Natural Resources Committee on Oct. 19th, 2009

[Dr. Alexander McEwan]

I'm not addressing the Ontario issue, but the issue of cost was discussed at the federal-provincial-territorial ministers meeting in September. This is why I stressed in my initial presentation that it is important to understand the financial impact at the individual hospital level. It is an issue that has made the federal-provincial-territorial table. I'm sure it will continue to be discussed at that level.

[The Vice-Chair, Liberal, Alan Tonks]

Mr. Trost, you're out of time.

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

I think Dr. Urbain wanted to respond.

[The Vice-Chair, Liberal, Alan Tonks]

We'll have to hold off on that. Perhaps he can integrate it into a future comment.

Mr. Easter.

[Wayne Easter, Liberal, Malpeque, PE]

Thanks, Mr. Chair.

I thank you folks for your remarks.

I'm from rural Canada, and I can't help but think about how folks must feel who have cancer or have family members with cancer. They must be worried about what might happen over the next several months.

In listening to you folks, it seems to me that it's likely that supplies are going to get worse before they get better. I chalk this up to government inaction, especially in the MAPLEs project.

Mr. West, you said that Europe looks after Europe, and in North America there's a different supply chain stream. That worries me. This is not normally my committee. I deal in the agriculture arena mainly. We're the boy scouts of the world, and we continue to supply the United States, even sometimes when we probably shouldn't, especially when it comes to oil. They're very quick to cut us off for any reason at all.

If there's a shortage in North America, what's the chance that we wouldn't be supplied on a proportional basis from the United States? What's the chance of that, and why is it? Is it a result of the private health care system in the United States and the supply chains there? We have to look at this issue and deal with it.

[Steve West]

I can't imagine that anybody, particularly the two major suppliers, would intentionally short Canada. I think it's just that the structures of the health care systems are very different. The U.S. structure relies upon a much more integrated supply chain stream than Canada does. We have to transport products from the United States across an increasingly thick border. That creates an issue too.

I'm also concerned about the long-term U.S. domestic strategy. As it stands at the moment, the proposal in the United States is to refurbish an old reactor that when refurbished would meet only 50% of the U.S. needs. Even with that proposal, it doesn't in any way guarantee Canada of long-term stability of supply. I think that is an issue.

[Wayne Easter, Liberal, Malpeque, PE]

As to the situation we're in at the moment, we know what the Prime Minister said. On the MAPLEs project, if by some miracle the government comes to its senses and decides to start the MAPLEs project again, what is the additional cost of having shut it down and eventually making the decision to get it going again?

[Steve West]

I'm going to ask Ms. Chitra to answer. She is our vice-president of technology, an expert on that matter.

[Jill Chitra]

Thank you, Steve.

I think that with the MAPLE projects, looking at how they're restarted would be the key to answering that question. There are a number of different proposals before the expert panel that envision different ways of restarting the MAPLE reactors. There are different potential ways of operating them, potentially operating them at reduced power, operating them with the safety case and a positive PCR instead of a negative PCR, modifying the actual reactors in cells to achieve the negative PCR.

Depending on which approach you take, they would have different timelines and different costs. The approach that we put forward was not to make any physical changes but to look at changing the software, using the South African nuclear association. That would be less expensive, and we hope would be able to be achieved in less than 24 months. But one of the keys is that with any of these proposals we'd need to get access to the technical information to make that final assessment, in order to be able to give that particular number.

At this point in time, it's not known, but there are some proposals with some estimates put forward.

[The Vice-Chair, Liberal, Alan Tonks]

You have one minute, Mr. Regan.

[Geoff Regan, Liberal, Halifax West, NS]

Thank you.

Dr. Tracey, to get back to you, Dr. McEwan is working on behalf of the Minister of Health to understand the financial impacts of this, but you talked about the fact that they're already experiencing real losses in operating for hospitals, for clinics. What is the real impact of that?

[Dr. Kevin Tracey]

I can tell you that contrary to the survey comments you have made, I think within my region in Ontario, in Windsor, we just had technologists who were laid off. That's the first that I'm aware of within the province. That occurred within the past few weeks. Three positions were lost. These technologists are difficult to train, and once they leave the community, in our area, they go to the U.S. To get them back is an extreme challenge.

I oversee another hospital in rural Ontario that is faced with an operating loss of 25% of its income for the year. That small community is wrestling with the question of whether it can sustain that practice. We're under tight budget constraints as it is, within the hospitals in Ontario, and when a service like this in a small community is pushed to that level, it's asking the question of whether it can maintain that service. That means patients have to go to the nearest community, which is Windsor.

I can tell you that in Windsor we haven't suddenly cured all heart disease, yet our waiting list has dropped off. Why is that? It is because referring physicians have this perception that there's a difficulty. They are triaging. Very clearly, they're coming to us and asking us if they can get a scan, whether we're up this week, whether we have supply. That's impacting referrals. The impact is not going to be like that. It's very insidious. Patients are not going to get investigated, and we will have events. It's only a matter of time that this will happen.

[The Vice-Chair, Liberal, Alan Tonks]

Thank you, Dr. Tracey. I'm sorry to interrupt you, but we are over the time limit.

Mr. Guimond, you have five minutes.

[Claude Guimond, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

Thank you, Mr. Chair.

Good afternoon, gentlemen.

My question is for Mr. West. I am new to this committee. My questions have more to do with abandoning the MAPLE project. We all know that the investment is huge. But we also know that by scrapping the project, the government opens the door to legal action by MDS, which could cost taxpayers very dearly. Perhaps the MDS representatives could provide us with the figures.

In such a case, I wonder whether it would not be better to give the MAPLE reactor another chance. What are your thoughts, Mr. West?

[Steve West]

Thank you for the question.

When it comes to the issue of the lawsuit between MDS and the government, I really don't think I can comment on that, since it is subject to a judicial procedure. Certainly there has been a large investment in MAPLE. I would point out that initially it was at no cost to the taxpayer, as intended. It was funded entirely by the private sector. MDS paid up to $350 million to AECL.

As for the economics of how to resolve the situation we're in, as Ms. Chitra pointed out, depending on the solution that you deploy there will be a cost-benefit analysis. In every single piece of work that we've done, and presumably in the work from those people who have put proposals to the blue-ribbon panel, there are very viable timelines and very viable economics in completing the project.

[Claude Guimond, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

My question is for either Mr. Urbain or Mr. Tracey.

In your remarks, you touched briefly on the issue of new replacement technologies.

Could you elaborate on this subject, as it could prove worthwhile? When could these new technologies be available and how much would they cost?

[Dr. Jean-Luc Urbain]

In fact, a new old technology, positron emission tomography, as I mentioned earlier, is widely available in Europe. There, the reason they can carry out nuclear medicine research and provide treatment to patients is that they have a large number of positron emission tomographers. There are 85 machines in France, 75 in Germany and 20 in Belgium. There is approximately 1 positron emission tomographer for every 180,000 inhabitants in Europe, at least in western Europe. That is the first technology, and Canada is 20 years behind on that.

The second technology, which came on the scene in the early 2000s—and I was involved in its development—is semi-solid detectors, which are much more sensitive, especially to technetium. As I was saying earlier, they require two to three times less technetium than the scanners we have now.

Those are two technologies to consider. Today, the easiest one to implement is the positron emission tomographers. Is it more expensive? Yes, it is much more expensive. Earlier, someone asked about the cost of isotopes. For example, doing a bone scan with a traditional camera requires a dose of isotopes in the neighbourhood of $30 to $40. Doing a bone scan with a positron emission tomographer, when the market is limited, requires $650 in isotopes. So the price difference is very significant.

However, as Dr. McEwan mentioned, it is also very important to consider new technologies that will lead to better healthcare overall and to determine how those advances can be implemented.

[The Vice-Chair, Liberal, Alan Tonks]

Thank you.

Thank you, Mr. Guimond. We're out of time.

I must apologize. Due to the inexperience of the chair, I was supposed to go to the Conservative side, the government side. So without any further ado, we'll go to Mr. Allen.

You can run out the clock, Mr. Allen.

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

Thank you, Chair. Many others I wouldn't forgive, but because it's you....

I have a few questions that I want to ask Mr. McEwan with respect to the charts and things.

First, I want to thank Ms. Chitra for her comments with respect to the time that it would probably take, assuming that it's a software fix and assuming that you can get the technical data on the MAPLES unit. It fits a little bit better in line with Mr. Labrie's comments, on July 28, in the National Post, where he said:

...in the best-case scenario, at least five to six years of intensive research and analysis before we can even consider bringing the MAPLE reactors on-line.

I think that is definitely a long-term solution for this issue, even if it is a solution.

Mr. McEwan, I'm talking about your charts here, about the spikes as you're going along here. What is causing the spikes on the upside, in the troughs? And what are the conditions that would be lending themselves to that?

The second question is also picking up on one of the comments by Mr. West where he talked about the fact that the actual impact of the shortage has been mitigated by patient scheduling, a greater overall efficiency in worker hours. We all know that the work hours is a short-term solution. They cannot sustain that. We all know that. But have there been some significant benefits gained by the process efficiencies that would actually reduce the long-term demand when isotope production is back?

[Dr. Alexander McEwan]

It's important to recognize that this is a national chart; it reflects supply over the whole country. The first of the troughs was obviously immediately after the shutdown of NRU. The second trough was caused by the planned one-month shutdown in August of the Petten reactor. We actually were surprised, when we looked at the data retrospectively, that we had quite a good supply. Our forecasts had been a little bit less than this leading into that period.

The third period of shutdown was partly related to a quality issue coming out of Petten. Part of it was due to the Air France pilot who refused to take the radioactive supply on his plane.

It's important to recognize that this is an international supply chain and we're dealing with five or six reactors around the world. So in that type of environment there are going to be areas where there is plenty of supply. For example, the BRE reactor spends 40% of its time producing isotopes and 60% of its time on research. One of the reasons the trough in August was low was that they opened up their production capacity to help support the community when Petten was down. So part of it is that it's like any commodity that is internationally produced and internationally supplied.

In terms of efficiencies, I think it's fair to say that we have learned how to use our generators a little more efficiently. We have learned how to ensure that we extract the maximum amount of radioactivity from the generators at a time when they are most radioactive and have the most medical isotope in them. I think those will carry forward. I think we have learned some lessons on how to use our generators more effectively and how to ensure that our patient flow is better.

As in any crisis, I think there are opportunities to improve process, and we have done that. I think we've probably improved our use of generators to the maximum level that we're likely to be able to.

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

As we get to the medium and long-term solutions for this, we all realize that the handful of reactors that are over 50 years old got us into this position right now. In Canada we've actually produced historically much more than our domestic demand and we've exported most of it. Are we better off pursuing solutions that are more distributed and smaller, as opposed to putting all of our eggs back in one basket again? So you have a Canadian.... If we're producing in Canada, I don't have a problem with our saying that, but if we have Canadian locations and we have much more of them and smaller.

[Dr. Alexander McEwan]

I think that's a question that lies at the heart of the future planning and the future evolution of our discipline that I mentioned. I think at the moment there's no doubt that the use of reactors to produce molybdenum is the most effective way of producing medical isotopes.

We need to remember we're talking about technetium and diagnostic scans. Iodine-131 is used to treat patients with thyroid cancer, and in my own practice, patients with neural endocrine tumours are a significant part of the patient population I see.

I think the challenge we have as a community is twofold. The first is how do we ensure that we can continue to provide the technetium-based tests that we're currently providing? The second challenge, and this is the much more important one for our patients, is how do we actually introduce the next generation of tests, those that are going to lead to personalized medicine?

Jean-Luc eloquently described the role of nuclear medicine imaging in the biological characterization of disease, allowing the selection of the right test for the right patient at the right time. That is the challenge that I believe we have to face and address going forward. Whether we do that with a distributed system, large central reactors, or whether we rely on new imaging technologies or new software technologies, I'm not sure. But it is going to involve new radiopharmaceuticals, it is going to involve the regulation of new radiopharmaceuticals, and it's going to involve the development of the evidence base that allows us to introduce those into clinical practice.

[The Vice-Chair, Liberal, Alan Tonks]

Okay, thank you, Mr. Allen. We have run out of time on this panel. We do have the Atomic Energy Commission of Canada coming in next.

Thank you very much. You'll pardon my use of a clinical analogy, but thank you for your collective analysis of the issue we're struggling with. It may not give you any comfort, but we are going to attempt to come up with a committee prognosis. This has been very, very helpful. We do thank you for being here and giving us the input that you have today. Thank you.

[Geoff Regan, Liberal, Halifax West, NS]

Mr. Chairman, we thank the witnesses and we appreciate your thanking them, but while we're waiting for the next witnesses to sit down, I know that we sought to have officials from Natural Resources Canada to appear today to present and to answer questions. I understand that they just simply refused and wouldn't give reasons. I would like to see you, perhaps through the clerk or the chair, write to the department and ask for an explanation of why they wouldn't appear. And while we're at it, we ought to ask them what their plan is in terms of the process. Once the expert panel reports in November, what will be the process from there in terms of how that report is going to be handled? Will they come before this committee? There are those sorts of questions.

[The Vice-Chair, Liberal, Alan Tonks]

Mr. Regan, I'm at a little bit of a loss, in as much as perhaps some of that discussion would be germane to the chair, who may have been involved in some of the back-and-forth discussion. I'm at a loss. I wonder if we could table those comments for the moment. I'll talk to the clerk.

We can invite the next panel to come forward. I don't think you want to shortchange the panel.