the dissemination of knowledge and the application of health research", the draft legislation has little to say about this concern associated with the creation of the CIHR.

In my opinion, the success of the future institutes depends on whether or not Canadians will be able to better understand how research findings can help improve their health.

In a nutshell, these are some of the concerns stemming from my experience as a regional researcher, and which I hope will be echoed in the questions and debates raised by your committee in its examination of Bill C-13.

Thank you for your attention.

The Chairman: Thank you very much, Mr. Perron.

[English]

Thank you very much.

Moving on,

[Translation]

we will now hear from Dr. Melançon, director of the Genetics and Ethics Research Group of Quebec, and founding member of the Bioethics Society of Canada and member of the National Council on Ethics in Human Research.

I've got it right?

Ms. Jocelyne Girard-Bujold (Jonquière, BQ): Keep going.

The Chairman: And so on and so forth.

[English]

Dr. Melançon.

Dr. Marcel J. Melançon (Director, Genetics and Ethics Research Group of Quebec, Université du Québec (Chicoutimi)): Thank you, Mr. Chairman.

I would like to thank those who invited me to be a witness at this session. Of course I will talk in French, because it will be much better for you as well as for me.

Voices: Oh, oh!

Dr. Marcel Melançon: You miss a good opportunity to hear a very good and strong French accent, but it will be for the next time.

Voices: Oh, oh!

[Translation]

Dr. Marcel Melançon: My observations and suggestions will be based on my experience as a citizen, as a bioethics research professor at the University of Quebec at Chicoutimi, as a researcher in the field of ethics and genetics, as the research director and coordinator of a multidisciplinary and multicentre ethics and genetics team that works as a network, as a member of various clinical ethics and research ethics committees, as a member of the National Council on Ethics in Human Research, and as a researcher who has worked with a number of Quebec and Canadian associations and organizations, such as the Bioethics Society of Canada, of whom I am a founding member, as was mentioned earlier, and from whom I received an award that was a great honour to me.

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That having been said, I will set aside my criticisms in order to stress the strengths of Bill C-13. I will leave it to others to point out the weaknesses and to propose improvements. It is quite possible that there will be some overlap with yesterday's testimony and that of the days to come. However, it will be an excellent opportunity to highlight some of its strengths.

I would like to say that, if the Medical Research Council of Canada is to be replaced by the institutes, we must pay special tribute to this organization which has served not only Canadians, but also researchers and health research in Canada.

My first observation concerns the concept and structure of the institutes. These pan-Canadian health institutes working as a network certainly appear to be highly positive new institutions in the country, despite the difficulties that may arise, for example difficulties related to distances, means of communication, funding, and so on.

However, such institutes will promote synergy and the concentration of human and scientific resources, while promoting, at least in principle, we presume, multicentre research in Canada. This clustering of forces across Canada may have a major influence on the quality and leadership of health research, probably at the international level. Similarly, the non-partisan nature and sensible neutrality of these concepts will very likely ensure a high level of credibility within and outside the country.

I was very glad to hear Professor Perron speak about the role of researchers and research in the regions. I refer to regions in a very broad sense—Eastern or Western Canada, for example. As Professor Perron mentioned, the Saguenay—Lac-Saint-Jean region could contribute a great deal to the country as a whole if it were to receive support and, above all, recognition. Research that is conducted far from the large urban centres is not necessarily of lesser quality.

Furthermore, the design of the institutes should take into account the fact that health is a firmly entrenched provincial concern. These institutes will have to work closely with the provinces, setting aside any ideological, or even political differences, because the health problems in Vancouver and in Quebec City, to name cities in only two provinces, may be different.

With regard to the peer review process at these institutes, from my past and current experience as an internal and external evaluator and member of national selection committees for the MRC and the SSHRC, as well as in the province of Quebec, I believe that peer review is at this time still the best means of evaluating scientific proposals. This issue has already been raised. Our colleague Dr. Labrie suggested, in his presentation, that there be a single expert committee for all the institutes. I have strong reservations about that, because I think it is unrealistic to contemplate a single committee. Each institute should have a peer committee of experts in its field of specialization. A wide range of expertise among peers may prevent bias in a committee made up solely of scientists.

In addition, in designing the institutes, we should not neglect the training and rotation of researchers. In one or two places, the bill mentions—in my opinion, this should be the subject of a specific clause—the researchers that we train, who are very costly in financial terms, in cultural and scientific terms and from the point of view of human resources, and who leave the country. There is currently a debate over the brain drain. I believe that this is disastrous for the country from a scientific point of view.

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Second, the bill should expand the role and contribution of the humanities and social sciences. Technosciences must be accompanied or analyzed by the normative sciences of ethics and law, which will ensure a comprehensive, holistic approach through their multidisciplinary and interdisciplinary nature. These social sciences should be included in the research directions and, if appropriate, in health research decisions, and they should be taken into account in formulating the main priorities in the field of health.

Still on this point of the social sciences, the public and the media should have a major role to play. As far as the public is concerned, we are currently experiencing a debate over genetically modified organisms. The public is becoming increasingly informed and increasingly critical. In some ways, an informed society is the supreme judge in the matters of health research and experimentation. That is what we are seeing here this morning.

My third point is a recommendation: to establish an institute specifically for human genetics. What are my reasons? If I have understood the bill correctly, the number, nature and research fields of the institutes are left to the discretion of the governing council. Establishing an institute specifically for human genetics would recognize the tremendous progress made in this field, in the field of health, not only physical health but also health as defined by the World Health Organization, a definition to which we would have to add the concept of the genetic health of populations, while being very careful to ensure that eugenics does not cast its shadow over this concept of genetic health.

To an increasing extent, multi-factorial diseases will be detected. The project for mapping and sequencing the human genome is there to point the way. Medicine in the next millennium will focus more and more on curing, preventing and predicting, and genetics will to a very great degree be its underpinning.

Community organisations, to which Professor Perron referred, have and will have an important role to play in any genetics institute that may be created. They must be encouraged, not just by receiving a blessing, but through various forms of support. I am referring here to associations of parents of sick children, volunteer groups and others who contribute to a more integrated approach for health research and health care.

Finally, I have a recommendation: that an institute be established for health ethics or bioethics. I also recommend the creation of a special unit within each institute, since each institute will have its own issues and concerns. There are two major Canadian organisations that could be of assistance in one way or another, because they have been in existence for at least 10 years already. These are the Bioethics Society of Canada and the National Council on Ethics in Human Research. The latter will be appearing before the committee next week, I believe, and will be represented by Dr. Janet Storch, its president, who is from Vancouver. These two organizations could play a very important role, a key role perhaps, in a future institute, for the good of Canada. They are already functioning well as a network and are pan- Canadian in scope. If you would like something pan-Canadian, we would strongly recommend that these two organizations be asked to participate, at least in an advisory capacity.

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This special institute for ethics or bioethics should not be the only organization of its kind and serve all the other institutes. This would cause segmentation and, sooner or later, this institute would become isolated and cut off from the grass roots, out of touch with the specific problems of the other institutes. Each institute should have its own unit, or an ethics or bioethics component, made up of multidisciplinary experts, according to the institute's area of specialisation.

Furthermore, ethics committees—both clinical ethics committees and research ethics committees—play a three-pronged role: first, to protect research subjects; second, to protect research itself and the researchers; third, to protect the general public. It is absolutely essential to analyze research protocols, as is already being done, in order to protect the well-being of individuals who are research subjects, as well as the other people I mentioned.

In closing, I would like to thank you for your invitation. As my time is up, I give the floor to the Chairman.

The Chairman: Thank you very much, Dr. Melançon, for your comments.

[English]

We'll move on now to the Prairie Women's Health Centre of Excellence, represented by Linda DuBick, who is the director.

Ms. Linda DuBick (Director, Prairie Women's Health Centre of Excellence): Thank you. I am very pleased that the Prairie Women's Health Centre of Excellence has been given this opportunity to speak to members of the standing committee on Bill C-13.

To begin, let me say we welcome and support the concept behind the CIHR, as we generally endorse Bill C-13. In particular we are very supportive of the identification of the four CIHR research quadrants, the transformative intent of the CIHR, and the interdisciplinary approaches to be taken by the CIHR.

However, we are very concerned that the general direction the CIHR seems to be taking and the content of the proposed legislation do not go far enough in confirming the Government of Canada's commitment to women's health research in general and the kinds of research activities undertaken by the centres of excellence for women's health program in particular.

It bears some repeating here that both the Liberal Party and the Liberal government have made strong commitments to women's health research and to the centres of excellence. For example, the centres fulfilled a red book commitment. Most recently they are cited by the Minister of Health as vehicles to advance the objectives of Health Canada's women's health strategy, released earlier this year.

We hope the members of the committee will understand and appreciate that the centres of excellence, as a concept and as a commitment, predate both the women's health strategy and the CIHR. I don't think it's an exaggeration to say the centres of excellence have stood as a centrepiece of the government's commitment to women's health research and are an important milestone in the evolution of health research in Canada.

The centres were created in mid-1996. There are five of them. They are located in British Columbia; in Ontario, which serves as the national centre; in Quebec; in the Maritimes; and our own prairie centre, which operates in Saskatchewan and Manitoba. We're based in Winnipeg, Regina, and Saskatoon. Our sponsors are the Fédération provinciale des Fransaskoises; the Prairie Region Health Promotion Research Centre at the University of Saskatchewan; the Universities of Regina, Manitoba and Winnipeg; and the Women's Health Clinic in Winnipeg.

We're committed to research that is women-centred, participatory, action-driven, and policy-relevant, all around women's health issues. We bring together community-based and academic researchers, and we develop working partnerships between women's groups, researchers, policy-makers, service-providers, and individuals.

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We conduct our research in many ways. One of those ways is by awarding research grants. Just to give you a flavour for what we do and a flavour for what the whole program does, these are just a few of the topics of the funded research projects that we have currently improved: the health of Salvadoran women in Manitoba; women survivors of childhood sexual abuse; gender analysis and determinants of health within a Manitoba first nations model, that project being carried out in partnership with the Assembly of First Nations; the effect of social isolation and loneliness on the health of older women; the effects of caregiving on the health of informal caregivers in rural Saskatchewan; and what women want when it comes to midwifery care.

We also commission research. One of our most recent commissioned reports is called Invisible Women. It showed that despite strong commitments from the governments of Saskatchewan and Manitoba, virtually nothing had been done to ensure that gender had been considered in health needs assessments and health plans conducted by health districts in Saskatchewan and regional health authorities in Manitoba. When we presented the report to the two governments late last month, the centre was asked to work with them in improving the situation.

More timely perhaps, we are a partner in a national project to examine the impacts of privatization of health care on the health of women. You'll be interested to know that even though Alberta is not part of our centre's mandate, we have worked to draw in researchers from Alberta to participate in this project.

We were also asked by Manitoba Health to manage a research project on services for pregnant addicted women. This is an issue that arises from the well-known G case, which received national attention and resulted in a Supreme Court decision.

I think these examples attest to the fact that the centres are meeting the expectations of the centres of excellence program and are doing important work.

It's important to emphasize here that our projects are community-based research. This means that the community affected by a health issue has a say in how the research is planned, conducted, and used.

The centres of excellence program has added its own special feature to community-based research. It requires that all our research have policy relevance at the local, regional, provincial, or federal level. Research projects also demand that they be undertaken by qualified researchers using accepted research techniques and methodology, including peer review. Policy-makers are also expected to be part of our research teams.

How does all this relate to the CIHR and Bill C-13? Centres of excellence were given $2 million each to use over six years. We have only 28 months left in our funding mandate, and it is now that we are starting to see some significant bang for these bucks.

None of the centres has been given explicit assurance that it will receive continuing funding. Health Canada has advised us there are no plans to budget for continued funding of the centres beyond March 31, 2002, and that future funding for women's health research will flow through the CIHR.

But what does the CIHR intend to do about women's health research? When we reviewed the main CIHR documents on its website, we found only one reference to women's health. We found a strong commitment to biomedical and applied clinical research. We did not find a clear and unequivocal commitment to research that links women's health and health systems and services research, nor between women's health and research on social, cultural, and population health matters.

We found some broad commitments to various partnerships, especially partnerships with commercial interests. We did not find a prerequisite commitment to the protection of the public interest when undertaking commercialized health research. In women's health, these issues are of vital importance.

In Bill C-13, there is one reference to women's health, and that is in the preamble, women's health of course having relevance to 52% of the population.

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We fear there is an academic and medical bias in the CIHR documents to date. We're left with the distinct impression that once all the legislative and organizational pins are put into place, community research may not stand much of a chance in the scramble for funding from the various institutes. A defeat at the institute level will mean our experiment, the centres of excellence experiment, will be halted before it is given the time and the long-term funding it needs to succeed.

If the CIHR becomes the one and only source of federal funding for health research, we fear women's health issues may take a back seat. Equally important, those who support women's health issues will have lost the high-profile commitment of the federal government. Women's health will become a part of the CIHR agenda rather than a priority of the Government of Canada.

Now, we don't suggest opposing the CIHR. We acknowledge that it has the potential to make an important contribution to health research in this country. But what we are concerned about is that the initiative could result in losing the significant gains achieved through the centres of excellence in terms of the recognition, the high profile, the direct commitment of the federal government to women's health research.

In July of this year we were pleased to join with the other centres of excellence in the Canadian Women's Health Network in a letter to the interim governing council of the CIHR. We pointed out that through international and domestic platforms, the Government of Canada and its machinery is obligated to work toward improving women's health. We stated that the CIHR, being part of that machinery, also is bound by federal policy to integrate gender into its science and into its management. It must also integrate women's health issues into its research program.

In that letter, the centres recommended several provisions for inclusion in the enabling legislation: one, equitable representation of women and men in the infrastructure and governance of the CIHR; two, gender mainstreaming throughout the CIHR institutes and activities; three, the equitable inclusion of women as subjects in all clinical research; four, that women's unique health experiences be recognized and studied by CIHR researchers; and five, that a separate institute of women's health be established.

Building on that joint letter, the Prairie Women's Health Centre of Excellence recommends the following amendments and additions to the standing committee:

First of all, that paragraph 4(i) be amended, with reference to the objectives of the CIHR, by inserting the phrase “consistent with the public interest” before the words:

encouraging innovation, facilitating the commercialization of health research in Canada and promoting economic development of Canada through health research.

Two, that subclause 7(4) and subclause 20(4) be amended to include the phrase “on a gender-equitable basis”, regarding the appointment of members of the governing council and the appointment of members to advisory boards.

Three, to add a new subclause 10(4):

(4) In establishing all committees, the Governing Council shall make all such appointments thereto on a general equitable basis.

Four, under clause 14, under which the governing council is responsible for the management of the CIHR, the addition of a paragraph (i), to read:

(i) introducing and maintaining gender mainstreaming throughout the CIHR institutes and activities to recognize that health policies, programs and services affect women and men differently.

Five, to add a subparagraph to existing paragraph 14(e), which would be subparagraph 14(e)(i), to read:

(i) ensuring that where such funding is in place for the conduct or support of clinical research, women are included as subjects in each project of such research, and members of minority groups are included as subjects in such research;

Finally, to add a paragraph (d) to subclause 20(1), to read:

Without limiting the number and function of any other Institute, create a Women's Health Institute, which, in turn, shall fund and provide policy and program direction to the Women's Health Centres of Excellence Program.

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Thank you for your attention.

The Chair: Thank you very much, Ms. DuBick.

May I quickly ask you, just on a point of clarification, when you say, “gender equitable” are you talking gender equal or...

Ms. Linda DuBick: No, we're talking gender equitable—in other words, that women and men are treated with equity according to their situations, experience, and social and economic conditions. Just about everything in life affects men and women differently, not necessarily equally.

The Chair: Okay. Thanks very much for that clarification.

We'll move on now to Dr. Lorraine Greaves, who is executive director of the British Columbia Centre of Excellence for Women's Health, and also, as we all know, a member of the interim governing council for CIHR.

Dr. Greaves, please.

Dr. Lorraine Greaves (Executive Director, British Columbia Centre of Excellence for Women's Health; Member, Interim Governing Council (CIHR)): Thank you.

I'm very pleased to be addressing you today on the important issues embedded in Bill C-13, an act to establish the Canadian Institutes of Health Research. I'm making my remarks as a member of the interim governing council of the CIHR and as the executive director of the British Columbia Centre of Excellence for Women's Health.

In my remarks, I will be highlighting the goal of transformation that is in the CIHR vision; secondly, the models that are possible for integrating the issues of sex, gender, and women's health into the CIHR; and finally, the important issues of appointments, governance, and evaluation.

In my role as a member of the interim governing council, I have been privileged to be a part of an exciting vision for redesigning Canada's health research system. The two parts of the vision—first, the integration of the four quadrants of research, of which you've heard lots about, I'm sure; and second, the transformation of health research that will result—are extremely exciting visions. If the CIHR succeeds in this transformation, Canada's international leadership, the quality of health research, and the health of Canadian women and men will definitely be enhanced. With this in mind, I've several observations and suggestions regarding the structure and content of the CIHR that I would ask you to consider in your review of this bill.

As a council member, I have appreciated the opportunity to introduce the issues—the scientific issues—of sex, gender, and women's health into the redesign plans. I have appreciated the support of other council members, in particular the support of the excellent CIHR secretariat staff, and I would like to take a brief opportunity to commend them for their work and their diligence in preparing us all for the CIHR vision.

I've worked hard to establish interest and support in this context for strategies for integrating these issues into the structure and process of the CIHR, and I'm very grateful for the aspects of Bill C-13 that acknowledge the differential health issues for women and men, and the importance of deliberately including gender as a consideration in the appointments processes. This will improve the quality of science, help fill in some of the missing knowledge in women's health, and contribute to the promise of transformation in the CIHR vision.

Including sex and gender as variables in the research process, no matter what the project, is simply good science. Just as sex is the first feature noted in assessing a patient, it is also a fundamental first question in designing a research project. It's essential to consider whether the biological differences between women and men or girls and boys have an impact on a project. Was the research designed with due consideration of sex differences? Do the results of a study apply equally to females and males? In other words, are the results generalizable? If we don't insist on researchers considering these questions in all research undertaken in the CIHR, we will not be able to answer them in practice.

In the past, such questions have unfortunately not always been asked, and we have ended up with research results and health knowledge that do not necessarily apply to both men and women. At best, this is a benign omission. At worst, it can mean inappropriate and damaging treatment. Diagnoses can be delayed or missed, treatments wrong, or health promotion imprecise. Specifically, heart attack symptoms may be missed in women, or the most relevant and effective advice for women smokers may not be known.

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Similarly, the role of gender in health research needs direct attention within the CIHR. Gender is the social experience associated with being male or female. This factor also has an effect on how people experience or acquire disease, how they may follow treatment, or how health care professionals may interpret their symptoms and responses. Specifically, this may explain why women report heart attack symptoms much later than men do, or how social roles like caregiving may affect the ability to follow treatment protocol.

Research, then, that includes sex and gender is better science. It will improve health, save lives, and lead to savings, eventually, in the health care system. It is also of high interest to the Canadian public. Last, but not least, it is the most basic form of social justice to conduct research that acknowledges and includes all Canadians.

Women's health raises some different issues. It is a growing speciality in health research and health practice. It's a knowledge area where there are, unfortunately, still some very huge knowledge gaps. Women experience both disease and wellness in some unique ways, about which we still have little information. There are diseases and conditions in which there are different risk factors, different treatment responses, different morbidities, and different death rates. Specifically, we do not know enough about lung cancer development in women, or osteoporosis, or disordered eating.

We are just beginning to identify some of the health effects of violence against women, the long-term consequences of sexual assault—whether they be physical or psychological—and the best approaches to treating addiction in women.

The women's health strategy released by the minister for Health Canada in March 1999 and—as Ms. DuBick has mentioned—several other important international documents signed by Canada define health in a very comprehensive manner, taking into account all aspects—physical, mental, and social well-being—not just the absence of disease. This view of health has motivated women's health researchers in Canada and elsewhere to pursue research in a multi-disciplinary manner that predates the CIHR vision and already integrates the four quadrants of research identified in that vision. Often this also involves different partners in research, including consumers of services and women in communities.

There is no doubt that Canada is primed, with the dedicated support of the CIHR, to take an international leadership role in women's health. To complete the transformation implied in the CIHR, it is necessary to identify elements of good science that embrace a wider vision of health research than has usually been pursued. This demands a conscious mainstreaming of sex and gender into all research across all institutes in the CIHR. This will secure the progressive approach, increase scientific excellence, and lead to more collaborative and wide-ranging partnerships as well as innovative methodologies. This approach will benefit both men and women.

I recently had the pleasure of leading a research team, funded by the Social Sciences and Humanities Research Council and the Canadian Health Services Research Foundation, to investigate these very issues. Our report is entitled CIHR 2000: Sex, Gender and Women's Health. It is available from the clerk.

After considerable investigation across four countries, the conclusion was to recommend the establishment of a women's health research institute with an educative gender mainstreaming arm designed explicitly to share the innovative solutions and practices that women's health researchers have used and do use with all the other institutes across the CIHR. Indeed, it is suggested that a full 50% of research budgets allocated to women's health actually be spent through and in other institutes to truly bring about integration and transformation, and to encourage inclusion of sex and gender as variables in research.

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Other countries, such as the U.S., have taken different approaches, such as legislating the inclusion of women, minorities, and children into clinical trials to achieve an element of such mainstreaming.

In my role as the executive director of the British Columbia Centre of Excellence for Women's Health, I've had the valuable opportunity to take forward another exciting vision. This is the vision of creating networked systems of researchers across all sectors, including community and academy, policy and service providers, to pursue the social and cultural determinants of women's health.

This has been done in the context of the centres of excellence program about which you have heard. The $12 million allocated to the centres has yielded relevant results for women's health, particularly in health systems and services, and social and cultural quadrants of research. This investment must be capitalized upon and expanded through a clear commitment to continuing and expanding women's health research in the CIHR framework.

The women's health research community in Canada is strong and growing, and is currently involved in several projects to develop the women's health research agenda even more. We have funds from the Medical Research Council to develop the basic biomedical capacity and the agenda in women's health.

We have had, as I said, funds from SSHRC and CHSRF to develop population health and social science agendas. We have applied for funds from the tri-council to share and merge the research agendas across all four quadrants among women's health researchers in Canada.

In short, the integration and partnership elements of the vision are part of the current model of doing women's health research in Canada. We are sure a dedicated women's health research institute will draw even more researchers and students to the progressive models and methods utilized by women's health researchers in Canada.

All that is missing is the allocation of resources and the articulation of structures and governance that will encourage progressive transformation. To this end, the appointments processes of the CEO and president of the CIHR, as well as the governing council members, must be women and men who are unafraid of this new vision, willing to question old assumptions and be creative visionaries with the capacity to lead.

In particular, it will be important for this measure of good science to include the most important variables of sex and gender across the CIHR to be a basis for evaluation of institute and CIHR performance. In these ways, health knowledge regarding women, men, and their families will be accrued to benefit all of Canadian society.

I want to thank you for your attention. I do appreciate this opportunity to offer you these comments in your deliberations.

The Chair: Thank you very much, Dr. Greaves.

I want to say that I'm going to have excuse myself in a moment and I'll get Mr. Jackson to replace me. But first of all we'll have questions from Madame Girard-Bujold.

[Translation]

Ms. Jocelyne Girard-Bujold: Thank you, ladies and gentlemen, for coming to testify before the Standing Committee on Health regarding Bill C-13.

Mr. Chairman, in light of what we have heard this morning, I believe that it was worthwhile for me to ask you to invite researchers from the regions. Their testimony has been very useful and will allow this committee to make very important amendments to Bill C-13.

Let's go back a little. Since 1993, the Canadian government made huge cuts in the field of health research. I'll give you a statistic. The budget of the Medical Research Council of Canada has gone down by 3% since 1997-98, which represents a lot of money, whereas in the United States, the budget for health research increased by 56%. It is high time that the Canadian government reinvested in health research. It is not a luxury, but a necessity. Today, our researchers have fallen behind because they don't have the financial means to conduct their research. It is absolutely necessary that in Canada and in Quebec, especially in Quebec, we remain at the forefront since our problems are vastly different.

It was important for me that Mr. Perron appear before the committee, since he carries out research on lifestyle and population needs. It is my belief that this research is fundamental and that it should continue within the new research institutes.

• 1150

Mr. Perron, you are the researcher. I am simply the member for your riding. Can you tell us just how important it is for these institutes to conduct research in your area of expertise?

Mr. Melançon, you do research in ethics and genetics. I would like to know how much weight these two disciplines should have within the institutes.

I also have some questions for you, ladies, later on.

Mr. Michel Perron: Thank you, Ms. Girard-Bujold, for your question. I believe it is a fundamental question since, in any case, the bill clearly concerns itself with the social and cultural dimensions of health. In the last 20 years, the research done in Quebec has taken these two aspects into account. We are interested in the various issues surrounding health, including genetic health, but also the general health of the public, in order to better understand why the health problems of men and women vary from one region to the next and why some families seem to have more health problems than others. Our research is often based on clinical, medical or genealogical data, but it is always very important to take into account the social and cultural dimensions in order to clearly understand why certain genetic illnesses affect certain people, for instance, or why certain illnesses seem to affect men more than women. Therefore, it is a good thing that the bill take the cultural and social dimensions of health into consideration.

A real challenge lies in truly integrating the social and cultural aspects of health into clinical and biomedical research.

Some social science researchers such as ourselves already work in co-operation with physicians and clinicians throughout Canada, but I believe there is still a lot of work to be done to better integrate the social aspects of health in the research projects which will be carried out in the institutes. Just because one of the bill's objectives is to integrate this issue into multidisciplinary research does not mean it will actually happen.

This morning, we provided some examples to illustrate how basic and applied research is carried out with the help of images of pyramids. The health pyramid, which included basic research all the way to applied research, demonstrated that there is no great tradition of integrating social sciences and health research in Canada. A lot of work will have to be done to ensure that the biomedical, clinical and social aspects of research be integrated.

I've been working with physicians on a daily basis for the last 20 years. We have been talking about the idea for 20 years, and physicians are beginning to recognize that they need the help of sociologists, geographers and epidemiologists to ensure that scientific work carried out on specific health problems take into consideration a number of determinants if the health of the public is to be improved.

In an area like the Saguenay—Lac-Saint-Jean, important gains have been made since we have studied health problems which from the very start were specific to the community, problems related to genetic health and illnesses of family or hereditary origin. This was one sector where it was possible to do research on the multidisciplinary integration of biomedical, clinical and social fields, but there are many other research sectors in Canada which are still in their infancy. A lot of work will have to be done to make molecular biology researchers and researchers working in labs doing pure research recognize the potential contribution of social science research, which may make their work even more beneficial.

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Ms. Jocelyne Girard-Bujold: Mr. Perron, would you like this type of research to play a major role within the institutes? Do you want people like yourself, who work in social sciences, to be completely involved in the institutes?

Mr. Michel Perron: We talked about this briefly a little earlier. In the peer evaluation committees, which will automatically be created once the institutes are set up, there will have to be a multidisciplinary presence able to assess not only the scientific content of projects, but also their true social impact. There will have to be representatives from both the social sciences and the life sciences on these evaluation committees. The committees cannot just be made up of pure and applied researchers.

This is a challenge. It is inevitable that social and biomedical research be integrated in Canada in the future, but there isn't much happening on that level in this country yet. Future members of the board will have to work hard at making that happen. As well, as was mentioned, women must be better represented within decision-making organizations at every level within these institutes. In the same vein, we will have to make sure that social and life sciences representatives also sit on the committees, at every level, and also within decision-making organizations which will be called upon to manage a lot of money to be invested over the coming years.

Ms. Jocelyne Girard-Bujold: I also asked a question of Mr. Melançon.

[English]

The Vice-Chair (Mr. Ovid Jackson): Madam Girard-Bujold, you're out of time, but I'll allow you one other question.

[Translation]

Ms. Jocelyne Girard-Bujold: I had asked a question of Mr. Melançon, but he did not have time to answer. Can he do so now?

[English]

The Vice-Chair (Mr. Ovid Jackson): We don't have a lot of people, so we'll do it, but please be a little bit shorter with your answers. We would like everybody to have a crack at the questions as well, not just one person.

Go ahead and answer.

[Translation]

Dr. Marcel Melançon: If I understood correctly, I was asked what role ethics and genetics should play within the institutes. I think I mostly addressed that issue in my presentation.

When ethics is defined as how people should behave in light of new advances in biomedicine and biotechnology, that is reason enough for it to be taken seriously, especially in the context of multidisciplinary ethics or bioethics. Many researchers are afraid that ethics or bioethics will impede their work, but they are there to assist and assess the research being done.

Second, I think it is very important that a specialized pan- Canadian bioethics institute be created to ensure that any advance made take into account the health and protection of the public.

I also think particular attention should be given to the research ethics committee of the institute. I did not have enough time to talk about this earlier, but I'd like to come back to it briefly.

In outlying areas, be it the Saguenay—Lac-Saint-Jean, the North or somewhere in British Columbia, ethics research committees which assess research protocols are poorly staffed, have little money and are poorly trained in ethics. There is a new phenomenon, at least in Eastern Quebec, and the situation is probably similar in the rest of Canada: the appearance, unless you want to call it the invasion, of multicentre research projects coming from the United States, whose approach to ethics focusses much more on the law than we do. There should be a committee to study the impact of these multicentre health research projects on various issues.

In conclusion, I would like to note that Canada has already made a lot of progress with its ethics research committees under the guidelines issued by the Medical Research Council of Canada in 1987 and under the new policy code of the three Canadian councils. Thank you, Mr. Chairman.

[English]

The Vice-Chair (Mr. Ovid Jackson): Thank you.

Does anybody else want to respond to Madame Girard-Bujold's question?

Okay. I'll go to M. Charbonneau then.

• 1200

[Translation]

Mr. Yvon Charbonneau: Mr. Chairman, I have several questions for our witnesses.

First, to Mr. Perron and Mr. Melançon. I listened to them plead their case in favour of the creation of certain genetic and bioethics institutes, specifically for the Saguenay—Lac-Saint-Jean region. I congratulate you for taking this opportunity to promote your ideas.

Ms. Jocelyne Girard-Bujold: They have a good member of Parliament.

Mr. Yvon Charbonneau: I wish to remind you, however, that Bill C-13 will not solve these problems, since it does not address them directly. The bill creates a framework for the institutes and gives the future board the responsibility of arbitrating each submitted proposal. So I congratulate you for proposing this idea, but it is not our place, in the course of our discussions over the coming days, within the committee and the House of Commons, until the end of the session, to fully delve into the matter. So don't be disappointed. I think you understand the thrust of the bill. Later on, these questions can be discussed by the people appointed under the bill.

I carefully listened to your point of view and I would like you to comment on the following. For one, the future institutes will have to be multidisciplinary and interdisciplinary and incorporate biomedical, pure and clinical research, as well as research on public health and various systems.

If each institute must incorporate these four or five dimensions, why does there have to be a specialized institute on bioethics on top of it all? The mandate of each institute will also include ethics. So each institute will incorporate this dimension. But it seems you want to create a special institute to study ethics. Why is this necessary? The people who came up with the idea of these institutes wanted to avoid their proliferation and therefore decided that each institute would address the four dimensions. Today, you're telling us that this makes sense, but that you would nevertheless like to have an additional institute for bioethics.

Dr. Marcel Melançon: Mr. Charbonneau, I would like to begin by correcting a misconception. I did not come here to promote a specific region, namely the Saguenay—Lac-Saint-Jean. I could have used northern Manitoba or another place as an example. So I don't want to promote a certain area, since that would only compound the problem. I'm talking about Canada as a whole.

Mr. Yvon Charbonneau: Outlying areas.

Dr. Marcel Melançon: Yes, generally speaking.

That said, I suggested the creation of an institute which would look at general pan-Canadian problems and would act as a link between the other institutes in case there was a problem. For instance, the Canadian Bioethics Society plays that type of role, as does the National Ethics Council on Human Research.

This should not prevent the creation, within one of the institutes, of a unit which would study particular or specific problems related to an area, such as particular health problems faced by women, or problems linked to human reproduction or genetics. I just wanted to clear up that misconception. To be ethically honest, I would not have come here this morning to promote a specific region, namely the one I come from.

Mr. Yvon Charbonneau: I was commenting more on the genetic health organizations or the ethics organizations mentioned by Mr. Perron at the beginning. He talked about a dozen organizations which were all located in your region. So I got the impression—

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Dr. Marcel Melançon: Self-promoter.

Mr. Michel Perron: That was not at all my intention. You must understand that I was trying to demonstrate what is being done in research in outlying areas in Canada. I wanted to show you just how important it will be to harness the expertise in outlying centres when the institutes are set up. That's where I was coming from. I'm sure that other small research centres would tell you the same thing, which is that, given working conditions, it is much harder to harness the available expertise and to link up with other research centres throughout the country. I was trying to show that it will be crucial for smaller centres to participate within the future institutes. I hope that this helps Mr. Charbonneau.

[English]

The Vice-Chair (Mr. Ovid Jackson): You have one more question.

[Translation]

Mr. Yvon Charbonneau: Thank you.

My second question has to do with the women's health centres of excellence. You made several recommendations regarding equal representation at various levels which will certainly be taken into account.

You have also argued for a specific approach, namely a sex- and-gender particular approach. The bill already says that the institutes must incorporate the public health dimension, as well as the social, cultural and other types of dimensions, if necessary, according to the type of research.

I want to give you the opportunity to give us your interpretation of public health in light of your own concerns. I get the impression that you are not happy with that concept. Perhaps it is still very new and a little vague. We've asked many people what they thought about it, and we got no clear definition, but I feel that you're not quite sure about the idea of public health and that you would like additional clarification. Please tell us what you think about this idea of public health and whether you like the rest of the section, which addresses several matters, and if would rather see something else in the bill.

[English]

Ms. Linda DuBick: Perhaps I could start, Mr. Charbonneau. I'm sorry if I was less than clear in my presentation. It's not that my centre in the Prairies is not confident that the two quadrants, specifically those that deal with health and health systems, and then on the other hand, in terms of social, cultural, and population health... We're very comfortable right there, because we work largely in the field of the determinants of health, those things other than the biomedical that affect the health of women.

Our discomfort, if you will, is whether those two quadrants will receive the same weight, the same respect and attention, as the more traditional aspects of health research—that is, medical research and applied clinical research. In the documents we have read to date from the CIHR, we don't see a balance among the four quadrants, and certainly in the discussions we've been following around the CIHR, we haven't felt that we should be confident that the kind of research we do will fit nicely into the four quadrants.

I hope I have clarified that a little.

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Dr. Lorraine Greaves: Perhaps I could add a few words. Part of the argument for including sex and gender is a direct request for that inclusion across all four quadrants. To actually take that suggestion out of the construction of any particular quadrant is actually the important statement that I was making. To say population health and its very worthwhile accomplishments and its very worthwhile perspective... while that's a good thing, it's not the whole story if we are to do comprehensive research in all four quadrants.

It would be easy—and I think some people make this error—to assume that population health approaches will take care of the study of women's health. I don't believe that's enough. I believe that's one quadrant where women's health can be studied, but all the other quadrants need a lot of assistance as well. Furthermore, of course, the vision is more about the integration on those lines.

This, quite specifically in practice, refers to the types of methodologies that are used, for example, and to the kinds of partnerships that go into developing the research question and the research methods used in carrying out the analysis. Those are things I touched on that are already in fact part of the women's health research tradition in this country. Those things need integrating across the four quadrants as well.

It is very important, and Mr. Perron made the point, I think... Sometimes it's very clear that, say, doctors in clinical practice need the exposure not only to a sociologist from another quadrant but also to the consumer or the consumer advocate group or to some other perspective on how their advice may be received or taken up.

These are the essential questions when we're actually talking about health status and whether or not it's going to be be improved by this redesign of the research system in Canada.

Mr. Yvon Charbonneau: May I continue?

The Vice-Chair (Mr. Ovid Jackson): Go ahead. I'll give you another question.

Mr. Yvon Charbonneau: Are you giving me your turn?

The Vice-Chair (Mr. Ovid Jackson): No, I have a couple, and then I'll go to Madame Girard-Bujold.

Mr. Yvon Charbonneau: Go ahead.

The Vice-Chair (Mr. Ovid Jackson): Okay. I have a couple of questions, and just one quick one. I'd like to ask Dr. Greaves if she agrees with Linda DuBick that in fact by the year 2002 there will not be any more funding for the centres of excellence for women.

Dr. Lorraine Greaves: At the moment, there is no concrete assurance that these funds will be continued in any way. What we do have is assurance from the health minister that women's health will certainly be included as an area in the CIHR. Of course we don't yet know what form that will take and what the amount will be.

The Vice-Chair (Mr. Ovid Jackson): Thank you.

Now I have one question for all of you. We've heard a lot from the entire scientific community about peer review being absolutely the best method, that it takes away the politics when somebody brings a proposal in, along with all the other aspects that tend to make that process biased. But yesterday we had the aboriginals in, and they were saying that you have to go to the community. What they meant by “community” is that they have different approaches to health care.

One of the things that has to occur when we try to make life better for people is that not only do we have to be seen to be doing the job, but people have to be included in it.

For instance, we have been talking about women's issues. How many people know about what goes on in a crisis centre or how verbal abuse impacts? I would like to ask each one of you if there's a better method than peer review of assessing these proposals. Or is that still the best technique to use?

[Translation]

Mr. Michel Perron: Mr. Chairman, allow me to answer first. In order to uphold the scientific quality of research projects in Canada, I believe that peers, other specialists, must be the ones to assess research proposals, their objectives, their methodology and their potential benefits.

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I believe Canada would err if it did not follow the lead of the international community. In every industrialized country, groups of peers assess research proposals, publications and the quality of scientific production.

I think we face a challenge in the way the committees will be set up and in the way the future board will rule over projects. I spoke about this a little earlier and there is something I want to insist on. One challenge is to ensure that the various areas of research are adequately represented on each committee, be it the fields of biomedical, clinical or social research. That's a big challenge. I myself have been a member of several multidisciplinary committees mandated to assess health or education research projects. There is a learning curve, which is important and not always easy, and a challenge: people of various backgrounds must learn to assess the quality of a scientific project together. I think this is an extremely important and innovative aspect of the future institutes. I believe it's a challenge, but we can never question the idea that qualified researchers must judge the merit of a scientific proposal and whether it should receive funding or not. This is exactly what the preceding witnesses from this morning said.

[English]

The Vice-Chair (Mr. Ovid Jackson): Dr. Greaves, do you want to tell us your perspective on this subject?

Dr. Lorraine Greaves: Thank you.

I do also have the benefit of being a member on the governing council. We've had many deliberations about this, so my remarks come from both places.

I think the peer review system needs expansion in a variety of ways. I do think the opportunity of the CIHR is one that should be seized to do just that. Essentially there are two elements in the CIHR vision surrounding research. One is to maintain standards and, indeed, increase and improve the standards of scientific excellence. I've spoken to that in part myself. The other one is to test health research projects for relevance as well.

We have a real opportunity here in this new organization to merge these two things in a very constructive way. One of the ways to do that would be to increase the inclusiveness of peer review panels. One way, certainly, is to make them more multi-disciplinary, and that has just been described. There's no doubt that this is difficult, but it is indeed part of the hard work needed in the transformation of the CIHR. Eventually those things will become less difficult.

The other piece, which is very important for you to think about, is the inclusion of community members or lay people, whatever term you may want to use. Many of the voluntary health agencies and the health charities in this country—which support a huge amount of our research—make this point as well, that is, their inclusion of lay people in their review panels is something that they want to maintain and increase.

Indeed, the breast cancer initiative is an example often put forth by the Cancer Society. They have experimented very successfully with these improvements. What happens there is that relevance is certainly high on the list when you have breast cancer survivors at the table when research projects are being discussed and reviewed. Certainly this has an ongoing impact on the development of appropriate and effective research agendas.

So it's in a variety of ways that one would see the results over time and that the increase in inclusivity on peer review panels could really pay off for the CIHR. I think it would only enhance Canada's standing in the world community, because we would have been courageous enough to grapple with this tricky problem.

So there are a couple of things there that I think need help. When you look back to the traditional system of peer review, it's very related to some really basic questions. Who are researchers? What's the definition? Who are peers? What's the definition? These are pretty essential questions when we start redesigning a peer review system.

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There's no doubt that tampering with standards of excellence is not something any of us would suggest we do, but there are ways to enhance them. I've suggested a couple in peer review.

The Vice-Chair (Mr. Ovid Jackson): Thank you very much for your input.

Madame DuBick.

Ms. Linda DuBick: I would concur with Dr. Greaves' comments, particularly around the expansion of the peer review process and the need for inclusivity.

In our own centre we do follow a peer review process, and we always try to involve researchers, obviously, for the rigour, for the discipline, to make sure the confidence is tangible in the way a research project has been conducted, in terms of methodology, ethics, and so on.

But we also try to insist that there are other partners participating in that peer review process, such as people from the community affected by the project, people who can influence health policy or actually make health policy, and individuals who are interested in a particular women's health issue—health advocates. These people, we find, bring an incredible richness to the review process. If we're talking about multi-disciplinarity, I think we find it leads to interdisciplinarity, whereby there's a sharing of expertise and views, which really has only benefited the projects in the long run.

I believe all research should be relevant somehow. Right now I'm working in an area where research is intended to affect health policy. So for me, the interdisciplinarity, if you like, of a peer review process has to be carried through to the communication of results to the people who need to know, not only to policy-makers and politicians but to communities and individuals. I also think that kind of interdisciplinarity has to be carried through in terms of the policy advice we give to those who make policy.

Again, we found in our projects that there's an incredible richness and an incredible confidence when we involve researchers, be they community based or academically based, community members or service organizations that have participated in research, or the policy-makers who have provided policy guidance.

The Vice-Chair (Mr. Ovid Jackson): Thank you very much for your input.

Dr. Melançon, here is your chance to have a go.

[Translation]

Dr. Marcel Melançon: Thank you. Until now, I believe we have a consensus, first, that there must be peer evaluation for scientific reasons; second, to assess the relevance of a proposal; third, they must be multidisciplinary; fourth, they must include lay-people, members of the public; fifth, they must also include people suffering from an illness, for instance, people directly affected by the research; sixth, the results must not only be made available to funding organisations but also to the public.

I also have a seventh and an eighth point. The seventh point is that the best way to proceed is still with a peer evaluation committee; that's the way it works throughout the world. Incidentally, a peer evaluation committee is not completely neutral; it is reasonably neutral, otherwise it would lack credibility. But I won't go into that.

The second issue is that the peer review committees should have an appeal process for researchers unhappy with the final decision taken by a national committee. Since I myself have already been a member of several national committees, I know for a fact that some unanimous decisions only appear to be so. I think an appeal process would be a good thing for researchers. Therefore, I think the bill should call for an appeal process for decisions rendered by peer review committees, in certain circumstances only, to prevent all 898 researchers whose proposals were rejected to appeal. Otherwise, the funding organization would not be able to cope.

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[English]

The Vice-Chair (Mr. Ovid Jackson): Thank you very much for your answers.

[Translation]

Ms. Girard-Bujold.

Ms. Jocelyne Girard-Bujold: Let's come back to earth for a moment. I have two small questions. The members of the Bloc support the principle of this bill, but we still have a lot of objections.

Health care falls under provincial jurisdiction in Canada. Let me read section 4 of the bill for you:

[...] strengthened Canadian health care system, by

a) exercising leadership within the Canadian research community and fostering collaboration with the provinces and with individuals and organisations in or outside Canada that have an interest in health or health research;

Don't you think that the idea of collaboration is rather weak? Don't you think that it is important that each province, since they are responsible for health care, should be an equal partner in this new system? At the moment, the federal government holds the purse strings. In the past, it gave the provinces the money they were owed, but today it's the opposite. The bill must give more weight to the provinces.

I don't know if one of you can explain this to me. You are researchers and you work in Quebec. Dr. Graves is from British Columbia; Ms. DuBick works for a health centre in the Prairies. Don't you think that you are best placed to know what is happening in your province?

It's an aberration that the provinces have been ignored in this process.

[English]

The Vice-Chair (Mr. Ovid Jackson): I'd like to say that this is a political question. You don't necessarily have to answer it. But you may have some expertise, or you may have some answers.

[Translation]

Ms. Jocelyne Girard-Bujold: No, it's not a political question, sir.

[English]

The Vice-Chair (Mr. Ovid Jackson): But it is a political question, I believe.

[Translation]

Ms. Jocelyne Girard-Bujold: I can ask another one, if you wish.

[English]

The Vice-Chair (Mr. Ovid Jackson): No, I'm not telling him not to answer. But I'm saying that it's more political than what we're trying to find out here today.

[Translation]

Ms. Jocelyne Girard-Bujold: It's not politics. It's reality.

[English]

The Vice-Chair (Mr. Ovid Jackson): It looks like Dr. Greaves has a response.

Dr. Lorraine Greaves: Some sociologists would say all questions are political, so I could be among them.

I think it's not answering your question fully, but certainly one issue in the provinces at the moment is that the provinces themselves spend very different amounts per capita on health research. Consequently, B.C., for example, is one of the least likely to spend money on health research in the provincial government. Quebec is a very good example where money is spent at the provincial level on health research, Saskatchewan is a bad example, and so we could go on. The point is that in many funding programs where matching dollars are required, or co-support, or co-funding, or co-partnering with the provincial research fund is a good thing, some provinces are better off than others, and I think that does need to be addressed.

I don't know how, under this bill, it could be addressed, but it's certainly something the CIHR will have to address, possibly through its programs. In other words, maybe programs... There are some at the moment, but they may need more specific expansion. Some of the programs may have to take into account the development of mechanisms for better partnerships with the provinces in funding, and more consistent partnerships across the country. And at the moment that's an area that I think needs a tremendous amount of thought.

The Vice-Chair (Mr. Ovid Jackson): Does anybody else want to try?

Madame Girard-Bujold, you could ask another question.

Dr. Marcel Melançon: I have something.

The Vice-Chair (Mr. Ovid Jackson): I'm sorry. Dr. Melançon, go ahead.

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Dr. Marcel Melançon: Yes, I think it is, as a matter of fact, a political question, but with a kind of scientific incidence. And in terms of this point, I would like to say that there should be and there must be a kind of collaboration or partnership, or whatever could be the concept of the meaning of the term, between the provinces and the federal. This is a scientific question for research in Canada. Otherwise the energies will be dispersed and so on.

The Vice-Chair (Mr. Ovid Jackson): Thank you.

Anybody else? Just a minute, Madame Bujold, you still have the floor. Will I give you another question? Sure. I'm a nice guy, you know.

[Translation]

Ms. Jocelyne Girard-Bujold: I have a small question for Mr. Melançon.

If the public is not threatened by our shrinking public resources and our dependence on private sector research, it seems that money would come before public safety. Don't you think that public safety is at risk in that regard as well as in terms of research?

You know, there are all types of research. Today, private research gets the most money because it sells the results of its research. Don't you think the institutes should make public safety their first priority before entering into partnerships with the private sector?

Dr. Marcel Melançon: There are many dimensions and sub- dimensions to your question. I'll try to address at least one issue. Is the public threatened by the invasion of the private sector, by pharmaceutical companies and so on? I can't answer that question. I would need to see hard data. But one thing is sure, however: in my field, human genetics, we cannot ignore the private sector and the advances being made in the fields of pharmacology and genetics, nor can we ignore private business and industry. It is something the government and the scientific community must deal with.

Now, where does the public figure in all this and what role should the private sector play in relation to the public sector? I'm not an expert. I would have to study management and partnerships. I can't answer that question.

Ms. Jocelyne Girard-Bujold: You've talked about ethics from the start. Public safety is an ethical issue. A fair partnership in health research investment is also an ethical issue.

Dr. Marcel Melançon: Not only is it an ethical issue, but it is a crucial one. How much money is invested in health research is decided by macroeconomics. It's called the principle of equity. Now, in technical and practical terms, in terms of mechanisms, I cannot tell you how to best protect the public. However, I think that private institutes and companies should not be allowed to abuse or take advantage of public health.

[English]

The Vice-Chair (Mr. Ovid Jackson): Thank you. You're out of time.

I'd like to respond to your question based on information we've had since we've been sitting. We've had scientists tell us that they have hundreds, if not thousands, of private sector agreements with scientists at universities, and only in one or two cases do they have these problems. The problems arise out of the terms of engagement. What that tells me—and I could be corrected if I'm wrong—is that before the scientists sign up at the university they have clear terms as to how this research is going to be carried out, and that in no way will the scientist be encumbered in the way they see the results and the way they translate them. Once that is followed, there is not really a problem.

Yvon, you're next.

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Mr. Yvon Charbonneau: I have a question for Madame DuBick.

At the outset of your brief, you indicated that you have two concerns. The second one is about what appears to be an implied parity being given to the commercialization of research findings. I have not seen anything in your brief supporting that. I'll give you the opportunity to be more explicit.

Ms. Linda DuBick: I think it's a little further on, maybe because I shortened my presentation. We noted that we're particularly supportive of partnerships in conducting research, particularly in community-based women's health research. We didn't find the level of support for those kinds of partnerships in CIHR documentation or the proposed bill, beyond partnerships that suggest commercial interests.

We feel very strongly at our centre that research that is linked to commercialization, if you will, should always be undertaken in the public interest. As a cautionary note, I think we'd feel more comfortable if those words did appear in the legislation. I believe we suggested a proposed amendment towards the end. On page 7, at the bottom, is our recommendation number one.

Mr. Yvon Charbonneau: It would be your amendment for subparagraph (i)?

Ms. Linda DuBick: Yes, sir.

Mr. Yvon Charbonneau: Thank you.

My last question, Mr. Chair, is with respect to this concept of a peer review process. I'm not really familiar with this, so please accept my question as coming from a layperson.

[Translation]

I asked some people what they thought of peer review committees. If I was working on a master's degree, I would not submit it to other master's students, but to other people more knowledgeable than myself. If I was working on a doctorate, I would expect the doctorate review committee to be deeply knowledgeable on my subject. If I was working in sociology, I would not expect my thesis to be reviewed by engineers.

That's one way to view the idea of peers. A proposal must be reviewed by people more knowledgeable than the one making the proposal. If, however, the members of the review committee know barely as much as the person making the proposal, you won't get very far.

On the other hand, regarding multidisciplinary integration, if you have different types of people on a committee, such as lay- people, it's not a peer review committee any more; it's a "non- peer" committee. If you have people from all kinds of backgrounds on the committee, how can it be called a peer review committee? In any case, I'm not questioning your idea, I just think we should perhaps change the name of this committee, since it's not the same thing any more. You're changing the system and the paradigm so that, for instance, a cancer research proposal may also be reviewed by people who have had cancer and who are particularly sensitive to the issue, or perhaps by people who know something about the health determinants of cancer. The idea is to have people with different backgrounds on a committee, not only cancer specialists, but all kinds of people. How do you call that kind of committee which represents a new reality?

Dr. Marcel Melançon: Since you are looking at me, I presume that the question is for me. I will be pleased to answer it.

Mr. Yvon Charbonneau: You spoke about this more than the others, but it involves everyone.

Dr. Marcel Melançon: I just love this peer-non-peer dichotomy. Peers are usually fellows working in the same field or in the same—

Mr. Yvon Charbonneau: And usually more knowledgeable.

Dr. Marcel Melançon: And more knowledgeable. For example, it wouldn't really work to have someone who only has a bachelor's degree sitting on a committee that is evaluating a proposal from a director of a research centre. I'm exaggerating. Historically, peers are fellows who have the expertise required to evaluate the quality of a project. That's it for peers.

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Now let's move on to non-peers. They may well be peers inasmuch as they are informed citizens.

Mr. Yvon Charbonneau: This is a new meaning, this new sense.

Dr. Marcel Melançon: Yes.

Ms. Jocelyne Girard-Bujold: It's the "common" sense.

Dr. Marcel Melançon: We're not just talking about anyone, someone picked up off the street. These are people who are able to represent, for example, an association of parents with children who have a certain hereditary disease, or to represent women. These people don't have the scientific expertise to assess a research project in technical terms, but they are able to assess which projects should be prioritized, for example if you have five projects that have been rated with the same number of points. I had the experience of sitting with a lay person on a social sciences humanities research council committee. They said: "As an ordinary person, it would seem to me that in Canada, you should really be considering this project here." These people shed direct light on things.

Thirdly, if you mix peers and non-peers, you have to be careful not to tip the balance of the historic and traditional notion of scientific peers. So, the inclusion of non-peers and scientific peers must be done in a way that gives added value to the assessment of a research protocol, and not in some pseudo- democratic way that would have projects carried out, for example, by people who have less expertise.

Mr. Yvon Charbonneau: Do you foresee these changes coming about gradually or quickly? I imagine that in some fields, people are already thinking this way, but this may not be the case in other types of research, where people are used to working in a very specialized manner in their field. When you visit a laboratory you see the type of equipment that these people are using. There are some fields where there may only be 20 or 30 people in all of North America who know what they're talking about. When you do very advanced research, you are part of a very small network of less than 50 people. These people can have a discussion among themselves with no problem. But what would a non-peer do in this situation?

Dr. Marcel Melançon: Mr. Chairman, do I have to answer?

Mr. Yvon Charbonneau: If we want to progress, it's up to those people. That's where things happen. Progress is made there, at the cutting edge. It's not made by going over the rudiments. It's done at the highest level.

[English]

The Vice-Chair (Mr. Ovid Jackson): We don't want it to be argumentative. It should always go through the chair, or else other people end up being spectators. If we're getting somewhere with this question and you feel you can add to it, you can go right ahead.

[Translation]

Mr. Michel Perron: I think that Canadian researchers would be disappointed if the quality of the scientific evaluations were affected or lessened by the creation of the research institutes. On the contrary, I think that these standards of excellence to evaluate research projects must not only be maintained, but they must be improved.

From this point of view, a research project can be evaluated from different perspectives: from the perspective of its objectives, from the perspective of its impact and of its relevance, but also from the perspective of the methodology used to carry out the research.

Quite obviously it's possible to have different steps in the evaluation of a research project. When a research project undergoes a peer review, that means, in my opinion, that the project meets the standards of the scientific method in the field in which it is proposed. I don't believe that non-peers have an important role to play when it comes to evaluating whether or not a project meets the different standards of the field or of the discipline. Some research funds conduct their evaluation in different stages. The first stage consists of reviewing a series of criteria to evaluate a research project in terms of its approach, its methodology, its scientific relevance, and its spin-off effects. Once a project has reached this stage and the peers have decided beyond any doubt that the project deserves funding, then we can ask questions with respect to the amount of funding and the relevance of the research. At that point, other committees, that are not made up entirely of peers acquainted with the methodological perspective, can decide on the amount of funding and how that funding is to be attributed.

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So, I don't think the solution is to have evaluation committees that would disqualify, in the eyes of the researchers, their scientific work. When researchers receive grants or notices for grants, because there have been peer reviews of their projects, they believe that their research project has received the endorsement of the scientific community in their field of work. And this is a guarantee at the outset that the work to be done will have every opportunity possible of producing a high quality scientific product which will be recognized by the community.

And in adding this new dimension of a public presence or the presence of the main stakeholders in research projects in order to make sure that these projects can have a more comprehensive evaluation, we must make sure that we do not detract from the methodology of these projects. But now we're talking about different stages. I believe it's possible to evaluate these projects in different stages, at different levels, to come to a final decision and a final approval by a board which would manage the different institutes and the different proposals. So to me the solution would be to split up the different stages of the evaluation.

Mr. Yvon Charbonneau: I'm satisfied with the explanations. It's rare for us to have the opportunity to consult with doctors for such a long time, and on top of that, it's free.

Which leads me to think that we need to clarify this issue of a mechanism. It's not enough to say "peer review, peer review". We need to establish a mechanism when we want to find other categories within that. I wanted to hear what you had to say about this idea and to try and flesh out this concept to come up with some clear ideas in the field, so that we're not always talking about peer review as some final concept.

[English]

The Vice-Chair (Mr. Ovid Jackson): I think they're saying that in the design model a lot of these factors are taken into account. I think it's just communicating with the group they're serving that in fact their information, their input, is in.

[Translation]

Ms. Girard-Bujold.

Ms. Jocelyne Girard-Bujold: I'd like to comment on what Mr. Charbonneau said. If I follow his reasoning, when we, members of Parliament, put questions to the doctors, we are non-peers. I have to wonder then why we would ask them questions. We are lay persons.

I think that your reasoning, Mr. Charbonneau, is shaky. I've always believed that the common sense of ordinary people, who may not have a diploma, but who have life experience in their given fields, is worth much more than the experience of people holed up in an ivory tower. In these peer review committees, there are certainly people who have common sense—at least, I hope so—but it would be good if there were non-peers among them, as Dr. Melançon said, who are affected by the disease. For example, they would have sick children, and they might be more qualified than a doctor to know how common sense could improve the field.

[English]

The Vice-Chair (Mr. Ovid Jackson): Thanks, Jocelyne. Is that the man on the street, or woman on the street, approach to this question? We won't be argumentative.

We'll go to Marcel first and then Yvon.

[Translation]

Dr. Marcel Melançon: I'd like to add one brief point. The idea of including non-peers with the peers comes from the idea of moving from the autocratic stage, where decisions on scientific research were taken by colleagues in a vacuum, to a more democratic stage, where there is a minority of people on a committee—one or two depending on the number of people on the committee—representing associations or the public. The fundamental idea is to democratize research, but without rendering these evaluations incompetent because there are not enough members on the committee from the specific field in question. Thank you.

[English]

The Vice-Chair (Mr. Ovid Jackson): I appreciate that.

Yvon.

[Translation]

Mr. Yvon Charbonneau: I simply wanted to tell my colleague opposite that she misinterpreted my comments if she thought that our asking questions discredited us. Quite the contrary, I considered myself as one of these people.

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Ms. Jocelyne Girard-Bujold: That's not what I said.

Mr. Yvon Charbonneau: On the contrary, I wanted to highlight the importance of ensuring the excellence of research within a field, all the while trying to provide a mechanism that would allow people from outside the scientific community or outside that specific discipline to make their contribution. I simply wanted to underscore that by always using the term "peer review", we don't capture this other dimension, and I was inviting you to help us find another expression. Mr. Perron was very eloquent, and so was Mr. Melançon. They showed us that within the process there were stages where the contributions of persons who are not scientists could be perfectly appropriate, and that there were other stages that must be preserved as they are in order to maintain excellence. I think that we can both agree on that, and I don't mean to slight anyone.

[English]

The Vice-Chair (Mr. Ovid Jackson): Dr. Greaves has an intervention.

Dr. Lorraine Greaves: This is a really exciting and fundamental question. I think you used the term “paradigm shift” potentially. I think, indeed, the CIHR is potentially a paradigm shift.

We're really talking here, in this group, about review processes in general. They obviously could include several stages, several different dimensions. One way of articulating the different points of view is to say clearly that we want different perspectives, or what sociologists will often call different locations.

It's interesting, because we talk about scientific reviewers and others as if they do not necessarily merge. But certainly people on peer review panels who are considered to be experts are also citizens of the country, are also vulnerable to disease, and may also be surviving a disease. So, most importantly, it's integrating those perspectives into the review, and articulating that all those perspectives are to be secured and welcomed, that will contribute to what I would see as a really transformative element in a review process. It does take some articulation, because at the moment the understanding of peer review is quite limited.

The Vice-Chair (Mr. Ovid Jackson): Okay. Thank you.

We're supposed to be out of here at 1 o'clock. I didn't see any further questions.

To our guests, is there anything at all you think we missed in your presentation that you want to take a last kick at, or did you feel you were fully heard and that your message got across?

We do have your presentations. We have people here from CIHR who are listening to us. The research staff and the clerks have taken due note, and hopefully in the refined project you will see how we made out. But is there anything you want to add? Everybody is happy?

Jocelyne has another question.

[Translation]

Ms. Jocelyne Girard-Bujold: Mr. Chairman, I didn't really understand what Mr. Melançon said with respect to training, the rotation of researchers and cultural and human financing. What do you mean by "training" and "turnover"?

Dr. Marcel Melançon: First of all, with respect to training, I wanted to show that we have to emphasize, in the universities and elsewhere, the training of researchers, whether this be with bursaries or other means, on the newest generation of research, in this case the field of health. Secondly, I also wanted to say that once they've been trained at a good cost in terms of dollars and effort, we have to make a great effort to retain them in the country and to avoid the brain drain.

With respect to the turnover of researchers, I don't know in what context I spoke of this and so I hesitate to answer as I don't want to mislead you.

Ms. Jocelyne Girard-Bujold: You spoke of it at the same time that you were talking about training. Is it that you want them to have experience in different places? You spoke of it in the same context. That's why I wrote it down word for word. But it's not important. We can talk about it another time, Mr. Melançon.

Dr. Marcel Melançon: That's fine. I'd be glad to help.

Ms. Jocelyne Girard-Bujold: Thank you.

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[English]

The Vice-Chair (Mr. Ovid Jackson): Thank you very much for coming here today.

We will wrap this session up. The meeting is adjourned.