Natural Resources Committee on June 9th, 2009

[Nathan Cullen, NDP, Skeena—Bulkley Valley, BC]

The government has expressed to us that they feel they have alternatives and substitutes. We're hearing they are not as accurate, they are not as good, that they double the exposure of patients to radiation. Is this something you would recommend to your patients? Is this something that would allow for the accurate and early detection of the possible cancer they have?

[Dr. Karen Gulenchyn]

If you're talking about the increase in radiation dose Dr. Urbain spoke of, he was talking about thallium, which is the drug that's used for imaging heart disease, not cancers. If you're talking about the concept in general—should we be advocating for increased radiation dose when we do an examination—no, we should not be advocating for increased radiation dose. The appropriate principle to follow is that the dose be as low as is reasonably achievable.

However, in the current situation, what we are working with is the fact that we do not have access to the amounts of technetium-99m we would normally have. One is then put in a situation of making a decision as to whether the test is necessary to be done now, with perhaps an isotope that will result in a higher radiation dose, or whether one is in a position that one can wait. Other alternatives include accessing MR or CT examinations, as has been talked about by Dr. Lyons. Sometimes those are appropriate. Other times they are not appropriate and cannot show everything the isotope test may be able to show. These things are always—

[Nathan Cullen, NDP, Skeena—Bulkley Valley, BC]

Doctor, if I can just interrupt for a second, I'd like to understand what it's like for you, then, dealing with the patient when you have to pull out these alternatives, these other techniques that are less than what you would like to do. What's that conversation like with the patient and the family?

[Dr. Karen Gulenchyn]

That conversation with the patient and family is like many conversations we have. One describes the benefit of the examination. One describes the risk of the examination. One describes the risk of not doing the examination or deferring the examination. One helps the patient and the family to the best choice for the patient under those circumstances. As I said, this is a matter of balancing risk and benefit.

[Nathan Cullen, NDP, Skeena—Bulkley Valley, BC]

Thank you.

I have a question about supply, Monsieur Urbain. Does Canada have a guarantee, at all in any form, of supply of medical isotopes right now?

[Dr. Jean-Luc Urbain]

First of all, there is never any guarantee in life. Secondly, the answer is no, Canada does not have any guarantee. My understanding is that the Minister of Natural Resources is trying to secure some agreement with the other countries producing isotopes.

[Nathan Cullen, NDP, Skeena—Bulkley Valley, BC]

But no guarantee, no ability to go to Canadians and give their doctors or those receiving treatment and diagnosis any sense of how long they might have to wait for the possible detection of the cancer?

[Dr. Jean-Luc Urbain]

No, we don't have that. The best guarantee Canada can give itself is to look at MAPLE 1 and MAPLE 2.

[The Chair, Conservative, Leon Benoit]

Thank you, Mr. Cullen. Your time is up.

We go now to the government side, to Mr. Trost, for up to seven minutes.

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

I guess I would like a little bit of feedback from the witnesses. I heard Dr. Urbain say he was first concerned about problems with Canada's system for cancer about six years ago, when he first started his practice in Canada. I heard Dr. Lamoureux mention about three years ago. When did you, as doctors who specialize in nuclear medicine, begin to become concerned first of all about the safety of supply of the world's nuclear medicine system?

Looking at it from my eyes as a layman, I see we have 50-year-old reactors, and 25, 30, 35 years in, I would have thought they would have started to be concerned. So three or six years ago seems to me to be a little bit short. Maybe we should have been concerned about this 10 or 15 years ago. Would that be an accurate viewpoint?

[Dr. Jean-Luc Urbain]

Well, I think this is reflected in the paper you have received. As I said before, Belgium, for example, approved the use of positron emission tomography for cancer, cardiac purposes, and also in neurological situations in 1990. So you are accurate in saying that basically the positron emission tomography story started 20 to 25 years ago, but—

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

Quickly, I just want to follow up on that point. Should we as a country have started expanding the use of that technology, the positron emission tomography, back in the 1990s? Is this something that provincial and federal governments of that era and I guess continuing forward have not really engaged on in the way they should?

[Dr. Jean-Luc Urbain]

Well, we have 20 to 25 years of delay in implementing that technology, except in Quebec.

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

Does anyone else have any comments on those two quick questions? No?

I guess my next question or point is this. As far as the long-term strategy for securing isotopes goes, from my perspective, having sat on this committee now in one form or another over five years--my term in Parliament--what has puzzled me is that our strategy seems to have been putting all the money on the MAPLE reactors, the equivalent of going into a casino and putting all your chips on one roll of the dice. Has there been any thought to other technologies or diversifying our supply of systems beyond the MAPLE reactors? It's basically been keep the NRU running, and somehow magically we can get the MAPLE reactors to actually work. Has anyone been proposing other solutions over the long term, other than those two solutions?

[Dr. Jean-Luc Urbain]

Many countries in the world have looked at that. You can produce technetium with a linear accelerator; you can produce technetium with a cyclotron. They're not very cost-effective solutions.

Remember that you don't have one die, you have two dice, because you have MAPLE 1 and MAPLE 2.

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

But they're the same technology.

[Dr. Jean-Luc Urbain]

Yes, but if you have two cars, one breaks down and you still have the other one to go to work.

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

But sir, my problem is this. The engineers at AECL, the physicists at AECL, can't figure out how to make these things work safely. Either we let the things work in an unsafe manner with unpredictable physics, or we don't use them. What are we going to do? Start up a machine and let her blow up and then have an even bigger problem on our hands? Or have we found out some magical, mystical way that the AECL engineers haven't been able to figure out?

[Dr. Jean-Luc Urbain]

Well, look, if I were to tell you today that you have cancer, you would be unwise not to consult and have a second opinion. That's why we're calling for an international panel of experts.

Secondly, my understanding is that AECL built a reactor very similar to the MAPLE 1 in South Korea. That reactor has been—

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

I appreciate what you're saying, sir, but candidly, more technical witnesses—engineers and physicists—have come to different conclusions from what you have. While I would very much hope your recommendation would be accurate, the engineers we've had before us have told us very differently.

[Dr. Jean-Luc Urbain]

I'm not an engineer, and what we're calling for is an international panel of experts, which I don't think, if my information is correct, has occurred so far.

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

I guess I'd like to bring my next question to Dr. Gulenchyn in Hamilton.

I'm very interested in how it's been functioning as far as our emergency plan is concerned. If we had not started the process of consultation and implementing the triage procedures we're now in 18 months ago, would we be in a much more serious situation if we had not done the planning over the previous 18 months?

[Dr. Karen Gulenchyn]

Yes, I believe that's true. I think the planning that has occurred over the last 16 to 18 months has allowed us to deal expeditiously with this circumstance, as opposed to trying to write the plan on the back of an envelope in the last three weeks to implement it. I believe the planning has been very helpful.

Unfortunately, we still have the situation that the reactor appears to be headed for a longer shutdown than we would have hoped for. We still have no assurances of security of supply. Although I think we're doing the best we can under the current circumstances—and that is due to the planning that has occurred—I'm still very concerned about what awaits us in the near and medium-term future.

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

On behalf of the committee, to you and to everyone who's dealing with this crisis, I want to say the whole country appreciates your work and applauds you for what you've been doing.

We have heard from other witnesses that the Dutch reactor, I believe, is going to be increasing its supply, my notes say by 50%, though my notes could be inaccurate. Have any of those supplies reached the North American market? Have they put the isotope production to a point where those supplies are in the system? Are they coming?

That's to Dr. Gulenchyn.

[Dr. Karen Gulenchyn]

I do not believe at this time we are seeing increased amounts of molybdenum going to the generator manufacturers in North America. The slight increase in supply we have for this week has occurred as a result of some activity leaving, I believe, South Africa and heading to Lantheus. Lantheus central radiopharmaceutical is purchasing generators from Covidien, but I think that's a redistribution of the molybdenum that was already out there, not an actual increase in supply from the Petten reactor.