Natural Resources Committee on Aug. 21st, 2009

[The Chair, Conservative, Leon Benoit]

Good afternoon, everyone. We will now proceed with this meeting.

I do want to say that this meeting is on a very important issue. There's no doubt about that. It's a very serious issue. I think it's obvious to everybody.

The reason we're having the meeting is that four members of the opposition, in proper process, have called the committee back. I want to read the terms as laid out in the letter from the opposition so that it's clear to everyone, members of the committee and witnesses, what we're here to discuss today and what we're not here to discuss today.

So I'll just read the notification that we got from opposition members asking for this meeting, as follows:

We the undersigned members of the Standing Committee on Natural Resources request that a meeting of our Standing committee be convened, pursuant to Standing Order 106(4), in order to study the prolonged closure of Atomic Energy of Canada Limited's NRU reactor at Chalk River, which has resulted in the decrease of supply of medical isotopes and a worsening health crisis, as well as the future of isotope reduction in Canada.

It's important to note that we are not the health committee, we are the natural resources committee. We're here today to discuss these issues as laid out in this notice from members of the opposition. We are not here to discuss health issues that are more appropriately handled by the health committee. Let's proceed on that basis.

I will explain who the witnesses are for this first panel, which goes until two o'clock.

We have with us, in person, Michael Ivanco, president, Society of Professional Engineers and Associates.

Thank you, Mr. Ivanco, for being here today. We appreciate it very much.

We also have, by video conference, Robert Atcher, president, International Society of Nuclear Medicine, and Sandy McEwan, special adviser on medical isotopes to the Minister of Health.

Welcome to all of you.

First of all, Mr. Ivanco, you can start with your opening statement. Then we will proceed, in the order that they appear on the notice, to Mr. Atcher next and then Mr. McEwan.

Go ahead, please.

[Dr. Michael Ivanco, Vice-President, Society of Professional Engineers and Associates]

Thank you.

My name is Michael Ivanco. I have a Ph.D. in physical chemistry. I'm the vice-president of the Society of Professional Engineers and Associates.

With me today is Peter White, who's president of SPEA. He happens to be an expert in safety analysis, and he is an engineer.

SPEA represents over 900 scientists and engineers who work for Atomic Energy of Canada at Sheridan Park. Our members design the nuclear reactors used in Canada and around the world for nuclear power stations, for research, and for production of medical isotopes. Our members also provide technical support, safety analysis, and a wide range of services for the nuclear industry. We also work closely with the technicians and technologists who provide fabrication, inspection, and testing on a variety of aspects in the nuclear industry.

I'm honoured to be invited here to speak to you about nuclear science. I'm very proud to represent the scientists and engineers who work at AECL and whose qualifications are too many to list. A great number of our members have advanced degrees in a wide variety of specialties, and they've been internationally recognized as experts in their respective fields.

I've worked in the nuclear industry for 24 years, the first 12 at Chalk River Laboratories. I've been at Sheridan Park, at the commercial division in Mississauga, for the last 12 years. My areas of expertise include laser isotope separation, analytical measurement, and product development ranging from heavy water upgraders to reactors serving the maintenance systems.

The majority of our members do not directly support operation of the NRU reactor in Chalk River, but many of them were involved in the life extension beyond 2000 and also in the design and construction of the MAPLE reactors that were meant to replace it. Technical questions regarding the design, repairs, and operability of these reactors are probably best left to management representatives, who are appearing later. They can draw from the expertise of individual members, both our members and those who work at Chalk River, whom we do not represent.

I think Canada has every reason to be proud of the people who've helped make Canada an internationally recognized leader in the production of medical isotopes and nuclear technology, and also the safe, peaceful use of nuclear reactors for the production of electricity. Canada is one of only five nations in the world that can deliver a reactor project anywhere, and it's something we should be proud of.

Much of the success is owed to the support provided by successive federal governments, who have demonstrated their confidence in AECL by providing necessary investments to enable the development of research and designs that could in turn be sold to domestic and international customers. This level of support and the tangible and intangible benefits it has generated has been the subject of many debates in the House of Commons and the subject of countless news articles and commentaries. I hope to avoid repetition of those debates here today, but I won't shrink away from declaring the position of our over 900 members, the related 30,000 jobs in Canada's industry, and the hundreds of thousands of family members, friends, and the Canadian public who support them.

Canadians should be proud of our role in providing medical isotopes, nuclear services, and reactors for peaceful purposes. We've profited from this research and innovation. Canada should continue to support AECL to ensure domestic supply of medical isotopes for Canada and the world, we believe, and we should continue to support AECL to successfully complete the design and generate sales of our newest product, the ACR-1000.

We must look at this as an investment by Canadians in an industry that has paid many dividends. The research that is conducted by AECL benefits Canadians and has established us as a world leader. There are few industries where all aspects are conducted in our own borders. This is the only industry I can think of in Canada where we dig the uranium out of the ground, we refine it, we turn it into fuel, we put it in reactors that we design, build, and make almost all the parts for, and then provide services for. There's no other industry like it, and few people appreciate that.

There has been much said about the sale and privatization of AECL. For the record, our members believe that a sale is likely detrimental to the national interest. We believe that nuclear technology should not be under the control of corporate interests but held by Canadians through their government.

I'd like to point out that the main shareholder of Areva, one of our main competitors, is the French government. It's a fact that escapes many critics of AECL. Areva has been successful in producing and selling its reactors, but it has also had its share of delays and problems with multi-billion-dollar cost overruns in Europe. I raise this only because Canadians have been led to believe that delays and cost overruns are somehow unique to AECL. They're not. As I pointed out earlier, or should have pointed out, the nuclear industry is not a production line company. In our industry, we can't afford a product recall.

Canadian technology is considered among the best in the world. We have an exemplary safety record in this respect.

As this committee is focused on the isotope issue, I'd like to urge you to consider the broader picture and what Canada's role should be in the nuclear industry. The isotope issue is extremely important but is just one aspect of the nuclear industry. We also need to have a discussion on the future of this industry, because that is indeed the question before you. If there's not a thriving industry, there is no isotope issue; we simply would have no isotopes, or we'd be buying them from somebody else.

[The Chair, Conservative, Leon Benoit]

Thank you, Mr. Ivanco, for your opening statement.

We now go to Mr. Robert Atcher, president of the International Society of Nuclear Medicine. Again, it's by video conference.

Go ahead, please, Mr. Atcher.

[Dr. Robert Atcher, Past President, International Society of Nuclear Medicine]

Thank you, Mr. Chairman.

I want to make one correction: I'm the immediate past president of the Society of Nuclear Medicine, and Michael Graham from the University of Iowa is our current president. But I have been tasked, starting with Dr. McEwan's presidency, with leading a task group responsible for addressing the problems we've been having with the supply of these critical medical isotopes.

My background is that I have a Ph.D. in nuclear chemistry and I'm a radiopharmaceutical chemist. I work at Los Alamos National Lab and I have a joint appointment in the College of Pharmacy at the University of New Mexico.

I want to address specifically some of the issues associated with the outage at the NRU at Chalk River. Approximately 50% of the material that we use in the U.S. is produced by that reactor, and it presents a huge problem for us whenever that reactor is not functioning.

In addition, that reactor also has more excess capacity than the other four reactors currently producing 95% of the world market of molybdenum-99. So whenever any of those other reactors go off-line, the NRU has the capacity to make up for a substantial percentage of the market it supplies. So there's a double whammy whenever the NRU goes down; not only is its normal production lost, but also the excess capacity this reactor produces when the other major reactors in the world are off-line.

Of the imaging procedures we do in nuclear medicine in the United States, 80% use technetium-99m, the daughter product of molybdenum-99. These procedures include cardiac studies and cancer studies, which in our case are about 80% of the imaging procedures. And then we do a number of other procedures for gastrointestinal problems, genito-urinary problems, and other issues associated with neurological problems, infection, etc. So we are imaging patients across the board using nuclear medicine procedures--in particular, nuclear medicine procedures utilizing this critical radioisotope we get from the reactor at Chalk River.

One of the problems with not having technetium-99m available is we then have to use other imaging procedures, which present one of four complications as far as the patient is concerned. One is that the radiation dose they receive from the procedure is higher. Another is that the accuracy of the procedure isn't as good as the one we would get from using a technetium-based imaging procedure. We've also seen an increase in cost as a result of the technetium-99m not being available. Finally, in many cases we use a much more invasive procedure, which presents a danger to the patient of increased morbidity and, potentially, mortality.

In the U.S. in particular, we have a problem because we use a technetium-based radiopharmaceutical to do bone scans of patients who have lung cancer, breast cancer, and prostate cancer and have a very high likelihood that the cancer may spread to the bone. We have asked our centre for medicare and medicaid services to cover sodium fluoride PET imaging for bone scans, but to date we have not received permission to charge for those procedures. So for those patients with these critical cancers, we currently don't have any alternatives in terms of imaging procedures.

In addition, for patients with breast cancer, we use a technetium-based test to find the lymph node that's closest to that tumour so that the surgeon can excise that lymph node, send it to pathology, and determine whether it has spread beyond the primary tumour in that patient. If we detect there is such a spread of that cancer, those patients go on to chemotherapy and other procedures to try to keep that cancer under control. So it's a very important part of the staging procedure for patients who are undergoing surgery for a tumour.

In addition, for cardiac patients who are obese, we get much better imaging procedures from using technetium-99m than we do from an alternative radioisotope, thallium-201.

Finally, pediatricians have expressed concern about the impact on a program called Image Gently in the U.S., which tries to reduce the radiation dose the pediatric population gets from imaging procedures. Those patients who are not availed of a technetium-based radiopharmaceutical for their imaging procedures often need to have procedures that involve much greater doses and much less accuracy as far as their staging goes. So another critical population is impacted by having this material not available.

So that in summary gives you a clear idea of the U.S. practice of nuclear medicine, the problems we have when a reactor such as NRU goes offline for what appears to be an extended period of time, and the problems associated with the alternatives we are looking at in using the technetium-based imaging procedures.

Thank you.

[The Chair, Conservative, Leon Benoit]

Thank you, Mr. Atcher.

We'll go now to Sandy McEwan, special adviser on medical isotopes to the Minister of Health.

Mr. McEwan, if you have an opening statement, please go ahead.

[Dr. Sandy McEwan, Special Advisor on Medical Isotopes to the Minister of Health, As an Individual]

Thank you, Mr. Chairman. I will be brief.

As you have identified, I'm the special adviser to the Minister of Health. My day job is as chair of the department of oncology at the University of Alberta. I'm also a previous chair of the department of radiology at the same university. I'm a nuclear medicine physician with an active therapeutic practice at the Cross Cancer Institute in Edmonton. I'm Dr. Atcher's predecessor as president of the International Society of Nuclear Medicine. I'm also a past president of both the Canadian Association of Nuclear Medicine and the Canadian Society of Nuclear Medicine.

As Dr. Atcher has correctly identified, there is an impact on our patients caused by the shutdown of Chalk River. Since the initial shutdown at the end of 2007, the community has had a working group in place that includes members of the nuclear medicine community, the oncology community, the cardiology community, as well as members of Health Canada, looking at ways of ameliorating the crisis. We have attempted to provide guidelines for our clinical colleagues on how to best utilize available resources. I think that the guidelines we have published and continue to modify have helped to ameliorate the impact of this on our patients.

In particular, we have recognized the importance of providing as accurate a guideline as we can of the supply of molybdenum. One of the key issues at the beginning of the shortage was the unreliability of this supply prediction. Over the last four to six weeks we've been able to provide a more consistently reliable guide to our clinical colleagues on the supply of molybdenum and the generators, and a more consistent expectation of what will be happening in the following week. This has helped to improve planning, patient flow, and the way our clinical colleagues have managed their departments and changed processes.

Now that we've survived the shutdown at Petten over August, with perhaps less disruption than we feared, we have to look to the medium term. AECL has indicated that it expects to be up and running in the first quarter of 2010. Our hope is that it is up and running before the planned six-month shutdown of Petten at the end of February.

We think it's important that we now start to again understand what the implications of the AECL startup are going to be. We really need to understand what regional disparities are occurring in the country. Some parts of the country have experienced very little disruption; some parts of the country have experienced significant disruption. One of my key tasks is to understand what those regional disparities are, what is causing them, and what we can do to help.

I think it's important to recognize the degree to which the community has made very significant changes to work practices to deal with the shortages, and the very significant involvement of all members of the community in ensuring that we can actually continue to supply our patients. We hope we will be able to continue the accurate indication of future supply, and we look forward to confirmation of when AECL will be able to reopen NRU.

Mr. Chairman, thank you for the opportunity to speak.

[The Chair, Conservative, Leon Benoit]

Thank you very much.

We'll go directly to questioning now so that we can get in as many questions as possible, starting with the official opposition.

Mr. Regan, you have up to seven minutes.

[Geoff Regan, Liberal, Halifax West, NS]

Thank you, Mr. Chairman.

Dr. McEwan, first of all, I understand that you're no longer a member of the Canadian Association of Nuclear Medicine. Who do you represent?

[Dr. Sandy McEwan]

I'm a member of the Canadian Society of Nuclear Medicine, which is the overarching body representing nuclear medicine in this country.

[Geoff Regan, Liberal, Halifax West, NS]

Would you say you represent that organization, or the doctors?

[Dr. Sandy McEwan]

I think I was appointed as special adviser to the minister because of the significant national and international expertise I have, my expertise in the field of nuclear medicine, the fact that I have breadth of knowledge through nuclear medicine and through pathology.

[The Chair, Conservative, Leon Benoit]

Did you have a point of order, Mr. Anderson? Okay, I guess it has been dealt with.

Go ahead, Mr. Regan.

[Geoff Regan, Liberal, Halifax West, NS]

Dr. McEwan, you're aware, I presume, of the motion unanimously passed by the Canadian Medical Association this week as it relates to medical isotopes. Do you agree with it?

[Dr. Sandy McEwan]

Which of the five motions?

[Geoff Regan, Liberal, Halifax West, NS]

It has five different points in it. Are there some you disagree with and some you agree with?

[Dr. Sandy McEwan]

If I can go through the motions in order, it might be helpful.

In regard to the first motion, as a clinician I am obviously supportive of this motion.

On the second motion, I believe we have attempted to have very broad representation in our consultation with the nuclear medicine physicians. The Canadian Association of Nuclear Medicine was actively involved in my appointment and in the conversations around my appointment, and Dr. Urbain was on the panel that agreed to my appointment.

I think the investment is important, and we have clearly started seeing that. The CIHR and the NRCan panel are important elements of that item. I think the motion that was proposed by the president of the CMA, recognizing and appreciating the responses of the clinical community, is appropriate and I enthusiastically endorse that motion.

I think the final motion, which is looking at new technologies and, most importantly, new ways of producing technetium-99m, which may not necessarily be reactor-based, is a very important one, and clearly this is now before the NRCan panel.

[Geoff Regan, Liberal, Halifax West, NS]

Thank you.

Dr. McEwan, I don't know if you addressed the motion about MAPLE nuclear reactors. The Canadian Medical Association urged the government to have a panel to thoroughly review the decision to cancel the MAPLEs project.

[Dr. Sandy McEwan]

My understanding is that it is part of the mandate of the NRCan expert panel. I have some knowledge of nuclear physics. I am not a nuclear physicist, and I certainly am not competent to discuss any specifics around that. I'm hoping that the NRCan expert panel will provide sound advice on that.

[Geoff Regan, Liberal, Halifax West, NS]

Thank you.

You're of course aware that on November 18, 2007, the National Research Universal reactor was shut down, and the shutdown was for approximately a month. At that time, you described the shutdown as “a catastrophe for patients”. Of course, the NRU has been shut down now since May 14, so over three months, and we're hearing that it's going to go on until sometime in the winter or spring, or it sounds that way at least. How would you describe the situation today?

[Dr. Sandy McEwan]

The situation for our patients is of great concern. I think we have learned a great deal from the 2007 shutdown. The working group that we have had going pretty much consistently since that initial shutdown has come up with sound advice, has come up with creative advice for our clinical colleagues on how to deal with the shortages. Without the role of that working group, we would not have seen hospitals able to cope as well as they have.

As I indicated in my opening statement, I am very concerned that there do appear to be significant regional disparities in how hospitals are able to cope. If you look at the data I have, hospitals in the west are dealing with it perhaps a little better than some of the smaller urban centres in Ontario and Quebec. That is of concern to me. It has been the basis of a number of conversations I've had with Dr. O'Brien, who is the president of the OANM, and I'll be continuing to try to understand where those disparities come from and what we can do to ameliorate them.

[Geoff Regan, Liberal, Halifax West, NS]

Mr. Chairman, I'll continue with the last question I have—unless we have time for more.

[The Chair, Conservative, Leon Benoit]

You have a minute and a half. Go ahead, please.

[Geoff Regan, Liberal, Halifax West, NS]

Given the fact that AECL's board of directors had already made a recommendation to the minister to shelve the MAPLEs, the MAPLE project, prior to the 2007 shutdown of Chalk River, is it your view that the government should have begun coming up with a plan B to deal with the production of medical isotopes at that time? We had, of course, a month-long shutdown then, and one would think it suggested the possibility that it could happen again.

[The Chair, Conservative, Leon Benoit]

Mr. McEwan, go ahead.

[Dr. Sandy McEwan]

Mr. Chairman, I was not aware the AECL board had made that recommendation that early.

I think there is clearly hope that the NRU will come up in the first quarter of this year.

The proposals I am aware of that have gone to the NRCan expert panel look creative. Many of them provide made-in-Canada solutions, and I'm looking forward with a great deal of enthusiasm to the report of that panel.

Mr. Chairman, as you know, I will be appearing before that panel on September 9.