Health Research Methods, Evidence, and Impact

Previous Labelle Lectures

The 24th Annual Labelle Lecture | 2015


Maternal Health Services Research: Work Worth Doing Link to PDF

October 7, 2015

2015 Labelle Lecturer Discussant Lectureship Introduction Speakers Introduction:
Dr. Katy Kozhimannil Dr. Eileen Hutton Dr. Michel Grignon Dr. Jeremiah Hurley
Associate Professor, Division of Health Policy and Management, University of Minnesota Professor, Department of Obstetrics and Gynecology and Clinical Epidemiology and Biostatistics; Associate Dean, Midwifery Education Program Director, Centre for Health Economics and Policy Analysis, McMaster University Professor, Departments of Economics and Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University

The 23rd Annual Labelle Lecture | 2014


From Lean to the Lean Startup:

Improvement and Innovation in the Design of Health Services
October 1, 2014
Photo-link to Labelle Lectureship Flyer

2014 Labelle Lecturer Discussant Host
Dr. Onil Bhattacharyya Dr. Lisa Dolovich Ron Goeree
Frigon-Blau Chair in Family Medicine Research, Women’s College Hospital
Associate Professor, Department of Family and Community Medicine and Assistant Professor, Institute of Health Policy, Management and Evaluation, University of Toronto
Associate Professor, Departments of Family Medicine and Clinical Epidemiology and Biostatistics

905 523 7284  Ext 5266

Admin: Elizabeth DeGrow
905 525 9140 Ext 22356

The 2012 Labelle Lecture

The Virtual Ward and other policy-relevant trials in health care

The 2011 Labelle Lecture - October 3, 2012

2012 Labelle Lecturer Discussant Host
Irfan Dhalla PJ Devereaux Ron Goeree
Assistant Professor, Medicine and Health Policy, Management and Evaluation, University of Toronto
Scientist and Staff Physician, Li Ka Shing Knowledge Institute, St. Michael's Hospital
Associate Professor
Department of Clinical Epidemiology & Biostatistics
McMaster University

905 523 7284  Ext 5266

Admin: Elizabeth DeGrow
905 525 9140 Ext 22356

The 2008 Labelle Lecture

Wednesday, October 1, 2008
HSC 1A1 3:00 – 4:30 pm
Reception to follow in the Phoenix Lounge, Wentworth House

“Reference drug programs: Can we contain costs without harming patients? "

Sebastian Schneeweiss, MD, ScD
Associate Professor of Medicine, Harvard Medical School, and Associate Professor of Epidemiology, Harvard School of Public Health

In the current economic environment, health care systems are constantly struggling to contain rapidly rising costs. Escalating drug costs are targeted by a wide variety of measures. Many jurisdictions have implemented reference drug programs (RDPs). RDPs for pharmaceutical reimbursement are based on the assumption that drugs within specified medication groups are therapeutically equivalent and clinically interchangeable and that a common reimbursement level should thus be established. This presentation summarizes the rationale of RDPs and presents evidence of their economic effectiveness and clinical safety. However, RDP programs will fail in situations of medications that are superior innovations and have no equally effective competitor on the market. These medications need to be made available to patients who will benefit from them. Ideally, prior authorization (PA) programs are designed to ensure that patients with a specified indication will benefit from the most innovative therapies with full coverage. The experience with PA programs is heterogeneous and their quality varies by their actual implementation. If the goal is to achieve full drug coverage for as many patients as possible in the most efficient manner, RDPs in combination with PA programs are safer and more effective than simplistic fiscal drug policies, including fixed co-payments, co-insurances, or deductibles.

Sebastian is a general internist trained in Munich with a doctorate in Pharmacoepidemiology from Harvard and is President-Elect of the International Society for Pharmacoepidemiology and was Chair of the Pharmacoepidemiology Section of the American Society of Clinical Pharmacology and Therapeutics. He is Fellow of the American College of Epidemiology and of the International Society for Pharmacoepidemiology and Vice Chief of the Division of Pharmacoepidemiology and Pharmacoeconomics where he is also Principal Investigator of the Brigham and Women’s Hospital DEcIDE Research Center on Comparative Effectiveness Research. He has 12 year of experience in Pharmaceutical Outcomes Research and Pharmacoepidemiology where his research focuses on the comparative safety and effectiveness of biopharmaceuticals, analytic methods to improve the validity of epidemiologic studies using large claims databases, and drug policy evaluation. He teaches epidemiologic methods for health services research and advanced pharmaco­epidemiology at Harvard.

David Henry, MB FRCP (Edin)
President and CEO
Institute for Clinical Evaluative Sciences (ICES)

Professor David Henry is a physician and clinical pharmacologist and has an interest in all aspects of medicines used by communities. He is an authority on cost effectiveness in drug selection processes, and was a member of the Australian Pharmaceutical Benefits Advisory Committee (PBAC) and Chair of the Economics Sub-committee of PBAC 1993-2001. Professor Henry was instrumental in establishing the Pharmaceutical Benefits Scheme (PBS) evaluation process now in use. He has worked with the World Health Organization and has expertise in international systems for pricing of therapeutic drugs. He has delivered invited national and international presentations on access to medicines and drug pricing issues and has conducted drug policy issues courses for the WHO, Boston University and AusAid. During the last decade, in addition to his academic commitments, he has worked continuously as an internal medicine specialist and clinical toxicologist in the Newcastle region of New South Wales. He was Chair of the Medical Staff Council at the Mater Hospital in Newcastle, New South Wales.

Professor Henry is currently working collaboratively with Professor Peter Drahos and Dr. Thomas Faunce at The Australian National University on an Australian Research Council-funded project to investigate the impact of international trade agreements, including the recent US-Australia Free Trade Agreement on the regulation of and access to medicines in Australia. He also has a continuing interest in the portrayal of illness and treatment by the media. Professor Henry established a media monitoring web site  and assisted in the establishment of the Canadian sister site

The 2007 Labelle Lecture

Wednesday, October 3, 2007
HSC-1A1...3:00 pm to 4:30 pm

"Expenditure Overdose? Causes, Consequences and Cures for Canada’s Pharmaceutical Cost Crises"

Steve Morgan , Ph.D.
Assistant Professor, Department of Health Care and Epidemiology and Centre for Health Services and Policy Research,
University of British Columbia

Canadians spend over $25 billion on medicines every year. This represents almost half of what we spend on hospital care and much more than we spend on physicians’ services. Pharmaceutical spending is also growing faster than these other components of health care. So much that if we were to freeze drug spending for just one year, we would save enough money to hire 20,000 new nurses or 10,000 doctors. This lecture provides an overview of trends and patterns of drug expenditures in Canada and reviews theory and evidence concerning the causes, consequences and potential cures for drug expenditure inflation. The causes of drug spending are relatively clear and likely surprising to some, while depressing to others. The consequences of drug spending are surprisingly elusive, and inferences that can be drawn from available evidence are frankly discomforting. So too is the fact that policy structures to promote value for money in this sector are almost totally absent in Canada. Yet, potential solutions are available. Despite rhetorical claims of vested stakeholders, expenditure management policy needn’t wreak havoc on patients today or the beneficiaries of tomorrow’s pharmaceutical innovations.

Dr. Steve Morgan is a health economist from the University of British Columbia. He is Assistant Professor in the Department of Health Care and Epidemiology and Faculty at the Centre for Health Services and Policy Research. Dr. Morgan studies pharmaceutical policy, health care financing, and processes for promoting evidence-based decision-making. His work seeks to identify policies that provide equitable access to necessary care, manage expenditures for efficiency, and provide incentives for valued innovation. He obtained his Bachelor's degree at the University of Western Ontario, Master's at Queen's University, and Doctorate at UBC. He conducted post-doctoral training at UBC and at McMaster University's Centre for Health Economics and Policy Analysis. Steve holds career awards from the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research, and is one of the Canadian Alumni of the Harkness International Fellowships in Health Care Policy.

The 2006 Labelle Lecture

Wednesday, October 4, 2006

"Technology Innovation in Health Care: Who's Calling the Shots?"

Pascale Lehoux
Associate Professor, Department of Health Administration, University of Montreal, Canada Research Chair on Innovation in Health

Since the mid-1980s, health care systems have had to adapt to the constant emergence of technologies and the rising cost of health care services. Nevertheless, we know very little about why certain innovations emerge while others do not, and who makes these decisions. Although industry is often portrayed as the profit-driven “big bad wolf,” several groups, including clinicians and governments, play a pivotal role in innovation. One issue that remains largely unacknowledged is the extent to which these groups are interdependent. For instance, the industry branch of government largely supports R&D while health care decision-makers are those holding the purse strings. Industry needs to collaborate with patient associations and the media to promote the idea that rapid access to innovations will benefit the population. And clinicians, who generally wish to increase the scope of their clinical tools, usually build convincing claims about their patients’ needs. This lecture will examine how these groups negotiate what innovations should be funded and promoted and how some of their claims become more convincing than others.

The 2004 Labelle Lecture

Wednesday, October 20, 2004

"Will changes in data health privacy legislation kill research as we know it?"

Valerie Steeves
Assistant Professor, Department of Criminology, University of Ottawa

The argument that privacy legislation is threatening research is misleading, for two reasons. First, 30 years of experience indicates that privacy laws were drafted to ensure the continued flow of information to data collectors and have proven to be ineffective as tools to restrict surveillance, including medical surveillance. A historical review of the development of data protection rules demonstrates that fair information practices were negotiated by data collectors to ensure a continued flow of accurate data for research and administrative purposes. Requirements such as individual knowledge of collection and rights of access and correction work to ensure that the data retains its integrity, which in turn protects its value to researchers. Accordingly, data protection legislation works not to restrict but to advance research interests. Second, an analysis of health privacy legislation across the country reveals that virtually every Act exempts research from the application of fair information practices and/or the requirement that the data collector obtain consent to the collection of personal health information. In other words, privacy legislation does not stop the flow of information to researchers or place restraints on the collection of data for research purposes. Instead, it throws the ball to REBs who are empowered to decide whether or not consent is impracticable in the specific context of each project.

The argument that privacy threatens research is also misleading because it obscures underlying factors which have restructured medical research and contributed to a perceived conflict between privacy and the development of new knowledge. Typically, researchers seeking to avoid a consent-based paradigm argue that the individual right to privacy detracts from the social benefits of advancing knowledge. However, pure research is no longer the norm. Public-private partnerships and the pursuit of intellectual property have blurred the line between public health care and academic research, on the one hand, and the health industry, on the other. Accordingly, research is no longer an unencumbered public good, but increasingly involves the conversion of personal health data into a form of property which is alienated from the individual in accordance with commercial imperatives. Ironically, the research environment is, in fact, not characterized by growing privacy constraints but by a shrinking public sphere due to the increasing privatization of health information as an exploitable commodity. In this environment, fair information practices may help to protect research against commercial imperatives and ensure that data currently being commodifed in the hands of corporate owners will remain available to the research community at large. To this end, it is naive to argue for rules (or the lack of rules) that are based on the needs of pure science divorced from any commercial imperatives; it is also important to remember that eroding any expectation that health information is private opens the data to other users, including enforcement agencies, and that will have serious social consequences which, in turn, may lead to biased data.

Social-psychological research indicates that any loss of expectation of privacy with respect to health records will necessarily be met with a social restructuring of the required level of privacy, typically through patients withholding information or providing false information. Recent research indicates that patients may even forgo medical treatment in order to protect their privacy. Especially now that the primary purpose of collecting health information for the provision of care is collapsing into secondary purposes such as quality control and research, it is likely that the relationship between patients and health care providers will be restructured due to a breakdown in trust, and that the accuracy and/or completeness of databases containing personal health records will be corrupted unless fair information practices are put into place.

The 2003 Labelle Lecture

Wednesday, October 15, 2003

"Paying for Quality in Health Care: Poison or Panacea?"

Meredith Rosenthal, Ph.D.
Assistant Professor of Health Economics and Policy
Harvard School of Public Health

Widespread efforts to measure and report the quality of health care delivery has made it clear to most that there are pervasive quality problems in the U.S. and Canadian health care systems. These include but are not limited to preventable medical errors that occur in the hospital setting, under use of prevention and screening technologies, and poor management of chronic illness. Neither the recognition of system-wide quality problems nor extensive benchmarking of quality among individual providers, however, has resulted in substantial changes to practice patterns. Some have argued that such change will not materialize as long as physicians and hospitals do not see any financial reward from producing more quality. Opponents of paying for quality believe that use of financial incentives will be demoralizing to providers and run counter to professionalism. Others believe that financial incentives will be weak instruments for motivating providers to change long-standing practice patterns. Despite the lack of consensus, many U.S. health plans and employers have introduced payment incentives that target health care quality measures. This presentation examines the health care quality “problem” and paying for quality as a potential solution. Mechanisms to induce quality in different situations will be examined, along with what types of effects we should expect from these initiatives to better target the most pressing quality problems.

The 2002 Labelle Lecture

Wednesday, October 16, 2002

"Assessing health technologies: Should Canada take the NICE path?"

Mark Sculpher
Director, Programme for Economic Evaluation and Health Technology Assessment
Centre for Health Economics, University of York, UK

The National Institute for Clinical Excellence (NICE) is a new body which is responsible for making decisions about which health care interventions and programmes should be funded by the UK National Health Service. NICE is part of an international trend of decision-making authorities which use cost-effectiveness evidence to reach decisions about the reimbursement of interventions that will be paid from public resources. There are many unique features about the NICE model including its breadth of scope beyond medications to also include surgical procedures and devices, and its policy to commission independent Technology Assessment Reviews (TARs) from academic groups to be used as part of the decision making process. This talk will draw on experience from NICE and illustrate a series of methodological issues which have emerged in the process. These issues include the choice of analytical framework within which to synthesize evidence; determining the appropriate way to describe uncertainty to decision makers; how to make decisions under conditions of uncertainty; and how economic analysis can help set priorities for further research.

For further information contact:
Secretariat, Labelle Lectureship
Department of Health Research Methods, Evidence, and Impact
McMaster University
Health Sciences Centre, Room 2C area
1200 Main Street West
Hamilton, Ontario, Canada
L8N 3Z5

Telephone: (905) 525-9140, ext. 22883
Fax: (905) 577-0017