Subcommittee on Neurological Disease Committee on Nov. 30th, 2010

[Dr. Rémi Quirion]

Yes, in the field of Alzheimer's disease, there will be five times as much as that left on the table. What's left on the table, and we should probably say that this is in the excellent category, because below that we don't want to necessarily fund, there are certainly some excellent grants that just miss the cutoff and are not funded. These guys have to try again six months later.

[Patrick Brown, Conservative, Barrie, ON]

Would you put the majority of the $150 million in applications in the excellent category?

[Dr. Rémi Quirion]

No. The excellent category I would say would be about 25%. There are maybe 10% of grants that are not funded that should be funded.

[Patrick Brown, Conservative, Barrie, ON]

That's interesting.

Go ahead, Inez, please.

[Inez Jabalpurwala]

That was actually our experience, as well, in doing the brain repair program and the large team grants.

There's another aspect to what Dr. Quirion has said, and that is that in addition to trying to cobble together a bunch of grants for one researcher, if they want to collaborate with other teams, those teams have to find the grants they need, because there are no natural grants that enable them to work together. Suddenly we have this complexity. Teams are each individual, and everyone within that lab is applying for multiple grants and is hoping that a team they want to work with is able to equally get funding so that they can finally bring their work together.

It's an enormous amount of time, because it takes a while for any kind of team to form and work together in a meaningful way and not just virtually. I think providing larger grants for at least three years, if not five years, and cutting down the process of having to apply every year for small amounts will make a dramatic difference. We saw the results, and we are a very small organization with limited funds. Our grants were $1.5 million for three years, and we were able to do five. But we saw dramatic results.

I think this is well supported by both the science and the science community.

[The Chair, Conservative, Joy Smith]

You still have more time.

[Patrick Brown, Conservative, Barrie, ON]

Thank you.

I understand that in the summer, or last year, there was an agreement signed between Canada and France and the U.K. about sharing research in the Alzheimer's field. What do you know about that, and how is that helpful to our efforts?

[Dr. Rémi Quirion]

Five teams have been funded in the context of the partnership between Quebec, Canada, and France. Some are working on the role of prions, a protein, in diseases of the brain. It's based in Vancouver, with some people in Quebec and some people in France. Then there are other animal models.

That's quite useful, because again, there's a bit of sharing of approaches and technology. And these grants are fairly large. They are bigger. They are in the $2 million category.

With Germany and the United Kingdom, the process is just under way. Now we are trying to establish the priority--which subfield of Alzheimer's disease we should fund--in partnership. It will again be in support of a joint platform.

Serge was talking about brain imaging as a potential marker. Well, if you take your image in London, England, and you take your image in Montreal, how do you compare? It's easy to take the image. The issue is analyzing it with different machines. Basically, standardizing all these methodologies in terms of diagnosis and in terms of biomarkers is very important. That's why international partnerships are so important.

The next one developing is with China and with the States.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Quirion.

I understand that you're finished with your questioning, Monsieur Malo. Thank you.

Now we'll go to Dr. Duncan.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madam Chair.

Dr. Gauthier, last time you provided a very clear example of how treatment with medicine varies across the country. I wonder if you can provide an example in terms of how care occurs. Are there different guidelines? How does care vary across the country? Do we need national guidelines? Is there somewhere it's being done extraordinarily well, and the model can be replicated?

[Dr. Serge Gauthier]

The good news is that in Canada, close to 20 years ago, we started to work together--GPs, specialists of different types, and the Alzheimer Society of Canada, representing patients and caregivers--on one set of guidelines. And we've updated those guidelines periodically. So that's national.

As far as the basic diagnostic approach and the care goes, we have harmonization across the country. There may be variations in access to specific technologies, such as CT scans and PET scans. That is a local issue, perhaps, rather than a national guidelines issue.

The surprising inequality has been access to available drugs. And it cannot be just a question of money, because they're not expensive, considering the cost of the disease. So there is something here that we don't understand about the CDR approach, which is negative. It's like going to court. You have to prove that you're a good person. There is something wrong with the current design that you may have to look at in a broader way.

My suggestion to you, at the national level, is that maybe the approach to take would be the approach of having a patients charter. There may be something like that already in existence that we can beef up. If not, maybe we should think about it.

[The Chair, Conservative, Joy Smith]

You can have one more question.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

We talked about needing a national brain strategy. I wonder if we need a national dementia strategy.

[Dr. Serge Gauthier]

I really hope you'll stay away from the D word--

[Kirsty Duncan, Liberal, Etobicoke North, ON]

It is Alzheimer's, yes.

[Dr. Serge Gauthier]

--because Alzheimer's disease is a spectrum, from mild forgetfulness to more than that but not dementia yet. It's Alzheimer's disease.

My argument for broadening it to the brain at large is that the pathology of Alzheimer's is actually a combination of things. There is some Parkinson's in there, and Lewy body, and some small stroke components, and amyloid and other changes in the brain cells. So it's actually a complex disease with bits of different pathologies.

Some patients will have a Parkinson-like course. Others will have a more traditional dementia, a typical Alzheimer's course. And others will fall early and have incontinence because of the stroke component.

That's why there is also a pragmatic, pathological reality check. Alzheimer's is a complex of different causes, and the brain approach will pay off better in the long run than just a disease-specific approach.

I never thought I would say that, but it's true.

[The Chair, Conservative, Joy Smith]

Thank you so very much.

Do you have a question? Okay, go ahead.

[Wayne Marston, NDP, Hamilton East—Stoney Creek, ON]

How much time do I have?

[The Chair, Conservative, Joy Smith]

Five minutes.

[Wayne Marston, NDP, Hamilton East—Stoney Creek, ON]

Thank you very much, Madam Chair.

I'm going to take this to a personal level for a second. In 1974 I was a signal maintainer for the railway, and I had four people killed on one crossing over 11 months. Over a period of years I had mental strain as a result of that; PTSD, I guess, is the word for it.

Then in the 1980s I was involved in a car accident. I pulled a guy out of a burning truck. When I first went to the side of that vehicle, I looked in. Your mind will try to protect you: oh, no, he's already dead, don't worry. I paused for maybe 20 seconds. I had nightmares for five years after that because I even considered leaving him, when in fact we got him out.

Using a lay term, I'd call the result of all that “mental anguish”. When you take that kind of thinking and you apply it to our veterans who are coming back from Afghanistan--I understand there are about 3,000 young men and women coming back from there with various injuries--what's the correlation between the mental anguish potentially causing it or a combination of physical and mental anguish leading to this kind of outcome? Is there evidence that this could be happening? And is there evidence that just the mental side alone might lead to something like this as opposed to physical head trauma?

[Dr. Serge Gauthier]

Maybe I can try to answer that with what's already known.

There were studies done about personality disorders and stress exposure in life as a factor leading to or increasing the risk of Alzheimer's disease. There's no convincing data to that effect. Perhaps it's fair to say that if you are predisposed to a disease because of your genetic makeup, you will have the symptoms at an earlier stage if you had head injuries, if you were drinking alcohol too much, if you had hypothyroidism.

So there may be accelerating factors to a disease that you will get someday. That's as far as I think we can go with the evidence.

[Wayne Marston, NDP, Hamilton East—Stoney Creek, ON]

So in fact we're saying these things are possible causes, but it's more genetic and it's more likely to be genetically caused.

I want to go to the discussion around a pan-Canadian strategy. I guess--and I am guessing--that you would say that because the federal government is responsible for the Canada Health Act, it might logically fall to the federal government, even though most of the health care is provided or administered by provinces. Some form of leadership from the federal level would be very important on this.

I like it when I see all the heads starting to nod. That doesn't happen in my life that often.

The strategy you talk about sounds like it's well under way. I think you referred a moment ago to how things have been happening for 20 years on the medical side.

This is the loaded question: how do you correlate that against what's been happening on the governmental side?

[Dr. Serge Gauthier]

It's a bit of mystery why there's so much discrepancy in drug approval processes among the different provinces. There was hope that the central review would be a positive thing to speed things up, but actually it turned out to be the opposite.

There will also be an ethical dimension to the whole process of diagnosing Alzheimer's before dementia. What do you tell people when they're 50? Do you tell them they have Alzheimer's, that although they don't have symptoms yet, we can see it on their scan or their lumbar puncture? Do we tell them they have mild symptoms of Alzheimer's and they'll have dementia in five years?

There's perhaps an ethical dimension and a resource-use aspect. You will be using more technology, more scans, more lumbar punctures, more specialized units. There may be a social debate that would be at the national level on the ethics of earlier diagnosis if there's no effective prevention. That's one aspect of the answer.

As far as harmonizing diagnoses and management is concerned, we will continue to do that, but this is not driven by governments. This is driven by the base, which is nice. It's doctors and lay public societies, and that will continue.

[Inez Jabalpurwala]

Madam Chair, if I may, only relatively recently have we actually understood the burden of disease for the brain. I remember even 10 years ago, when I first started talking about the idea of creating an entity around the brain, people said, this is impossible. We're diseases, or we're injuries, or we're mental illness. And now this is something that is fundamentally accepted.

With cancer, the Canadian Cancer Society was founded in the early 1900s. With the brain, it's been a long way before we've been able to reach this point. So I think we've done very well considering that the science is still quite young. I think the fact that we've done so much in 15 to 20 years really is an indication, and as Dr. Quirion has mentioned with the technologies that are developing around the world and with the way science has moved, we can do a dramatic amount in the next 20 years.

This is a really great time, I think, to be in this field.

[Wayne Marston, NDP, Hamilton East—Stoney Creek, ON]

The reservations that I hear are around money.