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.
Conservative
The Chair Conservative Joy Smith
I see.
Dr. Krewski, does that encompass some of the possible prevention of Parkinson's? As Dr. Fon said, if we knew about this before everything was damaged in the brain, we could do a lot of good things so people wouldn't have to go through what Mr. Simmonds went through. Does your study encompass that?
Professor and Director, R. Samuel McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa
We'll be able to tell you what is known about the causes of Parkinson's, about early symptoms that may not be classical Parkinson's symptoms, about the factors of active aggression. All of those pieces of knowledge are going to be key to designing proper treatments and therapies.
I wonder if I could take ten seconds to make one comment on personalized medicine.
Professor and Director, R. Samuel McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa
One of our big interests in the McLaughlin Centre—and I want to thank R. Samuel McLaughlin for the generous donation that created our centre 12 years ago—is drug safety, efficacy, use, and communication. We're looking at drugs, their effectiveness, adverse health outcomes, and whether people follow the dosing regimes.
Looking at these large population-based databases, I mentioned this cohort of 35 million patients we're working with in the U.S. We can look at what factors affect outcomes that may determine whether a drug is effective for an individual patient. These would include factors like pre-existing health conditions. Renal disease, for example, might affect treatment of certain conditions, so might genetic characteristics or lifestyle factors. So we end up being able to define which patient will respond to which treatment, and which treatment may actually be risky. I was interviewed by a British clinical journal a month ago about our work in this area, and I think this is really going to be a way of the future. We will be looking at large databases where you understand everything about the patient's health profile, lifestyle, polypharmacy, comorbidity, and you work towards using that information to define more effective personalized medicine.
Conservative
The Chair Conservative Joy Smith
We're very excited about this study and March 2013 is indelibly printed on my brain. So thank you.
We'll now go to Madame Papillon. Welcome to our committee.
NDP
Annick Papillon NDP Québec, QC
Thank you very much.
Thank you very much to all of you for having come here. Your presentations on various aspects were really very interesting.
I am a member from Quebec, and I met with some Parkinson Society representatives less than two weeks ago, and they explained some of the issues you have been discussing. It will be my pleasure to talk about them again.
There are various things that need to be improved. There will be a conference in two weeks on the topic of being physically active in order to have a better life, and its purpose will be to explain all of the benefits of physical exercise for those who suffer from this disease. There is the story of a Quebec man who has Parkinson's disease; he is a teacher in a CEGEP. When he is having a crisis, he finds a partner and starts to dance, because if he dances for five minutes, this allows him to keep his mobility and stay in shape. That is interesting.
One of the problems the organization said it had is that it only manages to reach some 500 of the 3,000 or so people who are living with the disease. Do you have any recommendations to make to us that might help to dispel the stigma around this disease, allow people who are living with it to access services more easily, and also allow them to talk about it?
Director, McGill Parkinson Program and National Parkinson Foundation Center of Excellence, Montreal Neurological Institute, McGill University; Parkinson Society Canada
In our clinic, when we see patients, we always give them all of the necessary information to communicate with Parkinson Society Canada and the one in Quebec. And so the information exists, but as you say, a lot of people prefer to keep things to themselves. And so there is a gap between what is offered and the way in which people deal with the disease.
For a lot of people, there is the stigmatization aspect you referred to. People feel stigmatized and prefer to isolate themselves. And so we regularly organize events such as the ones you have described, at least twice a year, to which we invite patients and their caregivers. I agree that the caregivers are absolutely crucial for the people suffering from this disease. A large part of the burden is taken on by the family caregiver. And I agree with you entirely—we have to find a way of destigmatizing the disease.
Moreover, one of the strategies we adopt, as do many other centres, is a very multidisciplinary approach. When patients come to see us, they are not only seen by a doctor, but also by a nurse, an occupational therapist and a social worker. This raises awareness and allows people to find out what the milieu offers to patients.
NDP
Annick Papillon NDP Québec, QC
That is interesting.
You also talked about basic research, and you got my attention there, since there is often a debate around basic research and applied research. It is true that both types of research have different objectives, but they both have their raison d'être, in my opinion. I know that at this time basic research is being called into question a great deal. For your part, you stated that an important part of your successes was related to that type of research. I would like you to take the few minutes we have left to tell us why this basic research, with the success it has led to, deserves sustained funding.
Director, McGill Parkinson Program and National Parkinson Foundation Center of Excellence, Montreal Neurological Institute, McGill University; Parkinson Society Canada
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—
Conservative
The Chair Conservative Joy Smith
Thank you, Dr. Fon, and thank you, Madame Papillon.
We'll now go to Mr. Gill.
Conservative
Parm Gill Conservative 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?
Professor, Department of Clinical Neurosciences, University of Calgary, As an Individual
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.
Conservative
Parm Gill Conservative Brampton—Springdale, ON
At what stage is the launch of a larger trial of 700 people?
Professor, Department of Clinical Neurosciences, University of Calgary, As an Individual
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.
Conservative
Parm Gill Conservative Brampton—Springdale, ON
How does the music compare with the use of medication when it comes to increasing mobility among people with Parkinson's?
Professor, Department of Clinical Neurosciences, University of Calgary, As an Individual
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.
Conservative
Conservative
The Chair Conservative Joy Smith
Your time is up. Thank you, Mr. Gill. Those were really good questions.
Now we'll go to Mr. Lizon.
Conservative
Wladyslaw Lizon Conservative 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?
Professor and Director, R. Samuel McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa
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.
Conservative
Wladyslaw Lizon Conservative 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?
Director, McGill Parkinson Program and National Parkinson Foundation Center of Excellence, Montreal Neurological Institute, McGill University; Parkinson Society Canada
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.
Professor and Director, R. Samuel McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa
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?