Evidence of meeting #8 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 treatment.
A recording is available from Parliament.
12:15 p.m.
Liberal
12:15 p.m.
Medical Doctor, Vascular Surgeon, Sunnybrook Health Sciences Centre, As an Individual
Madam Chair, I think I was asked to reply to the comment.
12:15 p.m.
Medical Doctor, Vascular Surgeon, Sunnybrook Health Sciences Centre, As an Individual
May I?
12:15 p.m.
Medical Doctor, Vascular Surgeon, Sunnybrook Health Sciences Centre, As an Individual
May I have one minute?
12:15 p.m.
Bloc
12:15 p.m.
Medical Doctor, Vascular Surgeon, Sunnybrook Health Sciences Centre, As an Individual
I'm sorry?
12:15 p.m.
Medical Doctor, Vascular Surgeon, Sunnybrook Health Sciences Centre, As an Individual
All right.
Thank you very much to Dr. Beaudet for his input.
I think we all know that what is lacking, at least in Canada, through all the research and all the commentary that has been made, is that we need a treatment arm to test the hypothesis. Unfortunately, the $2.4 million that has gone out from the MS Society in Canada and in the U.S. does not go in the direction of testing the hypothesis that treatment will or will not improve the outcome of the neurological symptoms.
These are people who are basically living in a terrible situation of chronic and progressive disability and without any real treatment available to them. I think that both Dr. Zamboni and our colleague from Poland have suggested that this is not new treatment for us. We treat veins and arteries with angioplasty routinely. It has a low-risk and a very minimally invasive component to it. Most of these treatments are outpatient treatments.
So I would really urge the committee members, the government, and the appropriate funding agencies to look towards funding the definitive study that will answer the question, which is not whether MS has or does not have associated venous disease, but rather, does treatment of the venous outflow obstruction, as reported by Dr. Zamboni, improve the neurological outcome? This is very analogous to any drug that neurologists are asked to test. If you don't test the drug to the patient and investigate the outcome, you will never know whether that drug improves the outcome or not.
What we're doing with our funding, for some reason that is very difficult for me to understand, is that we're running around and saying, well, do people with MS have venous obstruction? Do they have anomalous venous drainage? We're wasting time and money, and we're certainly not helping our people who are going overseas to get treatment when we should be able to do the studies in a blinded fashion within Canada.
What we need is teamwork among vascular surgeons and neurologists who are competent in MS and who can independently assess the efficacy of the treatment. But we need to get going on this, so that within a year or two we can let our MS population know the answer.
[Applause]
12:20 p.m.
Liberal
The Vice-Chair Liberal Kirsty Duncan
Thank you, Dr. Maggisano.
Now we're going to go to Monsieur Malo.
12:20 p.m.
Bloc
Luc Malo Bloc Verchères—Les Patriotes, QC
Madam Chair, before I ask my questions, I have to say that I completely understand the emotions of those who are in the room.
But I must point out that we are not on a television set, we are in a committee room. Witnesses may be present for the debate, of course, but you must understand that there are rules to be followed and decorum to be maintained. So I would encourage witnesses to curb their enthusiasm, just so that the committee can conduct its work as efficiently as possible.
12:20 p.m.
Voices
Oh, oh!
12:20 p.m.
Liberal
The Vice-Chair Liberal Kirsty Duncan
Mr. Malo, please go ahead with your questions. We're looking forward to what you have to say.
12:20 p.m.
Bloc
Luc Malo Bloc Verchères—Les Patriotes, QC
Thank you very much, Madam Chair.
I completely understand that what I have just said does not go over well with the witnesses. But if that kind of reaction were permitted in all committees, we could easily lose control of the proceedings. It is a rule, that's all. Perhaps the incident would be considered closed if the clerk could confirm the rule.
But I will ask my questions right away.
Dr. Zamboni, you said in your presentation that clinical trials could be conducted under the control of ethics committees. Could you please give us some more details on how you consider ethics committees could monitor or supervise clinical trials?
I would also ask our other witnesses for their opinion on the effectiveness of a process like that and on whether the approach is in common use.
12:20 p.m.
Medical Doctor, Director, Vascular Diseases Center, University of Ferrara, As an Individual
In Italy, we are now carrying out a randomized control study with the following characteristics. It's blinded so that you may take away any doubt about the placebo effect, because the untreated arm will have the same surgery, and the treated arm conventional angioplasty. We also need independent assessors measuring the clinical outcome as well as conventional MRI measures.
I want to underline that until now there are no treatments capable of having a real and serious primary end point for treatment regarding a neurodegenerative disease, because until now, the viable treatment can simply reach an MRI and radiological end point and not a clinical end point, because disability cannot be prevented at all by the actual treatment. The challenge with this supervised randomized control double-blind study is to try to investigate if the additional benefits of the angioplasty and the eventually associated treatment of a major vascular problem may also lead to the prevention of disability.
12:25 p.m.
Medical Doctor, Vascular Surgeon, Sunnybrook Health Sciences Centre, As an Individual
I think I can answer the question, because in most of the university centres across Canada, we have been evaluating disease processes for the last 20 years. We did this with coronary artery angioplasty and with peripheral arterial angioplasty. We've done it with carotid disease. We're doing it with the discovery of whether or not carotid angioplasty is better than surgery. So we have tremendous expertise across the country in evaluating and monitoring the efficacy of novel and new treatments for all disease processes.
So I don't think it's an issue of how our ethics committees would be structured to oversee the process of intervention of the venous lesions described by Dr. Zamboni. I think we have tremendous talent across the country to do that--and within the academic centres.
12:25 p.m.
Medical Doctor, Director, Vascular Diseases Center, University of Ferrara, As an Individual
We know this--
12:25 p.m.
Medical Doctor, Director, Vascular Diseases Center, University of Ferrara, As an Individual
We know this very well.
12:25 p.m.
An hon. member
There is a delay in the audio feed.
12:25 p.m.
Liberal
The Vice-Chair Liberal Kirsty Duncan
Monsieur Malo, would you like to ask a question or would you like Dr. Zamboni to answer?