Evidence of meeting #20 for Health in the 40th Parliament, 3rd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was disorders.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Peter Brenders  President and Chief Executive Officer, BIOTECanada
Jean-Luc Urbain  President, Canadian Association of Nuclear Medicine
Durhane Wong-Rieger  President, Canadian Organization for Rare Disorders
Maureen Coleman  President, Carcinoid NeuroEndocrine Tumour Society Canada
Gail Ouellette  President and Chief Executive Officer, Quebec Coalition for Orphan Diseases

7:40 a.m.

Liberal

The Vice-Chair Liberal Joyce Murray

Good morning, everyone. I'm pleased to commence our meeting this morning on rare disorders. My name is Joyce Murray. I'm sitting in for our regular chair, Joy Smith.

I want to welcome all the witnesses and guests. I hope you've had a chance to fill up a plate and have a bit of breakfast.

We have a bit of a different format than is usual in our meeting, so I'll just touch on it for the benefit of the guests and the committee members. The format of the session is an interactive round table. We'll begin the round table with brief introductions from our guests. Then there will be an open discussion, questions and discussion, among the members and the witnesses. The clerk will be keeping a list of speakers, so please let her know if you'd like to speak. The chair will recognize speakers, so we're not all chiming in at once. And as you are all aware, there is translation, so use your earpieces if you need that.

Lastly, I'll mention that this is not my normal hair colour, for anyone who thought it was. It's actually about a campaign for a rare disorder. It's called Reddy for a Cure. It's about cystic fibrosis, in honour of Eva Markvoort, a young woman who died recently and who was, unintentionally, a spokesperson. I'm pleased to be part of the campaign in her honour to raise awareness of cystic fibrosis. That's why I mentioned it this morning.

With that, we will start with Peter Brenders. Please introduce yourself.

7:40 a.m.

Peter Brenders President and Chief Executive Officer, BIOTECanada

Thank you.

Bonjour. Good morning. My name is Peter Brenders. I'm the president and CEO of BIOTECanada. We're the national organization representing biotechnology companies in this country. There are 21 today working on rare disorder treatments. So I'm pleased to be here.

7:40 a.m.

Liberal

The Vice-Chair Liberal Joyce Murray

Thank you.

Jean-Luc Urbain.

7:40 a.m.

Dr. Jean-Luc Urbain President, Canadian Association of Nuclear Medicine

Good morning. My name is Jean-Luc Urbain. I am the president of the Canadian Association of Nuclear Medicine.

I'd like to thank the committee for inviting me once again to testify on rare disorders and medical isotopes. We have significant issues, besides the big issue we have been dealing with over the last year. It turns out that we are now facing another significant crisis, due to the lack of authorization for isotopes that we need to treat patients with rare disorders. So I'm very pleased to be here this morning.

7:40 a.m.

Liberal

The Vice-Chair Liberal Joyce Murray

Thank you.

Durhane Wong-Rieger.

7:40 a.m.

Dr. Durhane Wong-Rieger President, Canadian Organization for Rare Disorders

Good morning. My name is Durhane Wong-Rieger. I am the president of the Canadian Organization for Rare Disorders, which is an umbrella organization for a network of rare disorders organizations in Canada.

7:40 a.m.

Liberal

The Vice-Chair Liberal Joyce Murray

Thank you.

Maureen Coleman.

7:40 a.m.

Maureen Coleman President, Carcinoid NeuroEndocrine Tumour Society Canada

My name is Maureen Coleman. I'm president of the Carcinoid NeuroEndocrine Tumour Society Canada. We're all over Canada. Our mandate is research, education, awareness, and support for our relatively rare cancer. We have a shortage of certain treatments, including isotopes. This will come out in discussion.

Thank you.

7:40 a.m.

Liberal

The Vice-Chair Liberal Joyce Murray

Thank you.

Gail Ouellette.

7:40 a.m.

Gail Ouellette President and Chief Executive Officer, Quebec Coalition for Orphan Diseases

Good morning. I am Gail Ouellette, the director of an information and support portal for orphan genetic diseases in Quebec and president and chief executive officer of the Quebec Coalition for Orphan Diseases, which includes 20 rare disease organizations.

7:40 a.m.

Liberal

The Vice-Chair Liberal Joyce Murray

Thank you.

Ladies and gentlemen, it's over to you.

Dr. Bennett.

7:40 a.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

I would prefer to hear more. We can't really have a discussion until they've put their issues on the table. So let's give them all a chance to actually tell their stories.

7:40 a.m.

Bloc

Luc Malo Bloc Verchères—Les Patriotes, QC

We should allow at least five minutes for each person to make a presentation.

7:40 a.m.

Liberal

The Vice-Chair Liberal Joyce Murray

Other thoughts?

It makes sense.

Mr. Brenders, you—

7:40 a.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

I think it would be better to start with the people who are representing the patients and then go to the organizations. Is that...?

7:40 a.m.

Liberal

The Vice-Chair Liberal Joyce Murray

It looks like everybody's in agreement with that.

Madame Wong-Rieger, would you like to frame the issues from your organization's perspective?

7:40 a.m.

President, Canadian Organization for Rare Disorders

Dr. Durhane Wong-Rieger

Certainly. Thank you for the opportunity.

The Canadian Organization for Rare Disorders is the national network for organizations for rare diseases in Canada. We are affiliated with both the National Organization for Rare Disorders in the U.S.A. and with EURORDIS, the European Organization for Rare Diseases.

The issue is that in Canada people with rare disorders are not well served. About 1 in 12 persons in Canada has a rare disorder. This may be surprising, but it affects nearly 3 million Canadians. There are between 6,000 and 7,000 rare disorders in the world, and many are found in Canada. So it is in fact a significant public health problem.

The way health care is set up in Canada, rare disorders receive disproportionately fewer and poorer services. Most people with rare disorders have poor access to diagnosis, poor access to treatment, and poor access to care. Around the world what's been happening, especially in Europe, is that they have recognized this. In the European Union they have introduced a recommendation that all member organizations, all member states, should adopt a national plan for rare disorders. This is what we're asking for in Canada as well, to make sure that we are able to treat patients with rare disorders in the same way as we do patients with more common diseases.

Within that plan, we're looking for three main things. First, we desperately need a definition of rare disorders. We're one of the few developed countries that has no national definition of rare disorders. Most countries define a rare disorder as a disease that affects fewer than 1 in 2,000 people. This definition would allow us to provide comprehensive services to patients right across the country. I think it would open us up to having a regulatory framework.

We are probably the only developed country that does not have a plan for orphan drugs and rare disorders. This means that our patients receive disproportionately less access to new treatments derived from research and development. It means that we have a more difficult time getting clinical trials for patients with rare disorders. It means that, unfortunately, Canadian patients with rare disorders are among the last patients in the developed world to get access to new medicines.

So as they're watching—we have families who are connected internationally—they see patients in other countries getting access to drugs. We have not set up a regulatory framework that would provide incentives for companies to bring their trials and products to Canada. So we are disproportionately served. Our patients are diagnosed later and treated later. Many of them become sick or die, even when treatments are available right outside the country and available to other patients who are suffering from exactly the same diseases. So we need the regulatory framework.

Second, we need a national plan for rare disorders. Countries around the world are establishing plans for providing integrated, comprehensive services for patients with rare disorders in the same way as they would provide services for common diseases, while recognizing that rare disorders are different. It takes more to be able to provide that expertise, but it takes more by way of organization, not necessarily by way of funding. What we know is that we pay for patients with rare disorders already; we just do it poorly, and we do it inefficiently, and we do it in such a way that we oftentimes don't really begin to take care of them until they're much sicker than they need to be. So our care and our treatment is just as costly as it would be if we had a good plan. We just don't service it well; we don't provide the same benefits. I think we also need to make sure that we have a national, integrated, comprehensive framework within which we can make recommendations for the funding of treatments for rare disorders.

We thank the health committee—I think it was two and half years ago—for holding a review on the Canadian Agency for Drugs and Technologies in Health. At the time, we recommended that CADTH come up with an appropriate way of reviewing drugs for rare disorders. What this committee recognized was that the way these drugs were being reviewed was not serving patients well. Patients with rare disorders do not get the access to treatments that they ought to. Drugs are approved, but then there is no program to allow them to be funded. We urge this committee, then, to actually pick up on what you began three years ago and to make sure that that does happen.

I'll leave it at that, but I look forward to the discussion.

And by the way, I love your hair colour and I think what you're doing is perfect.

7:45 a.m.

Liberal

The Vice-Chair Liberal Joyce Murray

Thank you.

The intent is that this is a round table, an experimental format that's a bit less structured than our normal meetings. So I'd like to invite the members, if you have comments and questions, to bring them up now, and then we can also have the other interveners give their five minutes.

Yes.

7:45 a.m.

Conservative

Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC

I have a quick question. It might help frame the future discussion. The definition that's fairly consistent, is it only related to numbers or does it have any relationship to acuity?

7:50 a.m.

President, Canadian Organization for Rare Disorders

Dr. Durhane Wong-Rieger

It really is based on prevalence, so it is defined as a disorder that affects fewer than 1 in 2,000 persons. But by their very nature, most rare disorders are in fact severe. Many are life-threatening, many are debilitating. So just by defining it as 1 in 2,000, you recognize that most of these disorders are in fact fairly severe disorders.

7:50 a.m.

Conservative

Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC

Thank you.

7:50 a.m.

Liberal

The Vice-Chair Liberal Joyce Murray

Are there others among the guests who would like to comment?

Dr. Bennett.

7:50 a.m.

Liberal

Carolyn Bennett Liberal St. Paul's, ON

I have met with Maureen Coleman and Dr. Urbain before, and I think the story in terms of “if you don't suspect it, you can't detect it”.... The real plight is of patients with neuroendocrine tumours who are diagnosed late and then find that the radiopharmaceuticals are not available in this country. I think the story of having a patient from Canada, with Canadian-made isotopes...which by the way are not being made in Chalk River; they're available now, the yttrium and lutetium. The patient is being put on a plane to England to be treated, sometimes travelling on the same plane as the isotope, and then comes home to fight with the insurance people, just because the radiopharmaceuticals haven't been approved yet in Canada.

I would like to hear Maureen and Jean-Luc tell their story.

7:50 a.m.

Liberal

The Vice-Chair Liberal Joyce Murray

Maureen, go ahead.

7:50 a.m.

President, Carcinoid NeuroEndocrine Tumour Society Canada

Maureen Coleman

Thank you for having me.

I was going to introduce the idea of our cancer, first of all. We are a cancer. We're sometimes not regarded as a cancer, but we're highly malignant, and it grows rapidly. It comes from the neuroendocrine cells in the body, and we need a variety of treatments.

When neuroendocrine cells produce too many peptides and hormones, they cause tumours to grow, and they can grow uncontrollably and you can eventually die from tumour load. One of the things that stops our tumours in their tracks is a variety of treatments, including radioisotope treatments, which are available right now in just about every country in the world. Lutetium and yttrium are available in Cuba, Bangladesh, India, Australia, Singapore, all over Europe, South America, everywhere. They extend our lives by many years. I've been a patient for 10 years. I haven't yet needed to use lutetium or yttrium, but many patients have.

One of the big problems is that not only do patients have to go out of the country, but they can lose their houses over it, because it's sudden. You're given two weeks' warning to go to England. The caregiver and the patient go out of country--with the isotope, possibly, on the same plane--and sometimes it's four treatments in a year. Once you take accommodation into account, it's $50,000. The money is very significant. Patients sometimes can't go because they can't afford to get on a plane. They just sit at home and wait for the end.

So I'd say about two-thirds of the patients who are approved can go and the others can't. They have to rely on less effective options.

One last thing. In Sweden, where they're quite common, the life expectancy is probably about four times as long as here. I remember Dr. Öberg at our Toronto conference in 2009 saying that it's 133 months or something for people once they're on isotope treatment, as opposed to 33 months in North America, in Canada, with certain isotopes.

Thank you.