Commercializing innovation in Canada: Retaining human and financial capital north of the border
Organized by: Ontario Centres of Excellence, Dr. Claudia Krywiak and Geraldine Chen
Speakers: Kathryn Hayashi, President and CEO, TRIUMF Innovations; Audrey Mascarenhas, President and CEO, Questor; Dr. Zhou Wang, Co-founder and Chief Science Officer, SSIMWAVE; Professor and University Research Chair, University of Waterloo; Rodney Wilson, Chief Technologist, Research Networks, Ciena Corporation; Dr. Alan Winter, Innovation Commissioner, Government of BC.
Moderator: Dr. Tom Corr, President and Chief Executive Officer, Ontario Centres of Excellence
Canada’s economic system has several strengths, including:
A diverse and multicultural population that opens trade and investment opportunities through global connections; diverse voices also contribute to better decision-making
Canada’s openness to immigration, relative to other countries, positions us well in the global fight for talent
Canada is home to the second largest ICT cluster outside of Silicon Valley, especially the Toronto-Waterloo corridor
An excellence education system that produces globally competitive talent (i.e., why Ciena’s largest R&D centre is located in Ottawa)
SSIMWAVE attributes much of its success to a supportive ecosystem (e.g., University of Waterloo commercialization office, incubators, funding from NSERC, OCE and local angel investors, mentoring from local entrepreneurs)
Ciena’s located the corporation’s largest R&D centre in west Ottawa (Kanata) because of close proximity to top engineering schools and graduates. But increasing competition for talent is making it more difficult to attract the skilled people they need.
There is a need for an ambitious and comprehensive innovation policy to help promote economic growth. This will require a whole-of-government and systems approach and recognition that business is the primary vector of innovation in the economy. (Also highlighted in Nicholson report)
Canada needs innovation policies that help a handful of homegrown firms grow to become $1 billion+ anchor companies; current policies are too heavily focused on supporting thousands of start-ups. Don’t be afraid to pick winners and celebrate winners.
As Nicholson noted in his report, the federal government has several levers beyond funding to encourage business investment in R&D – one of its strongest levers is procurement.
Don’t be afraid to set targets that everyone is aware of and will rally around.
The recent report from Canada’s Clean Technology Strategy Table Clean Tech Energy Table brought together 156 CEOs to discuss what Canada needs to do differently. Its six proposals are:
Develop an agile, high performing regulatory system (i.e., Questor has been able to expand its operations in Colorado because Regulation 7 mandates enclosed combustion for oilfield operations to deal effectively with emissions. It has resulted in producers more readily gaining approval for projects from state and local authorities.)
Accelerate the growth of Canada’s leading clean tech firms by addressing gaps in scale-up finance, and implementing the “Own the Podium” signature initiative
Drive clean tech adoption by having government be the lead buyer and incentivizing industry procurement
Grow jobs by expanding skills development, and enable meaningful diversity and inclusiveness target-setting through increased access to data
Seize domestic and international clean tech opportunities where Canada has strengths, and enable access to global climate finance
Engage with Indigenous communities to create opportunities for partnership and co-development of clean tech initiatives
British Columbia appointed an Innovation Commissioner to be a champion for technology in all sectors. The position primarily focuses on what can be done to increase business R&D in Canada.
BC has also established the has the Emerging Economy Task Force to provide analysis and advice on emerging trends, including transformative technologies
To accelerate drug discovery and attract R&D to Canada, implement a compassionate use regulatory framework to explore innovative new drug treatments. Such a framework would allow Canada to leverage its expertise in nuclear medicine, for example, to treat patients with metastasized tumors using targeted alpha therapy, as has been done in Germany.
An inventor-owned policy at the University of Waterloo has contributed to its success in commercializing academic research and attracting talent from around the world.
Change the Scientific Research and Experimental Development (SRED) program so that it rewards scale up, instead of “grinding down” the funding eligibility of companies that grow or become profitable (i.e., by selling products and services outside of Canada)
Canada needs more funding programs that support short-term (less than two years) research projects between industry and academia (i.e., similar to NSERC’s Partnership Engage Grants and Mitacs internships, Ontario Centres of Excellence programs, ENCQOR for 5G technologies, and Prompt and CEFRIO in Quebec).
What’s on the menu? Science-based policies to address new agri-food realities
Organized by: University of Guleph
Speakers: Professor Mary Buhr, Dean and Professor, College of Agriculture and Bioresources, University of Saskatchewan; Professor Maria Corradini, Professor of Food Science, University of Massachusetts; Dr. Bettina Hamelin, President & CEO, Ontario Genomics; Dr. Deb Stark, Former Deputy Minister of Ontario Ministry of Agriculture, Food, and Rural Affairs; board member, Canadian Agri-Food Policy Institute
Moderator: Dr. Malcolm Campbell, Vice-President of Research, University of Guelph
Takeaways and recommendations
The context of Canadian agriculture
The majority of people in Canada almost 50 years ago had a direct understanding of the value chain of food and how it got on their plates. They had a relationship with the primary producer. Then, productivity levels were low.
Today, there is a more distant relationship even between the farmer and the agriculture, due to the use of technology which increased productivity.
Consumers have a much lower understanding of how that food got to their table.
Canada is the 5th largest exporter of agricultural products.
How technology is used in agriculture
Farmers practice “precision agriculture”. It is how producers are managing their thousands-of-hectare farms. For example:
Farmers use variable rate cropping through seeding and fertilizing based on data about their land.
The use of satellites to detect subsurface moisture, identify soil microbes, characterize soil profiles, and more.
Big data that can be used to predict ideal phytogenetics for soil, climate, terrain and end use. What crops are ideally suited for this land?
No industry is a greater user of big data than agriculture.
Genomics in agriculture
Genomics innovations play a role across the entire food value chain.
Genomics are used to increase the amount of milk a cow produces, an animal’s immunity, the health of animals, etc.
We want to buy food we can afford, that is safe, has no spots and tastes great.
Genomics can help make plants resistant to pathogens, while at the same time allowing the plant to focus on growing large fruits/vegetables.
Genomics innovations in the future may include: calves with no horns, apples that don’t brown, etc.
We are moving toward active packaging, which includes components to enhance and prolong the shelf life of food.
The introduction of bioplastics and biodegradable packaging are up-and-coming.
Has my food gone bad? Open labeling (static), is what we do now; quality/safety attributes in real time (dynamic), is coming in the future. This innovation will have high implications for safety, reduce waste, and allow people to consume products at their peak shelf life.
Biodegradable electronics will help in assessing the remaining shelf life of food.
The future of Canadian agriculture
Historically, agriculture policy has been about economics: to create wealth in a sustainable manner.
Participants argue they need science and technology as fast or faster than our competitors to compete successfully.
Regulators continue to hear that their decisions aren’t science-based, and that they never go fast enough.
According to the Centre for Food Integrity, less than half of Canadians think their food system is headed in the right direction.
In 2017, Canadians provided input on a potential Food Policy for Canada. This may change the conversation about agriculture.
What’s next? Citizens will be part of the discussion. It is not a case of growth at any cost.
Fundamental tension: Food production is about technology, but food is about culture and values, and that makes for an uneasy relationship.
Science communication is about transforming science knowledge in impactful ways to the intended audience.
Laurentian University is the only post-secondary institution in Canada with a Master’s program in science communication for science graduates. Its 150 alumni work in government, research institutions, NGOs, science centres, museums, zoos, aquaria, industry and academia.
Science North partnered with the program to contribute to the development of science communication professionals through practical and experiential learning opportunities.
The program equips graduates with theoretical foundations in good communication and develops their communication skills through writing, design, production and evaluation.
Art the Science is a nonprofit organization that facilitates artist residencies in science labs and helps artists create digital renditions of their work (e.g., an artist resident at Queen’s University used creative coding to depict silica grains and activate the spaces in between them.)
One key theme that the evaluation demonstrated was the new perspective the artist brought into the lab. The artist challenged lab members to think about how to communicate their research to a non-expert and shed light on different ways to visualize data.
Seek out scientists online and learn from them. It can democratize access to science and knowledge and amplify marginalized voices.
Science policy leaders and scientists often exclude the taxpayer in their consultations. Social media, notably Instagram, is an effective platform for multi-directional communication. Instagram’s advantages include over 1 billion monthly active users, high engagement, and its appeal as a visual medium.
Visual communication is generally more engaging than textual, but this has been traditionally ignored in scientific communication, making it seem like an afterthought.
Incorporating creative strategy and design principles into scientific communication can help disseminate your research more effectively
Your intended audience needs to drive your communication strategy
It is a challenge in government to communicate science-based knowledge to the public. Messages tend to be tailored to a general audience, as opposed to a specific audience. Government approval of ongoing communications can make the process slow and more complicated.
Building relationships to ensure messages are accepted and understood can help bridge gaps. Tactics are secondary to the relationship.
Your partners, staff and audiences are people. You need to understand people to understand your business.
The focus on knowledge translation and communications should not be an afterthought. Build in communications at the beginning of the project.
Failure to Thrive: Why Canada struggles to grow world-leading companies
Organized by: Weronika Zych, Council of Canadian Academies
Speakers: Lisa Crossley, CEO, Reliq Health Technologies Inc.; Judy Fairburn, Board Director, Public Policy Forum and Sustainable Development Technology Canada; Victoria Lennox, Co-Founder and CEO, Start-Up Canada; Pierre Lortie, Senior Business Advisor, Dentons LLP; Iain Stewart, President, National Research Council
Moderator: Eric M. Meslin, President and CEO, Council of Canadian Academies
Takeaways and recommendations
Innovation policy, government programs and risk capital all play different and conflicting roles in the current environment. Canada has exemplars of scaled up companies but we must shift the pre-dominant focus on small companies to those that can scale and compete in a global marketplace.
Recognize the importance of scale and networks
Start-ups challenged by Canada’s small domestic market need to plan to go global from day one to overcome reliance on the U.S. market.
The knowledge economy is driven by the economics of networks, in contrast to the “old economy” which is driven by economies of scale.
Canadian policymakers have a misguided view of job creation, focusing on small firms instead of on companies that can scale.
Technology adoption centres and tax exemption centres can help bridge the gap between entrepreneurs and multinationals.
Progress is being made to reduce the disconnect between entrepreneurs and government.
Identify the issues holding back business innovation
Barriers to scaling companies include a lack of managerial talent, access to capital, pressure for short-term exits and procurement policies that don’t emphasize value-add.
Not enough venture capital goes to companies seeking to scale.
Canada has lost many of its global companies in recent years, dropping from approximately 15 to as few as five.
Time matters. Uncertainty and delays often result in business failure.
Risk culture is essential. We need to foster a can-do attitude; make it part of the Canadian DNA.
Take advantage of opportunities
Disruption creates opportunity and Canada has recognized this with recent investments in artificial intelligence (AI) and quantum computing.
Scale the AI Supercluster to succeed in the competition for talent, augmented by boosting the post-secondary training of AI talent.
Increase investment in Canadian ICT (information and communications technology) to lessen the gap relative to the U.S.
Policy considerations on the convergence of high performance computing (HPC) and artificial intelligence (AI)
Organized by: Compute Ontario
Speakers: Chris Loken, PhD, Chief Technology Officer, Compute Ontario; Suzanne Talon, PhD, Chief Executive Officer, Calcul Québec; Alison Paprica, PhD PMP, Vice President, Health Strategy and Partnerships, Vector Institute; Assistant Professor, Institute for Health Policy, Management and Evaluation (IHPME); Alain Veilleux, Chief Technology Officer, Calcul Québec
Moderator: Nizar Ladak, President & Chief Executive Officer, Compute Ontario
Takeaways and recommendations
The 2018 federal budget included a one-time investment of $572.5 million over five years (with $52 million on an ongoing basis) to implement a Digital Research Infrastructure Strategy that will deliver more open and equitable access to advanced computing and big data resources to researchers across Canada. This provides an opportunity to review policies related to issues like big data, skilled labour, technology investment, public-private collaborations, multi-level governance, funding, evaluation and impact.
HPC methods are continually evolving and AI/ machine learning is the latest area of convergence.
The convergence of HPC and AI has already begun, and as more research disciplines (e.g., drug discovery, weather forecasting, land use, psychology, construction) begin using AI to guide their simulations, analyze data and tackle more complex problems, demand for HPC will continue to increase.
Converging AI and HPC can create economies of scale, avoiding duplication of hardware and competition for skilled researchers to support systems. It also minimizes the need to move large amounts of data between HPC and AI sites. It makes sense to have an integrated system where researchers can do both HPC and AI.
It is important to distinguish between the people that do research into AI and those who use AI in their research, and to recognize that key scientific research achievements result from collaboration between the two research areas
AI evolves faster than computers so that can be a challenge as the two fields converge.
Some researchers need the ability to develop tools specifically designed for their needs (i.e., their own portal for data sharing). Being able to work closely with HPC teams can help to facilitate this.
Canada needs to go big in platforms that have data at their heart, especially in areas where we already have large datasets (i.e., health, cities, financial).
Rather than partition funding for compute power, connectivity, storage etc., invest in data platforms that bring all the required elements of digital infrastructure together, including large datasets and people who make the whole thing run are recommended.
The need for both people and computing resources
Canada needs to emphasize the training of graduate students, post-doc fellows and principal investigators to fully exploit the power and capabilities of HPC.
Competition is increasing for talent. Offering challenging work is often a bigger incentive for recruitment than salary levels.
“To out-compete, we must out-compute” (US Council on Competitiveness)
Two recent Compute Ontario reports highlight the strengths and gaps in provincial HQP and computing-related resources. Recommendations include:
Increased access to accelerators and other ARC resources designed to support emerging applications involving big data and AI
Consider a new initiative dedicated to AI and high performance data analysis
Broaden industry access to HQP and systems
Predictable and sustained funding
Canada’s data advantages
The data contained in provincial single-payer health systems can provide insights into wellness and disease that of which other countries can only dream. Canada also has people who are highly skilled at using that data (e.g., clinician scientists).
Funding from the Government of Ontario is making it possible to move population-wide longitudinal health data holdings into a secure environment with the compute power required for modern machine learning research. The new HAIDAP platform is a partnership between HPC4Health, IC/ES and the Vector Institute.
HAIDAP is operational in Ontario, but could be scaled nationally.
Siloed data assets have more value when they can be combined for analyses with other assets (note that data assets do not necessarily have to move or be combined in a central repository to accomplish this).
Collaborating with industry
Current efforts to create a national Digital Research Infrastructure Strategy have focused primarily on HPC, big data and network capacity. But it is important to also focus on complementary activities such as scaling AI and promoting academic-industry collaborations, which requires additional funding (i.e., for skilled personnel).
HPC infrastructure in Canada has been primarily funded by the Canada Foundation for Innovation, which means its main users have been academic researchers. Broaden the definition of researcher to include industry and look for more opportunities to collaborate (SOSCIP is a good example of industry-academic collaboration.)
If we want industry to be successful in using HPC and AI they need support from organizations like Calcul Québec and Compute Ontario. As such, it is important to fund that type of support.
Harnessing Diversity and Inclusion to Drive Innovation in Canadian Science and Technology
Organized by: Ryerson University, Wendy Cukier
Speakers: Mohamed Elmi, PhD Candidate, University of Cape Town; Jaigris Hodson, Assistant Professor of Interdisciplinary Studies, Royal Roads University; Doaa Mansour, Advancing Women in STEM, Youth Employment Services Montreal
Moderator: Wendy Cukier, Professor of Entrepreneurship and Strategy and Founder, The Diversity Institute
Takeaways and recommendations
Focusing on equity, diversity and inclusion (EDI) is integral to creating an economy that works for everyone.
Canada needs a multilayer strategy that looks at individual behaviours as well as organizational and societal contexts to drive change and do inclusive innovation properly.
Immigrants are some of our greatest entrepreneurs
Immigrants are more likely to pursue entrepreneurship than Canadian-born residents.
Unfortunately, most settlement agencies and support organizations focus on language training and traditional employment pathways (not entrepreneurship) and organizations designed to support entrepreneurs have a limited understanding of the challenges that newcomers face.
Innovation support programs are not designed with women in mind
Most incubators and accelerator programs focused on STEM replicate systemic biases, are led by men, are hyper competitive (think “Dragon’s Den”) and reinforce “bro-culture”.
There are fewer mentors, less support, and not as much funding or sponsorship for women.
Our image of entrepreneurs creates bias
We have to reconsider our image of innovators and expand our understanding of entrepreneurship to encompass more than just technology.
For example, most people would think of Bill Gates or Elon Musk (“white males in tech”) as entrepreneurs – fewer would think of Oprah and almost no one would think of farmers or artists.
Media representations of entrepreneurs need to be more diverse.
Exclusionary organizational culture is a huge issue
Inclusive innovation in organizations has to be more than just about hiring practices.
Organizations need to reconsider their processes at every level –management training and communications, product design, procurement, marketing and promotion. EDI needs to be baked in at every level.
Organizations need to consider their leadership – who is making the decisions? Who is visible? What is the tone coming from the top?
Organizations must have strong and transparent HR practices.
Unconscious bias training should be more common and systematic throughout organizations.
There needs to be incentives and reward systems for enforcing and/or supporting EDI. It can’t just be suggested guidelines.
Creating inclusive online environments
Online environments can facilitate innovation, can shut it down or inhibit it.
On the positive side, social media can spread information and knowledge of a technology or innovation to a wide audience.
On the negative side, it can inhibit innovation when it becomes an unsafe space for people to share ideas or join discussions.
Those most negatively affected by social media are people from disadvantaged groups (women, people of colour, etc.) and can include harassment, sexual assault threats, etc.
Online anonymity is a huge problem and organizations like Twitter need to step up and be more transparent.
Governments can play a role in creating or mandating the creation of safe online spaces through regulations, or refusing to do business with organizations that don’t comply with online safety standards.
Institutions can help by:
Educating themselves about the risks certain groups face on social media.
Giving training and clearly defining expectations around social media use for their employees.
Providing support networks for those who might be at risk of being negatively affected by social media.
Other ways Canada can harness EDI to drive innovation
Realize that people do not need tech backgrounds to be successful CEOs.
Support networking, mentoring and sponsorship of immigrant entrepreneurs and women by recognizing that entrepreneurial opportunities are diverse and extend beyond technology.
Provide better integration of business and immigrant support services, including “concierge” approaches to providing information about the full range of available programs.
Develop better societal support systems for women; e.g., Quebec has universal access to childcare, and higher rates of female participation in entrepreneurship.
Ensure all communities have equitable access to digital infrastructure.
The government needs to spend more money – current investments in gender and diversity are miniscule compared to, for example, the Supercluster initiative.
Traditional job pathways (where jobs are posted, how they are worded, the interview process, etc.) are exclusionary for many groups and need to be reconsidered.
EDI initiatives need to be applied across the board. It’s not about just having an entrepreneurship fund for women; we need to ensure ALL entrepreneurship funds provide equitable funding for women.
Speakers: Dr. Raphael (Rafi) Hofstein, President and CEO, MaRS Innovation; Cate McCready, Vice President, External Affairs, BIOTECanada; Dr. Stéphanie Michaud, President & Chief Executive Officer, BioCanRx; Karimah Es Sabar, CEO and Partner, Quark Venture Inc. and chair of the federal Health and Biosciences Economic Strategy Table
Moderator: Gordon McCauley, President and CEO, CDRD
Takeaways and recommendations
The federal government is investing nearly $1 billion in the Innovation Superclusters Initiative to secure the long-term future of five strategic industries: oceans, digital, mining, artificial intelligence, smart agri-food and advanced manufacturing.
The life sciences sector needs to address the reasons it is not yet a supercluster, namely the lack of anchor companies and alignment between organizations across the country. It therefore needs to come together as a sector to develop a unified story for how a life sciences supercluster can become pan-Canadian and globally leading.
Canada needs to act now to leverage its successes, capabilities and investments that have already been made in the fundamentals of an innovation economy. This will require a unified approach and bold investments. Without action, Canada will continue to be an “off-balance sheet pipeline” providing talent, discoveries, innovations and companies for the rest of the world.
Think of Canada as the incubator to test and advance new technologies; the market for those technologies is global, particularly the U.S.
Canada needs a health policy environment that sees the healthcare of Canadians and growth of biosciences sector as mutually reinforcing.
The federal economic strategy tables are a unique model of cooperation between industry and government. They are industry-led, but with some government members (e.g., Innovation, Science and Economic Development, Health Canada), and focus on industry-led solutions.
The Health and Biosciences Table has set a target of doubling the sector’s exports to $26 billion and doubling the number of companies from 900 to 1800 by 2025, including growing the number of anchor companies from 40 to 80.
Actions proposed by the Health and Biosciences Table (September 2018 report )
Accelerate innovation adoption by employing value-based procurement across Canada’s health systems and establishing a procurement innovation agency.
An agile and streamlined regulatory procurement system, including between the provinces, territories and federal government, could increase access to value-based innovations which emphasize better outcomes for patients over the long-term, rather than short-term cost savings.
Strengthen the health system with technology and incentivize public health care systems to be early technology adopters.
Talk to customers (e.g., hospitals) and regulators (e.g., FDA) first before developing a prototype to ensure you’re developing something the market needs and is willing to purchase.
Look for opportunities to use made-in-Canada prototypes as part of Canadian clinical trials.
Design agile regulations by adopting international best practices, eliminating duplication across jurisdictions and decreasing review times.
Health Canada has set a gold standard for regulation that risks becoming less effective unless it becomes more nimble (i.e., in responding to arrival of new cancer fighting biologics and CAR-Ts)
Canada is struggling with several capacity challenges: volume, talent, technology requirements, timeliness and increasing pressure to meet safety and sustainability expectations. It is not realistic to expect Health Canada to meet these challenges alone; provincial governments need to step up and work better together.
Health Canada has begun to improve its linkages (i.e., sharing data) with the FDA in the U.S.
Canada needs to get creative in accelerating regulatory and legislative changes. That will require the regulatory system (Health Canada) to work more collaboratively with colleagues both within and across departments (e.g., Environment and Climate Change Canada).
Harness digital technology by creating a national digital health strategy featuring an interoperable digital health platform.
Canada needs a robust, interconnected, national patient-centred health data infrastructure to improve the collection and analysis of data for informed decision-making. This could be “sandboxed” in certain regions first.
Develop and attract talent by equipping Canadians for highly skilled jobs, eliminating hiring barriers and streamlining government skills programs.
In addition to training students, BioCanRx trains academic researchers in pre-clinical experimental design and regulatory submissions to strengthen their skills in moving discoveries from the lab to the clinic.
Academic training needs to be increasingly interdisciplinary. (e.g., CDRD’s postdoc program requires participants to work across disciplines; 96% of graduates go on to work in relevant jobs in industry, with approximately 85% of those remaining in Canada).
Create anchor firms by mobilizing late stage capital (e.g., public pension funds), scaling up high-potential firms, and broadening research and development tax incentives.
To scale up companies and create anchor companies, we have to establish the foundation for it. In sectors like medical devices, for example, that means generating as much data about a technology as possible to ensure it aligns with the needs of regulators, industry and healthcare providers.
Ensure the right skills and talent are available. Canada needs a critical mass of activity to attract and retain talent, particularly access to executive-level talent.
Attract talent from Canada and abroad who will become our future CEOs, including Canadian expats.
Make it easier for immigrants to have their professional credentials recognized.
If large-scale implementation isn’t possible, sandbox the idea to demonstrate to others it works.
Bringing Innovative Medicines into the Hands of Patients with Alzheimer’s disease
Organized by: Hoffmann-La Roche Ltd.
Speakers: Christin Bexelius, PhD, leads payer related activities to support Roche’s phase III clinical trial programs in Basel, Switzerland; Andrew R. Frank M.D. B.Sc.H. F.R.C.P.(C), Cognitive and Behavioural Neurologist; Medical Director, Bruyère Memory Program, Élisabeth Bruyère Hospital; Dr. K. Jennifer Ingram MD, FRCPC, Founder, Medical Director and Qualified Investigator at the Kawartha Centre – Redefining Healthy Aging; Pauline Tardif, Chief Executive Officer, Alzheimer Society of Canada
Moderator: Soeren Mattke (MD, DSc), Senior Scientist at USC and the Director of the Center for Improving Chronic Illness Care
Takeaways and recommendations
Alzheimer’s and modes of treatment
Alzheimer’s disease is a continuum: 60-80% of dementias are Alzheimer’s.
Symptomatic treatments are currently available: These drugs do not change the progression of the disease but manage the symptoms of Alzheimer’s Disease.
Disease modifying treatments (DMTs) would slow down or stop the progression of the disease.
It takes two years to get a proper diagnosis. Doctors exclude all other possibilities before reaching an Alzheimer’s diagnosis.
We are getting closer to a DMT in Alzheimer’s. We understand how to diagnose early stages. We have thought leaders looking into how to implement a DMT when there is a therapy. Part of the solution is to adapt methods used in the treatment and management of other diseases.
We cannot afford not to pay for early detection. This is an invisible disease.
Imagine the impact on long-term care if there was a disease-stopping medication.
Set the standards for who needs a diagnostic test at the right level.
The societal side of Alzheimer’s treatment
We are talking about people.
DMTs will likely be most helpful at the beginning phases of the disease.
Stigma and lack of knowledge lead people to avoid seeking a cognitive impairment diagnosis or care.
DMTs will be useful to some, but not others. Explaining that a DMT may not be appropriate for you will be a challenge for clinicians.
There will be a media flurry around DMTs when they are available.
The Canadian healthcare system will need to cover the costs of DMTs, and diagnostics, and expediate their availability.
The stigma will be impacted by treatments, but may not be alleviated.
Day 1 and beyond: when a treatment becomes available, how must the healthcare system respond?
Determination of adequacy of a DMT for a person will be related to bio-markers. PET scans and lumbar punctures can find bio-markers in pre-symptomatic people.
Lumbar punctures are more affordable. Education and dissemination and training will be required to allow primary care providers to do this procedure. If cost of PET scanning came down, many people would prefer that.
Oral and intravenous treatments are under investigation. Oral treatments are easier to give, but are all failing. Intravenous would be given on a monthly basis, requiring infrastructure across the country.
IV would likely be coming first but would be more expensive; oral medicine may be less expensive.
The rate-limiting factor in delivering a DMT is the ability to scale up the lumbar puncture and the PET capacity.
Care by primary care physicians
Necessity is the mother of innovation.
Private care will be heavily involved in the diagnosis and management of dementia care.
Cognitive tests can be delivered in-office, if training is given to staff.
Primary care physicians in Canada can do it, are interested in doing it and will do it.
Canada is well-positioned to show the rest of the world that the workforce in primary care can and will care for those living with dementia.
We cannot scale quickly enough if we only rely on specialists. Primary care physicians are close to being able to handle this care. Primary care can do it, if we help them.