Debates of Nov. 1st, 2005

Cross-Border Drug Sales

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

Mr. Chair, I was happy to hear the words of the member for Glengarry--Prescott--Russell. I must confess that I have not yet had a chance to read his book; I am waiting for the movie and for volume two of his book.

There is a question that I would like to ask. I have listened to the debate and to where people are on that question of balancing economic interests and legitimate business with protection for Canadians. Let us look at the strategy that the minister has put forward. First, we would have a surveillance system of the drug network. This network would indicate exactly what the supply is in Canada and would monitor it. I think everybody would agree that this is a good move.

On the second point, I note that the member is an experienced member of Parliament who has done a lot of work internationally respecting Canada's role in the world and our need for trade and respecting our trade agreements. Under the strategy the minister has put forward, we know that if there is a human safety reason for restricting drug shipments, we can. The network would give us that information and we would have the tools to do that after the legislation is passed.

The true point remains, this last point that is contentious, and it is the question of the ethics of practice. Where we have those principles in Canada, at the Colleges of Pharmacists and those professional organizations, a pharmacist will only fill a prescription that has been written by a doctor licensed to practice in Canada. There is the question of having a relationship. That question remains for some interesting debate on how we balance that with the current operations of Internet pharmacies.

Would the member comment on those points?

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

Mr. Chair, I think the parliamentary secretary is totally correct. My approach to all this has been to focus on the issues that are important. They are not always the same ones that we see in the news.

For instance, about a year ago cameras were going gangbusters because there were two buses in Toronto with senior citizens getting out of the buses and coming from the U.S. to buy prescription drugs. It made for some great camera shots. At the same time, with one Internet pharmacy supplying 2,000 prescriptions a day we would have had to have a train about 20 miles long to accommodate that number of people if they had all come individually. Obviously that does not make much of a camera shot. A computer terminal just does not do it.

At the same time, it is not the busload that is the issue. Nor is it grandma who is in Florida going to see a doctor there because she is there for the winter. We have the doctor there confirming with the doctor in Canada that it is the grandma known by the doctor in Canada, that she is sick with that particular disorder, and that the doctor recognizes her and sees her all the time when she is back home. Then the doctor over there issues a prescription or some such instrument across the border.

That is not the issue. Nobody is trying to solve that so-called problem because it is not one. The real problem is that which affects the security of our drug supply and that is how I believe we have to address the problem.

[Dave Batters, Conservative, Palliser, SK]

Mr. Chair, I am here this evening to participate in the debate because it is an issue of great personal importance to me and to my constituents in Palliser, Saskatchewan. It is an issue of importance to all Canadians.

The issue is ultimately about patient access to medications so that Canadians can live longer, happier and healthier lives. It is about the sufferers of illnesses such as heart disease, Alzheimer's and cancer. It is about providing access to medications. It is for that reason that I am here this evening to participate in the debate. I must confess that given the circumstances with what has gone on today in Parliament in having Justice Gomery confirm that millions of dollars were stolen from the public treasury to benefit the Liberal Party of Canada, I do not think it is a coincidence that this debate is happening this evening. It is bumping CPAC off the airwaves where we would focus on some of the corruption that has gone on under the government.

Nonetheless, I thought it was important enough to come here tonight and participate in the debate because it is an important issue in terms of health care. It is also an issue with which I have a bit of a history. Prior to being elected, I was a pharmaceutical representative for Pfizer Canada. I was very proud of the work that I did travelling the southern half of Saskatchewan with the goal of educating physicians specifically on three different medications in the cardiovascular realm. Physicians have to be experts in 300 or more different medications and I only had to know three. I am proud of the work that I did in that realm. It was a good experience to meet the many good physicians that we have in Saskatchewan, especially those physicians I am thinking about tonight in Moose Jaw, in the riding of Palliser and in southwest Regina.

It was an honour to do that for a living for five years and to talk with physicians about mortality and morbidity data, data about drugs that saved lives. I would drive into communities in southern Saskatchewan and rural Saskatchewan. Whenever one drives into a community it seems that invariably one has to drive past the cemetery before getting to the doctor's office. That just seemed to be the pattern. I would remind myself that it was important work that I was doing. It may seem quirky but I used to say to myself, “Let us try and keep this cemetery a little bit emptier for a little bit longer”. That was how I treated that job. It is how my colleagues at Pfizer treated their jobs, and the seriousness of this issue.

It is very important. We seem to all be in agreement in the House about the need to ban bulk exports. We need to see some action. The member for Yellowhead showed some leadership. He put forward the motion calling on the government to end the practice of bulk exports, asking the Minister of International Trade to protect Canadians proactively from bulk exports. Proactive is the key word. We need to be proactive as opposed to being reactive and waiting to see if there is a crisis, waiting to see if there is a shortage for Canadians. We cannot afford to do that. Canadians need access to these medications and we cannot afford to put that supply at risk.

The Minister of Health said at Harvard on November 10 last year that Canada could not become the drugstore to the United States, a country with 10 times our population. I agree with him but again there has been no action. We have heard members opposite say that we need to study and to consult with the stakeholders. That is the Government of Canada. What we need is leaders. This applies to issues across the board. We really need the political will and some leadership on a topic where members voted 280 to 0 on a motion to ban bulk exports. The will of this House is pretty clear.

The government's approach appears to be reactive and not proactive to ensure that the medicines and vaccines destined for Canadians remain in Canada. The only obvious solution is a ban on the bulk export of pharmaceuticals.

Many people have alluded to a study by Dr. Shepherd, who will soon be in Ottawa. His study indicates that if the pending legislation in the United States passes, our drug supply will dry up in 38 days. That is terrifying. It is certainly terrifying for the people of Palliser and to everyone who is watching this debate tonight. That is shocking information. Clearly, we need some leadership from the government to safeguard Canada's drug supply.

There has been added focus on this issue tonight because of the avian flu issue and the drug Tamiflu which may protect Canadians from the avian flu. This starts the debate as to the need to safeguard Canadian medicines that are intended for Canadian patients.

There is certainly increased pressure in the United States to pass resolutions that call on Washington to legalize the bulk imports of drugs. Legislation to legalize imports from Canada has been introduced in the U.S. and it has bipartisan support. Tonight we have stressed the importance of protecting this drug supply and banning bulk exports.

In June of this year the Minister of Health proposed strengthening existing federal regulations under the Food and Drugs Act. The topic was that we are going to discuss it and we are going to study it. What we really need is action from the government.

The truth is that the government has done nothing to protect the Canadian drug supply. The government has not changed any regulations or brought in any legislation, despite the minister's lofty promises. The government needs to act now to protect Canadian medicines and vaccines that are intended for Canadians.

Earlier tonight during questions and comments I talked about the C.D. Howe Institute which said:

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.

Yet the government has done nothing.

This is a worry for me. It is not only the drug supply but the price of drugs. The member for Charleswood--St. James—Assiniboia who is the health critic for the Conservative Party said that the issues we need to concern ourselves with are price, supply and safety. All of these are critical issues.

The Canadian pharmaceutical industry develops, manufactures and distributes medicines based on its forecasting of the needs of Canadian patients. It does not calculate taking care of our neighbours to the south.

There was a comment this evening from a member who had been a member of the NDP until she was forced to sit as an independent about the fact that drug companies should make more drugs and hire more people.

Pharmaceuticals are not like any other manufactured good. Drugs have an active ingredient that is either derived from a biological source or is chemically engineered in laboratories. Some biological sources are scarce and oftentimes the lab work required to make the active ingredient is extensive. This makes it difficult to meet any unforecasted increases in demand. Plants cannot simply be built overnight. The required safety specifications cannot easily be met.

I will finish on the safety issue. One of the products on which I used to educate physicians in Saskatchewan was a drug called Norvasc, a drug for hypertension and angina. There was a case recently in Hamilton of patients being prescribed Norvasc, but when they picked it up from their pharmacy, it turned out that they were getting nothing more than talcum powder pressed into the shape of Norvasc, this pill that I know so well. I was outraged to hear that. Clearly we need to take steps to ensure the safety of our drug supply.

In summary, this is quite a simple debate. There seems to be agreement on all sides of the House. It is unfortunate that at this hour in this important debate there are no members of the NDP or the Bloc Québécois present to hear this, but it is critical that the government take action to protect our drug supply--

[The Deputy Chair]

Order. The member will recall one of the very important rules is that we do not mention who is present or who is not present. We will move on to questions and comments.

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

Mr. Chair, the member for Palliser raised a lot of concerns. I think he is quite right that the concern is about supply, price and safety. The main threat to those three factors is bulk exports to the United States.

The member also mentioned that at health committee the Conservative member for Yellowhead brought forward a motion to encourage the government to ban bulk exports so there is no threat that bulk exports to any other nation could occur. That motion was passed by the health committee and it was passed by the House 288 to nothing. Yet the minister has done nothing.

Is the member frustrated by the government's inaction? Also, could the member comment on the inaction on the entire health file, be it wait times, dealing with the human resource crisis in the medical field, or even the crisis that the government caused in the first place? Ten years ago the government cut transfer payments by $25 billion and reduced the number of medical graduates. Now we are in a big mess. Could the member expand on his comments to the broader issue of the health care crisis in which we see ourselves today?

[Dave Batters, Conservative, Palliser, SK]

Mr. Chair, I welcome the opportunity to address my esteemed colleague from Charleswood—St. James—Assiniboia on these subjects.

First, regarding the bulk exports, I think we have agreed in this House tonight that there is unanimity. Thank goodness for the leadership of the member for Yellowhead for bringing this issue forward and forcing the government to act. We are still waiting, but hopefully it will act soon.

The member for Yellowhead, I should mention, is also a member of, as are many of members opposite, the Conservative Party's crystal meth task force looking at issues relating to crystal meth that pose a serious health risk to Canadians. I know he has been pushing the government, as I have, to make changes to the laws to help deal with that threat to Canadians.

Regarding the overall health care questions, the member alluded to the fact that the government under the now Prime Minister, who was then finance minister, chopped $25 billion out of the budget in 1995 which was intended for transfer payments to be used in large part for health care. I remember I was watching with interest 10 years ago as that happened and thought, “Can we even comprehend the magnitude of this disaster and what it will mean down the road?” We are seeing it today, in terms of health care wait list times.

The government talks about the need to address wait times for surgeries, diagnostic tests and just to see a general practitioner, but it is unable to do anything. That is really the difference. It talked about a fix for a generation, but it has not actually done anything. We cannot recover overnight from a slash in spending of $25 billion. That takes years to recover from.

Nowhere in this country are the problems in health care more evident than in my home province of Saskatchewan, where we have the longest wait times in the country. While I am critical of the government opposite, our provincial NDP government has made some really poor choices in terms of health care in Saskatchewan. It is about priorities and where we place our priorities in terms of spending. Is it a priority to recruit physicians? Is it a priority to ensure that we have an adequate amount of nurses and pharmacists to serve the population of Saskatchewan? It has not been a priority for the NDP government in Saskatchewan, that is clear.

A friend of mine was an ophthalmologist in Moose Jaw. He loved Moose Jaw, but he left because of the NDP government. He said that it destroyed health care in the province of Saskatchewan, the province that he loved.

There are big issues that need to be addressed regarding the health care file. The government clearly has an awful lot of work to do on this file. It needs to make health care a priority, not just talk about it but back it up with some action, and we could start by banning bulk exports.

[Larry Bagnell, Liberal, Parliamentary Secretary to the Minister of Natural Resources]

Mr. Chair, I am delighted that the member was a representative for Pfizer because I would like to ask him a question related to the patenting system.

The member for Pickering—Scarborough East and myself have been working at leading an initiative to try and stop the abuse of patents where they get extended and extended, so that the brand name companies can keep the high prices forever and the drug does not get genericized, which costs everyone more for their drugs, especially those on low incomes and seniors who cannot afford it. We showed some leadership. The Bloc voted against us, unfortunately. His party sort of wavered; it was partly for and partly against.

I wonder if he will show some leadership and help us get the patent system fixed, so that we can get things running smoothly and on to generics, so the costs can be lowered for seniors and all Canadians.

[Dave Batters, Conservative, Palliser, SK]

Mr. Chair, the issue of patents and intellectual property is a very important one to the pharmaceutical industry and to Canadians. Clearly, the issue that is important, and we have covered this tonight, is the access of medications to ensure that Canadians have access to their cholesterol-lowering medications, their blood pressure control medications, and that seniors have access to drugs that lessen the effects of Alzheimer's disease. All this is extremely important.

The member will know that regarding the patent laws and intellectual property laws as they currently exist, it is a bit of a myth to say that the companies are marketing these drugs for 20 years. Currently, the patents are 20 years on these products. Those take effect when the molecule is first discovered and first patented. The member will know that it takes many, many years before that pill is ever available to the public and brought to the shelves of pharmacies. It is often 12 or 13 years, which leaves the pharmaceutical industry X amount of years to recover its investment, and then yes, make a profit. There is no question that these companies are in the business of making money, but more importantly, these companies are in the business of helping people live happier, healthier lives.

When I was with Pfizer, sure we talked about our sales but we talked about far more. We talked about the possibility of being part of a company that could cure cancer, or being in an industry that would find the cure for cancer and diseases like it. I was proud of that work and we need to support that industry. The industry is a big employer in this country. It spends huge resources in terms of research and development for new medications. I personally see the industry as part of the solution in health care and not, as some members do, as part of the problem. That is important to note.

It is also important to note that while I appreciate the member's efforts, there is really another issue that needs to be addressed. If we talk about the affordability of medications, our generic drugs in Canada are more expensive than generic drugs in the United States. It is because of increased competition in the U.S. There is much more competition there than here in Canada. So, I would like to end my remarks by talking about the need to look at generic pharmaceuticals and ensure that Canadians are not being overcharged for those products.

[Michael John Savage, Liberal, Dartmouth—Cole Harbour, NS]

Mr. Chair, I am pleased to have the opportunity to speak tonight on this issue. It is an issue that is important to me. When I came to this place last year, I sought out the health committee. It was the committee I really wanted to be on. I am proud that the Parliamentary Secretary to the Minister of Health is a Nova Scotian. It did not necessarily help me get on the health committee, but I fought to do so and am pleased to be on it for specific issues.

The official opposition critic on health will know my passion for the issue of a national wellness program, for example, and there are other issues that are important to me as well, such as caregiving and seniors. The issue we are discussing tonight is an issue that has a big impact on seniors, among other Canadians. It is a pleasure to have a chance to speak late this evening on this important piece of pending legislation.

On June 29 my colleague, the Minister of Health, on behalf of the government, announced the three prong strategy on cross-border drug sales that included proposed legislative and regulatory changes to safeguard the safety and the supply of Canadian drugs. I would like to speak briefly about those proposed changes to emphasize how they respond to concerns about this industry. They respond to the concerns of ordinary Canadians, Canadians from Dartmouth—Cole Harbour and across this country.

The security of our drug supply must be maintained. I think that when Canadians give it thought, they are concerned about the availability of drugs, particularly at times like this when there are concerns raised in the media and other places about specific health concerns like pandemics.

The measures that we are talking about are simply: a drug supply network, legislation under the Food and Drugs Act to restrict the bulk export of prescription drugs, and strengthening the food and drugs regulations to require that drugs be sold based on a prescription issued within an established patient-practitioner relationship.

The first measure to establish a drug supply network to be housed in Health Canada is essential for the federal government in order to have more comprehensive data to identify when or if a prescription drug supply shortage actually exists in this country. Such a shortage could be caused by exports to the United States or many other causes, such as manufacturing problems.

The growing importance of drugs in modern health care and the threat to Canada's drug supply through the potential legalization in the United States of bulk imports makes it necessary for the Government of Canada to have the capacity to introduce appropriate controls. It is essential that we know when shortages of essential health products such as drugs occur, so we can respond in an appropriate manner. Indeed, the health of our economy could be at risk at a time when the world is bracing for an overdue influenza pandemic. We must have all the necessary tools at our disposal in order to respond.

The second measure is export controls. They would only be implemented in response to a shortage or the risk of a shortage of a drug or a class of drugs essential to the health of Canadians that would only be maintained for a specified period or as the risk persists. We will respect our international trade obligations and investors can be assured that any actions under these measures will be reasonable.

The third initiative to strengthen the existing provisions under the food and drugs regulations is required, so that prescription drugs are sold pursuant to a prescription that has been issued within an established patient-practitioner relationship. The necessity for this measure has become clear as technological innovations such as the Internet, electronic prescribing, and telemedicine create new ways of linking patients with health care practitioners. These are important innovations for the health care system, but they also provide certain challenges and this is one of those.

Authorities responsible for regulating the practice of medicine will work to ensure ethical practices that are based on that established patient-practitioner relationship. I think most Canadians believe that this type of practical procedure makes sense. The patient-practitioner relationship is, after all, paramount to most Canadians in their experience.

I would like to take a closer look at the economics of the cross-border drug business with regard to the rise of Internet pharmacies. I acknowledge the inventiveness and the entrepreneurial spirit of our Internet pharmacies. However, we cannot forget that their business is based on an ancient and fundamental business practice known as arbitrage, which, in essence, is the old adage of buy low and sell high.

It is a fundamental tenet of our health policies that drug prices in Canada be affordable. This is increasingly important as pharmaceuticals replace many older forms of medical treatment.

Not so long ago, for example, ulcers were routinely treated with special diets, antacids and in the end, surgery. Then some scientists in Australia made the remarkable and unexpected discovery that ulceration of the stomach or duodenum was the result of an infection of the stomach caused by the bacterium H. pylori. The importance of this discovery is reflected by the receipt of this year's Nobel Laureates in physiology and medicine. Now we routinely treat such infections with antibiotics and avoid significant costs and intervention with patients and doctors and hospitals.

Many within the industry have attributed Canada's low drug prices to the Patented Medicine Price Review Board, the PMPRB, that regulates patented pharmaceutical prices. Most other developed countries in the world also regulate prices with a similar mechanism with the notable exception of the United States.

The PMPRB establishes the maximum price that can be charged by manufacturers for patented medicines sold in Canada to ensure that they are not excessive.Annually, it ensures that prices do not rise faster than the rate of inflation. Now on occasion manufacturers tend to set their prices internationally at a level that reflects the ability of the marketplace to pay. That is the relative purchasing power in different countries. In Canada's case these prices are often below the PMPRB maximum for marketing purposes.

Despite the sudden growth of cross-border drug sales since December of 2003, sales stabilized at about $1 billion Canadian retail per year, and Internet drug sales have declined from $617 million to $506 million over the past year. Currently, cross-border drug sales represent more than 8% of prescription drug sales in Canada, but less than 0.5% of the $300 billion U.S. market. Average savings to American consumers have fallen from 44% in December 2003 to less than 30% nationally. This is due in part to a strong Canadian dollar and to pharmaceutical manufacturers' restrictions on the supply of drugs to Internet pharmacies.

The recent decline also is due to the fact that Canadian Internet pharmacies are increasingly meeting U.S. demand indirectly through non-North American suppliers in places such as the U.K., India, and China where drug prices are often even lower than they are here. The top three Canadian Internet pharmacies source 50% of their product from Europe. These products do not flow through Canada and do not require approval by Health Canada. We should remember that these Canadian Internet pharmacies are businesses, not philanthropies, that are responding to market demand in the United States. If they do not, other foreign Internet pharmacies will fill that demand.

Another major constraint on the growth of these exports to the U.S. has been the refusal of pharmaceutical manufacturers in Canada to sell to those pharmacies which they have reasonable grounds to believe are exporting to the United States. A March 2003 ruling by the Competition Bureau in Canada determined that since cross-border sales violated U.S. laws against importing prescription pharmaceuticals, manufacturers had a reasonable business justification from restricting the export of Canadian products to sales contracts with pharmacies and wholesalers, so long as they continued to supply our market.

Ten manufacturers have limited the supply of their products to Canadian Internet pharmacies. While these manufacturers supply controls have caused concern for some that Canadians in general might face potential drug shortages, there is no evidence for this concern. Manufacturers have clearly indicated their intention to stop supplying export pharmacies but continue to ensure adequate supply for Canadians.

As well, pharmaceutical manufacturers' inventory levels in Canada continue to be at an all time high, double the level of three years ago, providing further comfort that the drug supply is okay. However, we do not want to rely solely on the current provisions to protect our access to affordable drugs.

In the U.S. 27 states and 19 municipalities are considering drug importation at various levels. Currently, there are bills before the U.S. Congress to legalize the importation of drugs for both personal and bulk rate. Given the relative size of our two markets, I think the health minister has noted that Canada cannot be a drugstore for the Americans. This has resonated strongly in Washington and in the U.S. media.

The government strategy to address the issue of cross-border drug sales has those three clear initiatives: first, a drug supply network; second, legislation to restrict bulk export of prescriptions; and finally, strengthening Canada's food and drug regulations to ensure that drugs are sold based on a prescription within that established patient-practitioner relationship. All of these are undertakings to safeguard the safety and supply of Canadian drugs.

We must continue to be sensitive to the economic dimension as we go forward, but we will move as a government to protect the drug supply of Canadians and we will ensure that our citizens have no reason for concern.

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

Mr. Chair, I thank the member for his presentation and his contribution at the health committee.

I am pleasantly surprised that his description of the industry, though there may be some differences in some of the specifics, is pretty accurate. Compared to some of the hysterics and questionable comments that we heard earlier this evening, the member is quite correct in the context of the argument.

For example, he recognizes that the industry has plateaued at about a billion dollars. It has not increased as what was claimed earlier. A lot of businesses have gone offshore, which is a point that I tried to make earlier tonight and seemed to be lost on some of the members across the floor.

When dealing with reasonable arguments, there is a lot of commonality in where the parties stand. I think we all agree that bulk exports are out of the question and that the appropriate safeguards should be in place.

I think the concern that exists goes to unintended consequences. We have not seen the proposal in its final form, but there seems to be room for concern about the fact that there are many situations where the patient does not see the doctor in a face to face situation. There are also concerns about provincial jurisdiction.

As a member of the health committee, could the member comment on why the minister has taken so long to act when clearly the health committee and the House have stated that bulk exports simply cannot be allowed?

[Michael John Savage, Liberal, Dartmouth—Cole Harbour, NS]

Mr. Chair, I thank the hon. member for his indication that we might have some meeting of the minds on parts of this. It leads me to believe I might have made a mistake, but that is not the case.

In terms of the health committee report, we all endorsed that. We all believe that this is an important thing. I believe it was June 6 that our health committee endorsed the resolution. There had been a previous one on February 3 by hon. colleague who asked me the question, indicating that the committee refrain from any action pertaining to the Internet pharmacy industry until the committee had fully studied the issue and submitted its recommendations to the House.

However, on June 6 we asked for action and on June 29 the minister moved. He is consulting in a way that is prudent and reasonable. He is ensuring that stakeholders are considered and he is balancing that with the need for action.

Therefore, I commend the minister and I think we can look forward to a common consensus when the bill comes before us.

[Robert Thibault, Liberal, West Nova, NS]

Mr. Chair, I thank the member for Dartmouth—Cole Harbour also for his comments. On a related subject, I know the member has been very much involved with the post-secondary initiatives and the post-secondary education caucus. He understands the question of how much effort has been deployed by the federal government in investing in research in Canada, in the universities and in the private sector and ensuring that there has been collaboration between the private sector and the universities.

The member made a great presentation about the drug for ulcers that was developed in Australia. He understands the role that can be played by the research field. Has he any thoughts on the question of research in pharmaceuticals in Canada?

[Michael John Savage, Liberal, Dartmouth—Cole Harbour, NS]

Mr. Chair, the parliamentary secretary talked about research and the investment that the Government of Canada has made juxtaposition with the private sector research that has been in place in Canada. When my colleague was the regional minister in the province of Nova Scotia, he was very involved in a large number of those research grants and investments in post-secondary education in Nova Scotia and Canada in general.

As most members in the House probably know, Canada has been hugely successful since 1998, investing in the range of $13 billion in publicly funded research through initiatives like CIHR and supporting granting councils like NSERC, SSHRC, and CFI.

Canada has become a leader, reversing the brain drain, bringing researchers back into Canada, not only repatriating researchers but keeping them here and bringing new ones here. When we look around the world, we see China and India, with populations over one billion people, investing heavily in research, innovation, technology and commercialization, it reinforces the wisdom of Canada's decision over the past five years. It also shows us the importance of keeping that up.

We have not had the level of private sector research that some other countries have had. We have been able to partner in a lot of cases. CIHR partners and leverages a lot of research money. Drug companies and others, some of whom are really responding to the challenge, would do well to keep Canada in mind, when they build their research plants, and continue to invest in Canada where a lot of their consumers are.

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

Mr. Chair, I am still looking for an answer as to why the bulk export portion of the health committee recommendation has been delayed. I think we would all agree that we would like to see faster action. The health committee stated that it wanted to study it in its entirety before the minister acted, but there was an issue about bulk exports so we decided that it should not be dealt with.

The member also indicated that the industry had plateaued and may even be in a decline. The urgency on the other issues is not there as it was on the bulk issue.

Would he be in agreement to have the health committee study this issue in conjunction with the consultations that are occurring? I also would like to assure the member that he did not make a mistake. I started to doubt myself too. Hopefully, we can get some progress on this very important issue.

[Michael John Savage, Liberal, Dartmouth—Cole Harbour, NS]

Mr. Chair, I would love to see our health committee work on a non-partisan basis as reasonably as possible. I certainly am prepared to work with it.

With all due respect, the health committee has been inundated with ridiculous motions on everything from asking the Prime Minister to appear before it and talk about why he wanted to get rid of the Canada Health Act, as per Sheila Copps' book, to recently proposing that Earnscliffe should appear and discuss why it received contracts with Health Canada. These motions were discussed in committee instead of important issues like the one we are discussing tonight.

If the health committee can play a role, I would be very much in favour of that. The motion was passed on June 6. It was brought up on June 29 by the Minister of Health. We recessed for the summer. It came back before the House and was passed on October 5. We are just barely past October, so we have acted expeditiously on this. The Minister of Health is very sincere and consistent and committed on this issue. I hope the entire House will support this when it comes before us.

[Ruby Dhalla, Liberal, Brampton—Springdale, ON]

Mr. Chair, I am pleased to speak to the issue of cross-border drug sales and the federal strategy to help ensure an adequate supply of safe and affordable drugs.

I am fully aware that quality, efficacy, supply and pricing of pharmaceutical drugs are important topics to many Canadians, including my constituents of Brampton—Springdale.

When we discuss this issue, one of the most troubling points is the way in which some doctors have begun co-signing some of the prescriptions for patients from the United States whom they have neither seen nor examined. As a former health care practitioner, this indicates to me a misuse of prescribing authority, encourages poor prescribing habits and is a potential threat to patient safety.

It has become apparent that some Internet based pharmacies do not require patients to visit a Canadian doctor to obtain a Canadian prescription. Instead, the Internet pharmacies are asking Canadian physicians to co-sign prescriptions for patients they have never seen. This practice has come to the attention of the government through the cross-border drug sales that are occurring. A prescription issued in the absence of an established patient-practitioner relationship raises significant safety concerns, regardless of whatever the originating circumstance is.

The principal motivation, from the research that I have done and that we have determined from this initiative, in co-signing cross-border prescription is to facilitate commerce and not to ensure patient safety.

Provincial and territorial colleges of medicine and other regulatory authorities are responsible for the practice of medicine and for ensuring that there is a patient-practitioner relationship. They have called the practice of co-signing prescriptions outside of an established patient-practitioner relationship disgraceful and unprofessional. I am sure that many Canadians and other stakeholders involved in this initiative will agree. These colleges and regulatory authorities have taken disciplinary against physicians who have engaged in this unfortunate practice.

From the federal government's point of view, the practice also raises questions about the quality of care and patient safety.

The food and drug regulations require, as a condition of sale, that prescription drugs be sold only if authorized by a practitioner who is licensed to practice in Canada.

Canada health care practitioners conduct a risk and benefit assessment prior to prescribing a drug to a patient. They meet with a patient. They evaluate the patient and then this forms the foundation of their clinical evaluation. This allows for an appropriate level of interaction to weigh the risks and the benefits of a patient using a particular type of prescription drug.

Fundamental to promoting the safe use of prescription drugs is a need to ensure that Canadians continue to benefit from the knowledge and the expertise of health care professionals who have gone to school for many years before those patients take prescription products.

This is why the Minister of Health is consulting with the Canadian public and stakeholders to discuss optimal implementation of a proposed regulatory amendment to the Food and Drugs Act. This proposed amendment would require that prescription drugs be sold pursuant to a prescription issued with an established patient and practitioner relationship.

Provinces and territories, as we all know, are responsible for the regulation of the practice of medicine and pharmacy. This responsibility has been delegated to them by the colleges and registrars of medicine and pharmacy in each and every province and territory in our country.

Provincial and territorial regulatory authorities have indicated that some Canadian health practitioners have begun co-signing prescriptions without ever undertaking an appropriate assessment of the patient. These bodies have stated that this practice is simply unethical and is not part of a sound medical practice on which many Canadian family physicians and practitioners pride themselves.

Thus, the dispensing of drugs that have been prescribed in this manner is of great concern not only to the regulatory bodies but to many other Canadians and this Minister of Health and parliamentary secretary.

The Federation of Medical Regulatory Authorities of Canada has stated that it is its position that physicians should only prescribe in the context of an established patient-physician relationship to ensure continuity of care and to ensure that appropriate information is transmitted to the patient. This includes telephone prescribing, Internet prescribing, countersigning of prescriptions and electronic prescribing.

The Food and Drugs Act and the food and drug regulations set out very general prohibitions and provisions for the sale and the advertisement of drugs in Canada and their standard of manufacturing. These include very specific requirements for the sale of prescription drugs because of their inherent health risks.

However the regulations that are currently underway do not explicitly require, as a condition of sale, that a prescription be issued pursuant to an established patient and practitioner relationship.

The inclusion of a regulatory requirement for an established patient-practitioner relationship as a condition of sale of prescription drugs would complement and reinforce existing provincial and territorial rules and also enhance our federal regulations, standards and guidelines.

In doing so, the intention is to enhance the protection of patient safety in relation to the sale of prescription drugs. The co-signing of U.S. prescriptions by Canadian physicians has highlighted the need for us as Parliament and as a House to address this very important issue. The planned requirement would apply equally to all prescription drug sale situations. This is a very important topic that is of great concern to many Canadians and to the health care professionals.

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

Mr. Chair, I would like to quickly outline for the member the information that has been provided by the Internet pharmacies.

We have been told that absolutely no prescription medications are filled through the Internet without patients providing their personal health information and their medical history to the international pharmacy, along with prescriptions by fax or mail. The patient also must be under the care of a U.S. physician and must have had a physical within the past year. The information is then passed on to a Canadian physician and, if satisfied, a prescription that is medically appropriate is filled by the pharmacy. That is what has been indicated, for example, by the IPS pharmacies.

I would also like to ask the member about the situation in remote communities where it is not practical to have a face to face meeting with a physician, even for a simple refill of a medication. We are also dealing with nurse practitioners who have the ability to prescribe in certain cases.

I wonder if the member would comment on the potential unintended consequences of the minister's proposed legislation.

[Ruby Dhalla, Liberal, Brampton—Springdale, ON]

Mr. Chair, in regard to the established patient-practitioner relationship, as a former health care provider I can say that relationship forms the basis of clinical decisions that are made for evaluations of patients and the type of treatment that is proposed for a patient. It is completely unheard of for any individual who is a patient to not have an established doctor-patient or patient-practitioner relationship and receive consultation or treatment advice.

Regardless of which physician, and even though everyone is trained, whether they are in the U.S. or Canada, it is extremely vital, for patient safety and for their own individual direction in their particular program of care, that they see a physician one on one so their course of treatment and type of treatment may be evaluated.

I must commend the Minister of Health and the department for including provisions that will strengthen and ensure that there must be an established patient-practitioner relationship prior to having anyone co-sign a prescription. It is vital for patient care. It is vital for patient safety and it is of paramount importance in that particular individual's treatment.

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

Mr. Chair, the member for Brampton—Springdale brings a lot of important experience to the table having been a health care practitioner. I guess if one was one, one is always one. Although not practising now, she is practising on a policy standpoint and doing an excellent job at the health committee.

One of the elements that was mentioned tonight by the opposition members was the question of practitioners within our country who have foreign credentials and who are not licensed to work in Canada but who could help alleviate a lot of the problems of the wait list times. It is often frustrating for them to get their accreditation or they are underutilized in the health care system, if in it at all, while they are waiting.

I know the member has a lot of interest and has been doing a lot of work in the area. I would ask that she comment on the potential, the possibilities and what would be the next steps in dealing with the problem.

[Ruby Dhalla, Liberal, Brampton—Springdale, ON]

Mr. Chair, it has been a pleasure to work with the hon. member and, based on his experience, he has done a tremendous job of representing his constituents and has added a tremendous amount of value to the health committee.

He raises a very important topic in regard to foreign credential recognition. We are very fortunate that we attract the best and the brightest to come to Canada and to make Canada home for both themselves and their families. It is quite unfortunate, as I have said time and again, that when these individuals come to Canada to make it home for themselves and their families their qualifications are not recognized nor are they accredited. The recognition of foreign credentials is a vital issue, not only for the our productivity but also for our economy and the future prosperity of our country.

It was a pleasure to see the number of individuals in the House who provided support for the motion I brought forward in June for the creation of a secretariat for the recognition of foreign credentials. This secretariat would work in collaboration with stakeholders, such as the provinces, the territories and the regulatory associations, along with individuals who have been affected.

It also has been wonderful to see our Prime Minister and our Minister of Health address health care as a priority and provide substantial funds into this very important issue to ensure that doctors who do come as new immigrants are able to get the expertise, the knowledge and the skills they require so Canadians can actually have access to a physician.

I have spoken many times before about new immigrants but the issue of recognition of foreign credentials, especially in the area of health care and medicine, is also affecting Canadians who have been born and raised in Canada, who are not able to get into medical school here in Canada, who have graduated with great university degrees and done well, have gone abroad into other international institutions but have had great difficulty once they decide to reunite with their families.

I hope as we move forward with the assistance and the support of the Minister of Health and other ministers in cabinet and in the government, including our Prime Minister, that we will be able to make significant progress in this very important area.

The Minister of Human Resources and Skills Development just announced a few days ago that we will also be holding a summit in relation to foreign credential recognition. I hope, as a result of that summit, by working in collaboration with all these stakeholders, that we will be able to have some significant deliverables and that we will have the secretariat up and running so that Canadians, whether they are new immigrants or whether they are Canadians who have been born and raised here, do have their qualifications recognized and accredited so that we can have an increase in the number of doctors so Canadians who are looking for physicians and health care providers will have access to them.

[Dave Batters, Conservative, Palliser, SK]

Mr. Chair, I too would like to thank the member for Brampton--Springdale for her comments this evening. I respect her as a health care provider, the information she is able to share with us and the special insight she has regarding this debate.

I would agree with the member completely on the issue of foreign credentials and the need for Canada to have a system in place across the country recognizing foreign credentials. Currently it varies from province to province and it is really quite difficult. In my home province of Saskatchewan there are a number of excellent physicians from South Africa. This is a serious issue. In Saskatchewan we have the longest health care wait lists in the country, so anything that is going to contribute to shorter wait lists is welcome news.

One could debate who had this plan first. This was a pillar of the Conservative Party's plan for health care in the last election campaign. I know this is something that the leader of the official opposition believes in strongly and I am sure it will be a pillar of our policy again.

I was going to spare the member from any partisan comments but then she talked about the Prime Minister who in 1995 was the finance minister. She commended him because health care is a priority. In 1995 when the current Prime Minister was the finance minister, we saw health care cuts of $25 billion, so I would hate to see the cuts to something that was not a priority. That was absolutely frightening.

I would like to ask the member quickly about bulk exports. There is unanimity here tonight that bulk exports need to be stopped in order to protect the Canadian drug supply. Quite simply, given that the member for Yellowhead brought forward a motion that was unanimously passed in this House calling on the government to stop bulk exports, I am wondering if the member opposite could tell the House what luck, if any, she has had in discussing this issue with the health minister or with the trade minister to expedite the matter of banning bulk exports.

It is a very serious issue that Canadians are looking at very closely, to safeguard our drug supply. What success has she had in discussing the matter with the ministers and why has it taken so long--

[The Deputy Chair]

The hon. member for Brampton--Springdale, very briefly, please. We are out of time.

[Ruby Dhalla, Liberal, Brampton—Springdale, ON]

Mr. Chair, if I do not have a lot of time, I do want to say very quickly, bringing in partisan politics, that ensuring quality health care for Canadians across this country is a definite priority of the Prime Minister and the Minister of Health. That is why we have seen substantial investment in it.

From my time here in the House of Commons, we have seen that the legislation on the ban of the bulk exports of prescription drugs is moving very quickly through the House. It was brought forward June 6. The standing committee unanimously adopted a motion to immediately ban the bulk exports. On June 29 the Minister of Health announced a three-pronged strategy. On October 6 we launched public consultations. It is now the beginning of November and we are here discussing this very important issue. We hope by the end of November that our Minister of Health and the government will bring in legislation required to restrict the export of prescription and other necessary drugs to ensure safety and quality--

[The Deputy Chair]

Order. Resuming debate, the hon. member for Winnipeg North.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Mr. Chair, I am very happy to participate in this debate no matter how late it is. It is a critical issue that needs thorough discussion. A consensus from this place needs to be presented to the Minister of Health so we can finally see some action on a very important issue.

It is interesting that we have heard tonight that the government will be presenting legislation. It has talked about this for a long time. We are still waiting to see what that legislation and the package of initiatives will be to address the matter of cross-border sales of pharmaceuticals. Would it not be nice for once if the Minister of Health instead of saying that there was a problem and that the government was going to do something, actually said that the government is doing something and said what it is doing.

Let us put this in perspective. If there ever was an issue that identified just how ingrained that culture of dithering is, it would be on the matter of Internet pharmacies. This issue has been around for a long time. I went through my files and I have mail going back to 2003. Perhaps if I went back further, I would find there were concerns raised even before then.

Here we are three years later in a debate that is very important, but the government has dragged its feet and we are still waiting for legislation. Perhaps tonight we will actually generate some good suggestions for the minister. Perhaps he will make sure that he brings forward a package of initiatives that deal decisively and creatively with the problems we are talking about.

I am glad to participate in this debate because it is an issue that has very clear and strong importance for people in Manitoba and particularly in my constituency of Winnipeg North. The Internet pharmacy business is a major part of the Manitoba economy. It brings in sales in Canada of $690 million. For a province that is a big player in this area of the economy that is significant revenue. It is estimated that about 2,000 residents of Manitoba work in this particular sector of cross-border drug sales. There are many benefits for the economy. Some would say they are as high as $1 billion per year in terms of trade revenue.

It is a matter of significance to many people who work in this industry. Many of my constituents have expressed concerns about their future, about whether or not the jobs they now hold will be there in the future and whether they will be able to provide for their families in the future, given the concerns and issues that have been raised.

However, there is another side to the issue. It is not simply a question of business gains and job opportunities for Manitobans, or Canadians anywhere in the country for that matter. Whatever we do in terms of addressing the issue of cross-border sales of pharmaceuticals, we have to be comfortable and confident that our drug supply is safe, secure and affordable for Canadians, first and foremost. That is an absolute requirement for public policy changes in this area.

It is clear that whatever we do in this field, we have to ensure that we have a made in Canada solution to an international issue. We have to be sure that we do what is in the best interests of Canadians, what is good for our economy, what is good for people who depend upon a safe, affordable supply of drugs and what is good for our health care system as a whole.

I mention the last point because drugs are the fastest growing segment of our health care system. It is the most costly part of our health care system. It has in fact exceeded the costs incurred to our health care system by doctors' fees.

Knowing all of that, it is clear that we have a lot of work to do any time an issue like this is raised. In this case I want to be clear that I join with others in the House in commending the minister for taking some preliminary steps in banning the bulk export of drugs. I want to be clear that I join with others in the House in terms of his efforts regarding doctors having signing responsibility for prescriptions filled in Canada.

I want to mention a few other concerns raised by people in my constituency and in my province. Some pharmacists in Manitoba do not feel that all of their concerns have been addressed. They applaud the government for some of the initiatives taken but raise other concerns.

I put them on the table tonight because we still have time. We are not dealing with legislation yet. We do not have a package of responses from the government. Obviously, the government has taken three years to get to this point and it is still working on the package. Perhaps some of these suggestions will be useful.

I want to raise a couple of concerns presented to me by two individuals in Winnipeg, Manitoba. The first is a pharmacist by the name of Archie Orlikow who happens to be the brother of David Orlikow who was a member of Parliament for many years. Until very recently he held the record for holding office for the longest period of time on a consecutive basis. That record was recently surpassed by my colleague the member for Elmwood—Transcona who now holds that title and that honour and who is, as we all know, the dean of the House.

Archie Orlikow is a pharmacist who has been involved in this area for many years and was one of the pioneers of the Manitoba Formulary. He has been raising concerns about Internet pharmacies for years. He has been a regular voice in this place through his letters, faxes and e-mails. He has done an admirable job of bringing some very serious concerns to our attention. I want to mention a couple of those concerns and make sure that the Minister of Health includes them in his package of solutions.

First, Mr. Orlikow talks about the possibility of increased costs to consumers and to patients if we do not deal with the issue of cross-border sales in a decisive way. He says it is clear that Canadian price controls through the Patented Medicine Prices Review Board are working effectively but that there is some evidence of deductibles going up in pharmacare programs and some evidence of the cost of drugs rising as a result of this whole phenomenon of Internet pharmacies. He also talks about the additional cost to traditional pharmacies that are trying to compete with the fairly massive Internet pharmacies that are able to compete for trained pharmacy personnel. That is one concern.

The second concern has to do with the availability of prescription medications. Archie Orlikow and Charles Cruden, the other person who signed the letter, indicate that there may be some evidence of some prescriptions not being filled completely because of a short supply. They question why that is and how we ought to address it. They say that some prescriptions are not available and there is a necessity sometimes to substitute another medication and they give some examples. They also say that it has been reported that prescribed medications are being purchased from different countries and they want to be sure that Canadians are receiving authentic medications.

The final area of concern has to do with patient safety and physician ethics. The authors of this letter acknowledge the promise made by the government to actually require Canadian doctors to have signing responsibility for prescriptions filled in Canada, but they raise questions for example with the communication for prescriptions by electronic means, how can there be assurance that the request is bona fide.

Mr. Orlikow raises questions around prescribing medications that are being purchased from different countries and how Canadians can be sure they are receiving authentic medications.

He raises these issues looking for assurances from a government that ought to have a complete handle on the question of safety and affordability of medications, because they are vital for the health and well-being of so many in our society.

It is such a centrepiece of any kind of health care prevention model that we have to be absolutely clear about any impact of a policy pertaining to Internet pharmacies. We have to be absolutely certain that we have done our utmost in Canada through our federal government to ensure that safety of all drugs is guaranteed, that there is no shortfall in supply and in fact that Canadians will never have difficulty accessing the drugs they need when they need them.