Health Committee on Nov. 23rd, 2009

[Some hon. members]

Agreed.

[The Chair, Conservative, Joy Smith]

Okay, go ahead.

Thank you.

[Dr. Alexander McEwan]

Thank you, Madam Chair.

Both Dr. O'Brien and Dr. Urbain identified the issue of cost. This is clearly multifactorial. Cost increases had been announced before the NRU shutdown. We are waiting to hear from our provincial colleagues on what the provincial differences in costs are, and we will report back as and when we get those data.

The Canadian Association of Medical Radiation Technologists have identified issues of human resources, and I am grateful for the information they provided in the report they issued earlier this fall. There is no doubt that the impact is greatest at the technologist level, where we have asked for really significant changes in work practices to help us deal with this, and they have responded magnificently. We are all concerned that we see a continuing flow of technologist students coming into the system and that we see continuing enthusiasm for this as a discipline.

My concern, obviously, now is moving forward into 2010. Our position is one of stressed stability. The international reactor community, as Dr. Bourguet has said, is working through AIPES to develop a plan for increasing supply from producers other than Petten over the course of the year. There is a meeting in Paris later this month of the producers, and after that they will be delivering a plan that will maximize utilization of reactors. AECL have indicated they anticipate being up and running in the first quarter of 2010. Clearly, we all hope this happens, but we have to plan for the situation should it not happen. That is the focus of my activities at the moment, and this coordination of reactor schedules and reactor activities is clearly going to help this.

Finally, we are continuing within the community to improve the way in which we use our resources. This involves the use of different isotopes--for instance, thallium imaging for the heart--for ensuring that we maximize the use of our generators.

There are three initiatives that are important going into the future. The Canadian Institute for Health Information, CIHI, will be looking at a detailed study of the impact on referrals, utilization, volumes, and technologist levels. We anticipate they will be reporting on this toward the end of the first quarter of 2010, so we will have a snapshot of what is happening at that time.

Second, I believe that the results of the Canadian Institutes of Health Research competition specifically looking at alternatives to current clinically used medical isotopes are a valuable and important tool for replacing, possibly urgently, some of our technetium products. I am currently discussing with the minister ways in which we can facilitate, as Dr. Doig said, the very rapid translation of this research into clinical practice. Seven proposals were approved for funding, of which at least four have the potential to have a major impact early on the practice of nuclear medicine.

Finally, we've heard that the expert review panel will be reporting at the end of this month. I believe this is a very important initiative and a very important report for the way in which we will practice our discipline.

Madam Chair, I am grateful for your indulgence in allowing me to talk a little longer. I'm grateful for the committee's indulgence.

[The Chair, Conservative, Joy Smith]

Unexpectedly, the bells are ringing to call the members to a vote. There is a 30-minute bell, with the vote around 4:45, so I'm thinking that with your indulgence, perhaps we could continue for 15 more minutes, because we are very close to the House.

Can I have unanimous consent to continue? We can get one round in if we're very diligent about doing it in five minutes each, but you will have to listen when I stop you.

Dr. Bennett, do you want to start, with for five minutes for questions and answers, please?

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

Thank you for coming.

This is quite worrying to all of us. I am concerned that there's quite a discrepancy between the testimonies that we've heard. I had hoped that there would be a process by which the government would be tracking things like referrals. In the testimony of the Canadian Association of Nuclear Medicine, we heard that if referrals go down 10% to 25%, diseases will be found much later.

I am also concerned about the evidence we had from the association of technologists. They are worried that the applications to their courses are diminishing. There is also a concern that if there is not sufficient research capacity at the NRU we will permanently lose international and Canadian researchers to somewhere else. There's a lack of leadership on this.

We've also heard internationally that there is no substitute for reactor-derived isotopes. We will always need isotopes coming from reactors. We don't have a plan B. With only 50-year-old reactors, we have to have a plan.

Rarely do we see physicians all agreeing. Usually there are more positions than physicians in a room. The coherence of the recommendations of the Canadian Association of Nuclear Medicine and the CMA is telling.

Dr. McEwan, the CMA, the CANM, and Ontario are all saying that an independent expert panel needs to revisit the decision on the MAPLEs. They are all saying that they need some of these other isotopes approved much more quickly. Mainly, they're saying that the money issue is serious. Money is needed for medical infrastructure and also to mobilize PET scanning across the country. There doesn't seem to be the kind of relationship that we hoped for between the government and these professional organizations.

There are four clear recommendations from the Canadian Association of Nuclear Medicine. Will you be recommending those four recommendations and the recommendations of the CMA to the minister?

[Dr. Alexander McEwan]

We need to recognize that the system is coping with this situation. It is doing no more than coping. I believe that the CIHR competition has addressed some of the requests of the CMA. In particular, I believe that the opportunities in at least two of the grants providing for alternative tests are significant and will supply us with data to facilitate the way in which these tests can be brought into clinical practice.

The issue of referrals is reflective of the geography of this country. In the centres that I polled last week, there is no year-to-year change in referral patterns.

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

Did you call all of them? How did you decide which ones to call?

[Dr. Alexander McEwan]

Those centres were in Vancouver, Alberta, Manitoba, and the Atlantic provinces. Dr. Lamoureux from Quebec is on record in the press as saying that there has been no significant change in referral patterns in Quebec. In my conversations with Dr. Tracey, he indicated that he is seeing some recovery of referral patterns in the hospitals that were concerning him in southern Ontario.

Before this committee and the NRCan committee, I have stated my belief that we are seeing a real difference geographically, and that the centres suffering most in this crisis are those in the smaller urban and rural areas of Ontario.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. McEwan.

Mr. Malo.

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

Dr. McEwan, I would like to ask you two questions. I hope that your answer will be brief so that I can ask you my second question.

First, Dr. Urbain said in his comments that in the long run the situation was untenable and that occupations linked to nuclear medicine face a long-term problem because not enough individuals are being trained. Furthermore, Dr. Bourguet told us that in Europe a continental solution is being developed and they'd like to develop a transatlantic solution. As well, the NRU reactor is old and even if it becomes operational in the first trimester of 2010, that will be a short-term solution precisely because it is an old reactor.

Are you going to recommend to the government and to the Department of Health that they develop a long-term plan for a supply of locally-produced technetium 99?

[Dr. Alexander McEwan]

Madam Chair, thank you for the question. I will be brief.

I believe that I indicated in my submission, my initial presentation, that we are now looking at medium- to long-term solutions. I believe we do provide an environment that is attractive for medical radiation technologist trainees. My concern is that they are being frightened off by a perception, if you will, that the sky is falling. Certainly our own training program continues to have an excess of applicants. My concern is that if we do not provide some continuity and confidence--I agree with Dr. Urbain--we are at risk of losing some outstanding young people to the field.

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

Second, you told us that you will be assessing the costs to provincial governments brought about by the crisis. Is it your intention to recommend to the minister to compensate provinces for the extra costs caused by the isotope crisis?

[Dr. Alexander McEwan]

I think that's a very important question. I know it is a matter that was discussed at the last federal-provincial-territorial ministers meeting, I know it is on the agenda for future federal-provincial-territorial meetings, and as I indicated in my submission, we are waiting for data from the provinces to understand those real cost impacts.

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

Will there be compensation?

[Dr. Alexander McEwan]

I am afraid I do not belong to the government. I cannot answer for those questions. All I can say is that I do intend to understand what the cost implications are. Once I understand those, I can have an appropriate conversation.

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

Dr. Bourguet, could you tell us what are the long-term solutions being considered by the experts and European governments? Perhaps you could give us some interesting examples that our government could consider because they do not seem to have a solution.

[Dr. Patrick Bourguet]

Are you talking about technetium?

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

Yes.

[Dr. Patrick Bourguet]

Just to clarify, the goal of the study that was conducted in Europe, and that I think also applies to Canada, was to figure out where the expertise is. Currently the expertise is clearly in reactors but also in processing. If you look at where the processing areas are, you can see that they are mainly in Canada, Holland and in Belgium. So it is true that there is expertise potential that we can use.

In Europe there's currently a mid-term project—I'm referring to 2016, which is in five or six years—and that is the Dutch project, Pallas. There's also a project in the south of France, the Jules-Horowitz project, whose purpose is not to manufacture molybdenum but rather to serve as an alternative producer, a backup to the Dutch reactor, and the third absolutely worthwhile project is the one involving the university reactor in Munich, Germany, which along with the Jules-Horowitz's project will provide backup to the Dutch initiative.

This is all clearly being designed with a view to providing lasting production that will be able to cover European needs—that is very clear. In other words, this will serve as an alternative to the Dutch HFR, but will not have the capacity to meet global needs. The idea is to double production capacity in order to fill any gaps or replace reactors if and when they are undergoing maintenance.

I'd like to say clearly what I said earlier: we need to conceive a transatlantic initiative with at least one North American equivalent because that is the greatest area of global consumption. I think it is important that there be an equivalent project on the other side as well.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Bourguet.

Now we'll go to Ms. Wasylycia-Leis.

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

Thank you, Madam Chairperson, and thanks to all of you for being here today.

Mr. McEwan, can you give us confirmation that the expert panel report to be tabled on November 30 will be made available to all of us in Parliament and publicly?

[Dr. Alexander McEwan]

Madam Chair, I know that it is being received on November 30. I do not understand or know enough about parliamentary procedure to know whether I can answer that question. I assume that it will be released when it can be.

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

I think we'll all be looking forward to having a look at it immediately after that.

Can you tell us, Mr. McEwan, in which way the federal government can ensure some coordination at the provincial level on these issues? It seems to me, at least with the pandemic and the H1N1 vaccine, that there was some accountability to the Public Health Agency of Canada. But I don't sense that there's any accountability through your office, or from the federal government as a whole, in terms of avoiding having the provinces or medical institutions having to deal directly with suppliers.

[Dr. Alexander McEwan]

There are two routes of communication that happen regularly. There is the federal-provincial-territorial meeting, which occurs weekly, at which data is shared. We have the meeting of the experts working group, which involves both the Canadian Association of Nuclear Medicine and the Canadian Society of Nuclear Medicine.

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

Do you, as the federal government, take responsibility for ensuring a reliable supply for all supply contracts?