Health Committee on March 18th, 2010

[Larry Bagnell, Liberal, Yukon, YT]

Okay.

In a similar vein, but in a different area, there's the $285 million over two years in budget 2010 that renews funding for a number of programs. You've mentioned a couple of times already the five programs: diabetes, suicide, maternal health... It's $140 million for this year. How much was it last year? These are just extended programs. I want to know how much we spent or allocated this year.

[Glenda Yeates]

In terms of the $142 million, it was a little bit higher this year. It is broken down for a number of programs. The community programs—we talked about maternal child health or youth suicide prevention—are all at the same level as last year. There are two programs that over this period have less money, particularly in the aboriginal health human resources and some of the transition funds. This current year's spending, I think, will be slightly higher than the $142 million. But the community programs, all of the treatment programs, are at the same level. We've done a very good job, we think, in terms of increasing the number of aboriginal students in various program. Those are areas where we are needing money.

[Larry Bagnell, Liberal, Yukon, YT]

I'm sorry; 2010 is going to be $140 million. So you're saying that this year, 2009-10, went slightly over $140 million?

[Glenda Yeates]

Yes, that's right.

[Larry Bagnell, Liberal, Yukon, YT]

It was just slightly over—about the same?

[Glenda Yeates]

No, it was higher. The community programs—maternal child health, youth suicide, some of the mental health programs—are all at the same level as they were this year. We're still finalizing some of the details, but that certainly—

[Larry Bagnell, Liberal, Yukon, YT]

But some other ones were higher this year?

[Glenda Yeates]

Yes, that's right.

[Larry Bagnell, Liberal, Yukon, YT]

So there's actually a cut to those programs.

[Glenda Yeates]

There were five years of funding, and in some cases we felt, regarding some of the transition programs, that we've moved on and have priorities elsewhere. So there are some areas where we have moved money.

[Larry Bagnell, Liberal, Yukon, YT]

Could you get us the exact figure later of what was spent this year?

[Glenda Yeates]

Yes. We're still in the process of finalizing it, but when it's available we can certainly make it available.

[Larry Bagnell, Liberal, Yukon, YT]

Thank you.

[The Chair, Conservative, Joy Smith]

We'll now go to Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you, Madam Chair.

I want to thank the witnesses for being here today. I always find your presence to be very informative.

I want to follow up on my colleague's questions on the Infoway. I want to commend the government for taking a leadership role for electronic records. I think everybody sees the goal, and it's getting closer and closer.

I know there are challenges with the patchwork system we have in Canada. I had the opportunity to read an article about some software being developed at McGill; how it would even work both ways, whereby the software could remind patients, for example, to take their shots of insulin on time.

But it brings up privacy issues. I come from Oshawa, where there was a situation in which electronic records were misplaced. What is the role of the federal government regarding privacy issues in development of these records? Is it something that's a jurisdictional thing with us, or do the provinces look after it, or is it a combination between the two?

And how is that situation being worked upon? When that situation happened in Oshawa, in which these records... Electronically, you can now condense so much information on even a little stick—it's portable, and you can put it on the Internet—that there are some concerns about this. What kind of progress have we had with that?

[Morris Rosenberg]

Thank you for the question. I will start, but I may turn to Glenda, only because in her previous job as the president of the Canadian Institute for Health Information she was very involved in some ongoing work that I'll mention.

Privacy is an issue, obviously, with respect to any electronic system, especially a system dealing with the nature of the personal information you'd find on the electronic health record. It's important to manage the evolution of this in a way that will achieve a number of goals in equilibrium. Obviously we want to have the most efficient health record possible. We want to do it in a way that's going to be respectful of privacy. We also want to do it in a way--and it's in this area that the work is really important--that gives us access to aggregate information. There is huge value in having that aggregate information so that the management of the health system can understand outcomes on a regional or population basis.

I'll give you one example of how aggregate information might have been helpful had we had an electronic health record. You'll remember the situation around COX-2 inhibitors and Vioxx back a few years ago. What I've heard in the United States... Vioxx killed thousands and thousands of people. It killed a lot of middle-aged men with strokes and heart attacks. It took lengthy detective work to associate those conditions, because, frankly, a lot of middle-aged or elderly people might come into hospital with those kinds of conditions. If you could have linked the drug interaction--in other words, what they were taking--with the fact that they were presenting with these symptoms and you did a search that determined there was a pattern, it might have been possible for regulators in the world to have moved much more expeditiously with respect to dealing with that situation. To have that capability, you're going to need individual patient information. You don't necessarily need everybody's specific identifiers right down to the name, etc., but you need to have enough information to enable you to draw those conclusions.

That's one illustration, one example, of the kinds of issues we're dealing with. On the one hand, we don't want to have rules that would just expose everybody's information; obviously that has huge implications with respect to insurability, and there is no question that there are issues about that. On the other hand, you don't want to do it in such a way that it's going to prevent us from having better interventions through the power of that aggregate data.

That work is going on now. There is a working group that involves the provinces and territories, the federal government, and the Canadian Institute for Health Information, because as the premier national health information organization, CIHI obviously has an interest in making sure that we're not going to have the perverse effect of electronic health records causing less information to be available to them. Obviously Infoway itself is also involved, and discussions would take place with privacy commissioners across the country as well.

[The Chair, Conservative, Joy Smith]

Is there any other comment?

Thank you, Mr. Rosenberg.

We'll now go to Ms. Wasylycia-Leis.

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

Thank you, Madam Chairperson.

I want to go back to Dr. Butler-Jones, because the more I ask about the HIV vaccine facility, the more questions there are, based on Dr. Butler-Jones' answers.

Last May you brought in a considerable number of experts from around the world to review the four bids that were part of this proposal your government announced in 2007.

So in late May you bring in a large number of experts from around the world--it must be fairly costly to do so--to create a review panel to look at the four bids. Why would you do a due diligence study after the fact, after the whole process was in place? None of this makes sense. You have to explain to us.

You bring in a review panel. You say there's a due diligence study going on that is at the end of the process. Either the whole process was done on a incompetent basis or there's some cover-up going on. It just doesn't make sense. I think you have to explain to us why you would bring in these expert reviewers to review four bids, all the while knowing there's a due diligence study going on at the end of the process.

[Dr. David Butler-Jones]

You've presented two assumptions, both of which are wrong.

In terms of the process itself, at the outset of the process, as I've said, casting about, not just with the Gates Foundation... Again, the Gates Foundation is probably the largest funder of these kinds of activities around the world in terms of dealing with HIV and a range of health conditions and research--the Grand Challenges, of which we actually have one, based in the lab in Winnipeg--and so on. They have tremendous expertise and access to expertise.

The need for a facility to produce trial lots of vaccine was something that was, at the outset of this process, a gap. That was something that both the Government of Canada and the Gates Foundation were interested in. So we went through that process. It was a transparent process and people had the right to apply. Four people came forward at the end of the day...were invited because of what they had potentially to offer, and we continued on that process.

In May, we brought together the panels and they identified deficiencies with all of them. None of them crossed the bar. There was some potential there, but still a lot of inadequacies to be addressed.

At the same time, Gates had recognized--again, they're involved internationally far more than we are--that the scope and the sea had changed. The world had changed. So they commissioned this report that we saw in July--so it was after that part of the process--that indicated we had a situation where capacity in the world had changed, and this would not be added value, and we would essentially spend a lot of money for a facility that would not be well used; I'm not sure that's the best use of the resource, given all the other things that we need to do.

It's nothing more complicated than that. Evidence came forward. We take evidence as it comes. At the outset of the process, two years ago, the need was there. In that time, the world has changed. A reassessment of that indicates that, yes, the world has changed. Therefore, given where we're at, we have to reassess it.

It's as complicated as that. As the chief public health officer, I am not interested in spending money on something that will not be well used, given all the other needs.

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

But new evidence has come forward, and so now it's important that we ask the questions about whether or not you're prepared to review that evidence and then reconsider the process.

First of all, I do want to say that the Oliver Wyman study said at the outset, as Kirsty mentioned earlier, that it was not a complete study, that in fact--quoting from it--based on the scope of choices agreed upon at the beginning of the project, there are “limitations” to this study that would require additional research.

It's a very important statement in the scheme of things, especially now that we have very clear research, scientific evidence, from Dr. Gerson. This is an expert in the field from whom your government has sought advice in the past. Dr. Gerson is seen as someone very important in the field, who has now confirmed what the Wyman study said at the outset, that it was not complete and there are serious problems with it--

[The Chair, Conservative, Joy Smith]

Ms. Wasylycia-Leis, your time is up.

Dr. Butler-Jones, do you want to--

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

My question is will you therefore now begin the process again and ensure that the four bids are given serious consideration?

[Dr. David Butler-Jones]

There are always exceptional views for whatever issue it is. We saw that through SARS. There were experts out there who had very contrary views to my own in terms of SARS and in terms of the H1. I go with not the one out of 10, I go with the nine out of 10.

We've reviewed this and the point is that you make decisions. If you wait for the 100% answer you can wait forever. The point is whether we have sufficient information to make a decision based on what we have. And our view is that was sufficient information.

The Gates Foundation does not feel they need to revisit. We do not feel we need to revisit.

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

[Inaudible--Editor]

[Dr. David Butler-Jones]

That is an individual's view. Around the panel--