Health Committee on June 3rd, 2014

[Carolyn Bennett, Liberal, St. Paul's, ON]

Thanks very much.

Thank you both for coming.

From what you have laid out and what you're already doing at CIHR and PHAC, I think it would be important for me to allow Elizabeth May to try to have some questions as to the intent of her bill versus what we've heard about what's already going on.

I only want to say that as a physician who missed a case of Lyme disease, probably 20 years ago, thankfully the patient had a brother-in-law who is a public health doctor who said, “Carolyn should check you for Lyme disease”. I was reminded by one of my colleagues at my medical school reunion this weekend that, “What I now realize when I miss something is not that I wasn't taught it and forgot it, but that it didn't exist when we were trained”. I think what I'm hearing about both the research and the public information is really important, the fact that when patients are empowered to think about it themselves, only then can we get into the education of our front-line workers. You can't diagnose it if he hasn't thought of it, so I think what we've heard both from CIHR and the Public Health Agency is really important.

Elizabeth, go for it.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Thank you, Carolyn. I appreciate it very much.

I am also very encouraged by what we've just heard from both witnesses on the degree of research and the attention being paid by both the Public Health Agency of Canada and Institute of Infection and Immunology.

I'll be very brief, Mr. Chair, and maybe, Carolyn, you'll still have some time left if you have a question.

To you, Mr. Sternthal, when was the action plan that's referred to in your evidence put in place? I gather that we're still at a preliminary stage, and I'm simply wondering when we started.

[Steven Sternthal]

It was started essentially in the last fiscal year, in the fiscal framework, but it's about a year ago now.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Okay.

I'm very encouraged by your conclusion that doctors should use a clinical approach for diagnosis. We've certainly heard this from a lot of people in the Lyme disease community and from other doctors that I've spoken with. They really believe that the lab tests are so problematic, and because it's so essential that if it is Lyme disease, it get treated early; hence, the clinical approach is the best.

How are you communicating this at the moment to the medical community, that they should approach this from a clinical diagnosis as opposed to waiting for lab tests?

[Steven Sternthal]

The Public Health Agency went through, for example, a significant review of the information that we currently have on our public website. In reviewing it last night, we have over 14 pages, if you print them, of information for health care professionals, which really drives that point quite clearly. In addition to that, the agency has purchased advertisements within key medical journals, including journals focusing on family physicians, across the country to raise awareness and to encourage early diagnosis or early treatment of Lyme disease. We're also working, of course, with the College of Family Physicians and McMaster University on developing a training module for physicians, as well as getting it embedded in the continuing medical education approach that physicians already have in place.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

I have one last question to you before I turn to Dr. Ouellette.

Having looked at Bill C-442, I don't think any bill is perfect at first reading. Are there things in it that you'd like to see improved that are not currently before us in government-recommended amendments?

[Steven Sternthal]

No. As I indicated, we view this building on our action plan, moving forward, and taking it to the next level of work.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Thank you.

Then I have a technical scientific question for Dr. Ouellette.

Thank you again for being here with us virtually.

[Dr. Marc Ouellette]

My pleasure.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

On page 4 of your evidence, you talk about the work of Dr. George Chaconas. I'm fascinated that he's investigating how genetic information in the bacteria which causes Lyme disease is passed on from generation to generation.

Can you clarify? Are we talking about generation to generation of humans or of the ticks?

[Dr. Marc Ouellette]

Of the bacteria within the ticks or within the human body. They had a very special way of dividing their genome from one bacteria to another. This is what he's studying, to try to find new targets that are not part of our human body but are part of the bacteria, and to target them.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

In other words, the focus of his research is to discover ways to limit the impact of the bacteria on the human body?

[Dr. Marc Ouellette]

Exactly. By understanding better how the bacteria divide, you can counteract this activity and reduce and kill the bacteria.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Dr. Ouellette, in your experience, as you present it here, Lyme disease is a complex and difficult illness. It's a hard question to ask, but compared to where we are in dealing with cancer, on a scale of one to ten, where are we on Lyme disease? If where we are with cancer is a ten, where are we with Lyme disease?

[Dr. Marc Ouellette]

Cancer is a big question because there are some cancers we're pretty advanced in treating and others where we're quite behind. It's not an easy question. Lyme disease per se, if you detect it early, responds very well to antibiotics. The problem is that often the symptoms are not clear; the diagnosis is not clear. The bacteria can live for a long time and then there are serious conditions. Even in those serious conditions, most of the time they respond to antibiotics, but again, there's a subset that will not.

I think your parallel with cancer is interesting because some cancers are relatively easily treatable and others are quite resistant to treatment. I would scale them in a similar fashion, although I have to say that cancer currently is affecting many more Canadians than Lyme disease. You have to put things into perspective also.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Of course. Thank you.

Carolyn, if there's any time left for you, I'd appreciate the chair—

[The Chair, Conservative, Ben Lobb]

Go ahead.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Okay.

The other question I want to ask....

Am I out of time?

[The Chair, Conservative, Ben Lobb]

We're right up on seven minutes.

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Okay, perfect. Thank you, Mr. Chair.

[The Chair, Conservative, Ben Lobb]

Thank you.

Mr. Wilks, go ahead.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Thank you, Chair, and I thank the witnesses for being here today.

Dr. Ouellette, I have two questions for you and then two questions for Mr. Sternthal.

In your statement, you said that CIHR's investments also allow researchers to examine protective practices against ticks and tick-borne diseases. Could you elaborate on what those protective practices are?

The second question is on your statement that “We have a better understanding of how this bacteria replicates, how it spreads in the bloodstream, how it evades destruction by the immune system, and how gene expression in the bacteria is regulated.”

Could you please elaborate on that as well?

[Dr. Marc Ouellette]

Very good.

On prevention measures, we know that it's in the environment. There are ticks. There are animals that are the carriers of the bacteria. Ticks have a blood meal on an infected animal, become infected with the bacteria and then can transmit it. Prevention can be at the level of the animals. I think there was this example of West Nile virus, where you can use insecticides to try to kill part of the reservoir of the bacteria, which are the ticks.

But it's also prevention measures and, again, it deals with awareness. People are more aware of the possibility of being bitten by a tick. So, if you wear long sleeves, if you spray yourself with insecticide; these are ways of preventing contraction of Lyme disease. There are multiple ways that you can intervene to try to prevent the transmission of the disease. That would be my answer to your first question.

The answer to your second question, and this is a paradigm of all infectious disease, is that you have to understand the infectious organism, in this case Borrelia—how it enters the human body, how it counteracts the immune system—in order to be able to tackle it. The work that Dr. Chaconas or Dr. Moriarty is doing is to try to better understand this host-pathogen interaction. The host is the human and the pathogen is Borrelia. By having a better understanding of those interactions, it provides a way to try to counteract the effect of that bacteria.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Thank you very much.

Mr. Sternthal, in your opening remarks, you identified a two-tiered test for Lyme disease. One was the ELISA to screen and then the Western blot to confirm the Lyme disease.

Could you explain these two processes a little better so that we understand them, and where they have worked and where they haven't worked?

[Steven Sternthal]

Thank you for the question.

Essentially, as we've said, the two-step testing is not as effective in the early stages of infection, as antibodies are not necessarily developed early on in infections. It becomes more effective as the infection progresses, weeks and then months into the illness, which is why we talked earlier about not wanting to rely on them for the clinicians' diagnosis during that early, acute phase.

In terms of how the tests work, I'm not a laboratory scientist, but these are well-established laboratory techniques for identifying this. If the member would like, I have a colleague from the National Microbiology Laboratory here with me in the room. We can certainly ask him to provide one minute response on the technical aspects of the two tests.

This is Dr. Robbin Lindsay. He's a research scientist from Winnipeg.