House of Commons Hansard #145 of the 38th Parliament, 1st Session. (The original version is on Parliament's site.) The word of the day was price.


Cross-Border Drug SalesGovernment Orders

10:50 p.m.


Steven Fletcher Conservative Charleswood—St. James, MB

Mr. Chair, as a fellow Manitoban, I share the member's concern about the job situation. It is interesting to know that the senior Liberal minister has been quoted on the front page of the Winnipeg Free Press as saying that he would like to keep the online pharmacy industry going, but yet it seems that what is being proposed here will close it down. Therefore, I do have a question for the member. Is she concerned about the Liberal Party hypocrisy on this issue?

I have another question. The suggestions that the Liberals have brought forward suggest face to face doctor consultation. This is doubly worrisome for Manitobans, because we have a lot of rural areas where that may not be practical, or because of the illness itself it may not be practical, and of course because we have a shortage of doctors it may not be practical. This may add a level of unnecessary bureaucracy. I wonder if the member could comment on that.

Finally, the Liberal Party has suggested that the health committee somehow has been delaying a study on Internet pharmacies when in fact the health committee is chaired by a Liberal and the Parliamentary Secretary to the Minister of Health is on the committee. Already this fall, two or three health committee meetings have been cancelled. Also, the Liberals suggest that the meetings that have happened have been clogged up with ridiculous motions. I assume they must be referring to the motions dealing with breast implants or HIV. I certainly do not agree that those were hopeless or not useful motions.

I wonder if the member could comment on the doctor issue, the unintended consequences issue and the fact that the Liberals seem to be cancelling health committee meetings and not allowing the health committee to actually study the issue of Internet pharmacies. Could she also comment on the hypocrisy of the senior Liberal minister in Manitoba?

Cross-Border Drug SalesGovernment Orders

10:50 p.m.


Judy Wasylycia-Leis NDP Winnipeg North, MB

Mr. Chair, I am happy to answer those questions from my hon. colleague, beginning with the first one pertaining to Liberal members of the government, particularly those from Manitoba.

I am not at this point able to ascribe any motives to the senior Liberal member in Manitoba in terms of this debate and this issue, because I think that what we are all grappling with is a difficult situation. None of us want to see the end of Internet pharmacies. We do not want to shut down the business, because it is providing a useful role in terms of the Manitoban and Canadian economies as well as meeting a need for an important service for lower income and vulnerable people in the United States. We are all cautious about maintaining a balanced position.

I imagine that the Liberal senior member from Manitoba is in the same boat. He is getting information after the fact. He is not getting direction from his own government and the Minister of Health in order to be able to deal with this expeditiously and on a timely basis.

I believe that we have to balance the role of Internet pharmacies in our economy with the real concerns that many have demonstrated, particularly those from the pharmacy community, who have an expertise in terms of pharmaceuticals and understand the possibilities for confusion, shortages, chaos and problems in terms of our supply.

What I want to do tonight is say to the Minister of Health that he must take those concerns into account when he brings forward his package of solutions. He must make sure that he listens to the Archie Orlikows of the world, hears their concerns, answers those concerns and comes back to the House with a package that gives all of us assurances that the quality of our drug supply is not threatened, the affordability of drugs is not in question, and the future supply is not a worry.

That was in answer to the first part of the member's question.

The second question has to do with the supply of doctors and the whole issue of broader questions around our health care system. I think the best thing I can say on this issue pertaining to that question is that we must not let ourselves assume, in this debate dealing with Internet pharmacies, that we can off-load onto it all of the other problems with the system of pharmaceuticals in Canada.

There are many problems that have to be addressed. There are many issues in terms of the whole health care system. There is a critical shortage in terms of some health care professionals. There are waiting lists in terms of other areas. There is clearly still a big impact from the cutbacks of 1995.

Let us deal with these separately. Let us acknowledge that in terms of safety and affordability we have major work to do in this Parliament to beef up the scientific research capacity of Health Canada in terms of scrutinizing drugs entering the marketplace and scrutinizing them for side effects once they are on the marketplace.

That is an area where the government has been totally negligent and totally irresponsible. It was in 1997 that the minister of health at that time, Allan Rock, actually killed the only independent research bureau for scientific analysis of drugs. The drug research bureau of Health Canada was killed by the Liberals, meaning that there is no independent capacity left within the federal government apparatus for determining safety of drugs and problems with interaction with other drugs and foods once they are on the market. This is a problem that has to be addressed.

There are questions about evergreening and the whole drug patent system, about the fact that the Liberal government keeps letting the brand name drug companies have open season in terms of pricing. Not only do those companies have, through the Liberals' help, an extension on drug patents up to 20 years, but they have also allowed for that period to be extended through court cases and challenges.

Let us start dealing with banning evergreening. That is what we have said in our end of the world, in the NDP corner of this place. Let us stop this control that brand name pharmaceutical companies have over our drug supply.

These are a couple of the issues that we have to deal with. There is so much more that we could do as a Parliament and as representatives of the people in terms of these issues.

The final question to me pertained to the role of the health committee and the minister's responsibility to the committee. I think that is a very important issue. It has been a problem throughout the time that I have been in this chamber, since 1997. It has been difficult for the health committee, a standing committee of Parliament, to get the ear of the government and to have timely and responsive meetings with the Minister of Health.

I sense that the member is dealing with the same problem, only on an even more harmful basis. It sounds like the present Minister of Health is practising the same kind of dithering with respect to this issue and the member's committee as he has shown with respect to the whole question of enforcing the Canada Health Act. The fact that he and ministers before him have let slide the issue of enforcing the act to ensure that privatization does not get such a strong foothold in our country is something that we have to wrestle with daily.

That is why the New Democratic Party has put forward a package of suggestions to the Prime Minister and the Minister of Health as a road map for the future. In fact, we have suggested that this Minister of Health take seriously the notion of tougher legislation to prohibit the establishment of private clinics and private hospitals, to prevent that kind of situation by penalizing provinces that allow for that kind of erosion of our health care system. We think that is an absolutely critical need in our society and in this country. We hope that the Minister of Health ends his dithering and starts to act on behalf of Canadians.

Cross-Border Drug SalesGovernment Orders

11 p.m.


Merv Tweed Conservative Brandon—Souris, MB

Mr. Chair, it is a pleasure to speak on the take note debate that we are having tonight. I want to begin by first thanking and congratulating my colleague, the member for Charleswood—St. James—Assiniboia, who has been a leader on the health issues in Canada in the short time that he has been elected to Parliament.

The member has been willing to bring forward the issues that Canadians are prepared to discuss and wanting to discuss, and facing them head on with solutions that are sensible and acceptable by many and most Canadians.

We are talking about the bulk export of drugs particularly into the United States. It is important that we not confuse this with the one on one sale of drugs which constitutes the online pharmacy industry. It is important because sometimes the government in its anxiousness to be seen as protecting the health care of everybody at all cost, it sometimes confuses the two issues. It is very important to acknowledge that the online pharmacy industry in Canada is separate and different from the bulk export industry.

There is not a Canadian, there is not a member of Parliament, who would suggest that at any time we should ever jeopardize the supply of drugs to our Canadian population. We understand that. I think we all agree to that, but I think we cross a line sometimes when we try and tie the two together. Sometimes we attempt to make political points in some parts of the country at the expense of others who are to some degree taking advantage of a system that has been put into place and enhancing their opportunities not just for the individuals that are doing it but for the people of the communities that they represent and live in, and the people that they work for.

I know that some members of the government would agree that there is a distinct difference. I know that the President of the Treasury Board stated and he believes that Ottawa can rescue the Internet pharmacy industry and save the jobs, not only in Manitoba, but across Canada. He believes that is has found a market, found an opportunity and has developed it into a good business with sound principles, but also a business and an industry that understands that we must be always aware and cognizant of the issues affecting the drug supply to the people in Canada.

It sometimes surprises me when the Minister of Health makes statements that I think are meant to aggravate and perhaps incite the people of Canada. However, I sometimes wonder if what he is trying to do is in the best interest not only of the industry but in the best interests of Canadians.

I do want to make note and I know that the member for Charleswood St. James—Assiniboia has mentioned it a couple of times, that there was a motion passed in the health committee that asked to study this issue. It was agreed upon and yet to this day the minister refuses to engage that committee and create some relevance where we can get a better understanding of the issue.

I do not think it is wise for governments to move forward on issues like these without proper consultation, without discussion, and without engaging Canadians on what they are asking for and what they are prepared to accept and prepared to work with.

We are talking about the Internet pharmacy this evening. I know that it has been mentioned by some of the members and one of the ways that they would control or regulate it would be by forcing patients to have an appointment with a doctor in Canada.

We live in an electronic age. We can travel anywhere in this world. We can access banking institutions with a card. We can access services anywhere in the world based on the recognition of a card. We put a card in and take our money and our services out. It is time that the government and Canadians accepted this as a way of moving forward and a way of providing service.

I challenge the government to tell me if it does not want to shut the industry down because sometimes I think that is its motive and that is what is driving the government.

We have a system in Canada right now where our patients cannot see doctors. We cannot get in. We have extremely long lineups and members across the floor would agree that it is an issue. Obviously, government members identified it. They said they have committed $41 billion to reduce lineups to see doctors. Yet, we want to force another group of people to have an appointment with a doctor in Canada. No matter where we are, the prescription is written by a qualified doctor. That, to me, is the issue. We do not have to question the credentials of the doctor. We do not have to verify them. Obviously, the relationship has worked well and has worked for many years.

I live in a border community and long before online pharmacy, people from the United States travelled to Canada with their prescriptions. This is not something new; it has been going on for many years. If we live in a border community anywhere in Canada and we ask our pharmacist what percentage of traffic is made up by Americans, I think we might be surprised at the number of people who are actually accessing our services and have been for years.

That is an important note to remember when we partake in the debate because the bottom line is that nothing has changed that has not happened in the last 20 years except the technology and the ability to access it. That is important to remember.

Where I live, and I suspect where most people live, getting an appointment with a doctor is difficult enough. To add this on top of it is only a ruse to suggest that the government wants to shut these pharmacies down. Government members may mask it in terms of ethics or in many other words they choose to use, but in essence, they are saying they want to shut this industry down. I do not think that is a good thing for Canadians or for the Canadian consumer. If we want to look at it purely from an economic position, it is not a good thing for the economics of our provinces and of our country.

As I said earlier, we must not confuse bulk exports with the one to one sale of drugs which constitutes the online pharmacy. I think we all agree that as long as we can offer a safe and secure supply to Canadians, we should continue to support the online pharmacy industry. Even the online pharmacies have agreed and recommended that if we were to ban the sale of bulk drugs to the U.S., we could resolve many of the issues that we have. It is not a complicated matter. It is a matter of supply and demand. We would not move large bulk supplies across to the United States or any country for that matter with the idea that we would protect the Canadian consumer.

In closing, we have to remember that across Canada many people access prescriptions without ever having seen a physician. It is done through home care. It is done through nursing. It is done through nurse practitioners. They make the call, they give the definition of the symptoms and the drug is prescribed. It is important that we never forget that. I think that a ban on bulk exports would satisfy all the stakeholders. It would ensure the viability of the Internet pharmacy, and a healthy Internet pharmacy in Canada is an option that we should all look at and consider.

Cross-Border Drug SalesGovernment Orders

11:10 p.m.

West Nova Nova Scotia


Robert Thibault LiberalParliamentary Secretary to the Minister of Health

Mr. Chair, I think there is some confusion here. We are talking about the same things but sometimes in different terms and there seems to be some confusion.

If we took the most pessimistic view of how the measures are being considered and the impact they would have on Internet pharmacies, it would not have the impact of closing the Internet pharmacies. The Internet pharmacies could still operate very easily within Canada.

The problem arises with cross-border exports. Within Canada, if patients have seen a doctor licensed to practice in Canada and a relationship exists--and the relationship can be defined differently, like home care or nurse practitioners in certain instances--people can purchase their drugs through an Internet pharmacy within Canada and it would not have an impact. But with cross-border Internet pharmacies, it does. There is a lot of discussion to be had as to how we should look at that in order to permit the continued operation of the Internet pharmacies and still meet the goals that I think we all share.

The member for Glengarry--Prescott--Russell made the point very well when he said that cross-border Internet sales, not only bulk but at the consumer level, can have an impact on the drug supply. At the present time, generally, the level of exports has not had an impact, but we do not know what the future may bring and it is always good to prepare in advance.

If the member removed the question about ethics, the practitioner and the relationship, I would ask him if he would agree with these two points. First, we have a national drug supply network, so that the left hand knows what the right hand is doing, and we monitor the state of pharmaceuticals within Canada. In this manner we can foresee if there are shortages coming and even make adjustments or transfers if there are shortages in one area of the country and surpluses in the other.

Second, we take the necessary measures to restrict all sales outside of Canada, bulk or at the consumer level, when it has a risk to human health. I believe that would be legally within all the treaties and the trade agreements that we have signed. Therefore, if we see that there is a shortage coming in those areas, the mechanism could work. Sometimes it might be a specific drug in bulk form and sometimes it could be a consumer level drug, patient level drug, or an Internet pharmacy type drug depending on the drug and the circumstances.

I wonder if the member would not see at least those two elements as being very good ways to manage our drug supply and preserve a secure and healthy future for Canadians.

Cross-Border Drug SalesGovernment Orders

11:10 p.m.


Merv Tweed Conservative Brandon—Souris, MB

Mr. Chair, the member is not necessarily wrong in his comments, but the antagonistic way in which the Minister of Health presents these to the public is to fearmonger. When the minister suggests that Canada will not become the drugstore for the United States, I think we can all agree that it is not our intent. However, it is the language the minister uses that tends to conjure up a government coming in with its heavy hand on an industry that has been relatively successful and obscure in the sense that it has never been brought to the public forum the way the minister has. The comments that he makes are too aggressive.

We do not want to see a shortage in Canada. With all the controversy that the minister has dragged up about Internet pharmacies, we have not seen this to date. We have not seen an issue where the Internet pharmacies have had to restrict, or reduce or cut back. If we listen to what they are saying, the suggestion is that one of the easiest ways to move this ball forward is to ban the sale of bulk drugs. They agree with that. They have been far more generous in their comments, suggesting it is not their desire either to see Canadians shortchanged.

However, to make a bold and sweeping brush statement that we will ban Internet pharmacies because Canada will not be the drugstore for the Americans, is only done for political reasons. To me it is political posturing. The member has made very reasonable comments, and I think most agree with that. We have to get rid of the rhetoric and work to possible and plausible solutions. I think it can be done and it can be done in the interests of all people. I think Canadians will and can benefit as can Internet pharmacies.

Cross-Border Drug SalesGovernment Orders

11:15 p.m.


Steven Fletcher Conservative Charleswood—St. James, MB

Mr. Chair, I commend the member for Brandon—Souris for his comments. In his role as a member of Parliament, he has demonstrated an outstanding ability to represent his constituents. As the western economic diversification critic, he has done an outstanding job representing that issue, and representing his constituents, the shadow cabinet and so on.

Beautiful communities like Ninette and Killarney are very fortunate to have the member as their representative.

One thing that struck me in the member's comments was the issue around the doctors and the fact that we already had lineups to see doctors. One of the unintended consequences that could happen by forcing face to face consultation with doctors is people will not have access. Because of the Liberal neglect of the health care system, the $25 billion that was cut in 1995, and the government's policy to reduce medical school graduates, we have a family doctor shortage. I happen to know the member's major community has a major doctor shortage so it is a double whammy.

Could the member discuss the implications of not having enough doctors in a rural community?

Cross-Border Drug SalesGovernment Orders

11:15 p.m.


Merv Tweed Conservative Brandon—Souris, MB

Mr. Chair, it is important for all of us not to ignore the issue of Internet pharmaceuticals and the bulk transfer of drugs. The member has a very important issue.

Regrettably, I live in a community of 50,000 plus people who continue to struggle on a day to day basis to find doctors to provide services to the community and to the region at large. It is frustrating that the government would focus on an issue like this at a time when so many other communities are facing the same shortages. I am not trying to belittle the issue that we are discussing tonight, but the far more important issue is the supply of doctors.

I know one of the members across, and I regret that I cannot remember the member's riding, stated that through the immigration policy we can enhance these opportunities and bring doctors into these communities that are in desperate need. In reality, the way the immigration system is now is almost prohibitive in bringing doctors into our communities.

Doctors in my communities have been in the immigration system for four years. They have met every qualification, they have been practising, we have accepted them as people in our community, as Canadians. Yet the system will not allow them to advance to finalize becoming Canadians. That is a far greater problem and a far greater obstacle.

If we had a surplus of doctors, the members across the floor might have some validity in suggesting that the one on one contact, if we decide we want to slow the industry down, might be good. There is no one on one contact with local doctors for the people in my community and that is my priority. I think it is a priority of many of the people who represent constituencies across Canada and it should be the priority of this government.

We need a way of bringing doctors to our country, training them and making them accessible to the rural parts of Canada which are not being served well by the government at this time.

Cross-Border Drug SalesGovernment Orders

11:20 p.m.


Anthony Rota Liberal Nipissing—Timiskaming, ON

Mr. Chair, I rise this evening to add my voice to the many who are speaking out on the issue of cross-border drug sales. From 2001 to 2004, Internet pharmacy sales grew by 1,100%, rising from annual sales of $70 million in 2001 to $840 million in 2004. Combined with cross-border foot traffic, the total industry accounted for approximately $1.35 billion Canadian in sales in 2004. Internet pharmacy sales growth has stabilized since mid-2004 and actually began to decline in early 2005 due to enhanced manufacturer restrictions to participant Internet pharmacy operations.

I note that the Government of Canada is fully aware of the economic significance of this industry. The minister has been clear that it has never been his intention to shut down the industry. However, the responsibility to ensure that 32 million Canadians have continued access to safe and affordable prescription drugs is paramount.

The appeal of Canadian prescription drugs is driven by the price differential for patented drugs between Canada and the United States. The latest Patented Medicine Prices Review Board annual report identified the fact that Canadian drugs are, on average, 40% less expensive than those in the U.S. It should be noted that such price differentials with the United States are echoed in other OECD countries.

It is a fact that the United States has the highest prices for pharmaceuticals in the world and its citizens are looking to Canada for some relief. Recent estimates indicate that one million to two million Americans are now filling their prescriptions through Canadian pharmacies each year.

A combination of factors has kept drug prices lower in Canada, one of which is the key role played by the Patented Medicine Prices Review Board in regulating the prices of patented drugs.

I applaud the government for its unwavering and continuing commitment to our regime of price controls. Furthermore, it is worth noting that our belief in the necessity of such regulations is in line with all other industrial countries, except the U.S.

The mandate of the PMPRB was developed in 1987 to balance increased patent protection for innovative medicines with affordable domestic prices. Under PMPRB guidelines, Canadian prices for patented drugs cannot exceed the median international price of a basket of comparator countries.

It s crucial to note that our price regulatory regime was implemented by the Government of Canada for the benefit of Canadians and our health care system.

Last year the American market for prescription drugs was worth about $300 billion. Last year sales of pharmaceuticals in the U.S. were equivalent to one-third of Canada's total GDP.

We have been fortunate thus far that the cross-border drug trade has not caused systematic drug shortages in Canada, but we should not take this to mean that shortages will not occur. At present, half of Manitoba's drug supply goes to the United States. The Government of Canada has a legitimate concern that any significant expansion of this trade could be at the expense of Canadian patients.

If Canadian drug policies were forced to the U.S. level, annual prescription drug expenditures in Canada would increase by more than $14 billion. The effect of such an increase on our drug programs and potentially on the finances of Canadians would be tremendous. It is also worth mentioning that if prices in Canada are forced to rise to U.S. levels, the price differential driving cross-border drug sales would vanish, as would the industry.

There are currently nine bills, four in the House of Representatives and five in the U.S. Senate, before the 109th U.S. Congress to legalize the bulk importation of prescription drugs from Canada. Import legislation currently has majority support in both the House of Representatives and the U.S. Senate and has a strong potential for passage.

In addition, while illegal under U.S. federal law, the cross-border drug trade is receiving broad support from state and municipal governments. At last count, there were some 30 American states, representing over half the U.S. population and more than five times the Canadian population, at various stages of implementing state operated drug import programs.

Import programs adopted by state and municipal governments are intended to control the escalating costs of prescription drug programs and to support drug affordability for individual residents. However, the motivation behind at least some of the current proposed federal import legislation is to weaken, if not remove, foreign price controls.

At the 2004 OECD health ministers meeting in Paris, then U.S. Secretary Thompson implied that OECD members should lift their drug price controls to generate greater corporate revenues to fund innovation. More recently, U.S. Senator David Vitter, sponsor of a leading drug import bill, has indicated his intention of using drug importation as an indirect instrument to undermine foreign price controls. These are not incidental or innocuous developments.

We are not unsympathetic to the plight of millions of uninsured or under-insured Americans, numbering some 70 million at latest count. I do believe, however, that the Government of Canada's focal concern must continue to be the continuity and adequacy of supply of safe and affordable drugs for Canadian needs.

To that end, the Government of Canada is proposing a strategy to help ensure a safe and adequate supply of affordable drugs for Canadians. This strategy includes three elements.

First is a pan-Canadian drug supply network to provide Health Canada with a more comprehensive understanding of our drug supply.

Second is an export restriction scheme. This means that if the domestic supply of an essential drug were dangerously low, we would have the authority to introduce appropriate export controls to help preserve the supply for Canadian patients when necessary to protect human health. These export restrictions would remain in place only as long as the threat to domestic supply makes them necessary.

The third piece of this strategy involves the strengthening of existing federal regulations under the Food and Drugs Act governing the sales of prescription drugs in Canada, strengthening patient safety.

Although the threat to Canada's domestic drug supply may not be imminent, responsible government requires that we monitor potential threats and be prepared to take the steps necessary to mitigate those risks.

Cross-Border Drug SalesGovernment Orders

11:25 p.m.

Yukon Yukon


Larry Bagnell LiberalParliamentary Secretary to the Minister of Natural Resources

Mr. Chair, before I ask my question I would like to say that the previous speaker commended a member of Parliament and I would like to commend our three privy council members, the Minister of Health, the Minister of State for Public Health and the parliamentary secretary, for their excellent work on a great number of tough issues, including this one.

I have a question for the member on arbitrage and what effect it will have on the prices in Canada and the United States. Before the member answers that, I want to mention that the supply of drugs in the north of course is different than it is in the south. It is even harder to get them there. We have to remember that there is a good supply available.

I remember that at the beginning of the last century there was the great Iditarod escapade, in which a diphtheria serum was needed in Nome, Alaska. There was a thousand mile dog trek to get there, which has led to the great thousand mile dog race held now between Whitehorse and Fairbanks.

Even today there are not international flights to most of the north, so drugs have to be available in Canada. Sometimes there are only periodic flights within Canada. We have to make sure there is a good supply of drugs in Canada for Canadians.

However, could the member answer the question I asked at the beginning of my remarks?

Cross-Border Drug SalesGovernment Orders

11:30 p.m.


Anthony Rota Liberal Nipissing—Timiskaming, ON

Mr. Chair, I will start with the question regarding the north and then go on to arbitrage.

The supply and quality of medicine have to be guaranteed. The last thing we need in this country is a shortage. Once we have a shortage, we cannot supply our own people with medication.

There is one thing I would like to make clear. Some of the opposition members on the other side make it sound like this is the end of Internet pharmacies. This is not the end of Internet pharmacies. This is merely the end of transporting our drugs to the United States or any other country that would undercut our prices.

One of the things to remember as well is that someone in a northern community can still order drugs through the Internet.

On the issue of arbitrage, I will cover it quickly. Arbitrage is a trading term used in the stock market and many markets. It is about finding a lower price somewhere and then selling somewhere else at a higher price. Unfortunately, it is all based on grabbing a supply and exhausting it. As soon as we exhaust it, then we are back up to normal. Otherwise, we see something average out.

What ends up happening with arbitrage is that once the supply ends, we end up with all the prices going to the higher price. In this case, we are looking at the United States, which is about 10 times our size. If we took our one-tenth of our size, and put it up against the U.S., which is 10 times our size, and we average it out, we know the prices are coming down. What will happen in fact is that our prices will rise to the price that the Americans are charging.

Not only would something like that be detrimental to Canadians' health, I think it would also be detrimental to our health care system and what it costs us to supply it.

Cross-Border Drug SalesGovernment Orders

11:30 p.m.

The Deputy Chair

It being 11:32 p.m., pursuant to order made Monday, October 31, 2005, under the provisions of Standing Order 53(1), the committee will rise and I will leave the chair.

(Progress reported)

Cross-Border Drug SalesGovernment Orders

11:30 p.m.

The Acting Speaker (Mr. Marcel Proulx)

This House stands adjourned until tomorrow at 2 p.m. pursuant to Standing Order 24(1).

(The House adjourned at 11.32 p.m.)