Finance Committee on Sept. 20th, 2006

[Jacques Derome, Professor, McGill University, Canadian Foundation for Climate and Atmospheric Sciences]

I'm Jacques Derome, member of the board of the foundation. With me is Dawn Conway, executive director of the Foundation for Climate and Atmospheric Sciences.

Weather, air quality, climate, and marine conditions have major impacts on Canada's economy, its sovereignty and security, and the health of its citizens. For example, in 2005, air pollution resulted in over 5,800 premature deaths in Ontario, and the Ontario Medical Association has estimated the total economic impact of that one year at $7.8 billion.

A major national effort is required to ensure that Canadians and their government have the necessary information on weather and climate to protect themselves and their property, to enhance economic efficiency, to act on new opportunities, and to establish strategic international partnerships. This effort is needed to permit policy and management decisions based on solid evidence, as well as strategic business development.

Since 2001, the Canadian Foundation for Climate and Atmospheric Sciences has been the leading player in Canada in stimulating and funding applied research in weather, air quality, and climate in Canadian universities. It focuses on research projects that are of direct interest to government departments and policy-makers. The foundation has generated the strongest level of interaction among researchers in universities in Canada and in government departments that has ever been realized in atmospheric science, and it has generated more than an equal amount of matching funds from the various research partners.

The foundation recommends a substantial increase in the federal investment for research on smog/atmospheric chemistry, the extreme weather that causes natural disasters, on climate trends and marine prediction to support federal environmental measures. The government’s made-in-Canada approach to clean air and climate requires new knowledge, innovative policies, an adaptation strategy, and skilled people. The foundation is an effective and efficient mechanism for generating relevant new knowledge and skilled human resources. It ensures its programs reflect federal needs through both consultations and senior federal representatives on its board of trustees.

We propose that the federal government boost its financial support for research in universities and federal laboratories to generate information for its made-in-Canada approach to environmental challenges and adaptation strategies addressing changing weather, water resources, air quality, and climate conditions.

We recommend support measures for continuous monitoring, archiving, and use of scientific and research data on the environment, including the north and adjacent oceans.

We also recommend enhanced financial support for Canadian involvement in measured bilateral and international science, and research initiatives related to weather, air quality, climate, marine conditions, and water resources.

Thank you, Mr. Chairman.

[The Chair, Conservative, Brian Pallister]

Thank you very much, Monsieur Derome.

We continue with the Canadian Pharmacists Association representative, Jeff Poston.

[Dr. Jeff Poston, Executive Director, Canadian Pharmacists Association]

Thank you, Mr. Chairman, and thank you for the opportunity to present to the standing committee today.

The Canadian Pharmacists Association is the national voice of Canada's 29,000 pharmacists.

The focus of our submission today is patient safety and the need for federal investment to ensure a more effective post-market surveillance of pharmaceuticals. As we all know, pharmaceuticals are playing an increasingly important role in our health care system, but as more and more Canadians benefit from drug therapy, the number of drug safety concerns and adverse drug reactions is rising. Adverse drug reactions are sometimes discovered--in fact, it would appear these days that you could almost say they are usually discovered--after extended use of a pharmaceutical product in real world conditions. We saw another example in the media last week, where a painkiller that had been used for many years was linked to increased heart attacks. Over 10,000 adverse drug reactions were reported to Health Canada last year, but this is estimated to only be about one-tenth of the actual events.

Last year the federal government budgeted $170 million over five years to implement a series of measures to enhance the safety and effectiveness of drugs. While this is a much needed investment, our concern is that the bulk of this funding is targeted towards pre-market approval of drugs, getting new drugs to the market earlier, rather than post-market surveillance in order to assess the safety of drugs in real world use.

Our recommendations centre on the need for significant investment in infrastructure that will enable health care practitioners to contribute to a well-designed program to support effective post-marketing surveillance. The development of this model is essential to the implementation of the progressive licensing framework being proposed by Health Canada.

CPhA recognizes the need for a new progressive licensing framework for pharmaceutical products that will support access to promising new drug therapies while continuously monitoring and assessing for potential safety and effectiveness. Under progressive licensing, patients could receive newly marketed medicines earlier from pharmacies, and monitoring the reporting on these new drugs would be completed by qualified health care professionals.

However, we are concerned that the resources required to implement and maintain such a program are inadequate, making it ineffective.

CPhA would like to see an additional $150 million over 10 years committed to improving drug safety and effectiveness for all Canadians, including the development of a progressive licensing framework.

We further recommend that an additional $50 million over five years should be invested in developing electronic tools for pharmacists, physicians, and nurses, allowing them to better participate in the ongoing surveillance of drugs for unwanted effects. Such tools need to be integrated into pharmacy and clinical management software systems used by health care professionals.

The development by Canada Health Infoway of a new system for public health surveillance may have some potential to be further developed to meet the needs for post-market surveillance of drugs.

A recent study indicated that only 63% of physicians and 44% of nurses knew how to report an ADR as compared to 92% of pharmacists. Therefore, we recommend that an additional $10 million over five years should be invested in training health care professionals in the monitoring of drugs for adverse effects.

These recommendations we're putting forward today are also supported by our sister organization, the Canadian Association of Chain Drug Stores.

Appropriate developments in training and in technology are key to better evaluation and measurement of real world drug safety and effectiveness. While the federal government is appropriately emphasizing pre-market evaluation of drugs, post-market surveillance is increasingly important and also needs to be adequately funded. This will be a key to a successful progressive licensing program.

Thank you.

[The Chair, Conservative, Brian Pallister]

Thank you, sir.

And thank you all for your presentations and for your willingness to accommodate our ever changing schedules here today.

I will mention in advance that you will hear bells ringing in approximately half an hour. That means we'll be called to a vote. We will endeavour, though, to get as many questioners in here as we can in the next half hour or so, and I thank you for your participation in that discussion.

We'll begin with Mr. Pacetti, and we'll go with five-minute rounds.

[Massimo Pacetti, Liberal, Saint-Léonard—Saint-Michel, QC]

Thank you, Mr. Chairman.

Thank you again to all the presenters. Concise, that's what we like.

Mr. Poston, in your last comment you said that we should be funding post-market research. Is that commercialization?

[Dr. Jeff Poston]

When a new drug gets onto the market, it's perhaps been used in 3,000 to 4,000 people during the clinical trial phase. If you are dealing with an adverse drug reaction that occurs, say, in one in 10,000 patients, then you're not going to know about that.

What we're saying is that when these new drugs get used in the population, there needs to be routine, systematic monitoring and collecting of data on their use in order to make sure they're safe.

[Massimo Pacetti, Liberal, Saint-Léonard—Saint-Michel, QC]

Is that anywhere in your brief?

[Dr. Jeff Poston]

Yes. We described it as post-market surveillance in the submission. We talked about it in supporting the progressive drug licensing framework.

[Massimo Pacetti, Liberal, Saint-Léonard—Saint-Michel, QC]

Thank you.

I have a couple of questions for the Multiple Sclerosis Society of Canada.

You request extra funding for the Canadian Institutes of Health Research. How will that affect the Multiple Sclerosis Society? How will you be guaranteed that the money will go toward research for multiple sclerosis? Is that the idea? How does that get distributed? How is that going to benefit your society?

[Deanna Groetzinger]

Initially it will benefit us indirectly. Essentially we fund research that's directly related to multiple sclerosis, and, as many other health charities, we really depend upon the bedrock of research that CIHR funds for conditions that may be related to multiple sclerosis. We really see it as building blocks. We need a very solid base of well-funded research that the rest of us can build upon.

[Massimo Pacetti, Liberal, Saint-Léonard—Saint-Michel, QC]

Is there an exchange of information?

[Deanna Groetzinger]

An exchange of information and the knowledge that can be gained from CIHR-funded research will certainly benefit those in other disciplines.

Secondly, organizations such as ourselves partner with CIHR. The funding of research and the research innovations are among the economic drivers of Canada. That's an important aspect of our economy today and I hope a growing one in the future.

[Massimo Pacetti, Liberal, Saint-Léonard—Saint-Michel, QC]

Does the society actually do research?

[Deanna Groetzinger]

We fund research. Between ourselves and a related foundation, we fund about $10 million to $11 million a year.

[Massimo Pacetti, Liberal, Saint-Léonard—Saint-Michel, QC]

Who do you fund, universities or independent organizations?

[Deanna Groetzinger]

We fund individual researchers based in hospitals and universities across the country.

[Massimo Pacetti, Liberal, Saint-Léonard—Saint-Michel, QC]

I want to discuss some of the recommendations you've made. On page 7, you strongly urge the committee to recommend that the MInister of Human Resources establish a task force.

If I'm not mistaken, haven't there already been a few disability reports done or issued?

[Deanna Groetzinger]

There have been a number of various reports looking at aspects of disability, but the one we are really looking at is the complex area of income security and support for people with disabilities. I think pieces of that have been looked at. There have been some great studies on the disability tax credit and other studies on CPPD. We think there needs to be a study to put this all together in order to look at the issues facing people with disabilities. Some Canadians with disabilities have among the lowest incomes across this country. As a country, we need to improve this.

[Massimo Pacetti, Liberal, Saint-Léonard—Saint-Michel, QC]

Again, I understand and don't mean to interrupt, but time is limited.

At what point are we going to ask for action? Are you requesting one more study? I mean, we should be asking for studies and you should be asking for action. I feel the roles are reversed.

[Some hon. members]

Oh, oh!

[Deanna Groetzinger]

True enough, and in the brief we have definitely concentrated on what we think is actionable that we would like to see happen within the next 12 months. But we're also conscious of the fact that the income securities and supports in this country are multi-level. There are both provincial and federal programs. How are we going to put them together? I think that's the issue.

[The Chair, Conservative, Brian Pallister]

Thank you very much.

Voulez-vous continuer, Madame Demers, s'il vous plaît.

[Nicole Demers, Bloc, Laval, QC]

Thank you very much, Mr. Chairman.

Thank you for joining us. I won't have time to put questions to all of the witnesses. However, Ms. Kirk, I do understand your concerns about the community and volunteer sector, because I'm familiar with this environment. I do understand and very much agree with your recommendations.

I have a question for Mr. Dudding. You talk about child poverty, a determining factor in a child's future. To my mind, poverty is a determining factor in the future and health of the global community. I'd like to share with you some of the recommendations we have made to government and to ask you if you believe they can help in the fight against poverty. We ask our constituents to give us some feedback, but we don't always know what people in Ontario, Manitoba, Saskatchewan or Alberta are thinking. The witnesses here today represent a cross-section of Canadian society and perhaps they can tell us if we're on the right path.

In Bill C-269 on employment insurance, we ask that the qualifying period be set at 360 hours of work, regardless of the regional unemployment rate, that the benefit period be extended, that the weekly benefit rate be increased to 60 per cent and that the waiting period be eliminated.

These are just a few of the changes we are seeking. We're also asking that CMHC's $4.2 billion surplus be reinvested in affordable and special needs housing initiatives. We also want the $3.2 billion owed to those seniors who were unaware of their right to collect the Guaranteed Income Supplement to be paid to them, because they are among the poorest in our society. We also want the application process to be automated, so that once seniors have initially applied for the GIS, they will automatically continue to receive it every year. Persons with decreasing independence shouldn't have to reapply for the GIS each year.

In your opinion, could these changes help alleviate the poverty you described?

[Peter Dudding]

The short answer is absolutely. Just to embellish on what you're saying, the single largest group of poor people in this country are single-parent, mother-led families. So anything we can do to address and focus on the needs of that group of people...because we know they are the ones who are going to most directly impact the lives of children. These are mothers of very young children.

Certainly this issue is of growing concern. Your concern that it is impacting the long-term effect on children is absolutely supportable by the evidence, and I would encourage and strongly endorse the propositions you're making.

Merci.

[Nicole Demers, Bloc, Laval, QC]

Thank you.

My question is for Mr. Poston. In her 2002 report, the Auditor General recommended that pharmacists be made aware of the over-medication of veterans and federal government clientele. She reported that the department did not collect data on cases where pharmacists had ignored certain information. She also called upon Health Canada to upgrade its system so that pharmacists are provided with names, dosages and dates appearing on at least the last three prescriptions filled so that both you and the consulting physician have more information.

Does Health Canada now relay this information and do you have access to it?