The Niagara Falls of Biomedical Research



The tiny river in my metaphor refers to commonly called Health Services and Policy Research. An applied field of research that seeks to understand and improve how health care systems are organized and managed, and how health care providers can generate greater health outcomes. Researchers engaged in this field produce and share knowledge that can help health care systems fulfill their mission and innovate as well (http://cahspr.ca/en).

However, the Niagara Falls of biomedical research brings in a constant flow of new products that are rarely properly evaluated before they enter the market. For instance, the Canadian Institutes of Health Research (CIHR), which is the most important public source of funding for health research in the country, spent in 2009-2010 around 938.3 millions of dollars. Only 7% of that envelope went to its “Pillar 3”, which consists in Health Services and Policy Research. Historically and still today, the bulk of CIHR budget has been devoted to foster basic biomedical sciences. There is also the Natural Sciences and Engineering Research Council (NSERC) – with an annual budget of close to 1 billion – that funds some health-related basic research. And there is of course private investments in R&D. In the biotech sector, which is made of basic sciences like genetics and molecular biology, firms’ R&D expenditures nearly tripled between 1997 and 2001. For the “human health” category, it reached $1.2 billion in 2001, which represented 92% of all R&D in the biotech sector.

Misleading assumptions that generate a significant waste of resources


In fact, from the perspective of industrial design, talking about “receptor capacity” doesn’t make much sense. When a technology is not adopted, it’s probably because it is badly designed: either it’s not appropriate or it doesn’t fit within the organizational context in which its use is supposed to take place.

Any scientific or technological discovery relies on a vision about what it may accomplish and why such outcomes are valuable or not. These initial visions are based, of course, on a number of plausible scientific and technological assumptions that will be tested through basic scientific studies. But one problem is that they also rely on a number of social, ethical and organizational assumptions about how an innovation may be disseminated and used. And very often these assumptions are either flawed or misleading, in part because they come from people who have a limited knowledge about health care systems needs and challenges.


In order to increase the potential usefulness and appropriateness of innovation in health care, the assumptions that come with the Niagara Falls of the biomedical sciences have to be carefully examined and put to test earlier in the development process This can be achieved with the insights generated by health services and policy research and applied social scientific research. Increasing the resources devoted to such areas of research is I believe pivotal. Otherwise, an important waste in terms of financial and human resources along the innovation pipeline will persist.

Author :Pascale Lehoux, Ph.D.

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