Health Committee on March 29th, 2012

[Diane Lamarre]

I do believe, however, that no country has experienced as widespread of a shortage as what Canada is going through. Right now, injectable drugs are severely affected in Canada. I believe it is incumbent upon us to learn from this specific case. I think it is in our best interests to show others the way. Despite dual legislation, I think the responsibilities and oversight are shared, and lessons must be drawn when it comes improving our processes.

Health Canada's special access program is a federal initiative that has never been tested in a shortage situation like the one we are in right now. It has always applied to rare situations, for patients who needed a drug with limited or no availability in Canada. A doctor would request it for a patient. This is the first time a group of doctors has needed a wide range of drugs for a group of patients. This is a first that we must learn from.

When the special access program was launched, it met certain needs. We are realizing that those needs are going to be felt again, unanimously around the world. I think that what we are experiencing should guide us in changing existing structures so we are better equipped to respond to needs quickly and much more appropriately. As it stands, the special access program has made it possible to import drugs more quickly for a large number of patients and in large quantities, and that is a first.

[Myrella Roy]

I think I'll restate what I said before. We're health care practitioners. We're not fully familiar with how all the political systems work and how the health care systems work around the world. That is Health Canada's responsibility. If there are solutions and there are other countries that have systems similar to ours and we can learn from their system, that is what we expect Health Canada to do.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Strahl.

Mr. Morin.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you, Madam Chair.

First off, I want to offer a special thanks to my colleague Anne Minh-Thu Quach for being the first member of Parliament to raise the drug shortage issue involving Sandoz in the House of Commons. I am proud to belong to a party that sees drug shortages as important and one that shows leadership.

Ms. Quach then addressed a question to the Parliamentary Secretary to the Minister of Health, Mr. Carrie. He replied that he would see to it that the appropriate information was provided to the right people at the right time and that, as a result, doctors, pharmacists and patients would be informed of what was happening with enough advance notice to adjust treatments if need be. That was his reply. If I go by that, I am inclined to think that the government is showing leadership, although everything you have said suggests that the federal Conservative government has failed to show any leadership in this matter.

Furthermore, Ms. Lamarre, I was quite struck by something you said: between 2006 and 2010, shortages had quadrupled. You even said the most recent shortage was widespread. That is disturbing, indeed.

I want to pick up on what my colleague Libby Davies pointed out. In 2008, the industry minister, Tony Clement, was made aware through a report by the Competition Bureau. In 2011, the Canadian Anesthesiologists' Society also contacted the Minister of Health, Ms. Aglukkaq, who has been on the job for four years. Unfortunately, raising the matter with cabinet or even Ms. Aglukkaq's office does not do any good. I agree with you, the government is failing to show leadership on this issue, and I find that appalling.

What's more, as Dr. Haggie mentioned, the current government prefers to point the finger at the provinces. Ms. Leitch, a Conservative member, repeated that position today. She blamed health professionals for not monitoring the situation, and the provinces, saying it was their problem.

What it boils down to, in my opinion—and I would like Dr. Haggie to comment on this—is a lack of leadership by the federal government and a passing of the buck to the provinces. It is already common knowledge that there is a doctor shortage in the provinces, at least in Quebec, and given the scarce drug supply, some treatments and surgeries are being delayed. Provincial wait times to see a doctor and receive treatment for a variety of conditions will increase. So that will be the provinces' problem, not the Government of Canada's. I am appalled by this lack of leadership. I want to hear your thoughts, Dr. Haggie, on what I just said.

[Dr. John Haggie]

Looking at it from a patient's perspective, they don't have a grasp of the niceties of jurisdictional disputes. They really don't understand how it is that the drugs they get actually get to them. To be perfectly honest, before these last few weeks, I was pretty well completely ignorant as well. I'm not sure I'm any wiser now, because what this whole exercise has highlighted to me is that there isn't a seamless approach to health care. There isn't a seamless approach to the issue of pharmaceuticals.

You could almost argue that pharmaceuticals now are the defining modality of medical management. When I trained, we were on the end of fixing things surgically. Diseases I treated with a knife, as a resident, are now treated medically, for the benefit of the vast majority of patients. Drugs are no longer just one of those things that are there as an optional extra.

I turn it back from the patient's point of view and say that the constitutional debate, the funding debate, the financing debate between health boards, provinces, and the national group has not informed them. It has not made them feel comfortable. It has not made them feel as though things are moving in the right direction. Finger pointing and blame....

You need to learn from case studies, and where you stand on that depends on where you sit, quite frankly.

As Rick Hillier, another Newfoundlander, said, no good crisis should go to waste. The one good thing that could come out of this is that we can do it a hell of a lot better next time and we won't end up in this pickle in the future. If that requires that the feds and the provinces and the territories sit down together and actually talk to each other, is that such a bad thing?

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Haggie.

We'll now go to Mr. Gill.

[Parm Gill, Conservative, Brampton—Springdale, ON]

Thank you, Madam Chair.

I also want to thank the witnesses for your wonderful presentations and for taking the time to be here with us today.

I'd just like to mention one thing for the record. My colleague, Mr. Lizon, pointed this out. One of the members of the NDP yesterday issued a press release claiming that the Minister of Health had not responded to the letter or the request that was made by Dr. Chisholm and his organization. I'd like to quote from that release: “Despite the warnings, Conservatives refused to act – or even respond [to] the letter from the Anesthesiologists Society.”

I'd like to thank Dr. Chisholm for clarifying for the benefit of the committee the fact that the minister had responded to the correspondence on September 7, 2011.

I have a question for Dr. Chisholm. Health Canada is speeding the review of more than 35 submissions for the additional supply of drugs. It has also fast-tracked approvals of replacement drugs, including at least one used in anesthesia. How will this replacement drug help patients?

[Dr. Richard Chisholm]

I would have to know which drug that was. I'm sorry. I don't know.

Would you know which drug it is?

[The Chair, Conservative, Joy Smith]

Dr. Haggie?

[Dr. John Haggie]

I think it's rocuronium, Rick. I think it's one of your wake-up medicines.

[Dr. Richard Chisholm]

Rocuronium is a short-acting, non-depolarizing muscle relaxant. If you needed to have your appendix out, we'd need to relax the muscles in your abdomen for a short period of time for the surgeon to remove the appendix. It makes the surgery easier.

It has been in short supply in some places, with no supply in others. Having it available will improve surgical access.

[Parm Gill, Conservative, Brampton—Springdale, ON]

I would also like to clarify further the dates that I mentioned on the letter. There was also another correspondence apparently that was sent in January, to which the minister responded in March of this year.

The other question I have I'd like to maybe direct to Dr. Chisholm, but anyone else is welcome to take a shot at it.

As the minister has written to you, a multi-stakeholder working group was established to address drug shortages in Canada. A national reporting system is being created so that health professionals have timely and accurate information in order to adjust their treatment plan as needed.

Another important component of this plan is to provide advice on alternatives to medically necessary drugs that are in shortage. You're representing health professionals on the front line. Are there further contributions that physicians could be making to help us collaboratively respond to drug shortages?

[Dr. Richard Chisholm]

As you mentioned, there are two online resources. When I go to those, in fact, I don't find enough about the ones I use. There are some industry links there, where Canadian pharma generic manufacturers list the drugs that are in short supply.

I didn't see, as you alluded to, alternatives and things like that. Unfortunately, in terms of what we find out, I'll get an e-mail in the morning that this drug is not available. That's the only way I know it's not there. There is something that is not in my cart, and that's the only way I find out whether a drug is available or not.

We could feed back, but the problem is the only place I can feed back to at the moment is my pharmacist, and they have to pick up the phone in order for you to do that.

[The Chair, Conservative, Joy Smith]

Ms. Roy.

[Myrella Roy]

Our association has been a member of that multi-stakeholder working group since last spring, so I can speak to that.

Although I think we've made significant strides towards having a drug supply management system, as was mentioned earlier, currently we have a temporary arrangement with two existing drug shortage or drug supply systems. Our biggest challenge is coming up with one single robust national system that would also provide the full scope of information that health care practitioners need to provide quality care to patients.

Our biggest challenge is the sustainability and financing for the system.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Roy.

Now there will be shared time between Mr. Brown and Ms. Block. It's only five minutes, so watch.

[Patrick Brown, Conservative, Barrie, ON]

Kelly has a quick point, so Kelly can start.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

I do, Madam Chair. Again, I'm sorry. It's just a matter of process.

I had requested that the letter that was referenced be submitted to the clerk. I understand that we will be asking Dr. Chisholm for that letter. Because that letter was written in January 2011, and he did state that there was a response in March 2011, I wonder if I could ask that the response be tabled to the committee as well.

[The Chair, Conservative, Joy Smith]

Dr. Chisholm, could you make sure that we have both of those letters tabled with the clerk? Could you do that, Dr. Chisholm?

[Dr. Richard Chisholm]

Yes, we'll do that.

[The Chair, Conservative, Joy Smith]

Thank you so much.

Go ahead, Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Madam Chair.

There have certainly been interesting comments today. Mr. Strahl asked about other countries that may not have had shortages. If I recall, Australia, New Zealand, and the U.K. were mentioned.

One of the challenges we have in Canada obviously is that we have several levels of government involved in the administration of health care, with the provinces administering health care.

Are there things that have been done in Australia, New Zealand, and the U.K. that you suggest should be utilized or looked at in Canada? And how would they apply, given the jurisdictions we have in Canada?

[The Chair, Conservative, Joy Smith]

Would you like to take that question, Dr. Chisholm?

[Dr. Richard Chisholm]

We could rewrite the British North America Act, but that would be historical.

In New Zealand and Australia, they source to other places where we cannot go. For England, again, I'm not sure. We need some dialogue at a level higher than I am to find out exactly how they have managed to avoid these problems. As I said, they did have problems a few years ago, but certainly not to the extent that we and the U.S. have had.

[The Chair, Conservative, Joy Smith]

Ms. Lamarre.