Health Committee on March 5th, 2013

[Dr. Pierre Meulien]

In terms of private insurance, the discussion is still—

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

The same applies to employers as well.

While I still have some time, I'm going to ask you my next question.

You referred to illnesses where genomic advancements could help, type 2 diabetes, for example. Is offering people with type 2 diabetes some miracle pill to help their condition really the most effective and smartest approach to the problem? Shouldn't we instead be focusing on other types of prevention such as exercise, physical activity?

I can see the benefit more in the case of rare diseases. When it comes to type 2 diabetes, however, I get the sense that people will just take their genomic drug, thinking that it will keep their chronic illness in check, even if they eat what they shouldn't and don't exercise. I wonder whether that wouldn't send people the wrong message.

[Dr. Pierre Meulien]

Using genomic solutions to help with type 2 diabetes does not in any way mean taking a pill.

The use of genome data for complex diseases starts with prevention, for sure. So I think we're never going to.... If we concentrate on treating chronic disease with new medicines and not look after the preventive part, we're going to lose; it's not sustainable.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

You mentioned that knowing some of the genes linked to diabetes could help have more specific medication.

[Dr. Pierre Meulien]

No, it could help manage—

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

The overall condition.

[Dr. Pierre Meulien]

—I'm saying could help manage people on the whole spectrum.

The one thing I did mention in terms of specificity was in the case of epilepsy or cancer when you want to treat somebody but it's not one disease. Any cancer will have multiple types of.... Epilepsy and autism are the same. We need to understand each person as an individual with their molecular profile so if you had a treatment, you could be more specific for sure.

I think you're absolutely right. For a lot of these chronic diseases, I think we should be focusing on prevention and better lifestyle.

[The Chair, Conservative, Joy Smith]

Thank you so much, Dr. Meulien, and thank you, Dr. Morin.

We'll now go to Ms. Block.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Thank you very much, Madam Chair, and I want to join my colleagues in thanking you both for being here. It's been very enlightening and somewhat entertaining. I would have to admit I've really appreciated your very down-to-earth approach and your talking about the work you do.

I am familiar with Genome Canada more through Genome Prairie, definitely through the ongoing support you've received from our government. I come from Saskatchewan.

Dr. Meulien, tell me about your relationship with, I think you mentioned, six subsidiaries of Genome Canada, and talk about either how you work with them in terms of collaborating on or coordinating research projects and any relationships Genome Canada has with the private sector, private industry.

[Dr. Pierre Meulien]

It's not a subsidiary relationship. Genome Canada has a contractual relationship with six regional genome centres from B.C. to Atlantic. The relationship is such that their job contractually, if you like, is to raise money for co-funding because each program we run is a co-funded model. We put in sometimes a half, sometimes a third, and the regional genome centres are responsible for raising that other money, whether that's through their interaction with the province or the regions or other funders. That's one role.

The second role is a monitoring role because all our projects are large scale, milestone-driven, and it's up to the regional genome centres to monitor those projects very carefully to ensure each team is meeting its milestones. We have been known to cancel projects that have not performed.

The third one is because it's large-scale science, they need to organize the teams that are going to compete. It's a very competitive process. To give you an example, 146 pre-applications were looked at for the personalized health competition. Seventeen projects are funded. You can work out the competitive nature of that calculation.

[Dr. Aled Edwards]

Can I add something? Think about how it was before this genome stuff. We all knew about one or two genes to study and we all studied them. It's as if you're an astronomer and you can see two stars, you study them. But what genomics did was it just went boom, there they all are. We're still studying the two as I showed you before, because we love them. What genomics has enabled us to do is to go into the unknown.

Canada is unique. I travel the world. I spend a lot of my time travelling, obviously. I'm in Mexico listening to a talk on cattle from a Brazilian scientist. He has 20 slides, of which five are from Canada. He says these are Canadian data funded by Genome Canada because this organization, unlike other ways of handing out funds, emboldens scientists to go into the unknown. When you're first, you obviously are in the lead. I didn't even realize how dominant this technology is in cattle breeding. Instead of taking seven years to find out if the meat is okay, you do the genetic tests and it happens faster and cheaper. We're in the lead according to Brazil. I was impressed. The funding of this kind of science is not just genomics and it sounds different, it's culturally different. It enables us to work in areas where no one else on the planet is working. I think that's why it's so important.

[The Chair, Conservative, Joy Smith]

You still have one more minute.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Go ahead, please.

[Dr. Pierre Meulien]

Traditionally, our projects have been reaching out to the private sector on particular, specific projects. We would like to move more to look at a program or look at an area in agriculture, for example. We would love to have more of a close connection with the food industry, the meat industry. We have a lot of small projects on food safety. It's a big issue—food traceability, food safety. We have one on E. coli, we have one on listeria. We're also into the bar-coding speciation area and we're looking at horsemeat in beef burgers and stuff like that, which has the attention of the media.

[The Chair, Conservative, Joy Smith]

Thank you so much.

We'll now go to Mr. Kellway.

[Matthew Kellway, NDP, Beaches—East York, ON]

Thank you, Madam Chair.

Thank you very much, gentlemen, for being with us today.

Dr. Meulien, I wanted to pick up on this issue of the implications of prevention from what you're discovering. When you started you talked about a spectrum of diseases. There's the rare disease on one end, and on the other end there are these complex ones that are influenced by environmental circumstances. When we get into the issue of identifying certain diseases that are impacted by environmental conditions, it seems to me there's a whole range of ethical issues that arise out of that. When you're talking about prevention, what kinds of things are you talking about in practical terms when you study this stuff?

[Dr. Pierre Meulien]

I don't know whether this is true or not, but....

[The Chair, Conservative, Joy Smith]

Well, you don't have to say it if you're not sure about that.

[Dr. Pierre Meulien]

No, it's an opinion that I have. I believe that if people have access to their own genome sequence, and it might be obvious that they have some susceptibility in the future to getting some of these chronic diseases—it might be some cancers, they might be prone to Alzheimer's disease or to type 2 diabetes—I believe, with that information, some of them, not all of them, will change their lifestyle to life longer, healthier lives. That to me is a tool for prevention. I'm thinking of it more as behavioural lifestyle changes rather than anything else.

[Matthew Kellway, NDP, Beaches—East York, ON]

That, to me, is the interesting implication. It seems to me that when I look at maps of the city—I come from Toronto—you can map out instances of poverty in the city and you can map out instances of type 2 diabetes, and they correlate very highly. The question becomes, how much do people or are people able to control lifestyle? And what responsibility then falls on the rest of us to enable people to change their lifestyle, etc.? Or do we, collectively as a society, say, well, if this is true that one of the social conditions or determinants of diabetes is poverty, then what are the ethical implications of that for the rest of us and how do we govern that? We can't just say you have a problem and you're going to cost our health care system so start eating brown bread instead of white bread, or whatever the case is.

[Dr. Pierre Meulien]

That is a super question. I think there's a whole host of things, societal issues, that we need a lot of debate around.

Let me give you the example of smoking. I was living in Ireland when Ireland became the first country to ban smoking in the workplace. There was a piece of very strong legislation that was driving a behaviour or lifestyle bit from individuals. I can tell you that when people were talking about what happened in Ireland, they were saying, “Well, we're only going to see the results in lots of years down the road.” No; visits to pulmonary clinics were tracking downwards within six months of the smoking ban.

I believe, when we're talking about nutrition and other things around that, that the responsibility lies also with the food industry and other stakeholders, and I would agree with legislative action here. In the same way that everybody knows that smoking is bad for you, everybody knows that eating a lot of processed food is bad for you. The amounts of salt, sugar, and fat in some of these processed foods are not healthy at all. Everybody knows about them. But I think we need legislation on that.

[Matthew Kellway, NDP, Beaches—East York, ON]

I have one more little question.

Dr. Edwards, just very quickly, you're responding to all this genomic information coming out and developing these crystal things—I don't even know what they are—that pharma can take off and develop drugs from.

[Dr. Aled Edwards]

...starting points for drugs, after that.

[Matthew Kellway, NDP, Beaches—East York, ON]

Okay.

Are you in a position to push that process further down, that drug patent process, to hurry this up, or do you stop at a very natural, obvious kind of place?

[Dr. Aled Edwards]

We've pushed it from, as Pierre said, the shapes of the human genes, with one company and then three, and now we have nine making an inhibitor of it, which is a proto-drug. That's pushing it a little further. In July there's the discussion at CIHR with the six pharma, pushing it even further.

You can imagine a world where all this discovery stuff is done in the open, pre-competitively, and pharma competes much later, when the risk isn't whether it will work. The risk is a business risk—i.e., whether I can make a better medicine than my competitor.

That will change the whole economics of drug discovery, and should drop—