A recently published CMAJ Q&A with David Naylor, chair of the federal government's new Advisory Panel on Healthcare Innovation, hinted at how Canada seems to be lagging when it comes to innovating in the health space. Last Thursday I attended the Canadian Academy of Health Sciences annual meeting in Ottawa, which focused on the commercialization of health research for health, economic and social benefit in Canada.
The forum began with a talk by former deputy chief of staff for policy in the office of the Canadian PM, Dr. Peter Nicholson. Nicholson talked about innovation in Canada beyond the health care arena and pointed out that Canadian business has only been as innovative as it has needed to be – i.e. not very – which has resulted in a decades-long low innovation equilibrium. Why? Because we are too comfortable in Canada. Canada’s good fortune in having vast natural resources means that business innovation is just not as pressing a need as for some other countries. And our proximity to the US is no help – Canadian business is comfortably and profitably integrated with US business (“the ‘junior partner’ in North America?” asked Bill Tholl, Founding President and CEO of HealthCareCAN) making it particularly challenging for Canadian business to embrace global business models, keep pace with revolutionary technology, establish significant positions in sophisticated global value chains and develop clusters of skills and infrastructure that enhance innovation, Nicholson said.
It seems that dragging innovation in the health care space is not an anomaly but mirrors that of general Canadian industry.
That doesn’t mean that we don’t have high quality research and development in Canada. We do. It’s just that this is driven by ‘push’ – tradition of excellence in research - and not by ‘pull’- demand on the corporate or user side for new ideas to invest in.
Weak policy plays in to the low-innovation equilibrium, argues Nicholson. If prosperity is delivered despite low innovation why have policies that drive innovation? Why fix what is broken. Historically, innovation policy in Canada has largely been a R&D policy with academic intermediaries. Nicholson pointed out that in the Federal government R&D policy is invariably assigned to a junior minister or is an add-on portfolio for a senior minister. The PM’s ‘science adviser’ has never gained traction – a very different situation to that in Korea, Japan and the US where science advisers have clout. In Canada there has been a revolving door of S&T agencies and advisory bodies. Nicholson called the CRA’s SR & ED tax incentive program ‘innovation policy on auto-pilot’. (Academics in the audience pointed out that form-filling and the need for expert advice to help with getting the tax credit turned researchers off from trying to claim it.)
What’s needed, according to Nicholson? Number one: strong federal policy that fosters innovation. Strategic public policy can anticipate and amplify the new incentives that are emanating from the global market and reward businesses that respond. This requires a more pro-active microeconomic policy than has been fashionable since the advent of ‘neoliberalism’ in the early 80s. And reciprocally….senior business decision makers need to engage more thoughtfully and collaboratively with policy-makers.
Bill Tholl, who kicked off a panel discussion, agreed with Nicholson. We have good ideas but have trouble capitalizing on them here in Canada. Mark Carney used to talk about the ‘500 million in dead money going nowhere and taking us nowhere in Canadian industry’, he said.
The additional challenge for health care innovation is that we are pretty much NEVER talking about a linear model of innovation. Health care is one of the most complex things on the planet and innovating in health care is not straightforward. Reductionist policies will not work. Tholl echoed the call for engagement strategies to encourage innovation in health care in Canada and to make it easy for academic and corporate players to come together. A cultural shift is needed, he said. No, our market is NOT too small (Who has the most NOBEL prize winners and patents per capita population? The tiny country of ISRAEL) and NO we don’t have to hold off until we can have very big impact.
Gabriela Prada of the Conference Board of Canada talked about the difference between innovation and invention. The difference, it seems is in the execution. An invention might never leave the laboratory; an innovation implies implementation and it is usually driven by business forces (‘pull’). Ms. Prada presented research done by the Conference Board that showed that R&D is sub optimally protected within industry in Canada – it is a low priority, and poorly protected, by the majority of company Boards. Yet Ms. Prada pointed out that the manner in which innovation is procured can prove decisive in turning a burden into a substantial advantage. Introduction of new products and processes into health systems has traditionally been perceived as a cost driver, which has prevented the adoption of innovations that can enhance health system performance and decrease overall costs. However, procurement is a very important policy tool. In Canada, where the health care system is public and the payer is big, the procurement advantage is huge. When used correctly procurement processes could be a strong tool to introduce innovation, and R&D shared between public and private bodies could lead to the innovation of customized products that meet the needs of the Canadian health care system.
A recent CMAJ blog “Medicine’s own brain drain” lamented the loss of trained medics to industry because there is just no one else to take good ideas and develop them. In it Shetty and colleagues pointed out that some universities are starting to cross pollinate business students into the scientific realm to try to foster the working together of science and industry in the future (for example, UBC’s Engineers in Scrubs (EIS) program and McGill University’s Medical Physics Research Training Network (MPRTN).
So there is hope, and perhaps we can be optimistic. But let’s hurry up already! Let's call for strong policy from federal government and break out of our relatively well-off comfort zone. (Yes, I’m talking to you Dr -well-paid-physician-with-too-little-incentive-to-change-the-status-quo!)