Perspectives (Volume 2, number 2) (fwd)

[Richard Plant]

Hello everyone:

Here is the most recent issue of "Perspectives" from HSSFC. It's focussed
on a new proposal concerning health research.

Has anyone else noticed the gap between the attitude toward medical
science people heading off to the United States for more lucrative
contracts and artists doing something the same? There seems to be a
accepted view that in order to "make it" artists have to go south.

Exactly how healthy would Canada be without artists and arts research?

Do you know of any research project which looks at the role of cultural
activity on our health? (Just a thought early in the morning.)

 Richard Plant
Dept of Drama, Queen's University
and
Graduate Centre for Study of Drama, 
University of Toronto

An electronic newsletter on research and science policy.  A pilot project of
the Humanities and Social Sciences Federation of Canada.

PERSPECTIVES will appear at regular intervals throughout the year and will
be posted on the Federation web site:
http://www.hssfc.ca/Pub/PublicationsEng.html.  Please address your comments
and suggestions to Jacqueline Wright, Executive Assistant, at:
jawright at hssfc.ca.

PERSPECTIVES (Volume 2, Number 2)

Editor: Wayne Kondro

Table of contents:
1)	Summary
2)	Introduction
3)	The Proposal
4)	The Political Environment
5)	The Impact

MEDICAL RESEARCH COUNCIL PROPOSES MAJOR FEDERAL PROGRAM FOR HEALTH RESEARCH 
Institutes of Health seen as ‘millennium' investment in research 

SUMMARY
With the governing Liberals canvassing for a vehicle by which to make a
‘millennium' investment in health care without stepping on provincial toes,
Medical Research Council president Dr. Henry Friesen has proposed that
Ottawa invest $500-million per year in the creation of "21st century
Canadian Institutes of Health." 

While details regarding the Institutes governance; structure, location;
operations; financing and programming are extremely sketchy, Friesen says he
envisions "virtual" institutes, electronic linking the biomedical and health
research community in a national effort to promote health innovations. He's
proposing that Institutes be allowed to provide direct financial support for
investigators' salaries and that 40 per cent of monies be set aside for
basic, biomedical science.

If implemented as a health research initiative, the scheme would
theoretically provide enormous new opportunities to the social sciences &
humanities community to become involved in an expanded national health
research program, particularly if it's created as a tri-council initiative
or a joint venture with the Social Sciences & Humanities Research Council.

But concerns have already been raised that the initiative is intended to
bolster biomedical research rather than more broadly encompass health
research like the social determinants of health, population- based health
and other psycho-socio aspects of health.

Thus far, the consultations haven't extended beyond the basic biomedical
research community and groups like Humanities & Social Sciences Federation
of Canada; the Canadian Psychological Association; or the Canadian
Consortium for Research haven't yet been placed on the consultation
schedule. Nor has there been much evidence to date indicating that the MRC
might be willing to create the Institutes in conjunction with other councils.

Yet if the Institutes aren't integrated with SSHRC in any way, or the monies
made accessible to the broader health research community, the initiative
would completely explode the ‘proportionality' formula which has
traditionally been used to divvy up the research pie between the social,
biomedical and natural sciences. 


MEDICAL RESEARCH COUNCIL PROPOSES MAJOR FEDERAL PROGRAM FOR HEALTH RESEARCH 
Institutes of Health seen as ‘millennium' investment in research 

It seems an elegant solution all around.

The biomedical and health research community is strapped for cash, while the
governing Liberals are canvassing for a vehicle by which to make a
‘millennium' investment in health care without intruding on provincial
jurisdiction.

So why not invest $500-million/year in the creation of "21st century
Canadian Institutes of Health Research," which would electronically link the
nation's 16 major health sciences centers with other research and health
institutions in a major research initiative to develop innovations in health
care treatment and delivery?

Architect and Medical Research Council Dr. Henry Friesen envisions the
Institutes as some sort of "hybrid" of the U.S. National Institutes of
Health, only more in the vein of ‘virtual institutes' and ultimately
yielding a "more coherent and coordinated" research program in areas of
national health needs.

It's certainly a grand vision, but highly embryonic in nature. Details will
be fleshed out over the course of the summer.

Yet, if implemented as a health research initiative, the scheme would
theoretically provide an enormous opportunity for the social sciences &
humanities community to become involved in an expanded national health
research program, particularly if it's created as a tri-council initiative
or a joint venture with the Social Sciences & Humanities Research Council
(SSHRC).

But several observers are already expressing concern that the initiative is
being developed as a funding mechanism for biomedical research, rather than
more generally for health research.

Thus far, the consultations haven't extended beyond the basic biomedical
research community and groups like the Humanities & Social Sciences
Federation of Canada; the Canadian Psychological Association; or the
Canadian Consortium for Research haven't yet been placed on the consultation
schedule.

Consortium chair Paul Hough says the concept has tremendous appeal because
of the vision it can provide for health research but "there's a universal
concern that the MRC is doing this in isolation. ...that MRC is following
its preferred habit of only talking to its own kind, so to speak, before it
comes out with something that is cast in stone."

Hough adds that if the definition of health research continues to be "very,
very narrow, then I guarantee that the rest of the community will not buy
into it at all."

Canadian Psychological Association executive director Dr. John Service notes
that the current scope of the consultations suggests the MRC views the
Institutes strictly within the confines of biomedical research. "But we see
health as much broader than that. So for us to lend any kind of support to
this, we have to be involved in a meaningful consultation and at an early
stage. It would also have to be a broad vision to include all the
disciplines, like nursing, and ourselves, and physio and the like, who are
also involved in health care services."

But MRC spokesman Marcel Chartrand says the agency has every intention of
contacting a wide range of associations and groups over the course of the
summer. "We want to reach out to the veterinary organizations, the nurses,
everyone. This is broader than biomedical, absolutely."

Service and others also argue the Institutes would be better developed as a
tri-council or joint initiative with SSHRC. But there's been little evidence
to date indicating that MRC might be willing to create the Institutes in
conjunction with other councils, although Friesen says the question of
governance hasn't yet been fully explored and it's even possible the
Institutes might be created entirely outside the purview of the MRC.

But SSHRC certainly appears open the notion of a joint initiative. "If the
intention is to build a national health research program, it makes sense to
explore it as a joint or tri-council initiative and SSHRC would be pleased
to explore the possibility," says Marcel Lauziere, special advisor to
president Dr. Marc Renaud.

However, if the Institutes aren't integrated with SSHRC in any way, or the
monies made accessible to the broader health research community, the
initiative would completely explode the ‘proportionality' formula which has
traditionally been used to divvy up the research pie between the social,
biomedical and natural sciences. 

Already the poor sister of councils, SSHRC has historically received in the
neighbourhood of 11.7 per cent of all granting council monies. But a
$500-million injection for biomedical research funneled through the MRC,
without a corresponding initiative to bolster humanities & social sciences
funding, would leave SSHRC with about 7.3 per cent of the pie, while
representing roughly 55 per cent of academic staff and student populations.

THE PROPOSAL
Details are extremely sketchy and seem deliberately cast as such, almost as
if the MRC was wary of putting a comprehensive proposal on the table because
it would easy to pick apart and would open the agency to accusations it was
moving with a rigid scheme without having consulted the academic community.

But the general concept --which Friesen likens to a "first architectural
drawing"-- would see the creation of some form of distributed national
institutes of health linking the disparate research efforts of Canada's 16
medical faculties, 50 teaching hospitals, 65 affiliated research institutes
and peripheral health care facilities and agencies.

The Institutes would apparently be organized around specific biomedical
disciplines or diseases and would oversee research sub-programs
headquartered in institutions across the country. An Institute of Children's
Health, for example, might have a cardiovascular research program located at
one university and a mental health program at another. 

Each Institute would be responsible for data collection and dissemination
within its field. To that end, Friesen says about 20 per cent of monies will
be needed for electronic networking functions.

Friesen says he doesn't envision the creation of anything like the massive
intramural research program which the NIH maintains in the U.S.. Rather,
it's some derivative form of the NIH's extramural program which is being
explored, in which research programs are built around national health needs
or research strengths. But the result, Friesen insists, will be a far more
cohesive national health research program.

However, Friesen hasn't articulated the areas in which Institutes might be
created, let alone spelled- out the form in which the monies might be
distributed, or the degree to which they'd be targetted at specific health
problems.

But as much as 40 per cent of all monies should be funneled into basic,
biomedical research to sustain the health of the research community which
underpins the medical sciences, Friesen says. He's also proposed the
Institutes be able to offer salary support for investigators so as to help
stem the flow of expertise to the United States and provide new
opportunities for young researchers in Canada. Such ‘direct costs of
research' are not currently supported by MRC operating grants.

Yet, even within those general parameters, the proposal remains highly
embryonic. Details surrounding the Institutes governance; structure,
location; operations; financing and programming will be ironed-out through
consultations with the academic community in the run-up to a conference this
November — to be co-chaired by federal Health minister Allan Rock — which
will put the finishing touches on the scheme before it's submitted for
cabinet consideration as part of the next round of federal budget
deliberations. 

Briefed on the initiative at the MRC's most recent council meeting in March,
Rock was said to be "enamoured" with the concept and "invited" the agency to
flesh out the details over the course of the summer.

THE POLITICAL ENVIRONMENT	
Flushed with the accolades that rained over the Liberals following the 1997
creation of the $800- million/10-year Canada Foundation for Innovation (CFI)
to upgrade research infrastructure in the nation's universities, the federal
government is soliciting proposals which will do for health care what the
CFI and the recently-minted $2.5-billion Millennium Scholarship Fund (which
will offer $3,000 scholarships annually to an estimated 100,000 students)
did for post-secondary education.

Both initiatives provided "visibility" to Liberal outlays for post-secondary
education and helped to deflect provincial criticism about cuts in
unconditional federal transfer payments, while carefully skirting
jurisdictional quagmires associated with investments in areas viewed as the
domain of the provinces.

The CFI and millennium scholarship fund, along with the March/98 restoration
of granting council budgets, have also created a widespread perception
within Liberal circles that Ottawa has now done its bit for post-secondary
education, so it's time to move onto the next item on the agenda: health
care. As one Liberal says, "we took care of the councils and took care of
the universities. Now it's time to take care of health."

Or as Rock noted in the aftermath of the March/98 budget: over the course of
the current Liberal mandate, there will be a "health care budget" much as
the 1998 financial blueprint was an education budget. 

Within that context, the elegance of Friesen's proposal is that it offers up
research as the avenue by which the Liberals can duck jurisdictional issues
while investing in health care. It proposes to hike research funding to a
level recommended by the Liberal-appointed National Forum of Health, ie.,
one per cent of health care outlays. 

The difficulty, of course, will be in crafting the program in such a way
that it garners political support by being clearly linked to a national
health agenda yet manages to remain palatable to the basic, biomedical
research community.

There's a "perception" within the biomedical community that the proposal is
in furtherance of the MRC's foray into health research, says Coalition for
Biomedical & Health Research and University of Saskatchewan College of
Medicine assistant dean (research) Dr. Barry McLennan. "MRC has to be very
careful to reassure the basic research community that they're still there to
support them and they're still there to nurture what they're doing."

Yet the conundrum is that there's limited political support for basic,
biomedical research, for its own sake. As former Science minister and
current MRC-scholar-in-residence Dr. Jon Gerrard notes, the proposal must
demonstrate that it will have the ability and flexibility to respond to
critical "health needs" across the nation, rather than just serve the needs
of basic research. The focus must be on "doing things which, in fact, will
help the whole health care system."

THE IMPACT
Despite those concerns, the Institutes proposal is nevertheless being viewed
by many as the opportune solution at an opportune moment in time. As
Association of Canadian Medical Colleges executive director Dr. David
Hawkins notes, it'll give the Liberals more "visibility" in health care,
much as the CFI gave the government visibility in post-secondary education.
Federal transfer payments "don't give the feds any benefits in terms of
public relations and give them a lot of grief."

"Opportunity knocks and then it moves on," Hawkins adds. "The government,
with the books balanced, is looking at perhaps some surplus. The millennium
is coming, when I think politicians like to thing big, in millennium-sized
projects, and the fact is that the health issue is still out there."

Such a program would also help to redress current shortfalls in support for
biomedical research, adds McGill dean of medicine Dr. Abraham Fuks. "When
you say that the roof is leaking, do you say: ‘can I fix the roof'? You say:
‘you've got to fix the roof'."

University of Alberta dean of medicine Dr. D. Lorne Tyrrell argues that such
an initiative will also serve to establish better links between basic
science and health applications and therein, "strengthen the whole Canadian
health care system, the whole publicly funded health care system, through
research and education."

Several academics also say the initiative will help improve Canadian
research competitiveness, as well as provide a further impetus to existing
pressures on universities to differentiate and specialize in select
biomedical and health areas.

"All too frequently in Canada we operate somewhat in isolation of each other
and all too frequently, we regard each other as the competition. Our
competition is not University ‘X' in province ‘Y'. Our competition is
external to the country and the only way that we as a country of this size
and geography can compete is if we compete collaboratively and collectively
against places like the U.S.. So I think a network of some form is
absolutely vital." says Dr. Peter Walker, dean of medicine at the University
of Ottawa.

Networks will also help universities in their efforts to clearly delineate
their areas of speciality and expertise, Walker adds. Medical faculties are
already making decisions, "whether it's been formally recognized or not,
about where their strengths are. As long as everyone's not seeking to
develop strengths in exactly the same area, that should be good. I mean, in
my university, we had decisions about where we want to develop and where we
want to compete. So we're not covering the waterfront. Therefore, I don't
have any reservations about sitting down with my colleagues and saying: this
is what we've been thinking about. This is where we should be willing to
take on responsibility on behalf of the whole. Does this meet with your
approval or is this presenting a problem? How can we manage it?"

Memorial University dean of medicine Dr. M. Ian Bowmer says smaller medical
faculties have already been forced to focus their efforts in select areas
because "we just cannot compete with places like Toronto or larger research
groups."

But an Institutes initiative should help strengthen regional interests in
areas like electronic medicine or means of improving health care delivery in
rural areas, he argues. "The idea of these institutes of health is that
you'd be able to develop your own areas of expertise and then that would
link with health sciences somewhere else in the country."


Editor:
Wayne Kondro is a freelance writer based in Ottawa.  The former Editor of
the "Science Bulletin", an independent newsletter on national S&T policy, he
is currently a regular contributor to such publications as "Science" and
"The Lancet".


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