Health Committee on Nov. 20th, 2012

[The Chair, Conservative, Joy Smith]

Good morning, everybody. Welcome to the health committee.

I want to extend a special welcome to the Minister of Health. We are very pleased that you could join the committee. It is a real treat to have you here.

Pursuant to Standing Order 81(5), we are examining supplementary estimates (B) for 2012-13. We are going to be studying the particular supplementary estimates referred to us.

We're going to begin with the minister, and following that, we will have questions and answers. Minister.

[Leona Aglukkaq, Conservative, Minister of Health and Minister of the Canadian Northern Economic Development Agency]

Good morning, and thank you for the invitation to speak to you regarding supplementary estimates (B) for Health.

I would like to start by congratulating Mr. Lobb on his appointment to the committee.

I will introduce the officials who are with me this morning: Deputy Minister Glenda Yeates; Jamie Tibbetts, chief financial officer for Health Canada; Greg Taylor, deputy chief public health officer; Krista Outhwaite, who is here with me for the Public Health Agency of Canada; James Libbey, senior financial officer for PHAC; and James Roberge, chief financial officer for CIHR.

Madam Chair, I want to begin by talking about the 2012 economic action plan. As you know, all federal departments and agencies were asked to review their operating and program spending. The health portfolio's efforts to reduce a deficit will modernize and strengthen the way our government operates. We will also achieve our core functions effectively while delivering the results Canadians expect.

Our review focused on finding the vast majority of savings through increased internal efficiencies. Every effort was made to protect the core front line services delivered by Health Canada and the Public Health Agency of Canada, as well as the Canadian Institutes of Health Research.

In total, we are going to save Canadian taxpayers $307 million. The measures taken are fair, balanced, and moderate.

Health Canada is a leader in health policy, is a service provider for first nations and Inuit, and remains focused on delivery of our core mandate as a regulator.

One of these core services involves providing direct health care and certain non-insured health benefits for first nations and Inuit people. The importance of this work is reflected in the new funding for the non-insured health benefits program that is presented in the supplementary estimates.

The Public Health Agency of Canada will continue to provide core emergency preparedness and response functions, as well as a national leadership role in health promotion, disease prevention, and public health capacity.

CIHR's grants and contributions envelope was minimally impacted; in fact, new funding was allocated for the strategy on patient-oriented research. Our support for basic research, student scholarships, and industry-related research continues.

This information is clearly reflected in the information provided recently to the Parliamentary Budget Officer.

The report shows that the majority of the savings are coming from administrative efficiencies in shared services, such as by merging such back office functions as human resources and information technology at Health Canada and at PHAC.

Other measures include re-focusing policy capacity at Health Canada, making business process improvements at the Public Health Agency of Canada, and making more efficient use of office and lab space.

All three organizations have been working very hard to minimize job losses for those wishing to stay in the public service. They have used attrition, retirement, and other management strategies where possible. In some cases, employees have decided to pursue a new career path and have volunteered to leave. There have also been examples of alternations, which allow people who wish to stay in the public service to trade places with those who wish to leave. Employees impacted by this process have been and will continue to be treated fairly.

Budget 2012 reconfirmed that health remains a key federal priority for our government. Federal actions and investments help strengthen Canada's health care system so that Canadians can stay healthy and be protected from harm as well as get the care they need when they need it.

Most notably, our government has significantly increased transfers to the provinces and the territories for health care and has put this funding on a long-term growth track that is sustainable and responsible. Unlike past governments, we will not balance our books on the backs of the provinces and the territories. Our government has been clear that we respect provincial and territorial jurisdictions when it comes to health care. We recognize that decisions on how to deliver health care services are best left to provincial, territorial, and local levels.

Record levels of funding will provide provinces and their territories with the certainty and flexibility they need to address health care needs of their population and to plan for the future. Federal action on health doesn't stop at annual transfers. The provinces and the territories have highlighted health care innovation as a key priority area and our government supports this approach through a range of initiatives.

We protect and promote the health of Canadians. We regulate drugs and medical devices so Canadians have access to safe and effective therapies. We invest in research so all Canadians can better understand whether health reforms are working for them and we work to improve the health of aboriginal people and northern Canadians.

We invest in a range of health programs, services, and benefits for first nations and Inuit to improve health outcomes for the population that faces the biggest health challenge in Canada. We are also investing in groundbreaking new research into aboriginal health, which I would be happy to speak about during the question and answer period.

It's not enough to invest lots of money. We need to make sure that it is used well. We are showing leadership in containing costs. The non-insured health benefit program expenditure growth is in general comparable or lower than similar provincial and territorial programs.

We are cracking down on fraudulent billings to the program. When there is evidence of fraud or wrongdoing, we take immediate action. I have raised this issue with my provincial and territorial counterparts and have encouraged them to look for similar types of practices in their jurisdictions.

As members of this committee know, there have been a lot of discussions recently about OxyContin and whether or not Health Canada should authorize generic versions of the drug. I want to reiterate what I have said all along on this issue, which is that it should not be up to politicians to determine which drug should be approved for medical use. Drugs will continue to be approved or restricted based on the scientific evidence. This means that Health Canada will continue its scientific review process of generic versions of OxyContin based on whether the drug is safe and effective when used as prescribed.

I believe we're leading by example at the federal level and have implemented rigorous controls in the first nations and Inuit non-insured health benefit program to address prescription drug abuse. I have offered Health Canada's officials to share the best practices of this program with the provinces and the territories to see if there are approaches that they can draw on from our own without having to reinvent the wheel. This is a challenge we can tackle together as federal, provincial, and territorial governments.

Under the non-insured health benefit program, changes made over the past few years have resulted in 50% reduction in the amount of long-acting oxycodone provided since 2010 without a significant shift to other long-acting opioids. These measures include a prescription monitoring program that addresses potential misuse and helps prevent double-doctoring, establishing maximum monthly and daily drug limits, changing the listing status of extended release oxycodone to exception status, and a real-time warning message to pharmacists at the point of sale. I encourage my counterparts to continue to build on any efforts they have taken to fight against those who would abuse the system.

As I have mentioned, we regulate drugs and medical devices. We also invest in the development and authorization of drugs for rare diseases. This will help improve access to new treatments that might have been harder to get or not available at all without these new rules.

Last month, we launched Orphanet-Canada, an online resource for people with rare diseases and the health professionals who care for them. This portal will give Canadians with rare diseases a new avenue for help. Federally we accelerate change through our support of pan-Canadian organizations, like the Canadian partnership against cancer, the Canadian agency for drugs and technologies in health, and Canada health infoway.

For example, Madam Chair, our government recently announced a significant investment in the Canadian Institute for Health Information. This funding will help build on CIHI's excellent work of providing reliable, nationally comparable data on more aspects of the health system and the health of Canadians. The information helps provincial and territorial governments measure performance of their systems. It also helps them apply innovative approaches that lead to improvements. It will also help Canadians track progress of their health care system.

This summer I was proud to welcome home double lung transplant recipient Hélène Campbell. To help more organ transplant recipients, our government committed $10 million to support a national transplant research program to increase organ donation and to help those who receive transplants.

Our government recognizes that health research is central to innovation and makes an important contribution to the quality and sustainability of health care at the provincial and territorial level. The federal government is the largest single investor in Canadian health innovation, primarily through grants and contributions by the Canadian Institutes of Health Research.

On any given day there are thousands of federally funded research projects involving more than 14,000 Canadian researchers. In particular, I wish to mention the Canadian Institutes of Health Research strategy for patient-oriented research. This strategy is about innovation and innovative practices, therapies, and policies from the research world to the decision-makers and health practitioners on the front line of health care. It is a new way of working with the provinces and the territories to leverage resources and to support research that will transform Canada's health care system. I'm confident this work will help the provinces and the territories meet the challenge of delivering high-quality, cost-effective health care.

The strategy for patient-oriented research's first focus will be on adolescent and youth mental health. The goal is to improve the care delivered to these young Canadians. Another initiative, called pathways to health equity for aboriginal peoples, will see researchers partner with aboriginal communities to carry out work linked to reducing suicide and a number of other key health priorities.

In addition to investments that help drive innovation in health care, we are also making investments to protect and to promote the health of Canadians, in other words to help keep them from getting sick and needing care. These family-friendly initiatives encourage Canadians to play a more active role in their own health. For example, we are investing $5 million in community-based activities that help Canadians make safe choices when they get involved in sports and recreation. I am pleased to note that the private sector organizations are joining the federal, provincial, and territorial health ministers in supporting the movement to healthier weights and more physical activity for children and all Canadians.

Our government is also using legislation to help protect the health and safety of Canadians. We recently fulfilled our promise to introduce tough new health warnings for cigarettes and little cigars. Members will also recall media reports last spring about a very serious and dangerous recreational drug known as “bath salts”. One of the key ingredients in bath salts is a substance known as MDPV. Our government acted quickly to make activities related to MDPV illegal in Canada. This means it will be harder for people to deal in or manufacture bath salts and easier for border officials and police officers to get these products off our streets. It was a move that received widespread public support from law enforcement officials, including the Canadian Association of Chiefs of Police.

With respect to mental health, I know this committee welcomed the release of Canada's first national mental health strategy from the Mental Health Commission of Canada, called “Changing Directions, Changing Lives”. The strategy was developed in consultation with health care professionals, patients, and their families. It contains recommendations that will help these groups make better decisions about mental health services and treatments in years to come. The strategy also reflects the first nations and Inuit priorities and actions outlined in the mental wellness strategic action plan.

Our government has also committed up to $10 million in matching funds to establish the Canada brain research fund in partnership with Brain Canada. This investment will help fund research to identify and treat brain disorders, including mental illness. Canada is recognized as a global leader in this area.

Our government plays an important role on the world stage when it comes to health and wellness. This summer we succeeded in bringing the issue of aboriginal AIDS to the forefront of the International AIDS Conference. This was the first time that the impact of HIV-AIDS on indigenous communities had been given such a high profile at an international conference.

At the World Health Assembly, I had the opportunity to discuss Canada's experience and support for universal health coverage and accountability. I also reinforced Canada's position on maternal and child health and encouraged countries to strengthen their systems in this area. I will continue to advocate for these issues at international forums.

I am proud of the vital role our government plays in health care in this country. Financial investments through the Canada health transfer are at an all-time high. Every day research and new discoveries are increasing our understanding of healthy living and our ability to treat and prevent diseases. However, there is much work to be done and many challenges ahead.

Healthy living and chronic disease prevention are complex issues that require sustained efforts from all levels of government, the private sector, NGOs, and all Canadians. Our government will continue to do its part. We will continue to invest in health care and research. We will continue to work with the provinces and territories as they try to improve Canadians' health, promote innovation, and ensure the long-term sustainability of the health care system.

Thank you, Madam Chair.

[The Chair, Conservative, Joy Smith]

Thank you very much, Minister, for that very insightful presentation.

We'll now go into our round of questions and answers. We'll begin with Ms. Davies, who is sharing her time with Monsieur Lapointe.

[Libby Davies, NDP, Vancouver East, BC]

Thank you very much, Chairperson.

Minister, thank you for attending today. It's very important that you are here. I regret that it's only one hour and I hope that we might encourage you to stay beyond that hour, because there will be very little time for questions.

You mentioned a number of things in your comments, but the issue that I'd like to focus on is drug safety. I'm sure you're aware that this is becoming a bigger and bigger issue in Canada. In fact, there were two major articles on this issue very recently, one in the Toronto Star, and one that came out yesterday in Maclean's magazine. Reading through that information as well as other information that we receive as MPs, it is clear that there is a lot of concern about the inadequacy of safety with the system in place.

I wonder if you could tell us how much money is spent on drug safety measures at Health Canada and why Health Canada is not investigating drug reaction reports and taking more concrete steps to prevent Canadians from getting sick or dying from adverse reactions.

These articles show that Canada is lagging far behind the United States, France, and other countries in the EU. For example, in the U.S. they've adopted plain language labeling, something which we've been talking about for a decade in Canada and still it hasn't happened. In other jurisdictions, clinical trial data enable people to see what information is being used to support a drug's approval. We're far behind in many of these aspects.

I think there's a great public concern about drug safety in this country. I wonder if you could tell us why Health Canada is not investigating drug reaction reports and taking concrete steps to prevent Canadians from getting sick or even dying from adverse reactions.

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you for the question.

I can start off by saying that our government has taken action to deal with the issue of monitoring drugs that are on the market. In fact, our government established the Drug Safety and Effectiveness Network, which I announced, I believe it was back in 2008, to start the process. An investment of $32 million was made in that particular area to monitor adverse drug reactions and whatnot in Canada.

We've also been taking steps to report side effects. Those reports are investigated through Health Canada's health products and food branch. We've also been working with doctors to share more information on potential adverse reactions of any particular drug prescribed to patients. We have a number of initiatives on the issue of reporting side effects of drugs that have to do with all the regulatory processes and the scientific review required in the process. We are making significant progress in this area in Canada.

[Libby Davies, NDP, Vancouver East, BC]

I would like to ask a brief follow-up question, Madam Chair.

It is curious what you're saying, which is that basically, it's only after a drug has come onto the market that we're following up on concerns. I know that the article in Maclean's pointed out that close to 20% of these new active substances are now being identified as problematic. It seems that we are taking too long to identify what the problems are. It's when they're on the market that adverse reactions are taking place. Again, there is a concern, first, that the study isn't taking place early enough, and second, that when there are adverse reactions, they're not being followed up. Now we see these stories, some of which are horrific, of people who have become sick or have died from some of these medicines.

[The Chair, Conservative, Joy Smith]

You are well over five minutes, so your partner will have no time.

Minister, could you take a minute to reply, please,

[Leona Aglukkaq, Conservative, Nunavut, NU]

There are processes in place within Health Canada for a thorough review before a drug is approved for market. Pre-market surveillance is completed. At the same time, once that process is done and a drug is approved, we have a system in place, which we introduced, that addresses that through the Drug Safety and Effectiveness Network. Some of those adverse reactions can only be reported after the fact. There is a system in place to allow patients, as well as doctors, to provide that information to Health Canada so that we can follow up and investigate. There are two processes—

[François Lapointe, NDP, Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC]

Madam Chair, can I go for it?

[The Chair, Conservative, Joy Smith]

I will call you. I know that you are anxious to go. You may go now.

[François Lapointe, NDP, Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC]

On August 13, 2012, an oncologist submitted an application for a nonmarketed drug to treat the cancer of a patient named Ms. Lajoie, a Canadian citizen who lived in Saint-Pascal in my riding. The application was made under Health Canada's special access program. The treatments were supposed to start in September. With no reply received, Ms. Davies and I had to make a number of requests. It was not until November that the treatments were finally scheduled to start. All those requests went to you, Madam Minister.

If the process had taken two weeks instead of ten, it would have been possible to delay or prevent Ms. Lajoie's death. She died two weeks before the treatments could begin. Ms. Lajoie's family join all concerned Canadians in wanting to know what happened.

Madam Minister, do you acknowledge that the response time did not conform to the special access program timelines? In the wake of a failure of this kind, can you commit to establishing the position of Health Canada ombudsman as quickly as possible, so that someone can investigate it?

[The Chair, Conservative, Joy Smith]

Go ahead, Minister.

[Leona Aglukkaq, Conservative, Nunavut, NU]

As I stated in the House with regard to your response to your constituents, my condolences to the family of the individual who passed away. I stated in the House of Commons that the special access program provides emergency access to products that are not approved for sale in Canada—

[François Lapointe, NDP, Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC]

Ten weeks is not an emergency, Madam Minister.

[The Chair, Conservative, Joy Smith]

Excuse me. Let the minister finish, please.

[Leona Aglukkaq, Conservative, Nunavut, NU]

The applications must be made by the physician to Health Canada.

[François Lapointe, NDP, Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC]

It was done on August 13.

[Leona Aglukkaq, Conservative, Nunavut, NU]

We investigated the process, and I believe that a response was issued. I offered every member of the House of Commons a special access program briefing, and I was happy to organize—

[François Lapointe, NDP, Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC]

You did that on August 13, Madam Minister.

[The Chair, Conservative, Joy Smith]

Excuse me, I'll give you an extra minute if we let the minister finish, please.

Go ahead, Minister.

[Leona Aglukkaq, Conservative, Nunavut, NU]

Yes, thank you, Madam Chair,

I said before that we'd be happy to organize a briefing on how the special access program works when applications are made by physicians to Health Canada. As soon as those are received, the physician receives a call. On an annual basis, we receive about 25,000 applications, and most of those are processed within 24 hours as opposed to 18 months. We do our part to respond to that. I don't want to be speaking to the specific case the member is raising, but the process is in place.

[The Chair, Conservative, Joy Smith]

I'm sorry, Minister, we're way over on this question. Perhaps the member could meet with you on this after the committee.

We'll go to Dr. Carrie.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

I have a point of order.

Madam Chair, I must remind you that, on March 27, 2012, my colleague Mr. Lapointe did the same thing. Then Ms. Leitch questioned the president of Sandoz and interrupted the witness in order to get an answer to his question. On that occasion, you said:

“Excuse me. At the committee, sir, you were asked a question. I will ask you to answer it specifically.”

Mr. Lapointe has been trying to get an answer to his question for some time now. If you want to be consistent, you must allow him to do so.

[The Chair, Conservative, Joy Smith]

Dr. Morin, I've given a whole lot of extra time for this question to try to get everything in. I need to be mindful of the time of all the committee. As much as the member thinks his question is the most important, I've given it extra time. It is very important, but we need to allow the rest of the committee members time to ask their questions as well.

[François Lapointe, NDP, Montmagny—L'Islet—Kamouraska—Rivière-du-Loup, QC]

A point of order.

The question was very specific: can the minister commit to putting in place an ombudsman who could objectively investigate cases like Ms. Lajoie's? Nothing…