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

9:50 a.m.

Executive Director, Canadian Society of Hospital Pharmacists

Myrella Roy

I think cooperation is critical. As I said, this is a global problem and it calls for global solutions. Discussion needs to happen at a global level.

And to answer your previous question, certainly health care practitioners don't have these solutions. As Dr. Haggie said, we're the front-line practitioners.

The discussion needs to happen between regulatory authorities around the world and the multinational drug manufacturing associations. They can discuss potential solutions and implement reasonable solutions to prevent drug shortages.

We can't do that. We can raise the issue. We can raise the flag. We can illustrate what challenges we face when we have drug shortages and not enough notice to deal with these shortages.

9:50 a.m.

Liberal

Ted Hsu Liberal Kingston and the Islands, ON

Do you have contacts with your colleagues and counterparts around the world?

In Canada our government has highlighted the issue of single-source suppliers for the provinces. Do you think that's the root cause of the problem around the world?

9:50 a.m.

Executive Director, Canadian Society of Hospital Pharmacists

Myrella Roy

It's one major cause, but it's not the only cause. There are multiple causes to drug shortages, as I'm sure you are aware. Some causes are national and could be dealt with within Canada, but many causes are global and need to be dealt with globally.

I've heard that 70% of drug products that are supplied here in Canada are actually partially or completely produced elsewhere, outside of Canada. It could be that the active ingredient came from a different country. It could be that the whole product was produced and manufactured elsewhere, came to Canada, and was packaged here in Canada. So 70% of drug products are completely or partially produced outside of Canada.

It is a global problem, a global issue. We have to deal with it at the global level.

9:55 a.m.

Liberal

Ted Hsu Liberal Kingston and the Islands, ON

Thank you.

I guess I would take from what you say that it's the responsibility of our federal level of government to deal internationally.

Here is a quick question for the pharmacist.

What is the view of pharmacists on the ground, would you say, with regard to the online databases, the websites that have been set up? Are they accurate enough? Do they reflect the reality that pharmacists are seeing on the ground and the needs of pharmacists?

9:55 a.m.

Executive Director, Canadian Society of Hospital Pharmacists

Myrella Roy

If you're asking about the current temporary solutions that we've put in place, as was mentioned, Saskatchewan Drug Information Services is one option. The other group we've made arrangements with is a group from Montreal; the database is called fridaypm.ca because typically when all hell breaks loose it's on Friday afternoon.

These current arrangements are good but insufficient. We really want to have a more robust system and a single national system that everybody can go to and that would convey all the same information. Right now, there is so much duplication of effort between all health care practitioners—certainly between pharmacists within hospitals and in communities.... You have something like 30,000 pharmacists across the country, and without such a system, you have potentially 30,000 pharmacists all looking up the same information. It's the same thing for physicians. That's not acceptable. While we're looking up all this information all at once, there is something else we're not providing: we're not providing appropriate care for our patients.

9:55 a.m.

Conservative

The Chair Conservative Joy Smith

Thank you, Ms. Roy.

I'm sorry, we'll have to go to Dr. Carrie and Ms. Block. They'll be sharing their time.

March 29th, 2012 / 9:55 a.m.

Conservative

Colin Carrie Conservative Oshawa, ON

Thank you very much, Madam Chair.

I want to thank all the witnesses here today for your input on this very important topic. I want you to know as well that quite often we share your frustrations with the way Canada's health care system works. You mentioned internationally the example of New Zealand—I think it was brought up—where they have one national system, so that a lot of things can be input.

But I think that saying where these silos are is just a question of where you want to draw the lines. As far as the delivery of health care in Canada is concerned, the reality is that it is a provincial jurisdiction. The provinces are responsible for delivering this health care.

One thing that I think is important to get on the record is—I think, Madam Attara, you brought it up—about piggy-backing. Health Canada does have a role. What we do is look at the safety and the efficacy of the drugs that are on the market, and we test for these.

Right now, just to give you an update, we've had submissions from other companies—17 recent submissions—and have already approved seven. With the SAP program, there were 61 applications received recently; in the last couple of weeks, 39 have been approved.

In our role, whether the drug is coming from the U.K., whether it's coming from the United States, what we do is approve how safe it is and whether, where it was manufactured, there are good manufacturing practices that are effective. Then we permit the provinces to go shopping with that approval.

That's one of the frustrations, and I want to ask you this. If you were a health minister, or if you were in one of these buying groups, first of all, would you sole-source a drug that is deemed to be medically necessary or essential? Is that the way you would do it?

9:55 a.m.

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

Gail Attara

Absolutely not; I would not do it.

I'm co-author of a study looking at patients who switched from one brand name to another—so I'm not even talking about generic drugs. It was predicted by B.C., where I'm from, that it would save $42 million in health care costs, and it actually cost $43 million. It's a published study.

This was just from switching patients to a cheaper medication. It didn't work. Patients are not all the same. You can't do that. What works for me is not going to work for you. Even if you bring it down to a simple thing like fruit, we can't even eat the same fruit, probably.

9:55 a.m.

Conservative

Colin Carrie Conservative Oshawa, ON

The answers seem to be quite obvious, but the reality is...let's say you were one of those buyers and you found yourself in a situation where you were going to have a sole-source contract. It's well within your means. If you wanted to, you could put in things like.... Would you put in financial penalties? Would you put remediation clauses in there?

10 a.m.

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

Gail Attara

You mean for not having consistent supply?

10 a.m.

Conservative

Colin Carrie Conservative Oshawa, ON

Yes. You signed a contract with them, and it's a legal contract. Wouldn't that be something you would put in remediation, risk management things, if they weren't able to deliver those products? Is that something you would put in?

10 a.m.

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

Gail Attara

I think it would be an important factor to put in. If I were in those shoes, I probably would try to build in a lot of those kinds of things, except I imagine if I were in that role there would be a lot of pressure back for concessions in other areas.

What we saw, again, in my experience in B.C. was that there was a lot of pressure on the government there in the B.C. pharmacare plan to prioritize that medication among the patients in that area, and that was not a good health decision.

The thing is those health decision-makers have to be so careful about cause and effect.

10 a.m.

Conservative

Colin Carrie Conservative Oshawa, ON

That's what I think is really important, the communication, because we all have to work in this together. The reality is, because it is a provincial jurisdiction, the health care providers really do have to get that input back and forth between the people who are actually buying the products for their services so they can deliver those services. I do take your comments because I do think they're very important.

I believe my....

10 a.m.

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

Gail Attara

Be there. The patients need to be there. Feedback about that particular disease would have been so helpful had the decision-makers known how different these medications were.

The study is available, should the committee want it. It's in the PPI class, which is for proton pump inhibitors for gastroesophageal reflux disease, which is a seemingly easy disease to manage, and yet 25% of the people failed when they had to go onto the designated products.

Had the decision-makers known about this kind of variance.... These medications all work. They all work, but not for everyone.

10 a.m.

Conservative

Colin Carrie Conservative Oshawa, ON

But you're helping to educate the decision-makers?

10 a.m.

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

Gail Attara

We're trying. We're doing our part.

Thank you.

10 a.m.

Conservative

Colin Carrie Conservative Oshawa, ON

Thank you very much.

10 a.m.

Conservative

Kelly Block Conservative Saskatoon—Rosetown—Biggar, SK

Thank you very much, Madam Chair, and I want to thank our witnesses for attending today and for your presentations. I've appreciated your answers to the questions that have been asked so far.

Madam Chair, I want to start by following up on the reference made by my colleague. She's left the room, but I want to follow up on the reference she made to a letter written by the Canadian Anesthesiologists' Society dated January 2011. I don't have a copy of that letter. What I do have is a copy of correspondence sent by that same organization dated August 23, 2011, and a response by the minister dated September 7, 2011. Then I have a copy of their most recent correspondence from a couple of weeks ago this month.

I'm wondering if the member would be able to table with the clerk a copy of that letter for the rest of the members on this committee.

10 a.m.

Conservative

The Chair Conservative Joy Smith

Yes. Absolutely. Thank you.

10 a.m.

Conservative

Kelly Block Conservative Saskatoon—Rosetown—Biggar, SK

Okay.

Do I have time for my question?

10 a.m.

Conservative

The Chair Conservative Joy Smith

You have a minute and a half.

10 a.m.

Conservative

Kelly Block Conservative Saskatoon—Rosetown—Biggar, SK

Thank you very much.

I want to follow up with...I think it's Ms. Lamarre, your presentation. You made three recommendations, or you've captured three recommendations—a monitoring unit, a legislative framework, and a list of essential drugs—and you've referenced the United States and France in your remarks.

I'm wondering if you are aware of other best practices in other countries that you'd be willing to share with us that support your recommendations or would add to them.

10 a.m.

Conservative

The Chair Conservative Joy Smith

You have less than a minute, Ms. Lamarre.

10 a.m.

President, Ordre des pharmaciens du Québec

Diane Lamarre

Of course, there are measures in place around the world. The current president of the Ordre national des pharmaciens de France, France's national order of pharmacists, is also the president of the European Union group. We can therefore assume that the message approved in France will be passed on to the European Union.

What I wanted to emphasize is that our American neighbours are similarly afflicted.The Sandoz situation comes from the FDA. The Caelyx issue came from Health Canada, and its impact has been felt across the United States. So we really are in a situation where we must establish international relations, but we certainly must also establish privileged relations with the United States.

10 a.m.

Conservative

The Chair Conservative Joy Smith

Thank you, Ms. Lamarre.

We will now go to Ms. Quach. You can continue that question, if you'd like. It's whatever you want to do.