Evidence of meeting #79 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was drugs.
A recording is available from Parliament.
As an Individual
Of course, one way of looking at this is when we have an expensive drug prescribed when less expensive drugs are available, or when quite often drugs are prescribed when they should not be prescribed and when other non-pharmacological therapies—by, for example, chiropractors, physiotherapists, or social work counsellors—are often as effective, or more effective, without the side effects of medication.
To a certain extent, the fact that we have so much mis-prescribing of drugs is a failure of the health professions but also specifically of how we organize primary health care. We still have most family doctors in Canada working not with a professional team of social workers, physiotherapists, chiropractors, and others who could deliver non-drug therapies.
They also are still not working with electronic health records. Canada's record there is very poor compared with other countries.
Conservative
The Chair Conservative Joy Smith
Dr. Rachlis, thank you very much.
We'll now go to Dr. Carrie and Ms. Block. You're sharing your time.
Conservative
Colin Carrie Conservative Oshawa, ON
Thank you very much, Madam Chair.
Dr. Rachlis, I want to talk to you for a moment. I'm a fan; I've read at least one of your books. I appreciate your opinion today on innovation and best practices.
You mentioned something earlier about how we have an archaic process of care in this country. I'm wondering if you could give us some advice. What do you think is holding the Canadian system back from adopting some of these innovative best practices?
I had a conversation with a friend of mine recently who was posted down in the U.S. She said that when she had to get some health care, she went to a nurse practitioner first. She had a lesion on her nose. The nurse practitioner took a bunch of pictures of it and e-mailed it to a specialist, who, according to her, was analyzing over 100, sometimes 200, patients a day, whereas in an old model of care, maybe he could see 30 or 40.
You mentioned chiropractors. As well, even in the U.K., to prevent readmission into hospitals, they will send people out, right into people's homes, to give diabetic care. It's a lot cheaper in the long run.
We had a witness earlier who said that in Canada we pay for the most expensive form of care. I was wondering if you could give us your opinion on why we don't utilize other health professionals to their full scope of practice. What is holding the Canadian system back from using these best practices that we're hearing from around the world, and even in our own country?
As an Individual
The so-called quality agenda in health care is something that all countries have heard of, and some are actually moving on.
I was in the U.K. last week, and Scotland I think is considerably ahead of most jurisdictions in Canada in appreciating that we need to move to make our system more patient-friendly. If we do that, that's the answer to our system: enhanced quality.
I think all systems have trouble dealing with this, primarily because we have providers, especially physicians, who are very powerful at maintaining doing what they have been doing. With that last federal agreement on health, I think one of its biggest faults was that there were not enough mandates in it, and providers ended up getting paid a lot more just for doing what they traditionally had been doing.
I think the federal government has a role in creating dialogues that can move the political agenda around. I think one of the reasons why we're less successful than a lot of countries is that so much of this goes down to the provincial level, and in many small jurisdictions we're not able to sort of move the ball.
I was working with a nurse practitioner almost 35 years ago. I had no idea that this would be still rare now.
I think we know what we should be doing. We have been talking about it for so long that I just know the whole script for any meeting I go to these days. But as opposed to other systems that are, I think, grappling with some of these issues more effectively, we don't do this well in Canada. The fragmentation of a lot of these issues down at the provincial level is one of our biggest problems.
I think the federal government doesn't have to take over provincial jurisdiction, but just to be way more.... Even if it were an effective head waiter—as it may have been described 30 years ago in constitutional terms—I think our country's health care system would be a lot more effective.
Conservative
Kelly Block Conservative Saskatoon—Rosetown—Biggar, SK
I don't know if I can do justice to the question that I wanted to ask Dr. Morgan.
You may have been answering this in response to another colleague's question, but you've mentioned a number of times a national strategy for innovation in R and D with pharmaceuticals.
I'm wondering if you could explain—in about a minute—how you would engage the private sector, entrepreneurs, that group of people, in a national strategy.
Associate Professor, Associate Director, Centre for Health Services and Policy Research, University of British Columbia, As an Individual
You're going to have to have a consultative process to create a strategy and to identify where your niche areas are. Canada is still lagging in its comparators, for instance, in coming up with a national strategy on personalized medicines. If even half the promises of this scientific paradigm in medicine come true, we really need to be on the ball with that.
So I might start with a process, that might be led by Genome Canada and other partners, around creating a strategy for personalized medicines, and go from there.
Conservative
The Chair Conservative Joy Smith
Thank you very much.
Dr. Fry, we only have a couple of minutes. You have time for one question.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Thanks very much.
I just want to follow up on your statement about basic research. In number four, your emerging trends are indicating that public money funding basic or clinical research is not organized as commercial campaigns.
We've heard that from many people who have come here, that in fact what would happen if you took basic research and you found a way to “build it and they will come”, with the basic research going on here that's feeding some of the innovations—including the translational research we need because of our national health care system—this would move. Do you actually believe that if we build it, they will come, i.e. pharmaceuticals from across the country, people who want to look at innovative ways of delivering health care?
The federal government has a huge role because we did this under Technology Partnerships Canada for about 10 years, and then it was cancelled in 2007. So there is a blueprint for doing it. Do you believe it really will pay dividends?
Assistant Professor, School of Public Policy and Administration, Carleton University, As an Individual
On the question, if you organize basic research based on the idea of getting monetary dividends out of that, I think—
Assistant Professor, School of Public Policy and Administration, Carleton University, As an Individual
If, at the university level, you can really develop an important expertise with lots of Ph.D.s and professors, you can do amazing research.
Basic research right now, first and foremost, is already public research, not only in Canada but all around the world. Basically this is what is feeding the beginning of the pipelines of most drug companies. They just acquire some of the promising molecules one can find and bring them into the pipeline.
The problem with that is what we are seeing right now, namely drug companies externalizing more and more research. That in itself is not really a bad thing because we know that innovation happens—with smaller biotech companies, for example—but the problem is why then do we still need the major drug companies in all of this in order to commercialize the product—
Conservative
The Chair Conservative Joy Smith
Thank you, Dr. Gagnon. Thank you very much.
I'm sorry our time is up, and we do have to go into a business meeting, but I want to especially thank Dr. Gagnon, Dr. Morgan, and Dr. Rachlis for their very insightful comments today. They have been very helpful.
I'm going to suspend for two minutes, and then we'll go in camera to committee business.
Thank you so much.
[Proceedings continue in camera]