Health Committee on Dec. 6th, 2018

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Glover, do you feel you have the resources? With those kinds of numbers, 40% to 50%—you think you're ordering Chilean sea bass, and it's tilapia, or whatever—do you feel you have enough resources, or are you beefing up your investigations in response to those reports?

[Paul Glover]

We are definitely concerned with the increase we are seeing in the areas of economically motivated food fraud and we are working to be able to invest more in this area, but it is an area of growing concern.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

I want to pick up on a question that was asked about thalidomide. We know that in budget 2018 the government agreed to accept this committee's recommendation to expand the eligibility criteria for the thalidomide survivors contribution program. Last May the Prime Minister was asked when the funding would flow to survivors, and he responded at that time:

We'll have more good news to share shortly on this issue.

Then last June the minister told this committee that an announcement would occur within “the next weeks and months”.

Now six months have passed, almost to the day, from that meeting, and these thalidomide survivors still have not seen any money. I heard the minister say, again, it would be in months. That's what I heard six months ago. Of course, these people are aging. There's a very limited, targeted group who took this drug. The mothers were pregnant in the early sixties.

Can you give us any idea when these forgotten thalidomide survivors will receive their funding or information?

[Simon Kennedy]

Mr. Chair, I'm not sure I can add a lot to what the minister said, but I can assure the member that we have been doing a lot of work to prepare for the rollout of the new program. On the timing of that, I'm not really in a position to add a lot more to the minister's comment.

[Don Davies, NDP, Vancouver Kingsway, BC]

Is that more of a political decision?

[Simon Kennedy]

I think that would be more a question to direct to the government.

[Don Davies, NDP, Vancouver Kingsway, BC]

We heard testimony from the Patented Medicine Prices Review Board a couple of weeks ago that I thought was quite disturbing. We know Canadians pay the second-, third-, or maybe the fourth-highest prices in the world, and we can't really seem to figure out a good reason for that. One thing we found out was that the comparator countries we're using, the seven countries that include the U.S. and Switzerland, the two highest in the world, lead to an artificially high average. I know there's been some talk to expand that to a more representative sample of 12 countries, and I think they would be more moderately priced.

We also heard that there's a lack of transparency. Drug companies are not compelled to reveal the rebate programs they're giving province to province. Frankly, the companies, even with the comparator countries, are allowed to charge whatever they want. It seems as though there's quite a mess here, and that came out quite clearly from the Patented Medicine Prices Review Board testimony.

Can you update us? When will this new comparator group of countries be implemented? What's being done now, in lieu of having universal public pharmacare, to bring down prices of drugs in Canada?

[Simon Kennedy]

Mr. Chair, maybe I would just update and remind the committee that we have been discussing proposals for the modernization of the patented medicine regulations now for about the last two years or so. There was a regulatory proposal that the government tabled a number of months ago that went to Canada Gazette, part 1.

There are two parts to this: There's the updating of the patented medicine regulations themselves, and then there are the guidelines that give effect to the regulations, so there are two pieces. There are discussions going on, not just with the industry but also with the patient groups, provinces and territories and other stakeholders in the health system about both of those tracks.

On the regulations, we've had a number of meetings with the pharmaceutical industry and with others, as we have on the development of the detailed guidelines. The development of the detailed guidelines is being undertaken by the Patented Medicine Prices Review Board itself, because that's a kind of technical conversation. A decision on when to proceed and next steps will be a decision the government will make, but we continue to discuss with stakeholders the kind of next steps on that proposal. There is a detailed regulatory proposal on the table on which we're in an active conversation now with all of the various stakeholders.

With regard to the guidelines, even when the regulations proceed, the guidelines will actually be a number of months later. That's a conversation that will likely unfold over the next year regardless.

I would just let members know that this is something that's in process now, and there's a fair degree of detail. I can certainly share with the committee a copy of the discussion paper the government issued about a year ago, and the draft regulatory proposal.

[The Chair, Liberal, Bill Casey]

Okay.

Time's up.

We'll now go to Mr. Ouellette for seven minutes.

[Robert-Falcon Ouellette, Winnipeg Centre, Lib.]

Thank you very much Mr. Chair.

My question is for Mr. Glover. On the topic of fish and food safety in Canada, how many lawsuits have there been about the erroneous labelling of our food products?

[Paul Glover]

Thank you for your question.

I don't know the exact figures, but I can gather them for the committee.

We can definitely provide those numbers.

I would say though, regarding prosecutions, that we do regularly refer issues to the public prosecution service for their consideration. It's not something that our inspectors do; we refer it to the prosecutors for their consideration, and then they make a determination about whether they would like to proceed in that regard. We do issue corrective actions, administrative monetary penalties, and we can provide the clerk of the committee with the full range of regulatory actions that we're involved in.

[Robert-Falcon Ouellette]

Have there been prosecutions? Food safety is extremely important, and people should actually go to jail, I think, if they are mislabelling food. If I put something in front my family, I want to know what it is they're eating, and I don't want to believe it's tampered with. If something's coming from other countries like China or India or Russia or any other country—

[Paul Glover]

Or domestically.

[Robert-Falcon Ouellette]

—I want to make sure our rules are respected.

[Paul Glover]

We are absolutely, whether it's foreign or domestic, regularly sampling food to make sure it's compliant with all of the regulations. There are instances when we do refer things to public prosecution. In addition to that, if you look, you'll see we are regularly recalling foods, stopping sales and issuing administrative monetary penalties to the company to incent correct behaviour on their part.

[Robert-Falcon Ouellette]

Thank you very much.

This is a question for Monsieur Perron, I believe. This is about medical products and drugs. When they are found to be not compliant or unsafe in the United States, why does it take so long for us to actually remove them from the market? It goes on continuously, and as a Canadian, I watch this on the news and I ask why we are taking so long. We're supposed to be better. We're supposed to have a better, more educated bureaucracy with better researchers, and yet it takes so long. Why?

[Simon Kennedy]

In fact, you really have to look at it device by device. There are certainly instances we could cite of the product being withdrawn from the Canadian market before it was withdrawn from the market in the U.S., for example.

When there is a serious issue—say, with a medical device—such that you need to issue a recall, or there needs to be some sort of safety communication, much as we do with pharmaceuticals, we do an assessment of what the impact will be on the patient population. With any one of these, whether it's a pharmaceutical or medical device, it may well be that this is something that's providing a significant benefit to a large number of people, even if there is admittedly a risk or a serious issue with a small number of individuals. There's an assessment of what the impact of a recall would be on the patient population.

It is not the case that in every circumstance the decision of what to do in Canada is going to mirror that in the U.S., and there are a variety of reasons for that. One of them is that we have a very different health care system. The use of some of these devices can be quite different in Canada from, say, the U.S. or in Europe, and so in the decision on a recall or whether to intervene in some way, we might actually reach a different conclusion. There are some really stark illustrations of the decision in Canada being quite different from what it was in the U.S., because the device is used in a very different way, in a different—

[Robert-Falcon Ouellette]

Then I also hear about other cases of it taking two years to remove it from the market, and there wasn't very good reporting and people suffered. For me personally, that's unacceptable, and I think it's unacceptable for Canadians.

Is there an expedited process for you to do these evaluations once you hear from the FDA in the United States that they've done an evaluation and they've determined that it's not right, it's not working? I would kind of believe the U.S. system would keep products on the market even longer, because there's more profit in it for them.

[Simon Kennedy]

To be clear, in some circumstances there are medical devices that remain in the market longer in the U.S. than in Canada. I think the minister has been pretty clear in her public statements. The government feels there's more that can be done in the area of medical devices. The department's been working on an action plan; we're going to be coming forward in the new—

[Robert-Falcon Ouellette]

Do you have an expedited process?

[Simon Kennedy]

An expedited process in what respect?

[Robert-Falcon Ouellette]

I don't know. Is there a special committee that this goes to automatically, and experts sit down and ask if there is something we should do in the next week or two weeks about this?

[Simon Kennedy]

It really depends on what the signals are that are coming from the marketplace. Whether it's a drug—

[Robert-Falcon Ouellette]

It shouldn't be about the marketplace; it should be about safety.

[Simon Kennedy]

When I'm talking about the marketplace, I'm talking about the way it's being used by patients. Whether it's a drug or a medical device, we receive a wide range of information once that product is in the market. It can come from voluntary reports from patients; it can come from the mandatory reports from the manufacturers.

We're going to be coming forward very soon with a regulatory proposal under Vanessa's law that will require mandatory reporting by hospitals of these sorts of incidents, so mandatory reports will be coming in. Also, signals can come in from foreign regulators, such as the European Medicines Agency discovering an issue, or the FDA.

There are a whole variety of signals that can come in, and the response on what to do is very much dependent on the situation. If the signals coming in indicate that there's a very serious problem, we might swing into action immediately and there could be a recall.