Natural Resources Committee on June 9th, 2009

[Dr. Jean-Luc Urbain]

I think that we should not confuse the chain of events. I think Dr. Gulenchyn described it very well: it's never a straight line between the diagnosis and the treatment. You do not fix a problem without knowing what the problem is. The problem can be structural or it can be functional. In order to have a comprehensive understanding of whether the problem is cardiac, oncological--cancer--or any other problem, most of the time we need good functional and structural aspects.

[The Chair, Conservative, Leon Benoit]

Dr. Gulenchyn, would you like to answer that as well?

[Dr. Karen Gulenchyn]

Thank you.

If we are talking specifically about cardiac function tests that are being monitored as a result of a patient, say, receiving chemotherapy, and we want to be certain that the patient's heart isn't being adversely affected, yes, there are alternative tests. Echocardiography would be one. A certain percentage of patients, perhaps up to 15% to 20%, may not be suitable for echocardiography for a number of different reasons. Another possibility would be to use MRI imaging, but with MRI, as Dr. Lyons has described, we run into very significant constraints: it's expensive to do an MRI, they are not particularly widely available, and some patients may not be able to tolerate them because of claustrophobia.

Every time we look at alternatives, we begin to run into some barriers. The system is structured the way it is now because we think that in at least most cases we do the best possible test for the patient. Sometimes we run into barriers because of lack of availability of those tests.

[The Chair, Conservative, Leon Benoit]

Thank you, and thank you, Ms. Gallant.

We will go now to the next round of five minutes. We will begin with the official opposition and Mr. Tonks. If there's time left, we will have Mr. Bains.

[Alan Tonks, Liberal, York South—Weston, ON]

Thank you, Mr. Chairman.

I do understand the international leadership issue that Canada has taken. We saw X-rays, however, of the NRU reactor, and to a lay person it would not look as though it's going to come back on stream quickly. The committee, I think, does understand also that 100% of the isotopes from the NRU were going down to Lantheus medically treated with a capacity to be used, and 10% were coming back to Canada. It appears that in the short term, the only suggestion that seems workable is not the MAPLE reactor, if the testimony we heard is accurate. The short-term solutions that have been put forward by the CANM are recommendations 2 and 3 with respect to positron emission tomography, which has clinical testimony in other countries, looking at the licensing provisions and so on, and enacting that very quickly.

My question is twofold. First, how quickly could that happen? My second question would be to Dr. Gulenchyn with respect to the McMaster reactor. If that reactor could be mobilized quickly, could it help to replace a large portion of the 10% that's coming back into Canada from Lantheus through MDS Nordion, if an agreement could be reached?

[The Chair, Conservative, Leon Benoit]

Go ahead, Dr. Gulenchyn.

[Dr. Karen Gulenchyn]

I'm answering the second question first.

I live and work in Hamilton and have very good relationships with the people at the reactor, but I'm not directly connected to the reactor. My understanding of the proposal that McMaster has put in front of government is that they are in a position to be able to produce molybdenum. Molybdenum would need to enter the supply chain. They are not in a position to produce reactors, so molybdenum would have to enter the supply chain at the level of MDS Nordion.

Whether or not that material could be specifically earmarked for Canadian uses, I just don't know. It would be subject, I think, to contract. The reactor staff believe they could supply a large proportion of Canada's requirement for molybdenum, should it be possible to earmark it.

[Dr. Jean-Luc Urbain]

If the chair of the committee is agreeable, I would ask Dr. Peter Hollet to address the question about PET.

[Dr. Peter Hollet, Past President, Canadian Association of Nuclear Medicine]

Thank you.

I simply represent the province of Newfoundland. That's where I practise. We don't have PET imaging in Newfoundland. We sent our patients originally to Edmonton; we tried sending them to Ontario, but ran into barriers there. We now send them to Halifax, and in the event that we had to switch totally to PET imaging for our patients, I'm sure Nova Scotia patients would come first, and we'd have great difficulty in accomplishing that. Certainly in my area of the country, we'd be in big problems.

[Alan Tonks, Liberal, York South—Weston, ON]

Thank you.

Thank you, Mr. Chairman.

[The Chair, Conservative, Leon Benoit]

Thank you.

We'll go to Mr. Bains. You have a minute and a half.

[Navdeep Bains, Liberal, Mississauga—Brampton South, ON]

Thank you very much, Chair.

My question is to Dr. Gulenchyn, and it's with respect to the government's plan. We've talked about it extensively today. In the past 18 months they've deployed various initiatives, but it was predicated under the notion that there would be a short-term temporary reduction in supply. As we see today unfolding, it seems it will be much more prolonged. There doesn't seem to be a plan per se for a prolonged shortage of isotopes, and we know the history at Chalk River.

This plan pertains only to a specific scenario, which is not necessarily the scenario we're dealing with today. Is that a fair characterization?

[Dr. Karen Gulenchyn]

I don't think it's entirely fair. Quite clearly, we are going to continue to use the strategies we're using right now in order to do the best we can for our patients in our current circumstances.

How long can we continue to do this? The major thing we've done is in fact divert myocardial perfusion imaging from using technetium-based agents to thallium agents. We're assured that there is a secure supply of thallium coming from cylotrons in a number of different centres. We then have diverted the technetium-99m that remains to other types of scanning, predominantly to bone scanning.

We can continue doing this as long as there isn't the breakdown of another reactor. I think that if there is a breakdown of another reactor, we are going to rapidly move into a situation that perhaps cannot be managed without some inputs coming either in alternative imaging, which I think Dr. Lyons spoke to, or the expansion of the capability of PET imaging.

So I think we can continue, where we are right now, but I am very concerned about the scenario in which we lose another reactor.

[The Chair, Conservative, Leon Benoit]

Thank you very much, Dr. Gulenchyn.

We go now to Ms. Gallant with a question, followed by Mr. Trost.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Thank you, Mr. Chairman.

Dr. Gulenchyn, in speaking about alternative diagnostic tests to those using moly-based medical isotopes, you mentioned that restrictions to use increase with cost and availability. To what extent are patients being told that cancer treatment cannot be conducted because of the possible costs related to using other diagnostic methods?

[Dr. Karen Gulenchyn]

To the best of my knowledge, that hasn't occurred. However, every hospital facility in the province I come from, Ontario, has signed an accountability agreement with government and is in a situation in which they must abide by their funding envelope. My financial people have not told me that I cannot spend the additional money to maintain my service levels. In fact, they've told me the exact opposite, to please go ahead.

I think the question that will come about is how the organization is going to fund that increase in cost. I would hope there would be some assistance forthcoming.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Thank you.

[The Chair, Conservative, Leon Benoit]

Thank you.

Mr. Trost, you have three and a half minutes.

[Bradley Trost, Conservative, Saskatoon—Humboldt, SK]

I have a very quick follow-up question to what Mr. Tonks was talking about and to some of the earlier questions. I need some clarification, because I'm not sure I understood something correctly.

Talking again about the PET technology and perhaps any other diagnostic tools, from what one of the witnesses said earlier I got the impression that this could be done fairly quickly; that in a few weeks this could be ramped up, and we could divert from other non-human medical sources.

I'm seeing nods of agreement, so it seems that I understood that correctly.

Are those steps being taken by the provincial ministries of health and the people involved, as far as you know? Could you verbalize what you are nodding to me?

[Dr. Jean-Luc Urbain]

I'm assuming you're looking towards me for an answer.

[Bradley Trost, Conservative, Saskatoon—Humboldt, SK]

I am, but the recorded evidence will not reflect nodding.

[Dr. Jean-Luc Urbain]

Quebec has definitely been very proactive. My understanding is that in Quebec, as we speak, a positron emission tomography study using FDG and sodium fluoride is being performed. Ontario has been a latecomer, but my understanding—

[Bradley Trost, Conservative, Saskatoon—Humboldt, SK]

Can that be done quickly all across the country?

[Dr. Jean-Luc Urbain]

Absolutely; we have 13 to 15 PET scanners.

[Bradley Trost, Conservative, Saskatoon—Humboldt, SK]

Are you giving that recommendation to the ministries of health everywhere, and are they responding to it?