Financial independence is essential to the future credibility and success of the Canadian Academy of Health Sciences (CAHS), says the former head of the US Institute of Medicine (IOM).
Modeled after the IOM and similar national bodies, the recently-minted CAHS, 1 of 3 member academies of the equally embryonic Council of Canadian Academies (CCA), ultimately hopes to serve as the nation's primary source of objective, evidence-based research on health issues.
To achieve this, it's vital that the CAHS establish a diversified source of funding during its formative years, former IOM president Kenneth Shine told the new academy's second annual meeting, held in Ottawa Sept. 26–28. “Depending on government money will compromise independence. In the [US], if the government doesn't like what you do, they will cut your funding.”
In the interest of maintaining credibility and ensuring that it isn't conflicted, the US National Academies have opted to turn down government money for studies that aren't science-based, he said. When they do take federal funding, it's under contract, so the academies can determine the conditions of the study.
The IOM, established in the 1980s, funds its 40 or so reports each year through contract work for governments, other institutions and organizations. It's also built an endowment fund through planned giving and annual gifts. Approximately 70% of its research is proposed by others, and the remainder has been self-generated, including a headline-grabbing report on medical error.
CAHS President-Elect Dr. Martin Schechter agreed that diversified funding would be preferable in terms of the long-term viability of the academy and, ultimately, will augment its credibility. “We'd be acting as honest brokers to everybody.”
For now, though, the CAHS has nothing in the way of a pot of money, although, as a member of the CCA, it could theoretically be asked to conduct a study for the federal government under the latter's agreement with the CCA. Ottawa provided $30 million over 10 years in exchange for a commitment to conduct roughly 5 studies annually on federally chosen topics.
CCA President Peter Nicholson said “there is little to no room” within the arrangement to investigate issues at the scientific community's initiative. The first CCA report was recently delivered in response to a June request to assess the state of science and technology in Canada (see CMAJ 2006;175:1046).
Shine argued that the CAHS' reputation will ultimately build on its capacity to initiate studies in areas of national need. “If you are all over the place, you won't have the impact … to develop credibility and make a difference.”
There's no doubt Canada needs a credible source of unbiased advice on health-related issues, CAHS founding President and University of Alberta professor of medicine Dr. Paul Armstrong said. Other nations are far more advanced in developing such a resource, including the UK, which is establishing the Academy of Medical Sciences, and France, with its Académie nationale de médecine.
“Canada has lagged behind other countries,” Armstrong said, adding that the CAHS voice could potentially be unique due to its multidisciplinary nature, with fellows from medicine, nursing pharmacy, dentistry, rehabilitation sciences and veterinary medicine. Fittingly, the academy's first self-initiated project assessed the barriers to, and benefits of, fostering interdisciplinary health research (CMAJ 2006;175:763-71).
Shine also stressed that an academy is only as good as “the quality of your membership.” In the IOM's case, one-quarter of members are from outside the health professions, including lawyers, historians and ethicists. By contrast, the current CAHS membership (roughly 220) is primarily comprised of biomedical researchers and administrative luminaries.
The IOM, established in 1970 as a private, independent non-profit organization, has drawn rave reviews for pivotal reports like To Err is Human: Building a Safer Health System (1999). No one wanted to fund the medical errors study, said Shine. But the IOM saved up for four years and used a $1.2-million endowment to conduct the study, which made international headlines and resulted in policy changes like the addition of adding bar codes to drugs, prompting a 50%–60% reduction in medication errors.
“We changed the anatomy in terms of truth,” said Shine. “It's now okay to admit, apologize and explain error. We've seen a drop in malpractice settlements as a result.”
“But simply producing a good report is inadequate,” adds Shine. “There needs to be clear dissemination.”
“We're not an advocacy group, but we know who is; you have to put it in the right language … [so] it is easily understood by media, policy-makers and others.”
Moving from evidence to action is a challenge, said Jonathan Lomas, president and CEO of the Canadian Health Services Research Foundation, formed in 1997 with a $120-million endowment.
Lomas argued the community must become more sophisticated about knowledge dissemination. “We need to inform science with the colloquial,” so that it's more likely to be comprehended and adopted.
Armstrong hoped the advice garnered at the gathering will help CAHS establish itself as neutral broker. “We should be the ‚go to' organization for research assessment.”