Health Committee on Nov. 19th, 2024

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

Thank you. Can you please provide that to the committee, ideally, before Thursday? We have to go into clause-by-clause, and having that information will be helpful to make sure that we are dealing with the right information before we head into doing clause-by-clause and making amendments. The deadline for amendments is by the end of this meeting, but this will be helpful, so the sooner, the better.

To go to the next piece, Mr. Chen, I really appreciate your coming here today. How many practitioners are in your industry here in Canada?

[Pierre Chen]

I have in my report that, in Ontario, there are about 2,700 acupuncturists and Chinese medicine practitioners; in B.C., there are around 2,000, and in Quebec around 1,000. Across Canada, as I said, in the job bank there are around 60,000 practitioners caring for Canadians.

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

That's 60,000 across this country who depend on natural health products to conduct their business and care for Canadians.

What is the economic impact of this business on Canada?

[Pierre Chen]

I don't have the exact amount in terms of the economic impact, but that 60,000 does not include the farmers. In Chinese medicine, we really emphasize eating where you live, so a lot of us purchase products locally. Canadian farmers—ginseng and herb farmers—are all people who will be directly or indirectly affected in Canada.

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

Do you believe that the policies that have been put forward by this Liberal government will have an impact on the day-to-day operation of these practitioners and farmers?

[Pierre Chen]

Yes, definitely. When people come in for a consultation and I prescribe these herbs, they see that it used to cost $5, $7 or $10, but now it's going to cost $50 or $100 for a bottle that will last maybe two weeks, so now it's a financial burden.

Also, Vanessa's Law is based on a pharmaceutical model, so it's based on high-risk products, like prescription drugs. This risk profile is very important. When you're doing a product profile, what we prescribe—pepper, ginseng or onions—is not the same as warfarin, nicotine or these kinds of products. It's not the same.

[The Chair, Liberal, Sean Casey]

Thank you. That's your time.

Ms. Sidhu, go ahead, please. You have five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

Thank you to all the witnesses for being with us.

Ms. Hoffman, most of us use natural health products regularly. We know that NHPs are generally safer than other health products, and yet they are not without risk. We heard there were 700 cases, which is a lot.

What are the most common safety concerns your organization has been seeing?

[Carolyn Hoffman]

Thank you for the opportunity to speak about the fact that NHPs are low-risk but there is some risk there. I'll start, and then I'll ask my colleague to finish up.

One of the biggest risks is around the dose or the amount of an NHP. In some cases, taking a large amount, or taking the dose that's ordered too often, can create a significant risk. We have seen that in previous cases.

Do you have other examples?

[Sylvia Hyland]

Another example would be when the person providing their own care or seeking their own care is not aware of potential interactions with other products they're taking. They can be pharmaceutical or other NHPs. They're also not well aware of contraindications. If they have liver, heart, kidney or eye disease, maybe this is not the right product for them and they don't know it. Those, then, are preventable harms. Had they known, they wouldn't have used that NHP.

Then there are the warnings, and not having clear warnings on the package or having difficulty finding them until they get home or until after they've taken the medication. Had they known about that warning, they actually wouldn't have used this product, or they would have chosen a different product for their care or their family's care.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

Ms. Hoffman, you said that Health Canada, if this bill passes, would no longer order a label change if there was a serious adverse...or something. Can you elaborate on that?

[Carolyn Hoffman]

This falls under Vanessa's Law provisions. We gave four examples. One of them was that the bill would result in Health Canada no longer having the authority to compel—that's the important thing—a label change if there was an identified serious risk.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

Ms. Callard, in a brief to this committee, your organization pointed to tobacco as an example of a natural product that is also harmful. “The lesson from tobacco”, your group wrote, “is that health authorities need the power to prevent harm.” Could you expand on how the lessons from tobacco apply to dealing with NHPs today?

[Cynthia Callard]

I think it's probably used as the most historic example: If we'd only known how dangerous it was, it would never have been allowed on the market. But things get on the market. Only later do you find out the nature of the danger. Sometimes it might not be anything. Sometimes it might be significant.

You know, some of the most dangerous products, or some of the products that cause the most harm, are in fact natural products. Opioids are natural products. Morphine is a natural product. Tobacco is a natural product. Cannabis is a natural product. We've chosen, generally speaking, to regulate these not as medicines, although they're used for medical purposes in many cases.

I think the reason we made that submission is that, too often, people associate “natural” with “benign”. We have this kind of thinking where if it's a natural health product, it's therefore benign. There's some confusion when it comes to the common understanding of “natural”—that if it's naturally derived, it's therefore okay, and if it's chemically produced in a factory, then it's harmful.

I think that's an education gap we have with the general public. I think that's an education gap we sometimes have in terms of a regulatory construct as well. Maybe we need a different term for some. Maybe the catch-all “natural health products” is too big a basket.

Anyway, thank you for drawing attention to that point.

[Sonia Sidhu, Liberal, Brampton South, ON]

You mentioned that a business model is risky for marketing. I want you to explain that business model. Public health is an important analysis. What kind of analysis do you think we should do?

[Cynthia Callard]

If you think of a company that's based on consumer health, they have a reputation to maintain, that their products are safe and reliable. But if you have an alcohol company or a tobacco company or someone who's already not dealing with or not worried about their public reputation—they're worried about their return to stockholders—their activities will be aimed at maximizing sales, maximizing profits and maximizing use.

In terms of NHPs, the Food and Drugs Act was really designed with a certain kind of manufacturer in mind. The Tobacco Act—alcohol kind of falls into it—and the Cannabis Act were designed with a very different understanding, that there's a different motivation to that manufacturing.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Callard.

Thank you, Ms. Sidhu.

Mr. Thériault, you have the floor for two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Ms. Hyland, you seem to be implying that Vanessa's Law is the be-all and end-all. However, section 16 of the natural health products regulations allows Health Canada to ask a company to change its labelling, including adding warnings, if the minister has reasonable grounds to believe that a natural health product is no longer safe even under the recommended conditions of use.

There are two possible scenarios. On the one hand, if the label is not compliant, Health Canada can use enforcement measures and powers such as seizure and detention of the product. It can also stop the sale of the product or suspend its licence. On the other hand, if the label is compliant but Health Canada wants the company to modify it for safety reasons, Health Canada can require the company to make the change or discontinue the product. If the company does not comply with these requirements, Health Canada has the authority to issue a notice to stop the sale of the product or suspend its licence.

The industry is already regulated. However, you talk as if there were no oversight. I think we have to be rigorous. I imagine you're familiar with Vanessa's Law in terms of pharmaceuticals, but I get the feeling you have a poor understanding of the natural health products regulations and their application.

[Carolyn Hoffman]

We can speak to our position today on Bill C-368 and be clear that, to our understanding—it's what we can speak to—if the bill does go through, the important, very focused provisions under Vanessa's Law will be reversed. One of them is to compel. Wording is very important with all these legislative mechanisms, and in this case, we understand and believe, and it's our position, that this would be lost—a “compel” provision around labelling. Although there is a regulatory framework, these regulatory provisions under Vanessa's Law are at risk.

[Luc Thériault, Bloc, Montcalm, QC]

What you're saying implies that people aren't protected and that the industry can do whatever it wants. However, Health Canada already has powers under the regulations. Since we are now going to add a recall authority that the minister can exercise, I imagine that will allay your concerns.

[The Chair, Liberal, Sean Casey]

Give a brief answer, please.

[Sylvia Hyland]

We understand that there are regulations for NHPs, and they're different from those for pharmaceutical medications and are designed differently, and we support that.

Also, Vanessa's Law brought in new tools and new authorities that would benefit NHPs. One of them is the reporting of serious adverse reactions, and the other is a label change such that maybe you don't need a recall. I agree that many recalls are voluntary and many label changes are voluntary, but it's not always the case. Imagine that Health Canada can't say, “We've learned about this and this needs to be added to the label” or—

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Hyland.

[Luc Thériault, Bloc, Montcalm, QC]

With the recall authority, then, you'll be satisfied.

[The Chair, Liberal, Sean Casey]

Mr. Julian, please go ahead for two and a half minutes.