Debates of Nov. 1st, 2005

Cross-Border Drug Sales

[Bev Desjarlais, Independent, Churchill, MB]

Mr. Chair, I have listened to the debate for some time this evening. My colleague from Quebec mentioned the huge shortage of medications that we would have in Canada. Would it not be reasonable to assume that if there were going to be an increased use of a drug, that the companies might want to hire more people and produce more of the drug? I am surprised that people would automatically think we are going to run out.

I am also a bit surprised that we would accept the fact, and I could have heard the member wrong in her comments, that if every person in the U.S. had their prescription filled we would run out in 38 days. I think the chance of that happening is pretty slim.

[Marlene Jennings, Liberal, Notre-Dame-de-Grâce—Lachine, QC]

Mr. Chair, if every American citizen went out and filled their prescription by the Canadian market that idea is not far-fetched. We would run out. Prescription drugs that are manufactured and sold in Canada are manufactured for the domestic market. They are based on forecasts of how many Canadians will require this particular drug over the coming year and the actual product is manufactured in numbers to meet that need. It is not manufactured in order for half of it to be sold to the United States.

However I also find it interesting that the member questioned the issue that the companies would simply increase the amount. No, the companies will not. Why will they not? Because the drugs in--

[The Chair]

I am sorry to interrupt the member but the time has expired for debate.

Resuming debate, the hon. member for Yellowhead.

[Rob Merrifield, Conservative, Yellowhead, AB]

Mr. Chair, it is a privilege to stand and address the people in the House and the people of Canada with regard to this debate.

First, we have to understand what has happened, what the problem is and why it is there before we can solve a problem. In reality, we do not have a debate here because all sides agree on one direction, one thing that should be done. It then becomes a matter of why it has not been done which is what the debate should be about this evening.

The problem is that we have a pricing regime in Canada for brand name pharmaceuticals and it sets the price for Canadians, not for Americans. The only reason the Internet pharmacy industry is alive and doing well today is because it is using that pricing regime to pump those pharmaceuticals into a foreign market that does not have a pricing regime and whose pharmaceuticals are sometimes 50% to 80% higher for some of the brand name pharmaceuticals.

However, before we think that our pricing regime is so good, we have to understand that it is only for the brand name pharmaceuticals that it is actually working because our pricing regime for generic drugs is actually quite a bit higher than that of the United States and, therefore, we are not seeing the exploitation of Internet pharmacies with regard to generic pharmaceuticals. The problem has to do with whether we can afford to allow the pharmaceuticals to go into the United States and compromise our pricing regime.

We have always, in our party, said that if it ever compromises either the availability of product or the pricing of our product, it has to be curtailed. The decision tonight is either to curtail the Internet pharmacy or to destroy it. The present government is the one that actually encouraged it at one time and said that it was all right and it started.

I for one believe that we should curtail it. I do not believe that we should destroy it. In Manitoba we are talking about the jobs of a significant number of individuals who are working in this industry. I think it is fine as long as it is contained and it does not compromise two fundamental things, which is price of the product or the availability of it.

First, let us deal with the availability of it. There is no fear of the availability of any product except Tamiflu, and I will talk about that a little later. When it comes to the availability of brand name pharmaceuticals, it is the pharmaceutical corporation that must decide whether it wants to play this game. It can decide to live with containing it, but containing it would mean shutting down the bulk sales of it.

What has the health minister done? The minister came forward a year ago this November and said that this was his number one issue. I wonder how many times we have heard the government talk about something being its number one issue, but this was the number one issue in the speech the minister gave a year ago at Harvard.

However all winter last year the minister would throw another balloon in the air almost every week saying that it should be stopped because of this or it should be stopped because of that. For a little while he had a different reason almost on a weekly basis, which made it difficult to understand where he was. It was obvious that he wanted to do something but absolutely nothing was done. Here we are a year later and this was his number one priority.

He sent this to the health committee and we looked at it but we got bogged down on it to some degree. However we did come forward with a solution to the problem to help the minister out. The reason we came forward with a solution before we had completed our study was because of what was happening in the United States, where a bill was being pushed through Congress that looked like it would pass perhaps in the summertime. Before we broke for spring we felt that something had to be done to kick the minister in the backside to make something happen.

We pushed a motion through committee and on June 6 we moved for concurrence in the House on the committee report. However the Liberals, who had agreed to the motion in committee, limited the debate on the report and we were not able to vote on it on June 6.

The motion put forward by myself asked that the bulk sales of pharmaceuticals be shut down. It was all right to go individual to individual but to shut down bulk sales, the two fundamental problems that we were afraid of was either the price or the availability of the product.

Now, not only do the brand name pharmaceuticals want us to shut down the bulk sales but the Internet pharmacy businesses also say that we should do that. They see it as a positive move. They are very content with the business they have at the present time, which is actually diminishing because of the difference in the Canada and U.S. dollars.

We pushed the minister into action but what did he do? On June 29 he came out with an announcement. We thought something would actually happen but nothing happened. He announced that something had to be studied a little further and that perhaps he would do something with regard to dealing with this, which would be to shut down the bulk exports by way of the Food and Drugs Act. That is what should have been done and we expected that to happen. It should have been done long before now.

Here we are this evening debating and we should be debating on which way we should go on this. We also drove that debate into the House where we actually had a vote in the House on October 6, less than a month ago. The vote was 288 to 0, which means that every member of the House representing every Canadian in the country voted to shut down the bulk exportation of brand name pharmaceuticals in this country. We still have a minister who has not acted even though it was his number one priority a year ago.

That is the situation we have seen not only with the Internet pharmacy but with other high priority issues like crystal methamphetamine, an issue that we have long been waiting for. I had gone to the minister with a private member's bill asking for the precursors of methamphetamine to be prosecuted and to change the Food and Drugs Act to make that happen. The minister agreed with me and told me that he would see what he could do. He made an announcement in mid-summer that had to go into the chronicles for 75 days, which is long past, and we still have seen no action on the precursors for crystal methamphetamine. I took the minister at his word when he said that he would do something but he has not done it.

It gets worse than that. Hepatitis C is another issue where the House spoke loud and clear. A motion was moved in the House which was a directive given by the House to the minister to be able to compensate those who were victimized with hepatitis C outside the 1988 to 1990 window and absolutely not one cheque has been given. There was $1.2 billion set up in a fund and $1.1 billion left in it and the minister is still saying that we should study it. He said that we had to study it in June to find out whether we had enough money to pay out. He found out there was enough money but there still has not been one cheque.

That is the kind of contempt that the government is showing to Canadians and to the House. That is not democracy.

If we are here debating something tonight, it is not whether there should be a decision to ban exports of pharmaceuticals. We should be debating whether the House means anything, whether a vote in the House carries any weight and why the government is still in power when it can treat this place, and Canadians in an extension of this place, with such contempt. That is the real debate that should be taking place in the House tonight, especially on a day like we have had today when we see the kind of situations that the government has got into over the last number of years. It is a disgrace and it is frustrating.

Let us talk about something that is really relevant and very current with regard to brand name pharmaceuticals, Tamiflu. We have right now another few birds that have contracted avian flu. We are not sure exactly what strain it is. It is not only in Manitoba and in Ontario but it was discovered this afternoon in British Columbia. We are seeing, almost on a daily basis, a potentially very serious problem happening in our country.

When we see why we should have had bulk sales of pharmaceuticals banned it is because of the Tamiflu. Yesterday, not the brand name pharmaceuticals, but the Internet pharmaceutical corporations said that they will stop all sales of Tamiflu to the United States.They are the ones who have shown the leadership, more leadership than we have seen from the government and the minister.

It is absolutely amazing, when we are sitting with a potential crisis and when we have seen that it was the number one issue on the mind of the minister a year ago, and we have still seen no action. No wonder we are excited and upset about what we are not seeing in so far as leadership from the government.

Should it happen? Should we be banning bulk sales? Yes, but not now; it should have been long before now. What this debate is really about is the lack of leadership from a government that has shown none in this regard.

[Don Boudria, Liberal, Glengarry—Prescott—Russell, ON]

Mr. Chair, the hon. member says that the banning of bulk sales is the remedy to everything. My contention is that is only part of the remedy. That is not where it ends.

Let us look at the Internet pharmacies themselves and how they have caused shortages of product and medications in this country. They have stretched medical ethics as though they were an elastic. They have gone so far as to send flyers in the mail last year telling doctors that if they want to make some extra money for their Christmas shopping they could sign prescriptions at $10 a crack. I raised that flyer on the floor of this House. Surely the hon. member, knowledgeable as he is on issues involving medicine, cannot say that this is okay, that this is acceptable.

I want to go back to the issue of Tamiflu. I want to read something that was read into the record earlier today. This is from a media report:

Online, demand by individuals is skyrocketing.

“It's crazy,” said Mark Catroppa, a vice president with CanadaMedicineShop.com in Vancouver, British Columbia. The company has about 175,000 U.S. customers.

Last year, his company sold no more than 10 doses of Tamiflu or Relenza in any month....During the past two weeks, about 400 people a day ordered the drugs [from outside the country].

Can the member say that these individual sales do not also affect the availability of product when that kind of increase is going on, not according to what I say, but according to what the people selling the stuff are saying themselves?

How can the member say that it is only the bulk sales that are at issue and not the Internet pharmacies as an institution?

[Rob Merrifield, Conservative, Yellowhead, AB]

Mr. Chair, I would like to clear up some of the numbers that the hon. member has been using.

The Canadian International Pharmacy Association, which is the bulk of the Internet pharmacy group, right now are serving 1.8 million individuals. That has actually been decreasing in the last year or year and a half, not increasing.

When the hon. member uses the red flag of Tamiflu, I do not know if he heard me but I mentioned in my dialogue that yesterday the Internet pharmacy completely banned all sales of Tamiflu, recognizing the potential shortage and that Canadians come first. I think that is an appropriate move. I am not saying they had to do it by any means. I am saying they did it voluntarily and hats off to them.

By the way, Roche Pharmaceuticals is the only corporation in the world that actually produces Tamiflu. It is the only brand name pharmaceutical, and I have never seen this before, that has actually stopped selling Tamiflu, so that it has enough for Canadians who may potentially need it for emergency flu symptoms this winter. I see that as a positive thing.

Getting back to my hon. colleague's objection to the Internet pharmacy, let us get serious about what his objection was, which was that a doctor in the United States prescribing to a patient in his office is not as valid and as safe as a doctor in Canada prescribing to his patient. That is really what he is saying by saying that a doctor cannot fill that prescription.

That is an argument which I absolutely believe has no weight. In fact, in some ways I would say that the relationships of physicians in the United States with their patients are just as valid as those of doctors in Canada with their patients.

I know the minister has used that argument. I know my hon. colleague has thrown that argument around. I say it is a phony argument. I say it does not pull any weight.

That would mean that if a doctor saw a patient in British Columbia who wanted a prescription to be filled in Newfoundland or any other place in Canada it would not be valid. Let us say that a patient in Vancouver was seeing a doctor in Vancouver but went up to Prince George to fill the prescription and that is valid, but a patient from Seattle who sees a doctor and goes up to Vancouver, which is just a few miles away, would not be valid. I say that is phony. That is a garbage argument that does not pull any weight as far as I am concerned.

Anyone in the medical profession who does not have an axe to grind and a bent on this one would recognize that.

[Bev Desjarlais, Independent, Churchill, MB]

Mr. Chair, to emphasize again the comments relating to Internet pharmacies and physicians from one country to the other, my understanding is that Canada recognizes American trained physicians and American trained pharmacists. They might have to do a bit of licensing here and there, but we recognize their credibility. The statements coming out of the mouths of politicians here in Canada that somehow one would not be as credible I would put along the same lines as statements by George Bush suggesting that drugs coming from Canada are not safe.

I would like the member's comments on that.

[Rob Merrifield, Conservative, Yellowhead, AB]

Mr. Chair, I would argue the same thing. That is what my argument was with my hon. colleague, that a doctor-patient relationship in the United States is just as valid as a doctor-patient relationship here in Canada.

We need to ensure that there is a doctor-patient relationship in the United States that is valid. We should do that in Canada as well. I would suggest to my hon. colleague that probably does not happen all the time, and perhaps that is the weak link.

This is not about a professional in one country being more professional than another. That is a phony argument and does not carry any weight at all.

The member asked a very good question. How do we fix the problem? Everyone says we need to ban the bulk sales of pharmaceuticals because that is what is really compromising the price and availability of a product for Canadians.

As for me, I will look after my constituents. I will look after Canadians first. They are our number one priority. As long as they are looked after, then we are doing our job in the House on behalf of all Canadians.

[Dave Batters, Conservative, Palliser, SK]

Mr. Chair, I would like to commend the member for Yellowhead on the motion that he put forward in committee and which passed unanimously in the House 280 to 0, asking that the Minister of International Trade and the government be proactive in protecting Canadians and end the practice of bulk exports.

The member for Glengarry--Prescott--Russell had some passionate views on Internet pharmacies, but he directed his comments toward my colleague from Yellowhead as though he could do something about it, as though he were the minister of health. I urge the experienced member to turn those comments toward his government and the Minister of Health and the Minister of International Trade. I urge him to ask that these things be fixed. He has the passion, but we are not the government yet.

I would like the member for Yellowhead to clarify something that was addressed by the member for Churchill earlier in the debate. She made a comment regarding prescriptions going south to the United States. She said that the pharmaceutical companies could just hire more people and make more pills.

I would like to hear the thoughts of the experienced member of the health committee on that process. My understanding is that this is a very complex process. Plants cannot be built overnight. Complex pills are being made that affect the human body. We are not selling record players or vacuum cleaners. These are medications that alter the human body.

Is it simply that easy, to just hire a few more people and pump out more pills?

[Rob Merrifield, Conservative, Yellowhead, AB]

Mr. Chair, obviously it is not, although I think it would be a stretch to say that we would have a shortage of some of those pills. A lot of the pharmaceutical corporations do not want to play the game if they are just going to sell into a regulated market and for that to be exploited and sent to another international market. That regulated market is for Canadians, and that is really the issue. Could they make more pills? In time they probably could because they are in the business of selling pills, but that is not the real issue.

The other thing which I think needs to be mentioned is that there is actually a law in the United States banning the importation of Internet pharmaceuticals. There is not a politician with the backbone to enforce that law and say, “Grandma, you have to pay twice as much for your pharmaceuticals in the United States”. That is the reality of the situation. They understand that full well. I talked to a number of them at a conference a couple of weeks ago.

[Robert Thibault, Liberal, Parliamentary Secretary to the Minister of Health]

Mr. Chair, I appreciate the opportunity to address this urgent matter of public health.

As my hon. colleague the Minister of Health has made clear, the Government of Canada is committed to securing the access of Canadians to an uninterrupted supply of safe and affordable drugs, particularly those used for serious or life threatening conditions.

The fact is that drugs may be in short supply for any number of reasons, including a shortage of raw material or an unforeseen breakdown in the manufacturing process. These are not desirable situations, but they are understandable.

What is not acceptable, however, is if our pharmaceutical supply in Canada becomes strained because we have sold off our medicines to a higher bidder. That puts the health of Canadians at a grave and immediate risk. To mitigate that risk, the Government of Canada is taking action now, bold and decisive action that will immediately protect our domestic drug supply. The strategy proposed by our government will have a direct and measurable impact on the health of Canadians.

Other effects of these measures will be felt over the longer term. By protecting uninterrupted access to safe and affordable drugs and by reducing pressure on the cost of our drugs and the pricing system, the initiatives we are proposing will help keep our health care system viable. As part of the measures we are planning, we intend to increase the security of prescription drug sales in Canada, something that will benefit all patients, whether they live in Canada or elsewhere.

Americans are keen consumers of our Canadian medications. They come in person over the border or order their medicines online. Without question this is good business for the Canadian drug manufacturers and pharmacies. According to IMS Health, total cross-border drug sales to the U.S. reached $1.35 billion in 2004. That may be a drop in the bucket for America's $300 billion retail prescription market, but it represents a sizeable 8% of the same market domestically.

It is not just the scope of the phenomenon that we are concerned about, it is the staggering growth rate as well. Consider that between 2002 and 2004, cross-border drug sales escalated by about $7 million to $60 million per month. We all know what is driving this trend: money.

For some time now Americans have been taking advantage of Canadian drug prices that are on average 40% lower than the cost of comparable products in the United States. While U.S. prices have soared in recent years, the costs of prescription drugs in Canada have been held in check by the Patented Medicine Prices Review Board.

With the growing price differential between our two countries, cash-strapped U.S. state governments, institutions and individual seniors have looked northward to meet their ever expanding needs.

Now if we could stop time so that nothing moves, we could meet the current demand for export handily. But nothing, obviously, is static. The demand for prescription drugs in the United States continues to grow, as in Canada, and reasonably so, since the population is aging, more people have chronic illnesses and the number of new drugs increases.

In addition, from time to time, a new demand arises, as with the recent rush to buy Tamiflu as protection against the effects of a potential flu pandemic. As well, the American Congress is currently considering nine bills all, more or less, involving the legalization of bulk drug imports from Canada.

We have no way of knowing the size of the American bulk drug import market, but we do know that it will be too big for Canada to handle without compromising its own supply. If the bulk market legislation revives cross border sales of drugs that meet American standards, from the current 0.5% to 1% of the American market, the impact on Canada would be considerable. It would mean that one drug in six intended for use in Canada would be diverted and sent out of the country.

The potential risk to public health is self-evident but there is another consequence to consider, the impact on our health care system. Right now, thanks to our made in Canada drug pricing regime, patented medicines here cost about 9% less than the international median. That is an important price break for us because patented drugs make up 80% of Canada's total drug expenditures, $18 billion of the $22 billion spent on all types of drugs in 2004.

What is more, we spend more on drugs than any other component of our health care system, including physician services. One dollar of every $6 we spend in health care goes to medicines. As we look toward the future, drug expenditures are projected to grow faster than any other component of health care. In other words, by preserving the access of Canadians to affordable drugs, we are also protecting our domestic drug pricing regime and that will contribute to the sustainability of our health care system.

To address these challenges, the Government of Canada has proposed a three part strategy. First, we would create a pan-Canadian drug supply network. The network would furnish us with precise, comprehensive and up to the minute data on Canada's drug supply. Information like this is crucial for governments to make effective plans and take meaningful action to safeguard Canadians' access to medicines.

The second element of the strategy would amend the Food and Drugs Act to allow the Government of Canada to restrict drug exports whenever necessary to protect human health. We could, for instance, impose bans on the export of individual drugs or classes of drugs if Canada appears in danger of suffering serious shortages.

The third and final element would reinforce conditions on the sale of prescription drugs. Physicians would be required to have an established relationship with their patients before issuing prescriptions to them. This would hold true whether the patients were Canadian or from any other country.

As the details of our strategy take shape, we are asking Canadians to provide their input. Toward that end, we launched public consultations on October 6. People can contact us with their thoughts either through online forums or other channels until November 7. Health Canada has also recently completed face to face consultations with representatives of the drug industry, wholesalers and distributors and professional associations representing pharmacists, medical practitioners and their regulatory authorities. A meeting with provincial and territorial ministers of health is slated for November.

Over the past seven months there have also been discussions with other federal departments, as well as with Americans, including the health and human services secretary and members of Congress.

It should be clear that the Government of Canada is paying very serious attention to protecting Canadians' access to safe and affordable drugs.

We are not trying—and I underscore this—to shut down the activities of any industry. Rather, our intent is to give priority to health protection, the security of Canadians and the viability of our health care services and system.

However, we cannot be paralyzed into inaction. We must plan and prepare today and be willing to take bold and swift action whenever the need arises, indeed before the need arises. That is why we have put forward the response strategy I described, to give us the information and tools necessary to secure Canadians' access to a safe and affordable supply of prescriptions drugs. I encourage my hon. colleagues to support these initiatives.

[Steven Fletcher, Conservative, Charleswood—St. James, MB]

Mr. Chair, the hon. member raises some interesting points, but one issue is very intriguing. The member says that the industry grew dramatically between 2000 and 2004 and that this was causing concern. This has happened under a Liberal government. From the year 2004 to present, the industry has shrunk. I know in my own province, the number of online pharmacies has gone down by about 50%.

On the issue of importation in the United States, we have to be clear. Bulk exports from Canada to the United States cannot be allowed. We all agree on that point. The fact that some states, as has been suggested, have allowed bulk imports is irrelevant because the FDA in the United States controls the boundary. The states can say whatever they want but the federal government in the United States will not allow for bulk importation.

Another interesting point is the PMPRB was a Conservative initiative, and the pricing is based on industrial averages of the OECD. To suggest that the pricing will somehow be affected is not an intellectually honest argument.

The member also talks about a pan-Canadian network. That seems like a good idea except the Liberal government has proven completely incapable of dealing with anything that requires coordination. We have to look at Infoway as an example, another billion dollar boondoggle that the government has caused. The Auditor General has raised several concerns about this.

If this is such a big concern, he is on the health committee, why did he not raise this at the health committee? Why did the Liberal chair of the health committee not raise it? It was the Conservative members who raised it and have insisted that the health committee deal with the issue and study it. The Liberals have refused to be proactive and push that agenda where it should be dealt with, at the health committee.

[Robert Thibault, Liberal, West Nova, NS]

Mr. Chair, the member is right on one point and one point only. It was a member of the Conservative Party, namely the opposition critic, who wanted this to be studied by the committee. He also put the proviso that the minister should not act until it had been fully studied by the committee. He has brought 32,000 dilatory motions at the committee. He has kept bills before the committee, like a private member's bill that would have antiperspirant classified as food. Because of that we have been unable to get to other points of business, which I think is interesting. However, I give credit to some of the points he makes.

On the question of bulk exports and the restrictions for them, if we get to the mechanics of the bill that the minister proposes to bring forward, it answers those questions. I do not think anyone argues on the three elements.

The member would argue one element. He would argue about the question of there being a relationship between the patient and physician. I will get back to an item that was raised a few times, the question of Tamiflu. The use of these drugs without proper supervision and under the wrong circumstances can have a detrimental effect to humanity.

That is why Roche has been very responsible in saying that it will provide its supply to governments, to ensure that those public supplies are done first and that it be handled properly. There is a risk of developing resistance to antivirals. In the eventuality of there being a pandemic, it is important that these products be used properly and that they be used under the supervision a doctor.

Those questions come to mind. I kid the member and we have some very interesting jousting matches. I understand where he is coming from. He, like all of us, shares a concern about the safety of Canadians, the safety of the drug supply and the proper use of our medical system. He also has the interests of his province on the question of the economics of these Internet pharmacies.

How do we strike a public balance? Consultations are underway. The bill that will be brought before us will be studied at the committee is the right way to proceed.

[Bev Desjarlais, Independent, Churchill, MB]

Mr. Chair, my colleague has said that the government wants to take action and wants to get something done. I go back to the comments that were made earlier about the vote in the House which had unanimous support to ban the bulk exports. Nothing has been done. It is wonderful to talk and talk about how wonderful one is and all the wonderful things one will do. However, when the government is in a position to do those things and does not do them, at some point Canadians have to say that it is just a lot of fluff. There is a key point that can be fixed and everyone seems to agree on it. That is the banning of bulk exports.

I know we want to look after Canadians first. There is no question that we want to ensure the pricing and the availability. I think we are all on the same page in that regard as well. However in return, as Canadians we should feel quite honoured with our health system and our system of pricing. Literally millions of Americans want to access our system. Their politicians are afraid to take action against them because they know they will be ripped to shreds by their own population. Somehow it is up to Canada to act responsibly because American politicians are unwilling to put in place the same type of system that we have, a system that benefits all their population.

[Robert Thibault, Liberal, West Nova, NS]

Mr. Chair, on the question of the motion on bulk exports, there is no argument anywhere in the House. There is a principle of many members of the House, especially the party to which the member used to belong, and that is we should consult with our stakeholders. I agree with that, but sometimes it is still in the process. We are going through that period now.

Also the question of having the proper legislative and regulatory framework to do that in light of our international commitments, our international contracts and engagements and treaties and trade arrangements makes it necessary to bring legislation forward. We have to do it. We are going through that process now to ensure we protect our drug supply.

The earlier comment that the price of drugs is not at risk by Internet pharmacies and bulk exports is not true. Our price control mechanism is at the factory gate and not necessarily at the pharmacy level or consumer level. If we restrict the supply and the demand remains the same, there is a risk of a price increase. It is important to maintain a good and proper supply to meet Canada's needs.

[Dave Batters, Conservative, Palliser, SK]

Mr. Chair, some interesting interventions tonight. I appreciate the comments of the member for Churchill. She talked about the democratic deficit opposite. If anyone knows about the democratic deficit, it would be the member for Churchill after what she has gone through, and I sympathize with her.

I would like to address the parliamentary secretary and get his comments on a quote from the C.D. Howe Institute. It says:

If large-scale drug exports were to occur, most likely drug prices would rise in Canada to U.S. retail levels, which would eat into provincial health care budgets and increase drug costs for most Canadians.

That certainly is the threat. That is why I am here tonight. That is the threat to senior citizens in Moose Jaw, Saskatchewan and people throughout Canada. This is all about access to medications that help Canadians live longer, happier and healthier lives.

Given that concern, I would like to hear the member's comments on that and I would like to hear why his government has done absolutely nothing. As the member for Churchill has said, there has been a lot of talk and a lot of studies, but nothing has been done to ban bulk exports which everyone is in agreement on.

[Robert Thibault, Liberal, West Nova, NS]

Mr. Chair, on the C.D. Howe comment, I just answered that question by saying the price management review regime is at the factory gate and not at the consumer level. If the supply is restricted at the consumer level, at the pharmacy the prices would increase.

I hear a bit of speaking from both sides of the mouth from that party. The official critic of the opposition brought a motion forward at the health committee saying “do not act until the committee has made a full study”. Then he presented all possible motions to stop the committee from studying the issue.

The minister is making the moves to do exactly what the House has asked. We all want to ensure that drugs that are manufactured for Canadians are there for the Canadian market. However, it has to be done within the legal framework in the proper way, and that requires consultation. Principles have been laid out. The consultations are on the way. The minister indicated this evening that legislation would come before the House, and I look forward to the member's support for that legislation.

[Réal Ménard, Bloc, Hochelaga, QC]

Mr. Chair, it is a pleasure to be able to come closer to you. This takes me back to the days when the Bloc Québécois was the official opposition. Of course, there is nothing to prevent optimistic thoughts about future seating arrangements, but that is not what we have to talk about tonight.

The Bloc Québécois has asked for this very important debate. All colleagues in this House recognize the intensity of our trade relations with the U.S. but precious few of us would be prepared to support drug exports. Motions have been made by a number of members, among them the likeable member for Glengarry—Prescott—Russell, one of the deans in this place. It seems to me that he may even have shaken hands with Wilfrid Laurier, his roots go back so far in the House of Commons.

The motions by the various members cause us to reflect upon the leeway we have here. In fact it is hard to propose solutions on something like this. Formally, given the treaties Canada has signed—trade treaties in particular—it is not clear whether it could enact legislation completely banning exports.

We know that there are provisions in these trade agreements that allow us to restrict exports if there is an anticipated crisis or danger of shortage. Might a permanent arrangement that would prevent drug exports not end up in a dispute with the United States? That is something to consider.

One fact remains, however. The number of Canadian Internet pharmacies has tripled since 2003. Today there are more than 150 of them, and half of those are in Manitoba. Of course, I understand the Conservative health critic's interest in this, since he is a Manitoba MP. I know this is a very important industry, with more than 1,000 jobs connected to it.

What is the explanation for the American attraction to our drug availability program? The first factor of course is that in Canada there is relative control over the sale of drugs. I say relative because people must not think that the control is over retail sales.

The patented medicine prices review board was created by the Conservatives under Brian Mulroney. I do not wish to bring back bad memories for the member for Glengarry—Prescott—Russell. However, the fact remains that the Conservatives created this organization at a time when patent duration was the subject of much debate and when Canada was not very competitive in terms of patent protection for industry. We moved from 10 to 17 years, and then from 17 to 20 years. As a result, we created a quasi-judicial body called the patented medicine prices review board, which controls the price at the factory gate.

So there is an action remedy system. Prices are limited to the median. For a drug available elsewhere, its retail price in seven countries is compared. If the price is determined to be excessively high, the patented medicine prices review board may take steps to force the industry to refund a portion of the retail price to consumers. That said, at present, drug prices are 35% lower than they are in the United States.

In passing, I want to say that, in recent years, the Bloc Québécois has been concerned that generic drugs were not controlled. We know that the patented medicine prices review board has no jurisdiction over them, although Canada has expanded its jurisdiction with regard to patents, but not necessarily with regard to generic drugs. The provinces decide which drugs will be on a formulary, and therefore eligible for a refund.

I also want to say that as a Quebecker and someone sensitive to the importance of research—I am very sensitive, and the member for Glengarry—Prescott—Russell is well aware that I have been known to cry in certain circumstances—I have often raised this question in caucus and added it to the agenda.

I have often included this issue on our meeting agendas. We have to recognize that the branded pharmaceutical firms, those doing research, are also behaving inappropriately. What they do has been called evergreening. In fact, a patent was to last 20 years. From the date of the application to the appearance of the generic drug on the market no more than 20 years could elapse. The branded companies filed secondary patents, thereby establishing an automatic 24 month injunction and starting the cycle over, regardless of the content.

As soon as an allegation of copyright infringement is made, under the Canadian system, which is quite similar to the American one, evergreening begins. It does not appear to me to be done for the benefit of consumers. In my battles, I have always had the support of our party's critic for industry, the member for Kamouraska—Rivière-du-Loup—Témiscouata—Les Basques. He is a member of the party's left and supports consumers' interests.

We also try to understand why Americans are interested in Canadian drugs. Our pricing system is quite controlled. Furthermore, 70 million Americans have no insurance. So when they face calamities and health problems, they have to pay full price for drugs. In some cases in the states, when you become ill without health insurance it can literally bankrupt you. This never or rarely happens in Canada.

From a technical standpoint, the whole issue of the export of drugs needs to be considered. It is not clear what level of government is responsible. What we do know is that no law in Canada currently prohibits the export of drugs. Provincial laws contain prohibitions.

I am more familiar with the situation in Quebec, where pharmacy legislation promotes the patient-doctor relationship. It is not possible for a practitioner in Quebec to fill a prescription for a U.S. citizen without facing a system of penalities going as far as being expelled from the college of physicians. Why? Because under the Pharmacy Act of Quebec a doctor must see the patient in person, must give a diagnosis and must develop a treatment plan. Unlike a doctor from Manitoba, a doctor from Quebec who fills a prescription issued in the U.S., could be found guilty and be expelled from the college of physicians.

That is why there are so few Internet pharmacies in Quebec. I am not saying there are none. The hon. member for Glengarry—Prescott—Russell is nodding his head. He probably read the same papers I did.

In closing, I think it is important for us to debate these issues. I know that the Standing Committee on Health will be conducting a study. The Bloc Québécois for the most part agrees with the idea of prohibiting the export of drugs.

Obviously the jurisdictions will have to be respected. As I was saying, Quebec already has rather hefty provisions to protect ourselves from this phenomenon. We know this is a debate that has well and truly been launched. Several million dollars are at stake, besides which if Canada were to supply the U.S. on a very large scale, it would have a shortage of drugs. Judging by the production infrastructure of companies, both generic and branded, it is not at all certain that we will be able to respond to this demand that is predicted to be 10 times greater than our own.

I am anxious to work on this issue in the Standing Committee on Health.

[Don Boudria, Liberal, Glengarry—Prescott—Russell, ON]

Mr. Chair, I thank our hon. colleague for his remarks. Like him, I have noticed that this problem is much more infrequent in Quebec and other jurisdictions that have a high quality, or at least strict, code of conduct. It is no coincidence that this industry has taken off in provinces with more, shall we say, flexible codes. The lack of such rules has created this situation.

So I want to ask my colleague if he too realizes that the problem boils down to the fact that the United States—how ironic—which invented consumer protection legislation, is apparently incapable of adopting legislation for consumers regarding pharmaceutical products. It adopted legislation on vehicle windshield height and all sorts of things. Recalls of defective vehicles and so forth originated in the United States.

However, for reasons beyond my comprehension, that same society is unable to adopt legislation protecting its consumers from, in the eyes of some, overly high prices or, at least, prices much higher than ours, and these people purchase their supply from a place that better protects its consumers, meaning from us. Therein lies the problem.

I fail to understand the reaction of some American legislators who say that importing drugs into their country is illegal. In truth, they want to avoid, at all costs, saying that they will enforce that legislation, because this could cost them votes back home.

So, I take issue with the comments of our colleague opposite, the member from Manitoba, who is saying that, since it is illegal to import drugs into the United States, bulk imports must be prohibited. Individual imports are illegal, but we have to ignore this. Only the provision on bulk imports, and not the other, must be enforced.

I want to hear what my colleague thinks about that.

[Réal Ménard, Bloc, Hochelaga, QC]

Mr. Chair, our colleague's comments are very pertinent and clearly show his knowledge of the issue. I agree with everything he says. I will perhaps add one explanation.

In the U.S., the relationship to medicine is rather different. This is, in my opinion, really one of the consequences of a desire to let market forces govern the health system. Hon. members will recall that, when he was president, Bill Clinton mandated his former wife, the first lady at the time, to carry out a study on the costs of “socializing” the U.S. health system just a little bit, but that reform never came to pass.

That does not surprise me. Although consumers are better protected in certain other areas, I feel that the U.S health system still leaves a great deal of leeway to the private sector and to market forces. This is, I believe, the reason we are in a bit of a bind here.

It is cause for concern that there have been nine bills introduced in the U.S. Congress, not all from Republicans but from Democrats as well. There is certainly a bit of hypocrisy about wanting this protection on the one hand but not wanting to respect the law on the other. Our colleague is right to encourage us to be cautious.

[Steven Fletcher, Conservative, Charleswood—St. James, MB]

Mr. Chair, I would like to mention that the number of Internet pharmacies in Manitoba has actually gone down. The reason for this is because a large portion of the Internet pharmacies are actually going overseas where there is an even greater price differential between the United States and the EU or Australia and New Zealand, for example. The industry is actually in a decline, it could be argued.

I want to get the member's comments on my concerns. One is the issue of provincial jurisdiction and whether the federal government has the ability to do what it is intending to do.

I think we are all in agreement on the ban of bulk exports. We have had that discussion. I have a question for the member, who is also on the health committee, and who voted to have the health committee study the issue and also ban bulk exports. Why does he think the government is taking so long to do anything on the banning of bulk exports? It has had the opportunity to control the agenda of the health committee to study the issue on an expedited basis and it chose not to do so.

I wonder if the member would comment on both the provincial jurisdiction and why the government has not acted on the direction of the health committee.

[Réal Ménard, Bloc, Hochelaga, QC]

Mr. Chair, I will answer my colleague's totally non-partisan question. This is sort of our trademark in committee. We leave partisan issues aside.

First, I believe it is very clear that the provinces are responsible for ensuring that the various codes of ethics and professional practice are upheld.

Second, one point is not clear in my mind. I was reading that article 309 of NAFTA prohibits restrictions on the import and export of drugs, except when a shortage is expected. Could the government simply have introduced a bill to prevent the export of drugs? This is not clear to me.

I think it warrants a little more investigation. We know our time is limited. We cannot take another two or three years to consult and consider. Clearly the states are going to move. As was mentioned earlier, nine bills have been introduced, by Republicans and Democrats alike.

I think, however, that it is worthwhile arguing for a little more room to consult and discover what sort of legislation would be most appropriate. I think the Standing Committee on Health, of which my hon. colleague is a member, has work to do in this regard.

[Don Boudria, Liberal, Glengarry—Prescott—Russell, ON]

Mr. Chair, I am pleased to take part in this evening's debate on Internet pharmacies.

Most hon. members would agree that I have been raising these issues in the House of Commons for a very long time. During the first year after I left cabinet, perhaps even longer ago than that, I was the only member to raise these issues in the House of Commons.

Many things still trouble me. I want to thank the parliamentary secretary and the minister for the plan they presented this evening, which is the first component in creating a drug supply network. This plan was overseen by the Minister of Health. It was a very good idea. We have to ensure the safety of the supply.

The second point is the need for enabling legislation under the Food and Drugs Act that would allow the Government of Canada to prohibit the bulk export of prescription drugs and other essential drugs when the health of Canadians is at stake. The hon. member for Hochelaga mentioned the section under NAFTA that is somewhat related to all this. At least this could be one of the reasons why that section was drafted that way. I intend to discuss this with the minister.

The third point consists in giving more teeth to the current provisions whereby any purchase or sale of prescription drugs should come as a result of consultations held between the patient and the medical practitioner. We must address this issue.

I heard a Conservative member in the House say that it is only those who have an axe to grind who think that the Internet prescription system damages the health care system. I believe I am paraphrasing the way the member put it.

However, Canadian Medical Association's statement on Internet prescribing in 2004 stated that “It is not acceptable for a physician to sign a prescription without properly assessing the patient”, except as indicated above, and there is a whole matrix of how this is to be done, and so on and so forth. This is the position of the Canadian Medical Association, hardly a group with an axe to grind.

Other people are also concerned with this whole business of prescriptions over the Internet in the kind of vacuum that we see now. Let me name a few from a press release that I have which dates back a year ago. I am sure the list is much longer now. It includes: the National Association of Pharmacy Regulatory Authorities; the Canadian Pharmacists Association; the Canadian Medical Association and I just quoted from its report; the Association of Deans of Pharmacy of Canada; the College of Physicians and Surgeons of Manitoba, would you believe, Mr. Speaker; the Manitoba Society of Seniors; Pharmacy Alliance for Canadians; and the Coalition for Manitoba Pharmacy.

Even within those jurisdictions, where these kinds of sales are going on in a very big way, certainly it is not supported by everyone there. The professionals in the health care sector say that this is going too far and that it is wrong. It is not me, not the member for Glengarry--Prescott--Russell. I am not a member of the Canadian Medical Association, much less the College of Physicians and Surgeons of Manitoba, a province 1,000 miles from my constituency.

On top of that there is a whole number of pharmacies themselves, groups of seniors, and a large number of people, consumer groups and others who tell us that we have to be careful with all of this. They include: the Canadian Hepatitis C Network, Canadian Treatment Action Council, Canadian Organization for Rare Disorders, Canadian Arthritis Patient Alliance, Best Medicines Coalition, Manitoba Epilepsy Association, British Columbia Persons With AIDS Society. Those are all consumers of medicine who are worried about this.

One cannot say that every single one of these organizations is wrong. Their concerns are legitimate when we start seeing runs on various products, whether they are caused by bulk sales which arguably of course is worse, or whether they are caused by Internet pharmacies all of a sudden selling thousands of prescriptions in an area where they were not selling any the previous year.

I read one example of 175,000 prescriptions where in the previous year only 10 doses of the same thing were sold. No one can say that increasing the sale of something and removing a product from this country where 10 units were removed last year and 175,000 were removed in a few months of this year, that it does not cause a shortage.

It is ridiculous to pretend that. That is not a bulk shipment at all. This has to do with the Internet pharmacies. Then someone says that the Internet pharmacies, after having seen the damage that they have done, have decided that they are not going to do this any more for a little while. That is hardly a redeeming value. Once one creates a mess and then says that one is not going to participate in the mess that one has created for a little while, to me is not good enough.

This is why I think that part of the program announced to us by the parliamentary secretary this evening is so vital, that is, when he says the government wants to establish a system whereby it will be possible to pinpoint one particular medication and say that is it, it is in the national interest that people not be allowed to send any more of this out of the country, whether it is bulk shipment, Internet pharmacies or anybody else, because it threatens the health of Canadians. That is why we are here.

To me, that is why it is so important. We cannot think of medication as little pills that look like candies, even though they do look like that most of the time. This is a very important component of the Canadian health care system. A member of my family is at home right now with pneumonia. She will be angry with me for raising this, but so be it. The prescription costs $100. I thought that was outrageously expensive, except that after three or four days of taking the medication she is getting better. Then what I thought was that about two hours in the hospital would have consumed twice as much as the $100. Maybe if we think of it that way, the medication, which we all think is too expensive, is not expensive if we compare it to the alternative.

The point I am making is how important all of this is for the well-being of Canadians. Prescription medication in particular is so very vital. I am leaving for South America with the Prime Minister in 48 hours to attend the Summit of the Americas, at least I think I am. I need to have a flu shot and a number of things before I leave. They are all provided to us. Countless other Canadians need medication: preventive, a vaccine, as I am going to get, and for treatment, in the case of others who are ill. We just cannot afford to be out of these products at any time. That is why I encourage the minister, as I have been doing for a long time, to be vigilant on this.

I thank the parliamentary secretary and the minister, too, of course. I listened attentively to the parliamentary secretary's presentation. He simply must continue on that track and be even more vigilant in protecting the health of Canadians.

[Steven Fletcher, Conservative, Charleswood—St. James, MB]

Mr. Chair, I would like to thank the member for his comments and congratulate him on his time in public office. I am looking forward to reading the member's book, which I understand I can pick up at any retail bookstore.

Having said that, let me comment that Health Canada has stated that there is no documented evidence on shortages. I would also like to mention that the member listed many organizations that have concerns about bulk exports. We do too. We all agree on that. Organizations have outlined their concerns, including those he has mentioned. We are all on the same page here. The fact is that the government has not done anything on the issue of bulk exports.

However, I will also note that there is a way of balancing the member's concerns and dealing with what is a legal and legitimate industry. Even the President of the Treasury Board, in a Winnipeg Free Press article earlier this year, is quoted as saying that he “would like to see the folks who provide the service continue to do it”. That is a direct quote.

I think we have to be reasonable. The fact is that patients have an established patient-practitioner relationship in the traditional sense with their U.S. physicians. There are ways to ensure that the ethical issues are addressed as well.

I wonder if the member would comment on the fact that the entire House agrees that bulk exports from Canada should be banned, that in the United States it is the federal government that is responsible for its own jurisdiction, and that as long as price, supply and safety of Canadian drugs are not threatened, this industry should be allowed to maintain itself. It is an opportunity to bring much needed jobs to have not provinces. Could the member comment on those points?

[Don Boudria, Liberal, Glengarry—Prescott—Russell, ON]

Mr. Chair, I do not agree with many of the points the member raised except that he has said he might like to read my book. I agree with that.

More seriously, though, the hon. member says there is no evidence of job shortages. We have had countless press conferences in this building with pharmacists, pharmacist associations, and members of the Canadian Medical Association. I have a letter here from the Canadian Treatment Action Council listing 132 drugs that were not available in one part of the country at one point in time, and so on. Many people inform us or at least allege that these shortages or at least strains on the supply in various regions of the country are going on right now.

The hon. member says that the authority is with the federal government in the U.S. and it is illegal to bulk ship into the United States. He referred to that slightly in this most recent presentation and more extensively a little while ago. I was listening.

What he does not say, though, is that both are forbidden to enter the United States. Internet pharmacies that send cases of stuff to 100 different people or bulk ship 10 cases of stuff to one person are equally forbidden. If the argument is that we should not be sending bulk stuff to the U.S. because it is against U.S. law, I take the hon. member's argument at face value. They are both forbidden. Why would we say that we should listen to U.S. law as it applies to bulk sales but not to the other? I think the argument is the same for both. That is the point I am making here.

I am going to go back to something I heard in the parliamentary secretary's discourse a while ago. If we are having a run on a product, and never mind the U.S. law for a minute, whether that run is caused by someone having shipped cases in bulk to the United States or it is like the other case that I talked about a while ago, with 175,000 prescriptions in one year being shipped individually out of Canada to the U.S., the effect is the same. That was in an area where there was only a handful of them a year ago.

The effect is the same. That is the point I am making. To say that it is only the bulk sale component is not so. In my view, both have to be addressed. That is why I think the government's plan is on the right track. I urge the government, though, to move expeditiously on this issue, not to wait until we have a major crisis and run out of something and then have Canadians getting sick because we do not have the medication in question.