Health Committee on May 9th, 2007

[Dr. Joel Lexchin]

We used a set of criteria to decide which agencies to compare to.

First of all, they had to use the same kind of evidence that the CDR uses, which is a combination of pharmaco-economic analysis and clinical evidence. They had to have evaluated at least half of the CDR drugs. They had to publish their material on the web. They had to make more decisions than just yes or no, so they had to have at least a third category of decision--in other words, fund with restrictions. All of those things were the bases on which we chose the comparisons.

Quebec didn't fit that, so we didn't use Quebec. That doesn't mean Quebec decisions are right or wrong; it just means that Quebec didn't turn up in the bases on which we chose the countries.

Why does Quebec fund more drugs than other provinces? There are a variety of reasons. It could be that the social priorities of Quebec are such that you are willing to put more money into drugs than other provinces are. It could be that Quebec feels that by listing more drugs, they will get more economic activity out of the drug companies, since a large number of them are located in the Montreal area, and sometimes drug companies make implicit promises that if drugs are funded, they will increase investment. There are a variety of reasons Quebec may choose to put more drugs on its formulary than other places, but we didn't explore that.

[Christiane Gagnon, Bloc, Québec, QC]

Did you do any comparative studies with the rest of Canada on the quality of life or the health of patients who are taking the medications? Have you evaluated the effectiveness of these medications? This is what we are being asked.

Some witnesses have come to tell us that access to new medications was difficult, because many were rejected, especially medications for rare diseases. Some would even like to see different processes for different diseases, because the sample is too small and too many products are rejected. In Quebec, the process is different. Does that have a more positive impact on the patients' quality of life?

[Dr. Joel Lexchin]

I think it would be a good idea to compare quality of life in a different group of patients with the same disease in different provinces, where access to care is different, but those kinds of studies haven't been done. If CIHR wants to fund those, I'd be happy to put in an application for money, but nobody has looked at that. It's a valid point, and something worth pursuing.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Mr. Fletcher, you have five minutes.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

Thank you, Mr. Chair.

Mr. Chair, I notice that the idea of an independent review has come up again at this meeting. Perhaps that is something this committee should consider when we come out with our final report.

As in every other committee, in this committee there doesn't seem to be enough time to ask all the questions I would like, so I'll focus on the Best Medicines Coalition. I'm just reading about your group. You say you're a national group of organizations representing millions of Canadians. What types of organizations make up your coalition? Please give a quick answer.

[Louise Binder]

They're all disease and disability groups. I won't remember them all, but Linda is representing the arthritis community here. There's hepatitis C and HIV. The cancer advocacy group and the breast cancer group are represented. I actually have a list. It's a broad-based group. There's a diabetes representative and others for a number of different diseases and disabilities.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

What is your annual operating budget?

[Linda Wilhelm]

It's $250,000.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

How much money have you received in recent years from pharmaceutical companies?

[Linda Wilhelm, Operations Committee Member, Best Medicines Coalition]

We got about $100,000 from Health Canada for the research project, and then probably the other half was from the pharmaceutical industry.

[Louise Binder]

I think we got about half from Health Canada and half from the pharmaceutical industry to do our work.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

So half of the money you receive is from pharmaceutical industries. Are these unrestricted educational grants?

[Louise Binder]

Totally.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

I think this is an important point. It's very interesting that the point of view your coalition has advocated for is virtually identical to Rx&D's point of view.

[Louise Binder]

I'm not surprised about that.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

That may be a coincidence, but I think it would be helpful, when NGOs ask for CDR to be transparent, that the NGOs are transparent as well.

[Louise Binder]

We're totally transparent about our funding.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

In the material that was provided to this committee there was no indication that any moneys were received from pharmaceutical companies. That would help put the point of view you are presenting in context.

[Louise Binder]

With all due respect, I wouldn't care where the money came from. What I want to see is access to treatment for people in this country. Do pharmaceutical industries want to sell drugs? Sure they do. Does that mean on this issue we have a commonality of interest? Sure we do, but for completely different reasons.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

Or there's a conflict of interest, depending on your point of view.

[Louise Binder]

That's not fair. I don't think any--

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

I'm just pointing out the reality of the situation. But having said that, I think there is a fair degree of sympathy for the point of view that CDR should be reviewed.

[Louise Binder]

You know, I've won awards from the Province of Ontario and from the law school I attended. I don't want to be disrespectful.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

The fact is that you brought forward a point of view and you received money from large organizations that would benefit significantly from your point of view, and that should have been disclosed. That is my point.

[The Chair, Conservative, Rob Merrifield]

Do you have another question?