Health Committee on May 15th, 2014

[Krista Outhwaite]

Thank you, Chair, for the question.

I believe the minister commented on the fact that she'd had a conversation with her provincial-territorial co-chair, Minister Horne, who is from Alberta, on the question.

I can tell you that in point of fact, that particular question first came to us at the international dementia summit, which was held in London in December 2012. Minister Horne agreed to discuss this with his PT colleagues, and my understanding is that's in the process of unfolding. I don't personally have knowledge of those conversations that he's having with his PT colleagues.

In reference to the point you made earlier around research and, again, referring to the international summit convened by the U.K. on dementia, it is very much the view that, for all of the issues you mentioned, research is key. We don't have the solutions we need to address these very important questions and issues, and research is key. It's not only fundamental research, but applied research, to help health care workers, to help people who are suffering from the condition to live better lives, as well as prevention and mitigation.

[Claude Gravelle, NDP, Nickel Belt, ON]

I think I mentioned to the minister that we're all in favour of research. Research is good. Nobody is against research. But we have to do more.

What are we going to do to help the caregivers? Research is not going to solve the problem for caregivers. We have to do more for caregivers. We have to do more for training the workforce. Why can't we do more?

[Krista Outhwaite]

These are tremendously important questions you're asking. Again, I am struck by the fact that the very questions you're raising today were also raised at the dementia summit, not only by those who are working very hard in the field but also by those who are suffering from these conditions.

Provinces and territories—in their respective jurisdictions responsible for health care delivery—are doing their very best to deal with the issues as they're manifested within their particular jurisdictions. There are initiatives under way that are grounded in research but also informed by the work that the department is doing with provinces and territories to look at how health care generally can be improved. It may even factor into the innovation work that is being undertaken by provinces and territories, as well as what the minister is talking about.

[Claude Gravelle, NDP, Nickel Belt, ON]

Canada does a lot of work with the provinces for cancer. There's a cancer partnership. I don't see any reason we can't do the same thing for dementia.

I want to quote from Mimi at the Alzheimer Society of Canada. She's talking about dementia:It's coming upon us fast and furious....As baby boomers age, age is one of the risk factors [and] we're seeing a major increase in people with disease at a younger age. Early on-set is absolutely devastating to a family when you think of a 40-year-old getting the disease.

Caregivers are working an estimated roughly 444 million unpaid hours per year. That's a loss of income of $11 billion per year. That's a lot of money.

[The Vice-Chair, NDP, Libby Davies]

There's just time for a very brief reply, perhaps 30 seconds.

Dr. Beaudet.

[Dr. Alain Beaudet]

Once again, I can only reiterate the importance of fully understanding the reasons for it and of seeing how we can help caregivers.

Let me remind you that, next September, Canada and France will host one of the G8 summits, the one following the London summit. The summit will specifically examine the best ways to collaborate on an international scale with the industrialized world, the world of medical devices and information technology, so that we can find ways to better assist caregivers in particular.

[The Vice-Chair, NDP, Libby Davies]

Thank you very much.

We'll now move over to Dr. Lunney.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Thank you, Madam Chair.

Thanks again to our officials for being here.

I want to start with you, Ms. Outwaite, as the acting head of the Public Health Agency of Canada right now, with the unfortunate departure of Dr. Butler-Jones, who is phasing out, I understand, after his circumstances have impaired his ability to continue. We certainly respect the work he's done at the agency over these years.

We're talking about innovation. We've had some discussion already about prescription drug issues and how to get a handle on the overuse of prescriptions. You're, of course, aware of the issue that I have been raising for a number of years. In fact, I think the first time I asked this question on the record was when Ujjal Dosanjh was minister in 2005.

I'm talking about proton pump inhibitors and C. difficile infections. There are an estimated 1,400 deaths a year. We don't have complete figures every year in Canada. It's clear these drugs are overused. I've been asking about the Canadian nosocomial infection surveillance program. Nosocomial, of course, is hospital-based, for those who aren't familiar with the language.

It seems to me I was told that in that area they were going to get to the bottom of the issue by looking at the issue in teaching hospitals. But somehow they failed to collect data at that time on the meds they were on at admission. It seems to me that would be a very simple thing to correct. Would you agree?

[Krista Outhwaite]

First, I'd like to thank you for your kind words about Dr. Butler-Jones. He is, indeed, a leader in the field of public health and certainly to all of us at the Public Health Agency.

To your second question and comment with respect to Clostridium difficile and the Canadian nosocomial infection surveillance program, if I may, I'm fortunate to have with me a colleague, the deputy chief public health officer, Dr. Gregory Taylor. Gregory has worked closely in these areas. I'd like to turn to Gregory to respond.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Sure. I was hoping the answer could be fairly quick. I have another question.

[Dr. Gregory Taylor]

Very quickly, the CNISP, as you referred to, was set up as a surveillance system. It wasn't set up as a research system. And what you're looking for is some research. I think there's lots of evidence to suggest an association. It's that causal proof that needs to be the next step of looking at the evidence of that.

We are going to work with CNISP. We're trying to expand and enhance CNISP; it seems relatively easy to add that question, as you've said. We're going to work with the folks at AMMI, the Association of Medical Microbiology and Infectious Disease, who are the folks who work in the hospitals that do that data collection, to see if we can add it as part of that and take advantage of the existing networks and do a little bit of research with the surveillance network.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Thank you.

You'd be aware, of course, that the drug safety and effectiveness network reported back that, in fact, there's a strong association.

On CIHR, or Canadian Institutes of Health Research, I see you've made a remarkable transformation here. The money used to be almost all dedicated to investigator-initiated health research. But I see your second is priority-driven health research.

On the same issue, we have a promising, but not established yet, use of probiotics as a preventative measure, not as a treatment measure, for C. difficile. But the study done, right out of a hospital here, nine years experience in Montreal as a lead agency, had 95% reduction in C. difficile. It hasn't been confirmed with other studies, because many use underpowered probiotics. This is nearly 100 billion CFUs administered through Bio-K Plus.

Would that be a possibility as a priority-driven health research, which is designed, as I see, targeted research to address challenges facing Canadians, where we might be able to engage CIHR to take some of our worst hospitals where there's a high incidence of C. difficile and actually check out the preventative measures—36 hours after starting antibiotics, they get a probiotic—and eliminate a high percentage of these infections?

[Dr. Alain Beaudet]

Very rapidly, the answer is yes, and we've started.

I'm proud to report that when I was president of the Fonds de recherche en santé du Québec, before holding this current job, I called upon CIHR when there was the scare of C. difficile in Quebec—as you know, a few years back—to work with CIHR to develop a major program of research on ways to diagnose early and find new ways of treating C. difficile. The probiotics studies that you referred to was some of the work that we funded at the time. It is part of our priority research in what we call emerging threats.

[The Vice-Chair, NDP, Libby Davies]

Thank you very much.

We'll now turn to Mr. Young.

[Terence Young, Conservative, Oakville, ON]

Thank you.

Thank you, everyone, for being here today.

Mr. Da Pont, I wanted to ask you about new drugs on the market. As you know, all drugs cause adverse drug reactions, and new drugs on the market do not have an established safety profile. They're essentially in phase four of testing. In the U.S., one in five new drugs put on the market will either have a new high level of warning—the highest level of warning, a black box warning—put on the label within two years, or actually be taken off the market for harming patients.

Vanessa's law will create an obligation for health care institutions to report all serious adverse drug reactions. This is great as an early warning system, but also while a drug is on the market to get warnings from doctors that a drug could be causing liver damage or heart arrhythmias, etc.

These wonderful people take care of us, and I mean it sincerely; they are wonderful people. My own brother is a surgeon, a tremendous surgeon. The problem is that our doctors refuse to accept responsibility to report adverse drug reactions, the serious ones. They don't want to do it, and there are a whole range of reasons they don't. I recently met the incoming president of the Canadian Medical Association and asked for help on it: this information is lifesaving information.

Do you have any ideas or any comments on how we might encourage our health care professionals, let them know the critical importance of reporting serious adverse drug reactions, and encourage them to report them so we can get this information early and get risky drugs either off the market or get proper safety warnings put on the labels?

[George Da Pont]

Thank you for that.

As you've noted, a big start, obviously, is Vanessa's law, which will make mandatory reporting on adverse drug reactions from hospitals and institutions. Within Health Canada we are organizing ourselves to actually have better capacity, then, to take those reports, analyze them and, of course, put out information, as required, to the medical community.

In terms of encouraging more adverse drug reaction reporting from individual physicians, we do try to do that. We work, as I'm sure you know, with the Canadian Medical Association and a variety of other associations, the colleges, to encourage that.

One of the things we would like to do is move to a more electronic system, a simpler mechanism for reporting to make it easier. We hope that will help.

[Terence Young, Conservative, Oakville, ON]

Thank you.

Mr. Da Pont, I'm sure you and your senior staff have been following the testimony we've heard on our study on opioids, addictive drugs. We heard that Purdue Pharma marketed OxyContin and oxycodone in the 1990s illegally, fraudulently, by telling doctors that it was not addictive, or that it wasn't as addictive as other drugs.

The president of Purdue Pharma actually came before our committee by his own request. I pointed out that his company had paid a $635-million fine in the U.S. to settle criminal charges for doing that, and how much harm the drug had caused. And I think he admitted.... I quoted a number of $23 billion in sales since 1995 of OxyContin worldwide. I asked him, being that his drug, OxyContin, oxycodone, has caused such a high number of addictions and so much human misery—500 Ontarians die a year from addictions related to OxyContin and oxycodone—if his company would consider matching the $45 million that the federal government put into our recent budget to help treat people who are addicted to opioids and help prevent further addictions.

I just wondered, have you heard anything about that, or any response to that? You haven't by chance received a cheque of $45 million from Purdue Pharma, have you?

[Voices]

Oh, oh!

[George Da Pont]

Not as of yesterday.

[Terence Young, Conservative, Oakville, ON]

Okay. Thank you.

With regard to health care transfers, health care transfers have been growing 6% a year, and they'll continue to grow after 2017. They're at a record number of $32 billion—$32.1 billion this year—and they'll be at a record number in 2018. But we know that in some of the provinces, the rate of increase in their spending has gone down, so there seems to be a spread there. In other words, we're giving them more money for health care than they're actually spending.

Do you have any idea where the money that they're not spending in health care is going? Are there any restrictions on that at all? Or can they just take the money and spend it on anything they want?

[The Vice-Chair, NDP, Libby Davies]

We'll need a very brief reply, perhaps 20 seconds.

[George Da Pont]

The transfer doesn't have specifics attached, obviously, to what the money is for. That downward trend is pretty recent. It just started in the last year or two. It is encouraging, and it should give the provinces more flexibility to deal with some of the chronic issues like continuing problems with wait times and so forth.

[The Vice-Chair, NDP, Libby Davies]

Thank you very much, Mr. Da Pont.

We now go over to Dr. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much, Madam Chair.

I want to pick up on Mr. Young's question with regard to OxyContin. I think, as we well know, this is all...having made that statement and seeing that Canada is now the number one country in the world with regard to OxyContin abuse.

Can you explain to me the rationale as to why the government and Health continue to give an okay to six generic companies to produce this particular drug when the U.S. is no longer doing it and other countries are no longer doing it? It doesn't make any sense to me to, on the one hand, put millions of dollars into some sort of prevention and surveillance and tracking when the drug, the one that everyone is begging the minister and the Department of Health not to give any approvals to...have gone ahead and given approvals to six new generic companies.

I don't understand it. It just defies any kind of common sense.

[George Da Pont]

That decision was taken, but when it was taken in terms of allowing OxyContin to remain on the market—and having allowed it on the market, if there are generic versions available it's very hard to deny them—at that time a number of stronger restrictions were put in place in terms of the licensing for reporting, for diversions, and so forth. We have been monitoring that very closely. From that monitoring we haven't seen any spike or increases yet.

But as the minister has said I think on a number of occasions, it is a significant concern. That's why there's going to be significant additional investment in dealing with prescription drug abuse. I would say the minister has also indicated that an important component of this is to look at options for tamper resistance that would also be a factor in helping.