I'm sorry.
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.
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.
9:30 a.m.
Conservative
Patrick Brown Conservative Barrie, ON
Thank you, Madam Chair.
It's great to have you all here today. We've all taken a great interest in the topic of neurological disorders from our previous study on them.
Joyce, I know you've been here a few times, with both the Parkinson Society and the neurological charities. We certainly appreciate that.
Some of the comments have certainly been interesting. One area that I've always found particularly fascinating is the collaboration with other neurological disorders. Mr. Fon and Mr. Hu both talked about that.
When you talked about Parkinson's you said you discovered that the neural breakdowns can potentially happen decades before. I know with Alzheimer's they're now doing a population study over a much longer period to try to examine how this happens and what causes it.
Will you be doing any similar large population studies over an extended period on Parkinson's? It's a general question to the panel.
9:30 a.m.
Director, McGill Parkinson Program and National Parkinson Foundation Center of Excellence, Montreal Neurological Institute, McGill University; Parkinson Society Canada
Thank you very much for that question.
I think you're absolutely right, and it's really been a shift in the way we think about Parkinson's disease. Literally 15 years ago people were completely focused on the motor components—the tremor, the slowness in movement. As we've gotten better at treating those parts of the disease, it's become very clear that patients have many other features. Maybe more interestingly, and I think this is what you're getting at, some of these features appear years if not decades before the motor manifestation.
I think this is really an opportunity to identify these people. I won't call them “patients”, because they're not really patients yet, necessarily. There are certain features...for example, a loss of smell. Almost all patients with Parkinson's lose smell. This is something that you could easily identify, possibly on a population level, as you were hinting at. Other things include sleep abnormalities, which occur sometimes a decade before.
One study led by a Canadian group—Ron Postuma at McGill—showed that there's a certain kind of sleep disorder, called REM sleep behaviour disorder, a very distinctive sleep disorder, and about half of the people who have that disorder, which is a huge amount, go on in the next decade to develop Parkinson's or Parkinson's-like disorders. You can imagine that if we had a way of identifying this subset in the population, it would be tremendous. You could not only potentially help them symptomatically, but if there were new breakthroughs in neuro-protective therapies, these would be the ideal patients to try to target.
I don't know if we this mentioned earlier, but by the time someone presents in your office with Parkinson's disease, about 70% of their dopamine neurons are gone. It's very late in the game by the time you see the patients. So if you could identify these people 10 or 15 years earlier, that would be tremendous.
I think Canada is ideally positioned to do those kinds of studies you're hinting at, because there's a very good cooperative, collegial atmosphere among the different research centres, among the different Parkinson's clinics. I think we're really poised to do those kinds of studies.
9:35 a.m.
Professor and Director, R. Samuel McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa
Just very briefly, I'm really excited about your question of what we can do to better understand the etiology of Parkinson's treatment and progression. We're currently just about to start a two-year study, which will be led by one of my doctoral students. We're going to look at Parkinson's patients throughout the province of Ontario—what medications they take, how effective those medications are, and whether there are any adverse reactions to those medications.
With a population of 12 million people we have retrospective data on going back some 15 years, we'll be able to get a really good handle on the factors affecting the onset, the progression of the disease in a large population, and particularly looking at the effectiveness of the medications the patients are taking.
A second part of the same study will be a parallel analysis of a similar data set from the United States. That is actually larger. We have data from 500 U.S. health care institutions, representing over 35 million patients' electronic health records. We'll do two analyses, one based on a large Canadian data set from Ontario and one based on nationally representative U.S. data sets. When those results are in, I think they'll be tremendously useful to answer some of the questions you're posing this morning.
9:35 a.m.
Professor, Department of Clinical Neurosciences, University of Calgary, As an Individual
Yes, I have a brief comment.
As I think my colleagues have indicated, it is extremely important to find the cause for any disease. For Parkinson's, for example, substantial evidence links Parkinson's with pesticides, metals, and other things.
The challenge is can you remove all the pollution, and at what cost? I think the solution would be to find the highest-risk population and intervene a little earlier, but not on a large scale that causes unnecessary economic burden. When it's something where we know the cost.... Take pesticides, for example. You can't ban pesticides. Some of the farmers use certain things, and they don't want to grow less food.
So you really need to support research in that area: how to prevent disease, on the one hand, and on the other, how to balance the other costs to society.
9:35 a.m.
Conservative
Patrick Brown Conservative Barrie, ON
Joyce, I'm glad you mentioned the stigma associated with some of these neurological disorders in communities. I remember we had Greg McGinnis testify. He's a constituent of mine from Barrie. I remember Kirsty was there for that. It breaks your heart when he talks about the tribulations he's had to go through. I am sure that's common with many Parkinson's patients. I think that's something we should certainly note.
I realize I only have one minute left. I guess if there's an opportunity very quickly.... I understand we spend $9 million a year from the federal government on Parkinson's research. Are we spending in the right areas? Are there things that aren't being researched that should be researched? Is there anything you would like us to get in our report?
9:35 a.m.
Director, McGill Parkinson Program and National Parkinson Foundation Center of Excellence, Montreal Neurological Institute, McGill University; Parkinson Society Canada
You want the ten-second answer? It's not enough.
9:35 a.m.
Conservative
The Chair Conservative Joy Smith
No. Time is up. Of course that's a very profound question.
We will go now to Dr. Duncan.
9:35 a.m.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
Thank you, Madam Chair, and thank you to you all for coming.
Mr. Simmonds, thank you for sharing your story. You touched us all. And thank you for saying that our brain power is our greatest strength and we must do everything to protect it and promote brain health in this country.
To our researchers, thank you for the extraordinary work you do. It was really exciting to hear about your work.
To the Parkinson's and neurological health charities, thank you for supporting Canadians.
We've heard from other witnesses. I just want to check in with you all. We heard this should be a recommendation in our report that we should make 2014 the year of the brain, in coordination with what's happening in Europe, and that we need a pan-Canadian brain strategy. Would you agree? Just yes or no.
9:35 a.m.
Professor, Department of Clinical Neurosciences, University of Calgary, As an Individual
Yes.
9:35 a.m.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
Everybody's nodding. Terrific.
For our researchers, should it be a recommendation in our report that the government should provide transformative multi-investigative grants to accelerate research from discovery to the development of new treatments and therapies for neurological and psychiatric diseases? Should that be a recommendation in the report?
9:40 a.m.
Professor and Director, R. Samuel McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa
Absolutely, but I don't know if you have thought about how to best do that, because there are a number of different venues for stimulating that kind of activity.
9:40 a.m.
Professor and Director, R. Samuel McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa
I'll mention one that both Ted and I have participated in for the last seven years. It's the concept of a network of centres of excellence where you get a series of centres collaborating. It promotes new research collaborations that hadn't existed. You get this tremendous intellectual synergism by bringing new ideas, new people, and new disciplines together. We had some terrific successes with prion diseases, which we think include Parkinson's and many of the other neuro-degenerative diseases.
So if I had to shoot from the hip, I think the NCE model or some version of it has a lot to be said for it.
9:40 a.m.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
Dr. Krewski and Dr. Fon, should a network of centres of excellence for neurological and perhaps psychiatric disease be a recommendation in this report then?
9:40 a.m.
Director, McGill Parkinson Program and National Parkinson Foundation Center of Excellence, Montreal Neurological Institute, McGill University; Parkinson Society Canada
Yes. I can add that my good friend and colleague Dr. John Stoessl also appeared before this committee, and I want to second his comments. I think they were in response to a request from you, Ms. Duncan.
I think the time is right to establish a consortium of networks of excellence for neurological disease and ideally for neuro-degenerative diseases. I think Parkinson's and other neuro-degenerative diseases are really going to be the major number one health issue in the next decades as the population ages.
9:40 a.m.
Liberal
9:40 a.m.
Director, McGill Parkinson Program and National Parkinson Foundation Center of Excellence, Montreal Neurological Institute, McGill University; Parkinson Society Canada
I think that should be a strong recommendation.
9:40 a.m.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
Thank you.
I'm going to ask if this should be a recommendation. Should the government develop a coordinated pan-Canadian program to develop technology platforms in neuro-genomics, neuro-imaging, neuro-proteomics, and disease models?
9:40 a.m.
Director, McGill Parkinson Program and National Parkinson Foundation Center of Excellence, Montreal Neurological Institute, McGill University; Parkinson Society Canada
Absolutely.
9:40 a.m.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
Absolutely? Okay. So that should be a recommendation in our report.
Should it be a recommendation that the level of support will need to be increased until such time as brain diseases are being successfully overcome therapeutically?