Health Committee on Nov. 29th, 2016

[Janet Yale]

I have to agree wholeheartedly.

I think, as you've heard, that many of the issues relate to education on the part of the prescribing physician. I think the stories we hear are much more about people doing without other things in order to be able to afford their medicines.

I don't think people want to overmedicate; I think people, particularly those with chronic disease, want to be able to live pain-free. With the current preoccupation with the opioid crisis and fentanyl, which is absolutely legitimate, the concern we would have is that undiagnosed and untreated chronic pain is under-treated because people fear getting onto pharmacological therapies that risk addiction. I think most people are very averse to that, and I think that copayment is not the answer.

[Anil Naidoo]

Copayment has been tried in Canada with medicare before—in Manitoba, I think in the seventies—and it just changed the nature of who was actually accessing the system. Poor people used it less, and wealthy people used it more. The system still was used cumulatively.

[Dr. Thomas Perry]

I don't have an ideological view on this, but I'll give you a specific example of what the problem has been with one drug.

Gabapentin is a drug brand-named Neurontin that was promoted for chronic “neuropathic pain”. It became a $3-billion-a-year blockbuster in the U.S. in about 2000 to 2004. Pfizer was successfully sued and convicted of racketeering fraud in United States federal court for its promotion, because there was virtually no evidence that it was effective and lots of evidence that it was not.

They were able to hide that by recruiting key opinion leaders in medicine who gave the message that you need to start with a small amount and then gradually increase the dose and keep taking more and more and for a long time, none of which was true. There was no clear dose response; the drug generally did not work at all. One could tell within hours, and certainly within a day or two, whether it was going to work or not for your own pain, and yet they managed to make a $3-billion-a-year empire out of that drug.

The legacy of that is that, as Dr. Eyolfson will undoubtedly be able to confirm for you, is that people feel they need to take gabapentin for a year or two years. As a doctor, you ask, “Why do you keep paying for this even out of your own pocket?”—or for Lyrica, which is not covered in most provinces—and the reply is, “Well, the doctor told me to keep taking it and it would work eventually.”

It sounds ludicrous, and yet as an experienced physician I could weep enough tears to fill this room over the times I've seen that situation and seen an individual's money, which could have been used for a better purpose, wasted, or public money wasted.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Naidoo, I want to finish by giving you the last word. You've been sitting here throughout listening, as Mr. Chair said, to all the testimony. I want to give you the last word.

What is the most important thing that you want to say to this committee about national pharmacare?

[Anil Naidoo]

I think the work of this committee is historic. I hope you recognize that what you produce will be something that provides the foundation for what we do in the future, because there has not been, I don't believe, as in-depth a study as is possible.

Now, whether you're able to produce that report.... I look at the people around the table and I'm hoping that you will.

I'm saddened that you weren't able to travel to ask the question, “What kind of system can we use?” The one benefit of being last in this, and Canada is the outlier, is that an abundance of countries have implemented different types of systems, and we have massive amounts of opportunity to do the right thing here in Canada. It just requires political will.

We met with the health minister yesterday and we have met with other politicians, and I'm not sure there is that political will. I think it has to start in this room, in a way. A cogent report will provide the foundation for the future, but our window is very short. With trade agreements that restrict us, with increasing costs, with a fragmented system, with all the entrenched interests, it is going to be difficult, but we are looking to you to provide some clarity.

[Dr. Thomas Perry]

I invite you to come to British Columbia. You are always welcome there.

[The Chair, Liberal, Bill Casey]

Thank you very much. I certainly want to thank the witnesses. At every meeting we have, we walk in and we don't know what we're going to hear, but you're all so committed and you're all so passionate about health in Canada and Canada's health. We appreciate it very much. We've learned a lot, and I'm sure that some of you will be back for further clarification from time to time.

I'd like you to stay, because I want to say goodbye to you, but first of all we have a little bit of business to do.

I'm going to invite Dr. Carrie to move again the motion that he moved earlier.

[Colin Carrie, Conservative, Oshawa, ON]

It is that pursuant to Standing Order 108(2), the committee call upon the Minister of Health to immediately appear as a witness to discuss the opioid summit and the next steps in dealing with this serious crisis.

[The Chair, Liberal, Bill Casey]

Is there any debate?

(Motion agreed to)

That was passed with unanimous consent. Thanks very much.

This concludes our meeting. Thank you very much, everybody.

The meeting is adjourned.