Chair, I do apologize because this is something.... No, I don't apologize for calling out Ms. Kayabaga. What I do apologize for is the passion with which I have approached this. It is incredibly important on behalf of Canadians and it's not humorous. It's incredibly important. For anybody who doesn't want to choose to believe it, that's their own prerogative
Chair, I would suggest to you that those who do not have the floor really should keep their peace.
That being said, Chair, it's having a government agency that wants to be responsible for health outcomes on “behalf of Canadians”, when—as I mentioned previously—we know that the relationship between a primary care provider and the patient is sacrosanct in Canada.
That's something that Canadians are absolutely starving for. When we ask them what they would like to see in a health care system, what do we hear? They'd like to have a primary care provider. That's because they trust that the training that the primary care provider has had will best represent their interests, will create a relationship and, hopefully, over the long term, the primary care provider will understand what the patient's goals are with respect to health outcomes.
This leads me very clearly to understand here that there's no mention in this pharmacare bill of what the patients may want. This is, again, a pharmacare pamphlet brought forward by the costly coalition, and it does not mention that.
There are two more points that we have to discuss here.
One is on system sustainability. Once again, the best stewards of the health care system are those people who are working in it, not another government agency. I don't believe for one second that there are groups of primary care providers out there who, when they make a decision.... It may be a pharmacoeconomic decision around understanding, for example, the best ACE inhibitor to prescribe, the pharmacoeconomic advantages among ACE inhibitors, the studies that have been released over the last 30 years that encompass all of them, and whether to choose to use generic medications, which is the choice, naturally, in this day and age, made by a prescriber. These appear, at the current time, to be reasonably good pharmacoeconomic decisions.
Those are often made outside of the purview of the prescriber, but certainly we know that when there are untoward effects, there's a significant ability to allow a primary care provider to advocate on behalf of their patient to have the best health outcomes related to the best medications with the fewest side effects available at the current time. That's something that primary care providers have done from time immemorial. The system itself is part of the overall ecosystem in which primary care providers and specialists alike practise.
Are there people out there who are ordering MRIs, CAT scans and unnecessary lab work willy-nilly? There are a few. I'm not going to sit here and tell you that there are not.
Do I believe in any way, shape or form that another government agency from this costly coalition government—the most inefficient government and the government with the greatest inability to provide basic services to its citizens—should be the one that is now in charge of system sustainability, believing that primary care providers and specialists alike have absolutely no idea what is going on or no responsibility to the system? That's a fallacy. Quite frankly, it's an affront to prescribers out there everywhere. More importantly, it's a big fat lie.
Finally, on appropriate use strategy, for the edification of those watching—and I hope not for my colleagues—physicians out there have to maintain a continuing medical education every year to ensure that they are able to continue to practise medicine in the most forward-looking fashion available. It's another slap in the face to physicians, pharmacists and nurse practitioners to talk about an appropriate use strategy, whether it is for medications, hospital beds, MRIs, CTs, ultrasounds or specialist consultation, etc.
The practice of medicine is not some cookbook kind of thing that you do on your days off, when you say, “Well, suddenly I think I'm just going to be a doctor. Maybe I could whip out this book and look up the fact that maybe somebody has syphilis” or something like that, and say, “Hey, this is the test I need to do, and knowing that syphilis is now rampant in this country and perhaps multi-drug-resistant, now we need to talk about an appropriate use strategy.”
I just don't believe that's true. If our primary care providers out there don't have a desire to understand the environment in which they practise and continue to get better. We have those governing bodies in existence now. We don't need another legislative body to come out and say, “This is what we need. Surely the Canadian drug agency will make sure that everything is going to be used appropriately. Surely the Canadian federal government will be the best arbiter of that.”
I will close by saying again that this is a slap in the face to every highly trained health care practitioner out there, and it needs to be amended.
Thank you.