Thanks very much.
Continuing on the matter we were discussing earlier, prescription overuse of the proton-pump inhibitors, they estimate that 70% of the people taking these meds should not be. They shouldn't be taking them for heartburn. This is where the regulator's role is so important. If the patient is on a PPI, the evidence under the literature is a 40% to 275% increased risk—40% to 275%—and it's dose-dependent and time-dependent. I think you'd see that as what was found in the DSEN report, Drug Safety and Effectiveness Network. Although they didn't give the numbers, that's on the FDA website.
Further, if they're on those meds, not only do they have increased risk of infection, but they also have three times the risk of the worst complications, which includes unnecessary bowel surgery. Of course, extended hospital stays are costing us hundreds of millions of dollars across the country. But also the research shows that if they're on those medications, not only is there an increased risk of infection and increased risk of complications, they also have five times the increased risk of death. That's the worst outcome. So I hope you understand the urgency I attach to that.
The number one thing on your Public Health Agency website is “elderly”, especially over age 80, but it's well known that the elderly have reduced stomach acid; it's part of the normal aging process, and puts them at a higher risk. It's really the same issue as acid suppression.
There's an immense urgency to taking some action on this. I hope you understand why, when we talk about CNISP, maybe it was designed for surveillance, but we should be collecting data on this. We can't wait another 10 years to start helping people avoid these risks of unnecessary death in the hospital and hundreds of millions of dollars in expenditures. We're hoping to be more nimble as we look at ways at innovating.
There are big concerns about antibiotic overuse. Of course, the risk of recurrence if you're on a PPI when you're in the hospital is 42%. With vancomycin, I think it's 25%; and in the new drug DIFICID it is 15%.
Back to Dr. Beaudet, this why there is urgency to check out prevention with the probiotic, and I hope you'll be on board in advancing that. If we can avoid these infections with such a simple thing, it's much easier than a fecal transplant, might I say, in managing it later on.
Finally, you're working with physicians, with CMA and with the Choosing Wisely Canada program, on this. They're talking about the appropriate use of medical imaging and antibiotic use. It seems to me, after my conversation with Dr. Chris Simpson, as my colleague mentioned, the head of the CMA, that this might be a way to help physicians engage with their patients on the unnecessary use of these meds for managing dyspepsia.
Could you comment briefly on that program, Choosing Wisely Canada?
Then I'll hand it over to my colleague.
