I heard some rather surprising news from the Canadian Institutes of Health Research (CIHR) today, regarding their long established MD-PhD program. It seems that after more than three decades of supporting the training of hundreds of Canadian medical students as both clinicians and research scientists, CIHR is now pulling the plug on the program.
That this comes as somewhat of a shock is underlined by the fact that it is totally contrary to what was recommended by two independent expert advisory panels that had weighed in on the subject. But all that is moot now, following the letter sent by Danika Goosney of CIHR to medical schools around the country, indicating that the 2015-16 academic year will be the program's last. It seems to me that in this burgeoning era of individualised, personalised medicine that we need more physician researchers, not less.
What seems to be most disturbing about the move is that it is purely based on budgetary concerns and does not appear to reflect either a deep analysis of the cost-benefit ratio of the MD-PhD program, nor does it reflect any apparent dissatisfaction with it at the recipient or university end. Au contraire. Dr. Mark Eisenberg, who heads up the program at Montreal's McGill University, summed it all up by one very direct comment - "This is insane."
Ditto Dr.Norman Rosenblum, Dean of Physician Training at the University of Toronto, who said that "The reaction has been horror. My colleagues across the country have been mystified as to how this decision would be taken when they were not specifically consulted". Rosenblum was closer than most to CIHR, having chaired an expert panel that was asked to assess the role and need for clinician-scientists in Canada, some two years ago. That panel concluded that the program not only needed to be continued, but that further support was warranted if capability gaps in various key medical areas were to be filled in the Canadian healthcare system.
“CIHR has no evaluation data on its training programs. It’s disturbing CIHR cancelled it without any semblance of us understanding whether there is a transition plan to ensure continuity in meeting this need".
A similar panel advising the National Institutes of Health (NIH) in the USA on the same matter recommended that NIH “should sustain strong support for the training of MD/PhDs.” So both CIHR and NIH expert panels concurred on the need for and benefit of such programs. In Canada, the sore point seems to be that CIHR has cancelled its program without having measured or assessed the impact the move is likely to have, nor having put in place any type of new initiative to fill the void that the dropped program will surely create.
Goosney has made vague mention of a strategic action plan at CIHR for the next phase of backing the training of patient-oriented researchers, but that is little comfort to many today, and the transition looks like it will be a long one particularly as there doesn't appear to be any plan in place yet. Additionally, lthough budgetary constraints were cited as the reason for the move, the program was hardly exorbitant in nature: the annual cost was something like $1.8M per year, out of a CIHR budget of over $1B annually for life science research and training.
There's something especially counter-intuitive about the cancellation given the prominence of the term "personalised medicine" these days, and the need for physicians who are closer to the lab bench in terms of finding solutions to medical problems via research as well as implementing new discoveries made in labs into daily practice at the hospital. It is felt that with no transition program in place, Canada will slide in terms of both expertise and leadership in the area of personalized medicine.
"On the one hand we are hearing that patient-oriented research and solutions is top drawer in terms of goals for health research, and then we are also hearing that the very people who would be in the centre of the whole enterprise are not a priority, and so we're confused." said Rosenblum.
This is a conversation that is likely to endure I feel, and yet it seems entirely likely that the medical community may find a way to come up with the $1.8M needed to run such a program each year, and maybe that's what CIHR wants them to do -even if that's historically been 100% the job of CIHR, and not the medical schools themselves. If the physician-scientist was already an endangered species in Canada, before, after this move by CIHR, its very existence will now be threatened. Let's hope a solution is found soon enough so that this exotic species does not become totally extinct!
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