On Jan. 1, professor and emergency physician Brian Rowe was reappointed as the scientific director of the Institute of Circulatory and Respiratory Health (ICRH). Now two month into his second term, Rowe sat down to talk with us about what the institute has done and where he'd like it to go in the next four years and beyond. What is the Institute of Circulatory and Respiratory Health?
Brian Rowe: ICRH is one of 13 virtual institutes under the umbrella of the Canadian Institutes of Health Research (CIHR) and the only CIHR institute hosted at the University of Alberta. It was one of the original institutes since the inception of CIHR in 2000, and has been at the U of A under my direction since 2016. This is an important year for CIHR; it's been 20 years since our funding agency was created!
The institute supports research into causes, mechanisms, prevention, screening, diagnosis, treatment, support systems and palliation in the areas of sleep, blood and blood vessels, stroke, critical care, respiratory and cardiovascular. We set the scientific direction for the community in these areas by creating funding, networking opportunities and other strategic initiatives. Once we create a funding opportunity and make it public, we are not involved in the decision-making process. We work with successful applicants to facilitate knowledge translation; but to avoid conflicts of interest, we don't make those decisions.
Why do you think having ICRH housed at the U of A is important for the university?
BR: I think if a university has an institute like ICHR, it helps to attract activities, speakers, research leaders and meetings.
For example, we have an Order of Canada researcher from U of T coming for our research day in emergency medicine, and I don't think that would have happened if I wasn't a scientific director and didn't have this larger role. Another benefit is that this role can provide western representation on the national scale and help encourage participation from the U of A for national projects.
CIHR has been developing a new strategic plan and I received an email from a leader at the U of A asking how many U of A academics were at the planning table. I told him there were two of us in attendance and he was shocked. So I asked what the U of A was doing to support having more staff participate and suggested he promote participation. At the next meeting, there was more U of Arepresentation. The U of A leadership wouldn't have known they were missing out if I wasn't there.
Moreover, it's important that we are there because we want our western voices to be heard. We have a unique situation in Alberta. We have a large Indigenous community-one of the largest on a percentage basis-and the University of Alberta Hospital's service range extends across much of northern Canada, including the Northwest Territories and Yukon. The health providers in these regions are contacting us to accept patients from their centres. We need to understand the needs of patients from remote, northern and Indigenous communities, the gaps in their care, and we need the federal government to understand what we're doing to support services. In addition, we have experts across all of the research themes and their perspectives should be part of the dialogue.
How has the institute's work benefited Albertans?
BR: A great example is the Transitions in Care initiative, which is designed to help address some of the gaps when people move through the health system, from their family doctor to to emergency department, specialist to rehabilitation and then back to their family doctor, for example.
That whole idea was driven home with the story of Greg Price. Greg, who was from Acme, Alberta, was found to have testicular cancer and a mass on his abdomen. Largely because of poor connectivity within the health system, a required surgery to remove his testicle was delayed by months, he was sent home to recover, and suffered a fatal pulmonary embolism.
His family have spent most of their time since Greg's death creating a charity called Greg's Wings, which made a movie about Greg's journey called Falling Through the Cracks: Greg's Story. Their goal is to try to improve the transitions in care for Canadians and prevent these poor outcomes from happening to others. Because of Greg's story and the crossover with our institute, we've helped create a $32-million initiative to improve transitions in care across Canada. We are very committed to this initiative because real people experience these terrible outcomes and patients and families really suffer.
How do you think Alberta, or the U of A specifically, ranks in terms of translational research in Canada?
BR: I think we've traditionally had a very strong basic science program at the U of A. I think we're emerging as an area of expertise in that translational space, from bench to bedside, and from bedside to health system or public health overall. My institute and others at CIHR support all research themes: from bench research to clinical and health services research and finally to research impacting population and public health.
Research today is very different than it was years ago, and the differences that new drugs or new treatments produce are much smaller in 2020 than they were years ago. More effort goes into finding these smaller and smaller health effects, and it costs more for funding agencies to support research in important areas. Costs of care, research staff and complex interventions are all higher, so it is a more expensive proposition; you need to give more of your money to individual researchers to accomplish these goals. Hopefully, researchers, clinicians and patients are working collaboratively to ask the best questions, and hopefully the result is actually impactful for patient care and decision-making in the health system. Overall, I think Alberta does a good job in that regard.
Looking back over the last four years of your term as scientific director, what are you most proud of?
BR: In partnership with Red Cross, Alberta Innovates, Alberta Health Services, Alberta Health and the community, CIHR developed a $3.5-million funding opportunity for two-year grants of $250,000 per year to study some of the effects of the Fort McMurray wildfire. The fire occurred during the first six months of my position, and we saw many of the patients here at the University of Alberta Hospital. Evacuees from Fort McMurray were living in local campgrounds and at the Edmonton Expo Centre; they were everywhere in the city. In health research, we thought, "We've got firefighters exposed to risks, the ash and air quality issues, and possible mental issues and other possible health effects from the fire. There's also the resilience of that community that needs to be examined and explored."
The partnership resulted in seven funded projects―four led by U of A scientists―and CIHR subsequently funded a knowledge-mobilization exercise in the Wood Buffalo area, where scientists presented the emerging results from their projects to community and funding partners.
What was great was that we didn't originally have any funding for that wildfire research; however, we were able to mobilize resources very quickly with these partners. Funds went out, the research was done and now we know more about the health effects of wildfires. Recently, Australia has contacted us about their wildfires, and Stephanie Montesanti, one of the U of A's investigators at the School of Public Health, has been able to participate in their grant competition as a reviewer.
What is your vision for the next four years?
BR: We've just announced a couple of training and research funding opportunities and hope to continue to partner with like-minded funders over the next four years. I strongly believe in research networks; I think they're ultimately stronger for Canada than teams are. Teams tend to be smaller and support only a small number of researchers. With networks, the whole country can benefit from this funding. Eventually, as the network matures, the research also matures to a point where multiple centres and researchers participate in large, impactful research projects. You need multiple sites collecting the same information and working together. The impact of that kind of work has far-reaching effects. It's when you see the dissemination of that research that you realize how impactful it is.
We believe very strongly that we should be investing more in clinical trials and the investments should be larger. Like other countries, we are seeking support for specific annual funding for large, often multi-national, studies that look at important outcomes for patients and the health-care system. Often, these studies require the inclusion of international collaborators. I think there's lots to do in the training environment and we certainly want to enhance capacity-development opportunities across our mandate areas.
Ultimately, the institute strives to fund the best science by securing the most money that we can to support as many projects as possible, in a fair and transparent way, so we can improve the health of all Canadians.