Health committee  Currently under the system in the province in which I practise, which is Newfoundland and Labrador, it only compensates you for face-to-face patient contact at a provincial level under the care plan. It is not unreasonable, I don't think, to adopt a graduated approach. If you have to spend a lot of time and effort providing copies of your charts, perhaps even looking up blood work and these sorts of things to provide information, that time and effort should be recognized.

Health committee  I think it's a balance, as with most things. If you look at the pharmaceutical industry and the licensing requirements for Health Canada, that negotiation could take place with protections for trade secrets and these sorts of things, provided the experts at that level were fully informed.

Health committee  Mostly, I get them by fax or snail mail, as my daughter calls it. Occasionally our college will promulgate an alert it has received, but it's very variable. The other problem I have is that when the alert arrives it doesn't mean anything to me, necessarily. Take, for example, the tragic case of that young lady, Vanessa, who had cisapride.

Health committee  Thank you. My electronic access to a patient's drug record is the telephone and the fax machine, if I cannot find what I need from the patient, and sometimes you can't because the patient will be in a condition that renders them not able to give a good account of themselves and there may not be any caregiver who's aware of their current situation.

Health committee  It would be a huge quantum leap in safety for the patient—there is absolutely no doubt about it—once you have that mechanism in place simply to tell me what they're on and what they're taking. They don't always take their medication, but if I know that they've not had a refill on one particular medication for six months, I can probably assume they may not have been taking it.

Health committee  If you look at primary care in the United Kingdom, you'll find that a vast majority of family practitioners, certainly in urban areas, have e-prescribing and electronic medical records. In some jurisdictions they don't actually give a written prescription. The patient has their pharmacy on record, the button's pressed, and the prescription goes directly there, so it's being filled while they're still leaving the surgery or making their way out.

Health committee  I think Dr. McCallum's points are well made. I think the reporting bias would work in favour perhaps of over-reporting of severe problems, but at the other end, you'd get very much an under-reporting of minor side effects. One of the issues for a practising physician is how to find out what a side effect is.

Health committee  I wouldn't dream of saying such a thing, sir. But you see what I mean about context and utility? It's practically a waste of the 20 minutes to look it up. If you have someone who's ill, then you will use any source you can. Quite honestly, as a little bit of an older physician, I would say my practice has changed dramatically in the last five years; I've stopped using this book.

Health committee  The issue of reporting an adverse event has been very cumbersome until lately. It has improved with Health Canada's MedEffect. Having said that, I would suggest that probably 60% of my colleagues aren't actually aware of its existence, even though it's been up and running for a while.

Health committee  We all have Newfoundland accents.

Health committee  The answer is that at the moment, the data doesn't exist in any usable way for this country. One of the things our proposal might do is to address that in terms of getting proper prevalence data. We would see the post-market surveillance system with reporting from physicians as a trigger, which would then be taken by centres of excellence to do proper epidemiological studies.

Health committee  Yes, essentially.

Health committee  No. We as an association think that is a nice outline of the system. We see the post-marketing surveillance very much as part of a process that begins with initial clinical trials and evaluation and the licensing of drugs, and then moves through the product cycle to keep an eye on what happens once these things are out there.

Health committee  You're right, there is a huge knowledge gap. The bulk of the information about pharmaceutical agents that the average practitioner receives comes from the pharmaceutical industry directly just because of ease and convenience. That's what the drug companies do. That's how they operate.

Health committee  I think everyone's looking at me. I think there are a couple of very important points here. One is medication error. Medication issues have been highlighted in other jurisdictions, and in the Baker and Norton report, as a major issue. I think I will just put that point to the side and concentrate on Madame Gagnon's initial point, which is about off-label use.