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37th PARLIAMENT, 2nd SESSION

Standing Committee on Health

EVIDENCE

CONTENTS

Thursday, October 23, 2003

0910

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

Mr. David Price (Compton—Stanstead, Lib.)

The Chair

Mr. David Price

The Chair

Mr. David Price

The Chair

Mr. Christian Jobin (Lévis-et-Chutes-de-la-Chaudière, Lib.)

The Chair

Mr. Christian Jobin

The Chair

Mr. Christian Jobin

The Chair

Mr. John Maloney (Erie—Lincoln, Lib.)

The Chair

Mr. Svend Robinson (Burnaby—Douglas, NDP)

The Chair

Mr. Svend Robinson

The Chair

Mr. Rob Merrifield (Yellowhead, Canadian Alliance)

0915

Mrs. Karen Kraft Sloan (York North, Lib.)

The Chair

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ)

0920

Mr. Svend Robinson

The Chair

Mr. Svend Robinson

Mr. Réal Ménard

The Chair

Ms. Hélène Scherrer (Louis-Hébert, Lib.)

0925

The Chair

Ms. Hedy Fry (Vancouver Centre, Lib.)

The Chair

Ms. Hedy Fry

The Chair

Mr. Svend Robinson

The Chair

Mr. Svend Robinson

The Chair

Mr. Svend Robinson

The Chair

Mr. Svend Robinson

The Chair

Mr. Rob Merrifield

The Chair

Mr. Rob Merrifield

0930

The Chair

Mr. Rob Merrifield

Mr. Réal Ménard

The Chair

Mr. Réal Ménard

The Chair

Mr. Réal Ménard

The Chair

Mr. Réal Ménard

The Chair

Mr. Réal Ménard

The Chair

Ms. Hedy Fry

The Chair

Ms. Hedy Fry

The Chair

Ms. Hedy Fry

The Chair

Ms. Hedy Fry

The Chair

Mr. Réal Ménard

The Chair

Mr. Réal Ménard

0935

The Chair

Mr. Réal Ménard

The Clerk of the Committee (Mr. José Cadorette)

The Chair

Chief Bill Erasmus (Regional Chief, Northwest Territories, Assembly of First Nations)

The Chair

Chief Bill Erasmus

0940

The Chair

Ms. Elaine Johnston (Director, Health Secretariat, Assembly of First Nations)

0945

The Chair

Chief Bill Erasmus

The Chair

Ms. Barb Shea (Director, Common Drug Review, Canadian Coordinating Office for Health Technology Assessment)

0950

The Chair

Mr. Michael McBane (National Co-ordinator, Canadian Health Coalition)

0955

1000

The Chair

1045

The Chair

Dr. Michele Brill-Edwards (Department of Pediatrics, University of Ottawa, As Individual)

1050

1055

The Chair

Mr. Rob Merrifield

Dr. Michele Brill-Edwards

Mr. Rob Merrifield

Dr. Michele Brill-Edwards

1100

Mr. Grant Hill (Macleod, Canadian Alliance)

Mr. Michael McBane

Dr. Michele Brill-Edwards

Mr. Grant Hill

Dr. Michele Brill-Edwards

1105

The Chair

Mr. Réal Ménard

Dr. Michele Brill-Edwards

Mr. Réal Ménard

Dr. Michele Brill-Edwards

Mr. Réal Ménard

Dr. Michele Brill-Edwards

Mr. Réal Ménard

Dr. Michele Brill-Edwards

Mr. Réal Ménard

1110

Dr. Michele Brill-Edwards

Mr. Réal Ménard

M. Svend Robinson

Mr. Réal Ménard

Mr. Svend Robinson

Mr. Réal Ménard

Dr. Michele Brill-Edwards

Mr. Réal Ménard

Dr. Michele Brill-Edwards

Mr. Réal Ménard

Dr. Michele Brill-Edwards

Mr. Réal Ménard

Dr. Michele Brill-Edwards

Mr. Réal Ménard

Dr. Michele Brill-Edwards

Mr. Réal Ménard

Dr. Michele Brill-Edwards

Mr. Réal Ménard

Dr. Michele Brill-Edwards

Mr. Réal Ménard

Dr. Michele Brill-Edwards

Mr. Réal Ménard

The Chair

Mr. Svend Robinson

1115

Ms. Elaine Johnston

Mr. Svend Robinson

Ms. Barb Shea

Mr. Svend Robinson

Ms. Barb Shea

1120

Mr. Svend Robinson

Ms. Barb Shea

Mr. Svend Robinson

Ms. Barb Shea

Mr. Svend Robinson

Ms. Barb Shea

Mr. Svend Robinson

The Chair

Ms. Hélène Scherrer

Dr. Michele Brill-Edwards

1125

Ms. Hélène Scherrer

Dr. Michele Brill-Edwards

1130

The Chair

Ms. Hedy Fry

Dr. Michele Brill-Edwards

1135

Ms. Hedy Fry

Dr. Michele Brill-Edwards

The Chair

Dr. Michele Brill-Edwards

The Chair

Mr. Réal Ménard

The Chair

1140

Ms. Barb Shea

The Chair

Dr. Vijay Shukla (Pharmacist - Common Drug Review, Canadian Coordinating Office for Health Technology Assessment)

The Chair

Dr. Vijay Shukla

The Chair

Dr. Vijay Shukla

The Chair

Dr. Vijay Shukla

The Chair

Mr. Svend Robinson

Ms. Barb Shea

Mr. Svend Robinson

Ms. Barb Shea

The Chair

Ms. Barb Shea

The Chair

Ms. Barb Shea

The Chair

Mr. Svend Robinson

The Chair

Mr. Rob Merrifield

1145

The Chair

Mr. Rob Merrifield

The Chair

Mr. Rob Merrifield

The Chair

Mr. Réal Ménard

Mr. Svend Robinson

The Chair

Dr. Michele Brill-Edwards

The Chair

Chief Bill Erasmus

The Chair

Chief Bill Erasmus

The Chair

Chief Bill Erasmus

The Chair

Mr. Svend Robinson

The Chair

Mr. Michael McBane

The Chair

Mr. Réal Ménard

The Chair

1150

Mr. Rob Merrifield

The Chair

Mr. Rob Merrifield

The Chair

Mr. Svend Robinson

The Chair

Mr. Svend Robinson

The Chair

Mr. Rob Merrifield

The Chair

Mr. Réal Ménard

The Chair

Mr. Réal Ménard

The Chair

Mr. Svend Robinson

The Chair

Ms. Hélène Scherrer

The Chair

Ms. Hélène Scherrer

The Chair

CANADA

Standing Committee on Health

NUMBER 061

2nd SESSION

37th PARLIAMENT

EVIDENCE

Thursday, October 23, 2003

[Recorded by Electronic Apparatus]

¿ (0910)

[English]

The Chair (Ms. Bonnie Brown (Oakville, Lib.)): Ladies and gentlemen, it's my pleasure to welcome you to this meeting of the Standing Committee on Health.

We have two items of business before us this morning. We have presentations on prescription drugs, our prescription drug study, and we have a motion. I think the mover of the motion will want some time to speak to it, and other people might want some time to respond. So as not to hold up the witnesses, I'm going to move to the presentations, and we will do the motion when we come back from the vote, which is scheduled shortly after ten.

Let me just check with the people who are here visiting to see if they can come back after the vote.

Mr. David Price (Compton—Stanstead, Lib.): I have another committee after I've finished here.

The Chair: What time is that?

Mr. David Price: At eleven.

The Chair: We would do it before eleven.

Mr. David Price: It depends on how long the vote goes.

If I can make it, definitely.

The Chair: How about you?

Mr. Christian Jobin (Lévis-et-Chutes-de-la-Chaudière, Lib.): I have another committee.

The Chair: At eleven, but not before?

Mr. Christian Jobin: Before, yes. Me too.

The Chair: Pardon me?

Mr. Christian Jobin: At nine o'clock.

The Chair: At nine o'clock, okay.

What about you, Mr. Maloney?

Mr. John Maloney (Erie—Lincoln, Lib.): I have committees from nine to one.

The Chair: Okay.

We're going to have to do the motion now, I'm afraid, because these people can't stay.

Mr. Svend Robinson (Burnaby—Douglas, NDP): On a point of order, Madam Chair, we have our witnesses who are here and who are ready to proceed. Why can't we come back right after the vote, which would be at approximately 10:30? This meeting was scheduled from nine to eleven.

The Chair: Yes, exactly.

Mr. Svend Robinson: So I would hope that we could come back right after the vote and proceed to deal with the motion then, in deference to our witnesses.

The Chair: That was my plan.

I will have to apologize to the witnesses for the time being, and we'll have to move to this motion, because we have people here who may not be here after the vote, and we have members of our committee who are now out of town on other business. So this is a problem.

Mr. Merrifield, this is your motion. It is now on the floor. Would you like to speak to it?

Mr. Rob Merrifield (Yellowhead, Canadian Alliance): Yes, I would like to speak to it.

I think we should have continued with the witnesses and brought this up later, but if this is what the chair is wanting to do, I suppose, let's hear the motion.

The intent of the motion is to not make light of this subject. It's a very serious subject that we've been dealing with. Some fascinating witnesses have come forward in the last number of weeks. I wasn't here at the point in the committee meeting when this was decided, but I was very upset when I got back to my office and was told you wanted to start with a final draft of the report on this subject.

It really bothers me that we start on a report when we haven't heard from Atlantic Canada or Quebec or Toronto. I feel it's very much premature, and more than that, it slights the witnesses who would come to this committee from those areas. I think that's totally inappropriate.

If we're going to do that, if we're going to move to actually starting a report prior to that consultation, I wasn't going to have any part of it. If that's the case, then we should shut down the travel and do as good a job as we can on what we've heard. And I have a problem with that as well. Nonetheless, that's one of the issues.

The other issue is Bill C-13, which is a piece of legislation we have been working hard on for three years now, actually, in this committee, from the beginning of the last election. It is in its final reading. It's in third reading. The last time the committee travelled I had commitment from the minister that this bill would not be brought forward for final debate during the time we were gone. Well, that sort of happened and sort of did not. It did come up on a Friday, but the commitment was that while we were travelling from Monday to Thursday wasn't there, and that was fulfilled. But here we are. It's going on the agenda Monday, supposedly, for third and final reading and final debate, and I think it's totally inappropriate. Bringing that to the floor of the Commons while we're away also slights this committee.

We can't have it both ways. Either we move the bill off or stop the travel. We can only do one thing at a time. For those two reasons, and I will leave my arguments there, I think we should either reconsider where we're going as a committee with Bill C-13 or reconsider travel.

¿ (0915)

Mrs. Karen Kraft Sloan (York North, Lib.): Thank you, Madam Chair.

I just received a copy of the motion, and it says that the health committee immediately cease travel for the remainder of the fall parliamentary session. This really disturbs me, Madam Chair, because if this motion were allowed to go through, the committee would not be travelling for the entire fall session. This does not sound to me like a motion that supports the work of the committee, in that it supports listening to witnesses.

Mr. Merrifield has said we haven't heard from people in eastern Canada, etc. How is this committee able to hear witnesses who are not located in Ottawa if they are not allowed to travel for the remainder of the fall session? Does that mean that we have to bring witnesses here? I'm a new member of this committee, but I do know that it is very important to get out and talk to people locally.

The other thing that I would really like to underscore, Madam Chair, is the fact that this is an interim report. This is a report on the progress of the committee's studies to date. There are people who have prepared briefs, just as these witnesses have prepared briefs for us this morning, and the reason we're taking up time discussing this motion is because the opposition has brought this forward.

I'm deeply concerned that the opposition would like this committee to cease travel for the entire fall session. I think it's important for you to continue doing the work you've done.

We're just talking about an interim report, which I think is a very positive way to approach this situation.

The Chair: Thank you.

Mr. Ménard.

[Translation]

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ): I would like to welcome the new members to the committee. It is always refreshing to be able to count on input from outside. We know that the Liberal Party had the ability to renew itself.

With regard to the essence of the matter, Madam Chair, there are to my mind two issues here that are quite distinct. The idea of preparing an interim report appears to me to be premature. Our colleague, Mr. Merrifield, is right in reminding us of the situation: just as we have not heard from witnesses from Quebec, it is not clear that we would have covered all of the bases in Toronto either. I therefore fail to see the need at this stage to make an interim report.

I would support the idea of a summary of what we have heard from witnesses. If we wish to have a synthesis of what people have told us, that might be useful. The difference between a summary of witnesses statements and an interim report is that the latter would lead us towards avenues for potential solutions. Of course, this would not be definitive, but I believe it is too early and that the matter at hand is more complex.

You yourself stated, Madam Chair, the first time you talked about our study, that it could take two years. If it is true that it could take two years, I do not see why we would need an interim report after two months' work.

Secondly, I believe we should travel. I find it pleasant to go out and see people, to reach out to other communities. That is part of our work as parliamentarians. Our whips are putting pressure on us—and I cannot imagine that the Liberal whip is less tough than the Bloc québécois whip, the Canadian Alliance whip or the NDP whip—because there are two weeks left in this parliamentary session. It is an open secret that Parliament should be adjourning in two weeks' time. We are not responsible for the fact that the Liberals will adjourn Parliament, but it is obvious that the whips want us to be here for the last two weeks, given that it is highly likely that there will be a speeding up of our work.

I would remind you, Madam Chair, that Tuesday evening there are three important votes. First, there is the supply vote. We will have to be told if it will be held at 5:30 or later. Secondly, there is an excellent and brilliant Bloc québécois motion, a true test of solidarity for the government, that will be a non-confidence motion. No one will want to miss that. Finally, there is of course Bill C-13.

Could we not agree to say that this trip should be made but that we make it in early January? Could we not postpone it without giving the impression that we do not want to travel? If it is true that there are only two weeks left in this parliamentary session, then we should be thinking about the way to most effectively use our time in order to carry out all of the duties that are incumbent upon us to carry out.

There is therefore some validity in our colleague's motion, but I believe that we should unlink it from the interim report.

¿ (0920)

[English]

Mr. Svend Robinson: Again, dealing briefly with the two key issues that have been raised, unlike my colleagues on this side of the table, I actually think it is important that this committee address the government on those issues on which hopefully there would be a broad consensus. That's my understanding of the purpose of the interim report.

Of course, Mr. Ménard is absolutely right, in that most of us assume that the House will be rising on November 7 and won't be coming back probably until February. And when we come back in February, the reality is that we're into a pre-election period, with a Speech from the Throne, a budget, and an election. There are a number of key issues on which this committee has already heard very powerful and compelling evidence, which I would hope we would be in a position to unanimously urge the government to take some action on.

As one example, there is the whole issue of direct-to-consumer advertising. I don't know why we would have to wait months and months and months, particularly when the government is in the process of studying this issue itself. We know the existing regulations aren't being enforced properly and we know there is strong pressure from industry and others to change the law. I would hope this committee could say let's make our views known at this stage of the proceedings.

So with respect to an interim report, I think it's something we should be doing, and I hope we will be doing it.

With respect to travel, I have to confess, I'm torn on this one. On the one hand, I think the arguments with respect to commitments that were apparently made around Bill C-13 are arguments that are important. If the commitment was made that the bill would not be brought forward when the committee was on the road, then that's something I think we should be concerned about—although I understand that the vote will take place on the Tuesday. It's the debate we're talking about, and not the vote; but even so, that is a concern.

So my position is that I am prepared to hear witnesses next week on the road, but frankly, if I'm the only opposition member sitting on that side of the table, then I think we would have to reconsider.

The Chair: (Inaudible--Editor)...is very interested.

Mr. Svend Robinson: Well, I've heard conflicting views on that.

In any event, I'm not prepared to just call for the cancellation of the hearings. But to come back to the point Ms. Kraft Sloan made, if the motion were a little more flexible and it indicated that while there's a possibility of hearings later, we seek the postponement of the hearings next week, I wouldn't have a problem with that, frankly.

The motion right now just says there will be no travel, period, in the fall session. If there were a possibility of postponing these hearings to later in November, for example, or early December, when the parliamentary calendar does have us sitting, I would be prepared to support that motion.

If a friendly amendment is acceptable, Madam Chair, which I believe would be in order, I would move an amendment that the committee postpone, not cancel, its scheduled hearings to a date later in the fall session.

[Translation]

Mr. Réal Ménard: I second the motion.

[English]

The Chair: Does the mover of the motion accept that?

Okay. So the motion now reads that travel be postponed.

Madame Scherrer.

[Translation]

Ms. Hélène Scherrer (Louis-Hébert, Lib.): Thank you very much, Madam Chair.

I will not go over the arguments that have already been given, because some of them appeal to me as well, but I would like to add a few things.

First of all, I was very pleased when I saw that, for once, the committee was going to make a stop in Quebec City, because as a rule, we go to Montreal but never to Quebec City. I have been a member of Parliament for three years and I believe that the Standing Committee on Citizenship and Immigration was the only one to stop once in Quebec City instead of Montreal. I think that the people of Quebec City were thrilled to see that we were taking them into consideration as well.

I would however not want us to send the wrong message to these people, who are excited about appearing before the committee and who have prepared presentations. I would not want them to think that we are treating them in a cavalier fashion either. Next Tuesday, we risk having a vote at 3 p.m. and one at 10. We risk having to sit Monday evening. I would be very uncomfortable if I were to appear at the committee meeting and have to tell witnesses that unfortunately we will have to leave at 2 p.m. or that we have to be in the House at 10 and that we will come back later, since the message that we want to relay to them is that we are listening to what they have to say.

I believe that the general population is very aware of the fact that within the next two weeks, or at some point, we will be going away. The Prime Minister will no longer be the same person and the minister and committee members will no longer be the same either. We therefore will not know what to do with what they will have brought forward to us.

I am hoping that we will make this trip to Quebec City and maintain our decision to meet with these people, be it now or in January. But I would really like them to get the message that we are going to the trouble of travelling there to hear them, instead of leaving them with the impression that they are simply being sandwiched between two votes. With regard to Bill C-13, however, we worked on it with a view to being present for the vote. I would very much like to be able to vote on this in the House, because I believe it is very relevant.

I am speaking for Quebec City, but it is probably the same thing for Halifax. In Halifax too, there are people who are ready and anxious to have us show them that what they have to say is interesting and relevant and that something will be done of their reports. They do not want to feel that we are simply going there because we are forced to and that we will look at their reports later.

That is my cry from the heart. Yes, I would really like the committee to go, but I would like everyone to be there and I would like us to follow up on what the people have prepared. We must show the people in Halifax, in Toronto or in Quebec City that we are there to listen to them and that we will do something with what they bring forward.

¿ (0925)

[English]

The Chair: Just on that point, there are 55 witnesses booked for next week.

Ms. Fry.

Ms. Hedy Fry (Vancouver Centre, Lib.): I think Hélène made my points very well.

We cannot continue to treat people who live in cities outside of Ottawa as if they're irrelevant. They've prepared for this; they expect us to come; and when we don't come it looks as if we don't care. Now, we do have a vote and we have some problems.

The Chair: No, that has been solved, Madam Fry.

If I may just explain it to you, we've had several cancellations on the Quebec City list, and the clerk, under my instruction, has rearranged them. We are starting at 8 a.m. in Quebec City, and the arrangements have been made to fly us back here. We will be back here by three.

Ms. Hedy Fry: I was about to say that when votes are important, we're whipped back; no matter whether we're in Rome or Venice, or wherever we are, we come back for votes. So I don't see how that should tell us that we should not make plans to travel or to continue committee business.

This is the point I'm trying to make. Not only do we let people down, but the cancellation costs for flights are also going to be a cost to the committee. And if we're talking about an interim report, there's no way we can postpone this, then go and travel and listen to people at the end of November and then have an interim committee report ready. It doesn't give you the time to do that kind of thing.

So I think we should just carry on with business. I don't think the business of committees should be hung up on issues like this. This is not a new thing to have a vote when you're travelling. We've dealt with it; we've come back; we've found ways to accommodate these things. Let's carry on with the business of the committee and the House. It's important enough that we must listen to Canadians on this issue.

The Chair: Mr. Robinson.

Mr. Svend Robinson: Just on a point of order, Madam Chair, and for clarification, because Madam Scherrer raised the issue, my understanding is that we are now talking about only three hours of hearings in Quebec City—if even that. Is that correct?

The Chair: They will be for three and a half hours, or maybe four.

Mr. Svend Robinson: What time would they start, and what time would they finish?

The Chair: At 8 a.m.

Mr. Svend Robinson: So we'd be starting at 8 a.m.

The Chair: But these are the people who wanted to come and are able to come.

Mr. Svend Robinson: Yes, I know, but I think there's a real problem with that.

The Chair: The others cancelled themselves. We responded to everyone from that area who wanted to come. In offering the time, a number of them couldn't come. We rearranged the groups in order to hear from everyone who was able to come.

Seeing no further speakers, I'll call the question.

Mr. Merrifield.

Mr. Rob Merrifield: Is it on the amendment?

The Chair: No, it isn't just an amendment, it's the motion. It's the new motion.

Mr. Rob Merrifield: Yes. Okay. That's fair enough.

¿ (0930)

The Chair: You can have the last word because you moved it.

Mr. Rob Merrifield: Yes, I moved it. It's not that I don't want to hear; I do want to hear. It's not that I take this lightly; I take it very seriously. This is a very serious subject, which we've had some compelling testimony on, and I'm hoping to hear a lot more.

My fear is that we don't do this justice. When we start putting together reports before we hear from these people, we do a disservice to them. The intent of the motion is not that I don't want to hear. The intent of the motion is that I don't want to take this subject lightly. It's what we're actually doing by travelling inappropriately, and saying that we're going to do a report prior to even hearing these 55 witnesses, if that's what we have next week. That's the rationale behind it.

On the idea of timing, I agree with the amendment. It's not that I was upset and didn't want to travel. The intent to my motion is that I didn't want to travel if we're going to write a report before we even hear from them. If we're going to waive that and say that we'll listen to all of them before we start on the report, it's fair enough. If we want to travel a little later, that's fair enough.

On the idea of prorogation two weeks from now, well, nobody really knows. Let's not get worried about that. Let's say we have all of the fall. We should have all fall and we should plan to go until Christmas, as far as I'm concerned. If that's the case, let's travel and let's do an appropriate job on this report. That's what I say.

Bill C-13 next week is another one that, if it's here, we have to be here to be able to finish off our work there.

[Translation]

Mr. Réal Ménard: Madam Chair...

[English]

The Chair: That was the last speaker on the motion.

[Translation]

Mr. Réal Ménard: I would like to ask a question.

[English]

The Chair: You have a question?

[Translation]

Mr. Réal Ménard: Have you talked to the Government leader and is it a certainty that Bill C-13 will be presented next Tuesday? Have you obtained any information from the Government leader?

[English]

The Chair: I am constantly asking that question of people. No one can ever guarantee what is going to happen. I understand that it's up for debate on Monday, that I'm sure of. It should lead to a vote on Tuesday night, along with several other rather important motions, including the one you alluded to earlier. There are three or four very important votes on Tuesday night that we should all be here for. It is why we've changed the arrangements slightly, in order to get back here so as to accommodate everyone.

The thing I'm happy to hear about is how people are talking about maybe working in December and January.

To me, it is very difficult, as the chair, to get approval for a trip and to get the money for a trip. You don't go to those meetings. I go and have to fight for every cent that this committee might spend in the way of a trip, and to also get on the calendar to be allowed to go out of town, because they don't want too many committees out of town at one time. There's a lot of work behind actually getting this in place.

I do not have any sense of optimism about rescheduling for January or rescheduling it for December. In this committee in several other years, I have asked if people would be willing to meet in January. I've never had a positive response yet, so I find it strange.

Anyway, if you're willing to do some work in December, my suggestion would be that we do the trip. If there's any kind of discussion around an interim report, we should not feel rushed about it. Maybe we could reassemble some time in December or in January to do that, but this way we don't throw up in the air all the arrangements of all the people who have worked on putting this trip together.

[Translation]

Mr. Réal Ménard: But how are you interpreting the motion? If we adopt Svend Robinson's sub-amendment, will you take for granted, as Chair, that...

[English]

The Chair: It still would effectively cancel next week.

[Translation]

Mr. Réal Ménard: Which means that we will cancel. And the mandate you have is to reorganize the trip between now and the end of the session. We agree on the fact that Svend Robinson's amendment would order us to travel between now and the end of December, but we are not responsible for the fact that the government wants to adjourn in two weeks. That is not the Opposition's fault. Do not adjourn Parliament.

[English]

The Chair: No.

Ms. Hedy Fry: Madam Chair, may I ask a question before we vote? What would it cost to cancel this trip next week?

The Chair: It would cost $20,000.

Ms. Hedy Fry: All right. Well, I think that is a consideration we have to make.

The Chair: It would be deducted from the budget. We would be short $20,000 on a future trip that was similar.

Ms. Hedy Fry: It's a fairly large sum of money.

The Chair: Anyway, I think I've heard all of the arguments now.

Ms. Hedy Fry: Yes, let's call the vote.

The Chair: I'm going to call the question.

[Translation]

Mr. Réal Ménard: Just a minute. Explain to us why it is going to cost $20,000 to cancel the trip. Let us have the clerk explain this to us. I do not understand. First of all, cancelling plane tickets will not cost us anything; it is the House that pays. It does not work the same way as for hotels, to which we must give one week's notice.

[English]

The Chair: We have a piece of paper here that the logistics person has done, called “The Cost of Cancellation of Health Committee Travel to Halifax, Quebec, and Toronto”. The cost for cancellations to Halifax is $4,600; to Quebec, $3,300; and to Toronto, $9,000. Then there is some on airfare. Anyway, the total is $19,449.50.

Are you ready for the question?

[Translation]

Mr. Réal Ménard: We do not yet have an answer to the question. I do not understand why cancelling would cost $20,000. As far as the hotels are concerned, we cancel 24 hours in advance. We travel all year long and we know that plane tickets are paid for by the House of Commons.

¿ (0935)

[English]

The Chair: They charge usually 10%.

[Translation]

Mr. Réal Ménard: Who? Explain this to me.

The Clerk of the Committee (Mr. José Cadorette): When we reserve a block of rooms, it is not the same as simply reserving one room. In the latter case, one can always cancel with 24 hours' notice. But when you reserve 20 rooms, you cannot cancel free of charge with 24 hours' notice. There are also the conference rooms we require. In Toronto, for example, we had made arrangements for two days. The cancellation of the plane tickets...

[English]

The Chair: Seeing no further speakers, I'm ready to call the question on the amended motion, which is to postpone the trip next week and perhaps do it another time.

(Motion as amended negatived)

The Chair: Thank you very much.

Now we'll go to our witnesses, who have been very patient. I thank you.

From the Assembly of First Nations, we have Mr. Bill Erasmus, the regional chief for the Northwest Territories. Mr. Erasmus, the floor is yours.

Chief Bill Erasmus (Regional Chief, Northwest Territories, Assembly of First Nations): Thank you, Madam Chair.

Can I ask, just for clarity, how much time we have as presenters? I need to know whether I should read the document into the record or if I should speak.

The Chair: You should speak. You have about seven minutes.

Chief Bill Erasmus: Thank you.

My name is Chief Bill Erasmus. I'm from Yellowknife. I travelled here yesterday to be in the nation's capital and see a colourful display of parliamentary democracy this morning.

I am here with Elaine Johnston, who is the head of our health secretariat at the Assembly of First Nations. In the event that there are questions I may not be able to answer, because I'm new to this portfolio, I'd like the opportunity for her to possibly speak on some of these matters, because she has been involved and is quite prepared to do that.

I'd like to thank you again, Madam Chair, for this opportunity.

As you know, the Assembly of First Nations is a national organization. We've been involved for many years now, working out of Ottawa. We're organized to represent the 634 first nations communities and we have, as an executive, ten regional offices. I work within the regional office in the Northwest Territories, and my portfolio, as I said earlier, involves health, social issues, and those areas.

What we want to talk about today is the Romanow commission, which looked at a number of issues. We want to concentrate on some of the recommendations it made. I won't go into all the statistics. You know, generally, where our people, as first nations, fit within the mosaic we call Canada. We're obviously not in a state where we ought to be, for a number of reasons, and I think what we need to do is look at how we can make improvements.

Romanow's recommendation number 37 looks at the whole area of prescription drugs: evaluating existing drugs; negotiating and containing drug prices; providing comprehensive, objective, and accurate information to health care providers and to the public.

In terms of first nations, our thoughts are that populations within our communities require the safety of properly tested and evaluated medications. A containment of drug prices generally may help protect needed access to medications for first nations people.

Looking at recommendation number 38, when you look at the national drug agency, we need to assess how that ought to work. It's based primarily on population, and we have a problem with that for a number of reasons. One is that if you look at first nations populations, there is no accurate read of how many people we have. For example, if you look at the latest census that was taken, many of our people don't get involved in the census for different reasons, so there is a gap between first nations peoples and the Canadian public at large. I think we need to develop a national formula that can begin to look at how we can address that.

To begin to understand where our people stand, there's an example in the text on page 4 that talks about.... We know a number of years ago, when we were younger, tuberculosis was a common thing in Canada, and it's beginning to be a common thing again in first nations communities. So we have to understand the scale and look at it from a different angle. I think Romanow tries to spell that out.

¿ (0940)

In terms of monitoring prescription drug use, recommendation 39 recommends: “A new program on medication management should be established to assist Canadians with chronic and some life-threatening illnesses. The program should be integrated with primary health care approaches across the country.”

A first nations pain management plan should be implemented to emphasize the vital role of education and prevention in this area. Traditional healing practices should be specifically targeted for enhancement and include research and review of international models.

This should also include the whole area of addictions related to solvents, therapies, methadone maintenance, provincial and territorial triple prescription detection systems, inmate populations, an overview of the cost of prescription drug misuse, reasons for the increasing costs of prescription drugs and how to contend with these.

I think maybe we can ask Elaine later to talk about methadone. I think there is a need to clearly understand that. I don't completely--

The Chair: Would you like her to speak now? You have about two minutes to explain this methadone thing. We've heard something about it out west, but it would....

Ms. Elaine Johnston (Director, Health Secretariat, Assembly of First Nations): Certainly, thank you.

Health Canada has developed new policies around prescription drugs within the non-insured health benefits. One of the issues with the methadone maintenance is that they have limited the amount of money for pharmacists on dispensing fees.

What has happened now is the Canadian Pharmacy Association has sent out notices to all of their pharmacists. Part of the problem is that pharmacists have to observe clients who are taking methadone. The pharmacists are quite concerned because they feel they are not being given adequate resources to take care of this particular medication.

We've had a number of physicians who have also phoned. They are quite concerned because their clients are being denied methadone because pharmacists are saying if they are a first nations client they will not give them service because of the policy for the methadone.

What has been happening is that Health Canada, as we understand it, has been looking for alternative drugs like OxyContin, I believe it is, and looking for alternative methods of treatment, whether it's looking for a treatment centre that can provide methadone or.... But it's still causing problems for clients.

We have been getting numerous phone calls that clients have been denied methadone treatment, which is for heroin addiction. That is a problem, and I know that the Canadian Pharmacy Association has been quite concerned about this particular issue.

¿ (0945)

The Chair: Thank you, Mr. Erasmus.

Chief Bill Erasmus: Madam Chair, perhaps I could just take 30 seconds to make a closing comment.

As first nations people we need to work closely with Canada on addressing first nations issues. There's the whole question of constitutionality, section 35 versus sections 91 and 92. I think we have to combine authorities to look at how to best address this question.

If there are further questions, I think we can get into some depth on it. But clearly it has to be a joint effort. It's a huge problem. I think part of it is to invest now so that in the future we have the healthy population we want.

Thank you, Madam.

The Chair: Thank you.

Our next presenters will be from the Canadian Coordinating Office for Health Technology Assessment, Ms. Sanders and Ms. Shea.

Ms. Barb Shea (Director, Common Drug Review, Canadian Coordinating Office for Health Technology Assessment): Thank you, Madam Chair.

Dr. Jill Sanders, who is the president of the Canadian Coordinating Office for Health Technology Assessment, or CCOHTA, as we are more commonly known, has asked me to convey her regrets, as she is unable to appear today.

My name is Barb Shea. I am the vice-president responsible for the common drug review at CCOHTA. The common drug review is a new intergovernmental initiative that CCOHTA delivers on behalf of participating publicly funded drug plans. All federal, provincial, and territorial drug plans participate, with the exception of Quebec.

With me today is Dr. Vijay Shukla. Vijay is one of CCOHTA's pharmaceutical research officers and the scientific adviser to the common drug review.

On behalf of Dr. Sanders and everyone at CCOHTA, we want to express our appreciation for this opportunity to contribute to the study on the health aspects of various prescription drug issues.

CCOHTA was created in 1989 by Canada's federal, provincial, and territorial ministers of health. We provide Canadian health care decision-makers with unbiased, reliable information about health technologies, including pharmaceuticals. We focus on the evaluation of clinical effectiveness and cost-effectiveness.

Our role in the system is very specific. We are not part of the regulatory system, nor do we make the ultimate decision about the funding of pharmaceuticals and other technologies. Rather, we exist to equip decision-makers with unbiased summations of the best available evidence so that they are in a position to make informed choices.

Information at CCOHTA is provided through two programs. First is CCOHTA's health technology assessment program, which assesses medical devices, health systems, and pharmaceuticals along a continuum ranging from emerging technologies to well-established ones. This program has existed since 1989. The common drug review program consists of rigorous clinical and pharmaco-economic drug reviews and an evidenced-based listing with recommendations to drug plans. The recommendations come from a national committee of drug evaluation experts known as the Canadian Expert Drug Advisory Committee, which has been just recently appointed by the ministers of health.

After delivering an interim common drug review program for about a year and a half, CCOHTA now has launched the permanent common drug review as of September 2003. While our health technology assessment program assesses a broad range of technologies, the common drug review will focus on new drugs and new chemical entities that have been submitted to the program by the pharmaceutical industry. The recommendations will come from the national expert committee and will go out to participating plans, which will make the ultimate decision on whether or not these drugs will be covered on formularies.

CCOHTA is not placed to speak on all of the issues identified by the standing committee; however, through those programs I have just outlined, we have experience in the assessment of prescription drugs. I would like to share what we have learned and observed from developing and delivering these programs.

Our first observation is that evidence-based decision-making can maximize health benefits and minimize costs. For example, CCOHTA's study on the cost-effectiveness of the availability of statins, which are low-density lipoprotein reduction drugs, showed that adoption of the CCOHTA guidelines on the cost-effective use of these drugs for the targeted groups could result in savings of $22 to $88 million with no reduction in clinical effect.

Second, decisions can be only as good as the data and evidence available to support them. In the case of new drugs, drug plans often make listing decisions based on limited evidence of the drug's impact on health outcomes in the real world over time. Frequently the head-to-head comparative information between a new drug and the existing gold standard is not available, and it should be. Throughout our health care system, we need to increase the volume of pragmatic cost-effectiveness analysis that is available.

Adequate post-market surveillance and reporting is required so that decision-makers can continually reassess the appropriate role of pharmaceuticals as new alternatives become available. They can then modify utilization so that drug-related outcomes become optimal. Processes for generating and sharing data and evidence should be open and transparent so that the right information is routinely available to decision-makers.

¿ (0950)

Our third and final observation is that federal, provincial, and territorial governments need to work collaboratively to ensure that better information is available to support decisions. The common drug review is a good example of intergovernmental cooperation. Other examples include the development of the national prescription drug utilization information system. This will provide Canada's health system with accurate information on how prescription drugs are being used in publicly funded drug programs. Also needed is the development of a comprehensive national strategy for health technology assessment, which will clarify the information needs of decision-makers and ensure the appropriate mechanisms are in place to support those decisions. Finally, we need to develop an initiative for best practices in prescribing, which will help ensure optimal drug-related health outcomes. These initiatives will result in better information, leading to better decisions, leading to better drug-related outcomes.

With increasing cooperation within Canada, the next logical step is international cooperation in terms of developing evidence, since Canada is not alone in facing challenges in this area.

In conclusion, our observations lead to three simple messages for the committee: evidence-based decision-making can maximize health benefits and minimize cost; better evidence leads to better decisions; and collaboration and cooperation are essential to develop the evidence base that is required to support more effective decision-making.

I would like to thank the committee once again for the opportunity to present our views. Dr. Shukla and I would be pleased to answer any questions.

The Chair: We'll move on to the Canadian Health Coalition and Mr. Michael McBane.

Michael.

Mr. Michael McBane (National Co-ordinator, Canadian Health Coalition): Thank you, Chairperson.

On behalf of the Canadian Health Coalition, I want to thank the committee members for holding public hearings on such an important issue. I must also acknowledge that it feels good to be looked over by the elders on the wall here, including Tommy Douglas. That's good to see.

It's hard to know where to begin, given the scope of your study. I'm sure you've heard enough about disturbing developments and trends in your hearings to realize that this topic certainly warrants much more rigorous investigation. It's difficult to appreciate the full extent and consequences of the pharmaceutical industry's hold on our health care system and the medical profession, Health Canada's therapeutic products directorate, and of course the political system itself.

The pharmaceutical industry giants are the most powerful corporate institutions in the world. I would say that industry promotion has paramountcy over health protection. There are hundreds, actually thousands, of examples of evidence to demonstrate that fact in Canada's policy towards pharmaceutical products.

I don't have time today to read my brief, and I won't, but I wanted to focus on the issue of patient safety.

On March 19, 2000, Vanessa Young died; she was 15 years old. I want the members to remember Vanessa, because nothing has happened since her death--nothing. There have been no changes on behalf of the Government of Canada. That is a betrayal of your duty to protect the public, a betrayal of the Minister of Health's duty to protect the public. The government has a duty of care in the law, and this betrayal results in massive buildup of legal liabilities for failure to perform the duty. Canada doesn't even monitor deaths from adverse drug reactions. Can you imagine? It's like we won't keep track of airline crashes. It's unbelievable. In the United States there are an estimated 106,000 deaths a year, the fourth leading cause of death, and we don't even monitor it. How convenient.

There's another area that I wanted to flag, because to me this is a warning signal that there's something really wrong in pharmaceutical issues. I want to mention the case of Dr. Nancy Oliveri and the case of Dr. David Healy. These are two cases that have now become international reference points in terms of what goes wrong when you create university-industry partnerships to develop pharmaceutical programs and drugs. You end up sacrificing patient safety, academic freedom, and the integrity of the research. That's the conclusion of Harvard experts and Oxford experts who looked into Nancy Oliveri's case. It's bad enough that she was betrayed by the Hospital for Sick Children in Toronto. It was worse that she was also betrayed by the University of Toronto. But in my books, the worst betrayal was Health Canada's. She insisted on a meeting with the health protection branch and she was betrayed there as well. There was collusion between the branch and the actual drug company, which the branch invited to the very meeting that Nancy Oliveri had requested. Of course, nothing happened; there was no support for a physician who happened to be upholding the law and her code of ethics. Where was the Minister of Health?

When Dr. Arnold Relman of Harvard, who is unimpeachable in terms of academic credentials, medical ethics, and expertise, came to the Senate's Kirby committee, he had a very simple explanation. He said to follow the money, the amount of money that is spent in Ottawa to make sure that no regulations stand in the way of pharmaceutical profits.

¿ (0955)

These aren't just unsubstantiated claims. This is Government of Canada policy. It's called cost recovery. In the therapeutic products directorate, the pharmaceutical companies are paying $40 million a year, and they want service in return for that money. So that's created a new operational principle in the therapeutic products directorate, and it's called “industry is the client”.

Those are facts. These are numbers that are in the blue books of the department. This is where the money is coming from and this is the new operational principle. That's why the drug company that produced the drug that killed Vanessa--I think it was Ortho-Johnson--said that Health Canada is their best customer. How scary that is. If they're into industry promotion, who's protecting health?

If a drug scientist finds a drug problem and brings attention to the fact that the research has found a problem.... Why would we do research if it isn't to look for problems? No, we're going to suppress that evidence. It mightn't be good for the product's sales. Where are the checks and balances in our system? Wouldn't you think that the therapeutic products directorate, which has the legal mandate of the duty of care, would intervene to look at Nancy Olivieri's case and many other cases?

I think that what we need is a major independent inquiry into the drug industry and its stranglehold over our health care system, our medical profession, our regulatory approval system, and our political system. So the Canadian Health Coalition is recommending the establishment of an independent public inquiry into the pharmaceutical industry's practices.

In my brief we've outlined a number of specific areas that a public inquiry should examine. I wanted to add as an important footnote that the public inquiry must precede any decisions announced by the federal government in the last Speech from the Throne to “renew federal health protection legislation”, which they're working on right now. They're also working on, as announced in the Speech from the Throne, speeding up drug approvals. Can you imagine that becoming Government of Canada policy without any evidence? We're just going to speed it up. We don't know how many people it's going to kill. We're just going to speed it up.

A third policy that must await an investigation of the industry is the direct-to-consumer drug advertising plans.

Finally, the fourth policy area that must wait until there's an investigation of the industry is the government's plan to adopt its intellectual property framework to enable Canada to be a world leader in emerging issues of new life forms.

All of these intentions must await a serious investigation of what the implications are of giving the pharmaceutical industry paramountcy over public health.

Thank you.

À (1000)

The Chair: I've just inquired, and the bell that's ringing now for the vote is only a 15-minute bell, which means we have about 10 minutes to get over there and vote.

Ms. Brill-Edwards, would you wait and put your testimony forward when we come back? Okay, thank you very much.

I hope everyone will stay and participate in the discussion, but for now we'll suspend the proceedings of the committee until we return.

À (1045)

The Chair: I'm calling you back to order, ladies and gentlemen, and we'll proceed with the testimony, this time from Michele Brill-Edwards, who is with the department of pediatrics at the University of Ottawa but is testifying as an individual.

Ms. Brill-Edwards.

Dr. Michele Brill-Edwards (Department of Pediatrics, University of Ottawa, As Individual): Thank you, Madam Chair.

I would like to first of all thank the committee for the invitation to appear before the committee. My remarks will be brief. I would like to leave time for questions from the committee, as I presume that is the purpose of the invitation.

I would remind you that I'm Dr. Michele Brill-Edwards, and I'm a specialist in the application of the Food and Drugs Act in Canada. I now practise privately, but I was previously with Health Canada for some 15 years, and I was the senior physician responsible for drug approval and clinical trial approvals in Canada in the years 1988 to 1992.

I resigned from Health Canada in 1996 in order to speak publicly about the dereliction of duty of Health Canada and its diminishing ability to uphold the Food and Drugs Act in the interest of the public, with the result that patients in Canada were dying who did not need to die.

Since that time, very little has changed in the area of pharmaceuticals and new drug approvals in Canada. It remains the statutory duty of the Minister of Health, through the department, to uphold the Food and Drugs Act for the protection of the public. The intent of the act is to protect the public from health hazards and fraud in the sale and use of foods, drugs, cosmetics, and medical devices.

Justice Krever has reinforced the notion that regulation must be done in the interest of the public and in no other interest. Nothing has been done, however, in my view, to ensure that the department is reoriented towards serving the public interest. The close association with the pharmaceutical industry and looking to the interests of the industry rather than the interests of Canadians is an ongoing problem still today.

The reason we're dealing with this kind of problem is that we have had a policy of deregulation, not only in Canada but elsewhere, for at least two decades. As a result, we have a diminished political will and also a diminished capacity, diminished expertise, and diminished funding within Health Canada to carry out the mandate.

There are solutions to these problems. I've spoken to this committee in the past and to the industry committee, and my remarks are on record. I believe the solutions are threefold.

The first issue is to stop the secrecy that surrounds the drug approval process. A great deal of corruption and error and wrongdoing can occur behind closed doors. A process that involves multimillion- and multibillion-dollar decisions cannot be left to bureaucrats behind closed doors, who do not have any recourse when they see wrongdoing occurring. The first step we have to take to ensure an honest and publicly oriented drug approval system is to make that system public to make it open.

The second solution, in my view, is to investigate the current circumstances. We can't plan for the future unless we know about the recent problems, the recent mistakes. Some of those mistakes have been investigated, such as the blood scandal, which is a direct responsibility of Health Canada. The whole blood contamination issue was a failure of duty of the department in serving the needs of industry.

We can only understand how we need to change the system if we have a public investigation of the drug approval process and the relationships between the various parties in that process and the pharmaceutical industry.

À (1050)

The third element of the solution is a new institution for the future. I'm not speaking here about a new regulator. I want to be clear about that. I'm speaking about a new drug safety board that would be independent, that would have zero influence from the pharmaceutical industry, and that would be charged with the duty to independently investigate drug safety crashes in the same way that the air safety board is charged with the duty to independently investigate air safety crashes.

Many people in the field with expertise such as mine have written to describe such an agency. For example, the esteemed American journal, The New England Journal of Medicine, has carried such an article in the last few years. This is not my proposal, but a proposal that I believe would apply exceedingly well in Canada.

I want to point out that in the Romanow report, recommendation 37, there is a recommendation that is rather confusing, which says simply that we should have a new agency, meaning a new regulator. I want to be clear that I think it is a confusing recommendation. To clarify it, I would say that we need the regulator as is in government, with the authority of legislation, but we need a new agency that is different from the regulator that is, in essence, a drug safety auditor/investigator. For fluency purposes, we're calling it a drug safety board.

The committee has spent a great deal of time and energy looking at the issue of the speed of the approval process. I would briefly and simply like to say that speed is not the issue. Whether a drug is approved quickly or slowly is not the issue. In Canada, we have systems to provide experimental drugs to patients prior to approval, so no one is dying for lack of access to unapproved drugs.

The key here is reliability, and that is where I would hope the committee would put its emphasis. How do we create, at Health Canada, a system that is reliable that Canadians have confidence in? That is really the key issue for both the industry and the government.

The public have now lost confidence in the drug approval process, not just in Canada but elsewhere. Unless we have authorities, such as this committee, advocating for an investigation and cleanup, then there is going to be more trouble, more poor safety decisions, a greater loss of public trust, and more grief.

I'm asking you today to take your responsibility seriously to advocate for an investigation that would help us to improve this system that we all rely on.

Thank you.

À (1055)

The Chair: Thank you, Ms. Brill-Edwards.

We'll move now to the question and answer portion. We'll begin with Mr. Merrifield.

Our time is a little bit restricted, so are you going to split with Mr. Hill?

Mr. Rob Merrifield: I'll split with Grant on the first one, for the sake of time, because he may not get back.

I want to pick up right where you left off, Michele. Thank you very much for coming in.

Your testimony was actually very compelling, and hopefully every member of the committee listened very closely. I'm sure they did, although we don't have enough of them here.

In reality, we need to know very succinctly from you what I'd like to ask you now. If you were sitting on this committee, what would your recommendations be to the Minister of Health, right now, coming form this committee? Give us, in very layman's terms, where you'd go.

Dr. Michele Brill-Edwards: I've been asked that question by people inside the department. I think the most important signal the Minister of Health must send to the department and to the public is that she acknowledges that her duty is the protection of Canadians with regard to their health and safety.

It's unfortunate that the atmosphere, the climate, in the department at the moment remains one of regarding the pharmaceutical industry as the minister's, the Prime Minister's, and the cabinet's primary concern. If I had one signal that I would ask the minister to send, it would be that.

Mr. Rob Merrifield: We've been saying that for some time. In the 21st century the patient must be paramount, and there has to be a paradigm shift. So I would concur with that.

Getting back to your drug safety agency that we've been talking about, we have the disappointment coming out of the Vanessa Young tragedy. Then we hear testimony, as we've heard over the last three weeks, saying that we have 10,000 deaths per year in this country within our hospitals because of misuse of pharmaceuticals within our facilities. The magnitude of the problem we have here is far beyond anything we had imagined before. I wonder if you'd comment on that.

Dr. Michele Brill-Edwards: Your point is well taken. It is not the misuse of drugs that is causing these deaths. It is actually the use of drugs period. The studies that show the highest death rates involve not overdoses and mistakes with drugs but actual proper use. Drugs are dangerous products, and they need to be very carefully regulated.

You sit here as a committee overwhelmed with technical data, with contrasting and conflicting viewpoints, and it's very hard for you to come to grips with all that's being said. Imagine how much more confident you would be in your decision-making if you had an agency such as we are proposing—basically an auditor for drug safety who could give you factual information about drug use in the country, about the estimated number of deaths, about whether we'll be doing better in the future than we are right now. Imagine the comfort we would have if there were an agency that would immediately delve into what went wrong when we have to suddenly withdraw a drug because of deaths that we didn't anticipate.

What we're asking for is not a new drug approval agency, but a separate auditing agency with investigative powers that is completely independent from the political and industrial forces, that can dive in and investigate in the same way as a team arrives at the site of an air crash. There are people who can do this work. There is expertise out there, but it is not available to you. It needs to be available on an ongoing basis. That's my thinking.

For example, with regard to the issue of the young child who died, imagine the comfort we would all have if that death had been prevented because such an agency, as soon as the drug was withdrawn in the U.S., would have been able to dive in and say the same thing needs to happen here. We wouldn't have had the spectacle of a junior bureaucrat at Health Canada trying desperately to take the drug off the market while senior bureaucrats acted in favour of the company trying to keep the drug on the market, with no warnings going out, and then Vanessa dying as a result.

Do you see what I'm saying? To me, when we have these cases in front of us, it's very compelling that we need to look at a new kind of system that will do that kind of audit.

Á (1100)

Mr. Grant Hill (Macleod, Canadian Alliance): I'd like to address my questions to both Michael and Dr. Brill-Edwards.

You've made some pretty stern accusations directed toward the pharmaceutical industry and to Health Canada. What jurisdiction could we look to that does better than Canada in relationship to the pharmaceutical approval process and your critiques? Where could we look to try to see a model for improvement?

Mr. Michael McBane: Just to take a couple of seconds, on a number of issues the European Union is doing a better job because they're learning from mistakes. They are now applying the precautionary principle much more rigorously in regulating. There's a growing evolution in responding to these problems. So I would say the European Community is much more advanced in developing a culture of safety than we have here.

Dr. Michele Brill-Edwards: There's no one system that is the model that everyone should follow. But if we look at other systems, we can see there are elements in those systems that serve their populations well. For example, in the U.S., when a drug decision is taken, the rationale for that decision is spelled out. There are public committee meetings—public meetings—where the pros and cons are debated. That level of openness is very advantageous, because when problems arise down the road, you then have that background information in the public domain, so that a real debate can take place about whether the decision was wise or unwise.

For decades now the U.K. has been regarded well within the drug regulatory community because they have the capacity to make decisions quickly, not just to get drugs on the market, but to get them off again. So while they often put a drug to market and then find later that it has to be removed, we respect them because they do the kind of monitoring that allows rapid removal and they don't have these protracted periods of uncertainty and debate before careful and quick action is taken to protect patients.

So I would say rather than looking at a single agency and saying that's the model, we should look to the attributes in these other agencies that we need here.

I would also say that the U.S. is much better staffed, for example, than we are. We can't run on the kind of shoestring that we've been running on in Canada for so many years.

Mr. Grant Hill: Could you just briefly let the committee know what happened to you when you spoke out in your position as a regulator?

Dr. Michele Brill-Edwards: I was the senior physician responsible for drug approvals. When I saw what we euphemistically call irregularities within the system, I spoke out internally and was surprised to find that there was really no effort to clean up internally. The efforts we made were pretty much rebuffed by senior management.

In 1996 I was aware again of another issue. By this time I was not the senior physician, but I saw that the decisions we were taking were heavily influenced by the pharmaceutical industry in the form of expert advisers to the department who had very tight ties to the companies whose drugs were being judged. I resigned and spoke publicly. As a result, basically, I forfeited my career as an expert in drug development. That I'm quite prepared to do. I now live comfortably as a practising physician.

But I think it tells my colleagues in the field that people who speak honestly, who raise problems, even if those problems are borne out, are going to be damaged. Those people are going to pay a huge price. My belief is that we ought to have not just legislation to permit employees of conscience to speak, but legislation to compel employees of conscience to speak up. We don't have that at the moment in Canada, so we can't expect very many people within government to speak up when they see wrongdoing, because they know they will be very surely shut out of any further opportunities in their field.

I'm just very fortunate that as a physician I have other options, but the vast majority of public servants don't have those other options.

Á (1105)

The Chair: Mr. Ménard.

[Translation]

Mr. Réal Ménard: Mrs. Brill-Edwards, I would like you to give us some more information. You say that the drug approval process is characterized by corruption and error. I think several members around this table are convinced that the system needs to be changed, but you are going somewhat further than other witnesses who appeared before this committee. Are you in a position to state categorically that the pharmaceutical industry has exerted pressure to have drugs approved even though officials in the federal public service or in the departmental hierarchy knew that these drugs were not safe for Canadians? Is this what you are telling us today?

[English]

Dr. Michele Brill-Edwards: I'm not sure I understand the question fully, but as I understand it, you're asking me if I am saying.... If you'll allow me to put my earphone on....

[Translation]

Mr. Réal Ménard: I will repeat. Are you saying that pharmaceutical companies have exerted pressure on reviewers of Health Canada or at the deputy minister level of the department in order to get drugs approved whose safety was not proven, as far as you knew, and which were a threat for the health of Canadians? Is this what you are saying? Can you be a bit more precise and tell us where in the hierarchy this complicity with the pharmaceutical industry you describe resides?

[English]

Dr. Michele Brill-Edwards: The question you put to me today is almost identical to the question put to me years ago at another similar committee meeting. The answer is yes, that is exactly what I'm telling you, and if you would like me to proceed, I can give you examples of how that occurs.

[Translation]

Mr. Réal Ménard: And names.

[English]

Dr. Michele Brill-Edwards: And the names.

Mr. Réal Ménard: All right.

Dr. Michele Brill-Edwards: What we're talking about here is influence from senior managers in the department who call by phone or who come to speak in person to reviewers who are responsible for evaluating mountains of data about drugs before the approval decision is taken. Those people might have several different dossiers they are working on. They know immediately when they get a call from the hierarchy that, for whatever reason, this particular dossier that the director general has called about is important, and the director general's questions make that clear: Why is this drug not on the market? This drug is on the market in England already. What is the holdup here? That employee then realizes that whatever other work he has on his desk, he had better move ahead quickly with that particular dossier. If the director general is ever challenged, he will say, “I was just inquiring”.

[Translation]

Mr. Réal Ménard: So you are saying that senior officials at Health Canada use influence in order to fast track drugs which will not go through the normal process. To your knowledge, has it ever happened that drugs were approved for sale on the market which were unsafe and about which we knew that if they were approved...

Á (1110)

[English]

Dr. Michele Brill-Edwards: Yes.

[Translation]

Mr. Réal Ménard: Would you be willing to state this under oath and would you be willing to come back before this committee?

M. Svend Robinson: It is not necessary to have her sworn in.

Mr. Réal Ménard: No, but being under oath would give added value to her testimony.

Mr. Svend Robinson: We accept the witnesses' word.

Mr. Réal Ménard: Two points of clarification, Mr. Robinson. First, I do not doubt the truthfulness of the witness. I just want to be able to go as far as possible with the information she will provide. I do not think that in the time we have available today she will be able to tell us all she knows and I am going to move a motion to invite her back before the committee. We know that we must not put her in an awkward situation, but what she is saying is extremely worrisome.

Madam, would you be willing to proceed with the identification of officials?

[English]

Dr. Michele Brill-Edwards: I'm most willing to be put under oath. I would welcome the opportunity to be put under oath. That's part of the reason that in my previous presentation to this committee I recommended an audit inquiry that would augment a parliamentary inquiry, so that you could have this kind of testimony, under oath with documentation, because I believe that once these things are known, the system will change.

[Translation]

Mr. Réal Ménard: Could you give us an example of a drug that was approved and about which you had reason to believe it should not have been given a notice of compliance? I would like to get some specifics.

[English]

Dr. Michele Brill-Edwards: In 1992, a drug for migraine, sumatriptan, known as Imitrex, went to market in a fashion that was unsafe, that was--

[Translation]

Mr. Réal Ménard: What was the name of the medication?

[English]

Dr. Michele Brill-Edwards: Imitrex.

[Translation]

Mr. Réal Ménard: A drug for migraine?

[English]

Dr. Michele Brill-Edwards: Yes.

That drug went to market improperly labelled, leaving doctors with the impression that cardiac side effects were minimal, when we knew because of the data in-house that there would be deaths due to that drug.

The appropriate signals were given in writing to the director of the day, who overruled the decision of medically qualified people and put the drug to market without the proper information and without the proper dosing.

[Translation]

Mr. Réal Ménard: Who was the director?

[English]

Dr. Michele Brill-Edwards: The director of the day was Claire Franklin.

[Translation]

Mr. Réal Ménard: Claire?

[English]

Dr. Michele Brill-Edwards: Claire.

As a result of that episode, I joined as an expert witness a case before the Federal Court to have the director removed. The director was removed by order of the Federal Court, and six months later the same director was reappointed.

I naturally challenged that reappointment, but the courts viewed that the department has the right to appoint someone if they feel they wish to do so. They basically lowered the standard for the position and the person was reappointed.

That was a very clear signal that we were in trouble, that even when medically sound, legally compelling information was brought forward, the urgency to put the drug to market would dominate the decision-making, and the consideration about Canadians who might die was set aside.

[Translation]

Mr. Réal Ménard: You never worked as a reviewer in Health Canada?

[English]

Dr. Michele Brill-Edwards: Oh, yes, I have.

[Translation]

Mr. Réal Ménard: You are a former reviewer.

[English]

Dr. Michele Brill-Edwards: I have been a reviewer. I have been a senior manager. I have had many of the drug approval processes report to me. I think that is part of the reason why it has been possible for me to see the problems in the system, because I worked throughout the system.

[Translation]

Mr. Réal Ménard: I will have a point of order at the end of the meeting. Thank you.

[English]

The Chair: Thank you, Mr. Ménard.

Is there anybody on this side? Seeing no hands, I'll move to Mr. Robinson.

Mr. Svend Robinson: Thanks very much.

I want to thank all of the witnesses for their evidence this morning and to once again, on the record, as I've thanked Dr. Brill-Edwards before, thank her again for her tremendous integrity and courage in speaking out on behalf of Canadians, who, I think the more they learn about this system and the extent of corporate influence in the Health Canada process, will become more concerned. I hope this committee will be able to get to the bottom of that as well.

We've heard from Michael McBane from the Canadian Health Coalition, for example, about Dr. Olivieri, Dr. Healy. A study was recently published by Arthur Schaeffer of the University of Manitoba, which I thought was a very powerful and eloquent argument for “total sequestration” in his words, a total sequestration, a separation, a complete separation of the Health Canada process from corporate influence. I'm certainly hoping that's one of the recommendations that this committee will be able to make.

I have a couple of questions, because I know our time is very limited, but I did want to follow up with Chief Erasmus and Elaine Johnston on the methadone issue. I actually intend at the end of the meeting to give notice of motion on this, because, frankly, I am appalled at the fact that apparently, without any meaningful consultation whatsoever with either the AFN, the Assembly of First Nations, or with pharmacists, the Canadian Pharmacists Association, or anyone else, the government announced this decision, in some cases only a couple of days before the decision was to be implemented. The impact of this on access by first nations people to methadone in a number of jurisdictions is really very, very serious.

I wanted to get confirmation, I guess, from Chief Erasmus as to whether there was any meaningful consultation at all with the AFN before this change was announced, or through you, to Ms. Johnston.

Á (1115)

Ms. Elaine Johnston: I can say that there was no meaningful consultation. We found out about it only shortly before the Canadian Pharmacists Association. We started getting phone calls from pharmacists across the country as well as physicians. So we quickly had to find out what Health Canada was doing, what were the alternatives to the whole methadone issue. So I have to say that there was no consultation on this.

Mr. Svend Robinson: I actually have copies of the correspondence here, in some cases from people who are using methadone now. One fellow wrote and said in his words that, “Honestly, if it was not for the meth program, I would either be dead or in prison, where I previously spent a number of years. If I had the opportunity to be on the meth program years ago, I might not have gone to jail.” This is a lifesaving program for some people.

To impose this kind of last-minute change without any consultation I just think is outrageous. So I will be giving notice of a motion, Madam Chair, and I hope this committee can unanimously urge the government to suspend this.

Just on the evidence of the witnesses from the CCOHTA, which gets back to the issue of corporate influence, my understanding is that some time ago there was a court challenge by the pharmaceutical industry to some of the important work you have done. We know these people have huge amounts of money; they're one of the most profitable industries in the world.

To what extent are your operations influenced by the knowledge of the fact that these guys could at any time sue you, as they apparently did previously, and really paralyze your work? Do you get corporate pressure on the work you do? This is a separate issue, but to what extent are you able to make recommendations with respect to the efficacy of generic drugs in your work with provincial and territorial health ministries?

Ms. Barb Shea: The issue of the court case with CCOHTA happened before my time, but I can tell you what I understand happened.

There was issue taken with one of the reports CCOHTA had done, and there was some contention about whether or not the evidence was interpreted correctly. Vijay may be able to help us here, if you want to know more particulars.

Although it was very resource-intensive for CCOHTA to deal with the court case, in the end it actually boiled down to the process that CCOHTA had used in looking at the evidence. So if we take that information and that knowledge and what happened within the organization, I can tell you that as we deliver the common drug review, which is our new book of business, we have taken under advisement how to put processes in place to ensure we are dealing only with the evidence. We have ensured that the process we use is very transparent and that the pharmaceutical industry does not influence what is interpreted as evidence, but they will be able to comment on steps along the way.

Mr. Svend Robinson: Will all of those comments be on the record as public comments?

Ms. Barb Shea: The part that will be public.... We cannot put some parts on public display because of what is called proprietary information, so there are some parts that will not be transparent. However, our drug approval process will be much more transparent than any other drug plan across the country.

Á (1120)

Mr. Svend Robinson: Let me just be clear. We're talking about an agency that is basically looking at the efficacy of drugs, as I understand it, and making recommendations to provincial and territorial health ministries. We've got a drug industry that is now being allowed to intervene directly and make representations to you.

Why shouldn't the public know what they're telling you? This isn't proprietary; this isn't a business of protecting their patent rights. What this is about is them saying to you, “No, we think this drug is effective in this particular area, and we think you should be emphasizing this particular thing more”. I think the public has a right to know that. I think proprietary excuses, frankly, are unacceptable in this area.

Why are you prepared to buy that?

Ms. Barb Shea: I hear your point, and if I can actually push that back a little bit, ideally I think it would be great if the things that go on in Health Canada were transparent.

For example, we know with the FDA in the United States, all the information is publicly available. So in an ideal world, the same would happen within—

Mr. Svend Robinson: And those representations are public as well.

Ms. Barb Shea: That's true.

So we come to the Canadian context, and the things we will be able to make available are those items that are published, and those sorts of things. As you might know, the industry has some concerns about what they call proprietary, but I can tell you that the process the common drug review will use is much more open than you'll find in any—

Mr. Svend Robinson: How can they do it in the States and not in Canada? Presumably, the industry has the same concerns there.

Ms. Barb Shea: I think some of those are actually questions for the federal government, as far as transparency and the availability of information are concerned.

What you will find with the common drug review is that the recommendations the committee makes will be public, which you will not—

Mr. Svend Robinson: Again, I don't want to blame.... We're not talking about the recommendations.

I can't speak for all on the committee, but I think we want to know just what the industry is telling you about this stuff and how they are intervening. And this should be transparent. It's transparent in the United States, as I understand it, and it should be transparent here as well.

You're operating under the existing rules, and I'm not asking you to defend them, because I suspect you probably can't.

I just want to ask one last question, if I may

The Chair: No, you're actually over your time.

Madame Scherrer.

[Translation]

Ms. Hélène Scherrer: Thank you, Madam Chair.

I would like to return to the testimony of Mrs. Edwards which is very worrisome, especially since she gave specific names and talks about specific situations. When someone is able to provide names, situations, times and names of drugs, this adds a lot of credibility to the testimony.

I would like you to tell us if the practices you have described today are common currency within the industry as well as Health Canada or if they are isolated occurrences. For example, when we talk about the pharmaceutical industry, this involves a great many people and when we say Health Canada, this is a large department. When we point the finger at one or the other, everybody gets painted with the same brush and we take away credibility from a whole institution such as Health Canada. It is important to know if we need to target a specific branch or practice within the pharmaceutical industry. Do the practices you have described apply to certain companies that were perhaps more lackadaisical while others were very rigourous, or do you feel the whole process needs to be changed?

[English]

Dr. Michele Brill-Edwards: Thank you for the question. It's a very discerning question.

It took me approximately a decade within the system to realize that what I had thought earlier were mistakes or bureaucratic errors and the usual confusion going on in any institution were in fact following a pattern. So my answer is that not all the submissions are subject to influence, but those that are subject to influence follow a very predictable course.

It's important to understand that when a regulatory agency operates, it has an obligation to be careful about the timing of submission work, so that one company's submission is not allowed to jump the queue over another company's submission. One of the common things you will see in this flow of work, which follows the pattern of a queue, is that a particular drug will suddenly be handled out of the queue and be pushed ahead. And when a reviewer needs extra time to do more work, it will be allotted. You then understand that submission is favoured, though you may never understand why.

But the pattern that I began to see was that while many of the submissions were not under influence, certain of them were, and the way in which that influence was exerted was variable. I've mentioned queue jumping. Another way is to alter the decision by switching the reviewers. If a submission is favoured and a reviewer is arriving at a certain determination, he or she will discuss that with his or her superior. The superior will get the sense that the reviewer is finding a lot of problems with the product. If it's a favoured product that's not good news, so suddenly the reviewer will be reassigned to something else and the submission will be put on another desk of someone who is more likely to take a favourable view.

So there are many different ways to influence a submission and to ensure advantage to a company with respect to their product.

Á (1125)

[Translation]

Ms. Hélène Scherrer: Within this whole system you may be the only one to have had the courage to put your job on the line and to quit but I hope there are many other people like you who are not happy with the process, who see it playing out, who see it at work and who are unhappy with the situation. Do you have a collective grievance process? Do you have any way to blow the whistle about a practice? Did someone listen when people complained about happenings that were somewhat out of line? Did other people complain? Was there a process to do so or did you always fall on deaf ears?

[English]

Dr. Michele Brill-Edwards: The first portion of your question is, are there other people who also believe there are serious problems? The answer is yes, very clearly.

I am very fortunate. I am extremely well trained in my field. I am probably one of the best trained physicians in Canada with respect to the development of new drugs, and for sure I am the best trained with respect to the application of the Food and Drugs Act. I was also, in my earlier life, a general practitioner and in my later life a specialist in pediatrics. I can go back to any of those things. I'm not married. I don't have a husband who has to have a job as well. I have one child. I don't have five to put through university.

I had many opportunities to be independent and to say that it's more important to me as a physician not to participate in decisions that will lead to certain death for citizens in this country than to worry about these external factors. Most of my colleagues are not in that kind of situation. They say it's not going to change. You can speak up as much as you like; the system is going to stay the same way.

When I resigned, I did multiple things to bring attention to the problem. The first was to participate in a CBC documentary about what was going on at Health Canada. The evening the documentary aired, my neighbour, who was the vice-dean of research at the University of Ottawa, spoke to me about it. He said, “Everything you're saying is true--everything. There's nothing you're saying that's not true, Michele. But nothing is going to change any time soon, because too many people are getting too much money.” So there you have a very eminent colleague saying yes. In essence, he didn't say that I shouldn't speak up, but he was saying that to speak up is not a guarantee that anything will change.

I can't tell you the number of colleagues who I have advised when they come to me saying they have an issue. They know it's important and should be brought to the public domain. They're scared. They say to me “It's easy for you, you can survive”. But they don't know that I didn't work for nearly three or four years after I resigned. Certainly, I was shut out. You become blackballed; you become blacklisted. You're not a loyal player.

What we have here is a system of what I call decadent loyalty. If you can be relied upon to lie for your boss and your boss's boss, and the minister, the prime minister, and the cabinet, and keep your mouth shut, then you will participate in the system of graces and favours. You'll be on committees. You'll travel. You'll be respected. You'll have peers who think you're a great guy. The minute you speak up, all that stops and you are labelled; you are marked. No one meets your gaze walking down the corridor. You know your career is over. In French, there's an expression...you're put on the shelf. In other words, your job duties are diminished to the point where you just basically read the newspaper.

These are the kinds of things that happen. Until we create a system where people who are honest, and who want to be honest, and who want to work in the public interest within government, are safe to do so--they're not being damaged if they try to do so--until we do that, we are going to have unsafe systems.

We have a good example right now. The minister has just said that we're creating a new CDC North. I'm sure you have all heard that. We already had a CDC. It was called LCDC, and it was dismantled in the 1990s. As a result, we were totally unprepared to handle SARS at the federal level. But rather than admit that these were conscious decisions of government, the minister announced that we need something like CDC. Nobody in government, even those who know the truth, spoke up.

We just talked about it a moment ago at the break. Dr. Shannon was here earlier, the former LCDC official. We asked ourselves exactly the same question that you're asking: What is it about human nature that compels honest people to keep quiet on seriously wrong situations and not to speak up? If we don't deal with that, then all of this is hot air.

Á (1130)

The Chair: Madam Fry

Ms. Hedy Fry: I want to thank you for being so frank and honest. I hear your frustration, the sense that you have spoken out and nothing will change. I think that is quite a damning and telling indictment of a system that is very sorely in need of systemic change.

I think you asked the question of what stops honest people from speaking out. Fear, intimidation, and the need to survive I think are still there.

There is something you said that really struck me. Interestingly enough, as a physician, I got the green light on Imitrex. We didn't know anything about cardiac symptoms at all. It was a great drug for persons with migraines. You could just get the shot and you moved away from all of the old therapies, like ergot, etc., that had so many side effects.

Anyway, that's neither here nor there. You said a person can be moved, one reviewer can be moved, if they are not giving a favourable review of a particular product, to another reviewer who would give a more faithful review. Am I being very naive to think that the review of a product is an objective exercise?

If there are certain problems, they would be found by any reviewer while following certain processes and certain procedures to find out the objective answer. How can one reviewer be more lenient than another? It doesn't make any sense in what is supposed to be an objective process.

Dr. Michele Brill-Edwards: I would like to respond to the first portion of your comment.

I want to be clear that I don't consider myself pessimistic about future changes. Many other people do, but I consider myself the ultimate optimist to even try.

With respect to changing reviewers, the review process is not an accounting process. It isn't adding up a column of figures and getting a certain answer. It's a forensic process, a matter of delving into data that have been presented in a certain way and trying to ask yourself if this is skewed, if this is slanted, or if there is another way to interpret the data.

The result very much depends on the intent of the reviewer. If the reviewer intends to be objective and truly looks at the data in different ways, he may say “If we aggregate the systems in this way, look, Imitrex is actually causing angina”, whereas the company disaggregated all the findings, so that you had left arm pain dissociated from chest pain dissociated from jaw pain.

Do you see what I'm saying?

Á (1135)

Ms. Hedy Fry: Yes.

Dr. Michele Brill-Edwards: If you have a good reviewer with the intent to do a fair and unbiased job and to look at all the possible interpretations, you'll get a good review. If you have reviewers who are perhaps not as well trained or not as well intentioned, who will do not as fulsome a job, they may give you, and often will, the easy answer, which is yes, the company's interpretation of the data looks fine, and it's signed off.

The Chair: It's very scary.

Dr. Michele Brill-Edwards: Actually, if you find this difficult, there's a book called The FDA Follies that documents a very similar case in the U.S., roughly in 1989, involving the assignment of generic drug reviews to particular types of reviewers in order to get a particular response. The chief of that division ended up in jail as a result, as did many company members.

This is not unknown in the drug approval field. It's just that because it's all behind closed doors, it rarely sees the light of day.

The Chair: Thank you, Ms. Fry.

Mr. Ménard has a suggestion and I have one comment.

[Translation]

Mr. Réal Ménard: I have a point of order. Since this deals with rules of procedure and we do not deal with these as with a motion, could you ask the committee if it consents to inviting Ms. Edwards to appear another time before us in order to get to the bottom of the issue and to completely understand the meaning of her testimony and how we could translate this into specific recommendations? Therefore, I would like her to appear another time before the committee in order to get to the bottom of the issue if my colleagues agree.

[English]

The Chair: I had a similar idea, and I feel we have not followed Mr. McBane's sufficiently either. He did not have time to read his whole paper.

My feeling is that based upon the knowledge Michael has gained through the research he's been doing for I'm not sure how many years, seven or eight, and Michele's experience, I would like to see them do a presentation for us, from the beginning of the process through. In other words, pretend to be a pharmaceutical company with a new product and explain to us what that pharmaceutical company has to do and where things can go wrong, at all stages. And we'd do this without putting a big time limit on them.

I'm sure their knowledge is vast and covers every step of the way, and it would really get us informed from that point of view. There are many questions about how that $40 million annually impresses the system. There are both subtle ways that play to the weaknesses of human nature, as Michele has pointed out, and less subtle ways that have probably been used. I think Michael could probably give us lots of examples of that.

If we could invite you back, that would be the format we'd follow. We'd have a much clearer picture.

The thing I'd like to comment on is that considering what we've heard from the Assembly of First Nations, from the Canadian Health Coalition, and from Dr. Brill-Edwards, I'm amazed at the calm way, as if everything is hunky-dory, that the Canadian Coordinating Office for Health Technology Assessment presented its situation.

This is the impression you gave me. I don't know whether I've taken it accurately, but, Ms. Shea, everything you said suggested the world is ticking as it should and everything is progressing beautifully. We're now into this common drug review and it's all wonderful. I'm wondering if you or Dr. Shukla want to affirm that impression or whether in fact you know there are lots of things that are wrong but you don't feel free to say them.

Á (1140)

Ms. Barb Shea: May I just start with the process itself and let you know that there was no intent to tell you that things were great. What we were trying to tell you is that we've been charged to do a job on behalf of drug plans, and I was trying to explain what we do within that job. In regard to all the concerns you've heard, I've read some of the presentations and the comments you've had. We are aware of those things.

What we're trying to do is ensure the job we do under the common drug review and on the health technology assessment side is based on as much evidence as can be found and that the work is done objectively, because CCOHTA is at arm's length. There was no intent to tell you that all the planets are aligned in Canada compared to other countries. That was not the intent.

Could Dr. Shukla perhaps talk to you a little bit about evidence?

The Chair: I don't want to hear about the processes you use. I don't want to talk about what a wonderful thing you're doing and how your organization works. I want to know if, considering the knowledge you have of the pharmaceutical industry and its relationship with government in this country, you are satisfied or whether you think we should be doing something about it.

Dr. Shukla.

Dr. Vijay Shukla (Pharmacist - Common Drug Review, Canadian Coordinating Office for Health Technology Assessment): First I want to make one thing very clear. We don't create evidence. We assess whatever evidence is available in the literature from different sources--where the whole thing stands. Our job is not to create the evidence. We simply say “Here is the evidence. We are drawing these conclusions based on the evidence available.” If you have good evidence, you can draw good conclusions. If you have bad evidence, you draw bad conclusions. It's like garbage in, garbage out. That's the way it works.

The Chair: Are you satisfied with the evidence you're being presented with at the present time?

Dr. Vijay Shukla: The problem here is when the drug gets approval, it's approved based on placebo control trials, whereas as far as our organization is concerned, we want to review the drug based on available alternatives in the market. When the information comes to us, it's mostly placebo control trials. We tell them that we don't have information comparing it to available alternatives, but compared to placebos, these are the good points and these are the bad points.

The Chair: Would it be better to have the placebo, the trials, and the alternative products available on the market?

Dr. Vijay Shukla: That's the best thing to do. Unfortunately, people don't do that.

The Chair: But Health Canada could ask you to do that, couldn't they?

Dr. Vijay Shukla: No, we can't.

The Chair: Oh, I see. They could ask the pharmaceutical companies as they submit their information to also test their product against something that's already there. But of course they won't want to give the--

Mr. Svend Robinson: Could I just ask a really brief supplementary to that line of questioning?

I had asked about generics. Are you able to assess the impact of these new drugs against existing generics, for example?

Ms. Barb Shea: Is that more like a class review? Is that the sort of thing you're talking about? When a new drug comes in for blood pressure, can we look at other drugs? Yes, the committee has the ability to do that--when a new drug comes in, to try to compare it to other therapies used for the same condition.

Mr. Svend Robinson: Including generics. And you pass that information on to the provinces and territories?

Ms. Barb Shea: Yes.

The Chair: Are you doing only new drugs?

Ms. Barb Shea: At this point we are doing only new drugs.

The Chair: So there won't be a generic if it's a new drug.

Ms. Barb Shea: There will be drugs used for the same condition that may be generic drugs.

The Chair: Oh, I see.

Are people satisfied with closing this down now?

Mr. Svend Robinson: I just have a notice of motion, if I might--I've written it out--very briefly give notice to the following motion, which I guess would be considered next week, hopefully. It reads:

That the Standing Committee on Health urge the government to immediately suspend the new fee structure announced on October 1, 2003 for pharmacists' services under Non-Insured Health Benefits Program for patients receiving methadone, to permit full consultation with the Assembly of First Nations, the Canadian Pharmacists' Association and other affected groups.

I hope that could come back at the earliest possible time for approval by the committee.

The Chair: Yes, as long as people come to the meetings next week, which will be held in Halifax, Quebec City, and Toronto.

Mr. Rob Merrifield: I have a point of order. In light of the motion that was made earlier in the meeting--

Á (1145)

The Chair: Which failed to carry.

Mr. Rob Merrifield: --my understanding is we can go only if one opposition member is there. My plea to the committee, and my point, is that if Bill C-13 is on the agenda--I've checked with our whip and Mr. Boudria and it is on and will be debated Monday or Tuesday, or both--it makes it very difficult for the committee to travel.

The Chair: No, it makes it difficult for you to travel, Mr. Merrifield. The rest of us are willing to travel.

Mr. Rob Merrifield: My point of order is, will there be an opposition person there so we can travel?

The Chair: I believe so. According to the list I passed around, we will have one opposition person at least in each city we're meeting in.

Now, the problem is this. Our whip will not let us go except in equal numbers. So if Mr. Thompson will go to Halifax--which I think he probably will because it's not far from where he lives--and Quebec City, we'll have three opposition members in both those places; therefore, we can have three Liberals. But we can't have four, which was our intent.

The problem is Toronto, where I have only one opposition member on each day. That would mean two people would be listening to the witnesses in Toronto, which does not look favourable for the government, I don't think, or for any of us.

[Translation]

Mr. Réal Ménard: Madam Chair, there is confusion and we need to settle this. We want to travel, but there is a...

[English]

Mr. Svend Robinson: Sorry, could our witnesses be excused? They don't have to be here for this discussion.

The Chair: Thank you very much. We're into a family feud.

Dr. Michele Brill-Edwards: I have one comment for the committee.

At a previous committee meeting in March 1998 we set out a description of the kind of process that would be available to the committee to conduct an investigation of the drug approval process. I think it still stands today as a good starting point for an investigation, and I would be happy to provide the clerk with a copy of that presentation.

The Chair: Thank you very much.

Mr. Erasmus.

Chief Bill Erasmus: Thank you, Madam Chair. I just wanted to very quickly say, in regard to your invitation to have the other presenters come forward to speak, that as first nations we also would like to be part of that.

The Chair: What we're looking for is a very technical insider view of how the drug approval process works within the Government of Canada, and those are the specifics of what we want to know.

Chief Bill Erasmus: I think it's important, because we're looking at a certain segment of the population.

The Chair: We're not looking at the population; we're looking at the technical process.

Chief Bill Erasmus: I understand that, but within that technical process I think it's important to understand Canadian society. Society is not all the same. Many of our people are illiterate. Many of our people assume that the drug on the shelf, or whatever is on the shelf, is good. I think you need that kind of a discussion also.

The Chair: We plan on having that kind of a discussion, just not at that particular meeting.

Mr. Svend Robinson: We can have the AFN back.

The Chair: We can have the AFN back, but not at that meeting.

Mr. Michael McBane: Madam Chair, I would just add to Chief Erasmus' point. There is in fact a separate stand-alone review process affecting first nations drug programs. I mean it would be a fit in the same question.

The Chair: Thank you very much. Thank you for your testimony and your time and your effort to prepare to come.

[Translation]

Mr. Réal Ménard: Madam Chair, one thing needs to be stated clearly. I believe everybody wants to get on with the work of the committee, but the government needs to be consistent. My whip will not let me go if on Monday morning Bill C-13 is on. Therefore, the government needs to decide what it wants. They cannot speak out of both sides of their mouth.

We are the Standing Committee on Health and the government should at least desist from introducing a bill dealing with health while we are travelling. I will put my name on the list but if I find out that Bill C-13 is coming up on Monday, I will not travel and nobody from the opposition will go. Let us not kid ourselves. We are not trying to filibuster nor do we refuse to travel, but the government needs to be clear about its intentions. Are we going to have Bill C-13 on the agenda on Monday, yes or no? If by the end of today we do not have information about Bill C-13, no one from the opposition will travel, because we will not be able to return on time. We will not be made into fools.

[English]

The Chair: Our best guess is that it's coming on Monday, and that's what the official opposition thinks also. That's our best guess.

I want to refute something that Mr. Merrifield said earlier. The Minister of Health cannot guarantee that a bill will not come, but the House leader can—the person. The Minister of Health, in making her request to the House leader, asked him to avoid the week we went west, when we were busy, Monday through Thursday, not to bring the bill and to bring it in the following week, and that was what she asked.

He gave half of her request by bringing the bill in on the Friday when we had finished our hearings, which wasn't very convenient. I had said to them, don't bring it in Friday, bring it in Monday when we'll all be back. But I was ignored, as was the minister. So it came in Friday, and we hope to have a vote on Tuesday. But for some reason that didn't happen, so now it's coming back in for discussion, we think, on Monday in hope of having a vote Tuesday.

But all these things I don't have control over, and neither does the Minister of Health. The House leader does.

Á (1150)

Mr. Rob Merrifield: That's right, but he's a member of your party. You can negotiate with them.

The Chair: Do you control your House leader? We don't control ours.

Mr. Rob Merrifield: We certainly give input to him, yes.

The Chair: We give input as well.

Mr. Svend Robinson: The bottom line is, we've just heard from Mr. Ménard that if Bill C-13 is on the agenda on Monday, he won't be travelling.

I spoke with Greg Thompson during the vote—Greg sits a couple of seats away from me—just to get some clarification as to his position. His strong preference is that the committee not travel next week, particularly, he said, if C-13 is going to be debated on Monday. So his strong preference, even though he wasn't here for the vote, was that the committee not travel next week.

We're in a situation, frankly, Madam Chair, in which it appears that there will certainly not be significant opposition representation. If there were one member of the opposition, then according to the whip of the Liberal Party, there would only be one government member. That's insulting to the witnesses.

The Chair: Exactly.

Mr. Svend Robinson: So whatever my willingness to travel, and I signed a paper saying I'm prepared to travel, I'm not going to be there sitting and listening to witnesses with one Liberal MP. It's just not going to happen. I think we had better just find out....

The Chair: I had assumed that at the third reading stage all the members of the committee on the opposition side had already spoken, which means they can't speak again.

Have you spoken?

Mr. Rob Merrifield: Yes, I'm the only one who has spoken, but in reality that's not the issue because....

The Chair: No, so you can speak. You can be there on Monday.

Have you spoken?

Mr. Réal Ménard: The government has to respect the work of this committee, and you don't have to table a bill, for which we are responsible, when we're travelling

The Chair: In an ideal world that's absolutely correct, but I can't control it and neither can the Minister of Health.

Mr. Réal Ménard: No, I understand that.

The Chair: You making these statements isn't going to change anything.

Mr. Svend Robinson: But let's be clear, Madam Chair. Whatever happens, the reality is that there's not going to be enough opposition to make it a meaningful hearing for the witnesses who are there. If Bill C-13 is going ahead on Monday, we'd better postpone the hearings.

The Chair: Hélène.

[Translation]

Ms. Hélène Scherrer: Madam Chair, I get back to what I said earlier. It is important for us to make a decision...

[English]

The Chair: Excuse me, I just realized we're talking private business and there are still people sitting in the room. I'm going to ask you to leave this.

Ms. Hélène Scherrer: Okay.

The Chair: We will move in camera

[Proceedings continue in camera]