Health Committee on May 9th, 2007

[Bonnie Brown, Liberal, Oakville, ON]

Thank you very much, Mr. Chair, and thanks to everybody who came.

Those of you who are participating in this meeting are witnessing the conflict we have been listening to now for several meetings. I'm wondering if you think that some of that conflict came about with the birth of the CDR, because the provinces and territories that came together had different reasons for wanting to have this body. That is, the poorer provinces now benefit from the quality of work and the scientific expertise of the CDR that is paid for as a group. The richer provinces also benefit, because they have another body that says no, sometimes, which they can blame for saying no. It seems to me that when two groups come together with totally different agendas and give birth to something for totally different purposes, there's bound to be some conflict.

I know that Mr. Bougher and Ms. Tennant blame that on the different decisions by the provinces that reflect the beliefs, experiences, and even biases of the decision-makers. But when you add to that the different motivations of the provinces for wanting to have this particular body, is it ever going to be possible to resolve it when these conflicting purposes are at work in one particular agency?

[The Chair, Conservative, Rob Merrifield]

Go ahead.

[Linda Tennant]

In the six years that I managed the Ontario drug benefit program, I heard every single argument that's been made around this table. These programs have been controversial for decades, and they will continue to be controversial. The fact that we have different ways of making decisions, different opinions, will always lead to a very lively debate on who's right and who's wrong.

I think what some of us are trying to suggest...and in fact at the provincial level I have to say that the provinces, in the drug review area, have been trying to work together for over a decade to streamline their processes so that they would match more closely. The common drug review was meant to be another step in that progress, if you will, and a first step towards even further consolidation of what we did.

Given that this is controversial and that it's very much open to conflict, we're suggesting greater transparency. What we're not suggesting is.... And I will give a personal opinion here. I don't see that having 12 committees versus one committee resolves conflict or makes it any easier; rather, one committee looking at what that committee does and trying to improve its processes would seem to me to be a better way to go. But I think the controversy will continue.

[Bonnie Brown, Liberal, Oakville, ON]

I'd be interested in what Dr. Lexchin thinks.

[Dr. Joel Lexchin]

I agree. You're never going to agree with all the decisions that are made, and there is certainly a wide variety of different values that people are going to bring to issues around pharmaceutical policy and what drugs should be covered and what drugs shouldn't.

But I think the more transparency there is and the more you can see how decisions were being made...you may not like them, but you're more likely to accept them. So transparency goes on a number of levels. For instance, I think the CDR should be more open to really seeing the evidence basis for its decisions. I wouldn't have any problem if they had open hearings, the way the FDA does, to allow different groups to make presentations before they make their decision.

I would also like to see some transparency from the pharmaceutical industry around why it's charging the prices it is for the drugs. Why are some things worth $20,000 or $50,000? If they can prove that it's the real value of these things, that's fine. So far, we don't see that either.

[Bonnie Brown, Liberal, Oakville, ON]

I think we're going to get to that, Dr. Lexchin, in our study, probably in the fall, the business about pricing.

The other thing I'm questioning—

[The Chair, Conservative, Rob Merrifield]

Louise Binder wanted to answer.

[Louise Binder]

Sorry, I was just going to comment.

First of all, I completely agree with Joel. I think the pharmaceutical industry does a very bad job at proving its prices. I've actually, notwithstanding the funding we get from the pharmaceutical industry, written a formal complaint to the Patented Medicine Prices Review Board, about every AIDS drug that they have ever reviewed. That's an area where my colleagues and I and the pharmaceutical industry strongly diverge, as we do about direct-to-consumer advertising, which I think also raises the price of drugs—

[Bonnie Brown, Liberal, Oakville, ON]

You're not answering my question.

[Louise Binder]

--and a number of other problems we have, such as cross-border Internet pharmacies, etc.

So I'm pretty clear about where we diverge and where we converge.

To your point—

[Bonnie Brown, Liberal, Oakville, ON]

Thank you.

[Louise Binder]

--you're right. I think that's exactly what happened. The irony is neither side is getting what it wanted.

The “smaller provinces” with smaller budgets wanted to get good-quality pharmaco-economics, and I would submit to you that they aren't.

The larger provinces were hoping that no would be no. The fact of the matter is, it isn't that no is no and yes is maybe; they are in fact providing many of the drugs that this group recommends not to provide, because they see in their own provinces that those decisions aren't withstandable from a scientific perspective and a pharmaco-economic perspective.

Yes, I think everybody wanted something, and nobody's getting what they wanted out of it, which is why the Atlantic provinces continue to have an Atlantic common drug review. They've actually come together to meet themselves, and the provinces have continued to keep their own processes going.

I don't think we're any farther ahead with CDR than we were before, and I don't think continuing to keep something going that nobody likes and nobody is getting what they want from is a good spending of $5.1 million. I would rather see—

[Bonnie Brown, Liberal, Oakville, ON]

That leads to my second question.

[The Chair, Conservative, Rob Merrifield]

Go ahead, but make it very tight.

[Bonnie Brown, Liberal, Oakville, ON]

It's about the accountability of this body created by the provinces and the federal government with a decent budget that is growing as they expand their role. It's really more our business, but are you satisfied that they are accountable to somebody?

I have this idea that if 13 people are in charge, nobody is in charge. I'm not sure the taxpayers are well-served. The federal government isn't even the biggest payer, but there's only one taxpayer and they're paying through their provincial taxes and their federal taxes for something. I'm not saying it's not a good thing--we haven't decided that yet--but I think there is a problem with accountability for the money spent.

Does anybody want to comment?

[Louise Binder]

I couldn't agree more. I completely agree with you. They report to--

[Bonnie Brown, Liberal, Oakville, ON]

Each other.

[Louise Binder]

They report to the deputy ministers of health who are their bosses and to whom they are also making reports. If we want to get into some conflict of interest questions, I think that's a fascinating one. They should be an independent body. Their bosses shouldn't be the same people they're making their reports and recommendations to.

[The Chair, Conservative, Rob Merrifield]

Does anyone else want to try that one?

Go ahead.

[David Bougher]

On the accountability question, obviously accountability flows through the deputy ministers to ministers. Ministers agreed originally, in fact supported CDR and agreed to a “no means no” recommendation. I would disagree with Louise about many drugs for which no recommendations are being accepted; I think there are some.

In terms of accountability, that's a question that goes to deputies and to ministers. You probably heard from the conference of deputy ministers about that. I can't answer that question.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

We're going to call this part of the meeting over. We have some business that we'll deal with for the committee.

I want to thank all the presenters for their presentations.

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

Mr. Chair, I believe the government has one more round.

[The Chair, Conservative, Rob Merrifield]

No, I'm sorry, Mr. Fletcher, you don't.

I want to say thank you, Janis Miyasaki, for your presentation as well. I'm sorry about losing your video, but thank you very much.

We'll call this part of the meeting over and then we have some business to discuss.

[Dr. Janis Miyasaki]

Thank you.

[The Chair, Conservative, Rob Merrifield]

We have a notice of motion from Ms. Brown that we'll talk about.