Evidence of meeting #33 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was need.
A recording is available from Parliament.
10:10 a.m.
Conservative
Rachael Thomas Conservative Lethbridge, AB
My first question here goes to Ms. Silas. You said that right now we are paying more for pharmaceuticals than for doctors. Wouldn't that just be exacerbated with a national pharmacare program? Wouldn't we be paying even more for pharmaceuticals than we are for doctors?
10:15 a.m.
President, Canadian Federation of Nurses Unions
The CIHI report of two years ago said that we were paying more for prescription drugs than for doctors. Now, the cost of physicians is a little bit more, but we're still talking about 30% and 32%.
No, we wouldn't be paying more for pharmaceuticals than for doctors, because we would base our national pharmacare program on efficiency, science-based evidence, and prescription habits. That, plus the bulk buying, is how we would reduce costs. You would have more than one prong here, and it would reduce your costs.
The goal is to have efficient prescribing habits, cover all Canadians, and reduce the costs. To do that, you have to have more than one prong.
As I mentioned in my notes, the costs in the last 20 years have gone up from $5 billion to $25 billion in drugs.
10:15 a.m.
Conservative
Rachael Thomas Conservative Lethbridge, AB
In your estimation, would you say that a national pharmacare program would give patients a greater choice in drugs? Would it make more available to patients?
10:15 a.m.
President, Canadian Federation of Nurses Unions
As Ms. Yale said, the patients have to be at the centre, but they have to be given the right choice. It would still be based on what your physician or nurse practitioner prescribes and advises you to take. It would be based on the formulary if you want it to be universally accessible under. You may not need a one-a-day pill, but if you can afford a one-a-day pill, go ahead and get your one-a-day pill. What we actually need is the specific medication to get better, and that should be covered. That is not a choice.
I agree with Dr. Perry that if my cholesterol is a little bit high and I don't want to take medication for it, that is my choice. It depends what your definition of choice is.
10:15 a.m.
Conservative
Rachael Thomas Conservative Lethbridge, AB
My other question is for you as well, Ms. Silas. No one at the table has been able to give a clear answer, and you haven't been asked yet, so I'm hoping that maybe you can bring some clarification. How do we work with all the provinces and territories to bring about a national pharmacare program?
Actually, I'll ask my preceding question before that. Is Quebec included under the body that you represent?
10:15 a.m.
President, Canadian Federation of Nurses Unions
No. We work with them. It's like any other national agreement. There's a little astérisque excluding Quebec.
I did say at a conference where Quebec was very well represented that we believe, because the numbers are clear, that Quebec would have to be included. They do not have a perfect system for covering medication in Quebec. Neither does British Columbia. The costs are skyrocketing. They will have to have a place at the table. It's called negotiation. If we can't negotiate among 13 or 14 parties, including the federal government, we're in big caca here.
10:15 a.m.
Conservative
Rachael Thomas Conservative Lethbridge, AB
In your estimation, what is the best way to go about doing that? There is sovereignty that has been granted to provinces, and they do have jurisdictional powers, so it seems wrong for us to just run roughshod over that. We do have to be respectful.
In your estimation, how do you go about forming a positive relationship when implementing a national pharmacare program?
10:15 a.m.
President, Canadian Federation of Nurses Unions
Let's look at the Canada Health Act. We have one Canada Health Act for the 13 provinces and territories and the federal government, so all are there. What the provinces and territories have is the delivery of care. That is very specific. There's not one federal health minister that I've met over the years that wants to get their hands into the delivery of care.
For how it's funded and how the major programs are covered, look at all the discussions we're having on mental health now. Everyone agrees we have to do something about mental health. We will have to do something on mental health together. Everyone agrees that we have to do something about indigenous health. We will have to do something on it together. Quebec is included in that.
10:15 a.m.
Conservative
10:15 a.m.
Liberal
10:15 a.m.
Chair, Education Working Group, University of British Columbia Therapeutics Initiative
I just thought they're such important questions that Ms. Harder and her colleagues were asking. I think the real goal in the interests of the people of Canada is that a national program provides better outcomes, with adequate and possibly better choices in some environments, and it saves money.
Sometimes too much choice is a bad thing. I don't know if you've ever tried to buy a sofa, but my wife and I have been trying to buy a little one for several years. We go to try them out and we can never make up our minds. When I was a medical student in Mr. Tootoo's riding, there was one shirt in the Hudson's Bay store in Pond Inlet, so I bought it, and a jean jacket as well. It was a great blessing to have only one choice.
That's an extreme counter-example, but to Ms. Silas's point about mental health, you could look at the number of antidepressants licensed in Canada. If you want to see an example of how Health Canada fails us, look at the summary basis of decision for licensing a drug called vortioxetine, which is the newest antidepressant in Canada. If you look a little further, you can see that Health Canada licenced it because in one experiment it was better than a placebo, even though in all the other experiments it wasn't better than a placebo, and it was worse when compared against other depressants. Nobody really needs that choice, and certainly we should not be paying for it out of public funds. If somebody wants to pay out of their own pocket, it's legal, but as a taxpayer, I'm a very fiscally conservative NDPer. It may surprise you, but I don't want to be wasting my money as a taxpayer. I want to be using it on patients like the one Ms. Yale referred to, who really needs a treatment that has saved his life.
10:20 a.m.
Government Relations Officer, Canadian Federation of Nurses Unions
There's just one thing I would say to Ms. Harder. The provinces have actually asked for an intervention on pharmacare. They've asked for the federal government to be involved in this, if you go back to the last negotiations in 2004. The represents them, trying to coordinate without federal leadership. It's not something that's being imposed on them.
10:20 a.m.
Liberal
November 29th, 2016 / 10:20 a.m.
Liberal
Sonia Sidhu Liberal Brampton South, ON
Thank you, Chair. Thank you to all the witnesses for the valuable information.
We have all heard that 20% of Canadians cannot fill their prescriptions. As a diabetes educator, I saw the impact of past untreated diabetes, which leads to serious complications.
My question is for Mrs. Yale. There are 4.6 million Canadians living with arthritis. You mentioned in your testimony a lower cost and a wider choice. As well, can you expand more on your view about rare drugs, or orphan drugs for rare diseases?
10:20 a.m.
President and Chief Executive Officer, Arthritis Society
Sure. Thank you for that question.
The interesting thing in arthritis is that of the 4.6 million Canadians with arthritis, about one million have inflammatory arthritis, for whom the biologic therapies I was referring to are relevant. Most Canadians have osteoarthritis, which is the progressive deterioration of the joints, for which right now the only treatment is a joint replacement, other than pain management and, as you were pointing out, non-pharmacological options. We shouldn't ever lose sight of the need for non-medicine options, whether it's physiotherapy, exercise, diet, nutrition, and so on, to prevent the progression of disease.
Generally speaking, people with arthritis are not necessarily well served by the medications that are available today, and yet there are huge numbers of people.... We're not talking about orphan diseases with small populations who need very expensive designer drugs, but about millions of Canadians who have progressive osteoarthritis and wait in the queue for years until their disease progresses to a point where a joint replacement may or may not be appropriate. We think there's a lot more need for more new treatments than exist today to alleviate their disease and their pain without having to go through surgeries—which in turn cost the health care system money—because we have no other treatment to prevent disease progression.
As far as orphan diseases are concerned, it wouldn't be my expertise to comment on whether or not we make those drugs available or on what basis we might provide catastrophic drug treatments for orphan diseases.
I'm sure you would, Doug.
10:20 a.m.
Professor and Interim Director, University of Ottawa, School of Epidemiology, Public Health and Preventive Medicine, As an Individual
Yes. I've done quite a lot of work in the area of drugs for rare disease and I'd recommend, if you get a chance, to go on a website called Million Dollar Meds that I've been working on with colleagues at UBC.
It's interesting that rarity comes up as a factor in discussions like this all the time. We have done surveys of Canadians and surveys have been done worldwide about what people value and what they would expect to place at a premium. It comes back time and time again that people want the health care dollars to be spent on maximizing overall outcomes for all Canadians and that rarity is not a factor that people think deserves a premium.
The reason we keep coming back to rarity is that rarity is the area now where pharmaceutical manufacturers are making their profits. That's why rarity has become a big issue in the last few years. If you look at the actual values and preferences of society, people do not think that rare diseases should be treated as a special case over and above the overall health outcomes for all Canadians.
10:25 a.m.
Liberal
Sonia Sidhu Liberal Brampton South, ON
Thank you.
Dr. Coyle, what additional steps could be taken to support prescribers in reducing the potential for prescription drug abuse among their patients?
10:25 a.m.
Professor and Interim Director, University of Ottawa, School of Epidemiology, Public Health and Preventive Medicine, As an Individual
I think that might be a better question for Dr. Perry than for me.
10:25 a.m.
Chair, Education Working Group, University of British Columbia Therapeutics Initiative
It's a very good question.
I think part of the answer goes back to remarks I read in a transcript of an earlier hearing, I think by Dr. Eyolfson, that the level of education about drugs of Canadian medical students and doctors has declined drastically in the last 20 or 30 years. Dr. Anne Holbrook also made this point to your committee. I was very glad to see that, because it's something that those of us in clinical pharmacology—my training is similar to Dr. Holbrook's or Dr. Juurlink's—have been lamenting for years. We've been absolutely impotent to change the trend of curriculum change. I do not think this is a conspiracy of the pharmaceutical industry. I think we did the damage to ourselves in the medical schools.
Before coming here, I asked some of my current fourth-year medical students if they had anything to say to the committee. Their advice was that they need much better education about the use of drugs, that they need it back in the curriculum, and that they need non-conflicted teachers. We cannot have our teachers decline to show their conflicts and clearly giving a sales pitch for a drug company, like the ad that I passed around. This should be elementary in any modern university in 2016, but it is not yet, for reasons that I alluded to earlier.
I had the opportunity to make that point directly, face to face, as close as I am to Ms. Silas, with the dean of our medical school 10 years ago, and I think he thought I was out of my mind, nuts. Please, I'm not. Talk to the students or come to some of the lectures. Just as drug therapy has become much more complicated, as Ms. Yale has referred to, knowledge has gone down. This is something that will require enormous efforts to undo, and it requires public education too.
Another step that would help it is if Health Canada were more transparent and the common drug reviews were more transparent and better promoted so that an intelligent layperson, such as you, not trained in medicine, could read for yourself and draw your own conclusions. There's no reason an intelligent, reasonably educated person with a high school degree in this country should not be able to understand whether a drug really benefits someone or not.
10:25 a.m.
Liberal
10:25 a.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
We started off with a motion to discuss national pharmacare. I think what we're finding out is the ugly underbelly of the current system in Canada. Something that's come up that we're hearing is that a lot of public money is currently spent on drugs that are dispensed but never used, perhaps drugs that should never have been dispensed at all. There seems to be waste in the system. I'm wondering if anybody has any suggestions on how we can tighten that up.
I'm not saying I believe in this, but what about the concept of having some form of patient copayment for drugs, to give them a bit of skin in the game? Is that a good idea, a bad idea?
10:25 a.m.
Professor and Interim Director, University of Ottawa, School of Epidemiology, Public Health and Preventive Medicine, As an Individual
I think we have to be really clear. There are a large number of Canadians who live in a fairly poverty-stricken environment. Any type of copayment really affects their ability to access health care. I think the fact that we now charge people to take an ambulance to emergency is scandalous. The idea that you have someone debating about whether or not they call when some loved one is in crisis because they're going to be charged a hundred bucks to get a ride to a hospital is just dreadful. The idea that we have a comprehensive health care system in Canada is just not true. I can understand the idea of copayments, the idea of trying to discourage waste, but I think we have to come up with more sensible ways of dealing with that. Maybe it's shorter prescription periods for the first prescription to see if the patient is going to be compliant, and then carry on.
I fundamentally don't like the idea of copayments.
