Health Committee on March 11th, 2008

[Some hon. members]

Oh, oh!

[The Chair, Conservative, Joy Smith]

All of your hands went up, but go ahead, Ms. Hyland.

[Sylvia Hyland]

I want to respond that health care is a little behind in utilizing technology, but there are efforts under way to implement computerized order entry systems, recognizing that there are problems with handwritten notes. There are also initiatives under way with manufacturers to look at voluntary bar coding standards, so that bar coding technology can be utilized in health care where appropriate. This is also an opportunity to look at the labelling of products, as there are a lot of products that do not have bar codes on them. This is an opportunity for improvement.

The other thing we have done, and which is being adopted, or being considered for adoption, in the accrediting standards for hospitals, is...the use of dangerous abbreviations. We recognize that there are abbreviations that are dangerous if used in the handwritten form, and in the electronic form. Those can be avoided.

Also, I do believe that when a prescription is handwritten, the patient should be able to read that prescription; it should be legible and not be in Latin. That is a safety thing, as well, for the pharmacist. As a pharmacist, I would like to be able to read the prescription.

I just wanted to comment on that.

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

The government has $1 billion in Infoway; in fact, it added $400 million in the second to last budget. It would seem to be a natural vehicle to help with what we're talking about here today.

What have your experiences been with Infoway thus far?

[Diane Brideau-Laughlin]

Within my province of New Brunswick, we're currently at the level where all of our health regions will soon be tied in through these electronic health records, which makes us extremely happy. We are looking at moving outside of just the institutions and including physicians' offices and pharmacies, so that everybody will be able to share the information.

There is concern, of course, about patient confidentiality and information confidentiality, but we also recognize that the people who should have access to this information are professionals who should, under the auspices of their professions, be able to use this information in an appropriate fashion.

It would be a huge step in providing better sharing of information.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Laughlin, and thank you, Mr. Fletcher.

If you don't mind, I would just like to ask a question as chair of the committee. There's one aspect I was just wondering about. When we're talking about drugs, I know that drugs for something like chemotherapy are very expensive; usually you're prescribed four, five, or six drugs, depending on the level of chemo. And sometimes those drugs don't work.

Have there been any answers as to who picks up the cost of those medicines that absolutely do not work? If you're experimenting, whether it's with cancer or another disease that is very dependent on the medication, has there been any examination of that in the medical world?

A doctor could prescribe a pill and really do the best he or she can in doing that, and they might spend a lot of money on that bottle of pills, but they might find out after you've taken one pill that, oops, we have to go to another one. Has there been any examination of that kind of predicament that patients get into?

[Dr. Yola Moride]

That's the daily job of the provincial reimbursement agencies; that's exactly what they do. They weigh the benefits and the risk of a drug. Part of the benefit, of course, is that if a drug doesn't work and is extremely expensive or very risky, they won't pay for it—or they will introduce restrictions on the payments.

[Dr. William Hryniuk]

The problem, however, in that situation comes when the funding agency—in this case, the provincial government—won't even fund the drug from the beginning for anybody. What has been proposed—

[The Chair, Conservative, Joy Smith]

I think you misunderstood my question. My question was about approved drugs, drugs that are given out, but the person then has to change their medication.

[Dr. William Hryniuk]

There is at least one example that I'm aware of where the company has come to an agreement with the funding agency that if the drug doesn't work in the first few cycles, no charge will be forwarded by the company to the agency. If the drug does work, then the agency will pay for the drug.

For these expensive cancer drugs, that may be one mechanism we should pursue.

[Dr. James Gowing]

I think you were asking about leftover drugs.

[The Chair, Conservative, Joy Smith]

That's right.

[Dr. James Gowing]

That's a real problem, and everybody deals with that differently. In the clinic that I'm in, we thrive on the leftover drugs, to use them on patients who otherwise wouldn't get them. So if a drug isn't working, we'll keep it in the refrigerator and give it to someone who needs it.

[The Chair, Conservative, Joy Smith]

Very good. Thank you so much.

Ms. Kadis.

[Susan Kadis, Liberal, Thornhill, ON]

Thank you, Madam Chair.

To our witnesses, in your experience, how serious a problem do you feel adverse drug reactions are in terms of the health and well-being of Canadians? How much are you seeing in your respective areas and organizations, and how much do you feel falls through the cracks?

[Dr. William Hryniuk]

In cancer medicine, the disease we're treating is so serious and the drugs themselves have enough side effects that we know of that the patients are willing to put up with this. So the issue of adverse effects in oncology drugs is not the pressing problem that it might be with more widely used drugs and other diseases.

That said, the most adverse effect is the failure of the drug to work, and that's the one we're concerned with here today, given the expense of these drugs.

[Susan Kadis, Liberal, Thornhill, ON]

So you have a different threshold and a different context.

[Dr. William Hryniuk]

Yes.

[Susan Kadis, Liberal, Thornhill, ON]

Thank you.

[Diane Brideau-Laughlin]

My answer to your question is that we all think it's very important and that there is definitely a problem. And yes, we're not reporting everything that needs to be reported, and that is also a problem. But it's such a wide spectrum, as indicated by the oncologists in the room. When you're dealing with oncology, it's completely different from dealing with a drug that's being used for blood pressure control, for instance, where your tolerance for adverse events is going to be minimal to nil.

So again it boils down to what is significant. Unfortunately for the individual who's being cared for, “significant” is what is happening to that person.

[Sylvia Hyland]

I thought of a quick addition. In answer, yes, there is a serious problem, and we use a fair number of drugs in this country. We do have a privileged health care system, but we also have access to a lot of drugs. I think one of the interesting areas that isn't yet accessible is usage, really being aware of how many drugs are used and to what extent. If one day we can also have transparent information on the usage of drugs, that would help put a lot of things in perspective in terms of the number of adverse events and the usage of drugs in this country.

[Dr. Yola Moride]

In my opinion, adverse drug reaction is a real public health issue. We're talking populations. Even though a drug may have a small risk, if you have 10% of the population exposed, it's going to result in a very large absolute number of cases.

Eventually the serious effects will be picked up by the pharmaco-vigilance. My problem here is that it's not timely enough. If additional measures could be introduced right at the time of marketing, the adverse effects could be picked up sooner.

[Susan Kadis, Liberal, Thornhill, ON]

Also, do you feel that the public has sufficient access to forums to enable or allow them to report their experiences with drugs? Clearly, we're talking about communication being a major issue here.

[Sylvia Hyland]

That's a good question. Overall, there isn't great awareness amongst the public of the fact that they can report adverse reactions to drugs they are taking. I do believe that is one of Health Canada's post-marketing surveillance strategies: to increase education to the public, to let them know that they themselves can report adverse effects that they experience with a drug.

[Susan Kadis, Liberal, Thornhill, ON]

Thank you, Madam Chair.