Health Committee on May 11th, 2023

[Terri McGregor]

I'll start with that.

My first thought would be to reframe that question and say that we're already paying. I do not know what it cost to treat me at Princess Margaret through multiple rounds of chemotherapy and my stem cell transplant, and I'm continuing on six-month follow-ups.

What we know is that Canadians.... In the study we talked about from Lorraine Greaves—and Nancy can talk to it—Canadian breast implant wearers go to their physicians four times more often than non-implant wearers do. We suspect that's because of these systemic issues that don't directly point to a breast implant. It's just that constant routine of family physician to referral, and then “we can't see evidence” and back.

I would suggest that the infrastructure is already there, because we're paying for it, and we are in complete support of a user fee. If we can do it for tires in Ontario, let's do it with breast implants.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Ms. Elliott, do you have a different comment or the same?

[Julie Elliott]

I fully agree with what Ms. McGregor said.

I believe Health Canada and two other organizations fund the Canadian Joint Replacement Registry.

I'd like to expand upon what Ms. McGregor said about the societal cost of her cancer. I personally have never had cancer in connection with breast implants, but I had systemic implant-related problems which began in the first month following surgery, and these problems continued for 10 years.

When the journalist for the French-language CBC program Enquête was preparing the episode about the dangers of breast implants, I gave her permission to access all the information in my medical file and all related expenses invoiced to the RAMQ over a period of approximately five years prior to my implants.

In the five years prior to my implants, I went to very infrequently to doctors' offices or hospital emergency rooms. But it became routine as of the first few weeks following the implant surgery.

Over a 10-year period, the total costs were significant. They included loss of income, money that I myself spent on various professional consultations, in addition to the costs invoiced to the RAMQ for the consultation of various medical specialists. The total cost was approximately $750,000 over a 10-year period, $200,000 or $250,000 of which were my out-of-pocket expenses and foregone income. The rest was paid for by society. Personally, it's difficult to total up how much I myself put into it, because I was taking care of my health. I didn't know why I was having health problems.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Elliott. That's all the time we have for this round of questions. There will be lots of other questions to come. You'll have an opportunity to provide more details.

Mr. Jowhari, go ahead, please. You have six minutes.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair.

Welcome to our committee. Thank you for sharing your experience with us. Thank you for the advocacy that you're doing. I'm sorry that you've had the experience that you've had. Once again, thank you for your advocacy.

I'll start with you, Madam Pratt. In the last committee meeting we had, I asked Dr. Morris as well as Dr. Cohen about medical tourism. You also highlighted the fact that medical tourism is trending and is becoming more prevalent.

What are your thoughts around how we can incentivize those who choose to do breast augmentation through the venue of medical tourism to ensure that they would register in such a registry?

[Nancy Pratt]

I'm not an expert on this, but I think there has to be a way to reach them so that when they've had their procedure done in another country and they come back to Canada, their doctors should be educated. Health Canada should do an outreach to the colleges so that there's a standard care in place. Their family doctors would be aware to notify them and to let them know that the registry exists and that it would be a good idea if they registered.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you. What you're suggesting is that most patients have a family doctor, and through their family doctor—

[Nancy Pratt]

No.

[Majid Jowhari, Liberal, Richmond Hill, ON]

—education plays a big role in ensuring that they register.

I'm sorry. You said “no”. Can you clarify?

[Nancy Pratt]

To your point about everybody having a family doctor, that's not true. There are so many Canadians, including me, who don't have a family doctor.

If we're calling in to a virtual clinic, even the doctors in those clinics should be updated, through the college, on the standard protocol of care. They should be aware and advise the patient. I guess the problem with that is that if they present to a virtual doctor and it isn't for an issue specific to their surgery, the virtual doctor might not know.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you very much.

I want to go to Madame Elliott.

You talked about there being basically two large manufacturers and that the onus is on them. I want to spend the rest of the time I have on participation.

My colleague Dr. Ellis talks about the percentage needed in terms of participation, whether it's the patient, doctor, surgeon, clinic or province. Numbers being thrown around are that 90% or 95% participation among patients and doctors is needed. I believe there was a discussion on opting out.

How do we incentivize the patients, doctors and clinics to ensure they do not opt out?

[Julie Elliott]

If you are asking me the question, the opt-out should not be an option.

[Majid Jowhari, Liberal, Richmond Hill, ON]

You're suggesting it should be mandatory.

[Julie Elliott]

Yes.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Okay, we now have a registry system that serves all the purposes we have set. It's mandatory. We have somehow built the agreement across all stakeholders—whether it's the province, federal government, patient, doctor, manufacturer and all those things—to come in.

What will happen if someone decides to go outside of the country to get that procedure done and chooses not to inform the registry?

[Julie Elliott]

Actually, that's the problem. The first problem with medical tourism is that a lot of popular countries right now are using breast implants that are not even manufactured here. I've personally talked to plastic surgeons who, right now, are doing business in Montreal removing breast implants or taking care of post-op complications for patients who went outside the country—outside North America—to have their breast augmentation, liposuction surgery or what have you.

That would be the first problem: Most of the time, they're getting breast implants or other types of cosmetic implants that are not even regulated here.

However, we're in 2023. There should be a way for whoever has any kind of implant.... If you come back here and have this type of implant, you're coming back with some information on your implant. There's a registry. You should be able to put those numbers into any kind of registry.

I think Terri would probably be way more efficient than I am at answering that question.

[Terri McGregor]

As somebody who ran a business for a long time, I can say that looking for 100% accuracy in this database is an unrealistic expectation.

Canadians who choose medical tourism.... That is an outlier percentage. It is minor. Do we give that patient or their surgeon an option when they land back in Canada and have a problem? Can somebody populate that data? Yes, medical tourism is an issue, but it is far greater an issue in Taiwan and Australia.

At some point.... We're not going to capture 100%, but less than 100% is better than the 0% we're collecting today.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. McGregor.

Mr. Thériault,, you have the floor for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

The issue of medical tourism comes up often. I'll give you my opinion on that matter. There's probably an financial saving in going elsewhere. On the other hand, if there's a higher level of safety here with respect to these implants, people wouldn't go elsewhere. Basically, it's our responsibility to provide added value for being operated on here, if we are to justify the extra associated costs. That's just my opinion, however. You can tell me whether you agree or not.

I have a question for Ms. Pratt, who was with us by video conference, to get her back into the discussion.

I asked the Health Canada representatives why they were not being very proactive. I asked Lorraine Greaves, who heads the Scientific Advisory Committee on Health Products for Women, about the virtual meeting held by this committee on February 23, 2021. I asked her whether there had been any progress with respect to the implementation of the recommendations made by the scientific advisory committee. She said that there had been no progress at all.

In the documents you gave to the clerk of the Standing Committee on Health, I saw that you had sent a letter to Health Canada in 2022, I believe, asking for a status report on progress with the recommendations made by the scientific advisory committee.

Did you get a reply?

[Nancy Pratt]

I didn't get a response, no. It's concerning.

[Luc Thériault, Bloc, Montcalm, QC]

Health Canada, which claims to be very proactive, made a big deal out of setting up a scientific advisory committee. It held one meeting at which breast implants were discussed and made recommendations. Since then, nothing has happened. You followed up in 2022 and still hadn't received an answer in 2023.

How do you explain that? Are you discouraged about it?

[Nancy Pratt]

Absolutely, it's hard not to be discouraged sometimes as an advocate, but certainly Health Canada has done minimal changes to this point, so even things like a black box warning and our request to put photos of failed breast implants on their website.... The website itself isn't as informative as it should be.

I want to draw attention to the fact that even though there have been some actions taken, we wrote them a letter asking what substantive changes have been made, and the really important issues are ignored. The issues with breast implants described in the “inconvenient truth” article, like migrated silicone and the chemicals in breast implants, they don't want to take on. These changes that are happening, and not to a good degree, to me are not really making women any safer than they were back decades ago, so they need to address these issues.

[Luc Thériault, Bloc, Montcalm, QC]

In the letter, you asked that Health Canada show photographs of some silicone implants to explain to women how the silicone migrates and to make them aware of the problem. In the report on the Enquête television program, a famous plastic surgeon cuts a silicone implant in half and says that the product should not be in a woman's body.

Did Health Canada circulate these photographs after your request, as was done for tobacco, for example?

[Nancy Pratt]

No, they haven't pursued those actions. The scientific advisory committee made some really great recommendations to Health Canada, and they haven't been pursued either. It's really troubling.

[Luc Thériault, Bloc, Montcalm, QC]

Is silicone migration an established fact?