Health Committee on Nov. 23rd, 2009

[The Chair, Conservative, Joy Smith]

Okay. Dr. McEwan.

[Dr. Alexander McEwan]

I'll agree to disagree with my colleague. I do think this is a very important initiative, looking to the short to medium term, and I believe we will see benefits from it.

[The Chair, Conservative, Joy Smith]

Dr. O'Brien.

[Dr. Christopher O'Brien]

One of the grants from CIHR is looking at ortho-iodohippuran for renal imaging. That's an agent I used 30 years ago. It's not a different agent, using iodine-131 versus iodine-123, but we already have the information.

The lymph node is a very important research project, lymphoscintigraphy. There are hospitals using that today in Ontario. So this is research that I think is important to gather information, but if I go back to ortho-iodohippuran, I was using that in 1978 as a technologist. So there are good things, looking at it, but it's almost as if we're reinventing the wheel a bit on certain aspects of this.

[The Chair, Conservative, Joy Smith]

Thank you so much.

We'll now go to Ms. Davidson.

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

Thank you, Madam Chair. I'm going to share my time with Mrs. McLeod.

I think we certainly owe a huge debt of gratitude to the whole medical community for stepping up and managing this issue. However precariously we may be managing it, we are managing it because of the medical community. As Dr. Carrie said, he and I both had the opportunity to meet with the CAMRT and discuss the issue with them last week. We know the sacrifices and the changes they have made.

Dr. Doig, you referred to reports of sporadic adverse events, and of course that's to be expected in this situation. You then went on to talk about delays of 48 to 72 hours in suboptimal imaging due to the extensive use of thallium-201 rather than technetium-99m. Do you have a concern that there will be less than optimal results or less testing being done if there are other mediums used rather than technetium?

[Dr. Anne Doig]

I think I ought to defer to all my colleagues to my left to give the technical answers to that, but the short answer is yes. Whenever we have to find a workaround to something that is current best practice or current standard procedure, we can often find a workaround, but there is always a risk attached to doing that. That's what I was alluding to in my remarks.

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

Would any of you like to add to that?

[Dr. Jean-Luc Urbain]

I fully agree with Dr. Doig.

The picture or analogy I can use is this. In 2009 none of us would like to drive a car from 1960. If you have to get from point A to point B and you have nothing else, that's what you use, but all of us would like the 2010 model.

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

I'm referring to new technology and new techniques that may be coming on board, just so we're clear.

Dr. O'Brien, do you have that same concern?

[Dr. Christopher O'Brien]

The concern from the suboptimal imaging that was being talked about with thallium is based on radiation exposure to the patient, because it is a higher exposure than what we are looking at. It's also very difficult to schedule, and the patients are subjected to different types of procedures. The diagnostic yield is not that bad, but it comes at the price of higher radiation exposure. This is what we used in the 1970s, so this is a 30-year-old technique.

With our sensitivity toward radiation exposure to patients, it's not an optimal product to use at this point. It's good to put your finger in the dike to prevent it from collapsing, but it's not what we want to use. With the future innovative stuff, definitely we would. We are seeing some very interesting radiopharmaceuticals coming down the pipeline, but without having the infrastructure to use those on a regular basis in community hospitals, they won't have a big effect.

[The Chair, Conservative, Joy Smith]

Ms. McLeod, perhaps you'd like to ask your question now. Thank you.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

I had hoped to get into--but I guess we'll see how it goes. Thank you everyone for being here.

Dr. Bourguet, we heard about some of the research we're going to be doing in Canada. Could you speak briefly to an international perspective in terms of where research is going on this issue?

[The Chair, Conservative, Joy Smith]

Dr. Bourguet.

[Dr. Patrick Bourguet]

I'm thinking of research in the area of radioisotopes for medical use.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Yes, thank you.

[Dr. Patrick Bourguet]

It is true that this is an area that is booming. Contrary to what some may think, this research does not deal exclusively with positron-emitting isotopes, but of course with simple photon-emitting isotopes as well, including technetium. Moreover, a significant part of this research is translational and consists of converting molecules so that they can be used with a technetium marker.

Currently, it is true that the arrival of PET technology on the international market and for clinical use has resulted in a boom in research in this area. What are the leading-edge countries? From a pharmaceutical perspective, they are clearly the industrialized countries. It is true that North America, the United States and Canada, Europe, Japan and Korea are clearly leading-edge countries in terms of radiopharmaceutical development. However, upstream, as far as research into radioactivity properly speaking is concerned, it is clear that the nations I mentioned earlier on in my comments, North America and Europe, are much further ahead in the forefront.

[The Chair, Conservative, Joy Smith]

We'll now go to Ms. Murray.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Thanks for your testimony.

Following up on what I just heard, and also an earlier question about the decision that Canada took to get out of the business with the MAPLE reactors, what's the implication for Canada, if any, if research is skyrocketing? What's the implication for the activities associated with the MAPLE reactors, not just the pure production of technetium? And what are the implications on the need to have a backup for Chalk River, which we know is an aging facility that has shown us it's going to let us down from time to time? I'm wondering about some of the other implications of discontinuing our role in this industry.

[The Chair, Conservative, Joy Smith]

Dr. McEwan.

[Dr. Alexander McEwan]

I would be happy to answer that, Madam Chair.

I think that Dr. Bourguet, in describing the explosion of research in this area, reflects the importance of what the nuclear medicine community can do in terms of assisting our clinical colleagues as they make important clinical decisions and stratify patients for treatments. And in the future, I think, as Christopher said, we will be moving to the era of personalized medicine.

What is particularly important, and why I think the CIHR round is very important, is that it indicates that we're not only looking at how we deal with technetium products, how we find alternatives to our currents tests, but we're committing to that evolutionary path to the next generation of tests.

I had the privilege of being part of a working group with CIHR on medical imaging as well. So within that context, we're building a framework that is going to enable us to look not only at alternative ways of making technetium but at technetium replacements at the same time as we build a framework to do what Dr. Urbain and Dr. O'Brien have so eloquently pointed out, which is leading to the next generation of tests.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Thank you, I want to make sure I have time to hear from the others about the implications on our research and other agendas of abandoning MAPLEs.

[Dr. Christopher O'Brien]

Without having research capabilities, if you abandon MAPLE you are losing a Canadian industry; you are losing the opportunity for our post-graduate Ph.D. individuals, our academics, to have a very fruitful career in Canada. We are also abandoning our patients, because without having the ability to have medical isotope research in Canada, our patients' ability to access new and innovative research protocols will no longer be here, because all of that research may be south of the border.

So it is collateral damage and impact, and that's the importance of really ensuring that Canada does have a role to play in medical isotope production and in basic nuclear research as well, because these reactors are research and production units. We are focusing on medical isotopes, but we cannot abandon our research potential, and I'm very concerned about that.

[The Chair, Conservative, Joy Smith]

Dr. Urbain.

[Dr. Jean-Luc Urbain]

I have two points. The first is that medical isotopes are produced by research reactors, so the first goal of those reactors is to do research. We should not lose sight of this. If we don't have a reactor to do research, this entire aspect of research technology would disappear. The second one is that there will not be personalized medicine without medical isotopes.