opinion: canada has what it takes to lead in the future of clinical trials
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clinical trials are the bridge between scientific innovation and real-world impact, helping canadians access-life changing drugs.
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canada has all the ingredients needed to be a global leader in clinical trials. in many areas, we already are. the next step is ensuring our systems are equipped to support the pace and promise of modern medicine.
from the isolation of insulin in toronto in 1921, which transformed diabetes from a fatal diagnosis into a manageable condition, to the development of cobalt‑60 radiotherapy in saskatchewan that redefined cancer treatment, canadian science has repeatedly led in discovery and altered the trajectory of human health.
but discovery alone is not enough. a breakthrough in the laboratory, no matter how innovative, does not improve a single patient’s life unless it is translated safely, rigorously and reliably into clinical (patient) care. clinical trials are the bridge between scientific innovation and real-world impact, helping determine whether new therapies, technologies and approaches improve outcomes for patients.
canadians have a long and rich history of leading high-impact, global clinical trials. over the past five years, canadian scientists led more than eight per cent of randomized trials published in the lancet and the new england journal of medicine, despite representing only 0.5 per cent of the world’s population. canada is already home to world-first clinical trials across areas such as focused ultrasound, cancer, critical care, trauma, heart, high-risk pregnancy and bone and joint care.
we are also uniquely positioned to attract and lead global clinical research thanks to a trusted health-care system, diverse patient populations, strong regulatory oversight and world-class clinical teams. canada’s competitiveness is not an issue of scientific capacity, clinician apathy or patient reluctance. it’s the friction within our clinical trial activation system.
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clinical trial activation time is a critical metric. every additional month required to launch a study is one less month patients may have access to promising new treatments. delays in activation result in increased costs to sponsors, reducing confidence in sites and potentially excluding canadian sites from global trials altogether.
to be clear: canada doesn’t have a regulatory speed problem. it has a coordination problem. the fundamental structural barrier is fragmentation across approvals. the current reality is a multi-layered approval process including health canada, research ethics boards (often duplicated across sites), multiple institutional contract negotiations (budget, legal, intellectual property) and hospital departmental approvals. these processes are often sequential rather than parallel, duplicated across sites and provinces and highly variable in timelines. the result is unpredictable start-up timelines and a high administrative burden for sponsors. we need a system that is nimble, integrated and efficient to bring more trials to patients, faster.
the good news is that solutions already exist. if we modernize regulatory processes at health canada (beyond its globally competitive review timelines), rethink the legal framework of how public institutions work together, streamline the interpretation of ethical and consent requirements, improve coordination across institutions and invest in the infrastructure needed to support research, canada can accelerate patient access to new therapies.
this matters because the future of medicine increasingly depends on clinical trials. the challenge is making sure our systems enable innovation and give us the flexibility to think outside the box in how we design, conduct and deliver trials. we are no longer looking for breakthroughs that move outcomes from zero to 100; rather, we are looking for advances that move us from 50 to 55. these gains may sound incremental, but for patients they can mean longer survival, fewer complications and a better quality of life. this often requires larger, more complex studies and more patients. the tools to bring this to life already exist. we can recruit patients remotely, leverage innovative statistical approaches and rethink how trials are delivered. what is needed now is the willingness to embrace these approaches.
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the advancements in clinical trials extend beyond patient care. clinical trials do more than test new drugs. they also help identify smarter ways to deliver care. a recent sunnybrook-led study found that reducing the duration of antibiotics in carefully selected patients produced similar outcomes to the standard of care while lowering costs, demonstrating how clinical research can strengthen both patient care and health system sustainability. a stronger clinical trial ecosystem also drives economic growth. conducting clinical research requires highly skilled professionals, from scientific designers and project managers to clinical research coordinators, analysts and statisticians, creating jobs, attracting talent and strengthening canada’s innovation economy.
investments in canada’s clinical research demonstrate a growing recognition of what is possible. the recent $41 million gift in sunnybrook clinical trials aimed to significantly accelerate the journey from discovery to patient impact could not have come at a more important time. this gift demonstrates that momentum already exists. while funding alone will not solve every challenge facing clinical trials, it represents a meaningful commitment to advancing research, strengthening innovation and ensuring promising therapies reach more canadians sooner.
the path forward is clear. if we can align our systems with the strength of our science, canada can help define the future of clinical trials. the science is here. the talent is here. the opportunity is here. now is the time to act.
dr. paul karanicolas is a surgical oncologist and scientist at sunnybrook’s odette cancer centre and co-chair of the president’s task force to accelerate clinical trials with sunnybrook health sciences.
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