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By Dr. Rodney Ouellette, M.D., Ph.D.

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New Brunswick faces daunting challenges in the delivery of health care services to residents. The current public debate between Saint John and Moncton regarding investment in a duplicate gene sequencing facility is another example of the consequences when we overlook opportunities to collaborate and optimize.

Patients want and need access to the best available diagnostic technologies. In the area of gene sequencing we already have the capability right here in New Brunswick through Vitalité Health Network and Atlantic Canada Research Institute (ACRI). The Molecular Genetics Laboratory is located in and part of the Dr GL Dumont University Hospital laboratories which was accredited in September 2014 by the Institute for Quality Management in Healthcare (formerly Ontario Laboratories Association). Any clinician in New Brunswick can access this testing through the Vitalité Health Network. Our professionals are skilled and available for consultation. Our service is timely and costs are comparable or lower to those charged by other labs operating outside of the province. As good stewards of health care dollars we believe should be using this existing facility taking advantage of our capacity before investing in another lab when there are so many pressing priorities to improving health care in our province.

Let me eliminate some of the misinformation that is clouding the current debate.

First, ACRI was created in 1998 as a not-for-profit hospital-based research centre co-located with the Dr. GL Dumont University Centre. I am not the owner since it has no owner. I work as the President and Scientific Director reporting to a board of directors with Horizon Health as a member. My income comes exclusively from my position as a physician in the Vitalité Health Network where I am the medical director of the Molecular Genetics and Sequencing Laboratory. I receive no remuneration from the Atlantic Cancer Research Institute (ACRI) . Since 1998 I have reported and signed off on over 20 000 genetic tests in the province and I am one of the senior-most molecular lab directors in Canada. I performed gene sequencing as far back as 1988 during my PhD. When we began the Molecular Genetics program it was one of the first such centers in Canada and the first in New Brunswick. Thousands of New Brunswickers are alive today because our Molecular Genetics Laboratory has delivered to clinicians the accurate information required to make crucial decisions for patient care. A little known fact is that ACRI has enabled our province to make important advances in the health care system that have benefitted New Brunswickers over the past two decades. Whenever possible ACRI has taken its unique expertise and technology that was developed for research and quickly made it available for the benefit of patients. We were the first in Atlantic Canada to introduce technologies such as PCR testing, in situ hybridization and recently NextGen DNA sequencing among others. Our team has worked diligently to move these powerful technologies into clinical practice in order to provide the best possible care for our patients. Our citizens have benefitted from this in two important ways; 1) from the obvious health benefits offered by these cutting edge tests and 2) from the cost savings to the health care system since all of these expensive and complex technologies were acquired from federal and other research grants. ACRI was never been reimbursed for the costs necessary for clinical implementation. We felt that this was our way of giving back to society and to improve the health of our fellow citizens. Furthermore, the savings continue long afterwards since ACRI has all the expertise and know-how to instruct hospital personnel and troubleshoot so again burden and cost is off the health care system. There is nothing sinister about this synergy between research centers and hospitals around technology implementation since it is the predominant model worldwide.

Second, the cost of gene sequencing tests performed by Vitalité is very competitive when compared to other labs in Canada or the USA. The calculations that are being put forward in Saint John to support a claim that acquisition of lab equipment there will reduce costs to Horizon Health are incorrect. When a thorough 'apples-to-apples' comparison is made, we can show that our model is the best choice given our small population. Duplication of infrastructure and personnel combined with splitting of test numbers will increase costs dramatically and make testing in New Brunswick uncompetitive and a poor use of taxpayer dollars. A detailed document including a need and cost analysis was presented to the former minister of health back in early 2013. Just as we have concentrated expertise in Saint John for the Cardiac Surgery Center; being focused and strategic in gene sequencing will allow New Brunswick to maintain a world-class competency, serve New Brunswickers in a timely manner, and ensure that health care funds are spent in the best way possible across the entire provincial system. We will gladly put our numbers forward to confirm our position and we would look forward to working with clinicians and researchers in Saint John to show how we can help them achieve their goals without lowering efficiencies and increasing health care costs needlessly.

Third, ACRI is dedicated to cancer research and uses these genomic tools every day while the Saint John group is focused predominantly on clinical services. It is thus more logical that we should invest in clinical needs within the Saint John facility as we concentrate gene sequencing with ACRI until we fill our service capacity. If New Brunswick had two similar labs in the province we would have more service per capita than centres much larger than ours elsewhere in Canada. Gene sequencing is a fast moving field and the future in this area is unknown. Technological changes and economies in scale may lead to obsolescence of existing technology and arrival of larger Canadian laboratories that could outcompete small provincial centers. Therefore this may not be the best time to over-build in one specific testing area when we have so many areas of health care we could invest in that would also bring benefits to patients. There are many unmet needs in the health care system and we should look to address these rather than duplicate existing technology and expertise where not warranted.

Many will view the current controversy as a political struggle between communities and within our health care authorities. This is unfortunate because this is a time for everyone to step back, take a long look at the bigger picture, and confront the challenges to our health care system with objectivity, putting the best interests of patients first. As this debate has increasingly become a battle for public support an increasing amount of incorrect and confusing information is being circulated. As this controversy grows reputations are been questioned and patient confidence is been eroded. This is unnecessary and regrettable. I have always had an open, transparent and collaborative approach with clinicians and researchers and will continue to do so. We should respect the contributions of all that are working to improve patient care and find the most efficient and sustainable ways to deliver the quality that patients deserve.

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Dr. Rodney Ouellette is CEO & Scientific Director of the Atlantic Cancer Research Institute and Medical Director of the Molecular Genetics and Sequencing Laboratory for Vitalite Health Network.

 

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