Health Committee on Dec. 4th, 2012

[Dr. David Huntsman]

This does come back, I think, to some point that Marco and I made, and others alluded to. If we are going to embrace the concept of more individualized disease control as a way of improving the effectiveness, cost-effectiveness, and appeal of our health care system, we have to refit our drug approval processes and the way we consider new interventions so that they're tailored for personalized interventions, as opposed to what we've had in the past. Our whole health care system is based on the very kind of generic approaches to controlling disease. There are things that can be controlled federally, and, obviously, there are things that can't. That's something that is a federal jurisdiction.

Also, there is the funding of research into system changes. Our health care record systems are really designed for minimal amounts of data per patient. This isn't going to work in the future. We're moving into an era of high-content medicine, where patient genomes and other materials are going to be base parts of the health records. Perhaps we have to go way outside the box and look at patient-controlled electronic health records and other innovative solutions.

Federally, you could create a framework where different models could be tested, and then, if they were successful, we would hope they would be adopted nationally. All of these forays into more personalized high-content medicine would be research of different descriptions, be they health services research or more basic research. But to take the fantastic discoveries that are going on in many disease domains and make sure that Canadians benefit, we have to start looking further downstream.

[Dr. Marco Marra]

I'd like to echo David's comments there. The question was how we avoid ending up with a big gap. I would—

[The Chair, Conservative, Joy Smith]

Dr. Marra, we only have a couple of minutes left, and we have two other people who also want to answer. Could I just ask that you maybe take a minute or 30 seconds to answer so we can get everyone's answer in?

[Dr. Marco Marra]

Right.

It's not that we're going to end up with a big gap. The point I was going to make is that we're at the precipice, so we need to work quickly.

[The Chair, Conservative, Joy Smith]

Good point.

Dr. Plummer.

[Dr. Frank Plummer]

I would point out that these things are all happening very quickly, and I don't think our society is ready for them currently. There are all kinds of issues related to personal health information and how this information is used, which we haven't really thought through. It's upon us right now. I think the others would agree with that. There are many issues in that realm that need to be thought about.

[The Chair, Conservative, Joy Smith]

Dr. Chan.

[Dr. Warren Chan]

I just want to start with the life cycle of development. As academics, we're at the bottom of the scale of that development, and we need companies to translate or want to translate. Right now the challenge is the fact that there aren't any companies in this area. If I want to translate my technology, who do I go to? Actually I have collaboration in the U.S. Because I'm in Canada, I want to support the Canadian economy with this. That's one of the challenges.

What I've done is to start a company—again, at this early phase—and we're just selling materials. These materials are being sold to the world, and I'm hoping to use that as an infrastructure to bring the technology into the company as time goes on. We've already gone global in two years.

This is a major challenge in academic research—getting to people, how to actually move it from the lab into the real world environment. Without that commercial entity, it doesn't—nothing can be translated. It would be a nice paper, but it doesn't go to people.

[The Chair, Conservative, Joy Smith]

Thank you.

Dr. Voyer, you also wanted to comment.

[Dr. Normand Voyer]

Yes, I'll be quite short.

I want to say that I think we need—this was alluded to before—a national strategy for research in nanomedicine that incorporates companies as well. We need a research and development strategy that incorporates fundamentalists as well as engineers and companies.

[The Chair, Conservative, Joy Smith]

Thank you so very much.

We'll go to Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

I just don't know where to start. It's been such an interesting forum of witnesses here today.

Maybe I'll start with Dr. Plummer, because I was very interested when you were talking about viruses to fight viruses. I remember hearing about this years ago from a researcher in autoimmune diseases. I think he was studying ankylosing spondylitis or something, and he found that if you had an innocuous virus, you could give a person an innocuous virus and it actually helped the symptoms of these autoimmune diseases.

You mentioned that you are working on a couple of Ebola vaccines, and you mentioned commercialization as well. How extensive is this research? Do you see this being available in the next few years? And how difficult is it to commercialize something like this?

[Dr. Frank Plummer]

Using viruses to deliver a gene of interest is a sort of standard thing in gene therapy and also now in vaccinology. We use two viruses to deliver Ebola genes: one is a nanovirus, and the other is a cow virus called vesicular stomatitis virus. Both produce very robust immune responses that protect monkeys against a thousandfold lethal challenge with Ebola. Also they have some efficacy post-exposure, so after somebody has been exposed accidentally to Ebola, it probably has a role in therapy.

This kind of gene therapy approach has a lot of different potential applications, in which I'm not an expert, but they would certainly include cancer and certain kinds of genetic deficiency diseases. It hasn't made its way into the mainstream yet for the most part, but we're forging ahead with commercialization of these two vaccines. We have companies that are interested. They either have licensed or are interested in licensing the technology, and over the next couple of years we will be doing some clinical trials with them.

The market for these vaccines is not huge. It's a niche market—military, the security community, laboratories. But I think within a couple of years, you'll see them commercially available.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much.

My next question is to Dr. Huntsman. How can the government help reduce red tape to facilitate joint research developments from projects that are funded at the provincial and federal levels? We hear today that things are moving so fast and government has to come up with a regulatory framework for all these things. What do you think we could do to start reducing that part of the red tape that researchers have to face?

[Dr. David Huntsman]

I think that researchers tend to be very imaginative and carrots tend to work very well. You do control funding. If you decide that removing red tape is a valuable thing to do, you can work on it inside Ottawa, but also you could present funding opportunities that have to be interprovincial and address major issues surrounding the personalization of health care. Then you're harnessing the imaginations of a large number of other people to try to find solutions.

In the drug-approval space this is something that is inside your domain where you could make a huge difference and work with the community to reshape drug approvals surrounding personalized medicine indications. There are a lot of people who have probably spoken with your group and others, such as Janet Dancey from the Ontario Institute for Cancer Research, and individuals from the National Cancer Institute of Canada Clinical Trials Group, about how we need to rethink drug approvals. It could make a huge difference.

Things don't have to be completely approved. They could be approved for on-the-ground study without having a global approval. There would be different ways of looking at this.

But in the funding domain, if opportunities were presented that encourage people to work together between provinces you would see solutions coming out of that.

[Colin Carrie, Conservative, Oshawa, ON]

Good.

Dr. Marra, I wanted to expand on what Libby was talking about, because this field of research has a wide range of applications but it will be very costly to apply across society. I was wondering if you had any ideas or if you could expand a little bit more on ways to control costs in order to make these applications scalable and more affordable to Canadians.

[Dr. Marco Marra]

It is still very much in development. The rate of change of technology will continue to drive costs down. It's not at all clear to me, based on what I know of the cancer treatment system, that costs for detailed genome analysis, even in a clinical setting, are prohibitive. If you consider that the direct costs of a bone marrow transplant are somewhat north of a quarter of a million bucks, $1,000 for a genome analysis to predict who should get that transplant and who should not is an investment, it's not a cost. That's where we are right now. That's why this business of personalized medicine is rearing its head and that's why genomics is being used very heavily in this context.

Dr. Huntsman made the point that there are other measurement tools that can and will be applied to personalized medicine. It's absolutely true. We don't know at this particular point whether or not we will need to do a whole genome analysis on every single patient who might benefit.

One does not have to invoke cost reductions of the technology beyond what exists today to know that personalized medicine is here.

There is an interesting corollary to all of this that emerged in the public domain that some people refer to as “recreational genomics” where you could interface with a company and you could spit in a tube and send them DNA. For the cost of a few thousand dollars you would get back a non-medically relevant readout of what your genome reveals, a propensity for earwax included. These kinds of things were purchased by the public without medical benefit at all. That's why I refer to them as recreational genomics, but it shows what the uptake has been. There were companies founded around this.

Now we're in an era where people are information-aware and they're coming forward. They want this kind of thing. They want personalized medicine. The public will demand it. The question is how do we get there and achieve medical benefits along the way.

Cost reductions will happen and the more we use the technology and, as Dr. Huntsman pointed out, the more people are engaged in using the technology, the more the costs will continue to drop. That will improve feasibility, but it's not going to change the fact that it's real and it's now.

[The Chair, Conservative, Joy Smith]

Thank you very much for your answer, Dr. Marra. You had told us that you had to leave at this time. Dr. Huntsman and Dr. Marra, can you stay a few more minutes or will you be leaving right now? I want to thank you for being here. What's your answer?

[Dr. Marco Marra]

Four minutes for me.

[Dr. David Huntsman]

I can do another five minutes as well.

[The Chair, Conservative, Joy Smith]

That's great.

We'll now go to Mr. Easter.

[Wayne Easter, Liberal, Malpeque, PE]

Thank you, Madam Chair.

Thank you, witnesses.

I will admit that I'm not a regular at this committee, but this has been probably one of the most interesting and forward-looking sessions I've been at in a long while.

I might say that I've just come back from meetings in the United States—Canada-U.S. interparliamentary association meetings—at which their fiscal cliff was on the agenda, and their whole health care system versus ours, etc. There's a real fear in the United States, given the need for the government to get its deficit under control, and there's some of that here as well.

There is a fear in many sectors that R and D will be cut back, and I think we can see, Madam Chair, in listening to the presentations, that it would not be a good idea for us to do so. Two things seem to come out of what has been said.

One of you—I believe it was you, Dr. Plummer—mentioned that we need to refit our drug approval process and that “tailored for personalized intervention” needs to be done faster. Someone said that. The other was that we need an R and D strategy that incorporates nanotechnology, etc. What needs to be done to accomplish those two things?

[The Chair, Conservative, Joy Smith]

Who would like to take that on?

Dr. Plummer.

[Dr. Frank Plummer]

I wasn't the one who commented about the personalized drug approval process. I think that's an important issue. I don't have an answer for it, but it's something that needs to be considered as part of how these technologies change the way we do things within the health care sector.

For me, as someone who used to spend a lot of time applying for research grants—not in nanotechnology but in other areas—I think we need larger grant amounts and targeted funding more often than we have currently so that we can actually focus our efforts on a given area, whether it's nanotechnology, or genomics, or whatever.

[The Chair, Conservative, Joy Smith]

Dr. Chan.