Health Committee on June 18th, 2009

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

Seeing that they don't have bone scans now and are going to have to have PET scans instead, this is a very different thing, and as you know, you can only do 10 PET scans where you could do 40 bone scans. Do you think the federal government should pay for the wildly increased cost of this, in terms of both transportation and isotopes, seeing that it's a mistake they made?

[Dr. Sandy McEwan]

Madam Chair, perhaps I could just go into the mechanism of producing a bone scan. A bone scan is produced on a gamma camera; a bone scan with fluoride is produced on a PET camera. A gamma camera doing bone scans all day would not be able to do more than 10, maybe 12 bone scans in a day. A PET scanner with current technology can do something between 10 to 15 scans in a day--that's with modern technology scanners. Therefore, a department that is doing 40 to 50 bone scans a day would have typically five scanners dedicated to bone scans. It would then have scanners dedicated to all the other work and the cardiac work.

I'm not aware of any centre in Canada that is capable of doing 50 bone scans a day. Certainly we do bone scans flat out, and we do 15 to 20 cancer patients a day on two cameras.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. McEwan.

Monsieur Malo.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you very much, Madam Chair.

As you know, the MAPLE reactors were designed to replace the old NRU reactor that is near the end of its life. That meant that we needed a reliable source for the production of radioactive isotopes.

When the government decided to put an end to the MAPLE project, it did not invest a penny in trying to find other ways of producing isotopes.

And today, Dr. McEwan, you are rejoicing about the $6 million provided to find a long-term solution. It seems to me that we are a bit late in trying to find solutions. What I hear is physicians in the trenches telling us that they have to manage this situation on a day-to-day basis.

What will this money, which you were so pleased to announce today, do to stop these physicians from having to manage this situation, which is so worrisome for the patients, on a day-to-day basis?

I heard Dr. Urbain mention this. It was a very interesting comment. The physicians have come to the end of their rope. The health care specialists, the nurses, the entire staff, they have all come to the end of their rope.

What answer do you have for those people today? I do not think I found the answer to these questions in your presentation.

[The Chair, Conservative, Joy Smith]

Dr. McEwan.

[Dr. Sandy McEwan]

Madam Chair, I am not trying to minimize the problems we face in the very short term. I agree that we have issues in supply. I do believe, however, it wouldn't be responsible to not look at resolving the medium term as well, and I believe this is one way of addressing that.

In terms of addressing the short term, I believe the conversations yesterday, as I mentioned, between the producers are leading to international collaborations. There is approval for molybdenum from Australia. Their program is ramping up, and they will soon become a significant supplier to the Canadian market. I do know that there are conversations with NTP on expanding their submission of medical isotopes to those suppliers of the Canadian market. I believe those are very important initiatives that will ensure that they will be an element of short-term reaction.

The toolkit that we put out from the working group is I think an important guide to hospitals. Where it is possible--for example, this has happened in B.C. and Alberta, where I have my clinical base and where I see my patients--we have worked out mechanisms to ensure sharing, to ensure that the central radiopharmacy can, for example, make available spent generators to sites that don't need such large volumes of molybdenum.

I believe we have opportunities to learn from what we've done in Alberta and to offer suggestions to the other provinces. We certainly have opportunities in Alberta. I would be grateful to hear...and I have already spoken to some of my colleagues in Ontario on how they've been dealing with it.

I'm not minimizing the short term. I'm not minimizing the need for our patients now. What I am saying is that if we don't start addressing the medium term now, then in 18 months, when I come back and see you, you'll be asking me the same question. I would like to be able to say that we started those activities now.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. McEwan.

You have a few more minutes.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Madam Chair, I would also like to hear from doctors who work with patients on a daily basis about what Dr. McEwan just told us.

[Dr. Jean-Luc Urbain]

The first thing I would like to comment on is the percentage that you mentioned, Ms. Bennett, the 10 PET scans as opposed to the 40 bone scans. You have to understand that the difference between the number of PET scanners and the number of bone scanners is less than 10%. That means that we do not have the positron capacity to carry out these bone scans.

The second thing concerns what you said about the untenable situation on the ground. Technicians are working 16-hour days and so are secretaries. In the medium and long term, they simply cannot keep up that pace.

I should also point out that isotopes are rather like ice cubes in the sun: they must be used when the sun is not out. That means that we have to use them as soon as we have them, and then they are gone. So often, practically speaking, a week's worth of work is compressed into two or three days.

We need solutions now. I agree with Dr. McEwan that we need medium- and long-term solutions. But the best medium- and long-term solution is to receive an official response about the MAPLE reactors as soon as possible.

[The Chair, Conservative, Joy Smith]

You have another two minutes, Mr. Malo.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

I believe Dr. Ruddy wishes to speak.

[The Chair, Conservative, Joy Smith]

Dr. Ruddy, go ahead.

[Dr. Terrence Ruddy]

I think you have to realize that there's going to be technetium during the shortage. It isn't zero; it's a reduction. Right now we're reduced to about 75%. We're okay, because we're using thallium, which is sparing some of the need. We'll go down to about 40%, or something in that ballpark, and we'll have problems at the end of July or the beginning of August. Then, at some point, the Petten reactor will come back on and we'll go back up to 75%.

So we have two weeks, four weeks, where there's a problem. Sandy McEwan's solution with the PET will help. We'll be able to handle the 40% to some degree. Patients will be postponed a bit, but I think that will be okay. The patients who desperately need their bone scans will get their bone scans.

So it isn't a crisis; it's a problem. The crisis is that this is a recurrent problem. We need a long-term solution. Either the MAPLEs get turned on--that would be a good long-term solution--or we get into PET in a big way and build PET centres at another 10 or 20 sites, which is more money. We could take the operating costs now for SPECT cameras and move them into PET so that the financial hit wouldn't be that hard. We'd actually end up with a better clinical solution for our patients. We'd end up with PET across the country. That would be tremendous. We'd still have technetium in there so that we'd have some cheap scans, which would be used for screening scans, but for the ones where we need real diagnosis, we would do PET.

So think of this as a five-year problem. I think if we weather the storm, we'll be okay. But we have to fix things so that in one or two years from now we'll have PET cameras up in Nunavut, maybe, I don't know. But it will be that kind of situation.

We need, I think, to move ahead with solutions, not just band-aids.

[The Chair, Conservative, Joy Smith]

Thank you.

Ms. Wasylycia-Leis.

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

Thank you, Madam Chairperson.

Thank you very much for being here. I know you've had a lot of requests to appear before different committees, and it's taking you away from time you need to spend sorting out this problem. Hopefully out of today I think we have to get some recommendations that this committee can take to the government before we recess tomorrow at two in the afternoon. Otherwise the summer will come and go and we won't have come any closer to the solution.

I want to start with you, Dr. Urbain. You've mentioned several recommendations. You suggested that regarding the $28 million recently announced to go into researching alternatives, there were already international studies showing that these alternatives are really not effective anyway. So you're suggesting that $28 million be put instead into meeting the demand for about 100,000-plus PET scans in this country. Is that what you're saying?

[Dr. Jean-Luc Urbain]

The first thing I'd like to clarify is that Japan has tried to produce technetium with a linear accelerator and it hasn't worked. Producing technetium with a cyclotron is not very efficient. We know that has been done in Europe too. So I would encourage the government to look at those studies that have already been published.

The second thing is that for that $28 million--$6 million was announced yesterday, and I think it was $22 million announced for McMaster--doing the math, we believe, based on some statistics we looked at two or three years ago in the Cancer Registry, that Canadians need about 125,000 PET scans a year. At $1,000 per PET scan, we could provide about 28,000 of these over the next three to four months. Hopefully in the next three to four months the technetium situation will be stabilized. The other aspect to it is that--let's face it--a bone scan is a wonderful tool, but it's not enough when we take care of patients. Why not take advantage of this crisis and deploy a diagnostic tool that is critical for the diagnosis, treatment, and follow-up of patients with cancer?

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

Further to that, I think it's important to note that all of this money, which adds up to $56 million, is not new money. It's coming from somewhere, presumably from other priorities within Health Canada.

Perhaps, Dr. Driedger, I could ask you for your assessment of this money going into these areas versus priorities as you see them.

[Dr. Albert Driedger]

Madam Chair, I don't really know enough about the details of what was in the grants to comment. I have read some background documentation that suggests that in three to five years we might have a model for cyclotron-produced isotopes, but I think it would still take some years beyond that for a stable robust production mechanism. I stand to be corrected if others have tighter facts at hand.

The $22 million is a grant that's given to McMaster University. The refurbishing of their nuclear reactor was mentioned. That's a reactor that, as I recall, has a maximum power output of five megawatts, which is 50% of the output that the MAPLEs are rated to produce. If McMaster can do it, maybe there's a way of doing it with MAPLE too.

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

Would there be some agreement that this committee should recommend to the Government of Canada that an independent expert international committee be set up immediately to study whether or not MAPLE 1 and MAPLE 2 could be up and running as soon as possible?

[Dr. Jean-Luc Urbain]

Both Dr. Driedger and Dr. Lamoureux are on the board of the Canadian Association of Nuclear Medicine. The document that you have seen today--and we have also presented something similar to the NRCan--has been approved by the board of the Canadian Association of Nuclear Medicine. We will stand by what we put in writing.

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

Go ahead, Dr. Driedger.

[Dr. Albert Driedger]

Madam Chair, I suspect the documentation already exists. We just need to find it, read it, and be comforted by it in some way. I would be pleased to see what is forthcoming.

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

Could I go on to another area, and if anybody wants to jump in on this question--

[The Chair, Conservative, Joy Smith]

Yes, Ms. Davidson.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

A point of order for a moment. I'm wondering what document Dr. Urbain was referring to that we've seen. I don't have any document.