Health Committee on March 12th, 2015

[The Chair, Conservative, Ben Lobb]

Good afternoon, ladies and gentlemen. Thank you for attending our committee.

We're continuing our study.

We have a number of guests today who are appearing by video conference. I think that while the technology is up and running, we better hear your testimony first.

First is the Cline Medical Centre, and John Cline.

Go ahead, sir.

[Dr. John C. Cline, Medical Director, Cline Medical Centre]

Good afternoon.

Thank you to the chair of the committee and to my MP, Dr. James Lunney, for inviting me to present.

As you know, there's an urgent need for health care reform in Canada. I believe the solution is to introduce and implement functional medicine in health care professions' curricula and practices throughout Canada.

Functional medicine addresses the underlying causes of disease using a systems-oriented approach and engages both patient and practitioner in a therapeutic partnership.

You have the cover page of “21st Century Medicine”, which is a white paper published a couple of years ago on how functional medicine could take our health care forward.

Functional medicine offers a powerful new operating system and clinical model for assessment, treatment, and prevention of chronic disease. It incorporates the latest in genetic science, systems biology, and the understanding of how environmental and lifestyle factors influence the emergence and progression of disease. It enables physicians and other health professionals to practise proactive, predictive, and personalized medicine.

The slide with the picture of the three-legged stool illustrates the importance of the three components of functional medicine: the patient’s complete story, looking at modifiable lifestyle factors, and a systems biology matrix framework.

The next slide goes over the seven organizing systems where core clinical imbalances are developed, such as, assimilation, defence and repair, energy, and biotransformation.

On the next slide the three core tools are the matrix, the timeline, and a GoTo It heuristic. What this provides the practitioner is a way of critical thinking when presented with complex cases.

The next slide is the functional medicine matrix, with a column “The Patient’s Story Retold” on the left, with antecedents, triggering events, and mediators. On the bottom is a section detailing fundamental lifestyle factors. In the centre is the mental, emotional, and spiritual components of the person, surrounded by the core clinical imbalances.

The next slide looks at the timeline from preconception to current concerns.

Then there is the GoTo It heuristic that helps the practitioner gather, organize, retell the story, and initiate a care plan.

The next slide is a picture of a dense jungle. That's how we often feel when we have these complex cases sitting before us and have to sort all of this out.

We know there are many famous detectives in the world, such as Detective Adrian Monk, Inspector Clouseau, Sherlock Holmes, and then the most famous of all, the medical detective, “Dr. Fxn L. MeD”.

I'll end this presentation with a case study of a woman with severe pain and gasping. This is a woman I met a few years ago. She is a 45-year-old businesswoman who had just got her M.B.A. She had a one-year history of episodic vomiting, diarrhea, abdominal pain, non-throbbing headaches, night sweats, red eyes, and severe muscle and joint pain, especially in the wrists and ankles. She also had intermittent shortness of breath with gasping episodes. You can see what I mean about being in a jungle and having to sort all this out. She had had several ER admissions, and most of her symptoms cleared up within several months.

She had evidence of fluid in her lungs at one of those admissions. Her joints were transiently swollen, and her C-reactive protein level was extremely high, at 211. That's the best marker we have for inflammatory disorder.

She had seen five specialists, including a rheumatologist, who thought she had inflammatory arthritis of unknown origin. She'd seen an ophthalmologist, as well as an allergist, and nobody came up with a diagnosis.

When I was taking her history, there was a key question I asked her: Did anything unusual happen to her just before becoming ill each time? She said, “Yes, one to two days before becoming ill, I sprayed my trees and shrubs with malathion”, which is a potent pesticide and herbicide. Examining her, I found her blood pressure was low, her skin was dry, her finger tips were cracked, the membranes of her nose were quite swollen, and her wrists and ankles were warm to touch.

Her lab work showed that she had iron deficiency anaemia, her C-reactive protein inflammatory marker had come down to 38 and it should be under 5, and her vitamin D level was quite low. I also ordered genomic studies to see how she was designed for detoxification and I found that in her phase I detoxification pathways, two of them had genetic mutations. Then in her phase II pathways, she had a complete absence of the most important pathway for getting metals and chemicals out of the system, called glutathione. This is specific to liver and kidneys.

I went on line to the Agency for Toxic Substances and Disease Registry and found the toxicologic profile for malathion and discovered that it is metabolized through the glutathione pathway, the pathway she was missing, and she had every symptom described in that profile.

The therapeutic intervention was to change her diet and put her on a medical food product to support her detox, probiotics, pharmaceutical-grade fish oil, a good dose of vitamin D, high dose of curcumin, which comes from the spice turmeric, the most potent anti-inflammatory compound on earth, and oral glutathione, and I told her to avoid further exposure to chemicals.

The outcomes at the four-week follow-up showed that her wrist and ankle pain and swelling had improved by 95%. Her arm muscles had regained strength. Her night sweats and GI symptoms had all resolved. Her sinuses were clearer than they had been in year. She had only occasional headaches now, and she was back to work.

The second-last page is cost comparisons. We look at the conventional approach and we see she had had numerous trips to the ER, eight days in hospital, five specialist consults, numerous blood tests and imaging studies, numerous medications, and no diagnosis, with prolonged disability. In the functional medicine approach, she had no ER visits, only two office visits, no specialists, and few blood tests. I had ordered the genomic study on detoxification and comprehensive stool study and arrived at the correct diagnosis. She experienced rapid recovery, was back to work in a month, and regained a thriving life.

I do believe that the answer to our health care problem in Canada is the introduction and implementation of functional medicine in the health care profession's curricula and practice throughout Canada.

Thank you very much.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Next up, from InspireHealth, is Janice Wright, chief medical officer, clinical services. Go ahead.

[Dr. Janice Wright, Chief Medical Officer, Clinical Services, InspireHealth]

Thank you for this opportunity.

As mentioned, my name is Janice Wright. I'm a medical doctor and the CMO of InspireHealth. We are a non-profit charity in Vancouver, British Columbia.

I'd like to talk today about bringing health into health care by using the example of our cancer care model. For us the most innovative thing that we could introduce into our health care system is the support of health.

I'll give a little bit of background on InspireHealth. We're a not-for profit. We were founded 18 years ago by two medical doctors. We are still to this day physician led. We provide a team approach to cancer care. We are grateful to be partially funded by the B.C. Ministry of Health. We work with local and national cancer foundations and would welcome a stronger opportunity to work with the national cancer strategy. I'd like to move right into talking about our current situation in health care.

We view this health care system as being actually more a disease treatment system, or as some people call it, a sick care system, rather than a health care system. Part of the reason for this is that as physicians, we're trained almost exclusively to diagnose and treat disease. Very little time in medical school is dedicated to learning to support our own or our patients' health.

As we all know, money alone will not save the health care system. The focus of our current system is on how to diagnose and treat disease, and few resources are given to prevention. In fact, as physicians and other allied health care providers, we are left to mop up when patients, who perhaps haven't learned how to take care of themselves properly or optimally, develop significant and chronic diseases.

Have we asked ourselves as physicians, as patients, as decision-makers, how we can work to turn off the tap, how we can work more towards prevention?

Our health care system currently does not effectively teach or model health. Medical students and residents, as I mentioned, don't learn how to support their own health let alone their patients' health. We learn how to diagnose and treat disease. Many doctors, as we know, are stressed and burned out and not in the position to model health for their patients.

Turning to our slides, in the disease treatment model, using cancer as an example from our practice, you'll see the tumour with standard therapy, such as surgery, chemotherapy, and radiation targeting the cancer, targeting the tumour, and the physician is the expert and advises the patient on what to do for their health.

In a fuller health care model, those standard therapies are still important. The surgery and chemo and radiation are still targeting the T—for tumour—in this next slide. However, you'll see all of these other ways that the patient...but also allied health care providers including physicians can support the patient to actually feel well, and perhaps to even have a better outcome than they would have with just standard cancer therapies alone.

I'd like to also point out—on the right-hand side of this slide—that the patient is in the driver's seat here. In fact, sometimes at InspireHealth we call them a participant. The patient is having conversations with their physician, their allied health care providers, and we are all having conversations with one another.

It is absolutely essential that patients become empowered, that they take responsibility, that they become engaged in their own health. Physician engagement in health care is equally important. Again, it's essential that physicians learn how to take care of themselves so that they can model this and support patients along the way, working as guides, as educators, as supporters, in addition to being diagnosticians and people who treat. This leads to a very powerful relationship, the physician-patient partnership, where they work together on shared decision-making and work to support the patient's good health.

You might be surprised to hear that actually many of our cancer patients who are working with a life-threatening illness tell us they've never felt better in their lives.

I'd like to also touch on two health care assumptions that I believe are quite prevalent.

One is that health is simply the absence of a diagnosable disease. Patients are sent the message from our current system that they need to be diagnosably sick before they go in to talk to a health care provider about their health.

There is a commercial on TV right now—I'm sure there have been many in the past, and there will be more in the future—that is quite compelling. I won't mention the name of the company. However, a gentleman who appears to be 20 to 25 pounds overweight runs into his home gleefully to eat foods that are highly processed, high-fat foods spread all across the dining-room table. The important part of this commercial is that he has a pill to take for his heartburn. Now, perhaps he doesn't have a diagnosable illness. He may consider himself to be healthy, and just needs to run to the drugstore for his next dose of a pill that might suppress his reflux. But this gentlemen being 24 pounds overweight, as we all know, is at higher risk for developing diabetes, cardiovascular disease, high blood pressure, and other illnesses.

Health is much, much more than the absence of a diagnosable disease.

The other assumption I'd like to touch on today is that people already know how to take care of their own health. I don't actually think that's true in many cases. In fact, as I mentioned, as physicians we don't necessarily know how to optimally take care of our health, or our patients' health either.

I'd like to show you this chart on the slide that reads “Deaths from Heart Disease”. I'd like to give you the example of cardiovascular disease.

Prior to the 1970s and healthy heart programs becoming de rigueur, patients were coming through the emergency room with an acute cardiac event and being told by their physicians that there was nothing that could be done for them. In fact, they were advised not to exercise because it would put them at higher risk for damaging their heart muscle and would lead to another cardiac event or death. Patients were labelled “cardiac cripples”. They were told that diet does not make a difference.

Thanks to some research, mostly that came out of the U.S., there was a change such that now healthy heart programs are recommended to every patient that has a cardiac event. Patients are up and walking and exercising the day after they have either cardiac surgery or an angioplasty. It's very, very powerful medicine. It shows that until that time, we as physicians didn't even know what was best for our patients' health. It's important that we recognize that we don't all necessarily know how to take care of our health and there is much to learn beyond just diagnosing disease.

I'd like to tell you a bit about InspireHealth's model of care. Again, we work exclusively at this time, mandated by the B.C. Ministry of Health, with cancer patients, adults living with cancer and their families. I'll highlight that in a moment.

We believe that we have an innovative program. We are research based. We support the health of cancer patients, but we also support the health of their families. The families come in and learn how to eat healthily through our cooking classes and other programs. They learn how to reduce stress in their lives, not just acutely but long term. They work towards restorative sleep and healthy nutrition. They learn to exercise. They take the programs home with them, or they participate in our exercise or other movement classes. They are provided with emotional and spiritual support.

One of the most important things is that with these group programs, they end up supporting one another. It's in a supportive environment. We provide patient-centred care, a team approach with allied health professionals including nutritionists, counsellors, and exercise therapists. We provide not only in-person programs but also virtual programs that we've now taken across Canada.

I mentioned that we were research based. I want to provide two examples. I won't go into the details, although I'm happy to provide references if you are interested. One shows that physical activity can actually help to prevent cancer in these particular cancers, and the other shows that physical activity can actually help breast cancer patients survive.

Coming to my conclusions, we believe at InspireHealth that the greatest innovation is to bring health into health care. One of the solutions, and a very important one in our eyes, is to actually educate physicians through formal modules on how to take care of their own health and how to support others in their health, so that physicians become educators. They become guides and supports in addition to diagnosticians. They are providing patient-centred care where the patient is in the driver's seat and this powerful relationship between doctor and patient, or other health care provider and patient, is strongly supporting health.

I cannot say enough about group programs. These have been instigated in certain cases across Canada, and I cannot say enough about them. I actually wonder whether we support our patients more greatly or they support one another more greatly. They've been there, and they can support one another in the lifestyle changes they're making that help them feel well and are potentially changing the course of their disease. A team approach is very important, where physicians learn to work not just in a multidisciplinary setting behind closed doors or siloed, but actually alongside one another toward the greatest health for all.

Our model of care is applicable Canada-wide. We've taken it in a virtual way across Canada to date. It is something that we would be happy to be consultants on, to help support the entire spectrum of health across Canada, not only for chronic disease, but for the whole spectrum, including prevention.

Our virtual programs, as I mentioned, have been supporting patients in underserviced areas already, and for patients across the country who don't have access to our services in person. We forge strategic partnerships across Canada with cancer agencies and foundations, and as mentioned, we would welcome the opportunity to work more strongly with the national cancer strategy.

We are very honoured that we are being studied by an international research institute at the moment. It's a four-year study. They have received a sizable research grant to study our model of care. They are doing an observational study, looking at survival outcomes and quality of life. We would also look forward to an economic analysis after that.

I welcome any questions. Thank you.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Up next is Pure North S'Energy Foundation.

[Allan Markin, Founder, Pure North S'Energy Foundation]

Chair, honourable members of the committee, my name is Allan Markin, and my vision is preventive health care for everyone.

I am the founder and chief accountability officer of the Pure North S’Energy Foundation, Canada’s largest primary prevention-focused not-for-profit organization. I'm accompanied by Dr. Mark Atkinson, a medical doctor and director of quality assurance, and Dr. Samantha Kimball, research director at the Pure North S’Energy Foundation.

At Pure North we empower Canadians to feel better and live longer through the use of simple and effective prevention-focused clinical interventions. These include vitamin D3 and high-quality multivitamin and mineral supplementation, health education, and the safe removal of mercury amalgam fillings. Our preventive program supports the advancement of modern medicine. Our multidisciplinary team of over 100 people includes medical doctors, naturopathic doctors, nurse practitioners, dentists, pharmacists, nurses, and other health care professionals.

Over an eight-to-ten-year period, 40,000 Canadians, including 25,000 vulnerable seniors, homeless, and first nations, have accessed our preventive health program, and have their blood panel taken regularly. Participants in our program experience a significant increase in quality of life and a 20% improvement in physical and mental health. Forty-eight per cent of those with pre-diabetes have experienced a complete reversal in their disease. Emerging evidence demonstrates there's a 17% reduction in the prevalence of metabolic syndrome for every 25 nanomoles per litre of vitamin D3 increase.

Our request is for the Government of Canada to proactively resolve what we call the four injustices, and for all Canadian physicians, medical students, dentists, and allied health professionals to be educated about these injustices.

Injustice number one is that Health Canada has regulated that no supplement in Canada contain more than 1,000 IUs of vitamin D3. Any amount higher than this requires a doctor’s prescription and is regarded a drug. In the U.S.A., a country that has exactly the same recommended daily allowance for vitamin D3 as Canada, people have access to vitamin D3 supplements containing 7,000 IUs of vitamin D3 per tablet. It does not require a prescription, to our knowledge. The FDA has not put a limit on the amount of vitamin D3 in a pill, but Health Canada has. Canadians should have access to vitamin D3 supplements at the same dose as Americans, or higher.

Injustice number two is that the recommended daily allowance for vitamin D3 should be changed to be between 7,000 IUs and 9,000 IUs. Health Canada has been proven to have made a significant mathematical error in their calculation of the RDA for vitamin D3. The Health Canada vitamin D3 RDA for most adults is 600 IUs per day. Using Health Canada data and the correct statistical methodology, Professor Paul Veugelers at the University of Alberta has shown that the IOM vitamin D3 recommendation would have been 9,000 IUs per day if IOM had not made a math error. Another group, led by Dr. Heaney, a vitamin D3 expert from Creighton University in Nebraska, came up with a similar figure of 7,000 IUs based on an analysis of a dataset of 3,600 individuals. Dr. Kimball has published extensively on vitamin D3, including a trial of 14,000 IUs per day in patients with MS. The evidence is clear: vitamin D3 is safe, and the vitamin D3 RDA should be 10 to 15 times higher than the current Health Canada RDA.

Injustice number three is that Canada needs to mandate a complete ban on the use of mercury amalgam fillings in all Canadians, and not just children, pregnant women, and those with impaired kidney function. In Health Canada's report, “The Safety of Dental Amalgam”, they acknowledge that amalgams impair kidney function. Pure North research has found that the safe removal of amalgams results in a significant improvement in kidney and liver function and in self-reported physical and mental health symptoms, such as anger, depression, and anxiety. The World Health Organization acknowledges that mercury is poisonous at any level. The use of mercury amalgam fillings has already been completely banned in Norway, Sweden, and soon Brazil, as well as a partial ban in Denmark. Canada needs to follow suit. Amalgam removal needs to be done safely.

Injustice number four is that Canadian emergency departments have unnecessarily long lineups and waiting times. The Wait Time Alliance’s annual report card states that 27% of Canadians reported waiting more than four hours in an emergency department, as compared with 1% in the Netherlands, for example.

A recent analysis of the data relating to 6,600 of our program participants by the school of public policy at the University of Calgary found that a preventive health program such as Pure North's keeps people out of hospital. Within one year of being on the program, the Pure North participants had 45% fewer nights in hospital and accessed emergency departments 28% less than controls. This happened in less than one year.

The inconvenient truth is that millions of Canadians experience disease and suffer unnecessarily because our health care system has not yet made primary prevention a priority.

In 1943 the Canadian Medical Association called for preventive medicine to become a federal priority.

The World Health Organization report on the impact of chronic disease in Canada predicted that between 2005 and 2015 over two million Canadians, or 400,000 people a year, on average, will die from chronic disease.

Studies have found that if Canadians optimized their intake of vitamin D3, 37,000 premature deaths would be prevented annually, and the economic burden would be reduced by $20 billion per year.

In summary, integration of a proven preventive health program such as Pure North’s prevents premature deaths and saves the government money. An assessment of the economic impact of our program estimated that every dollar invested in the Pure North program provides a return of between 13:1 and 25:1.

The result is that the health care cost curve is bent downwards with real potential cost savings of at least $420 million per year if rolled out to 600,000 Canadians. If Alberta, for example, implemented the Pure North program province-wide, this could free up the equivalent of 1,600 hospital beds every year. This is roughly the same as building two entirely new hospitals.

The provincial governments are also locked into an unfortunate mindset that the health care costs avoided rather than current health care dollars saved are not worth pursuing. Preventing [Technical Difficulty—Editor] chronic disease in the future avoids the size of the increase in budget that we are otherwise headed for. To avoid prevention since it does not reduce the size of the health budget today is nothing more than flawed logic with tragic implications, a sicker population and ever-increasing costs of treating them.

It is our hope that the Standing Committee on Health will attach great importance to these issues and take action to resolve them.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Our final guest today is here in person. From the Canadian Association of Midwives, we have Emmanuelle Hébert. Go ahead.

[Emmanuelle Hébert, President, Canadian Association of Midwives]

Thank you, Mr. Chair and committee members, for the opportunity to appear today to contribute to the study of best practices and federal barriers related to scope of practice and skills training of healthcare professionals.

My name is Emmanuelle Hébert, President of the Canadian Association of Midwives, registered midwife and professor at the Université du Québec à Trois-Rivières.

The Canadian Association of Midwives is the national organization representing midwives and the profession of midwifery in Canada. The association's mission is to provide leadership and advocacy for midwifery as a regulated, publicly founded and vital part of the primary maternity care system in all Canadian jurisdictions.

The Canadian Association of Midwives also works to support the interests and objectives of 13 provincial and territorial midwifery associations, as well as the National Aboriginal Council of Midwives. There are currently just over 1,300 practising midwives in Canada.

Registered midwives are health professionals who provide primary care to women and their babies during pregnancy, birth and the post-partum period. They are often the first point of entry to maternity services, and are fully responsible for clinical decisions and the management of care within their scope of practice. Models of care vary across the country, but are based on the principles of continuity of care provider, informed choice, and the choice of birth place which includes hospitals, birth centres and homes.

Midwives regularly interact with a wide variety of health care professionals and social services workers in order to provide optimal care for clients. These include obstetricians and gynecologists, family physicians, pediatricians, nurses, radiologists, psychiatrists, paramedics, social workers, pharmacists, dieticians, and many more.

Collaboration and consultation with other health care providers is integral to the scope and practice of midwifery. Midwives, together with physicians and nurses, are actively exploring collaborative models of care and multidisciplinary practice to help address shortages of care providers and ensure women's access to maternity services, particularly in rural and remote communities.

Let's talk about midwifery training. The midwifery education program is a four-year direct entry baccalaureate program in midwifery. Seven Canadian universities in five provinces offer the midwifery education program. There are also three community-based midwifery education programs located in first nations and Inuit communities that specifically address the needs of aboriginal peoples.

Three bridging programs also exist in Canada, designed to help internationally educated midwives learn how to use their skills in a Canadian context; one in British Columbia, one in Ontario and one in Quebec. All students graduating from the midwifery baccalaureate programs take the Canadian midwifery registration examination which demonstrates that they have the core competencies and meet a common standard for entry level competency in all Canadian jurisdictions. All midwifery education programs are based on the same standards of education to train midwives as autonomous primary health care providers able to practise in all provinces and territories.

In jurisdictions where midwives work to their full scope, midwifery practice includes epidural monitoring, induction for post-term pregnancy and augmentation of labour by pharmacological means, prescription or fitting of contraceptives, well women and well baby care beyond the six-week post-partum period, and other aspects of primary care.

Scopes of practice reviews to amend drug schedules and expand on the authorized acts that midwives may perform have been completed. The objective is to harmonize high standards of midwifery care across Canada, reduce barriers to interprofessional collaboration and keep pace with a changing maternity and newborn care environment.

In every jurisdiction where midwifery is regulated, the provincial and territorial colleges are responsible for registering competent, qualified midwives and establishing, monitoring and upholding standards of practice.

The Canadian Midwifery Regulators Consortium is a body that groups together the provincial and territorial regulatory bodies. It has identified competencies that are common across all jurisdictions, covering antepartum care, care during labour and birth, postpartum care of the woman, care of the newborn and young infant, breast feeding, well woman care, education and counseling, and professional, interprofessional and legal issues.

Regulatory authorities further specify advanced competencies that midwives with the necessary training and certification may perform in certain situations or practice settings. In some rural or remote communities for example, midwives work to an expanded scope and provide a broader range of services to meet the needs of the population. Definitions of advanced—versus entry-level—competencies vary according to the regulatory framework in each province and territory.

In June 2017, Canada will host the world's Triennial Global Midwifery Congress in Toronto. Over 4,000 midwives and maternity care providers from around the globe will be in Canada. This will be a unique opportunity for us to show the world Canada's contributions and to highlight what we do within our own borders to provide fair and equitable maternity care to all of the population.

In order to optimize that visibility in Canada, the Canadian Association of Midwives believes that we should ensure that federal mechanisms are in place to allow communities to hire midwives to deliver maternity and newborn care services. Midwifery is not listed as a recognized profession under the Health Services Occupational Group Structure within the Treasury Board of Canada. This lack of an occupational classification has been identified as a barrier to midwives being hired by communities under federal jurisdiction for service delivery.

Maternal and child health statistics in aboriginal communities fall well below that of the rest of Canada. As the rest of Canada's fertility rates decline, the fertility rates of first nations and Inuit peoples increase. This is in the midst of a severe shortage of maternity and newborn health care providers.

These communities are already underserved and will feel the effects of this crisis disproportionately in the coming years. It is therefore crucial that birth care be brought back to communities and that access to midwifery care services in all aboriginal communities be provided.

Since April 2013, the Government of Canada has been providing student loan forgiveness to eligible family doctors, residents in family medicine, nurse practitioners, and nurses who work in rural or remote communities. Including midwives in this incentive program would increase the outflow of maternity care providers to rural and remote communities.

In New Brunswick, Prince Edward Island, Newfoundland and Labrador and in the Yukon, the profession of midwifery is still not regulated. CAM is working with its provincial and territorial partners and stakeholders to support the regulation of the profession in all jurisdictions.

As stated in the prestigious and well-respected Lancet series published in June 2014, midwifery plays an essential and unique role in ensuring safe, quality and cost effective care to women and babies here and around the world.

Thank you for the opportunity to appear before the committee. I look forward to any questions you may have.

Thank you very much.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

We're going to go into our rounds of questions now. Usually I'm quite lenient on time, but to get our rounds in, I'll be cutting off the members at seven minutes sharp.

That being said, Ms. Moore will be asking her questions in French. She'll give you a little practice round just to make sure you can hear it and the interpretation is working. If it is, her time will start.

Go ahead.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Thank you, Mr. Chair.

When I was a student, there was a focus on clinical assessment. It was said that questions accounted for 70% of that assessment. You had to take the time to assess the patient well and this was done through questions alone. The physical and visual examination, where the patient is touched, made up 20% of the assessment. Additional tests such as blood tests or X-rays made up the remaining 10%.

One often gets the impression now that the opposite happens when you go to a hospital emergency ward to see a doctor. There they ask you questions during one or two minutes, you are examined for a minute or two, and then you are sent for a multiple series of tests, blood tests, lab tests, X-rays, and so on.

Dr. Cline, can you tell me what you think of that? Perhaps the same problem exists in traditional medicine, where physicians take less and less time to question a patient and carry out an in-depth clinical exam. If a physician took the time to question the patient, he or she could have a better idea of what is going on.

[Dr. John C. Cline]

Thank you for the question.

This is absolutely true. Sir William Osler, the famous Canadian physician, said to his medical students a century ago that if you listen carefully enough to your patient they will tell you what the problem is. For the case I presented, it took me one and a half hours to take that history and to do a careful physical examination.

When I teach residents in functional medicine, I'm surprised at their lack of physical exam skills. A large part of my teaching is on helping residents to sharpen up their history-taking skills and physical exams skills.

The power of the functional medicine matrix is that it forces you to think outside of your comfort zone and it forces you to be thorough in your critical thinking of these complex cases. It also helps us to hone in on what the patient has deemed most important. We teach our functional medicine residents to retell the patient's story back to them, and that's a very powerful therapeutic encounter.

The history and physical exam is still a cornerstone and should be the foundation on which you build other tests.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Ms. Hébert, my question to you is in the same vein as the previous one.

In your opinion, is the success midwives have in their relationship with patients attributable to the fact that they take much more time to talk to them and assess them properly so as to target their needs? This could be why many patients report preferring their experience with a midwife to the ones they have had with traditional medicine.

[Emmanuelle Hébert]

It is certainly true that the time spent with each woman is very important. In fact, the relationship is at the very core of the midwifery profession. In order to support a woman well in her labour and delivery, it is very important that the midwife develop a relationship with her. Also, the woman must be placed at the centre of the decision-making, so there is really a partnership that develops, which is very important.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

Is the building of such a relationship a part of the training provided to midwives? Is the training limited to teaching midwives the biological aspect of maternal health, or does it also focus on the relationship with the patient and the assessment of her needs? Does the training allow midwives to acquire communication and helping relationship skills, or is it mostly focused on the biological aspect?

[Emmanuelle Hébert]

A large part of the training is focused on the relationship, the helping relationship, and communication. The students who do a baccalaureate in midwifery practice have several semesters of practical training and are trained individually by midwives. The midwife becomes a role model for the students. This is an important and integral part of the midwifery practice curriculums. It is really very important to us.

[Christine Moore, NDP, Abitibi—Témiscamingue, QC]

My question is addressed to the two witnesses who have not spoken yet.

Do you find that the success of your preventive approach is due to the additional time you devote to patients and to the fact that as compared to more traditional systems, you are much more aware of their needs?

[Dr. Mark Atkinson, Director, Quality Assurance, Pure North S'Energy Foundation]

I'd welcome the opportunity to speak to that.

There are a number of factors here. The first thing is that when people come into a preventive health program, there are a number of health professionals who are working with them, from the receptionist, to the phlebotomist, to the nurse, to the doctor. We're wrapping around individuals so they know we are here to support them. That can....[Technical Difficulty—Editor]

The second thing is the time we spend with them. We are getting to know them, their context, and the way they live their life. That matters.

The other big thing in prevention is our focus on the solution rather than the problem. We are much more interested in not what's wrong, but what's right, what needs to change, and what their goal or aspiration is for their health. That combination is very effective.

[Allan Markin]

I would quickly add to that. Thank you for the question.

Our system has a lot of documents to fill out. It gives you a pretty good idea in a very short period of time exactly what their challenge is, in order that we can prevent it from happening in the future.

Do you want to add anything, Samantha?

[The Chair, Conservative, Ben Lobb]

We are out of time. I apologize. We have to keep it to seven minutes here for time's sake.

Mr. Lunney, go ahead, sir.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

We welcome all of our witnesses to this committee. I want to say to all of you how much we appreciate your testimony today.

Thank you, Dr. Cline, for that interesting case history and the importance of a proper investigation and diagnosis.

Of course, I think you'd be interested to hear that it was Pure North S'Energy that brought up the problem of toxification through mercury amalgam, which is a big concern to many people in the integrated med world.

Allan and Mark, I appreciate that Pure North S'Energy has raised the issue of Vitamin D. I think several of you mentioned Vitamin D, and I hope to hear a little more from all of you on that. I have a motion before this committee to look into two of the four injustices that you mentioned, so I want to come back to that in just a minute.

The first thing I want to mention is that I really appreciated this tile. Not all of you would have seen this, but it's from InspireHealth. Dr. Wright, you have a great cartoon presentation here. You won't be able to see this, but it shows a very busy doctor sweating away and mopping the floor while the sink is overflowing, and no one is paying attention to turning the tap off. I think there is something in common there with the energy that we are spending trying to manage our health care expenses while often missing the root-cause issues.

What I want to suggest is that there is a lot of stress in medicine, and what I've noticed about the groups that are present here is that you are very happy and enthusiastic about what you are engaged in. There is a lot of stress for some of your doctors.

I want to start with InspireHealth and just say that your program seems to take the stress out of cancer therapy for the patients. They can always engage with somebody. We heard from Dr. Cline about the importance of building a relationship with the patient, telling their story back to them, making sure they are understood, but managing stress.

Your results and outcomes in managing the cancer patients, along with the traditional cancer therapy that is targeting the lesions being addressed, have the attention of the B.C. government and the BC Cancer Agency. Your outcomes are sufficiently significant for your patients. B.C. has good statistics and you have received attention.

You do outreach to remote areas. I want you to briefly explain to this group how that works, and the role of Vitamin D in the better outcomes that you're getting. If you would, please start there.

[Dr. Janice Wright]

Thank you for the question.

With regard to our outreach, we reach out by virtual online programs. We provide group programs but also confidential consultations with any member of our team a patient chooses. Not only are those opportunities available right now throughout the province in rural and remote areas, underserviced areas, but we've also just taken it Canada-wide. There's that piece.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Do you fly out to the region, meet with the people first, and then follow up through electronic means once you've established a relationship? Is that part of the program? I know you started that way.

[Dr. Janice Wright]

That is part of the program. We send a multidisciplinary team into a community, and by the way, the community actually helps to fundraise to bring us out there, which is just amazing. They see the value of this and they fundraise to help us come. We arrive there, and we do a one-day program on preventive health and on secondary prevention and supportive health, including mind/body relaxation practices, exercise, nutrition, etc. Then we fly home and support them online and over the phone.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Someone can always get through to you.

Can you explain the role of vitamin D in your program, along with the other things you do?

[Dr. Janice Wright]

One of the foundational studies on vitamin D came out of the U.S. in 2007. We've been following the literature on vitamin D for many chronic diseases, but in our case specifically with regard to cancer care over the last seven or eight years. We recommend it not only for the prevention of cancer in a cancer patient's families and friends and community, but also for the cancer patients themselves. We're currently conducting an in-house trial as well on vitamin D and stage 4 colorectal cancer. There's very promising news about vitamin D and its role in cancer prevention and secondary prevention.