Interventions in Committee
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View Rona Ambrose Profile
Thank you very much, Mr. Chair, and thank you to the committee. I want to thank all of you for the work you do on the health committee. I know many of you are passionate about the issues of health, and I thank you for your commitment to that.
I'm joined by Simon Kennedy, Health Canada's new deputy minister; Krista Outhwaite, our newly appointed president of the Public Health Agency of Canada; and Dr. Gregory Taylor, whom you've met before, Canada's chief public health officer. I know he'll be here for the second half. You might want to ask him about his trip to Guinea and Sierra Leone to visit our troops and others who are working on the front dealing with Ebola. I'm sure he'll have some great things to share with you.
Michel Perron is here on behalf of the Canadian Institutes of Health Research. He's also new. Last time I know you met Dr. Alain Beaudet.
We also have Dr. Bruce Archibald, who's the president of the Canadian Food Inspection Agency. I think you've met Bruce as well.
Mr. Chair, I'd like to start by sharing an update on some of the key issues that we've been working on recently. I'll begin by talking about Canada's health care system, the pressures it's facing, and the opportunities for improvement through innovation. I will then highlight some recent activities on priority issues such as family violence and the safety of drugs in food.
According to the Canadian Institute for Health Information, Canada spent around $215 billion on health care just in 2014. Provinces and territories, which are responsible for the delivery of health care to Canadians, are working very hard to ensure their systems continue to meet the needs of Canadians, but with an aging population, chronic disease, and economic uncertainty, the job of financing and delivering quality care is not getting easier.
Our government continues to be a strong partner for the provinces and territories when it comes to record transfer dollars. Since 2006, federal health transfers have increased by almost 70% and are on track to increase from $34 billion this year to more than $40 billion annually by the end of the decade—an all-time high.
This ongoing federal investment in healthcare is providing provinces and territories with the financial predictability and flexibility they need to respond to the priorities and pressures within their jurisdictions.
In addition of course, federal support for health research through the CIHR as well as targeted investments in areas such as mental health, cancer prevention, and patient safety are helping to improve the accessibility and quality of health care for Canadians.
But to build on the record transfers and the targeted investments I just mentioned, we're also taking a number of other measures to improve the health of Canadians and reduce pressure on the health care system. To date we've leveraged over $27 million in private sector investments to advance healthy living partnerships. I'm very pleased with the momentum we've seen across Canada.
Last year we launched the play exchange, in collaboration with Canadian Tire, LIFT Philanthropy Partners, and the CBC, to find the best ideas that would encourage Canadians to live healthier and active lives. We announced the winning idea in January: the Canadian Cancer Society of Quebec and their idea called “trottibus”, which is a walking school bus. This is an innovative program that gives elementary schoolchildren a safe and fun way to get to school while being active. Trottibus is going to receive $1 million in funding from the federal government to launch their great idea across the country.
Other social innovation projects are encouraging all children to get active early in life so that we can make some real headway in terms of preventing chronic diseases, obesity, and other health issues. We're also supporting health care innovation through investments from the Canadian Institutes of Health Research. In fact our government now is the single-largest contributor to health research in Canada, investing roughly $1 billion every year.
Since its launch in 2011, the strategy for patient-oriented research has been working to bring improvements from the latest research straight to the bedsides of patients. I was pleased to see that budget 2015 provided additional funds so that we can build on this success, including an important partnership with the Canadian Foundation for Healthcare Improvement.
Canadians benefit from a health system that provides access to high-quality care and supports good health outcomes, but we can't afford to be complacent in the face of an aging society, changing technology, and new economic and fiscal realities. That is why we have been committed to supporting innovation that improves the quality and affordability of health care.
As you know, the advisory panel on health care innovation that I launched last June has spent the last 10 months exploring the top areas of innovation in Canada and abroad with the goal of identifying how the federal government can support those ideas that hold the greatest promise. The panel has now met with more than 500 individuals including patients, families, business leaders, economists, and researchers. As we speak, the panel is busy analyzing what they've heard, and I look forward to receiving their final report in June.
I'd also like to talk about another issue. It's one that does not receive the attention that it deserves as a pressing public health concern, and that's family violence. Family violence has undeniable impacts on the health of the women, children, and even men, who are victimized. There are also very significant impacts on our health care and justice systems.
Family violence can lead to chronic pain and disease, substance abuse, depression, anxiety, self-harm, and many other serious and lifelong afflictions for its victims. That's why this past winter I was pleased to announce a federal investment of $100 million over 10 years to help address family violence and support the health of victims of violence. This investment will support health professionals and community organizations in improving the physical and mental health of victims of violence, and help stop intergenerational cycles of violence.
In addition to our efforts to address family violence and support innovation to improve the sustainability of the health care system, we have made significant progress on a number of key drug safety issues. Canadians want and deserve to depend on and trust the care they receive. To that end, I'd like to thank the committee for its thoughtful study of our government's signature patient safety legislation, Vanessa's Law. Building on the consultations that we held with Canadians prior to its introduction, this committee's careful review of Vanessa's Law, including the helpful amendments that were brought forward by MP Young, served to strengthen the bill and will improve the transparency that Canadians expect.
Vanessa's Law, as you know, introduces the most significant improvements to drug safety in Canada in more than 50 years. It allows me, as minister, to recall unsafe drugs and to impose tough new penalties, including jail time and fines up to $5 million per day, instead of what is the current $5,000 a day. It also compels drug companies to do further testing and revise labels in plain language to clearly reflect health risk information, including updates for health warnings for children. It will also enhance surveillance by requiring mandatory adverse drug reaction reporting by health care institutions, and requires new transparency for Health Canada's regulatory decisions about drug approvals.
To ensure the new transparency powers are providing the kind of information that Canadian families and researchers are looking for, we've also just launched further consultations asking about the types of information that are most useful to improve drug safety. Beyond the improvements in Vanessa's Law, we're making great progress and increasing transparency through Health Canada's regulatory transparency and openness framework. In addition to posting summaries of drug safety reviews that patients and medical professionals can use to make informed decisions, we are now also publishing more detailed inspection information on companies and facilities that make drugs. This includes inspection dates, licence status, types of risks observed, and measures that are taken by Health Canada. Patients can also check Health Canada's clinical trials database to determine if a trial they are interested in has met regulatory requirements.
Another priority of mine is tackling the issue of drug abuse and addiction in Canada. There's no question that addiction to dangerous drugs has a devastating and widespread impact on Canadian families and communities. In line with recommendations from this committee, I am pleased that the marketing campaign launched last fall by Health Canada is helping parents talk with their teenagers about the dangers of smoking marijuana and prescription drug abuse. The campaign addresses both of those things, because too many of our young people are abusing drugs that are meant to heal them.
Our government also recognizes that those struggling with drug addictions need help to recover a drug-free life. From a federal perspective, of course, we provide assistance for prevention and treatment projects under our national anti-drug strategy. We've now committed over $44 million to expand the strategy to include prescription drug abuse and are continuing to work with the provinces to improve drug treatment.
I've now met and will continue to meet with physicians, pharmacists, first nations, law enforcement, addictions specialists, medical experts, and of course parents to discuss how we can collectively tackle prescription drug abuse.
Finally, our government continues to make very real investments to strengthen our food safety system. As only the latest example, I recently announced a five-year investment of more than $30 million in the CFIA's new food safety information network. Through this modern network, food safety experts will be better connected, and laboratories will be able to share urgently needed surveillance information and food safety data, using a secure web platform. This will put us in an even better position to protect Canadians from food safety risk by improving our ability to actually anticipate, detect, and then effectively deal with food safety issues. This investment will continue to build on the record levels of funding we've already provided, as well as the improved powers such as tougher penalties, enhanced controls on E. coli, new meat labelling requirements, and improved inspection oversight.
In conclusion, those are just some of the priorities that will be supported through the funding our government has allocated to the Health portfolio. This year's main estimates, notably, include investments for first nations health, for our ongoing contribution to the international response to the Ebola outbreak in West Africa, and the key research and food safety investments that I have already mentioned.
I'll leave it at that. If committee members have any questions, my officials and I would be very pleased to answer them. Thank you.
View Murray Rankin Profile
View Murray Rankin Profile
2015-05-07 15:46
I appreciate that.
As you speak of transparency, that takes me to Vanessa's Law, to which you made reference earlier.
Toronto doctor, Nav Persaud, made an information request to Health Canada to get clinical trials on a pregnancy drug, an anti-nausea drug called Diclectin. He tried that three and a half years ago. He finally got 359 pages, 212 of which were completely redacted or censored.
In March, after Vanessa's Law came in, he resubmitted the request for all of the 359 pages, and so far has been given nothing. I got that as recently as two days ago in a letter. The clinical trial data was something that was to be made available, as I understood it, under Vanessa's Law. His experience has been entirely frustrating.
View Rona Ambrose Profile
I sympathize with his experience.
Under Vanessa's Law, the intention is to make clinical trial information available, but still to some extent—and for legal reasons obviously—protect confidential business information. Our intention under Vanessa's Law—and it's my belief—is that we should be sharing as much as we possibly can.
On that specific one, I think that's still under way, but I know Simon is working on that.
Simon Kennedy
View Simon Kennedy Profile
Simon Kennedy
2015-05-07 15:48
Thanks, Minister.
On this particular case, the original submission was made under the access to information rules. The ministry is obliged to apply the access law, which does require a number of exemptions for business information and so on.
With new authorities under Vanessa's Law, there is this other avenue we can use to make information available where there is a health or safety threat. We've spoken to the researcher in question, and we sent him a fairly detailed letter to explain the process to make an application under Vanessa's Law. That conversation is going on and our hope would be to be able to move through that avenue to deal with the issue.
View Libby Davies Profile
Thank you.
I guess we can take it that the government House leader, who controls the House agenda, for whatever reason made a decision to wait on this bill for six months. I'm glad we are dealing with it now, and I'm sure the committee will go through the bill very carefully. We have witnesses to hear and I think they're going to be pretty good witnesses. We'll go through the bill clause by clause.
If I have some more time I would like to ask a couple of general questions.
As you've noted, you are open to amendments, which we very much appreciate. One of them has to do with the issue of overall transparency and the question of drug safety. We have to begin at the beginning and go right through the process.
There's the question of transparency in clinical trials, for example, the need to publish both positive and negative regulatory decisions, the need for Health Canada to publish the rationale for decisions they make concerning whether drugs are approved for sale or refused for safety reasons. I think the whole issue of transparency and people needing to know, whether it's the general public or whether it's researchers or clinicians in the field, is being raised about whether or not the bill could do a better job, and also including the results of clinical trials, including post-market studies and adverse drug reactions reported by drug manufacturers.
There are some elements of that in the bill, but we wonder whether it could go further. I wonder if you could give us a general response as to whether or not that's an area that could be looked at in ensuring greater transparency and greater reporting so we have the full spectrum from beginning to end.
View Rona Ambrose Profile
Sure, I'd be happy to.
I've made transparency in our regulatory decisions a priority at Health Canada. Quite a bit of work has already been undertaken in our transparency framework that we launched a few months ago. I'm proud we're moving in that direction, but as I said, I'm open to amendments. On regulatory transparency, in particular, I think that properly written amendments to Vanessa's law to require public disclosure of safety decisions would provide clarity to Canadians on how and why Health Canada takes certain actions.
I know some drug safety experts have considered the importance of transparency for both negative and positive decisions made by drug regulators. The committee may also want to consider that element, should it have thoughts on how best to improve Health Canada's transparency for decision-making. Again, I think this is a good opportunity to put forward amendments in that respect and around clinical trials, obviously. I've commented on that. I think this bill already takes us in the right direction and puts us ahead of some jurisdictions, but I'd like us to work on a bill that puts us ahead of all jurisdictions when it comes to transparency of drug safety.
Again, I'm open to amendments, both on the clinical trials and on the transparency of regulatory decisions.
Supriya Sharma
View Supriya Sharma Profile
Supriya Sharma
2014-06-05 9:15
Absolutely. In terms of the definition of serious, it is dependent on the situation. As you know, for an individual patient an adverse reaction can be quite serious...for a group of patients, because they are predisposed to that. The bill actually allows us to collect that type of information.
It's really important to understand when a product goes on the market it can be used for a variety of different purposes in a variety of different populations. Right now we do rely on the companies to come in with that information.
In terms of the new provisions, the bill allows us to ask for specific studies, specific analysis, specific information to come in. That helps us look at that analysis and then decide whether or not changes need to be made.
The changes can run the gamut of communicating to help practitioners and patients, making warnings more prominent on the label, adding warnings to the label, or it could go all the way to requiring that product to come off the market.
Now if you have a serious adverse event that affects a small group of people, you don't want to limit that access for everyone. Based on what the adverse reaction is and what we're seeing, we need to have the tools, the flexibility, to make the appropriate risk decisions.
View Rona Ambrose Profile
Thank you, Supriya.
To your question, Dr. Bennett, on the low-risk products, on natural health products, to be frank, I struggled with this one because I thought everyone should be under the legislation, but the reality is and the case was made from the natural health products community that their products are low risk.
My discussion with them was....
View Dany Morin Profile
Do you think it will put a lot of burden on those companies that say that they produce safe therapeutic products?
View Rona Ambrose Profile
First of all, I would say that I am sure those who are in the health care business take safety very seriously as a community. It's not just their own product. They should, I hope, support ongoing efforts to make the regulatory framework and the legal framework for patient safety legislation stronger. I hope that all companies do.
We believe, in terms of red tape, if that is your question, that the proposed changes will have a limited impact on the day-to-day business of industry, as companies are already responsible for meeting similar requirements in other countries.
As I indicated before, what I believe we're doing is closing a gap that needs to be closed. We see this approach in other jurisdictions. Many of these companies operate internationally, and so they are familiar with this kind of regulatory environment.
View Terence Young Profile
View Terence Young Profile
2014-06-05 10:09
Ms. Lamar, could you please describe how Vanessa's law will make drugs safer for children in Canada?
David Lee
View David Lee Profile
David Lee
2014-06-05 10:10
This is where a number of clauses in the bill can really work together very valuably.
You can start with approval. There is a section in the proposals that would allow us to put conditions on authorizations, so to plan out what to look for as a drug goes out. If it's not approved for kids initially, we can put in some measures that we want to see if we think it's going to be used in that population.
If we start to see something, we will also be able to ask for further tests and studies, which could include monitoring who's being prescribed the drugs. It would be a utilization study. Again, if we see anything of concern, we can ask for signals to be confirmed. They can come in and do a reassessment—
David Lee
View David Lee Profile
David Lee
2014-06-05 10:11
Oh, sorry.
If we start to see adverse events occurring and we see that kids are being harmed, then we can pick that up and try to understand it and figure out if it's the drug and if we need to do something, and we can use these powers to very immediately get at that analysis and do a reassessment. Then we can either go to suspension or indicate to the community of practice not to use it in that community, which we call a contraindication, and we can really make sure that message gets out there to change prescribing behaviour.
View David Wilks Profile
Thank you very much, Madam Chair.
Thanks to the minister for being here today. We appreciate it.
During our study on prescription drug abuse, we heard testimony from several witnesses on the need to ensure that Canadian families have the information they need to make informed choices on the medicines they are taking.
With the numerous risks inherent in many drugs, I think everyone around this table can agree that we simply must do better at making people aware. It's imperative that drug safety information be available and accessible for not only overburdened doctors but also parents and families. As a father and grandfather myself, it's critical for me as well to have the information necessary on drug safety, in order to fully understand the risks and benefits of certain medications.
Can you inform this committee on what is being done to ensure that drug safety information is available to those who need it?
View Rona Ambrose Profile
Thank you very much, and thank you for your good work on the committee.
I appreciate that question because it gives us an opportunity to speak about what I think is very good work that Health Canada is undertaking to become a leader, if it is not already a leader, on transparency. Nowhere, I think, is confidence in transparency more important than in our health system and around the decisions that our regulators make for health, whether it's products or medicines that Canadians take. So I was very pleased. We've done quite a bit of work in the last number of months, and very recently we launched what is a world-leading regulatory transparency and openness framework. So for the first time in Canada, practical and world-leading drug safety review summaries are being posted online, transparently, in an accessible format to Canadians. These summary safety reviews will provide the public with plain language descriptions of Health Canada's findings around drugs and their actions, so that Canadians can make informed decisions about their health.
With this new framework, Canada is now a world leader in a transparent posting of practical drug safety review summaries, ahead of both the United States and the European Union, in fact. Previously, as you know, drug review information like this was only accessible to those who made access to information requests, and I didn't believe that was sufficient.
I would also like to add for clarity that although not many regular Canadians are interested in the full-length technical reviews, a lot of researchers, doctors, and others in the health system and potentially journalists might be, and these are also available on request from Health Canada. On this point, we've also been receiving great feedback. In fact, the CEO of the Canadian Pharmacists Association commended the government for our efforts to increase transparency by making drug safety reviews publicly available. In the development of this framework, we consulted with a wide variety of stakeholders, and I have to say, a number of caucus members on all sides of the House worked on this issue. So I really commend the practical work that parliamentarians do around the issue of transparency.
These full technical documents are not only very exhaustive and complex, but they also range from hundreds to tens of thousands of pages in length. That is why I said while we'll make the practical, understandable summaries available, we'll also have those available on demand. It's also important to note that these steps forward in transparency are only the beginning. I have made that commitment. We will be looking at further steps to ensure that crucial drug safety information is made available to Canadians, and I will ensure that Health Canada continues to find ways to be more open and more transparent with Canadians each and every year.
But the bottom line is that our government is making this issue more relevant. We're making the information around drug safety information more useful and timely than ever before, and I know that it's information that Canadians want. We have a lot of Canadians who seek out this information on our Health Canada website. One of the positive things about the initiative, I think, is that we're engaging Canadians through a portal now, actually asking them for feedback on how much more they'd like to see, or what else we can do to be more transparent, and what kind of information we are lacking and what it is they're looking for. I think that's also a very positive step in the right direction.
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