David Clinton

Why Can’t We See the Canadian Institutes for Health Research-Funded Research We Pay For?

Right off the top I should acknowledge that a lot of the research funded by the Canadian Institutes for Health Research (CIHR) is creative, rigorous, and valuable. No matter which academic category I looked at during my explorations, at least a few study titles sparked a strong “well it’s about time” reaction.

But two things dampen my enthusiasm:

1. Precious few of the more than 39,000 studies funded by CIHR since 2011 are available to the public. We’re generally permitted to see no more than brief and incomplete descriptions – and sometimes not even that.
2. There’s often no visible evidence that the research ever actually took place. Considering how more than $16 billion in taxpayer funds has been spent on those studies over the past 13 years, that’s not a good thing.

If you’ve been reading The Audit for a while, you know that I’ll often identify systems that appear vulnerable to abuse. As a rule though, I’m reluctant to invoke the “s” word. But here’s one place where I can think of no better description: the vacuum where CIHR compliance and enforcement should be is a national scandal.

I’ve touched on these things before. And even in that earlier post I acknowledged how:

…as a country, we have an interest in investing in industry sectors where there’s a potential for high growth and where releasing proprietary secrets can be counter productive.

So we shouldn’t expect access to the full results of every single study. But that’s surely not true for the majority of research. And there’s absolutely no reason that CIHR shouldn’t provide evidence that something (anything!) productive was actually done with our money.

Because a well-chosen example can sometimes tell the story better than huge numbers, I’ll focus on one particular study in just a moment. But for context, here are some huge numbers. What follows is an AI-powered breakdown by topic of all 39,751 research grants awarded by CIHR since 2011:

Those numbers shouldn’t be taken as anything close to authoritative. The federal government data doesn’t provide even minimal program descriptions for many of the grants it covers. And many descriptions that are there contain meaningless boilerplate text. That’s why the “Other – Uncategorized” category represents 72 percent of all award dollars.

Ok. Let’s get to our in-the-weeds-level example. In March 2016, Greta R. Bauer and Margaret L. Lawson (principal investigators) won a $1,280,540 grant to study “Transgender youth in clinical care: A pan-Canadian cohort study of medical, social and family outcomes”.

Now that looks like vital and important research. This is especially true in light of recent bans on clinical transgender care for minors in many European countries following the release of the U.K.’s Cass report. Dr. Cass found that such treatment involved unacceptable health risks when weighed against poorly defined benefits.

A website associated with the Bauer-Lawson study (transyouthcan.ca) provides a brief update:

As of December of 2021, we have completed all of our planned 2-year follow up data collection. We want to say thanks so much to all our participants who have continued to share their information with us over these past years! We have been hard at work turning data into research results.

And then things get weird. That page leads to a link to another page containing study results, but that one doesn’t load due to an internal server error.

Before we move on, I should note that I come across a LOT of research-related web pages on potentially controversial topics that suddenly go off-line or unexpectedly retire behind pay walls. Those could, of course, just be a series of unfortunate coincidences. But I’ve seen so many such coincidences that it’s beginning to look more like a pattern.

The good news is that earlier versions of those lost pages are nearly always available through the Internet Archive’s WayBackMachine. And frankly, the stuff I find in those earlier versions is often much more – educational – than whatever intentional updates would show me.

In the case of transyouthcan.ca, archived versions included a valid link to a brief PDF document addressing external stressors (which were NOT the primary focus of the original grant application). That PDF includes an interesting acknowledgment:

This project is being paid for by a grant from the Canadian Institutes of Health Research (CIHR). This study is being done by a team of gender-affirming doctors and researchers who have many years of experience doing community-based trans research. Our team includes people who are also parents of trans children, trans adults, and allied researchers with a long history of working to support trans communities.

As most of the participants appear to have financial and professional interests in the research outcome, I can’t avoid wondering whether there might be at least the appearance of bias.

In any case, that’s where the evidence trail stopped. I couldn’t find any references to study results or even to the publication of a related academic paper. And it’s not like the lead investigators lack access to journals. Greta Bauer, for example, has 79 papers listed on PubMed – but none of them related directly to this study topic.

What happened here? Did the authors just walk off with $1.2 million of taxpayer funding? Did they do the research but then change their minds about publishing when the results came in because they don’t fit a preferred narrative?

But the darker question is why no one at CIHR appears to be even mildly curious about this story – and about many thousands of others that might be out there. Who’s in charge?

By Liam Hunt

Canada’s safer supply programs are “selling people down the river,” says a leading medical expert in British Columbia. Dr. Julian Somers, director of the Centre for Applied Research in Mental Health and Addiction at Simon Fraser University, says that despite the thin evidence in support of these experimental programs, the BC government has aggressively expanded them—and retaliated against dissenting researchers.

Somers also, controversially, raises questions about doctors and former health officials who appear to have gravitated toward businesses involved in these programs. He notes that these connections warrant closer scrutiny to ensure public policies remain free from undue industry influence.

Safer supply programs claim to reduce overdoses and deaths by distributing free addictive drugs—typically 8-milligram tablets of hydromorphone, an opioid as potent as heroin—to dissuade addicts from accessing riskier street substances. Yet, a growing number of doctors say these programs are deeply misguided—and widely defrauded.

Ultimately, Somers argues, safer supply is exacerbating the country’s addiction crisis.

Somers opposed safer supply at its inception and openly criticized its nationwide expansion in 2020. He believes these programs perpetuate drug use and societal disconnection and fail to encourage users to make the mental and social changes needed to beat addiction. Worse yet, the safer supply movement seems rife with double standards that devalue the lives of poorer drug users. While working professionals are provided generous supports that prioritize recovery, disadvantaged Canadians are given “ineffective yet profitable” interventions, such as safer supply, that “convey no expectation that stopping substance use or overcoming addiction is a desirable or important goal.”

To better understand addiction, Somers created the Inter-Ministry Evaluation Database (IMED) in 2004, which, for the first time in BC’s history, connected disparate information—i.e. hospitalizations, incarceration rates—about vulnerable populations.

Throughout its existence, health experts used IMED’s data to create dozens of research projects and papers. It allowed Somers to conduct a multi-million-dollar randomized control trial (the “Vancouver at Home” study) that showed that scattering vulnerable people into regular apartments throughout the city, rather than warehousing them in a few buildings, leads to better outcomes at no additional cost.

In early 2021, Somers presented recommendations drawn from his analysis of the IMED to several leading officials in the B.C. government. He says that these officials gave a frosty reception to his ideas, which prioritized employment, rehabilitation, and social integration over easy access to drugs. Shortly afterwards, the government ordered him to immediately and permanently delete the IMED’s ministerial data.

Somers describes the order as a “devastating act of retaliation” and says that losing access to the IMED effectively ended his career as a researcher. “My lab can no longer do the research we were doing,” he noted, adding that public funding now goes exclusively toward projects sympathetic to safer supply. The B.C. government has since denied that its order was politically motivated.

In early 2022, the government of Alberta commissioned a team of researchers, led by Somers, to investigate the evidence base behind safer supply. They found that there was no empirical proof that the experiment works, and that harm reduction researchers often advocated for safer supply within their studies even if their data did not support such recommendations.

Somers says that, after these findings were published, his team was subjected to a smear campaign that was partially organized by the British Columbia Centre on Substance Use (BCCSU), a powerful pro-safer supply research organization with close ties to the B.C. government. The BCCSU has been instrumental in the expansion of safer supply and has produced studies and protocols in support of it, sometimes at the behest of the provincial government.

Somers is also concerned about the connections between some of safer supply’s key proponents and for-profit drug companies.

He notes that the BCCSU’s founding executive director, Dr. Evan Wood, became Chief Medical Officer at Numinus Wellness, a publicly traded psychedelic company, in 2020. Similarly, Dr. Perry Kendall, who also served as a BCCSU executive director, went on to found Fair Price Pharma, a now-defunct for-profit company that specializes in providing pharmaceutical heroin to high-risk drug users, the following year.

While these connections are not necessarily unethical, they do raise important questions about whether there is enough industry regulation to minimize potential conflicts of interest, whether they be real or perceived.

The BCCSU was also recently criticized in an editorial by Canadian Affairs, which noted that the organization had received funding from companies such as Shoppers Drug Mart and Tilray (a cannabis company). The editorial argued that influential addiction research organizations should not receive drug industry funding and reported that Alberta founded its own counterpart to the BCCSU in August, known as the Canadian Centre of Recovery Excellence, which is legally prohibited from accepting such sponsorships.

Already, private interests are betting on the likely expansion of safer supply programs. For instance, Safe Supply Streaming Co., a publicly traded venture capital firm, has advertised to potential investors that B.C.’s safer supply system could create a multi-billion-dollar annual market.

Somers believes that Canada needs more transparency regarding how for-profit companies may be directly or indirectly influencing policy makers: “We need to know exactly, to the dollar, how much of [harm reduction researchers’] operating budget is flowing from industry sources.”

Editor’s note: This story is published in syndication with Break The Needle and Western Standard.

Dr. Julian M. Somers is director of the Centre for Applied Research in Mental Health and Addiction at Simon Fraser University. He was Director of the UBC Psychology Clinic, and past president of the BC Psychological Association. Liam Hunt is a contributing author to the Centre For Responsible Drug Policy in partnership with the Macdonald-Laurier Institute.