Annual Report 2010-2011
Addressing Health and Health System Research Priorities
A Strategic Approach that Adapts to Change
CIHR's mandate calls for it to be a strategic and proactive agency, focused on areas of greatest importance to the health and well-being of Canadians.
To help guide the organization in fulfilling its mandate, CIHR's Health Research Roadmap established key strategic directions for the years 2009-14, including the need to address health and health system research priorities. Within that strategic direction are five priorities:
- enhance patient-oriented care and improve clinical results through scientific and technological innovations;
- support a high-quality accessible and sustainable health-care system;
- reduce health inequities of Aboriginal peoples and other vulnerable populations;
- prepare for and respond to existing and emerging threats to health; and
- promote health and reduce the burden of chronic disease and mental illness.
Investments in health research are the result of careful consideration of where Canada, relatively small in terms of population and the size of the health research enterprise, can have the biggest impact globally. By concentrating on areas of Canadian expertise, CIHR invests in discoveries that translate into better health products, smarter health services and more prudent health policies. Strategic planning ensures that Canadians get the most benefits from investments in health research.
CIHR must also respond to emerging threats and challenges. Whether the issue is pandemic influenza, the provision of isotopes for medical imaging or the consideration of new developments in treating chronic diseases, CIHR uses its unique ability to bring together the best researchers in Canada and focus their attention on emerging threats to provide value to Canadians.
Strategy for Patient-Oriented Research - Removing Barriers to Improve Health and Health Care
Ultimately, health research is about enabling people to be healthy. However, translating research findings into better clinical practices, more effective health products and efficient services — clear benefits for patients — is often an overwhelming challenge. Obstacles in the research-to-care continuum can prevent patients from getting access to new and innovative therapies.
Through the Strategy for Patient-Oriented Research (SPOR), CIHR is removing impediments to the application of evidence-based advances in diagnostics, treatments and devices in order to improve Canadians' health and Canada's health-care system.
CIHR's work on the strategy began with the distribution of a discussion paper in 2010 and the launch of nationwide consultations with clinician and non-clinician researchers, health professional associations, health charities, nursing groups, provincial and territorial governments and funding agencies, federal government officials and industry representatives.
The consultation process culminated in the final strategy document, which the President's Advisory Board released in early 2011, and the creation of a SPOR steering committee consisting of representatives from major stakeholders in the public and private sectors. Health charities, other health funders and several provinces have welcomed the initiative.
"We need to increase the investments that we're putting into the evaluation of interventions and services," said Dr. Paul Hébert, a senior scientist at the Ottawa Hospital Research Institute who has conducted a number of groundbreaking studies in critical care. He championed the SPOR initiative and served as special advisor to the President for its development. "CIHR can lead in that, but it can't do it on its own. SPOR is an attempt to get all of the stakeholders aligned under one vision. If it achieves that vision, Canadians will see better health care."
One of the key tasks SPOR has taken on is overcoming the daunting challenges involved in conducting multicentre clinical trials. For years, obstacles such as inadequate funding, an absence of a common contracts template to engage industry partners and overly complicated ethics review processes have stymied researchers. SPOR plans to clear the path by supporting thematically organized clinical research networks that, along with identifying research priorities and establishing clinical protocols, will provide national platforms to undertake clinical trials. The first such network, a national imaging clinical trials network, has just been launched.
How many patients are too many?
How many patients can a family physician manage while continuing to provide high-quality care? CIHR-funded researcher Dr. William Hogg of the University of Ottawa and his colleagues are undertaking a comprehensive review of how Ontario's family doctors are serving their patients. Using anonymous health-care data, the researchers are measuring quality based on criteria such as the degree to which patients receive recommended care to prevent illness. "For example, we can tell whether a patient is diabetic and whether they've received a particular blood test that is indicated for patients with that disease," said Dr. Hogg. The goal is to find the tipping point at which quality of care begins to suffer. "People need to know this in order to craft the health-care system so that the incentives are in the right place," said Dr. Hogg, who credits colleague Dr. Simone Dahrouge as the powerhouse behind the study.
Findings show promise against dementia protein
University of Alberta researchers have shown that beta amyloid, a protein that destroys brain cells and is associated with dementia, may be susceptible to a compound developed to prevent destruction of insulin-producing cells in diabetes. Since making their initial findings in rodents, Drs. Jack Jhamandas and David Westaway and their research teams have performed electrophysiological and cell culture studies to test the compound's ability to overcome beta amyloid cell destruction in human neurons. They found that "apparently it does," said Dr. Jhamandas. Demonstrating these findings in human brain tissue is important because rodents, which are usually used to study neurodegeneration, do not develop Alzheimer's disease. The results were published in the American Journal of Pathology.
The Drug Safety and Effectiveness Network - Answering the Big Questions
How safe are our pharmaceuticals? While clinical trials test the safety and effectiveness of any new drug, these evaluations usually occur in controlled settings with specific patient groups. Things are different when a drug enters the "real world."
Until recently, no single organization in Canada had the responsibility for conducting real-world or post-market research into drug safety. Through a partnership with CIHR and Health Canada, the Drug Safety and Effectiveness Network (DSEN) is filling that gap.
DSEN will generate new evidence to weigh the safety risks of drug products against their therapeutic benefits. The Network will contribute to building the knowledge base needed for the safe and optimal prescribing and use of drugs within the health-care system.
Led by Executive Director Dr. Robert Peterson, DSEN began by striking a steering committee to set priorities, creating a coordinating office and beginning to build a virtual network of linked "collaborating centres" for post-market pharmaceutical research. In the fall of 2010, DSEN issued a request for applications for a collaborating centre on observational studies. After review by a panel of international experts, CIHR awarded the Canadian Network for Observational Drug Effect Studies, or CNODES, $3.5 million in annual funding for five years.
"CNODES brings together a pan-Canadian representation of expertise in broad collaboration to address a very important area of research," said Dr. Peterson. "Such a collaboration will constitute the basis for success of CNODES in filling knowledge gaps of importance to the Canadian health-care system. Collaborations of this nature are essential components of the CIHR/DSEN program."
Two more collaborative centres structured around other analytical methodologies will be established in 2011-12.
"This is what we've been trying to do for years," said Dr. Samy Suissa, McGill University's internationally respected pharmacoepidemiologist and CNODES' leader. "We already have the expertise in Canada — world-renowned expertise — but it was always individuals working separately. Now we will form a single Canadian entity working together and using cutting-edge methods to look at major drug-related questions of public health interest to Canadians and the rest of the world."
With research teams operating in eight centres across Canada, CNODES has begun investigating whether high doses of statins, which are prescribed to millions of Canadians to control cholesterol levels, are associated with kidney failure. "That is a question we can't study individually because each dataset is not sufficiently large on its own to identify the necessary number of high-dose statin users," said Dr. Suissa. "But by pooling the resources and the data from several provincial databases across Canada, such as the Régie de l'assurance maladie du Québec and the Ontario Health Insurance Plan, and using state-of-the-art methods, we'll be able to rapidly answer that question."
The overarching idea of DSEN is to bring investigators and information users together so that post-market drug research addresses identified information gaps. Partnerships with other organizations, such as the Canadian Institute for Health Information and the Canadian Agency for Drugs and Technologies in Health, will further expand DSEN's capacity.
"This initiative has allowed us to have this collaboration, something we wanted to do for a long time but didn't have the means to do," said Dr. Suissa. "DSEN is the means."
DSEN Catalyzes Research into Drug Safety
In January 2009, the Government of Canada committed $32 million to DSEN, to be allocated incrementally over its first five years, followed by $10 million annually in subsequent funding. From that initial funding, DSEN has already launched 14 one-year "Catalyst" research projects, worth $1.3 million:
- Using Genomics to Address Drug Safety in Children with Traumatic Injury: An Innovative Approach to a Common Problem. Principal Investigator: Dr. Samina Ali, University of Alberta.
- Use of Short and Long-Acting Beta2-agonists During Pregnancy and the Risk of Congenital Malformations. Principal Investigator: Dr. Lucie Blais, University of Montreal.
- Assisted Reproduction Techniques and the Risk of Major Congenital Malformations: The AtRISK study. Principal Investigator: Dr. Anick Bérard, CHU Sainte-Justine of Montreal.
- Real-World Effects of Bisphosphonates: Using Innovation to Link Datasets (REBUILD) - Phase I. Principal Investigator: Dr. Suzanne Cadarette, University of Toronto.
- Vincristine-Induced Peripheral Neuropathy in Children with Cancer. Principal Investigators: Drs. Bruce Carleton and Michael Hayden, University of British Columbia.
- Population Incidence of Serious Cardiovascular EventS and Medications for Attention Deficit Hyperactivity Disorder (PISCES). Principal Investigator: Dr. Colin Dormuth, University of British Columbia.
- A National Electronic Network for Rapid Assessment of Drug Safety and Effectiveness. Principal Investigator: Dr. Anne Holbrook, McMaster University.
- The Neonatal Safety of Breastfeeding During Maternal Use of Opioid Analgesics. Principal Investigator: Dr. Gideon Koren, The Hospital for Sick Children.
- An Observational Study of Cardiovascular Events Amongst Children and Adults Using Drugs to Treat ADHD. Principal Investigator: Dr. Mitchell Levine, McMaster University.
- The Feasibility of Using Community Pharmacists in Focused Surveillance for Drug Safety and Effectiveness: A Case Study of Anti-Hypertensives in Pregnancy. Principal Investigators: Drs. Carlo Marra and Larry Lynd, University of British Columbia.
- Exposures to and Outcomes of Prescription Drug Use During Pregnancy: A Population-Based Data Linkage and Analysis. Principal Investigator: Dr. Steve Morgan, University of British Columbia.
- Post Market Drug Safety and Effectiveness of Atypical Antipsychotics in Children With Disruptive Behaviour Disorders, Mood Disorders and Developmental Disorders. Principal Investigator: Dr. Tamara Pringsheim, University of Calgary.
- The Use of Atypical Antipsychotic Agents and the Risk of Breast Cancer. Principal Investigator: Dr. Samy Suissa, Jewish General Hospital of Montreal.
- Safety of Pregnancy Exposure to Antidepressants. Principal Investigator: Dr. Shi Wu Wen, Ottawa Hospital Research Institute.
Chronic Disease - An International Effort to Save Lives
Within the next decade, an estimated 388 million people worldwide could die of largely preventable conditions such as cardiovascular diseases (heart disease and stroke), several cancers, chronic respiratory conditions and type 2 diabetes.
To reduce those staggering numbers, CIHR has joined five of the world's foremost health agencies in forming the Global Alliance for Chronic Disease. The six agencies from Canada, Australia, China, India, the United Kingdom and the United States collectively manage about 80% of all public health research funding across the globe. South Africa and Qatar have since joined the Alliance.
In 2010, Alliance leaders drafted a core request for applications to fund research projects to address the critical problem of hypertension. Their goal is to provide joint funding opportunities for intervention and implementation research, with special consideration given to how such interventions could affect vulnerable populations in low- and middle-income countries and Indigenous populations in developed countries including Canada.
Canada is a main player in the hypertension research initiative, and several Canadian partners have joined forces with CIHR in this international endeavour. These include International Development Research Centre, Grand Challenges Canada, the Heart and Stroke Foundation of Canada and the Canadian Stroke Network. "CIHR's effort to work at an international level to be more effective in the management of risk factors is commendable, and we are happy to join forces in this international effort," said Dr. Antoine Hakim, CEO and Scientific Director of the Canadian Stroke Network.
The Isotope Crisis - A Rapid Response to an Urgent Situation
In the wake of the breakdown of the Chalk River reactor facility, CIHR, with the Institute for Cancer Research in the lead, has been quick to respond to the urgent need to find other reliable sources of isotopes for medical imaging.
Working in partnership with the Natural Sciences and Engineering Research Council (NSERC), in June 2009, CIHR launched an accelerated request for applications to speed the development of replacements for Techetium-99 or to support research on alternative means of production of this isotope. Within months, seven 2-year projects, with a total budget of $5.4 million, were under way across Canada.
Building on that momentum, CIHR and NSERC joined forces to organize a Medical Imaging Workshop in late 2009 that convened leading national and international researchers in the life and physical sciences to exchange ideas on overcoming the isotope shortage. One key recommendation was the creation of a national imaging clinical trials network.
The Government of Canada responded accordingly in its February 2010 budget by awarding CIHR $10 million to establish a national imaging trials network. By June 2010 a request for applications was launched and an international panel awarded funding for a pan-Canadian interdisciplinary imaging network. Under the direction of Dr. Jean-Claude Tardif of the Montreal Heart Institute, the network is now up and running at several centres and is uniting — for the first time — Canadian researchers involved in a variety of imaging technologies and medical disciplines in a common cause.
"It's a tribute to the Institute of Cancer Research at CIHR because they are the people who have driven this and have really made things happen," said Dr. Alexander (Sandy) McEwan, Chair of Oncology at the University of Alberta.
"CIHR made money available through the joint program with NSERC for research into alternatives and two or three groups have come up with quite good options," said Dr. McEwan, who is also Medical Director at the Cross Cancer Institute in Edmonton. "I've been very impressed with the process that CIHR put in place to put a network together to look at those alternatives and at the best ways of validating them quickly and effectively. It was a very quick turnaround. We've had the right people guiding it from the CIHR level, showing that the system can work and be reactive."
CIHR has also reached out internationally to meet the medical imaging challenge, co-organizing a workshop with Cancer Research United Kingdom and the National Cancer Institute of the United States in the summer of 2011 in London, England, to explore potential international collaborations. It is anticipated that such collaborations will expedite the use of new biomarkers and imaging technologies in clinics and advance the field of personalized medicine.
The Search is on for Other Isotope Sources
CIHR and NSERC are currently funding seven 2-year projects aimed at finding replacements for the Technetium-99 isotopes currently used for medical imaging, and at examining alternative means of production. These are:
- Cyclotron-Based Production of Technetium Radioisotopes. Principal Investigators: Drs. François Bénard and Thomas Ruth, University of British Columbia.
- Rubidium-82 - An Alternative Radiopharmaceutical for Myocardial Imaging (Rb-ARMI). Principal Investigators: Drs. Robert A. De Kemp, Rob Beanlands, George A. Wells, Ottawa Heart Institute Research Corp.
- Replacement of 99mTc-Macroaggregated Albumin with Biodegradable 68Ga-Labelled Microspheres for Lung Perfusion Imaging. Principal Investigator: Dr. Urs Hafeli, University of British Columbia.
- Substitution of 99mTc-labelled Red Blood Cells with a 68Ga-Labelled Polyglycerol for Cardiac Blood Pool Imaging. Principal Investigator: Dr. Urs Hafeli, University of British Columbia.
- Iodine-123 Labelled Rotenone for Myocardial SPECT Perfusion Imaging. Principal Investigator: Dr. Terrence Ruddy, Ottawa Heart Institute Research Corp.
- The Formulation and Clinical Testing of I-123 Lodohippuran as an Alternative to Tc-99m MAG3 for Assessment of Renal Function in Patients with Kidney Disease. Principal Investigator: Dr. John Valliant, McMaster University.
- Seventy-to-Ninety Per Cent Reduction of Tc-99m Required for Breast Cancer Lymphoscintigraphy. Principal Investigators: Drs. Pamela Zabel and Muriel Brackstone, London Health Sciences Centre.
CIHR Drives International Effort to Deal with Dementia
Alzheimer's disease and related dementias have been called a "rising tide" with the power to overwhelm health-care systems across the planet.
Unless research-driven treatments or interventions are introduced, more than 1.1 million Canadians — about 3% of the population — will be living with Alzheimer's disease or a related form of dementia within 30 years.
Because it will take a coordinated international effort to turn back the tide, CIHR has created the International Collaborative Research Strategy for Alzheimer's Disease (ICRSAD) to combine Canada's efforts with those of other countries so that Canadian researchers exchange knowledge with international colleagues and Canadians have rapid access to the latest preventive, diagnostic and treatment approaches.
"We're quite fortunate in Canada to have a cadre of experts in the field of dementia research," said Dr. Rémi Quirion, ICRSAD's Executive Director. "We're excellent, but we're a small team. To be able to tackle a problem of the magnitude of Alzheimer's disease we need to work with other groups around the world to make faster progress to find better treatments."
Dr. Quirion points out that Canada has produced world-leading work in dementia research. "So, for us at CIHR, when we discuss collaborations with international partners they know about our scientists, they know about the quality of their work and it's easy to open doors."
CIHR is also working in partnership with the Alzheimer Society of Canada, which co-hosted a Canadian Consultation Meeting during the International Conference on Alzheimer's Disease in July 2010.
Global Effort: Maximizing Resources to Combat Dementia
- In June 2010, CIHR, the German Centre for Neurodegenerative Diseases and the United Kingdom's Medical Research Council agreed to work together to establish uniform guidelines and technologies for neurodegenerative diseases. The agreement will help remove obstacles to aligning research into critically escalating conditions such as Alzheimer's disease. "We understand the importance of working together to ensure uniform global standards," said Health Minister Leona Aglukkaq. "I commend CIHR for its leadership in developing this initiative."
- CIHR has contributed $1.6 million of a total $8 million for collaborative projects with researchers in the United Kingdom, Germany, Belgium and Italy on Alzheimer's disease and related dementias.
- CIHR is providing $1.5 million for five Canadian sites to collaborate with 55 U.S. centres in the second phase of the Alzheimer's Disease Neuroimaging Initiative. The study is monitoring 1,000 people aged 55 to 90 over five years to detect changes in brain structure and function as mild cognitive impairment, a common precursor to Alzheimer's disease, develops.
- CIHR is investing $1.4 million in a $5-million France-Quebec-Canada collaboration that is helping to fund five research projects in the diagnosis, treatment or management of patients with Alzheimer's disease or related diseases.