Health Committee on May 15th, 2014

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you for that answer. I don't agree; I think if other countries can decide that they will no longer allow for generic OxyContin, we could. I don't know what our reasons are for not doing this.

Many countries, such as Scandinavia and Switzerland, have a HAT program, which is obviously heroin replacement therapy. The studies that have been done by NAOMI and SALOME in Canada have shown very clearly that for a small group of patients who are addicted to heroin and who are not responsive to methadone, they can benefit from prescriptions of diacetylmorphine.

I know that the department itself has actually agreed that it should be allowed under the SAP program, that it should be given to doctors who ask for this prescription. The minister has said no. Can you tell me if there is any move to let the minister read or to show the minister the clinical trials that are telling her that this is going to drive these people who cannot respond to anything other than diacetylmorphine and heroin, to go back on the streets and get street drugs again, when they could be treated with a pharmaceutical product that has been proven to be so internationally out there? Is there an answer to that?

Dr.Taylor, maybe you can answer it.

[George Da Pont]

Maybe I'll start, and then if Dr. Taylor has comments he can add them.

To my understanding, the science and the clinical trials are not yet as clear-cut as you're suggesting. As you know, that is really one of the main purposes of the clinical trial that's currently under way. That clinical trial will end I understand in the next year or year and a half. We will see from the results of that clinical trial whether the evidence is actually there. That's the whole purpose of the trial.

[Hedy Fry, Liberal, Vancouver Centre, BC]

I understand that, but it's also my understanding that the department suggested that this drug be allowed and the minister said no to it.

There is one other thing I wanted to ask, and it's to CIHR. You're reforming your funding and grant review programs. The new foundation scheme is going to give you a new set of two existing grant cycles. It would mean that there would be two applications and three distinct review stages. In 2015 and 2016, between the ending of the old cycle and the new cycle, there's a three-month shortfall in which many people who are doing the research and the granting cannot have the money to hire and keep their staff.

How are you going to address that particular and specific problem, a very practical problem actually?

[The Vice-Chair, NDP, Libby Davies]

A very brief reply, please, because we are just about at time.

[Dr. Alain Beaudet]

Well, very briefly, you're right; these reforms—and by the way, Canada has recently been commended in a PNAS article for these reforms—mean that we're going for a set of grants from two competitions a year to one competition a year, and that explains the so-called gap that you're talking about. You're absolutely right; it's not six months as it used to be. We managed to reduce it to three months, and it affects a very small number of individuals, between 75 and 100 in the whole country. We've negotiated with the presidents of the U15 universities, research-intensive universities, to ensure there's no disruption of the work of these individuals for this period.

[The Vice-Chair, NDP, Libby Davies]

Okay. Thank you very much, Dr. Beaudet.

We'll now go back to Dr. Morin.

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

Thank you very much.

Regarding maternal health, in Canada maternal death rose from 6 per 100,000 births to 11 per 100,000 births between 1990 and 2013. Many European countries and Japan have mortality rates in single figures. Why are today's Canadian women more likely to die in childbirth than their mothers were?

[George Da Pont]

Sorry, where are you quoting from?

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

A CBC report.

[Dr. Gregory Taylor]

I don't think that's consistent with the surveillance information we're collecting. Are you talking about maternal deaths?

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

Well, it will be a pleasure to find the information and give it to you.

[The Vice-Chair, NDP, Libby Davies]

Maybe Dr. Morin can supply the information to the officials. You can look at it, and then send something back if you dispute it.

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

If the CBC report is indeed true, it is highly concerning.

[Dr. Gregory Taylor]

Absolutely. I'd love to see that information, please.

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

Okay. My next question.... Time is running out.

Regarding diabetes, diabetes rates are set to double in Canada in the next 25 years. Last year your diabetes prevention strategy was blasted by the Auditor General of Canada for having no timeline, no goals, and no objectives, and for spending more on administration than on community programs. Can you tell us how you have fixed the program?

[Dr. Gregory Taylor]

I'll answer that.

Our diabetes program—and we're well aware of what you said, that diabetes is increasing—is trying to move upstream and trying to move away from.... We originally were looking at treating diabetics and assisting with that guidance, which we've done. We're starting to focus upstream to prevent diabetes. The risk-factor approach is looking at physical activity and nutrition to try to encourage people to adopt healthy lifestyles and reduce levels of obesity to try to preventing the onset of diabetes.

At the same time we've done some really innovative work that led us to the innovation agenda with CANRISK. That's a screening questionnaire that we've partnered with drugstores. People can pick them up in Shoppers Drug Mart in particular, who are very proud to partner us with this. Folks can answer this simple questionnaire, see if they're at risk for diabetes, and then see their doctor and follow up to have interventions focused on reducing the risk factors.

We believe in prevention, that Canadians would not want to get diabetes at all rather than have better treatment. It doesn't mean you have to ignore them; you have to focus on the folks who have diabetes. But I think going upstream and looking at the risk factors combined is a much more effective approach to prevent the diabetes onset to begin with.

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

But since the Auditor General of Canada said the comments I conveyed to you, have you modified the programs to respond to his concerns?

[Dr. Gregory Taylor]

We've addressed that. We're continuing to work with the Auditor General. We discussed this issue with him just last week, and we're making it much more targeted. We put it under the rubric of our integrated chronic disease strategy, so it makes sense, it's connected, and has its own targets, as well. So we're well on the track of addressing all of those issues.

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

Okay, on track, but you haven't yet implemented any of his recommendations.

[Dr. Gregory Taylor]

We're almost done. We've met almost all of them.

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

Okay. I'm looking forward to seeing those new changes.

So what are you doing to prevent diabetes, particularly in the most vulnerable communities? I fully agree with you that prevention is the key, but we know that in vulnerable communities in Canada it is very hard to prevent.

[Dr. Gregory Taylor]

As I say, a lot of our programs are targeted to those. Risk factors are extremely important, and determinants of health are important. I believe Health Canada has a targeted aboriginal diabetes strategy.

[George Da Pont]

Yes, we do. We have, as just mentioned, a targeted diabetes strategy that we invest in. It's part of what's covered off, obviously, by some of the funding here in the main estimates, and we continue to work with aboriginal communities to help them put the resources in place to deal with this issue.

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

Okay.

This is my last question for you. We have heard troubling news of the possible spread of the infectious Middle East respiratory syndrome coronavirus. Can you tell us what the Public Health Agency is doing to monitor this public health threat?

[Dr. Gregory Taylor]

I'd be delighted to answer that question.

This is very much in the media these days. I did five interviews on that yesterday alone. We are very well prepared for that. We have equipped laboratories across the country to detect this. That's coming out of our national laboratory, where we've equipped them and assisted them to do that. We've got guidance in working with physicians for heightened awareness. That means that when they're seeing somebody with symptoms that are compatible, they're asking for the travel history, asking whether somebody has been in the Middle East. They're doing the tests to confirm and be sure.

We have our quarantine officers who have worked to train border services and folks at the airports and crossings to look for disease like that. We've been working very carefully and very closely with the WHO. In fact, Canada's providing leadership. A doctor in our agency, Dr. Theresa Tam, is the co-chair of the emergency committee that just met. As you're aware, it was declared yesterday that this was not an emergency concern. That information is based on—