Natural Resources Committee on June 9th, 2009

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

How much time do I have, Mr. Chair?

[The Chair, Conservative, Leon Benoit]

You have ten seconds.

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

I pass.

[The Chair, Conservative, Leon Benoit]

Your time is up.

We will go now to the Bloc Québécois, Mr. Malo, for up to five minutes.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you, Mr. Chairman.

I would like to thank all of our witnesses for being here with us this afternoon.

You all talked about increased costs. In the case of Quebec, for example, how much do these isotopes cost per day, per week, as a result of this shortage?

[Dr. François Lamoureux]

They cost three times as much. I do not have the exact figures. For example, a millicurie of technetium—the millicurie is a unit of measurement—used to cost 19¢. Now we are paying 54¢. This represents 5 million additional dollars for Ontario—this information was conveyed to me by the President of the Ontario Association of Nuclear Medicine. As far as Quebec is concerned, we can foresee having to foot a bill that will cost, at a minimum, about $4 million more.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you.

Dr. Urbain, when you were talking about the OECD earlier, you said that there was no international cooperation in order to manufacture isotopes to deal with the shortage.

Do you think that a country like Canada, which produces approximately 50% of the isotopes, should be playing the role of a world leader in this field and invite all of the countries to sit down at the same table and discuss how we can take action together? Is it Canada's role to do that?

[Dr. Jean-Luc Urbain]

In a time where we see a resurgence of nuclear energy, I think that it is quite sad that Canada, over the past 10 years, has not been more proactive and shown leadership.

I think that Canada had a wonderful nuclear energy program and that still is the case today. I do not think that all has been lost, if you like. Canada has lost a great deal of credibility. One way to restore this credibility internationally is indeed to play a very meaningful leadership role on the world stage.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

You said earlier that technetium 99 was the only isotope or technology used to diagnose certain childhood cancers.

Have you already had to stop doing certain diagnoses? Are there already children who have not been diagnosed?

[Dr. Jean-Luc Urbain]

I have to correct something that you said. I did not say that technetium was the only isotope used for diagnosing cancer. For diagnosing most types of cancer, we have fluorodeoxyglucose, fluorine 18, sodium fluoride, that emit positrons. We use positron emission tomography.

What I was trying to say earlier to Mr. David McGuinty was that we are very reluctant to use positron emission tomography for children because the level of radiation is more intense. Children have priority. You no doubt know the saying "women and children first". In nuclear medicine, we apply this principle when there is a shortage.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you.

Could you tell us, in your opinion, what is the reason why the Canadian Association of Nuclear Medicine is not included in the group of experts?

[Dr. Jean-Luc Urbain]

Here again, I must make a correction. In fact, the Canadian Association of Nuclear Medicine belongs to the group. However, we note that within the group, individual experts are given preference over organizations.

For example, just recently, the Canadian Association of Radiologists and the Canadian Association of Medical Radiation Technologists were not represented in the group. It was inconceivable for the Canadian Association of Nuclear Medicine to recommend that nuclear medicine examinations be transferred to the radiology sector without the participation of the Canadian Association of Radiologists.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

What do you think is the reason for this?

[Dr. Jean-Luc Urbain]

I think that you should put this question to the elected politicians.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Dr. Lyons or Dr. Lévesque, have you an opinion about this?

[The Chair, Conservative, Leon Benoit]

Dr. Lyons, go ahead.

[Dr. Edward Lyons]

First of all, I want to thank Dr. Urbain for mentioning and insisting, at the committee level, that the organization that represents radiology, the CAR, be a representative too. I think he's done a lot by encouraging the government to do that, and now we are sitting at the table.

I have one comment, if possible. It was mentioned that there is a loss of leadership role by Canada by virtue of the lack of available isotopes. I would suggest that utilization of the isotope is one facet of this issue; the other facet is how the patients get into the system, and are they always choosing the best test first?

In fact, Canada today has a recognized leadership role in the use of guidelines to help the physicians—the specialists or the physicians—to identify the best tests. And maybe we also have to look at this facet to make sure that not all of the people who are getting in need to get in--and similarly, that those who really do need to get in will get in first.

[The Chair, Conservative, Leon Benoit]

Thank you, Dr. Lyons.

You're out of time, Monsieur Malo.

We will go now to Mr. Shory—and if there's time left, to Mr. Trost. Five minutes for the two of you.

[Devinder Shory, Conservative, Calgary Northeast, AB]

Thank you, Mr. Chair.

I'd like to thank the witnesses for being here this afternoon.

This global problem has put our country in a very sad situation, I would say, and we are all concerned.

We have been hearing the witnesses for quite some time, and it concerns me when it comes to the health and safety of human beings in this world. But I'm trying to understand this. I have heard about alternatives being available also. So I'm trying to figure out what percentage of diagnostic testing can be completed with the alternatives available to doctors.

[Dr. Jean-Luc Urbain]

Well, the best alternative for what we call conventional nuclear medicine procedures, SPECT imaging with technetium or other single-photon tracers, is basically positron emission tomography. There is a good reason these tests exist and there's a good reason that we must promote their use and continue to use them.

I fully agree with Dr. Lyons, with whom I am working, that what we ought to do gives us and Canada and its medical community a chance to show leadership. We ought to use a socialized step approach to medicine by defining the very best test. Technology is evolving very fast. What was true yesterday might not be true tomorrow, so when you're talking about alternatives, our preference for nuclear medicine tests--single-photon tests and technetium--would be to use an alternative nuclear medicine procedure.

[Devinder Shory, Conservative, Calgary Northeast, AB]

I really want to understand the percentage, basically. Let's say that in the past we were using the isotopes for 100 kinds of diagnostic tests. Out of those 100 tests, is it possible that in 5%, 10%, 30%, 20%, we can avoid using isotopes?

[Dr. Jean-Luc Urbain]

Once again it goes back to what we are trying to do. We triage very cautiously every single request made to nuclear medicine departments across Canada, and as a matter of fact across the world, to minimize the use of radiation by using the ALARA principle. That's the principle we're using, so I don't think we can cut much more than we have right now.

Let me give you an example. In the past, we were using carbon-14 to do breast tests. Carbon-14 is a radioactive isotope. Now we have switched towards carbon-13, which is not a radioactive isotope, in order to do those breast tests. I think you're going to find that the nuclear medicine community is extremely responsible when it comes to the use of radioisotopes; if there is any other test that we can recommend, we do recommend it. However, you need to understand that nuclear medicine essentially looks at the function of the organs, and not many other tools are available to look at the function of the organs.

[Devinder Shory, Conservative, Calgary Northeast, AB]

Thank you.

I'd like to share my time with Cheryl.

[The Chair, Conservative, Leon Benoit]

Ms. Gallant, you have about a minute and a half.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Thank you.

My question follows the previous question, and you were just about touching on it.

We've had a number of people ask questions about why their cancer treatment cannot be continued. moly-99, the isotope manufactured at Chalk River, hasn't anything to do with the treatment of cancer, but it does have to do with diagnostic methods.

When somebody's undergoing a treatment, they have to have their organs looked at to ensure that this treatment isn't having a negative effect. Are there alternative diagnostic tests that can look at the heart to see whether the current treatment is having an impact on it?

I'd like to ask Dr. Gulenchyn as well as Dr. Urbain.