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Dr. Zamboni's research suggests that MS is not, as widely believed, an autoimmune condition, but a vascular disease. (Alessandro Vincenzi/Alessandro Vincenzi For the Globe and Mail)
Dr. Zamboni's research suggests that MS is not, as widely believed, an autoimmune condition, but a vascular disease. (Alessandro Vincenzi/Alessandro Vincenzi For the Globe and Mail)

André Picard's Second Opinion

Health ministers: Stop micromanaging MS research Add to ...

Saskatchewan Health Minister Don McMorris is brimming over with good intentions. That's why he has decided to fund a clinical trial of a controversial treatment for multiple sclerosis.

His counterpart in Newfoundland, Jerome Kennedy, has his heart in the right place. He has decided to fund a study to monitor patients who undergo the so-called liberation therapy.

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The issue somehow found its way onto the agenda of the meeting of federal, provincial and territorial health ministers in St. John's this week, and it's constantly in the headlines.

One cannot help but feel for patients with MS. It is a terrible affliction whose treatments are largely ineffective. The theory put forth by Paolo Zamboni, that blocked veins may be a cause of debilitating MS symptoms, is, if nothing else, exciting.

But does anyone honestly believe that health ministers should be micromanaging the $183-billion-a-year health system to the point where they decide what research is done on specific illnesses?

What are the health ministers going to take a stand on next: the colour scheme for the Black Tickle Community Clinic?

What are they going to put on the agenda of their next meeting: the allocation of parking spots at Cranbrook Regional Hospital?

Good grief.

Having politicians tell researchers what to study is no way to manage a credible health research enterprise.

And using a summit of top officials to discuss minutiae is certainly no way to run a health system.

The inordinate amount of attention paid to the "to fund or not to fund" question surrounding an obscure MS clinical trial should lead us to step back a moment and wonder aloud: What is the role of a health minister?

Surely, the role should be one of leadership, policy guidance, strategic direction and stewardship of medicare.

The big picture stuff. The vision.

There is certainly no shortage of meaty topics for the ministers to sink their teeth into.

The Canada Health Transfer agreement, the method by which federal monies are transferred to the provinces/territories, is set to expire soon. That certainly merits some discussion.

Millions of Canadians have inadequate prescription drug coverage, a reality that offends the principles of medicare. So where is the high-level debate on the pros and cons of pharmacare?

Canada is a laggard on the implementation of electronic health records and the efficiency of the system and the safety of patients is suffering for it, so where is the urgency to get that done?

The aging of the population and how that will swell the ranks of those with chronic health conditions (dementia, cardiovascular disease, lung disease, arthritis and so on) requires a reallocation of health resources and policy change that will ensure health care is delivered differently. When are the health ministers going to start looking out for the best interests of seniors?

The Organization for Economic Co-operation and Development has, once again, questioned the sustainability of Canada's publicly funded insurance system given the inability (or perhaps unwillingness is more accurate) of governments to control costs or, alternately, generate new revenue (the OECD suggests some modest co-payments and user fees). Which minister has the courage to kick-start that emotional debate?

These are thorny matters but they will potentially have an impact on every single Canadian.

Health ministers should operate and act at this macro level. Micromanaging is inefficient and insulting - it neglects the talents of the specialists and undermines systems.

This is not to say that ministers of health should not have a say in research priorities.

Take the MS example. It would be entirely appropriate for our political leaders to say: Canada has one of the highest rates of multiple sclerosis in the world. We feel this should be a research priority and we are going to allocate X million dollars more.

This is precisely what they have done in some high-profile areas such as cancer and mental health.

But it is not the role of politicians - even health ministers - to determine what research specifically should be done. Should MS research dollars, for example, go to studying the Zamboni method or to studying the benefits of vitamin D supplementation?

There are structures in place to make those decisions rationally, such as peer-reviewed grants competition of the Canadian Institutes of Health Research and the grants competitions of various charitable groups such as the Multiple Sclerosis Society of Canada.

These processes should not be influenced unduly by public opinion, by media coverage or by political intervention.

Yes, that is frustrating, particularly to those suffering from a horrible illness and hoping desperately for a cure. (We will save the discussion of the merits of liberation therapy for another day, but they are largely irrelevant in this context.)

The funding of health research should not be determined by popularity contests and monies should not necessarily go to those who scream loudest.

Research monies should go to areas where there is the most promise and good evidence.

Federal Health Minister Leona Aglukkaq has taken a lot of flak, but, on this issue, she has acted properly. Pressured to fund a clinical trial, she confided the issue to a panel of experts and then accepted their recommendation. (The CIHR panel said there was an "overwhelming lack of evidence on the safety and efficacy" of liberation therapy, so it was premature to conduct clinical trials.)

What Ms. Aglukkaq did was delegate, not micromanage; she also told the other ministers to get their act together. It was a welcome bit of leadership from Ottawa on the health file.

MS clinical trials are well down the list of national health priorities requiring ministerial input. Funding decisions, like other policy decisions, should be guided by evidence, not by whimsy, wishful thinking, or even good intentions.

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