Health Committee on April 30th, 2007

[Carolyn Bennett, Liberal, St. Paul's, ON]

If you were going to design a perfect system--I mean, you guys meet all the time and want citizens, patients, and providers to have a say on what gets the green light, what we need and what we don't--how would you do this?

Around the world, the biggest nightmare for any health minister I've ever met is what drug goes on a formulary. There are some places like Israel, where they have a different formulary every year, and all the health minister does all year is receive petitions and lobbies.

So with Herceptin, with all of these things, when something goes politically ballistic, the minister has to make a different decision. This doesn't seem like a good system.

[Dr. William Hryniuk]

The reason with CDR and the reason I think the portfolio was lifted was because of the goof with the kidney cancer drugs. They really made the wrong decision there.

[Carolyn Bennett, Liberal, St. Paul's, ON]

So because of one goof we set up a whole new bureaucracy.

[Dr. William Hryniuk]

I think it was symptomatic of other goofs, but this was the most egregious one.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Were there not enough people on CDR who knew enough about cancer?

[Dr. William Hryniuk]

Yes, that's correct, or where this drug fitted in the armamentarium, or what it really meant. They didn't appreciate that.

[Carolyn Bennett, Liberal, St. Paul's, ON]

I know you guys care about cancer, but you must have friends who care equally about diabetes, heart disease, and all the others. Haven't you sort of abandoned it by now, thanking people nicely for this JODR, instead of actually saying we need this thing fixed for all Canadians, not only the ones with cancer?

[Dr. William Hryniuk]

Our mission is cancer and I don't make any apologies for that. If you fix these things for cancer on JODR and you fix them for CDR, it'll work much better than it does right now. In any case, transparency, competency, embracing a broad perspective, looking to post-marketing, getting patients on those committees--those are the lesions in CDR.

[Carolyn Bennett, Liberal, St. Paul's, ON]

I think, Bill, this is absolutely true, and having some secret black box where nobody knows if it comes out yes, no, or white smoke goes up the chimney as to whether--

[Dr. William Hryniuk]

That's what you have for JODR now.

[Carolyn Bennett, Liberal, St. Paul's, ON]

So how much further along are we on post-market surveillance?

[Dr. William Hryniuk]

We haven't done anything except receive data. As I understand it, Health Canada receives data on adverse reactions but doesn't do anything with it. It doesn't receive any information on the efficacy of drugs, and of course it doesn't do anything with it.

[The Chair, Conservative, Rob Merrifield]

The time is gone.

Go ahead.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Do you see, in a best possible world, that something like JODR or CDR would have almost a research capacity that could track this stuff forever in terms of post-market surveillance so that you would always be evaluating what's working and what's not working?

[Dr. William Hryniuk]

Yes, but get it to work in the first instance. Then, as an afterthought, work to see whether it really is correct or not.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Lifting the curtain and finding out what wizard is behind there would be good, yes.

[Dr. William Hryniuk]

That's the first step, finding out who's there and what--

[Carolyn Bennett, Liberal, St. Paul's, ON]

Okay.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Simply for the committee's information, JODR is a 100% provincial body, is that right?

[Dr. William Hryniuk]

Yes, but the CDR has observers there.

[The Chair, Conservative, Rob Merrifield]

But there's no federal funding for JODR, is there?

[Debbie Milliken]

It's a provincial-territorial initiative.

[The Chair, Conservative, Rob Merrifield]

Exactly. That's for the information of the committee.

Go ahead, Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Mr. Chairman.

I'm glad to have the perspective of cancer groups and agencies here today. I've asked questions previously as we've had testimony and opinions brought before us. One of my questions is related to a constituent's concern I had brought to my office, and it was very heartfelt. I'll ask it again today because it falls into an area you'd have greater familiarity with.

A daughter came in about her mother who was sick with cancer. Her mother had spoken to their physician and the physician mentioned that because of what he called government bureaucracy, the drugs he thought would be useful for her mother weren't available. One he mentioned was Iressa and another was Tarceva. They were very concerned and felt the CDR was holding that up. Not knowing very much about the CDR, I said I'd certainly look into it.

It concerned me, because I think the guidelines we should be worried and always concerned about in the Government of Canada are patient access and safety. What I'm interested in knowing about the CDR is whether, in your opinion, it has improved patient access to cancer drugs. Has it enhanced safety, in the sense that if it has reduced access, has it made up for it in increased safety? My concern is that I haven't seen evidence that it's doing that.

Perhaps you could comment on those two drugs and what happened with the CDR there. I understand it was approved in some provincial jurisdictions but not approved by the CDR. What are your general opinions about how this enhances or limits patient access?

[Barry Stein]

I think we first have to clarify the existing situation, which is that safety concerns are generally evaluated at the federal level by TPD or by BGTD at Health Canada; then the funding decisions are made on the provincial basis, and that's likely what the JODR is going to look at in terms of oncology products.

In my presentation I was referring to the harmonization or unification of this type of process. One of the things that I think would be very important to take away is that when it comes at least to the oncology products, an earlier review could be started at the time that Health Canada is evaluating the safety of the product, so as not to lose time and have an additional delay down the track.

I think in at least one case or so, CDR has attempted to do that in order not to add to the eventual delays. This becomes of paramount importance when we're talking about cancer medications, because this is life or death, as opposed to the situation with other medications, which may not necessarily be life or death. I think you actually alluded, maybe unwittingly, to the whole connection between the shortening of the delays between the decisions being made for reimbursement and the safety concerns. I think that opportunity should be looked into.