Leona Aglukkaq

[Health, September 20th, 2010]

Mr. Speaker, my thoughts go out to all those who suffer from MS.

Our government, with the provinces and territories, is speaking with one voice. At last week's health ministers meetings my colleagues and I agreed on the importance of accelerating research so that families can make informed decisions about the MS treatment options.

We will move as quickly as possible based on the best available science. If the experts advise in favour of clinical trials, our government, working with the MS Society and provinces and territories, will ensure they are fully funded.

[Questions on the Order Paper, June 17th, 2010]

Mr. Speaker, in response to a) From 1993 to 1996, Health Canada published three conference papers on the development of a laboratory study of aircraft noise-induced stress on people.

The only Health Canada published studies with a specific focus on aircraft noise were two reviews of the scientific literature on aircraft noise. One is a peer reviewed journal article in 2007 on aircraft noise-induced sleep disturbance and the other is a 2001 report on aircraft noise, stress and cardiovascular disease.

Aircraft noise has appeared in other studies by Health Canada, such as a very preliminary field study designed to examine possible relationships between noise annoyance and stress. This was presented in a poster at a 2007 University of Ottawa 4th year honours thesis symposium.

Aircraft noise was also noted in a national survey of noise annoyance published in a 2002 HealthInsider report, Number 7, and a peer reviewed literature article in 2005.

Aircraft noise annoyance was also used as an example in a 2008 published analysis of how noise annoyance can be used as a health impact in environmental assessments.

A study of annoyance and disturbance of daily activities from road traffic noise was also published in 2008 based on a 2005 HealthInsider report (Number 14)

Health Canada has also published a total of three laboratory studies on the potential for noise-induced stress in either rats, two studies, one published in 2003 and the other in 2005, or people, one published in 2006, using noise sources other than aircraft noise.

In response to b) Results are listed below from the various published studies that are relevant to the potential for a stress response to aircraft noise.

In the review of aircraft noise and sleep disturbance, it was found that people living around airports show disturbed sleep in the form of awakenings and increased body movement. Aircraft noise is one reason, but it is responsible for less sleep disturbance than spontaneous awakenings and other indoor noise events.

The review of the scientific literature on aircraft noise and cardiovascular disease indicated that average blood pressure levels of schoolchildren exposed to aircraft noise were slightly elevated, however there was no conclusive proof that aircraft noise caused chronic stress in children. Also, in adults, although scientific studies have shown that short term exposure to intense noise can cause temporary stress responses such as increases in heart rate and blood pressure, there is no consistent evidence that chronic noise leads to hypertension. Furthermore, it was found that, although there was insufficient evidence to conclude that aircraft noise causes heart disease, some studies suggested that people who live for many years in areas with intense road traffic noise, may face a slight increase in the risk of developing heart disease.

In the review of the scientific literature on noise annoyance, it was found that there was some evidence to suggest an association between road traffic and neighbourhood noise levels and some stress related adverse effects e.g., hypertension and migraines. It was also found that on average a given long term exposure to aircraft noise makes a greater percentage of a population highly annoyed than would road traffic noise. Furthermore, in a national survey of road traffic noise annoyance in Canada, it was found that people who were highly annoyed by road traffic noise, also thought this annoyance had a negative impact on their health.

In a laboratory study, exposure of people to noise events during sleep did not appear to create a stress response. It was also inconclusive as to whether there were adverse effects on their sleep.

In the very preliminary field study where exposure to aircraft noise occurred, the number of subjects was too small to obtain reliable conclusions about any possible relationships between stress hormone responses and annoyance level.

In response to c) Health Canada plans the following research studies to help assess plausibility of a cause-effect relationship between noise, including that from aircraft, and stress related adverse health effects: i) examination of potential correlations between annoyance to road traffic noise and actual health effects reported in surveys, ii) a study of stress markers in noise exposed rats that are predisposed to hypertension.

The following future reviews are also planned: (i) for fiscal year 2010-2011, an interim review taking into account recent developments in the scientific literature on the potential for aircraft noise-induced stress-related adverse health effects - to update the Health Canada It’s Your Health document on aircraft noise, (ii) for fiscal year 2011-2012, a comprehensive review paper on the scientific literature on potential links between stress, cardiovascular disease and environmental noise.

[Questions on the Order Paper, June 17th, 2010]

Mr. Speaker, Canada Health Infoway, Infoway, is an independent, not-for-profit corporation established in 2001 to accelerate the development of health information and communication technologies such as electronic health records (EHRs), telehealth and public health surveillance systems on a pan-Canadian basis. Its corporate members are the 14 federal, provincial and territorial deputy ministers of health. Infoway supports the development and implementation of eHealth technologies on a cost-shared basis with its provincial/territorial partners.

As part of the Government of Canada’s economic action plan, EAP, budget 2009 included $500 million for Infoway to support the goal of having 50% of Canadians with an EHR by 2010, to speed up the implementation of electronic medical record, EMR, systems for physicians and integrate points of service for hospitals, pharmacies, community care facilities and patients. Subsequent to the budget 2009 announcement, the federal government indicated that further due diligence would be conducted before the funds would be released. This included the monitoring of Infoway’s response to the Auditor General of Canada’s fall 2009 report, which contained a chapter on EHRs. Budget 2010 announced the government’s intention to move forward with the transfer of these resources.

With regard to a) In March 2010, Health Canada and Infoway signed a funding agreement related to the $500 million allocated through budgets 2009 and 2010. Under the new funding agreement, Infoway will periodically draw down on the allocation and is thus required to submit an annual cash flow statement, with supporting details, to access the federal funds. The first cash flow statement to draw-down upon the new funds is due by the end of June 2010. Funding will be disbursed to Infoway within forty-five, 45, days of the receipt and acceptance by the minister of the cash flow statement.

With regard to b) Through budget 2009/2010, the $500 million funding is intended to continue work on EHRs and to support the implementation of electronic medical record, EMR, systems for physicians and integrate points of service for hospitals, pharmacies, community care facilities and patients.

In this context, Infoway is working to establish corresponding funding strategies. These will be articulated in Infoway’s annual summary corporate plan, which is due to be released at the end of June 2010.

With regard to c)d) and e) As noted above, Infoway is working to establish funding programs for the $500 million allocated through budgets 2009 and 2010, which will be articulated in Infoway’s annual summary corporate plan, which is due to be released at the end of June 2010.

Since the provinces and territories are responsible for the delivery of health care, they also set their respective priorities and funding allocations for eHealth. Accordingly, within the parameters set out in the annual summary corporate plan, Infoway will work with individual provinces/territories to disburse funds based on jurisdictional priorities.

[Questions on the Order Paper, June 17th, 2010]

Mr. Speaker, in reponse to a)i) In late 2008, the Canadian and US governments contracted with the US Institute of Medicine, IOM, to convene a multi-disciplinary panel of Canadian and U.S. experts, the expert committee, to undertake a study to reassess current relevant data and to update as appropriate the dietary reference intakes, DRIs, for vitamin D and calcium, last published in 1997. This will result in the delivery of a detailed report that is peer-reviewed according to the protocols of the Institute of Medicine and the U.S. National Research Council.

In response to a)ii) The report from IOM is expected to be publicly available in the fall 2010. It is planned that the implementation process for government programs, policies, guidelines and information will take place in 2011.

In response to a)iii) Health Canada supported the IOM review in a number of ways. Health Canada provided publicly available data on usual distributions of vitamin D intake, based on the 2004 Canadian Community Health Survey. Health Canada also worked jointly with Statistics Canada on a preliminary public release of blood 25-OH vitamin D results from the 2007- 2009 Canadian Health Measures Survey. These results were essential for the IOM expert committee to take into consideration the Canadian vitamin D status in their deliberations. In addition, Health Canada, the Public Health Agency of Canada, the US Office of Dietary Supplements/National Institutes of Health and the US Food and Drug Administration funded the Agency for Healthcare Research and Quality (AHRQ) to prepare the report “Vitamin D and Calcium: A Systematic Review of Health Outcomes”, which was published in August 2009. The purpose of this review was to systematically summarize the evidence on the relationship between vitamin D, calcium, and a combination of both nutrients on a wide range of health outcomes.

In response to b) The review of DRIs for vitamin D and calcium is being conducted by a 14-member expert committee appointed through standard procedures of the national academies. Expertise includes, but is not necessarily limited to the following areas: nutrition, infant nutrition, reproductive nutrition, pregnancy and lactation, dermatology, gerontology, epidemiology, biostatistics, bone and skeletal health, cardiovascular health, immunology, oncology, cellular metabolism, toxicology, genetics, factors affecting intensity of UVB radiation, and population monitoring methodology.

In response to c) An AHRQ report published in August 2007 entitled “Effectiveness and Safety of Vitamin D in Relation to Bone Health” did examine the question of whether intakes of vitamin D above current reference intakes lead to toxicities. A total of 22 trials reported data on toxicity-related outcomes, 21 of which used doses above current reference intakes.

Overall, there was fair evidence from adult trials that vitamin D supplementation above current reference intakes, with or without calcium supplementation, was well tolerated. However, there were challenges in conducting this part of the review because harms are often secondary outcomes and may not be reported completely, especially if they are not significant. Most of the trials were not designed to evaluate harms, were of small sample size, and had short duration of exposure to vitamin D. There is also a lack of data on toxicity outcomes in infants, children, and specific ethnic groups.

In response to d) As part of its review of the evidence, the IOM expert committee will try to set a tolerable upper intake level, UL, defined as the highest level of daily nutrient intake that is likely to pose no risk of adverse effects for almost all individuals in the general population. The UL is based on an evaluation conducted by using the methodology for risk assessment of nutrients.

Until the recommendations for vitamin D have been updated, Health Canada continues to recommend that Canadians follow the existing tolerable upper intake level, which for anyone over one year of age is 50 micrograms, 2000 IU, vitamin D per day from all sources, including milk and supplements.

In response to e) According to the dietary reference intakes, DRIs, for vitamin D and calcium published in 1997, the adverse effects of excess vitamin D are probably largely mediated by increasing calcium levels in the blood, and limited scientific evidence suggests that direct effects of high concentrations of vitamin D may be expressed in various organ systems, including kidney, bone, central nervous system and cardiovascular system. Human case reports of pharmacologic doses of vitamin D over many years describe severe effects at intake levels of 250 to 1250 micrograms per day, 10,000 to 50,000 IU/day.

The IOM expert committee is looking at more recent clinical scientific data with regard to amounts of vitamin D that may be considered harmful and the indicators of adverse effects.

In response to f) The full set of studies used will be made available in fall 2010 in the IOM report.

[Questions on the Order Paper, June 17th, 2010]

Mr. Speaker, with respect to Health Canada, questions related to the treatment and diagnosis of chronic cerebro-spinal venous insufficiency, CCSVI, are of a clinical nature and are best directed toward the provinces and territories and their respective physician associations. The Canada Health Act requires provincial and territorial health insurance plans to provide medically necessary hospital and physician services to their residents on a prepaid basis, and on uniform terms and conditions. The provincial and territorial governments, in consultation with their respective physician associations, are primarily responsible for determining whether new treatments for CCSVI are medically necessary for health insurance purposes.

With respect to Canadian Institutes of Health Research, through the CIHR, the government is funding health research on multiple sclerosis, MS. In 2008-09 investments related to MS totalled approximately $5.3 million. CIHR also invested $120.5 million in the larger area of neurosciences research in 2008-2009 and approximately $38 million in stem cell research which is being pursued for the potentially useful therapies it may offer in the treatment of health conditions and diseases such as multiple sclerosis. CIHR also funds a great deal of research related to stroke, much of which focuses on the vascular component of the disease. In 2008/09 CIHR funded approximately $22.9 million in stroke research. All of these investments are building our overall understanding of multiple sclerosis toward more effective treatment and ultimately a cure. CIHR has been consulting with the research community and will be convening, in close collaboration with the MS Society, an international meeting of top scientists to identify research priorities for Canada and accelerate research and innovation on MS.

CIHR has not funded research on the possible relationship between MS and impaired venous drainage of the central nervous system or CCSVI since no researchers working in this area have applied for funding. However, CIHR is funding Drs. Bruce Pike and Douglas Arnold of McGill University who are working to advance functional magnetic resonance imaging to permit robust and continuous monitoring of cerebral blood flow, volume, and oxygen consumption. While their study is targeted to Alzheimer’s patients, the results will also increase our knowledge of the role that obstructed blood flow may play in MS. Drs. Pike, Arnold and Dr. John Sled are also collaborating on research to develop an MRI technique more able to detect tissue damage than current methods. The research will allow the tissue damage in MS patients to be comprehensively and quantitatively assessed, will lead to increased knowledge on the natural evolution of the disease and will enable the evaluation of new therapies that attempt to slow or stop the progression of this disease.

It is quite possible that the recent interest in the possible relationship to multiple sclerosis of impaired venous drainage of the central nervous system, or, Chronic cerebrospinal venous insufficiency (CCSVI), will draw more scientists to pursue MS research. CIHR would welcome funding applications through its ongoing programs such as the Open Operating Grants competition. The next competition has a registration deadline date of August 16 and an application deadline date of September 15.

With respect to Public Health Agency of Canada, estimates from the 2000-2001 Canadian Community Health Survey indicate that approximately 57,600 Canadians aged 12 and older living in private households have been diagnosed with MS by a health professional. This estimate does not include individuals living in institutions. The National Population Health Study on Neurological Conditions announced by the federal Minister of Health on June 5, 2009 will provide additional data by 2013.

(i) Estimates from the 2000-2001 Canadian Community Health Survey indicate that of individuals aged 15 years to 75 years of age who have MS, 23% reported that they were permanently unable to work. Updated information on labour force participation among individuals with MS will become available with the National Population Health Study on Neurological Conditions.

(ii) Although the 2000-2001 Canadian Community Health Survey included an optional module on home care, the survey module included too few individuals with MS to report reliable estimates of the percentage of MS patients who depend on family caregivers. The purpose of the 4-year National Population Health Study on Neurological Conditions is to fill gaps in knowledge about individuals with neurological conditions, their families, and caregivers.

(iii) An estimate of the percentage of MS patients in Canada who require around-the-clock care from professional caregivers is not currently available. A component of the 4-year National Population Health Study on Neurological Conditions will measure the prevalence of selected neurological chronic conditions among the institutionalized population and will provide new estimates on Canadians with neurological conditions, including MS, who are receiving care in nursing homes that provide 24-hour care.

The Public Health Agency of Canada estimates that the direct health care costs and costs from loss of economic productivity associated with MS in 2000-2001 were $950.5 million. Direct costs associated with MS estimated in 2000-2001 were $139.2 million: $58.4 million for hospital care, $12.1 million for physician care and $68.7 million for drugs. Indirect costs associated with MS estimated in 2000-2001 were $811.3 million: $172.8 million (21.3%) in loss productivity due to premature mortality and $638.45 million (78.7%) in long-term disability costs. Short-term disability costs are not included in the estimates of morbidity costs, and therefore underestimate indirect costs. Source: Canadian Institute for Health Information, The Burden of Neurological Diseases, Disorders and Injuries in Canada (Ottawa: CIHI, 2007). www.cihi.ca

[Health, June 15th, 2010]

Mr. Speaker, our government has been transferring funding to the provinces and territories where health care is delivered to first nations and Inuit people. This year alone it is $25 billion. We will continue to work with the provinces in improving the health outcomes of aboriginal people and Inuit.

As to first nations' health, as the member is aware, this morning at committee we were discussing the additional investments we are making to address the health outcomes of aboriginal people on first nations reserves.

[Multiple Sclerosis, June 15th, 2010]

Mr. Speaker, Dr. Zamboni also said during committee that his research was experimental. He is very much at the early stages of his research. It is important to support research. It is important for CIHR to conduct a team of researchers to Canada to organize the meeting to deal with this research. That will help the provinces and territories in the decisions that they need to make in the delivery of health care.

No jurisdiction in Canada would allow a procedure without the necessary clinical trials.

[Multiple Sclerosis, June 15th, 2010]

Mr. Speaker, I thank all the members who participated in a very important debate last night on MS. I also thank my colleagues for the input I received not only from the House last night but also from committee this morning.

We recognize the importance of research. Through the Canadian Institutes of Health Research, we are initiating the key researchers to come together to see how we can start this procedures research process in Canada through the leadership of the Canadian Institutes of Health Research. The research that we will be conducting will be providing support to the provinces and territories that, as the member—

[Multiple Sclerosis, June 14th, 2010]

Yes.

[Multiple Sclerosis, June 14th, 2010]

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.