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First, I must say that RIH has provided quite specific answers about their activity.

Unfortunately, when answering questions about chronic spinal cord injury, they mixed in other activity that is completely non-cure related or in the case of mentioning specific neuro protection trials it is with acutes. My opinion is this. RHI does a lot of good work, but has failed to mention anything that deals with chronic SCI. But what is worse than this, is that they tried to throw in all their work, including the kitchen sink, to confuse, not to answer. We asked very specifically about chronic SCI. They answered about ALL their other good work.

__________________________________ 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 hasnt and doesnt 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 preclinical 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 dont see the benefit for chronics. In a sense its 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 Ive heard of the registry it doesnt follow people past two years. Ive 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.
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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. The definition of cure is very simple; after medical treatment, the patient no longer has that particular condition anymore. http://kidshealth.org/teen/your_body/medical_care/curable.html

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, RHIs 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 didnt 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..
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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 were 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. Its just added in and again confuses the situation. Measurement of patient outcomes. Is this through the registry? I dont 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. (RHIs fiscal year ends March 31, 2013, so were currently wrapping up a number of projects started as far back as 2007. Details on new projects will be available in the new year).