Kirsty Duncan

[Veterans Affairs, September 23rd, 2010]

Mr. Speaker, veterans are waiting and watching. They deserve better.

Since the minister will not answer the question, is he really telling us that a veteran injured in Afghanistan a few months ago is less worthy of Canada's help?

[Veterans Affairs, September 23rd, 2010]

Mr. Speaker, for the third straight day we are forced to ask the Minister of Veterans Affairs whether veterans' benefits will be retroactive to 2006. For two days he has not answered the question. Veterans could be forgiven for concluding that the minister has no intention whatsoever of supporting veterans already in the system.

On behalf of courageous veterans, could the minister give this House a straight answer?

[September 22nd, 2010]

Madam Speaker, there is no treatment arm to those clinical trials.

It is becoming increasingly evident that liberation can alleviate some symptoms. MS patients who have had the liberation procedure seem to experience an improvement in brain fog, fatigue and circulation and, over time, some report a marked improvement in the quality of life.

Time is brain. Any delay in clinical trials possibly means more damage. The earlier MS is caught the better the prognosis. For some patients a delay of a matter of months may mean the difference between working and not working, walking and not walking, living on their own or in care, or living and not. This past week we lost another MS patient, 34 years old, with a five-year-old child.

Why the refusal to listen to CCSVI experts? Why the refusal to collect evidence? Why the refusal to lead when five provinces were calling for clinical trials? Why the delay?

[September 22nd, 2010]

Madam Speaker, Canadians living with multiple sclerosis are fighting their disease and fighting for clinical trials for the new liberation procedure for chronic cerebrospinal venous insufficiency, or CCSVI.

We had a parliamentary subcommittee on neurological disease that heard four hours of testimony from the leading researchers in the world on CCSVI, including Dr. Zamboni, who pioneered the liberation procedure, and Dr. Simka, who has undertaken the most procedures globally. These researchers indicated that, according to their initial studies, both the diagnosis and treatment of CCSVI were deemed to be safe and have resulted in significant improvements in the quality of life of many MS patients.

Instead of listening to the leading researchers internationally, the government chose to accept the recommendations of a panel, held behind closed doors with no minutes. Why were only nine papers reviewed? Why were no leading experts called for their expertise? Where was the scientific rigour in making sure panellists were not biased?

At the end of July, I travelled to New York to learn the latest science at an international symposium for CCSVI. Researchers from Bulgaria, Italy, Kuwait and the United States were all presenting similar results, namely that 87% to 90% of MS patients show venous abnormality. Of the 400 cases reviewed by Canada's Dr. McDonald, 90% show a venous problem.

We need evidence-based medicine in Canada. The question I have is why have we not been collecting it? There are two ways to collect evidence and we have been calling for both: clinical trials and a registry. When I spoke to a high-ranking official in July, I was told a registry was not possible because “we have no idea what is being done overseas”. I explained that it was not exactly true. For example, in Poland, each patient is seen by a neurologist and has an MRV, a Doppler scan, and an eye test. Before-and-after liberation photos are taken, and during the actual procedure there is video. Finally, a long, complicated form is filled out, including EDSS scores.

It seems to me as a scientist that there is data to be collected.

I would like to identify some incongruities. Over the last four decades, only 7% to 20% of surgeries performed in hospitals have ever been double-blind tested, yet detractors of the liberation theory are insisting on sham surgeries in some of society's most vulnerable.

Often in medicine, when a treatment shows promise, it is fast-tracked. A recent example is a new device that can suck out stroke-causing blood clots. Very quickly, 27 patients across 10 hospitals were rescued from strokes by the device.

Over 1,500 liberation procedures have been performed worldwide, yet we are told there is not enough evidence for clinical trials in Canada.

As an example from MS, a few years ago a drug that was known to cause a fatal brain infection was fast-tracked, and 68 people have acquired the infection and 14 have died. Yet there is the hesitation to undertake clinical trials for angioplasty, a procedure undertaken daily in hospitals across this country.

I am in touch with over 1,000 MS patients across this country. I have a list of over 150 people who have been liberated. One toddler said, “My mommy's not broken anymore”. One woman who was a quadriplegic is now writing.

I am also in contact with physicians who themselves have been liberated. As one explained, “My province allowed me to practise for decades, but after liberation, I cannot even get a hearing”. He questions, “If we had collected the evidence in a registry for the last many months, would we still be calling this anecdotal stories?”

[Questions Passed as Orders for Returns, September 20th, 2010]

With respect to chronic cerebrospinal insufficiency (CCSVI), does the government plan to have: (a) Health Canada establish that no Canadian ought to be deprived of the imaging necessary for diagnosis, or deprived of the angioplasty indicated by a diagnosis of venous insufficiency in the drainage of the brain, only by reason that that person would also have been diagnosed with Multiple Sclerosis (MS); (b) the Minister of Health convene her provincial and territorial counterparts to a meeting for the purpose of ensuring that no impediment will be placed in the way of diagnosis of venous insufficiency or of treatment by angioplasty on the mere ground that the patient has been diagnosed with MS; (c) Canadian Institutes of Health Research (CIHR) funds made available to assist in the creation of a registry by which it would be possible to collate data regarding the progress of MS patients who undergo venous angioplasty; (d) the funds released, as per the MS Society's research proposal, to allow for that research, with the help of the data collated in the registry referred to above, keeping in mind that such research should not be an impediment to patients obtaining diagnosis or the angioplasty to correct diagnosed venous insufficiency, but should proceed in parallel to any such treatment; (e) Health Canada or the CIHR investigate technology to study the vascular system in utero and, if so, (i) whether vascular or venous problems develop during this time period, (ii) what and where vascular or venous problems potentially occur, (iii) how identified problems might be treated; (f) Health Canada or the CIHR study whether pregnant women should be given vitamin D to understand the risk of children being born with, or developing, vascular problems and other conditions and, if so, determine what dosage is appropriate; (g) Health Canada or the CIHR study whether children and adolescents should be given vitamin D to reduce the risk of developing vein inflammation and venous hypertension and, if so, (i) what dosage is appropriate, (ii) what quantity is recommended for a child with a family history of CCSVI, vascular problems or MS, etc.; (h) Health Canada or the CIHR investigate whether vascular issues develop during childhood and, if so, identify methods to discover circulation problems at the earliest time possible; (i) Health Canada or CIHR study whether antioxidants, vitamin D and omega 3 reduce vein inflammation; (j) Health Canada or the CIHR determine the normal range of flow through veins, in particular the jugulars, and whether or not occluded jugulars can be treated to achieve normal flow; (k) Health Canada or the CIHR study how CCSVI potentially affects flow through the veins and possible permeability of the blood-brain barrier, and methods to reduce permeability, including mesenchymal stem cells and pharmacological agents; (l) Health Canada or the CIHR study the effects of chelators on iron uptake and release from the brain, and the potential use of iron chelators as therapeutic agents for the treatment of MS and perhaps other neurodegenerative disorders; (m) Health Canada or the CIHR investigate how the vascular system of someone with benign MS compares to that of someone with relapsing-remitting, primary progressive or secondary progressive MS; (n) Health Canada or the CIHR study whether a relationship exists between CCSVI and other neurological diseases, as well as between CCSVI and autoimmune disease; (o) funds made available to CIHR across the Institutes to bring together a conference of leading researchers in fields including CCSVI and the liberation procedure, vascular surgeons and neurologists; (p) research funds made available to design safe apparatuses to keep liberated veins open; and (q) a National Research Chair awarded in the diagnosis and treatment of venous abnormalities?

[Petitions, September 20th, 2010]

Mr. Speaker, I am pleased to present a petition regarding chronic cerebrospinal venous insufficiency, CCSVI, for which the testing and treatment is safe, inexpensive and effective. The treatment of CCSVI is veinography followed by balloon venoplasty, a routine treatment for vascular disease made available to all Canadians with vascular disorders, except those with MS.

The petitioners are asking the government to plan and implement a nationwide clinical trial for the evaluation of veinography and balloon venoplasty for the treatment of CCSVI in persons diagnosed with MS.

[Multiple Sclerosis, September 20th, 2010]

Mr. Speaker, today people living with MS are protesting across this country, including on Parliament Hill, for clinical trials for the new liberation procedure for chronic cerebrospinal venous insufficiency or CCSVI.

Over 1,500 liberation procedures have been performed worldwide, with researchers from Bulgaria, Italy, Kuwait and the United States showing similar results, namely that 87% to 90% of MS patients show venous abnormality. Of the 400 cases reviewed by Canada's Dr. MacDonald, 90% show a venous problem and, of the 381 patients angioplastied, the gold standard, by Dr. Simka in Poland, 97% show a problem.

We need evidence-based medicine in Canada. Again, I call on the government to collect the evidence through clinical trials and a registry. Time is brain and any delay in clinical trials possibly means more damage and may mean the difference between walking and not walking, living on their own or in care, or living and not.

[Robert Bruce Salter, June 17th, 2010]

Mr. Speaker, today I would like to remember Dr. Robert Bruce Salter, a world-renowned orthopedic surgeon at the Hospital for Sick Children, who passed away peacefully on May 10 with his family by his side.

I will briefly highlight some of his extraordinary accomplishments. He developed a procedure to correct congenital dislocation of the hip. The pioneered continuous passive motion for the treatment of joint injuries. He wrote a textbook of orthopedic surgery called Textbook of Disorders and Injuries of the Musculoskeletal System, which is used worldwide.

He was an inductee into the Canadian Medical Hall of Fame, a Companion of the Order of Canada and a recipient of the Order of Ontario.

While one of the best and most respected orthopedic surgeons in the world, he just wanted to be remembered as a surgeon who treated children.

I hope everyone in this House will join me in remembering this remarkable man.

[Questions Passed as Orders for Returns, June 17th, 2010]

With respect to nutrition in Canada: (a) does the government recognize good nutrition as a basic human right; (b) how is food insecurity defined by the government, and what factors are responsible for it in Canada; (c) what action, if any, has the government taken to address each of the factors as identified in the answer to (b); (d) what action, if any, has the government taken to promote nutrition in Canada and which specific populations have been targeted; (f) does Canada have a comprehensive initiative that aims to reduce undernutrition and hunger at the national scale and, if so, (i) what is it, and if not, (ii) why not; (g) what successes has the current government had in building on effective programs to reduce food insecurity, undernutrition and hunger, and what barriers has it had to overcome; (h) has the government facilitated communications between the provinces and territories concerning the best methods of improving infant, child and adolescent nutrition in Canada and, if so, (i) on what dates and what were the recommendations and, if not, (ii) why not; (i) what are the names of all food security, nutrition, hunger prevention, etc. stakeholders with whom the government meets; (j) what percentage of Canadian families seeks assistance from food banks, and how has this changed over the last 20 years; (k) what percentage of Canadian infants, children and adolescents require assistance from food banks to meet their nutritional needs, and are all their needs met; (l) what action, if any, has the government taken to address in particular the nutrition of pregnant women and children through two years of age; (m) what percentage of Canadian children and adolescents experience food insecurity or hunger, and how does this translate into numbers, how have these data changed over the last 20 years, and for what reasons; (n) has the government considered a national breakfast, lunch or snack program to help ensure that children and adolescents meet their nutritional needs; (o) how does the government define the categories overweight and obese, and what percentage of Canadian infants, children, and adolescents are overweight and obese; (p) how does socio-economic level impact overweight and obesity in Canadian infants, children, and adolescents; (q) what are the medical and psychological complications of child and adolescent overweight and obesity; (r) how has childhood overweight and obesity increased in Canada over the last 20 years, and what action, if any, has the current government taken to address the situation; (s) how has type 2 diabetes increased in Canadian children and adolescents over the last 20 years; (t) how many treatment centres for childhood and adolescent obesity exist in Canada, and has the government increased or decreased funding to these, and by what percentage; (u) what action, if any, has the government taken to expand the number of child obesity treatment centres; (v) what action, if any has the government taken to facilitate communications between the provinces and territories concerning successful overweight and obesity prevention and treatment programs, and replication of what is working well; (w) what action, if any, has the government taken to support research and evaluation of childhood overweight and obesity prevention, including behavioural, dietary, environmental, pharmacological, and physical activity approaches, and treatment initiatives; (x) what analysis, if any, has the government undertaken of nutrition programs in other jurisdictions, such as the United Kingdom and the United States; and (y) what consideration, if any, has been given to the Pennsylvania program that has led to more than 80 supermarkets being set up in unserved areas in the last five years?

[Questions on the Order Paper, June 17th, 2010]

With respect to chronic cerebrospinal venous insufficiency (CCSVI), the “liberation” procedure, and multiple sclerosis (MS): (a) does Health Canada recognize the International Union of Phebology (IUP), and is Canada a member; (b) does Health Canada recognize the IUP’s Consensus Document on the diagnosis and treatment of venous malformations; (c) will Health Canada be respecting the IUP’s standards regarding diagnosis and treatment of venous malformations; (d) will the government work with the provinces and territories to establish imaging and treatment guidelines for CCSVI and, if so, over what timeline and, if not, why not, (i) what are the benefits and risks associated with imaging and treatment techniques, (ii) what are the costs for each of the identified methods; (e) will the government, in collaboration with the provinces and territories, commit to imaging MS patients for venous malformations, and treating those patients who require interventions and, if not, why not and, if so, (i) over what timeline, (ii) what barriers would have to be overcome; (f) is CCSVI recognized as an official diagnosis and, if so, by what professional medical organizations and how is it defined; (g) what is the cause of narrow veins in the neck or thorax and what methods could possibly be undertaken to reduce their occurrence either in utero, in childhood, or in adulthood; (h) with what medical conditions is CCSVI associated; (i) what are the potential health impacts of CCSVI in the short-term, medium-term and long-term, both with and without treatment; (j) what percentage of MS patients show one or more blocked veins; (k) what veins, other than the jugular veins, are commonly blocked, damaged, or twisted in the human body, (i) what imaging procedures are used to identify the problems, (ii) what interventions are required to address the problems and why, (iii) what are the possible health impacts if left untreated, (iv) are interventions time sensitive, (v) what are the costs of imaging procedures and treatment; (l) what specific methods are used to investigate CCSVI, what costs are associated with each method, and what are the benefits and risks associated with these techniques; (m) where in Canada are these imaging methods available and, for each location, what procedures are offered and how much do they cost; (n) where in the world are private clinics emerging, what are their efficacy and safety records, and what are the imaging and treatment costs; (o) what percentage of MS patients show a reduction in MS attacks and brain lesions following the liberation procedure; (p) what percentage of MS patients with little or mild blockage show improvement following the liberation procedure; (q) what discussions is the government having regarding CCSVI, its imaging, and the possible link with MS; (r) what studies are government scientists conducting to assess the reliability and validity of imaging techniques, the possible association between CCSVI and MS, and to follow-up on patients who have undergone the liberation procedure; (s) how much money has the government allocated to research related to CCSVI, the liberation procedure and MS; (t) what is the estimated number of MS patients in Canada, and what is (i) the percentage who can no longer work, (ii) the percentage who depend on family caregivers, (iii) the percentage who require around-the-clock care from professional caregivers; (u) what is the estimated national annual economic impact of MS on families and healthcare plans; (v) what is the estimated national annual cost of disease-modifying therapies, including Copaxone and Interfon, for families and healthcare plans; (w) what are the projected imaging costs for CCSVI and treatment costs for MS patients who show a vascular abnormality; (x) what are the projected imaging costs for CCSVI and treatment costs for all MS patients; (y) what recommendations regarding CCSVI and imaging are being provided by the government to MS patients, particularly regarding (i) reputable imaging and treatment clinics, (ii) the pros and cons regarding venoplasty and stents, (iii) the need for continuing treatment regimes following any liberation procedure; (z) what steps is the government taking to educate MS patients about blogger patients and sham imaging and treatment centres; and (aa) what is the estimated number of Canadians who have gone overseas for imaging and treatment, and what tracking is being undertaken of their condition following such trips?