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37th PARLIAMENT, 2nd SESSION

Standing Committee on Health

EVIDENCE

CONTENTS

Tuesday, September 30, 2003

1305

The Chair (Ms. Bonnie Brown (Oakville, Lib.))

Ms. Tracey Bailey (Executive Director, Health Law Institute, University of Alberta)

1310

1315

Mrs. Betty Hinton (Kamloops, Thompson and Highland Valleys, Canadian Alliance)

Ms. Tracey Bailey

Mrs. Betty Hinton

The Chair

Dr. Devidas Menon (Executive Director and Chief Executive Officer, Institute of Health Economics, University of Alberta)

1320

The Chair

Dr. Devidas Menon

1325

The Chair

Mr. Rob Merrifield (Yellowhead, Canadian Alliance)

Ms. Tracey Bailey

Mr. Rob Merrifield

1330

Ms. Tracey Bailey

Mr. Rob Merrifield

Ms. Tracey Bailey

Mr. Rob Merrifield

The Chair

Mrs. Betty Hinton

Ms. Tracey Bailey

Mrs. Betty Hinton

Mr. Rob Merrifield

Dr. Devidas Menon

Mr. Rob Merrifield

Dr. Devidas Menon

Mr. Rob Merrifield

The Chair

1335

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ)

Ms. Tracey Bailey

Mr. Réal Ménard

Ms. Tracey Bailey

Mr. Réal Ménard

The Chair

Ms. Tracey Bailey

Mr. Réal Ménard

Ms. Tracey Bailey

Mrs. Betty Hinton

Ms. Tracey Bailey

Mr. Réal Ménard

Ms. Tracey Bailey

Mr. Réal Ménard

Ms. Tracey Bailey

The Chair

Mr. Réal Ménard

The Chair

1340

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

Ms. Tracey Bailey

Ms. Carolyn Bennett

Ms. Tracey Bailey

Ms. Carolyn Bennett

Ms. Tracey Bailey

Ms. Carolyn Bennett

The Chair

Mr. Greg Thompson (New Brunswick Southwest, PC)

1345

Ms. Tracey Bailey

Mr. Greg Thompson

Ms. Tracey Bailey

Mr. Greg Thompson

Ms. Tracey Bailey

Mr. Greg Thompson

Ms. Tracey Bailey

1350

Mr. Greg Thompson

Ms. Tracey Bailey

Mr. Greg Thompson

The Vice-Chair (Mr. Stan Dromisky (Thunder Bay—Atikokan, Lib.))

Ms. Hedy Fry (Vancouver Centre, Lib.)

Dr. Devidas Menon

Ms. Hedy Fry

Dr. Devidas Menon

Ms. Hedy Fry

Dr. Devidas Menon

Ms. Hedy Fry

Dr. Devidas Menon

The Vice-Chair (Mr. Stan Dromisky)

Ms. Tracey Bailey

1355

The Vice-Chair (Mr. Stan Dromisky)

Mr. Brian Staples (Chair, Seniors' Action and Liaison Team)

1405

The Vice-Chair (Mr. Stan Dromisky)

Mr. Brian Staples

1410

The Vice-Chair (Mr. Stan Dromisky)

Mr. Bruce McLeod (President, Canadian Union of Public Employees, Alberta Division)

1415

The Vice-Chair (Mr. Stan Dromisky)

Mr. Bruce McLeod

The Vice-Chair (Mr. Stan Dromisky)

Mr. Bruce McLeod

The Vice-Chair (Mr. Stan Dromisky)

Mr. Bruce McLeod

The Vice-Chair (Mr. Stan Dromisky)

Mr. Dale Watson (Red Deer Chapter, Council of Canadians)

Mr. Jeannot Castonguay (Madawaska—Restigouche, Lib.)

Ms. Hedy Fry

The Vice-Chair (Mr. Stan Dromisky)

Mr. Bruce McLeod

The Vice-Chair (Mr. Stan Dromisky)

Mr. Dale Watson

1420

The Vice-Chair (Mr. Stan Dromisky)

Ms. Wendy Armstrong (Secretary, Consumer's Association of Canada - Alberta)

1425

The Vice-Chair (Mr. Stan Dromisky)

Ms. Wendy Armstrong

The Vice-Chair (Mr. Stan Dromisky)

Ms. Wendy Armstrong

The Vice-Chair (Mr. Stan Dromisky)

Ms. Doris Ronnenberg (President, Native Council of Canada (Alberta))

The Vice-Chair (Mr. Stan Dromisky)

Ms. Doris Ronnenberg

1430

The Vice-Chair (Mr. Stan Dromisky)

Ms. Doris Ronnenberg

Mr. Richard Long (Executive Director, Native Council of Canada (Alberta))

The Vice-Chair (Mr. Stan Dromisky)

Mr. Rob Merrifield

Ms. Doris Ronnenberg

Mr. Rob Merrifield

1435

Ms. Doris Ronnenberg

Mr. Rob Merrifield

Ms. Wendy Armstrong

Mr. Rob Merrifield

The Vice-Chair (Mr. Stan Dromisky)

Mr. Rob Merrifield

Mr. Dale Watson

The Vice-Chair (Mr. Stan Dromisky)

Mrs. Betty Hinton

1440

The Vice-Chair (Mr. Stan Dromisky)

Mr. Greg Thompson

The Vice-Chair (Mr. Stan Dromisky)

Ms. Doris Ronnenberg

The Vice-Chair (Mr. Stan Dromisky)

The Chair

1450

Mr. Réal Ménard

Ms. Wendy Armstrong

Mr. Réal Ménard

Ms. Wendy Armstrong

Mr. Réal Ménard

Mr. Dale Watson

Mr. Réal Ménard

Mr. Dale Watson

Mr. Réal Ménard

The Chair

Mr. Réal Ménard

1455

Mr. Dale Watson

Mr. Réal Ménard

Mr. Dale Watson

Mr. Réal Ménard

The Chair

Ms. Hedy Fry

Ms. Doris Ronnenberg

Mr. Richard Long

1500

The Chair

Ms. Carolyn Bennett

Mr. Dale Watson

Ms. Carolyn Bennett

1505

Mr. Dale Watson

Ms. Carolyn Bennett

Mr. Dale Watson

Ms. Carolyn Bennett

Mr. Dale Watson

Ms. Carolyn Bennett

Mr. Dale Watson

Mr. Réal Ménard

Ms. Wendy Armstrong

Mr. Brian Staples

The Chair

1510

Mr. Glen Tashko (Native Council of Canada (Alberta))

The Chair

Mr. Bruce McLeod

The Chair

CANADA

Standing Committee on Health

NUMBER 052

2nd SESSION

37th PARLIAMENT

EVIDENCE

Tuesday, September 30, 2003

[Recorded by Electronic Apparatus]

· (1305)

[English]

The Chair (Ms. Bonnie Brown (Oakville, Lib.)): Good afternoon, ladies and gentlemen. Welcome to the afternoon session of the Edmonton day of our study on prescription drugs.

This afternoon we have representatives from the Health Law Institute at the University of Alberta and the Institute of Health Economics at the University of Alberta. From the Health Law Institute we have Tracy Bailey.

Ms. Bailey, would you like to begin?

Ms. Tracey Bailey (Executive Director, Health Law Institute, University of Alberta): Yes, thank you.

Today I would like to thank you for the invitation to address this committee on behalf of the Health Law Institute. Although we did not have time, unfortunately, to prepare a brief on the important issues this committee is considering, we appreciate the opportunity to comment briefly on some of the items you are gathering evidence on.

The Health Law Institute has a mandate to conduct research on health law and policy issues as well as to provide education in the health law area. It has several research projects currently underway, primarily in the area of health care reform and genetics, led by our research director, Professor Timothy Caulfield.

As you're well aware, the development of policy in the area of prescription medication is challenging. Aside from the jurisdictional challenges, given the division of responsibility between the federal and provincial governments as with other sectors of health care, there are a number of competing interests and priorities. On the one hand, there is the goal of providing access for Canadians to the best possible treatments in a timely manner. In order to improve on the current therapies and medications--as well, it may be argued, as to enhance competitiveness and economic growth--policy must encourage rather than dampen innovation and further research.

However, there are also the important considerations of ensuring the safety of the public as well as the always present need to control escalating costs.

I would like to highlight some of the issues you have been and will be hearing evidence about, issues that will raise a number of legal and ethical issues as well as policy dilemmas. The issues I will touch briefly upon are, first, pharmacogenomics; second, direct-to-consumer advertising; and third, physician profiling by the pharmaceutical industry.

Let's begin with pharmacogenomics. Advances in science and technology in the health care sector concurrently create new policy challenges. One such area that has the potential to radically change the focus of drug research and therapeutic treatment is pharmacogenomics. As you know, this includes the development of screening techniques to see whether an individual, given their genetic makeup, would benefit from or be harmed by a particular drug. One day adverse reactions to particular pharmaceuticals may be avoided by such screening, and customized therapy may be developed for patients.

It is likely that the cost of drugs created or marketed towards individuals with a certain genotype will be more costly than current prescription drugs as a particular drug may only be targeted to certain individuals with a particular condition rather than all such individuals. As well, genetic testing may lead to increased demands for current pharmaceutical products to prevent or combat things such as common late-onset diseases.

Direct-to-consumer advertising will likely influence the demand for such testing and may lead to an increase in sales of both existing and new pharmaceuticals, and that leads me to my comments on direct-to-consumer advertising. There are four opinions on either side of this issue. Proponents of DTC advertising would like current restrictions loosened. Others argue that DTCA should be banned altogether.

Arguments in favour of DTCA include the view that it provides consumers with information, empowering them to be more involved in their health care decisions. There is discussion of providing patients with more information so they can make informed choices. Second, more information will lead to more compliant patients, who will be healthier and will require fewer hospitalizations. Third, the argument goes that Canadians are exposed to DTCA from the U.S. in any event. And fourth, the rules against DTCA violate section 2 of the Canadian Charter of Rights and Freedoms, based on the right of freedom of expression, which includes commercial expression.

Arguments opposing DTCA include the views, first, that such advertising leads to increased and at times inappropriate prescribing of prescription medications; second, that ads may lead people to believe they have a particular medical condition when they in fact do not; third, that it has altered the encounters between physicians and their patients in a negative way, with many physicians feeling pressured to prescribe the medication requested; and fourth, that increased prescribing leads to further increases in spending on prescription drugs, at least some of which is unjustified.

Currently two countries allow DTCA, the United States and New Zealand. Studies done in the U.S. have shown a substantial increase in spending on drugs advertised through DTCA since its inception.

· (1310)

It may be argued that this has mainly benefited pharmaceutical companies by increasing the market for particular drugs. On the other hand, one might assert that this may have led to earlier diagnosis and improved health for many people.

The issue has recently been revisited, as is currently happening in Canada, in the European Community. They began by implementing a five-year pilot project allowing advertising by pharmaceutical companies with regard to three health conditions: diabetes, HIV/AIDS, and asthma. This year the European Parliament's Committee on the Environment, Public Health, and Consumer Policy voted against relaxing their ban on DTCA, and this decision was later ratified by the Parliament.

The issue has also been looked at recently in Australia and South Africa.

Given the existence of DTCA in the U.S. and the evidence coming out regarding DTCA thus far, I would urge this government to hold off on any decision to strengthen or relax the rules in Canada until further studies have been done. This decision, like many others, should be evidence based, especially when we have such close proximity and ties to a neighbouring jurisdiction that has loosened its restrictions in recent years.

In the meantime, some ads in Canada in recent years are of questionable legality. While there has not been a change in the legislation since the amendment in 1978 allowing comparative price advertising, there has been a change in policy as other types of ads are appearing. If this is not seen as the direction to go in, there should be more effective procedures implemented to monitor ads and to impose fines or other sanctions in the case of a breach. If the rules are to be relaxed to allow for more than price comparisons, then clear rules need to be set out.

The next item is the issue of physician profiling by the pharmaceutical industry. As you are all aware, information on the prescribing practices of physicians is being sold by pharmacists and pharmacies to IMS Health Canada. Pharmaceutical companies are then able to use this information to encourage physicians to prescribe more of a particular drug or to substitute one drug for another.

At present there are two decisions in Canada regarding this. The first was issued by the former Privacy Commissioner of Canada, who found that under PIPEDA the information being sold was not information about physicians but rather about their work product and, as a result, physicians had no basis for a complaint on this basis. The matter will be judicially reviewed in the Federal Court of Canada.

In Alberta, based on Alberta's Health Information Act, the provincial privacy commissioner found that the first and last name of a physician could not be released without the consent of the physician. This contrasting decision will also be subject to judicial review.

Regardless of the outcomes of these two court applications, as policy-makers one must question whether it is a positive or negative thing for pharmaceutical companies to be able to target the prescribers of prescription drugs in this way. This knowledge, often combined with incentives to prescribe a particular product, could lead again to inappropriate prescribing or prescribing a more expensive product when a lower-cost substitute is available.

With regard to this issue as well as the issue of direct-to-consumer advertising, the federal and provincial governments should be planning to expend a part of their health care budgets on the education of physicians as well as the provision to physicians, pharmacists, and consumers of unbiased, objective information on the various drugs available. Further, physicians could benefit from education on how to handle encounters with both patients demanding a particular prescription and pharmaceutical marketing representatives promoting a particular product. One possible solution is the formation of a national drug agency, as recommended in the Romanow report.

Finally, I have a few concluding thoughts to tie up those three areas. Firstly, evidence-based decision-making should be used as much as possible in policy-making, as it is in the scientific arena.

Secondly, with ever-increasing numbers of new drugs coming and many of them increasing in costliness, in addition to the many other areas of health care where new technologies are increasing costs in the system, there needs to be a public discussion of how we will allocate our finite resources. Will it be based on financial need, the number of people who may be helped by a particular intervention, or the severity of the condition? These are just a few of the many bases for decision-making, and we need to discuss upfront how we should be making these decisions to benefit Canadians. We cannot pay for every new technology that will be invented. How will we decide, and how will we provide incentives for research to be done in those areas?

· (1315)

Thirdly, both health care professionals and consumers need more information. However, what form should this information take? It must be from an objective, unbiased, and reliable source—at least in part. For Canadians to make informed choices, they need much more information than can be contained in even the best advertisements. Furthermore, education must be provided not only with respect to various drugs on the market, but also regarding how decisions should be made to prescribe or not prescribe a particular drug for a particular patient.

Finally, incentives, such as our patent laws, must remain in place to protect the innovation sector of the pharmaceutical industry, so that it may recoup the vast outlays of time and money that go into developing new drugs. However, to quote the United Kingdom's Commission on Intellectual Property Rights, it must also be remembered that,

the conferring of intellectual property rights is an instrument of public policy, which should be designed so that the benefit to society...outweighs the cost to society.... The IP right is best viewed as one of the means by which nations and societies can help to promote the fulfillment of human economic and social rights.

Those are my comments. Thank you.

Mrs. Betty Hinton (Kamloops, Thompson and Highland Valleys, Canadian Alliance): You mentioned three diseases that Europe is looking at with a five-year exemption. You said HIV, diabetes, and what was the third one?

Ms. Tracey Bailey: Asthma.

Mrs. Betty Hinton: Thank you.

The Chair: Thank you, Ms. Bailey.

Now we'll move on to the Institute of Health Economics, represented by Devidas Menon, executive director and chief executive officer.

Mr. Menon.

Dr. Devidas Menon (Executive Director and Chief Executive Officer, Institute of Health Economics, University of Alberta): Thank you, Madam Chair.

Thank you to the rest of the committee as well for this opportunity to speak to you on behalf of the Institute of Health Economics, the IHE.

I also bring greetings from the chair of my board, the Right Honourable Don Mazankowski, who is unable to be here today for reasons I think we're all aware of.

I should also apologize for having had to take a non-prescription cough medicine this morning, which has slowed me down a bit. So if my presentation is not as exuberant as one would like it to be, that's why. Also, if I appear to be more mellow than this serious occasion requires, I apologize in advance.

· (1320)

The Chair: All of our witnesses are mellow; I can't guarantee that the members of Parliament will be.

Dr. Devidas Menon: I suspect that in your current set of hearings, you have been and will be asked to take action in one way or another on recommendations that have emerged from Senator Kirby's committee or the Romanow report.

My aim here today is not very different. It relates to the whole area of pharmaceutical policy research in Canada. In my view, pharmaceutical policy in Canada is a dog's breakfast. For a variety of reasons—the federal-provincial division of powers; the exclusion of many drugs from hospital and medical services covered by medicare; the nature of the pharmaceutical industry, with both innovative and generic products in the market; and the fact that once a drug is available to the public, whether it is prescribed and for what it is prescribed is pretty much left to the prescriber—we have very many inconsistencies in pharmaceutical policies at numerous levels.

The two main roles of the federal government, as you all know, are price control through the Patented Medicine Prices Review Board and pre-market review and approval of new drugs through Health Canada. I believe the federal government could and should play a more active role in supporting multidisciplinary, multi-sectoral research, which is essential to inform the policies being implemented across the country by various players and payers.

Before I tell you how I think this might be done, let me give you a bit of background about the Institute of Health Economics. It was founded eight years ago as an independent not-for-profit research organization based in Alberta. We call it a P3+1 organization, a proven public-private partnership. Our partners are currently the Government of Alberta; the universities of Alberta and Calgary; the two major regional health authorities in this province; and nine research-based pharmaceutical companies. Western Economic Diversification was originally a funder of the IHE, but is not any longer.

The institute was created on the basis of two premises in 1995. First, the most important questions in health care require a collaborative and cooperative approach to research. Second, the research by itself is not enough; there have to be mechanisms and linkages to get the research results used in decision-making. Sectors cannot work in isolation of each other. This is why government, academia, the health delivery sector, and industry—which are not usually bedfellows—have joined in this initiative. We are unique in this respect in Canada.

The IHE has developed a research program that tries to address some of the major policy issues in health care today. In the area of pharmaceuticals, one is research relating to the issue of the availability of pharmaceuticals to publicly funded programs in Canada, which is an issue of importance to government, industry, and the public.

Some of us were involved in work a couple of years ago examining access to drugs through provincial drug programs. This was decided in the Romanow report, which went on to say, “To a very large extent, people's income, the kind of job they have, and where they live determine what types of access they have to prescription drugs.” Our research work shows this consistently, whether it is about provinces or even about regional health authorities in this province. What you are able to get depends on where you live.

More recently, we studied the availability of cancer drugs across the country. We found similar results. Of the 115 anti-cancer drugs approved for sale by Health Canada over the period of 1990 to 2001, I believe, one province covered 37 drugs and, at the other end, another covered 94. There have also been anecdotal reports of families moving lock, stock, and barrel from one province to another to get better access. I believe this was at least the case for one specific drug for leukemia, which is not very cheap.

As we move along with the tides of the genomic and genetic revolution, I would expect that these disparities will become even greater. The new and innovative pharmaceuticals that result from this revolution will be expensive and, in some cases, will be for small groups of people. One example is the new drug, Fabrazyme, for treating Fabry's disease. This is a genetic disorder affecting about 1 in 40,000 people. This drug is currently undergoing approval processes in Europe and is expected to cost approximately $200,000 per year per patient. This is a niche technology, with maybe 75 people in this province suffering from it. Who will be able to get it?

Research of this type, though descriptive to a certain extent, tells us what is happening in a sound, rigorous way and can be immensely useful to decision-makers. Quite often, they're unaware of the situation until the results are presented to them.

The cancer drug project was done by our researchers with the help of both the drug industry and the provincial cancer boards and agencies. In fact, two weeks from tomorrow, we will be presenting the results in detail to the interprovincial cancer drug strategies guidelines group, which is comprised of representatives from the cancer boards and agencies. This kind of work, and the possible impact it may have, is only possible with collaboration and cooperation.

· (1325)

Research on pharmaceutical policy is done in a few academic centres in Canada, with little or no consultation or cooperation. I believe we have an opportunity to do something about this. The Romanow report had recommended the creation of four centres for health innovation, one being on pharmaceutical policy.

The Canadian Institutes of Health Research had suggested that these centres, real or virtual, be established with a mandate to “engage government, industry, community groups, charities and others to foster and disseminate a culture of innovation and evidence-based decision-making across the health care system”.

The centre would bring together all of the various sectors that are impacted by pharmaceuticals to address issues such as the ones I have mentioned today. It will, by trying to integrate the views of diverse stakeholders in a manner that the institute tries to do, serve to evaluate pharmaceutical policy and disseminate results to the Canadian community at large. It will offer a vehicle for the public to participate in matters that ultimately impact on them directly.

This will be an improvement, in my view, over the current views of the public on how decisions are made, which reflect frustration--the decision is made in a closed room, or someone is making a decision, but I don't know how. I would urge you to think about making these centres of excellence happen.

Thank you.

The Chair: Thank you very much.

We will move on to the questioning portion of our meeting. We'll begin with Mr. Merrifield.

Mr. Rob Merrifield (Yellowhead, Canadian Alliance): Thank you for coming and sharing your ideas. I don't know whether you have a cold or you have a lack of energy, but you did a very good job.

I was watching TV last night. They were talking about advertising of drugs, and there's a pill for that. I don't need to go any further than that.

It's always the dilemma. Is it empowerment or is it exploitation in advertising? I think it's something that Canadians are wrestling with even now, because we have the spillover from the advertising coming in from the United States.

Has there been a case in law, since you represent a kind of legal perspective on it, in other countries or in Canada on either side of that? Have people taken a case, because they have not felt that they've had appropriate information and they could have...or where they've been exploited because of advertising in other countries?

Before you answer that or as part of answering that, do you expect, as we move forward in Canada, that we will see that dealt with in law schools?

Ms. Tracey Bailey: That's an excellent question. I'm not aware of a case that's directly related to advertising on that basis.

Of course, we have a number of cases in the non-profit area based on, I think, as you said.... People are saying that they would not have gone ahead with a particular procedure--and that could be the taking of a particular medication--if the physicians had only informed them of the things they should have informed them about. In other words, I didn't receive proper information; had I received proper information, I would not have gone ahead with the treatment, but I did, and I was injured, and I want to be compensated.

Although I'm not aware of cases directly related to advertising, I can definitely see that occurring in the future. I think the reason it's been contained, for the most part, in physician-patient interreaction is because that's supposed to be where people receive their information on the drugs they're taking or the treatment they're receiving. It's up to date. They receive better information from the physician who's going to be prescribing a particular medication.

With people receiving information in a new way, including some pharmacists and pharmacies, through advertising, I could absolutely see people initiating lawsuits and saying, “I made this decision based on this information. It wasn't accurate. I was harmed as a result and I would like to be compensated for that.”

Mr. Rob Merrifield: Okay. Let's talk about what we really have. You said that in 1978 the law was changed to ban advertising for a particular medication in Canada. Yet we have had testimony before the committee saying that the prevalence of that is pretty weak. The only way anyone ever finds about it is if somebody complains.

Has there ever been a case where they've taken it to court? Has there ever been a penalty? Do you know what a court would use as a penalty against a pharmaceutical that would fly in the face of this law?

· (1330)

Ms. Tracey Bailey: I'm not aware of a legal case. I agree with the proposition that there are advertisers out there who basically are violating the law at the moment. And I must admit I'm not intimately familiar with all of the details of how that is monitored and enforced. I believe the only repercussions have been as a result of complaints to the body that oversees those or approves the advertising.

Looking at the law made in 1978, my understanding is that really the only thing you're allowed to advertise is the name, price, and quantity, I believe, of a particular drug. In fact, if you look at some of the ads that are out there, they're talking about or implying things other than the name, price, or quantity of the drug, as you know. That's why I make the comment that I think some of the advertisements that are out there are actually not really within the letter of the law, so to speak.

Mr. Rob Merrifield: They're stretching the limits is what you're saying, yet you've never had a case. It's kind of interesting that it's finally happened.

Ms. Tracey Bailey: Yes. There have been complaints, I think, to the body that monitors it. I haven't heard of a lawsuit as a result of someone suffering damages.

Mr. Rob Merrifield: I would like to change my questioning a little to talk about this whole idea of prescription medication.

The Chair: It's time for another questioner, Mr. Merrifield. It will be Ms. Hinton's turn next.

Mrs. Betty Hinton: That's okay, Rob, I'll give you the last half of my time. I only have two quick questions here.

I was very interested in what you had to say about ads leading people to believe they have a disease that they don't have. I wondered if you could give me an example, because I've found that this happens quite often. People have these very vague symptoms and say, “Oh, I have that. I have to go and get help.”

You're talking about Europe giving a five-year exemption for advertising HIV, diabetes, and asthma. I'd like to know a little more about that as well, please.

Ms. Tracey Bailey: On your first question, I don't know that I can give you a specific example off the top of my head, but I would refer you to...and possibly you even heard from this woman when you were in B.C. yesterday. I have read some articles by Barbara Mintzes. She's with the Centre for Health Services and Policy Research at the University of British Columbia. A number of the articles I read were based on research that she has done. I could give you some citations on this, but if you look at some of the work she has done, she has some specific examples listed in there.

On your second question about the European exemption, I regret that I don't have detailed information in front of me, but I believe there was free rein for pharmaceutical companies to advertise with respect to those three conditions. I could be in error, but I believe the companies could basically advertise in any way they saw fit and they followed that process over a five-year period. Much of the evidence as a result of that pilot project led this committee to decide to continue the ban on direct-to-consumer advertising.

Mrs. Betty Hinton: Thank you.

Now we'll go back to Rob.

Mr. Rob Merrifield: Thank you.

On the whole idea of patent law and the difference between brand name and generic drugs, we know that brand name drugs in Canada are lower in price than the median around the world, especially in the United States. Generics are not.

We asked this question yesterday and never had much of an answer. Why would that be, from an economic standpoint? Do you have comments about that? We've had pricing review of the brand names and not of the generics, but some of the testimony yesterday said that the difference in our prices compared to those in the United States had more to do with the difference in the dollar than with the prices review board. If that's true, can you tell us why our generics are so much higher in price here than they are in the United States?

Dr. Devidas Menon: Actually, I am not an economist. I'm perfectly suited to running the Institute on Health Economics. I am not a health professional, neither am I an economist.

Mr. Rob Merrifield: Perhaps I'm asking the wrong people.

Dr. Devidas Menon: I honestly don't know the answer to that question.

Mr. Rob Merrifield: Fair enough. That's fine.

The Chair: Mr. Ménard.

· (1335)

[Translation]

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ): I have two questions, the first of which is for Ms. Bailey. I would like you to tell us more about physicians' prescribing practices. You say—and I remember that as members of Parliament, we were informed about this when we were studying the Privacy Act—that there are companies which keep track of physicians' prescribing practices. The information they collect is sold to Health Canada and to drug companies as well. Could you tell us a little about this practice? Do you see any ethical difficulties with it? What could the committee do, in your view? At first glance, I would say this is a troubling matter.

[English]

Ms. Tracey Bailey: I'm sorry, I didn't get that.

Mr. Réal Ménard: Did you understand my question?

Ms. Tracey Bailey: No, I didn't.

Mr. Réal Ménard: I'll repeat it.

The Chair: Wait until she's ready. Are you on channel 1?

Ms. Tracey Bailey: Yes.

[Translation]

Mr. Réal Ménard: Could you tell us more about what you said in your testimony regarding physicians' prescribing practices? You say that this information is purchased by drug companies. That means that there are companies that collect and sell this information. What is Health Canada's role, and how can we as parliamentarians get involved in an issue of this type? I find this issue raises troubling ethical concerns.

[English]

Ms. Tracey Bailey: I missed a little bit of that. Are you talking about information that physicians get from pharmaceutical companies?

Mrs. Betty Hinton: No. He means the profiling you referred to.

Ms. Tracey Bailey: Okay. You just want to know how Parliament can get involved in this. Is that what your question is?

[Translation]

Mr. Réal Ménard: I find some of your comments troubling from an ethical point of view. I would like to know who purchases this type of information and how companies can collect data that is supposed to be confidential between physicians and their patients. What is Health Canada's role in this regard, and how can we get involved?

[English]

Ms. Tracey Bailey: At the moment--and for some time now--the information is being sold by pharmacies and pharmacists to IMS HEALTH Canada. IMS HEALTH Canada passes that information on to pharmaceutical companies.

Basically, when a pharmaceutical company goes off to meet with a physician to market a particular drug, or more than one type of drug, they have in front of them a profile of the physician and their prescribing practices. So they know how often the physician has prescribed a particular medication to how many patients. They can look at that information, for example--

[Translation]

Mr. Réal Ménard: But who collects this information? I cannot understand that it would be the pharmaceutical industry that would be selling it. Who collects this information?

[English]

Ms. Tracey Bailey: It's been gathered by IMS. IMS basically passes it on to various pharmaceutical companies that use that information to go out to the market specifically.

Does that answer that part of your question? No. They are paying for the information. They're buying it from pharmacies.

The Chair: IMS is a private sector company that is in the business of collecting statistics. They will be presenting to us later, I believe. They're back in Ottawa. It is a private company that collects this information from pharmacies and pharmacists, collates it, develops physician profiles, and then sells it to the pharmaceutical companies. When IMS comes before us, it seems you'll have some good questions.

[Translation]

Mr. Réal Ménard: It is unacceptable, but I will keep my questions for that group. Thank you.

[English]

The Chair: Thank you, Mr. Ménard.

Ms. Bennett.

· (1340)

Ms. Carolyn Bennett (St. Paul's, Lib.): I'd like to follow up on that question. Given that the identifier comes off, ethically, shouldn't the prescribing habits of physicians be the knowledge of all Canadians? Why wouldn't we have information on who's prescribing all the Valium and everything on the Internet ? You could cut that down pretty fast.

In my experience as a physician, you know who's doing more hysterectomies than others. Why is prescribing deemed to be the personal purview of physicians? I think when we looked at the hysterectomy practice we learned that they were being done ten times more often in North Bay, Ontario, than in Toronto. The women of North Bay knew that maybe it was time to get a second opinion. We had fantasies of a “1-800 so-they-say-you-need-a-hysterectomy” line so patients would know if they were going to somebody who sort of overprescribed or underprescribed, or over-operated or under-operated.

In terms of health law, do you see any reason why we wouldn't just have that as transparent information on physicians? We know their billing information.

Ms. Tracey Bailey: In fact, depending on the part of Canada and the legislation that's in place, a lot of that information can be used for health management purposes. But this particular issue deals with the ability of pharmaceutical companies to get hold of that information.

Ms. Carolyn Bennett: But if it were transparent, then it wouldn't be a commodity you could sell. The pharmaceutical companies could look at it, but so could the patients. It would even the playing field. It would be transparent to everybody.

Ms. Tracey Bailey: It was a federal decision that this was not an infringement on the personal privacy of the physician, so this is fair game. It's opposite to the decision we had from Alberta, although part of the reason we have two different decisions in this area is because of the wording of the legislation. Parts of the health legislation in Alberta are quite different from the federal PIPEDA legislation.

The view you take was basically stated in the decision by George Radwanski, our former Privacy Commissioner. I guess the view the physicians are taking is that this is not information about their patients; it is information about them, and it can be used in a way that they don't think is ethical. They can come in and say to them, “We can see that you've prescribed so much of this particular drug. We're going to use that to try to get you to switch to this other drug that we want to sell to you.”

Ms. Carolyn Bennett: But in a health management regime, if this is being done under management that is paid for publicly, shouldn't public administration, in terms of the Canada Health Act, allow health planners and governments to see where there needs to be more attention, in terms of poor prescribing or optimal drug therapy?

On the second part of my question on direct-to-consumer advertising, if there were an ability, in terms of patient information produced in Parliament--either pooled drug company resources or government resources--we could say, “If you're still on such and such a drug, it's old fashioned and you probably don't need anything, or you need something new.” The drug of choice for strep throat is penicillin. If you're given a $64 medication for strep throat, you should ask your pharmacist why, or call the doctor.

Couldn't we be doing a better job of giving patients information on optimal therapies? Is there not a way we could do direct-to-consumer advertising, but not with brands and not in an industry-wide way?

Ms. Tracey Bailey: Yes, absolutely, I agree with you. That was one of my first comments, that we encourage further information being made available to consumers. I think it would be helpful to consumers to have more information. My question about the advertising is this: do they get accurate information, or enough information, to make informed decisions from advertising? I think the answer to that is going to be no.

Now, it's a different issue whether you allow the advertising or not, but I don't think the basis of whether or not we allow this advertising in Canada should be whether or not it's going to help people make informed decisions.

Ms. Carolyn Bennett: But with monographs where you scare patients to death that they might get these 105 different things, and they stop their medication and don't take it, we also have evidence that this doesn't work either, right? And they don't even tell their doctor they've stopped their medication.

The Chair: Ms. Bennett, thank you. I will move on to Mr. Thompson now.

Mr. Greg Thompson (New Brunswick Southwest, PC): Thank you, Madam Chair.

Tracey, we've heard that generic drug prices in Canada are higher than what they otherwise should be, for a number of reasons. One suggestion was that generic drugs are often given or prescribed under the guise of public savings only to find out that the druggist, the pharmacist, is pushing the generic drugs because of...we'll use the word “kickbacks” to the pharmacist.

Can you comment? Is that in fact happening, and what impact does that have on pricing among the other variables that we know are out there?

· (1345)

Ms. Tracey Bailey: Well, I can't say with certainty that this is happening, but I have heard similar stories. I guess the only comment I could make about this is that I don't see why there shouldn't be some price configurations with respect to the generic drugs, just as there are with patented medication. I think if you're going to look at the prices of patented medication, you should be doing the same with respect to the generic.

Mr. Greg Thompson: There's a huge difference between generic drug prices in the United States and Canada, correct?

The other point I want to make...and of course, we don't have time, as the chairman here has really cut the time...[Inaudible—Editor].

Is the advertising you've talked about...? And don't get me wrong, because I have huge concerns about advertising, about these miracle cures and so on in terms of patent drugs and so on. What would be the difference between these types of Advil ads that we see, or Bayer Aspirin, or Exlax--I mean, Exlax will cure everything, if you look at the advertising--or the nicotine patch or whatever? You're talking about the potential for lawsuits down the road if, for example, it doesn't work or whatever. One of the obvious examples would be Tylenol, where they can advertise Tylenol but not Tylenol 3.

So could you elaborate on some of those differences--and I'm not aware of any lawsuits taking place in Canada because of some of the exaggerated claims we see, a cure for back pain or whatever--between those over-the-counter drugs versus patented?

Ms. Tracey Bailey: I'm not as much concerned, although I guess I should be, about the lawsuit that I think will result as time goes by as I am about just the general increased costs to the system.

Mr. Greg Thompson: I thought you had specifically mentioned the potential for lawsuits, but maybe I misinterpreted you.

Ms. Tracey Bailey: No, you're right, I did. I guess I'm just looking at the big picture. I think the biggest concern is that with increased advertising, and more and more individuals saying, “I want this prescription for my condition”, there is some evidence today to show that this has led to greater prescribing of medication than might otherwise have been prescribed. It's led to prescribing more expensive medication when a cheaper one would have otherwise been prescribed. I just think that from that point of view, this is the biggest concern as opposed to lawsuits.

I do see these types of lawsuits coming down the road if the information is disseminated in a way that's different from what it has traditionally been, but that in itself might be a deterrent to pharmaceutical companies to advertise in a particular way or....

Do you know what I'm saying?

Mr. Greg Thompson: Yes. There would certainly be the possibility of consumers like me or you suggesting a certain prescription, and saying, ”Doctor, if you'd do that over the telephone I'll go down and pick it up.” There might be a tendency for more of that to happen, wouldn't there be, if we were allowed to advertise some of these new and wonderful pills?

Ms. Tracey Bailey: One could argue that. I would hope that more advertising wouldn't necessarily lead to doctors prescribing medication over the phone. They might be able to do that in certain circumstances, but I would think with respect to a majority of conditions, people want--

· (1350)

Mr. Greg Thompson: We heard evidence this morning that many drugs are overprescribed and some are underprescribed. How does that phenomenon take place? There were concerns expressed this morning by the director for pharmaceutical policy programs for the Province of Alberta. Did you happen to hear his testimony?

Ms. Tracey Bailey: I didn't, although I think there is some reference to those types of ideas in the Romanow report, which I have taken a look at. It basically says, if I remember properly, that more basic research needs to be done in that area. I believe it was the Canadian Pharmaceutical Association that said there is a lot of waste, either overprescribing or underprescribing, or misusing prescription drugs. But they're not necessarily sure why yet, or how to fix that problem. So you need more information, I think.

Mr. Greg Thompson: There's no disease that can go uncured provided the right pill is out there. That's sort of the philosophy, don't you think?

The Vice-Chair (Mr. Stan Dromisky (Thunder Bay—Atikokan, Lib.)): Dr. Fry.

Ms. Hedy Fry (Vancouver Centre, Lib.): Thank you very much.

I wanted to ask about the study that was done on the availability of pharmaceuticals in Alberta by the Institute of Health Economics. You said that availability was based on geography--well, on where people lived. Do I understand that you looked at this as a national issue? You said some provinces have as many as 94 drugs in their formulary and others don't have 30.

Dr. Devidas Menon: That's correct.

Ms. Hedy Fry: So it's a national study?

Dr. Devidas Menon: Yes, it is. That one is, but I should also mention that we looked at regions as well.

Ms. Hedy Fry: Obviously if you're looking at access to pharmaceuticals or access to drugs, where according to your studies availability is a result of geography, I think there would have to be two components of what we look at with regard to recommendations. It's not appropriate for some Canadians in some provinces to have access while others don't, just because of where they live. Have you any suggestions as to what we can do about this? Is there any way you can see us with a national formulary, given that many provinces believe this would be interfering with their right to decide what they pay for and what they don't pay for?

At the same time, I might like to argue that given that the federal government is ready to pump some money into health care in the provinces, Canadians should feel that their tax dollars benefit all of them regardless of where they live. I'd like to find some creative answer to deal with that.

There was one more thing: intellectual property rights. I think Tracey Bailey said that we should look at how intellectual property rights could be based on the good they do for the public. Could you elaborate on that a little bit?

Dr. Devidas Menon: You make a very good point. I think the way we've approached it on the research is that it's best to try to describe it. I think we've described it and others have. We've looked at formularies as a whole and we've looked at regions. Others have looked at sublevels of diagnostic groupings of drugs, and we've looked at cancer drugs. I think we've demonstrated there are these variations. The next step is to try to understand why they are there and to find if they can be changed somehow.

We're looking at part of the reason for the variation by looking at the processes by which decisions are made. Part of our research program is also actually dealing with drug and therapeutic committees to see what factors they use in coming to decisions, because if in fact the world is truly evidence-based, then this variation should not occur. We have a disconnect between...I suppose you would say that we have evidence-based policy-making and the results come out somewhat different.

Now, obviously there are other factors that go into the decision-making and they are important ones. The fact is that you may have the best thing in the world but you may not be able to afford it. I think part of the problem is that these decisions are not made, in my view, in a transparent enough way for people to understand it.

But the real obstacle to changing it does not lie in the research, it lies in the domain of you folks and the provinces. I think that is precisely the challenge.

Ms. Hedy Fry: But as a researcher who has looked to...[Inaudible—Editor]

Dr. Devidas Menon: Yes. In fact, there are people starting now to look at the possible implications of the catastrophic drug coverage that was also proposed as a means to somehow address this. It's possible to look at specific instances and try to get a supra-provincial or whatever approach to that. Only a week ago I saw a paper that said something like, who is actually going to benefit from the catastrophic drug coverage, which sector? So I think there's some research going into that and that might be one way to target this approach.

I don't know if a national formulary will, for the reasons you mentioned, really fly. If it's targeted to where there's a clearly demonstrated lack of availability, I think it is more likely that it will take shape.

The Vice-Chair (Mr. Stan Dromisky): Thank you very much.

Ms. Bailey.

Ms. Tracey Bailey: With respect to intellectual property law, my comment was just that some people look at patent laws, for example, as merely a protection, for example, for pharmaceutical companies that do all the research and innovation to create new drugs. But it's really more of a bargain between those companies and society generally. If we're going to give you a monopoly for 20 years, for example, so you can try to recoup all of the money you've spent developing these drugs and make a profit, in exchange, after that period you're going to share that information, you're going to disseminate that information, so it can be used by society and not just by you alone. It's protection for those companies, but in the longer term and the bigger picture, it's really there to benefit society, so that information is not kept in secrecy by the individual who developed it but is eventually disseminated and shared.

· (1355)

The Vice-Chair (Mr. Stan Dromisky): Thank you very much, and thank you very much for appearing.

We are going to take a quick break so the other witnesses can get into their places at the table.

· (1356)

¸ (1403

The Vice-Chair (Mr. Stan Dromisky): I'll call the meeting to order.

We're very fortunate to have some of the witnesses who are on the list here. I will introduce you as we call you to make your presentation in order to save time. We will hear first from Brian Staples, Seniors' Action and Liaison Team.

And before I forget, give your sister a big hug from me. Thank you, Brian.

Mr. Brian Staples (Chair, Seniors' Action and Liaison Team): Thank you, Mr. Chairman.

I apologize--and I've spoken to the two francophone members of the committee--we don't have a member in our group who's bilingual and we just got information about this hearing a few weeks ago, so I wasn't able to provide a translation. But I thought I'd bring along in symbol language a set of speaking notes, and that's this little yellow set of drawings, which can be translated into many languages.

You see the little symbol in the top left hand corner for salt, the salt shaker. SALT is the Seniors' Action and Liaison Team. It's a group of about 25 senior citizens in Edmonton who never got over going to Sunday school. We are interested in social policies for seniors but also very much so, in fact, in an overriding way across the society. We're concerned about many issues for advancing the civil society here in Alberta and across Canada. And being from Alberta, we certainly seem to have our plate full. We have all kinds of things that we need to be speaking out about at the present time, unfortunately.

So you see that this is a brief for SALT to the House committee on health policy, on pharmaceuticals, on drugs. The first point I want to mention, number one there, is who we are, and I've briefly covered that. I did want to say this. Do you see the little arrow with the x and the mortar and pestle there? We are totally self-financing. We pass around a little piggy bank to finance ourselves. We get no money from any drug companies, and I'll mention that again a little bit later.

One of our concerns has to do with ads. This is number two, vis-à-vis crazy ones you see from Viagra. We find that totally alarming in a country where there is supposed to be a ban on such advertising. We think it really does put a lot of pressure on medical doctors—that's the little picture with the hands over the ears—and we think there is a remedy to that. There ought to be a national database on drug effects that is made available on the Internet and by telephone, so that anyone who wants to can phone up and get unbiased, well-researched, publicly financed advice on the benefits and the knowledge they need about drugs. I noticed that Dr. Bennett has spoken about this kind of thing. We strongly believe that this ought to be the case.

A little bit more on the pressures to medical doctors is in number three there. You see someone's head between a vice. We've picked up from some of our research some practices that are aimed at medical doctors, which we find very disturbing. The idea that medical journals are often printed—I won't say often, but there are occasions when medical journals are printed by drug companies. Right away, you have to question how unbiased they are. And that there's a real preponderance of ads from pharmaceutical companies in those journals is what I meant to say .

We know that some medical doctors get gifts if they prescribe a lot of drugs from a particular company—televisions, trips to tropical islands, that kind of thing. We are also concerned about the tracking of the prescriptions and the use of that information by drug companies, as was talked about earlier today. We think there should be a tracking of prescriptions by medical doctors. There should be such a thing. But it should be totally public and it should be available to the Government of Canada and to the Health Council of Canada when it comes into effect. And incidentally, we are strong advocates of that health council. That is long overdue. We need to get on with that.

I'm looking now at number four. We also are very alarmed about some dirty tricks, in our view, that are performed by some of the drug corporations, the companies that manufacture and research and so on. We know of instances where seniors' groups are approached by representatives of drug firms and told things such as, “We can provide a speaker to you. There'll be no cost; we'll transport you to a venue; we'll pay the meal.” To us, that's really suspect.

We also know of cases where seniors have been approached about certain drugs that aren't yet approved and told about the tremendous benefits of them, and told that unless they speak up about this, they'll never get through to the government. So they've been offered workshops on lobbying. That kind of thing we find really suspect.

¸ (1405)

We're concerned also about the writing of journals by drug corporations, where they seek out medical doctors to sign their names to them. They haven't produced them but they sign their names, and I think that's really suspect.

We're also concerned about--this is the little x and the bar and the question mark--major drug corporations who actually own the generics. Before asking questions around this table as to why the generics are so high in our country, that might be one place to look.

In the United States seniors' groups have been approached by drug companies and secretly financed by them so that seniors' groups will speak up as champions of certain drugs and certain corporations. Those are the kinds of things we're concerned about ,and we draw those to your attention because we think there ought to be every step taken in our country to prohibit this kind of thing.

The Vice-Chair (Mr. Stan Dromisky): I'd like to draw to your attention that you only have a minute left.

Mr. Brian Staples: Okay.

I want to say that we believe strongly that there is a need for a public presence in the development of drugs at the universities, colleges, provincial institutes, that kind of thing. There needs to be whistle-blower protection.

Number six is probably the most important thing. I'm sorry, I'm going to move to number eight, the role of politics in government. We think probably the most important piece of legislation that has been passed in Canada since Confederation is Mr. Chrétien's bill on financing political campaigns and political parties. That needs to be greatly increased. Our politicians, our elected people, should not be at the beck and call of private donors for sponsoring legislation, and that applies in spades to the drug industry.

¸ (1410)

The Vice-Chair (Mr. Stan Dromisky): Thank you very much.

We will now go to our next speaker from the Canadian Union of Public Employees, Alberta division, Mr. Bruce McLeod, the president.

You have five minutes.

Mr. Bruce McLeod (President, Canadian Union of Public Employees, Alberta Division): Thank you.

I would like to begin by expressing my thanks for having the opportunity to make this presentation on behalf of CUPE, Alberta, to the standing committee on health as part of the study on prescription drugs.

I speak today representing CUPE members in Alberta in an effort to address not only our workplace concerns as they relate to prescription drugs but also our concerns about the direction of public policy.

In Alberta, the Canadian Union of Public Employees represents 32,000 workers in health care, municipalities, schools, and a variety of other services. CUPE is Canada's largest union, with over half a million women and men across the country, and access to essential, appropriate public health care has been a long-standing priority for CUPE and for our members in Alberta.

The issues related to prescription drugs are a critical part of meeting health care needs. The mandate of your committee includes a range of very important topics. In our presentation we will focus on access to medically necessary prescription drugs, specifically the burden created by drug costs and the requirement for drug benefit coverage.

Even a quick review of the literature on access to prescription drugs in Canada reveals a common need. The phrases that come up include “wide disparities in drug coverage between provinces”, “a hodge-podge mixture of public and private coverage with a substantial number of Canadians left without any coverage at all”, and in one review prescription drug coverage is described as “a dog's breakfast”.

Access to necessary prescription drugs has been an issue for a long time in Canada. Research evidence clearly shows that drug costs are escalating, access to less-costly generic drugs is threatened by existing and extended patent protection, and bargaining to protect negotiated benefits and improvements is becoming more difficult. Albertans without employee benefits or access to government programs must pay for individual insurance coverage and require co-payments, or often face very formidable costs in their efforts to pay for prescription drugs directly.

It is our position that access to medically necessary prescription drugs is an essential part of health care for all Canadians. Unfortunately, the present situation falls far short and studies show that while access to some form of drug coverage has increased in recent years, many Canadians have no coverage and must pay the full cost of medically necessary prescription drugs.

Full-time workers are more likely to have drug coverage than casual or part-time workers. Couples are more likely to have coverage than single people or one-parent families. Younger-aged people are less likely to have drug coverage. Higher-income earners are much more likely to have better drug benefit coverage. People on educational leave and individuals who are laid off or are retired have lower rates of coverage.

Premium payments may pose financial obstacles to voluntary access to benefit plans. In addition, where coverage exists, required co-payments may restrict access or compel selected use of medically necessary drugs. Some new drugs may not be covered by benefit plans. Prescription drug plans provided by the Alberta government support access to a specific number of drugs identified in the drug benefit list for certain defined groups of seniors, people on social assistance, children, and special drugs for people with certain diseases. In addition, individuals may participate in a provincial program on a voluntary basis.

Despite these provisions, the gaps that exist are clearly acknowledged in information provided on the Alberta government website. The Alberta government information includes the recommendation that all Albertans obtain and maintain insurance coverage for prescription drugs and further acknowledges that a significant number of Albertans have no insurance coverage and pay for prescription drugs themselves.

It is our experience that the general pattern of gaps and limitations in drug coverage in Canada holds true for Alberta. This is supported by conversations with sources in the benefit industry and community services. Please consider the following Alberta examples.

Alberta seniors have access to drug benefits but are required to make co-payments up to $25 per prescription. This can add up to significant personal expenditures where multiple and changing prescriptions are required to meet health care needs.

While residences and licensed and publicly regulated continuing care facilities such as nursing homes and auxiliary hospitals have their drug benefits covered, many seniors with increasing health care needs live at home or in new types of unregulated residential care facilities and have to make the required contribution to drug costs. As more support and care requirements are downloaded to individuals and families, the cost of health care, including very high drug costs, often become the responsibility of people with very limited incomes.

Most CUPE members working in support staff positions in Alberta hospitals have access to workplace drug benefit plans if they are employed in full-time or part-time positions, but many part-time and all casuals workers do not have coverage. This is very significant, as hospital support staff are generally divided into positions of one-third full time, one-third part time and one-third casual.

¸ (1415)

The Vice-Chair (Mr. Stan Dromisky): You have presented a brief to us already, and it will be translated into both languages. All members of the total committee--some are not here and they're in Ottawa--will receive copies.

You're reading from a different document. The document you're reading from is not this one.

Mr. Bruce McLeod: Yes, it is.

The Vice-Chair (Mr. Stan Dromisky): Word for word? No.

Mr. Bruce McLeod: Yes, sir.

The Vice-Chair (Mr. Stan Dromisky): Oh, is it? That's all right, then. I thought it was a different document, because I was trying to follow you here--

Mr. Bruce McLeod: I'm actually moving along pretty well, aren't I?

The Vice-Chair (Mr. Stan Dromisky): Yes, I'll say.

Dale Watson is next. Dale represents the Council of Canadians.

Mr. Dale Watson (Red Deer Chapter, Council of Canadians): Thank you.

I have seven brief points to make.

Mr. Jeannot Castonguay (Madawaska—Restigouche, Lib.): There's a page missing.

Ms. Hedy Fry: Some of us have a different document. That's why we couldn't follow you.

The Vice-Chair (Mr. Stan Dromisky): I have two.

Mr. Bruce McLeod: The translated document is a summary of the speaker's notes that I've given you. We forwarded on to the committee itself the full speaker's notes.

The Vice-Chair (Mr. Stan Dromisky): So mine is different from yours. There's a piece missing.

All right. Go ahead, Dale, from the Council of Canadians.

Mr. Dale Watson: I have seven points to make that are based on the thinking of the Council of Canadians and one to make on behalf of myself.

Number one, the Council of Canadians supports the creation of a universal publicly funded pharmacare program.

Number two, it is time to act. Implementing a catastrophic drug transfer plan would be a simple and effective way to begin.

Number three, the national pharmacare program could enable the effective and efficient integration of prescription drugs into the medicare system.

Number four, such an approach could also be a means of containing and restraining the dramatic increase in drug prices.

Number five, present patent laws severely restrict those who could produce cheaper drugs into the market.

Number six, patent laws should serve the health care needs of Canadian citizens, rather than the self-interest of brand name drug companies. Therefore, Parliament should reinstate the mandatory licensing policies that existed prior to 1987; repeal Bills C-91 and S-17; reduce patent monopolies from 20 years to 10 years; and require the justification of drug prices before approval by Health Canada or the national drug agency, if it is established.

Finally, brand name companies should be required to demonstrate the infringement of their patents by generic companies, and should be forbidden from expending patent monopolies by making changes that provide moderate or no therapeutic improvement over their existing drugs.

On my own behalf, I'm a retired minister of the United Church. I want to say something quite different, I think, from what you are probably going to hear.

I think we do not practise medicine on the basis of what we actually know about human beings. We know that human beings are not only physical but also emotional and spiritual creatures. As well, we know that the physical ailments we sometimes end up with are intimately connected with our emotional and spiritual beings, yet we usually treat physical symptoms. We focus on them and we often treat them with drugs.

I think we need to restructure our medical system on the basis of what we actually know, the full range of what we know. Give health care practitioners of all kinds the time and the resources to attend to the whole person. If we chose to do so, it seems to me that we could radically and drastically reduce the use of drugs, drug dependency, the overprescription of drugs and the abuse of drugs. We would be, I think, a much healthier nation and a more vibrant nation.

Thank you for allowing me to be here.

¸ (1420)

The Vice-Chair (Mr. Stan Dromisky): We'll go to Wendy Armstrong. Wendy represents the Consumers' Association of Canada, the Alberta division.

Ms. Wendy Armstrong (Secretary, Consumer's Association of Canada - Alberta): Thank you, Chair, members of the committee.

My name is Wendy Armstrong and I'm a volunteer board member of the Alberta Consumers' Association of Canada. Larry Phillips, the president of the Alberta Consumers' Association of Canada, is also in attendance here today.

For over four decades the Consumers' Association in Alberta has represented the issues and interests of Alberta consumers and communities in provincial and national forums related to the management of prescription drugs. Our focus has been, and continues to be, the safety, price, and appropriate use of this extremely valuable, but also extremely hazardous, class of goods in our society.

Our limited organizational resources and a discouraging lack of influence in such settings over the last few years has often limited participation. The association continues to monitor the issues and take action where it can. For example, over the last two years we've worked actively to maintain the already limited public availability of the prescribing records of physicians in the face of both legislative and physician group challenges, and just yesterday we sent off a letter to our Alberta Minister of Health on the issue.

I apologize for not having had time to prepare a brief for today; however, we were urged to come here by a number of groups in order to put our position on the record.

I'll go through a quick overview of the issues as seen by CAC Alberta.

First, little knowledge or understanding. Years of dealing with the public, individuals, and the media have taught our association an important lesson. When it comes to prescription drugs, the Canadian public and even most health professionals have little knowledge of the approval process, marketing, marketing decisions, prescribing, and sale of prescription drugs. Most believe that if a prescription drug is approved for sale in Canada it has been thoroughly tested and is entirely safe for anyone to use under any circumstances, without risk of harm, even if it does no good. Few recognize that unlike running through with their computer, what can cure one person can harm or kill another, depending on the circumstances or one's own unique biological makeup.

Two, compounding factors. Before we condemn consumers and the public for their foolishness, it's important to look at where this attitude may arise. For example, many health professionals and specialist associations routinely dismiss any cautions, side effects, or complications identified in studies. Most health professionals never read the package inserts related to drugs or medical devices such as implants, which I don't think the committee should ignore.

Number three, bandwagon behaviour. Despite all the experiences and scandal over the last two decades with serious and often unknown problems with new drugs rushed to market, the number of prescribers jumping on every new drug bandwagon for both approved and non-approved, or list and off-list, usage is disconcerting, if not embarrassing, looking at the statistics. And one of the main objectives of federal government policy is to speed up such approvals.

Next, the impact on private spending is often ignored. Often in policy decisions we're very disturbed that little consideration is given by provincial governments, regulators, or health professionals to value for money outside public hospitals or public drug plans. Far too many Albertans find themselves unable to fill a desperately needed prescription, while the number of inappropriate prescriptions filled by others continues to grow. The enormous amount of money in our society being spent on unnecessary or inappropriate prescription drugs is being lost for other even more valuable treatment options or things that would genuinely improve the health of individuals.

I also raise the issue of non-compliance or self-protection. The fear, stress, and ultimate impotence of patients and families in questioning a doctor means that most would rather switch, go underground, or passively resist than fight.

Some of the other points here, our other issues, include our concern that what we're seeing with both the marketing and the advertising is that we're being sold fear and we're being sold products. In our view, wellness has become just one more marketing tool for the investors in medical technologies and drugs.

We're very concerned about the new unintended addictions and demands on our system from new classes of drugs such as SSRIs and question whether we have simply traded Players Light and du Maurier for Paxil and Ativan.

Most of all, our greatest concern is focused on our increasing societal addiction to drug money. Certainly this applies to researchers, health professionals, universities, regulators, government programs, media, and patient groups, who increasingly depend on drug money to fund their work and their play.

¸ (1425)

The Vice-Chair (Mr. Stan Dromisky): Thank you very much.

Ms. Wendy Armstrong: With the indulgence of the committee, could I briefly identify the recommendations we would have?

The Vice-Chair (Mr. Stan Dromisky): No, I'm sorry. Whatever you have there, give a copy to the clerk, with the recommendations and all.

Ms. Wendy Armstrong: We've given it to the clerk.

The Vice-Chair (Mr. Stan Dromisky): Copies will be made for everyone on the committee, even those who are not here.

We'll now go to Doris Ronnenberg, who is the president of the Native Council of Canada, Alberta branch. Accompanying her are Glen and Richard.

Go ahead, Doris.

Ms. Doris Ronnenberg (President, Native Council of Canada (Alberta)): Thank you, Mr. Chairman.

First of all, I'd like to welcome you to Treaty 6, which is the territory of the Cree, and they say very famous battles have been fought by the Blackfoot and the Cree in the surrounding area.

With me today are my board member, Glen Stashko, who is from Fort McMurray, and Richard Long, our executive director.

The Vice-Chair (Mr. Stan Dromisky): You have only five minutes.

Ms. Doris Ronnenberg: I speak quickly.

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The Vice-Chair (Mr. Stan Dromisky): Good.

Ms. Doris Ronnenberg: I'm giving the committee a copy of our newsletter. At the back it explains who the non-status Indians are in this province. It also explains the type of work that the Native Council of Canada (Alberta) does.

I sit on the National Aboriginal Council on HIV/AIDS, the Prime Minister and Anne McLellan's 24-person committee.

We're saying there is a constitutional right for treaty Indians to have health care. Under Treaty 6 we have the medicine chest, which, in translation, is health care. We're making recommendations for treaty rights for health to include off-reserve Indians and non-status Indians. This is why I talked about the different types of non-status Indians we have. That was a study we did in 1985, before the changes to the Indian Act, Bill C-31, were made into law.

We also say the monitoring of adverse effects and prescribing practices should include qualified aboriginal doctors and nurses in the process. In this I'm talking about overprescription and unscrupulous doctors who use Indian people just to sell drugs and to make money, and I think there has to be a stop to that. It's not always from the viewpoint of the addicted aboriginal person that we must look. We also have to look at the unscrupulous professional who is making use of this person.

I'd like Richard to explain very briefly the types of non-status and the access to drugs by off-reserve and non-status Indians.

Mr. Richard Long (Executive Director, Native Council of Canada (Alberta)): Thank you, Mr. Chairman. I am aware of the time. I'll be brief.

There are two basic points here, and I say this with some 30 years of experience. There's a very poor understanding in the House of Commons among members of Parliament as to what a non-status Indian is. Most members of Parliament think of Indians and Indian Affairs as destiny. That is simply not true. We've listed in the newsletter 18 types of non-status Indians. These are Indian people who did not have benefits of any money or any programs from Indian Affairs. Down at Canada Place, they have an Indian and Inuit affairs branch. If they walk in there without the card with the photo on it, they're turned away.

We'd like you to look at these 18 types, in particular about the health care transition fund. It was $800 million that was agreed to by the Prime Minister and the premiers in 2000. We'd like you to look at it differently from status Indians on reserve. We'd like your committee to delve into the question of whether the health care system in Canada deals with these people.

Secondly, we have a question about the fund itself, the $800 million that we've agreed to. There is a paper that was submitted about the transition fund and it deals with aboriginals, the aboriginal envelope. The problem is that you don't look enough at access. It's superficial to say everybody has access. If you read the paper on the fund, it's based on this question of access.

In summary, our two points are these. We'd like the committee to take a look at our definition, which has been accepted across Canada, of what a non-status Indian is. Second is whether these people, who number in the millions and at least in this province in the thousands, and who are not Métis, have access.

Finally, as I point out in the paper we submitted to this committee, section 35 of the Constitution Act of Canada says that aboriginals are Indian, Métis and Inuit. The word “Indian” is not defined, nor is “Métis“. An Indian is an Indian is an Indian is an Indian. The concept of non-status Indian is not in the Constitution of Canada, is not in the BNA Act, is not in the Indian Act. We're arguing, basically--and I appreciate that I might sound arcane to many of you--that the average person needs to know what the Indian Act says.

The Vice-Chair (Mr. Stan Dromisky): Thank you very, very much.

Now we will go to questions. Each person has five minutes. We'll start with Mr. Merrifield.

Mr. Rob Merrifield: I'd like to start with a couple of questions, if I may.

One of the issues we dealt with actually in the spring is the consent forms. It came up as well in some of the hearings in the last couple of weeks with regard to the compulsory consent forms for native health, re-signing the forms and having those complied with by March 2004. Can you tell me where you're at from your perspective? We've heard the department's perspective on that. Can you tell us, on compliance for status, if that's something that is achievable and if you intend to comply?

Ms. Doris Ronnenberg: First of all, this came up at the Assembly of First Nations meeting and there was a big debate on it. I am of the mind that the form itself is quite harmless, providing there has been absolute legal examination as to whether there's any infringement on treaty rights. Barring that there is none, the form itself shouldn't be any problem. But there's still extensive research that has to be done into the legal question.

Mr. Rob Merrifield: You're suggesting that physicians are quite unscrupulous as far as prescribing for natives is concerned, and that addictions to prescription medication is a serious problem. We've been trying to get a handle on that. Can you tell me from your perspective just how big a problem it really is? We're really getting blank stares from the department. They're saying they don't have the consent forms, that they actually have the information but they don't have the consent to use it. From your perspective, how serious a problem is this addiction to prescription medication with the native people?

¸ (1435)

Ms. Doris Ronnenberg: The drug that comes to mind is Percoset, and I think Percodan or something like that. This is a painkiller, but there are people who are addicted to it. We have unscrupulous doctors who are giving.... You're supposed to get probably three pills a day, but some of these people are taking 30 pills a day. I think it has to be monitored, and you have to give the doctors who are overprescribing this more than a tap on the wrist. It's a very serious thing.

Mr. Rob Merrifield: Yes, I believe it is. That's why the committee is looking hard at dealing with it, and that's why we have so many different witnesses here. I appreciate the seniors being here, and their perspective on this as well. From some of the stories and testimonies we're hearing, a third of our seniors are addicted to prescription medication. We heard yesterday of somebody who was on 47 different medications at one time. That sort of thing is becoming more and more commonplace. The rate of mis-prescription of medications within hospitals, we were told yesterday, is at least 50%.

These are astounding figures. I'm wondering--and I'll just leave this open to the panel--if you can give your perspective on that. I'm sorry I didn't hear all your testimony. It's an important issue. Are those numbers valid, from your perspective?

Ms. Wendy Armstrong: If I could speak to that question, I didn't have an opportunity to present any of the statistics with regard to Alberta, but it's interesting that in Alberta between 1998 and 2002 we dispensed more prescriptions for psychotherapeutic drugs than we had people in Alberta. I recognize that there were probably three or four prescriptions a year involved in that, but certainly within our frame of reference our greatest concern is that many of the new drugs that come to market are like tobacco, which originally was claimed to be non-addictive. These drugs are proving to be quite addictive and problematic, particularly benzodiazepines, which are often cloaked in new brand names, and some of the SSRIs like Paxil.

Our grave concern is that the difficulties people are having trying to come off these drugs, to which they inadvertently became addicted, are having serious consequences in our communities, on our quality of health, and on costs for many people. So supports like that are a very important focus for your committee.

Mr. Rob Merrifield: I think Dale and maybe Wendy alluded to the idea of speeding up new drug approvals. I think Wendy mentioned being a little cautious about speeding up drug approvals, because we're rushing to new technologies. If, for instance, a drug had fewer side effects, would you still feel the same way about that? I guess that would be my challenge to you.

The idea of patent law is something the industry committee is presently looking at. In fact, we're just about to write a report on it. We've looked at brand name and generic drugs. Do you realize--and maybe you do--that the prices of brand name drug products in Canada are lower than in the United States and most other countries, but the generic drugs are not?

The Vice-Chair (Mr. Stan Dromisky): Get to the question.

Mr. Rob Merrifield: Generic drug prices are higher in Canada than in the United States, so how do you justify your position on patent law?

Mr. Dale Watson: I think they are higher because they can get away with it.

The Vice-Chair (Mr. Stan Dromisky): Thank you very much.

Mrs. Hinton, do you have a question?

Mrs. Betty Hinton: Actually, I have some comments.

First of all, to Mr. Staples, hear, hear! I agree with what you had to say. I don't have time to go through all of you, so I'll just say hear, hear!

Mr. McLeod, I read this over fairly carefully and I listened carefully to what you had to say, and with all due respect, I think you're talking about bargaining issues. I think it would be time to look at negotiating for part-time people. I think that would be a plus for everybody all the way around. For years I've been telling people who were willing to listen that I would always take benefits over an increase in pay, because government takes the increase in pay right back out of your pocket, but if you go for the benefits side, all the people in the CUPE union would benefit tremendously. I agree with you that it's very expensive and that you need to have some kind of security for part-time workers.

To Mr. Watson, with regard to the patent law, I've always been against extending the patent law when the vote came up in the House of Commons for the very reason that you outlined today. But I did not realize before today that the patent law forces drug developers to share the information with others after the expiry. I think that's to the benefit of all.

To Ms. Ronnenberg, my concern is still the same as it was two years ago when I first heard from Mrs. Stonechild, when she appeared in front of a different committee entirely. She talked about the loss of both her brother and her son because they were able to get 200 prescriptions within one year. No one fixed that, because there is a misconception out there that privacy is being invaded if we actually request how many prescriptions were given to native people. I think that's a very sad state of affairs. I think we have to take the drug abuse portion of it and the potential for death into consideration, and I think those outweigh the privacy portion of it.

To the gentleman sitting next to you--I'm sorry, I can't read your name tag and I didn't write your name down fast enough--you were saying an Indian is an Indian is an Indian. How would you define that? I have an Ojibway grandmother. Does that make me native or non-native? I think we have to look at consideration for the health care problems of all people in this country, whether they're aboriginal or non-aboriginal.

¸ (1440)

The Vice-Chair (Mr. Stan Dromisky): Thank you very much.

Do you want to respond to that? You have only one minute.

Mr. Greg Thompson: She can have some of my time.

The Vice-Chair (Mr. Stan Dromisky): Okay.

Ms. Doris Ronnenberg: You talked about the family that got the prescription drugs. We have to monitor the doctors, not just the patients, because it's the unscrupulous doctor.... A friend of my mine ran into a doctor in a mall in Calgary and talked to him. It had nothing to do with a disease. Then my friend found out that doctor had put in a claim to Indian Affairs for seeing him. So it's always economics. And the Indian is the one who is being used.

So I totally agree that there has to be some way of monitoring the kinds of drugs that people are getting, but also the doctor has to answer for that, not just the patient.

The Vice-Chair (Mr. Stan Dromisky): Thank you very much.

We're going to recess, and when we come back, Mr. Ménard will be the first to ask questions.

¸ (1443)

¸ (1449)

The Chair: I call the meeting back to order.

We were in the third round of questioning, and Mr. Ménard has the floor.

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[Translation]

Mr. Réal Ménard: My question will be general in nature. It is directed at whomever would like to answer it.

I am not sure that as a committee or as Canadians and Quebeckers, we will have much opportunity to review the Patent Act, because Canada has signed the TRIPs agreement, on intellectual property. We lost before a tribunal with respect to a mandatory convention, and that is why Bill S-17 was passed two years ago.

What would you think if we were to ask the Department of Health not to give a notice of compliance to manufacturers, to the major pharmaceutical companies, if we do not have prima facie evidence, based on the file, that the drug the company wants to introduce would provide at least 50 p. 100 new therapeutic effects? Does that seem desirable in your view? Would you be prepared to support a recommendation of that type? I know it would have to be more detailed than that but I have not had time to do that. What do you think of the general idea?

Would you like to begin, Ms. Armstrong?

[English]

Ms. Wendy Armstrong: Thank you.

I think it's a bit of a double-edged sword. The question you've raised is a bit of a double-edged sword, because certainly we have a bureaucracy that's absolutely overwhelmed with an onslaught of new drugs coming onto the market. But one of the challenges you face is that if you limit access to the market for comparable drugs you're really limiting access to competitive opportunities that might theoretically--in theory, although we don't see a lot of competition in terms of prices in drugs--come onto the market. So what I'm saying is that it's a bit of a tricky situation there.

From our association's perspective, it may be actually more valuable to change some of the laws that have what we consider, or the practices that have stimulated, the “evergreening”.... Are you familiar with that term and effect? Is there--

Mr. Réal Ménard: Yes.

Ms. Wendy Armstrong: All right.

So there is the evergreening phenomenon of drugs or the phenomenon of companies being able to withdraw old drugs on the market. The really huge problem, in terms of what we've found in recent years, is when the companies are bringing new high-priced drugs to market that really provide no benefit and may actually have some harm attached to them that we don't know about yet, and at the same time they withdraw the lower-cost, affordable, reliable drug that we know about, whether it's insulin or asthma drugs, or whatever the situation is.

Actually, one of the strategies I've heard suggested is that you could perhaps sit down with your deputy ministers of health provincially to make an arrangement, because when you have a bulk buying power like the aboriginal plan, or like our provincial plans, or like our fantasy federal pharmacare plan, you have the opportunity to say to a drug company, if you want a new drug, Health Canada may allow it onto the market, but we won't bring a new drug onto the formulary unless you keep the old drug there too, so that we have a lower-cost option.

[Translation]

Mr. Réal Ménard: I see. Mr. Watson?

[English]

Mr. Dale Watson: I think what you're talking about is a very common practice of bringing on a drug that has very little change in it and calling it a new drug in order to extend the patent. I think Parliament should say they're not going to allow that. So that's why we advocate the repeal of Bill S-17.

[Translation]

Mr. Réal Ménard: No. The idea is not to extend the patent protection, but rather to get another patent.

[English]

Mr. Dale Watson: Have another patent? I didn't even know they could do that. I knew they could extend patents this way, but I thought you had to introduce a new drug to have a new patent. No? Okay.

[Translation]

Mr. Réal Ménard: Do I have a little time left?

[English]

The Chair: A little bit. Short questions.

[Translation]

Mr. Réal Ménard: We must not forget that Canada has signed the agreement on intellectual property. Consequently, it is far from clear that...

First of all, all patents must be for a 20-year period. Withdrawing from the WTO might be a solution, and that is what some colleagues on the committee think. However, we must make recommendations within certain constraints. I think we must restrict the market access of new drugs. That is the main reason for rising costs. The Senate and the Kirby report supported this approach. We will have an opportunity to make some recommendations ourselves.

It is too easy to suggest a review of the Patent Act. Canada went to international arbitration and lost. That is why we had to pass Bill S-17. All patents—not just drug patents—must have a 20-year period. If we do not provide this protection, the solution is to withdraw from the WTO. There is no middle ground. What Health Canada introduces onto the market is what we can control.

¸ (1455)

[English]

You disagree with me, Mr. Watson?

Mr. Dale Watson: I'd like to see Canada withdraw from the WTO, absolutely. But I don't think Canada has the nerve to do that. I think we're being jerked around. I believe in national sovereignty and I don't think we have it economically.

[Translation]

Mr. Réal Ménard: I would have had quite a few questions for you on sovereignty, but I will come back to that some other time.

[English]

Mr. Dale Watson: Yes.

Mr. Réal Ménard: We can build a new partnership, if you like. But I am out of order.

The Chair: Thank you, Mr. Ménard.

Ms. Fry.

Ms. Hedy Fry: I actually haven't put up my hand, but since you're asking me, I will ask a question.

I just want to talk about access for non-status Indians. I think that is what Doris was talking about. I also want to comment on what she has said about abuse and how it is fed quite often by people doling out prescriptions for large amounts and repeating them over and over. And that goes on the street and is sold and is destined for use.

In the last committee on the non-medical use of drugs that I was on, we discovered a whole problem with prescription drugs being sold on the street. We went out to some aboriginal areas and some of the urban areas where there were non-status Indians, and they told us how they had just had a prescription for 300 MSContin handed to them and then two days later they got another prescription for 300 MSContin. I think one of the things we recommended, which we've heard talked about here over and over, is some sort of ability to have a national, for what of a better word, pharmanet, where you can in fact have everything available to pharmacists and to government and to citizens with regard to prescribing practices, with regard to who is getting what, who's getting the products, who's getting anything, so that you know and can track people and can track bad prescribing habits and obviously bring that particular physician to justice. But also, at the same time, you can pick up people who are multiple doctoring in order to sell it on the streets. I understand that for MSContin you can get something like $40, and so if you have 300, that's a pretty solid amount of money you can make in an afternoon.

So there are two features to this. I think Doris pointed them out very well. But I want to ask you, Doris, what you think we should do. Have you a suggestion with regard to access of non-status Indians to drugs?

Ms. Doris Ronnenberg: I think I'll ask Richard to answer that. I'm ducking out.

Mr. Richard Long: It's a good question, a difficult question to answer, but I'll try.

Maybe we could identify Indians who have medical training, university degrees in medicine, and get them more involved in the whole process of monitoring under the transition fund. The transition fund sets up $800 million. It sets up a series of procedures. But I've checked it out, and there are very few Indians in the system who are in this area of monitoring, and maybe the medical associations could help.

But I would say one thing to the lady who was here--she's not in the room. I said an Indian is an Indian is an Indian, and I bring this into the picture because in 1939, just before the Second World War, there was a case in the Supreme Court called “in re Eskimo”--and I forgive the word “Eskimo”, now it's “Inuit”. But the question on the table was were the Inuit people--Eskimo then--Indian within the meaning of Indian in the BNA Act? We have a Constitution that says aboriginals are Indian, Métis, and Inuit, but we don't define those words anywhere. Recently in the Powley case the Supreme Court held that Métis have rights to hunt, and it was the beginning of a positive change. This is not America, this is Canada, and when I said an Indian is an Indian, I meant that the non-status Indians, who, as outlined in this newsletter in front of you, are of 18 types, are Indians. Maybe we could have an “in re Indian”. Maybe we could sit before the Supreme Court judges and ask them what an Indian is, not what an aboriginal is, because the transition fund sets up $800 million, and some of that money is going to aboriginals, but nobody knows who.

If we get beyond the bureaucrat, we can say, okay, Doris is a status Indian, a treaty Indian; she has a card. Len here is a Métis from Fort McMurray.

A voice: He's a non-status Indian.

Mr. Richard Long: He is a non-status Indian, forgive me. We brought him here to show you a real live human being who's a non-status. He's one of the 18 types.

But if you're going to set a law for policy development, you have to define your terms. You're struggling.

Now, the focus of this committee is prescription drugs, and I don't want to get off the point, but the focus of the transition fund is to deliver services in this area, and it's to whom? So what do you do, short of hiring lawyers to go to the Supreme Court and ask them what an Indian is? Is it a BNA Indian? A constitutional Indian? An Indian Act Indian? A treaty Indian? There are four types of Indians: treaty Indians, the BNA Act Indians, the constitutional Indians, and the Indian Act Indians. And they carry consequences in terms of program delivery.

So to answer your question quickly, there are two things. There should be a concerted effort to get more Indians involved in the monitoring of this whole business, the claims people. And secondly, there should be a better effort to define.... A question was asked about the consent form. Do you know what the real problem with the consent form is, not in your world but in the Indian world? The Indians don't think they have to define their treaty rights. The treaties say you have health care. Then the bureaucrats come along and say, yes, but you have to give us permission to investigate you to find out whether 500 years ago your grandmother was an Ojibway. The Indians say, you have no right to do that, I'm a constitutional Indian. But somebody has to take a look at the definition of these things.

I don't know if I have answered your question.

¹ (1500)

The Chair: Thank you, Ms. Fry.

Ms. Bennett.

Ms. Carolyn Bennett: In term of the whole issue of drug pricing, I'm always surprised that neither CUPE nor the Council of Canadians actually seems to see that one of the big cost drivers really is the price of generics in this country. Our generic drugs are in some cases twice what they sell for in the United States, and there are a lot of drugs being prescribed on the formulary that are generic.

Would you see a difference if there was a change in patent laws or actually controlling the price of generic drugs?

Mr. Dale Watson: Why should an unreasonable monopoly on a patent be allowed just because generic drugs are allowed to cost more in Canada? I don't see that as a logical position at all.

Ms. Carolyn Bennett: No, I'm a holistic person. I don't see black hats and white hats on anybody. I just see that if we're going to drive the prices of the drugs or keep them in a reasonable way across the country, why is there this absolute focus on patent and absolute silence on the fact that the generic drug companies in this country are private and we have no idea how much profit they're making? Yet, as a physician, if I bill a whole bunch of stuff, because I'm being paid public dollars, anybody can come and look at my practice to see how much I'm billing and why. The fact is that generic drug companies are private companies. Therefore their profits and their annual reports are not available to consumers or to governments in this country. Why do you let them off on this?

¹ (1505)

Mr. Dale Watson: I didn't let them off. Are they accountable to me? I think the Canadian government has let them off.

Ms. Carolyn Bennett: I just think we need to look at the whole picture and I don't think either of them are saints.

Mr. Dale Watson: I'm quite willing to do that. It seems to me that one of those recommendations provides for that, because the ongoing review of drugs includes the drugs of generic companies. Right?

Ms. Carolyn Bennett: Right, but that wasn't in your brief. Basically this is the same brief as the one four years ago. Right?

Mr. Dale Watson: I don't know about that.

Ms. Carolyn Bennett: I just think if the committee were evolving.... It's a bit frustrating that certain presentations are so.... We've not learned anything over this last little while about the big picture and the holistic picture or that they intend to respond to Romanow. I guess I would like to hear what anybody has to say about a drug agency that would look at this in a pan-Canadian way.

Mr. Dale Watson: I think that's a great idea. It's part of the recommendation.

Mr. Réal Ménard: You have to respect their jurisdiction.

Ms. Wendy Armstrong: I would like to respond to that and also a bit to the issue of jurisdiction, because certainly my understanding of health economics and drug policy is they're all very tied together—how you finance a product, how you can affect how the price is controlled. I certainly think that in Canada we're missing an awful lot of opportunities to lever more kinds of things that could reduce the cost and introduce competition because of our fragmented and scattered pharmaceutical policies across this country.

I would also like to raise this issue since we've just agreed to enter into some negotiations on sovereignty here today. I would like to suggest that for ordinary Canadians one of the absolutely most disconcerting and mind-boggling things amidst the provincial-federal fights and the ongoing debate is that here we are heading into a new century encouraged to be global citizens. Our family, our work, is scattered. I travel to Quebec. I travel to Nova Scotia. I have friends and family in almost every province in this country. I have a stake in what kind of health care coverage an aunt in Ontario has, or a sister living in B.C. What I don't understand is that in this day and age, with the importance of portability of health benefits, whether you're working or travelling throughout this country or even throughout the globe, it's creeping to pre-medicare days where the only thing my plan will cover is local access to services in Edmonton, Alberta. I think it's abominable and I think there is a tremendous opportunity for this committee to put some leadership back into Canada and to give us back our portability.

Thank you.

Mr. Brian Staples: I would like to advise all of you, as members of Parliament, that the person who just spoke, Wendy Armstrong, is an absolutely phenomenal researcher and a very wise person. I know in our group, the Seniors' Action and Liaison Team, we listen very carefully to her, and I hope you will listen to her also and read carefully her report.

I just want to make one other observation also. I hope you read the document I've prepared. It wasn't able to be distributed because it wasn't translated. There is one area that has not been touched on, which is in our paper, and it has to do with prevention, to get people off drugs, and it should apply throughout the age groups. We should be converting every willing school in this country into a community learning and participation centre that has weight training and so on as part of that school for the children and for all community people and that deals with general community education in the process of educating young people to live their lives thoughtfully, constructively, fully, and happily. That's something I didn't get a chance to present, and I did want to say that to you now.

The Chair: Thank you, Mr. Staples.

I have no other questioners on the list. So that being the case, I don't think we quite have time for a summation from everybody. Is there anybody who, like Mr. Staples, felt there was one more thing he wanted to say?

Yes, Glen.

¹ (1510)

Mr. Glen Tashko (Native Council of Canada (Alberta)): Thanks for the opportunity to speak here.

I'd like to go on the record to say that I'm a non-status native and I don't have the same access that treaty and first nations people have to health care. If you want to define me, if you have the treaty feather, I'll be number 13, a descendant of somebody who received land or a split at the beginning of the 19th century. I hope perhaps they would look at changing these types of things in the future.

The Chair: Thank you very much, Mr. Stashko.

Mr. McLeod.

Mr. Bruce McLeod: Going back to a couple of comments that were on the table earlier today, you talked about the patent laws.

CUPE national, our national union, will be making a presentation in Ottawa. They will be dealing with those issues, with the standards part that I have not talked about today. I would encourage this committee to look at that and to look at what they're going to do on Bill S-17. We didn't have that opportunity today, but I would appreciate your reviewing that material.

The Chair: Seeing no further hands, on behalf of the committee members, I would like to thank you very much for putting your speeches together and for turning up today and listening to each other, and for helping us as we go about our prescription drug study and our western tour.

Thank you very much, ladies and gentlemen.

This meeting is adjourned.