Thank you.
Let me start, first of all, with the fact that there were major differences across the country. Our information led us to understand that British Columbia was handling and managing this issue the best of all of the provinces in the country. That was largely because there were a fair number of institutions in British Columbia that were contracted with a supply coming from an alternative supplier who was not dependent upon molybdenum that came from Chalk River. They then had a capacity to share and in fact ameliorate the situation that did not exist in other centres.
Secondly, let me point out that many of the difficulties that were experienced in the delivery of medical care occurred in smaller centres, where in fact they are on call at night and on call at the weekend to provide nuclear medicine services, unlike the major downtown institutions in Toronto, Ottawa, Vancouver, and Edmonton, where there is relatively good access to CT and MR, which provide for alternative imaging for many of these problems. Therefore, the problems were actually occurring in the smaller centres; the issues of lack of access to care were much more acute in those centres than they were in major urban centres.
It is absolutely true that therapy was not an issue. Therapy for using radionuclides in most cases is elective, and at no point was there an issue with respect to supply of radiopharmaceuticals that are used for treatment. However, therapy depends upon accurate diagnosis, and it is my belief, and certainly the belief of most of my colleagues, that nuclear medicine plays a pivotal role in making an accurate diagnosis.
In the case of Ontario, Cancer Care Ontario in fact met on an emergency basis to consider the lack of isotopes. There was in fact a central directive that came from Cancer Care Ontario, co-signed by the University Health Network and supported by the Government of Ontario, directing that the various nuclear medicine facilities should place priority upon doing bone scans, because it was viewed that there was no good alternative to bone scanning for the diagnosis of metastatic disease and the staging of treatment, and that the lack of access to bone scanning would lead to delays in staging and delays in treatment.
Finally, I think we need to understand that the health care system in Canada is a relatively constrained system. There is not a lot of extra capacity within the system. We don't have a lot of extra beds; we don't have a lot of extra CTs; we don't have a lot of extra MRs; we don't have a lot of extra high technology that's sitting unused. Therefore, when any portion of the system is withdrawn, its withdrawal has the potential to create backlogs that could take weeks and months to resolve.