This week, I changed much of the tech behind this site. If you see anything that looks like a bug, please let me know!

Evidence of meeting #37 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was shortages.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Richard Chisholm  President, Canadian Anesthesiologists' Society
John Haggie  President, Canadian Medical Association
Gail Attara  Chair of Operations Committee, President and Chief Executive Officer, Gastrointestinal Society, Best Medicines Coalition
Suzanne Nurse  Representative, Best Medicines Coalition
Diane Lamarre  President, Ordre des pharmaciens du Québec
Myrella Roy  Executive Director, Canadian Society of Hospital Pharmacists

9:40 a.m.

President, Canadian Medical Association

Dr. John Haggie

I'd turn that question around and be a bit cheeky. Imagine you're a patient lying there with acute appendicitis. They really don't care why the antibiotic isn't there or why their pain meds aren't there. That's for you guys to fix.

We need some leadership in terms of whatever levers you've got—and I don't know those because I'm not a member of government—and we need some security for the future. So that's a pharmaceutical issue. The facts of the case are that I can't make the drugs. Should the pharmacies be doing it off the cuff in the hospitals? That's another issue, and we've heard about that.

9:40 a.m.

Conservative

The Chair Conservative Joy Smith

Dr. Chisholm, we have less than a minute. Could you please try to address Ms. Davies' questions?

9:40 a.m.

President, Canadian Anesthesiologists' Society

Dr. Richard Chisholm

To be very short, I would echo what Dr. Haggie has said. I agree with what he said. I just have one thing I would add.

You mentioned New Zealand. One of the things in New Zealand is that they have an agency that covers the entire country, which is not the way it is in Canada because we have our silos with our provinces. When I asked them about drug shortages, they said it was a problem. I forget the name of the agency, but they addressed it, found an alternative source, and the problem went away.

So talking to colleagues from other countries, they have less of a problem than we seem to have in North America. The question of why that is, as Dr. Haggie said, I don't know, and I turn to you to find out why.

9:40 a.m.

Conservative

The Chair Conservative Joy Smith

Thank you so much.

Dr. Leitch.

9:40 a.m.

Conservative

Kellie Leitch Conservative Simcoe—Grey, ON

Thank you very much, everyone, for your presentation today. I appreciate it.

Similar to Dr. Haggie, I'm also a surgeon. I'm a pediatric orthopedic surgeon. Your points were well taken. I don't think a patient gets too worked up about who decides when. They just want to make sure they can have their surgery or have their procedure.

Dr. Haggie, you're a surgeon. You've worked in a hospital. Dr. Chisholm has as well. We had met before, but there's an anesthetist....

It's very clear to me, and I stated this in the House. When I run into a problem with a drug in my operating room, I don't pick up the phone and call the Minister of Health; I call my pharmacist. We also deal with our provincial formularies, and we deal with the circumstance of our hospital making sure that the supplies are available to us. That's who's actually doing the negotiating.

I want to be very clear that I think we understand that this is health care and the provision of those medications is a provincial responsibility, a provincial negotiation, a hospital negotiation. I just want to make sure that we're on the same wavelength on that, and then I have another couple of questions for you.

9:40 a.m.

President, Canadian Medical Association

Dr. John Haggie

I take your point. I think to be fair, and this is a slightly different perspective, it's a collaborative endeavour. The analogy that was used in an article recently about the blind men feeling the elephant and each getting a piece of it, that kind of resembles the provinces in this situation. This is a global matter. There is no mechanism that I'm aware of—and again, you're the experts in government—for the provinces to have a role on the international stage in addressing these kinds of issues.

Yes, the provinces are responsible for purchasing, but one could argue that they're doing it in isolation, in silos, and what we need is a more coordinated approach so that we don't end up with a lot of unintended consequences.

I think whatever happens, however it pans out, if you look at it from the patient's perspective, they would regard the hospital board, the provincial government, and the federal government as the fixers, the organizers. And whether you want to break it down into silos in how you do that, it doesn't really matter, so long as at the end of the day you get rid of the shortage now and make sure it doesn't happen again in the future.

I'd adopt a slightly different perspective.

9:45 a.m.

Conservative

Kellie Leitch Conservative Simcoe—Grey, ON

I have two other quick things.

I have a different perspective. I actually think my patients expect me to answer their questions, not the government. I think it's extremely important that we, as physicians, take that responsibility.

One thing I'd like to point out is that on September 28, 2011, the CMA was part of and signed a letter to the minister outlining their support of a voluntary drug monitoring system. I recognize a change in your approach now. I'd like to know a little bit about that.

Secondly, as the CMA has a responsibility for educating physicians, making sure that we're aware of what is going on, what has the CMA done to make sure that physicians know what's going on? You seem to be throwing it all back on our lap here as parliamentarians. I think the motion that has been put forward is actually a very sound one, and our government is supporting it.

I think it's extremely important.

Doesn't the profession have a little bit of a responsibility as well to make sure that individuals who are physicians actually know what's going on?

9:45 a.m.

President, Canadian Medical Association

Dr. John Haggie

I'd love to know what's going on.

9:45 a.m.

Conservative

Kellie Leitch Conservative Simcoe—Grey, ON

That's why I'm saying—

9:45 a.m.

President, Canadian Medical Association

Dr. John Haggie

I can't find out.

9:45 a.m.

Conservative

Kellie Leitch Conservative Simcoe—Grey, ON

I think you can.

9:45 a.m.

President, Canadian Medical Association

Dr. John Haggie

I beg to differ because I've actually tried.

9:45 a.m.

Conservative

Kellie Leitch Conservative Simcoe—Grey, ON

I'm a surgeon in your organization and I've been able to figure it out.

9:45 a.m.

President, Canadian Medical Association

Dr. John Haggie

If I may respond, that group, the working party that sent the letter....

You're right. Events have overtaken us. The bottom line with that group is quite simply that we were there to provide the health care provider and the patient's perspective to a group that did not have that mix, quite frankly.

We're agnostic on the subject of whether you want to legislate a fix to this, or have a voluntary mechanism, or you want to use economic levers. I really don't mind. One could almost say I really don't care, as long as the end result is security of drug supply.

In terms of what I know about the issues of drug shortages, quite frankly, we rely on the drug companies to tell us. That system, to call on my teenage daughter's phrase, sucks. It really does not work. The lists of supply are incomplete, there are gaps there in drugs that I know have been in short supply for two or three years, and they're still not there on what is allegedly up to date.

They are a poll system, which means in my terminology you actually have to go there every day and spend time going through this shopping list of medications. There are often no alternatives listed. It's simply a rudimentary system, and quite frankly, we cannot find out from the manufacturers, be they generic or branded, what these shortages are and how long they're going to last with any accuracy.

We are in the position the patients are in, one of complete ignorance.

Yes, we have to try to explain it to our patients, but we're the middleman. We're stuck in the middle. I would suggest that as an answer to your question.

9:45 a.m.

Conservative

Kellie Leitch Conservative Simcoe—Grey, ON

Is there any more time?

9:45 a.m.

Conservative

The Chair Conservative Joy Smith

You have another minute.

9:45 a.m.

Conservative

Kellie Leitch Conservative Simcoe—Grey, ON

I will point out once again that you are on this letter stating for a voluntary system.

One of the other items that was discussed in this working group was exactly that information.... And I know; I've gone to do it as a physician, to make sure that it did work so that I would have access. I will give a significant amount of credit to the pharmacists who helped develop the Saskatchewan system to make sure that physicians are informed, that there's a place for us to go and know where that information is.

I leave it with you that, first, you did sign on to a voluntary system, and also that there is one for which I give credit to pharmacists and some of the pharmaceutical companies for actually trying to build. But I know Gail had a comment she wanted to make, so....

9:45 a.m.

Chair of Operations Committee, President and Chief Executive Officer, Gastrointestinal Society, Best Medicines Coalition

Gail Attara

Quickly, while the provincial and territorial bodies have a role in reimbursement, it's actually Health Canada that has the role in notice of compliance for medications. There's certainly an area on which to piggyback safety and supply.

9:50 a.m.

Conservative

Kellie Leitch Conservative Simcoe—Grey, ON

I think it's extremely important that we recognize that when you're standing in an operating room and you get your medication, it comes from the pharmacist. That pharmacist works with the hospital—that provincial hospital, under provincial jurisdiction—to deal with receiving those medications.

The federal government under the Constitution has no responsibility in dealing with that issue.

9:50 a.m.

Conservative

The Chair Conservative Joy Smith

Thank you, Dr. Leitch.

We will now go to Mr. Hsu.

9:50 a.m.

Liberal

Ted Hsu Liberal Kingston and the Islands, ON

Thank you, Madam Chair.

The drug shortage is a problem that has international implications and has been known about for a number of years, even a decade.

Are any efforts being invested internationally to solve this problem? Is Canada participating and should it participate in those efforts?

9:50 a.m.

President, Ordre des pharmaciens du Québec

Diane Lamarre

We are not trying to place the blame here, but rather to find solutions. Across Canada, the responsibility for this complex mechanism is shared by federal and provincial entities.

We have a many ties with European countries. As my colleague from the Association des pharmaciens des établissements de santé said, this is a global issue. I went to the same congress organized by the International Pharmaceutical Federation, and I can confirm that statement. So, it is not a matter of feeling more or less guilty, but rather of asking ourselves what needs to be done so that Canadians can have proper access to their medications.

So, various aspects are involved. The government is responsible for approvals. We met with Sandoz officials. That company has 37 factories abroad, but very few of them can produce injectable medications. Therefore, Sandoz was really limited to one or two close factories that could offset that deficiency here.

The only organization that can recommend expediting the approval for importing drugs from other international pharmaceutical companies is Health Canada.

That said, there are some province-wide responsibilities involved. Incidentally, we have a long list of responsibilities in our report we will present in two weeks; there are some adjustments. However, since we are here before you today and you are open enough to welcome us, we have made our objectives and requests specific to the federal government.

Other countries have some more explicit requirements, and that is the second point: the industry should really inform the authorities when it receives a notice of non-compliance and when it anticipates a stoppage—at times voluntarily—in the production of certain medications. That is its choice. We cannot stop the industry from doing that. A very exceptional measure must be involved, but when the industry decides to stop production, we must allow it and we must find other international pharmaceutical industries ready to produce those medications. That information is currently missing.

9:50 a.m.

Liberal

Ted Hsu Liberal Kingston and the Islands, ON

Madame Roy, we talked about the global problem. What role do you think international cooperation will play in resolving this problem?

9:50 a.m.

Executive Director, Canadian Society of Hospital Pharmacists

Myrella Roy

International manufacturing corporations?

9:50 a.m.

Liberal

Ted Hsu Liberal Kingston and the Islands, ON

No, cooperation.