Evidence of meeting #138 for Health in the 44th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was industry.
A recording is available from Parliament.
Liberal
The Chair Liberal Sean Casey
Thank you, Mr. Thuna.
Next, we're going to Dr. Powlowski for five minutes, please.
November 7th, 2024 / 4:55 p.m.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Dr. Hepburn, from the lofty Hospital for Sick Children, were you not ranked the number one children's hospital in the world, or do I have that wrong?
Medical Director, Child Health Policy Accelerator, Hospital for Sick Children and Associate Professor, Department of Paediatrics, University of Toronto
Well, there are lots of those lists, but yes, I feel fortunate to work in a wonderful place.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
One aspect of Vanessa's Law that we haven't been talking about a lot is that Vanessa's Law requires that hospitals report any serious adverse effect of a drug, and if we were to remove Vanessa's Law from natural health products, that would no longer be the case.
You work at the lofty Hospital for Sick Children. Can you give me some examples where perhaps you've actually seen that at the Hospital for Sick Children, the adverse effects of natural health products, and have you reported them under Vanessa's Law?
Medical Director, Child Health Policy Accelerator, Hospital for Sick Children and Associate Professor, Department of Paediatrics, University of Toronto
I can't speak to any unique cases that our hospital would have reported. I can say, though, understanding the basics of pharmacokinetics and pharmacodynamics, that any product that has a physiological effect can have a physiological side effect.
At SickKids, we also care for medically fragile children, medically complicated children, many of whom experience what we call polypharmacy. They are on a number of different pharmacologically active substances that may or may not have drug-drug or drug-NHP interactions. It's incredibly important, especially as we care for the most fragile patients, that we understand drug-NHP interactions and that when a patient has an adverse event associated with an NHP or a drug-NHP interaction, it be reported so that we can better understand it.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Can you talk a bit about the known adverse effects of some natural health products? You're a doctor. You must deal with this at least from time to time. The whole notion that the poison is in the dose, which is what one toxicologist once said to me, I thought was interesting. Even water can be a poison, if you drink enough of it. Children, being small, are going to be particularly affected, potentially, by the adverse effects of drugs.
We're getting this narrative from the other side that these are overwhelmingly safe drugs. Can you give me some examples of where perhaps they're not safe drugs?
Medical Director, Child Health Policy Accelerator, Hospital for Sick Children and Associate Professor, Department of Paediatrics, University of Toronto
I agree that natural health products are safe. I feel comfortable recommending them to my patients—again, when it is the right product with the right indication and with the right evidence base to support its use.
That being said, extremely rare events are not unimportant events. In health care, we dedicate a huge amount of time, energy and effort to ensuring that extremely rare events do not happen. When they do happen, we report them, reflect on them, learn from them and act swiftly and accordingly.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Can you give me some examples of those extremely rare events with respect to natural health products?
Medical Director, Child Health Policy Accelerator, Hospital for Sick Children and Associate Professor, Department of Paediatrics, University of Toronto
I'm not in a position to give you case reports from our own hospital, but I can say that some of the natural health products that we in pediatrics are exposed to have been cross-contaminated with products that are unsafe for children. We have had children present with toxicity associated with contaminants from the natural health product.
We have also had children present with significant complications associated with drug and natural health product interactions. If, for example, a natural health product is competing for a metabolically active enzyme with one of their traditional DIN regulated products, they can have either an overdose or under-dose in terms of therapeutic effect.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
You talked about contaminated products. Can you give some examples?
I think there's lead toxicity in certain ayurvedic medicines, but can you give me some other examples of adverse effects when there's a contaminant?
Medical Director, Child Health Policy Accelerator, Hospital for Sick Children and Associate Professor, Department of Paediatrics, University of Toronto
Heavy metal toxicity and heavy metal contamination would probably be the most common.
If it suits the committee, I'd like to regroup with my colleagues to see if they can help provide a more comprehensive list of ones that we've experienced, both at the Hospital for Sick Children and with colleagues across the country.
Liberal
Marcus Powlowski Liberal Thunder Bay—Rainy River, ON
Yes, if you could table that with the committee, it would be greatly appreciated.
Can you talk a little bit about some of the common adverse drug interactions that you see with natural health products?
Medical Director, Child Health Policy Accelerator, Hospital for Sick Children and Associate Professor, Department of Paediatrics, University of Toronto
If you'll indulge me in a little basic metabolics physiology lecture, there are enzymes in the body—
Liberal
The Chair Liberal Sean Casey
No, Dr. Moore Hepburn, we don't have time for a lecture.
If you have a brief response, go ahead. Otherwise, I would urge you to provide it in writing. You can give us a lecture in writing.
Medical Director, Child Health Policy Accelerator, Hospital for Sick Children and Associate Professor, Department of Paediatrics, University of Toronto
I am more than happy to follow up with that question in writing.
Liberal
The Chair Liberal Sean Casey
Thank you.
Thank you, Dr. Powlowski.
Mr. Thériault, you now have the floor for two and a half minutes.
Bloc
Luc Thériault Bloc Montcalm, QC
Mr. Thuna, you said earlier that, over the past 30 years, you have never been inspected by Health Canada.
Did I understand correctly?
Bloc
Luc Thériault Bloc Montcalm, QC
The Auditor General's report noted that Health Canada was not doing its job. According to that report, there were audits of certain companies, but it wasn't the companies that were problematic. The problem was that Health Canada was unable to do its job to ensure the safety of products and carry out the necessary inspections to ensure that there would not be any problems related to natural health products.
In addition, the methodology was flawed. After 30 years without inspections, the government wanted a way to pay for inspections, so it implemented cost recovery, which is not at all appropriate for the industry. That's another issue.
Bill C‑368 would change the environment. It creates some distance from the pharmaceutical sector and considers natural health products on their own terms by imposing appropriate fines, appropriate labelling, and so on.
You haven't been inspected once in 30 years. That's hard to believe. That suggests the problem isn't you; it's Health Canada.
General Manager, Pure-lē Canada, As an Individual
I would say that the way Health Canada has chosen to treat our industry is an ongoing problem. In my time, Health Canada has.... In the beginning, it didn't understand us. I would say it still doesn't, but in the beginning, it didn't understand us, so we were drugs. That's the box we fit in that was easiest for them.
However, with the consultation and the creation of the NHPD, that was supposed to change. It was supposed to be that we were treated...and regulations were created that were right for us. Health Canada was supposed to educate consumers, doctors and other medical staff so they could better understand the regulations, the products, how they're manufactured and how they were going to be kept safe.
Health Canada fell on its butt with that one.
Liberal
The Chair Liberal Sean Casey
Thank you, Mr. Thuna.
We'll go over to Mr. Julian, please, for two and a half minutes.
NDP
Peter Julian NDP New Westminster—Burnaby, BC
Thank you very much, Mr. Chair.
I'm going to continue with you, Mr. Thuna. Thank you for being here.
You testified that the cost of compliance was $500,000 for the first year and $300,000 for each year afterwards. What are your total sales per year?
General Manager, Pure-lē Canada, As an Individual
As we're a private company, I can't give exact numbers, but I can say that we're well under $5 million.
NDP
Peter Julian NDP New Westminster—Burnaby, BC
Would the cost of compliance then be 10%, potentially, of your overall sales?
General Manager, Pure-lē Canada, As an Individual
The cost of compliance would bankrupt us within a matter of months.