Evidence of meeting #113 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was disease.
A recording is available from Parliament.
President and CEO, MS Canada
I was just going to ask Dr. Marrie if she wanted to comment, as a researcher who very regularly tries to get data across provinces.
Professor, Department of Medicine, Max Rady College of Medicine, University of Manitoba, As an Individual
Thank you for that.
Yes, I agree with the regulatory barriers issue. We know why they're there. It's important to protect the privacy of health information.
Unlike countries in Scandinavia, where you can have all the national data all at once through a single process, we have multiple processes, as Dr. Money said. Even within provinces, I had one study that needed 13 regulatory approvals to do one study in one province. This adds to costs, it reduces the productivity that we have for the amount of research dollars invested and it limits our ability to do things that are relevant on a national scale.
In addition, we have a fundamental data harmonization problem. We collect information differently in different regions about these key socio-demographic and diversity characteristics.
NDP
Jenny Kwan NDP Vancouver East, BC
Thank you very much that. I really appreciate it. I hope we'll make sure that we can advance that as a recommendation from this committee.
One of the issues that women often tell me is forgotten or is even hard to diagnose is endometriosis in women, and particularly young women. They're in such pain. Do you have any advice or action that needs to be taken to address that?
Dr. Money.
Professor and Head, Department of Obstetrics and Gynaecology, University of British Columbia, As an Individual
We do have research in this space looking at biomarkers—so markers in the blood—to pick up endometriosis in its early stages. It can be diagnosed surgically, and that requires a specialized centre and individuals with expertise. Again, focused research in areas like this are making a difference, and I think if we can get to the point of non-invasive markers that make it simpler in-community to make these diagnoses, it will help these young women.
Liberal
The Chair Liberal Sean Casey
Thank you, Ms. Kwan.
Colleagues, we have resources and sufficient time for one more round of questions from each party if the witnesses are prepared to stay for another 15 or 20 minutes. Does that suit you? Great. Thank you.
Ms. Roberts, please go ahead for five minutes.
Conservative
Anna Roberts Conservative King—Vaughan, ON
Thank you very much, Mr. Chair.
I'm really disgusted to hear that we can't share among provinces. Isn't it more important to save lives? I think it should be a recommendation that we change that legislation ASAP because we're important. I think all of us women here would agree to that.
I want to get my head around this, so please help me with this: What research has been done to discover why Canada has the highest number of MS individuals? How do we compare to other parts of the world? What can we learn from best practices used by other countries?
Dr. Valentine, do you have any comments on that?
President and CEO, MS Canada
Allow me to start, but I will toss it to Dr. Marrie.
I like to describe MS as a perfect storm. What we do know is that it's a complex disease. There are 230 genetic loci that have been identified and are associated with the disease, and then if you stack on top of that environmental circumstances over the life-course of an individual and it is that perfect storm, then you tend to see the expression of the disease.
What we know today is we could identify it much earlier—in fact years earlier—than we probably can today. We don't really know why Canada has the highest rates in the world, but it's likely a combination of those factors of genetic predisposition and environmental circumstances that has led to that. If you look around the world, there's a northern country band, a latitude band of the kinds of countries that have the highest rates in the world.
I ask Dr. Marrie to comment as well.
Professor, Department of Medicine, Max Rady College of Medicine, University of Manitoba, As an Individual
As Dr. Valentine mentioned, we think of MS as needing an underlying genetic template that you're born with, and then exposures over the course of your life that lead to disease.
If we think about who many of the first people were who settled in Canada, many of them have genetic backgrounds that are shared with other parts of the world with high risk, like Scandinavia, western Europe and the U.K. as examples. Then we can think about the environmental risk factors. We don't know all of them, but there are some that are common in Canada that are associated with risks: smoking; obesity, particularly in childhood; low vitamin D levels, which you see in northern climates, where the sun is further away for much of the year; as well as infections such as the Epstein-Barr virus infection.
If we want to think about changing that, we need to think about trying to act on the risk factors we can change. It's hard to change your genes, but we can take action to make sure people know that smoking is a risk factor for MS and work on trying to help people quit, with both policy measures as well as education and targeted efforts to people who may be at higher risk because they're known to have a family member with MS or another immune disease. We can work on childhood obesity. Again, there are lots of policy levers around availability of foods that have sugar, fats and all of those things, accessible to children and school programs. We can look at studies in which we can actually test whether interventions with vitamin D or trying to prevent or treat Epstein-Barr virus might prevent disease. These may allow us to move forward in terms of reducing the risk of MS that we see.
This is a critical issue. The number of people with MS is going up in Canada, not so much because the risk is going up but because we're doing better at diagnosing people earlier, and people are living longer, so the burden is going to continue to rise. It is really important for us, in terms of the country's well-being, to try to mitigate, as much as possible, the risk to future generations of developing MS.
Conservative
Anna Roberts Conservative King—Vaughan, ON
Do you think that there will ever be a situation in which we have the opportunity to develop a screening mechanism to stop this...well, maybe not stop it, but help identify it early in the stages of MS?
Professor, Department of Medicine, Max Rady College of Medicine, University of Manitoba, As an Individual
Yes, I think we are moving—if I may, Pam—in that direction.
We now understand that there are signatures of MS we're starting to pick up in health care use before people present with their first typical symptoms.
As well, we know that we can see markers of brain injury during that period of time.
New research—and this highlights the importance of research—came out just last week that identified a signature in the blood that might help identify people at higher risk.
We need to narrow it down so that we can target investigations to people at higher risk; those are active areas of research that would benefit hugely from additional investment. Because our early work tells us that if we can intervene early, before the typical symptoms of MS develop, we may be much more effective at preventing people from moving along that path.
There are people with brain MRIs who look like they have MS, but they have no symptoms. We refer to them as having “radiologically isolated syndrome” if it's just on imaging.
There have now been two clinical trials that show us that if you treat those individuals you can reduce their risk of going on to symptoms of MS, or at least the first few years, by 80% to 90%. This is dramatic. If we could identify people like that early, then we can potentially have an enormous impact. We're not yet able, due to the approvals process in Canada, to treat people who have radiologically isolated syndrome for that purpose, but these are things that we need to move towards to reduce the impacts of MS.
Liberal
The Chair Liberal Sean Casey
Thank you.
Moving over to the Liberals, we have Mr. Naqvi, please, for five minutes.
Liberal
Yasir Naqvi Liberal Ottawa Centre, ON
Thank you very much, Chair.
I will share my time with Mr. Powlowski.
I'll start, Dr. Valentine, with you.
I had an opportunity to meet some incredible folks from MS Canada just a few days ago, as I was mentioning to you earlier. Part of our conversation that took place was around the prevalence of MS in women. That came as a surprise to me. I had never thought about it in those terms.
I wonder if you can expand on that. What data and evidence do we have in that regard? Do we know the causes—are these environmental, genetic—that result in more incidents of MS in women than men?
President and CEO, MS Canada
I'll start, but I will toss it to Dr. Marrie again.
I don't think we really know why it's so prevalent in women versus men, but again, it's going to come down to that genetic milieu that a person has that they're born with, and then the set of circumstances or risk factors.
Dr. Marrie, perhaps you want to comment.
Professor, Department of Medicine, Max Rady College of Medicine, University of Manitoba, As an Individual
I think this points to part of what we heard from Dr. Money earlier.
There is what we call a sexual dimorphism in the brain and differences in the immune system, so things like hormones will influence manifestations of disease. We don't fully understand why, but knowing that those things are different, we can see that they may, then, interact with genetic factors and some of the other environmental factors that lead to the disease.
This is not a unique problem for MS. There are many other what we call “immune-mediated diseases” where there is some immune dysfunction leading to disease where women are more likely to be affected.
Understanding that interface between the sex-specific biology and disease risk is really important to allow us to successfully target prevention efforts, as well as learn how to treat disease based on an individual's characteristics.
Liberal
Yasir Naqvi Liberal Ottawa Centre, ON
As a follow-up question, Dr. Marrie, is there sufficient research taking place in Canada to determine those causes as they relate to women? In other words, is there more women-focused research in MS taking place right now, or does more need to happen to better understand the factors?
Professor, Department of Medicine, Max Rady College of Medicine, University of Manitoba, As an Individual
I think more needs to happen. I don't think this has been a focus of enough research in Canada or elsewhere in the world.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Concerning the link between EBV infection and MS, how certain are we of that? Is there an EBV vaccine?
I think you mentioned that it was a necessary causal factor for multiple sclerosis. I would assume it's not so easy as, okay, we've got a cure and we vaccinate everyone for EBV.
Is there a vaccine, or how close are we to a vaccine, and is there that kind of causal certainty that we can take that approach?
President and CEO, MS Canada
There's been a growing body of literature over a very long period of time that has linked EBV to MS. I think that the push in the field, the belief that this is really important and the strongest risk factor that we might be aware of today, was at a military database. They had biological samples and could look back 20 years, and it was the single viral indicator for everybody who ended up getting MS. I think that has really pushed forward the EBV story.
There are three EBV vaccines currently under development, one of which is an mRNA vaccine like a COVID-type vaccine. Importantly, there are other antiviral medications, many of which are available to us today, that might play as important a role as perhaps a vaccine will.
I don't believe it's realistic to think that, if a vaccine became available tomorrow, we would vaccinate the whole population. I don't think that's the most successful prevention strategy that we'll have available to us, but if you know that at-risk population that Dr. Marrie just talked about, then maybe you can deploy a vaccine or an antiviral, particularly early in the disease core. I don't think there will be one strategy at the end of the day; I think there will be multiple strategies.
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Valentine and Dr. Powlowski.
Ms. Larouche, you have the floor for two and a half minutes.
Bloc
Andréanne Larouche Bloc Shefford, QC
Thank you, Mr. Chair.
Ms. Gupta, I’d like to discuss a subject that hasn’t been touched on as much during questions, until now. In your opening statement, you talked about the issue of intimate partner violence and the consequences it can have on women’s psychological and physical health. More and more places throughout the country are stating that intimate partner violence is a serious problem, and some are even talking about an epidemic.
Is this really a good way to start drawing connections between women’s health and the issue of intimate partner violence, as well as its impact?
Full Professor, Department of Sociology, University of New Brunswick, As an Individual
From my point of view, research on the effects of intimate partner violence is underdeveloped, which also has an impact on the health system. That’s some of what I wanted to put out there. We know that 80% of health staff are women. So, we can’t talk about an epidemic for the general public without also talking about the impact of this epidemic on the health workforce. Furthermore, women who work in the health sector often—more often than men—experience violence from their patients and their families. So, I think that’s a dual vulnerability.
However, we don’t have a research system, and we don’t really have a funding system for the research to look into those types of subjects.
Bloc
Professor and Head, Department of Obstetrics and Gynaecology, University of British Columbia, As an Individual
I was just really agreeing with the situation that partner violence is definitely experienced to a great degree by women, although not exclusively, and we see then what the juxtaposition of a disease is on that vulnerable population. We see higher rates of HIV, sexually transmitted infections and other disease states, so it multiplies the damage and the problems.
We have a great deal of difficulty in quantifying partner violence because of the very nature of it, and women tend not to come forward, but more research into how to understand it better and obviously how to prevent it is critical.