Evidence of meeting #60 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.
Liberal
Family Physician, Shepherd's Hill Medical Clinic, As an Individual
For the treatment, those guidelines say two to four weeks of antibiotics, but with one single antibiotic—
Liberal
John Oliver Liberal Oakville, ON
I'm sorry, I didn't ask the question well enough.
Are there better guidelines than the IDSA 2006 guidelines?
Family Physician, Shepherd's Hill Medical Clinic, As an Individual
Absolutely. Yes, the ILADS guidelines are far better.
Liberal
Family Physician, Shepherd's Hill Medical Clinic, As an Individual
They're the ILADS guidelines, which are published on the U.S. National Guideline Clearinghouse.
Family Physician, Shepherd's Hill Medical Clinic, As an Individual
It's published on the National Guideline Clearinghouse. It's by Drs. Cameron, Johnson, and Maloney. It has a big, long name, “Evidence assessments and guideline recommendations for tick-borne infections, erythema migrans...”. The name is a paragraph long.
Liberal
John Oliver Liberal Oakville, ON
I'm on the Centers for Disease Control and Prevention site looking at the IDSA guidelines. The 2006 guidelines were last reviewed in 2016 by the Centers for Disease Control, the National Center for Emerging and Zoonotic Infectious Diseases, and the Division of Vector-Borne Diseases. They say that the guidelines “were re-evaluated and upheld by an independent scientific review panel whose members were certified to be free from any conflicts of interest by an independent ombudsman”, and that the CDC supports the IDSA Lyme disease guidelines as continuing to provide “comprehensive, accurate information that patients can use in their health care decisions.”
Dr. Njoo, there's a conflicting source here for guidelines. There's clearly a very heavily scientifically weighted opinion through the CDC, but there's an online group that the doctor has referred to. Can you talk to me about how PHAC discerns among guidelines so that as you're going out in the framework you are issuing the best scientific evidence-reviewed guidelines?
Acting Assistant Deputy Minister, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada
Thank you very much for your question. Yes, we work closely with the CDC and also with other public health organizations throughout the world, such as the one in the U.K.
What I will say is that when we look at the evidence, as the U.S. CDC has also done, we look at the preponderance of evidence in terms of the types of guidance put forward. I will say that, for example, the IDSA actually, in a sense, represents the majority of the research scientists, the clinicians, the infectious disease specialists in the development of the guidance that they put out.
We acknowledge that there are other groups out there who have their own view of what the science shows them and who have developed their own guidance, but we certainly go with the majority expert opinion and review of the evidence.
Liberal
John Oliver Liberal Oakville, ON
Just to be clear, I think the doctor respectfully referred to them as 2006 guidelines, as though they were significantly outdated, but I think it's important to note that they were extensively reviewed again in 2016.
One way to resolve these kinds of debates is to ensure, as we go forward, that besides the scientists, the doctors, and the others whom PHAC would be engaging, there's also the community of caregivers, such as our doctors here, and some of the patients' or advocacy groups that have formed around people with Lyme disease.
Do you see a way of engaging those voices in reviewing guidelines, in ensuring that we're staying current, and that alternative guidelines are being considered through the engagement of patients and—
Acting Assistant Deputy Minister, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada
Yes, certainly. As we did at the conference, we recognize that it is important to engage all the stakeholders, including patients' advocates, as we move forward.
One thing I mentioned before is that as we go forward with guidance we need to stick to what I believe are the principles of the scientific method. I respect patients being engaged in the process. I understand that they certainly have an important role to play in developing the types of research questions and the answers we need to look for. When it comes down to actually reviewing the evidence, however, they could certainly be involved, but I think that at the end of the day we all need to collectively agree that we need to look at using the rigour of the scientific method.
Liberal
John Oliver Liberal Oakville, ON
Another question that we had from the previous group was.... I don't know the gentleman, but there's a person named John Scott who I think did a lot of research around...maybe it was surveillance research; I'm not sure. They felt that his research was ignored and left out of the framework.
Do you have any comment on that?
Acting Assistant Deputy Minister, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada
I don't think any particular researcher or research finds were ignored in the framework. The framework, in a sense, is higher level. It doesn't get into pointing out any individual piece of research or research findings. It really maps out, in broad strokes, the way forward, recognizing that there are many different types of research already out there involving surveillance activities, diagnostics, and so on, and that as we move forward we need to be open-minded to basically receive and look at all the types of research there are without ignoring anything that could be of value.
Liberal
John Oliver Liberal Oakville, ON
In the final framework, there was a commitment of $4 million, I believe, to CIHR for research on diagnosis, treatment, and the ongoing chronic effects of Lyme disease.
There was a question about NSERC at the last meeting and why NSERC wasn't part of the funding award. Can you comment on CIHR versus NSERC, and the decisions around the research funding?
Acting Assistant Deputy Minister, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada
NSERC was involved in the development of the framework. Our closest partner in terms of human health research is CIHR, the Canadian Institutes of Health Research, but we'll certainly engage other federal departments, as appropriate, as we go forward with the research agenda.
Liberal
John Oliver Liberal Oakville, ON
Great.
The lab testing and diagnosis questions come up a bit. What are your thoughts on that? There was an understanding in the final framework that there is a need for improved lab testing and improved sensitivity of testing. How far away are we from seeing that? For the community, and for Canadians who have been bitten by a tick, that testing is pretty important. Do you have a sense of a time frame to get that lab improvement up?
Acting Assistant Deputy Minister, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada
Personally, I couldn't give you that kind of estimate. I would defer to my experts who work in laboratory science.
As we put out in the framework, we do need to improve testing. Our national microbiology laboratory and the other members of the Canadian Public Health Laboratory Network are well positioned. They have scientific experts who can look at the evidence of new testing methodologies that come to the forefront for review and evaluation. They work closely with their counterparts in other countries as well, including the U.S.
Liberal
Acting Assistant Deputy Minister, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada
At the national level, in terms of the U.S. CDC and us, no, there isn't.
Liberal
The Chair Liberal Bill Casey
Thanks very much.
We'll go to our five-minute round now, with Dr. Carrie.
Conservative
Colin Carrie Conservative Oshawa, ON
Thank you, Mr. Chair.
My first question will be for Ms. Fearon. I'm going to ask in advance for a short answer, if I can, because we have limited time.
Did you say in your opening statement there is no evidence that Lyme could affect the blood supply?
Medical Director, Medical Microbiology, Canadian Blood Services
No, I said that there has been no evidence yet of transfusion transmission of Lyme disease.
Conservative
Colin Carrie Conservative Oshawa, ON
Are you aware that back in 1992, John Scott, the researcher my colleague brought up, sent information over to the Red Cross that this could be affecting the blood supply and hence could be affecting transmission?
Medical Director, Medical Microbiology, Canadian Blood Services
No, I haven't seen that.