Simon’s Letter

I joined INITIO for one overarching reason: it is the logical extension of a 48-year career in science and medical practice significantly impacted by a fundamental change in how we think about disease and how we approach it.

Let me be clear: my decision had nothing to do with a desire to practice private medicine or enter into conflict with the public health care system. It was, and is, rooted in the fact that the future of medicine needs the technologies of PET/MRI and PET/CT, and their extension into targeted molecular therapies (theranostics). We know what they can deliver now, and we know that they will deliver much more in the future. So, for me, it is paramount that we bring medicine to where it can be sooner, ensure that knowledge brings real choices about care to every individual, and advance the control of cancer and other diseases.

In the early stages of my career as a cancer specialist, my initial focus was solely on the individual whom I was treating, leaving little room for an understanding of, or responsibility for, the broader population. Since then, I have led departments, cancer hospitals, and a provincial cancer agency, and worked with foreign institutions, agencies, and governments. In this time, I have developed new perspectives regarding cancer control, individual and population health, and professional and societal responsibility.

What has become apparent to me is that, while the biological potential and activity of cancer cells defines a cancer, the cancer resides in the much more complex environment of an organ; the organ resides in the much more complex environment of a person’s body; the person lives within a society and a culture that conditions how the person thinks, behaves, and acts; and this “complex whole” determines our states of health, illness, and well-being. I now appreciate the value and importance of the bigger system picture, with the understanding that this big picture is necessary if all of the smaller pictures are to fit together and function properly.

A major turning point in my understanding of the importance of medical technology, including PET/CT and theranostics, came in the mid- to late 1990s when genomics emerged, and it became clear that it would change the understanding and the practice of medicine. Genomics has established that the practice of medicine can be an objective science, based in quantitative measurements pertaining directly to the disease and practiced in a precise, personalized, and predictive manner in order to reduce the burden of disease at individual and population levels. Accordingly, we can provide optimal care with a precision driven by molecular interpretation of disease, biology, and response.

Whilst in England, I was involved in the early evaluation of Computed Tomography (three-dimensional anatomic imaging) in the assessment and management of cancer patients. In the mid-80s to 90s in Toronto, my interest continued to grow via clinical studies with magnetic resonance imaging (MRI) for cancer. In 1996, in Vancouver, I became aware of PET, a scientific field just starting to explore clinical applications in oncology practice, but there was no clinical PET capability in Canada. Despite clinical progress in the U.S., U.K., and Europe, the first conversations about PET in B.C. began in 1998. Despite not being on many people’s radar at that time, it was apparent that PET was a means to focus not on the descriptive, anatomic properties of a tumour, but rather on the functional properties identified in the “space occupied”, in other words, the biology or biological processes going on in the abnormal space. The first PET scanner was introduced to B.C. in 1999 at IPET, the forerunner of Premier Diagnostics Center (now INITIO). Subsequently, through the gathering of evidence regarding applicability and efficacy, substantial funding from non-government sources, the resolve to challenge the status quo, and the hard work of many individuals, as President and CEO of the BC Cancer Agency (2000-2009) I brought a public PET scanner to the Agency in 2005. This was not an easy process, largely because it was viewed as “research” and a costly medical technology that was not yet well established. In fact, the evolution toward clinical acceptance of PET took several years, requiring a culture shift to embrace clinically applied technology research, demonstrate clinical impact, and bring functional (PET) and spatial imaging (CT) together in a single unit. Notwithstanding the progress that has been made, limitations in the capacity of the system to deploy the technology appropriately remain apparent, particularly with access to commercially available clinical isotopes in Canada, and to the direction of the resources necessary for this new and evolving technology to transfer fully into clinical practice.

Which brings us to today. PET/CT is recognized as an important technology. The applications are becoming more clear, more extensive, and applicable to more diseases, yet challenges remain.

I continue to find myself asking questions such as: How do we know that individuals with health problems are coming to the attention of the technologies and the people that can help them? How can we create affordability and capacity so that the best available resources are applied to the benefit of those who have the clinical problem? And how can we continue to learn about and understand the value of emerging medical innovations, determining where they are useful, when to apply them, and for what conditions, including cancer?

Broadly speaking, in order to answer these questions, we need change rooted in experience: we need to understand the use of the technology and to establish its value within the context of our own health system. Through functional imaging and theranostics, INITIO can contribute to molecular medicine that leads from description to action, to the definition of location and extent of disease, to the response to treatment, and to the introduction of innovative therapies into clinical practice.

I have no illusions about the challenges of disease to both the individual and to society. Neither do I harbour any conceits that system change will be easy. However, I can say with confidence that the precedent for expanding our use of this technology exists, and the evidence of its power to improve health outcomes in terms of cancer and a host of other diseases is real and substantive.

So, let me again be clear. When I think about health, I believe that every individual should have the opportunity to understand their health choices based on valid and objective knowledge, and their treatment options should be accessible and available. INITIO is at the leading edge of providing this choice because we envision every person, in B.C., Canada, and abroad, having access to precise knowledge of their disease and to the best quality of treatment and care available, not only for their own wellbeing, but for the betterment of our society as a whole.

Yours respectfully,

Dr. Simon Sutcliffe