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CURRENT STRATEGIC INITIATIVES
Canadian Brain Research Strategy (CBRS)
The mission of CBRS is to build on Canada’s strengths and current investments in cutting-edge collaborative neuroscience to transform neurological and mental health for Canadians. The Strategy is a grass-roots initiative launched by leading Canadian neuroscientists, in partnership with representatives of the Neurological Health Charities of Canada to respond to a growing need for concerted efforts to understand the brain.
Its vision is of innovative and collaborative brain research that will drive policy as well as social, health and economic advancement for Canada and the world. Canada’s neuroethicists will guide these endeavors and continue to provide national and global leadership in aligning ethical, social, legal and policy considerations with advances in neuroscience.
The CBRS is not seeking to become a parallel funding stream, but rather to inspire decision makers and funders to further invest in programs that foster collaborative, transdisciplinary and open approaches to move Canada toward a big-science model for brain research.
By leveraging existing investments in brain science and adopting a big science approach to discovery, CBRS can establish transform the future of Canadian society.
Pan-Canadian Neurotechnology Ethics Collaboration
Groundbreaking work is being done in the areas of neurology and neurosurgery as new neurotechnologies open up the potential for innovative therapies for a variety of ailments of the brain, spanning psychiatric, neurodegenerative, and oncological disorders. However, the decision to make the transition from pre-clinical research to first-in-human trials is a difficult one, marked by the relative absence of information on the certainty of safety, efficacy, and risk of the intervention. While guidance exists for pharmaceutical development, there is less literature on this translation for novel surgical procedures and medical devices. Patients and practitioners alike are left with a dirth of tools to aid them in the decision to undergo a novel neurointervention. In the absence of such guidance, it is unclear what factors are the key drivers of decision makers’ choices. We seek to explore the factors that key stakeholders take into consideration when determining a novel neurointervention’s readiness for translation into first-in-human trials. Insight into the attributes of a novel intervention that drive patients’ decision making will allow clinicians and researchers to better understand patient values and preferences in future care and research. Similarly, insight into the factors that drive clinicians' and researchers' perceptions of readiness can inform the development and translation of future novel interventions for patients as well as regulatory guidance for the field. Our qualitative research will provide much needed data on the relatively underreported translational process for surgeries and novel medical devices.
Funding Agencies: Sunnybrook Research Institute
National Bioethics Council
The initiative to explore the need for and possibility of a Canadian national bioethics council was born from the view of some of Canada’s prominent ethicists that the country has unmet needs regarding normative guidance in matters related to science, values, and society. In 2021, Profs. Judy Illes and Vardit Ravitsky convened a small group of thought leaders who had previously expressed this concern in various contexts and venues to explore the potential interest in such an initiative. The group is currently in the information-gathering stage and, in 2022, will hold international and national consultations and engage with the broad Canadian academic bioethics and Science, Technology and Society (STS) communities to explore and advance possible models for Canada.
Ethics for UBC
Neuroethics Canada is pleased to announce Ethics for UBC, a series of panel discussions that will explore the current landscape of ethics scholarship and education across the Vancouver and Okanagan campuses of our university.
In attending one of the five interactive 75-min panel discussions, participants will have the opportunity to learn about the current ethics-related endeavours taking place at UBC, pressing ethical issues that exist across a wide range of disciplines, and the ways in which you can become more involved.
For more details, please visit: https://neuroethics.med.ubc.ca/ethics-for-ubc/
We are grateful to the following individuals for their important contributions to this strategic initiative: Dr. Judith Hall, Dr. Maxwell Cameron, Ms. Lerato Chondoma, Dr. Ralph Matthews, Mr. Roland Nadler, Dr. Julie Robillard, Dr. David Silver, and Dr. Alice Virani.
In addition, we thank our organizing committee: Dr. Judy Illes, Dr. Paul van Donkelaar, Ms. Louise Harding, Ms. Marianne Bacani, and Ms. Anna Nuechterlein.
International Neuroethics Patient Initiative (INPI)
In collaboration with colleagues at the University of Bonn, Centre for the Law of Life Sciences, in Germany, we are undertaking a multinational collaboration to examine neuroscience patents and the protection of intellectual property as they pertain to brain health and disease.
The abstract of the project is as follows:
Patents granted in the field of neuroscience cover diverse areas of diagnostics, devices, data processing methods and computational models, and networks and systems related to the central nervous system. Historically, patent protections have safeguarded the intellectual property of creative neuroscience discoverers and inventors, and offered financial incentives for innovation. Today, however, the far-ranging scope of neuroscience patents may lead not only to obstacles to research, but to massive threats to personal rights, human dignity, and health data protection. Compounding this threat are notions about “mind reading” and "the transparent brain" arising from new capabilities of both invasive and non-invasive brain computer interfaces (BCIs) involving signal recording and regional tissue stimulation variously in healthy individuals, and patients with neurological and psychiatric disorders. Here we propose to use methods from legal scholarship and the social sciences to: (1) examine patents already granted, (2) classify them into the applicable patent law, (3) address the question of the viability of the patent law that applies to them, (4) elucidate perspectives about the desirability and pitfalls of patents pertaining to brain from neuroscientists, patent lawyers, and patent officers, and other expert informants, and (5) close identified gaps that are unfulfilled and may place individuals, patients and society at risk. The limited discourse to date on brain patents is thus extended fully through this work and will, above all, be brought into patent law and policy decision-making.
Open Science Initiative
Mend the Gap
Mend the Gap is an international effort devoted to developing a novel treatment for spinal cord injury that uses nerve regeneration. Key to its success is collaboration with the SCI community and an understanding of translation pathways, commercialization, and regulatory steps. As lead of the Ethics, Knowledge Translation and Patient Engagement arm of this effort, Dr. Judy Illes and her team will engage with individuals and stakeholders touched by SCI in new research to understand their values, perspectives, and priorities. The goal is to interface closely with the basic science teams and create models and tools for developing and communicating new treatments in a way that respects the heterogeneity of spinal cord injury, cultural and personal diversity, and autonomy.
For more information about Mend the Gap, please visit: https://mendthegap.ubc.ca/.
Informing Choice for Neurotechnological Innovation in Pediatric Epilepsy Surgery
More than 500,000 children in the USA and Canada suffer from epilepsy today. Unmanaged, epilepsy can result in cognitive decline, social isolation and poor quality of life, and has substantial economic impact on families and society. 30% of children with epilepsy continue to have seizures while on anti-seizure medication, a condition known as drug resistant epilepsy (DRE). Properly selected, up to 70% of DRE patients become seizure-free after surgery. Nevertheless, epilepsy surgery carries with it risks proportional to its level of invasiveness. As a result, a variety of less invasive interventions have been developed, including MRI-guided laser interstitial thermal therapy, robot-assisted stereo-EEG, stereotactic radiosurgery, vagal nerve stimulation, and responsive neurostimulation. This project aims to identify what caregivers and physicians value when considering neurotechnological treatments for children with DRE. This knowledge will be used to develop, evaluate and deliver patient-directed resources in the form of infographics and informational materials and videos, and clinician resources for family decision-making, clinician counseling and care.
Funding Agencies: National Institutes of Health
Exploring Physician Perspectives on Prescribing Medical Cannabis to Pediatric Patients
In collaboration with the Canadian Childhood Cannabinoid Clinical Trials (C4trials.org), we are investigating physician perspectives on prescribing medical cannabis to children with brain and other cancers, and neurodevelopmental disorders. Recent changes to Canadian cannabis legislation and growing public awareness have introduced many new questions about the medicinal use of cannabis that need to be answered. We are addressing them here through a qualitative interview study of perspectives, priorities, and values on prescribing. By elucidating these ethics considerations, we hope to inform productive dialogues and have a positive impact on decision-making by all stakeholders.
Exploring Equitable and Culturally Meaningful Access to Advanced Neurotechnologies
Advanced neurotechnologies including deep brain stimulation (DBS) and ablative brain surgery are becoming increasingly common in the treatment of movement disorders, epilepsy, mental illness, and chronic non-malignant physical pain. In Canada, they are offered in academic medical centres of the most populated provinces. Some are classified as therapeutic; others as experimental. Two important considerations that have not yet been adequately explored about these technologies intended to remediate brain and other disorders are issues of access and diversity of cultural views about them. This study seeks to close that knowledge gap. In the first year of this long-term project, we are conducting expert consultations with two important cohorts: the physicians and researchers who work with these technologies, and Indigenous communities, who make up an important proportion of the rural and remote population. Through multidisciplinary, cross-cultural consultations, we will elucidate shared concerns and unique considerations that collectively inform the equitable and culturally meaningful delivery of these potentially life-changing treatments to diverse populations.
Insights on Managing Pain in Children and Teens (IMPACT)
Poor pain management after pediatric surgery remains a critical concern despite efforts in providing care information at hospital discharge. A recent audit of daycare surgical procedures at BCCH highlighted that children experience a significant amount of preventable pain at home in the days following surgery. The goal of this project is to observe the clinical encounters at discharge and identify areas for improvement in the communication of pain management information for families who have children in postoperative care. These pilot data will be leveraged for the co-design of evidence-based resources for pain management communication. Results from this project will fill an essential gap in our understanding of the lived experiences of pediatric postoperative pain management.
Program Evaluation of the First Link® Dementia Support Service in British Columbia
The First Link® dementia support evaluation project is aimed at improving support for British Columbians affected by dementia. The goal of this mixed-methods evaluation project is to identify the key strengths and areas for improvement of the program from the perspective of various stakeholders, including persons living with dementia, their care partners, and health care professionals. The results from this evaluation will inform the services offered and will help ensure that the Society is providing the best support and education possible to the dementia community in British Columbia.
Funder: The Alzheimer Society of B.C.
Conflicts of Interest in Neurosurgical Research
An increasing amount of research funding in neurosurgery research comes from device manufacturers. In addition to research funding, industry also funds continuing medical education and many neurosurgeons receive royalties, speaking fees and other financial incentives from these same device manufacturers. This creates a conflict of interest with the potential to bias research results. We are looking at a number of aspects of financial relationships between neurosurgeons and industry including the accuracy of disclosure of these relationships in research publications as well as the financial scale and scope of industry involvement with neurosurgeons.
- Schon E, Kulkarni AV, McDonald PJ (2016) Conflicts of interests in neurosurgical research: Effects of the 2013 Sunshine Act on voluntary disclosure. Canadian Bioethics Society Annual Meeting, Toronto ON.
- McDonald PJ (2014) Conflicts of interest. Neurosurgical Ethics in Practice (Bernstein M, Ammar M eds.) Springer
- Schon E, McDonald PJ (2013) Disclosure of conflicts of interest in published pediatric neurosurgery research: How do we compare? 42nd Annual Meeting of the AANS/CNS Joint Section on Pediatric Neurological Surgery, Toronto ON.
- McDonald PJ, Schon E, Ellis MJ, Kazina C (2011) Conflicts of interest in pediatric neurosurgery research- Comparing company data with surgeon disclosure. 40th Annual Meeting of the AANS/CNS Joint Section on Pediatric Neurological Surgery, Austin TX.
Students involved in project: Emma Schon BA, Madeleine de Lotbiniere-Bassett
Funding Agencies: College of Medicine, University of Manitoba
Ethical Issues in Concussion Research and Care
Concussion and the long-term effects of concussion have become a topic of much interest to the public, with numerous examples in professional and amateur sports of athletes being significantly affected by multiple concussions. This has led to a proliferation of health care professionals providing advice and management to patients suffering from the effects of concussion without any accepted standards of what is required to be considered a concussion “specialist”. We have examined the range of care being offered in Canadian concussion clinics and are examining some of the unresolved ethical issues in concussion care and research.
- Ellis MJ, Ritchie L, Selci E, Chu S, McDonald PJ, Russell K (2016) Googling concussion care: a critical appraisal of online concussion heathcare providers and practices in Canada. Clin J Sport Med (PDF)
- Russell K, Ritchie L, Vis S, Chu S, Selci E, McDonald PJ, Ellis MJ (2015) Measuring the scientific impact of sports-related concussion research: a citation analysis study. Curr Research: Concussion. 2(3):113-121. (PDF)
Funding Agencies: Department of Surgery, University of Manitoba
Ethics Education in Neurosurgery Training
While almost all medical schools now have mandatory courses in bioethics as part of their curriculum, postgraduate programs in North America provide ethics education sporadically to doctors undergoing specialty training. This project will survey neurosurgery program directors across North America to determine if and how they provide education in ethics to their trainees. We hope to identify best practices for post-graduate ethics education to provide a suggested framework for neurosurgery training programs.
Students: Naheeda Rajmohamed
Funding Agencies: Office of Pediatric Surgical Education and Innovation, BC Children’s Hospital