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.

On the agenda

MPs speaking

Also speaking

Howard Njoo  Acting Assistant Deputy Minister, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada
Clerk of the Committee  Mr. David Gagnon
Jean-Paul Bédard  Vice-President, Public Affairs, Canadian Blood Services
Margaret Fearon  Medical Director, Medical Microbiology, Canadian Blood Services
Ralph Hawkins  Clinical Associate Professor of Medicine, University of Calgary, Cumming School of Medicine, As an Individual
Elizabeth Zubek  Family Physician, Shepherd's Hill Medical Clinic, As an Individual
Karin Phillips  Analyst

12:40 p.m.

Liberal

Bob Bratina Liberal Hamilton East—Stoney Creek, ON

Thank you very much, Mr. Chair.

12:40 p.m.

Liberal

The Chair Liberal Bill Casey

I was hoping for a steam engine question there, but maybe next time.

Mr. Davies.

12:40 p.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Thank you, Mr. Chair.

Dr. Hawkins, just quickly, you referenced your narrow area of specialty. What is that area?

12:40 p.m.

Clinical Associate Professor of Medicine, University of Calgary, Cumming School of Medicine, As an Individual

Dr. Ralph Hawkins

I'm an internal medicine specialist. I was trained as a nephrologist, which is the study and treatment of kidney diseases. My career has spanned about three decades. I now practise in a cardiovascular risk reduction area. I see a large number of diabetic patients, and I do a lot of lecturing and teaching on diabetes. As a more senior physician in my division, I see the patients who have medically unexplained symptoms—chronic fatigue, fibromyalgia. This was the seed that started my interest in chronic Lyme disease.

12:40 p.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

I see. Thank you.

At the last meeting, a researcher joked about not letting researchers out unescorted. I would think that would maybe pale in comparison to letting politicians meddle in science or medical diagnosis. The more I read about this, it seems clear that an emerging issue in this area is the fact that the science does seem to be contested. In fact Dr. Timothy Caulfield, whom I'm sure you're familiar with, of the Health Law Institute at the University of Alberta, is quoted as saying that the science in this area is extremely contested. He quoted articles in The Lancet and The New England Journal of Medicine.

First of all, Dr. Hawkins, is it a fair comment to say that the science in this area is contested?

12:40 p.m.

Clinical Associate Professor of Medicine, University of Calgary, Cumming School of Medicine, As an Individual

Dr. Ralph Hawkins

Yes, that would be fair. The science in this area is contested. There is no keeper of 100% truth with this issue.

12:40 p.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Okay.

I have only a minute left, Dr. Zubek and Dr. Hawkins, so perhaps you could briefly explain what the major points of contention are and what advice you'd give this committee in terms of improving the framework to help resolve those conflicts.

June 8th, 2017 / 12:40 p.m.

Family Physician, Shepherd's Hill Medical Clinic, As an Individual

Dr. Elizabeth Zubek

To me, the major point of contention is this: do we need to have a fixed treatment end point, or can we have the flexibility to do multiple “n of 1” trials, as we call them? We look at whether this is working in a person. If they get 50% better, do we push it further? We need to exercise clinical judgment.

Another issue of controversy is whether or not the patient has a voice. We need to think of it in a way that's similar to cancer care. Would you say that we're going to treat all cancer in Canada with the same chemotherapy, no matter what organs are affected, no matter what stage, no matter what's happening? No. We have to look at the individual cases, the individual preferences, and tailor it there. That's what we're saying as family doctors.

12:40 p.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Dr. Hawkins.

12:40 p.m.

Clinical Associate Professor of Medicine, University of Calgary, Cumming School of Medicine, As an Individual

Dr. Ralph Hawkins

I would boil down the entire controversy to a competition in science. One group is wanting to have very fixed guidelines for the purposes of having everyone follow the same pattern or recipe. The other group, I think, is looking in a more holistic fashion at the outcome for an individual patient, with that individual person's risks in mind. I suppose it comes down to a matter of trust. Do you trust that you have educated your medical professionals to exercise their professional judgment, or do they need to be overseen by an arbitrating body?

12:45 p.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Very good.

Thank you, Mr. Chair.

12:45 p.m.

Liberal

The Chair Liberal Bill Casey

Once again, I want to thank all of our witnesses for very enlightening testimony. We learn so much at this committee. It's just incredible.

Dr. Zubek and Dr. Hawkins, I appreciate your passion and commitment to this. It's obvious that you care a great deal about it and are very helpful.

I want to thank our table guests as well.

Dr. Hawkins, you referred to Samuel...?

12:45 p.m.

Clinical Associate Professor of Medicine, University of Calgary, Cumming School of Medicine, As an Individual

Dr. Ralph Hawkins

Samuel Donta. He is a retired infectious diseases specialist, still living. He practised at Boston University and was at the forefront of infectious diseases doctors when the Lyme disease epidemic first came to the fore back in the 1970s and 1980s. He was able to practise in Lyme disease back in an era when there were not constraints from the organizations and when individual judgment was allowed to be practised, because there were no guidelines at that time. His writings are very, very helpful.

12:45 p.m.

Liberal

The Chair Liberal Bill Casey

Thanks very much. I just wanted to clarify that reference.

I want to tell you that I first encountered Lyme disease in about the fall of 2015. It was the first time I'd ever heard of it. A constituent came to me. I went to two local health care providers, and both health care providers gave me the impression that they didn't really believe there was such a thing as Lyme disease. So I believe we're making progress.

Dr. Njoo, you said in your comments that “Lyme disease is one of the most rapidly emerging infectious diseases in North America”. I think we are making some considerable progress. Why do you say it's one of the most rapidly emerging infectious diseases?

12:45 p.m.

Acting Assistant Deputy Minister, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada

Dr. Howard Njoo

In terms of surveillance, since Lyme disease became a notifiable disease in 2009, the number of reported cases to the Public Health Agency of Canada went up from 144 to over 800. We also recognize that there probably is a degree of under-reporting. As we move forward, one of the key things we want to improve is surveillance, as we mentioned with regard to the framework, for both the human illness and the ticks. That's one of the areas we will be focusing on.

The other point I want to make is that I would agree with Dr. Hawkins and the others that, yes, the science is contested. As in any area of science, there will be varying points of view. I guess what I would say is that, as I've mentioned before, we're going with where the main body of evidence leads us. I would say that Dr. Hawkins and others are probably in the minority compared with the majority of the scientists and infectious disease specialists who belong to organizations such as the IDSA and AMMI in Canada.

12:45 p.m.

Liberal

The Chair Liberal Bill Casey

Okay.

Thank you very much, everyone.

We have a little bit of committee business to do. We'll suspend for a few seconds while our witnesses pack up.

Thank you again.

12:50 p.m.

Liberal

The Chair Liberal Bill Casey

Do I have a motion to approve the budget?

I have a motion and a seconder.

Excuse me. First, are there any questions?

Mr. Davies, you have a question.

12:50 p.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Mr. Chair, is this the budget for the study that we just completed?

12:50 p.m.

Liberal

The Chair Liberal Bill Casey

Yes.

12:50 p.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Would it not be proper procedure to vote on the budget prior to having the study? Theoretically, if we voted this down, we would not have the funds to pay for what we've just done.

I would just suggest that we have the budget passed prior to engaging in the study.

12:50 p.m.

Liberal

The Chair Liberal Bill Casey

It can be done both ways. The clerk had it available for the last meeting, but I didn't raise it.

12:50 p.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Okay.

12:50 p.m.

Liberal

The Chair Liberal Bill Casey

Yes, Mr. Webber.

12:50 p.m.

Conservative

Len Webber Conservative Calgary Confederation, AB

I concur with Mr. Davies. Have we finished with Lyme disease?

12:50 p.m.

Liberal

The Chair Liberal Bill Casey

We've finished with the witnesses.