October 24-25, 2005
Table of Contents
The Chief Scientist hosted the fourth annual Health Canada Science Forum (Health Canada's showcase for its science and research activities) on October 24 and 25, 2005, in Ottawa, Ontario. The theme of the forum this year was Science in Support of Health Policies and Regulations. Over 50 presentations were given under four sub-themes, namely, Risk Assessment Methodologies, Building Health: Healthy Individuals and Healthy Communities, Emerging Issues and Product Developments, and The Role of Civil Society. The forum attracted over 500 departmental researchers, scientists and senior officials to its plenary, concurrent, and poster sessions, for sharing of research findings, learning from each other and establishing new linkages and networks for future collaboration. This summary report gives the highlights of the speeches and presentations from the forum. The full texts, where available, can be accessed by clicking on the icon beside the respective titles.
Pierre-Gerlier Forest, Chief Scientist, Health Canada
"...A vision of ourselves as part of one community is vital to our collective success."
In his opening address to the fourth annual Health Canada Science Forum, Dr. Pierre-Gerlier Forest, Health Canada's Chief Scientist, emphasized the importance of creating a unified scientific culture within Canada, a culture that cuts across disciplines and is aligned with scientific efforts worldwide. In this way Canada will continue to be a major partner in addressing the universally urgent questions faced by all those performing health science and research, nationally and internationally.
Dr. Forest's key messages included: recognizing the critical role of 'public science' as government researchers, scientists and analysts play crucial roles in furthering the public good, free of politics and ideology, and providing sound evidence to support decisions on complex issues and the importance of striving for excellence within public science and keeping Canadian citizens up to date on how their tax dollars are spent and how the resulting knowledge is being used.
Lorne Babiuk, Director, Veterinary Infectious Disease Organization (VIDO); Canada Research Chair, Vaccinology in Saskatoon; and Member, Health Canada Science Advisory Board (SAB)
In his lecture as this year's Chief Scientist Distinguished Guest Lecturer, Dr. Lorne Babiuk outlined the history, goals, activities and achievements of the Veterinary Infectious Disease Organization (VIDO) which was founded in 1975 at the University of Saskatchewan. The university provides the facilities and services that VIDO requires to fulfill its goal of providing high-quality research in food safety and the development of vaccines for animals through its core competencies of animal models, pathogenesis, genomics, antigen identification, and immunology.
Dr. Babiuk noted that infectious diseases have spread via globalization (e.g., bioterrorism and SARS), microbial evolution (30 new diseases have appeared in the last two decades), and antimicrobial drug resistance. VIDO sees the importance of collaborating with other companies and organizations to expand its expertise, gain funding, and obtain access to other technologies.
Dr. Babiuk noted that while it is not a legal entity, VIDO is entrepreneurial in spirit and currently operates with a budget of $12 million - a significant progress from its original $100K budget. A large part of VIDO's funding comes from Genome Canada, the Bill & Melinda Gates Foundation, the Krembil Foundation, and NSERC industry chairs. VIDO's notable achievements to date include 70 issued patents, 27 patents pending, two spin-off companies, and 30 licensing/research agreements. To ensure ongoing success, VIDO must continue to focus on its vision, protect its intellectual property, and keep an organizational culture that fosters teamwork, responsiveness, and imagination.
Moderator: Kathryn O'Hara, Carleton University, Science Journalism Program; Member, Health Canada Science Advisory Board
Panellists: Helen Braswell, Director, The Canadian Press;
George Hoff, Director, News Gathering, Canadian Broadcasting Corporation (Radio);
Tom Blackwell, Medical Reporter, The National Post;
Terry Murray, Medical Editor, The Medical Post
Terry Murray named two challenges for her medium. First, as a weekly magazine, The Medical Post cannot keep up with daily news and must devise ways to cover timely topics such as the influenza pandemic. The second challenge is that the magazine must ensure that it continues to serve its shareholders and its audience.
George Hoff named four challenges: journalists' limited accessibility to Health Canada scientists; the time-sensitive nature of radio reporting; the need for access to health information well before a show is aired; and the difficulty of reporting complex issues.
Helen Branswell discussed reporters' poor access to scientists and researchers and their resultant inability to write fully informed stories as key challenges.
Tom Blackwell echoed the other panellists, saying that reporters wish to obtain information "from the horse's mouth" rather than from media relations' staff. Sometimes it is also difficult to decide which of many news items in the vast scientific field to cover. Journalists must be responsible and balanced while delivering news.
Ms. O'Hara wrapped up the panel discussion by saying that scientists and researchers do not understand well the constant pressures that journalists face to meet tight deadlines, and this lack of understanding is a source of frustration for the media.
Issues raised from the audience were varied. In response to a question as to what is considered to constitute newsworthy items, panellists suggested that news is anything that is fresh to the audience or news could be developments in ongoing research or anything that changes medical practice. On the question of media-scientists relationship, it was reiterated that from the reporters' perspective, they need access to scientists and will take the time to write as accurately as possible if scientists talk to them. It was pointed out, however, that the relationship is not one of collaboration; sometimes a reporter will question how a person came to a finding if it contradicts current data. And in response to the suggestion that journalists exist to sell their product, one panellist expressed the opinion that "We don't write just to sell newspapers. At the same time, we are responsible for delivering news responsibly," while another indicated that the notion of "selling a story" is not a consideration.
Claude Rocan, Director General, Centre for Health Promotion, Public Health Agency of Canada(PHAC)
Presenting on "The Science of Health Promotion," Claude Rocan stressed the importance of effective health promotion - the process of enabling people to increase control over their health. He identified the expected outcomes of effective health promotion as including: a healthier, more integrated public policy; more efficient knowledge transfer; effective interventions; reduced inequities; and measurable results for Canadians.
Health promotion depends on high-quality science and there are many challenges in this task, including:
Mr. Rocan also discussed the importance of knowledge transfer between researchers and institutions. Currently there are gaps between translating research findings and putting them into practice, although the recent decline in tobacco usage is an example of successful information transfer. He stressed that in planning and carrying out their work, scientists must always ask whether their efforts are relevant to target groups, such as Aboriginal peoples. Initiatives must be targeted to these groups, and inequities must be addressed in program development. The Integrated Strategy for Health Promotion and Chronic Disease is intended to respond to these challenges.
Janet Smylie, Director, Indigenous Peoples Health Research Centre, University of Saskatchewan
Dr. Smylie stated in her address that the Indigenous Peoples Health Research Centre provides research-based evidence about Aboriginal health promotion and community performance measurement policies. The background theory is that the Western model and the indigenous model of knowledge translation are vastly different. Nevertheless, the notion of "ethical space" allows room for these two equally valid world views.
She noted that Ottawa has the largest urban Inuit community in Canada, with 1,000 members. It has been shown that posters are generally not effective in changing health behaviours (they only give information). But direct, face-to-face communications through cultural interpreters, community cohesion, and storytelling by elders was effective in reaching this community.
A comprehensive review of indigenous health system performance measurements in Canada, Australia, and New Zealand has revealed that current systems are underdeveloped at the local level. Hence they are deficient in their ability to support local service development.
Dr. Smylie concluded with two take-home messages:
A delegate asked why the community measure focused on non-diet soft drinks. Dr. Smylie replied that sugar in the non-diet soft drinks has been linked to diabetes, which is an emerging problem in many First Nations communities.
Arnold Naimark, Professor, Dean Emeritus and Director, Centre for the Advancement of Medicine, University of Manitoba; and Chair, Health Canada Science Advisory Board
In this presentation, Dr. Arnold Naimark introduced the members of the Health Canada Science Advisory Board (SAB). Comprised of external representatives, the SAB was established in 1997 with a mandate and role to provide: independent advice to the Minister on fostering the best science in health protection; to be a source of credible external advice on the science performed and used by Health Canada, and; to advise on emerging trends in science relating to health. He noted that the selection criteria for SAB membership included expertise, knowledge, experience, impartiality, and no conflicts of interest.
The SAB also facilitates the contribution that Health Canada scientists make to continually strengthen the foundation of objective knowledge required to support Health Canada's pursuit of its core mission. Dr. Naimark concluded by stating that the SAB looks forward to an increased number of opportunities for its members to interact with Health Canada scientists.
Dr. Arnold Naimark defined the health sector as all the elements involved in the development, organization, management, delivery, and application of health services. The analytical framework includes the risk categories (governance, operational, and behavioural risk), health sector functions (development, organization, management and delivery), and services (preventive, diagnostic and therapeutic).
He noted that, in North America, one million injuries and 100,000 deaths result annually from mistakes in medical care. Risks exist because of increasingly complex technology and patients, the number of "actors" in health care and inadequate communications. He noted that everyone must face these challenges. Priorities for strategic initiatives in systems analysis, data resources, interdisciplinary training, new tools for research, primary professional education, and in-service training must be set.
David Blakey, Director, Environmental Health Science, Safe Environments Program, Health Environments and Consumer Safety Branch (HECSB)
David Blakey outlined current challenges in risk assessment, including a domestic substances list of 20,000 items and the increased need for surveillance.
He noted that research staff at Health Canada and other experts from science-based departments had recently met to discuss multi-departmental issues. Several challenges have emerged from their discussions:
New tools for risk assessment include biotechnology, nanotechnology, computing, genomics, and proteomics.
In response to an enquiry from a Forum delegate concerning whether there was need for a special protocol to manage multiple linked risks, Dr. Naimark said that scientists need to evaluate the dominant issues and track events and Dr. Blakey stated that they must take a holistic approach and include everyone who has expertise.
Moderator: Michael Vandergrift, Director, Health Policy Branch (HPB)
Conscience, Process and Public Harms. Dr. Edward W. Keyserlingk, Public Service Integrity Officer, Government of Canada
How to Best Manage Science in the Public Interest? Dr. William Leiss, Professor, School of Public Policy Studies, Queen's University; and Scientist at the McLaughlin Centre for Population Health and Risk Studies, University of Ottawa
Ethics, Science, and Decision Making at Health Canada. Diane Gorman, Assistant Deputy Minister, Health Products and Food Branch (HPFB)
Key highlights of the panel discussion on ethics are as follows:
We need more dialogue on the inevitable tensions caused by the fact that scientists feel several loyalties: to the global science community, to the government of the day, and to the general public. Value tensions are natural and inevitable for the government scientist as a result.
We need more informal internal discussion and healthy debate on the meaning and impact of scientific evidence on policy making. The problem of the "bureaucratic culture" needs to be addressed by fostering more vigorous and honest discussion among government science experts on the meaning of research findings. When there is not enough free and open exchange of opinions, the culture of bureaucracy risks undermining the quality of science advice given to policymakers. It may also contribute to scientists' perception that policy makers ignore expert science advice given to them and that scientists are deliberately "kept in the dark" about the big picture. (Perhaps greater formal explanation of the policymaking process is also needed to more effectively demystify it for scientists.) These efforts could move forward without major disruptions to the status quo; for example, by commonly holding internal forums akin to this one.
We need to consider finding ways for government scientists to get more involved in public discourse on scientific issues. Although there may be a good rationale for not allowing government scientists complete freedom of public expression, there is a drawback to tightly constraining the government scientist's freedom to express professional opinions in science controversies publicly. It deprives the public of one of the best potential sources of diverse opinions on the pros and cons of controversial technologies. One way to strike a balance might be to provide experts with more opportunity to explain various sides of the issue as explored in-depth through responsible science journalism. However we cannot address the broader problem without first reexamining the whole framework of assumptions and measures around "loyalty" for public servants. Do current rules reflect an underestimate of the public's capacity to handle the inherent lack of scientific certainty in many areas?
Deanna St. Prix-Alexander, Executive Director, Bureau of Women's Health and Gender Analysis, Policy Planning and Priorities Directorate, Health Policy Branch (HPB)
Deanna St. Prix-Alexander discussed the mandate of the Bureau of Women's Health and Gender Analysis, which is to work with a variety of partners, including members of civil society, in the promotion of equitable health outcomes for men and women, girls and boys across the lifespan. She stated: "Civil society has helped us to secure a position of policy leadership in women's health." The three key messages from her presentation were the following:
To illustrate the first message, Ms. St. Prix-Alexander used the example of research and policy in genomics. For the second message, she discussed the case of Hormone Replacement Therapy. And for the third and last message, she profiled the limitations of current research, policy and action in Aboriginal women and girls' health.
Civil society is part of a system of decreasing state power and increasing market forces, and is rife with racial, ethnic, ideological, and economic differences. These differences have the potential of creating some serious challenges. On the other hand, science can also learn from such diversity.
Everyone agrees that civil society organizations are much needed. The World Health Organization reports that its ability to penetrate into societies, to deliver information and care, and to learn about problems, is dependent upon such organizations.
He noted that there are some important steps to be taken. We must understand that civil society is not either all good or all bad. There are peoples and associations that operate in pure self-interest and those that have the collective good at heart. Science must maintain its independence (and stay away from ideologies and self-interest). Canada must remain an open society by promoting multiculturalism and building bridges and linkages. It must protect health care as a social good; otherwise it risks developing subservient relationships to market forces. Finally, inequalities between science and the people it serves must be reduced.
Responding to a question about "what is civil society?" Ms. St. Prix-Alexander defined it as those people who bring forward a voice from the communities outside of industry and government. Dr. White agreed and pointed out that we often learn from civil society about other approaches to health and health promotion, citing the example of our understanding of other holistic ways of healing, such as Chinese medicine. With respect to what could be learned from the SARS outbreak, Dr. White responded that societies need to develop longer-standing relationships so that when a crisis strikes we already have built linkages which enable us to partner to deal with the problem.
Renaldo Battista, Director and Professor, Department of Health Administration, University of Montreal; and Member, Health Canada Science Advisory Board
Dr. Battista said that in the field of new genetics, there are several challenges, including:
He discussed the research work of Apogée.net, a knowledge network, toward addressing these challenges in the area of policy making. The network has three research streams: genetics and health care services, genetics and public health, and translating research findings into "earth language." Apogée.net has increased its production of relevant research in its priority areas for research, namely: the necessity to promote acceptance and to understand the problems and issues arising from genetic research; the impact of new genetic technology on health care services; technology transfer; public involvement in decision making; the management of genetic material and information; and population-screening criteria.
George Douglas, Head, Mutagenesis Section, Safe Environments Program, Health Environments and Consumer Safety Branch (HECSB)
Dr. George Douglas gave a comprehensive, highly specialized presentation on gene technology. Gene technology provides researchers with enabling methods and the potential to reduce uncertainty in the determination of environmental hazards. Gene technology also allows for the transfer of leading-edge technology to regulatory practice. Of the three gene technologies (in vivo gene mutation detection, tandem repeats, and genomics), genomics offers the prospect of new methods for toxicology and hazard assessment.
Dr. Douglas discussed a landmark study at the Hamilton harbour, which made two major observations. Firstly, HEPA (high efficiency particulate air) filters removed the mutagenic effect of pollutants, and secondly, air pollution caused inherited mutations through male mice. As a result of this study, four questions remain unanswered: the relevance of tandem repeat mutation to conventional gene mutation in disease-related genes, its relevance to the health of exposed population, which chemicals in particulate fraction are responsible for mutagenicity, and the source of the chemicals contributing to mutagenicity.
Rick Burnett, Safe Environments Program, Health Environments and Consumer Safety Branch (HECSB)
Dr. Rick Burnett used a famous photograph entitled "London Fog, 1952," to illustrate his discussion of his work in urban air pollution in Canada and the role of science in policy development. In one analysis of smoggy days in London, England, in December 1962, the correlation between the concentrations of particulate matter and the number of deaths and illnesses was very clear.
In an Ontario study, results showed that, during periods of higher concentrations of air pollutants, a higher level of hospital admissions was due to respiratory problems, especially among infants. This indicated that a high residual mortality rate corresponded to high levels of pollution. The Ontario hospital admissions studies demonstrated that serious cardio-respiratory health problems can be exacerbated by current outdoor levels of pollution, and that some cases result in death. Dr. Burnett concluded his presentation by observing that "Good science does not always make good policy, but bad science always makes bad policy."
Nimal Ratnayake, Food Directorate, Health Products and Food Branch (HPFB)
Nimal Ratnayake's research is focused on the safety and nutritional quality of dietary fats and the health effects of partially hydrogenated vegetable oils (PHVO) in foods. Trans fats are found mostly in margarines, shortenings, and bakery products, which can contain up to 50 per cent PHVO. Rarely located in plants and seeds, trans fats are hypercholesterolemic and increase the risk of cardiovascular disease, although their effect on blood pressure is negligible.
He noted that Canadians ingest extremely high levels of trans fats, so Health Canada is imposing new food labelling regulations. Effective December 2005, all food manufacturers must declare the amount of trans fats in all of their packaged foods. As well, the new Trans Fat Task Force will find ways to eliminate the amounts of trans fats in Canadian food.
Paul White, Safe Environments Program, Health Environments and Consumer Safety Branch
Dr. White spoke about his research regarding complex environmental matrices, such as contaminated industrial soil, contaminated air, the effects of tobacco and cannabis smoke, indoor air, house dust, and drinking water, all of which contain potential risk factors.
Major research projects are underway on the potential hazards in our environments, with the results showing both good news and bad news. The good news is that results suggest that standard risk assessment methodology for PAH-related (polynuclear aromatic hydrocarbons) mutagenic/carcinogenic effects likely overestimate the actual risk. The bad news is that fractionation and mutagenicity testing of polar organics suggests that unidentified polar organics do make an unknown contribution to the total risk.
Dr. White concluded his remarks with his understanding of scientific excellence as: "the quality of excelling in science," which "implies the use of best practices to generate research results of the highest possible quality, where quality reflects not only the utility of the ideas and hypotheses, but also the degree of innovation and scientific vision."
Moderator: Dr. Yvan Hardy, Chief Scientist, Natural Resources Canada
Arthur Carty, National Science Advisor to the Prime Minister
Presenting his views on excellence in science, National Science Advisor Dr. Arthur Carty told the audience that a country excels in science by setting national and international standards and by the number of its publications, scientific journals, and patents. In applying these criteria and indicators to Canada, he said that amongst the 31 top countries, Canada ranks sixth, behind the United States, the United Kingdom, Germany, Japan, and France.
Dr. Carty listed four key government roles in science and technology: supporting decision-making, policy development, and regulations; developing and managing standards; supporting public health, environment, and/or defence; and enabling economic and social development.
He stated that there is no room for "second-hand science and technology" - it must be first class, and it must meet or exceed international standards for scientific and technological excellence and deliver social or industrial relevance. He stressed in conclusion that this can only be achieved through openness, transparency, and appropriate expert review.
Paul Armstrong, Professor of Medicine, Division of Cardiology, University of Alberta
Excellence in science, according to Dr. Paul Armstrong, means substantial original research; extensive publications in the best journals; a significant contribution to ideas, concepts, and analyses; and the ability to attract good students. In scientific research in particular, excellence includes motivation, entrepreneurship, and critical decision making, as well as networking with other scientists.
Choosing a research problem is a critical decision, and the research scientist must keep a balance between low-risk and high-risk projects.
Trends in future research - changes in funding and the globalization of research - enhance the need for collaborative opportunities. Coronary heart disease, for example, is the leading cause of death worldwide, yet of Canada's 900 hospitals, less than 50 can delivery interventional catheter-based care.
Pierre-Gerlier Forest, Chief Scientist, Health Canada
Health Canada's Chief Scientist, Dr. Pierre-Gerlier Forest proposed in his presentation a model for excellence in science. He called the model "PIVOT", which stands for Partnership, Integration, Vision, Originality and Timeliness.
According to this model, partnership allows for the sharing of expertise and resources, while integrated management of science and technology enhances the capacity to use that expertise to its full potential. A vision of one common science culture places value on diversity and specialized expertise. The best science is original and uses new approaches, debates openly, and takes risks. Timely intramural science supports regulation and policy development and is critical of government's day-to-day decisions around health.
Health Canada strives to ensure that its science is aligned with its priorities, that it capitalizes on the best experience and expertise through collaboration, and that it demonstrates excellence and innovation. Science must reflect Canadians' expectations of sound management and stewardship.
A delegate asked how to ensure that science, as it has moved from evidence-based to evidence-informed, does not move to using deceptive information as a basis for decision making. Dr. Forest said he has urged the importance of listening to civil society, to reach a compromise. Dr. Carty pointed out that science rarely produces absolute answers; one must balance the evidence.
Marcel Nouvet, Assistant Deputy Minister of Health Canada on behalf of Associate Deputy Minister of Health Canada, Hélène Gosselin
Mr. Marcel Nouvet, on behalf of the Associate Deputy Minister, Hélène Gosselin, expressed her regrets and delivered the closing remarks of the forum. He congratulated the organizers for a very successful forum. He emphasized the importance of continuing to build bridges with policy makers, a path that has become increasingly important not just for Health Canada, but for the entire federal government.
Mr. Nouvet explained that science supports economic and social development and that it touches every aspect of our lives as citizens. The depth of this year's program and the variety of speakers emphasizes the complexity of this field, which in turn creates the potential for a rich cross-pollination of ideas, but also creates challenges for horizontal thinking.
He concluded by noting that the Forum represents a huge step towards integrating research, science and policy, which brings us close to putting evidence-based decision-making into what we do.