Evidence of meeting #117 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was research.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Deljit Bains  Leader, South Asian Health Institute, Fraser Health
Richard Sztramko  Chief Medical Officer, Reliq Health Technologies
Bruce Verchere  Professor, Departments of Surgery, Pathology and Laboratory Medicine, University of British Columbia, As an Individual
Marilee Nowgesic  Executive Director, Canadian Indigenous Nurses Association

9:35 a.m.

Professor, Departments of Surgery, Pathology and Laboratory Medicine, University of British Columbia, As an Individual

Dr. Bruce Verchere

That's an excellent question.

It seems that type 1 diabetes prevalence is highest in countries in sort of temperate climates in northern hemispheres. You also see it very high in Scandinavian countries and in Sardinia, interestingly. Canada is, I think, seventh worldwide.

The increasing prevalence of type 1 diabetes is going along with other autoimmune diseases, as well, that tend to be on the rise. There are a number of theories for that. Our genetics haven't changed that much over the years, so it's thought that it's maybe some environmental trigger like a virus or something that could initiate the autoimmune response.

In the case of autoimmune disease and type 1 diabetes specifically, one of the hypotheses out there is a hygiene hypothesis, and that we now grow up, our kids grow up in an environment that is much cleaner than the ones we grew up in as kids. I'm speaking about us older folks who played in the sandbox and got a bit dirtier. There may be something that goes on with sort of the gain setting of the immune system, the sensitivity.

What goes wrong in autoimmune disease is the recognition of self. The immune system fails to realize that the insulin-producing beta cells are its own cells and it attacks them as though they're an infection, a bug or a virally infected cell. One hypothesis is that in this cleaner environment we grow up in now, because of better antibiotics and the like, more antiseptic procedures and general cleanliness, we are more prone to the development of autoimmune disease when it's triggered by whatever that trigger may be.

October 23rd, 2018 / 9:35 a.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

You mentioned a number of countries and different experiences, Sardinia and some tropical countries. I'm wondering, Dr. Verchere, about the current state of international collaboration in terms of research. A more specific question I would ask you is whether we have targeted research monies in Canada that are assisting Canadian researchers like you to engage in internationally collaborative research on diabetes.

9:35 a.m.

Professor, Departments of Surgery, Pathology and Laboratory Medicine, University of British Columbia, As an Individual

Dr. Bruce Verchere

We're entrepreneurs and we apply for funds and to competitions wherever they may come up. We tend to create collaborative teams in the way that's most likely to allow us to move the research forward wherever that may be around the world.

For example, in the European Union, they have this European foundation that studied diabetes, so there are mechanisms within Europe for more collaborative international-type applications.

We are eligible, for example, through NIH in the U.S. We can apply with U.S. collaborators. So there are mechanisms whereby we can collaborate internationally. There are other broader programs like the Human Frontier Science Program, which doesn't specifically target diabetes research but targets biology in general. Those specifically require that there be investigators and labs from different participating and member countries. I think it's an excellent question, and I think it would be a really interesting and potentially impactful funding mechanism.

We have a lot to learn from what we share with those other countries. One of the things those countries do well—I'll use Finland as an example—is to track babies from birth, doing biomarker analysis and some genetic analysis and tracking them as they go through to assess their risk of diabetes, to try to understand what those triggers are. It's expensive, but I think it would be really valuable to do that sort of research to track Canadian kids from birth as they proceed and follow those who go on to develop diabetes and then look retrospectively to see what markers, what genes might have been there that would have given them risk or triggered the disease.

9:40 a.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Are there any gender considerations? We've heard a lot about differences in terms of cultures and ethnicity and the prevalence of diabetes. I don't know that we've heard a lot about particular differences in the prevalence of diabetes or different considerations from a gender perspective.

Do you have anything to share with us in that respect?

9:40 a.m.

Professor, Departments of Surgery, Pathology and Laboratory Medicine, University of British Columbia, As an Individual

Dr. Bruce Verchere

That's a really important question. It's being recognized now at CIHR. When we submit grants and when we review grants, we are obligated—and I think it's a good thing—to address gender and sex differences.

In terms of diabetes, I'll speak about the two major forms separately. Type 1 diabetes is quite interesting. There isn't really any notable gender difference in the incidence of type 1 diabetes. There are some potential differences, but they're not large. In terms of severity of disease, it may be a bit greater in the age of onset, a bit more severe in girls in earlier onset than boys, but those are not huge differences.

Interestingly, most other autoimmune diseases, for example, scleroderma, have a higher incidence in women. That's not really true for type 1 diabetes, so the question of why that difference isn't there is very interesting. It may be insightful into the mechanism of the disease. In one of the animal models we use, called the non-obese diabetic mouse, a type 1 diabetes model, the incidence is much higher in females. Learning why that happens in mice but not in humans could be insightful in terms of disease mechanism.

In type 2 diabetes, it's also true that the incidence is pretty similar. We don't see big increases. Of course, women are susceptible to gestational diabetes in pregnancy, but usually, after delivery the diabetes resolves. It does increase their risk of diabetes in a successive pregnancy and their risk of developing type 2 diabetes later in life. As they approach menopause with normal aging, it is higher in women who have had gestational diabetes. That's an interesting association, and it again gives us some insight into the disease, but there aren't really profound differences in the incidence of type 2 diabetes between men and women.

Gender and sex considerations must be addressed in grant applications to CIHR now.

9:40 a.m.

Liberal

The Chair Liberal Bill Casey

Thank you very much.

Now we'll go to Mr. Ayoub.

9:40 a.m.

Liberal

Ramez Ayoub Liberal Thérèse-De Blainville, QC

Thank you, Mr. Chair.

I will give a few minutes to ensure they get the translation on.

9:40 a.m.

Professor, Departments of Surgery, Pathology and Laboratory Medicine, University of British Columbia, As an Individual

Dr. Bruce Verchere

I will need it—despite the French name.

9:40 a.m.

Liberal

Ramez Ayoub Liberal Thérèse-De Blainville, QC

Dr. Verchere, I would like to continue the discussion on research you were having with my colleague Mr. Davies.

The Canadian Diabetes Strategy is not new. For example, a strategy was developed in 1999. An amount of $115 million was set aside over a five-year period. In 2005, there was a new strategy with a large investment—a $70-million envelope—specifically concerning aboriginals.

I don't want to make this into a litany, but a number of initiatives have been launched and a lot of money spent to advance diabetes research. The Auditor General recently concluded that the Public Health Agency of Canada did not know “whether its activities have had an impact on the well-being of people who live with diabetes or who are at risk of developing the disease.”

What is your short-term vision of the research, considering all those investments? Where are we going?

What is the purpose of the research? Is it a matter of finding a treatment, a drug or a way to cure the disease once diabetes has been diagnosed?

When do think you will be able to find that treatment, if ever?

9:45 a.m.

Professor, Departments of Surgery, Pathology and Laboratory Medicine, University of British Columbia, As an Individual

Dr. Bruce Verchere

Thank you for that excellent question, which I think is really fundamental to what we do. We certainly recognize that millions of dollars are invested in diabetes research. Science and discovery, by their nature, are sometimes frustratingly slow processes.

I'm not sure if I was cut off when I was making my opening statement, but I think one example in type 2 diabetes of these potentially game-changing drugs derived from gut hormones is from a discovery in Canada from many years ago in the 1960s and 1970s. Fifty years ago it was discovered that these gut hormones can stimulate insulin secretion, and it's only been in the last decade that these drugs have come into clinical use. From discovery to cure or to improved therapy is a long process. We're in it for the long haul. We still really need research to address the gaps in knowledge with regard to the basic mechanism of disease in both type 1 diabetes and type 2 diabetes.

I recognize that this is somewhat unsatisfying for people living with disease now—although it does provide hope—and for funders. At the same time as support goes on for that basic research into understanding disease mechanisms that have the potential to develop into therapies, there is also research that goes on and needs to be supported, research that has the potential to improve the lives of people right away. You heard from the other speakers about diabetes technologies, for example. There are better insulins now. There are insulin pumps. There is continuous glucose monitoring. There is movement towards the artificial pancreas, a closed-loop system in which insulin is released in response to algorithms that detect changes in blood glucose. These are incredibly transformative things that are happening now that are impacting the lives of people with diabetes. Also, there are new preventative-type strategic implementations, such as exercise and diet programs. These are things that are impacting the lives of people with diabetes now. They're not curing the disease, but they are reducing the burden of disease and are impactful. So, I think the—

9:45 a.m.

Liberal

Ramez Ayoub Liberal Thérèse-De Blainville, QC

I have to interrupt you.

I only have a few minutes, so I need to cut you off so that I can ask you a second question.

When we look at the numbers, they are dramatically increasing. From 2015 to the projection in 2025, 12% of the population is going to have diabetes. How can we measure the success of the research in the short term, and how can we have the funding put into the right place? I know that the solutions post-diagnosis are very high because the success is there. There are so many people involved, so the technology follows at some point, but just to make sure that we—

9:50 a.m.

Professor, Departments of Surgery, Pathology and Laboratory Medicine, University of British Columbia, As an Individual

Dr. Bruce Verchere

We definitely need research on the outcome side to understand. Are we flattening that line as the incidence goes up and up? Are we reducing the burden of disease, or are we at least decreasing the rate at which it is increasing?

Outcomes-type research that gives us an idea of how well programs and therapies are impacting people is very important, I think. As I mentioned, I think that funding research towards where there are knowledge gaps to understanding disease mechanism is important, as are implementation strategies, health services research, and things that would give us an idea of what is impacting the lives of people with diabetes today.

In terms of funding, I think there is a combination of mechanisms. If the CIHR-based funding is strong and increasing, I think the top diabetes research ideas will bubble to the top and get funded, and that will lead to new discovery. Then, targeted initiatives and partnerships—for example, the $30-million clinical trials partnership between JDRF and CIHR—allow us to look at the impact of potential new drugs on disease in clinical trials. I think there are innovative ways to fund in a targeted way with partners, but also to maintain that base funding so that the best diabetes research and research capacity will still be there.

9:50 a.m.

Liberal

Ramez Ayoub Liberal Thérèse-De Blainville, QC

Thank you.

9:50 a.m.

Liberal

The Chair Liberal Bill Casey

Now we are going to our five-minute round. Because we have to do our drafting instructions for diabetes strategies and also M-132, I'm going to just allow five minutes for the Conservatives, five minutes for the Liberals and three minutes for the NDP. We're going to lose two questions.

We'll start with the Conservatives. I understand you're going to split your time.

9:50 a.m.

Conservative

Ben Lobb Conservative Huron—Bruce, ON

I'll ask two quick questions and then turn it over to Mr. Kmiec.

9:50 a.m.

Liberal

The Chair Liberal Bill Casey

Two and a half minutes goes pretty quickly.

9:50 a.m.

Conservative

Ben Lobb Conservative Huron—Bruce, ON

It sure does.

Marilee, you're here today. We've seen you at committee many times before. We've heard Richard's comments about technology.

If it's a nice piece of technology and it's proven to work in other jurisdictions, what prevents it from moving into other communities in the north and helping more people out? Are there barriers there?

9:50 a.m.

Executive Director, Canadian Indigenous Nurses Association

Marilee Nowgesic

There are going to be barriers because of the level of literacy and language, the ability of the people who are the end users to be able to use the device in a positive fashion.

Because you're also having to consider broadband width, is there a connectivity issue? Then if something goes wrong, they don't have an IT department that they can just run over to and get help to fix a problem.

On the whole idea regarding activity, I encourage my colleagues to go to a first nations community and try activity—10,000 steps on a reserve—and see how far you get before you get to 200.

9:50 a.m.

Conservative

Ben Lobb Conservative Huron—Bruce, ON

Specifically though, are there issues dealing with the department or the band to provide the funding to allow projects like this to move forward?

9:50 a.m.

Executive Director, Canadian Indigenous Nurses Association

Marilee Nowgesic

It's going to be whether non-insured health benefits recognize it as an approvable device. Then it's a matter of what the application procedure is for the client to be able to obtain the device, work through it, download it; understand that there are high-risk cost factors.

9:50 a.m.

Conservative

Ben Lobb Conservative Huron—Bruce, ON

Richard, I know you guys are in remote parts of the south in very rural communities. How have you overcome the obstacles that Marilee has just mentioned there?

9:50 a.m.

Chief Medical Officer, Reliq Health Technologies

Dr. Richard Sztramko

I think it's the high-touch approach. I would never drop in on one of these communities and say, “This is what you should do.” It's really coming into contact with people like Marilee or people who are in the communities themselves. There are nursing stations in some of these communities, so it's about educating the people who will manage those nursing stations, making sure the human resources are well trained. As I stated, you can't just dump technology on people. You have to understand how they're going to use it.

Also, not all patients with diabetes are the same, so it's about trying to figure out who can use it and who can't use it and segmenting the population, so that you're finding the appropriate people with the solution.

9:55 a.m.

Conservative

Tom Kmiec Conservative Calgary Shepard, AB

How much time do I have, Mr. Chair?

9:55 a.m.

Liberal

The Chair Liberal Bill Casey

You have two and a half minutes.

9:55 a.m.

Conservative

Tom Kmiec Conservative Calgary Shepard, AB

That's perfect. Thank you.

The reason I brought up the disability tax credit is that I have a private member's bill, C-399, that is supported by JDRF, Diabetes Canada and the Canadian Nurses Association that would make it simpler, especially for diabetics—that was my intention behind it—to qualify for this tax measure, so they could have that $2,000 to $4,000, roughly speaking, returned to them because they're already managing enough with the condition they have. Taxes should be the simpler part of it, I would hope, which I understand is almost like a pun.

Is making it simpler on the tax side and on physicians to apply on behalf of their patients an important part of any diabetes strategy? I have the pre-budget submissions of JDRF and Diabetes Canada with me as well. They focus a lot on the tax side of things, because lightening the load is really important.

Marilee, I see you nodding quite a bit.