Evidence of meeting #35 for Health in the 40th Parliament, 3rd session. (The original version is on Parliament’s site, as are the minutes.) The winning word was bank.
A recording is available from Parliament.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
I guess I would ask this. To have an optimal kind of collection, what percentage of the population...? I know you would be looking at diversity, but is there a certain target--like, one baby in ten--to represent the diversity of Canada?
Physician, Pediatric Hematology and Oncology, CancerCare Manitoba
It's one baby in ten but with a representative, a proportion; you don't need a high number of cords. There are a lot of babies born in Canada, and you don't need all their cord blood units in the bank. That would be a prohibitive expense. You need high-quality cord blood units, and that translates into units that pass a multitude of potency tests. You need large units that come from a diverse population.
On the absolute number of cord blood units we ought to get into the bank to represent our population, if we got to 20,000 to 50,000 high-quality cord blood units in the bank, we would start to be able to contribute to the international inventory of cord blood units and meet the needs of Canadians.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
On the OneMatch system, I expect there's a profile of donors. Our chair, Ms. Smith, did a great job. I think a number of folks showed up here in Ottawa.
Is there a plan to be strategic about getting some of the under-represented population to add to that bank? Is that happening?
Physician, Pediatric Hematology and Oncology, CancerCare Manitoba
Yes, that's an ongoing initiative as part of Canadian Blood Services. I'll circle around to them to submit something to the Clerk of the House to address that.
But that is recognized and implemented as an initiative.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
Mr. Rudnicki, you talked about challenges at the very start. The challenges we've heard about involve the regulatory framework and optimal funding. We talked a little about the research. Are there any other challenges that you see?
Scientific Director, Stem Cell Network
A big challenge is jurisdictional, between the federal government and the provinces. The CBS program is well worked out. They have a mature business plan. They have the resources, and they can implement this. They can have quality cords available that represent the diversity of Canada.
The provinces don't have the funds right now, given the times we're in, to fund this. It's in an area of provincial jurisdiction, the funding of CBS, so how could the federal government provoke provincial funding? Maybe they could match that, I don't know; it's a jurisdictional issue. Regulations also have jurisdictional issues with the provinces.
That's a problem inherent to Canada, I think. It's something we struggle with, and I'm sure you do on a regular basis.
So I view that as a big area.
Conservative
The Chair Conservative Joy Smith
Thank you, Dr. Rudnicki.
We'll now go to Mr. Dosanjh. I think you're going to share your time with Dr. Duncan.
Liberal
Ujjal Dosanjh Liberal Vancouver South, BC
I believe in sharing. I know Deepak doesn't, but....
Dr. Rossant, you mentioned that the Assisted Human Reproductive Agency and the act, particularly the act, is challenged before the courts. You then said that the regulations haven't been done because of the challenge.
As a lawyer, I believe unless there is an injunction from the court that is in place to say nobody can do anything with respect to this act, the government has the right to proceed with the regulations and proceed with dealing with the issues if it sees fit, and let the challenges come whenever they may.
I want you to address that. I don't want to be partisan, but there is an elephant in the room here that nobody is talking about. This government has been fairly resistant to this kind of research, and that's why, perhaps, they have not proceeded with the regulations pursuant to the legislation.
Chief of Research, Hospital for Sick Children
I'm going to actually shift that to my colleagues who did meet with the regulatory group.
Would you like to address that, Michael?
Scientific Director, Stem Cell Network
Well, what they told us was exactly that. It's on hold because of this court challenge.
Liberal
Liberal
Ujjal Dosanjh Liberal Vancouver South, BC
Because if that were the case, I could bring perhaps the whole government to a standstill simply by issuing a writ.
Scientific Director, Stem Cell Network
I really don't have any idea what--
Liberal
Ujjal Dosanjh Liberal Vancouver South, BC
Well, if the government believed that, then they couldn't do anything with respect to anything. A writ would simply stop the government from proceeding. And that's what has happened in this case.
Thank you.
Go on, Madam Chair.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
I was going to pick up on the MS issue. You were talking about Mark Freedman's work.
I think it's important for the committee to understand that chemo is used to wipe out the immune system, and that it's only undertaken in people who are at the very end stages. Chemo is used to destroy the immune system and then do the stem cell transplant. Elsewhere in the world, that is not being done.
Scientific Director, Stem Cell Network
The bone marrow transplant procedure that's being used by Harry Atkins, the hematologist, as part of that trial, does involve a mild blade of therapy, which is chemo. The hope is that by using drugs that modulate the immune system they can move forward and not do that in the future. They are only treating the most severe patients at this point in time. It's not a general cure for MS. You're quite right; I stand corrected.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
People need to know that there were adverse effects associated with that.
The question I have is really around private banks, individual collection for individual families. The national cord blood bank would look at 10% of the population. In an individual family you can look at the individual plus, potentially, a number of family members who might be able to be treated.
We talked about bone marrow transplants, also the promise of about 70 diseases that might be treatable. If we go to the 10%, what will the coverage be? Would you meet the same coverage if you did it individually?
Conservative
Physician, Pediatric Hematology and Oncology, CancerCare Manitoba
This is going to be confusing. When we do a bone marrow transplant for a child or an adult with leukemia, we don't want to use their own cells again. On purpose, we want to use cells from somebody else, because part of the treatment is to get immune therapy. That's the reason why we think we cure leukemias with transplant.
When we do a bone marrow transplant for somebody who has a broken blood-making system--somebody who makes bad red blood cells, someone with sickle cell anemia, thalasemia, someone who has a broken immune system--we can't use that person's own cells. If there's private banking for that patient, we can't use that cord blood for that patient, so we're talking about something very different.
When you take a look at reasons for banking privately, you find that the indications are very small at this point in time. The indications for my field are next to zero for treatment of cancers and blood disorders. The purported indications for treatment of cardiac disease, diabetes, or neurodegenerative diseases at this point have no foundation on clinical trial experience and no foundation on clinical experience. Given the speed of development in the field of stem cell sources such as mesenchymal progenitors--cells isolated from other tissues in the body, induced pluripotent stem cells--I am not at all clear whether cord blood will be useful as a tool for these other indications, as opposed to drawing a tube of blood or sampling some fat.