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Anne-Marie Nicol
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Anne-Marie Nicol
2015-06-18 17:06
You should also have a slide deck from me. It says “Radon and Lung Cancer” on it. I recognize I am the very last person, and I appreciate your persistence. Luckily many people have also spoken to a number of the points that I wish to discuss, so I will go very quickly over the first few slides.
I am an assistant professor at Simon Fraser University in British Columbia. I also work at the National Collaborating Centre with Tom and Sarah, and I also run CAREX Canada, which is the carcinogen surveillance system funded by the Canadian Partnership Against Cancer. I am here because we prioritized Canadians' exposure to environmental carcinogens and the leading causes of cancer-related deaths from environmental exposures, and radon gas was by far the most significant carcinogen. I admit that when I started my research at CAREX, I had never heard of radon gas either. When I went back into the literature, I realized that over time Canada has actually played a very important role in understanding radon and lung cancer.
The data from many of the studies that were done on uranium miners, at Eldorado and even here in Ontario, has been used to determine the relationship between exposure and lung cancer. We've actually been on the forefront of this issue but very much in an academic context rather than in a public health context.
We've already discussed the fact that the WHO notes that this is a significant carcinogen. I would also like to point out that agencies around the world are coming to the conclusion that radon is more dangerous than they had previously thought. In 1993 we had a certain understanding about the relationship between radon gas and lung cancer. That's doubled. The slope that Tom was talking about used to go like this and now it goes like this. Radon is now known to be much more dangerous than we had originally thought. The reason for that is that radon is actually an alpha-particle emitter.
We are a uranium-rich country. Uranium is in the soil and as it breaks down there is a point at which it becomes a gas. That means it becomes movable within the soil. That gas itself gives off alpha radiation, which is a very dangerous form of radiation that can damage DNA. On the next slide you'll see both direct and indirect damage to DNA. This information is compliments of Dr. Aaron Goodarzi. We actually have a Canada research chair studying this at the moment in Alberta.
The next slide, on radiation and DNA damage, shows that alpha radiation is powerful. It doesn't penetrate very far, so if it hits our skin, it doesn't do as much damage as it does if it gets into our lungs. Our lungs are very sensitive. The lining of our lungs is sensitive and when the cells in them are irradiated, they get damaged. Alpha particles are very destructive. The damage is akin to having a cannon go through DNA. That kind of damage is hard to repair, and as a result the probability of genetic mutations and cancer goes up.
The next slide is on strategies for reducing risk. Just to recap, the kind of damage done by the radiation emitted from radon is significant. The damage is difficult for the body to repair once radon is in the lungs.
The next slide is on education and priority setting. Radon does exist across the country. People have developed radon-potential maps. This one is compliments of Radon Environmental where they've looked at where uranium exists and where the potential for higher-breakdown products is, although we do recognize that every home is different. Also there's a map of the United States to show that we are not alone in this and that the states that are on the border have a similar kind of radon profile to that found in Canada. We know that under our current Canadian strategies, we need to educate not just the public but ourselves. Most public health professionals have never heard of radon. When we do work out in public health units, environmental health inspectors, public health inspectors, and medical health officers are still unaware that radon is dangerous. Many bureaucrats and ministries of health are unaware that radon is dangerous.
Also health researchers are only really beginning to do work in this area across the country. In order to have building codes changed, people need to know why you're changing them. We need testing and remediation training. People need to understand why they're actually doing this kind of work.
Kelley Bush alluded to the fact that they've been tracking awareness among the population. This is done by Statistics Canada. The next slide shows a representative Canadian sample. It's been done since 2007 actually, but these are results for 2009 onward. You can see that about 10% of the population were aware of radon. That's gone up to about 30%. This is the number of people who know what radon is and can accurately describe it. We're still at around 30% of the population who know that radon can cause lung cancer.
Health Canada does recommend that everybody test their homes. The next slide, which is also using data collected by Statistics Canada, clearly shows that very few people have tested their homes. Less than 10% of Canadians across the country have tested their homes. We have had a radon awareness program since 2007, so why aren't people testing? We don't have regulatory requirements, as Kathleen Cooper stated earlier. People need to be aware and motivated to change. It's up to the consumer. We have left it up to the consumer to test their own home.
I believe things like denial, the invisible nature of the gas, and people simply being unaware contribute to this. Test kits are still not that readily available across the country. You can phone and ask where you can find them, but they're not always there. In rural regions it's much harder for people to get access to test kits. People then fear the downstream costs of remediating—i.e., I don't want to go in there because I don't know how much it's going to cost me to fix my basement. In some cases the costs can be somewhat considerable, depending on the structure of the home.
Turning to the next slide, I believe to reduce the lung cancer risk from radon gas we need more leadership. The government can legitimate this as a risk. It's something that people don't know about, and we need to take a stronger role in getting people more engaged in this topic. It's not just Health Canada; it's all levels of government—ministries of health, provinces, municipalities. We need to be training people in the trades so they know what they're doing when they're building those radon-resistant homes, and why. Why is that pipe important? Why is that fan important? Again, we need to build radon out, going forward.
Other countries have shown that providing financial assistance works. People will energy-retrofit their home because they get a rebate, but the energy retrofit does increase radon levels. There is clear evidence that this exists. The tighter your home, the more the radon gas remains in your home. In Manitoba they're doing research to look at that at the moment. In Manitoba, though, you can also now get a rebate through Manitoba Hydro to do radon remediation. Some parts of the country are starting, but we need to be offering some kind of incentive for citizens to do this.
I would also like to put in a plug for workplace exposure, because I do study workplace exposure and radon. There are places in the country where people work underground, or in basements and even ground-level buildings, where radon levels are high. Some of these are federal government workers. We need more testing and remediation for workplaces.
That's it. Thank you.
John Calvert
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John Calvert
2014-02-04 15:18
Good afternoon.
Let me begin by thanking the committee for giving me the opportunity to express my views today on the proposed Trans-Pacific Partnership trade agreement. This initiative has important public policy and public health implications, which I believe do merit extensive examination. Let me also note that I am here as an individual and not as a representative of Simon Fraser University, where I teach.
I'd like to start by making clear that I am not opposed to trade. We all benefit from trade. My focus is on whether the terms of this proposed agreement constitute a reasonable way to ensure that Canadians—and other parties to the TPP—achieve the benefits of trade in a fair, balanced, and equitable manner.
This committee hearing is also challenging because the full draft text of the agreement is not available. While secrecy is normal in trade negotiations, there is a powerful democratic argument that the public does have a right to know what is being negotiated on its behalf, given the major public policy and health implications of the TPP and given that once ratified, it is almost impossible to reverse. The limited information accessible to Canadians contrasts with the privileged access given to 600 of the world’s largest corporations that have been included as U.S. advisers in the negotiating process.
I believe the Canadian government should engage in a much wider process of consultation to enable Canadians to make an informed choice about whether they support the TPP. Canada should publish the full draft text of the agreement and provide adequate time for full legislative scrutiny and public debate before it considers ratification. It should follow the lead of the EU, which suspended negotiations with the U.S. on a new trade agreement until the completion of extensive public consultations on enhanced investor rights proposals.
Trade agreements are very complex, both in terms of the obligations in individual agreements and in terms of their interaction with other agreements. This makes it very difficult to know, in advance, how particular provisions will be interpreted by dispute panels. Complexity and interlinkage also open the door to costly trade challenges, the prospect of which can chill government initiatives. The increasing number of agreements—we have nearly 3,000 bilateral investment agreements globally and numerous other free trade agreements—also facilitates venue shopping by those who wish to challenge government policies. Dispute adjudication is handled by a small number of trade law experts who may have little background in health, increasing the risk that their decisions may ignore important population health considerations.
The proposed TPP, like other trade agreements, places restrictions on the policy tools available to governments. These restrictions are meant to minimize any policy on regulatory barriers to trade or investment flows, regardless of the actual intent of these policies. Public regulations to protect health or the environment or to achieve socially beneficial purposes can be challenged if they violate trade treaties.
However, there is a long history of public-health-based regulations that have contributed significantly to improving population health. In light of the well-documented benefits of public regulatory capacity, it is essential that nothing in the proposed TPP erode or restrict the ability of future governments to protect public health, or require governments to adopt measures that subordinate public health considerations to other policy objectives. Governments must continue to have the policy tools needed to protect and advance population health, including the policy flexibility to address future challenges.
The scope of the TPP is very broad, as you know, with 29 chapters covering matters such as intellectual property, public procurement, state enterprises, market access, investment, and so on. In the time available, I can comment on only a limited number of issues and will focus primarily on health implications. A more thorough analysis of the impacts of the TPP on population health is clearly needed. I hope the committee will do this.
Let me turn to some of the major health and public policy concerns raised by the proposed agreement. As the committee knows, intellectual property rights—IPRs as they're called—cover patents, copyright and trademarks. The U.S. has advocated stronger IPRs than exist in TRIPS and stronger than those Canada currently provides or may provide under CETA.
The proposals would extend the duration of pharmaceutical patents, that is TRIPS-plus; lock in data exclusivity, further restricting the ability of generics to enter the market; and include for the first time medical procedures, something the U.S. did not get in its recent agreement with Korea. They would also provide additional protection for biologics. If implemented, the changes will increase the time-to-market for lower cost generic drugs and increase the range of life-saving measures that may be patented, making it more difficult to provide affordable medicines and implement universal public drug coverage.
Canada’s past experience with patent extensions has not been favourable. In the mid-1980s under compulsory licensing, prescription drug expenditures represented 6.3% of total health spending. In 2012 they were 13.6% or $27.7 billion. Drugs have been the fastest-growing component of health expenditures over the past 25 years.
A recent analysis of patent extensions in the proposed CETA estimated that this would add between $850 million and $1.65 billion annually to our drug bill. High drug costs adversely affect many Canadians. Many patients do not fill prescriptions due to cost, or use less than prescribed amounts to make them stretch to fit their budgets, risking their health.
The multinational drug corporations promised to increase research and development in return for increased patent protection from Bills C-22 and C-91. The research and development target was an extremely modest 10% of revenues. While reached between 1993 and 2002, it has now fallen to 6% of sales despite the huge increase in industry revenues.
Much of this R and D is not basic scientific research, but rather applied, that is, clinical trials, marketing, and sales research. Almost half of the R and D is funded by federal and provincial subsidies and tax credits. Our ratio of R and D to sales is a fraction of that of other OECD countries.
John Calvert
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John Calvert
2014-02-04 15:25
I'll be quick as I can. Thank you.
Canada’s balance of payments in pharmaceuticals has also deteriorated. In 1987 under compulsory licensing, we had a trade deficit of $334 million. In 2012 our trade deficit had ballooned to $7.6 billion. Once our Patent Act changes were locked in by NAFTA and TRIPS, the multinational drug corporations had little reason and no obligation to locate production, employment, and research and development in Canada.
In light of the extensive evidence of this policy failure, it's not clear how further extensions of patent protection for pharmaceuticals will benefit Canada.
I'm going to jump down the page a little in light of your comments.
What Canada should demand is a clear commitment by all TPP parties to the Doha “Declaration on the TRIPS agreement and public health”, including “the right of WTO Members to make full use of the safeguard provisions of the TRIPS Agreement in order to protect public health and enhance access to medicines for poor countries”.
We should also oppose any proposals that would undermine existing protections for health in TRIPS.
The TPP proposes additional protection for trademarks, an area that's already witnessed numerous health-related trade disputes.
According to the World Health Organization, tobacco kills almost six million people annually. Over 168 countries have signed the 2005 WHO Framework Convention on Tobacco Control, but not the U.S. This treaty advocates numerous regulatory measures to restrict tobacco marketing and promotion, but the multinational tobacco industry has opposed these measures, launching numerous trade challenges to strike down public health measures designed to reduce tobacco consumption.
Canada should be particularly concerned about this. In 1994 we drafted new legislation that required manufacturers to sell cigarettes in plain packaging, based on evidence from the public health community that industry advertising linked logos and images on cigarette packages with attractive lifestyles and thus encouraged smoking. Despite the health rationale, Canada abandoned plain packaging, fearing it would lose a NAFTA trade challenge from U.S. tobacco interests. These fears were based in part on the testimony of Carla Hills, who was the U.S. negotiator representing R J. Reynolds.
We don't know how many Canadians might have stopped smoking had this legislation passed.
Other labelling requirements are also at risk. We see that Philip Morris has initiated arbitration to stop Uruguay from placing graphic images of smoking victims on its cigarette packages. There are several others that I cite in my paper.
Canada must also ensure in terms of technical barriers to trade that the provisions in the TPP be no more extensive than those in the current WTO TBT. This means that we need to have the right to an explicit guarantee for the right of governments to require health warning labels on all such products.
Another area is alcohol, which has numerous health and social problems. The WHO estimates that 2.5 million people die each year from its harmful impacts. The liberalization of alcohol markets and the elimination of restrictions on alcohol promotion have serious health consequences. In 2010, the UN’s World Health Assembly adopted the global strategy to reduce the harmful use of alcohol. However, TPP commitments to regulatory harmonization and easier market access may pose significant barriers to achieving this goal.
Food safety is another—
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