Nobody Wants to Go First: Why Canada Keeps Waiting For Someone Else To Believe In Its Best Ideas, And What It Would Take To Change

Last week, Anne Carson won the Nobel Prize in Literature. It was a proud Canadian moment. It was also a familiar one. Much of Carson's early recognition came from outside Canada: a MacArthur Fellowship in the United States in 2000, and the T.S. Eliot Prize in the UK in 2001, where she was the first woman to win it. Her first Governor General's Award came in 2020. As a CBC headline put it, everyone loves Anne Carson, "even if it took some time for Canada to get her."

Fifty years earlier, a young rock band from Toronto couldn't find a Canadian record label willing to sign them. Rush released their first album on their own label. It took Donna Halper, a radio music director in Cleveland, playing "Working Man" on the air for the band to land a deal with Mercury Records in the US. This year, more than half a century later, they're back on tour, adding shows to keep up with demand.

The fans were here first. The talent was here first. What was missing was someone at scale willing to believe before anyone else did.

Australian critic A.A. Phillips had a name for this in 1950: 𝘁𝗵𝗲 𝗰𝘂𝗹𝘁𝘂𝗿𝗮𝗹 𝗰𝗿𝗶𝗻𝗴𝗲, the habit of assuming our own work isn't quite real until someone elsewhere says it is. I'd add a second name for what it does to an economy. 𝗡𝗼𝗯𝗼𝗱𝘆 𝘄𝗮𝗻𝘁𝘀 𝘁𝗼 𝗴𝗼 𝗳𝗶𝗿𝘀𝘁.

𝗧𝗵𝗲 𝘀𝗮𝗺𝗲 𝘀𝘁𝗼𝗿𝘆, 𝘁𝗼𝗹𝗱 𝗶𝗻 𝘀𝗰𝗶𝗲𝗻𝗰𝗲 𝗮𝗻𝗱 𝗰𝗮𝗽𝗶𝘁𝗮𝗹

It would be easy to dismiss this as a story about arts and entertainment. It isn't.

✅ 𝗗𝗲𝗲𝗽 𝗹𝗲𝗮𝗿𝗻𝗶𝗻𝗴. In the years when neural networks were out of fashion, Canada did something brave. CIFAR backed Geoffrey Hinton and a small group of researchers, and from 2004 to 2013 Hinton directed CIFAR's Neural Computation and Adaptive Perception program. Canada went first on the science. Then, in 2013, Google acquired DNNresearch, the University of Toronto startup Hinton had formed with his students Alex Krizhevsky and Ilya Sutskever. Sutskever went on to co-found OpenAI. We went first on the research and waited on the business.

✅ 𝗦𝘁𝘂𝗺𝗯𝗹𝗲𝗨𝗽𝗼𝗻. Garrett Camp started StumbleUpon in 2001 while he was a graduate student at the University of Calgary. It took an American investor, Brad O'Neill, to help move the company to San Francisco in 2006 and introduce it to angels like Ron Conway and Mitch Kapor. A year later, eBay bought it for more than US$75 million. Camp stayed in San Francisco and went on to co-found Uber.

✅ 𝗙𝗹𝗶𝗰𝗸𝗿. Stewart Butterfield and Caterina Fake launched Flickr in Vancouver in 2004. Thirteen months later, Yahoo bought it for a reported US$22 to 25 million, and the servers and the founders moved south. Butterfield's next company also started in Vancouver, as a game studio called Tiny Speck. The game failed, but the internal tool the team built became Slack, headquartered in San Francisco.

In each case, the idea started in Canada. The money that turned it into a company came from somewhere else.

𝗙𝗼𝘂𝗿 𝗽𝗹𝗮𝗰𝗲𝘀 𝗖𝗮𝗻𝗮𝗱𝗮 𝘄𝗮𝗶𝘁𝘀 𝗶𝗻 𝗹𝗶𝗳𝗲 𝘀𝗰𝗶𝗲𝗻𝗰𝗲𝘀

In life sciences, the reflex shows up at every step:

✅ 𝗥𝗲𝗴𝘂𝗹𝗮𝘁𝗼𝗿𝘆 𝗳𝗶𝗹𝗶𝗻𝗴. Fewer than 5% of new drugs are submitted to Health Canada before the FDA. Nigel Rawson's new analysis in Canadian Health Policy finds that drugs not submitted here within two years of their US submission rose from 29.5% (2011 to 2015) to 49.7% (2020 to mid-2024). For cancer drugs, it rose from 19.1% to 51.9%. Health Canada's own review time is now close to the FDA's. Companies simply wait to ask.

✅ 𝗥𝗲𝗶𝗺𝗯𝘂𝗿𝘀𝗲𝗺𝗲𝗻𝘁. After approval, a medicine still passes through health technology assessment, national price negotiation and a separate listing decision by each province. On average, that takes 566 days (Alberta) to 816 days (PEI) from approval to provincial listing. In July, Health Canada approved Novartis's Vanrafia for IgA nephropathy, a kidney disease. About five weeks later, the company said it would not seek public reimbursement, because "the likelihood of securing reimbursement for Vanrafia is limited under the current Canadian access environment."

✅ 𝗛𝗼𝘀𝗽𝗶𝘁𝗮𝗹 𝗽𝗿𝗼𝗰𝘂𝗿𝗲𝗺𝗲𝗻𝘁. In my experience, the first question a Canadian hospital asks a homegrown medtech or digital health company is "who else is using it?" The answer that opens doors is almost always an American health system.

✅ 𝗖𝗮𝗽𝗶𝘁𝗮𝗹. All-Canadian investor groups put up more than 70% of the money in rounds under $5 million, but only 12.7% in rounds above $50 million, according to analysis by Peter Singer. We back our ideas when they're cheap and wait for permission when they matter.

𝗪𝗵𝘆 𝘄𝗮𝗶𝘁𝗶𝗻𝗴 𝗶𝘀 𝘁𝗵𝗲 𝗿𝗮𝘁𝗶𝗼𝗻𝗮𝗹 𝗰𝗵𝗼𝗶𝗰𝗲

Here's the uncomfortable part. Nobody in this system is behaving irrationally.

Canada's Drug Agency is asked to make sure we pay a fair price for value. The pan-Canadian Pharmaceutical Alliance is asked to negotiate the lowest possible price, and it estimates it saved public drug plans $4.87 billion in 2025-26. Provinces are asked to stay on budget. Hospital procurement officers are asked to avoid mistakes. Pension funds are asked to protect retirement savings. Each one is measured on its own step, and each one can defend its own decision.

But no one is measured on the total time it takes a patient to get a medicine. No one is measured on the drugs that never come to Canada at all. No one is accountable for whether a Canadian company finds its first customer at home. When the only risk anyone is measured on is the risk of being wrong, waiting becomes the safe choice. Every individual decision is prudent. Together, they hand the risk, and the reward, to whoever was willing to believe first.

That's diffusion of responsibility, and it's built into the design.

𝗪𝗵𝗮𝘁 𝘄𝗮𝗶𝘁𝗶𝗻𝗴 𝗰𝗼𝘀𝘁𝘀

✅ 𝗣𝗮𝘁𝗶𝗲𝗻𝘁𝘀 𝘄𝗮𝗶𝘁. Canadians get access to new medicines later, if at all.

✅ 𝗖𝗼𝗺𝗽𝗮𝗻𝗶𝗲𝘀 𝗹𝗲𝗮𝘃𝗲. In the Council of Canadian Innovators' study of 30 Canadian companies sold to foreign buyers, leadership and strategic control left Canada in 28 of them.

✅ 𝗪𝗲 𝗽𝗮𝘆 𝘁𝘄𝗶𝗰𝗲. Once to train the talent and fund the research, and once to buy back what it builds. Trillium Therapeutics grew from a single employee into a NASDAQ-listed clinical company before Pfizer acquired it in 2021. Allelix trained a generation of Canadian biotech leaders before it was sold.

Peter Singer put it in one line: "Canadians fund the risk; others own the outcome."

𝗛𝗼𝘄 𝘁𝗼 𝗯𝘂𝗶𝗹𝗱 𝗮 𝗰𝗼𝘂𝗻𝘁𝗿𝘆 𝘁𝗵𝗮𝘁 𝗴𝗼𝗲𝘀 𝗳𝗶𝗿𝘀𝘁

This isn't a culture problem we can lecture our way out of. It's a design problem. If waiting is rational, we need to make going first rational too. Four changes would do it.

𝟭. 𝗚𝗶𝘃𝗲 𝘀𝗼𝗺𝗲𝗼𝗻𝗲 𝗼𝘄𝗻𝗲𝗿𝘀𝗵𝗶𝗽 𝗼𝗳 𝘁𝗵𝗲 𝗰𝗹𝗼𝗰𝗸.

Every step in the path to patients should have a deadline with consequences, and someone should own the total time. Nigel Rawson proposes that provinces list a drug within three months of a positive assessment and a successful negotiation, and that review fees be refunded when targets are missed. Those are small changes that make delay visible and costly instead of free.

𝟮. 𝗠𝗮𝗸𝗲 𝗽𝗿𝗼𝘃𝗶𝗻𝗰𝗲𝘀 𝘁𝗵𝗲 𝗳𝗶𝗿𝘀𝘁 𝗰𝘂𝘀𝘁𝗼𝗺𝗲𝗿, 𝗮𝗻𝗱 𝗮𝗯𝘀𝗼𝗿𝗯 𝘁𝗵𝗲𝗶𝗿 𝗿𝗶𝘀𝗸.

Peter Singer has proposed a Canadian ARPA-H in which provinces name health challenges and become the first customer for what solves them. It's the right idea, with one addition. A hospital that buys an unproven Canadian product carries the downside alone if it underperforms. A first customer who can't afford to be wrong will still buy the safe option. Going first needs a risk-sharing mechanism behind it, so the buyer isn't the only one exposed.

𝟯. 𝗕𝗼𝗼𝗸 𝘁𝗵𝗲 𝗿𝗲𝘁𝘂𝗿𝗻.

Today, finance ministries record what an innovation costs, not what it saves. Treatments that keep people out of hospital, back at work and paying taxes never show up on the ledger of the person who has to say yes. Count the return, report it, and the case for going first starts to make itself.

𝟰. 𝗟𝗲𝘁 𝗰𝗮𝗽𝗶𝘁𝗮𝗹 𝗶𝗻 𝘄𝗶𝘁𝗵𝗼𝘂𝘁 𝗹𝗲𝘁𝘁𝗶𝗻𝗴 𝗰𝗼𝗻𝘁𝗿𝗼𝗹 𝗼𝘂𝘁.

Canadian companies should sell to global customers and welcome global investors. But Canadian capital needs a seat at the table in the large rounds where the decision about where to scale gets made, and Canada needs anchor companies strong enough to be the buyer rather than the bought. Control and capital are separate questions. We can welcome one without giving away the other.

𝗧𝗵𝗲 𝗾𝘂𝗲𝘀𝘁𝗶𝗼𝗻 𝗳𝗼𝗿 𝗲𝘃𝗲𝗿𝘆 𝗶𝗻𝘀𝘁𝗶𝘁𝘂𝘁𝗶𝗼𝗻

Carson didn't need Canada's approval to become one of the world's great writers. Rush didn't need a Canadian label to become one of the world's great bands. They succeeded anyway. The cost of our hesitation wasn't their careers. It was everything that grew up around their success somewhere else.

The same is true in life sciences, except the stakes are higher. When a Canadian medicine, company or idea has to leave to be believed, it usually doesn't come back, and Canadians end up paying full price to buy back what we helped create.

So here's the question I'd put to every gatekeeper, investor and policymaker reading this: what would it take for your organization to go first?

𝗔 𝗰𝗼𝘂𝗻𝘁𝗿𝘆 𝘁𝗵𝗮𝘁 𝘄𝗮𝗶𝘁𝘀 𝘁𝗼 𝗯𝗲 𝘁𝗼𝗹𝗱 𝘄𝗵𝗮𝘁 𝗶𝘁 𝗵𝗮𝘀 𝘄𝗶𝗹𝗹 𝗮𝗹𝘄𝗮𝘆𝘀 𝗽𝗮𝘆 𝗳𝘂𝗹𝗹 𝗽𝗿𝗶𝗰𝗲 𝘁𝗼 𝗯𝘂𝘆 𝗶𝘁 𝗯𝗮𝗰𝗸.

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𝗦𝗼𝘂𝗿𝗰𝗲𝘀

1. NobelPrize.org, The Nobel Prize in Literature 2026: https://www.nobelprize.org/prizes/literature/2026/

2. CBC News, "Everyone loves Anne Carson — even if it took some time for Canada to get her" (October 2026): https://www.cbc.ca/news/canada/anne-carson-canadian-literature-nobel-prize-9.7374614

3. Anne Carson, biography and awards: https://en.wikipedia.org/wiki/Anne_Carson

4. Rush (1974 debut album) history: https://en.wikipedia.org/wiki/Rush_(Rush_album)

5. CTV News, "For woman who discovered Rush, induction marks end of long 'injustice'" (December 2012), transcript: https://www.2112.net/powerwindows/transcripts/20121212ctv.htm

6. Castanet / Canadian Press, "Rush announce reunion tour five years after the death of drummer Neil Peart": https://www.castanetkamloops.net/news/Entertainment/576519/Rush-announce-reunion-tour-five-years-after-the-death-of-drummer-Neil-Peart

7. A.A. Phillips, "The Cultural Cringe," Meanjin (1950)

8. CIFAR, Geoffrey Hinton biography (Neural Computation and Adaptive Perception, 2004–2013): https://cifar.ca/bios/geoffrey-hinton/

9. University of Toronto News, "Google acquires U of T neural networks company" (March 12, 2013): https://www.utoronto.ca/news/google-acquires-u-t-neural-networks-company

10. The Globe and Mail, "Element AI sold for $230-million as founders saw value wiped out": https://www.theglobeandmail.com/business/article-element-ai-sold-for-230-million-as-founders-saw-value-wiped-out

11. Shopify, "Shopify announces $7 million Series A funding" (December 13, 2010): https://www.shopify.com/news/shopify-announces-7-million-series-a-funding

12. Till, J.E. and McCulloch, E.A., "A direct measurement of the radiation sensitivity of normal mouse bone marrow cells," Radiation Research (1961)

13. Rawson, N.S.B., "Canadians' access to innovative medicines is already limited: Trump's trade war will make it worse," Canadian Health Policy (October 2026): https://canadianhealthpolicy.com/canadians-access-to-innovative-medicines-is-already-limited-trumps-trade-war-will-make-it-worse/

14. Benefits and Pensions Monitor, "Drugmaker pulls approved kidney treatment from Canadian reimbursement path" (August 2026): https://www.benefitsandpensionsmonitor.com/benefits/pharma/drugmaker-pulls-approved-kidney-treatment-from-canadian-reimbursement-path/394020

15. Peter Singer, "A Canadian ARPA-H would pay three times," Global Health Insights (October 2026): https://singerp.substack.com

16. Peter Singer, "Canada's life sciences strategy doesn't estimate a return. So I did.," Global Health Insights (September 2026): https://singerp.substack.com

17. pan-Canadian Pharmaceutical Alliance, negotiation savings estimate for 2025–26, as reported in "Payers demand more proof of value"

18. Council of Canadian Innovators, The Scale-Up Gap: From Value Creation to Value Retention (August 2026). Coverage: https://betakit.com/canadian-tech-firms-are-selling-to-foreign-buyers-when-its-time-to-scale-cci-says/

19. Pfizer, acquisition of Trillium Therapeutics (announced August 2021)

20. Government of Canada, Pharmaceutical and Life Sciences Sector Task Force: Report to the Ministers of Health and Industry (2026)