Health Committee on Feb. 14th, 2008

[The Chair, Conservative, Joy Smith]

Thank you, Madame Lambert. You've kept repeating the answer, and thank you for that.

Madame Gagnon.

[Christiane Gagnon, Bloc, Québec, QC]

It would seem then that there is no register where the various health care professionals, for example, pharmacists, doctors and hospital staff, can record the ADRs that they observe. The various health care professionals seem to be working in silos. How could this data be collated so that it can all be made available to Health Canada? The manufacturers also have a role to play in this process. How could the process be made significantly more proactive? What process would you suggest implementing?

[Myrella Roy]

This is something to which I referred in my presentation. Obviously, we already have the MedEffect database; however, it unfortunately has a number of shortcomings. While it facilitates the reporting of new reactions for both health care professionals and consumers, it is difficult to use the information as there is so much of it. If all serious adverse drug reactions are reported, whether they be known or not, the users may wind up having to sift through a thousand individual reports. This makes it difficult to identify significant information. Each report has to be read. I therefore think that there is room for considerable improvement of the database, not only in terms of facilitating access, but also in facilitating use.

[Christiane Gagnon, Bloc, Québec, QC]

Indeed.

[Dr. Jeff Poston]

Perhaps I could just add that one of the things we haven't touched on a lot this morning that I think is important in terms of the work of the committee is looking at non-prescription products and natural health products. That's a very important area that needs some research. We really don't know much about what happens there. It's the other spectrum of the seriously ill patient in hospital who's on all sorts of new drugs. The type of patient that bothers me is the consumer who might be buying products from all sorts of different places and who will mix the products.

I think one of the things we have to look at is perhaps doing more around the role of the consumer in having some awareness around risks associated with drug therapy, and really facilitate reporting and making information available. We know difficult patients who have problems with side effects and that type of thing, but I think that's an important area.

[Christiane Gagnon, Bloc, Québec, QC]

I was actually just about to ask you a question on non-prescription drugs. Do some of these drugs contain ingredients that could cause problems? I'm thinking, for example, of certain cough medicines. Should these medications not be available as non-prescription products dispensed by a pharmacist? Often, people ask their pharmacist whether they can take a given product. As such, pharmacists are in the best position to inform consumers of the risks associated with a given drug and of how it ought to be taken. Implementing such a system would show greater commitment to tackle the problem. I would remind you again of the person who died after having taken cough medicine.

[Claude Gagnon]

If I could make a comment, I would urge caution here. We have to be careful not to blow things out of proportion without good reason. As long as information is provided appropriately, some drugs can be available freely over the counter. Obviously, it is important to educate the public, it is important to have awareness-raising campaigns and to underscore the importance of not exceeding the recommended dose. It is not the product itself that is dangerous, it is the amount that people take. No drug — be it non-prescription, pharmacy-only sale, or prescription — is without risk if the patient does not follow the instructions or fails to take the recommended dose. This is something that the general public has to understand.

We have a message to communicate. We cannot be negligent, it is imperative that the public receive the right information and that they are educated. Adverse effects frighten people. People have to be aware that they exist, they have to be educated, but they must also be reassured. What is important is how we can empower people.

Health Canada gets information after the horse has bolted, but at any rate, I think that there is a general realization that the department has no authority and, hence, no power to act. In what is, I would imagine, an attempt to show good faith, manufacturers withdraw their product from the market even before an official recommendation has been made. That probably explains why the general public is informed ahead of health care professionals. I think that Health Canada should be the first to be informed and should then immediately notify health care professionals.

Professional associations in Quebec, and in other provinces as well, I would imagine, post information on the Internet to facilitate quick access. Furthermore, when a product is considered dangerous, a fax is sent to all Quebec pharmacists. If we have the information in time, it will be delivered in time, but we have to have the information. At the moment, there is no feedback. I think that that is one of the shortcomings.

[The Chair, Conservative, Joy Smith]

Our time has run out for this particular one, but Ms. Wolfe and Ms. Lambert want to make a quick comment.

Ms. Wolfe, can you take just a few seconds to do that? Then we'll go to Madame Lambert after that.

[Karen Wolfe]

To address the issue of non-prescription drugs, our organization has an expert advisory committee that reviews non-prescription drugs and determines conditions of sale, which is a provincial authority. Those different conditions of sale would be a pharmacist-only sale—a pharmacist would need to be interacting with the sale—to be sold in a pharmacy only, a prescription only, or to be sold anywhere. So we do have extra.

[The Chair, Conservative, Joy Smith]

Thank you.

I am going to have to cut this one off because we're way over and I want to go to Ms. Davidson. We do have to go into committee business at a quarter to one.

Ms. Davidson.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you, Madam Chair.

I'm just going to go back to the same discussion we were just on--the non-prescription drugs. Whoever wants to answer this is fine.

My concern is about the combination of drugs. Who monitors that? Who gives the advice to the patient?

Monsieur Gagnon, you stated that it wasn't so much the drug, but it was the quantity.

But what about the combination? What if you're taking a prescription drug, but you're also buying something else yourself off the counter? Who knows about that and who advises people?

Whoever.

[Denis Villeneuve]

I can answer from the point of view of a community pharmacist. We systematically ask patients if they are taking any other medication before we dispense any drug. Once again, it comes down to educating patients.

Moreover, the federal government ran a campaign two years ago seeking to educate patients of the importance of informing their pharmacist of any other medication they were taking. The problem is that, often, patients do not see contraceptives and natural remedies as being medication. In their eyes, medication that you take occasionally is not medication either. That is why we systematically ask the question. As Ms. Gagnon was saying, there are cough syrups that can be highly toxic, and it is not just the combination of drugs that can cause problems. Some over-the-counter drugs are contra-indicated for diabetics and those with high blood pressure. Indeed, in Quebec, we systematically stick labels on drugs that those suffering from high blood pressure or diabetes should avoid.

[The Chair, Conservative, Joy Smith]

I want to thank our panel of witnesses. Unfortunately, we've run out of time. My apologies.

We're really going to have to get all of you back again. There are so many questions to ask, and there's so much to hear.

I want to wish you a happy Valentine's Day, I want to thank you for your presence here, and I want to ask a special favour of you. We're going into committee business, so I'd be so pleased if you could depart in a very timely manner. If anyone wants to talk, I would wish that you would go out of the room, beyond that door, to do that.

Thank you, panel.

I would like to have the committee go directly to committee business. We have committee business that we need to attend to.

First is the notice of motion put on the table by Mrs. Wasylycia-Leis.

Mrs. Wasylycia-Leis, would you like to read into the record your motion, please? Then we will discuss it.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Thank you, Madam Chairperson.

Should I read it all?

[Lui Temelkovski, Liberal, Oak Ridges—Markham, ON]

Yes.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

I move that the Standing Committee on Health call on the government to strengthen its monitoring and analytical capacity regarding enforcement of the Canada Health Act, in order to better identify challenges facing public health care, including excessive wait times for diagnostics and treatment, the high cost of prescription drugs to individuals and the health care system, and the impacts of increased privatization; and that the Minister of Health appear before the Health Committee within 30 days following the publication of his department’s Canada Health Act annual report to indicate what proactive measures his government will be undertaking to ensure that Canadians’ rights under the act are fully protected and strongly enforced in light of the current challenges to Canadians’ public health care system.

[The Chair, Conservative, Joy Smith]

Thank you, Mrs. Wasylycia-Leis.

Is there debate or questions or comments on the motion?

Mr. Fletcher.

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

Thank you, Madam Chair.

I'd like to thank the member for her motion, but I don't think it is a necessary motion. In fact, I want to assure the member that the government supports the Canada Health Act and the Charter of Rights and Freedoms, and we have made significant progress on this front.

We have put in $1 billion in regard to the patient wait times guarantee. That includes $612 million for the patient wait times guarantee trust, $400 million for Infoway technology, and another $30 million for pilot projects. That's in addition to the $41 billion invested over 10 years to strengthen our health care system. The 2004 health accord included $5.5 billion for wait time reductions.

We have seen significant progress.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

I have a point of order. I don't want to interrupt my dear friend Steven Fletcher. I just want to say that what he's discussing isn't really the intent of this motion.

The motion is simply to acknowledge the annual report to Parliament—

[The Chair, Conservative, Joy Smith]

Mrs. Wasylycia-Leis, this is not a point of order, with all due respect.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Could I explain my motion, then, before—

[The Chair, Conservative, Joy Smith]

We have to listen to his answer, and then go to Ms. Gagnon. We'll put you third on the list.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Could I not introduce my motion?

[The Chair, Conservative, Joy Smith]

You just did.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

All I did was read it.