Mr. Chair, the intention of my point of order is to put on the record my concern about rushing Bill through Parliament, and more specifically through this committee, without proper study and without the much-needed due diligence. It expands upon the concerns I raised at the February 28 meeting of this health committee.
I'm very much afraid of the consequences of plain packaging and how it may increase the use of contraband tobacco, both because of increased cost to the consumer as well as decreasing consumer knowledge of the brand of tobacco product. I doubt that plain packaging will have much of an impact on smoking rates, as we've seen recently in Australia. It may actually lead to an increase in the total consumption of cigarettes.
In Australia, as you may have noted in a recent March 12 article in The Australian, the University of New South Wales questions the effectiveness of measures to reduce smoking that have been put in place in that country, and that was without even considering the black market contraband purchases that are now widely available since plain packaging was introduced there.
Even a small increase in contraband means an increase in funding for organized crime and for terrorist organizations. We heard from Dr. Eyolfson that he considered me ridiculous for confirming the threats to Canada from the sale of contraband tobacco, but, Mr. Chair, these threats have been documented by such groups as the Library of Congress Federal Research Division; the congressional 9-11 Commission; the Cato Institute; the Macdonald-Laurier Institute; the United States Government Accountability Office; the International Consortium of Investigative Journalists; the Royal Canadian Mounted Police-led Combined Forces Special Enforcement Unit contraband tobacco initiative; the Ontario Provincial Police contraband tobacco enforcement plan; the federal Financial Transactions and Reports Analysis Centre, which you may more commonly known as FINTRAC; U.S. Immigration and Customs Enforcement, which specifically cited Canadian intelligence officials who helped prosecute international jihadi terrorists who were using contraband tobacco to fund their activities; Interpol; the OECD; the Center for International Maritime Security; the Organization for Security and Co-operation in Europe; and the Center for the Analysis of Terrorism. It's quite an impressive list.
None of these organizations that have either researched or directly dealt with contraband and its negative effects in Canada were called before this committee to discuss the potentially negative consequences of this bill. The groups that sell and profit from contraband tobacco are, or have links to, international terrorist organizations and organized crime organizations. This committee did not hear from law enforcement officials, who will have to deal with the mess that this bill could create if we do not do our due diligence.
Mr. Chair, we need to learn from our errors and from the errors of others. In the 1990s, both Conservative and Liberal governments learned about the risks of overtaxing tobacco products. An explosion in contraband occurred, so they lowered taxes on tobacco, and, not coincidentally, that reduced illegal contraband sales.
Unfortunately, recently both the Ontario Liberals and the federal Liberals have increased their taxes on tobacco in their latest budgets. I'm not against increasing luxury taxes on unhealthy products, but I am against it when it drives up sales of illegal contraband that fund all sorts of nasty activities.
Weeks after their forgettable budget, the Liberals seem to be set on giving another potential gift to contraband in the form of plain packaging. Bill very much feels like an omnibus bill, because it changes very different aspects of the tobacco industry, including plain packaging for tobacco products and regulating the vaping industry, among other measures.
Thankfully, Bill will not ban nicotine and vaping products as they have done in Australia. I say “thankfully” because many smokers want to quit or at least practise their addiction in a much safer way, but I do have concerns that Bill S-5 could be too strict on the vaping industry as well.
Mr. Chair, the last meeting was a great source of frustration. We had not heard from very many witnesses who could have educated the committee on many different aspects of this bill. Instead, we plowed ahead with clause-by-clause consideration on amendments that we got barely 24 hours before the meeting—some of those amendments being received the day of, in fact, after our arrival in the room for the meeting.
We did not have sufficient time to properly understand the amendments nor what their impacts could be, which is why I did not vote on any of those amendments. I didn't feel that I had been adequately informed about them or that I had an opportunity to see what the consequences, good and bad, could be. I want to be diligent.
Procedurally, when a bill such as Bill comes before Parliament, it's important that we as legislators not rush the process. It's imperative that we proceed responsibly.
Our responsibilities as members of Parliament are described on pages 404-405 of the fourth edition of Bourinot's Parliamentary Procedure and Practice in the Dominion of Canada, published in 1916, and I quote:
||All the checks and guards which the wisdom of English parliamentarians has imposed in the course of centuries upon public expenditures now exist in their full force in the parliament of the dominion. ...when burthens are to be imposed on the people, every opportunity must be given for free and frequent discussion, so that parliament may not, by sudden and hasty votes, incur any expenses, or be induced to approve of measures, which may entail heavy and lasting burthens upon the country.
In a ruling from Speaker Fraser on April 14, 1987, regarding the government's use of majority to limit debate on important bills, Speaker Fraser had this to say:
||It is essential to our democratic system that controversial issues should be debated at reasonable length so that every reasonable opportunity shall be available to hear the arguments pro and con and that reasonable delaying tactics should be permissible to enable opponents of a measure to enlist public support for their point of view. Sooner or later every issue must be decided and the decision will be taken by a majority.
I believe that we've just scratched the surface on the first part of Speaker Fraser's comments with regard to Bill , and we are nowhere near the “sooner or later” part of this.
Occasionally the House and its committees take the necessary time to consider complex legislation. The Naval Aid bill of 1913 was such a case with regard to granting a $35 million donation to Great Britain for its navy. At the committee of the whole they kept the House going, virtually in continuous session, for as long as two weeks. That was the first time that closure had been used in our chamber. We had the famous and lengthy pipeline debate in 1956, the Energy Security Act of 1982, and we had a very lengthy debate on GST. Mr. Chair, quite frankly, the ability to have such debates is one of the last great tools of a democracy.
Beauchesne's sixth edition Parliamentary Rules and Forms, chapter 3, outlines some elements of the Constitution Act and our system of government that I believe are very relevant to this point:
||More tentative are such traditional features as respect for the rights of the minority, which precludes a Government from using to excess the extensive powers that it has to limit debate or to proceed in what the public and the Opposition might interpret as unorthodox ways.
Beauchesne further describes the fundamental principles of our democracy as, and I quote:
||To protect a minority and restrain the improvidence or tyranny of the majority; to secure the transaction of public business in an orderly manner; to enable every Member to express opinions within limits necessary to preserve decorum and prevent an unnecessary waste of time; to give abundant opportunity for the consideration of every measure, and to prevent any legislative action being taken upon sudden impulse.
Mr. Chair, I'm citing these points not to have endless debate but rather to gather as much information pertinent to Bill as is possible and to hear from a wider range of witnesses to provide us with this information. This committee has set everything aside to try to rush this legislation through here and through Parliament without what I believe is the necessary due diligence.
I urge this committee, before it's too late, to listen to more witnesses and seriously consider the consequences of enacting Bill without due diligence. I ask that the chair reopen the calendar to hear a wider range of witnesses and that the committee commit to getting this Bill study done right by reopening the study and delaying a committee stage referral to the House of Commons.
Thank you, Mr. Chair. If the committee will just indulge me for a minute, I would like to read a motion into the record today. Thank you very much.
I submitted the motion on Wednesday, March 14, so it is in order. I move:
|| That, pursuant to Standing Order 108(2), the Committee undertake a study of Health Canada's recent decision to make Cystagon unavailable and of the impact of this policy change on the approximately 75 children and young adults in Canada suffering from the life-threatening effects of cystinosis; that the Minister of Health, government officials, and Canadians affected by cystinosis be invited to appear no later than Wednesday, March 28, 2018; that the Committee report its findings to the House; and that, pursuant to Standing Order 109, the Committee request that the Government table a comprehensive response to the report.
Committee members will all have access to the motion if they want to deal with it at this time. What I would like to say, Mr. Chair, if I can have another moment, is that a resident in the riding I represent is here today. Erin Little, from just outside of Port Elgin, Ontario, is in Ottawa this week for a conference dealing with rare disorders and rare illnesses. She was able to get her flight changed today to be able to sit at the committee and to hear this motion read into the record. I appreciate the committee's leniency to allow me to do that. I know it means a lot to her family and those who are supporting her.
Hopefully the committee will consider this motion, because in my experience there are a few things that are urgent in some ways, or in some cases even life-threatening, and certainly this motion would be considered both because of the urgency behind the medications that are available.
I would also like to say that I know the 's staff is here today and had an opportunity to speak with Ms. Little briefly, and I appreciate that as well. It was very nice of them to do that. Hopefully that will continue on with the dialogue. If the committee would like to deal with this motion now, that would be great. I have no intentions of delaying the work of the committee here today; I just appreciate the opportunity to read the motion.
I want to thank Mr. Lobb for bringing the motion forward and I think there is an important discussion here. Basically, besides Cystagon, there is a second drug, Procysbi, which has the same active ingredient for treating cystinosis. Neither of them was approved in Canada until just recently, and all patients had to go through Health Canada's special access program, SAP, to acquire the drugs.
Just recently the change was that the other drug has been approved, Procysbi, and for the most part, patients and doctors are now being directed to use that drug. There is an issue with it. That drug is significantly more expensive than Cystagon, and there is active work under way right now to renegotiate the pricing on that alternative drug.
What is still true today is that Health Canada will continue its practice of considering requests to access Cystagon through SAP, just as it's been done in the past. Patients were always accessing it through SAP. It's done on a case-by-case basis in accordance with established criteria. Practitioners who want to continue accessing Cystagon for their patients through the SAP can do so provided they identify the clinical reasons that treatment with Cystagon and not Procysbi is more optimal for their patients. Physicians, in discussion with their patients, are uniquely placed to determine the best treatment for their patients, taking all aspects of their health and well-being into account.
The fundamental statement in this motion, “Health Canada's...decision to make Cystagon unavailable”, is not correct. It's still available through the SAP on a case-by-case basis, just as it has been. There is an added requirement for the practitioner to identify why it's preferable clinically to Procysbi, but otherwise it's still available to patients. For that reason, I wouldn't support the motion. It is still available to patients through the SAP with a practitioner's request.
Further to Mr. Oliver's and Ms. Gladu's comments, I hear what Mr. Oliver is saying. The special access program obviously precedes this current government. There have been criticisms of it in this current government and in governments before.
The reality is that when a physician says that the patient, because of the condition, should receive a certain drug, but it is rejected by Health Canada, that's one of the issues that we deal with. It's important because I think, with reference to what Mr. Oliver is saying, that's how we hope the program is to work: if the physician says, “Yes, the patient should receive drug X, Y, or Z” to give the patient the best chance for a good outcome, we believe that Health Canada would grant that and allow for that drug to be provided. In some cases, and in this case, not only do the patients receive the best outcome with it, but it's also a fraction of the cost.
I think it would be great to hear from witnesses, whether they be physicians, concerned family members, or Health Canada. It would be great to have them appear before the committee to give us some understanding as to why they do what they do—in this case, why they are rejecting what a physician has recommended when the patient has had some significant positive outcomes with the drug. I think that would be all we're asking. We're not asking to slam the government, the minister, or the department. I'm just trying to do the right thing in a non-partisan way, and hopefully we could have a unanimous recommendation to do something positive for not just the 75 families who are dealing with this, but probably hundreds if not thousands of other families who face this very stressful situation of receiving 30-day, 60-day, or whatever number of days' access to the drug mentioned.
I would ask that the committee consider that proposal. Hopefully Mr. Oliver and the Liberals, even if they want to amend it—I would be open to that—would allow a chance to have a hearing in front of this committee.
In response to Ms. Gladu's comment, my understanding is that unlike the hookworm example, it is the same active ingredient in both of the alternative medicines.
I do want to say that the Government of Canada is clearly committed to ensuring that Canadians have access to safe, effective, and affordable medicines. Again, this drug has always been accessed through the SAP, the special access program. If the committee wants to do a big review of the SAP, that's a different topic altogether, but it continues to be available through SAP.
A physician has to request it and make the case on behalf of their patient. There's really nothing different, except that the alternative drug is now available without going through the SAP. It's more expensive, but, as I said, there is active work under way to reduce the price of it.
I don't know what more there is to study here. The drug is still available to patients if their physicians make the case for it and represent for their patients through the SAP, just as they have always been doing. I really don't see the need for this particular motion, and I won't be supporting it.
I have just one last comment, and then I'm happy to take a vote on it, if that's the way it is.
Next time Ms. Little's family is rejected by Health Canada, I just hope I can get hold of Mr. Oliver and that he is willing to go to bat for her. This is a case in which you have to fight tooth and nail every time you're rejected, and that's not the way it should be. You have a life to live and families have lives to live. It's not just Ms. Little's; it's all sorts of other families. When you're rejected, it must be a pretty tough thing to face. To think that you have to battle and battle to get it overturned so that you can get it must be quite a thing to deal with.
As I said, I'm glad that a member from the minister's staff was able to talk to Ms. Little today. That's great, but I think it would serve the committee well to hear and understand what families go through when they are rejected. I know what's supposed to happen sounds right, but that's not always the way it happens. I think it behooves committee members, to be quite honest, to understand what families go through when they do get rejected and face that uncertainty.
I'll say just one other thing. I am obviously not a pharmacist and I'm obviously not a doctor, but I will say this: the medications, the dosages, and the amount in each dosage are not the same in the two medications, and that does make a big difference. I'll give you one example.
Suppose the dosage is once every 12 hours. If your child vomits, obviously the medication comes up. If that is the case, you have no idea how much has been absorbed into the body. It could be very little. That's just a great example of the difference between two dosages per day and three dosages per day. There are differences. That's why it's so good to have this come to the committee so that we can hear about it.
I know I said I wasn't going to drag this out. I've heard both sides, and if we want to do a vote, then that will deal with it today.
Mr. Chair, since we are dealing with motions and we are well along in that process, it would be unfortunate to have to stop now. I apologize to the witnesses, and I am going to try to do this as quickly as possible.
My colleague, the member for , submitted a motion last week. Since the 48-hour deadline has passed, the motion may now be presented. I would like to read it and then see if the members of the committee have comments to make. I would like us to vote on the motion today.
The motion read as follows:
||That, pursuant to Standing Order 108(2), the Committee undertake an emergency study of no fewer than three (3) meetings in order to develop recommendations on actions that the federal government can take, in partnership with the provinces and territories, to better regulate pre-mixed drinks with high alcohol, caffeine, and sugar content; that the Committee report its findings and recommendations to the House no later than June 2018; [...]
As you know, Mr. Chair and members of the committee, a teenager met with a tragic death in Laval, Quebec. Her name was Ms. Athéna Gervais. In the morning before going to school, she had consumed one of these very sweet drinks with a high alcohol content—the alcohol content is in fact about 12%—and this is sold in grocery stores and convenience stores, to minors unfortunately. Each canned drink contains alcohol that is equivalent to approximately four glasses of wine. This is extremely dangerous. Since these drinks are very sweet, people do not feel the effect of the alcohol immediately.
We are concerned by the possibility that these products continue to be sold in Quebec and in Canada. They are dangerous to our adolescents and young adults. Moreover, all of the marketing and ads for these products are targeted directly to teenage boys and girls. A few weeks ago, an ad for one of these products advertised a “special for the break weekend”, in other words, the school break. That publicity was clearly not addressed to you or me, Mr. Chair.
We want to avoid a reoccurrence of the type of tragedy the family of Athéna Gervais has just experienced. That is why it is imperative that a study be done quickly on the impact of these drinks and on what Health Canada should do. Health Canada announced today that it would hold a citizens' public consultation, an initiative we applaud. We think that is a good thing but it is not enough. The Standing Committee on Health has some work to do. We can invite experts, physicians, specialists and social workers to appear. They could tell us what they think the best approach would be to prohibit these products, in whole or in part, or to control their labelling, publicity and marketing. I think it is our responsibility to do that, and I encourage everyone to vote for this motion.
I thank my colleague opposite for this motion. I am very much aware of the situation concerning poor Athéna Gervais, who lost her life. And I take this opportunity to extend my condolences to her family.
No one wants to see another tragedy. In Quebec, the provincial government is taking action, and the federal government is as well. The has ordered Health Canada to look into the matter with her provincial and territorial colleagues. We are taking action.
I welcome the motion. I saw it last Friday, and it covers most of what needs to be done. Our committee is independent, and given that I would like to support the motion, with some amendments. I don't know if my colleague is ready to accept amendments, but personally I would like to propose a few. I would change certain words to highlight the urgency of the situation.
When I read the passage “That [...], the Committee undertake an emergency study”, I interpret that as meaning “immediately”.
We have another motion on the table, and it is probably, if not certainly, very important as well. However, we have a lot of files to study. Personally, I would change “an emergency study” to “urgently”. This would allow us to study this file within our deadlines—the motion proposes that a report be submitted at the latest by June 2018. This change would allow us enough time to hold the three two-hour meetings proposed in the motion to meet with witnesses.
Below that, I would add the word “combining” in order to bring the three elements of the sentence together, because otherwise the sentence is very vague. And so, I propose: “to better regulate pre-mixed drinks combining high alcohol, caffeine and sugar content”. We are talking about large containers with a lot of alcohol and sugar in them. Those are the amendments I propose.
If you accept these changes, I will support the motion.
(Amendment agreed to [See Minutes of Proceedings]
The Chair: Now we will vote on the motion as amended.
(Motion as amended agreed to [See Minutes of Proceedings])
The Chair: It's interesting that as the health committee, we deal with urgent issues here. It doesn't matter where they come from. If they're urgent, we deal with them in the proper way, and I think that was the proper way to do that.
Thank you very much, everybody.
Now we go back to Bill . I was hoping to get to a bit of pharmacare today, but it's looking like we might not make it.
We're on clause 71. There are no amendments.
(Clauses 71 to 74 inclusive agreed to)
The Chair: Go ahead, Ms. Gladu.
An amendment to Bill S-5 would prohibit the sale and manufacture of vaping products that include the ingredients listed in Schedule 2, and the sale of vaping products that promote the flavours listed in Schedule 3. This amendment to section 69 of the bill would add a list to Schedules 2 and 3 to exclude vaping products that are made or sold for export.
This means that a Canadian company could sell a vaping product for export to the United States or other foreign markets, which would contain the additives listed in Schedule 2 or which promotes the flavours listed in Schedule 3.
I thus propose that the bill be amended by replacing the portion of items 1 to 9 in column 2 of Schedule 2 on page 51 by the following—I will only read one item of the nine contained in part (a)—“vaping substances, except prescription vaping substances and vaping substances that are manufactured or sold for export”.
In part (b), I move that we replace the portion of items 1 to 5 in column 2 of Schedule 3, which is also found on page 51. In this case, the first two items, 1 and 2, refer to “vaping products, except prescription vaping products and vaping products that are manufactured or sold for export”. Items 3 to 5 refer to “vaping products, except vaping products that are manufactured or sold for export”.
That is the proposed amendment.