Debates of June 14th, 2010

Canada-Colombia Free Trade Agreement Implementation Act

[The Acting Speaker, Conservative, Barry Devolin]

I declare the motion carried.

(Motion agreed to, bill read the third time and passed)

[The Acting Speaker, Conservative, Barry Devolin]

Pursuant to an order made on Thursday, June 10, 2010, the House shall now resolve itself into committee of the whole to consider Motion No. 5 under Government Business.

I do now leave the chair for the House to go into committee of the whole.

(House in committee of the whole on Government Business No. 5, Ms. Denise Savoie in the chair)

Multiple Sclerosis

[Jay Hill, Conservative, Leader of the Government in the House of Commons]

moved:

That this committee take note of the measures being taken to address the treatment of multiple sclerosis.

[The Deputy Chair, NDP, Denise Savoie]

Before we begin this evening's debate, I would like to remind hon. members of how the proceedings will unfold.

Each member speaking will be allotted 10 minutes for debate, followed by 10 minutes for questions and comments. The debate will end after four hours or when no member rises to speak.

Pursuant to the order adopted earlier, the Chair will receive no dilatory motions, no quorum calls and no requests for unanimous consent.

We will now begin tonight's take note debate. The Chair will now recognize the hon. Minister of Health.

[Leona Aglukkaq, Conservative, Minister of Health]

Madam Chair, the subject tonight's debate is in regard to multiple sclerosis. It is a devastating disease that usually strikes young adults.

I am delighted to be here tonight with my hon. colleagues to show our solidarity as members of Parliament with Canadians suffering with MS, and their families and friends.

I am also happy our government tabled the motion and asked for consent to hold this important debate in order that Canadians be as well informed as possible.

There are many aspects to this disease and its treatment. We know multiple sclerosis as a progressive neurological disease that slowly robs its victims of their mobility and their ability to speak. It robs them of their youth and robs them of their lives.

Every day in this country three more people are told they have MS. It is estimated that between 55,000 to 75,000 people are now living with MS in Canada. Some of us here tonight have family members and friends affected by this disease.

Being able to speak on the effects of this illness and the struggles, and there are those who see their loved ones fight this disease, is important and relieving. At the moment there is no cure for MS, but there is progress in research and we believe we will some day unlock the mystery of this illness.

Recently, news of a possible new treatment has captured the world's attention and given hope to Canadians who suffer from MS. I realize this news is a source of great hope for those who suffer from this disease.

In November of last year an Italian researcher, Dr. Zamboni, developed an experimental treatment for MS based on a possible relationship between MS and impaired venous drainage of the central nervous system. Many Canadians with MS and their families have contacted me to share their experiences and the importance of the findings for them.

I know all members have heard the same from their constituents. We share the hope that this has given those suffering from the disease. These findings challenge long held views on MS and have produced results that have drawn the attention of researchers looking into the causes of MS and other illnesses.

That is why we must pursue a thorough scientific evaluation to see who might benefit from the treatment and to see if there are long-term implications. The answers we are looking for can only come through studies and research done on a larger scale.

These studies are important for many reasons. They are important for Canadians with MS and their families who are filled with hope in the findings and want to see quick action. They are especially important to the provinces and the territories who deliver health care.

Canada's health care system is built on partnership that recognizes and respects the unique roles played by the federal government, the provincial and territorial governments, health care institutions like hospitals and health care practitioners, including the medical doctors who administer the treatments. It is a system that requires collaboration in the best interest of patients.

All of us in this chamber know the territories and provinces deliver health care. This means they make decisions on the administration and delivery of health services, including the treatment and diagnosis of multiple sclerosis. We also know the provinces and territories make these decisions based on the best available science.

The federal government's role is to support health research, which includes clinical research aimed at discovering and assessing new diagnostic treatment procedures. This research plays an important role in confirming and validating new scientific findings and helping the provinces and territories make decisions.

Our government understands the importance of health research for the Canadian health care system. That it is why in budget 2010 we increased funding to the Canadian Institute of Health Research by $16 million. This increase alone with other recent investments to CIHR will mean over $1 billion to health research in Canada this year.

This new funding will allow CIHR to build on the investments we have already made in neurological research. In 2008-2009 roughly $120 million was invested by CIHR, including $5.3 million specifically for multiple sclerosis. Another $38 million went to stem cell research, which could have an effect on the way we treat a wide variety of diseases, including multiple sclerosis.

Our hope for a new treatment for MS and other neurological diseases comes from advances in science that helps us understand the disease.

That is why I asked Dr. Beaudet, president of the CIHR, for his advice on how to advance research in MS in light of Dr. Zamboni's findings. I am extremely pleased that Dr. Beaudet will be holding a round table discussion with more than a dozen world experts on MS to seek their advice.

With the guidance of the world-leading experts and in collaboration with the MS Society, the CIHR intends to get a better understanding of the research being done around the world on neurovascular-related MS. The CIHR wants to identify gaps in the current research and develop a better understanding of any obstacles that may be standing in the way of clinical research.

Investments in neurological research by the Government of Canada means we are building on a foundation of strength. With over $45 million to date invested in MS research, Canadian MS researchers are among the best in the world. They are pursuing important research questions showing great promise for MS and other neurological diseases.

For example, at the University of Toronto, Dr. Courtney is looking at the links between vitamin D and the risk of childhood MS as it affects the progression of the disease. There may be a link between vitamin D and the controlled gene that increases the risk of multiple sclerosis. If we can reduce the risk of childhood MS by giving vitamin supplements to expectant women, there may be implications for adult onset MS.

At the University of Alberta two researchers are studying the use of antioxidants as a nutritional supplement during pregnancy to prevent brain injury. That research is adding to our understanding of how to prevent the damaging effects of low blood flow during pregnancy. Low blood flow is a restricted oxygen supply that can cause brain damage in the fetus. It is hoped that our broader understanding may help prevent brain injury. That research is particularly relevant now because the new treatment for MS is based on improving blood flow to the brain.

With the research now going on in Canada and around the world, we are getting closer to finding better treatments for MS and hopefully a cure.

Scientists are intrigued by the potential links between CCSVI and multiple sclerosis. CIHR welcomes and encourages funding applications from researchers wanting to study this new treatment. We know that good science does not happen overnight. Science demands a measured approach. Science produces results that can produce again and again under the same set of circumstances.

We also know that Canadians with MS in their families want action now. Through CIHR our government will balance the urgency of this issue with the importance of asking the right questions and getting the right answers.

Canadians with MS and their families are asking us to all work together to respond to their suffering and to recognize the great hope that this new finding may generate. Our government is committed to working with CIHR and the MS Society to bring the research community together.

The upcoming meetings of experts on MS with Dr. Beaudet will be an important summit of scientists on the issue. Their thoughts and opinions will help the CIHR, in the months ahead, and the research community develop its strategy on how to research this potential new treatment for MS. It is of interest from a scientific perspective and a great interest to all of those suffering from the disease and their families.

I would like to thank all members who are here tonight representing loved ones in their fight with MS. We will undoubtedly hear many testimonies about or from victims of this debilitating disease. We are here tonight to provide a forum of discussion because it is important that we stand together to show Canadians we are working toward a solution.

This is a time when partnership matters more than ever. Dr. Zamboni's finding challenges not only the scientific understanding of MS but challenges us all to work even harder to support our fellow Canadians with MS and their families. With hard work and strong will, together we will work toward a cure.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Madam Chair, many MS patients are experiencing a rapid decline in their health. We believe there is a moral obligation to offer all MS patients the imaging necessary to identify venous malformation and access to treatment that could possibly stop the progression of their disease in its tracks.

Why is the government not taking this issue seriously for patients today? They need help now. Why?

[Leona Aglukkaq, Conservative, Nunavut, NU]

Madam Chair, to respond to the question, we are taking the issue very seriously. This government has invested $120 million for neurological research alone, and $5 million for MS research.

We are working with the MS Society in pulling the research community together and looking at ways we can advance the clinical trials necessary for this particular procedure, and we will continue to do that.

I asked Dr. Beaudet, as I said in my opening remarks, to provide advice and pull the international research community together to see how we can advance this quickly.

We are also working with the provinces and territories to deliver health care and collaboration. It takes more than one individual to bring a team of scientists and researchers together to deal with this new, possibly important discovery relating to MS.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Madam Chair, I sit on the subcommittee, and over and over again witnesses have indicated there is a need to ensure that treatment continues during the research. They are asking that they be done in conjunction with each other.

I wonder what the minister's response is with respect to why would we not put a process in place to ensure that everyone who may have CCSVI, first has the opportunity to be diagnosed. If they are diagnosed with CCSVI, why not treat it? They should not be discriminated against having this treatment because they have MS.

Why not allow everyone, first to be diagnosed and ensure that the doctors who are treating these patients filter the information into the research part of it. I think that is crucial at this point. There are so many people out there who want the opportunity to do this. The cost is about $1,500 for this treatment in Canada. If they go elsewhere, we are talking about $15,000.

Would the minister include in her remarks the need to ensure this is a double study, which is what Dr. Sandy McDonald is asking for, and the need to ensure that it is study and treatment?

[Leona Aglukkaq, Conservative, Nunavut, NU]

Madam Chair, I will say again what I said in my opening remarks. There are a lot of investments being made to this research. We are working with the jurisdictions to move quickly on this new finding.

I have quotes from Ontario and from Alberta that state further independent and controlled studies are required to prove a better understanding of this particular result. The MS societies, both in Canada and in the United States, have called the early findings surrounding CCSVI “exciting and intriguing” but have said “more research is required to firmly establish the link between blocked neck veins and MS symptoms”.

On June 11, the MS Society released the following statement:

These new studies are necessary because we don't yet know whether, or if so how, CCSVI contributes to MS disease activity.

Our role in the federal government is to support the research in advancing this important work. We will continue to work with the various researchers, the MS Society, as well as the provincial health ministers and College of Physicians and Surgeons to advance this research.

[Tim Uppal, Conservative, Edmonton—Sherwood Park, AB]

Madam Chair, the Sherwood Park MS Community Group in my riding is the largest MS group in the country.

On their behalf, I would like to ask the minister how CIHR is mobilizing the research community around CCSVI and MS?

[Leona Aglukkaq, Conservative, Nunavut, NU]

Madam Chair, the Canadian Institutes of Health Research has been working over the last few years on neurological research, including MS. With regard to this particular issue, I have asked Dr. Beaudet to pull in the international research community to deal with how we can better address this new finding, as well, to identify within the global community what some of the gaps may be around MS research. That conference will be held in Ottawa. I am looking forward to how we can better support that research in this area.

We are also working with the MS Society on how we can better support the research projects with this specific new procedure. On June 11, members in this House may know that the MS Society made some announcements to support a number of research projects.

There is collaboration happening across the country with MS researchers, and we will continue that to find solutions for this issue.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Madam Chair, I have a letter from a Canadian medical doctor who has been practising since 1969, which states:

I have MS since 1990 and just got back from Poland where I had balloon angioplasty to a stenotic right internal jugular vein. I have noticed improvements in several areas.

I also met many Canadians in Ketovice, Poland who had been treated, with positive results. They were ecstatic and so grateful to an improvement to their quality of life.

Two-thirds of all the people treated by Dr. Simka and his colleagues...are Canadians. There are 2,000 people on the waiting list.

The argument in Canada by neurologists is that we need more studies before we can do this in Canada. The only way you do a study is by treating people and a follow-up. Neurologists should have no input into this aspect of treating MS. They are not vascular surgeons.

There is no problem paying for angioplasty for coronary artery stenosis or surgery for carotid artery stenosis. Why the discrimination to veinous stenosis?

[Leona Aglukkaq, Conservative, Nunavut, NU]

Madam Chair, the MS Society made an announcement on June 11 to support further research. The MS Society of Canada and the MS Society in the United States say the following:

These new studies are necessary because we don’t yet know whether, or if so how, CCSVI contributes to MS disease activity.

We will continue to support these types of research in Canada and we will bring in the international community to respond to this possible new procedure. We will continue to work with MS societies in the United States and Canada to do further research.

To answer the question the member is raising, we need to bring in the research community, and that is what we will do.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Madam Chair, the minister herself has mentioned that what is occurring is very promising, but I want to ask whether it is not correct to treat MS and the CCSVI in different functions. Where it indicates there are restrictions in a vein, why should people not have the treatment, as opposed to linking this? If there are benefits for MS, that is perfect. However, in the meantime, people are asking to be treated for the vein blockage.

[Leona Aglukkaq, Conservative, Nunavut, NU]

Madam Chair, MS societies in Canada and the United States have called their early findings surrounding CCSVI exciting, but they have also said they want more research. We will continue to work with them in terms of providing support to see if this new method is effective or not.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Madam Chair, I rise tonight to advocate on behalf of all Canadians living with multiple sclerosis, who not only have the courage to battle their disease every day but also have the guts and the tenacity to take on a new fight, the fight for diagnosis and treatment of chronic cerebrospinal venous insufficiency, CCSVI.

I have personally called, emailed, or met 1,000 MS patients and their families across this country. I have been touched by each and every one, and I am proud to know these extraordinary people.

I understand that this next four hours may determine whether some continue to walk, work, maintain their dignity or remain independent. I hope that everyone who rises tonight truly understands the science, the stakes, the desperation and fear of those living with MS, and the family and friends who watch helplessly.

I am a former scientist. I called for our subcommittee on neurological disease because I knew there were potential MS treatments overseas that were unavailable to Canadians. I have undertaken a comprehensive literature review regarding CCSVI, talked to leading researchers around the world, and I have heard the experts lecture: Dr. Zamboni, Dr. Simka and Dr. Haacke.

I understand that numerous research questions remain. Having acknowledged this, time is brain. Any delay in treatment possibly means more damage. The earlier MS is caught and treatment begun, the better the prognosis. For some patients a delay of a matter of months may mean the difference between working and not working, walking and not walking, or living on their own or in care.

The clock is ticking, and MS patients simply do not have the time to wait. It is time that government officials and bureaucrats take MS out of the equation. We need to explore whether individuals living with MS actually have a vascular problem, and if so treat them. If someone is suspected to have a blocked artery in the heart, he or she is imaged, as is an individual with a blocked hepatic or iliac vein.

Why are MS patients being discriminated against? Why is there such resistance to exploring whether an MS patient might have a blocked jugular vein? Is it the ordering of an MRV? It cannot be, as neurologists order MRIs to image the brain and spinal cord for their patients every day.

Is it the potential waste of human and monetary resources if someone does not have an abnormality? The cost of not picking up a potential abnormality is clearly greater, with potential damage to the brain, loss of function, loss of work and more dependence on the health care system. Whatever the reason, it is patients and their families who potentially suffer when imaging is refused.

What then are the possible impacts of waiting? No one can actually answer this. However, whether CCSVI develops in utero or early in childhood, we know that with age the veins deteriorate. Therefore, for those who have a vascular anomaly, the earlier it is caught the better.

Why then would a well-meaning doctor and a compassionate health care system wait? Is it not the first rule of medicine to do no harm?

No one can yet say whether liberation halts or stops debilitating MS, but it is becoming increasingly evident that it can alleviate some symptoms. MS patients who have had the liberation procedure quickly experience an improvement in brain fuzziness and circulation. Over time they have a marked improvement in the quality of life, sometimes moving from assisted to independent living, and from scooter to walking.

Some will argue there is a lack of evidence to support diagnosis and treatment of CCSVI. However, I would strongly argue there is precedence for moving forward. Doppler, ultrasound, MRI and angioplasty are standard procedures that are used safely every day in hospitals. These procedures are used on the neck, just not if a person has MS.

The question then becomes is there enough evidence to start imaging patients? How long will it take to accumulate good evidence? When will enough be enough? Is it in three months, six months, a year? What does this mean to a patient living with primary or secondary progressive MS?

There is precedence now. Often in medicine, when a treatment shows promise, it is fast-tracked. The most recent example, just last week, is a new device that can suck out stroke-causing blood clots. Twenty-seven Calgary patients have already been rescued from strokes by the device.

The liberation procedure shows promise. We know that poor venous flow can cause inflammation and damage to vessel walls. Poor venous flow can lead to major neurological problems. More than 1,000 people have now been imaged for CCSVI worldwide. It is clear that the majority of MS patients have vascular abnormalities. The angioplasty procedure shows that 80% to 97% of MS patients have vascular abnormalities and, in many cases, more than one major vessel is involved. Surely, 1,000 people is enough to allow for early adoption. After all, many medical procedures used daily in hospitals have never been double-blind tested.

Some patients diagnosed with MS present anomalous obstructions of the veins transporting blood from the brain. Some of these anomalies are serious enough for a doctor to conclude that there is a venous insufficiency depriving the patient of an adequate blood flow from the brain. Some doctors or hospitals decline to treat those anomalies by simply angioplasty on the grounds that it might be seen as a treatment of the MS rather than of the vascular problem and therefore decline even to screen for diagnosis.

It is indefensible that a number of patients are left to an undeserved and harmful limbo of non-diagnosis and, even in the case of diagnosis, non-treatment of serious venous insufficiency. It is in the interest of all Canadians, of MS sufferers in particular and also of the integrity of the Canadian health care system that an end be put to this harmful uncertainty.

I beg the government that no Canadian be deprived of the imaging necessary for diagnosis of venous insufficiency or deprived of the angioplasty indicated by a diagnosis of venous insufficiency in the drainage of the brain, by reason only that this Canadian has also been diagnosed with MS.

I beg that the Minister of Health should convene her provincial and territorial counterparts to a meeting for the purpose of ensuring that no impediment will be placed in the way of diagnosis of venous insufficiency or of treatment by angioplasty on the grounds only that that patient has been diagnosed with MS.

I beg that CIHR funds be made available to assist in the creation of a registry by which it would be possible to collate data regarding the progress of MS patients who undergo venous angioplasty.

I beg that the funds for the MS Society's research proposal be released to allow for that research, which must not be an impediment to patients obtaining diagnosis or the angioplasty and should proceed in parallel to any such treatment.

I would like to use cancer as an example. While only 1% of patients may be enrolled in a clinical study, the remaining 99% are not denied treatment. Why is MS being treated differently by our celebrated medical system?

Finally, I beseech and I implore the government to do the morally right thing and act: image MS patients for venous malformations and treat them if required. Do not make very sick people beg for health care that they have paid into all their lives.

There is no excuse not to image. Imaging is safe. There is no excuse not to treat. Angioplasty is an established practice. Failure to diagnose and treat is discriminatory.

My beloved cuz and patients across the country are waiting, getting sicker and, in some cases, dying. The government must fight for families.

[Ron Cannan, Conservative, Kelowna—Lake Country, BC]

Madam Chair, I thank my hon. colleague for her hard work on this issue and her passion. I think everybody in the House shares this concern, people with loved ones and my colleagues who have family members and personal friends who are stricken with this terrible illness. I have had constituents in my office, one specifically who went to Mexico and had the treatment, and it has been fabulous.

I understand where we are as a government, working together. This is a non-partisan issue. We all want to find results, but the reality is we have the Canada Health Act that is delivered by the provinces.

I have spoken with the MS Society. I have met with patients and heard their pleas first-hand to get the vascular scan, but it is up to the provinces and the territories that deliver the health care services. That is the way our health care act is. If members want to have a debate on that, they will need to do that at the health committee.

My hon. colleague has spoken with 1,000 patients, but has she talked with the College of Physicians and Surgeons? Has she spoken with the minister of health for her province of Ontario and asked her why she does not make the services available in her province and across the country?

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Madam Chair, health is not an area assigned exclusively to the provinces by the BNA Act. It is a shared area. That is why we have a federal minister of health and a federal committee on health. The Government of Canada has a legitimate role to play in the area of health. For example, it is responsible for the health of aboriginal Canadians and the Canadian Forces.

This issue is relevant to Canadians across the country, 75,000 of them. Much of the money spent on health care comes from federal transfers and the Government of Canada has an interest, the required jurisdiction and the constitutional power to ensure that those funds are spent efficiently, fairly and consistent with charter values.

I again ask that the minister convene her provincial and territorial counterparts and look at how we diagnose and treat CCSVI.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Madam Chair, I greatly appreciate the comments from my colleague. She was at committee when we heard from Steve Garvey, and I am sure she will remember how touching and emotional that testimony was. Mr. Garvey was diagnosed with multiple sclerosis about 10 years ago and really wanted control of his body back. That is what he talked about during that time. He talked about how difficult it was for him to see himself being imprisoned within his own body.

I have a friend in the riding, David McDowell, and that is how he feels. He feels imprisoned in his body because of the fact that he cannot do for himself. He cannot hold his six year old son. He wants access to this. If all it is going to do is give him a bit of relief, he has nothing to lose. Neither does Mr. Garvey.

Given the fact that we are seeing so much promise here, does she agree that the study being done should be done in conjunction with treatment for everyone?

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Madam Chair, there must be diagnosis and treatment of CCSVI and then we can follow the people with the research.

I also want to point out that it is simply not fair or consistent with charter values to say that angioplasty correction of diagnosed venous insufficiency will be available to Canadians generally but not to people who happen also to be diagnosed with MS. It is not fair or consistent with charter values to deprive people, even if the diagnosis is venous insufficiency, for no other reason but they are diagnosed with MS.

It is also not an efficient use of federal money to deny to MS sufferers a treatment which is not only cheap, about a quarter of the yearly cost of maintaining the disease, but by several accounts, actually appears to do good.

[Ralph Goodale, Liberal, Wascana, SK]

Madam Chair, I know the passion and the persistence which is so obvious tonight from the member for Etobicoke North in the way she approaches the issue of MS and emerging treatments like angioplasty. She prompted no fewer than five requests from the official opposition for this debate this evening and it simply would not be happening without her commitment.

I congratulate her for that, but mostly I want to understand her motivation. What causes her to fight so hard for action on these new vein related treatments for multiple sclerosis?

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Madam Chair, I came to the Hill to fight for neurological disease. That is why I started a subcommittee on neurological disease. For the past four weeks, I have not been to bed before 4 a.m., as I have talked to 1,000 patients across the country who are desperate. Some are suicidal. They are separated from their life. They are separated from their family and friends. They are separated from their dignity. They are fighting for their life.

There is only one think worse than having MS, is having MS and knowing there is diagnosis to treatment out there, but they cannot get it. It is unconscionable that Canadians are being forced to go overseas to Poland, to mortgage their homes in order to get the treatment that they should be getting in our country.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Madam Chair, I want to commend my colleague across the way as well for bringing this important issue to debate this evening. I, too, have had a lot of opportunity to speak to constituents in my riding in terms of this procedure and the frustration they feel in expecting something should be happening for them. They feel there are delays.

I want to focus on the fact that experts have said more research is needed to firmly establish the link between blocked neck veins and MS symptoms. Even Dr. Zamboni has said that more research is needed. I thought I heard my colleague say that she did not believe any more evidence was needed.

Could she elaborate, based on her scientific background, on her conclusion that no more evidence was needed?

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Madam Chair, that is not what I said at all. We absolutely need more research. In fact, I put 50 questions on the order paper that need to be thought about by the government to protect people today and going forward.

The big problem is right now there is no diagnosis for CCSVI, a recognized condition by 47 countries. Canadian MS patients are forced to travel to Buffalo or Detroit, with imaging ranging in costs of $1,200 to $6,000. Private imaging clinics are increasing by the day. Kuwait is the first country in the world to offer imaging and the liberation procedure to all its MS patients.

Canada is recognized the world over for its publicly funded medical system and we must protect accessibility and universality. Canadian MS patients should not be struggling along to determine what is a reputable imaging or treatment centre, but in the absence of help, they are forced to do so. Many seeking help are forced to go overseas for private health care. What does this mean for a family that simply does not have the financial resources to do so?