Health Committee on Nov. 27th, 2012

[Djaouida Sellah, NDP, Saint-Bruno—Saint-Hubert, QC]

With the time I share with my colleague? I have just one minute to question Dr. Hux.

I was very happy to hear you talk about the development of the project you are supporting. You were talking about Dr. Pere Santamaria's therapy, about Dr. Julie Lavoie's treatment, and about the research being done by Dr. Sapieha. Can you update us on these projects? Are they in the preliminary phase? If they have reached the clinical phase, can you tell us how many people have access to this type of therapy?

Thank you.

[Dr. Jan Hux]

I don't have the exact details on each of these projects. These projects are at the discovery stage, and clinical trials are required to ensure that before they are translated into practice, they are both safe and effective in a real-world setting. The information will be available in the public realm. We support researchers who publish their findings in peer-reviewed medical journals to ensure the integrity of the science and the availability of the research findings to the broader clinical and scientific community.

[Djaouida Sellah, NDP, Saint-Bruno—Saint-Hubert, QC]

Thank you.

Ms. Davies.

[Libby Davies, NDP, Vancouver East, BC]

Thank you very much.

I've got a very specific question, because if what I'm going to ask is still a situation, I want to make sure it's on the record.

I remember a few years ago there was a lot of concern, and even controversy, over people with diabetes 1 who, in effect, were allergic to synthetic insulin, and we had a number of deaths. I remember because I raised it in the House. There was concern about the fact that Health Canada didn't keep accurate records of people who were lodging complaints, and we didn't have good information about people who were basically intolerant to synthetic insulin and relied upon animal insulin, which was getting harder and harder to get. To source it at a particular pharmacy was getting to be very difficult.

I want to know, either from the Diabetes Association or from Dr. Sherman, from the institute, if this is still an issue. If it is an issue, how are we responding to it? Are we doing a better job, hopefully, of helping people who are intolerant to find a better source?

I remember that people had to go overseas to get pig insulin, and that we were doing a very poor job of recording the number of people who were intolerant. It was a hidden story. I recall that it's higher than what people think it is.

I wonder if you could respond to that.

[Dr. Philip Sherman]

Yes, I can. Thank you for the question. Indeed, this has been brought up as an issue. CIHR has been involved in the context of evaluating a research effort to look at other than synthetic insulin, like pork-derived insulin, so we have been in discussions with Health Canada, affected individuals, and big pharma producers of synthetic insulin. There has been an interest in supporting research in the area.

Health Canada has been monitoring how many affected Canadians are involved and whether there does need to be a source. The numbers are very small, as you heard from the testimonials, where—

[Libby Davies, NDP, Vancouver East, BC]

But for those people it can be catastrophic.

[Dr. Philip Sherman]

You're absolutely correct, so there is an ongoing issue of monitoring and seeing what's available.

There isn't a local source, as you say, so that still is—because the volume for the pharmaceutical producers is not high enough in Canada, but there is an international source.

As you heard from the testimonials earlier, for most Canadians who are affected with diabetes, the synthetic insulins of the various durations are a big advance.

[Libby Davies, NDP, Vancouver East, BC]

Right. I understand that.

[The Chair, Conservative, Joy Smith]

Your time is up, Ms. Davies. I'm sorry.

Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair. I want to thank the witnesses for being here today.

I saw my father suffer from the complications of diabetes, and to see the changes that have occurred just in my lifetime are quite amazing.

Our overall theme of these studies is technology and innovation. We heard from Ms. Sissmore. She talked about the glucose monitor, and I was excited to hear from JDRF here today.

Occasionally, we hear from Dr. Beaudet. He said some recent changes are happening at the institute in terms of reforming the granting systems. I was wondering, what capacity and infrastructure does CIHR have to be responsive to issues like juvenile diabetes, and can this be done efficiently?

[Dr. Jane Aubin, Chief Scientific Officer and Vice-President, Research and Knowledge Translation, Canadian Institutes of Health Research]

I'll take that one. Thank you for the question.

I think there are really two prongs to an answer. We're certainly making proposals to reform our investigator-driven or open grants programs to make them more hospitable to rapid innovations, including new technologies, but we also have, as one of our major strategies, as was commented on by Dr. Sherman, our strategy for patient-oriented research. Many of its key components, including networks and the infrastructure support units that we're going to partner with the provinces to establish, will speak toward sharing best practices and sharing evidence across jurisdictions so that rapid new knowledge could be put in practice much more quickly than today.

I think CIHR is making important advances on both prongs.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you.

To follow up, I always hear from my constituents about making sure government investments are done well. I was wondering if you could describe CIHR's approach to creating partnerships that build and leverage public funds, and what factors you think contribute to how well we can do this.

[Dr. Jane Aubin]

I think either Phil or I could take that one.

Much of CIHR's work, through the institutes and CIHR overall, is done in partnership with provinces, with charities, and with other stakeholders. Again, the strategy for patient-oriented research is indeed a collaborative strategy, where all voices are brought together to best shape the research being done, and then it's translation into practice.

The partnerships go beyond funding partnerships. They go to conceptual partnerships to help prioritize where needs are and how they can best be addressed.

[Colin Carrie, Conservative, Oshawa, ON]

How much time do I have?

[The Chair, Conservative, Joy Smith]

You have about another minute.

[Colin Carrie, Conservative, Oshawa, ON]

Mr. Lobb had—

[The Chair, Conservative, Joy Smith]

Mr. Lobb.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Thanks very much.

The first question is for Ms. Hux.

Is there a country or a jurisdiction where type 1 diabetes is much lower than, say, the average country or area or region?

[Dr. Jan Hux]

Type 1 diabetes is more common in northern latitudes. The highest prevalence in the world is in Finland, and it would be more than 20 times higher than in some of the peri-equatorial regions. People at one point thought that either light or coldness were contributors. Those theories haven't necessarily panned out.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Is there any scientific data that explains this phenomenon?

[Dr. Philip Sherman]

There is a lot of interest in the geographic representation of type 1 diabetes. It is considered that it falls in a category of so-called autoimmune diseases, where the body has fought against something and then it ends up fighting against itself. In the case of type 1 diabetes, the immune cells of the body are fighting against the cells in the pancreas that produce insulin. It occurs very early in life. The antibody testing that you heard of can detect it way before the signs and symptoms of diabetes occur.

The study I mentioned to you, the trigger study, is a Finnish-Canadian collaborative effort to look at high-risk individuals, where the thought is that the trigger is a dietary trigger. It might be a cow's milk protein antigen. Now we don't know that for sure, but that's what the study is going to find out. These aren't patients with an illness. Somebody in their family has type 1 diabetes. When they're born, half of the children go on regular feedings, breast feeding or formula feeding, and with the other half, the mother takes digested cow's milk or the baby goes on a formula with digested cow's milk protein.

That study is under way. We don't know the results. A pilot study had been done, which was very promising—that you could prevent diabetes enough to reduce the risk by about a half. But we don't know the result of the formal study.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Okay.

I'm not an expert on any of this stuff, but with type 1 diabetes, is this something that the father has in his genes that he can give to the child, or is this purely from the mother?

[Dr. Philip Sherman]

It's what's called a complex polygenic disorder. It's a big term, but it means that multiple genes from both the mom and the dad are risk factors for both type 1 and type 2 diabetes. Lots of excellent researchers around the world, including the group from Montreal Children's Hospital, are doing this kind of work in large populations to identify genetic susceptibility. So it's not from one side or the other, per se. It's not X-linked through the father.

[Ben Lobb, Conservative, Huron—Bruce, ON]

I think I have time for one last quick question.

We heard from the kids today, and there was quite a range in age that it was identified. The young lady explained how she knew it, but can we explain why one kid gets it at 21 months and another kid gets it at 9 years? What happens there?

[Dr. Philip Sherman]

That's a great question. Dr. Legault maybe can answer as well.

One of the things is that there may be epigenetic modification. It's certainly not just the genes. It's got to be something else more complicated, like environmental exposure or epigenetic modification. We don't know the answer, but there's lots of research looking to see why there is that variation in expression with common susceptibility genes. So we just don't—