HEAL Committee Meeting

STANDING COMMITTEE ON HEALTH

COMITÉ PERMANENT DE LA SANTÉ

EVIDENCE

[Recorded by Electronic Apparatus]

Wednesday, February 4, 1998

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[English]

The Chair (Ms. Beth Phinney (Hamilton Mountain, Lib.)): We're starting the meeting today a little early because we have a vote, which means we're probably going to lose an hour out of the middle of today's meeting. Our witnesses are here, so we're going to start.

This is the 13th meeting of the Standing Committee on Health on the study of natural health products. We have two groups of witnesses. From HerbTech Inc. we have Ken Broadfoot—welcome—and from the Toronto School of Traditional Chinese Medicine we have Dr. Mary Wu, whom you have met before.

Dr. Wu, would you start first. You look as if you are more settled. Please introduce the people with you.

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Dr. Mary X. Wu (Director, Toronto School of Traditional Chinese Medicine): Good afternoon, ladies and gentlemen. I would like to introduce to you Doctor Li, who is a medical doctor from China and is also a Ph.D. specialized in doing research in acupuncture using modern technology; and Mr. Cheung, who is a businessman, the general manager and owner of Kwok Shing Enterprises Ltd.

First of all, I would like to say thank you to all of you here for paying attention to our presentation and listening to our explaining and to our complaining as well. When we used to talk to TPP or Health Canada our voice was heard, but we were crying to our mothers. Sometimes our mother just does not listen—so we see that today we have this opportunity to cry in grandmother's arms and to complain so that hopefully we can have problems solved.

Because time is so short, I'm going to cut off some of my explanations and try to make my presentation as short and as clear as I can. I'm going to give you a little bit of an idea about the characteristics of the traditional Chinese medicine as well as traditional Chinese herbal medicine, and then I'm going to get into some of the problems with the regulation of traditional Chinese herbal products in Canada and also give preliminary recommendations on how to properly regulate traditional Chinese medicine.

The history of traditional Chinese medicine is over 5,000 years old. It is an integral part of Chinese culture and philosophy.

Traditional Chinese medicine is a distinct and complete medical system, with unique fundamental theories, diagnostic methods and treatment remedies. Traditional Chinese medicine includes Chinese herbal medicine; acupuncture; and Chinese massage, known as tuina—this is not heard of by the public very often.

Traditional Chinese medicine was formed through long-term clinical experience in preventing and treating diseases. The essence of traditional Chinese medicine has been documented in hundreds of text books.

Traditional Chinese medicine has made significant contributions to the health of Chinese for thousands of years and also to people all over the world for centuries. It has been recognized and accepted by many countries in the world recently. More and more Canadians are turning to complementary medicine today, including Chinese medicine.

What is so special about traditional Chinese medicine is the characteristics of traditional Chinese herbal medicine. Like acupuncture, Chinese herbal medicine is one of the major components of traditional Chinese medicine.

When we talk about traditional Chinese herbal medicine, we're not only referring to the medicines that are of plant origin. It includes animal as well as mineral ingredients.

The majority of Chinese herbs are used in combination. It's a rarity that we only use a single herb for certain conditions. Usually there are two, three, or even ten or fifteen different herbs. This combination, as well as the application of Chinese herbal medicine, is based on the fundamental theory of traditional Chinese medicine, which is completely different from western medicine.

I would like to spend a couple of minutes explaining what the Chinese medical theory is about. First of all, it comes from daily life, daily experience, from careful observation and also from an intelligent summarization as well as repeated clinical verification.

Maybe we all have noticed that sometimes our body feels hot, we have red eyes, we can feel burning sensation in the body, we are constipated and we can feel kind of a burning sensation at night when we urinate.

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In contrast, sometimes our body feels cold. We have an aversion to cold, and feel chills. There are times when we feel extremely tired because the energy is drained, and there are times when we're hyperactive. We try to move and move. Sometimes we feel extremely dry. We have dry eyes, dry throat and dry skin, and other times we feel wet, heavy-bodied, and we swell up.

These are the observations that ancient people have observed. These are the fundamental conditions of our body. We have a hot condition, which we call heat condition, and we have a cold condition. We have an excess condition, when we are hyper, and we also have a deficiency condition, when we are low. There is a dry condition and also a wet condition. We call it dampness.

Mother Nature is so loving and so good to us. She prepared very well for us. In nature there are some natural substances, such as plants or animal ingredients or minerals. They have their natural properties as well. Some natural substances have a cooling nature, especially peppermint. When we want fresh breath we take some peppermint, and that can have a cooling effect.

Other times there are things that have a warming effect—spice, for example, or hot pepper. When we eat hot pepper our body warms up and our face becomes red. If you eat too much, your mouth feels burning. So these have warm properties.

Some plants have the function to reduce, promoting a little bit of bowel movement to relieve constipation. Others could give us a little bit more energy—for example, ginseng.

There are some natural substances that have the effect of moistening; they give us a little moisture. There are some plants that have a dry property.

Therefore, we use cooling herbs for the heat condition and we use warm herbs for the cold condition. We use herbs that have a reducing effect for the excess condition. We use herbs that have tonic effects for the deficiency condition. We use moistening herbs, or substances such as honey, for the dry condition. We use herbs such as Poria for swelling.

This is the fundamental theory behind traditional Chinese medicine. This is how we use them. We do not use a single chemical ingredient or a single chemical compound. That is the big difference between Chinese herbal medicines and pharmaceuticals.

The body is a complicated organism. It is not that simple. Therefore, our conditions can be very complicated as well. It's not only a heat condition, cold condition, deficiency or excess; it can be a mixture. Sometimes there can be a heat condition, and because of the heat it dries the moisture, dries the fluid. Therefore, we have heat and we have also moisture deficiency, a dry condition.

In order to treat this condition we need to clear the heat, on the one hand, and on the other moisten the body. We need to give the body some moisture by using natural herbs or other substances. There are times when the body has lost warmth and we feel cold. There could also be wetness in the body. We need to warm the body up and increase the body function and get rid of the excess fluid.

Because of the complexity of the body condition, the combination of herbs also goes with this complex condition. When there is heat and dryness we need to combine the herbs that could clear heat and also moisten. When there is cold, or lack of warmth, in the body, there is at the same time accumulation of body fluid. So we need to warm up the body and also rid the body of dampness, as we call it. We need to get rid of the excess fluid.

That's how Chinese medicine works. It takes five years of full-time training to get a bachelor's degree in order to practice Chinese medicine in China, to become a well-trained medical doctor. It takes three years of additional full-time study to get a master's degree in traditional Chinese medicine, and it takes three additional years of full-time study to get a doctoral degree in traditional Chinese medicine.

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These degrees are comparable to the degrees that western doctors get. Traditional Chinese medical doctors are as well respected as western medical doctors and they use both western medicine and Chinese diagnosis and treatment.

The other characteristic of Chinese herbal medicine is that generally speaking traditional Chinese herbal medicines are safe and non-invasive to the body, because they are natural and their content is not intense. They are not a single ingredient.

If they're used properly, they do not do damage to the body, although sometimes they may cause a little bit of diarrhea. That is the intention, though.

The effectiveness of traditional Chinese herbal medicine has been proven for thousands of years through clinical practice and verifications. Chinese medicine is not only effective for chronic and mild diseases; it is also effective for serious illnesses and critical conditions when used by experts either alone or in combination with western medicines. I can give you quite a few cases if there's time, but I will leave that for later.

Traditional Chinese herbal medicine has been in Canada for over 100 years, and these products are safe and very low-risk.

I need to mention another thing. Most of the traditional Chinese herbal products in Canada are imported and they are made in China. Why we are here and why we are talking about this— The problem here with the current regulation for traditional Chinese medicine is that from the practitioner's point of view, if I'm going to a Chinese herbal store to buy some herbal products, what I can see is that on the label some of the words are scratched off. Some of the ingredients are covered up. Some of the compositions or ingredients of the whole formula are totally covered up. Also, the effects and the application of the remedy are covered up.

Why is this? It is because the claim on the label is not allowed and we're not allowed to say that we're clearing heat and we're moistening the body; we are toning yang to warm the body up, and we are also getting rid of the dampness.

What we're allowed to say is that the diuretics— The terminology of Chinese medicine and western medicine cannot be simply matched like that. If we do so, there will be more misunderstanding and it will cause more problems.

The second problem with claims is a schedule A claim. Schedule A is a list of diseases that cannot be claimed for treatment. With schedule A diseases, a lot of Chinese herbal remedies do have an effect for these conditions, although they may not be able to cure them. For example, we cannot cure cancer. When cancer patients are receiving chemotherapy, they feel a little bit of nausea and they're vomiting. Chinese herbal medicine can relieve this nausea and vomiting. Also, patients are very weak, but with Chinese herbal medicine they get stronger and they feel better. We consider that as effective.

So a schedule A claim is a problem for Chinese herbal products.

Certain herbs are treated as drugs. We have no idea why they are treated as drugs. So any product that contains certain herbs that are considered drugs is not allowed to come into Canada. Therefore, in order to avoid that, the importers had to cover the formulas or the products up.

Also there is the formulation. As I mentioned earlier, the effect of the herbal remedies is not just one way. We clear the heat. Everybody has to clear heat. All the herbs in the formula have to clear the heat. It doesn't work that way. The effect of the herbs can be quite different, but they can combine together. As a matter of fact, that's the art of traditional Chinese medicine. It's not just a simple additive.

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That is not allowed because we are told it doesn't make sense. Now, what is the problem? I've been thinking about this for a long time. I talked to industry people and I also talked to my colleagues. Why is this happening? Is it doing anything good or is it doing anything bad?

The problem is that traditional Chinese herbal medicines are treated as drugs. When they are treated as drugs you have to meet all the requirements of pharmaceuticals. They are treated as drugs because under the current definition in the Food and Drugs Act, anything with a claim is a drug. If I claim that ginger can help nausea and vomiting, ginger becomes a drug under the current drug definition.

The Chair: Dr. Wu, will the other two people be speaking?

Dr. Mary Wu: No, they are not—

The Chair: They are not going to speak right now. They are here to answer questions.

Dr. Mary Wu: Yes.

The Chair: All right. Can you wrap up, please, and we'll go to the other gentleman.

Dr. Mary Wu: Yes, I'll finish. Because of that, therefore, they're treated as drugs. If we treat a problem just from the leaf and we don't treat the root of the problem, we will never solve that problem.

Therefore, the recommendation is to recognize the unique nature of traditional Chinese theory and the differences between traditional Chinese herbal products and other health products. We need to establish a separate regulatory structure with TCM expertise to establish an appropriate policy and enforce the regulation of traditional Chinese herbal products.

We also need to establish a TCM advisory committee for the regulation and compliance of traditional Chinese herbal products. The committee should be composed of experts in the TCM herbal industry, TCM practitioners, TCM researchers and consumers.

Also, valuable textbooks of traditional Chinese medicine should be accepted in either English or Chinese because we do not have them all translated.

Those are my recommendations.

The Chair: We will go to Mr. Broadfoot and then you can speak later when we ask questions. Mr. Broadfoot.

Mr. Ken Broadfoot (President, HerbTech Inc.): Thank you. Honourable Madam Chair, honourable members of the Standing Committee on Health, and fellow witnesses, thank you for the opportunity of addressing the committee.

Today I would like to give you the perspective of a Canadian research manufacturing and marketing company. I've left with your staff copies of Dr. Pang's CV—the founder of the company and an eminent Canadian scientist—copies of the quality control we use for controlling the quality and safety of our products, and a copy of this presentation.

The history of our company is pertinent to the subject under review, so that's where I'll start. HerbTech and our affiliated company, C.V. Technologies, have their roots at the University of Alberta. They were based on pharmaceutical research and product developments with an interest in plants as potential sources for health care products.

For hundreds and perhaps thousands of years, certain plants have been used for their health-promoting benefits. The effectiveness of these natural treatments led to our curiosity about why some plants and natural substances appear to have natural health benefits; what the active ingredients in these plants are that cause the benefits; whether we could extract these active ingredients from the plant without changing their natural characteristics; how these natural plan ingredients work in the body; and whether we could standardize these products so their bioactivity was the same from batch to batch.

Good science has given us the answers to all these questions of why the ingredients are beneficial to human health, how they work in the body, how to process them and how to standardize them from batch to batch. As far as I know, we are the only company in North America that can do all of this.

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Essentially the products of the company represent a marriage of North American pharmacological technology and the traditional art of health healing care practised in many other parts of the world, such as China, South America, and right here in Canada by our first nations healers.

Our products are manufactured in Saskatoon and sold right across Canada and internationally. After two years, we are providing employment for 24 people in the company, and that number is expanding rapidly.

The market characteristics of health food supplements are really interesting. Within 10 years, the North American food supplements market has grown from literally nothing to exceed $3 billion in 1996. Forty percent of North Americans purchase health care supplement products. There are at least six North American health food supplement companies with annual revenues exceeding $250 million, and our distributors in the United States, Whole Foods, have revenues in excess of $1.3 billion. The market size could very easily reach $25 billion to $30 billion in North America in 10 years.

More than 8,000 medical practitioners in North America regularly prescribe non-traditional health care treatment, including health food supplements. So it's apparent that there is a major change occurring in health care.

That brings me to the recommendations HerbTech wishes to make to the standing committee.

First, the market numbers clearly indicate that public attitudes towards alternate forms of health are very positive. The public wants easy access and lowest possible costs to alternate health care, including health food supplements and herbal remedies. The present regulations are outdated and unnecessarily restrictive. Our recommendation is: implement the guiding principles for a regulatory framework as set out in the Advisory Panel on Natural Health Products arising from the meeting of the panel on November 13 and 14, 1997.

Second, safety should be the focus of government regulation of the health food and health food supplement industry. It's true that some products sold today may not be properly tested for safety.

Our recommendation for manufacturers of products in Canada—and this has nothing to do with Ms. Wu's talk about Chinese herbalists and so on, because we're not talking about that—is that manufacturers should be required to do both acute and subacute toxicity testing for all products sold as health foods and health food supplements. There are accredited laboratories across the country that can do this analysis for a fee. Second, require that industry produce products in facilities that meet food processing standards that are acceptable for other types of food products. Third, require that testing be carried out on finished products for bacteria, heavy metals, and such things as insect parts. And finally in recommendation two, require an officer of the company to certify that the company's products contain no artificial chemicals, drugs, and the like that are not listed ingredients on the package. Some people do this, and it should be stopped. The way to stop this is to get to the officers of the company.

The third recommendation is that consumers need more and reliable information on health supplements and herbal remedies. People are basically educated today in this field by hearsay, because regulations will not allow the printing of certain claims on the labels or in materials or advertising.

Why not let truth-in-advertising laws police the information the industry puts out? These laws are already in place, and there are formal processes to deal with unscrupulous advertisers. Let the companies tell the truth about their products without worrying about claims, and let them report anecdotal information that people want to hear about.

So the recommendation is to allow food companies to publicize factual, technical, and scientific information that describes performance and usage, and to allow health food companies to publicize anecdotal information that describes performance and usage, providing that such information meets the requirements of Canada's truth-in-advertising consumer regulations.

Finally, we would hope that properly drafted regulations will take into consideration economic and competitive factors affecting Canadian farmers and manufacturers. The economic opportunity for Canada in this industry is enormous. Already, for new cash crops and processing for such things as ginseng, oats for cosmetics, borage, royal jelly from bees, echinacea, evening primrose, feverfew—and it goes on—are made in Canada, right across the country; in the north, no, but certainly across the southern parts of the country. We think that Canadians should have an opportunity to really participate in this industry, particularly as it relates to their competition with our friends south of the border.

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So our specific recommendation is: carefully consider the needs of industry in conjunction with regulatory reform so that Canadian farmers, manufacturers and marketers are not at a competitive disadvantage, particularly in relation to the United States, and so that Canadians can build this industry and be among the world leaders.

In conclusion, Madam Chair, I would like to mention the Advisory Panel on Natural Health Products. HerbTech believes they've made excellent progress. I'd like to offer my compliments to the panel and to the process. The draft regulatory framework arising from their meetings—the last meetings were on November 13, and 14, 1997—is a significant improvement over present regulations, in our opinion. It is our opinion that the present regulations have become outdated and do not meet the needs of the public or the industry.

Madam Chair, thank you for this opportunity to speak with the committee today. I am fully aware of the complexity of your task and if there is anything further that we, or our scientists at HerbTech, can do to help, please do not hesitate to ask.

The Chair: Thank you very much. We thank both of you, and I'm sure that any other things you want to say will come out in the questioning.

Mr. Hill.

Mr. Grant Hill (Macleod, Ref.): Thank you indeed, and thank you all for presenting.

I'd like to start with Mr. Cheung, if I could, on a practical level, because I believe you manufacture the Chinese products.

Mr. Tony S. Cheung (General manager and owner, Kwok Shing Enterprises Ltd.): No, I'm importing.

Mr. Grant Hill: All right. From a practical standpoint, what products are being left off the shelf here in Canada that the practitioners and you would like to see on the shelf?

Mr. Tony Cheung: To begin with, we have a lot of products left off the shelf because of the claims we are making. That's the primary one. The second thing is that a lot of the products we import do not quite meet the labelling situation. That's the main thing.

Are you asking me about specific products?

Mr. Grant Hill: I just wanted, in a practical sense, to have some names of things. We have a couple in the presentation here. Are there a lot of products banned in Canada, or a few?

Mr. Tony Cheung: Actually, there are a lot. There are a lot that are not allowed to be brought in, especially those products for which we have schedule A claims. Actually, those schedule A claims are not really what schedule A is meant for, because what we have in schedule A, the meaning of— Let's say for the kidneys or for heart disease or things like that, actually it's not directed to the symptom of the disease.

Mr. Grant Hill: From your standpoint, is there any expert in the therapeutic products branch that you can talk to, professional to professional? I haven't found any expertise there at all in this area.

Dr. Mary Wu: Perhaps I may answer this question, Mr. Hill.

The current TPB—and there are no experts on traditional Chinese medicines—does have an expert advisory committee formed, and I am one of the members on that committee. We have had just one meeting, and I'm not quite sure that is adequate because the committee members are working on a part-time basis—not even on a part time basis; it is just for consultation. We're not paid anything. We only come together for two or three meetings a year, and with the piles of documents we have to review, I just cannot see how much time I will have, in addition to my teaching and my practice, to get that work done properly.

So we do think the government regulatory body needs experts on traditional Chinese medicine, or homeopathy, or other kinds of experts, to spend the time to do the job and to do the job properly and well. Without proper expertise the job cannot be done well.

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Mr. Grant Hill: All right.

Mr. Broadfoot, you endorse the work of the advisory panel. Did your company have any input directly—any members of the advisory panel?

Mr. Ken Broadfoot: No, we did not, not to my knowledge, and I'm quite sure that's right. We volunteered Dr. Pang to sit on the advisory panel, but the panel had already been established and it was too late. I think that's what led to our invitation to come to the standing committee, frankly.

Mr. Grant Hill: From your standpoint, is there any expert in the therapeutic products directorate you can go to and say you have concerns, where you feel there's a dialogue that's useful?

Mr. Ken Broadfoot: If we lived in Ottawa it might be okay, but it's very difficult to have these kinds of dialogues from a distance. I know when we have talked with people they have tried to be very cooperative, but frankly, for us, and perhaps it's different for the Chinese traditional herbalists, I think people understand, but they are working with such antiquated regulations there's really not much they can do. If they had proper regulations in a 1998 version, along the lines the advisory panel is doing, I think the people in the department would do just fine.

The Chair: Madame Picard.

[Translation]

Ms. Pauline Picard (Drummond, BQ): I want to be sure I understand. You say that you are the only company in North America to produce or combine natural medicinal herbs with Chinese medicine and other types of traditional medicine. You mentioned Aboriginal medicine as well. You must have some specialists. What is your basis for producing a product that can treat a problem or provide some relief? You must have some biologists, scientific staff and other experts who study the available documentation in order to produce medicines of this type.

You say that at the moment, the major problem with the federal regulations on these products is that there is no expert in traditional medicine in the group. Have you taken any steps to promote the experts who work in your company, to encourage the government to hire these people who could establish a proper regulatory framework?

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[English]

Mr. Ken Broadfoot: There are two questions there that I'll attempt to answer. The first one is the confusion perhaps over our scientific capability. We have seven PhDs in the company who are trained pharmacologists and who come from the pharmaceutical side of North American drug development.

The curiosity became how to develop pharmaceuticals from plants, and one thing led to another. We developed them from health food products and stopped worrying about them for pharmaceuticals. In the process we discovered some interesting things. One is why these plants are effective, how they work in the body, and how to standardize them.

It's the standardization part that I think is rather unique, because so far people haven't been able to standardize herbs from one bottle to the next. Many plants are different. They could be the same species, but you can't tell from bottle to bottle whether or not they have the same ingredients. It has nothing to do with the manufacturer, it's just the fact. So we've been able to do that.

The second thing is that we are a small company, and we did offer our help to the regulators here. We didn't press it because we're extremely busy, but we are still of the view that if our help is required, we're quite prepared to give it. I think we do have one of the best capabilities in terms of scientific review of herbal remedies in the country, and we'd be happy to share it. It's just tough to get to Ottawa. It's not because it isn't a wonderful city, it's just that it's a long way away.

[Translation]

Ms. Pauline Picard: Thank you.

The Chair: Thank you, Ms. Picard.

[English]

Mr. Myers.

Oh, I'm sorry. Did somebody else want to answer?

Dr. Jia Li (Toronto School of Traditional Chinese Medicine): I have an additional answer to that, although the question was not related directly towards me.

My impression is that lots of people don't know many details about herbal remedies and herbal industries. The first thing I want to make clear is that herbal products or herbal therapies are nothing new, although they may be pretty new in North America, in Canada. It's not as if we just discovered a new herb—maybe echinacea or St. John's wort—or just got a bright idea and are going to make a product today but don't have any reference, don't know how it works, and just heard about it somewhere.

I'm from China. I know we have used these products for over either 5,000 years, or a couple of thousand years, and it's the same for lots of formulas, not just single ingredients. They have been used repeatedly for over a thousand years. From that point of view they have been tested, although that doesn't mean tested in the pharmaceutical way. We didn't have that kind of pharmacology or that kind of scientific research project a thousand years ago, but they have been used and we're sure they're very effective and pretty safe. Otherwise, we couldn't have used them for so long.

I can say the same thing about a research project in China. We have been using that pharmaceutical—or you can say “herbal”—research for a long time. I know because I'm from the Research Centre for Traditional Chinese Medicine of Shanghai Second Medical University. We have a faculty of herbal pharmacology. We do a lot of research on this. We're not only doing a single ingredient; we have tested for lots of formulas, although this is still very limited to such a big medical system.

So maybe the reference in North America is still limited. I know there are a few herbal companies in North America, in the United States and in Canada, but most of them still have very few products compared to what we have in China. We have thousands of them. They didn't develop in just a few years. They have been developed over the centuries. We even have lots of scientific references from there. So if the panel is interested, maybe we have to go to look at some references from there.

That's my suggestion. Thank you.

The Chair: Thank you, and would you please correct me? Is it Dr. Li or Dr. Jia?

Dr. Jia Li: My Chinese name should be Dr. Li.

The Chair: Dr. Li. Okay, we'll do it correctly.

Mr. Myers.

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Mr. Lynn Myers (Waterloo—Wellington, Lib.): Thank you, Madam Chair.

Dr. Wu, on page 3 you talk about how the medicine is generally safe and non-invasive. I'm interested in safety, efficacy and side effects, and I'm interested in the training of those who recommend these kinds of products. On page 4, I note your recommendation 2 with respect to the separate regulatory structure. Would that in fact address those issues of efficacy, safety, side effects and training? Is that how you see it?

Dr. Mary Wu: The experts will be able to address those issues. If we have a TCM expert on the regulatory body, all these issues will be addressed.

Mr. Lynn Myers: They obviously would take a look at safety. They would look at side effects.

Dr. Mary Wu: Yes, because the safety, efficacy and side effects of traditional Chinese herbal products should be evaluated differently from those of the pharmaceuticals. Therefore if we use the expertise of pharmaceuticals in order to evaluate the safety, efficacy and side effects of Chinese herbal products, it's not going to work. They don't understand the traditional Chinese medical theory or the theory of Chinese herbal medicines.

Mr. Lynn Myers: And who would be on that body? Who would be part of that regulatory process?

Dr. Mary Wu: Certainly government would be part of it, and, let's see, regulating staff. You also need experts working with them. We have a few people in the TPP program now who are working on developing policy for traditional Chinese herbal products regulation. It would be better to have an expert there to work with them to develop this policy instead of just having people working on it who do not have expertise and adequate knowledge in traditional Chinese medicine. They need expert help. And you cannot get this help outside of the government itself because people do not have the time to invest without pay, putting their businesses aside, to do this part of the job.

The Vice-Chair (Ms. Elinor Caplan (Thornhill, Lib.)): Do you want to make a comment, Dr. Li?

Dr. Jai Li: May I give you some additional answers?

The Vice-Chair (Ms. Elinor Caplan): Yes.

Dr. Jai Li: I think there are two big concerns about this. One is the efficacy and another is the safety.

Let's say I give you a bottle of herbal products you've never heard of and tell you to try it because it's good for either your heart or your liver. You might become very skeptical and ask how you can trust me when I say this is good for your body. You've never heard of it and it's not recommended by your medical association. But I have to say that we've been using this for a thousand years, so that's the experience, that's a kind of test. Although the pharmacology hasn't been done over the centuries, there must be an understanding there, because I have been working in the department of physiology and I know physiology and pharmacology fairly well.

When we get a project from a pharmaceutical company, they give us a simple chemical ingredient and ask us to do the research on it. They have to be very precise. You can't mix a lot of different chemicals together because you get a lot of variations from that.

Most of the herbal products are compounds. They are mixtures of a lot of different herbs, so that makes things very difficult. And even if we just look at one single herb, like just one ginseng, even though it's a single plant, if you look at the chemical part and you say you want to purify it or make an extract, there's a big chemical complex. It would be very hard to use the regular applied pharmaceutical requirements for these herbal products because we have literally thousands of them. And how are you going to do this in a short time? If this legislation is passed, these herbs have to pass these tests before they get any approval in this country. That would be very hard.

Of course regulation is very necessary, but there might be different ways to look at this. In the United States and in China we have different regulatory bodies and we look at this, but not by using chemical testing.

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Another is safety and side effects. Lots of people may say, I heard someone tell me someone had some side effects from this herb and that herb—even from newspapers, from TV programs. I will just say that herbal products are relatively safe, although I will say, no, you can't take just any herb and it doesn't hurt. Even if I drink a cup of water, if I drink too much water, I might cause a problem for myself. If you go to any supermarket, if you choose any safe food, if you overdose by just taking it without any consideration for your health, you might cause a problem.

So of course regulation is necessary. But the safety part is pretty safe compared with western drugs.

The Vice-Chair (Ms. Elinor Caplan): Thank you very much, Dr. Li.

According to the list at this time, it would be a rotation to the opposition side for the two parties. I need some direction from the committee because of the membership that's here right now. Should we rotate to the opposition?

To be clear, no one is here from the NDP or the Conservatives. It would normally be their rotation. It would then go back to the government party and then back to the Reform Party.

It doesn't matter; let's just go ahead? Okay. Mr. Volpe.

Mr. Joseph Volpe (Eglinton—Lawrence, Lib.): Thank you.

Dr. Li, first of all, you will probably want to follow some of your own good advice and not drink that water, especially when it has been cooled down by those ice cubes. I would have thought that would be inconsistent with good Chinese practice.

No reaction. Okay.

On a more serious basis, one of the concerns people have expressed about herbals is precisely what you have indicated. If you have a plant such as ginseng, with a variety of active ingredients in it, for want of a better term, there is no indication which of those active ingredients are the ones most appropriate for a condition a patient or a consumer wants to address.

Secondly, there is the additional problem Mr. Broadfoot indicated a little earlier on, the consistency of dosages and the consistency of the quality of the dosage as it is applied to a single patient but then carried over to others as well.

I have a bit of skepticism, and if I have to apologize for it I will. I had occasion to be in a Chinese establishment in China that authorized the diffusion of these products. The practices that were prevalent in the place I visited led some of the heads of that department to ask for investment on the part of western companies in order to ensure quality control and product consistency.

Help me, as a consumer, through an understanding of what approach I should use if the herbal products appear to be helpful—people still get sick—but at the same time those who approve the kinds of products you speak of, through their experience and their expertise, are looking for better mechanisms to ensure quality. They are skeptical. What should I do?

Dr. Jia Li: First, I think you mentioned ingredients. You speak of an herb such as ginseng. We know it's like a tonic. You say you don't know which active ingredients are inside that. You just say ginseng.

This is a big question, because to be honest, we don't have the real answer for that. It's not because I don't know the answer or certain experts don't know it. I don't think we have that kind of technology, because we can purify only a few ingredients in certain ginseng. We did this a long time ago. It's been done in China, in Japan and in the United States, and I think somewhere in Canada as well.

• 1615

But having purified ingredients doesn't necessarily mean that they have the same effectiveness as the whole plant. That's the first thing.

It's not like a drug. If you buy a bottle of aspirin, you have to know how many milligrams of aspirin there are. It has to be standardized. This is to know that wherever you go, to a drugstore or a supermarket, you get the same in every bottle.

But it's different for herbs. With herbs we usually are just using what we call decoction. We are using a water solution and there is a standard procedure for that. We don't usually purify them, and don't usually purify them as a chemical extra. So that's the first thing.

I think somebody asked how you are going to make sure that different plants always have the same amount of the ingredient inside. It doesn't matter which ingredient is inside. We have a very strict regulation in China, which has been a kind of culture in China. If you want to buy ginseng, usually known as Siberian ginseng or Chinese ginseng, it's from a particular province and a particular region, just like if you were going to buy a bottle of champagne. We know champagne is from a small village in France. Although we can make something similar in Canada, we cannot say it is champagne. Maybe we can say it is sparkling wine or something else. That's how we can ensure quality.

So if a careful practitioner or an herbal company uses very high standards, they always use the standard herb, which is being clarified in our reference. They always select ginseng that has been grown in a natural environment for five years or longer and that's had no pollution. That's how we can make consistency.

The Chair: Your time is up, Mr. Volpe.

Mr. Anders.

Mr. Rob Anders (Calgary West, Ref.): I'm sorry; I can't help but wonder if some of the people in the room have ever had chicken noodle soup when they got sick with a cold, and whether it's the chicken or the noodles. That's what I found that question to be like.

I'd like you to comment on how you can have over a billion people with over 5,000 years of history and yet bureaucrats in this new department think they know better.

Speaking to some of the issues that were addressed in the throne speech, how is this voluntary choice on behalf of Canadians to look after preventative health going to impact you and companies like yours in terms of jobs and in terms of what costs it's going to mean and what it's going to mean in job losses and financial losses that we're going to suffer as a result of this? Have you figures for yourself or for other companies in your industry?

Mr. Tony Cheung: We have a history of having been—I don't know what we'd call it—struggling or fighting with Health Canada, for at least ten years. Let's say that ten years ago we had a big problem and big fight with Health Canada regarding angelica. Angelica is dang gui, which is what we call the queen of the herbs for women. At that time Health Canada initially saw a problem with dang gui and said it is toxic. Actually, Health Canada doesn't really know what we have in angelica, what type of angelica they are attacking. Finally they claimed it is toxic and they refused to let us market and sell it. Then we finally found out that the angelica is not the Chinese angelica but a North American angelica that is very toxic.

That's the predicament we had ten years ago. When they came to 1992, they issued in the status menu in the Health Canada regulation booklet—they said that angelica is a new drug, and that really confused us. We've been using it for so many years in China, and nobody was having a problem using it, but all of a sudden Health Canada issued that type of thing. It's really bothering us. I don't think it's fair for us.

• 1620

From an ongoing process, we found a lot of issues where Health Canada was treating Chinese herbal medicine with quite a bias. This type of angelica probably occupies about 30% of our herbal products. So if the regulations come through, if we don't fight for our right to use it, we will lose 30% of the market.

Also we found out that ginseng is classified as a new drug. Ginseng is a tonic, and pretty well every Chinese uses it. It translates to another 30% of the market.

When we apply for the DIN for angelica or for ginseng, we are refused. In March of last year, the CBC in Montreal denounced Chinese herbs as toxic and said to the public, “Be careful when you take Chinese herbs. They're harmful. If a consumer buys it, they have to have a DIN on the product before they buy.” But in fact, at that time, no single Chinese herb had a DIN. No Chinese herbal product had a DIN. So how can the CBC announce that publicly on TV? The government has responsibility for that.

We have 5,000 employees in our industry. In the last year, our business has gone down 50%. Especially in the Montreal area and the Quebec area, the herbal product business is practically wiped out because of the announcement by the government. It seems to me this is not fair for our community. The government shouldn't have done that before consulting us.

Mr. Rob Anders: Let me be sure I get this straight, then. Because of what Health Canada is doing right now, your business could be losing 2,000 employees, or something around that?

Mr. Tony Cheung: No, no. I'm talking about the industry.

Mr. Rob Anders: Okay, so we're talking about over 2,000 jobs.

Mr. Tony Cheung: The whole industry employs 5,000.

Mr. Rob Anders: Yes. So at 30%, essentially, we're talking about several thousand jobs.

Mr. Tony Cheung: Yes, if the government implements the regulations like that.

Mr. Rob Anders: Yes. Okay.

The Chair: Thank you, Mr. Anders. Ms. Bennett.

Ms. Carolyn Bennett (St. Paul's, Lib.): Thank you.

I do welcome the recommendations. I guess I just want to know this. Because this area is now more broadly available to Canadians, is there something else you think the government—

Obviously accurate labelling is very important, and I think you would help us make sure that if people thought they were buying echinacea, it didn't have Dristan in it. That's one of the problems the government has had, or the recent problem with Sleeping Buddha, or what have you. From what you describe, the mixture of herbs in those things is very complex.

There's a college of naturopathy now. As well as our job here at committee to look at the products themselves, is there something you think we should also be looking at in terms of some other regulation of the practitioners? Can anybody put up a shingle when they have a one-weekend course in something?

• 1625

I think the ones I'm really worried about are the checkout people at health food stores who actually, in some ways, feel they can help with diagnosis and treatment just because there's a certain product on a shelf somewhere. Is there some advice you would have for us as to who gets to sell or prescribe?

Dr. Mary Wu: This question was brought up yesterday as well. Whenever we talk about practitioners now, it's a provincial matter. It's a provincial issue. But I do think that right now we're talking about protecting the public and promoting the health of Canadians. We're dealing with products, but dealing with products cannot do well without talking about practitioners, or herbalists.

With some products, over-the-counter products, they do not need supervision. For some ginseng pills, say, it's probably okay if you just have ginseng ground up and put into capsules. That's very safe. But for some more complicated products, there does need to be intervention by practitioners. First of all, the products can be used more effectively, and of course more safely.

The current situation in Ontario—in Toronto, let's say—is that with acupuncture, everybody can claim he or she is an acupuncturist. Even with a weekend of training they can start doing acupuncture, whereas in China it takes about five years to get a degree in acupuncture and traditional Chinese medicine.

So I do think a certain standard is required for practitioners in order to protect Canadians and to provide quality service. But this standard needs to be set by consulting with the situation in China and the States, such as the naturopathy college.

Ms. Carolyn Bennett: In something that's in its own bottle, labelling is very important, but in traditional Chinese medicine quite often there are big jars. You buy in bulk, and it's bottled there. How would you suggest that the government look after the dispensing of things in bulk to protect the public?

Dr. Mary Wu: In terms of bulk, I would say that 95% of the bottled herbs are very safe. In our own culture, in our own tradition, let's say, for some astragalus, or what we call huang qi, is an energy tonic as well. We use it together with dang gui, and we use it to stew chicken from time to time. So there is no problem at all.

If a Canadian consumer walks into Mr. Cheung's store, tells him he wants to buy half a pound of angelica to stew chicken, and asks him if he thinks it will cause any problem—I don't think so. But I do agree that more potent herbs need to be controlled.

As a matter of fact, pharmacists in Chinese pharmacies do check all the prescriptions, if I may call them that. They're formulas, Chinese herbal prescriptions. They do need to look at it very carefully to check the composition of each different herb and to check the dosage. So there is quality control and safety control there already, even without any regulation from the government. We do that.

With other kinds of herbs, such as ephedra—and I'm not talking about ephedrine extract but the ephedra as a herb itself; we do use it as well, but that is considered a stronger herb—we cannot sell half a pound of that herb to anybody. Therefore, even right now, if you walk into the store and you have half a pound of ephedra in the prescription, you won't get it, because it's too much. You must be careful with it.

Ms. Carolyn Bennett: With those individual practitioners, would you see that there would be somebody who would be checking in practitioners' offices?

Dr. Mary Wu: No. There is no regulation in Canada for practitioners.

Ms. Carolyn Bennett: Is there in China?

Dr. Mary Wu: Yes. In China, you have to have a degree. You have to have authority for prescriptions in hospitals.

• 1630

The Chair: I'm just going to take the liberty of asking a couple of questions of Mr. Broadfoot.

Could you tell us what percentage of your resources are dedicated to research on the efficacy of your product? Secondly, how does your company monitor adverse outcomes arising from the use of your product?

Mr. Ken Broadfoot: Two companies are working on this together, so I'll give you the together numbers. It's approximately $1.5 million a year on research related to herbal products between the two companies of HerbTech and C.V. Tech.

The Chair: What percentage?

Mr. Ken Broadfoot: It's related generally to the area of research on why these plants work and new product development.

The second thing is that we haven't had any feedback where people are talking about any harm that has been done, but we do very serious toxicity tests ourselves. For example, as our friends have described, many of these products have been used for thousands of years and people haven't got sick with them. Nonetheless, we want to be reassured, so we put our products through a toxicology test at something like a thousand times a dosage, because they are going on a shelf somewhere and they are out of our control. I think that's impossible for Chinese herbalists.

So we're absolutely sure they are safe before they leave our plant. That's why we're not getting any feedback: they are safe.

The Chair: Mr. Drouin.

[Translation]

Mr. Claude Drouin (Beauce, Lib.): You say that these products have been on the market in your country for centuries. Is any follow-up work done? Some people have allergies and others may experience some side effects after taking some traditional medicine or treatment. Are you sure that the products are safe for the general public, or do you look at them on a case-by-case basis?

[English]

Mr. Tony Cheung: According to statistics in Canada, Chinese herbs have been in Canada for many years. We have not had many complaints and we have no track record of difficulties. Chinese herbs are very low risk, in general.

About China, maybe Dr. Wu can explain that. In Canada, we have been in the market for many years and we have not had many complaints about side effects or problems with herbs.

The Chair: Madame Picard.

[Translation]

Ms. Pauline Picard: Ms. Wu, I want to make things clear to ensure that I understand. In light of you said to Ms. Bennett, I understood that at the moment in order to practice Chinese medicine in accordance with the rules, you need a broader framework regarding expertise in natural products and you need regulations specific to Chinese medicine, as it is practiced in China at the moment. Is that in fact what you said?

[English]

Dr. Mary Wu: I would like to say the practice of traditional Chinese medicine here is like it is in China, but I know that is impossible. But I would also like to see that practice of using traditional Chinese medicine here.

• 1635

Our tradition for a couple of thousand years has been that of single passage. We call it a secret. Somebody has a secret recipe and passes it to one person for the next generation. It is very protective. Here we like to share our knowledge and our skills for the health of Canadians. I would expect that more and more people will be able to do this and provide quality service and quality, safe and effective products to benefit Canadians.

Yes, I would like to see traditional Chinese medical doctors be able to practise here as they do in China and have the same expectations and respect as well. I think it will be very difficult at first, but we need to work toward that for the health of Canadians.

Ms. Pauline Picard: Do you want to respond?

Dr. Jai Li: Yes. On the education and the regulation of Chinese medicine, it's a tradition in China because we didn't have a university a thousand years ago. Most of the formulas and experience were passed on by generations or by different people and not in an academic way.

I know the Chinese government has regulated the practice and products of traditional Chinese medicine for over 50 years now. If practitioners want to make herbal consultations or herbal prescription, they must get the authority. They must have traditional medical training. This is formal medical training in China.

I know in a few countries like Japan and Korea and a few American states, they have regulations similar to that. In order to protect the public, I agree the practitioner must have a high standard and must understand what he or she prescribes to the patient and understand the patient's condition. It's not like something you sell in a supermarket and just give to any people.

For the safety, side effects or allergy tests, I also say this has to be done through control of the industry. Lots of tests are done in China. We know most of the products are pretty safe. They have very minimal side effects because the dosage we use has been tested and we know it's very safe. We have also done allergy tests for a long time.

We also have to understand that if this is a product used for health, the practitioner must understand that. Even though things like ginger or garlic are very common, they can help. We can use garlic for the prevention of some kinds of heart disease. Most of the herbal products should be prescribed by the practitioner. That would be in the best interest of the people.

The Chair: Thank you. Ms. Caplan.

Ms. Elinor Caplan: I would like to share some information and get your reaction to it. The whole issue of regulation of professional qualifications is of course provincial, so the federal government really has nothing to say. In fact, none of the provinces would be happy about the federal government venturing into the area of regulation of professionals.

The Chair: Ask the question quickly.

Ms. Elinor Caplan: It is really the notion of risk of harm and how, in the broadening of our own horizon from the traditional allopathic methods to embrace and want to learn more about traditional Chinese and naturopathic remedies, we can assure the Canadian public it will have the information it needs to make wise decisions and it will have access to products that are safe and of high quality. The issue for me is what is the role of the federal government, the Department of Health, in determining effectiveness. So if over the course of these hearings you have any views on how broad or limited that role should be, I would be very interested.

• 1640

I was quite supportive and interested in the recommendations of the advisory committee of the different levels based on high to low risk. I think how that's implemented is going to be extremely important, and we're going to need people who have the expertise to be able to advise the government to do that. I really have no question, but I did want to make that statement.

The Chair: Again, I'll reiterate what was said. If you have any comments during the time that the hearings are still on, you could send to us in writing anything that you think would be interesting. Send it to the clerk.

To the witnesses, thank you very much for coming.

I want to mention to the rest of you that two students from Carleton University who are doing their theses on what we are doing in the committee here, and us working on it, will be in for a few minutes tomorrow morning before the meeting and just when we get started. I haven't actually confirmed it yet, but the CBC may turn up at 9 a.m. tomorrow. Unless there's some strong objection, I'm going to allow them 15 minutes, asking them not to interrupt our meeting, not to pull anybody out, but if they want to talk to people afterwards, then that's fine.

Ms. Elinor Caplan: There are no more delegations?

Mr. Lynn Myers: We're over now.

The Chair: No, there is nobody. You don't have to come back. The meeting is adjourned.