29 October 2007

Health research disconnects

Thirsting for clean, clear knowledge

You know, medicine is not an exact science, but we're learning all the time. Why just fifty years ago they thought your daughter's illness was caused by demonic possession or witchcraft. But nowadays we know that Isabelle is suffering from an imbalance of bodily humors, perhaps caused by a toad or a small dwarf living in her stomach.

Steve Martin as Theodoric of York, Saturday Night Live, 1978

When it comes to health research, Canadian lawmakers have shown they don't really know their toads from their dwarfs. A study published last week in the CMAJ (1) identifies "significant knowledge gaps among Members of Parliament" regarding this important issue. The men and women who set government funding priorities and vote annually to determine the budget of the Canadian Institutes of Health Research (CIHR), "were poorly informed about health research activities, benefits and costs in Canada." In fact, only 22% of participants were aware that CIHR is Canada's leading federal funding agency for health research, supporting the work of more than 11,000 researchers and trainees in universities, teaching hospitals, and research institutes across the country — and 32% knew nothing about its role. Although they valued health research in the abstract, participants did not seem to appreciate fully the impact of health research on the economy, nor did they understand research's role in the promotion of healthier lifestyles and the improvement of health care delivery. The study concludes: "Many of these knowledge gaps will need to be addressed if health research is to become a priority."

A Canadian Press article which appeared on the same day quotes one of the study authors, Patrick McGrath of Halifax's Dalhousie University (who chose his words carefully): "I feel that their knowledge of health research wasn't as good as I'd like it to be." The MPs ranked health care as the most important issue facing the country — topping security issues, economic growth and employment, the environment, and the war in Afghanistan. They also rated health research as the second most important funding priority, giving it an 8.2 rating on a scale of 10. However, they felt voters placed far less value on health research funding, and estimated voters would give it a 3.8 rating out of 10.

Christopher Paige, the Vice-President of Research at the University Health Network in Toronto and a professor in the Departments of Medical Biophysics and Immunology at the University of Toronto, wrote a commentary for the same issue of CMAJ (7). He perceives a "disconnect" between the MPs' acknowledgment that funding health research is important and their perception that Canadian voters don't care much about the issue. Paige told the media, "I think the voting public in fact does want health research to be well supported in Canada." He noted that a recent survey of the general public found 91% of respondents wanted more government investment in health and medical research.

Patrick McGrath told Canadian Press: "Here we have our members of Parliament thinking it's a wonderful idea to support health research. The voters think it's wonderful. And yet there's a disconnect there — the members of Parliament feel that the public doesn't think it's a good idea. Won't get them votes." According to Christopher Paige, the findings should be "a call to arms" for the scientific community. He sees policy-makers' lack of knowledge of health research funding as "a real barrier to progress" (7). As he told the media, "I think it just reinforces something that we do know in our community, that we have to be more effective at communicating how research is funded and what the key issues are. It's really as simple as that." He recommends a series of changes to funding regimes, including establishing a national system of credentialed research hospitals which would be eligible for federal and provincial funding to deliver health care innovations.

Health research in Canada is not yet sunk, but it is taking on water, according to a 1 Feb 2007 report in the Globe and Mail:
David Colman, director of the Montreal Neurological Institute, says huge investments are being made up front and then researchers are nickel-and-dimed on operating grants. If the best researchers can't get adequate funding, then the whole funding system is broken and the future of medical research is in peril, he warns. His exasperation is shared by many scientific and business leaders. After years of investment in health research (long overdue), the federal government has allowed budgets to stagnate, leaving not nearly enough money for operating grants. (And investments from provincial granting agencies and foundations are not making up for the shortfall.) ... [T]he situation recalls an old English proverb: "For want of a halfpenny of tar, the ship was lost."
In a situation in which there are more disconnects than even Ernestine on a roll could manage, health sciences librarians see yet another. On the one hand we have repeated pleas for increased research funding, including a national network of research hospitals to deliver health care innovations. On the other the glaring lack of a national network of libraries to support that research. The Canadian Health Libraries Association has long been championing a National Network of Libraries for Health, whose vision is to ensure that all health care providers in Canada will have equal access to the best information for patient care (2,4,6).

Part of the difficulty in achieving any kind of national solution is the way health issues often fall between the cracks in Canada's fragmented federal system, a situation in which achieving reform makes solving Rubik's Cube look easy. This is the subject of John Lavis's study of political elites and their influence on health care reform:
Who are these political elites, and how do they influence the prospects for change and for improved cooperation in bringing about change? The elites can include government officials at both the federal and provincial level who are engaged in constant finger pointing over health care, with federal government officials repeatedly saying to their provincial counterparts "administer the system better" and with provincial government officials responding "give us the money we need to run the system properly." Meaningful reform of any kind is difficult to achieve amidst such a dynamic, which some have called the "politics of blame avoidance." (3)
With such a dynamic holding sway, and with the now better understood knowledge gap in Ottawa, it may be some time before CHLA's vision can be realized. In a 2006 editorial in CMAJ, Sir J.A. Muir Gray, Director of the UK's National Electronic Library for Health, lent his support, calling for the provision of "clean, clear knowledge," centralized and made available through a national initiative:
I have watched with admiration and have benefited from Canadian developments, from the introduction of evidence-based medicine to the advances in knowledge translation and implementation. It has always seemed paradoxical that Canada, a country that is the fount of so much good work in these areas, does not have a national library. No new building is needed; simply a national network using the tools that are made available through the e-health revolution. Creation of the Canadian Health Libraries Association's proposed National Network of Libraries for Health would allow for coordinated, centralized access to evidence-based knowledge as well as support by librarians to all health care providers, researchers and policy-makers, regardless of their location or institutional affiliation. This network will capitalize on existing resources and networks. We look forward to learning from yet another Canadian initiative (5).
For this to happen Canadians must increase the importance of health research on the political agenda, and we health librarians must continue to work towards the goals set forth by our national association. At least we know our toads from our dwarfs.
Wait a minute. Perhaps she's right. Perhaps I've been wrong to blindly follow the medical traditions and superstitions of past centuries. Maybe we barbers should test these assumptions analytically, through experimentation and a "scientific method." Maybe this scientific method could be extended to other fields of learning: the natural sciences, art, architecture, navigation. Perhaps I could lead the way to a new age, an age of rebirth, a Renaissance! ... Naaaaaahhh!


1. Clark DR Bsc, McGrath PJ Phd, Macdonald N Md Msc. Members' of Parliament knowledge of and attitudes toward health research and funding. CMAJ. 2007 Oct 23;177(9):1045-1051.

2. McGowan J, Straus SE, Tugwell P. Canada urgently needs a national network of libraries to access evidence. Healthc Q 2006;9(1):72-4.

3. Lavis, John N. Political elites and their influence on health-care reform in Canada. Discussion paper no. 26. [Ottawa]: Commission on the Future of Health Care in Canada; 2002. Available: http://www.hc-sc.gc.ca/english/pdf/romanow/pdfs/26_Lavis_E.pdf (accessed 29 Oct 2007).

4. McGowan JL, Ellis P, Tugwell P. Access to the medical literature. CMAJ. 2007 Jul 17;177(2):176-7.

5. Muir Gray JA. Canadian clinicians and patients need clean, clear knowledge. CMAJ. 2006 Jul 18;175(2):129, 131.

6. National Network of Libraries for Health. Vision. Toronto: Canadian Health Libraries Association; 2007. Available: www.chla-absc.ca/nnlh/vision.html (accessed 29 Oct 2007).

7. Paige CJ. The future of health research is hanging in the balance. CMAJ. 2007 Oct 23;177(9):1057-58.


Rael said...

Canada cant be that bad, I think. The latest report says US pays more its doctors compared to most industrialized countries, and still has high demand for skilled health care workers, from nurses to
caregivers. Yet it lags behind in terms of results, compared to most of those first rate countries! Whats going on here?
family health news

The Shelver said...

It's not that Canada is bad. It just could be better. Our politicians could do a better job of understanding how knowledge management and health care outcomes are closely related.

Creation of the Canadian Health Libraries Association's proposed National Network of Libraries for Health would allow for coordinated, centralized access to evidence-based knowledge as well as support by librarians to all health care providers, researchers and policy-makers, regardless of their location or institutional affiliation.

If Canada had that, we would have something to crow about.