Compared to getting answers from the Rick Hansen Foundation, the Rick Hansen INSTITUTE gave us some answers after only a few emails and some back and forth on facebook (still too slow in my opinion).
I'm happy that they gave us answers and that the answers were quite detailed, but I have to admit that in my opinion, the answers clearly show that they are doing nothing, or very very little, to deal with a cure for chronic spinal cord injury.
RHI's advertising makes it look like they are dealing with a cure for chronics. Have a look at http://www.rickhanseninstitute.org/images/header/trudeau_oneday1.jpg and see as one of their own board members, Marie Trudeau who was injured at eighteen, says that, "One day...I hope to run on the beach." This is a clear statement that they are committed to a cure for chronics; I just wish that their research showed the same commitment.
Another good point is that they have agreed to talk. We are in the midst of trying to organize the first talk between myself and Mr. Bill Barrable, RHI's CEO. I'll keep you all posted about the progress.
Now without further ado, I will let you judge for yourself about the amount of RHI's work on a cure for chronic spinal cord injury.
__________________________________
Legend
Blue:
Our questions to RIH
Black: RIH answers
Green highlighting: our highlighting of the main part of the answers
Red: Our thoughts and/or questions
___________________________________
Q:
What percentage of your budget went to research (basic or translational) for a
cure for chronic spinal cord injury in 2009, 2010, and 2011?
A: RHI hasn’t and doesn’t invest in basic or discovery
research.
I guess that translation and not
basic research is their mission, but whether this is correct or not is a
different story. Regardless of this we need to find out what basic and pre clinical research they are
looking at for chronics. Since
they are involved in translation, they should be on the lookout for prospective
research aimed at chronics.
The cost of basic science research
continues to increase, with the funding required to do pre-clinical research on
a potential SCI therapy in the multi-millions. In conversation with our NIH
partners, RHI was advised to focus on the areas of research that are essential to translating research
from the basic science discovery to the patient's own bedside,
Including their answer about ICORD
below, we now know who is responsible for basic research and who is responsible
for translational research.
where funding is generally harder
to come by. Large public research funders like the Canadian Institutes of Health
Research, the Natural Sciences & Engineering Research Council, and the
National Institutes of Health (USA) fund this type of research,
Again, if they can name the
institutions responsible for basic research, what research is RHI currently
following for chronic spinal cord injury?
whereas there are few logical
funders for health services research, best practices implementation (to improve
and standardize SCI care), clinical trials networks, and other forms of
capacity building for SCI clinical research.
Thus, RHI has been directed to
invest our federal funding in these areas that are essential pieces of
translational research (patient
registry and research platform, clinical research network and standardizing SCI care and outcomes across the
country) that are unlikely to receive support from other funding. I
These are three things they do.
Patient registry and research
platforms: how does it apply to chronics?
Clinical research network: Yes, can be
used for chronics but is a whole network really necessary.
Standardizing SCI care and outcomes:
Outcomes must be their registry. Important for acute cure but I don’t see the
benefit for chronics.
In a sense it’s like putting the
care ahead of the horse.
in this way, RHI is ensuring we are
good stewards of our public funding, avoiding duplicating what is being done by
our discovery science partners
at ICORD. Following this strategy, RHI/RHF also contributes to seed funding for
our SCI research partners at ICORD, in order to enable SCI academic
researchers to do the preliminary research necessary to obtain research
grants.
Any seed funding toward a cure for chronic SCI? Again, not naming it in this document makes one doubt that
there is any seed funding for chronic SCI. If they can do seed funding for
ICORD it does mean that they are involved in basic research by financially
supporting the work at other organizations.
Now, onto where we spend our time.
About 20% of our projects deal
with reducing paralysis, and another 40% or so aim to enhance physical function.
Unfortunately, it is next to impossible
to calculate accurately how much of our budget was spent on a cure for chronic
SCI, as many of our projects target more than one expected outcome. For
example, our Rick Hansen
Spinal Cord Injury Registry (RHSCIR) collects data on people in Canada with an
SCI,
Reducing paralysis: is not cure and
often reducing paralysis is dealing with outcomes immediately after injury.
Enhancing physical function: by doing
what? How do you enhance physical function of a complete chronic injury without
regeneration?
Registry: important for measuring
outcomes in acutes. But what I’ve heard of the registry it doesn’t follow
people past two years. I’ve also heard that includes a lot of demographics
without follow up at different stages.
Actually registries done by EMSCI
and NACTAN are enough to monitor the evolution of patients with SCI? Why is
work being duplicated as no one can see the difference between people with SCI
in America or Europe.
which is anticipated to help
answer a number of research questions related to the cure, to alleviating secondary complications,
and other areas. As part of RHSCIR, a survey of people with spinal cord injury
was conducted to assess their readiness and willingness to participate in stem cell clinical trials. So
this one activity within RHSCIR was aimed at the cure for chronic SCI, but it
is not possible to budget this out as it is part of the larger RHSCIR project.
This was a survey, not “aimed at the
cure for chronic spinal cord injury.” Also, a lot of work is going on without
cells. Why the focus on cells?
What was the point of a survey like
this? How can you ask people if they would like to undergo some non-defined
procedure? Who would agree?
Similar types of activities are
carried out within other RHI projects, such as our Access to Care and Timing project and others.
Important, but in no way aimed at chronics.
__________________________________
Q:
What research was done in regards to question one above?
A: We define cure as reduction of paralysis and restoration of
physical function post injury.
Very broad definition of cure. Any
little improvement is not cure.
CDRF is also involved in this kind of thinking.
You cannot redefine the meaning of
cure so that even moving a toe becomes cure. That is not cure, it is moving a
toe.
If we are strictly talking about neuro-regeneration and
neuro-protection, we currently only have a handful of projects. Based on
our definition of cure(s), more
than half of our projects deal with reducing paralysis and enhancing physical
function. Specific projects include: Access to Care and Timing, CAMPER, FES and ReJoyce, for example, could fall within the category.
In addition to time into
surgery and stem cell
transplantation, RHI’s activities in fiscal year 2011-2012 oriented
towards reduction in paralysis also included support for two multi-centre trials examining
potential neuroprotective agents: riluzole and minocycline. In fact, since 2007, RHI has supported fully
half of the Canadian-sponsored clinical trials on SCI.
OK. In your handful of projects which ones deal with
neuro-regeneration and why didn’t you mention them here.
Reducing paralysis and enhancing
physical function is not cure. Specifically, how does Access to Care and
Timing, CAMPER, FES, and ReJoyce cure chronic spinal cord injury? None of these are a biological answer to cure and only offer
very limited functional improvement, if any, in chronics.
Both of riluzole and minocycline are
100% for acutes.
Yes of course they have done clinical trials, but saying “clinical trials” is not the same as “clinical
trials for cure for chronic spinal cord injury. Adding this just confuses the
situation especially is not one clinical trial aimed at chronics is mentioned.
We are strictly talking about a cure
for chronic SCI which means recovery of functions like breathing, hands, bowel,
bladder, walking..
__________________________________
Q:
What are your future plans for both spending and research for a cure for
chronic spinal cord injury in the near future.
A: RHF and RHI have recently
received a commitment from the Canadian government for the continuation of its
programs. RHI has submitted a
new five-year business plan to guide activities towards meeting its objectives
using these new funds.
Since our questions are about chronics, why is there nothing
mentioned specifically about chronics?
Given all the work conducted by
RHI and others, Canada has a unique opportunity to host clinical trials
for SCI, due to greater consistency in SCI care across the country. By supporting a network of clinical
researchers, creating
an infrastructure for clinical trials in SCI, standardizing care, enabling standard measurement of
patient outcomes, and creation of a patient registry, RHI is making it
possible to trial new treatments for acute and chronic SCI as they are
ready for clinical trials, which is the goal we’re all working
towards.
Great. A lot of leg work may have already
been done to get clinical trials going, but now the clinical trials have to
start.
Standardizing care is not part of this
for chronics. It’s just added in and again confuses the situation.
Measurement of patient outcomes. Is
this through the registry? I don’t understand the importance of this for
chronics, especially complete chronics.
There will be very few clinical trials
for chronic SCI in the future because very few labs are doing chronic SCI
research and that is also because orgs like RHI/RHF failed to direct founds
restricted to chronic SCI research.
(RHI’s fiscal year ends March 31,
2013, so we’re currently wrapping up a number of projects started as far back
as 2007. Details on new projects will be available in the new year).
