I respectfully disagree with Dr. David Sackett's criticism of preclinical science.1 Preclinical studies form the foundation for clinical trials. Without advances in bench research, there would be no GUSTO,2 no HOPE3 and no PRISM-PLUS.4
As Dr. Sackett noted in his commentary, Canada is far behind the US, Japan and Europe in biochemistry, biological sciences, preclinical studies and anatomy.5 Rather than limiting funding to research in these areas, Canada should catch up with the rest of the world. The future of the Canadian pharmaceutical and biotechnology industries is at stake. Commercial successes such as Lipitor6 and Canadian biotechnological innovations such as photodynamic therapy for wet macular degeneration7 and drug-resistance genotyping for HIV8 would have been impossible without such investment.
Dr. Sackett said that "the results of a significant proportion of pragmatic RCTs are country specific and not transferable." But the same is also true in basic research, especially in medical genetics and molecular epidemiology. For example, understanding the molecular basis for the predisposition of aboriginal Canadians to diabetes and atherosclerosis will be an important step in solving one of Canada's most difficult public health problems.9
Canada has a proud history of scientific accomplishment. The genes responsible for cystic fibrosis, Duchenne muscular dystrophy and Wilson's disease were discovered in Canada. With the approaching completion of the Human Genome Project and the development of new technologies such as gene therapies, molecular medicine is going to revolutionize the practice of medicine in Canada. The Canadian Institutes of Health Research will play a critical role in ensuring that the Canadian public reaps the benefits of this revolution. Limiting funding to preclinical research would lead to a worse disaster than the Canadian health care reform of the early 1990s.10
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