Evidence of meeting #25 for Natural Resources in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was medicine.
A recording is available from Parliament.
President, Canadian Association of Nuclear Medicine
Except that they've looked at them expeditiously, the answer is no.
Liberal
Carolyn Bennett Liberal St. Paul's, ON
In terms of getting other sources, I heard a worrying story that hospital will be fighting hospital, clinic will be fighting clinic, that if there were any available extra isotopes from around the world there would be a bidding war. Are you hearing that the federal government will have any ability to secure any of these, or will the United States just pay more and mop it all up? How confident are you that any of the extra capacity from the Dutch reactor will come to Canada?
President, Canadian Association of Nuclear Medicine
I'm not confident at all. To the contrary, it was very clear from the OECD meeting in Paris in January that the chain of supply is very complex. In case of a shortage, we do not know if we indeed are going to go into a bidding war, which is definitely likely. As I mentioned in my report, over the past 18 months we have seen five or six shortages of isotopes. One day we got notice that we would get only 60% of our generator capacity, with no explanation.
Clearly, it has been very frustrating. Right now we are operating on a day-to-day basis.
Conservative
The Chair Conservative Leon Benoit
Thank you, Ms. Bennett.
We go now to the Bloc Québécois. Madame Brunelle, for up to seven minutes.
Bloc
Paule Brunelle Bloc Trois-Rivières, QC
Good afternoon, ladies and gentlemen.
Dr. Lamoureux, you talked to us about a serious international medical crisis. I was very troubled by what I heard this afternoon. On May 21, you warned us about what would happen. During the course of an interview with the press, you said the following:
The shortage of isotopes should begin to be felt next week as the supply of 99mTc will be reduced by 60% to 70%, which will have a commensurate impact on the access to care [...]
Indeed, we can see that your forecast has been confirmed. During the same interview, you also said:
Technetium is used on a daily basis for 70% to 80% of our clinical interventions. It is used exclusively for diagnostic purposes, to detect cancer and its metastases, pulmonary embolisms [...] However, because of the shortage, we will have to delay these investigations and postpone some surgeries.
The case you described earlier truly spoke volumes. I tie that into what Mr. Jean-Luc Urbain said, namely, that the absence of technology has hurt Canadians a great deal. He has seen more and more cases of cancer over the past six years. Many people can look around them and see the numerous cases of cancer and realize the extent to which the fight against this disease appears to be lagging behind.
Dr. Lamoureux and Dr. Urbain, how do you see the actions taken or not taken by this government to deal with this crisis? Does the government realize that this is a serious medical crisis? Is it taking the required steps to resolve it? Do you have the impression that we will find a solution?
President, Quebec Association of Nuclear Medicine Specialists
Our sick are concerned. We have had to dramatically reduce access to care although people knew three years ago that this crisis was coming. I think action should have been taken long ago to avoid the situation we find ourselves in today.
The people being held hostage in this situation are the ill. They need urgent care. As Dr. Gulenchyn said, if the level of supply goes below the 50% mark, there is a high risk that the ill will suffer extremely negative consequences. According to Dr. Gulenchyn, the quantity of isotopes at Quebec's Institut universitaire de cardiologie et de pneumologie, one of the biggest cardiology and lung cancer investigation centres, has been reduced this week to 20%—so this is below the 50% mark—and we are going to have to go through all kinds of hoops in order to provide our patients with the greatest possible accessibility.
I think that a government, when it is in power, must govern and make decisions. A decision should have been made by the government three years ago. The Canadian government has a social responsibility not only to Canada but also to the rest of the world. I think that it must go to every possible length to ensure that an international committee assesses the Chalk River facility. People need to be told the truth, namely, whether or not this reactor can be made operational again. If this is at all possible, it must be made operational once again because there is no immediate solution in the rest of the world to compensate for this shortage of isotopes. The only solution for us and for the rest of the world is to, for the time being, try to prolong the life of the Chalk River reactor as much as possible. In addition, to ensure that an adequate assessment is done and that people are aware of the truth, we must establish an international emergency committee to assess the problem.
Bloc
Paule Brunelle Bloc Trois-Rivières, QC
Mr. Urbain or Mr. Lamoureux, I would like you to clarify two facts. First of all, when the minister was told about the shortage, she said that we could obtain supplies from the Netherlands or Australia. However, reports submitted by officials lead us to believe that this is unlikely. In addition, you have just told us that this is impossible.
Then, when we asked her what steps should be taken to deal with this isotope shortage, she responded by saying that there were alternatives, particularly 99mTc, which is a derivative of molybdenum. We are wondering whether there really are, in fact, any alternatives. Earlier, you talked about thallium, an alternative which, however, does not have the same qualities and involves a greater risk of radiation.
My question is for all of you and that is, I would like you to tell us whether or not there are any alternative solutions or are we going to have to simply rely on what we have, as if we were practising wartime medicine.
President, Canadian Association of Nuclear Medicine
With respect to your first question, which pertained to the shortage, and supply, I mentioned earlier the OECD meeting held in Paris at the end of January at the behest of the Canadian government. It was very clear that there was no meaningful cooperation at the international level.
Moreover, it was very obvious that over the past 30 or 40 years, governments, internationally, have not given much thought to developing a financial strategy for manufacturing medical isotopes produced as a result of research. So this therefore is not so evident.
Indeed, it must be understood that these nuclear reactors cannot be handled like a car or a bicycle. They must be maintained, and just to give you an idea of what this involves, the maintenance plan for these reactors is drawn up two or three years ahead of time. When one of these reactors fails, it is practically impossible to reactivate it if it is undergoing maintenance or being used for other pursuits.
In addition, it must be understood that the reactor that produces the most molybdenum and technetium in the world is the Canadian reactor. When you hear that the Petten reactor can increase its production by 50%, the means 50% of its own production, not 50% of the world's production.
For example, the French reactor manufactures only 3% of the world production and the Belgian reactor accounts for 9%. Even if the Belgian reactor increased its production by 50%, this would only constitute 15% of the world's production.
In my opinion, this is not as easy as it may look, and the international governments should have adopted measures long ago. Every year, the reactors are one year older. Their birthdays are not celebrated, but they are one year older.
Conservative
Nathan Cullen NDP Skeena—Bulkley Valley, BC
Thank you, Mr. Chair.
Thank you to our witnesses for being here and on the line.
I want to take us back to 2007 for a moment. The isotope crisis that happened at that time was described by the then Minister of Natural Resources, saying that had we not acted people would invariably have died. Was that an accurate statement, Monsieur Urbain?
President, Canadian Association of Nuclear Medicine
Yes.
I think the statement was indeed accurate.
NDP
President, Canadian Association of Nuclear Medicine
I think the situation is worse in this current crisis.
NDP
Nathan Cullen NDP Skeena—Bulkley Valley, BC
Okay.
If in 2007, when Chalk River was expected to be shut down and the government then fired Linda Keen, there were more reactors operating internationally. We now advance to 2009, and the shutdown at Chalk River is a minimum of three months—we're hearing potentially much, much longer than that—and the international supply has become less now in 2009. Is this a situation of life and death for Canadians who are seeking cancer diagnosis and treatment?
President, Canadian Association of Nuclear Medicine
In fact the supply is probably a little higher, because in 2007 the Dutch reactor was not on line. It only came on line last year.
Let me give you a picture in terms of death and life. Picture a patient who is waiting for a myocardial perfusion assessment, a myocardial scintigraphy study assessment, in order to decide if he's going to need a triple or quadruple bypass surgery, being told, “We are sorry, but we cannot perform this test because today we don't have isotopes.” So the answer is yes, it could be a life and death situation.
NDP
Nathan Cullen NDP Skeena—Bulkley Valley, BC
On January 30 of this year, was Canada facing an isotope crisis?
President, Canadian Association of Nuclear Medicine
There are so many things we have been facing over the past few weeks and months that I don't recall exactly where I was that day, but as I said, over the past 18 months we have lived through five or six shortages of isotopes, being told overnight that tomorrow you're only going to get 60% of your quota.
NDP
Nathan Cullen NDP Skeena—Bulkley Valley, BC
I'll quote from the then Minister of Natural Resources:
They’re terrified of the issues. You know what? Good. Because when we win on this, we get all the credit. I’m ready to roll the dice on this.
What do you think of that statement?
President, Canadian Association of Nuclear Medicine
First of all, I'd like to verify the origin of that statement. I've read it, like you, in the press. At times, several of my colleagues also put statements into my mouth that I never made. If those statements were made, I think they are irresponsible.
President, Canadian Association of Nuclear Medicine
I just think that, as physicians, we need to do the very best for our patients. I think it's the responsibility of those appointed at the highest government-level functions, particularly the Minister of Health and the Minister of Natural Resources, to make sure....
There are two major things in life that are very important. One is life itself, and the second one is health. I don't think that can be compromised.
NDP
Nathan Cullen NDP Skeena—Bulkley Valley, BC
Dr. Gulenchyn, I'm sorry if I said your name wrong, but I have a question for you.
How important is early and accurate detection of cancer? How critical is that in survivability, the health of patients as they battle cancers?
Medical Chief, Department of Nuclear Medicine, Hamilton Health Sciences and St. Joseph's Healthcare Hamilton
The patient's best chance for proper treatment is that cancer be diagnosed early, when its extent is limited, and accurately, so appropriate treatment can be prescribed.