Health Committee on Oct. 30th, 2023

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Skelton and Mr. Harrington, I assume no one is disputing the intent behind the regulations.

Compliance would be beneficial for the industry, not only for financial reasons, as Dr. Powlowski pointed out, but also because it would help it restore its image, particularly in light of a report that identified certain problems.

We could look at the pharmaceutical industry, which is also grappling with adverse drug reactions. We know that this industry is highly regulated. I asked for figures in order to compare these adverse reactions over a 17-year period, but we have not yet received them.

So you're in favour of regulations. You say that you want to be a participant in the process because right now, Treasury Board is the one calling the shots, added to which there has been no study on cost recovery for the industry or any environmental impact assessment.

In short, the government has chosen a financial and administrative approach rather than a reform that would be advantageous to all stakeholders, especially the consumer, who must be protected. It's not just a matter of free choice; it's a matter of consumer protection.

Do you agree?

[Aaron Skelton]

We would agree with that. The vast majority of our members appreciate and understand the benefit of a strong regulatory environment. I think that's why we're so proud of the regulations that we have today, and we've quoted many times that we're seen as a gold standard internationally.

We can speak to site inspections. I think our compliant companies are encouraged to hear the focus that the CESD put on operational and quality initiatives. I think those are all critical.

I reference what Ms. Vadacchino said. What is lacking is the enforcement and the education around that. What is lacking is the engagement so that, of those site licences that have some deficiencies, it is clearly understood what they are. We currently don't have an NHP site licence guidance document. That will probably shock most people. As you can imagine, as a small and medium-sized business, if you don't know what rules are going to be used as they're applied to your business, that can be quite concerning and make it quite hard to be compliant.

In our conversations with the department, though, most of those businesses that have some deficiencies are rectified almost immediately. These are simple corrections that just need an education tool to ensure that industry can be, as it wants to be, compliant.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Skelton.

Your time is up, Mr. Thériault.

Next is Mr. Davies, please, for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

I'd like to thank all the witnesses for being here today. I think I speak for all my colleagues when we say that this summer, after the recent proposed changes by Health Canada, we were all inundated with emails from our constituents and businesses in our community indicating great concern about this issue. I moved the motion to call Health Canada to come before this committee to explain themselves and I moved the motion to have you here. I just want to say that I think it's very important to have your voice on the record prior to our making decisions in this matter.

You know, I've been here 15 years, and this is at least the third iteration I've seen of Health Canada spontaneously, and without industry involvement, unilaterally trying to propose profound changes to a regulatory structure that, when I look at the 2003 report, strikes me as being unnecessary.

My first question is this, Mr. Skelton. There was a reference to 1998, when the first NHP regulations came in. I have a report in my hand from 2003—that's 20 years ago—reporting from Health Canada on the 53 recommendations. You referred to this already. Do we or do we not have a sophisticated regulatory structure in place in Canada right now for natural health products?

[Aaron Skelton]

I think we have a very strong, internationally recognized and robust regulatory system for natural health products—absolutely.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay.

I've heard the expression that this is really a solution in search of a problem. I want to probe that a bit. Health Canada has provided what is, to me, inconsistent and confusing information on what the adverse effects record says about natural health products.

Can you tell us what your data is on the injury or adverse negative health impacts caused by NHPs in this country?

[Aaron Skelton]

I appreciate the question. What we've determined is that this information is very hard to define. We actually had to engage with a third party management consultant group for us to try to scrub the data that is currently housed in the database for MedEffect. They discovered, after we heard the initial quotes made by Health Canada, that this information is not readily available. It is not categorized in such a way that this information can be pulled out.

The best we could do was to put a wider net, manually go through and try to identify which ones were related to natural health products. The best we could find was the potential for 32. Even within those 32, the complications of combinations with pharmaceutical prescription drugs also conflated that issue.

[Don Davies, NDP, Vancouver Kingsway, BC]

There were 32 cases of adverse effects from NHPs in what time period?

[Aaron Skelton]

That would be from 2020 to the current date.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay.

Mr. Skelton, in a recent interview, you said, “Canadians looking for their favourite NHPs are likely to turn online and source unmonitored and unregulated products that are less expensive than what they [would] find on Canadian shelves.” Do the proposed regulations by Health Canada effectively address that potential?

[Aaron Skelton]

I appreciate the question. The answer is, no, it does nothing to address the potential.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay. Thank you.

Mr. Harrington, you did a good job outlining some of the issues with the proposed cost recovery. You mentioned the GST. I also understand that natural health products are generally not covered by extended health care plans the way pharmaceuticals are. They have no patent protection providing a monopolistic pricing period, as pharmaceuticals have for 20 years.

Is it fair to compare the natural health products industry with the pharmaceutical industry when it comes to cost recovery?

[Gerry Harrington]

No. I think economically they're completely different models.

In terms of the impact of cost recovery on the public purse, there's a fundamental difference between the two. As you pointed out, they're not covered by health plans. The reason they're not covered by health plans is that they're not considered eligible expenses under the medical expense tax credit. There are many ways in which taxpayer money is going into the prescription drug market. I'm not disputing the validity of that, but it does completely differentiate the two product categories.

[Don Davies, NDP, Vancouver Kingsway, BC]

If I understand your testimony correctly, you're saying that the proposed cost recovery model for NHPs is the same as for the pharmaceutical industry.

[Gerry Harrington]

The fee ratio—in other words, the proportion of the total costs born by government that is billed to industry—is exactly the same.

[Don Davies, NDP, Vancouver Kingsway, BC]

That's without taking into account the factors I just raised.

[Gerry Harrington]

Exactly.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Mr. Skelton, it's funny. I've heard Health Canada explain that one of the reasons they want to change the labelling is that the current labelling requirements are so difficult that you need a magnifying glass, they say, to read them, yet those are the regulations they have prescribed.

Leaving aside that confusion, besides the fact that there is already a lot of information on NHP product labels—in fact, more than I've seen on others—what is the problem you see with having a reference to electronic information, such as scanning a bar code or a QR code, for any consumer who can get information? Is that potentially a solution to the information issue?

[Aaron Skelton]

The underpinning narrative is this: The industry is very open to conveying information in the clearest, most easily understood format. That's accepted across the industry.

What is challenged is that we're not embracing modern labelling solutions. You mentioned a few. There are others we can uncover. The lack of proper consultation with industry didn't allow any of those to be raised appropriately. Proper patient groups who have interests in this field weren't engaged in a meaningful way.

That's where we've landed. It's a 1980 solution to a 2020 problem.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Skelton and Mr. Davies.

Next, we have Dr. Kitchen for five minutes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair.

I'd like to thank all the witnesses for being here and those who are staying the extra hour. We appreciate your being here.

I see that Ms. Vadacchino is back online.

I'm glad to see you're still here as well. I thought we had lost you.

Mr. Skelton, you talked about a number of things that I find interesting, and Mr. Harrington did as well. I'll start with the first one.

My colleague Mr. Thériault asked you about regulations and I saw heads nodding. My understanding is that the industry is recognizing.... They are prepared to self-regulate. Is that correct?

[Aaron Skelton]

It's not only about self-regulation. It's about confidence in the regulatory system we have today. There isn't a need, necessarily, for self-regulation, because there is such a robust and thorough premarket and postmarket regulatory regime existing in Canada today.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you

As I indicated earlier, I was the registrar for the chiropractic profession in Saskatchewan and across the country. One of my sayings was that it's the association's role to protect the profession, but it's the regulator's role to protect the public. The government is supposed to be in place to put forward parameters such that there is protection for other outside interests. Ultimately, having that self-regulation is very important. Everything I'm hearing from the industry is about finding ways to work with people in order to make certain we try to regulate that part.

Mr. Harrington, you brought up the issue of inspecting facilities.

As a regulator, you tend to do those sorts of things. Ms. Hollett was here in a previous meeting. I asked her how many inspections had been done. She indicated that, in a pilot program project they had, they did 36 in a one-year time frame. They were aiming to do 37 this year alone.

How many businesses and facilities are there in the industry?

[Gerry Harrington]

Thank you for the question.

There are hundreds. That is very small. It's almost a rounding error, regarding the industry.

That being said, it's worth emphasizing that the kind of inspection program that makes sense is a risk-based one. You have to target places where you think there is the most likelihood of a problem that can be rectified. It's that kind of structure we're still waiting to hear about from Health Canada, so we're not just returning to the coalition of the willing, which lines up to get these licences, continues to put these products on the market and is compliant but then has to compete against non-compliant companies.

That's a nuance that is completely missing from the current approach.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you. I appreciate that. It leads perfectly into my next question.

The government is hiring 22 people to do this inspection. Ultimately, as you indicated, that's not enough. We need to have steps, and the industry, as well, needs to put in places to do that. Part of what Mr. Skelton talked about was the lack of stakeholder engagement. This whole issue is not only one of engagement. It's also an issue of inspection. That's where I see that engagement.

Mr. Skelton, take health food products. Most Canadians wouldn't have had a clue what went on when Bill C-47 went down. All of a sudden, if you hadn't gone through that issue with a fine-tooth comb.... What that bill did is.... I love to use a word that I put through in the House, which I made up: “thispocketnesia”. It's what this government does. It takes money from this pocket and puts it into that pocket. This pocket is the public's pocket. It's putting it into its pocket, and then forgetting to do it. Ultimately, when you take words and create them.... Here we have the issue of a government that doesn't engage with you.

Mr. Skelton, as part of the industry, when did you first hear about these steps, and how often has the government come to you and said, “Hey, we need to talk to you about this”?