Thank you very much, Madam Chair.
Good morning, and thank you for the opportunity to be here.
I would like to start by outlining my interest in the problem of Parkinson's. I'm a clinical neurologist. I've devoted my entire career to Parkinson's disease. I'm also a researcher in Parkinson's and now do pretty much clinically oriented research, although in the past I did more preclinical research.
I'm the former chair of the Parkinson's Society scientific advisory board. In my current administrative role I'm responsible for academic and clinical deliverables for neurology in an urban centre, but I spend a great deal of time thinking about the challenges of delivering care to largely disenfranchised communities that face these enormous geographic problems Joyce has already alluded to.
I'm sure this committee is well aware that brain diseases represent 28% of disability-adjusted life years worldwide. This is for non-communicable disorders. This compares with 22% for cardiovascular diseases and only 11% for cancer. Brain diseases are extremely expensive, both financially and in terms of social consequences, yet they have largely been ignored.
Brain diseases include psychiatric disorders. I understand that the focus of this committee is neurological disorders, but I would just like to remind the members that there are enormous co-morbidities. Most chronic neurological disorders have psychiatric co-morbidities, and the converse is also true. The mechanisms underlying these conditions are likely to be very similar, and in some cases identical.
I'd also like to emphasize that, in my view, clinical and research activities are not divisible. Excellence in one has to inform the other. For many of us, the clinic is in fact our laboratory.
On the research that's being conducted in neurological disorders, Michael has already indicated that Canada has an extraordinarily distinguished history of research in Parkinson's disease dating back to the fifties and sixties. That record of excellence has been sustained, despite the fact that we're a relatively small country, in terms of our economy, with limited resources. I'm happy to outline some examples, but I'll leave that for questions from those who might be interested.
It's also worth remembering that research in one neurodegenerative disorder is likely to inform advances in all the other neurodegenerative disorders, because we're really looking at the mechanisms that contribute to the selective death of isolated groups of nerve cells. Once we understand the mechanisms that are true for one, there are likely to be lessons that can be learned about the others.
In fact, the cross-talk is probably more extensive than that. As Michael was talking, I jotted myself a note that probably the greatest single advance in the last few weeks in terms of understanding Parkinson's is an example of a master regulator gene. That knowledge can be immediately applied because there are drugs that can be used to test the hypothesis in patients. But those are drugs that were developed for diabetes, not for neurological diseases.
The other point that Michael also raised is that while there is a great history of successful researchers, research nowadays will only very rarely succeed using the old model of the single investigator who's in their lab and is brilliant. What we really need are teams of people from multiple disciplines who work together and who actually cross disciplines, but we have very few models right now to support that kind of activity.
CIHR used to have a team grant program, but that has largely been eviscerated. There are only small emerging teams left, or ones with specific goals, so that capacity has been lost. The networks of centres of excellence is another model. Those are difficult to get. I'm currently in the middle of three NCE letters of intent that are going forward in the next week because of Parkinson's involvement, and I'm aware of others. But these are very difficult to get with very limited funding. So they're really not doing what we need.
Additionally, I think a huge problem in Canada, compared to the U.S., is that we do not have good mechanisms for supporting clinician scientists. It's difficult to convince people to do this. We don't have a good track record of training them or of recruiting them. MD Ph.D. programs, such as the one Dr. Schlossmacher just mentioned, are obviously one important mechanism for doing this.
Finally, if I can just talk briefly about the clinical challenges, I understand that health care delivery is a provincial mandate, but I also understand that the federal government plays a critical role in establishing the expectations and setting the standards for delivery of care across the country. I'm sure I won't be the first person to suggest to this committee that our health care system does a superb job of managing acute and critical illness, with care available for all who need it. That's why we love Canada. I, too, am an immigrant, by the way, and am very grateful for the opportunities this country has offered me. But I'm sure you all know that we fall very short in terms of providing care for those who have chronic diseases.
Parkinson's, I want to emphasize, affects not only the individuals who formally carry the diagnosis but all those around them. It affects their ability to work, to be parents, to interact with others, and it affects their sense of dignity. The disease and its treatment may be associated with cognitive and behavioural complications that can be absolutely devastating for the members of their families.
These are complex disorders that are best managed by a multidisciplinary and interdisciplinary approach, but getting funding for the delivery of multidisciplinary care is an enormous challenge, despite the fact that these approaches can save money.
I actually just asked my own hospital to pull out data from 20 to 25 years ago as compared to the present. The number of admissions, or hospital days, where the most responsible diagnosis was Parkinson's, declined from nearly 5,000 between 1984 to 1986 to just over 1,300 between 2006 to 2008.
That's a reduction of 73% in hospital days, despite the fact that the number of people in my province with PD has doubled in that time, and that the more recent figures include hospital and forced hospital admissions for surgical treatment of Parkinson's. But this is only possible if infrastructure can be provided to allow for outstanding ambulatory care, and we fall dangerously short in that matter.
I will close and thank you very much for the opportunity to be here and for your attention.