Canada's new and better-funded medical research agency will have a holistic view of medicine at its heart. Philip Fine reports
Canada has launched a revamped medical funding agency that will try to get a wide range of health-care researchers to collaborate across disciplines.
The country's Medical Research Council changed its name in June to the Canadian Institutes of Health Research (CIHR) so it could employ a new philosophy that takes in a wider cross section of scientific inquiry. It is hoping to foster an environment in which the sociologist will write a paper with the geneticist, and the public health educator will sit down with the transplant surgeon.
While the old MRC will be recognisable within the new CIHR, with funding of basic biomedical science remaining intact, the new agency has had its overall budget boosted by the federal government from C$0 million to C$500 million (from Pounds 120 million to Pounds 225 million). Those extra funds will help support the new philosophy and will also bring to the fold a number of additional researchers, whose work on health care does not fall within traditional biomedical criteria.
"Rather than evolving the MRC, it was better to start from scratch," says the CIHR's new president, Alan Bernstein, a University of Toronto professor of molecular and medical genetics. He explains the agency's philosophy as one that gives equal weight (but not necessarily equal funding) to the pillars of health-care research. They include biomedical, applied clinical, health-care systems and services, and research as it applies to society, culture and other factors such as behavioural determinants. That means one funding body will attempt to put such research stalwarts as diabetes or cardiovascular disease in front of several prisms - from genetic predisposition and diet to socioeconomic determinants.
Much of the credit for conceptualising the CIHR goes to the former head of the MRC, Henry Friesen. The CIHR is trying to look at medicine from "molecule to community", explains David Naylor, the dean of the University of Toronto's faculty of medicine and one of 19 members of the agency's governing council.
He says the time is ripe for a funding agency to go beyond the typical "disease-based policy". "As medical science drills down past the post-genome era, we need to link biomedical advances with clinical and community health concerns," he says.
The CIHR had been considered for years but was stalled by budget cuts and turf wars. Unlike the British model, where 1 per cent of the health budget is put into applied research managed by the National Health Service, the Canadian funder puts not only applied and basic science under one roof but brings in disciplines that would usually be more accustomed to getting grants from the Social Sciences and Humanities Research Council.
Many researchers have praised the CIHR's increased budget and have drawn hope from the broadening of their mandate. Bernstein was also pleased that an inaugural meeting of the CIHR in June drew enthusiastic responses from top researchers. Both the conference and subsequent emails have praised the new organisation's wider mandate.
The CIHR plans to offer incentives for "risk-taking" collaborative research, and Bernstein says he saw people ready to look widely at their discipline. "They all seemed ready to roll up their sleeves. I have not sensed any of that turf protection," he says, adding that this probably would not have been possible without increased funding from a now-enthusiastic federal government.
However, one researcher whose work linking bone density and diet would seem an obvious fit for the new mandate, does not trust the CIHR to include the type of work to which she is committed. Jerrilyn Prior, a professor of endocrinology and internal medicine at the University of British Columbia, says she has given up applying to the MRC.
Prior, who collaborates with psychiatrists, nutritionists and kineticists, says she sees no interest in trying to integrate women's health or clinical research in general into the federal funding body.
While the power to decide the research mandates may rest with the same jury panels, the new concept is at least giving a nod to higher education. The CIHR framework, which will keep the existing "virtual institutes" in Canadian universities, is helping to reassure academics that research will not be centralised in either Ottawa or Toronto.
The current funding framework is set out only until 2002. Some researchers, who fear that future governments may want to scale back the work of the CIHR, plan to continue lobbying government.
For now, the excitement is on seeing what a mandate of cross-fertilisation will bring. Bernstein, as director of Toronto's Samuel Lunenfeld Research Institute, has seen the benefits of fostering an environment where a bio-ethicist will call up a geneticist to work on a colon cancer study. He hopes that this will happen on a national front with the CIHR. Among his tasks is to set out a positive environment that praises - without enforcing - cross-disciplinary work. "You can't legislate collaboration."