Ms. Wasylycia-Leis.
Evidence of meeting #28 for Health in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was pet.
A recording is available from Parliament.
Evidence of meeting #28 for Health in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was pet.
A recording is available from Parliament.
5 p.m.
NDP
5 p.m.
Conservative
5 p.m.
Director, National Cardiac PET Centre, Chief of Cardiac Imaging, University of Ottawa Heart Institute
It was only to add that I think TRIUMF is an excellent institution, and we have a lot of confidence in their ability as a group to develop alternatives. I can't comment on the photofission method itself, but I do think that is a long-term solution that we should definitely be investigating and considering investment in. I absolutely agree with the comments about PET, and that making PET more widely available in Canada will only serve to help our patients.
You asked about alternatives. We heard about the sodium fluoride. If I could come back to a comment made by I think Madam McLeod on the ability to monitor and evaluate--which should also come with this issue with TRIUMF turning on and off--we need a better way to actually look at who is using what. Doing a survey from the Canadian Association of Nuclear Medicine is one way to do it, but really I think that one thing the government can do is look at better ways of monitoring the use of the tracers than the ones we've had. I don't know for sure, but does Health Canada have resources to do this? Are there resources available now that could use more sophisticated means to monitor this and look at the distribution, and really look at access for all Canadians?
5 p.m.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
Thank you very much, Madam Chair.
I'd like to go back to my earlier question about cancer and ask something to Dr. Driedger, who I believe is an expert in thyroid cancer. Someone just said there was evidence suggesting we're rolling in iodine-131. Is that true, or are you facing any kind of shortage to deal with thyroid cancer?
5 p.m.
Emeritus Professor, University of Western Ontario
To repeat something of what I said earlier, I was assured a very short time ago—last week, I think—that there would be no shortage of I-131. In the last two days, I've been hearing that there is a shortage this week, and you've been hearing that this is true. I have had a number of e-mails from patients who are concerned and want to know the situation. It appears from what Dr. McEwan has said that this is a hiccup in the system that will iron itself out, and that we'll be okay overall in terms of iodine.
The advantage of iodine over technetium is that it has a longer half-life. You can stockpile it in a small way, and you can ship it longer distances with less loss. So we should be okay, I think.
5:05 p.m.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
But you do need isotopes for the diagnosis and treatment of thyroid cancer?
5:05 p.m.
Emeritus Professor, University of Western Ontario
Yes, and I-131 is one of those isotopes. Technetium is also helpful at certain times.
5:05 p.m.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
Overall, would you say the number of people who absolutely have to have isotopes for diagnosis and treatment of any cancer or heart disease exceeds the number of isotopes available?
5:05 p.m.
Emeritus Professor, University of Western Ontario
I'd have to break that down into separate parts.
For radioiodine therapy of thyroid cancer and for benign thyroid conditions, I think there will be enough, because these are not conditions that routinely present as emergencies or even as urgent. Much of our use of isotopes is as adjuvant therapy for these patients. If we come to dealing with neuroendocrine tumours, it can be another story, and for the diagnostic side, as you've been hearing, it can be, and probably is right now, at the level of a crisis.
5:05 p.m.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
We were told a year and a half ago, when we had a 20-day stoppage of isotope production, that unless we acted immediately and put aside concerns about nuclear safety, it was a life and death situation. Now we have a much longer period of time. Are we in a life and death situation?
5:05 p.m.
Emeritus Professor, University of Western Ontario
I'd like to address that from the point of view of what we call the ALARA principle. The International Commission on Radiological Protection has written since 1928 the document on which all countries in the world base their radiation safety practices. The ALARA principle says that we should keep radiation doses to people as low as reasonably achievable. Most people stop there. But in the document there is actually a comma, and it then says, “social and economic factors being taken into account”.
I was out of the country 18 months ago, but it seems to me that the issue of social and economic conditions was taken into account in what was done. Similarly, I think if we look at the operability at any power level of the MAPLES, we need to address ALARA, taking social and economic conditions into account.
5:05 p.m.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
Does anyone else want to address that question of how critical the situation is without some immediate movement on the part of the government?
And while you're at it, could the respond to the following. The government—or at least the Minister of Natural Resources—announced on May 28, in the middle of this crisis, an expert review panel to find long-term solutions for isotope supply. I've never heard of such a committee ever being struck. Have you?
5:05 p.m.
President, Canadian Association of Nuclear Medicine
No, I haven't heard of that before. That said, it's a good initiative and we hope we will be consulted on it.
5:05 p.m.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
On the question of the crisis we're faced with right now and how we can get around it, if we were to make a recommendation to the government to take the $28 million now allocated for research on alternatives and put it toward developing or increasing PET equipment, would that be...? Are there any other alternatives we should look at as part of that?
In particular, Dr. Lamoureux, what do we do in the case of Quebec, which apparently already has a sufficient supply of PET scanners?
5:05 p.m.
President, Quebec Association of Nuclear Medicine Specialists
I think in our country we must give each province a percentage of the amount of money they have a right to receive. But the deployment of PET scanners we now have in Quebec is not enough; it's just a first step. We've already used that money instead of putting it in a different field. We have used it for PET, because it was a very important thing to do for the patients. It was in fact the orientation of the Canadian Association of Nuclear Medicine. So we have already applied the money owed by the province, in fact.
We need PET in remote areas, just as we have it in the central areas. People who are in the north must have the same kind of access and the same quality of medicine. The surgeon who does surgery for cancer must also have for his patient the same access to the same quality. So PET must not be concentrated in the university hospitals or big centres, but all over the country.
5:05 p.m.
Conservative
5:05 p.m.
Conservative
Patricia Davidson Conservative Sarnia—Lambton, ON
Thanks, Madam Chair.
I'd also like to echo my colleagues' thanks to each and every one of you for being here today. I know this is a very, very busy and stressful time for all of you while you are trying to deal with this situation as well.
What I've been hearing this afternoon, I think, has been very encouraging, from the fact that information is flowing. I think everybody has talked about a short-, medium-, and long-term plan. I think that's extremely critical.
The issue we're facing here today at the health committee, I agree, is the short-term plan. But the short-term plan is not going to be effective if we don't have the medium- and the long-term plans to follow it up.
I think we have a tremendous amount of expertise sitting here in front of us, and I have really enjoyed hearing what you've had to say. I think we've learned a lot here today.
I want to ask a question. I'll start with Dr. McEwan and maybe then go down the row.
If there were three things you thought we should be doing as a health committee towards making recommendations, what would your top three be to move forward in the short term?
5:10 p.m.
Medical Advisor to the Minister of Health, As an Individual
Madam Chair, my suggestions for that would be as follows. I think the first is that there is a mechanism to facilitate the current activities. These are working. I believe they're working relatively well. I'm sure there can be some improvements. I think that's the first thing: the ad hoc working group really is the key player in that.
The second element is to develop a mechanism or to again facilitate the type of communication that we've talked about across the country so that it's much clearer where the black spots are and where the areas are that are working well. There are things to be learned from that and I think it would help us understand.
The final thing is, in the very short term, the critical role of Health Canada as the regulator in facilitating access to medical isotopes from non-traditional suppliers. We talked about the radioactive iodine, and I believe that is one example of how we can do that.
Madam Chair, perhaps I could just have your indulgence for one second. The manufacturer of the cyclotrons that go into the hospitals is not TRIUMF. It's a company in Vancouver called Advanced Cyclotron Systems, which uses TRIUMF technology.
5:10 p.m.
Professor, Medicine and Radiology, Chief of Radiology, Director of Nuclear Cardiology, University of Ottawa Heart Institute
I think the answer is more PET. Right now we're at about 75% of the technetium that we had, say, a year ago. We're able to cope with that because we switched cardiac studies from technetium to thallium, so at 75% we're holding our own.
Thallium is not as good as technetium. There's more radiation for the patient. If we had more PET, we could do more cardiac PET. That would be desirable. If we're going to go down to something like 40% at the end of July, at the beginning of August, that's when it's going to be bad, and the problem will be bone scans. If we could do the PET bone scans in a larger number of patients, we'd save whatever technetium we have. That would be a good short-term solution--more PET times one month, two months. It's like Dr. Lamoureux said: $28 million going to that would be a good short-term solution. We have a lot of PET scans.
Dr. McEwan and others have to figure out how to spread that around. So we have to sort that out, and this would be part of the cost. That would be the short-term solution. Then, at the same time, I'd still think of the intermediate solution, which again would be more PET. I see more PET centres across Canada, either remote or you have these vehicles that carry the PET camera around.
5:10 p.m.
Professor, Medicine and Radiology, Chief of Radiology, Director of Nuclear Cardiology, University of Ottawa Heart Institute
Yes, PET can be mobile. It's an 18-wheeler, and they use it in the U.S. a lot right now. One state will have three or four PET cameras that move around to little places like Peterborough.