Health Committee on June 18th, 2009

[The Chair, Conservative, Joy Smith]

Ms. Murray, there are two people who want to give you some answers.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

I'll be happy to have that input once I've gone through the key things I'd like to ask.

I'm wondering about the name of the document you referred to that you thought had already identified some suggestions.

[Dr. Albert Driedger]

I don't know the document by name, but I know that major studies have been done to look at the functioning of MAPLE. But we don't have a direct, expert opinion, given in an understandable way, on the potential for MAPLE to function. We're getting mixed messages.

[The Chair, Conservative, Joy Smith]

Thank you.

Dr. Beanlands is next, and then Mr. McEwan.

I know Ms. Murray wants to hear your answers.

[Dr. Rob Beanlands]

I think the issue is really a balance between providing more supply and providing alternatives. The supply needs to be available or increased in some way. There are many initiatives being dealt with to get access to OPAL, moly-99, and so on. Dealing with MAPLE may be another solution for increasing production.

The other issue is distribution, dealing with the distribution companies to help, and working with those companies to try to make a balanced view for Canada in this time of need. So there's a lot of imbalance in the way it's being supplied in different jurisdictions. I agree that is an issue.

Having greater access to PET would also be a solution. For every patient who has a PET scan or a thallium scan, that's one less patient who needs to have a technetium scan. So all of these are solutions.

I also still think that the medium- and long-term solutions cannot be ignored in this balanced approach. We must have some medium-term solutions for new things that come along, and longer-term solutions.

[The Chair, Conservative, Joy Smith]

Mr. Trost, go ahead.

[Bradley Trost, Conservative, Saskatoon—Humboldt, SK]

Thank you, Madam Chair.

I will suggest to some of the members of the health committee who have those questions that they read transcripts from the natural resources committee. We've been covering the long-term issues and have had physicists and engineers answer some of these questions. I encourage the members to consult with other members of their parties.

My first question is to Mr. Urbain. I'm trying to understand his recommendation and the reasoning behind it.

As I understand it, you and the Canadian Association of Nuclear Medicine are arguing for putting more money into the MAPLEs and for getting them restarted. It's going to take more money for the MAPLEs, whatever we do with them, because you're going to need to work on them and do more engineering and so on. You would spend more money on the MAPLEs, which is a long-term solution, which would be great if they would work. But you're not altogether supportive of the $28 million for other research and other methods and so on. Am I interpreting that correctly? You want to spend money on the MAPLEs but not on others.

[Dr. Jean-Luc Urbain]

You were on the Standing Committee on Natural Resources, sir. I think you are misrepresenting what I'm saying.

[Bradley Trost, Conservative, Saskatoon—Humboldt, SK]

That's why I'm asking you the question, sir.

[Dr. Jean-Luc Urbain]

Yes, that's what I'm saying. You're misrepresenting what I'm saying.

The first thing is that we're not asking for more money for the MAPLEs. We're asking for clarity and transparency on the MAPLEs. The MAPLEs might never be able to be actively commissioned. We don't know. I'm not a nuclear physicist, and that's the answer I gave you last week.

We are saying that right now we have a crisis, and $28 million for a solution that might never provide anything, we find very frustrating.

[Bradley Trost, Conservative, Saskatoon—Humboldt, SK]

Mr. Urbain, I'm curious about how we could restart them without spending money.

You had said in your testimony to the natural resources committee that you were unaware of whether any international experts had been consulted. Actually, international experts have been consulted. I'm sure you've been made aware of that since you made your testimony. In fact, they were consulted and they brought back a report in 2005. I'm not sure if your association was aware of that when they made the recommendation. I think they should have been, and I think they should have done their research.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Did you read the Globe and Mail this morning?

[Bradley Trost, Conservative, Saskatoon—Humboldt, SK]

I'm not sure if Madam Bennett was at the committee.

[The Chair, Conservative, Joy Smith]

Order, please.

Let's just carry on, Mr. Trost.

[Bradley Trost, Conservative, Saskatoon—Humboldt, SK]

My next question is this. The nuclear reactors at McMaster, at the outset, could take a maximum of 18 months to get up and restarted. They've actually produced isotopes. They have a reactor at McMaster.

[The Chair, Conservative, Joy Smith]

Mr. Trost, could you direct your comments to the guests?

[Bradley Trost, Conservative, Saskatoon—Humboldt, SK]

They've actually produced moly-99 there before. They could produce in the neighbourhood of 20% of North America's supply. That's not as much as the NRU.

Why do you not think it would be prudent to spend money on something like that so that we could have a backup if the NRU went down again?

[Dr. Jean-Luc Urbain]

Mr. Trost, the first thing is that we would love to have access to the documents that have not been released by the government. That's number one, in terms of doing our own work. Yes, we do our homework.

Second--

[Bradley Trost, Conservative, Saskatoon—Humboldt, SK]

This is publicly available.

[Dr. Jean-Luc Urbain]

--you asked a question about technetium. I can guarantee you that if you develop chest pains, you'd like to have access to a diagnostic study today and not a year or two years down the road. When we have a patient coming to the ICU or CCU with an acute cardiac event or acute cardiac syndrome, ACS, we don't worry about the patient potentially developing colon cancer five years down the road. We treat the condition as it is. We need solutions today. I fully agree that we need solutions for tomorrow and the day after tomorrow. But let's worry about the acute situation today.

[Bradley Trost, Conservative, Saskatoon—Humboldt, SK]

My understanding was that, between the two committees, we were looking at the short term, the medium term, and the long term. That's where I've been going on that.

Also, I'm curious. It's been said that there's no problem with the supply of iodine-131. There are buckets of supply. I'm a little curious about that, because we had testimony at a previous committee that patients were terrorized by the thought that they might not receive their iodine-131 treatments. Dr. Lamoureux said that at a previous committee. I'm a little curious. If we have buckets of supply, why would we...?

[Dr. Sandy McEwan]

Let me be clear, the iodine provided to patients in Canada was almost entirely sourced from NRU in the past. The Canadian supplier has been sourcing radioactive iodine from other reactors. We believed that was enough, and that's what the company had told me as an individual clinician, and I'm sure Dr. Driedger had the same information. Last week we learned that there may be a problem.

The iodine that is made in Australia and South Africa is not as yet a licensed product in Canada. They hadn't gone through the regulatory process, so the special access program is being used to make that available. They have plenty of iodine. We are moving as a community as rapidly as possible through the special access program and through the ordinary regulatory process that DRAXIMAGE is doing to be able to access their supply, so there will be a recovery of supply from the normal suppliers. The special access program will be used to resolve some of the short-term issues, I understand, and I think quite soon we will have the regulatory approvals in place to enable NTP and OPAL--

[Bradley Trost, Conservative, Saskatoon—Humboldt, SK]

So there's no cause for--

[The Chair, Conservative, Joy Smith]

Thank you, Dr. McEwan.

Monsieur Dufour.

[Nicolas Dufour, Bloc, Repentigny, QC]

Thank you, Madam Chair.

I would like to thank our witnesses for coming to share their expertise with us today.

Mr. Lamoureux, to give us another viewpoint, you said earlier that there would be no treatment for thyroid cancer this week, given the shortage of iodine-131. In your opinion, what is the situation patients will be facing in the coming weeks?