Natural Resources Committee on June 9th, 2009

[Bradley Trost, Conservative, Saskatoon—Humboldt, SK]

But if the Dutch do get their supply on line, it will very much help ease the situation. Is that not correct?

[The Chair, Conservative, Leon Benoit]

A very short answer, please, Doctor.

[Dr. Karen Gulenchyn]

I'm afraid I can't answer “very much”. I don't want to qualify it. It will help. I don't think “very much” may be the correct adjective.

[The Chair, Conservative, Leon Benoit]

Thank you.

We go now to the second round, a five-minute round, to Mr. Bains, from the official opposition.

[Navdeep Bains, Liberal, Mississauga—Brampton South, ON]

Thank you very much, Chair.

I'll be splitting my time with my colleague Mr. McGuinty.

In today's opening remarks, the situation we're dealing with was described as “the sick looking after the sick”. This is an issue of life and death. And one key indicator used to indicate why this issue is life and death is that anything less than 50%, in terms of the isotope supply, makes it a situation of life and death because you're pitting one patient against the other, ultimately, and making those tough choices when you prioritize the needs of the patients and the diagnoses.

Where are we now, in terms of the isotope supply? How do we measure that? How do we track that? Where do we stand? Are we at the 50% threshold? Are we below that threshold? Are we above that?

[Dr. Karen Gulenchyn]

At the moment, we're at about a 70% supply level in Hamilton. The amount of supply probably varies from site to site within the country. I think the question about the monitoring effort is a very good question. I know what the monitoring plan is for Ontario. We are having our first telephone conference call in our own local health integration network tomorrow. I cannot tell you what the monitoring plans are outside of Ontario. I know Ontario does have a plan, but I'm not able to inform you what that plan might be for the remainder of the provinces.

[Navdeep Bains, Liberal, Mississauga—Brampton South, ON]

Just as a quick follow-up, you cited Hamilton, but do we have a national number for the isotope supply?

[Dr. Karen Gulenchyn]

No.

[Navdeep Bains, Liberal, Mississauga—Brampton South, ON]

Okay.

[The Chair, Conservative, Leon Benoit]

Mr. McGuinty, you have three minutes.

[David McGuinty, Liberal, Ottawa South, ON]

Thanks, Mr. Chair.

Thank you, ladies and gentlemen, for being here. I have a couple of points I want to make and just have confirmed—if I understood some of the testimony here today.

I heard a number of points. The first point I heard was that obscure experts are being chosen by the government to advise them on this entire isotope crisis, as opposed to working with the established associations around the country.

I heard there is absolutely no confidence that we're going to have substitutes from the Netherlands, from South Africa, from Australia, or elsewhere.

I heard Dr. Lamoureux state categorically that the Government of Canada is being dishonest with Canadians about Chalk River.

I've just heard our good doctor on the video conference, Dr. Gulenchyn, basically say she's not able to tell us how many isotopes we have in this country. She can't confirm if we're going to see any increase in supply and can't tell us whether we've hit the 50% threshold—after which, she says in her own testimony, it may lead to death.

I've heard that the best guarantee for Canadians and Canada now is to re-examine the MAPLE reactors.

And, Dr. Urbain, I want to congratulate you on your patience with respect to the questions you received from the Conservative government member about nuclear security and safety. It's very, very disturbing and rich for Canadians, because this is the government that fired Linda Keen, our chief nuclear safety regulator, at 11:15 at night with a phone call from a previous minister, the day before she was scheduled to testify to Canadians. So it's very rich for the government now to say they are possessed with security concerns.

Can I ask you a very pointed question, please? In the government's plan for the guidelines, the draft guidance for maximizing the supply of Tc-99 during a shortage, something struck me. I have a children's hospital in my riding, and I want to confirm this. It says that “Any bone scan for newly diagnosed or established pediatric cancers”—that is, for our kids—“since there is no alternative to Tc-99m bone scans for the pediatric patients in the event of a shortage”.... In English, for the viewers who are watching, does this mean that if we don't have the isotope production, the isotopes that we need, children with pediatric cancers cannot be properly diagnosed? Can you help us understand what this means?

[Dr. Jean-Luc Urbain]

I think you're absolutely correct. You read the statement correctly.

[David McGuinty, Liberal, Ottawa South, ON]

So...?

[Dr. Jean-Luc Urbain]

We don't have an alternative. The only alternative that we could potentially imagine, and which we are very reluctant to use, would be sodium fluoride and positron emission tomography. But remember, we're dealing with children, so we don't want to use excessive radiation when we don't need to. Children are a major problem, a major nightmare for us.

[David McGuinty, Liberal, Ottawa South, ON]

Have the children's hospitals across this country been informed of this? Do they know these shortages are looming? We heard just moments ago that the Ontario head of nuclear medicine says that rural hospitals in Ontario starting Thursday morning will have no isotopes. Do our children's hospitals and their pediatric cancer experts know this?

[Dr. Jean-Luc Urbain]

I think Quebec might be a little different. For the rest of Canada, as I said earlier, basically we are dealing on a day-to-day basis with whatever we receive, or whatever is left from the day before. The nice thing about the medical imaging community is that it is very small and very big at the same time. So we communicate very effectively and we pay a lot of attention to children. They are very precious, as you know.

[The Chair, Conservative, Leon Benoit]

Thank you, Mr. McGuinty.

Mr. Allen, for up to five minutes. Go ahead, please.

[Mike Allen, Conservative, Tobique—Mactaquac, NB]

Thank you, Mr. Chair, for the opportunity.

I can't help but say that I always marvel at Mr. McGuinty in committee and some of the things he does say. Given the fact that he said people were not consulting with experts, but I know that you, Mr. Urbain, have been involved, and I know Dr. Gulenchyn has been on the panel, that's a little bit rich of him, to say the least.

Dr. Urbain, you talked about the 1990s—and I just want to follow up on some of those technologies, especially the PET technology—and the opportunity that might have been missed back then to go with this technology. Regarding the comments you made about three years and six years, we've known with these reactors—and I think the youngest is about 45 years old, if I recall correctly—that this is really a time bomb for these five reactors around the world.

What I would like to understand is that if we had gone with the PET technology and had done the things needed in the 1990s to bring ourselves up to speed, as some of the other countries have done, what would have been the impact on isotope usage today if that had been implemented?

[Dr. Jean-Luc Urbain]

I'd like to comment on your first question, about the experts.

What we'd like to see from any government is the government engaging medical associations, and not necessarily individuals. At times we find an individual from an expert panel we never heard of. That's the first thing.

In terms of PET scintigraphy, it is going to vary from province to province. We estimate that if we have PET scintigraphy available today in Canada we would be able to shift anywhere from 10% to 25% of the technetium study to PET.

[Mike Allen, Conservative, Tobique—Mactaquac, NB]

We're talking about “expeditiously approved”. What would be the timeline to implement that type of solution?

[Dr. Jean-Luc Urbain]

The timeline can be as quick as one month or two months. There are many PET scanners available in many provinces. Unfortunately, those PET scanners are used to do research, clinical trials, or even animal imaging.

[Mike Allen, Conservative, Tobique—Mactaquac, NB]

You commented that thallium was a pretty good temporary alternative. Can you define what “temporary” means? Is it a week, two weeks, two months, or three months? And what does “pretty good” mean from your perspective?

[Dr. Jean-Luc Urbain]

If you are asking me for a number I'm not going to be able to give you the number. What I can tell you is that the rule of thumb when you deal with radioactive material is what Dr. Gulenchyn mentioned earlier: as low as reasonably achievable. We know that thallium increases the radiation by a factor of 1.12. Now, if you have to decide whether to let a patient die and not do a test and the patient was going to die, you are going to use thallium. But as I said, it's not the ideal isotope in the 21st century.

[Mike Allen, Conservative, Tobique—Mactaquac, NB]

Okay.

In talking about the international measures, we've got five reactors and we're going to see one come on line pretty soon, but there hasn't been a substantial change in the isotope supply that we can see, probably for five years or more. Even with the MAPLE situation, we were talking many years, even if we could do this power coefficient. I'd like to understand from a worldwide perspective--and I was really interested in the comments--what are the international measures we can do collaboratively? We all share these five reactors and we all are concerned about patient care around the world. What are the international measures we should be looking at? I'd like any comments from any of the panel on this.

[Dr. Jean-Luc Urbain]

That's a very good point.

Europe has not seen as much of an impact as we have seen in North America of the lack of production of molybdenum and technetium-99m. The reason is that since 1990 they have deployed a large program of PET scanning. I think that every country that is producing molybdenum and technetium is very sensitized to the issue. There is a very significant effort on the part of the producers of molybdenum--in other words, the reactor or creator--to try to better coordinate their production of molybdenum and technetium.