S03 E03

Keeping Evidence Current During Covid-19


Suzanne McGurn

President and CEO

Canadian Agency for Drugs and Technologies in Health

In the third episode of our third season, Peter Brenders, CEO of the New Brunswick Health Research Foundation, talks with Suzanne McGurn, President and CEO of CADTH, about the ever-evolving role of evidence and pivoting in her role as the new president of CADTH during a pandemic.



From the National Pharmaceutical Congress, this is the NPC Podcast for February 17th, 2021. This program is all about discussing and considering the purpose, process and people of the pharma industry during the Age of Covid. Today, let's continue our health care conversation by answering questions sent by listeners like you. 


This program is presented in cooperation with Impres, Impres' best in class, commercial solutions offered top line and bottom line growth with maximum sales force, flexibility, speed, and efficiency. Learn more about their next generation commercial model at www.impres.com


On today's podcast, our guest is Suzanne McGurn, President and CEO of CADTH. Your host for this episode is Peter Brenders, CEO of the New Brunswick Health Research Foundation. 


Now, here's Mitch Shannon of Chronicle Companies. 




Liona, thank you. 


You're hearing a lot of talk and healthcare circles these days about evidence, especially real world evidence. But that's not a new thing by any means. 


In Ottawa, the Canadian Agency for Drugs and Technology and Health, CADTH when it's at home, has been in the objective evidence game since 1989. It's an independent non-profit agency that somehow manages, on most occasions, to get Ottawa, most provinces and territories, and other stakeholders on the same page. That alone is kind of extraordinary. 


Suzanne McGurn has been running CADTH and it's 200 employees since last summer, which you'll recall was a rough time to join anything. 


Here she is in conversation with Peter. 



Welcome to the NPC Podcast. I'm Peter Brenders, your host. 


In our continuing look at the purpose, process and people in pharma. This episode explores the world of evidence review. Joining me today from Ottawa is Suzanne McGurn, the relatively new President and CEO of the Canadian Agency for Drugs and Technologies and Health known as CADTH. 


Welcome, Suzanne.



Good morning. And thank you, Peter, for inviting me. I'm looking forward to chatting with you today. 




That's terrific. We're delighted to have you on. 


Before we get into talking about evidence review and the Covid effect. I think we all want to know a little bit more about you and what it was like taking on a new role in a different city in the midst of a pandemic. I mean, you started at CADTH like last July, I believe. You got to tell us about this. 




Thanks, Peter. 


Well, let's start off with when I was originally considering the opportunity to apply and move to CADTH, I was not imagining what 2020 was going to look like. And a lot of my consideration actually was around the fact that it was a new decade and new opportunities for evidence and all of the changes that were going on and being considered that CADTH was a part of. And so certainly my arrival from my former role at the Public Service in Ontario, and working in Corrections in July was quite different than I expected. 


So like most other people, I've spent the better part of the last seven months working in my newly created home office. I've been into our physical space at CADTH once or twice, and I've met almost my entire team virtually, there was a few people I knew before I came. 


The other thing is it's really changed the way to connect with stakeholders, the key stakeholders for CADTH are obviously the jurisdictions. And I was kind of looking forward to my cross country opportunity to meet individuals and see the jurisdictions up close. But folks have been pretty busy with Covid. So I've been trying very, very hard to be respectful of their time and let them do the important job that they're doing right now. 




I heard it was minus 40 in Saskatoon this past week. So, you know, that tour can probably wait a little bit. 


So, maybe you can give our industry audience a little peek behind the curtain at CADTH. So, what's it been like for staff during this past year? 




Well, I guess I have to take what I've learned through meeting them virtually. And so it is a little bit hard, you don't get that natural vibe of what it's like when you're in a building and seeing people in the hallway and having coffee or lunch with them. But our staff have been working from home with some variations about what it looks like depending on where they work in Canada. 


What a lot of people don't know is that CADTH is an organization of just over 200 individuals with the greatest number located here in the Ottawa area. But we also have a satellite office in Toronto, but we also have individuals in most jurisdictions across Canada and at least regionally. And so it's been tough. You know, we have a staff mix that leads to a younger age population. So caregiving needs and the competing priorities at home. 


But maybe you know, the thing I would say, just in pulling back the curtain of arriving here at CADTH, what was most surprising to me and someone who's worked with CADTH for a long time is about all of the things I didn't know. In fact, one of the very first presentations I did to my colleagues at the Pan-Canadian level was entitled: What You Know, What You Might Not Know And What Might Surprise You About The Organization.


So yeah, it's been a real interesting start to this new role. 




Okay, so that was just an incredible teaser there. So you got to give us some insight that Okay, give me a couple examples here, Suzanne, in terms of what we might not know. 




For me, what I didn't know is that CADTH actually has one of the greatest library services in Canada in the health library world. We have research specialists that come from all over that have very unique backgrounds that are really the backbone of the work that we do here at CADTH. You know, I think what we're most all familiar with is the type of work we do in our evidence reviews where we make recommendations on pharmaceuticals, or the CAR T-Cell. But there's a whole suite of competencies about policy analysis, moving into the real world evidence, space, ethics, qualitative analysis, access to evidence and so many other things that I really didn't have a full appreciation of the breadth and suite of the skills here within the CADTH team. 




You're listening to the NPC Podcast, I'm Peter Brenders your host. 


Okay, so that's a great setup for a question I was gonna ask you a little bit about in terms of digging into the operations a little bit more in terms of CADTH. But maybe could talk to us about that in the context of, you know, what's changed during this pandemic? And has this been a good thing, been an improvement, it's like, "thank you pandemic for giving us new ways and breaking out of old bad habits", or what you guys guys put in place, are these just placeholders so you can get back to the way you were working before? 




Well, I think it's a little bit of all of them. 


So maybe what's easiest to start with for people is what hasn't changed. And so what hasn't changed is that CADTH really, you know, at its core and its heart is an evidence based organization. And so we bring those strengths to bear on whatever we're doing. With a flip of a switch, and I think CADTH was one of the first organizations that moved virtually, we were able to continue our formulary, pharmaceutical reviews, without skipping a beat, you know, we moved rapidly to virtual, we didn't have any delays, we didn't have to take a pause. So that was great. You know, we've learned lots and and we've learned to do it virtually well. 


Some of our programs, like the Scientific Evidence Advice Program, we did take a pause on, we set that aside to be able to redirect resources and skills and talents, and rejig other plans to help us with Covid. In fact, we've had, I just actually pulled the number up today, almost 300 requests related to Covid related items. And that's sort of a range of things that could be small or large. But what we had to do very quickly was figure out how to do that work differently. Certainly, the traditional evidence based approach to health technology assessment is a more prolonged process. And even with things that we traditionally do, like rapid reviews, the rapidness that's needed in a pandemic is very different. 


So we've certainly changed the way we do our work trying to figure out the right balance between quality, completeness, timeliness, and what things can we actually shorten, have no choice but to shorten and then some of those things are things we'll have to go back and look at, you know, some of the reviews that we've had to do, we've not been able to do the full HTA, get patient perspective, be able to give clinicians the same amount of time to weigh into some of the matters. 


But with that being said, we have I think at our heart also learned that there are ways that we can do things different. I guess, you know, as you set up the question, the thing that comes to mind for me is that, you know, I think every one of us hates to make a comment about the positive of having to experience a pandemic. But you know, we are at the same time as a pandemic in a moment where disruption and innovation and new technologies and devices and therapeutics are rapidly emerging. And I think everyone, industry, businesses, have all of a sudden had this door open of things that people never thought were possible. Healthcare may never be the same and I remain optimistic that it won't be the same in a way. And so really interested to see how we at CADTH are able to support those changes and that explosion of innovation, while supporting jurisdictions make really difficult decisions that are going to have to be made as we come out of a pandemic. 




So what I hear from you too is, again, you guys capitalizing on what you needed to capitalize on. But a message that came out of that for me was: I'm hearing about how you guys can act with speed in terms of maybe changed your process. And some things you might have dropped, that you wouldn't normally have done. But it seems to be much more about speed. 


So that's an interesting concept in terms of does that become a new way forward? Because, you think about what we've seen in this pandemic, and just on the evidence itself. And we're coming to expect the results and conclusions by press release, or CNN news breaker or even some twitter feed on that one. So I heard how it's changing you guys, but what do you think it's doing to the public perception on evidence and evidence review?




So, you know, I think as I was getting ready for coming into CADTH, it was just at the peak of so you know, leading up to July was the outbreaks in New York City, you had Andrew Cuomo on CNN, making presentations about evidence every day. You know, people were glued to their television sets to hear the evidence, what was coming from the experts in the field. And for me, it was sort of the Gloria Gaynor song, you know, at first I was petrified and terrified. That was sort of what it was like coming into this organization.


But I think what we've learned is that we can survive. I just think it's worth reflecting a little bit on evidence during the pandemic, because there's some really important lessons learned coming out of it. You know, there's a much greater awareness at all levels, and I would say, you know, from my experience in government, much higher levels in government of how evidence isn't what people thought it was, you know, something that is static, that never changes. So there's a greater interest and awareness and an understanding. People understand that things that you thought at the beginning, as evidence evolves, and changes may not be what they actually thought they were. 


So, you know, I didn't know what a preprint was before I started this job. But I certainly have been, you know, in my former job aware of how press releases and media can drive conversations. But I think we've all learned that you have to dig deeper and understand what the evidence is saying, isn't saying, and it may not be because it's wrong, it may just not have emerged yet. And I think that from a perspective of how is it going to change all of us going forward is, I hope that we figure out a way to capitalize on the best of what evidence awareness has done for everyone to be able to make more thoughtful decisions. 


But I think it also is important for us, as you said, you talked a little bit about speed and I think whenever I hear this speed equation in the the evidence, I think we have to be really careful as we think forward about how that fits in a risk environment. So in a pandemic, when 1000s of people are dying imminently, and there's so many unknowns, and the timelines for us to make decisions are so small, I think there's a different risk equation. So I think what that will look like for many of us is perhaps more segmented ways in which we do our reviews, how do we sort things into what comes first. 


And I think it will also lead us to do some of the things that we've learned through Covid, which is some documents need to stay living documents, they aren't point in time, they are things that we need to keep sort of alive and continue to go back to, as evidence emerges, particularly in places where there's importance, and yet the evidence is being generated almost weekly. 




So you know, that's a great point, because that was a question I was gonna ask you when you talked about sort of evidence not being static and that evidence changes. And then the question comes down to is how do we make these living documents? And a decision because I was looking on a catalog website talking to a company last week, and they were looking at a CADTH opinion review from five years ago, in oncology of all places, and the world of oncology today is completely different than what it was five years ago. And it's a challenge. So how does evidence get up? You know, I think about so the pressures now that are coming on CADTH. You guys had a view, but the world changes. And so how do you guys deal with that? Or whose responsibility is it to start to keep the evidence current and the opinions and reviews on that current? Can this be done?




Yeah, that's a really good question. It's one that CADTH had certainly turned its mind to before I arrived here at CADTH. And I think, you know, the term you would most commonly hear referred to is health technology management over the life cycle. And then, you know, I think CADTH has been out there as a leader in socializing this concept over the past number of years, and I think that as part of CADTH's strategic plan, this is a place for going to have to spend some really important reflective time. 


As someone who has been a user of the evidence, I too sometimes have been in a circumstance where, you know, you're responding to an inquiry and you're going, "wow, that was done five years ago, I wonder if anything has changed, because that would be really helpful to know in responding to this issue or this circumstance at this moment in time." 


And I think it's going to involve a couple of things, I think it's going to involve figuring out, which are the right things to go back and look at. It's impossible, I think, as we all know, to do everything all of the time. And so being selective about those places where, you know, there's special attention needed to that. I also think it's going to be important for us to change the dialogue. A lot of people have equated health technology management or Lifecycle Management with disinvestment, and disinvestment only. And I think for a lot of us, it's also just a good place for learning, are the things that we anticipated and expected, at the time that we did the evidence review, are they actually validated when we go back and look at those circumstances? 


So I think there's a real opportunity for us to bring, you know, assessment and performance of decision making forward as part of what CADTH does in adopting that Lifecycle Management of health technologies. So more to be done. And I think it is a really important space for us to figure out which things and when.




You're listening to Suzanne, McGurn, President and CEO of CADTH, on the NPC Podcast.


So it's interesting, as I'm listening to this, I'm almost wondering, does evidence, you know, not just evidence review, but the summaries, the recommendations and conclusions, if you will? Do they need expiry dates? Do they need to sort of say like, yeah, that was relevant at the time. But today, we can't say if it is or not, because we don't know the state of practice. And maybe that's a caveat that the system needs to adopt or look into it a little bit more. 




It's an interesting concept, Peter, I guess I would maybe, you know, say it's one of those issues that could have come with quite a quagmire, because I guess, then you would say, you know, perhaps back to the industries or the folks that are bringing the evidence forward, does their evidence expire? 


So I think it's one of those things where I think a really thoughtful consideration about what needs to be looked at and when is needed, because I think we've all come to understand that, you know, there's many things that work well, in our system. The current way we do our business, whether wherever it is across the continuum is working well, and patients are getting access or clinicians are getting access to new devices, new treatments, new interventions. But there are some places where I think we all know that we have some lessons to learn and it will be figuring those out. 




So thinking about sort of the future and changes, you know, I read the federal health ministers mandate letter and that talked about setting up a Canada Drug Agency as a priority. So you gotta wonder, I mean, CADTH has been central to Canada's drug access system. So how do you think this new CDA will affect CADTH? 




So yeah, I too, as I did in my former job and this job, I do read mandate letters from all jurisdictions that are made public with great interest. And yeah, the Canadian Drug Agency was included in the 2019 federal budget and was an integral part of what the federal government was advancing on the pharmaceutical space. I see it's been reconfirmed as part of the most recent mandate letter to health Canada's ministry, I guess what I would say is, you know, I would first off, acknowledge that I'm not going to get ahead of you know, the important dialogue that will be happening amongst jurisdictions on the suite of pharmaceutical issues, pharmacare, drugs for rare diseases, the idea of a Canadian agency, you know, further alignment, cost of drugs. 


What I can say from my experience here in Canada is that we are unique compared to some other jurisdictions. And we are somewhat difficult to understand from an end to end perspective, whether you're a clinician, a patient, a family member, industry, or even different government officials, depending on where you are in the system and your familiarity with the process.


So I think there's been a lot of work that's been done that's been good that we've improved things and there's been a lot of work on alignment and a greater cohesiveness across the country. But there is more to be done. And if it takes the form of an agency or whether it's continued to work for alignment, harmonization, it'll be important where it can and I don't think that the harmonization and improvement needs to wait for a Canadian Drug Agency. 


From CADTH's perspective, I would just say we're known for our expertise, experience and relationship. And, you know, our goal would continue to be a trusted organization that provides whatever evidence skills analysis, whatever they need to support them in this path, the federal government and the jurisdictions. We're here to be able to assist with that work and want to see ourselves continued to be an important player in the pharmaceutical landscape. 




That was a great summary. Great background and overview of CADTH itself, Suzanne. I truly appreciate the insights you're able to give us today. 


Any last words or counsel to the industry that you want to leave with us? 




Actually, I've done a couple of things recently, and I'll leave the same advice here, which is: relationships matter. 


And I do think that the more opportunity that we have to have exchanges and understand one another's perspective, the better off we will all be and being able to find our way to new and improved futures. 


So thank you, Peter. 




Great advice from Suzanne McGurn, President and CEO of CADTH, relationships matter. 


You've been listening to the NPC Podcast, I'm Peter Brenders, your host. Thank you for listening. 




Thanks to Suzanne and Peter. 


Let's keep that medical evidence coming and we'll keep reporting it. And one of the places will report it is in this here NPC Podcast, now in its third season. 


We've got some interesting guests lined up for you for the coming weeks including Lindsay Williams of Stryker, the device and surgical equipment company. So subscribe wherever you get your podcasts and don't miss an episode. 


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I'm Mitch Shannon in Toronto of Chronicle companies. Jeremy Visser is your Podcast Producer, the announcer is Leona McDroid. Our musical theme is performed by the NPC Podcast Orchestra under the direction of Maestro Arturo Millbrook. 


Have a good weekend. Stay safe. We'll talk to you again next Wednesday.