Steven Fletcher

[Cross-Border Drug Sales, November 1st, 2005]

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.

[Cross-Border Drug Sales, November 1st, 2005]

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.

[Cross-Border Drug Sales, November 1st, 2005]

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?

[Cross-Border Drug Sales, November 1st, 2005]

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?

[Cross-Border Drug Sales, November 1st, 2005]

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?

[Cross-Border Drug Sales, November 1st, 2005]

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.

[Cross-Border Drug Sales, November 1st, 2005]

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.

[Cross-Border Drug Sales, November 1st, 2005]

Madam Chair, I would like to clarify a few points the member made, dealing with imports from the United States.

A few bills were introduced in the House of Representatives in 2001. Each of these bills have failed to become legislation. The most recent bill, the pharmaceutical market access act, 2005, has garnered some attention, both north and south of the border. There was a recent proposed amendment to the bill in the fiscal year 2005, an agricultural appropriations bill. Although anything is possible, it is unlikely that the amendment or the bill will become law.

President Bush stated on September 20 that he would veto any agricultural appropriations bill that would permit the reimportation of prescription drugs into the United States. As a proactive measure, the international pharmacy trade associations in Canada has publicly supported a ban on public sale of prescription drugs from Canada.

The Conservative Party introduced a motion to the same effect, which passed through the health committee and the House. It was the Conservatives who raised the issue of bulk exports and that it should not be allowed. On that we are agreed.

Does the member recognize the harm, the unintended consequences that could be caused if physicians and patients are forced to have face to face meetings? There are numerous situations where it is not practical due to the geography in Canada, due to patient immobility and due to regular refills. Could the member could comment on unintended consequences?

[Cross-Border Drug Sales, November 1st, 2005]

Madam Chair, I agree with the member on the issue of medical graduates. There is no question about it. This government has allowed the situation for medical graduates to become a crisis situation.

I think the member and I would both agree that education is the best investment society can make in an individual and the best investment an individual can make in themselves. Certainly an education in the medical profession is a great way to spend one's life and contribute to Canadian society.

I do have one question for the member. Would she agree that the Liberal Party has failed abysmally on this issue and also that it is the party that is responsible for the medical graduate shortage? That is one question.

I wonder if the member would also agree that there are situations when a patient is unable to see the doctor. I know that after my accident there were times, due to other factors like getting proper attending care and so on, that I was not even able to get out of the bed but I needed prescriptions. I did not see the doctor but I was able to get the prescriptions. There may be issues such as that of a nurse visiting a patient living in a care home. The patient is obviously ill, the nurse phones the physician and the physician may or may not talk to the patient.

I wonder if the government has considered those types of scenarios. I wonder if there are situations in remote communities where nurse practitioners often have authority for prescriptions. I wonder if the member is concerned about unintended consequences on the third plank that the government is proposing: that there must be face to face consultation. In many cases, it just not practical.

Could the member comment on those points?

[Cross-Border Drug Sales, November 1st, 2005]

Madam Chair, I have to say that my colleague seems to be very well-researched on this issue and has raised a number of excellent questions. I wish the Minister of Health would be so informed.

The distinction between bulk and retail is very important. The member has raised the issue of the legality of this industry, the fact that it is a legal industry and it has occurred under the government's watch. Implicit in the member's comments was the hypocrisy of the government on this issue. On one side, it says that it is unethical. If we use the government's logic, this unethical practice has occurred under the Liberal watch for the last 10 years. Therefore, have the Liberals been condoning unethical practices for the last 10 years? The hypocrisy is really quite something.

Again according to a Winnipeg Free Press article in February, the President of the Treasury Board, the Manitoba political minister, actually supports what I have been saying all along.

It is too bad the Liberals contradict each other on this issue. I would like to talk about it more later.