HEAL Committee Meeting

STANDING COMMITTEE ON HEALTH

COMITÉ PERMANENT DE LA SANTÉ

EVIDENCE

[Recorded by Electronic Apparatus]

Thursday, February 12, 1998

• 0907

[English]

The Chair (Ms. Beth Phinney (Hamilton Mountain, Lib.)): Good morning, ladies and gentlemen. I call to order the 17th meeting of the Standing Committee on Health. We're doing a study of natural health products.

I will take a couple of minutes to mention that we do have a vote this morning. We don't control when it comes or why, etc. It's a half-hour bell. It gives us a half-hour warning to get over there. It's a slippery walk this morning. It will start, we think, at 10.05 a.m., which means the vote wouldn't be until 10.35 a.m. It takes about half an hour. Maybe we could be back here by 11 a.m., maybe by 11.15 a.m.

When the bells go, we still have a few minutes. If they go at 10.05 a.m., at about 10.10 a.m. I'll just look around and get the consensus. If there's no more questioning from the members, we'll stop at that point. If more questions are required, we'll come back after the bells. I know Dr. Best has something else to do at 11 a.m. and some other people are busy too, so we'll just play it by ear at about 10.05 a.m. or 10.10 a.m. If we can keep the questions and answers short, maybe we'll get everything done before then.

We have three groups with us this morning. From the Canadian Coalition of Herbal Associations there are two people, Michael Vertolli and Chanchal Cabrera. Then from the Tzu Chi Institute for Complementary and Alternative Medicine there is Dr. Allan Best. We don't have the other person who was supposed to have been here, so that might make questioning even shorter.

We'll start with the Canadian Coalition of Herbal Associations. Michael, go ahead.

Mr. Michael Vertolli (President, Canadian Coalition of Herbal Associations): Thank you.

First of all, I would would like to apologize to the members from Quebec. I've been involved in the creation of a couple of the other presentations you heard last week. Unfortunately this document didn't get finished until the last couple of days and we didn't have time to do a translation. I was told it would be translated and you would be provided with it later.

The Canadian Coalition of Herbal Associations is a coalition of regional associations which represents the interests of professional herbalists. It is largely formed to address federal regulatory issues on behalf of professional herbalists across the country.

• 0910

The proposed regulatory framework you see before you is done basically from the perspective of herbalists and deals largely with the issue of herbal medicines. However, at all points in this document we have considered the issues from the perspective of other stakeholders as well as considering the broader issue of natural health products. Repeatedly throughout the document we are sometimes referring specifically to herbal medicine and sometimes to all natural health products.

I'm going to keep this brief so we can get to questioning more quickly. A lot of what we have to say you've heard before. The cornerstones of our proposals with respect to the regulation of herbal medicines and other natural health products have to do with the fact that we see two essential problems—well, a number of minor problems, but two major problems. One of them has to do with the fact that all natural health products are currently regulated as either foods or drugs. You've already heard reasons as to why our group and other groups feel this is inappropriate.

In the case of foods, we feel that the standards for manufacturing foods are not stringent enough to be used for therapeutic products. And unfortunately at this time, most natural health products are still in the food regulatory category.

In the case of drugs, we feel that natural health products are distinct from drugs in a number of different respects. First of all, in the very essence of what they are, they are different, and they're also different in the way they are applied. Similarly, we feel that the average natural health product is associated with considerably less risk than the average pharmaceutical product. And since the regulations governing the drug category were essentially designed for the regulation of pharmaceuticals, we feel this is inappropriate.

Of course, given that most products are still regulated as foods, another concern of ours is the fact that the food category does not allow appropriate information on product labels to ensure that the public is able to use these products the way they're meant to be used and is aware of appropriate contraindications or sub-groups of the population that maybe shouldn't be using these products.

The essence of our proposal is that we would like to see the Food and Drugs Act amended so that the drugs category is redefined under the terminology “therapeutic products”, and we would like to see the therapeutic products category further subdivided into two distinct categories, that of pharmaceutical drugs and that of natural health products.

We believe a separate set of regulations should be established for natural health products that takes into account the unique aspects of these products and incorporates elements of the holistic medical paradigm, because in many cases attempts to subsume these products and their use under the conventional medical paradigm lead to problems. The application of these products is often quite different.

In addition, because any regulations, no matter how appropriate they are to the category of products being regulated, need to be regulated by individuals who understand the nature and applications of these products, we believe a separate regulatory body of some sort needs to be established that includes individuals with appropriate expertise in the field. We outline that expertise as including, but not being limited to, herbal medicine, complementary nutrition, orthomolecular medicine, homeopathic medicine, and traditional systems of medicine that are well represented in Canada, including, but not limited to, native American medicine, traditional Chinese medicine, and ayurvedic medicine.

In addition to requiring the obvious appropriate expertise, we believe the regulatory body must have sufficient regulatory power such that individuals from other regulatory bodies that do not have appropriate expertise cannot override decisions made by the regulatory body governing natural health products.

In addition, we would like to see the Food and Drugs Act amended such that schedule A is eliminated, because we believe this legislation is outdated and curtails the rights of Canadians to have access to the kinds of health products and healing modalities of their choice.

• 0915

I'd like to pass the floor to Chanchal, who's going to speak a little bit about the issue of regulation of practitioners.

Ms. Chanchal Cabrera (Canadian Coalition of Herbal Associations): Thank you, Mike.

Just to let everybody know, I am a medical herbalist. I have a four-year degree from England. I'm a member of the National Institute of Medical Herbalists, and I've been a practitioner for ten years in Canada.

The issue I want to address is the fact that we have spiralling health care costs in Canada today, and we have a bigger and bigger slice of limited resources being dedicated to health care. What we're seeing is that although we're very good at dealing with acute and epidemic conditions, we're not very good at dealing with chronic and degenerative health conditions. These chronic degenerative diseases continue to rise, so it seems that we have a need to emphasize preventative medicine and education, and patient self-care. It is exactly this that complementary medicine exemplifies. Complementary and alternative medicine is very strong on prevention and very strong on patient self-care, which will in fact help the Canadian economy significantly as our baby boomers reach maturity and go into the senior citizen population, and as our health care costs rise.

The problem we have in Canada today is that there have been to date no regulations or requirements for the training of professional alternative health care practitioners. Essentially, anybody can call themselves herbalists. Any of you could go out and hang out your shingle tomorrow and start taking money for seeing patients, even though you may not know anything about herbal medicine. There are no laws to stop you from doing that. As a health care professional in this country, I personally am very concerned about that. I have seen some very scary things, as well. Of course there are some wonderful practitioners who have great training. There are also many who call themselves practitioners but who I don't think should be out there doing what they do.

What we need to look at here is that the majority of herbs are, of course, entirely safe. You can take a great deal of them with no danger whatsoever, but there are some herbs that do need to be restricted. At the very least, they need cautionary labelling—and we have covered that to some extent in our document. There are also some herbs that really should not be sold without the guidance of a health care professional, that should not be used without supervision. Unfortunately, in this country, the only people who are authorized to supervise or prescribe such products would be medical doctors or, in some cases, pharmacists, and they are not trained to use these products. Some of you may have had the experience of going to a doctor and asking if you could take this herb while on this drug, but the doctors usually don't know.

This really points out the need for education of the practitioners, and for some form of registration or regulation about who gets to be a herbal practitioner in this country. I'm speaking specifically of herbal because that's my area of expertise, but it really could in fact be explored into all of the different aspects of natural medicine.

The registration of practitioners is a provincial issue, so each province is going to have to take care of this for itself. I would like to propose or suggest, however, that there needs to be a federal initiative to make this happen. The provinces may not get on board with this idea as fast as they would if the federal government were to suggest that there be what we're suggesting in our document here: a joint federal-provincial committee to review the issue of registration of herbalists and to look at all the different aspects that need to be encompassed there, most specifically education. What are the criteria for being a professional herbalist and how do we establish those?

Thank you.

The Chair: Dr. Best.

Dr. Allan Best (President and Chief Executive Officer, Tzu Chi Institute for Complementary and Alternative Medicine): Thank you, Madam Chair. It's a pleasure to again meet with the committee.

The Chair: Sorry to interrupt, but I presume Brenda Thomas is here now. We'll just let her have time to get her breath while you go ahead, Dr. Best.

Dr. Allan Best: I'm representing the Tzu Chi Institute for Complementary and Alternative Medicine. It's primarily a research institute, and you do have briefing notes in both English and French, I think. I'm not going to follow the notes directly. You're going to hear from other witnesses on lots of different kinds of concerns about the regulatory environment and regulatory issues. Particularly, you'll wrestle with lots of conflicting priorities from different groups. What I want to do is to speak from the research perspective of our institute and try to provide a bit of a broader context for looking at some of those regulation issues.

• 0920

The challenge I think we're struggling with, in large part, is that when we look at the regulation issue we're shooting at two moving targets. The first is a growing interest in complementary medicines across Canada and other western countries. The second is the health care reform that's currently going on in this country. If those two things weren't happening, it might be easier to come to terms with the specifics of the regulatory issues. But because they are happening, I'm going to argue that regulation must be dealt with in a much larger context if it is to achieve the goals of protecting the safety and the efficacy and the choice that are at the heart of the issue here.

There's a sense in which your goals, as a committee protecting safety and choice, are essentially the same goals as those of the institute. We're relying primarily on research as a tool to achieve that. You of course are relying primarily on regulation. But I think there's common ground.

Let me talk first about the context and the need for a complementary strategy.

I think what is happening at the moment is that we have twin solitudes in this country. A recent British study surveyed patients of both complementary and conventional practitioners and found that fully 75% of each camp had never heard of the idea of a cross-referral to the other. Clearly, the practices are happening separately. Yet it's a very small minority of patients who are using only complementary products. For the most part they see the value in having both complementary and conventional, and they are working to bring them together. It's that resulting fragmentation that is proving frustrating for the public, practitioners, and politicians alike. The fundamental need is to find ways to integrate complementary care and the issues we face there with the health reform that's going on in the various provinces across the country as we speak.

At the back of the handout you have you'll see a figure that tries to provide a framework for thinking about some of these kinds of issues. It starts with research: learning what is safe, what is effective. In many cases we already know a lot of those answers; it's just that they haven't been pulled together. In some cases there is a need for continuing research. In either instance we need to have processes, we need to have bodies, that can pull together the evidence that's available and come up with balanced judgments about what the safety and the effectiveness are.

That knowledge then feeds into a variety of different kinds of strategies. Certainly the regulatory strategy is the focus today, but as has already been mentioned, it also needs to be dovetailed with educational strategies for the professions. Herbal use, for example, takes place in the context of individualized care, typically. It makes no sense to separate those two issues. We need to find ways to bring them together. Certainly, because there is a relative lack of knowledge and lack of appreciation of the two solitudes, there needs to be a fairly massive program of public and professional education so people really understand what the regulations are trying to achieve.

When I think about the regulatory environment and take a step back from that and ask what fundamentally we are doing with regulations, it's largely a question of changing behaviour: changing individuals' behaviour, changing practitioners' and manufacturers' behaviour. It's much easier to change behaviour when people are working with you than when they are working against you. So it makes sense that we want to include these other kinds of educational and professional practice strategies which will help coordinate these different initiatives so they all are working in the same direction. Once we have that happening, we can start to look at some of the different support products, such as the various herbal remedies and professional services. I'll talk later about informational services, and finally about an evaluation loop to make sure the whole system is working the way it should.

The second issue is this one of public and professional education, which I'm already touching on. There really is a great deal of frustration right now. I've been talking, for example, a fair bit with the College of Family Physicians of Canada and their members, and they are terribly frustrated because patients are coming to them all the time, asking for information about what they can and can't do safely to combine the two different regimens, and they simply don't have the answers. They want that kind of education. Professional bodies, like family practitioners, but a variety of others as well on both the complementary and the conventional sides, would like to be working towards these solutions.

• 0925

Again, we're in conversation with several of the national health interest groups like the Canadian Cancer Society, the Multiple Sclerosis Society of Canada, and so on, who are trying to provide these kinds of information services because there is such a great public and professional demand for them, but it's not happening. It too is in a very fragmented and ineffective kind of stage at the moment.

There's a need for a fairly sophisticated, multi-level, ongoing public and professional education program to support the regulatory initiatives you're considering here. It's going to take a lot of work to pull that together. The good news is that there are a lot of partners out there who would be interested in working with the federal government to achieve that.

The third thing I want to touch on is the need for a knowledge base, an information system we can go to for one-stop shopping about what's going to work and what's not.

The last few years have seen an incredible explosion of information on the Internet and other kinds of situations. At the moment, if either the professional or the layperson wants to get information on herbal products, they go to the Internet and see what's there or they go to their libraries and look at all the books that have been written, but there's no way of judging which ones are credible and which ones aren't. We need to establish a process of critically looking at what's credible and what isn't and start to come up with a system for getting that information widely distributed.

It only makes sense to try to develop that kind of an information system centrally. It's too expensive and too demanding a task to think that these different interest groups and different professional groups, libraries, etc., are going to be able to do it effectively on their own. With a coordinated central resource that then feeds back to these decentralized delivery systems, we could start to meet the knowledge needs of health policy and programming as well as consumer choice.

The federal-provincial role is an obvious issue. As has already been mentioned, we have on the one hand provincial responsibility for professional regulation and on the other hand the federal responsibility for product regulation. They have to work hand in hand. I think there are good examples where that can be done. It is starting to be done more and more, and I'd encourage the committee to think seriously about the kinds of strategies that are going to be effective in getting the provinces aligned and working with you on these issues.

The final thing I'll just mention briefly is the need for a continuing research program if we're going to stay on top of what will be an evolving and rapidly changing environment and base of knowledge set of issues around the regulation and the use of herbal products.

The first is an ongoing program to know what works, to look critically at the research that's available and to make the best informed decisions about where we are in that process. We need to have what I'm calling ongoing epidemiological research. You could call it consumer surveys. It involves generally staying in touch with the different people who need this information so that we know who's out there, what kinds of questions they have, what kinds of answers they need.

We're going to need an ongoing research program that's asking how we can do better. We're not going to do a terribly good job over the next five years, for example, in terms of bringing together the complementary and the conventional systems. They're different, but on the other hand they're interested in working together, and as we start to study that process and try to facilitate the coming together, I think much better integration is possible.

Finally, we need strategies to grow our knowledge. There still is less information than we would like regarding the safety and efficacy of some of the products we're considering and we're going to need to have an ongoing research program that tries to fill those gaps.

I'd like to stop there, Madame Chair, and take questions when you're ready.

The Chair: Thank you.

We'll go on to the First Nations Health Commission and Brenda Thomas.

Do you have a question?

Ms. Carolyn Bennett (St. Paul's, Lib.): I was wondering whether it would be better to do questions from these two first.

The Chair: No, we've always....

Ms. Carolyn Bennett: We'll never get done? Okay.

The Chair: Brenda, go ahead.

Ms. Brenda Thomas (Senior Policy Analyst, First Nations Health Commission): Good morning. On behalf of the Assembly of First Nations, I wish to thank the standing committee for this opportunity to present the views of the communities that AFN represents with respect to issues regarding natural health products and traditional medicines.

My name is Kaheniostah. I'm a Cayuga woman of the Wolf Clan from Six Nations of the Grand River. My friends and my co-workers call me Brenda Thomas. I am currently living in Ottawa. I am a nurse by profession and work as a health promotions officer with the Assembly of First Nations.

• 0930

Living in my community and with my upbringing, I have had the experience of both using traditional medicines in my family and witnessing all of the necessary preparation that is involved, through the hands of my grandmother and individuals in my community called medicine men and medicine women. In recent years, I have been involved with indigenous peoples in many parts of the world in an attempt to protect their knowledge and the use of their plants and traditional medicine preparations.

For many years, pharmaceutical companies have extracted knowledge of indigenous plant medicine usage from the indigenous peoples and have exploited this knowledge, making fortunes with new drugs, with little or no benefit to those peoples who have shared this information. No recognition was given or retained for intellectual property rights, nor has there been respect for preparations and ceremonies that may be considered sacred or secret by those peoples from whom knowledge was extracted.

We are now entering into an era where governments wish to control the usage of plants that our Creator has provided. On one hand, this may be considered an appropriate measure for the protection of health hazards in the hands of charlatans. In the broader Canadian context this may be necessary; however, to first nations people such an act would impose restrictions on our use of plant medicines that we have used from time immemorial and it would be a threat to our culture, our traditional practices, and in some ways it would be a threat to maintaining some of our sacred ceremonies.

The food directorate of Health Canada has advised the restriction of 16 known herbs for restriction because of the supposition that these herbs could pose a health hazard if consumed regularly as foods. However, no reputable practising medicine man would advise such use, nor would such substances or similar substances be used in a manner that is contrary to normal prudent practice.

First nations have used preparations of plant medicines and herb mixtures that, used alone, might be considered toxic, but used in the right combinations with other herbs and other plants, the plant properties negate the harmful effects and potentiate the benefits. This is knowledge that is held by those who prepare medicine on a regular basis, much the same as a doctor or pharmacist knows which drugs the patient can take in combination, which are compatible, which drugs potentiate, and which drugs are rendered useless in combination with others.

The first nations people of this land also have a unique relationship with the plants that our Creator has provided for our use. We do not necessarily agree with government bodies interfering with our relationship with the Creator or those plants He has provided for our benefit. We believe that the Creator of all living things has provided the life-giving forces for the benefit of our people. He has created in this physical world all manner of plants to be used for relief from all ailments known to mankind and has gifted certain individuals with the knowledge of specific instructions for their preparation and use.

When making cures for illness, the doctor is cognizant of the life-giving forces and the spiritual component of the life medicines. In order to maintain the balance of nature, a thanksgiving ceremony is performed even before the plant is plucked from mother earth, and the spirit of the plant medicine is reminded of its duty, before taken to benefit man in his time of need. During gathering, often an offer of sacred tobacco is given along with the patient's spiritual name so the Creator can connect the spirit of the plant to the spirit of the patient, thereby strengthening the power to heal.

There is much more than this involved in preparing medicines, that cannot be included in this discussion; however, I wanted to allude to this to raise the awareness of the committee that first nations do not take natural medicines or their usage lightly. It is very much a part of holistic healing process not to be interfered or tampered with through any man-made obstacle or regulatory process.

Very rarely, if ever, does a traditional healer use preparations that are pre-packaged and sold in health food stores on the open market. This practice would violate the spiritual process involved in medicine making and would be disrespectful to the Creator by putting a price on the gift of healing. Individual consumers, however, might access some of these products for the sake of convenience because they cannot access the medicines that they need at the time that is plentiful for them to go out and harvest them. Among the first nations' indigenous plant medicine knowledge and the knowledge of its preparation, it comes from the Creator and should not be sanctioned or regulated by any government body.

Should it be required that licences be obtained in order to practise as a healer, particularly a traditional healer, or should restrictions be made with respect to access to certain natural plant remedies, traditional healers indigenous to this land should be exempt from this process by the very nature that traditional healing is practised.

• 0935

The Assembly of First Nations has very recently been involved with Canada's advisory panel on herbal remedies. However, the individual who sat on this panel, Ms. Casaway, who has been an active participant, is unable to be with us at this time because she is recovering from recent surgery. So I'll do the best I can to answer any questions you might have.

The Chair: Thank you very much.

Mr. Hill.

Mr. Grant Hill (Macleod, Ref.): Thank you, one and all, for your presence here.

First, many of the witnesses have reflected quite a few of the things you said, but each one of them wanted their own regulatory body. I recall specifically the homeopaths, the traditional Chinese medical people, those involved in natural products, each saying there needed to be a regulatory body that was specific to them. Now, you've been far more inclusive, but do you think they would agree to an inclusive body such as you have suggested?

Mr. Michael Vertolli: I think they would agree if the body has expertise in those areas.

I gave you a brief summary, but we go into a lot more detail in the full document. There's no doubt that natural health products can be broken down into numerous sub-categories and each of them is unique in their own special way. Regulations would have to reflect this. So we see the two issues here being (a) that whatever particular sub-modality of natural health products is well represented in the population should have representation in terms of expertise in the regulatory body; and (b) that it's inevitable that some of the regulations would vary from one sub-category of products to another because they tend to be used and even prepared differently.

Mr. Grant Hill: Excellent.

To Allan, if I could, it sounds as though you're trying to bridge the gap between camps that have been really at odds for quite some time. As a traditional medical person myself, I have heard and have been bitten by the criticism that I don't understand and don't care about natural products and, in fact, am an impediment to their use. I think it's a fair comment. I think many medical people look with derision at those who use and employ those products.

Now, do you think that among the traditional medical practitioners like me, there's a sea change in the attitude to those individuals? I think your research can bridge it, but do you see that as you are between these two camps?

Dr. Allan Best: Absolutely. I'm going to answer it on two levels, Grant.

The Journal of the American Medical Association, as you know, is one of the two most prestigious medical journals in the U.S., and in its December 17 issue it wrote an editorial about the need for a special issue and a call for papers for a special issue on complementary medicines this coming fall. Their editors ranked some 85 different topics that can be the focus of a specific issue, and in one year complementary medicine went from 78th to the top three. It's breathtaking.

Clearly, that sea change is happening. It's happening very quickly. You're well aware of the debate and the discussion documents within the Canadian Medical Association looking at this issue at their annual meetings last summer. So these things are happening and they're happening quickly.

The other level on which I want to answer the question is very much closer to home. One of the things we're doing at the Tzu Chi is developing an integrated practice model so that we are working both conventional and complementary practitioners in one clinic. We'll have an integrated dispensary that includes the products that all the different practitioners use, and, yes, there's a lot of enthusiasm and a lot of cooperation.

I wouldn't pretend it will be easy to bring together the different groups when it comes to regulatory professional licensing kinds of issues. You may also know that B.C. has been really struggling to get a college of acupuncture in place, for example. So there are different opinions and there is a working-through process because these different camps have operated in isolation, to the extent that they have. But I very much think the time is right, the willingness is there and it's doable. It will take some time and effort.

Mr. Grant Hill: It's really nice to hear and see that there is some effort.

The one thing I have heard, though, from the other practitioners is, oh yes, and now that there's a market you guys are just trying to whip in and get the market. I'm interested in any of the other three witnesses commenting on the perception that this is a johnny-come-lately trying to capture a market you've had all along and don't want to give up.

• 0940

Ms. Chanchal Cabrera: I'll try to answer that one. I think we really need to rise above those comments and criticisms. We could get stuck in that kind of debate for a very long time and I don't think it serves the Canadian public very well at all. If, as professionals in this business of health care, we can rise above that and agree to work together, and in some cases agree to disagree and still work together, I think we'll serve the Canadian public a whole lot better.

I'm involved in Dr. Best's research project, and while I do have criticisms about it, I'm also very glad to see there is that opportunity for integration. I think this word “integration” is a very key one for the future of health care in this country, because we've had polar-opposite counts that have not spoken to each other, or at least if they have spoken it's been with great antagonism. This has not helped the Canadian health care system and the individual patient in that health care system at all.

In my own clinical practice I have patients who come to me in tears because they don't know which to choose. “Should I go with the orthodox allopathic system or should I do herbs?” They don't even know they have the choice to do both. So I don't call my practice alternative medicine at all; I call it integrated medicine. I make a real issue of that because I think it's the way forward. If we can all hold that in our minds we might be able to find a common ground that will serve us all.

Mr. Grant Hill: That's quite refreshing. Thanks.

The Chair: Mr. Dumas. I'm going to stick to the five minutes, if I can, just so we can get through here.

[Translation]

Mr. Maurice Dumas (Argenteuil—Papineau, BQ): I have a question for Ms. Cabrera.

You said that you have a degree. I have a few questions on that. Who granted the degree? How long did you study for it? Are those schools recognized by governments or universities? Are there also schools that are not recognized and that grant degrees?

My background is in education. In the course of my career I have encountered many institutes, schools, correspondence courses that granted degrees. My question is not at all hostile; I use some natural products myself. Thank you.

[English]

Ms. Chanchal Cabrera: The training I took was a four-year diploma in herbal medicine. It was taken in England. That diploma two years ago became a bachelor of science degree. It is the same training, but they upgraded the qualification at the end and it is a fully accredited bachelor of science degree in phytotherapy. There are now three such university degrees available in the U.K. I don't know of an equivalent anywhere else in the world. But it is a bachelor of science degree in herbal medicine. I was ten years too early, so I got the diploma, not the degree.

There are no schools in Canada or the U.S., or indeed anywhere else that I'm aware of in the English-speaking world that offers training of that nature. The training I took in England was medically oriented. A lot of it was like pre-med studies—four years of biological sciences with the study of herbs in place of the study of drugs.

Does that answer the question?

[Translation]

Mr. Maurice Dumas: Yes.

The Chair: Is that all, Mr. Dumas?

Mr. Maurice Dumas: Yes.

[English]

The Chair: Okay. Mr. Myers.

Mr. Lynn Myers (Waterloo—Wellington, Lib.): Thank you, Madam Chair. I want to ask Mr. Vertolli and Dr. Best a question. Yesterday we heard testimony, I think it was from the guild of herbalists, that advocated a very comprehensive Canadian botanical pharmacopoeia. I wonder if you support that and think it's a good idea.

Mr. Michael Vertolli: We certainly support it. In the past we have suggested that approach in our proposals. In fact, we undertook to begin that process a couple of years ago, but the political climate changed and it was left by the wayside.

However, we caution that in the case of botanicals alone there are literally thousands of them available for medicinal use. Creating extensive monographs could be a very time-consuming effort. Our suggestion is to initially create a document consisting of much shorter labelling standards that would provide information on the plant identity, claims that can be made based on both traditional and medical sources, contraindications, etc.

• 0945

This is so that in the course of regulating, the regulatory body can say, okay, if a company wants to release a product, they can release it as long as the information conforms to the labelling standard. That would allow the information on many more herbs to be processed much more quickly.

But as a long-term goal, we think the creation of a Canadian herbal pharmacopoeia would be a great idea.

Mr. Lynn Myers: Do you agree, Doctor?

Dr. Allan Best: I agree. As Mr. Vertolli points out, this is not an overnight thing, this is a major undertaking.

Our board has made the development of information resource services their top strategic priority for the coming year. The reason they did that is because they think this lack of reliable information is the greatest single barrier we face at this point in moving forward.

Faced with that challenge, for the last few months, I've been trying to put together an international coalition that would work on developing the base for that kind of pharmacopoeia. We've been in conversation, for example, with Harvard, which is working on behalf of the Office of Alternative Medicine and the NIH in the States to try to do similar kinds of things.

The challenges are huge. There is no common language. There is no common set of terms that we can organize the information under. As pointed out, there are thousands of products, and it's going to take time to do the careful reviews and establish the benchmarks for what we know and what we don't know.

I think we must start. Now is the perfect time because it is such an integral part of effective regulation.

Mr. Lynn Myers: Thank you.

To Ms. Cabrera, I was really interested in what you were saying about education and training. I wonder if you could flesh that out a little bit in terms of curriculum, length of time, training, regulation, certification, monitoring, sanctions, or any of those things. Have you given thought to that?

Ms. Chanchal Cabrera: I've given a great deal of thought to it. As well as being active in the Canadian herbal world, I'm also on the governing council of the American Herbalists Guild, which is the professional organization in the U.S.

In the U.S., they've been moving faster than those in Canada on trying to put some of this in place. As chair of the education committee for the guild in the U.S., I have been involved for the last four years in designing an educational curriculum and criteria for professional membership.

It has been a very interesting process. We started out by looking at the western herbal medicine model, using the western biological sciences as the basis for the study of the body and then adding the plants onto that. That works for some practitioners, but it doesn't account for the ayurvedic, traditional Chinese, or native American practitioners. It didn't encompass their scope of practice at all.

So eventually this is what the guild in the U.S. came up with. This is a model that I have been showing around to herbalists in Canada as well and it has been very well received so far. In the American Herbalists Guild, to become a professional member, the final decision is made by a peer review process. That peer review committee consists of five people, including a medical doctor, a Chinese practitioner, a native American practitioner, and two others. But if you have followed certain educational pathways, you can fast-track your process into the guild. Those pathways have now been laid out.

The guild has actually just signed off on a document. I'd be most happy to share it with any in the standing committee if that's appropriate in the future. It allows for people going through a western-based biological sciences training to become a herbalist, but it also allows people going through the traditional Chinese and ayurvedic training models as those professional associations already have established.

We worked very closely with some native American practitioners to design what we call in the U.S. earth-centred herbalism, for lack of any more descriptive terminology. It's a way of looking at the plants and at the body, not based on western biological sciences, but perhaps with a more holistically inclined and less reductionist approach.

It seems to me that in Canada we probably will need to do something similar. Say we follow the European model. It's extremely reductionist and very allopathic in its orientation. Because I trained in Europe, I'm very involved with their educational process and criteria as well. There is an umbrella organization called the European Herbal Practitioners Association, which is the umbrella group for all the professional groups in the European Community.

• 0950

Their criteria for professional membership would completely eliminate somebody like Brenda, for example—well, perhaps not you personally, because you have gone through some of the western medical model—or people from her community who are extremely good practitioners and who serve the community very well but who don't have western medical science training. In the European model, they wouldn't be allowed to call themselves professional clinical herbalists.

That will not work in this country. We're too diverse a population. We have too many different ethnic groups who already have a system of medicine. To simply say to them that this doesn't work for us in Canada and they can't practise medicine this way any more is going to alienate them immensely.

When we create a regulatory structure for the practice of herbalism in this country it has to be embracing. It has to be all-encompassing. We can't afford to cut people out of this loop.

Our health care costs are so extreme right now that we need to bring all of those disparate groups into the fold and make sure that not only the professionalism but also the practice of the different types of herbalism are not compromised.

Mr. Lynn Myers: Thanks very much. That's very useful. Can we get a model from you? That would be good.

Ms. Chanchal Cabrera: I'd be happy to do that.

The Chair: Perhaps you can send it to the clerk. It's very interesting.

Ms. Wasylycia-Leis.

Ms. Judy Wasylycia-Leis (Winnipeg North Centre, NDP): Thank you.

Thank you very much to the presenters. I have a question for each of the groups.

Dr. Best, I appreciated your comments about the need for a strong research capacity within Health Canada. We've been told that prior to 1991 we had a very progressive and very expert capacity within Health Protection Branch, and we lost that with the cut to the Natural Health Research Bureau.

Is that the kind of model we should be looking at? Would that be roughly the direction in which we should be going?

Brenda Thomas, you referred to the panel Ms. Casaway is a member of, which recommends a separate regulatory structure for natural health products and herbal medicines and so on. How does that fit with what you just told us in terms of traditional medicines and remedies being something that should not be part of the marketplace, and highly regulated? I'm trying to make the two jibe.

Finally, to Chanchal and Michael, I didn't hear you address fully the question of cost recovery and this whole scheme of a third category. It was mentioned yesterday by the Ontario Herbalists Association.

What impact has the current cost recovery scheme had on members of your association, and what would you recommend in terms of future direction?

Dr. Allan Best: I'm going to duck your question a little bit. Certainly I'm very sympathetic to Health Canada and the strain that funding cuts have placed on a lot of what have been, and continue to be, very helpful programs. On the other hand, I think it's true that we don't yet have an effective model of the kind we're talking about. In no small part, the difficulties we have with the federal-provincial jurisdiction issues have always prevented us from having an effective way of linking central science to community services, if you want. I've certainly dealt with that within a variety of issues, not only complementary issues, with Health Canada over the years.

The most promising things that I think are coming out these days are coming out in the context of organizations like the Canadian Health Services Research Foundation and the framework that people like their executive director, Jonathan Lomas, are proposing at the federal-provincial level in terms of creating free-standing science bodies that link to nodes within government that are receptors, if you want, for that science information, and facilitate the flow back and forth between government and the science practice communities to make these things happen.

The ideas are there, and I think it's doable, but I don't think we have the right models quite yet.

Ms. Brenda Thomas: I'd like to respond by saying, first of all, I can't make too many comments with regard to the advisory panel, because I don't sit on that committee. I do know that to some degree what I have just said and what is outlined in the draft document that was circulated seem to run in parallel with one another. However, the contention still remains the same with regard to traditional medicine practices among our people. Those ideas and that paradigm will remain consistent no matter what is put in place.

• 0955

With regard to the draft document that has been developed by Health Canada and its advisory panel, my understanding is also that when Ms. Casaway was working on this, there was some degree of consistency with what I have just said. I don't know to what degree that has been done, but there was some consistency with what was just presented today, trying to get that type of recognition in that document as well.

Mr. Michael Vertolli: Before I answer your question, I'd like to add to that. Both Chanchal and I are on the advisory panel. A consideration of traditional medicines is very much at the forefront there, and it's important to keep in mind that regulations deal with products that are sold in Canada. Traditional native healers, who pick their own herbs and administer them in the context of a traditional ceremony, are not selling products. It's important that the regulations don't interfere with that process.

With regard to cost recovery, it's important to recognize here that a lot of the screaming and yelling by the industry about cost recovery didn't just have to do with cost recovery. It had to do with the cost of an excessively complex, expensive DIN system for the regulation of these products, the cost of site licensing and the whole cost recovery initiative, and the fact that natural health products being regulated as drugs required that manufacturers meet pharmaceutical standards, which often meant extensive renovations and purchasing expensive equipment to ensure pharmaceutical standards.

We don't feel pharmaceutical standards are always necessarily appropriate. In many cases the pharmaceutical standards are too stringent for natural health products, whereas on the other hand, the food standards aren't stringent enough. So we see them as lying somewhere in the middle. Our proposal, which is the creation of a series of labelling standards, would allow the approval of products on a notification basis, very simply. It could be done in a short period of time with a minimum amount of paperwork, and it would allow a much less expensive system.

In addition to that, we've also recommended—and so has the advisory panel—that it's not necessary to have regular inspections of facilities. If a facility is inspected annually for two or three years and demonstrates compliance, there should be enough goodwill there to say, “Okay, fine, they're obviously following regulations. Let's lay off and maybe inspect them every second or third year, because we have a history with them.” That of course would reduce the costs incurred as well.

Ms. Chanchal Cabrera: If I might just add one comment to that—

The Chair: Keep it short, please, because you're quite a bit over.

Ms. Chanchal Cabrera: Okay.

With regard to the cost recovery initiative, one thing the advisory panel and the Coalition of Herbal Associations have been very strongly in favour of is that we should maintain some system of good manufacturing procedures. So even though the cost recovery initiative itself was unpopular, I don't think we should throw out the baby with the bath water. The good manufacturing procedures in herbal medicine are as important as they would be in food or pharmaceutical products.

The Chair: Thank you.

Ms. Bennett

Ms. Carolyn Bennett: I have a couple of questions. First I wanted to ask the clerk, is Jonathan Lomas coming? Has he been called?

The Clerk of the Committee: The name is not familiar.

Ms. Carolyn Bennett: He's from the new Canadian Health Services Research Foundation.

The Clerk: No.

Ms. Carolyn Bennett: That would be great.

I think I understand a lot of what we've heard and the real problems. Where I find the integration gets into trouble is not in the wellness part, but in the times when people get sick and are particularly vulnerable, such as with cancer. Those probably are the people you're referring to in your practice, where people think they have to do either/or, or where the alternate title is particularly deleterious to people's health, and complementary or integrated kind of language is better.

I understand the Prince of Wales had a conference in England called Integrated Cancer Care. I was just wondering whether there's anything we could learn from that.

• 1000

Obviously, as a family physician, and with patients who have been very interested in complementary therapies and who have taught me a great deal about it, I find it is when they are really sick that I see the real conflict. When you look at regulating practitioners, are there products that you would say—if we had proper regulation of practitioners—you would want only with these trained practitioners. I'm thinking of maybe Essiac, etc. Or once somebody is sick, would we then direct them to trained practitioners rather than to the shelves of the health food store? How do we do this in a way...?

I guess it's the same with the aboriginal community. I think we have to be very careful not to meddle there. But I also want to know whether there is any problem we as a committee should be aware of in that community. Do you ever have a medicine man out there with maybe less traditional kinds of therapy, but because of their powerful position and the power differential in the community they could actually be misleading their community? This is obviously not a role for us, but is it something your community deals with occasionally?

Those are my two questions.

Ms. Chanchal Cabrera: I have several quick comments here. The Prince of Wales, Prince Charles, has expressed a great deal of interest in natural medicines. The royal family have consistently been users of natural medicines over the years. In fact, Prince Charles recently called for the National Health Service in the U.K. to have a complete integration of natural and allopathic medicine. That was a quote. A “complete integration” is what he called for. It was to resounding cheers in the U.K., by the way. It was a very popular statement.

On the issue of when somebody should see a medical doctor, when they should see an alternative or a complementary practitioner, I think we have to recognize in this country that people have the right to choose the health care they want. There is no law that says if you have cancer you must see a medical doctor. You can choose to do nothing, if that's what you want. So I think we need to be very careful that we preserve that independence of the patient, of the consumer, to make their own choice. Ideally it should be an informed choice; and that's perhaps the crux of the issue.

Ms. Carolyn Bennett: I don't think you answered the question. My question is whether there would be products you would say should not be on the shelf because you want a regulated or a trained complementary therapist, herbalist, actually to be dealing with them.

Ms. Chanchal Cabrera: I think the answer is yes, but it should be oriented towards the product, not the disease. You mentioned, for example, Essiac. Essiac is traditionally used to treat cancer, but the individual herbs in it are absolutely safe and there's no question that anybody will do themselves harm with Essiac. They might mistreat the cancer in general, but it wouldn't be the Essiac that would be the problem. The disease should not be restricted, but the products, yes.

Again, for example in the U.K., there is a group of products called the schedule A drugs. They have nothing to do with schedule A as we know it in Canada. That's just what they call it there. They are perhaps 15 or so herbal products to which only a member of the National Institute of Medical Herbalists will have access to. They include belladonna and jimson weed and yellow jasmine and aconite and a number of things that a professionally trained herbalist is perfectly competent to use but that should never be sold on the open market at all. I think that is absolutely necessary in Canada. The problem is we don't have that group of professional herbalists; and with all due respect, the doctors are not the ones who know how to use those products.

Right now it's a free-for-all. They are not actually on the list of restricted herbs, even though I would like them to be. A couple of them are, but many of them are not. Yet there are herbs on the restricted list in Canada that are completely benign and safe. We have this real discrepancy. It doesn't add up. It doesn't make sense.

• 1005

The simple answer is yes, there should be some restricted product. Who gets to use them is a different question.

Mr. Michael Vertolli: I'd like to add that the reason it's so important to have a federal-provincial initiative here is that we recognize that some of these things are not safe to be used over the counter, but they are of value to the public and we don't want to see them disappear.

Ms. Brenda Thomas: In answer to your question, yes, we do have those situations in our communities. We call them charlatans or frauds or whatever, for want of a better name. Generally the community knows who those people are, much the same as we know who the self-proclaimed elders are. These are individuals who have put themselves in that position.

Those who are true traditional healers have gone through a process. They've gained the knowledge from someone in the community who has taught them that from a very early age and they have gone through rites of passage to attain that level. Generally communities that are very close-knit know who's real and who isn't. They know who to trust and who to go to and who not to. Those situations do exist and it's pretty much regulated and governed at the community level anyway.

The Chair: Mr. Elley.

Mr. Reed Elley (Nanaimo—Cowichan, Ref.): Thank you very much, Madam Chair.

I'm really pleased that finally in this whole exercise we have representatives from the native community here with us today and that we're able to hear from you, Brenda.

I have a couple of questions I'd like to ask you, though, so that you might be able to expand more on what you've said.

In your experience, have you ever known of any deaths or any health problems associated with traditional healers administering herbs to your people? That's the first question. I'd be very interested to know a little bit more about why you feel that traditional native healers should be exempted in the use of administering herbs if indeed there were a move across Canada to regulate practitioners in this area.

Ms. Brenda Thomas: First of all, I have not known of any deaths or any poisonings that have occurred as a result of using any traditional medicines—not to my knowledge in the 42 years I've been on this earth, and not that I've heard of either from anybody my grandmother has spoken about.

With regard to your second question, the reason I feel that—

The Chair: I'd like to clarify something, because people are concerned. The bells have not started ringing yet. It'll be a few minutes yet and there will be a half-hour bell when we do get it, so we have lots of time.

I'm sorry, Brenda, go ahead.

Ms. Brenda Thomas: With regard to your second question on the exemption clause that I feel should exist with regard to traditional healers, the reason I feel that exemption clause should exist with regard to traditional medicine, the true traditional medicine among our people, is because these people are practising as doctors in their community. These are recognized individuals at the community level. They have attained their knowledge from the Creator through a process that has gone on since time immemorial. I feel that it's inappropriate for an outside party to step in at this time and say what is appropriate practice and what isn't.

Mr. Reed Elley: I have a question for Dr. Best.

In point three of your presentation you talked about the need for a national knowledge base and information resource centre. Who do you think, Dr. Best, should take the initiative for this? After the initiative is taken to get this going, who would best serve the interests of that? Should it be government sponsored or should it be private?

Dr. Allan Best: I think it needs to be a coalition. I think all those interests need to represented. The kinds of folks we're talking to at the moment include knowledge producers—for instance, some of the major universities that do critical appraisals or do some of the basic research—and health agencies like the Canadian Cancer Society, which is particularly interested in expanding their cancer information service to include this kind of component. We're talking to private sector software developers who are developing a custom search engine so that we can create the database and do text searches to get in a lot of the information that's available. It would necessarily, I think, have to be a fairly broad coalition of both public and private sectors, both the research producers and the research consumers, if we want the system to work.

• 1010

The Chair: Mr. Volpe.

Mr. Joseph Volpe (Eglinton—Lawrence, Lib.): Thank you, Madam Chair. I have a series of questions, and I'll try them one at a time.

You've used the question of choice, and I guess that's “informed choice”. You referred to that on several occasions. I'm wondering whether this debate is going to lead us, as some have suggested, to a discussion of what's covered under our medical care system and whether someone who wants to use a herbalist or a traditional approach actually has a choice if he or she has to pay for it. Using the more conventional western approach, they don't have to pay. Is there an underlying theme to some of this that relates to cost?

I'm sorry to be that brutal, but....

Mr. Michael Vertolli: Cost is a big factor. In fact, cost was probably the single most important factor that kept people away from complementary health practitioners in the past, simply because they're not used to paying out of their pockets. But we all know that whether or not they're directly paying out of their pockets, we're all paying for the cost of a health care system that's very inefficient right now.

In general, you may see a move on the part of consumers who will be demanding that complementary health care be incorporated into the medicare system. That might ring alarm bells for some people because they're afraid that if that happens the cost of health care is in fact going to go up. But my belief, in fact, is that it would actually still go down, for a couple of very simple reasons.

First of all, the cost of complementary health care is considerably less than conventional medical treatment. Even if you are going to a herbalist or a naturopath on a regular basis, monthly, the costs are considerably less. But in addition, the complementary health practitioners take a much more proactive approach by using a lot of education and by teaching people to take responsibility for their health. It's very prevention based, and traditionally it's had much better results with chronic health care problems than conventional medicine has.

So in the long run, I think, with people taking a more preventative, proactive approach to their health, being better educated on issues, using less expensive therapies, and as was mentioned earlier, as our baby-boomers become senior citizens, hopefully suffering a lot less in terms of chronic health care problems, even if we eventually incorporated this into the medicare system, costs would continue to go down.

Ms. Chanchal Cabrera: May I add a very brief comment? What we see in the U.S. is that more of the private health insurance companies are covering natural medicines, and that is because the consumer is demanding it. The CTV Angus Reid poll that came out in September of last year did indicate that 70% of Canadians think the provincial health care programs should cover natural health care products and services. In fact, it was 83% in British Columbia.

Mr. Joseph Volpe: It might be 100% if you told them that anything they wanted was free.

I want to get back to the business of integration into the system, because in my mind, when you're talking costs it's not just the product itself, it's the advice that goes along with the use of that product.

I have a little bit of a problem with some of this and I have to confess to the same sort of bias that has been avowed to by some others around the table. I'd stay away from a doctor for everything I could. Until I'm on my death bed I would refuse to go to see a doctor, and I think I'm not atypical. However, the moment I'm on my death bed, I'm looking for somebody who's going to give me some assurance that some practice and some product I'm going to be using is going to have an impact.

As a society, I think we've come to trust, rightly or wrongly, a western-based approach, a scientific, research-based approach, even though that's been waning recently if you take a look at the malpractice suits that are prevailing virtually everywhere. But that having been said, there's still a trust factor and an ultimate solution factor in which we have some confidence.

• 1015

One of my colleagues has said that while he's healthy this approach and the other approach are great, but the fact of life is that we all get sick. I'm approaching that age myself. You get to the big 50 and have to see a doctor every 30 seconds because otherwise you're going to collapse.

I'm sorry to make light of it, but do you see where I'm going? You get to a particular age and start getting sick. It's okay to talk about herbalists, natural approaches and traditional medicines. They were all great. I remember they were fantastic when my grandmother was around and I was as fit as a bull. She's not around any more and now I have to see a doctor. Again, without casting aspersions or anything, are we just talking about something that works when you're well but you might have trouble with when you get sick?

Ms. Chanchal Cabrera: Mr. Volpe, I think you've brought up some very good points. First of all, I would like to suggest to you and all Canadians to not wait until you're on death's door to get some health consulting. The great thing about natural medicine is that we practise preventative medicine, so if you choose to take responsibility for your health, see a natural health practitioner and get educated about how not to get to that sick place. That's the first comment in general.

Mr. Joseph Volpe: The unfortunate thing, Chanchal, is that I really represent the people.

Ms. Chanchal Cabrera: Absolutely, I understand.

Mr. Joseph Volpe: Just like everybody else, I really am as ill-informed as the next person. In my own defence, I had occasion at the beginning of this week to talk to an oncologist who should know a lot of things—you mentioned cancer, and that example immediately struck me. He referred to another practitioner as a quack because he was not published in the literature. I went on the Internet and found 200 publications by that individual. But I hold one as an authority and the other one I'm told is a quack.

If people who are at a very professional level and have gone through all of the rigours of education are ill-informed, what about me, a simple, regular, ordinary Canadian who's concerned about my health, who eats more or less well and exercises not because I'm told to but because there's nothing else to do at 5 a.m.? Are we having a serious conversation when we're talking about information? How do you get informed? It's on the Internet and you tell me I can't trust what's there. I go to a professional and he doesn't even know it's there.

Ms. Chanchal Cabrera: I don't think we're ever going to solve all those problems, but if we have a regulatory structure that allows for the registration of competent, qualified natural health care professionals, then at least uninformed consumers, when they're seeking some kind of help, will have a place to turn to. It may not always be perfect, but right now they have a choice between the standard medical practice and a free-for-all.

Mr. Joseph Volpe: But they don't have a choice. I refer back to price. If they choose to do something else they have to pay for it, whereas one other part is paid for. My understanding of choice is that everything is balanced equally, so I go back to my original question.

Ms. Chanchal Cabrera: This is a very good point. However, many of the natural health products are not expensive, certainly when you compare them to the cost of prescriptions. Many natural health practitioners, myself included, offer services for free to the financially challenged. I run two clinics a week where I make no charge whatsoever, and there are a lot of practitioners like me who do that because we are not happy with the elitist idea that natural medicine is only for people who can afford it. That's not how I want to practise medicine. I think there's a lot of people like me out there.

The Chair: Dr. Best would like to add something to this if he could.

Dr. Allan Best: You're describing what's wrong with the world now, and it's accurate.

Mr. Joseph Volpe: It's wrong and I can't find a solution.

Dr. Allan Best: It's partly why I stress the importance of linking this whole debate to health care reform. Fundamentally, the solutions are at the community level. For example, we're talking to some private sector companies and groups, like the College of Family Physicians of Canada and so on, about a community demonstration project where we would go in, try to work with the public and the practitioners from the different camps, and try to get better communications flowing. The regulations can't do that. The education program alone can't do that. It needs community-level action. It's a big challenge.

• 1020

I'm sorry if I went over time. I offended the doctors around the table.

Ms. Elinor Caplan (Thornhill, Lib.): Could I interject one thing and then perhaps get a comment from Dr. Best? You talk about the challenge of integrating with the alternate and complementary. My question is how much success you think we've had in getting the traditional providers to talk to each other.

Dr. Allan Best: It's challenging. As you know, that's at the heart of a lot of the health care reform movement that's going on now. I know it's difficult.

The Chair: It could be if you want it to be.

Do you have a question, Mr. Dumas? Okay.

[Translation]

Mr. Maurice Dumas: Ms. Thomas, when you were speaking about your traditional healers earlier, you talked of knowledge acquired over the years, but also of divine inspiration.

I have often heard in the Gospels about the laying on of hands. Do you remember that? Probably. I don't want to shock my colleagues but I must admit that I have great difficulty understanding that phenomenon. I wonder if we're not putting too much responsibility on God's shoulders when we say that he is responsible of everything that happens, good or bad.

So I would like you to elaborate a bit on the issue of God's participation, let us say, in the healing process as practised by the healers in your community.

[English]

Ms. Brenda Thomas: I think it's a little bit more complex than that. When I refer to traditional healers and traditional medicine men from the perspective of our communities as first nations, it's looked at from the whole perspective. It's holistic healing at its ultimate. It's not only the way the healer views how he heals or how she heals, it's also looked at in the way illness is viewed in the community.

In the traditional sense, illness in itself is due to an imbalance, whether it be physical or mental, whether it be spiritual or emotional. It's from those four elements that the individual who is considered a healer takes and tries to balance those things out. He takes from the earth what the Creator has put there for our benefit. In taking from the earth, he also connects the spirit of that ill person with the spirit of that plant by speaking to the Creator and connecting the two spirits. Through that, the Creator then gives the instruction to the plant to heal the individual who is sick.

It's a ceremony that is carried out, and it's through this process. It's not through the laying on of hands or divine measures from that aspect. It's a whole ceremonial process in terms of preparing the medicine, in actually getting the sick person prepared for the healing process itself. It's not only the physical preparation that's involved. There's a spiritual component and a sacredness that's respected in the whole process.

You can't divide one from the other. It's all interconnected, much the same as we all are interconnected with the universe in which we live. So it's a respect for life, and it's with this respect for life that.... Part of the teaching comes from the process when an individual is gleaned for that role as a medicine person.

I don't know if that answers your question or not.

[Translation]

Mr. Maurice Dumas: Yes, thank you.

[English]

The Chair: I would like to make a comment. There are two people left to ask questions, and I hope they can keep them short.

• 1025

I'd like to comment to the members of the committee that we're getting to a point where we're all understanding this a lot better, and if you're going home and thinking we should hear from one group or another or more from some group, please let us know. We want feedback from you if you're beginning to think you'd like the whole panel again on this one or another. So please let us know if something comes up.

Ms. Judy Wasylycia-Leis: The more I listen to everyone, the more I wonder if the question we're dealing with is not so much whether we have legislation or regulate differently as whether or not we have the political will actually to move, as Dr. Best said, in terms of a true health care reform model and whether or not we've got the will actually to have in place, whether it's in or out of government, the capacity to deal with fraudulent activity, to deal with substitution and adulteration and so on in terms of a product. That's one question.

The other is particularly to Michael and Chanchal, because we've heard so many conflicting views in this committee. There seems to be a great divide between the consumers of your products and the professionals and the producers, and we're supposed to try to bridge this divide.

Is there a role you can play? Is there somebody who could bring all these groups together and come up with some consensus?

Dr. Allan Best: You're asking me if you've got the political will.

Some hon. members: Oh, oh.

Ms. Judy Wasylycia-Leis: Isn't the question more one of political will than one of developing a new legislative framework?

Dr. Allan Best: I agree. Political with a small “p”—

Ms. Judy Wasylycia-Leis: Yes.

Dr. Allan Best: —because it certainly includes the political will of professional associations and a variety of other groups to engage seriously in this process.

I honestly believe that the will is there. It follows on Ms. Caplan's question, for example: do people really talk at the community level? Well, darn it, the provincial governments are making them talk at the community level. They don't always like it. They're kicking and screaming.

I come from the north shore of Vancouver. We fired our board last week. This is happening. I think there is no greater time than now to try to do these sorts of things, but I don't want to underestimate the challenge. I think you're quite right. It's a question of political will, multifaceted will, but that's the reality we face. That is the problem.

The Chair: Does somebody else want to answer that? Michael?

Mr. Michael Vertolli: I'm wearing a number of hats. I'm also the president of the Canadian Coalition for Health Freedom, which you heard from last week. We worked for a long time leading up to last year's federal election, in preparation for that, to create a consensus among the various layers of stakeholders that are affected by this issue. The perspective you've been hearing over and over again about separate regulatory categories, a separate regulatory body, appropriate regulation, not no regulation, is very much a consensus position.

Unfortunately, a number of minority groups take a more extremist position, most of them calling essentially for deregulation. They scream loudly, but they're not as well represented as they might appear to be.

Another big problem is that a number of the journals in alternative medicine, in that whole field, are being run by people who support the more extremist minority position. So one of the big problems with the consumers is what information they're being fed, because many of them are not being properly informed about the issues.

But we'll never have a complete consensus. There are always going to be minority positions. What we have to try to work towards is creating a framework that will work the best. Unfortunately, we have to satisfy very different mandates. On the one hand we want safety and we want assurance of quality. On the other hand we want freedom of choice.

There's been a lot of talk about looking at other regulatory models around the world. The unfortunate situation is that there really aren't very many or really any absolutely solid regulatory models for the regulation of these products. Different countries have aspects of their regulation that are good.

• 1030

One of the things we have here is hopefully an opportunity, through goodwill and cooperation, to put together a model that could be the first in the world to really integrate these issues. It could be a role model for other countries around the world.

The Chair: Thank you.

Joe, you have one minute.

Mr. Joseph Volpe: I want to thank the panel, because I learn something every time people like you come before us.

I want to ask you one question. I guess I didn't make myself clear earlier on. In a society and in a system where we value evidence-based decisions—in fact, we prize them—have you made an effort or are you making an effort to quantify your vision and your claims so that we can make some decisions based on objective data?

Dr. Allan Best: We're the exception to the rule. We're blessed to have partnerships with the major conventional teaching hospitals and other agencies in Vancouver and we're able to do that job in a way. Yes, we're evaluating everything we do. We do nothing that we don't evaluate.

We plan to consistently link outcomes to the MSP data in B.C. so that over time we are tracking individuals and whether or not their utilization costs go down as they start to participate in the research programs we run. I think there will be more and more of that starting to happen, but it is just starting to happen now.

Ms. Chanchal Cabrera: I would just like to remind you of the empirical evidence of 100,000 years of continuous use of herbal medicine as well. That should not go unnoticed.

Mr. Michael Vertolli: I would also like to add here that there's a common misconception about conventional medicine. The fact of the matter is that the vast majority of the drugs and practices used by conventional medical professionals are not rigorously proven. This is well documented in well-respected medical journals. Look at the widespread use of chemotherapy. Chemotherapy has only been actually proven in cases of childhood leukemia and a few very rare types of cancers. In most cases it's completely unproven.

The Chair: Thank you very much. I'd like to thank the panel.

The meeting is adjourned to the call of the chair.