Health committee  In terms of medicalization, what I mean is the provision of medical care--and it plays out particularly in terms of drug treatment--for people who actually don't have an illness, or who are in a situation where they're dealing with normal life, and where there isn't evidence that giving what they have a diagnostic category, a diagnostic name, and then treating it with drugs is actually going to provide a health benefit.

Health committee  It's just that Lichtenberg's research is based on lousy methods. Nobody quotes it outside the pharmaceutical industry and pharmaceutical funding. If somebody gets morphine near the end of life, that's considered an older drug and therefore more likely to kill them. If they get an allergy drug when they're not near the end of life, that's considered something that's life-saving.

Health committee  I would like to add a note on innovation and patent protection. What we're seeing more and more is the patenting of what are called isomers of existing molecules. The molecule has two orientations in space. The patent is due to expire and a new drug, which is one of the orientations in space of the same molecule, but with a very different brand name, is then produced by the same company.

Health committee  There are some numbers bandied about that have been highly contested, and that keep going up, of about $1 billion. But that's based on a tiny proportion of drugs and on factoring in about 40% to 50% opportunity costs. So just the idea that at the top of the stock market bubble, the money could have been spent elsewhere....

Health committee  In Canada currently, if it's on the market, the physician has the right to prescribe it. That does not mean, for instance, that as taxpayers we would necessarily say that we would reimburse that particular product.

Health committee  To go back to the COX-2 inhibitor story, for instance, you're also looking at a situation where part of the information was actually kept from doctors in terms of the outcomes of those drugs on their patients. What I would say is that if you are looking...I think both the doctor and the patient should have a right to access the full information on the safety and effectiveness of the products that are being prescribed and used, in order to make sure they can actually get the best health outcomes out of them.

Health committee  None.

Health committee  I haven't seen modelling on the effects of direct-to-consumer advertising in Canada. There certainly have been a number of studies in the U.S. The National Institute for Health Care Management, for instance, looked at annual increases in retail drug costs. They found that approximately half were due to the 50 drugs that were being advertised to the public--this was between 1999 and 2000--and the other half were due to the 10,000 additional other drugs.

Health committee  I just wanted to respond a bit on the so-called rationing question. I think there's an assumption here that a new drug is necessarily going to be better than what existed before, and that certainly does not hold up to the evidence. If you look at large series of evaluations of new drugs, only a very small minority are actually breakthroughs that make a significant difference to health.

Health committee  I haven't been consulted more recently. My understanding is that many of the issues that Ingrid Sketris has just raised in terms of needing to put many more resources into post-market surveillance and to ensure that there is a less piecemeal process in place in terms of supporting better quality use of medicines and better quality prescribing is something you'd expect out of a national pharmaceutical strategy.

Health committee  I certainly haven't seen the final document or the final plans that are coming out. There was a broad consultation meeting that Health Canada held in September--or something of the sort.

Health committee  Thanks very much for inviting me to speak to you today. The focus of my remarks is going to be on direct-to-consumer advertising of prescription drugs. In the health committee's April 2004 report, “Opening the Medicine Cabinet: First Report on Health Aspects of Prescription Drugs”, this was one of three key issues addressed.