Thank you very much for inviting me to testify.
My name is Samuel Ludwin. I'm a physician, a neuropathologist, which is somebody who studies the brain. I have been studying neuropathology for the last 40 years. During this period, although I look at all brain diseases in my clinical job, my research work has been in the study of multiple sclerosis brains. I'm also an experimental researcher.
My whole academic life has been related to trying to understand the link between what we observe in the experimental situations and what we see in the clinic and what we see in the brains of patients with multiple sclerosis.
I might add that pathology is a unique discipline that gives the physician the privilege of being able to look at a patient from an objective point of view, and we take that responsibility very seriously. I'm also a teacher on both clinical and basic matters.
I have also served as an associate dean of research and the vice-president of research in the Kingston hospitals, and this has given me a unique perspective on research in general. I've served as a patient advocate on both multiple sclerosis and some other myelin-related diseases. Finally, and I will come back to this, I am currently the incoming chairman of the federal panel on research ethics set up by the three funding agencies that provide the guidelines for ethical procedures in human research.
Dr. Murray has mentioned some of the issues, but I think they bear repeating, because a lot of these I will have done. Canada is a unique country in the world of multiple sclerosis, admired throughout the world for the quality of both its clinical work and research. As they say, we punch far above our weight in terms of the number of people treating and publishing and doing research. This has come about, of course, from necessity, because of our large patient load.
But in addition, there have been two very good reasons that our scientists and our clinicians have achieved this very enviable position in the world. The first is an extremely well-organized clinical network, which really looks after most multiple sclerosis patients in the country—this is very different from the situation in most other countries—and also to a very dedicated Multiple Sclerosis Society, which has provided funding for many decades and has funded some of the most important advances in multiple sclerosis.
I can't emphasize too much the relationship between good clinical practice and research. I'll start off by making a general statement from all clinical research: that studies have shown that patients who are undergoing clinical trials generally, whether they're on trial arms or not, have a much more favourable outcome than patients who are not treated this way.
But this is a side effect to providing a rational basis for therapy. Any time one looks at a therapeutic process, one has to have some sort of justification. Sometimes the justification can come from clinical observation and sometimes it can come from experimental observation on animal and tissue culture models. For instance, we all know—and this has some analogies to CCSVI—that coronary angioplasty and coronary stenting is a routine, accepted procedure. But people forget to stop and think about what our knowledge about coronary angiography has derived from. It has derived from a decade and maybe even centuries of observable pathological changes in the actual heart, changes that have shown blockages in the vessels and have led to techniques for diagnosing them, fortunately, before the patients die.
These have been established over many decades before the advent of some of the treatments. With new technology, this observable time can be greatly shortened, so patients will not have to wait for the kinds of decades that they did for coronary angiography.
Research in Canada covers most fields. There are very many important fields—