Health Committee on Oct. 29th, 2024

[Todd Doherty, Conservative, Cariboo—Prince George, BC]

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Doherty.

Next, we will go to Dr. Powlowski, please.

You have six minutes.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

The Conservatives wanted to spend their whole time talking about rat shit in factories and about how much is acceptable to them.

Let me ask you another question regarding this PMB. My understanding is that it removes the applicability of Vanessa's Law to natural health products, which removes the ability to recall natural health products and to impose higher fines when there are violations of safety requirements, and it also removes the requirement of mandatory reporting.

Is that not only mandatory reporting for adverse effects of the actual drug, but also mandatory reporting of harmful interactions with other drugs?

[Dr. Supriya Sharma]

As you noted, we have authorities under the natural health products regulations. These deal with the authorities under Vanessa's Law. Currently, under the natural health products regulations, a company is required to provide adverse reaction reports within 15 days if they are serious domestically, or serious and unexpected internationally. The reporting in Vanessa's Law, which is not in effect yet—you need regulations to bring that into effect—would be mandatory reporting of adverse reactions in hospitals, the way we do for prescription and non-prescription drugs.

If I could use this opportunity, there was one comment made in committee previously about Health Canada already having the authority to make a label change—to add, for example, a serious warning to a label. That is something in Vanessa's Law. It is not in the natural health products regulations. If you take this out of Vanessa's Law, we lose the ability to make a change to a label in order to add a serious warning in the case of a serious or imminent health risk.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

The Conservative perspective on this is that these are overwhelmingly safe products, and that there are not many, if any, adverse effects caused by natural health products. I think both of us know that's not the case. There are certainly lots of case reports in the literature of lead poisoning, including in Canada, from ayurvedic medicine.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

I have a point of order, Chair.

[The Chair, Liberal, Sean Casey]

We have a point of order by Dr. Ellis.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

I have incredible respect for Dr. Powlowski, but I'm not sure with which testimony he's putting words in the mouths of Conservatives, where we said these were overwhelmingly safe products. I don't think anybody ever said anything about that.

Please, could he conduct himself with comport?

[The Chair, Liberal, Sean Casey]

That is not a point of order.

Dr. Powlowski, it's back to you.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I will accept Dr. Ellis's advice on that matter.

Let me cite another study. A NIH-funded study looking at drug-induced liver injury concluded that 16% of cases of liver injury were caused by herbal and dietary supplements.

Do you want to talk a bit about other examples of adverse effects from natural health products?

[Dr. Supriya Sharma]

In terms of natural health products, I think we're all in agreement. They are an important part of the health care system. It's important for Canadians to have products they can use to treat minor ailments, and for prevention. Over 75% of Canadians use them. That's the first part of it.

As to the risks associated with them, they are overall, as a category, lower-risk than prescription products, for example. That does not mean there are no risks. There are the risks of the products themselves. There can be risks of problems with manufacturing. We talked about contamination. The risk of bacterial contamination in a natural health product would be the same as in a non-prescription drug or a prescription product for someone who, for example, has an immune system problem. The last section of risks we alluded to is when there is an erroneous impression about the use of the product. There could be risk in using products and potentially not seeking care.

In all three categories, there are examples we can offer.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Do you want to briefly talk about drug interactions?

I saw a Canadian Medical Association journal article that estimated that only 10% of adverse reactions are reported. The frequency of drug interactions, and Dr. Ellis referred to this early on in his questions.... I know there are quite a few drug interactions with natural health products. For example, they can affect the INR of Coumadin. It's less well known on newer anticoagulants like dabigatran. Some natural health products, like St. John's wort, can affect the plasma concentration of cyclosporine with organ transplants or antiretroviral levels.

Can you talk a bit about drug interactions between natural health products and other medications?

[Dr. Supriya Sharma]

I think those examples are very salient.

I'll give you another example with St. John's wort. It's a product often used for mood disorders or anxiety, but it can change the levels of some antidepressants in the body. As you noted, there are also some vitamins that can predispose people to increased clotting. There's a lot of interaction.

Again, it's not just in natural health products. We have foods with interactions. Grapefruit juice is the classic example. There are a lot. Any product that can have an effect in the body could potentially have a negative effect. Then there's a whole series of products that could have interactions with other pharmaceuticals as well, or other health products.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

This came up earlier, but I think it's an important point. Do you want to just reiterate the difference between a stop-sale, which the Conservatives say currently exists, and the ability to recall products? Also, how would this PMB affect that?

[Linsey Hollett]

Actually, I welcome the opportunity to explain the difference.

We, as the regulator, can order a stop-sale for any parties that we directly regulate. If we issue a licence to a party, if we have regulatory oversight, we can issue a recall: manufacturers, distributors, packagers, labellers. That does not apply to the retail level. It is not within our mandate to regulate retail. We have that stop-sale power, but it does not apply to the retail space. We had a gap. Vanessa's Law for NHPs filled that gap with the ability to order a recall, including at the retail level.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Powlowski and Ms. Hollett.

Mr. Thériault, you have six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Dr. Sharma, you're a scientist. Do you consider pharmaceuticals and natural health products to be similar in nature?

[Dr. Supriya Sharma]

Thank you for the question.

Natural health products and pharmaceuticals, prescription or non-prescription, are the same in that they are things that are used for health purposes.

[Luc Thériault, Bloc, Montcalm, QC]

That's not what I asked you. I'll repeat my question: Do you consider pharmaceutical products and natural health products to be similar in nature? It's simple. I'm asking for a quick answer.

[Dr. Supriya Sharma]

In terms of their nature, they're used for health purposes, so that's similar. However, they are different products. They are used for different purposes and have a different risk profile.

[Luc Thériault, Bloc, Montcalm, QC]

I've asked you in the past to submit information to the committee on adverse drug reactions. You haven't done that yet. Why?

[Dr. Supriya Sharma]

We have submitted to the committee a 10-page document with adverse reaction reports, and we've received receipt of the fact that we've tabled that, so I'm not sure.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

I have a point of order.

As this is something that my colleague has asked for that I think is very relevant to the study we're taking on, when can we expect to receive that?

[The Chair, Liberal, Sean Casey]

When you have the floor, you'll get a chance to ask that question.

Go ahead, Mr. Thériault.

[Luc Thériault, Bloc, Montcalm, QC]

Isn't it true that pharmaceutical products have a lot more adverse effects than natural health products?