EDITORIAL * EDITORIAL
The future of medical research in Canada Martin J. Hollenberg, MD, PhD T he future of medical research in Canada can be summed up in two phrases: never have the opportunities been greater, and never have the problems been more acute. Certainly a solid and broadly based research foundation has been established over the past 10 years that will serve us well into the next decade. In fact, few areas of research have been neglected, and there are several truly exceptional research centres, with great promise in such fields as neurobiology, cardiovascular research, molecular biology, immunology, regulatory biology and structural biology. Significant discoveries, such as the recent identification of the gene for cystic fibrosis, are being made in Canada more often than in the past, and there is every indication that the pace of discovery will quicken. Yet these outward signs of success mask a system that is now in rapid transition and beset by many seemingly unsolvable problems at all levels, from the federal government to the research bench. Undoubtedly the most acute problem (now well into its second decade) is the chronic underfunding of our universities, which strikes precisely at the indirect, supportive costs of research. When this is coupled with its underlying cause - a deep lack of understanding in both federal and provincial government circles of the enormous benefits of medical research, both economically and to health - it is easy to see why many Canadian researchers and research trainees despair. Certainly research dollars are in shorter supply in Canada than in many other developed countries, but a key question remains: Are we using the dollars we now have to the best advantage of medical research in Canada as a whole? To attempt to answer this question it is essential to know first what other developed countries are doing, and the article on health and medical research funding in the United Kingdom by Dr. R.A. Heacock (see pages 811 to 815 of this issue) is of great interest in this regard. Although, as the article
states, there is low morale among UK researchers, the past record of achievement in medical research in the United Kingdom greatly outshines Canada's in many respects, even when the 2:1 discrepancy in funding at the federal level is taken into account. The United Kingdom has taken steps in the right direction to achieve such remarkable success - in garnering Nobel prizes, for example - and we should try to identify what these steps are. First, in the United Kingdom the Department of Education and Science (DES) provides both the direct (operating) and the indirect (foundational) costs of research.* As a result, the potential exists for close coordination of support for all aspects of major research projects so that well-funded researchers are not left without salaries, equipment or a place to work. In Canada we have just the opposite situation - the main responsibility for direct costs is left to federal sources and for indirect costs to the provinces. In practice, little coordination exists between the two levels of government in medical research planning and funding. Even worse, political considerations can sometimes obstruct rational planning; for example, the continued, obstinate refusal of the Ontario government to turn over to medical research the federal commitment of $36 million over 4 years, now being transferred to Ontario as a result of Bill C-22, an act to amend the Patent Act. Similarly, the new Federal Networks of Centres of Excellence Program provides no indirect costs and has left investigators scrambling to obtain the necessary funding as best they can. Some provinces have responded modestly, others have not. Indeed, provincial funding of medical research across Canada has been uneven, Quebec and Alberta leading the *In Canada direct costs include operating and equipment grants and some personnel costs. Indirect costs include capital and upkeep costs, library and administrative costs, most investigator salaries and basic equipment.
Dr. Hollenberg is associate dean ofresearch, Faculty of Medicine, University of Toronto.
Reprint requests to: Dr. Martin J. Hollenberg, Faculty of Medicine, Medical Sciences Building, University of Toronto, Toronto, Ont. M5S IA8 -
For prescribing information see page 892
CAN MED ASSOC J 1990; 142 (8)
805
way and the other provinces trailing considerably. Investigators have naturally followed the flow of research funds, often moving from place to place within Canada. Thus, some strong research groups have been built up in certain provinces, although the question remains whether the movement of a scientist from one province to another is always a net gain for the country. In Canada the division of direct and indirect costs primarily to the federal and provincial levels of government respectively is historical and would be exceedingly difficult to change constitutionally. However, if the UK experience is any guide, what can and should be changed quickly is the level of cooperation in medical research development between the provinces and between the provinces and Ottawa. Although federal and provincial ministers and deputy ministers of health meet regularly, they have failed badly in this regard, and it is virtually certain that many superb opportunities have been missed. For example, the federal-provincial transfer payments for postsecondary education do not include funds specifically allocated for medical research or professional training in research, and enormous gulfs exist in the perception of what is needed between the ministers (federal and provincial) responsible for science and technology, education and health. Proper planning could have eliminated the current situation, in which we have outmoded, poorly equipped and overcrowded laboratories in some regions and superb but badly underused research facilities in others. In this key area of development it is time to set political rivalries aside so that we can spend our medical research dollars to the maximum benefit of all Canadians. The situation in Canada is further complicated because most provinces typically have two ministries (a ministry of health and a ministry of colleges and
universities) providing funds for medical research, with little or no cooperation and planning between them. The objectives of the two ministries are usually quite different: the ministry of health is typically in a constant battle to contain health care costs and still provide a reasonable quality of care; the ministry of colleges and universities is largely concerned with education. In its attempt to straddle both, medical research suffers enormously, since it is low on the list of priorities of either ministry and thus has few, if any, champions within ministerial ranks. Furthermore, the balance of medical research in Canada is now shifting rapidly away from impoverished university campuses to hospital-based centres and institutes under the purview of the ministries of health, with their overriding concern for health care costs, not research. A resolution to this problem is urgently required. A second major difference between the UK 806
( AN MED ASSOCJ 1990, 142 (8)
system and ours is the presence in the United Kingdom of in-house research within the Medical Research Council (MRC). Canada has no counterpart, although the United States has the National Institutes of Health, which have huge research establishments. The record of the MRC's research units is outstanding, and on the surface it would appear that Canada has suffered greatly by this omission. Yet, few people in Canada would argue that our MRC should devote a considerable portion of its current, badly overstrained budget to this purpose. Obviously a large additional amount is required from federal or joint federal-provincial sources if we are to set up one or more research units under the auspices of the MRC that could compete with such centres as the MRC Laboratory of Molecular Biology, in Cambridge. These units could focus on areas of research that, by consensus, require development or strengthening. With appropriate university links they could also provide trained research personnel, which, according to current trends, will soon be desperately needed in large numbers in Canada. The presence of in-house laboratories in Canada's MRC would also add stability, strength and impact to an agency urgently in need of all three, particularly if it is to expand and broaden its extramural programs to meet the ever-growing needs in the scientific community. There would be other advantages, too, since MRC in-house facilities funded on a long-term basis would be freer to explore risky, long-term projects than their university-based and hospital-based counterparts, which are constantly seeking new funding and renewals. Highly qualified scientists would be quickly attracted to such a situation, and exciting, unexpected discoveries would almost certainly follow, adding immeasurably to our national standing and visibility in science. In addition, the United Kingdom's MRC is expanding its effort in health services research. In Canada such research is funded at the federal level, mainly by the National Health Research and Development Program and to a much larger extent by the provinces in accord with the provincial role in the provision of health care. Currently the role of Canada's MRC in health services research is extremely small. Again the problem is that the provinces vary greatly in their support of research and run independent research enterprises. As a result, the overall Canadian effort in health services research is fragmented, with a large potential for major omissions and duplications; even worse, it is abysmally small considering the nation's commitment to health care and universality. Accordingly, the whole is much less than the sum of the parts and much less than it could be with a well-conceived, Canada-wide effort. Once again the United Kingdom has the advantage because of its centralized administrative
and funding system. If Canada is to play its part internationally in health services research an entirely new approach is needed that emphasizes central planning and includes the necessary funding. Canada's MRC, in its independent, arms-length position at the federal level, is ideally placed to take on this responsibility. Given the requisite additional funding, it could readily supply the necessary leverage to the provinces to bring them into line in this regard, apply national standards and priorities and create some order out of the current chaos. The other side of the coin, of course, is that centralized funding can lead to centralized control of research. Our UK colleagues do not have the provinces to rely on if they object to the actions and policies of the MRC or its funding parent, the DES. Thus, the major concerns of UK scientists about the directions medical science might take are fully warranted, since an adverse change because of centralization could have widespread, deleterious effects that might be more difficult to counteract in the United Kingdom than in Canada. In contrast, we seem to have the opportunity to enjoy the best of both worlds, provided government and science representatives keep in mind that the operative words are cooperation and coordination, not control. The Canadian and UK systems clearly have advantages and disadvantages rooted in the way each country is structured politically and in how the responsibilities for education and research are handled. Although Canada's system gains strength from diversity, it has suffered from a lack of cooperation and coordination in medical research development. In contrast, the United Kingdom has been able to concentrate its resources more effectively, particularly in the development of its in-house MRC research units, and if past experience is any guide it may be better poised to move ahead quickly in the future. Investigators in Canada and the United Kingdom seem to have the same concerns: a fear of predetermined, government-directed research aims and a fear of a takeover by the private sector of a major portion of the university research enterprise, the emphasis being shifted to short-term, profitmotivated goals. However, Canada has the potential to offer a more balanced approach to research development. We should be able to take advantage of the best that industry has to offer and, in so doing, to develop a number of additional medical research centres of excellence of international calibre by capitalizing on the huge increases in funding from industry that are resulting from Bill C-22. First, though, we urgently need adequate, accepted conflict-of-interest guidelines and a national research strategy involving increased cooperation and coordination in medical research at both federal and provincial levels.-
Conferences
continued from page 803 May 24-26, 1990: Celebration 1990: a National Conference for Deaf and Hard-of-Hearing People (presented by the Canadian Hearing Society, the Canadian Association of the Deaf and the Canadian Hard of Hearing Association) Holiday Inn Downtown, Toronto Susan Carbone, conference coordinator, Celebration 1990, Canadian Hearing Society, 271 Spadina Rd., Toronto, Ont. M5R 2V3; (416) 964-9595, TDD (416) 964-0023, FAX (416) 964-2066 May 25, 1990: 1st Annual National Rehabilitation Nursing Conference and 2nd Annual Meeting of the Canadian Association of Rehabilitation Nurses
Rehabilitation Centre, University of Ottawa Education Department, Rehabilitation Centre, 505 Smyth Rd., Ottawa, Ont. K1H 8M2; (613) 737-7350, ext. 602; FAX (613) 737-7056 May 25-27, 1990: Ontario Medical Secretaries Association Annual Convention Ramada Inn, North Bay, Ont. Sylvia Taus, convention chairman, Ontario Medical Secretaries Association, 600-250 Bloor St. E, Toronto, Ont. M4W 3P8
May 26, 1990: Epilepsy Canada Annual General Meeting Buffalo Mountain Lodge, Banff, Alta. Denise Crepin, PO Box 1560, St. C, Montreal, PQ H2L 4K8; (514) 876-7455 May 27-29, 1990: 9th King's College Conference on Death and Bereavement King's College, London, Ont. Dr. John D. Morgan, coordinator, King's College, 266 Epworth Ave., London, Ont. N6A 2M3; (519) 432-7946
May 31-June 1, 1990: American Association of Clinical Anatomists Annual Meeting Health Science Building, University of Saskatchewan, Saskatoon Dr. I. Munkacsi, College of Medicine, University of Saskatchewan, Saskatoon, Sask. S7N OWO; (306) 966-4085, FAX (306) 966-4098 May 31-June 2, 1990: Canadian Psychological Association Annual Convention Westin Hotel, Ottawa Mary Ahearn, convention coordinator, Canadian Psychological Association, Vincent Rd., Old Chelsea, PQ JOX 2N0; (819) 827-3927, FAX (819) 827-4639 June 1-3, 1990: 4th Canadian Neuro-Oncology Conference Fort Garry Hotel, Winnipeg Dr. Derek Fewer, conference coordinator, 61 Emily St., Winnipeg, Man. R3E lYO; (204) 788-6372
continued on page 839 CAN MED ASSOC J 1990; 142 (8)
807
The future of medical research in Canada Martin J. Hollenberg, MD, PhD T he future of medical research in Canada can be summed up in two phrases: never have the opportunities been greater, and never have the problems been more acute. Certainly a solid and broadly based research foundation has been established over the past 10 years that will serve us well into the next decade. In fact, few areas of research have been neglected, and there are several truly exceptional research centres, with great promise in such fields as neurobiology, cardiovascular research, molecular biology, immunology, regulatory biology and structural biology. Significant discoveries, such as the recent identification of the gene for cystic fibrosis, are being made in Canada more often than in the past, and there is every indication that the pace of discovery will quicken. Yet these outward signs of success mask a system that is now in rapid transition and beset by many seemingly unsolvable problems at all levels, from the federal government to the research bench. Undoubtedly the most acute problem (now well into its second decade) is the chronic underfunding of our universities, which strikes precisely at the indirect, supportive costs of research. When this is coupled with its underlying cause - a deep lack of understanding in both federal and provincial government circles of the enormous benefits of medical research, both economically and to health - it is easy to see why many Canadian researchers and research trainees despair. Certainly research dollars are in shorter supply in Canada than in many other developed countries, but a key question remains: Are we using the dollars we now have to the best advantage of medical research in Canada as a whole? To attempt to answer this question it is essential to know first what other developed countries are doing, and the article on health and medical research funding in the United Kingdom by Dr. R.A. Heacock (see pages 811 to 815 of this issue) is of great interest in this regard. Although, as the article
states, there is low morale among UK researchers, the past record of achievement in medical research in the United Kingdom greatly outshines Canada's in many respects, even when the 2:1 discrepancy in funding at the federal level is taken into account. The United Kingdom has taken steps in the right direction to achieve such remarkable success - in garnering Nobel prizes, for example - and we should try to identify what these steps are. First, in the United Kingdom the Department of Education and Science (DES) provides both the direct (operating) and the indirect (foundational) costs of research.* As a result, the potential exists for close coordination of support for all aspects of major research projects so that well-funded researchers are not left without salaries, equipment or a place to work. In Canada we have just the opposite situation - the main responsibility for direct costs is left to federal sources and for indirect costs to the provinces. In practice, little coordination exists between the two levels of government in medical research planning and funding. Even worse, political considerations can sometimes obstruct rational planning; for example, the continued, obstinate refusal of the Ontario government to turn over to medical research the federal commitment of $36 million over 4 years, now being transferred to Ontario as a result of Bill C-22, an act to amend the Patent Act. Similarly, the new Federal Networks of Centres of Excellence Program provides no indirect costs and has left investigators scrambling to obtain the necessary funding as best they can. Some provinces have responded modestly, others have not. Indeed, provincial funding of medical research across Canada has been uneven, Quebec and Alberta leading the *In Canada direct costs include operating and equipment grants and some personnel costs. Indirect costs include capital and upkeep costs, library and administrative costs, most investigator salaries and basic equipment.
Dr. Hollenberg is associate dean ofresearch, Faculty of Medicine, University of Toronto.
Reprint requests to: Dr. Martin J. Hollenberg, Faculty of Medicine, Medical Sciences Building, University of Toronto, Toronto, Ont. M5S IA8 -
For prescribing information see page 892
CAN MED ASSOC J 1990; 142 (8)
805
way and the other provinces trailing considerably. Investigators have naturally followed the flow of research funds, often moving from place to place within Canada. Thus, some strong research groups have been built up in certain provinces, although the question remains whether the movement of a scientist from one province to another is always a net gain for the country. In Canada the division of direct and indirect costs primarily to the federal and provincial levels of government respectively is historical and would be exceedingly difficult to change constitutionally. However, if the UK experience is any guide, what can and should be changed quickly is the level of cooperation in medical research development between the provinces and between the provinces and Ottawa. Although federal and provincial ministers and deputy ministers of health meet regularly, they have failed badly in this regard, and it is virtually certain that many superb opportunities have been missed. For example, the federal-provincial transfer payments for postsecondary education do not include funds specifically allocated for medical research or professional training in research, and enormous gulfs exist in the perception of what is needed between the ministers (federal and provincial) responsible for science and technology, education and health. Proper planning could have eliminated the current situation, in which we have outmoded, poorly equipped and overcrowded laboratories in some regions and superb but badly underused research facilities in others. In this key area of development it is time to set political rivalries aside so that we can spend our medical research dollars to the maximum benefit of all Canadians. The situation in Canada is further complicated because most provinces typically have two ministries (a ministry of health and a ministry of colleges and
universities) providing funds for medical research, with little or no cooperation and planning between them. The objectives of the two ministries are usually quite different: the ministry of health is typically in a constant battle to contain health care costs and still provide a reasonable quality of care; the ministry of colleges and universities is largely concerned with education. In its attempt to straddle both, medical research suffers enormously, since it is low on the list of priorities of either ministry and thus has few, if any, champions within ministerial ranks. Furthermore, the balance of medical research in Canada is now shifting rapidly away from impoverished university campuses to hospital-based centres and institutes under the purview of the ministries of health, with their overriding concern for health care costs, not research. A resolution to this problem is urgently required. A second major difference between the UK 806
( AN MED ASSOCJ 1990, 142 (8)
system and ours is the presence in the United Kingdom of in-house research within the Medical Research Council (MRC). Canada has no counterpart, although the United States has the National Institutes of Health, which have huge research establishments. The record of the MRC's research units is outstanding, and on the surface it would appear that Canada has suffered greatly by this omission. Yet, few people in Canada would argue that our MRC should devote a considerable portion of its current, badly overstrained budget to this purpose. Obviously a large additional amount is required from federal or joint federal-provincial sources if we are to set up one or more research units under the auspices of the MRC that could compete with such centres as the MRC Laboratory of Molecular Biology, in Cambridge. These units could focus on areas of research that, by consensus, require development or strengthening. With appropriate university links they could also provide trained research personnel, which, according to current trends, will soon be desperately needed in large numbers in Canada. The presence of in-house laboratories in Canada's MRC would also add stability, strength and impact to an agency urgently in need of all three, particularly if it is to expand and broaden its extramural programs to meet the ever-growing needs in the scientific community. There would be other advantages, too, since MRC in-house facilities funded on a long-term basis would be freer to explore risky, long-term projects than their university-based and hospital-based counterparts, which are constantly seeking new funding and renewals. Highly qualified scientists would be quickly attracted to such a situation, and exciting, unexpected discoveries would almost certainly follow, adding immeasurably to our national standing and visibility in science. In addition, the United Kingdom's MRC is expanding its effort in health services research. In Canada such research is funded at the federal level, mainly by the National Health Research and Development Program and to a much larger extent by the provinces in accord with the provincial role in the provision of health care. Currently the role of Canada's MRC in health services research is extremely small. Again the problem is that the provinces vary greatly in their support of research and run independent research enterprises. As a result, the overall Canadian effort in health services research is fragmented, with a large potential for major omissions and duplications; even worse, it is abysmally small considering the nation's commitment to health care and universality. Accordingly, the whole is much less than the sum of the parts and much less than it could be with a well-conceived, Canada-wide effort. Once again the United Kingdom has the advantage because of its centralized administrative
and funding system. If Canada is to play its part internationally in health services research an entirely new approach is needed that emphasizes central planning and includes the necessary funding. Canada's MRC, in its independent, arms-length position at the federal level, is ideally placed to take on this responsibility. Given the requisite additional funding, it could readily supply the necessary leverage to the provinces to bring them into line in this regard, apply national standards and priorities and create some order out of the current chaos. The other side of the coin, of course, is that centralized funding can lead to centralized control of research. Our UK colleagues do not have the provinces to rely on if they object to the actions and policies of the MRC or its funding parent, the DES. Thus, the major concerns of UK scientists about the directions medical science might take are fully warranted, since an adverse change because of centralization could have widespread, deleterious effects that might be more difficult to counteract in the United Kingdom than in Canada. In contrast, we seem to have the opportunity to enjoy the best of both worlds, provided government and science representatives keep in mind that the operative words are cooperation and coordination, not control. The Canadian and UK systems clearly have advantages and disadvantages rooted in the way each country is structured politically and in how the responsibilities for education and research are handled. Although Canada's system gains strength from diversity, it has suffered from a lack of cooperation and coordination in medical research development. In contrast, the United Kingdom has been able to concentrate its resources more effectively, particularly in the development of its in-house MRC research units, and if past experience is any guide it may be better poised to move ahead quickly in the future. Investigators in Canada and the United Kingdom seem to have the same concerns: a fear of predetermined, government-directed research aims and a fear of a takeover by the private sector of a major portion of the university research enterprise, the emphasis being shifted to short-term, profitmotivated goals. However, Canada has the potential to offer a more balanced approach to research development. We should be able to take advantage of the best that industry has to offer and, in so doing, to develop a number of additional medical research centres of excellence of international calibre by capitalizing on the huge increases in funding from industry that are resulting from Bill C-22. First, though, we urgently need adequate, accepted conflict-of-interest guidelines and a national research strategy involving increased cooperation and coordination in medical research at both federal and provincial levels.-
Conferences
continued from page 803 May 24-26, 1990: Celebration 1990: a National Conference for Deaf and Hard-of-Hearing People (presented by the Canadian Hearing Society, the Canadian Association of the Deaf and the Canadian Hard of Hearing Association) Holiday Inn Downtown, Toronto Susan Carbone, conference coordinator, Celebration 1990, Canadian Hearing Society, 271 Spadina Rd., Toronto, Ont. M5R 2V3; (416) 964-9595, TDD (416) 964-0023, FAX (416) 964-2066 May 25, 1990: 1st Annual National Rehabilitation Nursing Conference and 2nd Annual Meeting of the Canadian Association of Rehabilitation Nurses
Rehabilitation Centre, University of Ottawa Education Department, Rehabilitation Centre, 505 Smyth Rd., Ottawa, Ont. K1H 8M2; (613) 737-7350, ext. 602; FAX (613) 737-7056 May 25-27, 1990: Ontario Medical Secretaries Association Annual Convention Ramada Inn, North Bay, Ont. Sylvia Taus, convention chairman, Ontario Medical Secretaries Association, 600-250 Bloor St. E, Toronto, Ont. M4W 3P8
May 26, 1990: Epilepsy Canada Annual General Meeting Buffalo Mountain Lodge, Banff, Alta. Denise Crepin, PO Box 1560, St. C, Montreal, PQ H2L 4K8; (514) 876-7455 May 27-29, 1990: 9th King's College Conference on Death and Bereavement King's College, London, Ont. Dr. John D. Morgan, coordinator, King's College, 266 Epworth Ave., London, Ont. N6A 2M3; (519) 432-7946
May 31-June 1, 1990: American Association of Clinical Anatomists Annual Meeting Health Science Building, University of Saskatchewan, Saskatoon Dr. I. Munkacsi, College of Medicine, University of Saskatchewan, Saskatoon, Sask. S7N OWO; (306) 966-4085, FAX (306) 966-4098 May 31-June 2, 1990: Canadian Psychological Association Annual Convention Westin Hotel, Ottawa Mary Ahearn, convention coordinator, Canadian Psychological Association, Vincent Rd., Old Chelsea, PQ JOX 2N0; (819) 827-3927, FAX (819) 827-4639 June 1-3, 1990: 4th Canadian Neuro-Oncology Conference Fort Garry Hotel, Winnipeg Dr. Derek Fewer, conference coordinator, 61 Emily St., Winnipeg, Man. R3E lYO; (204) 788-6372
continued on page 839 CAN MED ASSOC J 1990; 142 (8)
807
