Lifetime of Leadership

Dr. Henry Friesen Discusses His Past and the Future of Canadian Health Care

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By Amber Lepage-Monette

From leading endocrine researcher to health-system champion, Dr. Henry Friesen has in many ways become an icon in the area of Canadian health research.

Adding to the many accolades that already honour this status — including the Order of Canada, the McLaughlin Medal of the Royal Society of Canada and induction into the Canadian Medical Hall of Fame — Friesen was presented with a Lifetime Achievement award from the Toronto Biotechnology Initiative (TBI) (Toronto, ON) last month.

Landmark Discovery

Though his more recent years have been spent providing leadership and advocating for health issues, some of the awards and honours Friesen has received over the years stem from his early research work that led to the discovery of the hormone prolactin. At the time of his discovery, physicians were unclear if prolactin existed in humans. Friesen’s discovery not only confirmed that it did, but that prolactin-secreting tumours found in the pituitary in women were causing many cases of infertility.

“It was an enormously gratifying experience to move from a hormone that doesn’t exist to, not only is it here, we can now measure it, we can appropriately treat it very successfully,” Friesen says.

Thanks to the discovery, researchers were able to shut off prolactin production, which in turn reduced tumour size and restored fertility in many affected women.

Friesen studied in Boston, Mass., under renowned endocrinologist Dr. Edwin Astwood, PhD, but had moved to Montreal, Que.’s McGill University and Royal Victoria Hospital by the time he had made his prolactin discovery.

“That was probably an extraordinarily important opportunity, because McGill and the Royal Vic in particular, were (together) one of the leading endocrine centres,” Friesen says. “So again, (being) surrounded by outstanding colleagues allowed me to attract a lot of outstanding young graduates, just like Astwood’s lab had. So I was blessed with having people from all over the world as trainees and had the opportunity to admire their success.”

Following eight years at McGill, Friesen would eventually settle in at the University of Manitoba (Winnipeg, MB), where he would work for almost two decades in a variety of roles, including professor and head of the department of physiology, and professor in the department of medicine.

Providing Leadership

In 1991, Friesen made a move that would not only change his career, but also the face of government research institutions in Canada.

Friesen was invited to take over the role of president of the then-existing Medical Research Council (MRC) in Ottawa, Ont., an organization he, like most Canadian researchers, was very familiar with.

“I’d benefited from support by the MRC for 25, 30 years,” he says. “It was, in a sense, the bedrock research support system that I’d enjoyed and it was helpful to me, and of course many others across Canada.”

Shortly before be took over at the MRC, Friesen had served as president of the National Cancer Institute of Canada (Toronto, ON), which had undergone a strategic planning exercise under his leadership. The importance of this process and the need to energize the research community were two things Friesen took away from the experience, he says, and he knew right away that the MRC should undergo a similar exercise.

“MRC was kind of a quiet government agency . . . and the interaction with its constituency was quite minimal — modest. It seemed to many that it was somewhat remote and detached,” Friesen says. “So a comment I’d made many times was, well, imagine if we have a different point of view: that the MRC is all of us — all of the scientists, and the institutional base that they represent. Now suddenly you have a very robust, vibrant institutional base that has thousands of adherents, as opposed to the staff of MRC in Ottawa of 80.”

The MRC’s strategic plan highlighted three definitive conclusions about how the MRC should work, Friesen says.

The first conclusion was that the MRC should embrace the full spectrum of health care. The second was, while doing that, the MRC should foster and encourage partnerships. And third, that the MRC should evaluate everything it decided to do.

In the early to mid-90s, federal government program review effectively cut the budgets of all agencies and departments, including the MRC. Though Friesen says the MRC fought hard for concessions — and as a result had its budget reduced by only 10 per cent, rather than the 13 per cent at other agencies — the cuts were difficult to deal with.

When government budgets were restored, Friesen says he felt it was an opportune time to change the MRC entirely, to completely restructure how the MRC worked in an effort to command a $1-billion-per-year budget, rather than the approximately $250 million it was getting at the time.

Though not everyone supported the creation of this new entity, Friesen says eventually “good reason and good sense prevailed,” and the Canadian Institutes of Health Research (CIHR) (Ottawa, ON) was established.

The CIHR currently has a budget of $662 million for 2004-05, and funds over 8,500 researchers in universities, teaching hospitals and research institutes across Canada.

For Friesen, the creation of the CIHR was the realization of a promise he’d made regarding the MRC’s scope of support.

“It was in a sense . . . an important chapter to deliver on, (that) the MRC should support the full expression of health research,” Friesen says.

The CIHR focuses on four major research areas: biomedical, clinical, health systems and services, and population and public health, which remain true to the MRC’s initial goals.

“Those four streams are visible, demonstrable expressions of what really was agreed to in the MRC strategic planning exercise,” Friesen says.

Moving Into the Future

Though he helped establish the organization, Friesen did not end up staying to run the CIHR. Despite his stepping away, Friesen says the CIHR has exceeded his initial hopes.

“Under the leadership of (current) president Bernstein, (CIHR) has evolved. And with new input and insight from the 13 institutes — each of whom is now led by outstanding Canadians in each sector — each institute in turn has input from a dozen or so advisors,” he says. “CIHR now is seen as more integral to the health system than ever before.”

That health-care system is changing and evolving in substantial ways. Friesen points to information technology having already altered the way the system operates. With individuals accessing the Internet, people are much more informed and involved when it comes to health issues, he says. In the future, this information revolution will impact the way we view health care even more.

“In terms of genomics, where increasingly there will be a move toward adopting and using the genetic fingerprints to shape both diagnostic, preventative (measures) — so that preventative measures will now take on a more personalized perspective,” Friesen adds.

With genetic fingerprinting, individuals will be given tailored medical advice about diet and lifestyle, sub-populations will be better identified in clinical trials, and physicians will be able to offer treatment sooner. Friesen points to the heel-prick test for phenylketonuria as an example of preventative medicine currently in practice.

“I think the same is going to be possible over time for at least some of the diseases,” he says. “It will be incremental. It won’t all happen in the next decade.”

More recently, Friesen has focused much of his energy as a member of the board of the Canada West Health Innovation Council (Vancouver, BC), an organization that promotes the idea of capturing economic and social benefit from health research.

Lack of stewardship and management plague the Canadian health system, Friesen says, and, like any good investment, with so much money going in, one should expect something in return.

“If we got it right . . . prior to a move from where we are in net deficit annually of about $8 billion, could we — with the right enlightened policies and incentives — move over a decade to see that reduced to close to zero and ultimately become an exporter? And if we did that, we would create in this country an industrial sector bigger than the auto sector in terms of employment,” Friesen says.

“That should be the goal and aspiration of Canadians: to marry our most cherished social program with the most innovative economic program.”

Friesen says that with proper attention and management, the health-care sector could be a platform for economic growth that would include many industries, such as construction, design, architecture, service and consulting. He cites the example of the high-containment laboratories in Winnipeg, Man. — the architect of which has gone on to become a specialist in this type of construction whose services are now in demand the world over.

It’s these visionary views about medicine and health care that have kept Friesen in the spotlight, and why over the years, so many have chosen to honour his work and achievements. And while the recent TBI award is just one of many, it still holds meaning for Friesen.

“I marvel that people look at some of these things, which I’ve enjoyed participating in. And so I’m deeply honoured and grateful for people who think that some of these things have contributed to trying to make Canada a better place,” he says. “I think it’s important that we keep our focus not only on the progress made, but the gaps that remain and the opportunities that exist.”