The Revolution in Health Research

Alan Bernstein, OC, O. Ont, PhD, FRSC, FCAHS, LLD, DSc Canadian Institute for Advanced Research, Toronto Canada

BIO After PhD studies at the University of Toronto, and postdoctoral work in London, Alan worked at the Ontario Cancer Institute and then the Samuel Lunenfeld Research In- stitute (eventually as Director of Research). As inaugural president of the Canadian Institutes of Health Research (CIHR; 2000–2007), he led the transformation of health research in Canada and an almost tripling of the budget for health research. He then was named executive director of the Global HIV Vaccine Enterprise (2008–2012). Since 2012, Alan has been president of CIFAR, Canada’s global research institute, where he has led major initiatives to increase CIFAR’s programs of research and global impact, and launched new programs to nurture the world’s next generation of researchers. Author of 250 scientific and 50 op-ed and lay publications, Alan has received numer- ous awards and honors, including induction into the Orders of Canada and Ontario, honorary degrees, the Gairdner Wightman Award, induction into the Canadian Medi- cal Hall of Fame and the Henry Friesen International Prize.

Let me begin by wishing the Journal of Clinical and Inves- come the new drivers of change in health research. And tigative Medicine (CIM) a very happy 40th birthday! And because science is the art of the doable, new tools and my sincerest best wishes for the next 40! technologies are essential to progress. People and new Like you, I have had the exceptionally good fortune tools, many taken from other fields of research, have of being a witness and participant in the truly remark- made health research increasingly interdisciplinary. able and indeed accelerating revolution in health re- The remarkable progress that has taken place since this search. The origins of that revolution can be arbitrarily journal was first launched reflects the synergy that hap- marked by the discovery of the double helical structure pens when people with diverse backgrounds come to- of DNA in the early 1950s. Beginning with that discov- gether to tackle problems with the complexity posed by ery, or perhaps the earlier discovery that DNA was the the human body, by health and by disease. For close to carrier of our genetic material, health research and 40 years, the Canadian Institute for Advanced Research clinical medicine began a journey from largely observa- (CIFAR), the organization that I now lead, firmly believes tional-based to mechanism-based and now to informa- that diversity and interdisciplinarity are key ingredients tion-based science. in driving transformative progress in science. This remarkable journey in health research is at Nowhere are the changes in health research more least as profound as the 1920s revolution that saw quan- evident than in clinical medicine. Precision medicine, tum physics overthrow classical or Newtonian physics. AI applied to health and disease, rational drug design, As was seen with the revolution in physics, new people targeted therapy, stem cells and regenerative medicine, and new tools are driving the revolution in the life and reverse vaccinology and immunotherapy are just some clinical sciences. This is not surprising. People are, of of the new terms that reflect the profound changes un- course, the source of all ideas. But the revolution in the derway in diagnosis, treatment and prevention. This is health sciences would arguably not have happened, or truly a uniquely exciting time to be working at the inter- not have happened when it did, without the migration section of leading edge science and the clinic. of physicists and chemists over the past 40 years. Today, As the readers of this journal will know, we have artificial intelligence (AI) and data scientists have be- historically been restricted to making clinical decisions

© Clin Invest Med 2018; 41 (sup): 9-10 | October 2018 9 based primarily on clinical symptoms rather than the nature of science (not unlike fishing which is also char- underlying causes of disease. We lacked the necessary acterized by long periods of calm interrupted by a hit) tools—genetic, genomic, imaging and analytic—to dig is both frustrating and exhilarating at the same time. underneath the presentation of disease to understand Throughout my career in science, I have been fortunate and treat the underlying causes. That is rapidly chang- to enjoy fishing in the amazingly deep and rich waters ing. Cancer research, my own area of research, is a case of human biology and disease (and I think that I have in point. When I started in cancer research as a young caught several big fish as well!). investigator, we had no idea why cancer cells behaved When the government of Canada asked me to serve differently than their normal counterparts. As a result, as CIHR’s inaugural president, I was given the special treatment protocols were empirically-derived and were privilege and responsibility of leading the transforma- (and still are) largely based on the differential suscep- tion of health research in Canada. The vision for CIHR tibility of cancer cells to killing by drug(s) or radiation goes back to the Lalonde Report in the 1970s, which ar- treatment. Today, we know some of the most intimate gued for a more holistic approach to health and disease, molecular details underlying and driving the differences to CIFAR, with its emphasis in the 1980s on the socio- in behaviour between normal and cancer cells. Impor- economic determinants of health, and to the publication tantly, elucidating these molecular changes is not just of the influential book, “Why are Some People Healthy exciting science. The discoveries and insights coming and Others Not?”. This historic foundation, and the cru- from this research are being used daily to diagnose can- cial leadership that Henry Friesen provided 1998-2000, cer and increasingly form the basis for rationale drug culminated in the creation of CIHR. With colleagues in design and treatment decisions. CIHR’s 13 new institutes and partner organizations, we I do not mean to suggest that the cancer problem is built on this work to develop a novel, strategic and in- solved. It is not. But the paradigm today of modern can- tegrated approach to health research while continuing cer research and clinical medicine has been profoundly to strengthen bottoms-up investigator-driven research transformed as the result of this scientific revolution in across the entire spectrum of research. New empha- health research. sis was placed on interdisciplinary research, reflecting What are the implications of this revolution for the way that health research is increasingly carried out. how we train the next generation of clinical investiga- Simply put, health and disease are challenges, not dis- tors? First, I cannot emphasize enough how important ciplines, and health research has become a crystallizing young people are to all areas of science. They are the agent; bringing together virtually every discipline to bear true drivers of change and new ways of thinking and on these challenges. doing. Second, as important as young people are to sci- As CIHR’s and now CIFAR’s president, I am struck by ence, they are especially important to clinical medicine how rapidly research is changing and how important it and to bridge the lab with the clinic. Young investigators is, therefore, that the research enterprise in this country have the energy, passion, intellect and curiosity need- remains agile in order to respond to and lead in both ed to be a fundamental scientist, a clinical investigator new directions in science and the changing ways that and, in their spare moments, a clinician. If we fail to train science is carried out today compared with just a few the next generation of clinical investigators, we place in years ago. The opportunity to both carry out exciting jeopardy the movement of ideas between the lab and science and make a difference in clinical outcomes has the clinic. It is imperative that funding agencies and host never been greater. These are indeed remarkable times institutions place a high priority on novel ways to en- to be a clinical investigator and to be doing health re- courage and support early career investigators, both search! clinical and fundamental. As scientists, we know that progress in research typ- CORRESPONDENCE TO: ically takes place incrementally, occasionally interrupt- E-mail [email protected] ed by a profound leap in understanding. This punctate

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