In terms of making a commitment toward this concept of collecting as much data as possible, I would recommend that Canada consider creating some centres of excellence in multiple sclerosis. If you had a single centre of excellence dedicated to this, you could collect 4,000 MS cases a year. If you had five of these centres across Canada, you could collect 20,000 such cases a year. That would still take you three years to cover the total population in Canada, but it would be a significant progress.
This could fit within the centres of excellence program in the federal government. Within a month of starting such a program, you would have more than 300 cases for each of these sites, or 1,500 cases from across the country. Conventional funding for such a project takes a year to get started from inception to the beginning of the scanning, and no site that I know of in Canada or the United States would be prepared to collect the numbers that I have just mentioned to you. Their research will be ten times more expensive and ten times less the number of people that I have just quoted to you here, using conventional funding mechanisms. The approach I have proposed for you would be 100 times more efficient and cost-effective.
The current wait-and-see attitude to treat people is really something that is coming about by treating people as numbers and not as suffering individuals. This is not just a scientific issue; it is a moral issue. It is akin to watching someone drown while you are testing a new flotation device, while all previous ones only sink several hours later. Perhaps this device will not work perfectly at the beginning either, but if it helps keep people afloat rather than watch them drown, then this testing should be done to save someone's life.
Are double-blinded studies, then, the testing that should be done, as claimed by many people, to save someone's life? These double-blinded studies in fact have their own weaknesses associated with them. I will give you an example of this. There is an operation called vertebroplasty that's performed on 200,000 people a year throughout the world. There are two recent studies that have done 100 cases per study and have claimed they did not find an effect. However, according to the surgeons who performed this operation, they did not use the same criteria we would use when choosing a patient for surgery. Still, the vertebroplasty surgery continues today on a daily basis.
I think that demonstrates to you that if the scientists cannot carefully design the double-blinded study with the right criteria after years of following this process, who is to say that the naysayers today will design the right study for the MS population? We don't need to wait to get strong data to show, first, what types of abnormalities are present, and second, to begin following patients immediately. I would say that we should allow patients to have their data retrospectively reviewed, even if they follow a clinical route where data is not usually used for research. In fact, a retrospective analysis of clinical data is allowed when appropriately presented to human studies approval committees.
To date, I have reviewed, coincidentally, 65 cases—the same number as in Zamboni's pioneering study. I have seen a wide variety of venous abnormalities. Questions arise about the total cardiac input to the brain, about the arterial and venous flow patterns, about the structural changes in the veins, and about other issues related to valves and septums and other abnormalities. The imaging methods that we use today are ultrasound, MR imaging, and the gold standard is angiography itself, where the clinician, such as Sandy McDonald, goes in and actually evaluates what is present in the person's vessels.
All these need to be used as an important--