Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology

Issue 26 - Evidence - November 22, 2012

OTTAWA, Thursday, November 22, 2012

The Standing Senate Committee on Social Affairs, Science and Technology, to which was referred Bill S-204, An Act to establish a national strategy for chronic cerebrospinal venous insufficiency (CCSVI), met this day at 10:30 a.m. to give clause-by-clause consideration to the bill.

Senator Kelvin Kenneth Ogilvie (Chair) in the chair.


The Chair: I call this meeting of the Standing Senate Committee on Social Affairs, Science and Technology to consider Bill S-204 to order. I will ask my colleagues to introduce themselves.

Senator Martin: Senator Yonah Martin, from British Columbia.

Senator Seth: Senator Asha Seth, from Ontario.

Senator Enverga: Senator Tobias Enverga, from Ontario.

Senator Eaton: Nicole Eaton, from Ontario.

Senator Lang: Senator Daniel Lang, Yukon.


Senator Verner: Josée Verner, from Quebec.


Senator Campbell: Larry Campbell, British Columbia.

Senator Cordy: I am Jane Cordy from Nova Scotia, and I am the sponsor of the bill.

Senator Munson: Jim Munson, Ontario.

Senator Merchant: Pana Merchant, Saskatchewan.

Senator Eggleton: Art Eggleton, Ontario, and deputy chair.

The Chair: I am Kelvin Ogilvie, Nova Scotia, chair.

Colleagues, the item on the agenda is the consideration of Bill S-204. I need to ask the committee the following question: Is it agreed that the committee proceed to clause-by-clause consideration of Bill S-204, An Act to establish a national strategy for chronic cerebrospinal venous insufficiency, more frequently known as CCSVI?

Senator Martin.

Senator Martin: Thank you, Mr. Chair. I move:

That the committee not proceed to clause-by-clause consideration of Bill S-204, An Act to establish a national strategy for chronic cerebrospinal venous insufficiency, CCSVI;

That pursuant to rule 12-23(5) the committee recommend that the Senate not proceed further with the bill;

That the committee adopt the attached draft report;

That the steering committee be empowered to modify the report for the purpose of correcting any typographical or grammatical errors; and

That the chair be instructed to present the report to the Senate at the earliest possible opportunity but, in any case, no later than Tuesday, November 27, 2012.

The Chair: I assume that every member of the committee received a copy the motion and the attached report.

Senator Eggleton: A few minutes ago, yes. Just a few minutes ago, but we have it.

The Chair: That is the motion that is on the table.

Senator Eggleton, do you wish to address the motion?

Senator Eggleton: Yes. I have a question with respect to paragraph 3 of the attached draft report, which, as I pointed out, we received just a few minutes ago. In the last sentence you say, ``However, it should be noted that provincial health authorities and the colleges of medicine took quick action to ensure that no Canadian would be denied medical treatment.''

We heard witnesses at this committee tell us numerous stories of people who badly needed medical treatment in this country and were not getting it. Because they had gone overseas to get the procedure, they were not finding it very easy, if at all possible, to get follow-up medical treatment here. Some of them ended up with complications or just needed some follow-up advice but were being turned away. In fact, we heard that one person died as a result of this. Another person we heard was told to go back to Poland rather than being treated by a medical specialist here.

You are addressing the issue here by saying that the provincial health authorities and the colleges of medicine took quick action. I am not aware of any evidence that came before this committee that indicated any action was taken. We certainly heard from medical professionals and professors that they thought that it was abhorrent that these MS patients who had gone through the procedure were not getting proper medical treatment. I never heard anything that said that action had been taken. In fact, you are saying they took quick action.

You are putting it in the past tense. What is the evidence of this? We did not see any evidence before this committee.

Senator Martin: Senator, first, I know that all of us around the table share the concerns of our sponsor and all the proponents of the bill as articulated in the draft report. We were all shocked to hear what happened to some Canadians at the early stages of this, when the medical community was not prepared to treat it. Of special concern were Canadians returning to Canada without documentation detailing what procedure they had undergone and the exact details needed.

There are different ways to define ``quick,'' but it is my understanding that the provinces, territories and the medical community itself is now responding and Canadians are being taken care of when they return to Canada. Initially, there was that disconnect because the information did not come back into Canada in some cases. We have heard from different representatives who said that that initial issue, because that was a concern we also expressed, is being addressed and that is no longer the case.

Senator Eggleton: You say it is your understanding, but what is the basis of that understanding? Do you have a written document from these authorities, from the provinces or from the colleges that indicates that? Who gave you this understanding that this was the case? I have not seen any documentation to that effect. You are the person putting this on the table. You should have an answer for that.

The Chair: I believe she gave an answer. I will move to Senator Campbell.

Senator Campbell: Thank you, chair. I am not a regular member of this committee; however, I have read the actual details of the bill and I understand them. I am concerned about the last paragraph, and I will read it out:

Finally, your Committee shares an overriding concern with the bill and believes that, in regards to CCSVI, MS, and health matters generally, the best path forward should be determined by science and medicine, not by Parliament.

This is completely hypocritical. If this in fact is true, we should not have a ministry of health. Parliament deals with health matters all of the time. We deal with drugs and we deal with issues involving health, even though it is a provincial responsibility. As far as this last paragraph is concerned, it would be nice if the government actually did rely on science for decision making, which we know is not true. I think it is unnecessary to have this in here, and I do not think it is correct.

The Chair: As chair, with regard to clarification of information, it is reasonable that I make an observation. The reality is that the country and most progressive countries have health ministries to set up a huge complex set of organizations that are to deal with the health of the citizens in their country, based on the best medical evidence available at the time. As a Canadian, I personally found your comment with regard to not taking science into consideration offensive with regard to the health system, having some knowledge of the enormous amount of capital that Canadians invest in the research and health profession in the country.

Senator Campbell: Chair, I am sorry that you find it offensive, but the fact of the matter is if Canadians actually pay attention to what goes on with regard to science in this country, and you can take anything from the environment, to law, to health, this government does not believe in science. I will leave it at that.

Senator Lang: On a point of order, I find that offensive as well. To sit in your place, senator, and to say to this committee that that is a given fact and a truth is totally unwarranted when you look at the various departments, whether they are federal or provincial, and the amount of money that Canadian taxpayers who are viewing this are paying to ensure they get the necessary support when called upon.

I want to go on the record. You have made your statement and I disagree totally with what you just said.

Senator Campbell: Again, I am sorry that the Conservative members of this committee find it offensive. I suggest you actually talk to the scientists who have been fired by this government in all various areas to see if that is what is going on.

The Chair: Colleagues, I believe the senator made a clear point and has had two or three chances to articulate that point. It has been responded to. This is not a debate that I think is constructive with regard to the motion before us to continue further. The points have been made and responded to. Are there further points with regard to the motion?

Senator Martin: If I may, in terms of the final paragraph and what you are saying, senator, we did hear from some of the leading world experts. At the last session we had Dr. Zivadinov, Dr. Laupacis and Dr. Zamboni himself. All three experts acknowledged the work we did in Canada. The peer review was undertaken with the expert panellists who chose the study that is being done in Canada for the Phase I/II clinical trials, and that the Canadian Institutes of Health Research, Health Canada, and the Public Health Agency of Canada have all been collaborating over the past two years. I do say that is in part because of the kind of advocacy and work that our colleague Senator Cordy and others have done in collaboration with various stakeholders, U.S. and Canadian MS societies, and the list goes on.

I do, with respect, say for the record that you are right, Senator Eggleton. I have limited knowledge. Yet given what we have been privy to listen to and to study and the letters we have read and the submissions, based on what we are hearing, in essence, we are actually doing what is best for our MS patients together. Action has been taken and there is a commitment, and that is why, again, I point to the draft report as to the reasons. I do have confidence in our researchers and in the experts. It is such a specialized, technical area, and this is what is best for our MS patients.

Thank you for your point.

Senator Eaton: I just wanted to pick up the point that Senator Eggleton made about the last sentence.

Senator, you are more experienced than I am. Is it not against the law for a doctor not to treat someone who is sick or for a hospital to turn away someone who is sick? Is that not part of our health system? Please educate me. Can doctors and hospitals simply say, ``You had this done in Poland, away with you,'' or are they by law obligated? I always assumed, and maybe I am wrong, that most physicians and most hospitals care for everyone.

Senator Eggleton: I assumed that myself, but then we heard evidence at this committee to the contrary. Some people who are highly recognized in the medical profession were also here and found that abhorrent and that it is something that should not happen at all. I think we can all agree with that.

Some doctors may use the excuse, ``Well, you had it done over there; I don't have your records.'' However, it goes beyond that. These people should have been getting the treatment. I do not think anyone disputes that. However, I cannot agree that the health authorities and the colleges have taken action on this without some evidence to that effect. There has been no evidence whatsoever supplied to that effect.

Senator Eaton: I think anecdotal evidence by witnesses is a slur on Canadian physicians and Canadian hospitals, and it is anecdotal evidence.

The Chair: A specific question of procedure was asked, and the reality was that in the early stages there were those news reports, to which Canadians reacted, as they should, immediately and with great objection. The physicians stated the same statement. They did not say that is currently the situation. They said it should never be denied. They were going on the basis of the fact that there were reports that it was denied at the outset. It is clearly understood that the colleges of physicians in the country, which have the disciplinary responsibility, Senator Eaton, with regard to delivering medical care to Canadians, have indeed taken the action referred to by Senator Martin.

Senator Eggleton: What is the evidence that action has been taken to deal with the matter? That is what I am asking.

The Chair: Senator Merchant is next, and then Senator Munson.

Senator Merchant: Senator Martin, I am trying to find a place to make my comments. Perhaps in the middle of paragraph 5, when you speak about the large discrepancy in the reported benefits and harms of using venoplasty in the treatment of CCSVI, I cannot help but say something about what Saskatchewan has done. We have sent patients to Albany, New York, for Phase II and III trials.

First, the way it was done in Saskatchewan, fortunately, I think is the appropriate way to go. Unfortunately, we chose not to hear from people who have undergone this procedure. The Premier of Saskatchewan and the Minister of Health at the time, two years ago, met with 15 patients who had undergone this procedure. When they were trying to make up their minds as to whether this was beneficial or not, or how to proceed with their trials, they heard opinions from the very people, as well from experts. However, they heard from the people who themselves have had the treatment.

Unfortunately, our committee decided not to go that route, for some reason. I think that if you are going to have hearings, you have to include everyone, and that is how you make up your mind as to how you weigh the evidence, but you have to hear all the evidence.

Somewhere in the report, instead of just brushing aside the reported benefits, why not hear from everyone to decide whether they are the benefits, firstly, and secondly, whether we should be again starting over with Phase I trials? The Government of Saskatchewan is doing Phase II and Phase III trials. That is where they start. They felt there was enough evidence. The Phase I trials had already been done and there were enough results to go on. I would like this statement to be a little more reflective of what happened here.

Senator Martin: Yes, I am aware of the Saskatchewan patients participating in the U.S. trials, and I am sure that each province, since this is under provincial jurisdiction, will make those decisions.

In terms of what is stated in this particular paragraph where it says there are large discrepancies, we did hear from the expert panels in the previous session. Senator Merchant, you were not here on that day, but I am sure you have read the transcripts. Particularly I recall Dr. —

The Chair: I just want to point out that we do not refer to the presence or absence of any member on the committee.

Senator Martin: I apologize. I will retract that, if I can. I apologize.

Senator Merchant: I was travelling with the Standing Senate Committee on Agriculture and Forestry throughout the three Western provinces, and that is why I was not here.

The Chair: I do not believe the senator intended a slur, but the point is that that is an inappropriate reference in any event, and she has apologized.

Senator Martin: I missed one of the key sessions, looking back. In my own way, I was sorting out my thoughts. It was not intended in any way to point that out. I apologize, senator.

These huge discrepancies were confirmed by the experts themselves, who said that what we are doing in Canada is important and will contribute to the understanding of this disease. That is where I think this paragraph is very accurate in pointing out these discrepancies.

I am very curious about the results from the Saskatchewan participation. I am sure every senator has received such letters and submissions from patients themselves. I know I have a whole folder full of such letters and submissions that has been organized by my staff, and I have been reading through each of those testimonies that have been given to me.

Senator Merchant: However, it was the very expert witnesses who were here before us who said that receiving letters is not exactly as good as looking someone in the eye when you are trying to judge all the testimony. I am saying that in order to comment about discrepancies, we did not hear from everyone who ought to have been included in the study.

Senator Munson: I have just a few observations. The bottom line is that we should have heard from MS patients — bottom line — not written submissions, but real people, real faces, real stories.

In this draft report, paragraph 4 says ``your committee recommends that this Bill not be proceeded with further in the Senate,'' and it outlines reasons.

Yesterday, you said to us that the agenda item, clause by clause — meaning the bill, Bill S-204 — would be dealt with in public. You said you hoped Senator Eggleton could confirm that is the assurance you gave, and he responded, ``Yes, absolutely.''

Then we have this sort of — I cannot call it back door, because it is a front-door, last-minute motion suggesting we do not go clause by clause. When were you made aware that we would never go to clause by clause? Have you read this just today, like the rest of us, or did you read it before?

The Chair: Senator, I am not required to answer questions directed at me personally in terms of how I conduct any part of my affairs, but I will tell you that the procedure we are using today is exactly the procedure of the Senate. At the point of calling the question on the bill, that is the point at which an intervention is to be made.

Senator Munson: I am still concerned over who was made aware of this and when because, as an impartial chair, you have a very important role. I have been here for nine years. Perhaps this has happened before, but it has not happened on the 10 or 12 committees I have sat on where a motion at this stage of the game has come in just before a vote to do clause by clause. We know what that vote would be if it were clause by clause. We certainly know what the vote will be today when it comes to this motion, and we will never get to clause by clause. I am very concerned about who knew what, when, why, where and how. Those are legitimate questions — I may not have to direct them to you, but I can direct them to the public — about this very important issue.

We have been pushed around, and we are pushing back because we sincerely feel that this issue was so damn important that, at the end of the day, the bottom line was for this to be in front of us. The experts said that, the public is saying that, and I just do not understand that.

Senator Seth: I just want to clear up the situation here. It was earlier discussed about patients being refused treatment when surgery was done for CCSVI. As far as I am concerned, as a physician — and I see my colleagues in the hospital and I have done 35-plus years of practice — there are rules and regulations we have to follow no matter where surgery is done or what the patient is suffering from. If a patient walks into my office or into the ER, we are not supposed to refuse. We may not have documents for the patients where the surgery is done, but we see what is required and what has to be done for this patient in order to save lives or alleviate the symptoms. We cannot delay other treatment or not take a decision. The primary concern is treating a patient. We must, we should, and we always do it. That is not right. At least in Ontario, I can vouch for it.

If it ever happened that a patient was not being treated and was not satisfied, we have the College of Physicians and Surgeons of Ontario. This is like our police station, where complaints are made and are taken care of. It is not something we do at all. I do not understand. It is not the question of this surgery. It could be done in any part of the world. If the patient comes in, we are not supposed to refuse, no matter what. We are there to help the patient, not to say, ``You had surgery in Poland or Russia.'' We look after the patients. That is not true. I have to tell you that.

Senator Eggleton: I applaud your ethics, and I am sure most physicians follow that same pattern, but obviously not everyone does. We heard stories here that that was not always the case. We know there are many cases in the history of the college where people have been disciplined for not following procedures. You would admit that. We are trying to deal with a case here where people have been denied. It may not be your ethics, but someone else is doing something that is wrong.

Senator Seth: That is what I am saying. The college is there to take care of that.

Senator Eggleton: What have they done about it?

Senator Seth: If they have not treated the patient and the patient dies or is suffering, yes, the complaint goes to the college. We are aware of the situation. It is not easy for any physician to refuse to treat a patient. I am surprised to hear all those things. I am a witness for that. I do not see it, although there is good and bad happening in any profession.

Senator Eggleton: Senator Martin is saying that the colleges took quick action. What evidence do you have that they took quick action?

Senator Seth: When you are asking about evidence, no one can give you evidence. Do we have the name of the patients who complained?

Senator Eggleton: No, I mean evidence that they took quick action. If you do not have evidence of that, it should not be in this statement.

Senator Cordy: I have a few comments before I ask questions. Like Senator Munson yesterday, I asked whether we would be hearing clause by clause in public. You said at that time that it would be dealt with in public. I guess procedurally you are correct, but the spirit of the procedure I do not think is correct. Certainly, I was left with the understanding yesterday when I left the meeting that clause-by-clause consideration would be dealt with at the meeting today in public. In fact, we have a Conservative senator bringing forward a motion that that, in fact, is not the case.

Like Senator Campbell, I find the last paragraph offensive. Politics has been used on the whole issue of MS both in the House of Commons and in the Senate since Dr. Kirsty Duncan and I brought this forward in the House of Commons and in the Senate. I also find it offensive that you say that the committee shares an overriding concern with the bill. I find that hard to rationalize when the Conservative senators voted unanimously in the house not to hear from MS patients — unanimously, every Conservative senator. If you really felt that concern, you would want to hear all the witnesses. I find it offensive because if you have an overriding concern, why are we not allowing the hundreds of MS patients who are watching this webcast today the dignity of at least going through clause-by-clause consideration? To put the sentence in there that there is an ``overriding concern with the bill by all members'' is offensive and wrong because it is not true.

Let us go back to paragraph 3, which Senator Eggleton mentioned. To say that the provincial health authorities and colleges of medicine took quick action is wrong. We were told in the rationale why MS patients could not appear before the committee and that written submissions would be given equal weight. If you have read the written submissions that we received from patient after patient after patient after patient, you will have read, in documents that are supposed to be as important as testimony that we heard from people appearing before the committee, that MS patients who have received the treatment outside Canada are not receiving follow-up care.

You say here that the provincial health authorities and colleges of medicine took quick action. What was the quick action that they took? If we are to put that in, what was the quick action that they took?

The Chair: Senator, I made a general observation earlier and I will make a general observation now. I believe that what Senator Martin indicated and Senator Seth confirmed was that in actual fact when issues are brought to the attention of the colleges, they are required to respond quickly with regard to the general issue. I believe that what I heard them say was that after the initial reports, which all Canadians were shocked by, I am sure, the colleges took those actions. It is the understanding, as reported here, that there have been no further reports since those initial ones.

Senator Cordy: Since Senator Martin has brought this before us, could you explain what quick action was taken by the provincial authorities and the colleges of medicine? What was the quick action? It is written down here. If we are supposed to be submitting this as a committee, then I think those of us on the committee should know what the quick action taken was. You have brought it forward, and I think you should explain it.

Senator Martin: I said earlier in my response to Senator Eggleton about the way we define the word ``quick.''

Senator Cordy: What is your definition of ``quick''?

Senator Martin: Within the regulatory system and the laws of Canada, physicians take an oath and do their best to serve the Canadian public. With their understanding of what they can do, they are receiving patients and responding in the ways that they can.

As you said, we all agree that what happened to some of those early cases is absolutely abhorrent; and none of us would want to see that. I am not a physician or research expert, but we have heard from expert testimony that Canada —

Senator Cordy: What expert testimony?

Senator Martin: — has come a long way from the initial stage of understanding MS; and that is what we are moving toward. We have been doing clinical trials as a study, pre-approval and post-approval. We all have heard those experts talk about the importance of having such trials in Canada within our system to ensure that the results that the data we are collecting are relevant to our system in Canada. I believe that with the study that has been selected by the expert panel, including the doctor who was on that panel, we are moving in the direction that we need to go.

I say ``quick'' within the system. I believe that our physicians were acting in the best interest of Canadians; however, those early cases are really unacceptable. We all share that concern.

Senator Cordy: I do not think you do.

Senator Martin: I am saying that I do.

Senator Cordy: You have said several times that expert witnesses have said that they are receiving it and that it was only the early cases where they did not receive it. We have had many, many written submissions from patients who have said they are not receiving care. You have talked about the expert testimony saying they are receiving it. Could you just tell me what expert testimony said that they are receiving follow-up care? The witnesses that I remember, aside from all the written submissions, which are, according to the Conservative senators and the Liberal senators we agree, as important as those who appeared before us. One said it is a human rights issue that they are not receiving it; Dr. Barry Rubin spoke against it; Dr. Robert Zivadinov said it was unacceptable; and Dr. Andreas Laupacis, from the University of Toronto, said it was unacceptable. They all said that it is unacceptable. We agree with that, but then we read here that it is not taking place anymore. Is that our report? That is a joke. If we report that, what will MS patients say? We have not listened to anybody if that is the case.

You said that we do not need a national registry. In March 2011, the government announced that we would have a national registry. It was supposed to start in August 2012. It was moved to July 2012 and then to September 2012. It is now November 2012; and we still do not have a registry. After reading this, I guess what you are saying is that the committee is against the announcement made by the Government in March 2011. I have not heard about it, but has there been a change of policy by the government such that we will not have a registry because the government thinks it is too expensive?

Senator Martin: Are you referring to the Canadian Multiple Sclerosis Monitoring System?

Senator Cordy: I am referring to paragraph 7.

Senator Martin: When you said that the government signed on to a registry, are you talking about the development of the Canadian MS monitoring system?

Senator Cordy: No, I am talking about the national registry that was announced in March 2011 by the government.

Senator Martin: If you look at the wording of the second last paragraph, when we are focusing on —

Senator Cordy: It says that the national registry would be costly and provide no benefit.

Senator Martin: It was when we were focusing on —

Senator Cordy: It says that the national registry, such as proposed by Bill S-204, would be costly and provide little benefit. Is this a change of policy by the government from the announcement that was made in March 2011 that there would be a national registry?

The Chair: Are you speaking for the government or for your role in this committee?

Senator Martin: I am not speaking for the government. I wanted to say that in our understanding of MS and the actual complex procedure, a national registry would not directly contribute to that understanding because a scientific, specific clinical trial and process would have to be undertaken. Monitoring is happening all around.

Senator Cordy: Monitoring will be happening. The announcement that was made in September was that there will be monitoring of the clinical trials. Those 100 patients involved in the clinical trials would be monitored. That is not a national registry of those who had the procedure done outside the country. It is specifically related to MS patients who will be part of the clinical trial.

I guess what I can say by this comment is that you, personally, are against the government policy that was announced in March 2011 that there would be a national registry to collect data from those who had the procedure done outside the country; is that correct? That is it what this says.

Senator Martin: I do not think I am against the government policy.

Senator Cordy: That is it what this says.

Senator Martin: No. I am saying that, in my recommendation —

Senator Cordy: Your recommendation is that there be no national registry.

Senator Martin: I am for collection of data that will be relevant to what we are attempting to do in understanding the procedures and that will contribute to the best treatment for MS patients, however that gets done. I am not in a position to say that this is what should be done, but I do know that I support the action that is being taken by our government at this time — the action plan is clear. Many experts we heard from said that what we are doing in Canada is of relevance and of importance. That is what we are hearing.

Senator Cordy: You are saying — because this is your work — that the national registry would be costly and provide little benefit, contrary to what the government has said in terms of establishing a national registry.

Anyway, I will move on from that.

In the paragraph before that, where you talk about clinical trials and national trials, I want to clarify that the clinical trials that have been set up by the government are not national. The clinical trials that have been set up are not pan- Canadian, despite the minister's announcement and despite the announcement that was made on the day of the clinical trials on September 28. The clinical trials will be taking place in British Columbia, Quebec and perhaps in Manitoba.

People from my province of Nova Scotia — all Atlantic Canadians, in fact — are excluded from those clinical trials. People from Ontario are excluded from the clinical trials. People from Alberta are, also, as are people from the Northwest Territories and the Yukon, although they have their own clinical trials. They will all be excluded.

This is it not a national clinical trial. A lot of Canadians are being excluded from it. Nonetheless, it is a first step.

The fact that it is 100 patients seems very small to me; that will be about 25 per clinical site. We know that Dr. Zivadinov and Dr. Zamboni both talked about their concern regarding the way the patients would be tested for CCSVI.

In paragraph 5, the data is inconclusive as to whether or not chronic CCSVI is more common in MS patients. If you look back to the witness presentation by Dr. Zivadinov, I thought he gave an excellent explanation of the differences. He quite rightly said that we have had studies come out and say that it was zero up to 100. The 100 was Dr. Zamboni, and he himself in appearing said that was not the reality.

If you look back at any new thing, it changes. Look back at the first artificial heart when a person was hooked up to a huge machine and how that has changed. These are the early stages of clinical trials and the whole study of CCSVI for MS patients. However, the more we look at it, the more we are seeing that it might not just be MS patients who have CCSVI but also patients with Parkinson's and other issues. I hope we continue to work along that line.

Getting back to Dr. Zivadinov, he said the challenge seemed to be the way in which MS patients were imaged. He said that it should be multimodal imaging. When you had multimodal imaging, you got a much higher percentage of correlation between CCSVI and MS patients.

I agree that there has been a discrepancy in the reported presence of CCSVI in MS patients. I would say it is certainly changing as we are having more and more clinical trials, but I would never use the word ``inconclusive.''

Regarding the discrepancy in the report of benefits and harms of using venoplasty, I go back to what Senator Munson said. If we had had the courage to look MS patients in the eye, to have them appear before our committee and to hear their stories of whether the procedure worked or did not — at no point did I ever suggest that we should just have patients appear before us where the procedure worked. We do know that one third of patients who have had it have had significant positive changes. We know that one third have had minor changes and one third have had little or no change.

I think having MS patients appear before us so we could hear their stories would have been the decent thing for the committee to do. There is nothing like hearing testimony and looking someone in the eye. I know that a number of them have written submissions. However, it appears that when you talk about whether they are receiving follow-up care, you did not pay much attention to those written submissions.

I am totally against what we are doing today. I believe that we should be doing clause-by-clause consideration. This bill has been around for over a year. There are 75,000 MS patients in Canada. To give them platitudes that we all have great concern and care is offensive to them. I find the spirit of what we are doing today to be offensive.

The Chair: I have exhausted the speaker's list. Are senators ready for the question?

Some Hon. Senators: Question.

The Chair: The question has been called.

All those in favour of the motion before us please so signify.

Some Hon. Senators: Agreed.

The Chair: Contrary?

Senator Eggleton: Could we have a recorded vote?

Senator Munson: Could we have a recorded vote?

The Chair: Indeed we will. Clerk, please call a recorded vote.

Ms. Richardson: The Honourable Senator Campbell.

Senator Campbell: No.

Ms. Richardson: The Honourable Senator Cordy.

Senator Cordy: No.

Ms. Richardson: The Honourable Senator Eaton.

Senator Eaton: Agreed.

Jessica Richardson, Clerk of the Committee: The Honourable Senator Eggleton, P.C.

Senator Eggleton: Opposed.

Ms. Richardson: The Honourable Senator Enverga.

Senator Enverga: I agree.

Ms. Richardson: The Honourable Senator Lang.

Senator Lang: Agreed.

Ms. Richardson: The Honourable Senator Martin.

Senator Martin: Agreed.

Ms. Richardson: The Honourable Senator Merchant.

Senator Merchant: Opposed.

Ms. Richardson: The Honourable Senator Munson.

Senator Munson: Opposed.

Ms. Richardson: The Honourable Senator Seth.

Senator Seth: Agreed.

Ms. Richardson: The Honourable Senator Verner.


Senator Verner: Agreed.


Ms. Richardson: Yeas, six; nays, five.

The Chair: I declare the motion approved, and we will so report to the Senate.

If there is no further business, I declare the meeting adjourned.

(The committee adjourned.)