Colin Carrie

[Emergency Debate, March 12th, 2012]

Mr. Speaker, I am sharing my time with the member for Kildonan—St. Paul.

I am pleased to be taking part in this important debate this evening. I believe that all members' constituents have expressed their concerns about the drug shortage by email, telephone and even fax.

Some have family or loved ones who worry about possible delays in needed surgery. They are unhappy about the scope of the shortage. Understandably, people want to know how this happened. They want to know what is being done to fix the problem.

This evening the government will address all aspects of this complex and frustrating situation. We have just heard the Minister of Health lay out the broad strokes of action she is taking to help address the shortage. I would like to express my deep appreciation for her, for the work she has done to make drug makers like Sandoz and drug purchasers live up to their responsibility to do better and to prepare better for shortages.

I know that she and her officials have worked 24/7 to help solve the drug shortage issue since suddenly learning about it a few weeks ago. Before we can understand the proper role of the federal government on drug shortages, I think it is important to understand the basics of drug approval and supply in Canada.

The federal government's main role is to ensure that drugs purchased or sold in Canada are safe, effective and of high quality. Once Health Canada has approved a drug, the manufacturers and buyers are free to enter into commercial contracts for its supply. The terms of these contracts—cost, quantity, rate of use, number of suppliers required, distribution and penalties for failure to supply—are all agreed to by the buyers and the suppliers.

Provincial and territorial health authorities have set up bulk buying groups to buy drugs for patients. This model has worked for provinces and territories because it has maximized their purchasing power and price leverage over suppliers. It has worked for suppliers because it means they do not have to negotiate separate deals with each government, health authority or hospital.

The federal government has no involvement in or knowledge about the nature of these arrangements. Indeed, one would wonder how the provinces and territories would react if the federal government tried to dictate to them any terms of these private, commercial arrangements.

The most important consideration in any shortage situation is the needs of the patients. Doctors and pharmacists need enough advance notice of a shortage so that treatment plans for patients can be smoothly adjusted if needed. When production and distribution of medically necessary drugs is interrupted, a drug maker is the first to know that a shortage is about to happen. This means it will not be able to fulfill the terms of its supply contracts. The drug maker is responsible for advising its health care customers in advance what drugs are affected and how long they may be in shortage.

Drug makers must also identify alternative supplies that can make up the shortfall to customers. This may be found within their own operations or from other suppliers that make similar drugs in Canada or in other countries. The drug maker must also come up with a plan to solve the problem that caused the shortage in the first place. When supplies are interrupted, hospitals, clinics and health professionals must implement strategies to ensure the most efficient use of existing supplies and to minimize the impact on patients. They keep patients advised of the supply situation in each facility and community and adjust treatment schedules and procedures if required. If a shortage is significant and long in duration, alternative supplies may be sought from drug makers within Canada or in other countries.

Once we understand the basic facts of how drug purchasing and supply works, then the proper role of the federal government in any shortage situation is clear and logical. When there is a shortage, Health Canada, consistent with its mandate and authority, works closely with purchasers and suppliers to ensure any new supplies of needed drugs are safe, effective and of high quality. Health Canada has a variety of tools available to help do this. It works closely with companies so they can quickly resolve manufacturing, quality and distribution issues. It works with manufacturers to ensure alternative suppliers, changes in manufacturing processes or locations can be reviewed and market authorized on a priority basis. It ensures all necessary licensing requirements are met. It works with international counterparts, such as the U.S. Food and Drug Administration, to identify additional sources of supply and to share needed safety and quality information. It provides priority access to alternatives on an emergency basis.

Health Canada will use the right tool for the situation at hand. The time required for each will depend on the specific request, but Canadians can be assured that Health Canada responds on a priority basis.

Health Canada is expediting authorization processes during the ongoing Sandoz shortage, but safety will never be compromised. The last thing anyone wants is for patients to be harmed by unsafe drugs authorized in a rush to fill supply gaps. A team of departmental experts has been assigned to deal with shortage requests. They are providing fast, real-time guidance to purchasers so they have a clear understanding of the safety information needed when a new source of supply is found. Through the various networks supported by the health portfolio, Health Canada is bringing together purchasers and companies to exchange the latest supply information and to foster pan-Canadian coordination of the shortage response. Through co-operative relationships with other trusted regulators, such as the U.S. Food and Drug Administration and the European Medicines Agency, Health Canada has ready access to the wealth of information that will help expedite approval of foreign sources.

One of my colleagues will be addressing the recent and growing global nature and impact of drug shortages a little later on. Despite the ample evidence of this phenomenon, we have not seen a parallel increase in the systematic sharing of shortage information or advance contingency planning on the part of drug purchasers or suppliers. Purchasers express surprise and frustration at shortages that have appeared to have come up out of the blue. Rather than seeking multiple sources of product as a cushion against supply interruptions, we have seen a greater reliance by them on fewer suppliers. Sandoz, for instance, has been allowed to become the sole or dominant supplier of many critical medications. Producers do not appear to have done any real work to identify alternative sources in advance, even though they are fully aware of the global supply constraints.

I cannot say why this state of affairs has been allowed to develop, but the bottom line is that in a shortage situation there is no substitute for information. The right information needs to get in the right hands at the right time. This means doctors, pharmacists and patients getting enough advance notice from manufacturers so that treatment plans can be smoothly adjusted if needed and if possible. That is why the Minister of Health has been encouraging companies to fill information gaps around actual and potential drug shortages and make it a top priority.

Health Canada's collaborative work with industry has paid off. It has resulted in a commitment by Canada's research-based pharmaceutical companies and the Canadian Generic Pharmaceutical Association, of which Sandoz Canada is a member, to collect information from member companies on current and impending drug shortages. They have committed to communicating this information to Canadians on two existing public websites on drug shortages.

Industry, together with health professional associations, have also committed to the development of a national one stop drug shortage monitoring and reporting system in 2012. The minister commends companies that have stepped up to provide more information.

However, she is disappointed, and with good cause, that Sandoz Canada has not met this commitment in the current situation.

The government is disappointed with the lack of clear and timely information that Sandoz has provided to Canadians about this serious shortage. The company knew months ago that it was coming, but it did nothing to find other supplies until very recently and it only advised customers and Health Canada about the extent of the impending shortage a few weeks ago. I am cautiously optimistic that Sandoz has heard our concerns about information sharing and making information available as soon as possible to provinces, territories and medical professionals.

While Health Canada officials were speaking with Sandoz about possible disruptions in light of the FDA warning letter, requests for specific details about which drugs would be affected were not responded to. Today the company has said that it is responding to the Minister of Health's concerns about transparency, committing to share information about potential future drug shortages 90 days in advance.

I want to encourage Sandoz by saying that if the company were to take this step, it would go a long way to rebuilding trust that patients need for the company to be successful in the long run.

[Emergency Debate, March 12th, 2012]

Mr. Speaker, I have been paying attention to the speeches this evening. I found one of the comments from my colleague, the member for Brampton—Springdale quite interesting. He said everyone in the House understands the difference between federal and provincial jurisdiction. Listening to the speeches tonight, I do not think that is true. It is obvious, for anyone who knows the jurisdictional issues, that Health Canada has a regulatory obligation to approve drugs sold in Canada, determine the appropriateness of the drugs to be sold in Canada and ensure that where the drug is manufactured is safe.

We have been hearing this evening that we should be regulating, regulating, regulating. However the truth is we cannot really regulate supply. We cannot mandate supply. I was listening to my colleague talk about reporting. We have a voluntary system in place and we are monitoring that. I wonder if he could explain to us what the federal Liberal regulations would look like so that Canadians would know?

[Health, March 12th, 2012]

Mr. Speaker, we are taking leadership, but I think the NDP members need to talk with one another, as they do not seem to be on the same page. As a matter of fact, at the health committee last week the NDP member for Chicoutimi—Le Fjord filibustered and prevented the committee members from voting on a motion to look at this issue. Perhaps the hon. member opposite could discuss how we as parliamentarians are taking the issue very seriously and suggest that her colleague vote with us next time.

[Health, March 12th, 2012]

Mr. Speaker, if you read between the lines, it is clear that the NDP does not understand provincial areas of jurisdiction and wants to encroach on these areas.

This shortage is a result of provincial decisions to have sole source agreements. They sign these agreements, not us.

The Minister of Health is taking steps to help the provinces with this issue. Health Canada is going to assist the provinces and territories to identify alternative companies and fast-track the approval process.

[Purple Day Act, March 9th, 2012]

Mr. Speaker, I will start again.

Mr. Speaker, I am pleased to speak today about Bill C-278, which was introduced by the hon. member for Halifax West.

This bill seeks to establish March 26 as Purple Day in Canada, helping to raise awareness of epilepsy. On March 26 we can encourage people to wear the colour purple to show their support for people living with this disease.

This is an idea that all of us can support.

It is an area in which we all play a role, whether it is through raising awareness, learning about the disease or working with government colleagues and stakeholders on important programs, activities and research. For my part today, I would like to take a few minutes to tell the House more about epilepsy and the federal government's role, including its initiatives, programs, research and support.

The government is committed to promoting and protecting the health of all Canadians. Those living with epilepsy face challenges on a daily basis: discrimination, stigma, and at times a lower quality of life. The incidence of epilepsy continues to increase with diagnosis now more common in children and older adults.

There is no cure for epilepsy. The major form of treatment is long-term drug therapy, which bears its own side effects and costs every day for those suffering and their families. We now know that people living with epilepsy are often able to live normal, happy and full lives. Most go to school, make friends, date, have jobs and raise families. However, routine tasks and everyday life can still be very difficult. Whether it is coping with the negative stigma and reactions associated with unpredictable seizures or dealing with low self-esteem, self-confidence and depression, people living with epilepsy do not have an easy life, but by raising awareness of these kinds of facts, for example, what it is like to live with epilepsy, we can help affected Canadians reach their full potential.

There is much we do not know, but we do know that symptomatic epilepsy has known causes. Brain damage, head injuries, infections and tumours all contribute to this condition. Although not all of these issues can be prevented, precautions can be taken to lessen the chances of injury. This government is investing in efforts to raise awareness and shed light on this condition, including steps that can be taken to reduce risks and prevent injuries.

Before we get into the details, it is important to understand the terminology.

Epilepsy can be separated into two types: idiopathic epilepsy and symptomatic epilepsy. Idiopathic epilepsy accounts for 60% of cases. It cannot be prevented and its cause is unknown. Symptomatic epilepsy is caused by trauma to the brain, and steps can be taken to prevent it.

I would like to focus on the latter as it represents a key area in which all sectors of society can play a role. Why? For selfish reasons. I believe this is the cause of my own epilepsy, but also because injury prevention begins with all of us.

According to the Canadian hospital injury reporting program, almost 50% of all injuries in children between the ages of 10 and 19 are play related. Additionally, 40% of all reports are attributed to injury through the participation in team sports such as hockey, baseball and soccer. Between 2000 and 2002, skull and brain injuries related to team sports made up almost 15% of all reported injuries, with almost 5% of these cases requiring hospitalization.

This government is committed to reducing that incidence. For example, $5 million has recently been allocated to address sport and recreational injuries among children and youth through the active and safe injury prevention initiative.

This initiative focuses on raising awareness of the importance of safety and precaution in sports and recreation activities while encouraging children and youth to be active.

As part of the active and safe initiative, in January 2010 the Government of Canada announced approximately $1.5 million in funding to address the prevention of brain injuries and concussions in hockey.

ThinkFirst Canada, in partnership with Hockey Canada, the Coaching Association of Canada and the Canadian Centre for Ethics in Sport also continue to make significant headway.

Epilepsy Canada, founded in 1966, is a non-profit organization whose mission is to enhance the quality of life for persons affected by epilepsy. Through promotion and supportive research, education and awareness initiatives, this organization is building understanding and acceptance of epilepsy.

The Canadian Epilepsy Alliance is a Canada-wide network of grassroots organizations dedicated to the promotion of independence and quality of life for people with epilepsy and their families. It provides support services, information, advocacy and public awareness, and is working to make a difference for those living with epilepsy.

Working together to develop shared resources, they have standardized protocols for the prevention of head injuries and activities that target sports organizations at all levels. This includes team sports participants, their coaches, trainers and parents.

In order to make its own programs work, the government relies heavily on research and surveillance. For this reason, $15 million has been allocated to the national population health study for neurological conditions to strengthen the knowledge and evidence base related to this condition.

Along with other neurological disorders, this study will examine the prevalence of symptomatic epilepsy and emerging risk factors, identifying trends in preventable injuries so that an appropriate response can be developed.

It is a suite of studies aiming to fill gaps in knowledge about individuals with neurological conditions, their families and their caregivers. The studies are administered by the Public Health Agency of Canada. They will provide key information to improve current knowledge about the incidence and prevalence of neurological conditions.

Some will study risk factors for the development and for the progression of neurological conditions. Others will investigate the use of health services by patients with neurological conditions, identify gaps in those services and recommend improvements. Finally, they will assess the impact of neurological conditions on individuals, families, caregivers and communities.

In addition, the Government of Canada funds research into new treatments for epilepsy, notably through the Canadian Institutes of Health Research, CIHR.

Since 2006, CIHR has invested more than $46 million in epilepsy research to deepen our knowledge of this disease. This research investigates how genetics affect the development and treatment of epilepsy. It examines how epilepsy affects development in children, and it attempts to develop interventions to benefit the quality of life and care for people living with epilepsy.

In addition, McGill University's Montreal Neurological Institute and Hospital is examining the link between brain conditions and epilepsy.

CIHR also provided funding for the brain connectivity workshop in June 2011. This workshop brought together leading Canadian and international experts on brain development, epilepsy and neuroscience. These are partnerships that will enhance our relations with Canadian scientists and researchers in Canada and will focus attention on important health concerns. The resulting research will help us to better understand epilepsy, its causes and possible interventions.

Research funded by CIHR will improve our understanding of this complex condition, our capacity to respond effectively, and the quality of life of those living with epilepsy. Improving our understanding of the disorder will facilitate the development of treatments and better drug therapy regimens for epilepsy.

The Government of Canada is committed to these goals. Regardless of the specific area, it is critical that we work together with all sectors of society. To be fully successful in preventing secondary epilepsy through the promotion of injury prevention, our efforts must be shared and be collaborative in nature. Encouraging and supporting the work of partners and stakeholders to address symptomatic epilepsy and its causes is one way we can do just that. For example, many municipalities across Canada are making it mandatory for children and beginners to wear a certified multi-impact helmet during public skating sessions.

By working with others and taking responsibility at all levels, we are better able to prevent serious head injury and reduce the potential for secondary epilepsy. However, governments and stakeholders cannot act alone in injury prevention. We all know well that the most effective strategy for reducing any injury is to take personal precautions. According to research, many head injuries are the result of improper playing techniques and can be prevented or reduced by teaching proper skills and enforcing safety-promoting rules.

Improved conditioning, particularly of the neck; protective head gear; and careful medical supervision also minimize the risk of head injury or trauma. By encouraging and supporting the use of proper safety equipment and training, we can all greatly reduce the risk of injury and, subsequently, consequences such as symptomatic epilepsy.

By learning more about the impacts of epilepsy, we will gain reliable information on its effects on Canadians. Knowledge is power, and through that knowledge we can build awareness of this important disease.

Bill C-278 would be an important step forward toward raising awareness of epilepsy in Canada. It would be a clear sign of our support for those living with this challenging condition.

[Purple Day Act, March 9th, 2012]

Mr. Speaker, I want to thank my colleague from Halifax West. As he knows, as a young child I was quite clumsy. I had an injury which brought on epilepsy. I was one of the kids the member is trying to raise awareness of. He is trying to help Canadians understand the stigma. When people see someone with epilepsy having a seizure, they do not know what to do. There can be serious consequences for those of us who have suffered seizures.

I wonder if the member could comment on some of the things that the different groups working with epilepsy are doing to help raise awareness in the communities. He brought forward some examples at committee. Could he comment further?

[Purple Day Act, March 9th, 2012]

Mr. Speaker, I am pleased to speak today about Bill C-278, which was introduced by the hon. member for Halifax West.

The bill seeks to establish March 26 as Purple Day in Canada, helping to raise awareness of epilepsy in Canada. On March 26, we can encourage people to wear the colour purple to show their support for people living with this disease.

[Safe Streets and Communities Act, March 9th, 2012]

Mr. Speaker, my colleague from Edmonton—St. Albert made an excellent speech. He has done a lot of good work on this. I think I will use his speech when explaining this issue to my constituents. What we have heard from the NDP is the shameful rhetoric that the opposition parties are putting out on this very important bill.

I am a chiropractor, and I had many patients who were addicted to different forms of drugs. They told me over and over again to do what I can because it is a slippery slope, that people start taking drugs and once they are addicted it is extremely difficult to get off them. That is why we as a government are focusing on stopping people in the first place.

I was wondering if the member could take a few minutes to clear up some of the misinformation. I know that in my constituency of Oshawa people are listening to the rhetoric and saying that we are going to be putting in jail kids who are found in their basement with a couple of joints or a couple of marijuana plants.

Could he reiterate the facts so that other members of the House are able to communicate with their own constituents about this important issue?

[Health, March 9th, 2012]

Mr. Speaker, the question was factually incorrect. The reality is, and I will repeat, the shortage results from decisions by the provinces to sole-source the drug contracts. They signed the contracts, not us. The minister will be working consistently with the provinces. We need to address this shortage and work together. Other provinces are working together with us.

As far as Sandoz is concerned, it should not have withheld information from the provinces and territories for as long as it did, which has made the situation worse. It is responsible for managing the safe supply of its products in Canada and for taking steps to prevent supply interruptions that could lead to shortages.

[Health, March 9th, 2012]

Mr. Speaker, I appreciate the member's bringing this question forward because the shortage does result from decisions by provinces to sole-source drug contracts. The Minister of Health is taking action to help the provinces address these shortages. We are working 24/7. Health Canada is helping the provinces and territories identify alternative suppliers for these drugs and we will fast-track approvals if required.