Thank you very much.
Madam Chair, honourable members of the committee, on behalf of the Canadian Association of Nuclear Medicine (CANM), I would like to thank all of you for giving us the opportunity to appear in front of your committee.
The Canadian Association of Nuclear Medicine was founded in 1971. The CANM is the national voice of nuclear medicine physicians across Canada and the two million patients that they serve every year.
Since the first dramatic shutdown of the NRU reactor in December of 2007, the Canadian Association of Nuclear Medicine has worked relentlessly on the ad hoc health experts working group constituted by the Ministry of Health to mitigate the effect of the isotope shortage on the well-being of Canadians.
In May of 2008, the ad hoc health experts working group on medical isotopes published and submitted to the Ministry of Health a report detailing the lessons learned from the December 2007 shutdown of the NRU reactor. In that report, the working group emphasized the need to: ensure efficient and effective communications with the medical community and the public; in decision-making, ensure a balance between the health and safety of the public and the health outcomes of individual patients; assure appropriate physician participation and input into the decision-making process; and establish a clear and appropriate alignment of authority and accountability for the management of medical radioisotope supplies.
Among other recommendations, our working group proposed that the Government of Canada: secure a "made in Canada" solution for the supply of isotopes, particularly molybdenum and technetium 99m by expeditiously commissioning the MAPLE 1 and 2 reactors; work with its international partners to review global capacity to produce medical isotopes, encourage the development of international protocols and remove current barriers or obstacles to international movement of radio isotopes during periods of shortages; actively engage in developing and approving other medical isotope technologies, such as positron emission tomography.
On May 16, 2008, and while we were finalizing our report in open consultation with Health Canada, the federal government made the unilateral decision and announcement to abandon the MAPLE 1 and 2 reactors project. Since May 2008, the medical community has gone through five or six isotope shortages.
Upon the May 18 announcement that the NRU reactor had to be shutdown again, this time for one month due to a leak—and we now know that it will be for at least three months—the CANM expressed major concerns regarding the ability of its members to deliver 21st century medicine to Canadians.
Over the past four weeks, our community has maximized and overstretched the use of personnel and equipment resources to service patients with totally unpredictable and unreliable supplies of technetium. We have cancelled on-call service to spare the technetium that we had and have turned toward the less desirable thallium isotope to perform cardiac stress tests. Pediatric patients have been given priority for technetium imaging tests when available.
Positron emission tomography, also called PET, as mentioned before, uses medical isotopes that characterize extremely well the physiology and pathophysiology of the human body, such as cardiac diseases, most cancers, and neurological conditions like Alzheimer's disease. Most of the nuclear medicine tests performed on cancer patients with technetium-99m can be replaced with PET procedures. The absence of availability of the PET technology and isotopes throughout Canada severely impact our ability to diagnose and offer expedited treatment to our cancer patients.
Our community is very confused and frustrated by the recent announcement from the Ministry of Health to allocate a total of $28 million for research projects aiming, at least in part, at developing methods to produce technetium with alternative technologies that, to our best understanding, have failed in other parts of the world. In the best-case scenario, these methods would not yield any results for at least three to five years. Based on the cancer registry throughout Canada, we estimate that Canada needs about 125,000 PET studies per year for cancer patients. With $28 million, one could perform about 28,000 of those PET studies and provide adequate diagnosis and treatment today and over the next three to four months to cancer patients across Canada, while securing a reliable source of technetium.
So we are very confused. Patients across Canada need solutions today, not five years down the road. The Canadian Association of Nuclear Medicine would like to recommend that this committee and the government urgently consider the following aspects.
One, the decision to abandon MAPLE 1 and MAPLE 2 should be immediately and thoroughly revisited by an international experts panel.
Two, the federal government, through Health Canada, should expeditiously approve the use of positron-emitting isotopes and their radiopharmaceuticals. This is based on preclinical and clinical trials performed in Europe and the United States over the past 20 years and the criteria established by the United States and the European Union regulatory agencies.
Third, we'd like to recommend that for a period of five years the federal government work with the provinces and territories to support and subsidize the recent increased cost of technetium-99m and the cost of deployment of the PET technology.
Fourth, the Ministry of Natural Resources and Health Canada should work formally and expeditiously with their international counterparts to secure a reliable and affordable supply of technetium-99m until the NRU is restarted or the MAPLEs are commissioned.
Fifth, the Ministry of Natural Resources and Health Canada should clearly define the processes by which they're engaging the relevant medical organizations, and the Ministry of Health should define the mandate of the special advisor that was just appointed.
The CANM strongly believes that the current challenges still represent a unique opportunity for Canada to salvage its nuclear industry and to reaffirm its leadership and prominence in the world. It's also an opportunity to update the Canadian health care system with the 21st century nuclear medicine diagnostic and therapeutic tools that Canadians deserve.
The Canadian Association of Nuclear Medicine would like to reiterate once again its offer to provide its ongoing support, experience, expertise, and testimony to achieve these goals.
Thank you very much.