Veterans Affairs Committee on March 2nd, 2011

[Dr. Alain Beaudet]

It's a difficult question and, again, I'm not an expert. Yes, we are actually funding research in that area. What you're describing is typical of post-traumatic stress disorder. Again, you have to understand it as the brain circuits that are involved in fear. These brain circuits also involve the hormonal axis that will release noradrenalin, adrenalin, and corticosterone in the bloodstream when you face anxiety and any stressful situation.

Normally, there are mechanisms whereby the fear circuit will be stopped; the hormonal imbalance will be stopped and will revert to normal. Everything reverts to normal, and you're okay. In the case of post-traumatic stress disorder, it's as if the mechanism to extinguish the fear reaction and the mechanisms to bring the hormonal levels—particularly the cortisol level—back to normal are no longer operational.

Lots of studies are trying to understand what is going awry in the brain circuitry. Not only are the normal mechanisms that extinguish the signal not operational, but also, you will have triggers exactly as you described. It could be sound. It could be smell. Very often there are spontaneous images--often dreaming.

As you know, it's like a state of hyper-vigilance, right? These people have huge problems sleeping, and they have a very strong dream content that always brings back the memories. The hippocampus is very much involved. All the circuits that are involved in recalling the memories are recalled and are put into action in an appropriate way.

You're asking me how we can understand it. We're talking about the next frontier, which is understanding the brain. Yes, there are several studies that we're supporting currently that are trying to examine just that through imaging techniques: what the relationships between the brain and the hormonal system are and what circuits of the brain are involved. But I would say that it's still early days.

It's critical in my sense, too, that we understand this, because it's only when we understand it that we'll be able to develop treatments that are not empirical. Right now, the treatments we're using are, as you know, the same types of treatments that we are using in depression. It's very difficult to treat.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Another question I have has to do with some of the research you're doing on MRIs and the cutaneous tissue and all these things you're doing post-service for our servicemen. Do those studies look at what the brain looks like before and after? Are you doing a lot of the “after” now? If you are, what are you seeing?

[Dr. Alain Beaudet]

It's always very difficult to.... Actually, they could exist, but I'm not aware of longitudinal studies that are looking at before and after, but there's a lot of comparison between the normal population and the population that has been exposed to stress, and comparisons between people who have been exposed to combat stress versus other types of stress. As you may imagine, it's more difficult to do the longitudinal study, the before and after, but there might be some studies that I'm unaware of, quite frankly, I think it would actually be an excellent thing to look at.

Because again, I'm really convinced, from what I've read, that there must be some neurobiological basis for the susceptibility of some individuals but not others to develop distress disorders. If we could develop either bar markers or imaging that would allow us to screen these people beforehand, it would be great. I'm sure there must be interventions in that area. I'm just not aware of them.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Is the research...? Obviously PTSD can be many different things to different people, with the triggers and all of that, but--

[Dr. Alain Beaudet]

But the syndrome is pretty well defined, though.

[Ben Lobb, Conservative, Huron—Bruce, ON]

That's fair enough.

The question I want to get to now is whether you, through your research, are able to narrow it down to say that there are actually different types of PTSD. Or is it still globally accepted within the research community that PTSD is PTSD? Are you able to now narrow it down exactly?

[Dr. Alain Beaudet]

My understanding, from what I know of the literature, is that it's still a big syndrome, but there could be a narrowing down that has occurred that I'm not aware of. You have to remember that I'm funding research; I'm not a researcher working in the field.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Yes, I understand that.

I'll close with an experience that I've encountered. At one time, I was a competitive baseball player. You've talked about freezing once the adrenalin starts flowing. I always found relief pitchers interesting. You could warm up in the bullpen and throw strike after strike, but as soon as you crossed that line, you couldn't throw a strike to save your life. I know that's not PTSD, but it's to do with the adrenalin flow and all the--

[Dr. Alain Beaudet]

It's the same thing. But it's because what you're describing is an extinguishing mechanism that works. That's the normal mechanism.

First of all, I find it very interesting--it's not fun, but it's very interesting--that such a high proportion of the population develops post-traumatic stress disorder. It makes us wonder why they have it and why there's a susceptibility. I believe there's a genetic buildup. There might have been a protective role at a certain point in developing that. It may have been protective to ensure avoidance of certain stresses by human beings—and I'm talking about millions of years ago—but it stayed in parts of our genes. It's clearly no longer very useful.

[The Chair, Conservative, Gary Schellenberger]

Thank you.

Ms. Coady, please.

[Siobhan Coady, Liberal, St. John's South—Mount Pearl, NL]

Thank you very much.

I certainly appreciate you being here today. I have a great deal of respect for the Canadian Institutes of Health Research. I hope you continue to do great work.

I have a couple of questions.

I was in biotechnology. I had a company that looked at how genes affect human health and disease; that's why I'm so familiar with CIHR. Here's one of my questions, though. You talked earlier about a lot of the research that you were doing. I'm wondering how that research is being translated? Do you know of programs that have been developed and where we are in the cycle of the research?

Because it's great to do the research, and I applaud you for it and I think it's important, but how is that being translated to help today?

[Dr. Alain Beaudet]

Actually, you know, it's very interesting, because you're putting your finger right on the tender spot.

We have a dual mandate at CIHR: to create knowledge, and to ensure that this knowledge, as I read earlier, is translated into better health outcomes and a better health care system. That's a huge challenge. It's a huge challenge for several reasons. I won't go through all of them, but we've identified that as a key and critical objective.

We're dealing in an area, however, which is right at the juncture of federal and provincial jurisdictions, because health care, as you know, is provincial jurisdiction and research is a mixed jurisdiction. So I'm convinced that the only way we're going to be able to very efficiently translate the results of the research is working more closely with the provinces to ensure that research is fully integrated in care, first of all.

Second, we've developed a patient-oriented research strategy at CIHR, which has one very clear, specific aim: to improve health outcomes through research. To do that, one of the things we want to do is create research networks that will be clinical research networks that will help us evaluate innovations, bring things more efficiently from the bench to the bedside, evaluate innovative treatments, and also evaluate current treatments and eliminate what we're doing that is useless or does more harm than good. It is less glamorous, but it's equally important to do that if we want to improve the impact of that great research we're doing in Canada on the quality of our health care system, and of course in the quality of health outcomes.

The same is particularly critical in the area of mental health, where we have excellent research, but yet not enough clinical research. We have fantastic people, but not enough, and they're not sufficiently networked across the country. That's what we want to do: we want to support the establishment of clinical research networks in mental health.

[Siobhan Coady, Liberal, St. John's South—Mount Pearl, NL]

Thank you for that. I couldn't support you more in those initiatives.

Having said that, I note that with veterans we are in a cycle right now where we have a tremendous number of veterans returning from the theatre of war who are suffering, a lot of them, from PTSD. We know that. We have peacekeepers who are suffering from PTSD. Their symptoms are still fresh even though they may have been returned from duty 10 years ago; they still have these issues.

So I think that with veterans, because they are the responsibility of the federal government...I know they utilize the provincial health care system, but the federal government still has the responsibility. I believe my honourable colleague across the way said earlier that we have to ensure that really we have a lifelong care of veterans.

So I guess we have an opportunity now, utilizing some of the research that you've done, of actually applying that for veterans and probably getting out of the inter-jurisdictional quagmire that we have between the province and the federal government. I would encourage you—and I know that you do work with Veterans Affairs Canada—to cross that chasm.

[Dr. Alain Beaudet]

But it's exactly what we've been starting to discuss with our colleagues at Veterans Affairs—

[Siobhan Coady, Liberal, St. John's South—Mount Pearl, NL]

I would suggest that this committee could recommend that, because we really need to apply that research that you've done, that good research, and get results today. It can't be a 10-year negotiation—

[Dr. Alain Beaudet]

No, absolutely. Quite frankly, there are some results we already have that need to be implemented in a more systematic fashion and evaluated. One thing is implementing them, but evaluating the long-term effect of treatments, comparing them, doing true clinical trials, and ensuring that we truly exert the effective—

[Siobhan Coady, Liberal, St. John's South—Mount Pearl, NL]

Well, here's an opportunity to do translational research quickly.

[The Chair, Conservative, Gary Schellenberger]

The time is up.

[Dr. Alain Beaudet]

Thank you.

[The Chair, Conservative, Gary Schellenberger]

Thank you.

Mr. André, please.

[Guy André, Bloc, Berthier—Maskinongé, QC]

Thank you for being here.

What I found interesting in your comments was the entire issue of the diagnosis of individuals experiencing post-traumatic stress. I always wonder about screening, and this is the first time someone has talked about it here, in committee. I think it's the most important aspect.

You said that 25% of people who are victims of stress can, according to Henri Laborit's theory—I remember because I studied in this area back then—be more likely to develop post-traumatic stress, and that 75% of them are not. I do have a question to ask about that.

The level of stress can also be different. I can be exposed to stress…

[Dr. Alain Beaudet]

Absolutely, and it is always difficult to assess. We are clearly talking about an average.

It seems that about a quarter of people are much more likely to react over an extended period of time after being exposed to intense stress, as we are seeing in this case. But, in others, the system restores itself normally.

[Guy André, Bloc, Berthier—Maskinongé, QC]

Based on what you said, we are on the verge of being able to screen soldiers before they take part in a mission.

[Dr. Alain Beaudet]

Unlike economists, I don't like making predictions. But, it is clear to me that we need to continue subsidizing research that focuses on making early diagnoses, so we can prevent rather than cure. I think that, once the stress is established and these people have entered a vicious circle, it is clear that there are considerable neuronal and hormonal malfunctions. We are seeing that it is very difficult to treat. It would be tremendous if we could have biomarkers that would enable us to make a diagnosis earlier, and therefore prevent the illness.

I also want to stress one of the major problems that is enormously harmful to the treatment of people dealing with post-traumatic stress: either people don't believe them or, as your colleague described earlier, they are sent from one office to another, and so on. Afflicted individuals, the poor people, have the impression that it's their fault, so it's a biological reaction. But as soon as this is explained to them, the treatment becomes much easier. Not only do we need to listen to these people, but we have to explain this to them, too.

[Guy André, Bloc, Berthier—Maskinongé, QC]

We know that men seek help less than women. It is a phenomenon peculiar to men.