Health Committee on May 11th, 2023

[Luc Thériault, Bloc, Montcalm, QC]

Ms. Elliott, if we can't rely on the industry, which never did the studies it was supposed to carry out when the moratorium was conditionally lifted in 2006, and we can't count on the surgeons, because it's impossible to know whether they are practising informed consent in a consistent fashion, then although we can rely on associations like yours, it's not enough. In this particular instance, responsibility falls to Health Canada, which is responsible for the safety of women, and for product certification and safety. If a high-risk product or instrument is involved, and there doesn't appear to be enough conclusive data, then the precautionary principle has to apply. That would mean more warnings, not fewer.

Do you think that the Health Canada site has improved since 2019? Has it done enough to be considered comparable to an organization like the Food and Drug Administration, the FDA?

[Julie Elliott]

I'd have to say no. It hasn't done enough and the Health Canada website hasn't improved. If you wish, I can give you two examples.

First, manufacturers' sites and the FDA site recommend that women who have implants should undergo an MRI, magnificent magnetic resonance imaging, three to five years after surgery. I can't remember the exact number of years stated. That's not recommended anywhere on the Health Canada site. We're not talking about mammography or ultrasound, but an MRI. That is stated at the Mentor and Allergan manufacturers' sites and on the FDA site, but it's still not mentioned at the Health Canada site. It's a manufacturer's recommendation. Why on earth isn't it on the Health Canada site?

I'll give you another, somewhat more personal, example. You'll understand why. In 2021, Health Canada started a blog containing data on Canadian monitoring of BIA-ALCL.

[Luc Thériault, Bloc, Montcalm, QC]

That's lymphoma.

[Julie Elliott]

Yes, it's breast implant-associated anaplastic large cell lymphoma, a form of cancer linked to textured breast implants.

I was contacted by a woman from Health Canada. I can't tell you which committee she was on, because I don't have the email in front of me here. She asked me if I would like to revise their article for their data blog. I'm a patient. I'm a representative and a patient. I don't have the letters MD after my name. That shows how information can be altered. I was asked to revise the PDF file that Health Canada was going to put on its blog and on its social networks page. There were major mistakes in it.

So they asked me, not a specialist, to revise the article. They asked me, a patient.

[Luc Thériault, Bloc, Montcalm, QC]

And yet there is the Scientific Advisory Committee on Health Products for Women.

[Julie Elliott]

I found two major mistakes.

For example, the original version said that BIA-ALCL was linked only to textured implants. I had to tell them that was not the case, and that textured expanders were also involved, not just the implants themselves. I had to explain to them that in their very minimal blog, they should also warn patients who had undergone breast reconstruction surgery.

I can't remember the other mistake, because it was two years ago, after all.

Is the information at the Health Canada website adequate? No.

Information at the website of the Food and Drug Administration, the FDA, is also probably inadequate. In fact both sites are equally short of information.

An enormous amount of work and effort is needed at health Canada. For the precautionary principle, right now, given that the two studies by Allergan and Mentor…

[The Chair, Liberal, Sean Casey]

Thank you.

Mr. Davies, go ahead, please. You have two and a half minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Ms. Pratt, I want to follow up where I ended my last questions.

We've heard about the linkage between breast implants and three major conditions: the BI illness, the BIA-ALCL—in other words, the cancer that's associated—and autoimmune disorders.

In your view, how clear is the evidence that those illnesses are linked to implants?

[Nancy Pratt]

I think there is absolutely no doubt, and I think we're asking the wrong question.

I think the question isn't whether BII is real, for instance. We've seen, since implants were introduced in the sixties, that within a year, those symptoms were already being manifested. Through six decades, wearers have developed the same symptoms.

From my perspective, the question should be how the industry so masterfully convinced individuals who are medically and scientifically trained to buy into their narrative. It should just make sense that when you're implanting a device that has chemicals inside it, and the silicone doesn't stay encased in there—and as I said earlier, it's certainly not inert, as I can attest, given what I feel in my body—I think we're asking the wrong question. The question is, how did medically and scientifically trained people become so willing to step out of what is just common sense?

[Don Davies, NDP, Vancouver Kingsway, BC]

Let me tell you why I ask. I ask because if there is a clear link—at least when it comes to cosmetic applications—I am asking the theoretical question of whether we should be allowing the sale in Canada of products that are clearly linked. They're carcinogenic and they are linked to other very serious illnesses. Given those health concerns, why are we allowing that product to be licensed and sold and implanted in people in Canada if that link has been established?

[Nancy Pratt]

I think that's a great point.

I think that until they have addressed the issue of migrated silicone and its impact.... And again, I can tell you that I live with the impact of it daily. I am in pain 24-7 from the silicone in me.

I think until they have addressed the inconvenient truth of breast implants, there should be a pause. I don't feel they should be available until they have taken appropriate action.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Pratt.

Next we have Dr. Kitchen, please, for five minutes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair.

Thank you all for being here and sharing your stories with us and helping us as we move forward on this.

I realize I have little time, and I have so many questions I want to ask, but I'm going to apologize to you all right now initially.

What we've heard today is basically a conversation in which we've talked about CIHR and the registry they have. I'd like, Mr. Chair, to propose a motion that we extend our meeting one more day to hear from CIHR on their orthopaedic registry so that we can have that information here.

I see a lot of consensus around the table, so I'm hoping we can very quickly get approval for that.

[The Chair, Liberal, Sean Casey]

The motion is in order. It is to add a meeting to this study for the purposes of hearing from CIHR.

The debate is on the motion.

Go ahead, Dr. Hanley.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you, Mr. Chair.

Greetings to everyone.

I think there may be some confusion between CIHR and CIHI. I stand to be corrected, but my understanding is that the orthopaedic registry is actually with CIHI, the Canadian Institute for Health Information.

Can we get clarity on who holds what and who has already appeared, and then revisit what our need is?

[The Chair, Liberal, Sean Casey]

We have Dr. Kitchen and then Dr. Ellis.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

If that's the case, it's a friendly amendment. Just for clarification, if it is CIHI or CIHR, I'm comfortable with that.

[The Chair, Liberal, Sean Casey]

We've heard from CIHI.

Go ahead, Dr. Ellis.

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

Thank you, Chair.

The new information that has come to light is to understand how we can move this study forward. To me, it makes sense to hear from whichever government agency it is to ask how much this is going to cost, what the orthopaedic registry costs, etc., if we're going to use it as a template to move this forward.

In deference to the witnesses, the issue, as I see it, hasn't been moved forward in the 20 years that this issue has been coming here. I think hearing from a government agency that may or not be responsible for this is important and germane.

[The Chair, Liberal, Sean Casey]

Dr. Hanley is next.

[Brendan Hanley, Liberal, Yukon, YT]

Given it's CIHI, and we did already hear from CIHI and Health Canada, and some of those very questions were posed, and we did hear their opinions, perhaps in light of all that we've heard, we may want to revisit that. I'm certainly open to that consideration. Perhaps there are other witnesses within CIHI who might speak to that, but just to be clear, they have already appeared and spoken to this issue.

[The Chair, Liberal, Sean Casey]

Are there any further interventions?

Mr. Thériault, you have the floor.

[Luc Thériault, Bloc, Montcalm, QC]

I'd appreciate it if people could avoid using initials, because that often makes it difficult for the interpretation. It would be better to give the full name of institutions so that we can hear them and know exactly what we're talking about.

[The Chair, Liberal, Sean Casey]

I see.

The initials used in the motion were CIHR, but I don't know its precise meaning.

Can someone here tell us?

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

It's the Canadian Institutes of Health Research.