Evidence of meeting #59 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was lyme.
A video is available from Parliament.
Lyme Disease Advocate and Patient, As an Individual
That's a great question to ask Dr. Hawkins on Thursday. He is very familiar with the science and mechanisms of the testing. He has some suggestions on using existing testing technology under a different set of criteria, which would significantly improve testing in Canada.
Liberal
Ramez Ayoub Liberal Thérèse-De Blainville, QC
Thank you, Mr. Chair.
I don't know if you understand French very well, but my question is going to be in French.
Let's talk about the difference in the treatment of Lyme disease and the treatment of the chronic form of this disease. There seems to be an important difference from the scientific point of view. There are nuances, and some controversy. Normally physicians try to use a science-based approach when prescribing medication, and there have been all sorts of discussions on side effects and the scope of treatments.
What is your perception of the report? How is this discussed in it? What is missing? What would you like us to support in this regard, Ms. Sperling?
Board Member, Canadian Lyme Disease Foundation
I think you need to speak to Dr. Hawkins. He bases his conclusions on the clinical diagnosis, and he knows whether a person will react well or not to antibiotics. Another approach may have to be taken if the antibiotics no longer work. Doctors who are very familiar with Lyme disease can make a clinical diagnosis.
Liberal
Ramez Ayoub Liberal Thérèse-De Blainville, QC
Let's compare the Canadian approach to the American one. Let's use that as an example, because there are unfortunate cases of people who had to go to the United States. They get treatment there at an exorbitant cost, that is to say close to $300,000 per person. We can't imagine paying $300,000 for each Canadian. That is beyond all reason.
Liberal
Ramez Ayoub Liberal Thérèse-De Blainville, QC
What is the difference in treatment given in the United States and what is done—and what is eligible—in Canada? How can we get definite results that will make a difference?
Board Member, Canadian Lyme Disease Foundation
The big difference is that in the American physicians may prescribe long-term antibiotics.
It is more difficult for physicians because the cost of insurance is higher. In the United States a medical appointment costs $400, whereas it costs $40 here. That is the big difference. The prescription of long-term antibiotics would not be as costly in Canada.
Liberal
Ramez Ayoub Liberal Thérèse-De Blainville, QC
If that is the case, why is there a controversy? What is the hold up? When you speak, it seems to be obvious. What is causing the problem?
Board Member, Canadian Lyme Disease Foundation
The problem comes from the fact that the diagnosis is complex; it is not black and white.
Liberal
Ramez Ayoub Liberal Thérèse-De Blainville, QC
The diagnosis is not more black and white in the United States than it is in Canada.
Board Member, Canadian Lyme Disease Foundation
The systems are different. Our system is centralized, whereas in the United States there is a great diversity.
The Infectious Diseases Society of America, the IDSA, states that you only need two to four weeks of treatment. However, another group will say that things are not that clear and that you need a third option. It depends on the medical system.
I prefer the Canadian medical system, but our system recommends two to four weeks of antibiotics and that's all. There's no diversity here and everyone does what the IDSA suggests.
Liberal
Ramez Ayoub Liberal Thérèse-De Blainville, QC
I am almost ouf of time, so I'll ask my last question.
Education seems to be key in this situation. I am thinking of Ms. Faber's testimony.
Ms. Faber, you went to several places before you found a physician who was able to make a potential diagnosis. Do you believe that education, which is discussed in the report, will allow us to deal with this problem?
Lyme Disease Advocate and Patient, As an Individual
Yes, we need to train our doctors, so that they're aware of the concern in the first place.
One of the things I actually spoke to Dr. Njoo about yesterday, which we agreed on and I'm very excited about, is that he agreed to reach out to the Canadian Pediatric Society, the Canadian Society of Obstetricians and Gynaecologists, the College of Midwives, and the College of Family Doctors to make an introduction to them on my behalf and to request that these agencies, societies, and associations meet with Jennifer and me, as patient representatives and advocates who can speak to the literature that, unfortunately, has not been available in Canada. I'm really thrilled that he has taken the initiative to do that on our behalf. Hopefully, he will also be able to introduce the reality that 29 years ago Health Canada did report congenital transmission.
I'm really excited about that forward momentum because I believe that's exactly what is required. Just as Dr. Vett Lloyd and Janet Sperling have said, patients, advocates, and people, including our researchers and our physicians, need to be actively engaged, involved, and at the table together. I really look forward to those meetings and to future progress.
Thank you.
Liberal
The Chair Liberal Bill Casey
Your time is up. However, I'd just like to follow up with a question that Mr. Ayoub had. If a doctor diagnoses me with Lyme disease and says that I need eight or 10 weeks of antibiotics, who says he can't prescribe that?
Board Member, Canadian Lyme Disease Foundation
The doctor can get away with it once and he might be able to get away with it twice, but eventually somebody is going to start saying, “Why does that person keep having these people to whom he keeps giving long-term antibiotics?”
Board Member, Canadian Lyme Disease Foundation
The colleges. Certainly, I can think of three doctors right off. They didn't go in saying that they were closing them down for their treatment of Lyme disease. They said that they were going in and investigating something else. However, they happened to take every file of somebody who had Lyme disease.
I think it really comes down to the idea that it's not the patients making the complaint. The patients are generally very happy with their doctors. It's that the other doctors are saying that this doctor keeps giving out too much antibiotic and they have to shut him down. It's happening behind closed doors.
Liberal
The Chair Liberal Bill Casey
It's the college of physicians in each province that is the police department.
Green
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you, Mr. Chair.
I want to focus a bit on education and awareness. One of the basic concepts that has come out for me very strongly from the testimony here today is that, wherever the differences may lie, we're looking at a serious pan-Canadian health issue with some urgency. Ideally, I think that what we want to do is educate Canadians and try to prevent. To me, sometimes the best health approach is to prevent the disease or condition in the first place.
I'm just wondering whether any of the witnesses have any thoughts that you could give this committee, in terms of guidance about the education and awareness steps we ought to be recommending to the government, so that Canadians are more fully aware and maybe can take steps to protect themselves.
Lyme Disease Advocate and Patient, As an Individual
Prevention is absolutely key because, obviously, if you don't get bitten by a tick you're not going to get sick. The reality is that ticks are so tiny; they can be microscopic, the size of poppy seeds. It's not possible to 100% prevent ticks. Education has been great on that—pulling your socks up, staying in the middle of the path, using repellent—but the education has stopped there. People now need to know the prevalence of the risk, that it's not just in endemic areas, and they need to know what to do when they find a tick. Where do they go? What do they look out for? What are the signs and symptoms of the disease, because they are varying? They need to know the urgency of immediate treatment. As well, we need education for doctors.
The issue of children is very urgent, because kids are a very high risk group for Lyme disease, one of the highest risk groups because of the time they spend outside. We need schools to have training on how to remove ticks in the principal's office. We need summer camps to train their counsellors on how to do tick checks. There is a huge gap in the education because to date it is only focused on pulling your socks up and putting repellent on. It doesn't go any further than that.
NDP
Don Davies NDP Vancouver Kingsway, BC
You know it is often said that lacrosse is the national sport of Canada, but I actually think it's determining whether something is federal, provincial, or municipal in this country. Mr. Chair raised this issue about the impact of provincial colleges of physicians and surgeons, and obviously provincial governments, which administer health care in this country.
I am wondering, being federal politicians here, what you would advise us to do in terms of helping to get the provinces to make the kinds of changes necessary—or that you think are necessary—and whether you have specific recommendations on the curricula taught in medical schools and whether that is something you'd like to see us involved in. Are you putting pressure on provincial governments, as well?
Lyme Disease Advocate and Patient, As an Individual
We will be. We've been busy the last couple of months here.
