Health Committee on Nov. 23rd, 2009

[Dr. Alexander McEwan]

Madam Chair, I would like to remind you that I am not the federal government. I'm an adviser to the minister, and therefore I cannot answer a question like that.

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

Okay. Would you be able to tell us the costs to the provincial governments because of the medical isotope shortage?

[Dr. Alexander McEwan]

Those data have been requested from the provincial governments. They have not yet been given to us.

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

You can't confirm or deny that at the last conference of health ministers there was an indication of at least a minimum cost of a quarter of a million dollars.

[Dr. Alexander McEwan]

I can tell you anecdotally that I have discussed it with colleagues on the ground in individual institutions. There is quite a range in the increasing costs noted. One centre, for example, has said that they are seeing an increase of between $8 to $12 per dose.

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

All the additional costs are borne by either the provincial governments or the health care institutions, as opposed to the federal government. Correct?

[Dr. Alexander McEwan]

My understanding is that health care delivery is a provincial role. I will remind you that this issue was raised at a recent federal-provincial-territorial ministers meeting. The data have been requested. Once the data have been received, we can understand what those real costs are.

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

I'd like the rest of the panel to comment on Mr. McEwan's use of the term “stressed stability”, because I haven't found too much by way of stability in the system and I think it would be useful to hear about the impact on patients, the impact on professionals, and the impact on our colleges and our nuclear medicine facilities.

[Dr. Anne Doig]

Thank you for that question.

I think perhaps the best way to answer your question is simply to underline the language that Dr. McEwan has used, which is exactly that: it is stressed stability at the moment.

If you reflect on the language I used when I spoke to you about the H1N1 situation, we talked about surge capacity and the lack thereof, and that is the situation with the nuclear isotope crisis. We are, at the moment, coping. We have very little, if any, room for further coping. As your international guest alluded to, if the overseas reactor goes down at the same time as we still have no capacity in Canada, that will be a negative surge capacity that will undoubtedly adversely affect all these people here who actually deal with this on a daily basis.

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

Dr. O'Brien.

[Dr. Christopher O'Brien]

I think the best way to describe this is as an example of what goes on in my department on a day-to-day basis. Because we're told there's only 20%, or 50%, or 80% supply, on a day-by-day basis it's like we're horse-trading: If I can reduce so much activity to do a certain test, can I move a few millicuries over to another test to try to get that test done for that patient? This is day in, day out, day in, day out for our technologists.

Our patients are still getting the tests done. There are days when there are no isotopes, and if I have to do a study called a lung scan to look at blood clots in the lung and that patient cannot have the CT scan, that patient may or may not get the full study done on that day because I will not have the amount of isotope needed to do it. So a study that would have taken an hour now takes two days because I have to wait until the next day to do the second part. This is very stressful on our clerical staff and on our technologists. They come to me on a day-to-day basis and say, we need leadership; we need supplies; we need to get this fixed; we cannot continue on as is.

I think everybody here is right: we are coping. We are coping in an unsustainable, fragile system that is beginning to fray at the edges more and more.

[The Chair, Conservative, Joy Smith]

I'm sorry, Ms. Wasylycia-Leis, your time is up. Thank you for those good questions.

We're going to suspend the committee, and I would ask the committee to resume here in this room after votes.

Thank you for your indulgence. We have to go into the House, and then we will be back with more questions.

[The Chair, Conservative, Joy Smith]

Order, please. Could I ask the witnesses to please take their seats? Thank you.

We are going to begin. We are continuing our five-minute question and answer round, and we start with Dr. Carrie to finish off the round.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

I just wanted to say that I did have the opportunity, with my colleague Pat Davidson, to meet with the Canadian Association of Medical Radiation Technologists, and I think we should all commend them. With the amount of hours they put in and how they change their own personal schedules, they really make a big commitment, even with the difficulties, to get the job done for Canadians.

I wanted to ask Dr. McEwan about the research announced. The Canadian Institutes of Health Research recently announced $5.3 million in funding for seven research projects that look into the alternatives for key priority diagnostic needs. I think it is a good example of our trying to find alternatives. Now, you did mention earlier on that there were four proposals as well, that you were aware of, that might help in the medium and long term. Would you expand on that a little bit and let the committee know about that?

[Dr. Alexander McEwan]

Certainly, Madam Chair. It would be a pleasure to address that. I think the CIHR initiative is an extremely important initiative in looking at ways of ensuring that this crisis does not continue longer than it has to, if we continue to have disruptions of technetium supply.

Of the seven projects, I believe four have the potential to have a very early impact on clinical practice. If you look at the projects that have been funded, one is a study of rubidium-82 in cardiac imaging. I believe this will provide the evidence that will enable the regulator to approve this as a new way of imaging the heart. Certainly the literature data suggests that this is an effective way of managing patients. If that research pans out, then it relieves a lot of stress on the technetium system, because cardiology is such a major part of nuclear medicine practice.

I believe there are two projects, one related to imaging the kidney and one related to imaging lymph nodes in patients who have breast cancer, that could translate very rapidly into clinical practice and that could again reduce the amount of technetium that was needed.

There is one slightly more ambitious project looking at red cell imaging. This is where we take a radioactive label, put it on red cells, and use that to measure two things: one, whether bleeding is occurring, and where bleeding is occurring from the gut; and the other, to look at cardiac function in patients who are receiving chemotherapy. Both of these are very important tests that use a lot of technetium. Again, if this test can be substituted, it provides a lot more flexibility to the system.

Finally, I believe this is not a short-term solution but a solution that I believe the scientific community must look at. Can new target design and new technology enable technetium to be produced on cyclotrons? Whether or not that is possible I do not know. I am not a physicist. I do not know. But if the new technology enables us to do that, then it enables us to redefine the business model, so I think this is not short term, but it is very exciting long-term research.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much.

Dr. O'Brien, you stated something along the line of some doctors wondering if we would even need technetium in the future. Is that what you stated? Is that in line with what Dr. McEwan was saying? We're seeing this research into alternatives. Could you elaborate a little bit on what you were saying there, what you meant?

[Dr. Christopher O'Brien]

It is in the sense that there has always been the debate as to whether nuclear medicine will be around and whether we have to make the investment to ensure that there is a medical isotope supply for the Canadian population or whether the specialty will be replaced by something else. Data would tend to show that medical imaging with nuclear medicine techniques...functional imaging is here to stay and will actually become more and more important. A part of the CIHR grants is looking at positron emission tomography rubidium-81, as Dr. McEwan mentioned. Two others are associated with positron emission tomography as well.

So the importance that nuclear medicine brings to physiological functioning imaging surpasses a lot of other techniques. PET imaging, in our specialty, is the next evolutionary process in that ability, and so I think it is safe to say that we will continue to have a demand for medical isotopes. In Ontario we have 100 nuclear medicine departments and something around 200 gamma cameras. PET imaging is not going to replace all of that. So PET will have a role to play, and that's part of the balanced strategic plan that we look at in Ontario, as PET playing a role and routine medical isotopes playing a role. The important component is to upgrade our gamma camera equipment that's on the ground now so that we use fewer medical isotopes, reduce the exposure, and that could be done today. The technology exists.

That's what I was getting at, sir.

[The Chair, Conservative, Joy Smith]

I think Dr. McEwan also wants to make a comment on that.

[Dr. Alexander McEwan]

Thank you, Madam Chair.

I'd like to agree with Chris wholeheartedly. I think this issue around technetium supply in many ways has shown the value of nuclear medicine to our patients now, but more importantly, it is enabling us to redefine how we will practise in the future. I think, amidst dealing with the crisis, we have to recognize that this is an opportunity to redefine our practice.

[The Chair, Conservative, Joy Smith]

I'm sorry, our time is up, Dr. Carrie.

We did have committee business at 5:15. Due to the fact that we have votes, I will ask the committee if we can take the first 15 minutes of Wednesday's meeting to clean up our committee business.

Is everybody in agreement with that?

[Some hon. members]

Agreed.

[The Chair, Conservative, Joy Smith]

We will continue with the questions and answers today while we have these people here. It's very important.

We'll now go into the second round, with five minutes for questions and answers.

We'll start with Dr. Duncan.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madam Chair.

Thank you, witnesses, for your testimony.

I think the job of this committee is to ensure that patients' health is protected in the short, medium, and long term.

There appeared to be a dichotomy of positions here. We heard “not optimal”, “serious public health concern”, “nuclear isotope crisis”, “suboptimal imaging”, and “stressed stability”. I think we need to address some of those.

I'd like to begin with you, Dr. Urbain. Did the Canadian Association of Nuclear Medicine ask for meetings with the Minister of Health or the Minister of Natural Resources?

[Dr. Jean-Luc Urbain]

We've basically been active at the level of Health Canada. In January of this year, our association was sent to Paris. There was a delegation from Canada led by Serge Dupont from NRCan.

I'm not totally sure there is a direct line of communication between the CANM, NRCan, and the Minister of Health. My understanding is that we have to go through Health Canada and some various processes.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Did the ministers ask for any meetings with you?