Health Committee on Oct. 18th, 2018

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you.

Does anyone at the table have anything to add to that?

[Louise Kyle]

I'll add a quick comment.

I think it's important to note, especially with insulin but with every drug, that we're talking about two different things when we're talking about cost and price. A recent study that came out in the BMJ Global Health journal estimated that the cost to produce insulin sits at around $5 a vial, and current list prices in the United States are at around $300.

With regard to cost and access, ultimately I think that if you're looking at the cost, there's still an opportunity for pharmaceutical companies to make a profit when they're not charging the prices that they're charging today.

[Benjamin Davis]

If I may...?

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Yes.

[Benjamin Davis]

Part of the submissions that the MS Society has made have been related to changes that are being proposed by the Patented Medicine Prices Review Board. I flag that here because the theme we have in our recommendations is certainly around patient-centred coordinated approaches and a priority-setting framework for these sorts of things.

At the end of the day, any changes that are made in the landscape should not result in a reduction in choice. That's critical. When we talk about access, certainly the financial piece of that is important, but outcomes are equally important. Some of the difficulties we hear about from our community and others in the health charities sector is that Health Canada-approved disease-modifying therapies are not consistently available across this country. There are stories of people moving from one province to another to get the treatment that works for them if they do not have private health insurance, and that's a concern.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you very much. I think that's my time.

[The Chair, Liberal, Bill Casey]

That finishes our seven-minute rounds.

Now we'll go to five-minute rounds, starting with Mr. Webber.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you, Mr. Chair.

I want to go along the same lines as Dr. Eyolfson with regard to his questions on diabetes and insulin.

I'm a bit confused here. First of all, Sir Frederick Banting gifted his insulin to the world. I just don't understand why it's so expensive and why these pharmaceuticals are charging so much. They didn't have any R and D, or not much, and to charge what they are charging, they're obviously just trying to make a profit. Is there no pharmaceutical company out there that will have a kind heart and develop this insulin at a relatively reasonable price?

[Louise Kyle]

It's a really good question. I think it's something that folks in the insulin space have been grappling with quite a lot—trying to understand why this is going on, what the factors are, and where we can have an impact to see some relief.

There are a couple of issues going on here. The first is that globally, as you heard me mention, one in two people cannot access insulin. There are several different reasons for this, and only one of them is that the market is dominated by these three big companies. There are concerns about tariffs and concerns about physical access to the drug in different communities.

The second big issue going on in insulin is the price that's going up and up and up. We're seeing this really hit hard in the United States in particular right now. We've looked at emerging smaller companies that are trying to enter the insulin space. We think what's happening is that they're being bought by these big three insulin manufacturers. They're the subject of lawsuits for anti-competitive behaviour and a whole host of other things from different states in the United States right now—but I don't know; I wish there was a better answer, and I wish there was a pharmaceutical company that had a good heart.

[Len Webber, Conservative, Calgary Confederation, AB]

Dr. Kiddell-Monroe, would you comment?

[Dr. Rachel Kiddell-Monroe]

I would just add that what happens with these things as well in terms of the intellectual property is that as you tweak and develop something, of course, you can get follow-on patents. Louise mentioned the move from the pork-based insulin to the human insulin and to the analogue. Well, as you go through all of these stages, you get different intellectual property and follow-on rights coming up that inhibit access for other companies that would wish to come in to compete.

[Len Webber, Conservative, Calgary Confederation, AB]

I see. I guess there are other costs too, other than the insulin—the syringes and the monitoring devices and such.

[Dr. Rachel Kiddell-Monroe]

Yes, and these are extremely expensive objects. In many environments they often don't work. If your insulin pump breaks down and you're in the middle of Ecuador or somewhere, what do you do?

[Louise Kyle]

That's if you can even access an insulin pump in Ecuador.

[Dr. Rachel Kiddell-Monroe]

Precisely.

[Dr. Jason Nickerson]

As an organization that works predominantly in crisis-affected countries, generally in low- and middle-income countries, our experience in trying to access affordable medicines is that the way in which we get the price of these things down is through competition. This is really where we have seen the largest price reductions.

Look at the antiretroviral market for HIV treatments. For first-line antiretroviral therapies around the world where we now have really quite vibrant competition, we're probably approaching the lowest-sustainable price for these things. That's really what I think we need to be talking about: What is the sustainable price that ensures access, that is affordable for the patients and the health systems who need them, but is sustainable enough—in terms of manufacturing costs and a reasonable profit—to incentivize someone to be producing this and selling it?

[Len Webber, Conservative, Calgary Confederation, AB]

That's interesting.

I'd like to move on to MS here. I'm quite a layman when it comes to knowledge of MS. Of course, we don't know what causes MS. You do mention that Canada is one of the highest population bases for MS in the world. I don't know if you can answer this, but is it because of the climate? Is it because of genetics?

[Dr. Karen Lee]

It's exactly those things that you just said. In fact, there are a lot of hypotheses looking at climate; that's vitamin D. Viruses like Epstein–Barr are heavily studied. For many of us that's known as the “kissing disease”, or mono. It's almost that what we're looking at is potentially a perfect storm that causes multiple sclerosis. Your genes may be primed, and when you are situated in the perfect environment, that might then cause multiple sclerosis. Therefore—and there are a lot of theories right now—being further away from the equator may actually be one of the reasons that we have one of the highest rates in the world.

[Len Webber, Conservative, Calgary Confederation, AB]

That's interesting.

You talked a bit about this young woman who was married and who was on a clinical trial for a stem cell. I've heard stories of people being on clinical trials. The trials have been quite successful, but then, once they're over, the people are without the drugs.

[The Chair, Liberal, Bill Casey]

Please be very quick.

[Len Webber, Conservative, Calgary Confederation, AB]

Okay.

To go back to the stem cell, is that a permanent fix?

[Dr. Karen Lee]

For this particular stem cell clinical trial that we funded, they saw in essentially a majority of the people a significant difference. They didn't have any more relapses. For this woman, who is actually situated here in Ottawa, she went from a wheelchair to now walking without any aids.

[Len Webber, Conservative, Calgary Confederation, AB]

That's fantastic.

[Dr. Karen Lee]

It is a very aggressive treatment, but it does work for a very small population.

[The Chair, Liberal, Bill Casey]

Wow. That's exciting. Walking in heels, you said?