Health Committee on Feb. 12th, 2008

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

You could challenge or simply express concern about the lack of notification.

[Douglas Abrams]

I think if you had been privy to the board meetings of the CSNM, the CANM, CARS, CCRS , and the ad hoc committee, you would know that it was made abundantly clear that we were very concerned about communication. One of the things we would like to implement in the future is a better communication line. One thing that was stated at the NRCan committee meeting was that there used to be representation from the nuclear medicine community on the CNSC advisory committee. I'm not sure exactly what the terms were, but we'd like to see that reinstated as one of the items. Having lines of communication from the different professional associations to the different government departments would be very helpful indeed.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Abrams.

We'll go to Mr. Fletcher.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

A point of order, Madam Chair.

[The Chair, Conservative, Joy Smith]

Your time is up, Ms. Wasylycia-Leis.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

I am just wondering if it would be appropriate for us to ask for the minutes of the board meeting that was referenced.

[The Chair, Conservative, Joy Smith]

We certainly could do that.

Dr. Abrams, would that be available to the public?

[Douglas Abrams]

I've never been asked that question before. I will go back to my board and find out.

[The Chair, Conservative, Joy Smith]

Can we look into it, and could you get back to us as a committee through the clerk's office?

[Douglas Abrams]

Indeed.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Abrams.

Thank you, Mrs. Wasylycia-Leis.

Go ahead, Mr. Fletcher.

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

Thank you, Madam Chair.

I would like to thank the witnesses for coming. We certainly appreciate your professionalism. Some people around here could learn from that.

I wonder, Dr. Abrams, if you could explain to us a little bit about the timelines. When was it that you began to see that the continued shutdown and shortage of medical isotopes was going to have an adverse effect on patient care?

[Douglas Abrams]

I think we were aware that there would be an adverse effect on patient care probably at the beginning of the week of December 10 or 11--that Monday--whatever day that was.

We started getting phone calls that week from a lot of the centres that were solely supplied by Bristol-Myers Squibb. Once we got the first phone calls, we made it part of our mandate to check with the different facilities across Alberta to find out where they stood.

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

Dr. Abrams, we, as parliamentarians, have been hearing conflicting information about the severity of the impact on patient health. We have some people who say that lives were not in danger as a result of the shortage of medical isotopes, and we have physicians who describe the situation as life-threatening. Based on your experience, I wonder if you could describe what the potential was for patient harm in December.

[Douglas Abrams]

That's a difficult question for me to answer. I'm not a physician, so it is best for me to leave the specifics of that to the physicians. But I do know, through my colleagues, that the information given by Dr. Gulenchyn , Dr. O'Brien, Dr. MacEwan, and some others we discussed it with was that essentially 10% of the nuclear medicine patient population would have been considered critical and in need of radioisotope imaging, around 40% to 50% would have been considered in need, and 40% could have been put off and done at a later date.

With respect to the direness and the health impact, that would be better answered by a physician.

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

I found Mr. Malkoske's comments interesting that planning wasn't really an issue, almost any amount of advanced planning would not necessarily have been helpful, and there weren't enough isotopes in the world to help. That's obviously a larger issue for the future, but that was the situation in which we found ourselves in December.

Dr. Abrams, in the December 13 press release the Canadian Society of Nuclear Medicine expressed pleasure and relief that Parliament, and I quote,

has taken a strong and balanced approach in assessing the risks of operating the Chalk River facility versus the risk to Canadians of not having access to essential medical diagnostic and therapeutic services.

I'd like to thank you for those words.

In your opinion, what would have been the outcome if Parliament had not passed legislation to reopen the Chalk River reactor and resume supply of the much-needed medical isotopes?

[Douglas Abrams]

We would have seen a continued decline in services throughout Canada in the areas that could not be supplied by alternate suppliers. So everywhere in Canada that was supplied solely by Bristol-Myers Squibb would have been cut back to the levels they were able to get through Bristol-Myers Squibb, the increased supply from Europe, and what Nordion could obtain. That would have levelled off to a certain amount until the reactor was back online.

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

So people would have been denied potential life-saving diagnostic services.

[Douglas Abrams]

Definitely.

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

If Parliament hadn't acted, the reactor could be still shut down to this day. People would have died.

[Douglas Abrams]

As I said, I don't know if I can restate the dire consequences of death, but I can certainly go back to what Dr. O'Brien said, and he felt unequivocally that was the case.

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

I know you're not a doctor, but do you agree, support, or understand that people would be dead now if Parliament had not acted?

[Douglas Abrams]

I can't answer that one way or the other. It's a very complicated answer to that question, and take this from me in my current position. Most of the nuclear medicine tests are diagnostic in nature. They inform physicians what they need to do to give the best care possible for that patient. If they do not get the best diagnostic care, they may not get the best therapeutic care, and if they don't get the best therapeutic care, then what happens is up to fate.

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

So based on a balance of probabilities, people would certainly not be here at present, or would soon not be here, if we had not taken action.

Those are my questions, Madam Chair.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Fletcher.

We'll now go to the second round, keeping in mind that the minister will arrive at 12:15. At that time we will suspend the round and go to our first round of questioning for the minister.

First is Dr. Bennett, for five minutes, please.