HEAL Committee Meeting

STANDING COMMITTEE ON HEALTH

COMITÉ PERMANENT DE LA SANTÉ

EVIDENCE

[Recorded by Electronic Apparatus]

Wednesday, November 24, 1999

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[English]

The Chair (Mr. Lynn Myers (Waterloo—Wellington, Lib.)): Ladies and gentlemen, we will call this meeting of the health committee to order.

There are a couple of housekeeping items that I think we should deal with first. One is a request from Mr. Martin with respect to the minister appearing before the health committee on supplementary estimates, at least by December 6, because of the statutory requirements. I am wondering, with the agreement of the committee, if we could simply deal with that as follows, and that is to ask the clerk to contact the minister to see whether or not he is available to appear before the committee prior to December 6 to deal with supplementary estimates.

If that is agreed to, I think we can move on. Is it agreed?

Mr. Greg Thompson (New Brunswick Southwest, PC): Mr. Chairman, I would prefer that we take it to a vote and deal with it decisively so that we are on the record as requesting the minister to appear before the committee. I think that way the minister will make every effort to be here. If his schedule doesn't allow it, his schedule doesn't allow it, but I think it's imperative that the committee vote on it and send a clear message to the minister that we would like to have him before this committee.

The Chair: Then I'm simply going to call for a motion.... Let me put it this way. Is it agreed by all members of the committee that we request the minister to appear if his schedule permits? All those in favour?

Some hon. members: Agreed.

The Chair: It is carried unanimously. Thank you very much.

I also wanted to bring to this committee's attention, and those of you in the audience.... On a personal note, let me indicate to you that since I have arrived on the Hill, I've been very impressed by the calibre of our staff and the people who work for us. We look around this room and we see people to my right and to my left who I think do exceptional work when it comes to not only this committee but for the government as a whole, and certainly for Canadians, wherever they may be in this country.

To this end, I want to single out Nancy Miller Chenier, who has returned from Oxford, where she successfully defended a thesis for a PhD. I wanted you to know it dealt with gender and equality employment issues. Hopefully by Monday she will hear officially that she has been granted a PhD.

It underscores the calibre of the people we have working for us, who not only serve us as parliamentarians and others, but also the people of Canada. I think we should recognize Nancy for her good work, so I would ask you to do that.

Some hon. members: Hear, hear!

Ms. Judy Wasylycia-Leis (Winnipeg North Centre): Can we call her as a witness on this bill?

The Chair: I think at some point we may have to, yes.

Let us move on to the witnesses dealing with the Canadian Institutes of Health Research. As you know, that is being debated in the House now, and we hope to soon have that come to this committee. I think that will happen, hopefully within a short period of time. To that end, we have Dr. Henry Friesen, who is chair and president of the Medical Research Council.

What I propose for the committee today is to have Dr. Friesen lead off and make whatever introductory remarks he wants to make. Then I would ask if he would introduce the witnesses he has brought with him today and we will hear from them as well. At that point, we'll start off with the question and answer period, beginning with the Reform Party at seven minutes.

Dr. Friesen, please make whatever comments you think are appropriate at this time.

Dr. Henry Friesen (President, Medical Research Council; Chair, Canadian Institutes of Health Research Interim Governing Council): Thank you very much, Mr. Chair. For all of us here it is a special moment; it is a moment in history. We are part of an exercise that will lead to the creation of a new institution of profound significance to Canadians.

With me is Eric Maldoff, a senior partner with the firm Heenan Blaikie from Montreal, who has been vice-chair and continues to be vice-chair; Dorothy Lamont, who is the president and CEO of the Canadian Cancer Society and the National Cancer Institute of Canada; Dr. Yves Morin, who is a professor emeritus, a member of the council of the MRC, and a leading cardiologist; and Dr. Tom Brzustowski, who is the president of the Natural Sciences and Engineering Research Council.

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Mark Renaud, whom I understand you may meet subsequently, would have preferred to be here, but other obligations called him to other duties. So of the three council presidents who normally would be here, we are missing Dr. Renaud, who of course brings a special insight of the social sciences and humanities community to this exercise.

I thought it would be worth referencing very briefly why we are here, what our backgrounds are, and what has brought us together to a common view of what is possible as we seek to modernize the Canadian health research enterprise.

The MRC, which is being repealed in Bill C-13—or is proposed to be repealed—has a 40-year history. That reminds us to cast our eyes back 40 years, not far from when I graduated, to what life was like then and what it is today. We are part of that changing tempo, in the structures and the opportunities and the challenges ahead.

Forty years ago in Winnipeg there was a raging polio epidemic. Today, for the last decade, polio has been eradicated from North America. There have been no cases. Smallpox in that interval disappeared from the face of the earth. But we have new scourges. We have HIV. There will continue to be these changes that will arise, and where institutions and organizations engage in health issues, we need to be prepared, we need to anticipate, and we need to be responsive.

There were tens of thousands of individuals in institutions for TB and for mental disease concerns. There was little recognition about the social and economic impacts on health at that time. New understandings have arisen. We are part of that change.

The MRC and the national health research development program have created a very excellent base, an excellent foundation, on which to build, which will be part of the structure that is embraced by CIHR. It is a special moment for all of us as we look ahead at the opportunity, a new opportunity, a profound change that is at hand that will transform and modernize and bring a linked health research organization that is inclusive, that is focused on results, whose chief objective is rooted in and inspired by the pursuit of excellence—excellence at an international standard—creating new knowledge that will be benchmarked, where Canada can be a world leader and, in its application, seek to see that knowledge applied for benefit and translated urgently for the benefit of the health of Canadians to an improved health care system, a strengthened health care system, and improved health services and product.

There is a singular objective in the bill. It was approximately a year ago when we made the case with the minister. We came together as a broad coalition. This was not just the health researchers coming to say to the minister that there was an opportunity. It was indeed a new arrangement, a new coming together of forces in institutions and organizations.

I would reference particularly the extraordinary commitment that the national voluntary agencies have brought to the table. They represent millions of Canadians, in truth, and their generosity, because millions of Canadians understand the hope that research brings to issues that affect them.

I had the honour a number of years ago to serve as a voluntary president of the National Cancer Institute of Canada, the organization of which Dorothy is the CEO. There I first learned about the dynamic and the passion and the commitment of volunteers that are part of that glorious organization.

The effort of all groups that came to the table resulted in the February 1999 budget announcement that forecast new money and the development of a process leading to the position and the place we are today. The Minister of Health appointed 34 distinguished scientists to an interim governing council, and we are here as representatives. It was again a broad reach that brought a variety of perspectives.

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There was considerable discussion, and sometimes heated debate, on certain issues, but at the end of the day there was a convergence of views—that is, the proposal before us today, in the legislative material before us, is the right way for this country to proceed.

Its impact will have effects right across the country. It's right, in my view, that it's Bill C-13, as there are 13 provinces and territories. All people of all of those regions of this country should see the benefits that will flow from this bill.

The legislation, in our judgment, is enabling. It's facilitative. It provides a framework. The structure is indeed quite simple. There is a governing council, a president, and a set of institutes focused on thematic areas, led by outstanding individuals and informed by advisory boards. The legislation is enabling. It provides flexibility.

It's a new organizational arrangement that will, in my view, deliver on the Prime Minister's commitment to see Canada as the place to be. Canada is the place to be for the creation of new knowledge. It will recognize new determinants of health that were not front and centre on the agenda before. It will create a robust research environment. It will build on other investments by the federal government in a very logical way. The CIF and the 21st century chairs will brand Canada as being synonymous with the highest levels of research.

Before concluding and turning over to Eric Maldoff the opportunity to speak from his perspective, I would like to say thank you to the members of this committee, who throughout the exercise that led to the creation of CIHR...and in the past for their support of MRC.

Mr. Maldoff.

Mr. Eric M. Maldoff (Vice-Chair, Interim Governing Council, Canadian Institutes for Health Research): Thank you very much, Henry.

It's a great pleasure and honour to be here with you today. It's also a great relief to see that we could arrive here today.

This has represented an enormous challenge to the research community in Canada to come together as it has, with such great solidarity, to encourage you to move forward with the legislation that is now before Parliament.

I have been introduced as a lawyer, which I am, as one of two on the IGC. Aside from that deformation, I have also served for the last ten years as the chairman of the board of the Montreal Children's Hospital, the pediatric teaching hospital of McGill University, and more recently as a member of the executive committee of the McGill University health centre. During that period I also served on the National Forum on Health, with which I am sure you are familiar.

This has been an extraordinarily exciting initiative. The research area is obviously key to the health of Canadians and to our health care system, and is a highly held value of the people of this country. The research agenda is integral to all of that.

It has been a remarkable experience working with this committee—a typically Canadian experience, I may say—of 34 people drawn together from different backgrounds, different milieux, and different interests from across the country. They were all able to come together because they care about research and because they deeply distrust each other. They all believe their interests should be paramount.

As usual, the wrestling match starts at the beginning, and within weeks the group coalesces. They find out that regardless of their background or region or where they come from, or whatever their language, they are very committed to the goal. They start to speak very much in the same terms.

The first item on our agenda as an IGC was to make recommendations as to drafting instructions for the legislation. This was a sprint for us, having come together for the first time in late March, early April, and having to have that advice in by the end of June from a standing stop.

The group came together amazingly. The legislative drafting instructions represented the unanimous views of 34 people from across the country, views developed after extensive consultations had been carried out by the IGC across this country within the interested and involved milieux, with the research communities, and in consultation with experts at home and abroad. For example, we met with the national institutes for health and with the agency for health care policy in the United States, among others.

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In terms of further consultations, there was a major consultation in June at the MRC science summit. In September there was an interaction workshop convened by the Social Sciences and Humanities Research Council and the Canadian Health Services Research Foundation, where scientists and researchers from across the country came together to speak to what this should be about. National voluntary organizations held a major meeting in September.

These are just some of the events bringing together people from across the country.

The key aspect of the legislation proposed, I think very thoughtfully, by the IGC is that if the research agenda of the country is to remain responsive to the changing realities and needs of the Canadian population, we need to endow ourselves with a structure that is capable of being strategic, encouraging the initiative of individual investigators, and embracing diversity. We need legislation, therefore, that will be broad, enabling, flexible, and deeply committed to excellence in health research.

I think all members of the IGC were very gratified to see that the first draft tabled of Bill C-13 reflects all those thoughts. It is a very strong and positive articulation of the values behind this and the purposes of this endeavour.

A key feature of this, of course, is the notion of institutes. Each institute, as Henry has mentioned, will have a scientific director who will be regarded, respected, and known for excellence in the field. Institutes will focus on themes, and they will be seen as nodes of scientific leadership in Canada. They will not be bricks and mortar. They will be virtual, bringing together researchers and the research community—funders, users, the charitable organizations, and the provinces—linking all in a research endeavour on behalf of Canadians.

These institutes will therefore be capable of setting a strategic research agenda in their thematic areas and will have budgets that will provide for investigator-initiated research, strategic initiatives, and institute development.

The institutes will be mandated, as the legislation provides and clearly directs, to address all four areas of health research: biomedical; applied clinical; health services and health systems; and culture, society, and health of populations.

This is one of the great innovations and advances that Canadians can be very proud of in the health field, the linking together of the complete span of all aspects and factors that apply to and bear upon the health of Canadians. It is in recognition of the fact that our understanding of health has changed. We understand it to be multifactorial. We understand that it takes an interdisciplinary effort. We understand that issues and problems and solutions are complex, and that a great deal of money is involved in being able to find solutions and ensure that they are taken up and implemented.

We believe the institutes for health research will provide new synergies for Canadian health research and at the end will advance the health and well-being of Canadians and provide opportunities, jobs, and a very bright future for Canadians.

The Chair: Thank you very much, Mr. Maldoff.

Ms. Lamont.

Ms. Dorothy Lamont (Vice-Chair, Interim Governing Council, Canadian Institutes of Health Research): Good afternoon, ladies and gentlemen. I too am greatly honoured to be here today—and I share Eric's relief.

As well, I also have been honoured to be involved in the remarkable process we're undertaking to re-engineer health research enterprise in this country.

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I want to talk a bit about one critical player in health research, the voluntary sector, and about one important characteristic of CIHR, the matter of partnerships.

As chief executive officer of the National Cancer Institute of Canada and the Canadian Cancer Society, I've seen directly the impacts of health research for Canadians. I've seen people who some twenty, fifteen, or even ten years ago would not have survived their cancer, and here they are experiencing the joy of living and seeing their children and even their grandchildren grow, thanks to the research carried out by Canadian researchers.

My organizations have been privileged to support a great deal of that research through the generous philanthropic donations of the Canadian public. The voluntary sector in this country is strong, and it has a very long and proud tradition of funding health research. In fact you may not know that in this regard, this support is really a model in the world.

The CIHR enterprise is designed to build on that strength, just as it's designed to build on the strengths of many players with an interest in health research. This is the Canadian way, and we should take pride in our ability to establish this entity, which I am confident will multiply the effect of our various investments in health research and ultimately will improve the health status of Canadians.

The Canadian Cancer Society and the National Cancer Institute of Canada are large organizations, but they provide only one example of many voluntary organizations that together were responsible for funding almost 15% of all health research in Canada in 1997. In dollar terms, that was about $227 million. In 1998 that amount has been estimated to be closer to $300 million.

It's not insignificant that this sector, which represents as many as 10 million active volunteers in networks across the country, has been at the table and will play an ongoing and meaningful role in developing the potential of CIHR.

To my mind, one of the greatest accomplishments in fact of CIHR is that the national health charities will be at the table with other stakeholders to form partnerships that will expand and enhance the impact of research funded by the federal government and by others. That role will be particularly evident on the institute advisory boards.

Beyond some rare examples that I've been privileged to be involved in—some of them anyway—this is the first time the voluntary sector and other members of the public have actually had a formal role in making decisions about the direction, funding, and organization of health research funded by the federal government in Canada. For organizations such as mine, institute advisory boards are among the most exciting and transformative features of CIHR.

Regarding partnerships, there will be a broad range of types of partnerships envisioned with CIHR, some with the national charities and provincial health charities and other voluntary organizations, and there are many, as you know. CIHR will enter into partnerships to establish common goals and research agendas and to improve coordination and planning of our common efforts.

The users of research, such as private health care providers, professional associations, the private sector, consumers, and others, will, with CIHR, foster partnerships to ensure that research results are disseminated quickly to those who can benefit from them.

CIHR will establish effective links with provincial health services, agencies, and those responsible for delivering health care to ensure they benefit from the knowledge generated from the research.

CIHR will also form partnerships with the private sector to fund research and to help commercialize the results of CIHR-funded research where this can lead to health, economic, and social benefits for Canadians.

CIHR will build strong and cooperative partnerships with all members of the research enterprise to integrate the activities of these diverse players and to transform the way health research is conducted. This is a tall order, but it's a vision worth working toward, and it's one that is achievable in the best interests of Canadians.

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Thank you for your attention. I look forward to further discussion.

The Chair: Thank you very much, Ms. Lamont. That was very good.

[Translation]

Mr. Morin.

Dr. Yves Morin (Member of the Medical Research Council of Canada Board; Member of the Interim Governing Council, Canadian Institutes for Health Research): Thank you, Mr. Chairman.

It is rare for an organization to appear before a parliamentary committee to recommend its own elimination, but that is exactly what we are doing today.

Bill C-13 would repeal the Act regulating the Medical Research Council of Canada and will bring an end to its existence after 40 years. This bill has the unanimous support of all researchers who are affiliated to the MRC, as we were able to see during the scientific summit held in Toronto last June; it has also received the unanimous support of the members of the board on several occasions.

[English]

Under Bill C-13, the Medical Research Council Act will be repealed and forty years of the existence of the MRC will come to an end. The fact that this is being done with the full support of the MRC community speaks to the trust this community has in CIHR and the high regard in which it holds its important initiatives.

[Translation]

During its 40 years supporting research, the MRC has allowed for discoveries which have made a real contribution to the well-being of Canadians.

But if our past was productive, our future will be even more so.

The creation of the Canadian Institutes for Health Research, the CIHRs as they are called, will allow our best researchers to carry out research at levels such as those that are found elsewhere in the world, while maintaining monetary support for a larger number of researchers at all stages in their career.

The CIHRs will make researchers even more efficient. As an example, Dr. Jacques Simard, a young researcher from Laval University who discovered the BRC A2 gene which indicates a predisposition to breast cancer, sees in the arrival of the CIHRs an innovative element which will allow him, in the context of his research, to integrate new disciplines—he is a geneticist by training—such as epidemiology, ethics, demographics, clinical research and health delivery services, and all this to better serve the people in Eastern Quebec.

As a Quebecker I would like to stress the important role played by Dr. Michel Bureau, president of the Fonds de recherche en santé du Québec, as a member of the Interim Governing Council of the CIHRs. Health research in Quebec is in a particularly good state and has greatly benefited from the support of the MRC. I'm convinced that our researchers in Quebec will benefit from the creation of the CIHRs.

In conclusion, Mr. Chairman, the Canadian Institutes for Health Research will build on the foundation of the MRC a structure that will meet the possibilities offered by science and meet the needs of Canadians in the area of health at the dawn of the 21st century.

[English]

CIHR builds on the legacy of MRC and helps to create a health research environment for the 21st century.

Thank you very much.

The Chair: Thank you.

Dr. Brzustowski.

Dr. Tom Brzustowski (President, Natural Sciences and Engineering Research Council; Member, Canadian Institutes of Health Research Interim Governing Council): Thank you, Mr. Chairman.

Good afternoon, ladies and gentlemen. I too am delighted to be here to support this tremendously important initiative.

I'd like to support what Mr. Maldoff has said. This is something that was produced with a great deal of work. It was difficult work, but it was work that was driven forward by the very attractive and in fact compelling vision Dr. Friesen has presented on very many occasions.

Mr. Chairman, I think I owe it to you to say one or two words about myself and how it is that the president of an agency that sponsors research in science and engineering should be in front of you.

Let me just say at the personal level, as you know, I was a professor at the University of Waterloo for many years—25 in fact. Then I served eight years as deputy minister in Ontario, and my last assignment there for several years was to lead the Premier's Council on Health, Well-Being, and Social Justice. That has given me some personal understanding of the theme and what we're looking at here.

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I'd like to relate it for you, however, to the activities of NSERC. If you'll permit me, I'll just read into the record two brief paragraphs—and that will be the extent of my statement—appearing in a statement I issued a few weeks ago to the research community of NSERC, some 9,000 to 10,000 people, explaining to them what the relationship might be.

[Translation]

First of all, let's remember that the CIHRs are very promising. Their integrated approach to health research in its four areas of activity (basic biomedical research, applied clinical research, health delivery systems and social and cultural factors in health) will allow us to examine, from an overall perspective, an increasing number of factors which have an impact on our health. We would expect this new vision of research to improve the provision of services and therefore lead to better health for the people of Canada.

I will continue in English.

[English]

But what about NSERC? How are we involved? The simple answer is that the NSERC Act expressly rules out our supporting health sciences in these words:

The functions of the Council are to

(a) promote and assist research in the natural sciences and engineering, other than the health sciences;

Nevertheless, of course NSERC does fund basic research in natural sciences and engineering that may contribute to downstream research in health, among other areas. We also fund research in areas of technology that may have uses in health sciences and in health care.

At the turn of the millennium, the boundaries between disciplines are so blurred that a discovery made in basic life sciences one week may be put to use or to further development in a medical research lab the next week, and a discovery or an invention in an engineering lab one day may start to be adapted to a use in the health care system the next day.

It's for that reason and for all the reasons you've heard from the other speakers that I'm quite proud to be here and to express my unequivocal support for the concept of the CIHR.

Thank you very much.

The Chair: Thank you very much.

Thank you to all of you. I'm sure there will be more discussion in a minute, when we begin questions. We appreciate your sharing your points of view and your opening statements to this point.

Mr. Elley, would you lead off, please?

Mr. Reed Elley (Nanaimo—Cowichan, Ref.): Thank you very much, Mr. Chair.

I am also honoured to be part of this very historic day and would like to begin by saying on behalf of this grateful Canadian many thanks to the Medical Research Council over the years for the incredible work they have done on behalf of Canadians in the whole area of medical research. You are to be highly commended for what you have done in the past.

Like any good organization, you can look at the past, but you can't stay in the past. Speaking on behalf of the official opposition and the Reform Party, we are very supportive of this move. We think it's good for medical research, it's good for the health of Canadians, and it's good for this country, so we're very, very supportive. We may have a few questions about it, but they certainly are not major questions at all.

By the way, I had a very fine briefing from Health Canada officials on this previous to this meeting, so I really don't have a lot of serious questions. I think they were all answered, mainly.

Of course there are other research bodies in this country. Some of those are private research facilities. Some of them are linked to provincial research, and the moneys come from the provincial governments for the purposes of research. I'm wondering particularly how the interprovincial and federal-provincial jurisdictions play out in this and how the provinces were consulted on this and just what their role would be in the new Canadian Institutes of Health Research. Maybe someone would like to answer that question.

Dr. Henry Friesen: That's a good question.

Voices: Oh, oh!

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Mr. Reed Elley: Yes, well, it's also Reform's question. I come from western Canada.

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ): [Inaudible—Editor].

Mr. Reed Elley: There's no monopoly on that, by the way, Réal.

Dr. Henry Friesen: Let me begin by first of all gratefully acknowledging your laudatory comments.

The health research environment in Canada is a partnership that is often implicit, because in many cases there aren't formal arrangements and agreements. If I can give you the macro picture, there is roughly $2.3 billion of health research funding—that's a Statistics Canada figure, recently quoted—of which about $1 billion-plus, roughly, is from the private sector. The other billion is from the public sector. There are the voluntary agencies.

First of all, let's begin, then, with the federal government funding, which is about 20% or 25%. It had dipped a bit. It is coming back up. The next biggest piece is the voluntary organizations in aggregate. The provincial research agencies are a very important component. Also, there is a lot of local support. In each community, there is tremendous pride in the institutions in support of health research.

The truth is, there are no formal agreements with any of those major funders. In turn, the performance sites for research are, again, varied. There are hundreds of institutions—universities, hospitals, research institutes, and private laboratories of course—all of them operating in a Canadian way.

Specifically, to answer your question about provinces and provincial consultation, we had, on the interim governing council, representatives of the two provinces that have invested formally in health research in an agency. In the case of Quebec and the FRSQ, Fonds de la recherche en santé du Québec, its president, Michel Bureau, was on the interim governing council. He was on an antecedent task force that led up to the initiative. From Alberta, there was Dr. Matt Spence, the president of the Alberta Heritage Foundation for Medical Research.

In addition, at various points the deputy as well as others briefed the deputy ministers of health at the federal-provincial deputy ministers' consultation. I have met on several occasions with individual deputies and/or ministers of health—or in some cases, of economic development—as part of the initiative. You might be interested to know the mere discussion around CIHR has been catalytic.

In some of the regions of this country, research isn't flourishing appropriately, as we see it. As a result of the initial additional support through CIHR funding, we were able to reach a partnership agreement with the Province of Saskatchewan, a joint arrangement with the ministries of health and economic development, and one in Manitoba. As well, we have moved east to New Brunswick and Prince Edward Island. It is the first opportunity to see research more appropriately represented across this nation.

Mr. Reed Elley: Thank you very much, Dr. Friesen, and thanks to all of you for coming here today. Unfortunately—I hope you will excuse me—I have to go and speak in the House.

Dr. Henry Friesen: My colleague reminds me that Jeff Lozon, the deputy minister of health of Ontario, was a member of the committee as well.

Mr. Reed Elley: Good. I'm glad to hear that. Thank you very much.

The Chair: Thank you for your question, Mr. Elley.

Moving on,

[Translation]

Do you have a question, Mr. Ménard?

Mr. Réal Ménard: I could never foresee a time when I wouldn't have any questions. I have five questions.

Obviously the Bloc Québécois enthusiastically supports this bill. I would like you to tell us the difference between centres of excellence and the institutes which we are about to create. It is important for the members of the committee to have a proper understanding of the distinction.

Secondly, what will be the effect of the amalgamation of the MRC and the research institutes in terms of responsibility from the human resources point of view?

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Thirdly, I have a question on a very important point, for opposition parties and for democracy in general, the issue of accountability. I know that there is a lawyer among us. He's no doubt familiar with the concept. In the past, the Medical Research Council was accountable to the minister, who defended the MRC budgets before a committee. Now, how will the principles of resource allocation and accountability be implemented? Will it be done in the same way as it was done for the MRC? That is a very important question for us.

There is another very important question. How will arbitration be carried out? For example, with my good friend Dr. Patry, I've followed AIDS issues very closely. When you speak to Dr. Remis, an epidemiologist, you don't discuss things the same way as you do when you talk to Dr. Weinberg or Dr. Sékaly from the Clinical Research Institute of Montreal. And I was told that you received a large number of suggestions for the creation of institutes. There are people who will have to make decisions. If you say you want to create some 15 institutes and you have over 300 proposals, it may be possible to group a certain number of them, but somebody will have to make the decision. Therefore, tell us a little bit about the arbitration process and tell us how all of that is going to be done.

Dr. Yves Morin: You wanted to ask five questions.

Mr. Réal Ménard: Yes, but I'll save two for later on, just to make them sweeter.

[English]

Dr. Henry Friesen: Thank you. I'll start with the first three and perhaps invite Eric Maldoff, who brought forward the idea that captured the support of the interim governing council, to talk about the creation of the institutes, the arbitration question, about which institutes would be formed.

There are important differences between the networks of centres of excellence and CIHR. The purpose of the networks of centres of excellence is to see, with special emphasis on the objectives of the networks of centres of excellence, research linked to economic growth development and, more recently, to policy output as well. But fundamentally, the purpose is to see a special emphasis to try to ensure that discoveries made by scientists see an economic output as a goal. That's an essential criteria.

CIHR is about health. That is the first and most fundamental drive and objective. The terms of the objectives are different. Secondly, the scale is different. If you imagine as we do—and you will hear shortly from Eric Maldoff—we imagine 10 to 15 institutes. So with a budget of $500 million and growing...that's a $50 million enterprise. So one institute is the size of almost the entire networks of centres of excellence program, which now has a budget of about $70 million.

I will also perhaps ask Tom Brzustowski if he wishes to elaborate on that.

The programs and their delivery are very different. In the network of the centres of excellence, there is the occasional yearly call for new networks of centres of excellence, which then have a seven-year history or horizon. This is an active, dynamic, ongoing, twice-a-year competition, so it has a very significant number of differences.

On the issue of the transition of the staff that is now part of MRC into CIHR, in the bill you will see in boldface—and I gather the boldface signals that after a certain period of time those items are removed from the bill itself—where they specify and guarantee that those staff that are today part of MRC will find employment opportunities in CIHR. CIHR, of course, is expanding, so there will be new opportunity for additional staff to be integrated.

The NHRDP is coming in to the CIHR. They will be embraced within the new structure. I see an opportunity to grow, but within reason. CIHR should be a lean, streamlined organization. The pressure should be on making sure that the maximum amount of dollars goes to research as opposed to building the bureaucratic organizational structure—accountability.

Accountability has some very significant and interesting new dimensions in CIHR, compared to MRC. You noted the usual procedures. We submit an annual report, which the minister tables. We of course have appeared from time to time, called to account by your committee or other committees, and in that sense we are accountable. Those two mechanisms will continue to operate.

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There are two new elements framed in legislation. I suspect it may be one of the first times the governing council is obligated, is called for, to conduct a review of each institute at five-year intervals. It can amend, modify, or change if the performance isn't as expected. Second, it must itself subject the entire organization to a five-year international review. That is a new element.

Lastly, in regard to the advisory boards at each institute, I suppose that by some they weren't initially seen as an accountability mechanism, but this will have, within each theme of an institute, a series of knowledgeable, informed, wise people who themselves, if dissatisfied, have an opportunity to register their concerns, to the governing council or in different ways. There are some important new dimensions to the accountability, which I think will serve the organization well.

Eric, perhaps you could respond to the question of the approach, the process that we as a governing council see as being helpful in the difficult task of creating institutes, and which ones.

[Translation]

Mr. Eric Maldoff: You asked a question regarding arbitration.

If I understood you correctly, arbitration has a somewhat wider meaning than simply the issue of choosing institutes. In my experience, in the health sector, arbitration is a daily matter. People don't necessarily all agree amongst themselves. There are people who stick to their guns. There are broad debates on anything and everything. Having been involved in the amalgamation of four hospitals in Montreal, I can tell you that it's no small challenge.

I will look at the question from several angles. In any endeavour dealing with health, there is a daily arbitration process. At each level, every day, at each location, issues must be settled.

As to the choice of institutes, over the last months, we have received some 175 proposals from all sorts of organizations and individuals. Some were very well thought-out and others, less so. There are interest groups and each interest group of course wants its own institute.

To change how we look at institutes, we have proposed that the general public and certain organizations make proposals to us on a whole range of institutes. Instead of proposing a single institute, their own, they should perhaps propose 10 or 15, if we take for granted that we will end up with 10 or 15. We would want to encourage people involved in the area to think of the whole range of research which must be carried out and on the best way to organize it.

We would expect a very positive response. I think that that will help the interim governing council, as well as the permanent board, if the bill is adopted, to make better choices. However, pursuant to the legislation, the decision as to the choice of institutes will be made by the board.

• 1630

As to the other types of arbitration that will occur, there will be a board whose members will be chosen amongst people who are well versed in the field. These people will be representative of the regions and of various fields of interest. They will sit together as a board and make decisions on strategic directions and on any other major issues.

As well, within each institute, there will be an advisory council, also comprised of people from all walks of life, from all regions and all sectors, who will participate in making major and strategic decisions.

As to the choice of research proposals, the legislation seems to favour a peer review system which, as we know, ensures excellence. There will be wide-ranging debates on the issue. We therefore have to choose the best people to sit on the board, on the advisory councils and on peer review committees.

Mr. Réal Ménard: Do I have time to ask another small question?

The Chair: No, sir.

Mr. Réal Ménard: My life is so hard.

The Chair: Thank you.

Mr. Patry, go ahead please.

Mr. Bernard Patry (Pierrefonds—Dollard, Lib.): Welcome to our committee. First of all, I would like to thank the members of the interim governing council for the work that they have done. They did a huge amount of work. Some of them will certainly not be members of the governing councils of what we now call the CIHRs.

I would like to continue along the lines of my colleague, Réal Ménard. I have two short questions.

First, I would like to know whether the CIHRs will report to the Minister of Health. I thought that that was the case, but I would like to know whether they will be at arms length, like the CRTC, or whether they will be fully integrated into the Department of Health.

Secondly, Mr. Ménard spoke of the centres of excellence, but there are many other research councils in Canada. There was the National AIDS Strategy, there are councils for innovation, health research, natural sciences and engineering research, etc. Is there not a danger of duplication. How will you avoid such duplication?

Next, you mentioned four themes,

[English]

four themes or sectors. There was the biomedical research, applied clinical research, the research into health services and systems, research into the societal and cultural determinants of health and the health of populations. You talk about maybe 10 to 15 institutes. I would just like to know, is the money that will be available going to be in pro rata of these sectors? We always feel the health and the determinants of health are les parents pauvres, the ones who receive less, and most of the money will be for biomedical research or applied clinical research. I just want to know what your feeling is about this.

My last question is for Dr. Morin.

[Translation]

Doctor Morin, in your introduction you referred to Dr. Simard. You said that he was doing excellent research, and I am fully aware of this, but after the creation of the CIHRs, he might get involved with other disciplines. You seem to be saying that he would be the one to get involved, but I rather had the impression that other people would come to work with him, but completely in another context. I would like to have a better explanation of how the various disciplines could be integrated. Thank you.

[English]

Dr. Henry Friesen: If I could begin, Dr. Patry, I will respond to your question about accountability. As the bill outlines, the intent is that CIHR will report to the minister, that an arm's-length relationship is intended under the act. So the relationship in that sense will be very similar to what exists now.

There will be the additional opportunity in CIHR to advise the minister on issues relating to health research and health policy. That is a new responsibility to CIHR. It doesn't appear in the MRC Act, so there's an opportunity of being engaged on this important new matter.

• 1635

The issue about duplication is always a concern. There are a number of programs. Let me begin with the granting councils. I think my colleague Dr. Brzustowski indicated that their act, the act that created NSERC, has some language that indicates that duplication should be avoided, specifically that health sciences should be excluded. The social sciences too have opportunity, and have had in the past, to fund areas in health research. The truth is it has been quite limited, partly because their budget is limited. There are Health Canada initiatives that speak to areas where quite properly MRC could be engaged.

Good sense has prevailed in a number of these initiatives where Health Canada then has invited and asked MRC to look after the research component. The AIDS strategy, after all, is much broader than just research. In that case, as an example, or the hepatitis C initiative, for their research component we, MRC—and I presume in the future Health Canada would ask CIHR to be a partner in delivering the program.... Another good example is the breast cancer initiative, where Health Canada, MRC, the Canadian Cancer Society, the National Cancer Institute, and others have come together to engage in a common activity.

There was a very explicit agreement, particularly at the outset, not to draw the boundaries too tightly but to allow some reasonable porousness to continue to exist until the boundaries are somewhat more clarified. I think that makes sense, because otherwise we run the great danger of trying to define what is, as Tom pointed out, one day in this field and the next day in that, and we would do ourselves harm by drawing the boundaries too tightly.

The point about the four sectors and the underfunding of two of the four domains, the health service and social science, I think is fact. That is, in my view, one of the opportunities CIHR will have to become more inclusive, to embrace and recognize that investing in these areas of research is important for the Canadian health system for a better understanding of some of the elements where the social sciences perspective is probably the best response available.

Let me take the example of smoking and the knowledge of the link of smoking to ill health in many forms. One-quarter of deaths are smoking-linked, it is stated. The knowledge is there; the behaviour is not. Ultimately, if we could influence the behavioural choices, particularly of young women, through insights gained from social sciences, what a profound impact that would have on the health of literally thousands of people. That is an example of why....

I believe what we should do as soon as possible is identify what is the level of investment in these two domains you have referenced that are underfinanced. I expect the governing council will say we should set some goals and targets over five years to repair, to build the capacity.

I might say as my last point, on the transitional programs, in the first year of CIHR the deficiency was recognized. There are some specifically targeted programs for these domains available even in the first year of CIHR.

Ms. Dorothy Lamont: I would just like to add another few comments regarding the plans for organizationally ensuring that these four cross-cutting themes are adequately addressed, because we recognized early on the need to build on strength, existing strength, as well as to build capacity. Each institute we would see as having a strategic plan that would be approved by the governing council and form part of the overall strategy. That strategic plan would form the base of the budget allocations each year and would also be a point of measurement in the five-year reviews.

• 1640

Within the work of each institute we see that there would be a mix of funding of applications that have come in from the general pool of applications as well as a portion of the budget to be able to develop what we're calling “strategic initiatives”, which will help in a variety of ways—for instance, help answer some unanswered questions or build capacity—to ensure that at the end of the day each institute can prove that it has adequately addressed the four themes in terms of both capacity and building strength.

Finally, we also envision the notion of having a standing committee whose basic order of business is to ensure or to monitor the development of those areas that have been particularly under-resourced in the past and to sound the alarm if they see any problems throughout an organization.

[Translation]

Dr. Yves Morin: Your question is quite appropriate, Dr. Patry. You're quite correct to say that this integration will not be carried out by a single person. To get back to the example of Dr. Simard, he is a renowned specialist in genetics. He has made a major discovery. He realized that in eastern Quebec, particularly in the Saguenay—Lac Saint-Jean region, 15% of women with breast cancer carried a specific gene, which he identified, namely the BRC A2 variation. This is a major discovery.

Now that this discovery has been made, it has to be applied. Obviously, population studies have to be carried out. Is each of the populations different? Dr. Simard has been looking at all of eastern Quebec. Are there variations in populations? This study is being carried out.

There is also Dr. Sylvie Marcoux, an epidemiologist who previously received support from the Health Canada national program for health research development. Her support came from another agency.

There is also an ethical question related to screening in these areas. At what age should it take place? Should it be done? Dr. Bartha Knoppers, who will come before you here next week, is, I believe, involved in Dr. Simard's project because such screening involves major ethical issues.

In the area of demographics, Dr. Maurice Bouchard, the brother of a well-known personality,...

Mr. Réal Ménard: And esteemed.

Dr. Yves Morin: ...has produced a genealogy for the Saguenay—Lac Saint-Jean region since 1850. It is therefore very easy to trace the families of the region.

Finally, there are some surgeons involved. Also, with respect to the distribution and health care system, we have to decide whether to carry out such screening in the entire population.

Dr. Simard could never conduct all of this research which will obviously be beneficial in eastern Quebec but will affect all of Canada and even the world, without involving all of these people from very different fields, which could never have been supported by a single agency or a single grant. This is really a first. As Dr. Friesen said, it is a world first. This is the first time that a single agency has been able to support people in all of these fields, including the field of ethics, under the auspices of a single grant. This is really a major step forward for research. It makes it much more efficient.

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

[English]

Ms. Wasylycia-Leis, please.

Ms. Judy Wasylycia-Leis: Thank you, Mr. Chairperson.

I also would like to thank all the presenters for appearing this afternoon and acknowledge the work that has obviously gone into the whole development of the CIHR.

Having said that, I am sure you won't mind if I poke a few holes in it now. I had some concerns coming into the room, but having heard that Reform thinks everything is fine, I now have a lot more concerns.

Voices: Oh, oh!

Ms. Judy Wasylycia-Leis: I am really worried.

With regard to my first question, I don't think there is an answer to it. It has to do with Dr. Friesen's point about knowledge being used to change society, and good research leading somewhere in terms of social change.

• 1645

I think the question we all want to ask is, yes, this is a great new model, but how will the good research that will come out of it get translated into meaningful policies? It's a question we had yesterday during the debate, and it's a question of political will. I don't expect you to answer it, but I throw it out.

The second issue I want to raise has to do with the role of the private sector. I've raised this before, and we're hearing about this every day on the news; that is, the issues around private sector influence over research in this country, the bind it puts the researcher in and how it influences research. I'm wondering how we've dealt with that in the bill, which shortly may come before the committee.

Under paragraph 4(i) of the bill the words “facilitating the commercialization of health research” appear. Could those words either be dropped or changed to something like “utilization of research in both public and private sectors for the sake of the public good”? That would be one way to acknowledge the potential problem with such close partnerships between the public and private sectors and to protect against possible conflict of interest, recognizing that commercialization is a byproduct of good, ground-breaking research, and therefore it is implicit in the more general wording of the bill.

I have a couple of additional questions. Should I throw them all out?

The Chair: Please do.

Ms. Judy Wasylycia-Leis: My next question has to do with carrying this concern through to the way in which the governing council is set up under the bill. It's very vague. It allows for the government to appoint up to 20 members. It references scientific excellence and women and men from relevant backgrounds and disciplines. But that's very vague, and I'm not sure how that will protect against the government of the day. We could have a change in government. God, it might even be the Reform. How do we ensure that we don't end up with a council that is very much biased in terms of commercial interests and pharmaceutical companies playing a key role and in terms of potential conflict? Is it not possible within this bill to actually define some characteristics for the kinds of positions that should be filled on the governing council?

I have a lot more questions. Can I have Reform's time, the next five minutes, since they're gone?

The Chair: No, I think you've taken quite a bit of time yourself. Those are good questions, and we will get some answers to those right now.

Dr. Henry Friesen: Let me begin with the issue of how the product of the creative mind and the new knowledge effectively get transmitted, used, and adopted and benefit the health of individuals and institutions in the health sector. It is recognized, I think it's fair to say, that this is a challenge. The traditional mechanisms or means that appeal to the individual in the academic world, of course, to publish, to have workshops and meetings, and to disseminate the knowledge go a certain distance, but that by itself isn't adequate. I think that has been recognized.

With regard to thoughtful analysis, we've had, as an example, Jonathan Lomas on our interim governing council. He's a world authority on the issue of dissemination. “Closing the Loop” was an international conference we sponsored early in October. It brought together the best minds on the subjects of strategies and mechanisms. Knowledge sitting on a shelf is really knowledge that by itself is all right, but the investment made doesn't produce a return on that investment.

The interim governing council, as one of its efforts, recognizes the importance of knowledge dissemination. We have had a subcommittee, of which Jonathan Lomas is a member, which put together a very extensive series of recommendations and advice to the governing council on the issue. It will require some investment both in people and strategies and of course some of the new communications tools. The Internet is changing and transforming the dissemination of knowledge, and led by the National Institutes of Health, there was the idea that all new knowledge should just go out to a specific site on the Internet. That created quite a reaction from the publishing industry, as you can imagine, because many organizations depend on this as a proprietary interest.

We are in a changing environment, and CIHR is part of that environment. The issue has not gone unnoticed.

• 1650

You're right, I have no definitive answer other than to say that the best practice guidelines are terribly important. All of those elements are an important dimension. A specific example that I think reflects the point you're making is that a modest study was done here in Ottawa where an emergency physician looked at all of the ankle X-rays being taken and said “I think this is excessive. What if we do a very careful physical examination, set some guidelines, and use those in lieu of X-rays? Is the end result just as good?” The answer was yes, you could in fact avoid 90% plus of unnecessary ankle X-rays. The implementation of that, which is now happening throughout Ontario, is going to save the system millions of dollars.

This is one example of the dissemination. The first step was the knowledge. The second was dissemination.

With regard to the role of the private sector, you should know that issue was very prominent in the discussion at the interim governing council. It is an important issue. It is important that conflict-of-interest issues be identified. That's part of the ethical framework that is embedded both in legislation and in action.

First of all, it is clear, certainly to me, that CIHR's funding is not intended to be a subsidy to industry. CIHR funds will flow exclusively, in my judgment, to the university, the researcher, and the hospital. The private sector, however, brings a point of view. The determination of any funding flowing from CIHR will result only after peer review. The same standards of scientific excellence will be required in any arrangements.

Dr. Morin talked about Dr. Simard's experience. Here we had a situation where a brilliant discovery, which has gained international recognition, has been translated into a diagnostic test, but in order to develop that test American capital and some American expertise had to be found. So here we have the irony that a diagnostic test from a Canadian discovery now has to be purchased back by Canadian organizations at inflated prices. That's wrong. I think we need to develop mechanisms and approaches that are more productive, because in the end health and wealth are linked. A productive society should find ways and means.

Lastly, I would make the point that while some are concerned that the private sector will steer the priorities of CIHR, I would simply note that the private sector arrangements with MRC are 3% under the same arrangements I've specified—that is to say, there is no money going to industry. The money is going to the university researcher who sees an opportunity to engage productively in an arrangement that meets the standards of scientific excellence, and the leverage money from industry—it's actually an extraction, in my view—will be helpful to add to the pool.

On the issue of appointments, perhaps one of my colleagues might choose to speak to that issue. Perhaps Tom would care to comment from his own perspective. But I must say there's greater specificity—you suggested it's vagueness—in the characteristics that should be applied to members of the council in this bill than to the governing council, the board, my council, which I have enjoyed for the last nine years. So my experience has been that there is a great deal of interest, and I think the government is responsive to those views from the communities to appointments on the governing council.

• 1655

The Chair: I think we'll leave it at that. I think that covers it nicely.

Ms. Wasylycia-Leis, if in the next round you require additional information, perhaps we can do that at that point.

Mr. Thompson, please.

Mr. Greg Thompson: Thank you, Mr. Chair.

I want to echo the comments of the chairman and my colleagues in thanking you for your fine work. It really is nice to have all of you here.

I do have some questions that come strictly from the organization. I know we have had some questions on the government's side on the organization and the arm's-length relationship with the government that we would like to see. Very frankly, in the organization as described in the bill, I don't see that relationship being arm's length, and I don't see any independence from government. I'm really concerned about it.

If you turn to page 6, where we step through in the bill the organization itself, starting with the president, the president is appointed by the Governor in Council, which means the Prime Minister of Canada, at pleasure. I suggest to you that pleasure means he's at the disposal of the Prime Minister at any time.

If you go down to the governing council, it's the same thing. The governing council is appointed by the Prime Minister at pleasure, meaning that at the will of the Prime Minister they can be dismissed and replaced. The governing council, in turn, chooses the advisory boards. So there is a direct linkage from the Prime Minister's Office right down through as to who sits where and how long they will sit there. I think there is enough evidence within this institution of Parliament and the organization of institutes like this that this relationship is not conducive to independence and independent thought. We've had some very recent situations in Health Canada of where it can become a very destructive pattern of appointment. I'm really concerned about that.

The other thing I am concerned about is the funding levels. Again, I want to say that I do support this. I think it is an important initiative. But I do have these grave concerns, and I think they are legitimate. The funding itself will take us up to commendable levels within the OECD. As most of you recognize, we are lagging behind. I think that is very commendable.

In my examination of government over the years, that huge injection of money can do a number of things. It is nice to see the money, but I think it leads to, and can lead to, laziness and sloppiness in terms of how that money is spent. Again, if you examine any model in the western world where moneys are abundant and all of a sudden we have an organization that is there certainly at the whim of the government, I think it sometimes leads to mismanagement. Obviously I support the money going in, but I want to see some checks and balances and making sure.

It goes back to a question one of our other colleagues asked in terms of the institutes. Again starting with the Prime Minister's Office and how the organization is structured, these institutes will be determined by the governing council, which basically reports back to the Prime Minister of Canada. I think that can lead to some sloppiness, arrogance, and possibly callousness in how some of these institutes are set up, because, in a nutshell, I think you are going to be servants to your political masters.

The other difficulty I see is a reporting mechanism. There is a review process that will be set up for every five years, if I am correct. It will be a five-year review process. I think the review process has to be a little more intensive, and five years is probably going down the road far beyond what I think it should.

• 1700

I do agree that you can be called before this committee, but I think there has to be a little bit stronger reporting mechanism in terms of the involvement of the Parliament of Canada and the accountability and the measuring stick at the end of the day. Who will actually determine whether your objectives are being met? Will it be the Parliament of Canada, or the people sitting on the advisory boards? Will it be the president? Will it be the governing council?

I think those are legitimate questions. I know there are a lot of them there, and I appreciate the time I have had to throw those out. I will look for responses and see where the debate takes us, if you wish.

Thank you.

The Chair: Thank you very much, Mr. Thompson. Indeed, you do have a number of questions there, and I'm sure Dr. Friesen is already starting to sort through them.

Dr. Friesen, I wonder if you want to lead off on those.

Dr. Henry Friesen: I will touch on the questions very briefly, but I will also invite my colleague vice-chairs to respond.

On the issue of appointments, I think the facts are clear, and I think you have framed them correctly. Appointments are made by the Prime Minister's Office both for the governing council and the president.

The governing council is charged with meeting a set of objectives in legislation. That's a benchmark. There is a whole range of constituencies that are now even more engaged than was the case when it was the MRC. In a sense, we've broadened the perspectives and input of Canadians, who will be very interested and vigilant, and express their views, as I know they do now, on appointments.

While you are certainly entitled to express your concerns, I speak from experience. I operate under this arrangement now. I must tell you that all ministers of health I've dealt with, and there have been several, have been very respectful of the arm's-length relationship. I have never been put in the position where any of them have put in a call and suggested that the council do this or that. That has been my experience.

In terms of the appointments, again, we are consulted, but in the end it is the Prime Minister's prerogative, of course.

I would invite Eric and perhaps Tom to reflect their own experience of many years now on another council with the same characteristics.

Mr. Greg Thompson: Mr. Chairman, I have a slight point here before that response takes place.

What I have looked at is the American model, which I assume you looked at when you set this up, because nothing is created in a vacuum. There are always models you look at and refine. But I guess the National Institutes of Health in the U.S. are a model, the model we would be looking at in comparison to the institute we are talking about here today.

How does that model in the U.S. work in terms of appointments? I don't believe the President of the United States appoints to the degree that the Prime Minister of Canada does.

The Chair: Mr. Maldoff, did you want to answer that quickly?

Mr. Eric Maldoff: The Secretary of Health makes the appointments in the United States. The institutes themselves are free-standing separate bodies established by legislation and get their appropriations from Congress.

The information we had from the NIH is that it wasn't their favourite system in the world. It also created an ossified system that was very difficult to change, because everything became the subject of major political lobbies.

As concerned as one might be about government interference, for the research community, government is government, whether it's Parliament, the bureaucracy, or anybody else. Their concern would be equally great about major political interference as it would be about bureaucratic or ministerial interference.

That was discussed at great length among us, and it is a question of trying to find a balance. The people around the table are quite satisfied that this does establish the balance. There is genuine accountability. If the members of Parliament wish to avail themselves of the mechanisms here, there will be considerable accountability. The appropriations for this body to be created will come from the Government of Canada. The budget is voted by the Parliament of Canada.

• 1705

There will be an annual report that goes to Parliament and that report will deal with the objectives and goals, strategies and performance of the CIHR in every given year. The Auditor General will also be reporting as part of that.

I think there will be considerable opportunity for the elected members of government to address the CIHR as to whether it's on track, whether it's being efficient, whether it's making sense. We were very strongly in favour of an annual report that does go to Parliament, not just to the minister or into a department, or we publish some nice piece of paper, but something that will be laid before Parliament. Presumably this committee or some other committee can convene the CIHR leadership to account for what is going on.

The Chair: I am going to have to interject there. I saw Dr. Brzustowski also wanted to speak in response to Mr. Thompson.

Dr. Tom Brzustowski: Thank you, Mr. Chairman.

Given what we have heard and just for completeness, I can offer one piece of evidence for the independence of an arrangement very much like the one described in Bill C-13. That was in the case of a decision made under the program through a peer review process by an arm's-length panel and administered by ourselves in which the people who felt the scientific peer-reviewed decision had gone against them tried to go the political route to have it overturned.

What was very evident was that from the first moment and right through to the end, the minister in question was steadfast in refusing to have anything to do with any questioning of a decision that was reached through appropriate processes involving peer review—I might say, even at some political expense to himself. For me that is a beacon, and I take that very seriously.

Mr. Greg Thompson: If we have that strong kind of leadership in the ministry, I guess we will all be happy.

The Chair: Thank you very much, Mr. Thompson.

As I understand it, Dr. Friesen, there is a bit of a time constraint here; you must leave at approximately 5:15.

Dr. Henry Friesen: Yes, 5:15 is fine for me.

The Chair: We do have a couple more questions.

Dr. Henry Friesen: My colleagues will continue.

The Chair: Keeping that in mind, Mr. Szabo, if you would lead off, and then Mr. Jackson, followed by Mr. Charbonneau.

Mr. Paul Szabo (Mississauga South, Lib.): Thank you, Mr. Chair.

I am sure everybody is excited about the prospects of increasing the amount of quality research being done in Canada to be able to retain our research human resources, as well as get back the brain drain element, which Dr. Friesen has brought to the finance committee on many occasions. We are making progress here.

I have no personal concern about the accountability in terms of either the funds or the quality of the work. We are talking about professionals with a high degree of a professional code of ethics.

I am interested in something that flows from a statement of yours, Dr. Friesen, about the concept of focusing on results. I want you to give me some assurance or some insight as to whether or not results from your perspective are simply the production of a paper, or whether results really are something that are translating into recognizable determinable improvements in the health of Canadians. This is health care spending to me.

Mr. Maldoff may want to throw in a couple of words. I can tell him I was a little disappointed in the National Forum on Health's final report, because the language in the interim report, which I thought was very reflective of the individual research teams, seemed to be changed, softened, sanitized, and modified in ways that took some of the edge off some of the critical issues.

I would, with respect, refer to things like the Statistics Canada national longitudinal survey of children and youth, which made references to family, traditional family, etc. All of these were taken out of the final report. It also ignored the report's conclusion that 25% of Canadian children enter adult life with a significant physical, mental, social, behavioural, or academic problem, which to me represents a major challenge for research as to the determinants of the health of those children.

• 1710

It has an awful lot to do with something other than medical research. It has to do with social issues. It has to do with some other sensitivities.

Those are my concerns about where the rubber hits the road. How can we tell Canadians that the investment we are making in pure research is going to be translating into better health for Canadians?

The Chair: Who is going to answer that? Dr. Friesen.

Dr. Henry Friesen: I will leave the health forum question to Harry.

I think the issue you raise is a very important one. At the international conference on closing the loop—how do we ensure that the knowledge generated makes a difference to the health and the health care system and its integration—we had Henry Mintzberg, a guru in management. He made the point that it is so easy to measure things that really don't matter. The things that really matter are hard to measure. That would be true here.

I think I can answer the question by noting that the results from the perspective of the researcher are publications, publication of quality journals, publications that receive international acclaim and recognition. That translates ultimately in a scientific arena, of course, into the highest award, the internationally recognized Nobel Prize.

I think that has been a problem for Canada. Michael Smith is the last scientist who has won a Nobel Prize in the biological area who is resident in Canada. There are lots of ex-Canadians who won Nobel Prizes, but regrettably the reality is their resident address is the U.S.

We should change that. I think that too is an important measurement of results, to make sure, as the Prime Minister noted, Canada should be branded as the place to be for knowledge creation. One expression of that is the scientific norm and the awards that come with that performance.

In terms of the health of Canadians and the health system, there are also things like the lifespan. When MRC began, the lifespan was very much reduced compared to what it is today. It is argued that four to five years of research investment adds one year of lifespan, but it's quality of life that is also an issue.

So there are some very practical things that should be looked at, such as the efficiency of our health care system. We should be looking at some elements of the point I was making earlier about unnecessary X-rays. There are dozens of those examples.

I happen to believe that if we had invested more adequately in research in the health care system, maybe some of the pressures that those who are forced to manage or have the opportunity to manage the health care system—they would have found more innovative ways. An investment, for example, by Health Canada in more information measurement devices would mean that when the question comes up as to what are the facts about the pressures on the health care system, they are available. Too often they are not.

I think there are some really important questions buried in what seems like a simple question: how do we measure results? I believe that is going to be an important obligation of CIHR to deliver on.

The Chair: Thank you.

Mr. Maldoff, did you wish to address it?

Mr. Eric Maldoff: Can I defend myself for a moment?

The Chair: Go ahead.

Mr. Eric Maldoff: Thank you.

The final report of the health forum was the result of further deliberations after consultations that we undertook publicly and after a pretty difficult process at a time of severe budget austerity. There was enormous pressure on the forum not to be coming forward with recommendations that would just blow the ceiling off cost-wise.

My recollection is that part of the deficit situation was that it led to some grinding down of some of the things the forum wanted to do. It was an environment where, for fear of discrediting the whole report, spending a dollar was heresy. Everybody was so deficit-conscious.

• 1715

It did result in some good things, which I will come back to. Child poverty was a key theme of that report. It's been a very major initiative of this government over the last few years in terms of the investment that has been made. I don't know if it's coincidence, but certainly the members of the forum feel that was helpful.

In terms of your rubber-that-hits-the-road question, we are right now, happily, in a situation where there is more money available to government, and government can make some choices as to where it wants to spend that money. By broadening the health research agenda and stating the mandate in this way, I think it creates a serious opportunity now to see results translated into better, and very practical, health outcomes.

What do I mean by that? By having a series of institutes, we're going to create an internal competition within the CIHR itself. Institute directors are going to be in there competing for budget. They're going to have strategic plans. Those plans are going to talk about how to translate knowledge into practice, into changes in health. When they come back every year to ask for more appropriation from the governing council, they are going to have to show what results they have achieved.

With ten institutes, somebody is going to start making some headway, and everybody is going to start following very quickly. We hope we can create a dynamic that will work to satisfy the concern you have expressed, because it has been paramount for us as well.

The Chair: Thank you very much.

I wanted to ask Dr. Friesen a question before he left, but I think he's gone know.

Maybe, Mr. Maldoff, you can help me out. In his remarks earlier, Dr. Friesen talked about enshrining an ethical framework in health research. I wonder if you can elaborate a little bit on how that is done in Bill C-13.

Are you familiar with that?

Mr. Eric Maldoff: I'm not sure, but perhaps Yves can answer.

Dr. Yves Morin: For the first time for a council of this type, ethics were included, and in three different parts of the bill. It will be enshrined at two levels. First, it will be enshrined at the level of the governing council, where there will be an office of ethics as recommended in the creation of the institutes. In addition to that, every time one of the institutes puts in a strategic plan there will have to be an ethical consideration to it.

So it's really at two levels, at the governing council level, where there will be an office of ethics, and at the institute level, where each program will have to be considered in terms of ethics. In addition to that, of course, there will be support for the discipline of ethics, as with any other research.

Next week, apparently, you will be meeting with Dr. Bartha Knoppers, a leading ethicist. She is chair of our ethics committee.

By the way, the report of the ethics committee should be on the web within the next few days.

The Chair: Thank you for that clarification.

We are back into rotation now, starting with Ms. Wasylycia-Leis.

Ms. Judy Wasylycia-Leis: I will try to ask just four short questions.

The first goes back to the question on the private sector. I heard the response, and I still have questions on that. The working group of the interim governing council actually states that the CIHR should ensure that its research priorities are set at arm's length from commercial concerns. Could you tell me where in the legislation that is entrenched?

A second question has to do with the governing council. Since we are talking about a transformative approach to research, I wonder if we shouldn't try more innovative approaches around the governing council and actually include it in the bill that the make-up of the governing council be based on gender equity and regional balance.

I have another concern about women's health. I don't know how the institutes will break down and whether or not there will be a separate women's health institute, but I wonder if there couldn't be something in the legislation that recognizes the need for gender analysis to be a crosscutting theme across all institutes.

• 1720

The third question has to do with a concern I think folks will have about whether in fact, with this new model, money and projects will get down to all regions of the country, even those where there may not be a strong tradition of research. Will they get down to the community level and get down to non-traditional qualitative projects? How will that happen? And along the lines Greg Thompson suggested, would it be important to have some mechanism to evaluate the institute as it goes along over the next, I would suggest, three years, since the money flows bit by bit up until the year 2002, until it's fully operational? Could some evaluative mechanism not be put in?

The final question has to do with ethics. I'd still like to know where that issue is seriously dealt with in the bill, because we've had concerns raised, and the concerns are about whether or not CIHR is the appropriate place to regulate itself. Should you have a self-regulating process around ethics? Shouldn't there be some sort of independent review, especially given the concerns that have been raised with what's happening in TPP and how changes are being made with respect to human research subjects in phase one trials? There's a real concern that at the government level, there's a watering down of the whole process and a stringent regulatory process is not required.

In the context of that, shouldn't we have at least a stronger approach to ethics in the bill?

The Chair: As usual, there are a number of questions. Thank you very much.

Who's going to lead off with this?

Dr. Yves Morin: Concerning ethics, as I said, Bartha Knoppers will be here next week. She's really our ethics expert. She's the one who worked on this. Actually she's surprisingly pleased with the bill, because she said it's the first time in a bill that ethics is mentioned at three points. I'm quoting her.

Your concerns are well taken. She had an important part to play in the creation of this body, and she is, by the way, the leading ethicist in Canada. So she'd be the person.

Ms. Judy Wasylycia-Leis: Okay, fair enough.

Dr. Yves Morin: I'd like to deal with the community thing, and then maybe colleagues will deal with the other questions.

As you know, eastern Quebec has many small communities, and a program has been set out by the transition team for year one of the CIHR. As you know, the governing council will not be in existence for year one, so a transition program will allocate money for various funds. That too is on the web.

There's what is called the Community Alliance for Health Research, and $10 million has been put aside for this program. This is funding that will be given to community organisms—for example, a volunteer organization that would deal with a special need in a community. The money is given there, and then there will be health researchers within the community and outside. The research done will involve the community and will profit the community. This is outside large centres. This is outside large universities. There's a lot interest in that—a lot of interest. People are interested in and enthusiastic about it.

It's really the first time we're doing this, and it's important, because many communities have specific problems. For example, Saguenay—Lac-Saint-Jean has a problem with congenital disease, and it's important to have research.

So following your question, this is a major breakthrough in community research.

The Chair: Dr. Brzustowski.

Dr. Tom Brzustowski: Let me very briefly add just one thing to the answer on ethics and try to address the question on balance.

On ethics, there's one more level beyond the granting councils. The three councils together—that is, SSHRC, MRC, and NSERC—have published a tri-council policy on ethical conduct in research involving human subjects. That puts the responsibility on each of the research-performing institutions to have their own research ethics boards and be involved in dealing in a very ethical way with the design of the research—not picking up the pieces, but at the design stage.

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Parenthetically, you should know these things are not done without cost, and that is part of the growing indirect cost of doing research, which generally is not supported at the universities.

On the second point on balance, in our own experience, the NSERC council has a maximum of 21 members in addition to the president, so it's comparable. In the appointment of people to NSERC council, one tries to achieve a balance among regions; among linguistic groups; between genders; among private sector, academic, and government researchers; and among discipline groupings, such as life sciences versus physical sciences versus engineering. To try to do that with 21 people is really quite a challenge.

Nevertheless, at any given time, if one were to come to a council meeting, one would see something very close to an acceptable balance of all participants in these interests, these representations. And the appointments are made exactly the same way as they are described in the bill.

Ms. Dorothy Lamont: I'll try to comment on your first two questions.

The first one, as I understand it, is your continuing concern about industry influences in the whole process.

Ms. Judy Wasylycia-Leis: Yes.

Ms. Dorothy Lamont: There's no question that there was a fair bit of debate about this at the IGC, and in fact very clearly the notion was that the health of Canadians and things that are going to influence the health of Canadians were absolutely pre-eminent in our expectation. Where commercial interests and the interests of the health of Canadians intersect, then fine, but the absolute, number one issue here was health research that was going to impact on health. So that was certainly the intent of the IGC.

On your second question about the balance and so on within the IGC, again we talked about this at length. You'll notice the phrase “women and men” as opposed to “men and women”.

Ms. Judy Wasylycia-Leis: Yes, I was going to say that.

Ms. Dorothy Lamont: I can assure you that was a hard-won issue in and of itself. So it is not insignificant that it's there.

Again, the issue becomes a slippery slope if we start saying we must have so much of this and so much of that and so much of the other thing. We were very constantly concerned, in developing our legislative recommendations, that we remember this legislation is going to have to stand the test of time. Yes, I'm sure gender issues and regional issues will continue over time, but there are many issues that may become new issues that would have to be balanced in the process. So we felt we were better to be less proscriptive for that reason: we wanted this legislation to be able to stand the test of time.

Many people have particular concerns. Certainly some of my voluntary-sector colleagues, I can assure you, have wanted to see a very clear representation in the governing council, but they seem satisfied and are satisfied with the fact that it's important to get the best people and a basic confidence that the right things will be recognized when these appointments are made—not just the initial appointments, but the appointments for many years to come.

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

Mr. Eric Maldoff: Mr. Chairman, I have one point that should be spoken to very briefly.

Moving to a three-year review we think would be an error. It is going to be a major endeavour to get this up and running and the system to be full-blown operative. The transition from where we are to where this vision takes us we estimate will take five years. If in the middle of this we start reviewing....

The idea of the review is to review the output and what's happening. If in mid-course we throw the whole thing into a review, I think we're just going to delay the ability of it to get up and running at full speed.

Ms. Judy Wasylycia-Leis: I'm talking more about a built-in evaluation mechanism so that you can check where the money is flowing and whether it's accomplishing all the goals and objectives that were set out.

Mr. Eric Maldoff: But that will be in the report to Parliament, plus the standing committee is mandated by this legislation, which will create a lot of screaming rights, if nothing else.

The Chair: Thank you very much. That was a very important clarification.

I have two patient questioners: Mr. Jackson, followed by Mr. Charbonneau, who's the parliamentary secretary to the Minister of Health.

Mr. Jackson.

• 1730

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

I want to welcome our guests and thank them for the work they do for all Canadians. They're actually forming a new organization, and more and more of our committee systems and more and more of the delivery systems from us, as a government, will have to go through that transformation.

As you said, you're going to move from the Medical Research Council to the CIHR. I congratulate you as a group for being able to make that decision without anyone getting territorial about keeping the Medical Research Council because of its origins and the comfort zone you had.

There's no question that among the general public there's a lot of knowledge out there, some of it good, some of it bad, and some of it just from the Internet, where nobody knows who the authors are. There's going to be a lot of filtering, and there's obviously going to be a lot of feedback and a lot of information flowing back and forth. As I listen to my colleagues, not only here but in the House, I wonder if we're leading or following with some of the ideas that we as a government believe about the way we should govern.

Personally, I believe all of us, whether it's the government or yourselves, have to be open and fair. You have to take in all of the issues that we bring to you. If you're not doing that, then you're not a good organization. But I would say to you that I think you're one of the leading-edge organizations in trying to figure out how you will best deliver resources to Canadians.

Dr. Friesen has left. The last time he was here, he told me Canada provides about 3% of the knowledge base. Hopefully we're going be able to improve that, but I wonder if there are some statistics on what the Americans provide, for instance, and how those break down. That's one question.

The other question that always comes to mind for me is around the fact that when we started medicare I think we had some basic services and things like that. As we said, we had different challenges and problems forty years ago. Now we're forgetting sometimes that an ounce of prevention is worth more than a pound of cure. For instance, instead of having to retrieve a heart for transplant, if we had stopped the accident and they didn't run into a tree, then we would not have had to find a spare part with a heart.

So there's a whole bunch of stuff. There's health, there's diet, there's exercise, and there are some times when the prognosis is that the thing is terminal but people still think maybe machines would help them.

Most countries use between 9% and 14% of their GDP. I wonder how you're going to handle that in terms of the amount of research you need. When we listen to people across the way, it's always with more money, more money. If you use more money, you could use $163 billion, but we'd still be trying to use even more money. You have to look at some of these things, and you may change that. You may say it should be more than 9% of GDP simply because we're using more machines now, we're using more imaging things, we're changing more knees, or we're doing more eye operations.

So I guess I have two questions. First, how does the world stack up with the knowledge base? Secondly, who in your organization will look at the stats in terms of GDP, for instance, and the delivery systems for Canadians?

Dr. Yves Morin: Thank you very much for these very good questions.

It's very difficult for any country in the world to compare its health research with that of the United States. They're in a class by themselves. In Canada, if we just take the federal funding to MRC, we started out with $250 million. In a matter of three years, this has risen to $500 million with CIHR. And by the way, it's unique in the world that we've doubled our health research support in such a short time. That being said, though, the United States is up to $16 billion, which is about six times per capita what we are doing in Canada, and they still will have a 15% increase in their budget again this year. So they're in a very unique situation.

As mentioned earlier, we are creeping up in the G-7 group. We were nearly last until recently, but now I think we're fourth. The aim, of course, for Canadian health services research is 1% of what is spent on health in Canada, which would be $800 million. I think we're moving there, and I think the effort would place Canada in a very good position.

So I think we have to see what has been done. We're pleased with it. It's a major effort, and we have doubled, but we think there is still space left.

Mr. Ovid Jackson: May I interject, Doctor? That's fine for where you want to go, but how much of the world's knowledge do we produce in comparison to the Americans?

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Dr. Yves Morin: Well, I'm not very good at arithmetic, especially in front of a parliamentary committee, but if you say $500 million is 3%, then how much is $16 billion? That would give you a rough idea of what the U.S. effort is.

Mr. Ovid Jackson: There is a direct correlation between the amount of money you spend, then?

Dr. Yves Morin: Yes.

With regard to the other point, the cost of health care in Canada, of course it's very expensive. We spend $80 billion on that, and it's getting more and more expensive. The population is getting older. The technology you referred to is more expensive. But I think the creation of CIHR is a major step in terms of controlling costs.

Really, as I think Dr. Friesen said earlier, what we lack is information. We really don't know what we've been doing. We put money in an issue and we really don't know if it's improving things or not.

So a major part of the CIHR health research budget will be dedicated to the health care delivery system study. That, I think, will help us very much in rendering our system more efficient and keeping costs down. What we want to do, of course, is to keep costs down while still giving a maximum of service.

The Chair: Thank you.

Dr. Tom Brzustowski: I think I can help a little bit. The 3% is very important, but it's important also in terms of its implications—namely, that the other 97% will be available to us on the condition that we understand what other people are doing so that we are doing research ourselves and know what is important and what isn't.

These days you can say one can download anything off the net, but you have to know what to look for. You have to be able to assess the quality. You have to understand what it means when you get it. You don't do that without doing good research yourself.

So having good research funding and high-quality, world standards of research, as the bill says in several places, supported by the CIHR, will open the door wider than it's ever been to getting that other 97% for our use.

As for the United States and what they produce with regard to world knowledge on health, I think the number is something in the order of between 50% and 60%.

The Chair: Thank you very much.

Monsieur Charbonneau.

[Translation]

Mr. Yvon Charbonneau (Anjou—Rivière des Prairies, Lib.): It is my turn now to greet you and to congratulate you for the time that you have devoted to developing this bill. It is now up to us, as legislators, to adopt legislation that will enable the health sciences community to develop. Your work has been very important, and this is merely a preamble to what will be done in the future.

We will do everything we can, in several sittings, to hear the many witnesses and to discuss with our colleagues from the various parties, and to try to produce a bill that will not, I hope, be too far from your proposals and that will respect the spirit of your work and also reflect some of the suggestions that we may hear.

It is getting late in the afternoon. I would like to ask you a few questions, but I would like you to tell us something about how the performance evaluation will be conducted.

I noted, in reading sections 14 and 15, that the governing council may delegate the responsibility to "evaluate its overall performance, including with respect to the achievement of its objective," which is set out in paragraph 14(b). We see that section 15 provides for a delegation of responsibility, except for those listed in paragraphs (a) and (c). Paragraph (a) deals with strategic direction, and (c) concerns the budget, and these cannot be delegated, but evaluation can be delegated. What is the reason for this?

Also, I would like you to tell us something about the percentage of expenditures for administration. I know this question will be raised, and that it has already surfaced. You are familiar with the Medical Research Council. What percentage of the MRC expenditures covers administration, and how do you see this happening in the Institutes? Will this organization spend as much money, about the same percentage of money or less money for administration costs? There will not be one council, but 10 or 15 institutes. Will the administrative costs be proportionally higher? Naturally, all budgets will increase, including the administrative costs, but will there be economies of scale?

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The Chair: Thank you, Mr. Charbonneau.

Dr. Yves Morin: Thank you for your questions and for your comments concerning your review of our bill. I know that you will examine the whole bill very carefully.

As for the evaluation of its overall performance, there is a precedent. First of all, I must tell you that the annual report will not change. With respect to the overall assessment, there is a precedent: the Medical Research Council of Canada is regularly evaluated by an outside agency. It is evaluated by an outside organization that comprises people from various countries as well as one or two Canadians. The evaluation must be fully independent, and I believe that this is advisable. So we are talking about the possibility of calling for an outside assessment of the CIHRs by foreigners and Canadians.

This is probably why we have provided for the possibility of delegating this responsibility.

As to your second question,

[English]

what about the administration costs?

Mr. Eric Maldoff: Did you want to talk about the evaluation?

Ms. Dorothy Lamont: I actually think Dr. Morin has covered the evaluation question quite well. In fact that's one that should be done at arm's length in order for it to be done right, and it should be delegated in order for it to be a proper evaluation of the work of the governing council.

The Chair: Could we then deal with administrative costs?

Dr. Yves Morin: Do you want me to deal with the administration costs?

[Translation]

Dr. Friesen has told us on a number of occasions that the research budget, which is the major item, would account for 90% to 95% of the budget. Our structure will obviously be somewhat more centralized than those of traditional councils. However, all of the administrative aspects, including finances, personnel, research project assessment or the president's office, will be centralized.

There will be a small number of support personnel in each institute, perhaps two or three people. In other words, all of the administration will be centralized at the governing council.

Consequently, we can state that research will account for 90 to 95% of the budget, which is about the Canadian average.

Dr. Friesen has examined the budget and he assures us that from 90 to 95% of the CIHR budget will be applied directly to research.

[English]

The Chair: Just as a very quick question of clarification, I want to make sure in my own mind that I understand this.

On the interim governing council and its recommendations with respect to the institutes, what have you determined in terms of design, for example, or in terms of levels of funding, size and such? What about things like creation? What are you going to focus on? Has that in fact been looked at, and are you prepared today to speak about that?

Mr. Eric Maldoff: Institute design and institute creation have obviously been very important topics of discussion at the IGC since the drafting instructions or the recommendations were completed. We have had a working committee, chaired by Dorothy, that has dealt with that subject. Institute design is on the web now, so the thinking is out there. This is the heart of it. And if you want to go into a discussion on institute design, we're in a position to do so. You have the right people here.

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Dr. Yves Morin: We have the next five hours.

Mr. Eric Maldoff: But this is a serious discussion.

The one thing I would say is that we are an interim governing council. We are making recommendations. We made recommendations on legislative drafting instructions, but it's up to the proper authorities to develop the legislation that's before you. Similarly, we've worked up recommendations and are developing recommendations for the structure and operation of the CIHR. Ultimately, should this legislation be adopted—and I expect it will be—it will be up to the president and the governing council to decide what recommendations we've made that they wish to accept, if any.

The Chair: That's a good clarification. Did you say it's on the web, Mr. Maldoff?

Mr. Eric Maldoff: It is.

The Chair: So we can take a look at it, right?

Mr. Eric Maldoff: Have I misled them? Is it on the web?

A voice: Yes, it's on the web, and it's in the committee book that I understand the committee members will be receiving tomorrow.

Ms. Dorothy Lamont: Once they get the legislation.

The Chair: Very good.

Thank you very much. We've had a very productive meeting. I think that's obvious. Unless there are any further items, I want to thank each and every one of you for being here today. You've provided absolutely valuable insight for us, and we appreciate it very much.

Mr. Eric Maldoff: Mr. Chairman and members, we thank you for the time you have given us. This is a very important initiative. We are deeply appreciative of your attention. This is an initiative that has come from the research community, from Canadians seeking a modernized health research agenda. On behalf of all the people we have consulted and the members of the IGC, we thank you for your efforts and the time you have devoted.

The Chair: Thank you very much.

This meeting is adjourned.