Kirsty Duncan

[Questions Passed as Orders for Returns, September 14th, 2009]

With regard to the current outbreak of new influenza A (H1N1) virus, including its potential global spread, and including the probability that it will become widely established: (a) seeing as swine is an important reservoir for the new virus, what specific measures are being undertaken by animal and human health experts in Canada to monitor swine; (b) what, if any, funding has been made available for a coordinated surveillance effort; (c) how does the new H1N1 compare with the 1918 H1N1 virus and H5N1, particularly regarding the adaptation markers and virulence, and are the current human cases of H1N1 similar (in pattern) to the possible cases of influenza between the spring and fall of 1918 and, if so, what lessons can be learnt; (d) what planning is being undertaken for a worse-case scenario, especially if a more virulent virus emerges during the course of a pandemic can never be ruled out; (e) what specific measures are being taken to reduce the spread of H1N1 in local communities (and particularly in low resource areas) and institutions, and in the future, at what point should affected provinces consider activating aggressive containment or mitigation efforts for affected communities; (f) what new surveillance is taking place in the southern hemisphere, particularly in respect to the Americas’ flyways, humans, and pig populations; (g) has the source of H5N1 infection in the Fraser Valley of British Columbia been established and, if so, what is the source, and is it endemic; (h) what steps are being taken to address the source of H5N1 infections in the Fraser Valley, particularly with the approach of the Vancouver Olympic Games; (i) what specific preventive and treatment recommendations, if any, will be provided to young adults and pregnant women; (j) what are the predicted impacts on the Canadian economy and society should a pandemic occur if illnesses and deaths are concentrated in a young, economically productive age group, and what specific measures can be implemented to reduce these effects; (k) what underlying medical conditions may make individuals more at risk of complications or more likely to experience severe or lethal infections, and how will this information be related to at-risk groups; (l) how might our current disease burden influence the impacts of a possible H1N1 pandemic, and how might these impacts be reduced; (m) what is the known full clinical spectrum of the disease caused by H1N1, does it impact multiple organs and, if so, which ones, what specific supportive therapies might be given, and will there be resources to provide these; (n) what specific steps have been taken to engage the private and voluntary sector in Canada, what percentage of organizations are prepared for the economic and social impacts of a possible pandemic, and what measures are being taken to better prepare these sectors; (o) what percentage of Canadian companies activated their pandemic response plans because of the H1N1 epidemic, and what are the learnings from these companies; (p) since the emergence of the H1N1 epidemic, what steps have been taken to evaluate the effectiveness of communications among all stakeholders, including the levels of public awareness, degree of concern, and complacency; (q) what, if any, steps could have been taken to contain the spread of H1N1 infection in Canada, and going forward, what is the decision framework to move from a policy of containment to mitigation; (r) what will be the decision process for deciding whether to produce and stock seasonal or new influenza A (H1N1) vaccines for Canada; (s) what specific measures will be taken to avoid complacency about the H1N1 virus and keep the public engaged; (t) what steps are being taken to monitor antiviral resistance in Canada, (i) what alternative therapies, including, new antiviral agents for flexibility in developing prophylaxis treatment, benefits of combination therapies and novel therapies, including, monoclonal antibodies, are being explored to deal with this possibility, (ii) what resources are being provided for these efforts, (iii) how will it be decided who has been exposed and requires treatment, (iv) how will antivirals be distributed in the event of a pandemic; (u) what specific funding is being provided for clinical vaccine studies for commercial-scale production of both antigen and adjuvant for a novel H1N1 influenza vaccine; (v) how quickly will influenza A (H1N1) vaccines be available, (i) what regulatory processes would need to be modified, (ii) what delays might occur in production, (iii) how could these be overcome; (w) will vaccines being developed now be effective if the virus causes a mild pandemic in the warmer months and changes into something more severe in the fall; (x) who specifically is likely to receive priority for vaccination with a future pandemic vaccine, and how can decision makers engage citizens regarding ethical choices in order that the public understand the decisions that will have to be made during a pandemic; (y) what advice is being given to medical personnel and community members regarding masks, (i) what is the Canadian stockpile of N-95 and surgical masks, (ii) could Canadian companies supply enough of the required masks for a serious outbreak, (iii) what is the Canadian supply of respirators and does it meet the needs of the government’s estimate; and (z) what is the possibility of a wider clinical spectrum of H1N1, and a longer medical legacy (i.e. long-term sequelae)?

[Questions Passed as Orders for Returns, September 14th, 2009]

With regard to funding for pandemic response in the 2006-2007, 2007-2008 and 2008-2009 fiscal years: (a) what is the detailed breakdown of the (i) total funding allocated , (ii) total funding spent; (b) what are the official criteria required to access the pandemic response funding; and (c) what funding amounts have been distributed, on what date and towards what project?

[Health, June 18th, 2009]

Mr. Speaker, Canadians repeatedly hear that most H1N1 deaths were among people who had underlying medical conditions or respiratory problems, like Crohn's disease and lupus. Over 7.5% of the Canadian population suffer--

[Health, June 18th, 2009]

What do you think is funny over there?

[Health, June 18th, 2009]

Mr. Speaker, the chiefs are concerned. In 1918, they fared very poorly.

Canadians repeatedly hear that most H1N1 deaths were among people who had underlying medical conditions--

[Health, June 18th, 2009]

Mr. Speaker, the World Health Organization is paying very close attention to Canada and where H1N1 infections in aboriginal communities, St. Theresa Point and Garden Hill, show a disproportionate number of cases.

History has taught us that our aboriginal communities fare worse during a pandemic. What specific steps are being taken to reduce the burden on first nations and Manitoba public health?

[Cracking Down on Tobacco Marketing Aimed at Youth Act, June 17th, 2009]

Mr. Speaker, I am pleased to follow my hon. colleague in speaking to Bill C-32, as I believe it is vitally important to curb tobacco use among children.

Most smokers begin smoking in childhood or early adolescence. Ninety per cent smoke before the age of 18. Early starters are more likely to become addicted daily smokers. Partly because the tobacco industry targets adolescence, 82,000 to 99,000 young people start smoking every day.

Tobacco smoke contains over 4,000 chemicals, 60 of them known or suspected carcinogens, such as arsenic, DDT and methanol. Cigarette smoke is directly linked to an increased risk of many diseases, including cancer, heart disease and even sexual impotence. In fact, 30% of all cancer deaths can be attributed to smoking. Cancers other than lung cancer that are limited to smoking include bladder, cervical, kidney, liver, pancreatic and stomach cancer.

Even light smokers risk their health. For example, a 2005 British Medical Journal study showed that smoking only one to four cigarettes per day was associated with a significantly higher risk of dying from heart disease. According to the World Health Organization, smoking accounts for one in ten deaths worldwide. As a result, Gro Harlem Brundtland, former director general of the organization, repeatedly and angrily spoke out against the tobacco epidemic, “Civilized nations protect their people under 18—they do not let them play around with a product which statistically kills one out of two of its permanent users”.

The Standing Committee on Health did work collegially and heard testimony from anti-smoking groups to small business owners to the tobacco industry. Much of the questioning focused on contraband tobacco, smokeless products and menthol flavouring and whether more work needed to be done in these areas.

We have a crisis in Canada, namely contraband tobacco, which lacks government control, inspection, taxation, is cheap and is easily bought by youth. Research tells us that the price of cigarettes is an important factor in determining whether young people begin to smoke, whether current smokers continue and how much they smoke. We know low cost contraband cigarettes are particularly attractive to vulnerable populations such as young people. Lab analysis of contraband shows that dead flies, insect eggs, mould and even human feces have appeared in contraband cigarettes.

Our children are smoking contraband cigarettes in disturbing numbers, 25% of youth in Ontario and 32% of youth in Quebec. Dave Bryans, president of the National Coalition Against Contraband Tobacco, reports:

We've got the wild west of illegal tobacco manufacturing and distribution right under our noses and most Canadians don't know it's happening.

The reality is that trade in cigarettes undermines prevention and smoking cessation strategies.

In a 2009 example from Hamilton, Hamilton's public health department and the Canadian Cancer Society blame the jump on easy access to contraband and tax-free cigarettes that sell for a fraction of the regular price. Smoking increased by a third in one year. Public Health estimates that contraband cigarettes cost $8 to $15 compared with the usual $55 to $80.

A last point regarding contraband tobacco is that while it may rob government of enormous tax revenue, at least $1.6 billion each year, it is statistically likely to kill one in two of the youth it sucks in.

While contraband is growing in popularity among youth, so too is smokeless tobacco, better known as chew, snuff or spit tobacco. Spitless tobacco is a cleaner, friendlier version of chewing tobacco, developed in an effort to convince more smokers to consider using smokeless products in places where smoking is prohibited.

Regardless of the name or form, smokeless tobacco causes serious health problems. Chewing tobacco hooks users on nicotine, similar to the way cigarettes do, and makes it difficult to stop using chewing tobacco. Over time, users develop a tolerance for nicotine and need more tobacco to feel the desired effects of the drug. Some switch to brands with higher nicotine content or use tobacco more frequently and longer.

Severely addicted users may leave the chew in their mouths overnight and swallow the tobacco juices. Smokeless tobacco causes gum disease to tooth decay because it contains high amounts of sugar as well as coarse particles that can scratch away tooth enamel, making teeth more vulnerable to cavities.

More seriously, smokeless tobacco increases blood pressure and heart rate, and may increase the risk of heart attack. Smokeless products also increase the risk of developing small white precancerous patches inside the mouth where the chew is most often placed or worse, oral cancer, including those of the cheek, gums, lip, mouth, throat and tongue. Surgery to remove cancer from any of these areas can leave the chin, face, jaw or neck disfigured.

Smokeless is not harmless. Joe Garagiola, a former spit tobacco user, played major league baseball and later worked in broadcasting. He reported:

I chewed tobacco because it seemed to be the thing to do if you were playing baseball. Everybody chewed when I was playing, and nobody knew the dangers of it.

He has since become a crusader against smokeless products because he lost three close friends to oral cancer. He said:

You won't die of gum disease or yellow teeth, but develop oral cancer and it's a terrible way to go. Here you are with oral cancer from using spit tobacco, your jaw has been removed and you have to eat through a tube. You die one piece at a time. Spit tobacco is a horrible, horrible thing. I just wish I could get this message across to everyone.

Today, more than 600 additives including caramel, cocoa, coffee extract, vanilla and menthol can legally be added to tobacco products.

Many appear to be present simply to add flavour, but some may have more sinister effects. For example, cocoa when burned in a cigarette produces bromine gas that dilates the airways of the lung and increases the body's ability to absorb nicotine.

Researchers at the Harvard School of Public Health explored tobacco industry manipulation of menthol levels in specific brands and found a deliberate strategy to recruit and addict young smokers by adjusting menthol to create a milder experience for the first time user. Menthol masks the harshness and irritation of cigarettes allowing delivery of an effective dose of nicotine. These milder products were then marketed to the youngest potential consumers.

Howard Koh, professor and associate dean for public health practice said, “For decades, the tobacco industry has carefully manipulated menthol content not only to lure youth but also to lock in lifelong adult customers”.

We know that younger smokers use menthol at higher levels. About 44% of current smokers, age 12 to 17, have tried menthol. That compares to 31% with older smokers.

To be fair, a spokesperson for Philip Morris said:

We disagree with the author's conclusion that menthol levels in our products were manipulated to gain market share among adolescents...The company's various brands, including our menthol brands, are designed to meet the diverse taste preferences of adults who smoke. We believe kids should not use tobacco and our marketing methods are designed to minimise reach to unintended audiences--

Regardless, there are significant knowledge gaps regarding menthol: the role of menthol in tobacco reinforcement and addiction; the relationship between menthol cigarettes and cancer of various sites; the effect of menthol cigarettes on cardiovascular disease; and the association between use of menthol and illicit drugs.

Importantly, this year there will be a second scientific conference on menthol cigarettes.

In closing, Bill CC-32 is important and necessary. I am encouraged that it is receiving strong support from anti-smoking and health groups. Rob Cunningham, senior policy analyst at the Canadian Cancer Society, said, “We're hopeful that MPs will adopt this bill quickly. It's a very important gain for us”.

Going forward, however, we have to close the loop on contraband tobacco. This may mean looking at the Criminal Code as 49% of cigarettes smoked in Canada are contraband. We also need to look at smokeless tobacco and menthol cigarettes.

[Corporate Social Responsibility, June 17th, 2009]

Mr. Speaker, today I congratulate two businesses in my riding of Etobicoke North which have demonstrated exemplary corporate social responsibility.

First, I recognize Harmony Printing. Harmony is its name and that is its guiding principle. It has developed and is maintaining an environmental management system to help achieve its goals in reducing its environmental footprint.

Second, I recognize Molson Canada. Recently the head office in Toronto participated in the 20 minute cleanup. Employees cleaned up nearby grounds and collected donations of clothes, computers and furniture that were distributed across my riding of Etobicoke North.

These two companies are taking action, making a difference and serving as a catalyst for change. They are outstanding role models for other businesses in Etobicoke North and for the rest of Canada.

On behalf of the House of Commons, I thank Harmony Printing and Molson Canada for all their hard work and commitment to our communities and our planet.

[June 15th, 2009]

Mr. Speaker, the broad topic was science and technology. As a former university professor, I will say, without investment in researchers and their work, there will be a brain drain.

MS affects between 55,000 and 75,000 Canadians. An experimental treatment offered at an Israeli clinic may alleviate symptoms, even in patients with an untreatable form of the disease. Researchers pioneered a procedure whereby they remove a patient's own stem cells, grow them into large quantities in a laboratory and inject them back into the patient.

The government must invest in stem cell research, explore results of clinical trials and experimental technologies, which are yielding positive results here in Canada and internationally, and investigate the possibility of bringing successful stem cell therapies for MS and other diseases to Canada.

Why is there no long-term strategy for stem cells? Why did the government cut funding to Genome Canada?

[June 15th, 2009]

Mr. Speaker, stem cells grown on contact lenses improve the sight of people with cornea damage. Stem cells injected into the central nervous system of those with spinal cord injury allow victims to stand and walk again, and halt the disease course of multiple sclerosis.

In December 1999, the editors of Science called stem cell research the “Breakthrough of the year”.

Since then, there have been numerous announcements about developments in stem cell research and hints of promising treatments for diseases such as ALS, Alzheimer's, cancer, cardiac damage, macular degeneration and type I diabetes.

Within the last five years, the Kirby report and the Romanow Commission noted the importance of new technologies and therapeutic approaches in achieving long-term financial stability for Canada's health care system.

Stem cell research has a critical role to play in the future of Canada's health. For example, every year, 1,500 Canadians suffer a spinal cord injury. The direct health care costs for each case are estimated at $500,000 over the lifetime of the patient, for a total of $750 million, spending that could be reduced by stem cell therapy.

Stem cells are the precursors of all cells in the human body and are the focus of regenerative medicine, medicine that involves growing new cells, tissues and organs to repair or replace those damaged by aging, disease or injury.

There has been intense debate over the use of stem cells. However, it is important for government to first understand and second, to educate the public regarding sources of stem cells. For example, these powerful cells can be taken from adults, harvested from bone marrow.

Bone marrow transplants are now a routine procedure, with 45,000 people receiving treatment every year. Moreover, a new technology induces human skin cells to change into stem cells, a process called “cellular reprogramming”, the 2008 “breakthrough of the year”.

Many researchers have criticized the government for shutting out Genome Canada in the federal budget and for cutting $148 million to basic curiosity-driven research, particularly because Canada is a global leader in stem cell research. Ontario and California together account for about 70% of the stem cell research currently conducted in North America.

The Ontario government is stepping up to provide more money for research, while Ottawa scales back. A few weeks ago, Mr. McGuinty announced $100 million in new funding for genomic research. The U.S. is also investing. In 2008 Massachusetts Governor Patrick signed legislation that would set aside $1 billion toward biotechnology over 10 years to turn the state into the second largest stem cell research region in the United States.

Governments are investing because regenerative medicine represents an enormous economic opportunity, $2 billion to $3 billion over the next three years.

Canada's stem cell researchers need more money, for example, money for diabetes which annually cost Canada $12 billion. As President Obama states, “Medical miracles do not happen simply by accident”. They require investment in people, research, equipment and facilities. We need investment in our world-class stem cell researchers and their work.