Evidence of meeting #67 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.
President, Canadian Society of Plastic Surgeons
The main obstacle to creating a registry has always been funding. How do you organize it? How do you make it truly national? Those are things we can overcome.
Professor of Medicine, University of Alberta, As an Individual
It's the surgeons, especially surgeons working in private clinics who may be a little more difficult. That's why in the Netherlands they say that you will lose your licence if you don't do the registry.
Chair, Scientific Advisory Committee on Health Products for Women
I would agree. Those surgeries taking place in private clinics are probably the hardest ones to follow, and there may be the most resistance there.
Conservative
Ziad Aboultaif Conservative Edmonton Manning, AB
There was mention that it's been 33 years since the first discussion on having a registry, and so far nothing has been done. In the meantime, by the time we agree on a registry, and with all the complications of finding the proper legislation, can government regulations or ministry regulations replace some of the conditions that a registry can provide?
Professor of Medicine, University of Alberta, As an Individual
It's a governmental issue to have licences for private clinics. We have to realize that there has already been a registry for hip and knee implants for a long time. In many countries, there are cancer registries, so why not for this?
President, Canadian Society of Plastic Surgeons
Compliance is always a problem with a registry, and without 90%-plus compliance, the registry would have little value. It could be criticized, or it could be doubted. In order to have the trust of the Canadian population for the safety of breast implants, it's inherently the government's responsibility to provide that. I think you have a big stick in terms of legislation to ensure compliance.
Chair, Scientific Advisory Committee on Health Products for Women
As I mentioned already, the improvement of mandatory reporting of adverse events for all medical devices needs to happen quickly. In particular, it needs to be extended past hospitals and manufacturers to individual practitioners, private clinics and private settings, including long-term care homes and private clinics that have been promised but have not happened yet.
The other aspect of this is the consumer. Up until recently, the way to file an adverse event report for a consumer was very hard to understand and was quite obscure. That's been improved, but there's a long way to go to make that a much more publicly and well-understood system, so we could also get more reporting that way.
Conservative
Ziad Aboultaif Conservative Edmonton Manning, AB
Thank you, and feel free not to answer the next question.
Is the industry in favour of a registry, yes or no?
President, Canadian Society of Plastic Surgeons
I have never asked them.
Chair, Scientific Advisory Committee on Health Products for Women
I can't speak for the industry, obviously. I have seen examples where the industry has been supportive, but I don't have an answer to that.
Conservative
Ziad Aboultaif Conservative Edmonton Manning, AB
Dr. Tervaert, in terms of ASIA, which is a term you've used, can you expand on the impacts that different properties of breast implants have in relation to an increased susceptibility to develop ASIA?
Professor of Medicine, University of Alberta, As an Individual
When you implant anything in a human body, there is an immune reaction to that, so it's not specific to only breast implants. We see this more often in breast implants than in other implants, but it's still not specific. It is also the same inflammation that actually causes the contractures and the same inflammation finally causes ALCL. ALCL is, in fact, a mistake of the immune system by attacking. Dividing cells then go wrong and it's a lymphoma. It is a similar mechanism that is occurring in these patients.
Liberal
The Chair Liberal Sean Casey
Thank you. That's your time.
Mr. van Koeverden, you have five minutes, please.
Liberal
Adam van Koeverden Liberal Milton, ON
Thank you very much, Mr. Chair.
Thank you to our witnesses. It's been extremely interesting.
I'd like to join my colleagues in first acknowledging that this is National Nursing Week. Thank you for bringing that up.
I would also like to say this to Dr. Tervaert, since last week was the Dutch Heritage Day in Canada and Liberation Day in Holland: As a Canadian of Dutch descent, I feel an obligation to say happy Dutch Heritage Day to you.
I think now that we've had a few meetings on this issue, it's less about the “if” and now about the “how”. We've kind of gotten over whether or not this would be a necessary implementation or consideration. Now we're starting to discuss the nuts and the bolts and the next steps.
I think it's important to acknowledge that Canada has some fairly unique challenges around health data. Federalism gets in the way of a lot of great ideas sometimes. In Canada, we have a patchwork of data privacy laws across the country. We're quite behind—a decade behind, if not more—in terms of being able to make that data interoperable and able to communicate.
I did have a recent meeting with some AI specialists to discuss the fact that there might be a faster solution to that than waiting 10 years for all of the systems to be changed. It's worth acknowledging that our government recognized the challenges with respect to data back in February and made data a pillar of our $198.6-billion investment over the next decade in our health care system with standardized health data and digital tools.
At the same time, the collection, the use and the disclosure of all of that data is still up to various provinces and territorial jurisdictions that don't necessarily talk to each other in the right language or in the same language. Moreover, those regulations are governed by provinces and territories in that health privacy legislation.
These are challenges unique to Canada. It's often said that Canada is 13 countries that pretend and try to be one. These are the challenges that face us as legislators. The fact that these privacy and data laws vary widely across the country might pose new challenges, but it's something that we need to tackle. For example, some provinces might also have to initiate legislation in order to be in compliance because there are certainly issues with respect to privacy. It will require more than one piece of legislation in order to get a registry in every province and territory.
Do you have any suggestions or solutions for overcoming some of these jurisdictional issues in the context of a registry in Canada?
That's a question for anybody, in fairly broad strokes. For example, have you ever been to a provincial committee meeting like this to discuss these health concerns?
Professor of Medicine, University of Alberta, As an Individual
The registration in Alberta is top. It's one of the best in the world. I'm not sure that the other provinces can do the same.
Chair, Scientific Advisory Committee on Health Products for Women
I can say that Australia may have addressed some of these questions with interstate issues. That might be worth investigating for the committee.
Secondly, one of the private member's bills that I mentioned in my timeline took place in Ontario, so at least at that point in time, there was some interest in one province around doing this, in addition to what we've already seen happen.
I do think it's an FPT issue, but that should not stop us.
President, Canadian Society of Plastic Surgeons
I thought this was the place where all those important decisions happened.
Liberal
Adam van Koeverden Liberal Milton, ON
We try.
The other issue that came up was with respect to cost.
Can you point to any jurisdictions that have overcome these costs? Is it usually a government obligation to pay for these registrations or this registry overall, or is it something that industry or others can accommodate?
President, Canadian Society of Plastic Surgeons
I think the best approach going forward is at the federal level. Create it as a Government of Canada initiative through whichever agency and then make industry pay for it.
Professor of Medicine, University of Alberta, As an Individual
I'm not sure that it's making industry.... It's making patients.... I mean it's your choice to do the cosmetic surgery. If you have reconstruction, it will be paid by the insurance.
Liberal
Adam van Koeverden Liberal Milton, ON
In Alberta, Dr. Tervaert, you mentioned it's world class. How is it paid for in Alberta?
Professor of Medicine, University of Alberta, As an Individual
It's not clear. I don't know.
Liberal