Evidence of meeting #40 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was disease.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

  • Bin Hu  Professor, Department of Clinical Neurosciences, University of Calgary, As an Individual
  • David Simmonds  As an Individual
  • Joyce Gordon  President and Chief Executive Officer, Parkinson Society Canada
  • Edward Fon  Director, McGill Parkinson Program and National Parkinson Foundation Center of Excellence, Montreal Neurological Institute, McGill University; Parkinson Society Canada
  • Daniel Krewski  Professor and Director, R. Samuel McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa

10:20 a.m.

Director, McGill Parkinson Program and National Parkinson Foundation Center of Excellence, Montreal Neurological Institute, McGill University; Parkinson Society Canada

Dr. Edward Fon

That division between basic research and applied research in clinical settings is very artificial, and I believe that both types of research go hand in hand. This is something we do quite well in Canada, and so I do not think that there is a real conflict or debate.

Certain physicians are more interested in doing clinical or applied research, but my personal conviction is that ultimately, especially given the explosion of these neurodegenerative diseases, if we really want to see the end of these problems, the answers will come from basic research. That said, I would not agree that we have to devote all of the resources to it. Dr. Hu's case is a perfect example: by carrying out very fundamental research, he comes up with some very practical results. And there are many other such examples. Often—

10:20 a.m.

Conservative

The Chair Joy Smith

Thank you, Dr. Fon, and thank you, Madame Papillon.

We'll now go to Mr. Gill.

10:20 a.m.

Conservative

Parm Gill Brampton—Springdale, ON

Thank you, Madam Chair.

I'd also like to thank the witnesses for being here with us today on this very important topic. I want to thank you for your wonderful presentations.

I'm actually very interested in the study Dr. Hu has been conducting on music and how it's going to help patients. Would you be able to share with us what you've discovered from this study so far?

10:20 a.m.

Professor, Department of Clinical Neurosciences, University of Calgary, As an Individual

Dr. Bin Hu

This study is not built on just my own research. It is built on very broad research.

You have exercise. You're walking. You have music. And you have Parkinson's pathology. It turns out that Canadians are leaders in this field. The music aspect of the study I gained from the Montreal Neurological Institute. Dr. Zatorre's group has shown that music, especially with vocals, actually stimulates the motor pathways, because when you hear a singer sing a song, you visualize, not even consciously, the person's face and facial movements. I think this is the aspect of music we have found most effective. When the patient walks with these highly salient vocal songs, the person's motor circuitries are activated. There's a synergy between auditory stimulation and walking. They converge on these neural networks, causing long-term plasticity change.

What we have found out so far is that patients start forming a habit. Some patients have told me that if they don't walk, they feel that they've missed something. It's very fundamental. With Parkinson's there is this problem of forming new motor habits.

Second, Parkinson's disease is characterized by very specific deficits. People have the will to do something, but they can't transform that will into action. Dopamine is considered something like a lubricant. It helps you very smoothly make that transformation. After this walking, the patients tell that they can automatically increase their stride length, while they couldn't do it before.

Last, and I think most important, is what we heard from the other witnesses about non-motor symptoms, such as fear of falling, anxiety, and depression. These are the most important benefits patients will gain from this aspect. I gave you the example of the person who was afraid to step on the escalator. This patient is essentially symptom-free, so she doesn't need music any more. For twenty years she couldn't get on the escalator.

10:25 a.m.

Conservative

Parm Gill Brampton—Springdale, ON

At what stage is the launch of a larger trial of 700 people?

10:25 a.m.

Professor, Department of Clinical Neurosciences, University of Calgary, As an Individual

Dr. Bin Hu

How did you get that number, 700? You're quite close. Statistically, we need 800 patients. We're proposing a study that starts with 200. Alberta has a new program called the collaborative research program. They are very interested in funding this type of research. My plan is to have a pan-Canadian network of trials with 2,000 patients in the next four years. I already have a link with people in Edmonton and Vancouver. So yes, we're going to do larger trials.

10:25 a.m.

Conservative

Parm Gill Brampton—Springdale, ON

How does the music compare with the use of medication when it comes to increasing mobility among people with Parkinson's?

10:25 a.m.

Professor, Department of Clinical Neurosciences, University of Calgary, As an Individual

Dr. Bin Hu

It won't replace medication. Medication is always the front line. But the medications lose their effectiveness after ten years. There's a honeymoon. The main problem is loss of mobility and then avoiding activities. There is general physical deconditioning. So mental health and depression is very high. It's 40%. These patients will not move. They can't move, and they get into a vicious cycle. Their condition gets worse and worse. The medications will not cure that aspect of the disease.

This therapy will probably help patients delay that process. Second, if you look at the brain network activated when you're walking and listening to music, the activation in terms of the spatial and the intensity is probably five times greater than it is with medications. The brain receives a very strong stimulus.

10:25 a.m.

Conservative

Parm Gill Brampton—Springdale, ON

How much time do I have, Madam Chair?

10:25 a.m.

Conservative

The Chair Joy Smith

Your time is up. Thank you, Mr. Gill. Those were really good questions.

Now we'll go to Mr. Lizon.

April 26th, 2012 / 10:25 a.m.

Conservative

Wladyslaw Lizon Mississauga East—Cooksville, ON

Thank you very much, Madam Chair.

Good morning, and thank you, witnesses, for coming here this morning.

I have a few questions that will follow up on the questions that were asked.

My first question is for Dr. Krewski. In the study you are conducting currently, you're doing several other diseases, not only Parkinson's. You and Dr. Hu stated that there are several causes of neurological disorders: pesticides, food, etc. Is there a geographical aspect of those diseases or of Parkinson's in particular? As far as I know, and I might be incorrect, there are places, for example, where people do not get MS. Is this the case with Parkinson's or other diseases that are part of your study? If that's the case, do we have any idea why it is so?

10:25 a.m.

Professor and Director, R. Samuel McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa

Prof. Daniel Krewski

A second study is being done. This is one of the 18 studies under the PHAC initiative, which is looking at incidence and prevalence by geographic location. We're not involved in that. It's being led, I think, by the University of Calgary. That will directly answer your question if there are hot spots or areas where we don't see the disease occurring, and then we can ask what is unique about those areas that may contribute to those differences.

10:25 a.m.

Conservative

Wladyslaw Lizon Mississauga East—Cooksville, ON

In the general public, generally we all consume the same things. We are exposed to pesticides, fertilizers, because they all go into the food chain. Why does a particular group develop the disease in their lifespan and the larger group doesn't? Is there an explanation for that? What triggers the disease?

I would assume, not knowing enough about medical science, as I'm not a medical professional, that we can all develop Parkinson's or other diseases, but maybe we don't live long enough and therefore we don't get it in our lifespan.

Can anybody respond to that?

10:30 a.m.

Director, McGill Parkinson Program and National Parkinson Foundation Center of Excellence, Montreal Neurological Institute, McGill University; Parkinson Society Canada

Dr. Edward Fon

Maybe I can have a crack at that one. That's a fantastic question. That's a question that's at the centre of a lot of the research that's going on.

Clearly, as you've heard today, there are almost certainly environmental factors, maybe pesticides, maybe other factors, and hopefully we'll have some answers about those, but you're absolutely right: people living in the same house who are doing the same work, one gets Parkinson's and the next person doesn't. It's almost certainly a combination of the environment and genetic susceptibility. These are the two big factors that come into play about exactly who develops Parkinson's.

You may have someone who has a certain combination of genes whereby no matter how much pesticide he may see in his lifetime, he would never develop Parkinson's, whereas someone else may be extremely susceptible, even though they are very mildly exposed to it.

This also plays into the question of personalized medicine. Probably certain genetic and environmental factors will make people more responsive to certain treatments. Now we treat almost everyone with Parkinson's in a similar way, whereas we think that in the future, with personalized medicine, which is a field that's just in its infancy, if we can say a person is much more likely to respond to one medication than another, or someone might be more responsive to music than to tai chi.... There is another study showing that patients with Parkinson's who do tai chi have fewer falls when they practise tai chi. This is the kind of thing where we'll see a big shift in the future.

10:30 a.m.

Professor and Director, R. Samuel McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa

Prof. Daniel Krewski

Could I answer the question in a similar way but with a different perspective? All day long I work in a research centre that focuses on what determines the health of populations. In most cases it's a combination of a number of factors, so we have to look at biological factors such as the status of your immune system, genetic susceptibility, the environment within which you live, your occupation, social behaviour, what access you have to health services. Lifestyles serve as factors. All these factors typically interact to determine whether you might demonstrate an adverse health outcome, and trying to disentangle them and understand those interactions is my job, not just for Parkinson's but for a whole host of diseases.

That's the general answer, I think, to why we don't see the same thing everywhere. It's because of these complex interactions among a wide range of health determinants.

Did we say the same thing, Ted?