Thank you very much.
In addition to chairing the scientific advisory committee on health products for women, I am also a senior investigator at the Centre of Excellence for Women's Health, which is based in Vancouver, and a clinical professor at UBC in the faculty of medicine. I'm a medical sociologist, so I am trained to analyze the links between health and various systems.
There is no doubt that a breast implant registry would benefit Canadians and that all measures should be taken to establish one. However, such a registry is just one example of the need for a comprehensive system for tracking and monitoring medical devices in Canada. I want to briefly address both aspects.
Women's health has a long history of neglect. That has included exclusion from clinical trials, under-researching of key health issues specific to women and under-researching of women's presentation of shared health issues, such as cardiovascular disease, as just one example. This is a result of a long-term systemic bias in health research and in treatment.
Remedial actions have been taken by the Government of Canada around this neglect, one of which has been the funding of the centres of excellence program between 1996 and 2012. There were five centres and a working group on health protection. The latter group, including the centre that I established in Vancouver, did do two reports that were of relevance to the issue of breast implants. They are linked in the written remarks I sent to the clerk.
A joint research program is the second initiative to remediate this problem. Health Canada and the CIHR launched this between 2019 and 2020 to address key policy issues. It was called SGBA+, or sex and gender based analysis plus, health policy-research partnerships.
Two of the seven projects under that particular program are of relevance to today. One, done by Anna Gagliardi at the Women's College Hospital and her team, analyzed the management of medical devices in Canada from an SGBA+ perspective. She recommended a complete revision of documentation and procedures, and certainly SGBA+ training for industry. I led a team doing a parallel piece of work on SGBA+ on the management of prescribed drugs. We had similar recommendations, including the mandatory inclusion of sex-related data and gender-related data—the former beginning in 2023—on submissions for drugs and devices. These both speak to some of the oversights that we have in our current system.
The establishment of the scientific advisory committee is the third example. We're mandated to advise on better management of drugs and devices that affect women. We have identified numerous issues with respect to both, and we have made those recommendations in concert with various planning efforts from Health Canada.
With respect to the registry, as you've heard so far, the issue of the registry is extraordinarily important to those women who have had an implant, and in particular to those women who have had problems. You've heard about the problems. At the committee level, we have heard testimony from some of the women who have had problems, which is utterly moving and often relays catastrophic, life-changing issues.
The registry is of keen importance to clinicians and researchers as well, as it will provide more robust data.
The request for a breast implant registry in Canada dates back over 33 years. As the last speaker said, that would have been the time to establish this. These include reports, special advisory committees, expert committees, at least two legislative bills, testimony and recommendations from consumer advocates. Most recently, we had a best brains exchange in March of this year, and now you have embarked on this study. I submitted a PowerPoint from the best brains exchange to you for background. You will see the timeline there.
However, we still don't have a registry, even though many other countries do. It's well past time to establish one. Discussions about logistics and pros and cons, and arguments about objectives and complexity prevail, but 33 years is a long time to work out a system.
It's ample time. It should include registration of all implants sold in Canada—implanted, replaced and explanted in both private and public health care facilities, including recall information.
The members of the SAC, the scientific advisory committee, are an esteemed and experienced group of clinicians, scientists, consumer advocates and researchers. We have recommended action. We were engaged in the best brains exchange.
A registry would finally provide a denominator for calculating risk. We don't have that at the moment. Therefore, we can't calculate risk, which underpins informed consent. That affects clinicians. It also affects women. We don't know the number, the total number, of devices implanted or explanted, replaced, failed or succeeded, so we can't do this. This lack of evidence, I would suggest, supersedes even the strongest consent forms.
It should also provide data for research to understand the dynamics of breast implant usage, something that gets very little discussion. CIHR should be encouraged to utilize the registry data, should we get one, to produce research for the public domain.
If implants and when implants take place in private clinics, follow-up health care utilization is in the public domain, so this is an issue for all Canadians.
We've also recommended improved communication with clinicians and potential recipients of implants, including robust information about consumer experiences; reasons and motivations for seeking implants; alternatives to implants; lifespan of devices; and relevant qualitative research. Even non-problematic implants expire and require replacement. Women need to anticipate this and learn about alternatives to breast implants.
We don't generally do that at the moment, but at root, by and large—