Thank you very much.
Mr. Chair and honourable members of the committee, on behalf of the Canadian Association of Nuclear Medicine, I would like to thank all of you for giving us the opportunity to appear in front of the Standing Committee on Natural Resources and to report back to the committee on the effect of the isotope shortage.
As you know, the CANM is the national voice of the nuclear medicine physicians across Canada and the two million patients they serve every year. Since the first shutdown of the NRU reactor in December of 2007, the Canadian Association of Nuclear Medicine has worked relentlessly with the Ontario Association of Nuclear Medicine, the Association des médecins spécialistes en médecine nucléaire du Québec, the Canadian Association of Medical Radiation Technologists, the Canadian Association of Radiologists, the Canadian Association of Radiopharmaceutical Scientists, the Canadian Organization of Medical Physicists, Health Canada, and the NRCan expert panel and its international sister organizations in order to mitigate the effect of the isotope shortage on the well-being of Canadians.
The NRU reactor has been out of service for five months. The impact on Canadians and the Canadian nuclear medicine community has been very significant. It will also have a lasting effect on patient health, the practice of medicine in Canada and across the world, the Canadian and international nuclear medicine community, and Canadian nuclear technology.
Over the past five months, the weekly supply of technetium across Canada has varied between 0% and 100%, with an average of 50% to 70%, depending on the geographic location and the suppliers. Nuclear medicine professionals, technologists, physicists, radiopharmacists, support personnel, and physicians across Canada have worked tirelessly to accommodate the needs of their patients. By working double shifts, by reorganizing examinations around the timing of the delivery of the spare technetium available, by using different protocols and isotopes, by spending an enormous amount of time on the phone contacting patients and referring physicians to reschedule studies, and by not providing core services, our community was able to minimize the effect of the shortage of isotopes on Canadian patients.
Due to that very delicate balancing act, and at the expense of a significant increase in operational costs, the cancellation of patient tests has been limited. This extraordinary and unsustainable effort of our community, the unreliability of technetium supply, and the uncertainty of medical isotope production in Canada have already generated serious and very damaging consequences. The enrollment of students, mainly technologists and physicians, in nuclear medicine sciences is down. The first layoff of technologists has been witnessed, and nuclear scientists are contemplating or are already moving out of the country.
By its unique ability to investigate the function of cells, tissues, and organs, nuclear medicine enables the detection and treatment of diseases at the molecular level before those diseases become evident anatomically and before patients become symptomatic. The earlier the diagnosis of a disease is made, the better the chance of cure for the disease. The CANM is extremely concerned by the significant decrease—from 10% to 25%, depending on the region—of patient referrals for nuclear cardiac and oncologic tests. Without early detection and assessment, cardiac diseases and cancer progress to a point where a patient's well-being is severely compromised and morbidity is higher regardless of the treatment, not to mention the increased financial burden on the health care system and society.
A fair number of us attended the meeting of the European Association of Nuclear Medicine that was held last week in Barcelona. The annual EANM meeting is one of the largest annual gatherings of nuclear medicine professionals in the world. This year more than 5,000 people attended the conference.
It is not an understatement that the credibility of Canada in its ability to build up nuclear reactors to produce medical isotopes has been thoroughly shattered. Also, our colleagues from Europe simply do not understand why Canada is currently entertaining the production of technetium, whose experimental technologies using cyclotron and linear accelerator have all failed in Europe and Japan. In fact many western European countries have decided to continue relying on their nuclear reactor technology for another 25 years.
France is currently building a reactor to produce medical isotopes in the south of France, and the European countries have reached an agreement to build a new reactor to replace the Petten reactor in Holland. The CANM strongly encourages the members of this committee to consult the European expert reports that have been generated over the summer on the subject.
Based on more than 600,000 years of experience and expertise of worldwide physicians in the field of nuclear medicine, the numerous national and international expert reports that have been generated over the past few months, and the technologies available today, the CANM recommends that this committee and the government urgently consider the following.
Number one is that the decision to abandon the MAPLE 1 and MAPLE 2 reactors to produce medical isotopes be immediately and thoroughly revisited by an international expert panel, and the conclusion of the panel be released to the public and medical organizations.
Number two is that the federal government, through Health Canada, expeditiously approve the clinical use of positron-emitting isotopes in their radiopharmaceuticals, based on the pre-clinical and clinical trials performed in Europe and in the United States and the criteria established by the United States and the European Union regulatory agencies for the safe clinical use of these radioisotopes.
Number three is that for a period of five years, the federal government work with the provinces and territories to support and subsidize the increased cost of technetium-99m imposed by the manufacturer and the distributor and the cost of the deployment of the positron emission tomography across Canada.
Four is that the ministries of natural resources and Health Canada work firmly and expeditiously with the relevant medical national and international organizations rather than relying on expert individuals and that they rapidly establish processes to implement these recommendations.
In addition to the deployment of PET in Canada and in order to mitigate the chronic and drastic shortage of technetium, the CANM also believes that the short-, middle-, long-term, and immediately implementable solution is the use of the newer gamma camera that uses a solid-state crystal detector and resolution recovery software. These new and clinically available technologies reduce by a factor of two to three the amount of technetium-99m needed to perform the nuclear medical procedure and radiation exposure to the patient and personnel.
To accomplish this, a nuclear medicine equipment fund should be established for all clinics and hospitals to replace older equipment with more modern and efficient scanners. As stated in our letter to Minister Raitt in December 2008, the CANM strongly believes that current challenges still represent a unique opportunity for Canada to salvage its nuclear technology and industry, to reaffirm its leadership and prominence in the world, and to update the Canadian health care system with 21st century nuclear medical, diagnostic, and therapeutic tools that Canadians deserve.
The Canadian Association of Nuclear Medicine would like to reiterate its offer to provide its ongoing support, experience, expertise, and testimony to achieve this goal.
Thank you very much.