Evidence of meeting #31 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was research.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

  • Kim Elmslie  Director General, Centre for Chronic Disease Prevention and Control, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada
  • Alain Beaudet  President, Canadian Institutes of Health Research
  • Inez Jabalpurwala  President and CEO, Brain Canada Foundation
  • David Kaplan  Vice-Chair, Science, Brain Canada Foundation
  • Vanessa Foran  Director, Policy, Partnerships and Government Relations, Neurological Health Charities Canada
  • Celina Rayonne-Chavannes  Director, Research Initiatives, Neurological Health Charities Canada

9:05 a.m.

President, Canadian Institutes of Health Research

Dr. Alain Beaudet

I'm sure they will be happy to provide you with an answer when they meet with you.

What I can tell you, however, is that we have been very sensitive and sensitized to this very important project for many years. You are absolutely right that the nature of these diseases is such that very often the pharmas are not all that interested in engaging in research because the potential markets are extremely small. It's really for us to support research in this area, which we have done. We've done it at the level of understanding what diseases are, so that we can target proper therapeutics for them. In particular, we've had a very successful collaborative initiative on rare diseases with Genome Canada, which has led, I must say, to the discovery of several new genes for rare disorders. I think there is quite a bit of hope there for patients with these disorders.

We've also been involved with the provinces in a major clinical trial for enzyme replacement therapy in Fabry disease. We are clearly aware of the problem, and we've been ramping up our research efforts in that area. We are not involved in regulating, as I'm sure you understand.

I apologize for answering your question in English. I should have answered in French, but you seem to have understood what I said.

9:10 a.m.

NDP

Anne Minh-Thu Quach Beauharnois—Salaberry, QC

Yes, it's okay. Our interpreters are excellent.

Mr. Beaudet, you also talked about personalized medicine, and about therapies and treatments. Could you give us more details about that and tell us which area is the most developed?

9:10 a.m.

President, Canadian Institutes of Health Research

Dr. Alain Beaudet

There is no doubt that personalized medicine is a major hope for all countries. Progress has been made in research in the U. S. and in Europe. Asia is also beginning to see some advancement. I think that Canada was lagging a bit behind in this area. That is why a major strategy on personalized medicine was launched a few weeks ago and was announced jointly by ministers Aglukkaq and Goodyear.

Personalized medicine could completely change the way diagnoses are made. I hope we will one day be able to use it to treat patients. Currently, a large number of patients being treated with medication are not responding to it. In many cases, that is due to the fact that the patients simply do not have the genetic elements that encode the targets the medication has an effect on. Therefore, medication is usually given to much more people than would be likely to respond to it.

The advantage of personalized medicine is that it will enable us to stratify patients and thereby focus specifically on the people whose genetic makeup predisposes them to respond to that medication. That will help us target treatments much better. As you know, that method is already being used to treat cancer in cases where it must be determined whether certain types of cancer cells will respond to a specific chemotherapy treatment, for instance. If it is known that, in terms of genetics, cells can respond to a chemotherapy treatment, we can subject patients to chemotherapy—which, as you know, is no trivial matter—and ensure they respond to it. On the other hand, that same treatment will not be administered to patients whose cancer cells do not have the required receptors for the medication and who, consequently, would not respond to it at all. So it is really a matter of specifying who is at risk, what the signature of the disease is and how we can ensure that the therapy is actually in line with a given treatment.

Personalized medicine is also very useful in the drug industry. Once randomized treatment trials are carried out, we will be able to ensure that we target specifically those groups of people that can respond to the treatments being tested. We hope that this will enable us to conduct randomized treatment trials on fewer patients and that we will not have to submit patients to treatments they are unlikely to respond to. In the case of neurological diseases, it is often not a matter of specific diseases, but syndromes that, presumably, cover various genetic identities. Therefore, we would be able to administer treatments that are more appropriate for stratified patients we refer to as responders.

9:10 a.m.

Conservative

The Chair Joy Smith

Thank you so much.

Thank you, Ms. Quach.

We'll now go to Dr. Carrie.

March 1st, 2012 / 9:10 a.m.

Conservative

Colin Carrie Oshawa, ON

Thank you very much, Madame Chair.

I want to thank the witnesses for being here again to update us on this very important study.

I did want to touch base with you, Dr. Beaudet. Could you give the committee a rundown of the progress made in the last year on CCSVI? I know you mentioned that it was just a couple of years ago, in 2009, that Dr. Zamboni hypothesized that this was a cause for MS.

I know there are many organizations around the world, including the Canadian Medical Association, that still consider it a recently proposed condition. Are there any definitive tests out there that doctors could use to diagnose CCSVI?

9:10 a.m.

President, Canadian Institutes of Health Research

Dr. Alain Beaudet

That's an excellent question, Dr. Carrie. As you know, one of the numerous difficulties, to start with, has been in establishing protocols of research to even demonstrate whether or not there was a higher prevalence of an association of CCSVI with patients with MS than with patients without MS. As you know, when you look at the literature on the subject, there's a huge variation and it is widely believed that the reason for that is the difficulty of diagnosing the CCSVI condition.

It is an ultrasound diagnosis, to start with, and several of the seven studies that the MS Society is currently supporting are actually comparing various diagnostic methods. What's interesting is that they all compare the various methods—for instance, intravenous angiography or NMR spectroscopy—with the Zamboni standard, which is ultrasound. So the idea is whether or not we see the same thing as with an ultrasound, and in some cases, an ultrasound performed using exactly the same machine as Zamboni used. There are some groups in Canada that actually went to the trouble of purchasing the same machine as Zamboni's and sending their technicians in the trial to Zamboni's lab, so that they would really learn to do it exactly as he did, and then they compared this with a variety of other approaches of looking at venous pathology, which are the current imaging approaches to look at venous pathology.

As you will see if you go on our website and look at the protocol for the therapeutic trial that we launched several months ago now, we've been extraordinarily specific—actually, I would say more specific than CIHR usually is in its call for proposals—in how to establish a proper diagnostic procedure, and preferably several diagnostic procedures, to make sure that we wouldn't start putting balloons in the veins of patients where the existence of CCSVI could be questionable. But if you read the recent review articles on this topic, you will see that this question of the difficulty of diagnosis is a recurrent one.

9:15 a.m.

Conservative

Colin Carrie Oshawa, ON

I do see it as a difficult diagnosis, and that's why I was wondering. I want to thank you for that update because it seems to me there's been some questioning around whether it exists and whether people without MS can have CCSVI, and I'm glad that you were able to—

9:15 a.m.

President, Canadian Institutes of Health Research

Dr. Alain Beaudet

It has been one of the problems, actually, because some of the people who really don't believe in the association of CCSVI have put forth exactly this observation: Why is it that so many patients have the same abnormalities in their vein system and don't show the MS symptoms?

We could discuss at length the various reasons for that. Let's just say that right now there's enough evidence, as you know, for the possibility of an association, or an increased prevalence, for the working group to recommend to us that we go with a trial. And if we're moving on a trial, it's because we believe there are scientific reasons for it. Otherwise we'd know there would be no chance for the ethics review boards to approve such a trial. So if we launched it, it's because we feel at this point there are enough question marks of importance to really further investigate this.

9:15 a.m.

Conservative

Colin Carrie Oshawa, ON

I do want to commend CIHR for helping to coordinate this research, because so many people are counting on it.

You brought up trials. We recently heard that the Italian MS society's scientific community was mandated to review Dr. Zamboni's clinical trial, but did not approve his large-scale clinical trial. Why was that decision made, do you know?

9:15 a.m.

President, Canadian Institutes of Health Research

Dr. Alain Beaudet

Very simply, they recommended to Zamboni that he should do things the way they're normally done—that is, go first to a phase one and two trial before moving to a large number of patients, as we always do with clinical trials. It's the normal prudent process. You first demonstrate that it is safe, you demonstrate therapeutic efficacy on a small number of patients, and then if there are no problems and if things are positive, you ramp it up to a large number of patients.

Basically, what the committee of the Italian MS society told Dr. Zamboni is, well, to do as Canada does. They didn't really say that, but they recommended that he take an approach that is exactly the same as the one we've chosen to take.

9:15 a.m.

Conservative

Colin Carrie Oshawa, ON

Is there anywhere in the world, that you know of, that has attempted to legislate the research process? I was wondering what you thought of that as a precedent. What would it do to researchers?

9:15 a.m.

President, Canadian Institutes of Health Research

Dr. Alain Beaudet

I am not aware of any precedent. Irrespective of MS now—and I think I've been very clear on this topic, publicly—I think it would be a dangerous precedent to legislate the type and the object of research that we carry out and that the federal government would be supporting in this country. The federal government—I'm sure you're aware, after a number of very serious issues that arose with the use of some drugs like thalidomide and laetrile, where there were major complications, when trials were not as tightly regulated as they are now—set up some very stringent regulatory mechanisms to ensure that trials carried out on patients are scientifically based and ethically approved.

They have set up principles to do that. That have set up organizations such as ours to do that. I would think it would not be a good idea to bypass the process you've already set up to protect the safety of the population and to start legislating on very specific objects of research. I understand very well, on humane grounds, how tempting this may be.

9:20 a.m.

Conservative

The Chair Joy Smith

Dr. Beaudet, I'm just going to say we're over time now. We need to go on. Thank you so much.

Dr. Duncan, go ahead.

9:20 a.m.

Liberal

Kirsty Duncan Etobicoke North, ON

I have seven minutes?

9:20 a.m.

Conservative

The Chair Joy Smith

You have seven minutes. Welcome to the health committee.