Subcommittee on Neurological Disease committee  I was just seeing if you were going to continue in French, in which case I would have to put in my earpiece, because my French is terrible.

Subcommittee on Neurological Disease committee  Yes, please.

Subcommittee on Neurological Disease committee  That is a good question. Actually, we broke it down into four different main sections. The first one is on communication. The whole section is on communication and how those in the health care system, whether it be physicians, physiotherapists, or nurses, should be communicating with individuals with Parkinson's, trying to give information that patients want to hear--but not too much information that they don't want to hear--and trying to make sure that when they do communicate things, they actually give the instructions, writing them down.

Subcommittee on Neurological Disease committee  The biggest and most comprehensive ones are the U.K. guidelines. These are the NICE guidelines. They really work through all or almost all of the different aspects of Parkinson's. Those were really the basis for developing our Canadian guidelines. The Europeans came out with some guidelines that were okay but not great.

Subcommittee on Neurological Disease committee  In Ontario there's a big problem. Nobody gets their drugs covered until they're 65 unless they're on some sort of assistance program, or in Ontario through the Trillium drug program, where then they are balancing out their drug costs with what their income is. In Parkinson's, 15% of people, maybe even 20%, will have their onset before age 65.

Subcommittee on Neurological Disease committee  Yes, I think you're easily getting up there when you're looking at the costs for the Parkinson's drugs, and then there are the depression drugs and the blood pressure drugs. It quickly snowballs, because people are taking drugs for other reasons as well. So the drug costs can really skyrocket.

Subcommittee on Neurological Disease committee  That's part of the dilemma. This is a real limitation for a lot of patients. I mean, there have been studies now such that if somebody comes into my office and they have a rest tremor, and they have stiffness and slowness, I'm right 95% of the time. If somebody comes into my office and they only have some stiffness, and they only have some slowness, and they don't have a tremor, and it's symmetric, and they have a couple of other things going on, my diagnostic rate could go down to as low as 70%.

Subcommittee on Neurological Disease committee  That's a good question. That's the condition for which I most often say to people, “You came here thinking you might have Parkinson's, but you actually have essential tremor.”

Subcommittee on Neurological Disease committee  It's based on what the story is and what their findings are. If you haven't seen many people with Parkinson's, and if you haven't seen many people with essential tremor.... It's often not diagnosed correctly. For a lot of the people who come to see me, when I will tell them, yes, I think they have Parkinson's, they will reply, “Well, okay, my dad had Parkinson's, and my mother has Parkinson's.”

Subcommittee on Neurological Disease committee  One of the things we looked at when we were trying to develop the guidelines was that, as I mentioned, some other countries have guidelines, and one of the real difficulties we have in Parkinson's, when it comes to evidence-based medicine, is how much evidence-based medicine we have for treating the depression, for treating the bladder troubles or bowel troubles, or all the other things—these non-motor things that you're starting to hear about with Parkinson's.

Subcommittee on Neurological Disease committee  It was an unusual request.

Subcommittee on Neurological Disease committee  Good morning. I'm a clinician who runs a very large Parkinson's clinic here in Ottawa. I am also involved in clinical research as well as some basic science research. I've been looking after Parkinson's patients for close to 12 years. It became very apparent to me that as Canadians we could do a lot better in both our basic research realm, clinical research, as well as in the clinical care of patients.