Thank you, Dr. Carrie.
I agree with you. I think the framework has missed the mark. I think the reason it has missed the mark is that there are people within the mechanism of health delivery in Canada who do not want to cut the umbilical cord from the CDC in Atlanta. You've heard answers this morning pointing to there being a reluctance to deviate from what the CDC has put forward for this or that or the other thing.
Mr. Oliver was on the CDC website earlier. I would ask him, just as an example, to look at the case definitions for Lyme disease and then look at the Canadian case definitions. There's a deviation. The Canadian case definitions for Lyme disease are not as encompassing as the CDC's guidelines. That is something that would pose a question, in my mind, to the Public Health Agency.
To get on with testing, the testing that's being done right now is surveillance testing, and surveillance testing is biased in favour of being specific. That means when they say a positive test is found, they want to make absolutely sure that it's a positive test, and they're willing to not count every case for the sake of the specificity of the test. On the other hand, a front-line provider such as Liz or me is not interested in that approach. We're interested in sensitivity of diagnosis for our patients.
There's a very simple way of improving the sensitivity of diagnosis. Dr. Njoo will be an expert in this, because this is basic epidemiology. It has to do with parallel testing rather than in-series testing. Parallel testing will increase the sensitivity of what you do, and the parallel testing that we could be doing in Canada today would be to do the C6 assay that every province is already doing and simultaneously do the ELISpot.
If that approach is used, the sensitivity we would expect to see would be in the 96% range, and the specificity would be in the 93% range. This is very strong clinically. This would give us positive predictive values greater than 10 and negative predictive values less than 0.1. But the mechanism that runs medicine in Canada isn't prepared to be innovative.