Interventions in Committee
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Suzy McDonald
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Suzy McDonald
2019-06-18 11:47
I did hear the question. Thank you very much.
I don't have the breakdown by province, but I can talk to you a little bit about how it works. I'll just note that this is the Canada health transfer for which the main estimates has over $40 billion estimated.
Essentially, this program grows in line with a growth track. We do a three-year moving average on the gross domestic product, with funding to increase by a guaranteed amount of 3% every year. For 2019-20, that growth is 4.6%, which is in line with that growth track.
This funding is flexible. It goes to the provinces and territories. It's block funding; they can use it as they want, although we do have conditions associated with it, and it is allocated on a per capita basis.
In addition to this amount—and it might be what you're referring to as well—there is funding that is provided through Health Canada that in a previous year came through Finance Canada's budget as a one-time payment, but the funding for home care services and mental health services is included in Health Canada's budgeting process.
Greg Carreau
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Greg Carreau
2019-06-06 8:56
Thank you, Madam Chair and members of the committee.
Good morning. My name is Greg Carreau and I'm the director of the water and air quality bureau at Health Canada.
I would like to begin by acknowledging that the land on which we are meeting today is on the traditional and unceded territory of the Algonquin nation.
I welcome the opportunity to discuss Health Canada's role in protecting Canadians from environmental risks to health. I will speak to the department's activities and expertise related to mercury and contaminated sites, first in general, and then as it relates to Grassy Narrows. Health Canada works closely with Environment and Climate Change Canada to protect the health of Canadians from environmental contaminants such as mercury through our chemicals management plan. This work is accomplished under the Canadian Environmental Protection Act, 1999, which provides the authority for the federal government to take action to address harmful chemicals.
Mercury poses a host of human health risks. The health risks of mercury depend on its chemical form, route of exposure and the level of exposure. Mercury in its organic form, methylmercury, bioaccumulates up the food chain—for example, in fish—and is absorbed through the digestive tract and distributed throughout the body. It readily enters the brain, where it may remain for long periods of time. In pregnant women, it can cross the placenta and into the fetus.
A child's developing nervous system is particularly sensitive to mercury. Effects can include a decrease in IQ, delays in walking and talking, blindness and seizures. In adults, extreme exposure can lead to personality changes, changes in vision, deafness, loss of muscle coordination and sensation, intellectual impairment and even death. Cardiovascular, renal and carcinogenic effects have also been observed.
The federal government has taken action to reduce levels of mercury and risks to health. A wide range of regulatory and non-regulatory initiatives have effectively reduced mercury emissions in Canada. Since the 1970s, domestic sources of mercury emissions have been reduced by approximately 90%. Global efforts are also important, and Canada ratified the Minamata Convention on Mercury in 2017, a global treaty to reduce mercury emissions and exposures.
Today, methylmercury exposure in Canadians is often linked to eating fish. Health Canada establishes standards for the amount of mercury permitted in retail fish. To further reduce exposure, Health Canada provides advice to Canadians on the consumption of certain types of fish known to contain higher levels of mercury.
Health Canada has undertaken research to evaluate the levels of mercury in Canadians. The Canadian health measures survey collects information from Canadians about their health and includes measurements of chemicals in blood and urine. Results found that over 99% of Canadians sampled had levels of mercury below the established methylmercury blood guidance levels. When levels of methylmercury in blood are below the guidance value, no negative health effects are expected.
Regarding the health risks of contaminated sites, Health Canada participates in the federal contaminated sites action plan. Health Canada's role is to provide expert advice, guidance, training and tools on the assessment and mitigation of health risks. The historical source of the mercury contamination that impacts Grassy Narrows First Nation has not been part of the federal contaminated sites action plan.
Health Canada has had historical involvement in evaluating the human health impacts of mercury contamination in the river system of the English and Wabigoon rivers. Beginning in the 1970s, Health Canada has been investigating the impacts of mercury on the residents of the Grassy Narrows and Whitedog communities. This work was carried out by Health Canada's first nations and Inuit health branch, which was transferred to Indigenous Services Canada in 2017. My colleague from Indigenous Services Canada described these activities earlier.
The residents of Grassy Narrows First Nation have been exposed to elevated levels of mercury resulting from past industrial practices. Health Canada is committed to continuing to work with partners to address the health risk posed by mercury, including our scientific expertise and any future collaborative action with Grassy Narrows First Nation.
I wish to thank the committee for the opportunity to appear today.
View Kevin Waugh Profile
Thank you.
Thank you to all of you for coming here today.
Dr. Wong, you said there was still poisoning going on in the community.
Mr. Carreau, in your remarks, you noted that mercury poses a host of human health risks, including for the brain and pregnant women. It can cross the placenta into the fetus.
Health Canada refused to reveal the names of 150 residents who were identified at birth. The umbilical cord blood of babies was tested for 22 years, from 1970 to 1992, and 357 infants on reserve had testing data that sat somewhere. Some of it was, they said, in bank boxes in Thunder Bay and Ottawa. The information was slow and at times never even passed on.
If we're still having issues today, has this improved situation improved at Health Canada and your departments?
Tom Wong
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Tom Wong
2019-06-06 9:29
Perhaps I'll ask Jennifer Mercer, the director of the program, to speak to that.
What you described was something in the past. However, the department has spent a lot of time working with ethicists at the research ethics board and the community and has poured in additional resources in order to hand search all of the historical documents from the past 40 years and provide those to the communities in boxes, literally.
I'll turn to Jennifer Mercer for the details.
Jennifer Mercer
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Jennifer Mercer
2019-06-06 9:30
You're right. There's over 50 years of historical data in approximately 100 banker boxes. This data is owned by the individuals who were tested. This personal medical information has been released to the individuals who were tested. If you have an individual who, for example, was born to a mother whose cord blood was tested at the time of birth, the cord blood data was released to the mother.
Throughout the past 50 years, we've had ongoing requests from community members to get access to their personal medical information. I've been in the position for about two years, and I've had 40 or 50 individuals who have asked for their personal medical information. That information has been released upon request to the individual, or, depending on how they sign the consent, to the person with whom they want to share the information, such as a researcher or a physician. It is an individual's personal medical information.
That said, since, I think, the mid-1970s, upon request by researchers who had the support of the community, we have been releasing this data, and this data has been going to the researchers in a de-identifiable format. That means it doesn't have a date of birth or a name. You cannot identify who the individual is, but we have been releasing that data when requested.
We need to make sure that we protect individuals' personal medical information, and we have to respect the Privacy Act. If we released data without the appropriate measures in place, we'd be not in keeping with the Privacy Act.
View Bill Casey Profile
Lib. (NS)
Welcome, everybody, to meeting number 148.
We are going to have a little chaos today with the votes and everything. I managed to meet with the minister on the way in and I asked if she would forgo her opening statement to allow for more questions. She said to table the statement. I appreciate that very much.
However, before going to questions, we'd like to invite the minister to say some opening words.
Simon Kennedy
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Simon Kennedy
2019-05-28 16:43
I realize there is limited time so I won't run on, but there are essentially two different kinds of activities that we conduct with regard to medical cannabis.
Tolga Yalkin
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Tolga Yalkin
2019-05-27 12:09
Certainly, Mr. Chair. I'm Director General of Consumer Product Safety at Health Canada.
David Lee
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David Lee
2019-05-06 16:13
Thank you, Mr. Chair.
Subdivision C would amend the Food and Drugs Act to optimize patient safety, but to enable innovation.
Clause 164 would introduce a more organized way to determine classification. Right now, products can fall under more than one definition, such as a food and a drug, or a device and a drug. This would help increase transparency and cause the minister to consult. It would also reduce, especially for innovative smaller businesses, the uncertainties when you have to choose which pathway to take.
Clause 166 would introduce measures to modernize our clinical trial structure. Many advanced ways of conducting clinical trials are being developed. This will be especially good for physician-led research for our children with cancers. It would also include new abilities for clinical trials in foods such as infant formulas and hospital-given foods, for example, through a feeding tube. Right now, companies have to do those clinical trials in other countries because they're not enabled here.
Clause 169 and on would introduce a new pathway for advanced therapeutic products. This is very important because science and technology is really multiplying the developments that we're starting to see, a lot of in-hospital manufacturing of devices that can be embedded with cells. This is for a regulator to be very agile, and look after the safety but make sure we can tailor the requirements through what this pathway is intended to do.
Perhaps I can pass the floor to my colleague to go over the inspection measures.
Greg Loyst
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Greg Loyst
2019-05-06 16:15
Thanks for the opportunity to provide a brief overview of clauses 170 and 171, which deal in particular with the powers of inspection.
We work in an increasingly complex world, and technology is evolving at unprecedented speed, but our powers of inspection have not kept up with the pace of those developments.
The proposed amendments would clarify some of the powers conferred by the act and grant inspectors modern powers to enforce it, which would make it possible to adopt more flexible and adaptable approaches.
The proposed amendments are really intended to help us better protect the health and safety of Canadians. These are in keeping with powers that you would find in other modern federal legislation, including many of those acts that are administered within the health portfolio.
What I'll do is quickly run through some of the highlights of the authorities that we're seeking.
The proposed amendments would allow inspectors to order a person to provide an inspector with any document, information or sample specified by the inspector. This could be done without the inspector being on site. They would add electronic data to the list of records or documents that could be examined, by giving the inspector the ability to reproduce this electronic data or use a computer system or a means of telecommunication at the place being inspected. They would allow things like the inspectors taking photographs or making recordings and sketches during an inspection. An inspector would be able to examine, test or take samples of anything in the place being inspected, or remove anything from the place being inspected for those purposes.
Inspectors would be able to cause a person to identify themselves to the satisfaction of the inspector in the place being inspected. The inspector would be able to order a person to move or stop a conveyance for the purpose of inspecting that conveyance, or if a conveyance is blocking access to products in a warehouse, for example, to move that conveyance so that the inspector could get at it.
It would also allow an authority to pass through or over private property. This would not include a dwelling house. The sanctity of the home would remain. The only two ways we could get into a home would be with a warrant or with the consent of an owner, but this would allow us to pass over private property to execute our functions.
I'd also like to mention that in clauses 173 to 175 you'll find the offence provisions. What's important to note is that where there is a duty created by these new authorities, it would fit within the existing infrastructure of the offences that are currently in the act, so there is no increase to penalties or offences. In those clauses we've really just aligned the provisions that we're seeking here with the existing infrastructure of the penalties.
That's it.
Tolga Yalkin
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Tolga Yalkin
2019-05-06 16:40
Good afternoon, ladies and gentlemen.
To give you some context, Canadian law requires businesses to disclose on their labels the ingredients used in chemical products sold for use in the workplace.
That said, some companies consider their formulas trade secrets, and accordingly, they can file a claim to exempt a chemical product from the requirement to disclose its ingredients on the label.
When a company makes such an application to Health Canada, we review the other information that a company plans on providing a worker on the chemical product in question, including the hazard symbols, the precautionary statements and the first aid treatment in the case of exposure. We review that information obviously to make sure that it is sufficient and accurate to keep workers safe.
The proposed measures, although not radical, would make minor improvements to our process for considering the claims businesses make that their chemical formulas not be disclosed.
The first is removing the requirement that Health Canada be the guarantor of the information they do plan on providing workers on their chemical products as required by the law.
The second is replacing the Canada Gazette process for publishing individual product notifications with an online system. I want to stress that this is not about eliminating the gazetting process for new regulations. That would remain. Rather, it's about individual product notifications. That we are still gazetting these, I think, is really a reflection of the fact that the act in question was conceived of over 40 years ago, a time in which gazetting was really the only way to communicate to companies such notifications.
Other similar notifications you might be interested to know about, as well, for which Health Canada is responsible, such as relating to natural health product licences, drug sale authorizations and novel food safety assessments, for example, are not gazetted but are presented online.
The third is eliminating a heavy and cumbersome appeal process and leaving any disputes to be dealt with by way of judicial review.
The fourth is providing for more graduated sanctions for non-compliance.
The fifth is providing the Minister of Health with the authority under a very narrow set of circumstances to disclose chemical formulas where there is a serious or imminent danger to human health or safety.
That concludes my remarks, Chair, and I'm happy to take any questions.
Jason Flint
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Jason Flint
2019-05-06 16:54
Mr. Chair, clauses 217 to 219 propose changes to improve efficiency and remove some duplication in the Pest Control Products Act.
Just as a background, pesticides in Canada are regulated by Health Canada to protect health and the environment. Products undergo a pre-market scientific risk assessment before being authorized. Once registered, products are subject to cyclical re-evaluations. They're also subject to special reviews if new information comes to light about a registered product.
The issue revolves around the Pest Control Products Act, which requires a special review to be conducted every time another OECD member country removes all uses of a pest control product for health or environmental reasons. The way this is written, it can result in multiple reviews of the same issue having to be conducted, often at the same time.
The amendment proposed would allow Health Canada to combine multiple reviews into one special review, or to examine the issue as part of an ongoing special review or re-evaluation, provided it could be incorporated early enough in the review process to allow for a scientific assessment and consultation on the decision, or in some cases, not to conduct a review at all, if the basis of the foreign decision had already been considered previously by Health Canada and there was no new information.
In summary, this should provide some savings for both government and industry, if we can remove the requirement to do these duplicate special reviews.
Remington Nevin
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Remington Nevin
2019-05-01 15:47
Thank you, Mr. Chair, and thank you, members of the committee, for inviting me here today.
I'm Dr. Remington Nevin, and I'm the executive director of the Quinism Foundation, which is a Vermont-based non-profit organization. Our mission is to support and promote education and research on the medical condition known as chronic quinoline encephalopathy, otherwise known as neuropsychiatric quinism. This is the medical condition caused by poisoning of the central nervous system by mefloquine and related quinoline anti-malarials.
I last provided evidence to this committee in December 2016 in the form of a written brief on the topic of mefloquine, and in that brief I commented in part on what were then the recent changes to the Canadian mefloquine product monograph updated in August of that year. The monograph was subsequently updated again in, I believe, September 2017, following the publication of both the Canadian Forces surgeon general report on mefloquine and the Health Canada report on mefloquine. It is the language from this most recent update that I will refer to in my testimony today.
The current Canadian mefloquine product monograph now warns physicians and other prescribers, in bold typeface, that:
Patients should be advised to consult a healthcare professional if any neurological and/or psychiatric symptoms occur during the prophylactic use of mefloquine
—for the prevention of malaria—
as healthcare professionals may have to discontinue mefloquine and prescribe an alternative medicine for the prevention of malaria.
The monograph further clarifies, in a boxed warning, that not only may mefloquine have to be discontinued, but that “mefloquine should be discontinued” and an alternative medication substituted if psychiatric or neurologic symptoms occur during prophylactic use.
The updated monograph then also makes clear that:
Psychiatric symptoms ranging from anxiety, paranoia...and depression to hallucinations and psychotic behavior...can occur with mefloquine use. Symptoms may occur early in the course of mefloquine use and on occasion...these symptoms have been reported to continue long after mefloquine has been stopped.
The monograph then also makes clear that:
In a small number of patients it has been reported that dizziness or vertigo and loss of balance may continue for months or years after discontinuation of mefloquine, and in some cases vestibular damage may be permanent.
There are several important points being made in this approved labelling, which has been approved by Health Canada and, therefore, presumably are being agreed to by Health Canada.
The first point being made is that there is an acknowledgement by Health Canada and the product's manufacturer that in some cases there are long-term psychiatric and neurologic symptoms that result from mefloquine use. The assumption in the labelling is that there is a likelihood of these symptoms being causal, meaning caused by the drug, and not merely associated with its use. To be clear, this causality is really not disputed by experts. There is broad consensus among international drug regulators on this fact. There's good evidence from the medical and scientific literature and from the accumulated pharmacovigilance data—meaning the adverse-event reports—that symptoms such as insomnia, abnormal dreams, nightmares, anxiety, depression and cognitive dysfunction, among other psychiatric symptoms, for example, can continue for years after use of the drug. That's the first point.
The second point being made by this updated language is that there's also tacit acknowledgement by Health Canada and the drug's manufacturer that to reduce the risk of these long-term symptoms, mefloquine should be discontinued at the onset of any psychiatric or neurologic symptom. This is made clear by the additional language in the monograph, that:
During prophylactic use, if signs of acute anxiety, depression, restlessness or confusion occur, these may be considered prodromal to a more serious event. In these cases, the drug must be discontinued and an alternative medication should be substituted.
It should be clear, given the other language in the monograph, as well as international drug labelling, that these specific symptoms—the acute anxiety, depression, restlessness or confusion—should be considered illustrative and not exclusive. For example, the European drug labelling makes clear that abnormal dreams, nightmares and insomnia should also require the drug's discontinuation. I believe this is clear from the Canadian product monograph language as well.
For the purposes of this committee’s mandate, these two points have profound implications for the care of Canadian veterans, tens of thousands of whom since the 1990s have been exposed to mefloquine, in most cases without the benefit of these enhanced warnings.
One obvious and profound implication is that for those Canadian veterans who were ordered to take mefloquine prior to these warnings appearing in the product monograph, and who were therefore not told to discontinue the drug at the onset of any psychiatric symptoms, there is an increased risk that they experienced the “more serious event” that these psychiatric symptoms are considered prodromal to. To be clear, this more serious event is in fact the development of the long-term psychiatric and neurologic symptoms that in some cases can contribute to disability.
This then raises the question: what is being done systematically by Veterans Affairs Canada and others to identify those veterans who did in fact develop these long-term psychiatric and neurologic symptoms as a result of their use of mefloquine? The answer appears to be nothing. As a result, in a recent letter to the former Minister of Veterans Affairs, we called upon VAC to implement a program to screen veterans for a history of symptomatic mefloquine exposure, meaning those veterans who not only recall having taken mefloquine but who recall having experienced those symptoms that are specifically listed as being prodromal to the more serious event, which we understand is a euphemism for the development of disability from the drug’s use.
Unfortunately, what we received in reply from the current minister was a very unsatisfying response, which suggests to us that VAC is not taking this issue seriously. I'd be happy to share this response for the record on request.
As we noted in our original letter to the veterans affairs minister, we believe that screening veterans “for symptomatic mefloquine exposure is a necessary first step to raising clinicians’ awareness of the prevalence of mefloquine poisoning among the recent Canadian veteran population”. We also believe that screening will permit VAC to more accurately and validly “estimate the total number of veterans exposed to mefloquine” and “how incomplete prescribing documentation may be”. We also believe that this will permit VAC to estimate “how many veterans may be suffering disability who may become eligible for disability compensation” as a result. As we noted in our original letter, our organization would be pleased to work with VAC to help implement such screening in this population.
That concludes my prepared testimony. I would be very pleased to answer any questions the committee members may have. Thank you.
View John Oliver Profile
Lib. (ON)
View John Oliver Profile
2019-02-07 9:48
Thank you very much.
My question is for Brian and MEDEC.
In December, Health Canada released its action plan on medical devices. It had three principal focuses. In part, it came out of the concerns that some media had with complications from some devices.
First—and you've commented on it—is improving how medical devices get to market. Your presentation really hit on that, and the advice that you've given appears to be heard well by Health Canada.
There are two other areas, though. One was strengthening monitoring, and following up that would include increasing inspection and enforcement by Health Canada regulators. The second was improving information to Canadians. Right now, if there's an incident with an existing licensed piece of equipment, it requires an FOI request to get that information released. Health Canada is looking at, I believe, creating a database of information so that Canadians can more readily access it.
Could you comment on those latter two areas of focus by Health Canada to improve safety for Canadians?
Brian Lewis
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Brian Lewis
2019-02-07 9:49
I'll start on it, then Diana will finish.
What we found with Health Canada, with everything that was identified when the International Consortium of Investigative Journalists was looking at this, is that 80% of the work that the consortium was indicating needed to be done, Health Canada had already started. They were well ahead in the process, realizing that there was a need there for all the things you're talking about.
Diana, you have some of the specifics.
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