A catalyst, not a Crutch:” The msi foundation and the Development of Medical and Health Research in Alberta, 1970-2006 icon

A catalyst, not a Crutch:” The msi foundation and the Development of Medical and Health Research in Alberta, 1970-2006

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A Catalyst, not a Crutch:” The MSI Foundation and the Development of Medical and Health Research in Alberta, 1970-2006

Carolee Pollock, PhD, Grant MacEwan College

Matthew Eisler, PhD, University of Alberta

Alberta’s reluctant entry into the nation-wide health care insurance program in 1969 presented its College of Physicians and Surgeons (CPS) with a remarkable opportunity: the reserve fund of the very successful physician-sponsored medical services insurance plan, Medical Services (Alberta) Incorporated (MS(A)I), would no longer be needed. The College decided to use this money to endow a foundation to fund research that would promote the health of Albertans. The Act to incorporate the Medical Services Research Foundation of Alberta (MSRFA) was passed by the Provincial Legislature on July 1st, 1970 and outlined a broad mandate for the Foundation. It was to administer its property “for the purpose of fostering and supporting research into any aspect of the provision of medical and allied health services and the promoting of matters of health in the interest of the people of Alberta.”1 The MSRFA, renamed the MSI Foundation in 1980, pioneered funding for medical research in the province well before these other players took up the challenge. It has provided over $9.71 million to more than 314 research projects, some of which have proven to be very significant. In 1970, the Foundation had no model to emulate; no blueprints existed for private medical research foundations of similar size. So the Trustees and the Directors of MSRFA had to build the organization from the ground up, researching and experimenting to create a viable and effective research foundation. Two functions occupied their attention from the beginning – managing the finances in order to preserve and enhance the endowment within the regulatory boundaries of federal and provincial legislation, and choosing worthy grant recipients whose projects would fit within their mandate of funding research in medical and health services. The Foundation faced important challenges along the way: a volatile economic climate that made managing its assets difficult, the costliness of modern medical research and the involvement of government. Throughout its life, the Foundation has worked to maintain its autonomy and identity in a complex environment. Its story is one of growing managerial professionalism and sophistication and a consistent commitment to support original medical research.

^ Building a Foundation, 1970-75

The advent of the federal government’s universal medicare program in Canada in 1968 built on the foundation of physician-sponsored voluntary medical care pre-payment plans. In Alberta, the College of Physicians and Surgeons had developed such a plan, Medical Services (Alberta) Incorporated (MS(A)I, beginning in 1948, and by 1966 it had enrolled half of Alberta’s population.2 As the specially created Alberta Health Care Insurance Commission assumed responsibility for administering medicare, the question arose as to what would become of the money that remained in the account of MS(A)I.3 The three million dollar reserve fund had been set aside from subscribers’ contributions and held back from payments to physicians to provide an emergency reserve for the plan. Practically, it could neither be returned to subscribers nor paid out to physicians.4 The CPS played a key role in lobbying the Social Credit government of Premier Harry Strom to provide the legal framework for such a foundation, leading to the drafting of the Alberta Medical Services Research Foundation Act.

The new Board of Trustees of the MSI Foundation reflected the very close association of the new Foundation with both the old MSI and its sponsors, the CPS and the Alberta Medical Association (AMA).5 Representatives of both the CPS and the AMA joined lay members of the old MS(A)I board, Robert W. Chapman and Charles Hayes, on the new board.6 Chapman, an Edmonton entrepreneur, had been appointed Chairman by Order-in-Council.7 At that first board meeting, the Trustees decided to ask former MSI Executive Director Dr. Steven M. Schmaltz to become part-time Director until they knew what the needs of the Foundation would be.8 He accepted.9 Thus, the administration of the new Foundation largely replicated that of the old MS(A)I.

Three members of the Board of Trustees, whose terms were to be reviewed every five years, were appointees of the government, typically members of the business community, and four were representatives of the medical community, two physicians each selected by the AMA and the CPS.10 A Finance and Investment Committee made up of three Trustees would manage the investments. A five-member research committee, also drawn from the Board of Trustees, would evaluate research proposals.11 Although the government would continue to reserve the right to select its appointees to the Board, in effect, the Foundation was independent.12

The appointment of Dr. Schmaltz as Director of the new Foundation provided continuity in leadership,13 but the Trustees faced important challenges. Board members needed to decide how best to manage the endowment, what types of research the Foundation would fund, what it could reasonably expect in return for its investment and what function it would play in the larger medical community. The Foundation had to be developed from the ground up and the Trustees immediately sought guidance and advice from more experienced foundations. Trustees visited the Glenbow Foundation,14 the W.K. Kellogg Foundation in Michigan, the Vancouver Foundation and the Winnipeg Foundation. They received a good deal of helpful advice from these consultations. For example, the Kellogg Foundation did not always favour “sure bet” projects; instead, it preferred to encourage experimentation on the premise that even if a particular project failed, others might use the insights gained. “The funds of a Foundation should be used as a ‘catalyst, not a crutch,’” emphasized Andy Patullo. The Board agreed.15 From the Vancouver Foundation, they adopted the practice of granting “seed money” for projects that would be more fully funded by others, such as the government or the university.16 The Winnipeg Foundation suggested broadening the scope of the new Foundation’s activities in order to enhance its ability to attract bequests and donations and to prevent fragmentation of benevolent efforts in the province. The Trustees considered this idea from time to time until the 1980s but they felt a duty to the original contributors to the endowment, both subscribers and physicians, which made them adamant that the integrity of the funds and autonomy of the Foundation should be preserved.17 Given its relatively small endowment, the MSRFA was reluctant to incur the expense of external assessment of project applications, as the Kellogg Foundation did. The Trustees considered they had sufficient expertise on the Board to evaluate most project applications.

The Board members had been interested both in how the older foundations assessed projects and in how they managed their finances. Several of the foundations reported that their boards or investment committees made the investment decisions themselves, sometimes on the basis of their own expertise and sometimes with the advice of experts. The Trustees decided that they would manage the endowment themselves through the Finance and Investment Committee and that the investments should be handled to maintain the fund in perpetuity.18 In September 1971, they decided that the Finance and Investment Committee would meet monthly, review the investment portfolio, decide what changes would be desirable and take appropriate action. All actions would be presented to the Board in writing at next Board meeting.19

In these early days of the Foundation, Trustees naturally focused on laying the groundwork for the future. The Trustees sought to create an administrative structure and to devise appropriate means of managing the finances. Ian Walker became Director in August 1972 and remained in that position until 1982.20 In early 1972, the Board authorized any two of the Chairman, the Honorary Treasurer and the Director of the Foundation “to negotiate purchase and sale of securities and investments of the Foundation without prior reference to nor negotiation with the Board on individual transactions.” All such transactions were to be submitted in writing as information to the next meeting of the Board of Trustees.21 This discretionary power would allow the Foundation to react quickly to investment opportunities or concerns, important since the Foundation was managing its investments directly, rather than through an investment management company. L.W. White died on 17 February 1972 and Fred Stewart, previously Deputy Provincial Treasurer and General Manager of Alberta Municipal Financing Corporation, was invited to replace him on the Committee in March.22 Stewart served on the Committee as a paid consultant until he was appointed to the Board of Trustees by Order in Council in June 1973.23

Although the MSRFA devoted much attention in these early years to laying the groundwork for the future, it also began to accept applications for funds. Many of the early applications to the Foundation were inappropriate, natural, perhaps, as applicants were uncertain as to what its policies would be. By the end of 1971, the Trustees had rejected many applications either because they fell outside the Foundation’s terms of reference or because the Trustees believed the matter proposed for research was the responsibility of the provincial department of health.24 Trustees chose to support health services and operations research, activities designed to assess and improve the operations of health care institutions through the application of existing techniques of social science. The Foundation funded seven such projects between 1970 and 1972 worth about $180,000, ranging in value from $1045 to $76,569, projects such as: “Hospital Visitations to Determine Future Needs for Blood Banking and Cross Matching Facilities,” “Medical Problems and Use of Medical Services Among Senior Citizens in Alberta, and Medical Manpower Needs of the Province of Alberta.”25 An innovative project for the times was a grant in 1970 to Dr. Robert Fraser of the University of Alberta for the, “Development of a System for Analysis of Electrocardiograms Using a Small Computer.” An early form of telehealth, the system would allow “physicians anywhere [to] call in by telephone and have the computer analyze the e.c.g. as it is being taken – the telephone line providing the electrical connection between the computer and patient.”26 Some of the grants in these early years seem to have been made on the basis of a very broad and modern definition of health research, grants for such projects as a “Study on Homeless Women,” or “Development of a Pre-School Program to Detect Incipient Learning and Emotional Disorders.”27 They also funded a number of projects that focused on evaluation – the Evaluation of a Geriatric Day Hospital Project in Calgary and Edmonton, for example.28 This would remain a feature of the Foundation’s research funding for some time.

The Trustees gradually shaped the research funding policies of the Foundation, informally discussing the merit of various proposals as they arrived. In 1972, they adjusted their funding methodology and definition of research. Over time, the Foundation developed its primary relationships with researchers based at the University of Alberta and the University of Calgary.29 In these first few years, the Trustees and the Directors of the MSRFA laid a solid foundation for the future. They worked to create an administrative structure, to craft an investment policy and to develop their research policies.

^ Blazing the Trail, 1975-1980

The Foundation’s research policy evolved as the Trustees responded to the changing political and economic climate and to changes in medical research. They continued to fund evaluation research – projects such as “Program Evaluation in Residential Child Care” and “An Evaluation of the Edmonton Home Care Program.”30 They were also willing to consider and fund very practical projects if they met a real need and were research-based. One example was the design, development and testing of a motorized auxiliary unit for wheelchairs.31 An equally practical project was one proposed by Dr. A. Kernaleguen, of the School of Household Economics, to design and test clothing for physically handicapped people. Funded in 1973-74, this research culminated in a very successful book published by the University of Alberta Press in 1978, Clothing Designs for the Handicapped.32 Epidemiological research was first funded by the Foundation in 1972-73 when it began to give small grants to researchers to screen various Alberta populations for diseases such as Tay-Sachs Disease, ankylosing spondylitis, breast cancer and neonatal hypothyroidism.33 The latter project, funded in 1977-78, was already in routine operation in Alberta by November 1978, screening 36,000 to 40,000 babies each year. With a prevalence rate in Alberta established by the research project of 1:3,500 – 4,000 newborns, this project meant that up to ten children per year were saved from severe retardation as a result of this condition.34 In the late 1970s, a different type of research project began to receive funding from the Foundation – basic biomedical research. For example, Dr. Bryce Weir received a grant of $85,000 in 1976-77 to study Autoregulation in Subarachnoid Hemorrhage in the Rhesus Monkey.35 Not all biomedical projects were as costly as this one, but many were and this was one of the challenges faced by the Foundation. With its relatively small endowment, it would be difficult to fund the increasingly expensive type of research that was becoming the norm.

In May 1975, Minister of Hospitals and Medical Care Gordon Miniely had asked if the Board would consider performing specific research for the provincial government “which may be valuable in determining future policy directions in the hospital and health care field.” The overture triggered considerable debate among Trustees as to whether the Foundation should participate in such research as well as the future role it would play as a funding agency. Costs in the medical and health fields were rising, making it harder for the Foundation to make an impact on research given its limited endowment. It had to be highly selective, earning it a reputation in the medical community as “ultraconservative” and limiting its public profile.36 Trustees agreed that the Foundation should play a larger role in health research and policy and support activities of broader social relevance, but they were concerned that the provincial government or other bodies were seeking Foundation funds for activities they ought to be funding themselves. They had laid a good foundation, they believed, but perhaps it was time to strengthen the Foundation’s role by associating with the government, while being careful to maintain their independence.37

Given their restrictions, the Trustees began to ponder other options. They did not want to passively respond to funding requests but rather to identify areas of need and research thrusts that “seed money” might be able to encourage. In order to determine these areas, the research committee reasoned, the present operation of the health care system needed to be thoroughly understood and its future considered.38 Miniely’s request to conduct a study on health care delivery systems came precisely at the moment when the Trustees were already contemplating policy analysis, even health-care management, as a possible research field. Interpreting the offer as an invitation to expand into this field, they decided to conduct the study in-house, creating a special Policy Committee in late July 1975 and providing for the hiring of additional personnel as needed.39 This was a major departure from normal practice. The Foundation was willing to fund the study with the government on a 50-50 basis, up to $100,000, with the Trustees acting as consultants.40 The government approved funding for the study by December 1975.41

In June 1976, news that the government was planning the formation of a dedicated medical research foundation caused consternation among Trustees. This institution, which would eventually be named the Alberta Heritage Foundation for Medical Research (AHFMR), would inevitably be much larger and better-funded than the MSRFA. The Foundation believed that it must either bolster its endowment by amalgamating with other local foundations, or play some role in the new medical research foundation. If, however, the government chose its own administrative structure, Trustees feared that the MSRFA would become obsolete.42

The Trustees resolved to take the matter up directly with Premier Peter Lougheed. They were unsuccessful in arranging a meeting with him. In fact, the government was reappraising the Foundation’s potential involvement in health policy at the highest levels. The Foundation’s request to the cabinet to renew the terms of its government appointees was not immediately granted and instead referred back with a request for additional information on the Foundation’s history and its Trustees. The government eventually approved the re-appointments but to Trustees it seemed as if they had lost their direct channels of communication with health officials, creating apprehension within the Board. By the spring of 1976, the Policy Committee study had compiled “all relevant information” on the operation of the hospital system and waited for Miniely to provide recommendations for the drafting of the final report, due for completion in September. Yet the Minister provided no further guidance for some seven weeks, causing the Trustees to wonder if the government had abandoned the study.43

Miniely’s sudden unavailability and the government’s reluctance to articulate its intentions regarding the new medical research foundation compounded a growing sense among Trustees that they were being frozen out of the decision-making process. This impression was likely reinforced when Community Health and Social Welfare Minister Helen Hunley diplomatically informed them in a 7 July meeting that she was now the Foundation’s main point of contact with the Minister of Hospitals and Medical Care.44

The government held out a slim hope that the MSRFA might still wield some influence in shaping the provincial research policy. In the fall, Miniely once more asked whether the Foundation would be interested in discussing the terms of reference for several jointly-funded studies of how Heritage Trust funds might be used to support medical and health research. Perhaps understandably, Trustees were unsure how to proceed. Their internal position now was that the Foundation did not conduct its own research projects but would be willing to draft terms of reference and help Miniely prepare the proposal. Alternatively, the Minister could retain his own consultants.45

For the Trustees, such studies represented both an opportunity and a danger. On they one hand, they could be an entrée into negotiating the much larger issue of the Foundation’s involvement in the structure and operations of the AHFMR. On the other, they might lead to a loss of autonomy. Should the Foundation be funding studies that were the responsibility of government? The government did not seem to want any substantive input from the Foundation into the formation of the AHFMR. Participation in other minor roles relating to health policy where government money was involved was unattractive for the Trustees because it would place the “identity of the MSI funds” at risk, jeopardizing its existence as an independent entity.46 Nevertheless, Trustees remained committed to the principle of somehow contributing to the development of medical and health research policy in the province and tried to stay abreast of developments and maintain communication with the government.

In April 1977 Miniely once again asked the MSRFA for help with research, this time on projects dealing with the needs of the elderly and waiting lists in medical institutions. Trustees wondered whether the proposals involved research or, as one trustee put it, merely the compilation of existing information.47 Again Trustees were hesitant to fund activities in support of a government ministry. They resolved to support the request if a “researcher” resubmitted it. In September, the Foundation received a letter from Miniely indicating he did not wish to follow up.48 In December 1978, Trustees arranged a meeting with Hunley to express their concerns about the future of health research policy, stressing that the MSRFA was receiving applications that the Medical Research Council or the new Heritage Trust Fund foundation would be better suited to addressing. Noting their own experience in the field, they offered the Minister an unsolicited statement of principle outlining how they believed such a funding agency should be structured.49

Hunley provided no positive signals and the Trustees concluded they were unlikely to have a say in how Heritage funds were to be used for research. Nevertheless, they attempted to pursue the matter. Drs. LeRoy leRiche and R.R. Francis were delegated to meet with John E. Bradley, a former member of MSI who was Lougheed’s Special Advisor on Medical Research and his chief lieutenant on the AHFMR file. This confirmed the matter. Beyond supplying an appointee to the AHFMR board, the MSRFA would have no role in the new foundation. Talks between the Foundation and the Edmonton philanthropic organizations including the Muttart, Winspear and Lee foundations regarding some form of collaboration, underway since January 1978, now focused on the possibility of forming an “Alberta Community Foundation.”50 The premier himself declined to meet with the Trustees. The Foundation would go its own way. The private sector was a necessary part of society and Trustees were committed to enlarging their support base.51

Meanwhile, the Trustees had gradually reformed the administration and policy of the Foundation in response to the changing political landscape. In April 1977, they took action to register the MRSFA as a charitable foundation. This required the Foundation to spend ninety per cent of its annual net income and make grants only to registered charitable organizations, requiring long-time recipients such as the universities and other non-profit organizations to acquire such status.52

During this period the Finance and Investment Committee, with a stable membership from 1973 to 1978 of Fred Stewart, Robert Chapman, E.F. Donald and the Director Ian Walker, met frequently to deal with the volatile economic situation resulting from the energy crisis and its impact on both bonds and equities.53 In November of 1973, they decided to establish a new investment strategy for presentation to the full Board.54 In 1974, they were holding over one million dollars of the $3.9 million dollar endowment in short-term notes at 9%.55 Over the course of the next few years, they sold a significant number of bonds, sometimes at a capital loss, but with the result that they were able to buy bonds with higher rates of interest and place money in short-term certificates that paid high rates of interest.56 Their concern throughout this period was the high rate of inflation, which they feared would erode the value of the Foundation’s assets in real dollars.

^ Challenge and Response: The 1980s

By the end of the 1970s, Foundation had established itself as one of the province’s medical research funding agencies, although it still felt some uncertainty as to what its role ought to be. In the 1980s, its Trustees would shape research policy in ways that reflected the MSRFA’s internal and external politics, its own material constraints and the weakening provincial economy. In 1977, Trustees had taken a progressive approach to health care research. They had wanted to help shape the government’s health research policy, but the government was seeking advice elsewhere. They now adopted a more conservative position. Once spurred by the advent of the AHFMR to consider applications for basic research, a move motivated at least partly by their desire to retain influence in the province’s new medical research order, the Trustees now reverted to their earlier guidelines. Though they would continue to accept such applications, basic research was now made a low priority. This was not simply a reaction to a perceived slight but rather an indication of the thinking within the Board of Trustees as it considered how to conduct business in the new decade. It faced serious obstacles. Administrative costs were considered high in relation to total income.57 But the greatest concern was how to remain relevant in medical research once the AHFMR began operations.

Two options were open to the Trustees: make alliances or increase their independence. They took up both. Continuing to consider the possibility of amalgamating with other foundations to create a larger community foundation, Trustees now began a campaign to revise the terms of the MSRFA Act to create a wholly new organization to be named the “Alberta Foundation,” modeled after the structure of the Vancouver Foundation.58 The proposed umbrella organization would have broader investment powers, the ability to borrow money and pay fees and expenses to Trustees and committee members, and, perhaps most importantly, the right to draft its own by-laws and choose its own members. It would be exempted from the province’s Financial Administration Act, which placed restrictions on the Foundation’s ability to shape its investment policies. In short, these reforms would have augmented the already-considerable autonomy of the MSRFA not only in relation to the provincial government but also the AMA and CPS.59 The preferred route for this was a private member’s bill – the Alberta Foundation Act – to be introduced in the provincial legislature.

Neither the government nor the medical establishment were pleased. The AMA and CPS had not been consulted in advance of the Foundation’s plans; the Trustees had not thought it necessary until something was actually in process. In a meeting in May, the three groups reaffirmed the principle of the independence of the medical profession’s appointees to the Board of the Foundation, (they were not accountable to the nominating agencies), while agreeing to share more information in the future.60 In February 1980, the Ministry of Social Services and Community Health indicated it was not in agreement with the broad sweep of the revisions to the MSRFA Act and Trustees agreed to drop the provisions allowing the Foundation to draft its own bylaws and choose its own appointees if this expedited the legislation. 61

The Foundation’s proposed new name was another source of contention. The government insisted it select another one, believing the “Alberta Foundation” was suggestive of a government organization. Trustees considered alternatives including the “Alberta Community Foundation,” the “Alberta Communities Foundation” and the “Community Foundation of Alberta” before settling on the “MSI Foundation.” In fact, the Trustees hoped that once the new foundation act was enacted, they would form an umbrella foundation called the “Charitable Foundation of Alberta” that would exempt the MSI Foundation from the province’s Financial Administration Act and allow its high administrative costs to be reduced.62

The branding controversy was not a trivial issue but a microcosm of the different views of the government and the Foundation regarding its role. The province had decided that AHFMR would be the centre of Alberta’s medical and health research infrastructure, the keystone of its program of industrial diversification. It saw only a minor role for the MSRFA in its health research policy. The Trustees, disappointed that the government seemed unwilling to avail itself of their advice or experience, had to find their own way. For its part, the Foundation needed to reconcile the increasing complexity and expense of medical research with its own limited resources and desire for autonomy. In early 1981, the Act passed in the legislature and the Foundation was no longer subject to the Financial Administration Act or the Auditor General Act.63 The Trustees agreed that Walker, director since 1972, would be the new chief executive of the Charitable Foundation of Alberta, which would be an arm of the MSI Foundation.64

These changes unfolded against a background of socio-economic upheaval in the 1980s. The operations of the MSI Foundation during the decade were characterized by two long-term trends. It supported projects that were increasingly complex and ambitious in their scope, reflecting the increasing sophistication of Alberta researchers and their interest in probing the basic properties of biological matter. Despite the decision of Trustees to discourage applications proposing basic research, nearly a third of the ninety or so projects they decided to fund between 1979 and 1986 had a biochemical aspect to them, suggesting a fundamental shift was occurring in the kinds of questions Alberta doctors believed were important. In addition, AHFMR-provided salary support attracted many new researchers to the province. Once here, they sought funds to carry out their research from other agencies, such as the MSI Foundation.

The other trend was a result of the economic turmoil in the early 1980s and its effects on the Foundation’s income. The Trustees decided to eliminate the position of director and assigned some of the functions of the executive director to the Board Chairman, Robert Chapman.65 This reduced expenses but the foundation faced other challenges in managing its finances. Since its inception, the Finance and Investment Committee had managed its portfolio. Facing a volatile and inflationary economy and restricted to investing no more than fifteen per cent of their funds in equities by the Trustees Act, the Committee complained that it was hard to keep up with inflation.66 With interest rates above fifteen per cent, however, the Committee was able to earn significant income by selling bonds and keeping a good portion of the endowment in short-term interest bearing notes. New investment guidelines from the Alberta government in the early 1980s gave the Foundation, in common with others, more latitude. It could now hold twenty-five per cent of its funds in common shares and up to thirty-five per cent of its portfolio in a combination of common shares and real estate. It was no longer limited to thirty-five per cent corporate bonds.67 The difficulty of forecasting trends in the tumultuous 1980s was compounded by the fact the Foundation dealt with up to ten investment houses. From mid-1982, the Finance Committee began to reform its financial operations, a process in which Chapman played a leading role. At the end of the year, Trustees decided that three brokerage houses would administer the Foundation’s funds.68 By 1987, one third of its investments were held in mutual funds managed by Prestholdt, one third were under the care of Wood Gundy and the Foundation and Pemberton Houston jointly managed one third.69

Despite these reforms, however, the Foundation faced major challenges both in the management of its endowment and in its relationship with the research community during the turbulent 1980s. Its annual income declined through most of this period before recovering in the last three years of the decade. At the same time, over a period of five years beginning in 1985, the Foundation began granting more money than it was generating. Due to a misinterpretation of amendments to the Charities Act of Canada in 1983, which changed the ways charities calculated their disbursements, the Foundation’s average annual disbursements were far larger than necessary, resulting in the paradox that its most generous support came at a time when the Alberta economy was at its lowest ebb. Nearly half – $4.2 million – of the $9.2 million it granted between 1972 and 2004 was distributed during the 1980s. The peak came in 1986-87 when it approved 27 grants totaling over $750,000. It also agreed to fund two research chairs in the province, awarding the University of Alberta’s Faculty of Medicine $250,000 to endow a chair in medical ethics in commemoration of its seventy-fifth anniversary and, to maintain regional balance, granting $100,000 for the LeRoy leRiche Chair in Substance Abuse at the University of Calgary.70 Doubtless this benefited Alberta’s medical research community, particularly at a time when it was expanding rapidly due the salary support provided by AHFMR. But the error also prevented the Foundation from enlarging its asset base at a crucial point in its history and had serious consequences for its ability to support its research program later.

^ Financial Crisis, Process Reform

By the late 1980s, the Trustees had begun to think that revisions might be necessary to the way they managed their research funding. Dr. D. F. McPherson, Chairman of the Research Committee, prepared a discussion document on a revised Research Program for the consideration of the Trustees. In this document, he indicated that the Foundation was facing pressure from the universities to expand access to the Foundation’s funds to disciplines other than medicine.71 The Trustees were reluctant to succumb to such pressures, and sought to find a basis for their funding decisions that would not make them subservient to the universities. Restrictions in the amount of funding for medical research available throughout the country and the increase in the number of investigators due to the impact of AHFMR led to a marked increase in funding applications to the MSI Foundation and in their quality and complexity. McPherson recommended a more formal application process, including “an abbreviated but comprehensive application form,” review of applications where necessary by expert consultants paid for these services, and more complete and formalized reporting procedures.72 Recognizing the importance of peer review, the Research Committee approved these recommendations, and began to send applications for external review.73 In June, a new system of screening applicants, in which proposals would first be approved by the associate dean of research and the ethics committee at the universities, was approved by the Board of Trustees.74

The Board of Trustees initiated a far-ranging consideration of its future plans at a special meeting in February of 1988. It could continue its prudent investment policy and steady growth into the future or it could put its energies into developing the Charitable Foundation of Alberta (CFA). While the latter might offer increased funds to work with through donations and therefore an increased role, it also meant less independence for the MSI Foundation. Chapman suggested that while he believed he was capable of carrying on as Chairman and Director of the MSI Foundation, he was willing to be “flexible” in the interests of the Foundation. The Trustees were unanimous in their determination that the Foundation should preserve its independence.75 The Charitable Foundation of Alberta never became a viable entity as a result.

The misinterpretation of the Charities Act was identified and corrected in 1990. This had important effects on the Foundation’s ability both to plan for research and to retain its presence in the research environment. Trustees believed the MSI Foundation’s capital fund of $5.7 million trailed well behind the rate of inflation and was $3.5 million smaller than it should have been.76 Although the Board could legally refrain from disbursing funds and build up the Foundation’s capital reserve, a long hiatus would also erode the Foundation’s public image and reputation.77 In the end, Trustees chose to compromise. They instituted a partial research moratorium, canceling disbursements over three of the next five years between 1991 and 1996 while funding some small projects in order to keep the Foundation “in the public eye.”78

Trustees also agreed that the Foundation’s entire portfolio should be overseen by one investment house, selecting Beutel Goodman as the primary fund manager for the next several years. In practice, Trustees also retained the services of a variety of other investment firms in subsequent years to manage a smaller proportion of the investments, regularly monitoring their performance and switching companies accordingly. With the administrative streamlining came less need for office space. In late 1991, the Foundation began subletting its prime space in Edmonton’s Standard Life office tower on Jasper Avenue first to the Winspear Foundation and then to the Missing Children’s Society. By 1996, the twenty-fifth anniversary of its creation, the Foundation had resumed its normal funding routine. To mark the occasion, it held a special research competition, offering ten grants worth $25,000 each in fall 1996.79

That fall, Trustees once more reviewed research policy, noting the original principles of the 1970 Act that incorporated the Foundation had to be read in light of current conditions. Although the Foundation had decided to favour patient-based projects after 1990, a high proportion of its grants continued to support experimental research in which costs and potential benefits were great. The Foundation now faced new challenges in the environment it had helped create, one in which medical research now flourished. Over the years, it had periodically encouraged precisely these kinds of advanced science-based activities. As AHFMR had become established, the Alberta medical research community grew increasingly confident and capable and was more eager to push the frontiers of science. The Foundation found it increasingly difficult to satisfy the demands of this very expensive type of research. Once more it reaffirmed its commitment to patient-based research, but it was to some degree at odds with a research community whose ambitions had surpassed the scope of such objectives.80 In a sense, the Foundation’s difficulties were an indication of the coming of age of Alberta’s medical research establishment.

^ The MSI Foundation and the New Millennium

During the 1990s, the MSI Foundation continued to refine its operations. Dr. LeRoy leRiche replaced Chapman as Chairman of the Board and Chief Operating Officer in 1991. The Foundation increasingly rationalized its administration, moving its headquarters out of the city’s downtown in 2001 to offices in the University of Lethbridge Building on 107 Street and 100 Avenue and then in 2006 to 124 Street and 103 Avenue. In 2001, Trustees simplified the application process, asking applicants initially only for a letter of intent before deciding whether a full proposal was merited, saving much work for researchers and for Foundation staff and the Trustees.81 They were vigilantly cost-conscious, regularly reviewing ways to trim administrative expenses and preserve as much revenue as possible for grants. In 2005, the Trustees began to think about succession planning and moved to formally separate the positions of Chair and Chief Operating Officer, asking Dr. leRiche to outline the duties and responsibilities of each.82

Under leRiche’s tenure, research policy was tailored to fiscal reality. After more than two decades of experimentation, Trustees felt they could not adequately fund capital-intensive bench science or clinical research. Limited resources compelled them to consider those strategic areas where they could have the greatest impact. In practice however, it had not been easy to distinguish between basic and applied research and the Foundation had emphasized both at different times in its history. Over thirty-five years, the ten leading areas of research by funding were non-clinical sciences ($1.35 million), neurology ($1.09 million), cardio-vascular ($872,239), psychiatry ($652,688), genetics ($632,392), pediatrics ($534,968), bowel ($453,427), diabetes ($443,189), infectious diseases ($363,339) and geriatrics ($279,398). 83

The complex nature of medical and health research was demonstrated in the “Centennial Report,” the Foundation’s study of its legacy conducted in 2005. Recent recipients of Foundation grants for whom addresses were known were asked whether their research had been published, presented to colleagues or applied in clinical practice and whether projects had leveraged further funding. Trustees wished to know not simply if funding had produced knowledge of immediate practical use – the Foundation’s oft-stated chief goal – but if new knowledge had been produced and, if so, whether it had fostered new avenues of investigation. Letters went out to approximately one hundred grant recipients and the Foundation received fifty-six responses. The results of some forty-five had been published or were in the process of being published, forty-five had received subsequent funding and the results of forty-two projects had been “applied.”84

A number of the projects funded first by the MSI Foundation have grown to become programs of international significance.  In 1977, the Foundation gave a small grant ($14,000) to Dr. Einer Boberg for a treatment program for stuttering in developmentally delayed children; this was followed the next year by a larger but still modest grant ($81,000) for a “Therapy Program for Children who Stutter”85 and two more ($25,000, $4,840) in 1982 and 1983 for the publication of the materials for the behavioural treatment program for adult and teenaged stutterers that Dr. Boberg developed.86 In 1984 the Foundation funded a study of the long-term outcomes of the Comprehensive Stuttering Program authored by Dr. Boberg and Deborah Kully ($31,850).87 This series of grants shows the development of the program over the years. None of the grants were very large but each one proved to be significant “seed money” that enabled Dr. Boberg to continue the development of a comprehensive and effective treatment program for a problem that causes great suffering. The publication of the results of the study of long-term outcomes begun in 1984 in the premier journal in the field of speech pathology in 1994 showed that Dr. Boberg’s research was in the vanguard of the new evidence based medicine that has swept the field of medical research since the mid-1990s.88 A MSI Foundation grant to Dr. Boberg in 1986 for a study of central nervous system differences in stutterers shows that he was able to move into complex basic medical research on the solid basis of the clinical research that he had done. Together with Deborah Kully, he founded the Institute for Stuttering Treatment and Research (ISTAR) in 1986. Now a self-supporting, non-profit institute of the Faculty of Rehabilitation Medicine at the University of Alberta, ISTAR has treated over two thousand clients and trained more than three hundred students, clinicians and professors.89 Although Dr. Boberg died in 1995, ISTAR continues to work with clients and clinicians within Alberta and around the world to treat children and adults, to do research into stuttering and to “offer advanced professional training for speech-language pathology students and clinicians” and to promote public awareness of the problem and its treatment. Its members collaborate with researchers from overseas and are often invited to give workshops and conference presentations both in Canada and in other countries.90 As Kully asserts, “the MSI foundation had a significant impact on the development of our program and that impact continues to this day. We are grateful to have had their support. Rehabilitation Medicine in general and speech pathology in particular are areas where relatively small grants can have substantial impact. In spite of their importance to society, they often fall below the radar screen in terms of research funding.”91

The work that the Foundation funded has often had ongoing impact in the work of other researchers and in clinical settings. For example, the relatively small grant received by Jules Lamarre and S. B. Patten for their project, “NeuroBehavioural Cognitive Status Examinations” ($11,360) in 1988 has had a lasting effect. The article resulting from this project was published in the Canadian Journal of Psychiatry92but the significance of the research was the development of the scale, the Modified Mini-Mental State Examination, known as the 3MS. As the researcher stated in response to the survey, “The study has had an impact – the best evidence of this is the fact that it has been cited in nine important studies of the scale…indicating that these subsequent studies (including one published last year) have drawn sufficiently from the information generated in the project that the authors have felt obliged to acknowledge the research. The scale itself was subsequently taken up by the Canadian Longitudinal Study of Health and Aging.” The scale continues to be used here in Alberta – it is one of the most frequently used tests at the Peter Lougheed Centre.93 Foundation-funded researchers have contributed both to their fields of study and to the practice of medicine in the province.

Perhaps the most renowned project which received early funding from the MSI Foundation was the work of a number of researchers in the treatment of diabetes. The first project funded by the Foundation was George Molnar’s study on the “Regulation of Hepatic Insulin Balance” ($27,000) in 1978-79. In 1988, D.W. O’Brien and Ray Rajotte were awarded funding for a “Long-Term Study of Hepatic Insulin Balance in Pancreatic Islet-Transplanted Dogs” ($78,600) and Garth Warnock received a grant for a study entitled, “Isolation and Immunomodulation of Adult Human Pancreatic Islets of Langerhans” ($37,000). Numerous other researchers, including James Shapiro, Sulaiman Nanji, Norman Kneteman, Jonathan Lakey, from the Clinical Islet Transplant Program received grants from the MSI Foundation. Not only did these grants result in significant presentations and publications but they also assisted in the creation of the world-class team that developed the program of islet transplantation that is at the cutting edge of diabetes therapy today.94 The Edmonton Protocol, as it is known, has won world-wide acclaim for its potential to cure diabetes rather than just treat it.95 While the size of the grants that the MSI Foundation provided may seem small in comparison to the multi-million dollar grants of the Juvenile Diabetes Foundation or government-funded organizations, they often functioned as “seed money” that allowed researchers to begin work on something that may not have otherwise received funding. As one researcher, William Pearce, put it in responding to the Foundation’s survey in 2005, “The support of the MSI Foundation was critical in the early stage of our research…Once a paper or two [has] appeared it is less difficult, though still not easy, to obtain research grants. It is the “venture capital” approach such as provided by the MSI Foundation that is vital for new scientific projects to get off the ground.”96

It is also clear that MSI Foundation funding has often been important in allowing researchers to be successful in applications to other larger funding agencies. Dr. James Raso of the Glenrose Rehabilitation Hospital received a grant in 1997 for a project, “The Mechanics of Surgical Correction in Adolescent Idiopathic Scoliosis” ($24,700). Not only did publish his results widely (three peer-reviewed publications, seven published conference proceedings and abstracts, and eight conference presentations and posters), but he and his team also successfully applied for $80,000 from the National Science and Engineering Research Council “Mechanics of Surgical Corrections” as well as nearly $70,000 from the Edmonton Orthopaedic Research Committee.97

Another example of MSI Foundation funding leading to further funding was the $25,000 grant that Drs. Diane Taylor and Mavanur Suresh received for the study, “Development and Characterization of a Mouse Model for Helicobacter pylori Infection” in 1997. This was funding of basic research, a type of research that the Trustees sometimes worried would not produce results in human health. But this research team then received a three-year Terry Fox Research Grant from the National Cancer Institute of Canada in 1997 with a total value of $170,500 for the next phase of their work, a study entitled, “Helicobacter Pylori and gastric carcinogenesis.”98 The MSI Foundation funding of the development of the mouse model enabled them to investigate gastric carcinogenesis with a NCI grant. Seed money, indeed!

From small beginnings, the MSI Foundation grew to have a major impact in Alberta’s medical research community. Dr. leRiche’s philosophy of addressing the needs of fledgling researchers was shared by his successor, the former AHFMR president Dr. Matthew Spence, who broadened the clinical approach to embrace applied patient-based research on assuming the Chairmanship in 2006. In more than thirty-five years of operation, the Foundation played a pioneering role in the construction of an Alberta research culture where one had not existed before. Funding increasingly sophisticated projects, including many of a biomedical nature, it provided nearly $10 million for Alberta medical scientists in thirty-seven fields. It also provided for research chairs at the two Alberta universities, one a chair in medical ethics at the University of Alberta and the other, the LeRoy leRiche Chair in Substance Abuse at the University of Calgary. As Alberta’s medical research community grew and developed over the years, the Foundation wrestled with the problems of identifying research questions, accounting for work that had never before been attempted in the province and sustaining a steady flow of income. Funding a great number of useful studies and projects, it built research capacity in the province and created a rich reservoir of experience in these matters. By 2006, equipped with an endowment that at $9.5 million had nearly tripled since its establishment, the Foundation had found its niche. It has proven to be a catalyst of advanced medical and health research in Alberta, supporting patient-based research relevant on a national and global scale. The MSI Foundation today occupies pride of place in a scientific community it did so much to help foster.

1 The Act also included provision for the new Foundation to take over the assets and responsibilities of the Alberta Medical Research and Education Foundation. Bill 46, An Act to incorporate the Medical Services Research Foundation of Alberta, 1970.

2 C. Howard Shillington, ^ The Road to Medicare in Canada, (Toronto: Del Graphics Publishing Department, 1972), pp. 60, 204.

3 The new Foundation received $3,378,068 from the Liquidator of the MS(A)I and another $29,396 from the Alberta Medical Research and Education Fund, which the provincial government had decided to turn over to it as well, making for an initial endowment of nearly $3.5 million. Statement of Assets and Liabilities, 31 December 1970. Minute Book 1. In 2008, its value was $8,047,000.00.

4 Interview with LeRoy leRiche, 2 April 2008.

5 In fact, it met in the boardroom of the College and agreed to take up its offer to set up the new Foundation’s offices in the CPS Building. Minutes, Board of Trustees, 21 July 1970.

6 The Joint Executive Committee also suggested the appointment of F. Jenner, a former president of the board of MS(A)I, but the government chose to appoint L.W. White instead. Order in Council 23 June 1970. Correspondence, 8 October 1970, Robert F. Clark, MD (Executive Secretary of AMA, Deputy Registrar of CPS) to Dr. S. Schmaltz (Director, MSI Foundation) enclosing certified copies of resolutions (formal appointments). Minute Book 1.

7 Order in Council, 23 June 1970.

8 Minutes, Board of Trustees, 21 July 1970.

9 Minutes, Board of Trustees, 19 August 1970.

10 The Registrar of the College of Physicians and Surgeons would fill one of the positions ex officio.

11 The Trustees appointed Dr. D.F. McPherson, Dr. E.F. Donald, Dr. R.M. Parsons, C.P. Hayes and Dr. R. Woolstencroft to the first Research Committee; L.W. White, C. P. Hayes and R.W. Chapman formed the first Finance and Investment Committee. Minutes, Board of Trustees, 21 July 1970.

12 Minutes, Research Committee, 31 October 1970.

13 Minutes, Board of Trustees, 21 July 1970.

14 Minutes, Board of Trustees, 19 August 1970.

15 Memorandum re: Foundations, Minutes, Board of Trustees, 14 October 1970.

16 Minute Book I, Memorandum Re: Foundations, Minutes, Board of Trustees, 14 October 1970.

17 Memorandum re: Foundations, Minutes, Board of Trustees, 14 October 1970.

18 Minutes, Board of Trustees, 13 January 1971.

19 Minutes, Board of Trustees, 1 September 1971.

20 Minutes, Board of Trustees, 23 August 1972, 30 April 1982. Minutes, Board of Trustees, 3 October 1980.

21 Minutes, Board of Trustees, 19 January 1972. White was the first Honorary Treasurer; Fred Stewart replaced him.

22 Minutes, Board of Trustees, 15 March 1972.

23 Minutes, Board of Trustees, 20 October 1971, 23 August 1972, 30 October 1972.

24 Minutes, Research Committee, 14 December 1971.

25 Appendix B, MSI Research Projects Funded from 1971-2006.

26 Medical Services Research Foundation of Alberta, Annual Report 1972.

27 Appendix B, MSI Research Projects Funded from 1971-2006.

28 Drs. D.P. Flathman and D. Larsen. 1972-73. Appendix B, MSI Research Projects Funded from 1971-2006.

29 Minutes, Board of Trustees, 14 May 1975.

30 The Alberta Association of Child Care Centres received a grant of $12,900 for its project, Program Evaluation in Residential Child Care and Dr. D.P. Flathman received $46,400 for An Evaluation of the Edmonton Home Care Program in 1973-74. Appendix B, MSI Research Projects Funded from 1971-2006.

31 Alberta Rehabilitation Council for the Disabled, $8,075, 1973-74. Medical Services Research Foundation of Alberta, Annual Report, 1974.

32 “…this project has received national and international recognition as a first in the field.” Medical Services Research Foundation of Alberta, Annual Report, 1980.

33 Tay-Sachs Disease Testing Program, Dr. D. J. Segal, $1,950 and $2,100, 1972-73; To Assess the Possibility of Earlier Diagnosis and Treatment of Ankylosing Spondylitis in an Indian Population, Dr. A.S. Russell, $9,180, 1974-75; A Breast Registry with Clinical and Research Applications, Cross Cancer Institute, $129,000, 1975-76. Appendix B, MSI Research Projects Funded from 1971-2006.

34 Medical Services Research Foundation of Alberta, Annual Report, 1980.

35 Appendix B, MSI Research Projects Funded from 1971-2006.

36 At the end of Fiscal Year, 1975, the book value of its assets was $4.238 million and it had disbursed a total of $601,841 since its founding. Minutes, Board of Trustees, 14 May 1975.

37 Minutes, Board of Trustees, 14 May 1975.

38 Minutes, Research Committee, 23 April 1975.

39 Minutes, Board of Trustees, 23 July 1975.

40 Minutes, Board of Trustees, 23 July 1975.

41 Minutes, Board of Trustees, 17 December 1975.

42 Minutes, Board of Trustees, 16 June 1976.

43 Minutes, Board of Trustees, 7 July 1976, “Notes on a meeting with Miss Helen Hunley, Minister of Social Services and Community Health at 2:30 pm, Wednesday, July 7, 1976 in the Legislative Building.”

44 Minutes, Board of Trustees, 7 July 1976. “Notes on a meeting with Miss Helen Hunley, Minister of Social Services and Community Health at 2:30 pm, Wednesday, July 7, 1976 in the Legislative Building.”

45 Minutes, Board of Trustees, 25 October 1976.

46 Minutes, Board of Trustees, 1 December 1976; “Minutes of a Special Research Committee Meeting held at 9:00 am, Tuesday, November 16, 1976.”

47 Minutes, Board of Trustees, 27 April 1977.

48 Minutes, Board of Trustees, 21 September 1977.

49 Minutes, Board of Trustees, 28 November 1978.

50 Minutes, Board of Trustees, 24 January, 23 March, 30 May 1979.

51 One entry from the 30 May meeting of the Board of Trustees noted that they had to deal with the issue of the appointment to the AHFMR, “even though we may not wish to make such an appointment – after all we were not consulted.” Minutes, Board of Trustees, 30 May 1979.

52 Minutes, Board of Trustees, 4 February 1977. Over the next five years, annual disbursements rose dramatically from an annual average of $159,000 to $310,000; see MSI Foundation, Analysis of Income and Expenditure, September 1, 1971 to August 31, 2005.

53 E.F. Donald died in 1978 and was replaced both on the Board of Trustees and on the Finance and Investment Committee by E. B. McKitrick. Medical Services Research Foundation, Annual Reports, 1978, 1979. Minutes, Finance and Investment Committee.

54 Minutes, Finance and Investment Committee, 13 November 1973.

55 Minutes, Finance and Investment Committee, 6 March 1974.

56 In February of 1976, for example, they had sold $700,000 of bonds to take advantage of higher rates of interest on new issues even though this resulted in a capital loss of approximately $41,000. They had improved the yield to the Foundation and improved the quality of their holdings. Minutes, Finance and Investment Committee, 18 February 1976. They sold the majority of their corporate bonds in September, 1979 which provided them with an additional cash surplus of over $800,000.00, at the cost of a capital loss of about $25,000. The funds were to be invested in short term certificates for time being. Interest rates were over 11%. Minutes, Finance and Investment Committee 10 September 1979. By May, 1980 they were holding about $1,400,000.00 in short term notes at nearly 16%. Minutes, Finance and Investment Committee 5 May 1980.

57 Minutes, Board of Trustees, 17 July 1979; between 1971 and 1981, annual income had slightly more than doubled from $227,380 to $481,900, while administration costs had risen from $42,444 to $104,443. Administrative costs remained high as a proportion of income throughout the 1980s. Analysis of Income and Expenditure – September 1, 1971 to August 31, 2005.

58 In August 1979, the Trustees went to British Columbia to consult with representatives from the Vancouver Foundation; Minutes of a Meeting of MSRFA with the Vancouver Association, 29 August 1979.

59 Minutes, Board of Trustees, 26 September 1979.

60 Minutes Board of Trustees, 7 May 1980.

61 Minutes, Board of Trustees, 20 February 1980.

62 Minutes, Board of Trustees, 26 September 1979, 3 October 1980.

63 Minutes, Board of Trustees, 18 February 1981.

64 Minutes, Board of Trustees, 21 September 1981.

65 Minutes, Board of Trustees, 30 April 1982.

66 Minutes, Finance and Investment Committee, 14 February 1973.

67 Minutes, Finance and Investment Committee, 19 January 1981.

68 Minutes, Finance and Investment Committee, 9 July, 2 September, 26 November 1982, 2 February 1983.

69 Minutes, Board of Trustees 21 July 1987; Chapman to Trustees, 6 November 1987.

70 MSI Research Projects Funded from 1971-2006; MSI Foundation, Analysis of Income and Expenditure, September 1, 1971 – August 31, 2005.

71 Memorandum, Dr. D.F. McPherson to Robert W. Chapman, 5 May 1987.

72 Dr. D.F. McPherson to R.W. Chapman, 5 May 1987.

73 Minutes, Research Committee, 26 May 1987.

74 Minutes, Research Committee, 21 June 1988.

75 Minutes, Board of Trustees, 8 February 1988.

76 Minutes, Board of Trustees, 19 June 1990.

77 Minutes, Board of Trustees, 30 October 1990.

78 Minutes, Board of Trustees, 5 September 1990.

79 Minutes, Board of Trustees, 26 April 1996.

80 Minutes, Board of Trustees, “Minutes of the Meeting to Review Research Priorities of the MSI Foundation,” 15 December 1999, 6 January 2000.

81 Minutes, Joint Meeting of Board of Trustees and Research Committee, 22 June 2001.

82 Minutes, Board of Trustees, “MSI Proposed Succession Plan for Chair and CEO,” 9 September 2005.

83 MSI Foundation: A Summary of Research Funding from 1971 to 2006.

84 Results of the Centennial Report at 1 September 2005.

85 MSI Research Projects Funded 1971-2006.

86 The Minutes record that the Research Committee members were “very impressed with Dr. Boberg’s achievements on previous projects funded by us.” Minutes, Board of Trustees, 7 February 1982; MSI Foundation, ^ Annual Report for the Year September 1, 1982 to August 31, 1983.

87 MSI Research Projects Funded 1971-2006; MSI Foundation, Annual Report for the Year September 1, 1984 to August 31, 1985.

88 Boberg & Kully (1994). Long-term results of an intensive treatment program for adults and adolescents who stutter. Journal of Speech and Hearing Research, 37, 1050-1059.

89 Institute for Stuttering Treatment and Research, Smooth Talk, Number 17, Spring 2007, http://www.istar.ualberta.ca/content/pdf/Smooth_talk_07.pdf.

90 This continues a pattern that began under Dr. Boberg’s leadership. In 1990, he was invited to Kuwait to plan a speech pathology program for the University of Kuwait. Institute for Stuttering Treatment and Research, “Our Story,” http://www.istar.ualberta.ca/. See also: Langevin, M., Huinck, W.J., Kully, D., Peters, H.F.M., Lomheim, H., Tellers, M. (2006) A cross-cultural, long-term outcome evaluation of the ISTAR Comprehensive Stuttering Program across Dutch and Canadian adults who stutter. Journal of Fluency Disorders, 31(4), 229-256.

91 Deborah Kully, personal communication, 13 June 1008.

92 C.J. Lamarre, “Evaluation of the Modified Mini-Mental State Examination in a general psychiatric population,” Canadian Journal of Psychiatry 1991 36 (7): 507-11.

93 C. Jules Lamarre and S.B. Patten to MSI Foundation, Response to Survey, 2005.

94 “Diabetes breakthrough has patients off insulin injections: U of A researchers are leading the way to a cure” Folio (37) No. 19 May 26, 2000 http://www.ualberta.ca/~publicas/folio/37/19/front.html

95 Jerome Groopman, Annals of Medicine, “The Edmonton Protocol,” The New Yorker, February 10, 2003: 48.

96 William G. Pearce to MSI Foundation 26 June 2005. Pearce and his colleague, N.T. Bech-Hansen, received a grant in 1988 for the project “X-linked Congenital Stationary Night Blindness with Myopia.” Nineteen papers flowed from the initial seed grant.

97 V. James Raso to MSI Foundation, Response to Survey, 2005.

98 Diane Taylor to MSI Foundation, Response to Survey, 2005.

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