Evidence of meeting #66 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was implants.
A recording is available from Parliament.
11:55 a.m.
Conservative
Ziad Aboultaif Conservative Edmonton Manning, AB
Thank you.
Dr. Lennox, what would it take to establish a registry, from the technical perspective and in terms of the cost, including the cost to maintain it on an annual basis?
11:55 a.m.
Clinical Professor, Division of Plastic Surgery, The University of British Columbia, As an Individual
Those are excellent questions that I don't have the answers to in terms of the specifics, so I apologize. I don't know how expensive it would be to set up a database, or what the annual costs would be. I could probably track that down from comparable ones, like the Australian one, which is for a similar-sized population. I could find that out.
11:55 a.m.
Conservative
Ziad Aboultaif Conservative Edmonton Manning, AB
What's the average cost of an implant, excluding labour and doctor charges?
11:55 a.m.
Clinical Professor, Division of Plastic Surgery, The University of British Columbia, As an Individual
They are around $1,000 per implant, roughly. It's less for saline.
11:55 a.m.
Conservative
Ziad Aboultaif Conservative Edmonton Manning, AB
How many implants do we do in Canada on an annual basis, on average?
11:55 a.m.
Clinical Professor, Division of Plastic Surgery, The University of British Columbia, As an Individual
I don't know. That number is hard to find out.
11:55 a.m.
Conservative
Ziad Aboultaif Conservative Edmonton Manning, AB
Health Canada has this data. We must know how many we import, how many we produce and how many we use a year. Is that correct?
11:55 a.m.
Assistant Professor of Surgery, Université de Montréal, As an Individual
They should be able to know how many are imported. There are none produced in Canada.
11:55 a.m.
Conservative
Ziad Aboultaif Conservative Edmonton Manning, AB
Do we know for sure whether they know or whether they don't?
11:55 a.m.
Assistant Professor of Surgery, Université de Montréal, As an Individual
I don't know.
11:55 a.m.
Conservative
Ziad Aboultaif Conservative Edmonton Manning, AB
In order to determine what or who it can be up to, to commit to having a registry, as far as Health Canada.... Also, Dr. Nicolaidis has suggested that this should be paid for by the industry, not the taxpayers, which is something I agree with.
How do we get to that, to basically speed up the process, if a registry is a must?
Noon
Clinical Professor, Division of Plastic Surgery, The University of British Columbia, As an Individual
Some of the databases that are referenced in the presentation I sent are funded by industry. They basically put a surcharge on each implant, and that is used to fund the registry.
There are countries that use that model, for sure.
Noon
Conservative
Ziad Aboultaif Conservative Edmonton Manning, AB
Dr. Nicolaidis, would you like to weigh in on this too?
Noon
Assistant Professor of Surgery, Université de Montréal, As an Individual
Yes. As I said, the NBIR in the U.S. is an optional one, but I reached out to them to see about it. It's funded there by The Plastic Surgery Foundation, but it's receiving significant funding from the breast implant manufacturers. I think that's a direct one. It's not necessarily per implant, as a tax on the implants themselves, but that's another way of doing it.
Certainly, at the end of the day, it's.... The implant companies were supposed to do this, but they failed to in the past. I think they realize that they have to fund this registry in order to ensure the safety of implants.
Noon
Conservative
Ziad Aboultaif Conservative Edmonton Manning, AB
Any registry, as such, will require legislation at some point. Do you see a way to avoid going through legislation in order to establish something like that?
Noon
Assistant Professor of Surgery, Université de Montréal, As an Individual
Is that directed to me or Dr. Lennox?
Noon
Assistant Professor of Surgery, Université de Montréal, As an Individual
Dr. Lennox, go ahead.
Noon
Clinical Professor, Division of Plastic Surgery, The University of British Columbia, As an Individual
I don't know the machinations of government at that level, so I'm not aware of a way within CIHI to do that outside of legislation. I don't know.
Noon
Conservative
Ziad Aboultaif Conservative Edmonton Manning, AB
Dr. Lennox, since you're answering this question, you've suggested we need a registry, and then you've mentioned other models out there, such as those in Australia, Korea and the U.S. How can we get from you a clear answer on what shape of a registry we're looking at, and how can that be done in order to make sure the registry is beneficial to Canadians?
Noon
Clinical Professor, Division of Plastic Surgery, The University of British Columbia, As an Individual
I've provided guidelines for what makes an effective registry. I'm happy to go through that. They're pretty straightforward. It's well established what makes an effective registry. It would just be a matter of how you implement that within Canada.
Noon
Conservative
Ziad Aboultaif Conservative Edmonton Manning, AB
Dr. Nicolaidis, I would like you to weigh in on this, please.
Noon
Assistant Professor of Surgery, Université de Montréal, As an Individual
As I said, there are a few basic premises. I think Dr. Lennox knows more about the details of the registries than I do. There are some basic things to make sure the registry works. One is that it's mandated that basically an implant can't be put in and the guarantee respected unless, for example, the plastic surgeon has gone through a checklist with the patient initially of all the complications, and the patient understands each and every complication. Then it's a question of how to make it so that implantation is not recognized for the guarantee unless it's registered in the Canadian registry, so that it's mandated. Once again, I think it's very practical, and, as I've said and am going to keep saying, it's the breast implant companies who ultimately have to foot that bill.
Noon
Liberal
The Chair Liberal Sean Casey
Thank you, Dr. Nicolaidis.
The final round of questions for today's panel will come from Ms. Sudds, please, for five minutes.
May 4th, 2023 / noon
Liberal
Jenna Sudds Liberal Kanata—Carleton, ON
Thank you very much, Chair.
It's a pleasure to be with you today. I'm not a typical standing member here, but I'm happy to have the opportunity to interact on this important issue.
We have heard in the past, and a bit today, that the safety of medical devices in Canada is a shared responsibility. The federal government is responsible for regulating the sale and importation of medical devices, and then the provinces and territories are responsible for the delivery of health care services, including the licensing of health care professionals and regulating the practice of medicine. Nothing is ever simple, of course.
We heard from Health Canada that any requirement for physicians to provide information to a national registry would need to be supported by the provinces and territories, and that adds a layer of complexity.
I'm wondering from both of you, and perhaps we'll start with Dr. Nicolaidis first, do you see this as an insurmountable barrier? Do you have a perspective on how to bring the provinces and territories, and the regulatory body, really, into this conversation?