Health Committee on May 9th, 2007

[The Chair, Conservative, Rob Merrifield]

Okay. We'll go to Janis and then Linda.

[Dr. Janis Miyasaki]

With respect to conflict of interest, it's certainly an issue that's foremost in my mind, because we are producing important guidelines for our members.

You've touched on financial conflict of interest. What's perhaps even more compelling is intellectual conflict of interest, when someone is intellectually vested in a certain point of view. We can talk about all kinds of conflicts of interest.

I think that disclosing and being open is important, and it's why I provided my CV to the members. They can look to see how much money I'm making from these studies that go on for years.

I think acknowledging it up front doesn't mean you might be any less biased, but it acknowledges that you are aware you could be influenced. I think not acknowledging that all of us have some interest around this table is the really difficult thing.

[The Chair, Conservative, Rob Merrifield]

Thank you.

We'll have one quick answer from Linda.

[Linda Tennant]

On David's and my behalf, I would like to again emphasize the need for increased transparency in whatever we do, whether it's through CDR, CEDAC, or anyone around this table.

[The Chair, Conservative, Rob Merrifield]

Thank you.

Mr. Patrick Brown, you have five minutes.

[Patrick Brown, Conservative, Barrie, ON]

I think Steven wanted to say one thing.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

I think Patrick is splitting his time.

To follow up on the previous comment, my injury is probably the most expensive injury society can incur. It'll cost tens of millions of dollars if I live to a normal life expectancy. I don't think costs should be the mitigating factor. I would ask that there be transparency.

Could the individual who advocated for the independent commission or review explain how that independent review can be done in a transparent and fair manner?

[The Chair, Conservative, Rob Merrifield]

Does anybody want to respond?

Yes, go ahead, Linda.

[Linda Tennant]

I think David and I mentioned an independent review. We were again thinking along the lines of transparency and the fact that CEDAC and CDR must remain relevant to all stakeholders. You only maintain your relevancy if people in fact understand what you do and you're open about it.

It was our thinking that if an agency evaluates or reviews itself, it doesn't look very good to the outside world. If you bring a degree of independence to the review, you will hopefully satisfy the stakeholders to a greater extent.

[The Chair, Conservative, Rob Merrifield]

Thank you.

Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Chairman.

I'm very interested in the comments we've heard today, and I've heard many similar comments from my constituents. It's why I'm looking at this from the issue of patient access.

It always breaks your heart when constituents come into your office to tell you that government has been a hurdle to get the drugs they believe are absolutely necessary for their families. I heard the Best Medicines Coalition and the Ward Health Strategies say that.

Elisabeth Fowler, you made a few comments in terms of kidney cancer and in terms of cancer drugs. It's one of the themes I've heard again and again when I've heard concerns about this. You mentioned the most blatant one as being drugs that would be helpful for kidney cancer.

Are there a few other examples you can share with us in terms of cancer drugs that struggle to get to the market where the CDR has potentially been a barrier? We've heard before there are some differences among the drugs that British Columbia viewed as being approved, which the CDR turned down. Maybe there are a few other examples you can give us.

The other comment I wanted to hear is this. Mr. Bougher, you mentioned there were differences in drugs. It's why this has created differences in the provincial plans and it's why it was initially created. But aren't we still at the point today where we have wide differences across the country? If that was the reason for the creation of the CDR and it's still occurring, why would it be necessary now?

My third question for the guests today is this. Mr. Lexchin said the CDR was specific to Canada. But aren't the provincial plans specific to Canada too? Wouldn't health services in each province and drug plans in each province also have that Canadian sense to them?

Could I first hear from Ms. Fowler, and then Mr. Bougher, and then Mr. Lexchin, if there's time?

[Elisabeth Fowler]

Thanks for the question. I have to admit that I don't know specifics of other cancer drugs, because Nexavar and Sutent are the ones I know most and I've talked to the patients about. I know the struggles they've had in getting access to it and what the alternatives would be. If they didn't have access to this drug, they would be subjected to numerous invasive massive surgeries and that's it. So this drug is pretty key for them.

But I can say that the Cancer Advocacy Coalition of Canada has done an extensive report. They have looked at disparities between provinces--as you said, B.C. has great access--and they have found that in the provinces that have chosen to give access to more drugs to their patients, deaths from cancer have gone down. Mortality is much less--it has not gone down--than what it is in other provinces.

[Patrick Brown, Conservative, Barrie, ON]

And the differences in the provincial plans?

[David Bougher]

I think the point was that members of the committees bring their own biases and professional knowledge to the table and the discussions. In fact, for the provinces, it's an area of our concern with respect to decisions that are contradictory. Cancer was one in relation to CEDAC recommendations. Introducing conditional listings or more flexibility in terms of providing patients with access to new drugs would assist in giving that flexibility. We've heard about Quebec. There are perhaps social considerations and economic considerations, and those aren't brought into the picture.

[Patrick Brown, Conservative, Barrie, ON]

But if one of the original reasons for creating CDR was differences in the plans, aren't the differences still there today?

[David Bougher]

Yes, the differences are.

[Patrick Brown, Conservative, Barrie, ON]

So what was the point of that being one of the reasons for the creation of CDR? Clearly if it was to eliminate differences in the provincial drug plans, that hasn't been achieved.

[David Bougher]

There are a lot of consistencies in the acceptance of the “no” recommendations.

[Patrick Brown, Conservative, Barrie, ON]

Are there more than there were four years ago?

[David Bougher]

I haven't studied that. I don't know if anybody else can speak to that.

[The Chair, Conservative, Rob Merrifield]

Thank you, Mr. Brown.

We'll go to Luc Malo.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you, Mr. Chair.

Dr. Lexchin, when you were having the discussion with my NDP colleague just now, you seemed to be of the opinion that one of the reasons why there are more medications in Quebec was that there are a number of pharmaceutical companies in the province. I would just like you to clarify one thing. Was that a personal opinion, or was it based on any fact analyses and studies that you have conducted?

[Dr. Joel Lexchin]

The fact that the pharmaceutical industry is heavily concentrated in the Montreal area is well known. The rest of it is speculation, based on the fact that, as I said, the Quebec provincial government has made the development of the pharmaceutical industry one of its key pieces of industrial strategy for obvious reasons. You've got a lot of people there. It generates a lot of economic activity. Quebec wants to build up on that. The relation between economic activity and listing is speculation. I don't have any firm evidence on that, and I said that.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

So anyone could conclude that it is also because the Quebec government wants to offer the greatest possible range of medications to everyone with diseases, rare or not.

Ms. Fowler wants to speak on the matter.

[The Chair, Conservative, Rob Merrifield]

Okay, we have two other answers there, and I don't want you to cut those off because it's probably very valuable stuff for you.

So, Elisabeth, go ahead, and then Linda.