Health committee  Once again, like Dr. Lennox mentioned, I'm not really familiar with the machinations at that level of the government, but I think the need for a registry is so common sense at this point. Mr. Thériault, from Quebec, brought this forward. I don't see why any physician or organization would be against the idea.

Health committee  Certainly. It's just one more reason to have a mandatory registry. At the end of the day, in hospitals things tend to get better documented, and that's certainly an issue with plastic surgery. You'll have breast implants being used for both private aesthetic surgery and breast reconstructions.

Health committee  Yes. As I said, the NBIR in the U.S. is an optional one, but I reached out to them to see about it. It's funded there by The Plastic Surgery Foundation, but it's receiving significant funding from the breast implant manufacturers. I think that's a direct one. It's not necessarily per implant, as a tax on the implants themselves, but that's another way of doing it.

Health committee  Is that directed to me or Dr. Lennox?

Health committee  Dr. Lennox, go ahead.

Health committee  As I said, there are a few basic premises. I think Dr. Lennox knows more about the details of the registries than I do. There are some basic things to make sure the registry works. One is that it's mandated that basically an implant can't be put in and the guarantee respected unless, for example, the plastic surgeon has gone through a checklist with the patient initially of all the complications, and the patient understands each and every complication.

Health committee  I don't feel that.... They've had their chance. They've had 60 years to do something, and they haven't. Unfortunately, at the end of the day, as we all know, money talks. That's been the primary driving force for them. The conflict of interest has remained. Are they going against the registry?

Health committee  As I said, the cost has to be assumed by the companies. It shouldn't be from my taxes or the government.

Health committee  They should be able to know how many are imported. There are none produced in Canada.

Health committee  I don't know.

Health committee  That's something they have actually started introducing in the U.S., Arizona for instance. Breast implant safety advocates have lobbied hard for that, because they found that plastic surgeons tended to minimize the risk of complications associated with breast implants. It would be easy to establish a checklist.

Health committee  Sure. These are two completely distinctive entities or two problems caused by implants. With BIA-ALCL it's proven, as I alluded to and as Dr. Lennox has just mentioned. It's accepted now that it's the texturing of the implants, as he said, that is leading to the ALCL. Now, the exact details of that are not yet 100% clear, but they're being understood more and more over time.

Health committee  I've heard nothing but negative things about Health Canada from health critics such as Julie Elliott. The department really hasn't been proactive. The difference between Health Canada and the Food and Drug Administration, or FDA, in the U.S. is that the FDA has been much more proactive.

Health committee  The latest numbers I have are four Canadian women dying from ALCL in Canada, and I think there are 60 around the world. Dr. Lennox, correct me if you're aware that my numbers are off. The incidence of the lymphoma, of ALCL, varies depending on the type of texturing. Microtextured implants, such as the ones sold by Mentor, are not very rough.

Health committee  It's the Biocell implant made by Allergan.