Health Committee on June 18th, 2009

[Dr. Rob Beanlands]

As Dr. McEwan mentioned, I think we should continue to invest in the initiatives that have already begun--the committee that Dr. McEwan has been referring to--and continue this in a balanced approached. I think we should be looking at the short, medium, and long term, really keeping all three balls up in the air. I think this has to continue.

I would agree that increasing the accessibility and availability of PET imaging would also be a priority. I think we also need better ways to be actually monitoring the usage and the distribution throughout the country, as was brought up earlier.

Thank you.

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

Dr. Lamoureux.

[Dr. François Lamoureux]

Patient must absolutely be able to trust again, and deploying PET technology is the most meaningful thing to do.

As for mobile PET units, it is absolutely a mistake to try them. They rejected them in France, the country with the most experience with PET. Quebec rejected them. It is a denial of service for those with the equipment. To those who promote them and who are so convinced of their merits, we suggest offering them a mobile PET unit to replace the one in their hospital.

In hospitals, stable magnetic resonance equipment is installed because we cannot know in advance when the tests will take place. These tests have to be programmed on a daily basis. In those conditions, a mobile PET scanner is no use; it is a waste of money. This approach was rejected because it costs too much to maintain the tractor, the motor. In France, they completely rejected it. Canada would do better to look at what is being done in France or in Belgium, because those are the countries with the most expertise.

[The Chair, Conservative, Joy Smith]

I know we're quite over time. We're so interested in what you have to say. But Dr. Urbain, could you comment?

[Dr. Jean-Luc Urbain]

Yes, there are three things. The first thing is that I'd like to put emphasis on the fact that the current Health Canada regulation for approving radiopharmaceuticals, which are considered as pharmaceuticals, is totally outdated and we need to expedite the approval of radiopharmaceuticals based on international standards, not on the Canadian standard.

The second thing is positron emission tomography is a must have, particularly for oncology patients.

The third thing is that I would definitely encourage everybody to talk to medical organizations, rather than to individuals.

[The Chair, Conservative, Joy Smith]

Dr. Driedger, do you have some comments?

[Dr. Albert Driedger]

Yes, thank you, Madam Chair.

I agree with the summary statements of the last few moments that we need to have a comprehensive plan for the short term and the longer term.

While I'm always in favour of research and development, and while I am hesitant to criticize what is being funded this week--because I haven't seen the fine print--with regard to the McMaster reactor, we should note that we are using a 50-year-old reactor to back up a 52-year-old reactor. The wisdom of that leaves me a little bit in doubt.

[The Chair, Conservative, Joy Smith]

Mr. Uppal.

[Tim Uppal, Conservative, Edmonton—Sherwood Park, AB]

Thank you, Madam Chair.

Thank you all for your summaries, and thank you for coming.

First of all, obviously the government recognizes the serious and challenging nature of this global medical isotope shortage. Really, even the previous government was aware of the challenges as far back as 2003, so this has been going on for a while.

I'm curious, Mr. McEwan. How are we working with other countries to deal with this global situation, and how do we compare with other countries?

[Dr. Sandy McEwan]

I've made reference to the meeting that the society facilitated between a number of different countries and medical and nuclear medicine organizations.

We are actually coping better than most and not as well as some. There is no doubt that there are a number of issues, particularly on information-sharing, where we can improve. There is no doubt about that. Clearly, and I have stated this several times, I see that as an important part of my role. I have worked with Jean-Luc and Al for many, many years. We know each other well and we are able to communicate and share ideas, and I think it's very important that the linkages within the working group--which, remember, also has oncologists, cardiologists, and access to the CMA--continue, because that's one way of ensuring that happens.

If we look at the way in which other countries have dealt particularly with problems of radioactive iodine supply, we have probably handled that better than most. As Dr. Driedger and I have both said, this short-term blip really has come at us out of left field, because the company that supplies it had assured us in the community that everything was going to be fine.

The final area where I think we are seeing real progress, real advantage, is in the way in which Health Canada over the past little while has been addressing the regulatory issues for the radiopharmaceuticals that we can use as replacements, or, more importantly, for the medical isotopes that are coming from other sources. Approvals have been quick, they've been comprehensive, and they have been facilitative and interactive.

[Tim Uppal, Conservative, Edmonton—Sherwood Park, AB]

I know you've only been on the job for a couple of days, but would part of your mandate be to help facilitate that communication that you're talking about, where that has been lacking?

[Dr. Sandy McEwan]

I would hope that both the minister and the community would see that as a really important part of my role. I clearly see it as that, and as I indicated earlier, I have already started having conversations with colleagues in Ontario so that I can really understand the issues in Ontario. Ontario and Quebec are different from Alberta and B.C. They have small communities where they don't have access to central radiopharmacies, so I need to understand those issues very well. And I'm delighted with the conversations I've had so far.

[Tim Uppal, Conservative, Edmonton—Sherwood Park, AB]

Dr. Beanlands, can you indicate how we're doing globally compared to other countries?

[Dr. Rob Beanlands]

In terms of the cardiac field, at the recent Society of Nuclear Medicine meeting, certainly there were comments made about how—at least in the cardiac imaging realm—we've been able to manage this both at the Ottawa Heart Institute but also nationally, in terms of being able to switch over to thallium. Many American centres haven't used thallium for a long time and they're looking to us for guidance in terms of how to make that switchover in their departments. So we've been an example that we should be proud of.

It's an example of how we as a community have been able to work together to try to solve some of these problems. Certainly, with Dr. McEwan's leadership, we look forward to solving a lot of these problems as we go forward. Nuclear medicine is certainly an important community, but there are also cardiology patients and oncology patients who are being affected. These specialties also need to be engaged in the process, and I'm pleased to hear that this will be happening.

[The Chair, Conservative, Joy Smith]

We do have a few more minutes.

I've had two requests. I'm going to keep the time really close. I'm going to say one minute for the question and one minute for the answer, if that's okay.

Dr. Bennett, and then Dr. Carrie.

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

It's just a request for Dr. McEwan. Obviously, here in Ontario we have 95% of our supply coming from Chalk River usually and we have no PETs. From the Ministry of Health in Ontario we need them to come clean on real timeliness in supply. We don't get info from the feds, so we had to call the supplier directly. I think your job is very clear in terms of letting people know what's available, how it's coming, and whatever.

Yesterday, I asked the minister if she would be able to table with the committee the source and supply of all 245 sites, the alternatives that would be available to those sites, and the capacity of those sites to help somewhere else, or as you were able to do for Saskatchewan. If we could get this mapped, as Cathy has suggested.... We need to really encourage the government to come up with some money, because that's the other thing that Ontario is very clear about. In terms of incentives to be moving towards PET scanning, it would be very important for the community and for the people of Canada. As Allan Rock once said, “Geography is no excuse for inequality.” If we could see if there could be incentives put in place to move to PET that would be both short and long term, perhaps you could agree to table that.

[The Chair, Conservative, Joy Smith]

Is there a response to Dr. Bennett's comment?

[Dr. Sandy McEwan]

Madam Chair, from my perspective, I appreciate her confidence in my ability to work with the minister and the community in the communication area. I'm encouraged and look forward to working with the chair and the committee.

Remember, there are only two suppliers of generators in North America. Those are the units that convert molybdenum into technetium. The problem is the discordance of source for those two manufacturers. I'm sure they are working 24 hours a day to try to rebalance that supply. Clearly, it is very important that those two manufacturers work as hard as they can to bring in molybdenum from Australia.

You saw the other day that Health Canada has actually approved and given an NOC to the molybdenum from OPAL in Australia. I think it's clear that we can use the regulatory process to facilitate access to molybdenum and technetium products.

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

How are you going to deal with the bidding war around the world?

[The Chair, Conservative, Joy Smith]

Dr. Bennett, that's the last one.

Very quickly, Dr. McEwan.

[Dr. Sandy McEwan]

Technetium is an interesting product. For many years technetium was an insignificant part of the cost of a ready pharmaceutical. With the increase that is going up now, it has gone from being insignificant to being a meaningful part of the overall cost of the ready pharmaceutical test. So people are now noticing what in the past they didn't notice.

[The Chair, Conservative, Joy Smith]

Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

I just wanted to sum up, again, Dr. McEwan, if you don't mind. We heard the three things that you think are important. You mentioned the ad hoc working group that we've had for the last 18 months. You're saying it's working well, and you're recommending that we continue working with that group to get good advice, not only provincially and territorially but internationally.

The second thing you mentioned was communications. That was one of my questions earlier, to make sure that the recommendations you're making are going to be disseminated properly to the key players.

Third, you and also Dr. Urbain mentioned Health Canada as a regulator. I noticed in your comments earlier that you did praise the government for the special access program and how we are working to fast-track it, but you're saying that we can work on improving that.

Those would be the three key things that you're recommending. We continue doing what we're doing and try to expand them.

[Dr. Sandy McEwan]

We certainly should in the very short term. Those are the things that are going to make a difference for our patients tomorrow. Many of the other things we've talked about around the table will take some time to roll out. What we have to ensure is that the regulatory process is as facilitative as possible to ensure that molybdenum anywhere along the supply and production chain of radiopharmaceuticals is made as rapidly as possible. As I said, I got my approval for my clinical trial application for fluoride in under a week. It actually came faster than I was able to implement it.

[Colin Carrie, Conservative, Oshawa, ON]

I like hearing that.

I was wondering if I could make one recommendation to you in your new job. We heard a lot about the PET scanners, and it appears to be a solution. I think there's a lot of agreement on that. I was wondering if we could encourage you to work really closely with the provinces and territories, because I know Dr. Lamoureux mentioned things. We always have to be careful stepping on jurisdictional issues, and when it boils down to it, we all represent the people we represent. If we can work to get over those issues to better support our constituents, that would be wonderful.

In wrapping up, I want to thank you all. I really appreciated your being here.

Thank you very much, Madam Chair.