Health Committee on Oct. 23rd, 2018

[Marilee Nowgesic]

It's an interesting concept, one that both first nations and Inuit would be very new to. It's a matter of understanding how the application will be done by them. It's even a matter of how it's understood. Have they even filed before? Because they're at the community level, we know there are problems with getting forms done. Then regarding the physician being able to help the people in getting the application filled, physicians aren't always readily available at the community level, especially in remote and isolated communities, so it becomes problematic.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Mr. Sztramko, we talked a little bit about the technology you have. I mentioned that it was an opportunity to keep the calculation of dosage in mind. In my private member's bill, I'm proposing it be included in the 14 hours, and the 14 hours be reduced to 10 to make it simpler on the physicians and on the patients to qualify for it. Is it something that your company could help with, or do you know of other companies that could monitor and track that particular portion so that patients would be able to qualify for DTC? The DTC actually opens access to provincial welfare programs, access to the RDSP, registered disability savings plans, which have matching up to something like $60,000 to $80,000 from federal and provincial sources. There is a lot of money that could go here that could help patients deal with their conditions in the long term.

There's the prevention side, which Ms. Bains, you're doing a lot of. But there is also the point where you have a condition now; it's about managing as best you can.

[Dr. Richard Sztramko]

I think it's a brilliant idea. Speaking as somebody who actually fills out the form, any time you can simplify or automate the process...it's essentially filling out the same information on 10 separate sheets. I'm very excited about this. I have not thought about this previously but we can certainly track that information.

Right now, in the United States, we have to track physician time and nursing time for chronic management codes. That's part of the platform we continue to build down there. I'm actually really excited about this concept. We could automate so much of the process from the patient's health information, if they're okay with it, to help to fill out this form and get them coverage. I'm very excited about this idea.

[The Chair, Liberal, Bill Casey]

That's a good point. In my experience, when somebody becomes disabled, the first thing that happens is they go broke because they can't work, and that adds an extra burden, making their disability a lot worse, especially with diabetes.

Mr. McKinnon.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Thank you Chair.

I have one quick question for Ms. Nowgesic and then I'll pass the baton to Mr. Boissonnault, who has a most excellent question also.

Mr. Lobb and Mr. Kmiec spoke of some of the cultural barriers. I wonder if you could expand on the cultural and other barriers that indigenous individuals face in accessing care for pre-diabetes and diabetes.

[Marilee Nowgesic]

We know that it's going to be based on a couple of barriers, one of them being the colonial legacy of health care where indigenous people are experiencing poor impacts, poor access to health care, racism and blaming, a you-did-this-to-yourself type of attitude, instead of looking at some of the underlying conditions. The other is to take into context the cultural safety that is being provided to clients. How does the family understand their impact in relation to helping the person deal with their illness, rather than the stigma of telling them they did it to themselves?

Also, there's a problem with authority figures. The physician or nurse may be seen by the indigenous client as one who has a type of control over them, not realizing that all people actually have control over themselves. They also have to understand the environment that this person is having to live with. Are they looking to live off the land? They're not able to run to a Shoppers Drug Mart or to a grocery store to buy healthy foods or get the healthy quantities required.

It's a matter of looking at what we're dealing with here. Another cultural aspect is the fact that we have to be respectful of the protocols for leadership. What is the leadership doing in order to be able to address the illness in a positive fashion so we can move forward and identify some of those health-access barriers. Why are they there?

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Thank you.

Mr. Boissonnault.

[Randy Boissonnault, Liberal, Edmonton Centre, AB]

Dr. Verchere, it was Ray Rajotte and James Shapiro, two physicians at the Alberta Diabetes Institute, who were responsible for getting us to the Edmonton Protocol. In your opinion, what else could we be doing to make sure that more people can take advantage of that, and what are some of the other milestones you would like to see for this type of diabetes research?

[Dr. Bruce Verchere]

I know Ray and James very well. Ray is retired but I collaborated with James and colleagues at the University of Alberta. We're quite interested in this question. I think it's just not as promising as the potentially curative therapy that islet transplantation is. It's really been limited worldwide to only a few hundred patients, and that's for a number of reasons. One is that there are just not enough donor pancreases to go around, but there are also issues around how long the transplants last. Also, the recipients still have to go on immunosuppressive drugs for life to prevent the rejection of the transplant itself.

The real promise here is that when someone with diabetes injects insulin, they're making an educated guess as to how much insulin they need and they risk low blood sugars. When you put the beta cells back, the islets back, those cells know precisely how much insulin to secrete to produce them. The blood sugar control is much better and they don't have these really dangerous lows.

Going forward, I think there's great promise in stem cells as a potential source, an unlimited source of insulin-producing cells. There's world-leading research going on across the country. There's some in Vancouver, where Tim Kieffer is making these cells in the dish, and in Alberta, I know that Dr. Shapiro is doing clinical trials with these cells in collaboration with a company in the U.S.

It's not ready for prime time yet but it is important. I think the limitations here have to do with making good cells, cells that are safe and suitable for transplant, and also protecting them from the immune system. I think the research going forward is going to be finding ways to either encapsulate them or to genetically engineer them so that they're camouflaged from the immune system. We'd like to do this in a way that if it's truly curative then patients who receive the cells wouldn't need to take immunosuppressive drugs for life.

[The Chair, Liberal, Bill Casey]

Thank you.

Now we go to Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

I have four questions and three minutes, so that's 45 seconds each.

Dr. Sztramko, I'll start with you. Are your products covered by public or private insurance plans in Canada?

[Dr. Richard Sztramko]

No, they're not covered in Canada right now.

[Don Davies, NDP, Vancouver Kingsway, BC]

Ms. Nowgesic, the aboriginal diabetes initiative was established in 1999, so we're coming up to 20 years. The rates of diabetes in the indigenous population have increased in that time. Do you have any recommendations on what we can do to improve that diabetes initiative? Clearly it's not working in the way we all would like it to.

[Marilee Nowgesic]

We have to take a look at the current structures that are in place. Why are the medications increasing? Why are the prevention and promotion not effective? We have to be able to look at the geographical isolation of these people. We have many problems, of course, such as physician shortages, nursing burnout and things like that, but it's the health care worker turnover and the lack of coverage and continuity of care in particular.

We also need to look at the other factors that are now coming into play, so not only having diabetes but it being complicated by other chronic illnesses such as heart disease, stroke, and so on and so forth. It's the question of food security and the high cost of food in our communities. I'm sure most of you would not relish the thought of having to pay $15 for a four-litre bag of milk, or $6 to $8 for a three-pound bunch of carrots. There's also some doubt as to whether or not those are even going to be fresh once you're able to access them at the Northern store.

We're looking at the mechanisms, what we can work with that the people have, and how we can make it work effectively.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Ms. Bains, you mentioned the Sehat program, and I'm just wondering if diabetes is one of the chronic diseases targeted by that program. Have the rates of pre-diabetes or type 2 diabetes changed since the introduction of your program?

[Deljit Bains]

We haven't been able to do any research around whether the rates have increased or decreased. As a chronic disease, diabetes is certainly a focus, but we're in the early stages. You'd have to be doing this research for 10 years to be able to see effective change.

[Don Davies, NDP, Vancouver Kingsway, BC]

Right. It's too early to tell.

Dr. Verchere, the last word goes to you. You talked about the U.S. special funding of $150 million being transformative. How much more money would you like to see the federal government put into diabetes research? Where would that diabetes research funding be best deployed, in your view?

[Dr. Bruce Verchere]

A number similar to what the U.S. has invested would put us back on a competitive pace with them. Seeing what they've done with these funds has really opened my eyes to where we're falling short and what we're capable of.

My sense is that it would be a combination of competition—just letting the best ideas bubble up—as well as perhaps some targeted and specific areas of Canadian strength. For example, we could advance our work in islet biology, in replacement and regeneration, in prevention and in partnership perhaps with organizations like JDRF, where there's a specific interest in type 1 diabetes. We still have a lot to learn about autoimmunity, on beta cells and in clinical trials as well.

[The Chair, Liberal, Bill Casey]

I want to thank all the presenters today for your incredible contributions to our study. We're going to now talk about the drafting instructions for our report. Again, I want to thank you for coming. I want to thank Marilee for coming back again.

It's the first time we've had a witness from Albuquerque, so thank you for that.

Thanks to everybody.

We're going to suspend for a couple of minutes, and then we're going to go in camera and we'll have to clear the room.

[Proceedings continue in camera]