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Canadian Health Care Needs to Make Like the iPhone and Evolve

12/12/2013 12:28 EST | Updated 02/11/2014 05:59 EST

In my last post, I considered the adoption of technology in Canada and looked at the sweeping improvements related to healthcare being brought to Canadians and how individuals can manage their medical information. Canadians are living longer; in fact, the average life span has increased by 30 years over the past century. Many health challenges that may have previously required invasive surgery, hospitalization or perhaps been altogether untreatable are now being detected earlier by sophisticated screening and diagnostics, treated with much less invasive procedures, or managed with innovative medicines.

Our Association's Chair, Mark Lievonen, spoke at our Annual General Meeting last month and observed that as recently as 25 years ago entire hospital wings were devoted to patients needing or recovering from ulcer surgery. Today, ulcers are identified earlier and for the most part treated with a host of innovative medicines such as H2 Antagonists and Proton Pump Inhibitors. Mr. Lievonen mentioned ulcers but his example could just have easily been about diabetes and the technological advances of insulin and insulin pumps or the cardiovascular treatments that have improved the lives of millions of Canadians, or HIV/AIDS treatments that have saved the lives of countless others.

Recently, I read an article in Forbes entitled "How to delight Customers with Incremental Innovation" which discussed the role incremental innovation plays in our everyday life. As the author sang the merits of incremental innovation it got me thinking -- why is our sector held to such a different standard when it comes to incremental innovation? You see, incremental innovation is the series of small improvements made to an existing product that over time equate to major change -- think of smartphones as one example. In the life sciences this could include changes to dosing, discovering new interactions, new formulations, or any other ways to rework a product to better meet the patient's needs.

The Conference Board of Canada's Centre for Business Innovation notes that "most innovations are incremental in nature and if implemented properly, lead to cost reductions; enhancements to existing products... and improvement to environmental or safety performance." It's a topic we can get a tad sensitive about in the life sciences community. This is due to the fact that the substantial advances in our health sector have come about not only through medical breakthroughs, but also by a host of incremental improvements.

I think most people would be surprised to find out that about 50 per cent of the new medicines approved by Health Canada are not recommended for listing by the Canadian Agency for Drugs and Technologies in Health (CADTH), the agency that makes the recommendations to Federal, Provincial and Territorial drug plans of what should and should not be covered. Why is that?

In the context of innovative medicines, the concept of incremental innovation has taken on a negative connotation along with a view held by some that every new treatment must be a "breakthrough" treatment or provide benefits that meet a certain threshold to justify its inclusion in drug plans.

A notion has taken root that we must find the right balance or "optimal use" in order to keep drug costs down and maximize the use of our healthcare resources. We must be careful that this approach does not come with an unintended cost...the reduction in incremental innovation and the benefits it brings.

I will put aside for the moment that we fundamentally believe that patients, doctors and clinicians are best served with the widest range of medicines at their disposal so that they can find the best fit or combination of medicines for each individual. It also ensures that options are available if a particular medicine becomes less effective over time.

Instead, I will ask a question: What would happen if we restricted access to "incremental innovations" for a host of consumer products? What would things look like? Well, the Internet, smartphones and tablets would be treated as breakthroughs, but what about the series of small but steady improvements to the size and speed of chips, or design and programming enhancements? Would we have ever realized the iPhone 5 if not for the hundreds of versions before it, as far back as the first cell phones in the 1980s? Google is continuously improving mail service and what about Windows 5, 6 or 7? What about the iPad 3 and those Minis? Like medicines and vaccines, each new version demonstrates incremental innovation -- tangible improvements that matter to people.

Our community shares the goal of managing healthcare costs, and finding the best value to sustain our healthcare system. This includes maximizing the tools at our disposal to prevent, treat and cure disease. We must not lose sight of the fact that innovation must be viewed over the longer term and is, for the most part, undertaken in small incremental steps. One innovation will bring about the next. In fact, according to the Canadian Institute for Health Information, Canada's drug costs are growing at a slower rate than the entire health sector. It is clear that the fears of ballooning drug costs widely held just a few years ago did not materialize.

In our own industry, incremental innovation has a real positive impact for patients -- it brings to bear the latest scientific thinking to improve safety, tolerability, efficacy and quality of medicines. We believe the notion of this value to our society must meaningfully include its by-product... better health outcomes, keeping employees off disability and at work, and promoting productive citizens of all ages.

To quote David Shaywitz, a fellow contributor, we must find the right balance "that preserves the unsexy but important incremental improvements upon which medical advancement depends."

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