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opinion: canadian healthcare choke points put patient lives at risk
canada’s healthcare system is strained. it was always strained. it was designed that way.
canada leading in healthcare research but challenges remain for bringing treatments to patients: dr. tom hudson
dr. tom hudson's optimism about the future of healthcare in canada is tempered by a deep understanding of the challenges and practicalities.
the centre at mcgill university in montreal is recognized for genome studies for common diseases where it partners with labs around the world.
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when it comes to leading scientific discovery, whether it’s in a lab or on a discussion panel to rally policymakers and investors, dr. tom hudson is a visionary.
he has an md from the university of montreal (along with his twin sister who works in public health) and decades of expertise that includes a fellowship at mit where he worked on the human genome project to build a physical map of the human genome. his work with a team of biologists, engineers and mathematicians pioneered robotics and data technology tools for health research.
his optimism about the future of healthcare in canada is tempered by a deep understanding of the challenges and practicalities, however he still believes meaningful advances in research and patient access to new and innovative therapies have been made.
“the more we understand science and we understand which patient is going to respond to a drug, the better clinical programs we can have and the better ability to show the benefits in that patient population for precision medicine,” says hudson, a canadian scientist and authority on human genetics and disease.
“we’re going to see more tailored therapies for patients, not just in oncology, but in immunology and neuroscience. and these will be gamechangers, obviously for alzheimer’s, parkinson’s disease and the older population. there’s a huge unmet need that’s going to continue to be important for society,” he adds. “i see a lot of hope to actually penetrate some disease areas where progress has been slow.”
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that is hopeful. in canada, the number of people aged 85 and older has doubled since 2001, reaching 861,000 in 2021. according to population projections, this number could triple by 2046. although younger-onset neurodegenerative disease is rising, aging is a risk factor. one in four seniors age 85-plus have been diagnosed with dementia, for example, and the prevalence more than doubles every five years for people 65 and older, notes the canadian institute for health information. the added pressures on healthcare services and caregivers to help aging canadians is one growing concern that comes with changing demographics.
canada as a leader in innovative research
hudson wants to have a hand in helping canada continue to make its mark in the life sciences, like biotechnology and pharmaceuticals. he’s played a significant role in this effort already in his career at mcgill university where he established what’s now the mcgill university and genome quebec innovation centre to identify genes involved in asthma, multiple sclerosis and inflammatory bowel disease. he was also president and scientific director of the ontario institute for cancer research in toronto heading up studies in prevention, detection and treatment.
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now hudson is chief scientific officer for the american pharmaceutical company abbvie in chicago where he leads global research and development partnerships. part of his job is scouting new drug therapies that he can help take to market – and ultimately benefit patients who need them. he spoke to representatives of the public and private health sectors at a public policy forum in ottawa about where canada shines and what we need to improve on, and shared his insights with healthing.ca in an interview after the event.
first, he says canada has a lot going for it in terms of research and how we rank on the world stage. “at all the international meetings, you are always seeing canadians that are actually giving some of the big talks [on medical discoveries].” the research community has hubs of innovation at universities and research institutes, and the results of high-quality work are widely circulated in science journals and promoted at conferences. another stronghold is the clinical research, including multicultural clinical trials, where therapies are tested in patients.
“it’s not surprising that canada is the second country after the u.s. for abbvie partnerships because it has the infrastructure: clinician scientists, labs, follow-ups of patients,” he says. “it’s been shown many times that patients have access to more care and more follow-up with new drugs here so it’s a win-win for everyone.”
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here and abroad, canada’s science is well regarded. in hudson’s specialty of genetics and genomic investigation, for example, he points to successes from leading research for cystic fibrosis out of sickkids hospital in toronto and our advances in alzheimer’s treatment.
the centre at mcgill university is recognized for genome studies for common diseases where it partners with labs around the world. collaboration is a key driver for innovation, he explains, noting his work at mcgill to form the canadian genetic disease network with geneticists across the country.
“we developed tools in genomics at mcgill and applied them to colon cancer, asthma, leprosy, cardiovascular disease. we had 500 collaborations across canada. i had a chance to work on many, many different diseases and use the centre as the engine for this new wave of genetic approaches,” hudson says.
science on rare diseases is also a leadership area for canada, where researchers have pushed to make sure that children with rare hereditary diseases still have access to innovation. the canadian institutes of health research is working to establish a national pediatric rare disease clinical trials and treatment network to streamline clinical research and connect patient families, healthcare providers and policy and regulatory bodies.
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“it’s a very tight scientific community in canada which is very good. so we’re able to set up some critical mass of projects through collaboration. i formed all types of collaborations with labs across canada and then we’d have experts come to canada to review for funding.”
the challenges of bringing research to clinical practice
funding for bringing discoveries from the lab to trials in patients is more challenging in canada for a number of reasons, but it’s something that hudson flags for more discussion and strategy. “it’s one thing to discover, but it’s another thing to have a path to show that it works in patients.
and in canada, a lot of good projects get started and small companies get started, but they don’t mature at the same level.” pharmaceutical companies like abbvie have more drug development in the u.s. and increasingly in china because projects there are typically more mature with more data and validation of drug safety and effectiveness.
how do you make that happen?
a 2022 review of the literature on barriers and facilitators of translating research evidence into clinical practice notes that finding solutions is a global priority because of the potential impact on health services delivery and outcomes. so, it’s not a rally cry for canada’s life sciences sector alone. the authors noted the knowledge disconnect happening between healthcare professionals, researchers and policymakers, and identified the need for building technology like web-based conferencing for “robust collaboration and connections” to help all stakeholders participate in the process.
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that process is long and competitive, and hudson stresses building a framework to take innovation forward starts with the kind of dialogue that resonated with participants at the public policy forum. the aim is to bring experts around problems to solve them.
“the bar is high. you always have to come with drugs that really help patients’ unmet need for therapy. there’s also the importance of being there first because it’s very competitive. part of it is great science, but it’s also having speed, executing clinical trials, getting approvals and getting to market.”
hudson explains that investors in canada are skittish about making investments on products that might take 10 years. because, of course, how do they get the return on investment if they don’t have that predictability of a market? solutions could be ways to incentivize investment and get the word out about drug discoveries underway.
and while canada has health authorities who want to keep canadians safe and do the right thing for patients, innovation is at a disadvantage because of a fragmented healthcare system where drug approval can take two years after the already lengthy process of clinical trials.
adopting best practices from other world leaders
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like businesses across all sectors, there’s success to be found in adopting best practices from other places. hudson applauds japan for looking at new drugs that show something that could be transformative and allowing for special approvals and fast-tracking. if superior data is maintained, health authorities have input in the project and promote getting medications into practice. the u.s. has a similar incentive with its breakthrough therapy designation to expedite the review of drugs for serious conditions that demonstrate substantial improvement over available therapies.
“we all want to bring superior therapies to patients, so there is a path where all of that can accelerate by a couple years going to market. that’s even before getting the approval because we can go from phase two to phase three based on interim data that still shows that strong response and that superior efficacy and safety profile. there are incentives that are given along the way.”
after seven years at abbvie, he knows the value of bringing in larger companies and stable employers to advance projects and benefit the economy. these become clusters that can accelerate even more innovation because there’s now a community of physicians, scientists and managers that understands how to bring projects forward, he says. those ecosystems are thriving in places like boston and san francisco where many companies are on board that have a qualified workforce and educated investors who want to contribute and make a difference.
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the business of health in canada: supporting patients and researchers
hudson speaks from his experience as a business incubator and expert scientist, coming back to the point that at its heart, scientific discovery in health is about helping patients as much as it is about supporting canada’s economy and researchers.
“i’d like to know that everyone has access to their best care and that canadians don’t have to go to the u.s. to get that access. it’s one thing to do discovery, but if we don’t bring benefits to patients, we kind of miss the whole goal,” he admits.
that access to care is not just based on cost, but on the larger picture of human health and vitality. better care means less hospitalization, longer lifespan and better quality of life, and helping those who’ve had health setbacks get back to work.
as hudson sees it, these goals are what’s driving biotech and drug discovery. “the dialogues are often on cost, but i’m on the other side that’s pushing transformative innovation. it’s really about bringing new options to patients. those are the projects that you want to make sure that there’s an opportunity for a faster pass or other types of incentives. and those are the ones that are the easiest to justify because you measure the benefit, not just in the drug response and safety – you measure it in quality of life.”
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karen hawthorne is a toronto-based writer.
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