Canada’s new Minister of Science is Kirsty Duncan, Liberal Member of Parliament (MP) for Etobicoke North. The position is formally designated as a Minister of State “to assist the Minister of Industry in the carrying out of that Minister’s responsibilities”. Many in the science community have welcomed Duncan’s appointment. Her background is in medical geography, and before entering politics she was a professor at the universities of Windsor and Toronto.
But not everybody is happy with Duncan as Science Minister. For example, Tom Blackwell in National Post wrote that she has
“vigorously promoted an unproven medical treatment, clashed publicly with some of the world’s top virus experts, and repeatedly warned of a ‘darker side’ to science replete with power politics and resistance to change.”
Are these charges fair? A “clash” with other academics nearly two decades ago hardly seems relevant, while anyone who supposes politics is absent from science has clearly never worked at a university.
The concerns about Duncan’s promotion of an “unproven medical treatment,” however, are much more substantive. In particular, McGill University neurologist Michael Rasminsky labeled the ideas Duncan supported as “profoundly non-scientific”. Is he right? If Duncan was a promoter of pseudoscience then her appointment as Science Minister would indeed be problematic.
A Brief History of Events
In 2009, Italian researcher Paolo Zamboni hypothesized that Chronic Cerebrospinal Venous Insufficiency (CCSVI) was involved in the development of multiple sclerosis (MS). His work was published in the Journal of Neurology, Neurosurgery, and Psychiatry, a peer-reviewed journal established in 1920 with an impact factor of 6.807 (this can be taken as indicative of a “good” journal). For comparison, the Multiple Sclerosis Journal has an impact factor of 4.822.
A treatment for CCSVI was devised and termed “liberation therapy”. The treatment generated intense public interest, particularly in Canada where there is a high incidence of MS. A 2010 editorial in the Canadian Medical Association Journal called the treatment “promising but untested”, noting that “scientists and skeptics should avoid dismissing novel ideas prematurely” while worrying that research might be put at the “mercy of advocacy campaigns”. One neurologist described the public’s reaction in 2011 as one of “hysteria”.
On 21 September 2011, Duncan introduced a private member’s bill, Bill C-280, titled “An Act to establish a National Strategy for CCSVI”. She proposed, amongst other things, to fast track clinical trials for the treatment of CCSVI “in order to place Canada at the forefront of the international research”.
Parliamentary debate about the bill was largely cordial. Duncan communicated that she had been personally in touch with over 1,500 MS patients across Canada, including four hundred who were treated outside Canada. She described attending conferences on CCSVI, and argued that “Canadians with MS deserved science and they deserved evidence-based medical practices.” Fair enough.
Opponents in the debate countered that they were concerned “about the concept of having politicians trying to legislate scientific research and trials.” This is an eminently reasonable position. The bill was narrowly defeated in a vote on 29 February 2012.
Following defeat of Bill C-280, the US Federal Drug Administration issued a warning about liberation therapy. They also acknowledged that “studies exploring a link between MS and CCSVI are inconclusive”, which suggests a need for more research.
Experts witnesses were invited to parliament to discuss CCSVI. In his testimony on Oct 4 2012, Dr. Alain Beaudet, president of the Canadian Institutes of Health Research (CIHR), acknowledged
“A meta-analysis of all scientific evidence published to date, commissioned by the CIHR, led to the conclusion that there was a small but statistically significant increase in the incidence of venous abnormalities in patients with MS as compared to controls. Based on these conclusions, our Scientific Expert Working Group recommended that CIHR support a small-scale, Phase I/II clinical trial to evaluate the safety and efficacy of the venous angioplasty procedure proposed by Dr. Zamboni. A call for research proposals was therefore developed and launched last winter.”
Beaudet’s remark suggests that the Canadian scientific community thought the CCSVI hypothesis had enough merit to warrant further study. A grant was subsequently awarded to Dr. Anthony Traboulsee from the University of British Columbia. Formal approval for the trials was granted on 28 September 2012, a full year after Duncan’s bill was introduced.
Duncan followed the defeat of her bill with an op-ed arguing that patients treated for CCSVI abroad needed to have their health care rights in Canada assured. She did not advocate for additional clinical trials, although their progress was questioned in an earlier missive.
In the meantime, the science continued forward. Studies published late in 2013 did not find a link between CCSVI and MS, a result confirmed by Traboulsee’s team in early 2014. A recent study disagrees. Conclusions on the safety and efficacy of the CCSVI procedure from Traboulsee’s clinical trials are expected in 2016.
From my perspective, the scientific and political processes have played out exactly as they should.
On the science side, a hypothesis about MS was published by researchers in a peer-reviewed journal, subsequently examined and found wanting by some studies. This is part-and-parcel of the scientific method: some hypotheses work out, while others do not. To my knowledge, there are no specific allegations of misconduct on the part of the journal or CIHR, although a non-specific allegation was made against CCSVI proponents by a neurologist in 2012.
On the political side, citizens raised their concerns about the availability of a particular medical treatment with an opposition MP, who, after due diligence, introduced an Act to parliament. The bill, which proposed fast-tracking clinical trials, was defeated following a reasonable debate.
The sequence of events leads me to conclude that the attack in National Post on Minister Duncan was profoundly unfair. Duncan can hardly be faulted as an MP for responding to the Canadian public’s concerns, nor should she be lambasted for not having clairvoyance enough to foresee the results of clinical trials to come. Some results are not yet in.
What will Minister Duncan do with this file going forward? Will she exert “top down” political pressure on the scientific community as warned by the article? I have no idea. However, given her scientific background and consistent advocacy for science in the House of Commons I remain optimistic, as I am for the rest of the Liberal plan for science and the environment.