Good morning.
I want to begin by thanking the committee for the opportunity to appear before you on behalf of the Canadian Medical Association. The CMA also submitted a brief to the committee.
On behalf of the 76,000 doctors represented by the CMA, and the millions of Canadians they serve, I have one message for you today. As members of Parliament, you are among our country's leaders. At a time like this, when Canadians are facing what is nothing less than a national crisis, they look to you and your peers in legislatures across the country to exercise that leadership and live up to the trust that has been placed in you.
At the risk of sounding harsh, the early finger pointing between governments was anything but a demonstration of leadership. Since then, I believe there has been progress. Recently, the federal government announced that it would open its stocks of medicines to provinces experiencing shortages. While I'm not sure of the types of drugs this would cover, or what the process involves, it is nonetheless a step in the right direction.
Also encouraging is the fact that Health Canada has fast-tracked approvals of alternative drugs, but I am disappointed that the focus of the generic and brand-name pharmaceutical companies has been on providing information on drug shortages. Information about the problem of drug shortages is no substitute for fixing the problem of drug shortages.
I'm going to take a moment now to identify the impact of these drug shortages and the lack of information surrounding them on physicians and the patients we care for.
Clinical treatment is interrupted, putting patients at risk of relapse and worse. Surgeries are cancelled, leading at best to delays and at worst to a real deterioration in the health of those patients forced to wait.
Sometimes there are no alternative drugs, or the alternative is not covered by insurance. Sometimes people simply can't afford the new medication. Whatever the reason, when an appropriate alternative therapy is not available, sick people must go without.
As all drugs have risks, there is a risk of side effects from alternatives. Further, the alternative might not work as well as the drug originally prescribed, and it's even possible that the alternative is a drug that has been tried before without success.
Changes in the timing and dose of medications can be confusing, particularly for those on long-term therapy or those for whom learning a new regimen is difficult.
Finally, all medications being taken by a patient must be reviewed for potentially harmful interactions with any new medication. This might require blood tests or trials of dosage that will further delay treatment. Any of these situations can harm our patients and do damage to their health, particularly in the case of patients with complex problems.
At the CMA, patient organizations are telling us about the anxiety, pain, and harm that drug shortages are inflicting on patients. I committed to some of those patient organizations that couldn't join us to share their experience with you.
Allow me to read excerpts from a few messages we have received.
The Brain Injury Association of Canada told us, and I quote:
Any drug medication shortage endangers Canadian patients. In the brain injury community, anti-depressants are prescribed to some, as is pain medication, so if there is a shortage some members in the community will be endangered even if the medication is altered.
The interim president of the Canadian Arthritis Patient Alliance, Louise Bergeron, wrote to us:
Actually, I have had this happen to me on three occasions and it is quite scary when you know you will not have access to certain drugs for an extended period of time, since you know your health will be on the line.
Sharon Baxter, executive director of the Canadian Hospice Palliative Care Association, says:
All are encouraging the government to find a solution very quickly as pain medication at the end of life is essential and urgent. I don't think we are at the stage where people are dying without access, but getting to that end is totally unacceptable in a country like Canada.
Shortages also lead to an increase in the consumption of health care resources because of the need for additional monitoring and multiple consultations among health care providers, including physicians and/or emergency room visits. To put it bluntly, while doctors are trying to source medications or alternatives for drugs that should be readily available to patients, other patients have to wait longer to be seen and cared for.
Last but not least is the greater cost to our economy. Healthy citizens are productive citizens, contributing to their families and communities and to our country's economic prosperity. How can it make sense from an economic standpoint to have people ill and off the job because of a lack of access to medically necessary therapies?
In order to deliver the best possible care to patients, physicians require timely, comprehensive, and accurate information about current and anticipated drug supply shocks and constraints. More to the point, our country requires an uninterrupted supply of medically necessary medication for patients—period, full stop.
With that objective in mind, we have provided input to government and to the pharmaceutical industries. As health care providers we must have a monitoring and early notification system for pharmacies and physicians, and there must also be a proactive, systematic mechanism to prevent interruptions in the provision of medically necessary medications to our patients.
In a survey of physicians conducted by the CMA in January of 2011, two-thirds of respondents said the shortage of generic drugs had negative consequences for their patients and practices. The gap between what we have in Canada and what we need is even more clearly evidenced by the current shortfall of injectable drugs.
We recognize that other countries are also grappling with drug shortages. We've noted with interest that President Obama signed an executive order last fall directing the Food and Drug Administration “to take steps that will help to prevent and reduce current and future disruptions in the supply of lifesaving medicines”.
The CMA encourages the Government of Canada to consider every lever available, including the economic inducements it provides to the pharmaceutical industry, to ensure Canadians are assured of an uninterrupted supply of medically necessary drugs. Drug shortages are a serious and escalating problem, one that needs to be fixed and one that Canadians expect their elected representatives to act upon.
The bottom line is that the pharmaceutical industry itself must resolve its supply challenges. My responsibility as a physician is to provide care; theirs is to make sure we have the medications we need for our patients when they need them.
Thank you for the opportunity to come before you regarding this very important issue. I would be happy to answer your questions.