Evidence of meeting #14 for Subcommittee on Neurological Disease in the 40th Parliament, 3rd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was alzheimer's.
A recording is available from Parliament.
Vice-President, Policy, Canada's Research-Based Pharmaceutical Companies (Rx & D)
It depends, because all sorts of factors influence investments.
Vice-President, Policy, Canada's Research-Based Pharmaceutical Companies (Rx & D)
For instance, patent laws may have an influence. In the private sector if you want patent protection, a certain market exclusivity that rewards the investments that the private company makes in research, that can attract funds. For instance, the United States quite recently passed a patent extension, particularly to encourage research on biologic medication.
The same sort of incentive measure could be used not only for biologic medication, but also perhaps for vaccines. Research on vaccines takes much longer than research to develop medication.
Bloc
Luc Malo Bloc Verchères—Les Patriotes, QC
What I understand from your comments is that the development of vaccines is at a very preliminary stage.
Vice-President, Policy, Canada's Research-Based Pharmaceutical Companies (Rx & D)
Yes. At least that is the case for vaccines against Alzheimer's disease. There have not been any successes in the past few years, in spite of the large amount of research that is being done in this field. Since the 1990s and the beginning of the last decade there has of course been research on vaccines against Alzheimer's. A great deal has been learned, but no effective medications have been developed that would be approved by the FDA or Health Canada. There is still work to be done.
Bloc
Luc Malo Bloc Verchères—Les Patriotes, QC
If I understand correctly, Doctor Gauthier, you are working on finding tools to prevent the disease, or that is what you hope to focus on in your research.
As an Individual
Yes. I think that we have reached a certain plateau currently with regard to molecules that can attenuate symptoms at the dementia stage. However, we may be luckier with new models or new molecules. Also, as the lady was saying, we may develop an original approach that may derive from observation in the context of another disease, which could apply to many other cerebral pathologies.
We need to invest in prevention at this time. We have a whole cohort of baby boomers, and I am one of them, who are aware of the risks and who may be willing to invest some of their own funds. To add something to the reply given to Ms. Duncan earlier, I would say that if we could get the public fired up about the prevention of neurological diseases, we might be able to obtain private investment to add to the funds available from the federal level.
Bloc
Conservative
The Chair Conservative Joy Smith
Thank you, Monsieur Malo.
I want to welcome Mr. Marston to the committee.
You have seven minutes for questions and answers, Mr. Marston.
NDP
Wayne Marston NDP Hamilton East—Stoney Creek, ON
It's interesting to take a seat about a minute before you have to ask seven minutes' worth of questions, but thank you, Madam Chair, I appreciate your welcome.
I see there's a recommendation from Mr. Gauthier regarding an increase in the tax credit for patients with chronic debilitating illnesses. Tax breaks don't put much money into people's pockets unless they already have money and resources.
We have some supports under employment insurance. Would an expansion of the program under employment insurance be more helpful?
As an Individual
Most of the Alzheimer's patients are already retired and about 75 years of age, so they would have to pay income tax to get some money back with the tax credit. Perhaps the new generation of baby boomers, as they move into the ages when many of them unfortunately will have dementia, will have enough income to take advantage of such a program. But for the children who are caregivers and still working, your suggestion is a very appropriate one to explore.
Wayne Marston NDP Hamilton East—Stoney Creek, ON
Most of us know more people with MS than with AD in my generation. I'm a boomer as well--although it's hard to tell. Recently there has been anguish around the magic bullet they'd thought they had found for MS.
Is there anything on the horizon investigatively that would lead us to the same kind of situation, where there might be something to push back Alzheimer's once it starts?
As an Individual
Actually, the starting point has changed. We no longer wait for dementia to say that someone has Alzheimer's disease. The new biomarkers include spinal fluid examination--we need a spinal fluid lab in Canada, so add it to the wish list, please--and PET imaging, which is imaging of the brain with different tracers.
If we can make a diagnosis of Alzheimer's before there is dementia, we can gain about two years, on average. Those two years before dementia is our window, we think, to study the disease where the brain is still able to recuperate. Some of the connections could be rebuilt. It bridges what the young lady was saying here about brain repair systems.
That's what we're hoping. It would take three years, I would say, to establish whether this prevention in the pre-dementia stage was actually working. Some of the drugs that have failed in the later stages might work earlier. There are new molecules being tested in animal models right now.
NDP
Wayne Marston NDP Hamilton East—Stoney Creek, ON
I'm sorry I missed the part of the presentation that spoke to that, because prevention is always the better model in anything we come up against from a health standpoint.
When you talk about this advance screening, how do you choose the persons to screen? There must be some evidence or family history. How do you make that choice?
As an Individual
You're right on the mark: family history is probably the key factor. There may be some blood test to support your family history as a risk. There was a discovery made in Canada about a gene that malfunctions in 15% of the population. It's a variation of a gene that allows your brain to carry cholesterol efficiently in and out, and to build connections as you grow up as a child and maintain those connections as you age. So there are ways to identify people at risk from family history, some genetic tests.
Some new brain scans—fMRI—would also allow detection of people with some brain connection abnormalities even before they have symptoms. This is technology available now. So we're building momentum in the next year at McGill, and hopefully elsewhere across the country, for prevention in people at the highest risk, where the risk is justifying the means for prevention.
But in parallel to that, for the population as a whole, at lower risk, there are other interventions that resemble heart and stroke prevention that are already in place, such as controlling your blood pressure, having red wine, men staying married. There's a host of other prevention measures that can be diffused through knowledge transfer for the people at the lower level of risk.
NDP
Wayne Marston NDP Hamilton East—Stoney Creek, ON
I wouldn't have expected the “staying married” part.
My wife and I are fine, thank you very much.
NDP
Wayne Marston NDP Hamilton East—Stoney Creek, ON
You talked about cholesterol. Is there evidence that cholesterol at high levels impedes the function of the brain, or even leads to this?
As an Individual
It's part of a number of vascular risk factors, which include high blood pressure, especially at your age—40 to 60. In mid-life, high blood pressure is a known risk factor for dementia in general and Alzheimer in particular. That's preventive with technologies already available. That also includes diabetes, which is on the rise in our continent; high cholesterol, which we're starting to control in mid-life now, with appropriate medications, with exercise and diet; smoking is a factor we're controlling. So cholesterol should be seen as part of a number of vascular risk factors on which we do have some control.
NDP
Wayne Marston NDP Hamilton East—Stoney Creek, ON
I'll keep taking my Crestor, thank you.
Thank you very much, Chair.
Conservative
Conservative
Patrick Brown Conservative Barrie, ON
Thank you, Madam Chair.
Thank you for all the presentations here today.
Certainly this is a fascinating topic. I know my family, like most families, has been touched by Alzheimer's. I remember seeing my grandmother two years ago pass away of dementia. I remember that the doctor told us seven years before that it's one of the worst ways to die, and it really is, because it is so insidious. I hope that with the work we're doing we're making progress. There's an exciting remedy here about the $30 million invested through CIHR, and the list of other ideas of what we could be doing.
I have a few questions that I'm curious about. We had the Alzheimer Society on the Hill two years ago when they presented the “Rising Tide” report about the economic consequences associated with Alzheimer's and dementia. Could you share a little bit of information on that and how real those numbers are? Do you agree with the assessment? At the time, Scott Dudgeon was their CEO, who shared with MPs that this was going to be a multi-billion dollar cost to the Canadian health care system.
Executive Director, International Collaborative Research Strategy for Alzheimer's Disease, Canadian Institutes of Health Research
The Alzheimer Society of Canada is part of the coalition that Inez talked about, and it is a partner with us. We are working very closely with them in developing the international strategy that I talked about. The numbers they have are real. We all mentioned them, so it's billions of dollars. Of course, the number of Canadians suffering from dementia is also increasing very rapidly, so it's the rising tide. Now we are calling our report “Turning the Tide”.
So we need to find ways to slow down the progression of the disease and to reduce the number of Canadians suffering from that disease. One way is prevention, as Serge was discussing, controlling your blood pressure, exercise, good diet, and so on. There is a pharmaceutical approach as well.
Conservative
Patrick Brown Conservative Barrie, ON
One thing I've always been perplexed by, and I remember when I asked questions about this years ago I was surprised by it, is how little we really knew about the brain. It was a very frustrating process. I've heard people say that mental activity certainly helps avoid the onset. Then I think of people like Ronald Reagan and Margaret Thatcher, who have had incredibly stimulating lives. You hear about physical activity, but then you hear in the NFL there are higher rates of Alzheimer's and dementia than anywhere else, and they have incredible levels of physical activity.
How certain are we that those are means to delay onset? When you see examples like that, it certainly causes confusion.