KelleyBushKelley-BushInterventionMs. Kelley Bush (Section Head, Radon Education and Awareness, Radiation Protection Bureau, Environmental and Radiation Health Sciences Directorate, Healthy Environments and Consumer Safety Branch, Department of Health): (1605)[English] Good afternoon. My name is Kelley Bush, and I am the head of radon education and awareness under Health Canada's national radon program. [Translation]Thank you, Mr. Chair and members of the committee, for inviting me to be here today to discuss radon as a cause of lung cancer and to highlight the work of the Canadian – National Radon Proficiency Program.[English]Through the ongoing activities of this program, Health Canada is committed to informing Canadians about the health risk of radon, better understanding the methods and technologies available for reducing radon exposure, and giving Canadians the tools to take action to reduce their exposure.Radon is a colourless, odourless radioactive gas that is formed naturally in the environment. It comes from the breakdown of uranium in soil and rock. When radon is released from the ground in outdoor air, it gets diluted and is not a concern. However, when radon enters an indoor space, such as a home, it can accumulate to high levels and become a serious health risk. Radon naturally breaks down into other radioactive substances called progeny. Radon gas and radon progeny in the air can be breathed into the lungs, where they break down further and emit alpha particles. These alpha particles release small bursts of energy, which are absorbed by the nearby lung tissue and lead to lung cell death or damage. When lung cells are damaged, they have the potential to result in cancer when they reproduce. The lung cancer risk associated with radon is well recognized internationally. As noted by the World Health Organization, a recent study on indoor radon and lung cancer in North America, Europe, and Asia provided strong evidence that radon causes a substantial number of lung cancers in the general population. It's recognized around the world that radon is the second leading cause of lung cancer after smoking, and that smokers also exposed to high levels of radon have a significantly increased risk of developing lung cancer. Based on the latest data from Health Canada, 16% of lung cancers are radon-induced, resulting in more than 3,200 deaths in Canada each year. To manage these risks, in 2007 the federal government in collaboration with provinces and territories lowered the federal guideline from 800 to 200 becquerels per cubic metre. Our guideline of 200 becquerels per cubic metre is amongst the lowest radon action levels internationally, and aligns with the World Health Organization's recommended range of 100 to 300 becquerels per cubic metre.All homes and buildings have some level of radon. It's not a question of “if” you have radon in your house; you do. The only question is how much, and the only way to know is to test. Health Canada recommends that all homeowners test their home and that if the levels are high, above our Canadian guideline, you take action to reduce. The national radon program was launched in 2007 to support the implementation of the new federal guideline. Funding for this program is provided under the Government of Canada's clean air regulatory agenda. Our national radon program budget is $30.5 million over five years. (1610)[Translation]Since its creation, the program has had direct and measurable impacts on increasing public awareness, increasing radon testing in homes and public buildings, and reducing radon exposure. This has been accomplished through research to characterize the radon problem in Canada, as well as through measures to protect Canadians by increasing their awareness and giving them tools to take action on radon.[English] The national radon program includes important research to characterize radon risk in Canada. Two large-scale, cross-Canada residential surveys have been completed, using long-term radon test kits in over 17,000 homes. The surveys have provided us with a much better understanding of radon levels across the country. This data is used by Health Canada and our stakeholder partners to further define radon risk, to effectively target radon outreach, to raise awareness, and to promote action. For example, Public Health Ontario used this data in its radon burden of illness study. The Province of British Columbia used the data to inform its 2014 changes to their provincial building codes, which made radon reduction codes more stringent in radon-prone areas based on the results of our cross-Canada surveys. The CBC used the data to develop a special health investigative report and interactive radon map.The national radon program also conducts research on radon mitigation, including evaluating the effectiveness of mitigation methods, conducting mitigation action follow-up studies, and analyzing the effects of energy retrofits on radon levels in buildings. For example, in partnership with the National Research Council, the national radon program conducted research on the efficacy of common radon mitigation systems in our beautiful Canadian climatic conditions. It is also working with the Toronto Atmospheric Fund to incorporate radon testing in a study they're doing that looks at community housing retrofits and the impacts on indoor air quality.This work supports the development of national codes and standards on radon mitigation. The national radon program led changes to the 2010 national building codes. We are currently working on the development of two national mitigation standards, one for existing homes and one for new construction. [Translation]The program has developed an extensive outreach program to inform Canadians about the risk from radon and encourage action to reduce exposure. This outreach is conducted through multiple platforms targeting the general public, key stakeholder groups, as well as populations most at risk such as smokers and communities known to have high radon.[English]Many of the successes we've achieved so far under this program have been accomplished as a result of collaboration and partnership with a broad range of stakeholder partners. Our partners include provincial and municipal governments, non-governmental organizations, health professional organizations, the building industry, the real estate industry, and many more. By working with these stakeholders, the program is able to strengthen the credibility of the messages we're sending out and extend the reach and impact of our outreach efforts. We are very grateful for their ongoing engagement and support.In November 2013 the New Brunswick Lung Association, the Ontario Lung Association, Summerhill Impact, and Health Canada launched the very first national radon action month. This annual national campaign is promoted through outreach events, website content, social media, public service announcements, and media exposure. It raises awareness about radon and encourages Canadians to take action. In 2014 the campaign grew in the number of stakeholders and organizations that participate in raising awareness. It also included the release of a public service announcement with television personality Mike Holmes, who encouraged all Canadians to test their home for radon.To give Canadians access to the tools to take action, extensive guidance documents have been developed on radon measurement and mitigation. Heath Canada also supported the development of a Canadian national radon proficiency program, which is a certification program designed to establish guidelines for training professionals in radon services. This program ensures that quality measurement and mitigation services are available to Canadians.The Ontario College of Family Physicians as well as McMaster University, with the support of Health Canada, have developed an accredited continuing medical education course on radon. This course is designed to help health professionals—a key stakeholder group—answer patients' questions about the health risks of radon and the need to test their homes and reduce their families' exposure.The national radon program also includes outreach targeted to at-risk populations. For example, Erica already mentioned the three-point home safety checklist that we've supported in partnership with CPCHE. As well, to reach smokers, we have a fact sheet entitled “Radon—Another Reason to Quit”. This is sent out to doctors' offices across Canada to be distributed to patients. Since the distribution of those fact sheets began, the requests from doctors offices have increased quite significantly. It began with about 5,000 fact sheets ordered a month, and we're up to about 30,000 fact sheets ordered a month and delivered across Canada.In recognition of the significant health risk posed by radon, Health Canada's national radon program continues to undertake a range of activities to increase public awareness of the risk from radon and to provide Canadians with the tools they need to take action. We are pleased to conduct this work in collaboration with many partners across the country.(1615)[Translation]Thank you for your attention. I look forward to any questions the committee members might have.Building codeCanadian – National Radon Proficiency ProgramCarcinogenCaregivers and health care professionalsDepartment of HealthGovernment advertisingGovernment assistanceGuidelinesHousingIndoor air qualityInformation disseminationLung cancerNumbers of deathsRadioactive materialsRadonResearch and researchersSetting of standardsSmokingUraniumWork-based trainingWorld Health Organization41697324169733416973441697354169736416973741697384169739416974041697414169742416974341697444169745416974641697474169748416974941697504169751BenLobbHuron—BruceBenLobbHuron—BruceTomKosatskyTom-KosatskyInterventionDr. Tom Kosatsky: (1640)[English] You know, anyway, that smoking causes lung cancer in smokers. You probably also know that to a degree it causes lung cancer in people who live with smokers. I won't really talk about either of those things, but if you can get to the slide that's marked “Lung Cancer in Lifelong Non-Smokers”, you'll see that there is a new thing that's been described only over the last, about, 10 years, which is lung cancer in lifelong non-smokers, something which, before this committee invited me to speak with you, I didn't know much about. It turns out that it's a whole other disease. It has some similarities to smokers' lung cancer but some very important differences.The geography is different. It's a huge phenomenon in Asia and in Asians in Canada. It has a female predominance, so there are far more lung cancers in female non-smokers than in male non-smokers. The age distribution is different, so it tends to present itself at a much younger age than smokers' lung cancers do. The cell types, the cancer types are different. The typical small cell squamous lung cancer that you see in smokers, you don't get in non-smokers. You get a whole different cell type and cell shape. The genetics are different, so there is some family relationship. It's not very strong, but there's a very strong genetic relationship based on genetic analysis. You can almost predict who's going to get it, which is a really important thing. Further, it tends to be much more symptomatic at diagnosis than is lung cancer in smokers. The five-year survival, oddly, is better, even though it presents later, for non-smokers' lung cancer than for smokers' lung cancer. In many ways it's a different disease.Radon-related lung cancer is somewhere intermediate, because, as I'm going to say, most radon-related lung cancers occur in smokers. The question of whether it is more cost-efficient to stop smoking was right on the mark.The next one is called “Principal risk factors (excluding occupational exposure)”, only because you asked. There are a number of conditions, including radon exposure, that are associated with non-smokers' lung cancer, like the history in your family. It's associated with hormone use in women. It's associated with environmental tobacco smoke. It's associated, to a degree, with air pollution. It's associated with cooking-oil fumes, so indoor cooking over a long period of time. It's associated in Asia and Africa with domestic heating by wood and wood products in the home. Those are also associated with lung cancer. Something that I didn't know much about before is that it's associated with lung infections like tuberculosis and other lung infections over a long period of time. It's also, like so many of the other bad things in life, associated with being poor. Getting lung cancer is associated with being poor, even if you eliminate all the other stuff. To a degree it's mitigated or prevented by a diet high in fruits and vegetables, so eat your leafy greens, eat your fruit, and you're less likely to get lung cancer no matter what else you do.The next one is an American slide. It has a little American flag, and it looks at the attributable percentage of lung cancer by cause. For active smoking, it's 90%. For radon exposure in the U.S., it is between 9% and 15%, and in Canada it's estimated at 15%. For workplace carcinogen exposure, it's 10%. For air pollution, it's 1% to 2%. That adds up to more than 100% because, as you'll see, some of those causes add to or multiply each other. If you're exposed to radon, don't smoke. If you smoke, don't be exposed to radon.Non-smokers' lung cancer is a really important cause of lung cancer. It's about number six in terms of all the causes. Radon-related lung cancer—this is U.S. data but for Canada it would be the same—is number eight. How could that be? It could be because smoking and radon exposure are interactive, so one multiplies or adds to the effect of the other. That leads, in any case, to non-smokers' lung cancer being a very bad issue.Any radon exposure is bad news, not just at over 200. An artificial limit, no matter what it is, is not very useful for lowering the whole population's exposure. It would be better if we were all exposed to less radon rather than picking one area, maybe for convenience, or one level. It may be good for convenience, but it's not a really useful population health measure. For the whole population, it would be better if we were all exposed to less radon. It's a linear relationship. The more radon you're exposed to and the longer you're exposed, the more likely you are to get lung cancer.(1645)The other thing is that, as I was saying, the more you smoke the more it interacts. On the last slide, which I made up using Canadian data, most radon-associated lung cancers occur in smokers. If you've never smoked, as you get up to high levels, like interior B.C. levels, of radon about 36 people out of 1,000 exposed to those levels would get lung cancer. On the other hand if there was no radon exposure and you did smoke, about 100 people would get lung cancer. If you add the two together, you're exposed to a high level of radon and you smoke, 270 people exposed to those two for their whole lives, smoking and radon, will get lung cancer. It's 270 out of 1,000 people; that's tremendous. How can you lower it? The number one way to lower it is to stop smoking or to never have smoked. The number two way to lower it is to lower your radon exposure, and you'll do that for everybody in the population. The less smoking there is, the less radon there is, the less lung cancer there will be, to the point that as we lower the level of smoking exposure, radon will become a more important cause of lung cancer. But there will be a lot less lung cancer. If we eliminate smoking, there will be less lung cancer in general, but all of these other causes other than smoking will increase in focus. The big issue is the interaction, the doubling, tripling, quadrupling, or really octupling effect, because it's an eight-time effect, of smoking and radon will go away.What's been the Canadian public health stance on radon? Before the year 2007, it was pretty passive and largely seen as a private issue. Health Canada was helpful. They gave advice when people asked for it. That was at the time of the 800 becquerels per metre cubed, or 800 disintegrations per second per metre cubed level, which is what a becquerel is. Then when the level was lowered a more active stance was taken. Health Canada was involved with large-scale testing across the country to establish a radon profile across the country so that we knew what our levels were likely to be. They were much more active in terms of giving advice, and with this lower guideline, they promoted it and they encouraged “test and remediate”. Test and remediate to me is not the way to go. The way to go is to build it out in the first place.If you look at this complicated Ontario slide, Ontario looked at levels of radon across the province and how many cases of lung cancer could be saved by doing something for those above 200 becquerels per metre cubed, by adopting 100 becquerels per metre cubed, by adopting 50 becquerels per metre cubed—all of which are attainable—or by going to as low a level possible and getting close to outdoor air levels, which are relatively benign. At 200 becquerels per metre cubed, if every Ontario resident got their house from that point down to outdoor levels, 2% of all the lung cancers in Ontario would be averted. If you got down from current levels above 200, if everybody tested and remediated and they successfully got their house down to background or no radon, it would avert 2% of all lung cancers. If all houses in Ontario with any level of radon in them could get down to outdoor levels, we'd get rid of 13% of all Ontario lung cancer deaths. If there were a way to do it, why not do that? Why not get it down lower?The next slide looks at the change in levels of radon over time. This is Dutch data. Canada would be the same. Yes, as we've made our buildings tighter, radon levels have increased. This is even more reason to look at the joint effects of building changes on radon.CarcinogenDepartment of HealthGuidelinesHousing repairs and renovationIndoor air qualityLung cancerNational Collaborating Centre for Environmental HealthOntarioPublic healthRadonSmokingStatisticsUnited States of AmericaWorkplace health and safety4169880BenLobbHuron—BruceBenLobbHuron—BruceSarahHendersonSarah-HendersonInterventionDr. Sarah Henderson (Senior Scientist, Environmental Health Services, BC Centre for Disease Control): (1655)[English] Good afternoon.There is a slide deck for me as well. The first page of that slide deck should say, “Radon risk areas and lung cancer mortality trends in British Columbia”. I hope that you all have it. I will try to speak to the slides as I go along for those who don't have them.I want to start by saying thank you so much for inviting me to be here. It's a real honour. My title at the BC Centre for Disease Control is senior scientist, and I'm really a research scientist. The mandate of my role is to conduct applied public health research in support of good environmental health policy for the province, and that's how I first became interested in radon in British Columbia. I'm going to show you some real, hard numbers today that come directly from the population data for British Columbia, and that's a bit different from what everybody else has been talking about so far.If you move to the first slide, it's just a recap of the current guideline values for radon in Canada. We've heard about the number 200 all day, and any concentration lower than that is below the Health Canada guideline. Then if you measure your home and the concentration is between 200 and 600 becquerels per metre cubed, Health Canada currently recommends that you try to remediate that within the next couple of years, whereas if your measurement if over 600 becquerels per metre cubed, they really recommend that you remediate right away. That is the high-danger area for radon.We've used these values in British Columbia to sort of break up the province into areas that we consider to be low, moderate, and high radon areas. If you are not seeing this in colour, the darkest areas there are coloured in red, and those are the high radon areas. We're very lucky right now in British Columbia. We have a database of over 4,000 residential radon measurements, including measurements from Health Canada national surveys as well as from a bunch of surveys that have happened in the province, so we were really able to use the data that we have observed in the province to break things up this way. These geographic regions are called local health areas. They're the smallest health geographic unit that we use in British Columbia. We are able to look at deaths that have occurred in this province at this geographic scale, which is why we've used this geographic scale. We did something quite simple, but I hope you'll agree, also quite effective. We looked at the province by those regions, and over the course of 25 years we summed up all of the deaths attributed to lung cancer in the low, moderate and high regions, and all deaths attributed to all natural causes, and then we divided the number of lung cancer deaths by the number of deaths from all natural causes, and in general, we expect about 7% of all deaths in B.C. to be attributed to lung cancer, which is probably true for most of Canada. Slide number 4 shows the hypothetical situation. If there were no lung carcinogens in the world other than radon, we would expect lung cancer to be high and steady in the higher radon areas, somewhat lower and steady over time in the moderate radon areas, and then lower still and steady over time in the low radon areas. That's the framework I want you to think about when we go to this next slide.When we looked at all deaths in British Columbia, we saw something quite different from what one would expect to see under that hypothetical scenario. The bottom line there shows the low radon areas. You might not be able to see that if you're not looking at it in colour. The middle line, which is just a little bit higher than the bottom line, shows the moderate radon areas. Then that line that is sloping upward over time and is quite distinct from the low and moderate lines is the lung cancer mortality proportion that we see in high radon areas over the past 25 years in British Columbia. We don't have a lot of data about these people. We're doing this with only administrative data. We don't know whether or not they smoked. We don't know whether or not they lived their entire lives in those high radon areas. There are a whole lot of limitations here that we simply can't speak to.(1700) When we split up these data by the higher and lower smoking regions of the province—we know that smoking rates can be up to 30% in some areas and down to 12% in some areas of B.C.—we still see these same persistent trends. It does seem to be that radon is an important factor here.Another important distinction, and I think it's probably why I was asked to be here today, is what we see when we look at the trends for men versus women. To look at men, the low line shown on the slide is the low radon areas, the middle line is the moderate radon areas, and the top line is the high radon areas. There's not as big a difference among those three lines as there was when we were looking at everybody together. In general, the lung cancer rates are going down. That's what we expect as the population stops smoking. When we go ahead and look at women, as shown on the next slide, we see the low and moderate lines towards the bottom there, and then the line for women is just taking off and is quite divergent from the other regions. We're seeing a pretty big difference with respect to the two sexes here when we split up these data. Speaking anecdotally, it's not very scientific, but those of us who are interested in radon in British Columbia hear so many stories from people who say, “My wife died of lung cancer and she never smoked a day in her life.” This matches up with what we hear anecdotally, although that's not very scientific.Somebody asked about the burden of radon-related lung cancer in high- and low-risk areas according to the current Health Canada guidelines. On this next slide, what we see is from data published by Jing Chen from Health Canada. There's an estimate of 6% of the housing stock currently being over the 200 becquerels value, and that's related to 28% of lung cancers in Canada, versus 94% of the housing stock being under the guideline value and 72% of all radon-related lung cancers being attributable to homes in that range. The bulk of the burden really remains below what we're currently talking about in terms of the Health Canada guideline.This very point is something that we've addressed in a new paper. I want to make it clear that this work has not been published yet. It's currently under review, but it's not in the scientific literature and it has not been peer-reviewed. We looked at a bunch of different threshold values. It's really just a line in the sand that we're drawing when we say that 200 is the level or 100 is the level. We took that line in the sand and drew it at 600, 500, 400, 200, 100, and 50 becquerels to see whether or not we could still see a clear distinction between high and low radon areas in B.C. with respect to lung cancer mortality trends when we drew that line in the sand in different places.Indeed, if you look at the far right-hand side, that top plot shows you lung cancer mortality trends in men and in women at a threshold value of 50 becquerels per metre cubed, and you can see that the trends are still distinct from one another. We still see that sharp increase in lung cancer mortality in women in the high radon areas.In the final slide, the key message again is that these are very limited administrative data. This is something we've done as a surveillance exercise. It was really an exercise we undertook because a lot of the evidence we use in Canada to build our policy comes from places other than Canada. We're pulling together studies that have happened in Europe, the U.S., and elsewhere. We really wanted to show some hard-hitting data from the Canadian context.Again, most radon-related lung cancers in Canada happen below the current guideline of 200 becquerels per metre cubed. We see clear temporal trends by radon risk areas of British Columbia. We have not repeated similar analyses elsewhere in Canada, but I wouldn't be surprised to see similar results. The trends that we see at 200 becquerels per metre cubed persist when we drop that threshold to 50 becquerels per metre cubed. This is really supportive of that idea of ALARA, or “as low as reasonably achievable”. As Tom said, the way to pursue ALARA in Canada is really through widespread changes to our national building code to protect the population into the future.(1705) We have estimated that it would take about 75 years to turn over the entire residential building stock in Canada, or most of it, but at the end of that 75 years, you would have a radon-resistant building stock and a population that was well protected.Finally, there does appear to be a difference between men and women in terms of risk.Thank you very much for your time.BC Centre for Disease ControlBritish ColumbiaBuilding codeCarcinogenCorrective actionDepartment of HealthGuidelinesHousingIndoor air qualityLung cancerMenNumbers of deathsRadonSmokingStatisticsWomen41698984169909BenLobbHuron—BruceBenLobbHuron—BruceSonyPerronSony-PerronInterventionMr. Sony Perron (Senior Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Health): (1535)[English]I would like to thank the committee chair and the rest of the committee members for the invitation to appear here today.[Translation]I, and other officials at Health Canada, have reviewed the Auditor General's 2015 Report, and we have paid a great deal of attention to his recommendations. We take the findings seriously and are addressing each of them through an action plan. This plan will continue to be refined and defined in collaboration with first nations. Indeed, as you know, we work in cooperation with first nations. This plan can therefore only be completed with an additional commitment by our first nations partners.The health care system serving first nations is highly complex. Provincial health systems do not directly extend to first nations reserves. To support first nations, Health Canada provides the delivery of a range of effective, sustainable and culturally appropriate programs and services. We work with first nations to increase their control of health services and collaborate with provinces to increase access and promote system integration.(1540)[English] We also support programs that address first nations health priorities in the areas of mental health, chronic disease, maternal and child health, and health benefits providing coverage for prescription drugs, dental care, vision care, mental crisis intervention, and medical supplies and equipment. Most of the community-based programs have been transferred in varying degrees to over 400 first nation communities. This number does not include British Columbia, where in 2013 Health Canada transferred its role in the design, management, and delivery of first nations health programming in British Columbia to the new First Nations Health Authority.Health Canada provides funding to first nations to deliver clinical care in 27 remote and isolated communities, again, outside British Columbia. In an additional 53 remote and isolated first nation communities, Health Canada continues to deliver clinical care. The delivery model varies based on the specifics of each province and geographic conditions. The clinical care teams are located in nursing stations, along with community health workers delivering other programs. Because of the importance of these services, it is imperative that Health Canada ensure that remote communities have access to clinical and client care, that nursing stations are staffed with registered nurses, and that nurses work in a safe environment, have access to physicians to support them, and have access to tools. Registered nurses and nurse practitioners are predominantly the first point of contact in isolated communities and are highly educated and qualified individuals. To ensure that our nurses are prepared for the unique demands of working in remote stations, a mandatory training requirement has been defined and is now part of the national education policy. I can report that we currently have an 88% compliance rate on Health Canada's nursing education model for controlled substances in first nations health facilities, while advanced cardiac life support is at 63%, trauma support is at 59%, pediatric advanced life support is at 64%, and immunization is at 61%. The overall compliance rate is at 46% as of the end of April 2015. We still have work to do, and we are doing it while ensuring that we have resources in place to backfill these important positions while incumbents are in training.Health Canada is committed to ensuring that nurses working in remote first nations communities meet established public service requirements on top of these workers' already robust credentials.[Translation]Remote and isolated practice environments sometimes require nurses to respond immediately to life-threatening or emergency situations. Nurses therefore need appropriate mechanisms to perform these important duties.[English]Clinical practice guidelines assist nurses to address clinical care situations and provide instruction on whether and when consultation with a physician or a nurse practitioner is required. There are arrangements in place for all nursing stations to access physicians when physicians are not located in the community. We also continue to collaborate on region-specific solutions with provinces to advance access to health services and with regulatory bodies to support nurses practising within their scope of practice. A key challenge is the need for more nurses. Health Canada has implemented a nurse recruitment and retention strategy, which involves a number of initiatives: a nursing recruitment marketing plan, a nursing development program, a student outreach program, and an onboarding program. Since its February launch, we have received over 500 nursing applications, with 200 of these moving to the next level of screening. As well, the strategy aims to increase the number of nurse practitioners, which will provide greater stability in the clinical teams, assist in meeting training objectives, and enhance the level of services available at the community level.Nurses and other community health professionals require facilities to conduct their work. Currently, we invest approximately $30 million annually for repairs, renovation, and construction of health facilities, plus an additional $44 million for maintenance and operations. The nursing stations are owned by first nations communities, and we collaborate with them to support their operation. We work with first nations communities to ensure buildings are inspected and deficiencies are addressed. In response to the audit, we are implementing a more robust tracking system to capture this work. We will also enhance our process in order to use facility condition reports as a tool to better plan maintenance and renovation work with the owners. In addition, to ensure new nursing stations are built to code, we have updated our requirements for attestations and have communicated the change to facility management staff. The audit rightly noted that the requirements, such as the station as defined currently, did not provide the necessary level of assurance.Another area reported on was the management of medical transportation; medical transportation that provides coverage to support access to insured health services. Health Canada spends over $300 million on medical transportation per year, and approximately 60% of that is in remote and isolated communities. The main reasons for transportation are emergencies, at 24%, hospital services, at 10%, appointments with general practitioners, at 7%, and dental services, at 5%.The program provides coverage for transportation to the nearest appropriate professional or facility that takes place when the needed service is not locally available. Our goal is to provide timely coverage for medical transportation to avoid an undue burden for clients and health care professionals. Decisions are based on a national program framework and are made with a solid understanding of the health services available and the transportation options at the regional level. In response to the audit observations, the program has already modified and disseminated guidelines to resolve discrepancies observed between our practices and the medical transportation framework in terms of the level of documentation required.(1545)[Translation]Regarding the transportation of children who are not registered, Health Canada has a long practice of allowing coverage for a child up to one year of age to be covered for medical transportation under the registration number of their parents. Health Canada will continue its efforts with partners to inform parents and make available registration material in nursing stations and health centres.[English]Health Canada and the Assembly of First Nations are undertaking a joint review of the non-insured health benefits program, of which medical transportation is a component, and I am pleased to report that the work is well under way. It will identify strengths, weaknesses, including inefficiencies in administration, and recommendations for action.Given that the geographic location, the size of the community, and the need to ensure cultural safety influence the range of programs and services funded or provided by Health Canada, comparing one community to the other is not always possible or the best approach. Community health planning, investing in the integration of services with provincial systems, and the development of community programs and capacity have proven to be more effective and more responsive to community needs over time.As indicated earlier, Health Canada funds a number of community programs aimed at addressing specific needs and working as a complement to the clinical and client care program. These programs are funded to support community health needs and mostly managed by the communities themselves. In response to the audit, we will improve our support to community health planning to enhance integration of the community-based programs and clinical services where these services are delivered by Health Canada. We will also engage with the communities to review the current service delivery model and clinical care resource allocations.[Translation]The last area I would like to discuss is coordination among health system jurisdictions.We work closely with partners to build health service delivery models that take into account community needs.[English] We have made significant progress with health service integration over the last 10 years. We see examples in various regions where there are more physicians' visits, provincial services are being extended on reserve, and there are more collaborative arrangements between community health services and regional health authorities. Co-management and trilateral tables exist in most regions to formally engage with provincial and first nations partners to advance common practices and resolve systemic issues. We will formally engage these tables in order to make progress on the important issues raised in the report.Health Canada will continue to collaborate with our partners to develop and implement other models of first nations-led health systems across the country, as we have celebrated in B.C. We have presented an overview of our action plan, which requires further engagement and collaboration with first nation partners. We believe the next update will be more comprehensive as it will benefit from our partners' input.In closing, we are working on a number of actions in response to the audit, and we will continue to do so.I would note that I am accompanied today by three senior officials from Health Canada's first nations and Inuit health branch: Valerie Gideon, assistant deputy minister, regional operations; Robin Buckland, executive director, office of primary health care; and Scott Doidge, acting director general, non-insured health benefits. We would be pleased to answer your questions. Thank you.Caregivers and health care professionalsChildrenDepartment of HealthFirst NationsHealth educationHealth services accessibilityNursesRemote communitiesReport 4, Access to Health Services for Remote First Nations Communities, of the Spring 2015 Reports of the Auditor General of Canada4149096414909741490984149099414910041491014149102414910341491044149105414910641491074149108414910941491104149111414911241491134149114414911541491164149117414911841491194149120414912141491224149123414912441491254149126DavidChristophersonHamilton CentreDavidChristophersonHamilton CentreRobinBucklandRobin-BucklandInterventionMs. Robin Buckland (Executive Director, Office of Primary Health Care, First Nations and Inuit Health Branch, Department of Health): (1600)[English] Thanks, Sony. I am a registered nurse, and I have been for the last 27 years. To become a registered nurse, you have to complete a nursing program. In the vast majority of the country, it's at the baccalaureate level; you have to have a degree in nursing. In Quebec, the entry to practise is actually a diploma, so you can obtain a nursing diploma from the CEGEP in Quebec. Basically, through nursing school, you obtain the core competencies that are required to function as a registered nurse.Generally speaking, nurses come out of nursing school and they are generalists. They're able to practise in a wide variety of areas. In remote and isolated locations, there are additional competencies that are required. As the report indicated, they are often the only provider in the community and they are the first point of contact for the patient. They need to be able to respond to what comes in the door. If it's an emergency, a trauma, they need to have the competencies to deal with it. That is why Health Canada has identified advanced cardiac life support, pediatric life support, trauma, and the other courses you'd see listed as our five courses. Those are the key competencies that RNs will require to meet the needs of the community, in addition to so much more.Department of HealthEducation and trainingFirst NationsHealth services accessibilityNursesRemote communitiesReport 4, Access to Health Services for Remote First Nations Communities, of the Spring 2015 Reports of the Auditor General of Canada4149183414918441491854149186SonyPerronJohnCarmichaelDon Valley WestValerieGideonValerie-GideonInterventionMs. Valerie Gideon (Assistant Deputy Minister, Regional Operations, First Nations and Inuit Health Branch, Department of Health): (1625)[English]Very quickly, we have a trilateral table in Ontario with the Ontario Ministry of Health and Long-Term Care. We also have a specific northern table that the northern first nations have asked for, and in that table, which has just started this year, we do anticipate that we're going to be talking quite a bit about clinical and client care and medical transportation and engaging them in terms of our follow-up actions on that plan.In Manitoba, we've had a committee for several years that was at a more junior officials level. We've now bumped it up to an assistant deputy minister level, with the Province of Manitoba, the Grand Chief of the Assembly of Manitoba Chiefs, and me. As well, we will be using that table to engage first nations in Manitoba with respect to our actions on this report to ensure that we're also monitoring progress and partnership of first nations.Those are just two examples that are more relevant to this audit, but there are many more across the country. We also have national partnership agreements with the Assembly of First Nations and the Inuit Tapiriit Kanatami, which we signed this year.Department of HealthFirst NationsHealth services accessibilityManitobaRemote communitiesReport 4, Access to Health Services for Remote First Nations Communities, of the Spring 2015 Reports of the Auditor General of Canada414926941492704149271SonyPerronJayAspinNipissing—TimiskamingSonyPerronSony-PerronInterventionMr. Sony Perron (Senior Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Health): (1535)[English]Thank you, Mr. Chair, for the opportunity to provide an overview of the programs and services supported by Health Canada in the area of mental health and wellness for first nations and the Inuit.[Translation]Health Canada recognizes that addressing mental health and addictions issues are important health priorities for First Nations and Inuit. Consequently, the department is investing more than $300 million this year on a suite of mental wellness programs and services.Programming includes mental health promotion, addictions and suicide prevention, other crisis response services, treatment and after-care services, and supports to eligible former students of Indian residential schools and their families.Health Canada is working with partners so that efforts to support individuals, families and communities around mental health care are coordinated and include family support, employment and training, education and social services.Building on best practices, we know that efforts to support individuals, families and communities should be culturally safe and community-driven. We can find lasting solutions only if we work together with our partners, including First Nations and Inuit organizations and, most importantly, the communities themselves.[English]Mental health promotion and suicide prevention research emphasizes the need for comprehensive and multi-layered interventions across a continuum of wellness. Interventions at each of the individual, family, and community, and federal, provincial, and territorial levels have been found to be most effective.We have worked with the Assembly of First Nations and mental wellness leaders to develop the first nations mental wellness continuum framework. Through this process, communities were engaged and brought their ideas to the table.From these discussions, culture emerged as a foundational component. Community innovation, partnerships across government, collaboration and coordination across sectors, and linkages between programs and services were also identified as being crucial for moving forward.This framework has been ratified by the Assembly of First Nations' chiefs of assembly and was released by the AFN in January 2015. We are now working with the Inuit Tapiriit Kanatami to develop a mental wellness continuum for the Inuit.Health Canada is a partner in implementing the first nations mental wellness continuum framework, which calls for integrated models of service delivery that focus on community strengths and indigenous knowledge.Moving forward, we will look at ways to strengthen the federal mental wellness programming with our partners to meet community-specific needs, such as moving away from siloed program approaches toward more coordinated and effective approaches, and through closer integration between federal, provincial, and territorial programs.(1540)[Translation]We are also supporting mental wellness teams, which provide specialized treatment to a group of First Nations communities facing mental health issues. These teams seek to increase access to a range of mental wellness services including outreach, assessment, treatment, counselling, case management, referral and aftercare. Through the National Aboriginal Youth Suicide Prevention Strategy we support screening for depression in schools; education and training for front-line workers to reduce stigma and increase community awareness; referral and intervention training; crisis services; follow-up and support for at-risk youth; and cultural and traditional activities to promote protective factors and to reduce risk factors.Since 2008, we have supported a range of services to former students of Indian residential school and their families so they may safely address emotional health and wellness issues related to the disclosure of childhood abuse. For example, in 2013-14 alone, Health Canada supported approximately 630,000 emotional and cultural support services to former students and their families, and 47,000 professional mental health counselling sessions. [English] On February 20, 2015, Minister Ambrose announced an investment to prevent, detect, and combat family violence and child abuse. Health Canada's investment will support enhanced access to mental health counselling for first nations victims of violence who are in contact with shelters, and will support the improvement of services to first nations and Inuit victims of violence so that services are better coordinated, more trauma informed, and culturally appropriate.Thank you for your attention. I am pleased to take your questions afterward. Aboriginal residential schoolsCommunities and collectivitiesCultural diversityDepartment of HealthDomestic violenceFirst NationsFirst Nations Mental Wellness Continuum FrameworkGovernment expendituresInuitMedical researchMedical techniques and proceduresMental healthNational Aboriginal Youth Suicide Prevention StrategySuicidesVictim counsellingWhole-of-government approach4116487411648841164894116490411649141164924116493411649441164954116496411649741164984116499411650041165014116502BenLobbHuron—BruceBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose (Minister of Health): (1530)[English]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.[Translation]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.[English]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.(1535) 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.(1540) 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.AdvertisingC-17, An Act to amend the Food and Drugs ActCanada Health TransferCanadian Food Inspection AgencyCanadian Institutes of Health ResearchChildrenConsumers and consumer protectionData sharingDepartment of HealthDomestic violenceDrug addiction treatmentDrug reaction reporting networkFederal-provincial-territorial fiscal arrangementsFederal-provincial-territorial relationsFirst NationsFood safetyGovernment accountabilityGovernment advertisingHealth care fundingHealth care systemInformation disseminationInnovationInspections and inspectorsMain estimates 2015-2016MarijuanaMeat inspectorsMedical researchPhysical activity and fitnessPrescription drugsPublic consultationPublic healthPublic Health Agency of CanadaPublic-private partnershipsSafetyTherapeutic productsYoung people41060484106049BenLobbHuron—BruceBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/60078MurrayRankinMurray-RankinVictoriaNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/RankinMurray_NDP.jpgInterventionMr. Murray Rankin: (1545)[English]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.Access to information requestsC-17, An Act to amend the Food and Drugs ActDepartment of HealthDrug reaction reporting networkInformation disseminationMain estimates 2015-2016Safety410608641060874106088RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1545)[English]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.Access to information requestsC-17, An Act to amend the Food and Drugs ActDepartment of HealthDrug reaction reporting networkInformation disseminationMain estimates 2015-2016Safety410608941060904106091MurrayRankinVictoriaSimonKennedySimonKennedySimon-KennedyInterventionMr. Simon Kennedy (Deputy Minister, Department of Health): (1545)[English] 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.Access to information requestsC-17, An Act to amend the Food and Drugs ActDepartment of HealthDrug reaction reporting networkInformation disseminationMain estimates 2015-2016Safety410609241060934106094RonaAmbroseHon.Edmonton—Spruce GroveMurrayRankinVictoria//www.ourcommons.ca/Parliamentarians/en/members/72006DavidWilksDavid-WilksKootenay—ColumbiaConservative CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/WilksDavid_CPC.jpgInterventionMr. David Wilks: (1705)[English]Thanks, Chair.I just have a couple of questions both related to the same topic, one for Health Canada officials and then one to CIHR. They both are with regard to electronic cigarettes. As you know, this committee carried out a study of electronic cigarettes and made a number of recommendations on which the minister is moving forward, including that the Government of Canada establish a new legislative framework for regulating electronic cigarettes and related devices.Has any of the $26.5 million in planned spending for the tobacco program been identified for developing a legislative framework toward this initiative?Department of HealthElectronic cigarettesMain estimates 2015-2016SmokingTobacco products41063734106374BenLobbHuron—BruceSimonKennedySimonKennedySimon-KennedyInterventionMr. Simon Kennedy: (1705)[English]Mr. Chair, on the issue of electronic cigarettes, this is something the department is looking at quite carefully. We're grateful actually for the work of the committee and all of the consultations that were done and the recommendations. We've been examining those quite carefully.At this point I would say we have not dedicated specific funds to that work because we have policy staff, and analysts and so on, who are busy doing that work, but there hasn't been a necessity of, for example, hiring additional staff or setting up a dedicated office. We have specialists who look at these kinds of issues all the time who are actually doing that work. Depending on the ultimate decision of the government in terms of how to move forward on this, it's entirely possible we would need to make budget decisions to reallocate resources. But when it comes to the policy development work, and the assessment of the work of this committee, and to develop a government response, that doesn't require the movement of money budgetarily. We're able to handle that within our existing resources.Department of HealthElectronic cigarettesMain estimates 2015-2016SmokingTobacco products410637541063764106377DavidWilksKootenay—ColumbiaDavidWilksKootenay—ColumbiaSimonKennedySimon-KennedyInterventionMr. Simon Kennedy: (1705)[English]I want to assure the member there's a lot of work going on to come back with a response.Department of HealthElectronic cigarettesMain estimates 2015-2016SmokingTobacco products4106379DavidWilksKootenay—ColumbiaDavidWilksKootenay—Columbia//www.ourcommons.ca/Parliamentarians/en/members/25486ColinCarrieColin-CarrieOshawaConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/CarrieColin_CPC.jpgInterventionMr. Colin Carrie (Oshawa, CPC): (1715)[English]Thank you very much.I'd like to split my time with Mr. Young. First, I wanted to express my appreciation to Health Canada for all the work you've done over the years for natural health products and the world-class regulatory system. As you may know, I still work as the minister's...part of the committee for traditional Chinese medicine. With many more Canadians today coming from Asia, looking to have the traditional Chinese medicines they're used to taking, could you explain the work you're doing with traditional Chinese medicine? What approach are you taking with traditional Chinese medicine and what kinds of innovations are you working with to make these products available to Canadians? Alternative medicineChinaDepartment of HealthMain estimates 2015-201641064194106420BenLobbHuron—BrucePaulGloverPaulGloverPaul-GloverInterventionMr. Paul Glover (Associate Deputy Minister, Department of Health): (1715)[English]Thank you for the member's question.It is absolutely correct that, increasingly, Canadians are turning to alternatives like traditional Chinese medicine. There are a number of steps the department is taking. First and foremost among them is that, under the leadership of the minister and others, an advisory committee provides advice to the department on an ongoing basis with respect to the regulation of traditional Chinese medicines, the challenges the community has faced in terms of bringing these products into the country, the practice of traditional Chinese medicine, some of the issues related to that, claims around the products, and all of those sorts of things.We've been working closely with the Chinese government. It has been very generous in providing traditional pharmacopoeias about the different herbs and substances, and how they have traditionally been used in China, to make sure that practitioners making claims about those herbs are in line with their historic use and use patterns so there is an alignment between what is happening in this country, where these herbs come from—the medicines—and how they have long been used. Those are some examples of the range of things we are doing to work closely with that community to make sure that they understand their obligations when bringing these medicines and herbs into the country. We have a quick and efficient way to understand what it is they're proposing and see if that aligns with the traditional uses from their origins.Alternative medicineChinaDepartment of HealthMain estimates 2015-2016410642141064224106423ColinCarrieOshawaTerenceYoungOakville//www.ourcommons.ca/Parliamentarians/en/members/35600BenLobbBen-LobbHuron—BruceConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/LobbBen_CPC.jpgInterventionThe Chair: (1720)[English]Thank you very much.This is going to conclude the question and answer portion of our meeting. We have one final task that we need to do. We have to vote on the main estimates. We've received unanimous consent among the three parties. What we're going to be able to do is lump our questions all together in one, and that will save us a little time.Shall votes 1 and 5 under the Canadian Food Inspection Agency, votes 1 and 5 under the Canadian Institutes of Health Research, votes 1, 5, and 10 under Health, and vote 1 under the Patented Medicine Prices Review Board, less the amount approved in interim supply carry?Mr. Murray Rankin: Is this a recorded vote?The Chair: Yes, it's recorded.CANADIAN FOOD INSPECTION AGENCYVote 1—Operating expenditures and contributions..........$537,749,431Vote 5—Capital expenditures..........$25,783,194(Votes 1 and 5 agreed to: yeas 5; nays 4)CANADIAN INSTITUTES OF HEALTH RESEARCHVote 1—Operating expenditures..........$47,463,563Vote 5—The grants listed in the Estimates..........$955,287,128(Votes 1 and 5 agreed to: yeas 5; nays 4)HEALTHVote 1—Operating expenditures..........$1,777,987,439Vote 5—Capital expenditures..........$28,035,364Vote 10—The grants listed in the Estimates and contributions..........$1,678,425,178(Votes 1, 5, and 10 agreed to: yeas 5; nays 4)PATENTED MEDICINE PRICES REVIEW BOARDVote 1—Program expenditures..........$9,947,595(Vote 1 agreed to: yeas 5; nays 4)Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDecisions in committeeDepartment of HealthMain estimates 2015-2016Patented Medicine Prices Review BoardRecorded divisions41064454106446410644741064484106449BruceArchibaldBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/460StéphaneDionHon.Stéphane-DionSaint-Laurent—CartiervilleLiberal CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/DionStéphane_Lib.jpgInterventionHon. Stéphane Dion: (1715)[Translation]Okay. Thank you.[English]Madam Cornell, in recommendation number 4 you state the following:That the federal government recognize those dance organizations working to improve Canadians’ health and well-being by providing access to federal funding at agencies such as Health Canada and Industry Canada. What do you have in mind here?DanceDepartment of HealthDepartment of IndustryGovernment assistance40962014096202LorraineHébertKateCornellKateCornellKate-CornellInterventionMs. Kate Cornell: (1715)[English]There are many dance organizations that are working in schools across Canada, helping those teachers who are afraid to teach dance, to have the benefit of a professional artist in the schools to give them exposure to professional dance. Those dance organizations are helping to keep Canadians healthy.Because education obviously is a provincial concern, currently these programs come under operating funding from the Canada Council, and possibly from the Department of Canadian Heritage. There is no special funding directed toward these programs.I can't help but notice that at Industry Canada they have in their Canada 150 program a pillar that is culture, and yet several—I believe that most of their programs are not-for-profits—aren't actually eligible to apply for those programs. It may be examining that.I'm certainly not an expert in health. But I also wonder, in terms of the incredible benefits Mr. Dalrymple was speaking about with the Sharing Dance program, getting a million Canadians dancing, if there could possibly be some funding there to recognize the health value of dance and the work that's going on at these important dance organizations.DanceDepartment of HealthDepartment of IndustryGovernment assistance4096203409620440962054096206StéphaneDionHon.Saint-Laurent—CartiervilleStéphaneDionHon.Saint-Laurent—CartiervilleFrankCleggFrank-CleggInterventionMr. Frank Clegg (Chief Executive Officer, C4ST, Canadians For Safe Technology): (1545)[English]Mr. Chair and committee members, I'd like to thank you for the invitation to speak with you this afternoon and for deciding to invest committee time on Safety Code 6.When I ran the Canadian operations for Microsoft, I learned that it is critical to focus on process. Today, as a board member for Indigo Books and Music, my role has shifted more towards governance and oversight. In both roles, process is critical to success. Government is the largest corporation of all, so process is of paramount importance. As someone who regularly examines success and failure, I believe I can explain why the Safety Code 6 process is a failure by all metrics and has left Canadians unprotected. There is a book written by Nassim Taleb called The Black Swan, a focus on very low-probability, high-impact events that aren't supposed to happen. Oil spills, train derailments, and airplane crashes are some of the events in this category. Taleb calls these “black swan” events. If one decides that all swans are white and refuses evidence of black swans, then one will conclude that all swans are white. Black swans are rare, but they do exist. Unfortunately, experts convinced themselves that these events had zero probability. They did not plan appropriately and people died. The American Academy of Environmental Medicine is an international organization of physicians and scientists that has predicted, among other things, the rise in multiple chemical sensitivity, which is now protected in many public policies. Regarding the unprecedented increase in wireless devices, the academy forecasts “a widespread public health hazard that the medical system is not yet prepared to address”. I believe Health Canada's analysis focuses on identifying and counting white swans, while ignoring black swan evidence. Health Canada's representative informed this committee on March 24: ...some of these studies report biological or adverse health effects of RF fields at levels below the limits in Safety Code 6, I want to emphasize that these studies are in the minority and they do not represent the prevailing line of scientific evidence in this area.In other words, black swans exist.In your handout—I don't know if you have it, as we put it in for translation—is a document entitled “Analysis of 140 Studies Submitted by Canadians for Safe Technology (C4ST) During the Public Comment Period on Safety Code 6”. A chart in that document shows that Health Canada accepts that there are in fact 36 studies all passing Health Canada's quality criteria showing harm at levels below Safety Code 6. As a Canadian, I find this confusing. As an executive, I find it inexcusable.Of the 36 studies Health Canada deemed satisfactory, cancer is linked in six of them. In 13 of them, the brain and/or nervous system is disrupted. In 16 studies, Health Canada admits that biochemical disruption occurs. Finally, seven high-level scientific studies indicate an effect on intellectual development and/or learning behaviour. All of these studies show impacts with radiation below Safety Code 6 limits. How was this black swan evidence evaluated?In our two-year investigation, C4ST has determined that Health Canada doesn't even have the proper software required to access, summarize, and analyze the large number of relevant studies. If our group of learned and qualified volunteers can uncover 140 studies, how many more are being missed or ignored? Health Canada references its weight-of-evidence approach. It is unclear how many studies you need to outweigh 36 studies that show harm, especially to children. I just can't fathom why Health Canada is not highlighting these studies and prioritizing their implications. Despite requests to publish the weight-of-evidence criteria as per international standards, Health Canada refuses to do so. Even the recent 2015 rationale document does not provide this critical information.Health Canada dismisses scientific evidence unless it shows harm where the microwave levels are strong enough to heat your skin. The notion that microwaves are not harmful unless they heat your skin is decades out of date. The core premise of this white swan dates back to Einstein's theory that non-ionizing radiation cannot cause harm, or if it does, it must heat tissue to do that. Albert Einstein passed away the same year Steve Jobs was born. To think that science has not evolved since then is classic white swan thinking. It's part of a process predetermined to fail.(1550) Health Canada says on its website today that there is no chance that Wi-Fi or cellphones can harm you because it has studied all the science, but when pressed under oath, Health Canada officials give a more fulsome answer. In Quebec Superior Court in September 2013, Health Canada senior scientist James McNamee admitted that Health Canada only assesses risk based on the thermal effect, i.e., the heating of tissue. Unfortunately, Canada has not invested the necessary time nor had the balanced opinion of experts necessary to undertake a proper review. Our research has uncovered that the Health Canada author of Safety Code 6 has published papers demonstrating his bias towards this topic.In a few hours over three days, this health committee has spent more time speaking with scientific experts who believe there is harm from wireless radiation below Safety Code 6 than all of Health Canada combined. You can't find black swans when you don't talk to the experts who've identified them.There is a fundamental business rule: you can't manage what you don't measure. It is clear that Health Canada not only doesn't follow that rule but even resists it. A memo obtained under access to information to the Minister of Health in March of 2012 revealed that Health Canada “does not support the recommendation to establish an adverse reaction reporting process specifically for RF exposures”. The memo goes on to state that “consumer complaints...may be directed to...the web-based system...under the...Canada Consumer Product Safety Act”. This is an inadequate solution and, I believe, a missed opportunity. I refer you to the C4ST fact sheet. I think you have it. I'd like to highlight three examples from that fact sheet: Health Canada's Safety Code 6 is among the countries with the worst guidelines in the world; Canada has fallen behind countries such as France, Taiwan, and Belgium in protecting Canadians; and finally, Health Canada wasted over $100,000 of taxpayers' money, as the Royal Society report is not an independent review.Health Canada also states that Safety Code 6 is a guideline and that other organizations at the provincial and local levels of government are free to implement lower levels as they see fit; however, that's not the reality of what happens. We have witnessed school boards, power and water utilities, Industry Canada, and manufacturers depending on Health Canada's analysis, and frankly, abdicating to it. They don't perform their own analysis. Safer solutions exist. There are several situations in Canada regarding cell towers where the proponents have voluntarily offered to restrict radiation exposure, in some cases to thousands of times less than Safety Code 6. There is a solution in Iowa for smart meters that use a wired meter that provides a safer, more secure solution at a lower cost. Given that our track record in North America is not successful regarding such products as tobacco, asbestos, BPA, thalidomide, DDT, urea-formaldahyde insulation, and many others, use of the precautionary principle of prudent avoidance should be recommended until the science proves beyond reasonable doubt that there is no potential for harm. For the last three years, science has published a new study every month that shows irreparable harm at levels below Safety Code 6. That is why we're asking the committee to take three decisive steps. First, conduct a national campaign to educate Canadians about methods to minimize exposure to RF radiation, ban Wi-Fi in day care centres and preschools, and ban the marketing of wireless devices to children.Second, protect individuals who are sensitive to RF radiation by accommodating them with safer levels of wireless exposure in federal workplaces and federal areas of responsibility.Third, and finally, create an adverse reporting system for Canadians and a publicly available database to collect improved data regarding potential links between health effects and exposure to RF radiation. Parallel to the above, recommend that Health Canada conduct a comprehensive systematic review, subject to international standards, regarding the potential harmfulness of RF radiation to human health, with a scientific review panel that is balanced in opinion. It was a textbook case of black swan thinking that has led to this failure of Safety Code 6.(1555) In conclusion, C4ST volunteers found 36 black swans that Health Canada agrees are high quality. How many would be available if Health Canada sincerely looked? Better yet, how many black swans will it take before Health Canada takes serious actions? Thank you very much.Best practicesCanadians For Safe TechnologyChildrenData banks and databasesDepartment of HealthElectromagnetic radiationExamination of the Potential Health Impacts of Radiofrequency Electromagnetic RadiationExpert Panel Report on A Review of Safety Code 6 (2013) : Health Canada's Safety Limits for Exposure to Radiofrequency FieldsGovernment advertisingHealthInformation disseminationMicrowavesPrecautionary principlePublic complaintsPublic healthPublic Service and public servantsRisk managementScientific dataScientific research and scientistsSetting of standardsWireless communicationWorkplace health and safety40743914074392407439340743944074395407439640743974074398407439940744004074401407440240744034074404407440540744124074413BenLobbHuron—BruceBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/232ChristineMooreChristine-MooreAbitibi—TémiscamingueNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/MooreChristine_NPD.jpgInterventionMs. Christine Moore: (1610)[Translation]We know that provincial health care is paying more and more for infertility treatments. Should we, in your opinion, pay particular attention to this issue if we want to avoid getting an enormous bill later? Often, people try to have a child for a long time before realizing that they have these problems. If someone has been carrying a cell phone in his pocket for 20 years, then it may be difficult to help with related issues later. Should this be of particular concern to us, in your opinion?CostsDepartment of HealthGovernment advertisingHealthHealth care systemInfertilityMicrowavesYoung people4074471MagdaHavasFrankCleggFrankCleggFrank-CleggInterventionMr. Frank Clegg: (1610)[English]One of our recommendations is for Health Canada to raise an awareness campaign. Part of that awareness campaign should be telling young men to keep the phone out of their pants' pockets, because that's where men keep their phones. Young men keep their phones in their pockets. That's why we were calling for a recommendation to have Health Canada educate people to be aware that there is a potential risk and prevent it.Department of HealthGovernment advertisingHealthInfertilityMicrowavesYoung people4074472ChristineMooreAbitibi—TémiscamingueMagdaHavas//www.ourcommons.ca/Parliamentarians/en/members/72006DavidWilksDavid-WilksKootenay—ColumbiaConservative CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/WilksDavid_CPC.jpgInterventionMr. David Wilks (Kootenay—Columbia, CPC): (1615)[English]Thanks, Chair.Thank you to the witnesses for being here. I'll share my time with Mr. Richards, because he has to leave here after the first hour, I believe.You perked my interest when you said police officers and radar because I did that for a year and a half. Professor Miller, you mentioned in your opening remarks that an opportunity to provide greater safety to the public has been missed. You did explain a bit about it, but I wonder if you could articulate a little more on what we've missed and what we could move forward with in respect to recommendations to Health Canada and to the minister.Department of HealthHealthMicrowavesPublic health4074480BenLobbHuron—BruceAnthonyMillerAnthonyMillerAnthony-MillerInterventionDr. Anthony Miller: (1615)[English]When I think about Health Canada, I'm not saying this committee has missed. What Health Canada has missed is a proper scientific review of the data that would convince them—and I don't understand why they haven't been convinced—that the limits they have placed in their advisory limits are not sufficiently safe to protect the population. That's why I believe an opportunity to protect the population, and potentially to prevent a major cancer problem in the future, has been missed by Health Canada.Department of HealthHealthMicrowavesPublic health4074481DavidWilksKootenay—ColumbiaDavidWilksKootenay—Columbia//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionThe Honourable Hedy Fry (Vancouver Centre, Lib.): (1620)[English]This is like déjà vu. I think you asked a very important question, Dr. Havas. I don't understand. Inherent, for instance, in the medical ethos is to first do no harm, so the primary thing for a physician is the precautionary principle unless you see that the benefits outweigh the risks and you are prepared to do some harm in order to divert worse harm. I've been listening to this so I called up my son and my daughter-in-law and I said, “Hey, you guys have a wireless baby monitor on my granddaughter's crib. I'm hearing this stuff and I think maybe you should take precautions and get a plug-in monitor or find a way to turn it on only when you need to”. They said to me, “Oh, for God's sake, that is such a bunch of hokey stuff. The guidelines are clear, blah, blah, blah”, and of course I was almost accused of crying wolf. If I couldn't convince my children that this is not reasonable and fair.... I think you said that it was 50 years before we got anybody to understand, in spite of evidence, that cigarettes caused cancer; and in the case of acid rain, it was 20 years. Surely to goodness we have learned by now that we shouldn't be taking that long. We need to see the harm that not acting on evidence sooner does.Given that those blocking this the most are in industry themselves, and the fact that, let's be honest, governments have to balance economic growth and development and progress against harm to the greater good, and given that there is almost this conflict of interest between how governments currently operate and how governments could operate to protect people, how can we convince the public, which is completely addicted to Wi-Fi and to wireless devices, when they don't know anything else? I'm addicted. I can't put away my stupid BlackBerry, so how do we convince people, because public awareness, obviously, as Frank said, must be a part of the recommendations? How do you put forward a public awareness program that will actually reach people and sink in without people saying, “Oh my God, everybody is being so hysterical about this”?Department of HealthElectronics industryHealthInformation disseminationMicrowavesWireless communication4074512BenLobbHuron—BruceFrankCleggFrankCleggFrank-CleggInterventionMr. Frank Clegg: (1625)[English]I would make two comments, Dr. Fry. I would say that people are smart, and when they have the right information, they act appropriately and they act responsibly, particularly parents with newborns. What I've heard though, hundreds of times now, is that it must be okay if Health Canada says it's safe. They don't understand that it takes time for this information to be digested. As Dr. Miller said, we are befuddled as to why Health Canada isn't being more active. If the health authority in Canada, which is Health Canada, came out with very clear statements that said there is proof that there could be harm, so we should be careful and take a precautionary approach, I think you would see the majority of Canadians change what they do. You also made a comment about industry. I have spent my life in industry. We go out and work hard to provide technology that is cheaper, faster, better. That's the way we work.Department of HealthHealthInformation disseminationMicrowavesWireless communication4074515HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1625)[English]I do think, however, there's this inherent conflict and problem because Industry Canada should be looking at how we can make sure that industry is progressive, is functioning, and we have economic development going on in the country. But that is not Health Canada's mandate.Department of HealthHealthMicrowaves4074523FrankCleggFrankClegg//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1625)[English]Health Canada's mandate is very clear. It is supposed to protect the health and safety of Canadians.Department of HealthHealthMicrowaves4074525FrankCleggFrankCleggFrankCleggFrank-CleggInterventionMr. Frank Clegg: (1625)[English]Agreed.Department of HealthHealthMicrowaves4074526HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1625)[English]Surely to goodness I think we in this committee here, having heard the things we heard, and having learned—because I'm long in the tooth—from the things we had been fighting against, for such a long time, that cause great harm and eventually everyone.... Now we have seatbelts in legislation, and all of those kinds of things that protect people. It was a long fight.For me, the idea that we should let Health Canada believe that it has to be true to its own mandate, which is the protection of Canadians, should be the overriding concern of this committee. I can tell you now it's something that I've taken seriously and it's something I'm going to do something about. I've lived through this stuff, as a physician and in all of my years as an environmental advocate, etc., and we have to do better than we currently do now. I want to thank you for your presentation, actually, because it's clear and it's scientifically based. The evidence you talked about is something that we need to call for, which is a new review. Given that other countries have set the tone, France and Israel, and other countries, I think this committee should hear you very clearly. I know some of us are.Department of HealthHealthMicrowaves4074528FrankCleggMagdaHavas//www.ourcommons.ca/Parliamentarians/en/members/59265CathyMcLeodCathy-McLeodKamloops—Thompson—CaribooConservative CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/43/McLeodCathy_CPC.jpgInterventionMrs. Cathy McLeod (Kamloops—Thompson—Cariboo, CPC): (1625)[English]Thank you.I'd like to thank the witnesses for their presentations.Certainly, as I mentioned before, I was on the committee that originally set that process in place in terms of the work done by the Royal Society. Certainly the intention of the committee was to have something that was very solid in terms of its response to that issue.I understand Canada is also currently very active with the WHO in terms of a massive undertaking. Is maybe that the better place to be really looking at the scientific reviews around this issue? Could someone speak to the WHO process? It seems sometimes like we have all these different countries that spend a lot of time, money, and energy, and keep reinventing the wheel. What about this international collaboration piece and is that the better mechanism?Department of HealthElectronics industryHealthMicrowavesSetting of standardsWorld Health Organization4074544BenLobbHuron—BruceAnthonyMillerFrankCleggFrank-CleggInterventionMr. Frank Clegg: (1630)[English]I would also add, Ms. McLeod, that as a Canadian I am proud that we're leading the world on some things, like acid rain. I don't want to wait for an international consensus to act. I would be afraid to death that my future grandchildren would have to wait for the WHO to lead what I think is clear evidence today that Health Canada has the mandate, the authority, and the resources to lead the world, or be among the leaders, in fact, not even lead the world, but catch up to some countries. I would really resist relying on a WHO process.When they did the IARC committee—and you'll hear from the next speaker, that the IARC committee, and Dr. Miller wrote the paper on the cancer section—you had a full body of scientists who had contrarian opinions. That's what I have learned over the last several years now is where good science happens. You have two sides of the debate and they get in a room and debate, as they did in 2011 when they debated among 30 scientists around the world. The WHO committee is not made up of a balance of scientists with opposing views.Department of HealthHealthInternational Agency for Research on CancerMicrowavesSetting of standardsWorld Health Organization4074546AnthonyMillerCathyMcLeodKamloops—Thompson—CaribooDariuszLeszczynskiDariusz-LeszczynskiInterventionProfessor Dariusz Leszczynski (Adjunct Professor, Department of Biosciences, University of Helsinki, As an Individual): (1640)[English] Thank you very much.Thank you for inviting me to this hearing. It's an honour and a pleasure.My name is Dariusz Leszczynski. I'm currently adjunct professor for biochemistry at the University of Helsinki, in Finland. I have done research in the area of biological and health effects of cellphone-emitted radiation since 1997. I was a member of the expert group of IARC, which in 2011 classified cellphone radiation as a possible human carcinogen. When scientific evidence is unclear, contradictory, or ambivalent, careful and unbiased interpretation of it is of paramount importance. However, it is often the case that such scientific evidence gives room for a diverse interpretation that may lead to the development of contradictory expert opinions, causing confusion and impairing development of rational recommendations aimed at protecting the general population. This is the current situation in the area of cellphone- and wireless communication-emitted radiation. Unclear experimental evidence leads to the polarization of the scientific opinions into two extremes: the no-effect opinion and the harmful-effect opinion. Currently scientists do not agree on the matter of biological and health effects of radiation exposures. The term “consensus” might be be misleading for the general public. We should rather speak about “differences in scientific opinion”. A recent comment by the head of the World Health Organization's EMF project, Dr. Emilie van Deventer, well describes the current situation, and I will quote her comment given for The Daily Princetonian, “There is no consensus, it’s true. There’s a big group and a little group, but it’s still two groups.”Talking about a big and a small group is a pure speculation because the size of the groups was never examined. From my nearly 19 years of experience in this area of research, I know that the vast majority of the scientists do not openly take a side in the debate. The interpretation of scientific evidence by committee is of most use for the decision-makers. This is the reason that the development of unbiased opinions by committees are of paramount importance. Opinions of committees are defined by the expert composition. In an ideal committee, experts would not have conflict-of-interest issues and would be independent of any kind of lobbying; only science would matter. Nearly all of the committees dealing with the health effects of radiation emitted by wireless communication devices have a problem of biased expert selection, a potential conflict of interest, and a potential influence by an industrial lobby, which may occur in spite of set-up firewalls.The majority of the committees consist of scientists having the same expert opinion. Individual committees experts commonly do not reflect all current scientific opinions. This concerns both international committees and national committees. This includes the committee in Canada that provided evidence for Safety Code 6. The composition of the Health Canada expert committee was clearly biased towards the no-effect opinion, and some of the experts are known to advise the telecom industry. This is a serious potential conflict of interest.The above-mentioned system of firewalls to protect experts from influence of industry doesn't work. Industry sponsors know who receives funding; sponsored scientists know who provides funding. This is especially worrisome when the influential ICNIRP committee is in part funded by the industry through firewalls of the Royal Adelaide Hospital in Australia. The same goes for the EMF project of the WHO. If your experts know very well that the opinions of ICNIRP will be unfavourable for the telecom industry, their sponsorship may end. The firewall is only a gimmick.(1645) Currently, WHO's EMF project is preparing an evaluation of the scientific evidence concerning health effects of radiation emitted by wireless communication devices, the so-called environmental health criteria for RF-EMF. The major problem with the draft document of environmental health criteria is the lack of balanced presentation of the scientific evidence. The environmental health criteria draft was written solely by scientists with a no-effect opinion.The environmental health criteria document will have a global impact on billions of users of wireless technology and on the multi-trillion dollar business. This is why it is disturbing that preparation of such a document is solely reflecting opinions of ICNIRP, an organization with a firm, single-sided, no-effect opinion. This is a disturbing situation, where one group of scientists was given preferential treatment only because of their close link with the WHO and where other relevant expert opinions were deliberately and arbitrarily excluded without scientific debate.Recommendations for decision-makers developed by committees, where memberships are consistently biased towards either a no-effect opinion or harmful effect opinion, are not representative of the whole currently available scientific evidence and should be viewed with extreme caution, or outright dismissed, until the proper, unbiased evaluation takes place.To my knowledge there was only one scientific committee—IARC's working expert group in 2011, of which I was a member—where the full scope of diverse scientific opinions were represented. IARC classification completely disagreed with one-sided opinions of the majority of international and national committees, including Health Canada. Until an unbiased, round table of scientific debate takes place, where all scientific opinions will be duly represented and evaluated, the opinions developed to date by various international and national committees, based on biased expert selections, should be dismissed by decision-makers as insufficient.According to year 2000 documents of the European Union on the precautionary principle, there are three criteria that need to be fulfilled in order to implement the precautionary principle. All of them are currently fulfilled.Number one, scientific information is insufficient, inconclusive, or uncertain to make a firm decision. This is exactly what the IARC classification says on cellphone radiation as a possible human carcinogen, group 2B.Number two, there are indications that the possible effects to human health may be potentially dangerous. Increased risk of brain cancer in long-term, avid users is a dangerous outcome, shown by three replicated epidemiological studies: European INTERPHONE, Swedish Hardell group, and French CERENAT studies.Number three, the effects are inconsistent with the chosen level of protection. Epidemiological studies showing an increased risk in long-term, avid users were generated in populations using regular cellphones meeting all current safety standards. This means that the current safety standards are insufficient to protect users because the risk of developing cancer increases in long-term, avid users.Proponents of the precautionary principle need to understand that precaution does not equal prevention of use of wireless technology. Requirements to develop more efficient, less radiation-emitting technology, and further biomedical research on the radiation effects, will create new knowledge through research and will create jobs in the research and technology. Implementation of the precautionary principle will not prevent technological developments. Claims by some that the implementation of the precautionary principle will cause economic stagnation are unfounded.(1650) In the current situation of inadequate review of scientific evidence by groups of scientists with biased selection of members, and until the round table, unbiased review is performed, decision-makers should implement the precautionary principle. The reason is not that the harm was proven beyond doubt, but because the harm is possible and evidence is uncertain and suggesting that harmful health effects are possible. The precautionary principle was developed just for such situations where scientific uncertainty with concomitant indications of possible harm requires society to wait for more scientific evidence. Saying, “Better to be safe than sorry” applies here.Thank you.Conflict of interestDepartment of HealthElectronics industryEuropean UnionExpert panelsHealthInternational Agency for Research on CancerInternational Commission on Non-Ionizing Radiation ProtectionLegislationLobbying and lobbyistsMicrowavesPrecautionary principlePublic healthScientific dataScientific research and scientistsUniversity of HelsinkiWireless communicationWorld Health Organization4074581BenLobbHuron—BruceBenLobbHuron—BruceAndrewAdamsAndrew-AdamsInterventionMr. Andrew Adams (Director General, Environmental and Radiation Health Sciences Directorate, Department of Health): (1530)[English]Thank you very much. I have some opening remarks to make. Chairman and members of the committee, it is my pleasure to be here today to speak on Health Canada Safety Code 6. My name is Andrew Adams, and I am the director of the environmental and radiation health sciences directorate in the healthy environments and consumer safety branch of Health Canada. I am joined today by Dr. James McNamee, the chief of the health effects and assessments division in the consumer and clinical radiation protection bureau and the lead author of Safety Code 6.Safety Code 6 is Health Canada's guideline for exposure to radio frequency, or RF, electromagnetic energy, the kind of energy given off by cellphones and Wi-Fi, as well as broadcasting and cellphone towers. Safety Code 6 provides human exposure limits in the 3 kilohertz to 300 gigahertz frequency range, and we have provided chart A of the electromagnetic spectrum, just so committee members can situate the frequency range we're talking about. But Safety Code 6 does not cover exposure to electromagnetic energy in the optical or ionizing radiation portions of the electromagnetic spectrum. Safety Code 6 establishes limits for safe human exposure to RF energy. These limits incorporate large safety margins to protect the health and safety of all Canadians, including those who work near RF sources.[Translation]While Safety Code 6 recommends limits for safe human exposure, Health Canada does not regulate the general public's exposure to electromagnetic RF energy.Industry Canada is the regulator of radiocommunication and broadcasting installations and apparatus in Canada. To ensure that public exposures fall within acceptable guidelines, Industry Canada has developed regulatory standards that require compliance with the human exposure limits outlined in Safety Code 6.[English]I'd like to talk a little bit about the approach for updates to Safety Code 6. Safety Code 6 is reviewed on a regular basis to verify that the guideline provides protection against all known potentially harmful health effects and that it takes into account recent scientific data from studies carried out worldwide. The most recent update to Safety Code 6 was completed earlier this month. I will describe the process used for that update later in my remarks.When developing the exposure limits in the revised Safety Code 6, departmental scientists considered all peer-reviewed scientific studies, including those pertaining to both thermal and non-thermal, and employed a weight-of-evidence approach when evaluating possible health risks from exposure to RF energy.The weight-of-evidence approach takes into account both the quantity of studies on a particular end point and the quality of those studies. Poorly conducted studies receive relatively little weight, while properly conducted studies receive more weight.Now I'll focus on the recent update of Safety Code 6. (1535)[Translation]The most recent update to Safety Code 6 was initiated in 2012, with the goal of ensuring that the most up-to-date and credible scientific studies on the potential effects of RF energy on human health were reflected in the code.Health Canada proposed changes to Safety Code 6 that were based on the latest available scientific evidence, including improved modelling of the interaction of RF fields with the human body, and alignment with exposure limits specified by the International Commission on Non-Ionizing Radiation Protection. These changes were proposed to ensure that wide safety margins were maintained to protect the health and safety of all Canadians, including infants and children.[English]Some of you may recall that this committee previously conducted a study on the potential health impacts of RF electromagnetic radiation. Among the recommendations included in the committee's December 2010 report was a recommendation that:Health Canada request that the Council of Canadian Academies or another appropriate independent institution conduct an assessment of the Canadian and international scientific literature regarding the potential health impacts of short and long-term exposure to radiofrequency electromagnetic radiation.... ln response to this recommendation, in 2013, Health Canada contracted the Royal Society of Canada to review the results of emerging research relating to the safety of RF energy on human health, to ensure it was appropriately reflected in the revised Safety Code, through a formalized expert panel process.I'm sure you know that today we're joined by the chair of the expert panel and one of the members of the expert panel. The Expert Panel of the Royal Society released their review in March 2014, concluding that in the view of the panel there are no established adverse health effects at exposure levels below the proposed limits.Among the recommendations made by the expert panel was the suggestion that the proposed reference levels in the draft Safety Code 6 be made slightly more restrictive in some frequency ranges to ensure larger safety margins for all Canadians, including newborn infants and children. [Translation]ln the interest of openness and transparency, Health Canada also undertook a 60-day public consultation period for the proposed revisions to Safety Code 6 between May and July 2014. The department invited feedback from interested Canadians and stakeholders.Comments related to the scientific and technical aspects of Safety Code 6 received by Health Canada during the public consultation period, as well as the recommendations provided by the Royal Society Expert Panel, were taken into consideration when finalizing the revised guideline.[English]The final version of Safety Code 6 was published on March 13, 2015. Health Canada also published a summary of the feedback received during the public consultation period. Given the scientific basis of the guideline, only feedback of a technical or scientific nature could be considered in the finalization of Safety Code 6; however, the summary of consultation feedback responds to both technical and non-technical comments received from Canadians. [Translation]With the recent update, Canadians should be confident that the radiofrequency exposure limits in Safety Code 6 are now among the most stringent science-based limits in the world.[English]To shift a little bit and talk about the scientific methodology that underlies the revision of Safety Code 6, a large number of submissions received during the public consultation period raised concerns that Health Canada had not considered all of the relevant scientific literature when updating Safety Code 6. ln particular, it has been stated that 140 studies were ignored. I would like to address that criticism here today. ln updating Safety Code 6, Health Canada made use of existing internationally recognized reviews of the literature along with its own expert review of the relevant scientific literature. Numerous reviews on this issue have been written in recent years by international organizations such as the World Health Organization, the European Commission's Scientific Committee on Emerging Newly identified Health Risks, and ICNIRP. I believe we have provided links to some of these reports for the committee's interest.(1540)[Translation]While Safety Code 6 references these international reviews, the code is an exposure guideline, not a scientific review article. Accordingly, most individual scientific studies are not referenced in the code. However, this does not mean that Health Canada did not consider all relevant scientific information when deriving the science-based exposure limits in the code. I can assure you we did.[English]lt should be noted that studies with inappropriate study design or methodology can lead to erroneous results that are scientifically meaningless. Studies were considered not to be of sufficient quality to inform the recent update if it was not possible to determine the dosage studied, if the study lacked an appropriate control, if experiments within the study were not repeated a sufficient number of times, if no statistical analysis of the results was conducted, or if other improper scientific techniques were used. Of the 140 studies that have been cited, a large number fall into this category. Other studies were not considered to be within scope. For example, some of these studies looked at exposures to a frequency range outside of the frequency range covered by Safety Code 6 and were therefore not considered relevant.[Translation]However, Health Canada did consider all studies that were considered to be both in scope and of sufficient quality for inclusion in our risk assessment. While it is true that some of these studies report biological or adverse health effects of RF fields at levels below the limits in Safety Code 6, I want to emphasize that these studies are in the minority and they do not represent the prevailing line of scientific evidence in this area.[English]The conclusions reached by Health Canada are consistent with reviews of the scientific evidence by national and international health authorities. Of note, the European Commission's Scientific Committee on Emerging and Newly Identified Health Risks earlier this month released its final opinion on the potential health effects of electromagnetic fields. SCENIHR concluded that there are no evident adverse health effects, provided exposure levels remain below levels recommended by European Union legislation.Now I'd like to talk a little bit about an international comparison. Members of the committee may be wondering how the limits in Safety Code 6 compare with limits in other parts of the world. I refer you to the chart of radio frequency exposure limits for the general public in different countries. Internationally, a few jurisdictions have applied more restrictive limits for RF field exposures from cell towers; however, there is no scientific evidence to support the need for such restrictive limits. Canada's limits are consistent with, if not more stringent than, the science-based limits used in such other jurisdictions as the European Union, the United States, Japan, Australia, and New Zealand.In conclusion, the health of Canadians is protected form radio frequency electromagnetic energy when the human exposure limits recommended in Safety Code 6 are respected. Safety Code 6 has always established and maintained a human exposure limit that is far below the threshold for potentially adverse health effects. The health of Canadians was protected under the previous version of Safety Code 6, and recent revisions to the code ensure even greater protection.Health Canada will continue to monitor the scientific literature on this issue on an ongoing basis. Should new evidence arise that indicates a risk to Canadians at levels below the limits in Safety Code 6, the department would take appropriate action.[Translation]Thank you for your time.Best practicesCellphone towersChildrenDepartment of HealthDepartment of IndustryElectromagnetic radiationEuropean CommissionExamination of the Potential Health Impacts of Radiofrequency Electromagnetic RadiationExpert Panel Report on A Review of Safety Code 6 (2013) : Health Canada's Safety Limits for Exposure to Radiofrequency FieldsExpert panelsForeign countriesHealthLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowavesPublic consultationRegulationRoyal Society of CanadaScientific dataScientific research and scientistsSetting of standards4037665403766640376674037668403766940376704037671403767240376734037674403767540376764037677403767840376794037680403768140376824037683403768440376854037686403768740376884037689403769040376914037692403769340376944037695403769640376974037698BenLobbHuron—BruceBenLobbHuron—BrucePaulDemersPaul-DemersInterventionDr. Paul Demers (Director, Occupational Cancer Research Centre, Cancer Care Ontario, As an Individual): (1550)[English] Thank you, Mr. Chair and members of the committee, for inviting me here today. I know I've been asked to come here today because I chaired the expert panel of the Royal Society of Canada on Safety Code 6. But I thought I'd start by saying a few other things about my background.I'm the director of the Occupational Cancer Research Centre, which is based in Cancer Care Ontario, a provincial agency that is also funded by the Ontario Ministry of Labour and the Canadian Cancer Society. I'm also a member of the faculty of the schools of public health of the University of Toronto and the University of British Columbia. I am an epidemiologist, so I study impacts of different types of health effects upon populations of people, but my primary area of research is on the risk of cancer associated with workplace chemicals, dust, and radiation, although I have done research on a number of other diseases as well as on environmental exposures. However, I want to state that, unlike Dr. Prato, I'm not an expert specifically in the area of electromagnetic fields and have never actually done research on radio frequency radiation.As you know, at the request of Health Canada the Royal Society convened an extra panel to conduct a review of the 2013 draft of Safety Code 6. I was asked to chair that panel because I had no conflicts of interest and because of my expertise in cancer epidemiology, which was identified as one of the areas for which they wanted expertise on the panel. I was also asked because of my experience sitting on similar panels for the International Agency for Research on Cancer, the U.S. national toxicology program, the U.S. Institute of Medicine, which is part of the National Academy of Sciences, and the Council of Canadian Academies, the latter two being fairly similar to the Royal Society of Canada in the way they operate.I should also mention, although you may be aware of this already, that I was the second chair of the panel. The first panel resigned because of a perceived conflict of interest, and I took over as chair of the panel about midway through. But I also want to state that I'm here as individual and am not representing the Royal Society of Canada or any other organization at this point.The panel was presented with five specific questions, and I'm going to over very briefly our responses to those five questions. Overall, they were all dealing with whether or not there were any established health effects at levels below those recommended by Safety Code 6 and related types of questions. To answer these questions, we did a review of recently published studies in the area on a wide range of different types of health effects. We also looked at many of the international reviews, which I think have already been mentioned here today. These are conducted on a pretty regular basis by many agencies around the world.Because we were asked to look in particular at established health effects, we defined an established adverse health effect as something that has been seen consistently or been observed consistently in multiple studies with a strong methodology. So we had a fairly flexible definition, but still it required an effect's being observed in not just a single study.Before I get into the questions—because I'm actually going to read out the questions we were given—I want to explain two different terms that are used quite a bit in those questions, namely the definition of what basic restrictions are and what reference levels are. Basic restrictions in Safety Code 6 are things that happen within the body, either heating or induced fields within the bodies, or things like those. Many of the actual limits are set based upon that. Because these are not easily measured, the code also uses reference levels, which are things you can measure outside of the body using a meter. They are much easier for regulatory purposes. You will often see that the questions are phrased in terms of these basic restrictions and reference levels.(1555) Our first question was, do the basic restrictions specified in Safety Code 6 provide adequate protection for both workers and the general population from established adverse health effects of radio frequency fields? Our conclusion was that yes, they provided that protection. Specifically, Safety Code 6 was designed to protect against two kinds of established health effects, thermal effects and peripheral nerve stimulation. The margins of safety, we concluded, appeared to be quite protective. For peripheral nerve stimulation, it was a safety factor of five for the workplace or controlled environments, and a 10-fold factor for uncontrolled environments, which are closer to what you would experience in the general public. For thermal effects, the safety factor was 10-fold for workplaces and 50-fold for the general public.The second question that we were given was, are there any other established adverse health effects occurring at exposure levels below the basic restrictions on Safety Code 6 that should be considered in revising the code? Our conclusion to that question was no. The panel reviewed the evidence for a wide variety of health effects, including cancer, cognitive and neurologic effects, male and female reproductive effects, development effects, cardiac function, heart rate variability, electromagnetic hypersensitivity, and adverse effects in susceptible areas of the eye. Although research in many of these areas—important research, I think—continues, we were unable to identify any adverse health effects occurring at levels below those allowed by Safety Code 6.Our third question related specifically to the eye: Is there sufficient scientific evidence upon which to establish separate basic restrictions or recommendations for the eye? We concluded that no there wasn't sufficient evidence. Recent studies do not show adverse health effects in susceptible regions of the eye at exposure levels below those proposed by Safety Code 6 for the head, neck, and trunk. Therefore we recommended that it not contain separate basic restrictions for the eye.The fourth question was perhaps a bit more complex: Do the reference levels established in Safety Code 6 provide adequate protection against exceeding the basic restrictions? That is, do the levels that are proposed as limits for things you can measure outside the body actually protect against the target health effects the code is trying to prevent within the body? Our conclusion was that for most frequencies, yes, reference levels were adequate, but that there were some regions where compliance with the reference levels may not ensure compliance with the basic restrictions. We recommended that the proposed reference levels in Safety Code 6 be reviewed by Health Canada to make them somewhat more restrictive in some frequency ranges to ensure a larger safety margin for Canadians, including newborn infants and children. This recommendation took into account recent studies that we call dosimetry studies, at least one of which was published after Health Canada produced the proposed Safety Code 6. Our fifth question was, should additional precautionary measures be introduced into Safety Code 6 exposure limits? I'll state that although there was a range of opinions on the panel regarding precautionary efforts, overall the panel believed that Safety Code 6 was well-designed to avoid established health effects; we did not have any science-based recommendations for precautionary measures to lower the limits. I'll say that it was for the reasons that I think Dr. Prato explained quite well, which is that we couldn't, at least in looking at the study, say that the evidence tells us that we should lower it it in such a fashion. However, we did recommend a number of other measures that can and should be taken by Health Canada.I'll read some of them here now.(1600) First was to investigate the problems of individuals with what's called electromagnetic hypersensitivity—it goes by other names as well, IEI-EMF, and things like that—with the aim of understanding their health conditions and finding ways to provide effective treatment. Second was to develop a procedure for the public to report suspected disease clusters and a protocol for investigating them. Third was to expand Health Canada's risk communication strategy to address consumer needs for more information around radio frequency radiation.Fourth was to identify additional practical measures that Canadians can take to reduce their own exposure.These recommendations are really in response to the public input that we received as part of the panel. We also had a number of different research recommendations. In particular, if one has the chance to read the report, you'll notice that each section on a particular health effect usually ends by basically pointing out that more research is needed on that health effect. A few of the specific ones are that Health Canada should aggressively pursue research aimed at clarifying the radio frequency radiation cancer issue, which would allow the government to develop protective measures if the risk were substantiated; and that Health Canada should pursue research to expand our current understanding of possible adverse health effects of exposure to radio frequency radiation at levels below those allowed by Safety Code 6.The response to the panel's report from Health Canada—CancerCancer Care OntarioCommunications strategyDepartment of HealthEnvironmental hypersensitivityEpidemiologyExpert Panel Report on A Review of Safety Code 6 (2013) : Health Canada's Safety Limits for Exposure to Radiofrequency FieldsExpert panelsHealthLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowavesPrecautionary principlePublic consultationPublic healthRoyal Society of CanadaScientific dataScientific research and scientistsVision healthWorkplace health and safety40377384037739403774040377414037743BenLobbHuron—BruceBenLobbHuron—BrucePaulDemersPaul-DemersInterventionDr. Paul Demers: (1605)[English]I have about two sentences left. Thank you very much.The response to the panel's report from Health Canada, which is publicly available on the web, is that it would review all the panel's recommendations and would revise the levels in the update to Safety Code 6, which has now been adapted. I am personally not an expert in the measurement of electromagnetic fields, as I mentioned, but Health Canada has reported that our feedback was incorporated. In looking at the new Safety Code 6, you can actually see that changes were made in the frequencies that we had recommended be lowered.With that, I'll end. I'm sorry if I went over time.Department of HealthExpert Panel Report on A Review of Safety Code 6 (2013) : Health Canada's Safety Limits for Exposure to Radiofrequency FieldsHealthLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowaves4037747BenLobbHuron—BruceBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/232ChristineMooreChristine-MooreAbitibi—TémiscamingueNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/MooreChristine_NPD.jpgInterventionMs. Christine Moore (Abitibi—Témiscamingue, NDP): (1605)[Translation]Thank you, Mr. Chair.In December 2010, the Standing Committee on Health published a report entitled “An Examination of the Potential Health Impacts of Radiofrequency Electromagnetic Radiation”. Allow me to summarize the five recommendations I'm interested in.The first recommendation was to provide funding to the Canadian Institutes of Health Research for studies into this matter.The second was to conduct an assessment of scientific literature.The third called for a comprehensive risk awareness program for exposure to electromagnetic radiation.The fourth involved providing information, including awareness sessions.The fifth recommendation was to implement a process to receive reports of adverse reactions.As we know, the government did not respond to that report because of the 2011 federal election. I would like to know which of those five recommendations submitted by the committee over four years ago have been followed, why some of them may not have been implemented, and to what extent certain recommendations were followed.I would also like to know what the next steps are.Department of HealthExamination of the Potential Health Impacts of Radiofrequency Electromagnetic RadiationHealthInformation disseminationLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowaves4037759BenLobbHuron—BruceAndrewAdamsAndrewAdamsAndrew-AdamsInterventionMr. Andrew Adams: (1605)[Translation]Thank you.Health Canada did receive the committee's recommendations in 2010. I can give you an overview of what we have done in response to the recommendations.It could take some time, as there are five recommendations.The Health Canada website provides some information on the effects of electromagnetic fields and on what Canadians can do to protect themselves. We have information on cellphones and on how Canadians can reduce their exposure to those devices. We also have information on Safety Code 6, as well as on its development and measures to protect the health of Canadians.I think we have submitted to the committee a list of documents available on the Health Canada website. I should have a copy of it. Perhaps I should be asking you whether you have received the list. I think we have given you documents from the Health Canada website. Department of HealthExamination of the Potential Health Impacts of Radiofrequency Electromagnetic RadiationHealthInformation disseminationLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowaves4037762ChristineMooreAbitibi—TémiscamingueChristineMooreAbitibi—Témiscamingue//www.ourcommons.ca/Parliamentarians/en/members/232ChristineMooreChristine-MooreAbitibi—TémiscamingueNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/MooreChristine_NPD.jpgInterventionMs. Christine Moore: (1610)[Translation]If I understand correctly, only people who look for the information on your website will be educated. There are no awareness programs for the general population—for instance, warning young people against carrying their cellphones in their pockets, directly against their skin.Department of HealthHealthInformation disseminationLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowaves4037769AndrewAdamsAndrewAdamsJamesMcNameeJames-McNameeInterventionMr. James McNamee (Chief, Health Effects and Assessments Division, Healthy Environments and Consumer Safety Branch, Department of Health): (1615)[English]Yes. For the past several years—at least two years now—there has been an ongoing effort to assemble a risk assessment at an international level through the WHO's international EMF project. This process is basically a systematic review, wherein all studies are identified. They are assessed for quality according to a variety of required measures; the studies are summarized; and there is a statement of their strengths and weaknesses. Some studies that have very poor methodologies or quality are included in the analysis but are removed from the final decision matrix. But they are actually documented, so that there is a very clear, transparent accountability over which studies have been looked at, which studies have been included for risk analysis, and which studies have been excluded based on quality.A draft version of that document was posted on the WHO website, I believe in December 2014. The public consultation was, I think, originally for 30 days, but it was extended to 60 days. I believe that period has now ended. The intent is to publish that risk analysis document by 2016.Department of HealthHealthLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowavesScientific research and scientistsWorld Health Organization40377934037794AndrewAdamsCathyMcLeodKamloops—Thompson—Cariboo//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1620)[English]If there is no database that looks at clusters of new diseases, new cancers, etc., in people who have had extensive cellphone usage, and that is age-related and based on frequency of use, and of course the cumulative effect.... Especially in children, how do you gauge the cumulative effect when it is only in the last three or four years that we have seen people exposing their kids as young as two or three years old to cellphone use, etc. Now, there is obviously no study done on the longitudinal effects of cumulative use, etc., because these kids are still little.Do you not feel that it is important to have some kind of database that looks at clusters, that is reporting clusters, or that physicians may be asked to look at any kind of possible cause and effect on new cancers among people based on the frequency of their cellphone use, the cumulative effect, and age-related use? Has that been done? Has Health Canada tried to set up such a database or reporting system of some kind?CancerChildrenDepartment of HealthEpidemiologyFederal-provincial-territorial relationsHealthInformation collectionLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowaves4037818PaulDemersAndrewAdams//www.ourcommons.ca/Parliamentarians/en/members/35663TerenceYoungTerence-YoungOakvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/YoungTerenceH_CPC.jpgInterventionMr. Terence Young: (1630)[English]I'll tell you why I ask. The two at the bottom are the lowest levels. They are Russia and Switzerland. China and Italy also have extremely low levels. Had they been included, it would have told a significantly different story. In fact, that's 1.2 billion people who are covered by very low levels, well below the levels in Safety Code 6. I was a little disappointed by that.I want to ask you, on record, why you expect the Canadian public to just take your word for it that you looked at 140 studies presented by a national group based in my riding of Oakville. “Just trust us. We looked at them.” Why can't you practise the scientific method and put together a report that says, “We reject this study because it was the wrong frequency. We reject this one because it wasn't repeatable,” or some such thing? That's the scientific method. Why don't you have enough respect for Canadians to show them why you reject the studies or why you accept them. What is your methodology?Department of HealthElectromagnetic radiationHealthLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowavesScientific research and scientists40378474037848403784940378504037851AndrewAdamsAndrewAdamsAndrewAdamsAndrew-AdamsInterventionMr. Andrew Adams: (1630)[English]I can assure you, as I did during my opening remarks, that we did look at the 140 studies. Most of those studies had already been looked at when the safety code was updated, but—Department of HealthElectromagnetic radiationHealthLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowavesScientific research and scientists4037852TerenceYoungOakvilleTerenceYoungOakville//www.ourcommons.ca/Parliamentarians/en/members/35663TerenceYoungTerence-YoungOakvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/YoungTerenceH_CPC.jpgInterventionMr. Terence Young: (1630)[English]Thank you very much.I read your Safety Code 6. I've read all those documents, all the links you showed, and I read the latest one. I read about nerve stimulation, excitable tissue, dosimetry, and I read quotes such as that the evidence does “...not provide a credible foundation for making science-based recommendations...”.Frankly, it doesn't tell me what I need to know and it doesn't tell me what my constituents need to know. No evidence of harm does not mean safe. That's the industry line. They always say there's no evidence of harm. They just repeat it ad nauseam. But it's not their job to keep Canadians safe; it's your job.Department of HealthHealthLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowaves4037864AndrewAdamsAndrewAdamsAndrewAdamsAndrew-AdamsInterventionMr. Andrew Adams: (1630)[English]And we're doing it.Department of HealthHealthLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowaves4037865TerenceYoungOakvilleTerenceYoungOakvilleMegSearsMeg-SearsInterventionDr. Meg Sears (Adjunct Investigator, Children's Hospital of Eastern Ontario Research Institute, As an Individual): (1640)[English] Thank you very much, Mr. Chairman and members of the panel. I'm very grateful for this opportunity today. I apologize for not providing bilingual materials, but I received my invitation just a week ago, so the timing didn't work out to take advantage of your translation services.My name is Margaret Sears. I am here as someone with some knowledge on the subject matter—a very limited knowledge on the subject matter—but more importantly, as a scientist interested in environmental health as well as methodology in this field.I am inspired by working with Dr. David Moher's research group here in Ottawa at the Ottawa Hospital. He is among the world's premier methodologists in clinical epidemiology, a highly respected and influential scientist. I also work in environmental health, was funded as a principal investigator for a Canadian Institutes of Health Research project. I'm associated with research institutes at both CHEO and the Ottawa Hospital, and have worked with Canadian medical specialists in environmental health preparing reports for the Canadian Human Rights Commission, the Canadian Transportation Authority, the Alberta Energy Regulator, and others. I have been a guest editor for peer-reviewed medical journals and have co-authored several systematic reviews. That's enough about me.Regarding Safety Code 6, I made submissions to the Royal Society of Canada and to Health Canada, and Dr. Moher and I also attended a meeting on September 19 with Mr. Adams, Dr. McNamee, and Ms. Bellier.I also recently responded to the World Health Organization during consultations on their review of health effects of radio frequency radiation. I'll briefly answer one of the questions about that. That consultation document is only partially done. There were no conclusions associated with it, and according to the method section, the literature search ended in 2011, so it's far from complete. So it is nothing that we could be basing anything on at this stage. And it also had no tables of evidence or anything like that in it.In short, I see major problems with the reporting of these studies, which should reflect on the execution of these reviews. If a review is not well conducted, it is subject to bias and incorrect conclusions. Last year, the prominent medical journal, The Lancet, published a series of articles on waste in research that was not adequately conducted or reported. It is a big problem, wasting a lot of money on badly conducted and badly reported research. You have been provided a paper by Rooney et al describing the most recent methodology for systematic reviews in environmental health. The reviews of health and frequencies covered by Safety Code 6 that I have examined, including many of the authoritative reviews relied upon by Health Canada, are lacking salient features of systematic reviews, as summarized in the chart you have been provided. They have also captured but a fraction of the literature, according to what's referenced, with organizations referring to the validity of one another's reviews. On the other hand, I have a sample of one of the systematic reviews that I co-authored. It's on the relatively narrow topic of dietary supplements and cardiovascular drugs. This is a concern for a much smaller segment of the population than radio frequency radiation that we're all exposed to, but we started from scratch because there was no good review to base it upon, and initially we screened over 33,000 records. There are methods and software established to handle this kind of volume of literature. In a 2012 presentation, it was stated by Pascale Bellier that Health Canada has reviewed 50 years of research. Canadians are waiting to see this evidence because it is not evident to date.Systematic reviews address specific questions, not really general questions so much, so you have to parse your question to be able to tackle it with really good methodology. They are collaborative. They're transparent. Certainly these processes with Health Canada leave a lot to be desired. Systematic reviews address ingrained biases. (1645) You can only build upon previous reviews that are of high quality. Without previous high-quality reviews to build upon, we have to go back to that 50 years of data. What we have currently is a bit like that telephone game in which messages get mixed up as they're half-heard while they are whispered to one another around the table. I also believe that there's good reason for concern in this field. Safety Code 6 is said to protect against “established” health effects. What does it take to establish a health effect? Sometimes that hurdle is very high, and there's a somewhat arbitrary bar, because people are.... We'll talk about that in a minute, but keep in mind that every time you hear “established health effects”, there is the question, what does it take to establish a health effect?I'll give you a couple of examples of research. In the slides that were distributed to you, there is a table with cancer studies. The clearest research originates from Hardell's group in Sweden, comparing phone use between people who had brain tumours and healthy individuals; this is called a case-control study. In Sweden, the background rate of glioma is, I believe, lower than in Canada. We do not properly capture details of brain tumour incidence in Canada, although a database is being set up. Higher risks, up to fourfold increases, were seen in Sweden with use of wireless phones, both cellphones and cordless phones. The risk of a tumour on the side of the head the phone was held against increases when use begins earlier in life, so children and adolescents are at greater risk, with longer cumulative time on the phone and more years of use. But only part of this information was referenced by the Royal Society of Canada. The Interphone Study was referenced. This was an enormous study extending over 13 countries, and the diversity of health status and co-exposures really muddied the waters in this study. For example, in some countries, having a phone was a symbol of wealth and was associated with a healthier diet and a cleaner environment. Initial analyses showed that cellphones protect you from cancer, which even the author said was a completely implausible effect, and it was because of this confounding. Further analysis did show higher tumour incidence with phone use. These two human studies were key in the IARC determination that cellphones possibly cause cancer. But since then, the French CERENAT study was published in 2014. It was not referenced in any of the documents from Health Canada or the Royal Society. It is similar to the Hardell studies. When the analyses were performed in the same manner, the results were basically replicated. So now we have that replication, and such replication is key to becoming an established health effect.Another concern relating to cancer is women who carry their phones in their bras. Phones are sending signals constantly to keep in touch with a network, even when you're not talking. The first case was reported in 2009, in a keen cell phone user who stored her phone in her bra for 10 years. Cases are piling up of characteristic tumours in young women with no known genetic predisposition. This information also was not taken into account, as far as we know. Maybe it was, but it was certainly not documented that it was taken into account.Now, if women carry phones in their bras, men carry a lot of phones in their pockets. In Canada, we have some problem with infertility. This is one of many studies showing effects on sperm—there is a graph in your handout. When exposed to typical radiation from phones in pockets, sperm stop swimming, their DNA is damaged, and they die. What we see in people is backed up by much other research into cells and animals. A lot of the recent research demonstrating potential harm was omitted from reports that supported Safety Code 6, as was discussed previously.I should say that in the comments regarding the ability to assign a dose to an exposure, what happens in this research is that, if animals are merely exposed to a phone.... With a phone, it's hard to say that the exposure is precisely such and such a number, but it's status quo. But these status quo phone exposure studies are discarded. There's a huge body of evidence that is discarded just because they used a phone instead of something that was more “scientific”. (1650)In summary, I'd offer three recommendations.First, Health Canada must systematically access, assess, and act upon all the science from scratch. It needs specific tools as well as methodological and library expertise to accomplish this.Second, we have to open our eyes and collect this environmental health data, both exposures and health outcomes. On that, I would note that the regular compliance data that Industry Canada is accumulating should be made public, so that if a doctor is concerned, he has that data to connect the dots. We also have to be collecting really good, detailed cancer incidence data. We used to collect that, but it's not available any more. The Public Health Agency of Canada has some data on their website. It used to be reported in small areas, but now it's only reported at the provincial level.Brain tumoursBreast cancerCancerCellphonesChildren's Hospital of Eastern OntarioDepartment of HealthDepartment of IndustryHealthInfertilityInformation collectionInterphone StudyLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMenMicrowavesPrecautionary principleScientific research and scientistsSwedenWorld Health Organization4037907403790840379094037921BenLobbHuron—BruceBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/60078MurrayRankinMurray-RankinVictoriaNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/RankinMurray_NDP.jpgInterventionMr. Murray Rankin (Victoria, NDP): (1705)[English]In fact, I'll take six minutes, please. I would like to ask if you could interrupt me toward the end so my colleague, Ms. Moore, could ask a very short question.I want to say thank you to the two witnesses. I must say that your testimony is very, very disturbing. I'm putting myself in the position of a parent sitting at home hearing what you've said, just after we've heard from Health Canada and Industry Canada assuring us that nothing is wrong. Recently Health Canada sent a fact sheet to our committee. It was modified less than two weeks ago, on March 13. It would seem to suggest that there's really nothing wrong with Safety Code 6 in protecting Canadians. So I must say it's very, very disturbing.The first question I have is for Doctor Sears. If I could summarize, in your words Health Canada must review the science from scratch. They have to make the data more publicly available and they have to collect detailed cancer data because what you used to be able to get is no longer available, except at the provincial level. That's a very disturbing conclusion. The fact that the information is not being made publicly available is equally disturbing.Can you elaborate a little on that?CancerDepartment of HealthHealthInformation collectionLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowavesScientific research and scientists4037969BenLobbHuron—BruceMegSearsMegSearsMeg-SearsInterventionDr. Meg Sears: (1705)[English]There are two issues here.One issue is that a lot of data that should have been collected is simply not being collected. An independent brain tumour group is starting up a database, but it's not in place yet. In order to detect the oncoming tsunami of brain tumours, should that happen—and it looks as if we may see an increase in brain tumours—we would have to have detailed information about where exactly these tumours are located. There's also an issue with tumours in the salivary gland, and we're not collecting that data at all. You need to have detailed data on the location and the histology, the actual details—Brain tumoursCancerDepartment of HealthHealthInformation collectionLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowaves4037972MurrayRankinVictoriaMurrayRankinVictoria//www.ourcommons.ca/Parliamentarians/en/members/60078MurrayRankinMurray-RankinVictoriaNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/RankinMurray_NDP.jpgInterventionMr. Murray Rankin: (1710)[English]Yes, thank you. You'll appreciate that time is so limited.Dr. Blank, you started by saying that Health Canada was not measuring the right parameters, that it was focusing on temperature but not looking at the biological parameters. I think you said something to that effect. Health Canada tells us in this fact sheet that I just mentioned that they do. They say: ....Health Canada scientists consider all peer-reviewed scientific studies (which includes thermal, non-thermal, and biological effects).... They claim they are doing what you say they should be doing.Biology and biologistsDepartment of HealthHealthLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowavesScientific research and scientists403798240379834037984MegSearsMartinBlankMartinBlankMartin-BlankInterventionProf. Martin Blank: (1710)[English]Well, I don't see that. They didn't elaborate what the biological effects were and what the non-thermal effects were. The only one they referred to was the...I forget the particular ones they had about non-thermal effects.The fact is that they didn't refer to the stress response, which I think is the body's first line of defence in connection with a lot of stimuli that are present in nature.Biology and biologistsDepartment of HealthHealthLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowavesScientific research and scientists403798540379864037987MurrayRankinVictoriaMurrayRankinVictoria//www.ourcommons.ca/Parliamentarians/en/members/60078MurrayRankinMurray-RankinVictoriaNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/RankinMurray_NDP.jpgInterventionMr. Murray Rankin: (1710)[English]If there is a stress protein created, as you've suggested, or that some studies that you and Dr. Goodman refer to suggest, the implication seems to be that the creation of stress proteins is a serious thing.Does that necessarily follow—?Biology and biologistsDepartment of HealthHealthLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowavesScientific research and scientists4037988MartinBlankMartinBlankMartinBlankMartin-BlankInterventionProf. Martin Blank: (1710)[English]That's the body's reaction. You'd never know that because this was not written by biologists. I'm amazed that at the beginning of the report they put in a word for a chemical engineer, another engineer to come on board. They didn't even mention that they need one biologist. They need somebody there who understands what's going on at the level of a cell.Biology and biologistsDepartment of HealthHealthLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowavesScientific research and scientists4037991MurrayRankinVictoriaMurrayRankinVictoria//www.ourcommons.ca/Parliamentarians/en/members/60078MurrayRankinMurray-RankinVictoriaNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/RankinMurray_NDP.jpgInterventionMr. Murray Rankin: (1710)[English]Here we have your analysis, which has been very clearly presented by both of you. Toward the end of your recommendation, you refer to Dr. Lerchl, from Bremen, who has in the past not been alive to these concerns, but who has recently been concluding that there is a concern. Yet, as recently as March 13, Health Canada puts out to the Canadian public a fact sheet saying that there are no concerns here.This is very hard for Canadians to understand. It seems that our regulators are not giving this the attention that this deserves. I say “seems” because I'm not a scientist. I have to rely on what they conclude and what you two are asserting.Brain tumoursDepartment of HealthElectromagnetic radiationHealthLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowavesScientific research and scientists4037992MartinBlankMartinBlankMartinBlankMartin-BlankInterventionProf. Martin Blank: (1710)[English] Well, we have been carrying this message out. I'm not a shrinking violet, as you can tell from my presentation. I call things the way I see them. I've published a lot of papers. I was president of the Bioelectromagnetics Society. I've organized symposia on the precautionary principle. I've been active in this and I've made the message go out. My papers have been published as well. The fact that they have been ignored, that's on the other side of the ledger. These guys don't want to hear it. Why? You may inquire into that as well, because that's an interesting question. The fact is that they have ignored it. I actually pointed it out when I presented at an earlier review, when the draft of the report was being considered. I made a presentation then and said the same thing, more or less, and it just was not mentioned. The fact that they ignored the papers by Dr. Goodman and me.... We've published many papers on this subject, and it's a very important thing, if I may say so. I mean, this is a basic reaction of cells, and especially when you're interested in harm that's coming to cells, this should be mentioned. It should at least get a footnote or get a reference in there that we looked at it. Mr. Murray Rankin: Thank you.CancerCellphonesDepartment of HealthHealthLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowavesScientific research and scientists403799440379954037996MurrayRankinVictoriaBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1720)[English]Dr. Sears gave us protocols of how we should be looking at good research, and so on, and how we should be evaluating it. I noticed that those are not the protocols used for evaluating research by Health Canada when they got their report. They used a totally different set of protocols. Professor Blank, you are very intriguing, and I think everything you said makes a lot of sense. The body is an electric organism in many ways. The cells respond—Department of HealthHealthLimits of Human Exposure to Radiofrequency Electromagnetic Energy in the Frequency Range from 3 kHz to 300 GHzMicrowavesScientific research and scientists4038063BenLobbHuron—BruceMartinBlankAllanMarkinAllan-MarkinInterventionMr. Allan Markin (Founder, Pure North S'Energy Foundation): (1550)[English] Chair, honourable members of the committee, my name is Allan Markin, and my vision is preventive health care for everyone. I am the founder and chief accountability officer of the Pure North S’Energy Foundation, Canada’s largest primary prevention-focused not-for-profit organization. I'm accompanied by Dr. Mark Atkinson, a medical doctor and director of quality assurance, and Dr. Samantha Kimball, research director at the Pure North S’Energy Foundation. At Pure North we empower Canadians to feel better and live longer through the use of simple and effective prevention-focused clinical interventions. These include vitamin D3 and high-quality multivitamin and mineral supplementation, health education, and the safe removal of mercury amalgam fillings. Our preventive program supports the advancement of modern medicine. Our multidisciplinary team of over 100 people includes medical doctors, naturopathic doctors, nurse practitioners, dentists, pharmacists, nurses, and other health care professionals. Over an eight-to-ten-year period, 40,000 Canadians, including 25,000 vulnerable seniors, homeless, and first nations, have accessed our preventive health program, and have their blood panel taken regularly. Participants in our program experience a significant increase in quality of life and a 20% improvement in physical and mental health. Forty-eight per cent of those with pre-diabetes have experienced a complete reversal in their disease. Emerging evidence demonstrates there's a 17% reduction in the prevalence of metabolic syndrome for every 25 nanomoles per litre of vitamin D3 increase. Our request is for the Government of Canada to proactively resolve what we call the four injustices, and for all Canadian physicians, medical students, dentists, and allied health professionals to be educated about these injustices. Injustice number one is that Health Canada has regulated that no supplement in Canada contain more than 1,000 IUs of vitamin D3. Any amount higher than this requires a doctor’s prescription and is regarded a drug. In the U.S.A., a country that has exactly the same recommended daily allowance for vitamin D3 as Canada, people have access to vitamin D3 supplements containing 7,000 IUs of vitamin D3 per tablet. It does not require a prescription, to our knowledge. The FDA has not put a limit on the amount of vitamin D3 in a pill, but Health Canada has. Canadians should have access to vitamin D3 supplements at the same dose as Americans, or higher. Injustice number two is that the recommended daily allowance for vitamin D3 should be changed to be between 7,000 IUs and 9,000 IUs. Health Canada has been proven to have made a significant mathematical error in their calculation of the RDA for vitamin D3. The Health Canada vitamin D3 RDA for most adults is 600 IUs per day. Using Health Canada data and the correct statistical methodology, Professor Paul Veugelers at the University of Alberta has shown that the IOM vitamin D3 recommendation would have been 9,000 IUs per day if IOM had not made a math error. Another group, led by Dr. Heaney, a vitamin D3 expert from Creighton University in Nebraska, came up with a similar figure of 7,000 IUs based on an analysis of a dataset of 3,600 individuals. Dr. Kimball has published extensively on vitamin D3, including a trial of 14,000 IUs per day in patients with MS. The evidence is clear: vitamin D3 is safe, and the vitamin D3 RDA should be 10 to 15 times higher than the current Health Canada RDA. Injustice number three is that Canada needs to mandate a complete ban on the use of mercury amalgam fillings in all Canadians, and not just children, pregnant women, and those with impaired kidney function. In Health Canada's report, “The Safety of Dental Amalgam”, they acknowledge that amalgams impair kidney function. Pure North research has found that the safe removal of amalgams results in a significant improvement in kidney and liver function and in self-reported physical and mental health symptoms, such as anger, depression, and anxiety. The World Health Organization acknowledges that mercury is poisonous at any level. The use of mercury amalgam fillings has already been completely banned in Norway, Sweden, and soon Brazil, as well as a partial ban in Denmark. Canada needs to follow suit. Amalgam removal needs to be done safely.Injustice number four is that Canadian emergency departments have unnecessarily long lineups and waiting times. The Wait Time Alliance’s annual report card states that 27% of Canadians reported waiting more than four hours in an emergency department, as compared with 1% in the Netherlands, for example. (1555) A recent analysis of the data relating to 6,600 of our program participants by the school of public policy at the University of Calgary found that a preventive health program such as Pure North's keeps people out of hospital. Within one year of being on the program, the Pure North participants had 45% fewer nights in hospital and accessed emergency departments 28% less than controls. This happened in less than one year.The inconvenient truth is that millions of Canadians experience disease and suffer unnecessarily because our health care system has not yet made primary prevention a priority.In 1943 the Canadian Medical Association called for preventive medicine to become a federal priority. The World Health Organization report on the impact of chronic disease in Canada predicted that between 2005 and 2015 over two million Canadians, or 400,000 people a year, on average, will die from chronic disease. Studies have found that if Canadians optimized their intake of vitamin D3, 37,000 premature deaths would be prevented annually, and the economic burden would be reduced by $20 billion per year. In summary, integration of a proven preventive health program such as Pure North’s prevents premature deaths and saves the government money. An assessment of the economic impact of our program estimated that every dollar invested in the Pure North program provides a return of between 13:1 and 25:1. The result is that the health care cost curve is bent downwards with real potential cost savings of at least $420 million per year if rolled out to 600,000 Canadians. If Alberta, for example, implemented the Pure North program province-wide, this could free up the equivalent of 1,600 hospital beds every year. This is roughly the same as building two entirely new hospitals. The provincial governments are also locked into an unfortunate mindset that the health care costs avoided rather than current health care dollars saved are not worth pursuing. Preventing [Technical Difficulty—Editor] chronic disease in the future avoids the size of the increase in budget that we are otherwise headed for. To avoid prevention since it does not reduce the size of the health budget today is nothing more than flawed logic with tragic implications, a sicker population and ever-increasing costs of treating them. It is our hope that the Standing Committee on Health will attach great importance to these issues and take action to resolve them. Best practicesCaregivers and health care professionalsCost recoveryDentistry and dentistsDepartment of HealthHealth care systemMercuryPreventive medicinePure North S'Energy FoundationVitamin DWaiting lists in health care40168084016809BenLobbHuron—BruceBenLobbHuron—BruceClaudetteDumont-SmithClaudette-Dumont-SmithInterventionMs. Claudette Dumont-Smith: (1240)[English]The Native Women's Association had different departments. One, for example, was health. In April 2012 we had word from Health Canada that all our funding was cut. We couldn't do anything in the health sector for aboriginal women. Eight of our staff were laid off, and we never brought them back on because we were not successful in getting any more funds from Health Canada. That was one major cut.Other cutbacks were, of course, with the Status of Women funding. During the Sisters in Spirit, the Native Women's Association of Canada was receiving about $1 million, which is public information. It has decreased steadily since then. We're getting much less than we had then, than we had last year. We have even less this year than what we had last year. Again, it has to be in relation to our staff. We have fewer staff in that department as well.Core funding was decreased, as well, for all NAOs and aboriginal regional organizations across the board last year. In order to get funds to do work in various areas, we had to apply to a $20-million pot with the other four NAOs and all the aboriginal regional organizations across Canada. It was a very competitive process.We entered the process. We submitted our 10 proposals on February 20, or something like that, of last year, which was the due date of each proposal, and we had word only in October, November, that some of our projects had been funded. Right now we're doing work that has to be completed by March 31. It's one year of work that has to be completed by March 31, in three or four months.It's very difficult for me and for our staff to work under those conditions. Of course, as my colleague was saying here, it is hard to keep a dedicated staff, where they want to work, where they want to be in the workforce, and where they like their job. But we can't offer stability. That's the situation I, along with all the other NAOs and ROs, am in right now in terms of funding.Aboriginal peoplesAssociations, institutions and organizationsDepartment of HealthEducation and trainingGovernment assistanceLayoffs and job lossesNative Women's Association of CanadaRetention of employeesSisters in SpiritStatus of Women CanadaViolence against women3972665KirstyDuncanHon.Etobicoke NorthHélèneLeBlancLaSalle—Émard//www.ourcommons.ca/Parliamentarians/en/members/71680SusanTruppeSusan-TruppeLondon North CentreConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/TruppeSusan_CPC.jpgInterventionMrs. Susan Truppe: (1145)[English]What about the funding you receive from Health Canada, or is that not correct? Did you ever receive any funding from Health Canada?Department of HealthEducation and trainingGovernment assistanceViolence against women3965747JennyWrightJennyWrightJennyWrightJenny-WrightInterventionMs. Jenny Wright: (1145)[English]Not really. We don't have Health Canada funding. We get small grants from our local health initiatives. We also run a housing program, which gets provincial funding. That comes from what we call the supportive housing program, which comes out of housing dollars. We have AIDS-supportive housing.Department of HealthEducation and trainingGovernment assistanceViolence against women3965748SusanTruppeLondon North CentreSusanTruppeLondon North CentreKendalWeberKendal-WeberInterventionMs. Kendal Weber (Director General, Policy, Planning and International Affairs Directorate, Health Products and Food Branch, Department of Health): (0950)[English] Thank you, Mr. Chair, and members of the Committee.My name is Kendal Weber and I am the director general of policy, planning and international affairs in the health products and food branch at Health Canada. Thank you for the opportunity to present Health Canada's perspective on Bill C-21, the red tape reduction act. As you know, Health Canada's primary mandate is to protect the health and safety of Canadians. We support the government's red tape reduction action plan, including enshrining the one-for-one rule in law to target and control administrative burden on business. Cutting red tape to business fosters growth, competitiveness, job creation, and innovation. As one of the government's major regulators, Health Canada is committed to reducing regulatory administrative burden to industry, while ensuring that the health and safety of Canadians is not compromised. Health Canada has an ambitious regulatory modernization agenda and follows good regulatory design principles, including the reduction of unnecessary administrative burden to industry. The good practices required by the one-for-one rule are consistent with departmental approaches to regulatory design.With respect to reducing administrative burden, it is now a matter of practice within Health Canada that the development of regulations includes an assessment of the cost, alternatives, and consideration of ways to reduce the imposition of administrative burden on regulated parties, particularly small business. This practice is embedded in the design of our regulations. Stakeholders are consulted throughout the regulatory development process, including on the assessment and costing of administrative burden, as well as identifying alternatives to minimize the burden without compromising on health and safety requirements.Stakeholder consultations begin early and include publishing regulations in the Canada Gazette, part I. This pre-publication of regulations gives all Canadians a chance to submit their comments about a proposed regulation well before it is made. Bill C-21 would allow for a 24-month reconciliation of administrative burden. This flexibility over two years respects the realities of the timelines involved in introducing new or amended regulations through the Canada Gazette process.ln implementing the requirements of the one-for-one rule over the past two years, we have recognized that there are opportunities within the 95 regulations which we administer to cut red tape and minimize burden on businesses while continuing to meet our mandate of protecting the health and safety of Canadians. These two objectives of health and safety and administrative burden reduction are not incompatible.Here is an example of how Health Canada has been able to do just that: reduce administrative burden on business without compromising the health and safety of Canadians.Pharmacists and their regulatory associations told us that certain requirements under the food and drug regulations were out of step with more modern provincial legislation and were unnecessarily prescriptive, requiring pharmacists to perform functions which could be safely performed by pharmacy technicians. We listened and amended the provisions that regulate prescription drugs. The regulations now allow the transfer of prescriptions by pharmacy technicians, an administrative task that was previously administered solely by pharmacists. This means that community pharmacies and retailers that dispense prescriptions may better utilize the skills of lower-salaried pharmacy technicians, thereby reducing the overall operating and administrative costs of business.This change alone represents a net annual reduction of almost $15 million in unnecessary administrative burden and does not compromise the health and safety of Canadians. lt was of benefit to everyone, was practical, and made good sense.As of June 2014, the department has contributed to approximately 70% of government-wide administrative cost reductions.Health Canada will continue to seek opportunities to reduce unnecessary regulatory burden to industry implementing the one-for-one rule while protecting the health and safety of Canadians.Furthermore, the department has embedded in its regulatory design a small business lens assessment to consider flexible regulatory options that reduce costs to small businesses. Thank you for the opportunity to appear before you today on this important issue. I'm happy to answer your questions.BureaucracyC-21, An Act to control the administrative burden that regulations impose on businessesCompaniesDepartment of HealthGovernment billsRegulation39409713940972394097339409743940975394097639409773940978394097939409803940981394098239409833940984394098539409863940987Pierre-LucDusseaultSherbrookePierre-LucDusseaultSherbrooke//www.ourcommons.ca/Parliamentarians/en/members/35600BenLobbBen-LobbHuron—BruceConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/LobbBen_CPC.jpgInterventionThe Chair (Mr. Ben Lobb (Huron—Bruce, CPC)): (1105)[English] Good morning, ladies and gentlemen. Thank you for all being here today.We're looking at the supplementary estimates (B).We're happy to have the minister here today and all of her officials. I thank the minister for taking the time out of her schedule today.Do you have your prepared statement ready, Minister?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913060391306139130623913063RonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose (Minister of Health): (1105)[English]I do.The Chair: Okay. Thank you very much.Hon. Rona Ambrose: Thank you, Mr. Chair.It's great to be here in front of the health committee.I want to start off by thanking you for all of the good work that you're doing. Thank you for the invitation to discuss supplementary estimates for the health portfolio.We have a number of officials here that many of you know already: Alain Beaudet, from the Canadian Institutes of Health Research; of course, Bruce Archibald, who's here from CFIA; George Da Pont, our deputy minister from Health Canada; Gregory Taylor, our chief public health officer; and Krista Outhwaite, our newly appointed deputy minister for the Public Health Agency.I'm going to provide just a short update to committee members on Canada's response to the Ebola outbreak in West Africa, as that I believe would prove helpful to all of you.As many of you know, this outbreak is the most severe and complex the world has seen in 40 years of combatting the virus. The humanitarian, social, and economic impacts will be felt long after the virus is contained. Canada has been at the forefront of the international response to this outbreak, and has been since April. We are contributing funds, expertise, and equipment. To date we have committed over $65 million in health, humanitarian support, and security interventions. I'm pleased to report to the committee that 57 million dollars' worth of this funding has now been disbursed. This funding has gone to support the United Nations, the World Health Organization, UNICEF, and many others to improve treatment and prevention, improve health capacity, save lives, and support the basics such as nutrition.Our efforts are directed at bringing an end to this outbreak, treating patients, assuring the availability of essential services, preserving stability, and preventing outbreaks in surrounding countries.We've also now donated and delivered over 2.5 million dollars' worth of personal protective equipment to West Africa that was requested by the WHO, including 1.5 million pairs of gloves, two million masks, over 480,000 respirators, and over 1,000 beds and blankets. The Public Health Agency also has deployed our mobile laboratory again to Sierra Leone to provide rapid diagnostic support and infection control testing, and we're currently awaiting further direction from the WHO on where our second mobile lab can be deployed. In addition to Canada's invention of an experimental Ebola vaccine, which is currently undergoing clinical trials, we've generously donated the Canadian Ebola vaccine, in the amount of 800 vials, to the World Health Organization in Geneva. This vaccine is a fine example of Canadian scientific innovation. It's our hope that if found to be safe and effective, it will be used in West Africa to help stop this outbreak.To support this goal, we've recently launched a Canadian phase one clinical trial for the vaccine, led by the Canadian Immunization Research Network in Halifax at the Canadian Centre for Vaccinology in the IWK Health Centre. This trial will support concurrent trials elsewhere in the world by determining if lower dosages could be just as effective as higher ones, potentially multiplying the amount of doses in each vial. While there has never been a case of Ebola in Canada, we must of course continue to be prepared and take every precaution necessary.I've now spoken with health ministers from across the country several times and we've held, I think, three meetings. Our chief public health officer is in regular contact with medical officers in provinces and territories, I think now meeting almost twice a week for a number of months. In the event of an Ebola case, the Public Health Agency is ready to support the provinces and territories by deploying our Ebola rapid response teams. These five teams are made up of a team lead, a field epidemiologist, an infection control expert, a biosafety expert, a laboratory expert, a communications expert, and a logistics expert, and they would be deployed immediately to support any local public health systems that would need our support.Transport Canada is also supporting the Public Health Agency by having planes readily available to deploy at a moment's notice. These planes are also stocked with emergency supplies, including protective equipment, like masks, gloves, and gowns. Our government is also providing additional funding to support Ebola preparedness and response capacity here in Canada to further support the provinces. This includes, of course, the $27.5 million that will be directed towards domestic preparedness. This amount includes just under $25 million to support further research and development of Ebola medical countermeasures. This means more money for research of the Canadian Ebola vaccine and monoclonal antibodies.(1110) Funding has also been set aside to support infection control training and equipment, and to deploy additional quarantine officers at Canadian airports.We've also launched an online Ebola information campaign designed to help raise public awareness about the disease and its risks, through social media such as Facebook and Twitter. As we combat the disease, we need to fight the stigma around it. Canadians need to know the facts about Ebola, how the virus is transmitted, its symptoms, and any other information that will help them manage their fears of contracting this disease.Of course, we are making a strong contribution to international efforts abroad and working together to prepare here at home. We are strengthening coordination across the federal, provincial, and territorial governments, and other important agencies, and doing everything possible to protect Canadians and fight the disease.On a different subject, I'd like to commend and thank all of you for your thoughtful study of Bill C-17, Vanessa's Law. In addition to the many months of consultations—C-17, An Act to amend the Food and Drugs ActCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015391306439130653913066391306739130683913069391307039130713913072391307339130743913075391307639130773913078391307939130803913081BenLobbHuron—BruceBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1110)[English]In addition to the many months of consultations that we held with Canadians, this committee's careful review of this bill contributed to the successful passage of Vanessa's Law. I feel that we've made very real progress in the last year on improving public health and safety, and nowhere is this more apparent than with the royal assent of Vanessa's Law. Vanessa's Law contains some of the most profound changes to the Food and Drugs Act in more than 50 years. It's truly an historic step in our government's continuous improvements to patient safety, especially over the past several years. Thanks to the hard work of this committee, and Vanessa's Law, Canadians can have renewed confidence that the medicines they are using are safe. As Minister of Health I now have the powers to recall a drug and take it off store shelves when it's not safe. For the very first time, serious adverse drug reactions and medical device incidents will have to be reported by health care institutions. As well, as you know full well, courts can now impose penalties on drug companies that include up to $5 million per day or jail time for distributing unsafe products. Also, we can compel drug companies to revise labels so that they clearly reflect health risk information, including updates for health warnings for children. We can direct companies to do further testing on a product, including when issues are identified with specific at-risk populations such as children. Many of these new powers came into effect with the royal assent of Vanessa's Law, and we are moving quickly to put regulations in place to support other powers, such as the requirement for all authorized clinical trials to be registered, and some elements of mandatory adverse reaction reporting for health care institutions.Canadians need access to information, especially when it comes to their health, and beyond Vanessa's Law we've made great progress in increasing transparency through Health Canada's regulatory transparency and openness framework and action plan. For example, Health Canada has begun to post summaries of drug safety reviews that both patients and medical professionals can use to make informed decisions. Patients can also check the clinical trials database to determine if a clinical trial they are interested in has met regulatory requirements. These concrete initiatives are making more information on departmental decision-making and results available to Canadians in an easy-to-understand format. More can always be done. I have asked my officials to accelerate the implementation of the transparency initiative. I would also like to congratulate this committee on your report on the serious health risks and harms of marijuana. As this committee noted, smoking marijuana has serious health risks for youth. As many of you know, Health Canada launched an awareness campaign aimed at educating parents on how to talk with their teenage children about the dangers associated with prescription drug abuse and smoking marijuana, in line with recommendations included in your report. Television ads began airing in October focusing on the developing brains and bodies of teenagers and how marijuana use, as well as prescription drug abuse, can cause permanent damage to their development and put educational achievement and long-term mental health at serious risk.The department developed web and social media content as well on the dangers associated with marijuana and prescription drug abuse in order to encourage parents to get the facts, and tips on how to speak with their children on drug use and abuse. As this committee will know, our government has also committed almost $45 million over five years to expand the national anti-drug strategy to now also include prescription drug abuse. The many dangerous and unpredictable consequences of drug abuse make this a very real and widespread public health issue, and no one feels that more acutely than Canadian families.Over the past year I've met with health officials, physicians, pharmacists, first nations representatives, law enforcement, addiction specialists and medical associations to discuss how we can collectively tackle prescription drug abuse. I've issued a call for proposals to seek new ways to improve prescribing practices for opioids and other drugs that pose a high risk of abuse or addiction. Additionally, we are now providing funding to build on initiatives to support research on new clinical and community-based interventions for preventing and treating prescription drug abuse.I'd like now to turn to innovation in health care, Mr. Chair. (1115) As you know, Canadians benefit from a system that provides access to high-quality care and supports good health outcomes, but with Canada's aging population and a growing burden of chronic disease, we know we need to accelerate the pace of change. That's why I launched the advisory panel on health care innovation back in June. It's headed by Dr. David Naylor and this panel has truly hit the ground running.The panel is consulting broadly across Canada, identifying promising areas for innovation, and determining how the federal government can help accelerate that progress. In fact, the panel is eager to hear from Canadians from across the country in an online consultation that runs until December 5. I anticipate the arrival of the final report by the end of May and I look forward to sharing this information with members of this committee. Mr. Chair, Canadians expect their federal government to play a major role in sustaining our high-quality health care system. Today, I want to reinforce that our government is at the table and we want to make sure Canadians have the highest level of care. Once again, thank you for inviting me to be here today to speak with you. My officials and I are pleased to take any questions that you may have.Associations, institutions and organizationsC-17, An Act to amend the Food and Drugs ActCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthDrug use and abuseHealth care systemMarijuanaPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015391308539130863913087391308839130893913090391309139130923913093391309439130953913096BenLobbHuron—BruceBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies (Vancouver East, NDP): (1120)[English]Thank you very much, Chairperson.Thank you to Minister Ambrose for appearing before our committee today as we deal with the estimates.Thank you to the officials who will be here.Minister, I know you're here only for an hour so obviously we want to ask as many questions as possible. I'm glad that you began your comments with an update on the Ebola situation because I do think that has been a very urgent matter and as you know, we've raised it in the House a number of times with you and also with the parliamentary secretary. There have been a lot of concerns about delays from Canada, both in terms of getting equipment and protective gear out the door, and there have certainly been significant concerns around the vaccine. So I'm glad to hear you say today that now $57 million of the federal commitment has actually been disbursed.I do want to come to a question, though, on the vaccine itself. You're probably aware that the contract with NewLink, which is the company in Iowa that received a contract from the federal government in 2010. That's four years ago, and that contract requires the company to commercialize the made-in-Canada vaccine, and within that contract there are specifics that outline that any parking, shelving, or lack of diligently and aggressively commercializing the vaccine is considered to be a fundamental breach of contract. The question that I have is whether or not you as the minister, or the federal government, have given notice to NewLink Genetics outlining the concerns that many Canadians have—certainly we have—with the apparent parking of the vaccine development over the last four years, and the lack of urgency this summer to conduct the clinical trials. The contract says that 90 days' notice has to be given for required inactivity to be considered a sufficient cause for termination. Basically we want to know, have you given notice of breach of contract? Have you been seeking alternate sources to ensure that this vaccine is commercialized, given that now we're looking at four years since this contract was initiated?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverImmunizationPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015391309939131003913101391310239131033913104BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1120)[English]First of all, I think we're all very proud that Canadians and Canadian taxpayer money has paid for the research over 10 years to develop this vaccine. As you know, this outbreak has become urgent in the last year. I have absolutely no evidence that there is any lack of urgency around commercializing this vaccine. In fact it's the opposite. I've asked many times. I received very clear reassurances—and I'll be happy to allow Dr. Taylor and Krista Outhwaite to speak to this—that this process is moving at an unprecedented pace. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverImmunizationPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913105LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1120)[English]Why is it taking the company so long then?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverImmunizationPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913106RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1120)[English]The words that have been shared with me are that the international community has been brought to bear to support the rapid commercialization. Let's remember this is an experimental vaccine. We are in phase one clinical trials. We're still testing for safety and efficacy. Let's hope that it is safe and that it is able to be deployed quickly once we do know that it is safe to be used.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverImmunizationPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913107LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1120)[English]Minister, I think we all share your concerns about safety, so I want to ask you again. You have no concerns whatsoever that this company has been parking or shelving or has lacked any diligence in terms of aggressively commercializing this very desperately needed vaccine, no concerns with the company whatsoever.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverImmunizationPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913108RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1120)[English] I'll allow Dr. Taylor to give you as much detail as we're able to give you.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverImmunizationPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913109LibbyDaviesVancouver EastGregoryTaylorGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor (Chief Public Health Officer, Public Health Agency of Canada): (1120)[English]I don't think we have concerns with this company. They've been working diligently. Some of the delays have to do with a production process to produce a large amount of vaccine for clinical grade. That took some time. We placed our order with them initially so we would have some vaccine. We just received that batch early this year. I think it was around February, so it took a long time for the production to get going.As for the clinical trials, I think it's worth remembering that typically this process takes five years or more from the beginning. Prior to this outbreak there had been only 2,500 cases in the world—Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverImmunizationPublic Health Agency of CanadaSupplementary estimates (B) 2014-201539131103913111RonaAmbroseHon.Edmonton—Spruce GroveLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1120)[English]But they did have the contract since 2010, so that's four years.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverImmunizationPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913112GregoryTaylorGregoryTaylorGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor: (1120)[English]That's 2010. So it took a long time to get the production facility in place. Once the vaccine was produced and we had some of that early this year, there have been no less than six clinical trials they've engaged with.They have another manufacturing system on line. They've produced some for this year and there will be some in early March 2015, which could be as many as 100 million doses. We don't know that. We go by vials. We purchased initially 1,400 vials, but with some of the testing in the Canadian clinical trials using a very low dose, as the minister suggested, it could be much longer.They've invested well over $10 million, and they've leveraged as much as $42 million. million from the U.S. Department of Defense, National Institute of Allergy and Infectious Diseases, etc.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverImmunizationPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015391311339131143913115LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1125)[English]Dr. Taylor, perhaps I could just do a quick follow-up to you. As you know, we have the visa ban that was initiated by Canada from affected Ebola countries, and I'd like to ask you as the chief medical health officer for Canada, do you support the visa ban from affected Ebola countries? What evidence supports the decision that was made?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverPassports and visasPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913116GregoryTaylorGregoryTaylorGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor: (1125)[English]The balance we have to take between protecting Canadians and trying to assist and trying to deal with the outbreak is always very difficult to do. It's not an outright ban. It's a pause in issuing new visas. In my understanding there are about 1,700 to 1,800 existing visas that will continue to be valid.It's very difficult to get exactly the right balance. It's not like it's a border closure; it's a pause in issuing that. My understanding as well is that the—Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverPassports and visasPublic Health Agency of CanadaSupplementary estimates (B) 2014-201539131173913118LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1125)[English]What evidence supports that?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverPassports and visasPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913119GregoryTaylorGregoryTaylorGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor: (1125)[English]—minister can issue them on an exceptional basis.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverPassports and visasPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913120LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1125)[English]Do you support it yourself as the medical health officer?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverPassports and visasPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913121GregoryTaylorGregoryTaylorGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor: (1125)[English]Personally I think it's the appropriate balance to take, and yes, I support a very measured approach like this.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverPassports and visasPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913122LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1125)[English]What evidence is it based on?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverPassports and visasPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913123GregoryTaylorRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1125)[English]MP Davies, I think there's been some misinformation. The media, I think, didn't do Canadians a service on this. This is not a travel ban. This is a pause in new applications of visas. Just to put it into context, we get very few visa applications from even the three combined countries—Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverPassports and visasPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913124LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1125)[English]But it's anybody coming with visas, is that correct?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverPassports and visasPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913125RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1125)[English]Existing visas, and there are about 1,900 of them that are active today from people who have visas from those countries. Many of them are multiple-entry visas. People will continue to be able to travel back and forth from those West African countries, and Canadians can travel in an unlimited way. But we have told Canadians not to travel there unless they need to, unless they're humanitarian workers or it's essential business travel.We've done the same thing in reverse. In a very practical way we said we'd look at it case by case. If it's essential travel for economic purposes, we're honouring the visas that exist, both single entry and multiple entry, and the Minister of Immigration has the discretion to look at these on a case-by-case basis. It's a cautious, prudent, and practical approach. We're taking the same approach with Canadians.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverPassports and visasPublic Health Agency of CanadaSupplementary estimates (B) 2014-201539131263913127LibbyDaviesVancouver EastBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/71688EveAdamsEve-AdamsMississauga—Brampton SouthLiberal CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/AdamsEve_CPC.jpgInterventionMs. Eve Adams (Mississauga—Brampton South, CPC): (1125)[English]Thanks, Mr. Chair.Thank you, Madam Minister, for joining us here at the committee today. It's our great pleasure to have you.I'd like to follow up and ask some additional questions regarding Ebola. I want to thank you for your comments and for focusing on the significant contributions that Canada has made to date.This is, in our lifetime, one of the most significant health crises that the world is facing. Perhaps you could provide some additional detail on the leadership role that Canada has played in fighting the Ebola outbreak in West Africa.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverHumanitarian assistance and workersPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913131391313239131333913134BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1125)[English] Sure, I always appreciate the opportunity to speak about Canada's response to the Ebola outbreak in West Africa. It also allows me to correct some of the misinformation that exists and combat the stigma that we're seeing in some places, especially for returning health care workers. It's clear that we're in the midst, as you said, of the largest outbreak ever in the four-decade history of this disease, but for all the headlines and the horrifying statistics, there is a great deal of misinformation about Ebola, and that persists. Because the virus has never actually been present in Canada, the facts about what Ebola actually is and how it spreads might not be top of mind for many Canadians. That's why earlier this month we announced that throughout November we're broadcasting a public awareness campaign to communicate the facts on Ebola and combat stigma. This includes the basics on what the virus is, how it spreads, and what people should do to be prepared. What was of significant concern to me after speaking to the heads of our aid agencies was that many aid workers were returning home to Canada and not being treated like the heros they really are. The head of Doctors Without Borders was particularly concerned about how people in neighbourhoods were reacting to returning doctors, how hospitals were reacting, and even other health care workers were reacting to people who were returning. The truth is that these people are putting their lives on the line at great personal risk, and the aid agencies are managing their health care workers with very rigorous rest periods and self-isolation. They're taking all the precautions necessary. The Canadian public needs to have the facts on the virus should there be a case of Ebola ever occurring here in Canada, but we also need to make sure that the public is well educated, and as a country we need to be prepared. In terms of our preparedness, I feel quite reassured about the level of preparedness in the provinces and territories. I speak regularly with my provincial counterparts, and Dr. Taylor speaks almost twice a week with his counterparts. Our provincial colleagues feel very confident about their preparedness or their readiness. The Public Health Agency has now provided updated guidance to provincial and territorial health authorities.Of course, they are responsible for training their health care workers, but we've really seen them step up to the plate and offer the necessary training to nurses and doctors. What I've said to the heads of the nurses union and nurses association is that if any of their members still feel vulnerable to step up and speak to the people in their organization, make sure that the training is offered and that it's hands-on training, not just a video, and that they feel completely confident putting that equipment on and taking it off. It seems to me from the feedback I've received that this is happening. People are speaking up should they feel they need more training and the provinces are working hard to make sure that training is available. As I mentioned earlier, the Public Health Agency stands ready with all our expertise. Our five rapid response teams are ready to support the provinces should they have to receive a patient with Ebola. Our teams are ready to deploy at a moment's notice. We've been provided with the aircraft necessary to make sure we're able to get to any point in Canada should we need to do that. We also have set aside $3 million for the provinces and territories to support them in their preparedness on the community side.As committee members will appreciate, I want to thank my officials from the Public Health Agency. They've worked very collaboratively with the provinces and territories and with front-line health care workers. At every point that there have been any concerns, they have been invited in to be heard. We've done our very best to respond to everyone, whether it's the provincial-level officials or nursing associations. Even though nurses may not be our jurisdiction we wouldn't even think about not having them at the table. We've worked very hard to make sure everyone is included at every step in the guidelines we've been providing. We've communicated directly with not only the provinces and territories but with many front-line organizations as well so that we can support them directly.We'll continue to take all steps necessary, and we continue to respond to requests.(1130) Canada's response has been very significant and very effective, and it has been based on requests. As requests come in from the World Health Organization, such as for protective equipment, we'll continue to respond.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthEbola hemorrhagic feverHumanitarian assistance and workersPublic Health Agency of CanadaSupplementary estimates (B) 2014-201539131353913136391313739131383913139391314039131413913142391314339131443913145EveAdamsMississauga—Brampton SouthEveAdamsMississauga—Brampton South//www.ourcommons.ca/Parliamentarians/en/members/71688EveAdamsEve-AdamsMississauga—Brampton SouthLiberal CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/AdamsEve_CPC.jpgInterventionMs. Eve Adams: (1130)[English]Thank you.Let me move on to food safety, Minister. We had some wonderful news this morning as we opened up The Globe and Mail. Canada has tied for first place in food safety, along with Ireland. It's of paramount concern to ensure that the food we're placing on the table before our families is safe. I can tell you that it's something I'm concerned about as a mom and that my girlfriends are concerned about as they prepare meals for their families. Could you update us on Canada's food safety system and what the next steps might be?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthFood safetyPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913146391314739131483913149RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1130)[English] I'd be happy to, and I'd like to take this opportunity to congratulate Bruce on the number one position—no pressure on the head of the CFIA, but it's obviously great news. A lot of work has been done at the Canadian Food Inspection Agency over the last few years to continue striving to be the best. It's obviously wonderful to be recognized. It doesn't mean that we won't stop working very hard, because this is an issue that matters to all of us, as you said. In the last budget, we reinforced our commitment to food safety by investing another $400 million to strengthen our food safety regime. We hope this will give our inspectors and those who work in this area the tools they need to continue to ensure that our food safety system remains the best in the world.In addition to that, of course, our government has now invested more than half a billion dollars in various safety initiatives since 2008. These also include enhancing food inspection programs and hiring more inspectors. The significant funding being delivered through our economic action plan over five years is further strengthening our food safety system, and it will include resources to hire 200 additional food safety inspectors and staff. We're also establishing the food safety information network, which is a network among federal, provincial, and territorial food safety partners and laboratories. What it does is it helps better protect Canadians from food safety risks by improving our ability to anticipate, detect, and respond to food safety hazards. The funding will also—Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthFood safetyPublic Health Agency of CanadaSupplementary estimates (B) 2014-201539131503913151391315239131533913154EveAdamsMississauga—Brampton SouthBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry (Vancouver Centre, Lib.): (1135)[English]Thank you very much, Mr. Chair.I want to thank the minister for the presentation. I've always felt that health is too important for us to play political, partisan games with, so I will start by congratulating the minister on what I consider to be now—in the past, the minister knows how I felt about certain of the Ebola initiatives—a very excellent response, including the vaccine.The only question I have to ask with regard to that is this—and I'm going to ask the questions, and maybe you can answer afterwards, so that we can get a fulsome answer. Who did you consult with concerning the pause in visas? I know that the World Health Organization and many other public health officials felt that it created a bit of an anxiety in the public when you did that pause because they felt people would believe that travellers could in fact be a risk. That's the first question I want to ask. Other than that, good work on Ebola, I say to Dr. Taylor and to you.I also want to bring up the issue of marijuana. As you well know, I felt that the marijuana report.... We had a report that suggested that the study was very flawed, because you cannot look at risks without looking at benefits, and there was very little done to look at benefits.We felt that much of the contradictory evidence that came from many of our expert witnesses was not reflected in the report. We also felt that there were a couple of pieces, including looking at some studies and some research that would eventually talk about risks and benefits and at long-term and short-term effects of marijuana both on youth and on others, that were very important things to do. That was not accepted as a recommendation. So we feel that the report leaves a lot to be desired.What I want to ask, though, is very simply this. There are ads out there now, and I know that the minister is asking for more than $5 million to present the ads. Given what we heard in the testimony, that the evidence was not really out there suggesting that the long-term effects of marijuana use are so absolutely awful—we know the short-term effects—who did the minister consult when she put those ads out? Would she tell us who they were, list them, and table the list to the committee at some point in time?AdvertisingCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913158391315939131603913161391316239131633913164BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1135)[English] Sure, no problem.AdvertisingCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913165HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1135)[English]That's the second question.The third question is about PHAC. Again, while I congratulate you on how well you have responded to Ebola—although we thought there was a bit of foot-dragging at the beginning, now I think the response is good—I wanted to know if you could tell us who you consulted when you created the changes in the chief public health officer's position within Health Canada. Not that this has anything against Dr. Taylor or Ms. Outhwaite, but I do think that the concept of the chief public health officer having a deputy minister position was one that was studied really well as a result of some of the things that we found after SARS and after H1N1. This all came together with a lot of public health officials coming up with this particular way that Health Canada had existed, and now this change, I think, brings down the chief public health officer's ability to respond quickly to get the resources he needs. Currently that may work if he and Ms. Outhwaite get along really well, but when changes occur.... It shouldn't be personal; it should be objective.I want to know who the minister consulted with. I have heard from many public health officers across the country that they think this is a bad decision, so I wanted to know who the minister consulted with. Could she table the list of people she consulted, because I do think it's a major problem?Finally, actually, no, that's it. Those are the questions.AdvertisingCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaSupplementary estimates (B) 2014-201539131663913167391316839131693913170RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1140)[English]Do I have time to answer?The Chair: Yes.Hon. Rona Ambrose: Okay.Sure, I'm happy to answer.Thank you for your compliment on the Ebola response. The Public Health Agency has worked very hard. We have tried, as a government, to.... I shouldn't say try, we've supported them in every possible way with any requests that they've had to make sure that they're able to respond appropriately, and we'll continue to do that.On marijuana, who did we consult? I held a number of round tables that I'm happy to share with you. Actually, I think we put out a press release after the expert round table we had with researchers and physicians who have studied this issue for many years, addiction specialists. When I asked them, overwhelmingly their message to me was that the evidence is absolutely irrefutable. Of course, the same message has been made publicly by the head of the Canadian Medical Association, that the evidence is irrefutable about the harm of marijuana to youth and the developing brain. I asked the researchers point-blank, “What can we as a government do? If you had your wish, what would you ask me to do to help you?” They said that we needed a national marijuana smoking cessation campaign, a national one. Kids don't know how harmful marijuana is to their health. Parents think it's the same as what they smoked 30 years ago. They have no clue about how this could harm their kids. We've seen psychosis; we've seen mental health issues.I said, “Okay, we're going to try to do that”, and we did. We put together an awareness campaign, focused on the impact on the developing brain of youth. Health Canada did a lot of work with researchers to make sure that anything that was said in those campaigns was backed by research, and we can table that and give it to you should you want to see it. We can provide you a briefing. There's no question about the harmful effects of marijuana on the developing brain. The science is irrefutable.To your point about people wanting to know what the benefits are, if there are any legitimate researchers who would like to do a clinical trial, I haven't met them yet. They haven't come forward to me and said, “We have the funds and the backing of a company or someone who wants to do clinical trials.” There's no evidence right now, and you know that from the recent report of the Canadian Family Physician and from the guidelines that are being given to doctors to prescribe marijuana across this country. We don't have the evidence that it's actually— AdvertisingCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015391317139131723913173391317439131753913176391317739131783913179HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1140)[English]Minister, I sat through the committee hearings. The recommendations from many of our experts was that we do research on the benefits and risks of marijuana, the short- and long-term effects of marijuana on the developing brain. There's only one study that said irrefutably that there were very long-term effects.The idea of saying that the CMA, etc.—and I think that's unfair to them—have decided that you should do this ad, when they refused to do the ad with the Ministry of Health—AdvertisingCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaSupplementary estimates (B) 2014-201539131803913181RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1140)[English] I did not say that. What I said is—AdvertisingCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913182HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1140)[English]It's not true. AdvertisingCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913183RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1140)[English]—that the president of the Canadian Medical Association is on the record saying, “especially in youth, the evidence is irrefutable—marijuana is dangerous.” What I'm telling you is that I think the experts told me loud and clear what we needed to do, so we have a public awareness campaign to support parents who are struggling with trying to help their kids get off marijuana. AdvertisingCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaSupplementary estimates (B) 2014-201539131843913185HedyFryHon.Vancouver CentreBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/72006DavidWilksDavid-WilksKootenay—ColumbiaConservative CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/WilksDavid_CPC.jpgInterventionMr. David Wilks (Kootenay—Columbia, CPC): (1140)[English] Thank you very much, Mr. Chair. Thank you, Minister, for being here today. I'll go down that same road with you, Minister, with regard to Health Canada and their running of a series of TV ads warning children and parents about the serious health risks involving both prescription drug abuse and smoking marijuana. As MP Fry has indicated, the committee recently concluded our study on the serious health risks and harms of smoking marijuana, in which we recommended that a public awareness campaign be undertaken. During that study we heard from doctors and researchers on the serious and harmful effects associated with marijuana use, especially on teens. Could I add that in my previous career I did three years of drug work, predominantly on marijuana? I can rest assured that not only with regard to teens, but well beyond that, there are some significant problems and we need to deal with them. So I'm very happy to see that we ran this series of TV ads.Could you update the committee on how this campaign has been received?AdvertisingCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015391318839131893913190391319139131923913193BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1145)[English]It's interesting, because someone approached me the other day and said, “I didn't know that marijuana is so much stronger today than it was when I was a kid”. In fact, there are experts who think that we've underestimated, and that it's actually much stronger, but we used very credible researchers, very credible experts, to ensure that what is in these ads is completely defensible. I'd be happy to share any of that information from Health Canada.I commend Health Canada for doing this. I don't think we've had an anti-marijuana smoking-cessation campaign for a.... Well, I don't even know if we've ever had one in Canada. What we know, I think it's from UNICEF, is that our kids are smoking more pot per capita than anywhere in the world. We know that the experts are saying very clearly that it's harmful to the development of their brains. That's not only in terms of mental health issues, but serious mental health issues such as psychosis and the onset of schizophrenia.I could give you reams of documents from very credible experts who say the same thing. The former head of the CMA said it's dangerous. The current head of the CMA said, “Any effort to highlight the dangers, harm and potential side effects of consuming marijuana is welcome”. Addiction specialists are struggling, people who are dealing with these kids in their offices are struggling, and rehab specialists are struggling. Kids are using more and more of this. People are putting it in the form of candy now, and giving it to kids in grade school. I mean, this stuff is more addictive. This is not the pot of the 1960s, and it's really difficult for parents because they're up against the idea that it's normal, that it's like smoking cigarettes, and that it's not as harmful as alcohol. Well, alcohol is harmful; smoking cigarettes is harmful. We have smoking-cessation campaigns for tobacco. We don't want people to drink a lot. We have all kinds of ad campaigns about alcohol abuse, yet somehow we're not supposed to have an ad campaign about kids smoking pot. It's nuts. I can't believe the reaction of people from a partisan point of view. This is based on science. Parents are struggling with their kids, who are clearly being impacted mentally and physically, and it would be irresponsible for us not to do a public awareness campaign. So I think in the face of accusations where the Liberals are normalizing marijuana so that somehow this is a partisan campaign, this is absolutely ludicrous. It's based on science, it's necessary, and we'll continue with it.AdvertisingCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaSupplementary estimates (B) 2014-201539131943913195391319639131973913198DavidWilksKootenay—ColumbiaDavidWilksKootenay—Columbia//www.ourcommons.ca/Parliamentarians/en/members/72006DavidWilksDavid-WilksKootenay—ColumbiaConservative CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/WilksDavid_CPC.jpgInterventionMr. David Wilks: (1145)[English] Thank you very much.Prior to the marijuana study, we did a study on Vanessa's Law, on which I must congratulate my colleague Terence Young for his admirable work and years of getting it to where it got to. We heard testimony from several witnesses who are experts in the field of drug safety on the need to ensure that Health Canada shares information in an open and transparent manner.As a former police officer, I know that there are a number of inherent risks present in many drugs, including those that are freely available over the counter. That is why I was very pleased to be part of the committee's deliberations on Vanessa's Law and of amending the legislation to include a greater degree of transparency.Can you update the committee on what is being done to ensure that drug safety information is being made available to those who need it?C-17, An Act to amend the Food and Drugs ActCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015Therapeutic products3913199391320039132013913202RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1145)[English]Sure, but here is just one more thing about marijuana.It's really important that everyone, as health committee members, remember that marijuana is not an approved drug in this country. It has never gone through any rigorous approvals or scientific clinical trials to show that it is safe to take as a medicine. Let's all remember that. Think about it as health committee members. It's very difficult, because that message is out there, and kids have a sense that somehow it's safe because it's “a medicine”, whereas it has never gone through any approval processes at Health Canada, is not an approved drug, and is not an approved medicine.Going back to your question about Vanessa's Law, I again commend the committee and all members of Parliament who worked so hard in a multi-party, non-partisan way to make these important improvements.The legislation, as you know, updates the Food and Drug Act for the first time in 50 years, something which is incredibly important. The sound amendments that were made by the committee..... Again, I want to thank each and every one of you for having been a part of this achievement. You laid it out quite well. Nowhere is confidence and transparency more important than in the decisions made that affect the health and safety of Canadians.Vanessa's Law will ensure that additional details on Health Canada's drug approval process are made public, concerning both those that receive approval and those that do not, which was, I know, an important point brought to light when the legislation was first tabled. I was happy the committee was able to amend it.We now have a world-leading regulatory transparency and openness framework and action plan, and I will continue, as I said, to work with Health Canada to further our transparency in the way we approve drugs. I'm very pleased to report that, as of November 5, Health Canada has posted a list of all of its inspections of drug manufacturing plants over the past three years, something that I know Canadians were looking for. I applaud them for their level of transparency.C-17, An Act to amend the Food and Drugs ActCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015Therapeutic products391320339132043913205391320639132073913208DavidWilksKootenay—ColumbiaBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/71585MatthewKellwayMatthew-KellwayBeaches—East YorkNew Democratic Party CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/KellwayMatthew_NDP.jpgInterventionMr. Matthew Kellway (Beaches—East York, NDP): (1150)[English] Thank you, Mr. Chair.Thank you, Minister, for coming today and spending some time with us and answering questions. I have two questions for you today. Let me set them both out and leave you to determine how to judge your response times.The first has to do with the Mental Health Commission of Canada and mental health as an issue that we need to deal with. Of course, Minister, our job in the opposition is always to be critical, but when asked whether I can say something good about the government I always happily refer to the Mental Health Commission of Canada. It's accomplished a great deal in a very short period of time. It's put in place a national strategy, as you know, and has moved beyond that to do a lot more in terms of policy and best practices and training, and so on. But the issue, Minister, as you know, is not going away. One in five Canadians is living with mental illness and it's costing our economy $50 billion a year, and it's anticipated that those costs are going to rise significantly as we move forward. It's time and the Mental Health Commission of Canada has asked to put in place a renewed mandate to turn their strategy into an action plan and extend the funding to support a new mandate for the Mental Health Commission of Canada. So my first question is this. Will your government do that, extend the mandate of the commission, and of course provide funding to support that mandate?The second question has to do with food labelling. We know that chronic diseases are the leading cause of death and disability in Canada and are among the most costly but also preventable diseases. We know that part of that equation is an unhealthy diet and that they are in fact a public health risk to Canadians with 60% of adults suffering from obesity and nearly a third of kids. We know that Canadian diets do not meet national recommendations. We also know that your department has put forward some recommendations or proposals with respect to food labelling, but those proposals seem to have some glaring omissions to us. First is that they continue to give, on the front of food packaging, priority to the marketing claims of the producer as opposed to nutritional information. Second, the labelling doesn't deal with added sugars, and we know that research is showing that excess sugar from added sugars can triple the risk of dying from heart disease. Lastly, we ought to have on those labels standardized serving sizes that actually reflect consumption, so that we don't have to reach for calculators to figure out what it is we're actually taking in. Have your proposed changes to food labelling gone through, been approved, or are they outstanding? Depending on your answer to that, will you make some further changes to those proposals or why didn't you include these three issues in your proposals?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthFood labellingMental healthMental Health Commission of CanadaPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913211391321239132133913214391321539132163913217BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1155)[English]Sure. Maybe I can get more specifics from you offline, but standardized serving sizes is one of the things that we're looking at and we went out to consult with Canadians at large and then also to consult with health groups. In the industry we've done focus groups. The consultation is just wrapping up. But by all means, if you have some ideas you want to share with us we're happy to take them. But standardized serving size was something we heard loud and clear about from people. I use the example of one of my staffers who said when she buys two different brands of perogies, one serving size is six and one serving size is two. Trying to figure out the calorie content—and who eats two perogies, nobody does—it's very confusing. When you're buying bread it's by one slice. Normally people eat two. People want consistent, realistic, relevant serving sizes to what they actually eat, so we've been looking at that and I hope we can make progress on it. Sugars is a big one. We heard that loud and clear from moms—I say moms, because moms apparently do almost all the shopping as we found out through a lot of questions—and they said loud and clear they want to know about added sugar and how much sugar is in the food. So that was one of the things we had on our proposed label change.In terms of front-of-package labelling, I might ask Bruce to speak a bit to that. But if a company or a manufacturer does make a health claim they do have to come through Health Canada. They have to show evidence of that health claim if that's what you mean. If it's just marketing, different kinds of marketing.... Do you want to be more specific, maybe?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthFood labellingPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015391321839132193913220MatthewKellwayBeaches—East YorkBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/35663TerenceYoungTerence-YoungOakvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/YoungTerenceH_CPC.jpgInterventionMr. Terence Young: (1155)[English]Minister, I'd like to expand on my colleague's previous question on transparency and delve a little more deeply into the mechanics behind Vanessa's Law. Like you, I was extremely pleased to see it receive royal assent three weeks ago. A number of measures contained in this bill are effective immediately upon the Governor General signing the bill into law, while others will take some time to come into effect. I get a lot of questions about that. We know there's a need for more consultation. Health Canada has done a superb job on consultation on this bill over the years, which I much appreciate. Can you please update the committee on what measures in Vanessa's Law are law right now, immediately, and which ones will require some ongoing consultations and come into force over time.C-17, An Act to amend the Food and Drugs ActCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015Therapeutic products391322739132283913229RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1155)[English]Sure, I'd be happy to.First of all, thank you for the many years of your work on this. I think it provided all of us with the knowledge, but also the inspiration, to work together across parties to get this done. With royal assent, I can tell you that the new authorities for me and any future ministers as Minister of Health, would be the ability to compel information, recall unsafe therapeutic products, impose tougher fines and penalties, incorporate by reference, disclose confidential business information, direct package label changes, and seek an injunction. In terms of regulations that are not in force and that we will be developing and are already developing to ensure they come into force soon are the ability to require tests and studies, order a reassessment, and attach terms and conditions to market authorizations. I would say they still need further work in the regulatory process. They're important, but I think the ones that matter the most, as you know, are the ability to recall products quickly, compel information, direct label changes, and tougher fines. For the things that really impact consumers and those who are using the product, we have the power today, thanks to all the work you and the committee did, both here in the House and the committee in the Senate. I would say it also saves us a great deal of time. I know I spent some time speaking about this in the Senate, but the fact that we now have the power to do this means we don't have to negotiate with pharmaceutical companies. Our officials spent literally hundreds of hours negotiating with companies to change their labels, to pull unsafe products off the shelves. Of course, the longer they can keep them on the shelves, the better for them, and the more profits. It was very frustrating. The fact that this law has passed will not only allow us to act more quickly in the public interest, but also frees our officials to do the work they should be focused on instead of negotiating with companies.C-17, An Act to amend the Food and Drugs ActCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015Therapeutic products391323039132313913232391323339132343913235TerenceYoungOakvilleTerenceYoungOakville//www.ourcommons.ca/Parliamentarians/en/members/35663TerenceYoungTerence-YoungOakvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/YoungTerenceH_CPC.jpgInterventionMr. Terence Young: (1200)[English]Thank you, Minister. Dr. Beaudet, I'd like to refer to the Ottawa statement, which was put together by some Canadian scientists in Ottawa, I think it was four years ago. It's a very high standard for clinical-trial transparency, and it makes reference to.... I'll just read a section from it, because I respect it so much. Protocol information and results from all trials related to health or healthcare—regardless of topic, design, outcomes, or market status of interventions examined—should be registered and publicly available....I'm familiar with CIHR's standard for trials on transparency that CIHR funds right now. I want to refer to any changes that might happen with regard to how you enforce transparency in CIHR-funded trials, and how you intend to enforce those changes, please. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthExperimental methodsPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913236391323739132383913239RonaAmbroseHon.Edmonton—Spruce GroveAlainBeaudetAlainBeaudetAlain-BeaudetInterventionDr. Alain Beaudet (President, Canadian Institutes of Health Research): (1200)[English]First of all, I thank you for this question and for your comments.You should know that some of these new regulations will be incorporated in the TCPS, which is the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. We're again tightening some of the screws in the policy, which as you know is really the guideline used universally in Canada for ethics regulating trials. Obviously, what we can regulate are the trials we fund.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthExperimental methodsPublic Health Agency of CanadaSupplementary estimates (B) 2014-201539132403913241TerenceYoungOakvilleTerenceYoungOakville//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1200)[English]Thank you very much.I know we just have a few minutes left with the minister, so just to follow up on a couple of things.... We didn't actually get a response and maybe Mr. Da Pont could respond about the question on the Mental Health Commission of Canada. We know that they're seeking a new 10-year mandate. They have put in a funding request. We'd like to know if the minister specifically is supporting that new mandate and the funding request. Obviously, it goes through the finance department but it's very important to know if the minister is supporting that. Then I have a quick second question. So if you could just answer briefly, please.... Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMental healthMental Health Commission of CanadaPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015391324539132463913247BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1200)[English]If the question is about me, then I'd be happy to answer it and George can follow up if he wants.The Canadian Mental Health Commission's mandate is over in 2017, so I do know that they are starting to talk about a new mandate. I haven't had a chance to meet with them directly. I do know that there is that request but there is still time obviously for—Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMental healthMental Health Commission of CanadaPublic Health Agency of CanadaSupplementary estimates (B) 2014-201539132483913249LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1200)[English]The material that we got that was sent around says that they're seeking a new mandate of 10 years, 2015 to 2025. I think it is coming up earlier and that's why they put in the prebudget consultation this year because they know it is coming up. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMental healthMental Health Commission of CanadaPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913250RonaAmbroseHon.Edmonton—Spruce GroveGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont (Deputy Minister, Department of Health): (1200)[English]Actually both points are correct. The current mandate does run longer and you're correct that they have come in with a proposal for an earlier renewal of their mandate, a proposal both for funding and the mandate. We're working with them on that. Their mandate doesn't end in 2015. It does run later. They just would like an earlier renewal. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMental healthMental Health Commission of CanadaPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913251LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1205)[English]So we can assume that this mandate is going to continue. They're not going to get chopped off in 2017. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMental healthMental Health Commission of CanadaPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913252GeorgeDa PontRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1205)[English]I would just say that obviously they've done incredible work and we'll consider this. But I would just say that they're still working hard. Their mandate ends in 2017 and we'll obviously take a look at what they.... But regardless, I think it's clear from not only the investment in the Canadian Mental Health Commission but billions of other investments that this government has made that— Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMental healthMental Health Commission of CanadaPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913253LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1205)[English]If I could move on to my last question, just to come back to the medical marijuana, you might have seen a story yesterday on CBC. It was called “My QP”. It was a very compelling story about a young mother who has a very young son who suffers from a rare condition that results in multiple seizures. The only thing that's proved effective is to take medical marijuana but not in a smoked form. The question arose from this mother as to why the rules from Health Canada are so rigid and inflexible that it doesn't allow her to use an ointment or a tincture, which is a much better product for her son. I know that you're totally opposed to medical marijuana and it's only there because it's being compelled by the courts. But it seems to me that there is evidence and there are compelling situations where different kinds of products are needed. I want to ask if Health Canada and you as minister are prepared to consider these kinds of situations so that Ms. McKnight can actually get the help she needs. What she's doing now is basically illegal. She said that publicly. Of course, she doesn't want to do that, but what is she left to do to help her young son? So I wonder if you would respond to that.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaResearch and researchersSupplementary estimates (B) 2014-201539132563913257RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1205)[English]Sure, I would be happy to. I have a lot of sympathy for what she is dealing with, obviously. But we do consider these things. We consider them through the special access program. The special access program is there for drugs that have not been approved or are experimental or are not available in Canada. That decision is made by experts and researchers and scientists within Health Canada. My understanding is that when these requests have been made, the researchers, the scientists have said there is no evidence. I don't know what to say to you. What we need is research. We need clinical trials to show that these kinds of alternatives are actually—Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaResearch and researchersSupplementary estimates (B) 2014-20153913258LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1205)[English]But the government hasn't wanted to do any research. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaResearch and researchersSupplementary estimates (B) 2014-20153913259RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1205)[English]We put money towards research. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaResearch and researchersSupplementary estimates (B) 2014-20153913260LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1205)[English]You could initiate that yourself. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaResearch and researchersSupplementary estimates (B) 2014-20153913261RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1205)[English]We did initiate a number of years ago through Health Canada and when I asked what happened, they said that basically the clinical trials fell apart because the research that was happening wasn't valid. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaResearch and researchersSupplementary estimates (B) 2014-20153913262LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1205)[English]Do you think it's important to do research and clinical trials? Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaResearch and researchersSupplementary estimates (B) 2014-20153913263RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1205)[English]Pardon me?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaResearch and researchersSupplementary estimates (B) 2014-20153913264LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1205)[English]Do you think it's important to do clinical research?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaResearch and researchersSupplementary estimates (B) 2014-20153913265RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1205)[English] Absolutely; without clinical trials, without research, we have no evidence that these things work. So this mom comes to Health Canada and says, “Can you give me special access to this drug?”, but the researchers look at all the evidence and say, “There's no evidence that this works”.We're the government. We don't do clinical trials. You know how it works. There needs to be evidence and research and clinical trials. There needs to be clear scientific evidence that this is not harmful, and that it's useful and effective.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaResearch and researchersSupplementary estimates (B) 2014-201539132663913267LibbyDaviesVancouver EastBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/1814JamesLunneyJames-LunneyNanaimo—AlberniIndependentBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LunneyJamesD_CPC.jpgInterventionMr. James Lunney (Nanaimo—Alberni, CPC): (1210)[English]Thank you very much. Thanks to our officials. To the new faces who've just joined us at the table, welcome. We appreciate your being here today.One of the issues that's top of mind for everybody in health care right now—and I didn't get a chance to address this to the minister—is of course the subject of innovation. Actually, everybody seems to have an opinion on where we're going with innovation. We have an advisory panel to which the minister has appointed some very capable Canadians. About eight distinguished Canadians are joining Dr. Naylor on the panel.But Dr. Chris Simpson from the CMA spoke here in Ottawa just a couple of days ago on a national strategy for seniors. The minister mentioned in her remarks the challenges facing us with chronic diseases and managing those. Dr. Simpson's remarks had to do with the contribution of chronic illnesses to occupying hospital beds, creating gridlock in the hospitals, and tying up whole facilities because there's no place to move people. The Hill Times has about 20 pages of opinions on how to get through some health care innovation. By way of background, I'll just say that in my own province, I think we're at about 45% of the provincial budget. Most of them are at 45% or 46% right now of their entire provincial budget. But going back to 2000, when I first ran for office, in my province, when you added education and social services, you were at 85% of the entire provincial budget on those three alone. So we know that health care, as we've been practising it, is not sustainable. Dr. Simpson's take is that we have to dehospitalize health care. We're hoping that the panel, as they hear lots of opinions from across the country, will come up with some useful suggestions. The minister mentioned briefly in her opening remarks that Dr. Naylor's committee has hit the ground running, that they're doing consultations. The minister is not here now to answer this question, so Mr. Glover, Mr. Da Pont, or whoever wants to address this, can you please give us a review of where Dr. Naylor's committee is at, how this is playing out, and how those consultations are taking place?Associations, institutions and organizationsCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthHealth care systemPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913278391327939132803913281391328239132833913284BenLobbHuron—BruceGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1215)[English] Thank you very much.As the minister indicated, the panel is now out in full force in its consultation process. There are several different avenues under way. As the minister mentioned, there is an open, online consultation available to any Canadian who wants to offer ideas to the panel.The panel has been meeting various health care stakeholders and associations on an individual basis. They also have been and are planning to meet at various regional levels with a broad section of stakeholders. For example, I believe just a couple of weeks ago they had their first such meeting in Halifax, well attended by 25 to 30 key health care stakeholders in that province, including a good representation by provincial officials. They're intending to have similar sessions over the next month or so in various other parts of the country. I think they have sessions set up for Toronto, Vancouver, Winnipeg, and a couple of other cities. Dr. Naylor and his panel have been doing work with provincial governments seeking input from them as well. They will be doing the same with territorial governments. Finally, they are looking at and working to see if there are any international examples or models of innovation that could possibly be considered or applied here in Canada. One of the things that I certainly am aware of and the panel is seeing is that there's a great deal of innovation going on across the country in almost every single jurisdiction. There are many effective pilots that have been done or are under way. I think one of the biggest challenges is that it seems so difficult to take those effective pilots and scale them up on a broad basis. I think those are some of the issues that are coming out in the discussions that they're having.Associations, institutions and organizationsCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthHealth care systemPublic Health Agency of CanadaSupplementary estimates (B) 2014-201539132853913286391328739132883913289JamesLunneyNanaimo—AlberniJamesLunneyNanaimo—Alberni//www.ourcommons.ca/Parliamentarians/en/members/1814JamesLunneyJames-LunneyNanaimo—AlberniIndependentBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LunneyJamesD_CPC.jpgInterventionMr. James Lunney: (1215)[English]Thank you for that.I know time is short, so I quickly want to review an issue that I've raised before with officials for a number of years, and that's the proton pump inhibitor issue. I want to ask if it is under PHAC, the Public Health Agency of Canada, or under CIHR, that the CNISP program is managed. It's PHAC, okay.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthNosocomial infectionsPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015391329039132913913292GeorgeDa PontBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/1814JamesLunneyJames-LunneyNanaimo—AlberniIndependentBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LunneyJamesD_CPC.jpgInterventionMr. James Lunney: (1215)[English]We know that there is a 40% to 275% increased risk when patients are on those medications. The CNISP program has been reviewing this for a number of years. They haven't been collecting data on the medications the patients are on at admission. That's an issue I've raised with the department before. Do you feel, Dr. Beaudet, or the two of you as clinicians, that in fact collecting data would help clarify the role of proton pump inhibitors in contributing to C. difficile cases?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthNosocomial infectionsPublic Health Agency of CanadaSupplementary estimates (B) 2014-201539132963913297BenLobbHuron—BruceBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/71430Marc-AndréMorinMarc-André-MorinLaurentides—LabelleNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinMarcAndré_NDP.jpgInterventionMr. Marc-André Morin (Laurentides—Labelle, NDP): (1215)[Translation]Thank you, Mr. Chair.My question is for the deputy minister.The government receives $700 million in supplementary revenue because of the increased tobacco tax, but it does not use that money to reduce smoking. Instead, the government has cut funds set aside for reducing smoking.The government has also put forward weak regulations against flavoured tobacco. It isn't following the lead of other countries, like Australia, that impose regulations on uniform packaging.When will the government get serious about reducing the biggest predictable cause of death in Canada?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSmokingSupplementary estimates (B) 2014-201539133013913302391330339133043913305BenLobbHuron—BruceGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1220)[Translation]Thank you for your question.The government launched a very good campaign to reduce the number of smokers here, in Canada.[English]When you look at the results, today we have among the lowest smoking rates in this country that we've ever had, both among youth and among adults. They're among the lowest in the world, and that is an indication of the many years of work and campaigning—education and other campaigns—not just by Health Canada but by many other organizations.At the same time we've taken a leadership role in dealing with issues of flavoured tobacco, which appeals to children and has a significant risk of renormalizing smoking. As you're aware, a few years ago Canada was the first country in the world to put these sorts of measures in place, and the minister has recently announced an intent to augment those measures even further to deal with the innovation of tobacco products by some of the major companies.[Translation]I think we are seeing very good results. We are continuing to invest in this program. I am really encouraged by the results we are getting, which are among the best in the world.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSmokingSupplementary estimates (B) 2014-201539133063913307391330839133093913310Marc-AndréMorinLaurentides—LabelleMarc-AndréMorinLaurentides—Labelle//www.ourcommons.ca/Parliamentarians/en/members/71430Marc-AndréMorinMarc-André-MorinLaurentides—LabelleNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinMarcAndré_NDP.jpgInterventionMr. Marc-André Morin: (1220)[Translation]Of course, there has been a drop in tobacco use, but the costs for smoking-related health care resulting from smoking are still quite substantial. When you see people smoking outside hospitals with their IV drips, you have to wonder how many of them are unaffected by this government action and find themselves in this situation.Shouldn't extra effort be made?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSmokingSupplementary estimates (B) 2014-201539133113913312GeorgeDa PontGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1220)[Translation]I will repeat the same answer and say that we have made a lot of progress in this area.[English]Right now smoking rates among Canadians are down to 16%. Smoking rates among young people are down to 7%. Both are record lows, and I think they show the effectiveness of the work that has been done and continues to be done not just by Health Canada but by many medical organizations, provincial governments, and many others. We are continuing to see a steady reduction. As I mentioned, we are putting more effort into an area where we think there is risk, and that is flavoured tobacco. It appeals to children, and in our view, it has a very high risk of renormalizing smoking. The measures the government put in place a few years ago and the enhanced measures the minister announced a few weeks ago are good demonstrations of continued effort. From the work we are doing, we are getting very good results.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSmokingSupplementary estimates (B) 2014-20153913313391331439133153913316Marc-AndréMorinLaurentides—LabelleBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/71693WladyslawLizonWladyslaw-LizonMississauga East—CooksvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LizonWladyslaw_CPC.jpgInterventionMr. Wladyslaw Lizon (Mississauga East—Cooksville, CPC): (1220)[English]Thank you very much, Mr. Chair.Welcome to all the witnesses. Thank you for coming. The first question I have is related to supervised consumption sites. How would Bill C-2, the respect for communities act, change the process for exemptions related to supervised consumption sites?C-2, An Act to amend the Controlled Drugs and Substances ActCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSafe injection sitesSupplementary estimates (B) 2014-2015391332039133213913322BenLobbHuron—BruceGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1225)[English]Thank you very much for the question.The proposed legislation that is before you for consideration would essentially create two separate exemption regimes: one for licit substances, which are defined as substances obtained in a manner authorized by the Controlled Drugs and Substances Act or its regulations, and a second for illicit substances, generally street drugs.The new regimes will strengthen the safety and security provisions for licit substances—the authorized uses—as they would obviously be for medical and scientific research and other things that are in the public interest. For activities involving licit substances, the categories under which applications would be considered would be medical, law enforcement, or prescribed purpose. As I'm sure you and members are aware, there was a Supreme Court decision around some of these issues that set some broad principles and categories of things that would be taken into account in assessing applications, and those are set out and expanded upon in the proposed legislation. The other significant piece is that the proposed legislation would authorize the minister to publicly post a notice of application for an exemption for a supervised consumption site and invite comments from the public on that application for a period of time. The purpose of that is to ensure that the broader community has an opportunity to express its views on an application as obviously it would be affected by the outcome. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSafe injection sitesSupplementary estimates (B) 2014-201539133233913324391332539133263913327WladyslawLizonMississauga East—CooksvilleWladyslawLizonMississauga East—Cooksville//www.ourcommons.ca/Parliamentarians/en/members/71693WladyslawLizonWladyslaw-LizonMississauga East—CooksvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LizonWladyslaw_CPC.jpgInterventionMr. Wladyslaw Lizon: (1225)[English] Thank you.Actually, I would like to go back to the question of marijuana and the clinical studies that were conducted.Are you familiar with any study anywhere in the world that would prove or suggest that either marijuana or a substance derived from marijuana can be used to treat certain medical conditions?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaResearch and researchersSupplementary estimates (B) 2014-2015391332839133293913330GeorgeDa PontGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1225)[English]Yes, there are actually some studies under way. Maybe I'll go back and use the example that Ms. Davies referred to.My understanding is that the U.S. has six clinical studies under way right now looking at a derivative product that is being tested for safety and efficacy for just that type of condition. I think, at least for that specific case, as we begin to get the results of some of these clinical trials, obviously it may lead us to reconsider the approach, depending on the outcome.We are seeing a few other applications for clinical trials, but not, as the minister said, on a widespread basis. I think everyone's aware that there may well be benefits to some drugs, but also there are significant risks. The purpose of the clinical trials is to assess whether potential benefits outweigh the risks. That's the sort of evidence that just doesn't exist at the moment. It'll hopefully begin to come in over time as we see more clinical trials.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaResearch and researchersSupplementary estimates (B) 2014-2015391333139133323913333WladyslawLizonMississauga East—CooksvilleWladyslawLizonMississauga East—Cooksville//www.ourcommons.ca/Parliamentarians/en/members/71693WladyslawLizonWladyslaw-LizonMississauga East—CooksvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LizonWladyslaw_CPC.jpgInterventionMr. Wladyslaw Lizon: (1225)[English]Well, maybe quickly, on another topic, what progress can you report following the last implementation of the health agreement with the First Nations Health Authority in B.C.?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthFirst NationsPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913337BenLobbHuron—BruceGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1225)[English]Again, I would say that really is a landmark tripartite agreement that has seen the responsibility for design and delivery of programs and services that previously came from Health Canada now being turned over to a newly created First Nations Health Authority. That authority has gotten off, we think, to a very good start.One of the early things we notice is that now they have developed stronger relationships with the province, so with regional medical delivery mechanisms, and are taking a more integrated approach. They now have the ability, really, to redesign programs, get better integration and consistency with the province, and hopefully, get much better outcomes for first nations people in B.C.Obviously, it's only been a year that it's been in place—Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthFirst NationsPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015391333839133393913340WladyslawLizonMississauga East—CooksvilleBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/35663TerenceYoungTerence-YoungOakvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/YoungTerenceH_CPC.jpgInterventionMr. Terence Young: (1230)[English]Thank you, Chair.For Dr. Beaudet, again, please, when people drop out of clinical trials early on, the researchers call that microdata. Sometimes it's because they're reacting to drugs. I call that life-saving information, and the drug industry sometimes just calls it CBI, confidential business information. This is a big problem for patient safety.How will the requirement in Vanessa's Law to register all clinical trials change the way you enforce transparency in CIHR-funded trials?C-17, An Act to amend the Food and Drugs ActCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015Therapeutic products391334539133463913347BenLobbHuron—BruceAlainBeaudetAlainBeaudetAlain-BeaudetInterventionDr. Alain Beaudet: (1230)[English]In CIHR-funded trials it's very clear. The requirement for registration and reporting of adverse effects is mandatory. It's part of the contract that we sign with the investigator when we give out the grant. Should the terms of the contract not be respected, they would be in breach of the contract, actually. They would be in breach of the TCPS's tri-council policies on ethics for trials, in which case that would come under the secretariat on ethics, which would recommend—would recommend to me, actually—a number of sanctions, the first one usually being non-eligibility for future funding at CIHR.C-17, An Act to amend the Food and Drugs ActCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015Therapeutic products3913348TerenceYoungOakvilleTerenceYoungOakville//www.ourcommons.ca/Parliamentarians/en/members/35663TerenceYoungTerence-YoungOakvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/YoungTerenceH_CPC.jpgInterventionMr. Terence Young: (1230)[English]You would cut them off from future trials?C-17, An Act to amend the Food and Drugs ActCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015Therapeutic products3913349AlainBeaudetAlainBeaudetAlainBeaudetAlain-BeaudetInterventionDr. Alain Beaudet: (1230)[English]We'd cut them off—C-17, An Act to amend the Food and Drugs ActCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015Therapeutic products3913350TerenceYoungOakvilleTerenceYoungOakville//www.ourcommons.ca/Parliamentarians/en/members/35663TerenceYoungTerence-YoungOakvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/YoungTerenceH_CPC.jpgInterventionMr. Terence Young: (1230)[English]Is that your only tool of enforcement?C-17, An Act to amend the Food and Drugs ActCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015Therapeutic products3913351AlainBeaudetAlainBeaudetAlainBeaudetAlain-BeaudetInterventionDr. Alain Beaudet: (1230)[English]Our only tool for enforcement is not being able to fund them in the future, indeed.C-17, An Act to amend the Food and Drugs ActCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015Therapeutic products3913352TerenceYoungOakvilleTerenceYoungOakville//www.ourcommons.ca/Parliamentarians/en/members/35663TerenceYoungTerence-YoungOakvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/YoungTerenceH_CPC.jpgInterventionMr. Terence Young: (1230)[English] Thank you.Mr. Da Pont, could you describe what administrative changes at Health Canada will support the enforcement of Vanessa's Law, perhaps with specific reference to adverse drug reaction reporting for health care institutions? How are you going to make it work?C-17, An Act to amend the Food and Drugs ActCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015Therapeutic products39133563913357BenLobbHuron—BruceGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1230)[English]Again, thank you very much for the question.We will be putting in place a regulation and a framework to define the reporting of adverse drug reactions. We will have to, and want to, engage in discussions with provinces, local hospital authorities, and other institutions that we would be asking to report, to work out the mechanics of what exactly gets reported: the timing, the mechanism, and the frequency of reporting. Obviously we want to get any severe reaction, any serious reaction.A lot of those discussions have started. We want to move this along as quickly as possible because obviously it's one of the critical new components of Vanessa's Law. We need to work out the nuts and bolts of how that information is going to come, when it's going to come, and in what form. That will significantly enhance our ability to make assessments and take action when we see patterns or trends.C-17, An Act to amend the Food and Drugs ActCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015Therapeutic products391335839133593913360TerenceYoungOakvilleBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/1814JamesLunneyJames-LunneyNanaimo—AlberniIndependentBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LunneyJamesD_CPC.jpgInterventionMr. James Lunney: (1230)[English]Thank you very much.I asked a question earlier about the proton pump inhibitor, about CNISP, and collecting the data. Dr. Taylor, increased risk of 40% to 275%—is that clinically significant? Compared to other things I've heard, it's over the top.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthNosocomial infectionsPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015391336239133633913364BenLobbHuron—BruceGregoryTaylorGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor: (1230)[English]Thank you for the question.We're looking at CNISP and re-evaluating that surveillance system right now to see if we can add those kinds of questions to collect and answer that. CNISP wasn't originally created for research. It was created for surveillance, but it's nice to be able to use that network to do that. That's a work in progress. We have to work with our partners to see if it's feasible to add those questions. Any clinical change of 200% to 400% certainly seems clinically significant to me, but we're certainly working on that and hopefully the information will be able to address that. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthNosocomial infectionsPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913365391336639133673913368JamesLunneyNanaimo—AlberniJamesLunneyNanaimo—Alberni//www.ourcommons.ca/Parliamentarians/en/members/1814JamesLunneyJames-LunneyNanaimo—AlberniIndependentBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LunneyJamesD_CPC.jpgInterventionMr. James Lunney: (1230)[English]Thank you for that.I have the study here. They collected all kinds of information, including the genetic variations in the bug. That sounds like research to me. So saying that it's not set up for research.... I think it shouldn't be that hard to collect the data; it's already in the hospital records. It's costing us a lot of money—hundreds of millions of dollars. We're talking about innovation. There ought to be some way of moving forward there.Dr. Beaudet, there was a change in the mandate of CIHR to reserve some funding for priorities, including those of the Government of Canada. Might this be a place where CIHR might be useful in doing a study to investigate not only that but what the hospital in Quebec's been doing for nine years, giving a potent probiotic 24 hours after they start antibiotic therapy and eliminating C. difficile infections with probiotics? Might that be something CIHR could help with?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchClostridium difficileDepartment of HealthPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015391336939133703913371GregoryTaylorAlainBeaudetAlainBeaudetAlain-BeaudetInterventionDr. Alain Beaudet: (1235)[English]This is something CIHR is already helping with. We're funding some work in that area.As you may know, DSEN, the Drug Safety and Effectiveness Network, has looked at this issue of the proton pump inhibitor and the relationship to C. difficile. We funded a number of studies looking not only at probiotics but at other approaches to treating C. difficile in the hospital.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchClostridium difficileDepartment of HealthPublic Health Agency of CanadaSupplementary estimates (B) 2014-201539133723913373JamesLunneyNanaimo—AlberniJamesLunneyNanaimo—Alberni//www.ourcommons.ca/Parliamentarians/en/members/1814JamesLunneyJames-LunneyNanaimo—AlberniIndependentBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LunneyJamesD_CPC.jpgInterventionMr. James Lunney: (1235)[English]Are you familiar with the Bio-K+ program with 50 billion CFUs?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchClostridium difficileDepartment of HealthPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913374AlainBeaudetBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1235)[English] Thank you very much, Chair.I just wanted to follow up on some questions that I didn't think the minister was able to answer because of time limits, but before I get there I would like to ask the minister to table three particular things. One is the consultation on the marijuana advertising. Could the minister list who was there, and to table it with the committee? The second one is the consultation with regard to the visa denial. Who did the minister consult with? Could she table that, please? I just wanted to put that on the record. The final one is the decision to change the chief public health officer's position. Who did the minister consult with, and could she list those people for me, please?Now I want to go to the question with regard to the chief public health officer. Again, I have the greatest respect for both Dr. Taylor and Ms. Outhwaite. Sometimes things work when the people and the stars are aligned and get along well, and they're willing to look at the problem. My concern here is that we have had the Public Health Agency of Canada, and I have heard from many chief public health officers from provinces and territories that they are not happy with this decision. The problem is that if there is a mistake, there may be delays in making decisions that are required of a chief public health officer who is waiting on red tape. We were in government during SARS, and we saw that actually did inhibit our ability to have quick responses to the problem and to have scientific evidence guiding us on what should happen. There is a huge concern by everyone involved.Now I know that this is done, and I don't usually see this government going back on anything it does. However, if evidence shows—hopefully without harming Canadians if it does happen—that the chief public health officer is not able to do the work that he needs to do in a quick and scientific manner due to the requirements of what his responses must be, would the government consider rescinding this decision, which I consider to be potentially risky? That's my first question.Finally, I wanted to talk a little bit about marijuana ads. My concern isn't that marijuana doesn't have an impact on the brains of youths. We all know that. We heard it from everyone. There was no contradiction on this particular issue. My concern is whether long-term effects do carry through from childhood smoking into adulthood. What I consider to be a panicky ad that is out there makes parents believe that their children are harmed irreversibly and are going to lose all their ability to perform at school, etc. It's a panicky ad. It's not based on good evidence, since there is still a question of whether this is so.My question is, again, for the CIHR. Would you, and could you, do those clinical trials without someone coming and asking you to? Could you do it? Do you not believe...? Well, you shouldn't have to answer that question, since it puts you in a difficult position, but do you not believe that the government should have done that work before it brought out what I consider to be panicky ads based on what most physicians believe is flawed evidence? It's over the top in terms of what it's saying. Everyone thinks we should stop young people from getting access. Right now they are getting access and we are not even considering how to stop that access. We're just going around scaring everybody to death with this panicky ad.Would, or should, CIHR and the government do those kinds of studies and perhaps tone down the ads until they're done?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaResearch and researchersSupplementary estimates (B) 2014-20153913377391337839133793913380391338139133823913383BenLobbHuron—BruceAlainBeaudetAlainBeaudetAlain-BeaudetInterventionDr. Alain Beaudet: (1240)[English]The short answer is yes. Any proposal for a clinical trial that is scientifically sound and has clear objectives could be funded by CIHR. I can only repeat what the minister has said about the importance of getting more scientific evidence on both the negative and the therapeutic effects of marijuana, because as the member said, there are very few clinical trials out there. You know that they are very difficult to do for a number of reasons, such as the mode of administration of the drug, the variety of strains out there, and the variety of products, with the result that there are huge discrepancies in the results of these clinical trials, even though there are therapeutic benefits.I suggest that you look at all the Cochrane systematic reviews of all the trials for all the indications on the therapeutic use of marijuana. None of them comes out with a significant result.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaResearch and researchersSupplementary estimates (B) 2014-201539133843913385HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1240)[English] I think, though, there's actual medication based on cannabis that is out there as a drug, an actual drug in a pill form. So I don't think that those two arguments, and I still would really like to hear about the—Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMarijuanaPublic Health Agency of CanadaResearch and researchersSupplementary estimates (B) 2014-20153913386AlainBeaudetBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1240)[English]We have one question that we're going to try to split.Ms. Outhwaite, I just want to very quickly ask if you'll table with the committee the job description, responsibilities, lines of reporting, and any communication protocols for the chief public health officer position, the new position that's being created, and the new president of the agency, so we can look at both and see what the differences are. Could that be tabled with the committee, please? Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSupplementary estimates (B) 2014-201539133893913390BenLobbHuron—BruceKristaOuthwaiteKristaOuthwaiteKrista-OuthwaiteInterventionMrs. Krista Outhwaite (Associate Deputy Minister, Public Health Agency of Canada): (1240)[English]Yes.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthOuthwaite, KristaPublic Health Agency of CanadaSupplementary estimates (B) 2014-20153913391LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/71585MatthewKellwayMatthew-KellwayBeaches—East YorkNew Democratic Party CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/KellwayMatthew_NDP.jpgInterventionMr. Matthew Kellway: (1240)[English]Thank you, Ms. Davies. I was concerned about the non-response by the minister to my question about the Mental Health Commission and then the response to Ms. Davies' question. There has been a lot of dancing, if I can call it that.There are emerging issues in mental health and they're set out by the commission. They are serious issues in many different ways including economically. If not the Mental Health Commission, then can you tell us what plans the department has, because 2017 is just around the corner, to tackle these emerging issues? I'll say editorially, I look at the estimates and this is a department that is dropping FTEs. So what are you going to do about mental health issues in Canada?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMental healthMental Health Commission of CanadaPublic Health Agency of CanadaSupplementary estimates (B) 2014-201539133943913395LibbyDaviesVancouver EastBenLobbHuron—BruceGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1240)[English]On that, as I said, and as the minister said, the Mental Health Commission has done very good work. Their mandate runs for a little bit of time yet. They put in a proposal for an early renewal and funding. We are working with them and we are looking at the proposal. I think it just wouldn't be appropriate to speculate much further, but I think there is a broad sense that the Mental Health Commission has been very effective and has done very good work.It's not the only avenue of investment. Dr. Beaudet may want to talk about it a bit more, but through CIHR there is a considerable amount of money being invested in research around mental health. There are other expenditures even in Health Canada. For example, significant components of our first nations programs try to address mental health and addiction issues. There is a very concerted effort around things like the Indian residential school program to help people who went through the residential schools. There is a very concerted effort on mental health on a wide variety of fronts including the Mental Health Commission.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMental healthMental Health Commission of CanadaPublic Health Agency of CanadaSupplementary estimates (B) 2014-2015391339739133983913399BenLobbHuron—BruceBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/35600BenLobbBen-LobbHuron—BruceConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/LobbBen_CPC.jpgInterventionThe Chair: (1240)[English]Thank you very much.Thank you to all the officials who have appeared today. We do need to make sure that we have heard all the evidence and heard all the numbers. Now we actually have to put it in motion and do a few votes here. Without further ado, we are looking at the supplementary estimates (B) for 2014-15 and there are five questions I need to ask.Shall votes 1b and 5b under Canadian Food Inspection Agency carry?CANADIAN FOOD INSPECTION AGENCYVote 1b—Canadian Food Inspection Agency—Operating expenditures and contributions..........$21,605,828Vote 5b—Canadian Food Inspection Agency—Capital expenditures..........$630,703 (Votes 1b and 5b agreed to on division)The Chair: Shall vote 5b under Canadian Institutes of Health Research carry?CANADIAN INSTITUTES OF HEALTH RESEARCHVote 5b—Canadian Institutes of Health Research—The grants listed in the Estimates..........$11,143,000(Vote 5b agreed to on division)The Chair: Shall votes 1b, 5b and 10b under Health carry?HEALTHVote 1b Health—Operating expenditures..........$23,956,508Vote 5b—Capital expenditures..........$1Vote 10b—Health—The grants listed in the Estimates and contributions..........34,987,989(Votes 1b, 5b and 10b agreed to on division)The Chair: Shall votes 1b, 5b and 10b under Public Health Agency of Canada carry?PUBLIC HEALTH AGENCY OF CANADAVote 1b—Public Health Agency of Canada—Operating expenditures..........$1,624,812Vote 5b—Health Agency of Canada—Capital expenditures..........$1Vote 10b—Public Health Agency of Canada—The grants listed in the Estimates..........$1(Votes 1b, 5b and 10b agreed to on division)Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthPublic Health Agency of CanadaSupplementary estimates (B) 2014-201539134003913401391340239134033913404391340539134063913407391340839134093913410391341139134123913413GeorgeDa PontBenLobbHuron—BruceHilaryGellerHilary-GellerInterventionMs. Hilary Geller (Assistant Deputy Minister, Healthy Environments and Consumer Safety Branch, Department of Health): (1635)[English]In terms of answering the question, it may be helpful to separate the two different kinds of consultation. The first kind the minister referred to are the criteria in the act that require letters from various organizations: police chief, provincial ministers, records of community consultations. There's absolutely no timeframe on that; they just have to be made available in order for the application to be considered complete and for the minister to be able to begin the review of the application.The other kind of consultation is the minister having the authority—it's a discretionary authority—to notify the public that an application has been received and to seek the views of the public. For that type of consultation, it would be a 90-day period. That's set out in the legislation.Application processC-2, An Act to amend the Controlled Drugs and Substances ActDepartment of HealthDrug use and abuseGovernment billsPublic consultationSafe injection sites387228038722813872282RickNorlockNorthumberland—Quinte WestRickNorlockNorthumberland—Quinte WestSuzyMcDonaldSuzy-McDonaldInterventionMs. Suzy McDonald (Associate Director General, Controlled Substances and Tobacco Directorate, Healthy Environments and Consumer Safety Branch, Department of Health): (1710)[English]As Hilary mentioned earlier, the national anti-drug strategy is really built on three pillars. Those pillars are all designed to reduce or eliminate the negative impacts of illicit drug use and contribute to healthier and safer communities.The health portfolio invests approximately $126 million a year to address addictions and illicit drug use in Canada. Since 2007 Health Canada has funded 139 projects to discourage illicit drug use among youth through the drug strategy community initiatives fund. Health Canada also provides $13.2 million annually to provincial and territorial governments and other key stakeholders to strengthen substance abuse treatment across Canada through the drug treatment funding program. As our minister noted, prescription drug abuse is now also being addressed through these funding programs.Specifically with regard to prevention, the program provides approximately $9.6 million in contribution funding, and this supports a variety of recipients in delivering health promotion and prevention projects that facilitate the development of national, provincial, territorial, and local community-based solutions to drug use among youth aged 10 to 24, and promote public awareness of substance abuse issues.More than 139,000 youth, 11,000 parents, and 2,000 work or schools have been reached through these programs. Projects have focused on capacity building: they've resulted in more than 13,000 youth and almost 5,000 teachers being trained on various topics, including peer leadership, facilitation, and life skills.I'd note that an evaluation of that prevention program did note that the program increased awareness of healthy choices, increased perceived overall awareness of illicit drugs, increased awareness of potential problems that can affect people who use illicit drugs, decreased the likelihood of trying or regularly using marijuana, decreased the likelihood of trying or regularly using other illicit substances, and improved overall community engagement and capacity.With regard to treatment, the program provided funding to 29 projects across Canada. I'd say that, for example, the introduction and increased reporting against national treatment indicators has provided consistent measures for treatment systems across the country for the first time. The production of evidence-based standards and guidelines has led to consistency and quality of treatment of care. Prior to the program, many PTs reported working in silos where collaboration with other sectors or regions was not a priority. Evidence shows that the program has helped to establish conditions necessary to support collaboration, including the development of a national knowledge exchange platform for all of these projects.I can go on a little bit further in terms of first nations and Inuit health. We've invested $12.1 million to improve quality access to addiction services for first nations and Inuit. This funding has contributed to the reorienting of 36 treatment centres to more effectively meet community needs: services for women, youth, people with co-occurring mental health issues, and prescription drug abuse. It has contributed toward an increase in the number of treatment centres receiving accreditation: 82% of treatment centres were accredited in 2013, which was up from 68% in 2010. It has contributed toward an increase in addiction workers receiving training and becoming certified: 434 community-based addictions workers and treatment centre counsellors were certified in 2013, and this was up from 358 in 2010. Now 78% of all treatment centre counsellors are certified, up from 66% in 2011.You can see the enormous impact these are having on prevention and treatment, both in first nations and other vulnerable communities, and particularly among our youth, parents of youth, schools, and teachers.Aboriginal peoplesC-2, An Act to amend the Controlled Drugs and Substances ActDepartment of HealthDrug addiction treatmentDrug use and abuseGovernment billsSafe injection sites38723893872390387239138723923872393387239438723953872396BlakeRichardsWild RoseBlakeRichardsWild RoseHilaryGellerHilary-GellerInterventionMs. Hilary Geller (Assistant Deputy Minister, Healthy Environments and Consumer Safety Branch, Department of Health): (1100)[English]Thank you, Mr. Chair, and good morning.My name is Hilary Geller. I'm the assistant deputy minister of the Healthy Environments and Consumer Safety Branch of Health Canada. I'm joined here today by Suzy McDonald, the associate director general of the Controlled Substances and Tobacco Directorate within my branch; Dr. John Patrick Stewart, executive medical director within the Health Products and Food Branch; and Peter Brander, the acting senior director general of the regions and programs branch, where Health Canada's inspection capacity resides.[Translation]We are pleased to be here today to discuss the issue of electronic cigarettes, or e-cigarettes.[English]Mr. Chair, in recent years Canada and the world have witnessed the emergence of the e-cigarette market. E-cigarettes are devices, some of which resemble conventional cigarettes, that turn a liquid into a vapour inhaled and exhaled by the user. The liquid may contain propylene glycol, glycerin, and such flavours as candy, fruit, menthol, or tobacco flavour, which may be sold separately from the device itself. Some liquids contain nicotine, a toxic and addictive substance, while others do not. There is a rapidly growing consumer demand for e-cigarettes. While the e-cigarette market barely registered in 2008, there are now more than 450 brands on the global market. ln 2013, the global e-cigarette market was worth approximately $3 billion U.S. Some business analysts project that e-cigarette sales in the United States may surpass those of traditional cigarettes as early as 2020. E-cigarettes are marketed, sold, and consumed as alternatives to tobacco or as smoking cessation devices. ln some cases, marketing appears to be targeted at youth and young adults through the use of flavours and certain promotional techniques that glamorize their use.(1105)[Translation]The single greatest challenge with regard to e-cigarettes is that there is a lack of conclusive scientific data on the risks and benefits of these products.[English]A limited number of studies have shown that e-cigarettes with nicotine may be beneficial for smoking cessation; however, other studies have shown that e-cigarettes may prevent quitting attempts by smokers by allowing them to satisfy their addiction in places where smoking is not permitted, such as public indoor spaces and workplaces. The health effects of long-term use and exposure to e-cigarette vapour are unknown. What is known is that nicotine is a toxic and addictive substance. The World Health Organization has also identified the potential for fetal and adolescent nicotine exposure to have long-term consequences for brain development. E-cigarettes have caused injuries due to device or electrical malfunction, and there are documented cases of poisoning, including cases among children, due to ingestion or spilling of nicotine-containing liquids. Variability in the quality of products available on the market has also been observed, with some products containing nicotine while labelled as containing none.There is also a lack of evidence regarding the risk that e-cigarettes pose to the tobacco control environment, particularly when youth are involved. There are concerns that e-cigarette use may increase the social acceptability of smoking-like behaviour or the re-normalization of smoking, and about whether e-cigarette use could initiate a nicotine addiction that might then lead to tobacco use. While there is a lack of evidence regarding youth e-cigarette use, we know that youth are using these products. ln a 2013 Ontario study, nearly 15% of students in grades 9 to 12 were reported to have tried e-cigarettes. We know that preventing early initiation of tobacco use is one of the most effective means of reducing tobacco use in adulthood. [Translation]This lack of evidence on risks and benefits poses a significant challenge for regulators, as regulatory regimes are generally based on a risk/benefit profile of what is being regulated.[English]ln the case of e-cigarettes, there is agreement that youth protection is a fundamental objective and that measures should be put in place to ensure it; however, evidence may arise that allowing adult access might have a positive impact on cessation, and so an overly restrictive regulatory approach has the potential to lead to unintended consequences.Under the current legislative regime, e-cigarettes that contain nicotine and/or that are marketed with a health claim, such as smoking cessation, are subject to the Food and Drugs Act. These products need to be authorized by Health Canada prior to sale, based upon evidence of safety, quality, and efficacy as demonstrated by the manufacturer. To date, no e-cigarette product has been authorized under the Food and Drugs Act. This means that currently the advertisement and sale of e-cigarettes, including e-liquids that contain nicotine or that make health claims, are illegal and may be subject to compliance and enforcement actions. E-cigarettes that do not contain nicotine and do not make health claims are legally available without authorization by Health Canada and are subject to the Canada Consumer Product Safety Act.While these acts address human health or safety concerns, they do not prevent marketing and sales to youth. They do not address risks to the tobacco control environment, nor do they prohibit the addition of flavours that may appeal to youth. Canada's compliance and enforcement approach for e-cigarettes is led by the regions and programs branch. Examples of our approach include the issuance of a compliance letter requesting that parties stop selling or advertising illegal e-cigarettes, the refusal of non-compliant commercial and personal shipments at the border, and the issuance of import alerts for repeat commercial offenders. To give you an idea of recent compliance activity, from April 1 to the end of June of this year, almost 740 commercial or personal shipments were recommended for refusal. During the same period our laboratories tested 91 e-cigarettes that claimed to contain no nicotine or had no nicotine information on the packaging, and almost half of the samples actually did contain nicotine. Mr. Chair, the Government of Canada is not the only jurisdiction seized with the issue of e-cigarettes. This issue is also a concern to our provincial and territorial counterparts. In fact there has been significant federal-provincial-territorial collaboration over the last year, including discussions at a recent federal-provincial-territorial meeting with ministers of health. No province or territory has yet taken action to regulate e-cigarettes; however, Nova Scotia, Quebec, British Columbia, and Alberta have indicated plans to do so. This issue is also receiving attention internationally. In April of this year, the United States Food and Drug Administration announced a proposal to regulate e-cigarettes with nicotine but without health claims as tobacco products. Under this approach, e-cigarettes with nicotine and health claims would continue to be regulated as therapeutic products. This proposal is currently being consulted on and is not likely to result in a new regulatory framework for a number of years. In March of this year, the European Union approved a revised tobacco products directive that subjects e-cigarettes containing small amounts of nicotine but without health claims to tobacco-like restrictions. E-cigarettes with higher concentrations of nicotine may be available if approved under therapeutic products frameworks. Member countries may also choose to regulate e-cigarettes with any concentration of nicotine as therapeutic products. Mr. Chair, there have also been a number of reports published on e-cigarettes. I would like to briefly mention two of those. The first is a report published by the World Health Organization in August of this year. The report noted that regulations by member states are needed to impede e-cigarette promotion, minimize potential health risks to e-cigarette users and non-users, prohibit unproven health claims, and protect existing tobacco control efforts from commercial and other vested interests of the tobacco industry. The report also recommended that legal steps should be taken to end the use of e-cigarettes indoors in public places and workplaces.The second report I'll mention was also published in August of this year by the American Heart Association. The AHA offered policy recommendations for areas in need of focus such as the inclusion of e-cigarettes in smoke-free air laws, preventing youth access, restrictions on the marketing and advertising aimed at youth, taxation of e-cigarettes at a rate high enough to discourage youth use, labelling, and quality control over manufacturing and standards for contaminants.(1110)[Translation]Together, these two reports address the scope of the challenge of the issue of e-cigarettes and provide a wide range of areas for possible regulatory intervention.[English]Mr. Chair, what I've attempted to do with my remarks today is to provide a high-level overview and some context on the issue of electronic cigarettes. What becomes clear when discussing this issue is that in many cases there are as many unknowns as there are knowns. The lack of evidence with regard to the dangers these devices might pose to users or bystanders, whether there are potential benefits, and what impact their presence will have on tobacco control objectives all contribute to the challenge of establishing an appropriate regulatory framework.[Translation]Thank you again for the opportunity to appear before you today to discuss this important issue.[English]My colleagues and I would be happy to answer questions that you and members of the committee may have.Merci.Consumers and consumer protectionDepartment of HealthElectronic cigarettes3862072386207338620743862075386207638620773862078386207938620803862081386208238620833862084386208538620863862087386208838620893862090386209138620923862093386209438620953862096386209738620983862099BenLobbHuron—BruceBenLobbHuron—BruceSuzyMcDonaldSuzy-McDonaldInterventionMs. Suzy McDonald (Associate Director General, Controlled Substances and Tobacco Directorate, Healthy Environments and Consumer Safety Branch, Department of Health): (1120)[English]As Hilary noted earlier, the evidence is not clear on whether or not these products assist folks to quit smoking. There has only been one randomized control trial done by Bullen and that indicated that the quit rates were similar to other nicotine replacement products. There are a number of other studies ongoing that have mixed reviews around the ability of these products to help folks quit smoking.I think the second piece of information that's interesting to look at is whether or not the products create dual use within smokers, as opposed to helping folks quit, that folks continue to smoke a regular tobacco product and then use e-cigarettes as a secondary mechanism. What we do know is that quitting tobacco outright has a much better overall impact on your health than continuing to smoke even some products in the long term. But the bottom line is that we do not have the evidence yet to demonstrate that these products definitively help folks quit smoking.Consumers and consumer protectionDepartment of HealthElectronic cigarettesSmoking38621263862127GeoffReganHon.Halifax WestGeoffReganHon.Halifax WestJohn PatrickStewartJohnPatrick-StewartInterventionDr. John Patrick Stewart (Executive Medical Director, Therapeutic Products Directorate, Health Products and Food Branch, Department of Health): (1120)[English]Maybe I'll answer the first question a little bit more substantively.The intuitive assumption is that yes, this product may assist with smoking cessation as have other nicotine replacement therapies that are out there. But the fact is that this is a novel route of administration. The nicotine replacement therapies that are now marketed have provided evidence that they do have a positive impact and an understandable safety profile. They deliver the nicotine through a different route, through the skin or the oral mucosa. The rate of rise in nicotine in those products is slow and predictable. When these products were marketed they came in with clinical studies around blood levels and the addiction potential of the product, as well as efficacy of treating smoking cessation.This is a new product. It is actually delivering the nicotine into the lungs. What the e-cigarette does is generate a vapour that has very, very tiny droplets that allow the nicotine to get into the pulmonary tissue. Some studies that have been done show that you have a much more rapid absorption of the nicotine, so you have much more of a cigarette-like effect of nicotine coming into your bloodstream and distributing it very quickly. It more mirrors not only the craving but the reward that you get from a cigarette.The other thing is that we don't know the addictive potential of this. The concern is that intuitively it may play a role but actually it may be as addictive as, if not more addictive than, cigarettes. Before we run off and plan a regulatory framework we need to look at what the science is telling us and not introduce risks we don't understand.Consumers and consumer protectionDepartment of HealthElectronic cigarettesSmoking3862131386213238621333862134GeoffReganHon.Halifax WestGeoffReganHon.Halifax WestPeterBranderPeter-BranderInterventionMr. Peter Brander (Acting Senior Director General , Regions and Programs Bureau, Department of Health): (1125)[English]Since 2009 Health Canada's been very clear in advising Canadians not to purchase or use these cigarettes. As Hilary has mentioned, their safety, quality, and efficacy remains unknown, and they may pose a health risk.Our compliance and enforcement approach for these products is complaint-driven and risk-based. It includes site visits, warning letters, stop-sale requests, and customs refusals and/or the seizure of products. We continue to monitor the sale of these products as well as non-compliant retail locations and websites. We're taking actions in accordance with our compliance and enforcement approach.Consumers and consumer protectionDepartment of HealthElectronic cigarettesRegulation38621393862140GeoffReganHon.Halifax WestGeoffReganHon.Halifax West//www.ourcommons.ca/Parliamentarians/en/members/23915GuyCaronGuy-CaronRimouski-Neigette—Témiscouata—Les BasquesNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/CaronGuy_NDP.jpgInterventionMr. Guy Caron (Rimouski-Neigette—Témiscouata—Les Basques, NDP): (1555)[Translation]Thank you kindly, Mr. Chair.I will begin with the pharmaceutical representative.I could go through all of your recommendations, but the fourth one, in particular, caught my attention. It calls on the Government of Canada to "amend Health Canada's mission, vision, core values and objectives to incorporate the promotion and acceptance of innovation into its culture, mandate, processes and procedures."Health Canada did that in other areas. For instance, the Pest Management Regulatory Agency more or less did it by including that new mission in its public protection mandate. And in that connection, the environment commissioner indicated that "the agency's mandate [was] dual and often incompatible", its mandate being to serve the industry and protect Canadians' health. Following your recommendation would lead to a similar situation. Could we run into problems around a dual mandate if we were to amend Health Canada's mandate, as you recommend?Department of HealthPre-budget consultations3851353JamesRajotteEdmonton—LeducWalterRobinsonWalterRobinsonWalter-RobinsonInterventionMr. Walter Robinson: (1555)[English]Merci, monsieur le président.Through you to Mr. Caron. Very quickly, as we pointed out in our submission, the promotion of health and patient safety is not incompatible with innovation for the FDA. It is not incompatible with the role of innovation for the European Medicines Agency. Indeed, the Government of Canada, through the leadership of federal health minister, Rona Ambrose, has embarked on a health innovation panel to drive the sustainability of the health system, the thing that federal government is working toward, and which includes the provincial and territorial partners in that regard. They all see health innovation and medical science innovation as a key enabler of driving health system sustainability.To your specific question with respect to the PMRA, in a former life, as some of you know, I've testified before this committee wearing various hats. By way of disclosure I worked for a corporation that had an interest in some of the products that the PMRA regulated. The pursuit of innovation and science was to ensure that you had a science and evidence-based risk management framework through the PMRA. Again, I didn't find at the time that those objectives were incompatible. I appreciate the environment commissioner's report, but as long as human health and safety is paramount and driven in an evidence-based way, science and health care can co-exist. We think that making human health sciences a priority as you move into budget 2015 and the asks that we have made don't involve any money or any disclosure, or disbursements of the forthcoming federal surplus, but a lot of policy and regulatory-based change. So in short we think it can be done and that Health Canada in that respect should mirror what other leading jurisdictions have done in ensuring that there's a health and innovation mandate and, indeed, we are encouraged by the health innovation panel that the federal Minister of Health has appointed. We'll be making submissions to them in short order with this recommendation.Department of HealthPre-budget consultations3851354385135538513563851357GuyCaronRimouski-Neigette—Témiscouata—Les BasquesGuyCaronRimouski-Neigette—Témiscouata—Les BasquesDavidLeeDavid-LeeInterventionMr. David Lee (Director, Office of Legislative and Regulatory Modernization, Policy, Planning and International Affairs Directorate, Health Products and Food Branch, Department of Health): (1115)[English]Mr. Chair, the inclusion of a list in this definition may be a very vulnerable way to introduce what the member is suggesting. There is a commonly understood international approach to what is protected, and that's really expressed in this definition. By saying what is not on that list.... Much of what's on that list would be considered protected in most countries, so it could attract international challenge. What Mr. Young has gone through in terms of the appropriate way to deal with that information is really what flows to the other motions.C-17, An Act to amend the Food and Drugs ActClause-by-clause studyDepartment of HealthGovernment billsTherapeutic products37982573798258TerenceYoungOakvilleBenLobbHuron—BruceSupriyaSharmaSupriya-SharmaInterventionDr. Supriya Sharma (Acting Associate Assistant Deputy Minister, Health Products and Food Branch, Department of Health): (1130)[English]Yes.Just to add, in terms of the Health Canada assessment around the Alysena issue, we did actually deem it to be a serious risk when we did do the risk assessment. When the testimony was given, I think the issue was that when the company had made the assessment, they had not raised the same issue. Certainly the Health Canada assessment was that it was a serious risk, and we've had subsequent issues around recalls of similar products since that time. Again, it has been treated as it would apply in terms of the definition that we have moving forward.C-17, An Act to amend the Food and Drugs ActClause-by-clause studyDepartment of HealthGovernment billsTherapeutic products379831037983113798312BenLobbHuron—BruceBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/35600BenLobbBen-LobbHuron—BruceConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/LobbBen_CPC.jpgInterventionThe Chair (Mr. Ben Lobb (Huron—Bruce, CPC)): (0845)[English] Good morning, ladies and gentlemen. Welcome and thank you for coming to the committee meeting this morning. We're studying Bill C-17. We have the minister and officials with us. The minister will be with us for the first hour and then we'll continue on with the officials. If we have 15 minutes for committee business at the end, we'll do that.Welcome, Minister. Welcome, officials. We'll allow you to start. You have 10 minutes or thereabouts for your opening remarks and then we'll go into our rounds of questions.C-17, An Act to amend the Food and Drugs ActDepartment of HealthGovernment billsTherapeutic products379574137957423795743RonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose (Minister of Health): (0845)[English]Thank you, Mr. Chair.It's great to be here. I'm going to ask Anne, David, and Supriya to introduce themselves quickly.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products37957443795745BenLobbHuron—BruceAnneLamarAnneLamarAnne-LamarInterventionMrs. Anne Lamar (Acting Assistant Deputy Minister, Health Products and Food Branch, Department of Health): (0845)[English]How do you do. I'm Anne Lamar. I'm the acting assistant deputy minister of health products and food branch at Health Canada.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795746RonaAmbroseHon.Edmonton—Spruce GroveDavidLeeDavidLeeDavid-LeeInterventionMr. David Lee (Director, Office of Legislative and Regulatory Modernization, Policy, Planning and International Affairs Directorate, Health Products and Food Branch, Department of Health): (0845)[English]Good morning, I'm David Lee. I'm the director of the office of legislative and regulatory modernization within the branch.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795747AnneLamarSupriyaSharmaSupriyaSharmaSupriya-SharmaInterventionDr. Supriya Sharma (Acting Associate Assistant Deputy Minister, Health Products and Food Branch, Department of Health): (0845)[English]Good morning. I think I have the longest title of anyone here. I'm the acting associate assistant deputy minister of the health products and food branch and also the senior medical adviser for the branch.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795748DavidLeeRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0845)[English] Thank you, again, Mr. Chair and committee members. I'm pleased to be here today to speak to the protecting Canadians from unsafe drugs act, or Vanessa's law. This important legislation will make a difference in the health and safety of all Canadians. I commend the committee for studying it. I know you will ensure that it receives the focus it deserves.I would like to state at the outset that I'm appearing before you with an open mind. I know there are many parties interested in making this piece of legislation better. I look forward to the recommendations from the committee.I am the minister responsible for this bill, but I do believe that all political parties and all members of Parliament have an interest in ensuring the safety of the drugs that we rely on for our health. I look forward to the study by the committee and potential amendments to this legislation.As you know, this bill is actually named after Vanessa Young, who tragically died of a heart attack while on a prescription drug that was later deemed not safe and actually was removed from the market.Stories like this remind us all of the very serious consequences pharmaceutical drugs can have, and of course of the need for all governments to ensure we have the strongest possible safety systems in place in order to prevent other families and patients having to suffer such a terrible loss.I'm also pleased that Terence Young is here not only as a committee member but also very much as a subject-matter expert on this issue. I appreciate all the work he has done to get us to this place.Colleagues, what it comes down to is this. Canadian families expect when they go to a pharmacy or a hospital that the drugs they receive are safe, that they're of high quality, and that they're effective in treating their condition. They expect that government will ensure that unsafe products are quickly identified and appropriate action is taken, including, if necessary, their removal from the marketplace.Canada does have one of the most rigorous drug approval systems in the world for pharmaceuticals and medical devices. This system ensures, as far as possible, the safety of these products before they are marketed.However, once these products are on the market, my department has very limited ability to gather information about these products and to take action when a problem arises. This is largely because the laws in this area have not been substantially updated in over half a century to reflect the post-market realities of drugs and medical devices.Because of the problems with the current legislation, as Minister of Health I use the example that I have the authority to recall a bag of Doritos, but I don't have the authority to recall an unsafe drug from the market.When there is a safety concern and a drug should not be on the market, we have no option other than to negotiate with the manufacturer in the hope that it will voluntarily come to the right decision. I find this unacceptable.Vanessa's law will enable us to order a manufacturer to take immediate action to recall a product if it poses a serious or imminent risk to human health. Health care institutions are also not currently required to report adverse drug reactions. There exists no authority to order label changes on packaging if we feel additional information or studies are required.In this bill's development, we spoke with representatives from patient safety organizations, the provinces and territories, and industry. All of their input was invaluable in developing this bill. There was an overwhelming consensus that stronger drug and medical device safety tools are absolutely necessary.Vanessa's law will give our government the tools needed to ensure that drugs are safe and that strong measures are taken when concerns are raised. It will require health care institutions to report serious adverse drug reactions and medical device incidents. It includes tougher penalties to better reflect the serious nature of violations.The measures included in Vanessa's law will provide the power to order drug or medical device manufacturers to make changes to the label or package of a drug or medical device. This will speed up the communication of important safety information and prevent harm to Canadians and their families who rely on these products.When a consumer buys a drug at the pharmacy, the drug is accompanied by the manufacturer's label on which there is information on the safe use of the drug and warnings about the negative effects. Sometimes the information and warnings are not sufficient or clear enough.When the labels are not clear, the patient's health may be in danger. Currently, when my department becomes aware of a safety problem that requires a new warning on a label, we contact and try to convince the manufacturer to add this new warning to the label. This process can take a long time, since we have to rely on the manufacturer to take action to change it. Meanwhile, the patient's health continues to be in danger. Again, this situation is unacceptable and it must change. Vanessa's law will provide the power to compel information and require companies to perform additional tests and studies on products. For example, I would be able to compel further studies on a drug that was designed for adults but was routinely causing adverse reactions in children.(0850) Vanessa's law also introduces tough new fines for those who do not comply with these measures. It allows for significant penalties, including jail time, on companies that sell unsafe drugs in Canada.The current fines and penalties simply do not reflect the severity and the nature of offences that can occur. Previously, the fine was $5,000 per day. To put this into perspective, this is the same amount that a person can be fined for littering under some municipal bylaws. That will now change to $5 million per day. For any company that intentionally misleads Health Canada, or recklessly harms a Canadian, the law will also provide the courts with the discretion to impose even higher fines and jail terms where they find it justified. Before concluding, I would like to state once again that I am open to amendments to this bill. I've listened to the debates in the Commons, media commentaries, and heard directly from doctors and patients, and of course patient safety experts, since we introduced the bill. I think it's clear that improvements can be made that address elements including transparency in clinical trials, disclosure of regulatory actions, and confidential business information. I think the committee is in a good place to put forward well-informed amendments that will make this bill even better. I have consulted widely, and feel these amendments will be very helpful.In closing, let me again state that our government has listened to the experts. We agree with health care professionals that we need a strengthened drug safety system. Drug safety is not an issue that should become, in any way, a victim of partisan games and rhetoric. I thank the committee for approaching it in this fashion. I know that Canadians expect this issue will be taken very seriously as this committee studies Vanessa's law. Thank you, Mr. Chair.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products379574937957503795751379575237957533795754379575537957563795757379575837957593795760379576137957623795763379576437957653795766379576737957683795769379577037957713795772379577337957743795775SupriyaSharmaBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies (Vancouver East, NDP): (0855)[English]Thank you very much, Chairperson.Thank you to the minister for appearing here today. It's good to hear your comments about the bill. I know that you've put a lot of work into the bill. It's a very important bill. As you noted, there's been support in principle from all the parties in the House, because I think we all recognize that drug safety and the provisions in the bill are long overdue. In fact, I would remind us that it was as far back as 2011 that the Auditor General, in his report, flagged this issue as something that needed attention. Minister, I have been a bit perplexed about the process here. Recently we had charges made, allegations, that this bill was being held up, when in actual fact it just had a very few hours of debate in the House at second reading. Of course, second reading, looking at the bill in principle, is very important. Members wanted to speak in the House. The government basically sat on the bill for six months. I wonder if you could tell us why the government didn't move on this bill for six months and is now apparently trying to create a political crisis around this bill, that it has to be rushed through at the last minute, when really it's been sitting there for six months and not being called for debate. We could have debated it, have it go through committee, send it back to the House and it probably would have been passed by now if the government had moved on it. Could you respond to that please?C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products37957783795779379578037957813795782BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0855)[English]When Vanessa's law was introduced, I did have high hopes for its quick passage, given the support that it received by all parties in the Commons. I know you yourself said that it was a step in the right direction. I also received correspondence from several members, from all parties, who believe that this is a very important bill and urged me to secure passage of Bill C-17, which is Vanessa's law, as quickly as possible. We did work in that direction. I will simply say that sometimes the work we do is caught up by.... The House leaders do the work that they do. I will just say at this point that, yes, there were exchanges between House leaders as to when this bill should move forward. I'll just leave it at the fact that I'm glad that we have now seen the bill unanimously supported by all parties to move to committee. I'm glad to see that happen.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products37957833795784LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (0855)[English]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.C-17, An Act to amend the Food and Drugs ActDepartment of HealthPrescription drugsSafetyTherapeutic products379578537957863795787379578837957893795790RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0900)[English]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. C-17, An Act to amend the Food and Drugs ActDepartment of HealthPrescription drugsSafetyTherapeutic products3795791379579237957933795794LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (0900)[English]Thank you very much. I appreciate that response.There's one other area of the bill. A number of people have written in, and maybe you won't have time to address this, but we'll certainly ask your officials in the next round, regarding what's in and what's out in the bill in terms of the new definition of a therapeutic product. Some of us, and maybe all of us, have received a very graphic picture of over-the-counter products, some of which would be in the definitions in the bill and some of which would not be. I think we're going to have to...or maybe it's just a better explanation, but on the face of it, there are certainly some questions about what the definition means and what's included and what's excluded. That's going to be another area that we obviously need to look at and clarify. C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795795379579637957973795798RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0900)[English]Sure. I could go into the definition in the bill, but it sounds as if you're more interested in what's in and what's out. I'll ask David, who did a great deal of the work drafting the legislation, to speak to what's in and what's out.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products37957993795800LibbyDaviesVancouver EastDavidLeeDavidLeeDavid-LeeInterventionMr. David Lee: (0900)[English]Mr. Chair, technically what's in is both drugs and devices and what's excluded is natural health products as it's defined in those regulations. We are certainly looking at some products that would apply under the drug definition, like disinfectants, and so on. Again, that's also part of our regulatory road map as we work on regulations under the act as well, so we can speak to that. C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795801RonaAmbroseHon.Edmonton—Spruce GroveBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/71688EveAdamsEve-AdamsMississauga—Brampton SouthLiberal CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/AdamsEve_CPC.jpgInterventionMs. Eve Adams (Mississauga—Brampton South, CPC): (0900)[English] Thank you very much, Minister, for appearing before us today. I know you have been extremely diligent and have shown great leadership in advancing this file.All Canadians feel vulnerable going to their doctor or to their hospital when they're ill or their children are ill. We rely on the expertise of medical professionals to prescribe the best possible medicine for ourselves and for our family members.What is tragic is to eventually find out that information that would have, perhaps, provided for a better outcome could have been available and made available to families and individuals.I genuinely want to commend the minister for coming forward and for showing great openness in advancing this legislation, in coming to our committee and saying that she's extremely open to listening to amendments that would make for more transparent legislation. We share your desire to become global leaders when it comes to patient safety.Minister, currently hospitals and health care institutions are not required to report serious adverse reactions. I know that doctors are certainly very busy when they're in the hospital, and so on. Could you explain to us what this legislation would bring about, how we would strengthen patient safety in requiring hospitals and health care institutions to report on adverse drug effects?Adverse drug reactionsC-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products37958053795806379580737958083795809BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0905)[English]Thank you very much for that question.You've raised an important point. It is the case that reports on adverse drug reactions are essential pieces of information for drug regulators. It's essential that Health Canada receive that information, that it be high-quality information, that it be clear, and that it be comprehensive so we can ensure that we have the appropriate knowledge to take action.We are all aware that drugs are powerful chemical and biological substances. They can have both positive and negative effects, but also unwanted side effects, so the issue of adverse drug reactions is an important one. Currently, only drug companies and sponsors of clinical trials must report serious adverse reactions to Health Canada. That obviously is important information for us to have because it allows us to take action with the aim of preventing such effects from recurring. We know that a significant number of Canadians who are admitted to hospital each year suffer from very serious adverse drug reactions. However, reports of these drug reactions are not always shared with Health Canada. As the regulator, that seems like a gap we need to close, which is what we want to do with Vanessa's law. Indeed, while adverse drug reaction reporting to Health Canada has been on the rise over the last five years, it's still estimated that less than 10% of all incidents are reported. So you can see the need for closing this gap. This under-reporting of critical drug safety information is a very serious concern. It limits our ability to identify potential safety issues at an early stage and then, of course, to take quick action to prevent further harm to patients.Of course, we see hospitals as being the unique entities and institutions to identify and report these incidents. Although most drugs are prescribed by family doctors and used outside of a hospital setting, the truth is that when there's a really serious interaction, people usually go to the hospital or take their children to the hospital. It makes sense to us that this would be where we would focus our efforts. We already know that adverse drug reactions are under-reported. Vanessa's law would give us the tools needed to improve the collection of this information. Although some tools, such as electronic reporting, have already been developed to encourage health care institutions to provide this information, it's still not enough. This is why we've introduced these measures to require certain health care institutions to report serious adverse drug reactions and serious medical incidents directly to Health Canada.Better reporting by health care institutions will ultimately lead to a reduction in preventable harm to patients. We know that many emergency room visits are related to serious adverse drug reactions and that many of these are actually preventable. If we have the information and the ability to take action to prevent harms from occurring in the first place, not only will this lead to the safer use of drugs, but it will also free up valuable hospital resources.We understand that all of us rely on the health care system. This is why we've increased transfers to health care. We also recognize, and we are acutely aware, how busy health care institutions are. We believe that Vanessa's law does not impose any unnecessary burdens on our health care system. I mention this because it was one of the issues raised with me by the provinces and territories. I have to tell you that the provinces and territories are very supportive of this legislation, very supportive. They are looking forward to working with us on the implementation, more so on an institutional basis, to make sure hospitals understand what their requirements and obligations are. We look forward to working on that.We will obviously be developing the regulations in consultation with the provinces and territories. Those will then set out exactly for them what information they are required to report, which health care institutions will have to report, and how that information will be reported and in what timeframe. We've made a lot of progress with them already to date.Adverse drug reactionsC-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products37958103795811379581237958133795814379581537958163795817379581837958193795820EveAdamsMississauga—Brampton SouthEveAdamsMississauga—Brampton South//www.ourcommons.ca/Parliamentarians/en/members/71688EveAdamsEve-AdamsMississauga—Brampton SouthLiberal CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/AdamsEve_CPC.jpgInterventionMs. Eve Adams: (0910)[English]Thanks, Minister. I know you've been working collaboratively with not only the provinces and territories but also with the leading minds, the experts and the patient groups, on this file. Can you give me a sense of the feedback you've been receiving from those patient groups?C-17, An Act to amend the Food and Drugs ActDepartment of HealthPublic consultationTherapeutic products37958213795822RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0910)[English]We've received very positive feedback, particularly in the area of adverse drug reactions. We're essentially building a new system across the country of reporting. It's one that is obviously much more thorough, much more comprehensive, and much more consistent. I do believe that all of those who are involved in the health care system feel strongly that this needs to be done and are supportive.After the bill passes, then we move to the regulations, which will impact the institutions themselves. We'll work with them on how they'll report and we'll make sure that hopefully we have the most consistent type of reporting across the country.At the end of the day, the important thing here is that we have a huge gap. As I said, we think we're collecting at this point only around 10% of adverse drug reactions across the country. That's not nearly enough. If the regulator doesn't have that kind of information, how can we make the appropriate decisions on the safety of drugs? On that issue alone, the issue of adverse drug reaction reporting, this piece of legislation will make a huge difference for the safety of Canadians. I'm very excited that we're moving forward with this, as are the many, many stakeholders who care about patient safety and as are the provinces and territories. They know that this is a way we can collaborate. We're the regulator. They have the information. We look forward to closing that gap so that we can provide better safety information to patients and to physicians.Adverse drug reactionsC-17, An Act to amend the Food and Drugs ActDepartment of HealthPublic consultationTherapeutic products379582337958243795825EveAdamsMississauga—Brampton SouthEveAdamsMississauga—Brampton South//www.ourcommons.ca/Parliamentarians/en/members/992CarolynBennettHon.Carolyn-BennettSt. Paul'sLiberal CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/BennettCarolyn_Lib.jpgInterventionHon. Carolyn Bennett (St. Paul's, Lib.): (0910)[English]Thank you for coming, Minister. I have three questions. The first is with regard to the issue you raised around prevention. When we did the post-market surveillance study at this committee, it was very clear that in future, with personalized medicine, we can sort out that certain people have genetic predispositions to a certain drug interaction or to an adverse reaction. In the science around the definition of serious risk or injury or harm, how will the department determine whether it's a number of people with a serious predisposition to a problem or whether it's a general problem for which the drug must be recalled for the public good?Second, as my colleague was asking, could you explain your thinking on why toilet bowl cleaners are included in this because it's a disinfectant, but natural health products are not?Third, I think we know, whether it's trying to talk to physicians about SARS or whether it's trying to talk to physicians about recalls, that the time that elapses before Health Canada makes a decision and it actually gets out to the doctors is.... From the time when you make your decision, I may have in my office been prescribing this drug for three weeks before I get the letter from Health Canada. In 2014 do you think Health Canada has the resources or the systems in place to actually communicate with the front-line providers to tell them they have to stop prescribing this today, and not when...? I can remember one situation when I was up all night delivering a baby, and it was on the news that a drug had been recalled. One of my patients, who'd been watching the news, came in and asked me the next morning what I thought about that drug being removed from the market. I wouldn't have known about it if my astute patient hadn't filled me in.Those are the three things that I would like to know about in terms of whether those are areas for amendments.Adverse drug reactionsC-17, An Act to amend the Food and Drugs ActDepartment of HealthInformation disseminationNatural health productsTherapeutic products379583037958313795832379583337958343795835BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0910)[English]On the question of prevention and how Health Canada will assess whether or not it's a predisposition or a general harm, I'll ask Dr. Sharma if she would answer that for you.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795836CarolynBennettHon.St. Paul'sSupriyaSharmaSupriyaSharmaSupriya-SharmaInterventionDr. Supriya Sharma: (0915)[English]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.C-17, An Act to amend the Food and Drugs ActDepartment of HealthNatural health productsSafetyTherapeutic products37958373795838379583937958403795841RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0915)[English]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....C-17, An Act to amend the Food and Drugs ActDepartment of HealthNatural health productsSafetyTherapeutic products379584237958433795844SupriyaSharmaCarolynBennettHon.St. Paul's//www.ourcommons.ca/Parliamentarians/en/members/992CarolynBennettHon.Carolyn-BennettSt. Paul'sLiberal CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/BennettCarolyn_Lib.jpgInterventionHon. Carolyn Bennett: (0915)[English]May I just say that on the study of natural health products, it's one thing to be a natural health product from a reputable company, but I think what we were worried about is if you find out that Sleepytime Tea has Valium in it, or if echinacea actually has ephedrine in it, you have the ability—C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795845RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0915)[English]Yes.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795846CarolynBennettHon.St. Paul'sCarolynBennettHon.St. Paul's//www.ourcommons.ca/Parliamentarians/en/members/992CarolynBennettHon.Carolyn-BennettSt. Paul'sLiberal CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/BennettCarolyn_Lib.jpgInterventionHon. Carolyn Bennett: (0915)[English]—to remove that in terms of it not being accurately labelled. But if something has a contaminant in it or.... I think there is some concern about.... Do you believe you already have that power?C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products37958473795848RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0915)[English]We are regulating natural health products now, as you know. In terms of capturing them under Vanessa's law in adverse drug reactions, their belief is they are low risk, and so they shouldn't be treated as pharmaceutical products.What I will say is if someone goes to the hospital with an adverse drug reaction, the reality is it doesn't matter what they have used. They are going to tell the physician what it was, and it will be captured. C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products37958493795850CarolynBennettHon.St. Paul'sCarolynBennettHon.St. Paul's//www.ourcommons.ca/Parliamentarians/en/members/992CarolynBennettHon.Carolyn-BennettSt. Paul'sLiberal CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/BennettCarolyn_Lib.jpgInterventionHon. Carolyn Bennett: (0915)[English]You don't even have to say how much sugar is in it. That pink water that actually is full of sugar, a diabetic may not even know they shouldn't be drinking that.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795851RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0915)[English]On labelling, that's not.... Vanessa's law is about adverse drug reactions and about patient safety. Obviously, natural health products are regulated, and we are able to change labels on them, and we deal with health claims made by naturopathic or natural health product manufacturers.Again, I think you should ask the experts that question when they come to committee. Ask them if there is an adverse reaction from a natural health product whether this legislation is enough to cover that.C-17, An Act to amend the Food and Drugs ActDepartment of HealthNatural health productsPackaging and labellingTherapeutic products37958523795853CarolynBennettHon.St. Paul'sCarolynBennettHon.St. Paul's//www.ourcommons.ca/Parliamentarians/en/members/992CarolynBennettHon.Carolyn-BennettSt. Paul'sLiberal CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/BennettCarolyn_Lib.jpgInterventionHon. Carolyn Bennett: (0915)[English]In terms of how you will communicate with physicians....C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795854RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0915)[English]Diane-35 is an example. We had 40% off-label prescribing with Diane-35. Not only had we sent numerous Health Canada warnings to physicians, we also did a checklist to....C-17, An Act to amend the Food and Drugs ActDepartment of HealthPackaging and labellingTherapeutic products3795855CarolynBennettHon.St. Paul'sCarolynBennettHon.St. Paul's//www.ourcommons.ca/Parliamentarians/en/members/992CarolynBennettHon.Carolyn-BennettSt. Paul'sLiberal CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/BennettCarolyn_Lib.jpgInterventionHon. Carolyn Bennett: (0915)[English]Do you have an ability to do that other than through the—C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795856RonaAmbroseHon.Edmonton—Spruce GroveBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/992CarolynBennettHon.Carolyn-BennettSt. Paul'sLiberal CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/BennettCarolyn_Lib.jpgInterventionHon. Carolyn Bennett: (0915)[English]—College of Physicians and Surgeons?C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795858BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0915)[English]We have a number of ways we communicate. I can ask Anne to give you a list of all of the different ways in which we communicate through associations beyond just the College of Physicians and Surgeons. We can communicate directly, but, yes, we have a number of ways.Anne, if you want to expand on it....C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products37958593795860CarolynBennettHon.St. Paul'sBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/72006DavidWilksDavid-WilksKootenay—ColumbiaConservative CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/WilksDavid_CPC.jpgInterventionMr. David Wilks (Kootenay—Columbia, CPC): (0915)[English]Thank you very much, Mr. Chair.Before I ask my question, I've heard from time to time that sometimes those of us in the back seats of the House of Commons can't make a difference. I believe my colleague, Mr. Young, has proven that wrong, and that he will make a significant difference in the lives of millions of Canadians in years to come. So thank you for that.Minister, I appreciate your being here today. You made mention of the competence and transparency in regard to the health care system. Can you provide the committee with some additional details on what Health Canada is doing to provide Canadians with the information they need to make informed health decisions? How will Vanessa's law give Canadians the information they need to make informed decisions about the use of therapeutic drugs and medical devices? Would you be able to provide the committee with some examples of these transparent measures?C-17, An Act to amend the Food and Drugs ActDepartment of HealthInformation disseminationTherapeutic products3795863379586437958653795866BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0920)[English]Sure. Thanks so much.The fact is that Canadians do expect more information from Health Canada when it comes to patient safety issues. This legislation is incredibly important, but the current legal framework that we have is outdated. Just like every Canadian, I expect more. We expect to have that kind of information at our fingertips, and we expect the regulator to be able to make decisions when they're confronted with clear information that a drug is negatively impacting Canadians.We know that 83% of Canadians are online now. They expect access to accurate information. They want it quickly and they want it easily. This is especially true when it comes to health and safety information. In most cases we will purchase over-the-counter medications or pay a visit to the doctor to receive prescribed medication. Along the way, we will read the label or receive information from a pharmacist about the proper dosage, when to take the medicine, and how to take it. We may also read or receive information about any side effects or other health warnings of which we should be aware. But the reality is that we sometimes do not get all of the information that we should, and the information can be confusing for people to follow.Last year, as you know, we took important steps to help Canadians better understand medicine. As a result, our plain language labelling initiative is set to make prescription and over-the-counter labels and safety information easier to read and understand. Through the introduction of a standardized format for information on drug labels, this includes what's called a drug facts table.In addition, the plain language labelling regulations will advance key safeguards, such as requiring labels to be in plain language, requiring that companies include contact information on labels so that users can report problems and adverse drug reactions, requirements for manufacturers to provide mock-ups of labels and packages for our review, and requirements for manufacturers to provide evidence that drug names will not be confused with other authorized products.Canadians are already familiar with the nutrition facts table on food. Many report using this information to make informed decisions when choosing healthier foods. It makes sense then that we would have a similar tool to help Canadians make equally informed decisions when it comes to choosing the right medications and over-the-counter drugs.Vanessa's law will build on the successes of the plain language labelling initiative by enabling new ways for our government to collect more information to provide to Canadians. First, it will require a mandatory reporting of serious adverse drug reactions and medical device incidents by health care institutions. The knowledge gained by Health Canada through this reporting will help us to inform Canadian patients about any safety concerns or risks more quickly and more transparently.Second, it will authorize Health Canada to compel manufacturers to make a label or packaging change when it's needed to alert patients and prescribers about a potential side effect or other health risk that only becomes known after the product is on the market. This will also expedite the communication of important safety information by Health Canada to prevent harm to Canadians who rely on these products.Third, Vanessa's law will authorize Health Canada to compel manufacturers, when necessary, to provide more post-market information about their products. Companies may be required to gather ongoing evidence of the product's benefits and risks, to conduct new tests and studies, perhaps on specific populations, or to undergo a product reassessment. For example, as I mentioned, I would be able to compel further studies on a drug for adults that was routinely causing side effects in children.Of course, information is power, and we are committed to gathering the information that Health Canada needs to ensure that Canadian patients and caregivers are empowered to make the most informed choices about their drug and medical device decisions. The measures in Vanessa's law will build on other efforts that we've undertaken to make more data and information available to Canadians than ever before.For example, the department's Healthy Canadians website and social media channels give Canadians important up-to-date health and safety information, written in plain language. More than five million Canadians have visited these online sources. Canadians also have access to Health Canada's online databases, including a drug product database that provides information about all approved drugs. Our recalls and safety alerts database is another critical resource to learn more about the possible risks associated with health, consumer, and food products. Vanessa's law will help us to add valuable information to these trusted sources.(0925)Canadians also need to understand that when they are using therapeutic drugs and medical devices, they need to know how to use them. They need clear, plain language information on the drug label to make the right choices for themselves and their families, and they need access to it transparently and in a timely way. They also need assurance that the regulator of therapeutic products has the ability to gather information throughout the life cycle of these products.The plain language labelling initiative and our commitment to regulatory transparency and openness are important steps forward to meet the information expectations of Canadians. Vanessa's law will provide the necessary legal authorities for us to ensure that labels and information contain the most accurate information for Canadians to use to make informed decisions for themselves and their families.C-17, An Act to amend the Food and Drugs ActDepartment of HealthInformation disseminationTherapeutic products37958673795868379586937958703795871379587237958733795874379587537958763795877379587837958793795880DavidWilksKootenay—ColumbiaDavidWilksKootenay—Columbia//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin(0925)[English]You just mentioned all the different consequences of this law. Would you estimate that there will be a great deal of burden on the companies producing therapeutic products if they have safe products? What kind of burden do you think this will have on those companies?C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795889RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (0925)[English]Do you think it will put a lot of burden on those companies that say that they produce safe therapeutic products?C-17, An Act to amend the Food and Drugs ActDepartment of HealthSafetyTherapeutic products3795891RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0925)[English]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.C-17, An Act to amend the Food and Drugs ActDepartment of HealthSafetyTherapeutic products379589237958933795894DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (0925)[English]Thank you, Minister. I agree with you. That is why I believe, if I can go back to natural health products, that this law would not put any new heavy administrative burden on the natural health product manufacturers. Are you still insisting that even those low-risk products should not be included in this law? As you said, the burden of this law will not be cumbersome for companies that say they produce safe products.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products37958953795896RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0925)[English]I'll leave it up to you to question the experts on that. The recommendation to me was that those are considered to be low risk. The pharmaceutical industry and the pharmaceutical and prescription products are what this law applies to. Again, I'll leave it up to the committee to ask those questions further and probe on that issue.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795897DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (0930)[English]Okay.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795898RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (0930)[English]Before moving to the second question, I would say again that the administrative burden will be quite low, so I believe that the natural health product companies could also be under this law.Minister, my other question is, how will you ensure that there are enough resources to report adverse drug reactions and to coordinate the information once it has been received?Adverse drug reactionsC-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products37959023795903RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0930)[English]This is a priority for the government. We will ensure that we have the resources available to implement the legislation.Adverse drug reactionsC-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795904DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (0930)[English]Can you expand a little more on that? As Dr. Bennett has said, the ramifications are nationwide. It is, needless to say, a complex system. You said that you seem to be prepared. Can you expand more?C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795905RonaAmbroseHon.Edmonton—Spruce GroveAnneLamarAnneLamarAnne-LamarInterventionMrs. Anne Lamar: (0930)[English]Yes, there are a couple of points that I would make in terms of our resources. The short answer is yes, we have the resources to implement the new authorities.In terms of the reporting, the department has been continuing to invest in really updated IT infrastructure and platforms that enable us to do more efficient reporting, a sort of e-reporting, which also lessens the burden to industry in that regard.We will also be using new technologies to mine data more efficiently and be able to access the information more rapidly. We think, in fact, we'll be moving to a more efficient system. In addition to that, we'll be working very closely with the provinces and the territories to ensure that we are leveraging the systems they currently have in place as well, so not to duplicate those over again.Adverse drug reactionsC-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products379590637959073795908DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/35663TerenceYoungTerence-YoungOakvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/YoungTerenceH_CPC.jpgInterventionMr. Terence Young (Oakville, CPC): (0930)[English]Thank you, Chair.Minister, when the safety of patients is at stake, Canadians expect strong measures in place to ensure appropriate action taken by regulators. Currently in Canada the penalties that can be levied against wealthy companies that put Canadians at risk are the equivalent of a slap on the wrist.Existing levels of fines and penalties in the Food and Drugs Act reflect the age of the legislation and not the multi-billion dollar pharmaceutical industry that Health Canada regulates. If I can just give some examples from my own research, I have a list here of the who's who of the pharmaceutical industry, what we call big pharma, the biggest companies.These are companies that parents trust, that have safe drugs for their children, themselves, and aging seniors, and that have, in fact, committed criminal offences in the United States and paid fines. No one ever seems to go to jail. I've never heard of anyone going to jail. I'll just give you some examples.GlaxoSmithKline, in July 2012, paid a $3-billion fine for illegally promoting packs of Wellbutrin and Avandia. Now illegal promotion is not just that they put up too many billboards. Illegal promotion means they told the doctors, or they somehow made the doctors believe, that the drug was safer or more effective than it was, or that it was appropriate to prescribe it off label for uses for which it hadn't been proven safe. When drug companies promote off label and illegally, people die. A lot of people die. GlaxoSmithKline paid $3 billion in 2012 for illegal promotion of Paxil, Wellbutrin, and Avandia.Merck paid $1.6 billion from 2008 to 2012 for giving kickbacks to health care providers to get them to prescribe their drugs. Eli Lilly paid $1.3 billion in 2009 for illegally promoting Zyprexa, so that doctors thought it was effective for Alzheimer's with zero evidence that it helped Alzheimer's patients. In fact, it increased their risk of death by 200% to 300%. Novartis paid $422.5 million in 2010 for off-label promotion of Trileptal. Forest Labs paid $313 million in 2010 for off-label promotion of Levothroid and Celexa.The list goes on: Allergan, Elan, Johnson & Johnson—$81 million in 2010. AstraZeneca, Abbott, Sanofi-Aventis.... This is just back to 2008. This has been going on since the late 1990s.Can you please provide the committee with some additional details on how Vanessa's law addresses this reality with regard to fines and penalties? Do you feel that these new fines and penalties alone will serve to deter wrongdoing in the world of profit-driven big pharma companies?C-17, An Act to amend the Food and Drugs ActDepartment of HealthPenaltiesTherapeutic products37959123795913379591437959153795916379591737959183795919379592037959213795922BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0930)[English]First, let me thank you for all the great work you've done to advance this issue and for being such an amazing patient safety advocate. We're really thankful to have you on committee as this bill goes through. Thank you very much to MP Young.Obviously, you know full well the consequences of adverse drug reactions and I do think it is so critical that Vanessa's law provides for much higher penalties and even jail time, because we do have to recognize, as you say, the serious impact of adverse drug reactions on our communities. The bill does introduce new fines for those who do not comply with important safety measures. It allows for significant fines and penalties for companies that sell unsafe drugs in Canada. As you point out, right now the fine for companies who put Canadians at risk is simply not reflective of the realities of the harms that they cause. A fine of $5,000 per violation is a drop in the bucket for many companies that can generate profits of literally hundreds of millions of dollars. With this amendment the fine will change to up to $5 million per violation. In addition to this, the proposed law will also give the court discretion to impose even steeper fines, with no limitations imposed through legislation, and up to two years of jail time if companies break the law intentionally.I do think that Canadians will support this legislation. They expect that the drugs they purchase from the pharmacy or from store shelves should be safe for the use of their families. I do think by introducing these tough new fines for companies who put Canadian families at risk, we will ensure that companies that break the law will pay the price for compromising this trust and putting the health of Canadians at risk. It is an unfortunate reality that there are always a few who choose to engage in unethical behaviours, suppressing negative research and withholding vital safety information in order to increase their profit margins, but if these companies were to be convicted today, the punishment for their crimes would fall woefully short of meeting the severity of the risks. Through Vanessa's law, a company that intentionally provides Health Canada with false information, fails to adhere to conditions of sale, fails to recall a product when ordered, or fails to revise a label as requested, will be in violation of the law and will face very stiff new penalties. The increased fines and penalties are also consistent with those found in our other consumer-based legislation, such as the Canadian Consumer Product Safety Act and the Safe Food for Canadians Act. Vanessa's law also proposes an injunction power to permit the minister to apply to the court to order a person to stop doing an action related to an offence. This new authority will prove helpful in preventing future contraventions and in dealing with cases where ongoing non-compliance creates a risk to health. If an injunction is not complied with, the regulated party would be in contempt of the court and the court could then impose a fine or imprisonment. These measures will allow the government to take more effective action against those who jeopardize the safety of Canadians. I think the updated powers go a great distance further than what we have today to protect Canadians from unsafe drugs.C-17, An Act to amend the Food and Drugs ActDepartment of HealthPenaltiesTherapeutic products37959233795924379592537959263795927379592837959293795930TerenceYoungOakvilleBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (0935)[English]Minister, I'd like to come back to a question that my colleague, Dr. Morin, raised. Although one could say that there's a measure of responsibility for the pharmaceutical companies that are producing these drugs, and that's very important, at the end of the day, as I see the legislation, it's actually Health Canada, your department, that has to do the heavy lifting in terms of seeing this process through. For example, it gives you the power to call for more studies. It gives you the power to actually make a recall, to require labelling, to do follow-up.You're not going to do that on your own. You have to have experts who are helping you do that. I do want to say that nothing would be worse than passing this law only to find that we actually don't have the resources within the department to undertake the levels of work and the further research that might be required to actually put this law into effect. There have been cuts at Health Canada, so I think it would be very helpful for the committee to know, for example, what additional resources your department will be able to draw on in order to actually implement and enforce this bill, assuming that it is passed by the House.C-17, An Act to amend the Food and Drugs ActDepartment of HealthPackaging and labellingTherapeutic products3795933379593437959353795936BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0935)[English]Let's remember that Health Canada is doing a lot of this work today in terms of assessing the safety of drugs, going through the drug approval process. We have many hundreds of experts, researchers, physicians, who work on our staff, who are doing these assessments. What we're talking about in terms of the drug approval process is making those assessments more transparent, easier to understand, more available to Canadians. Obviously, that takes some resources, but it's about doing our work differently.In terms of collecting the information from institutions and then ensuring that we can assess that information, again, we do those assessments on an ongoing basis.I don't know, Dr. Sharma, but maybe you want to explain how it is we do a drug safety assessment. We do these things today. What we want is more information— C-17, An Act to amend the Food and Drugs ActDepartment of HealthInformation disseminationPackaging and labellingTherapeutic products379593737959383795939LibbyDaviesVancouver EastSupriyaSharmaSupriyaSharmaSupriya-SharmaInterventionDr. Supriya Sharma: (0940)[English]Yes.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795940RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0940)[English]—and more information will help us do our work and make sure that we have more comprehensive information about any particular drug when we're looking at the post-market analysis.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795941SupriyaSharmaLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (0940)[English]The reason it's very important is that the Auditor General's report in 2011 clearly referred to the time lag for people actually getting information. In fact, he said that two years is too long, so already we have a problem. I don't know whether or not now, since 2011, the time lag has improved, but to me it's a really serious question. If the information isn't getting back to people about the adverse reactions, about what the problems are in terms of drug safety review, then really the bill is not doing the job it should do. I think we need some very specific markers on this to demonstrate to us that the recommendations from the Auditor General are being met, and that there will be serious improvements in terms of drug safety review and the timeline that it takes.C-17, An Act to amend the Food and Drugs ActDepartment of HealthInformation disseminationTherapeutic products379594237959433795944RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0940)[English]Sure, and Anne wanted to make a comment about the timeliness.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795945LibbyDaviesVancouver EastAnneLamarAnneLamarAnne-LamarInterventionMrs. Anne Lamar: (0940)[English]In reference to the AG report from 2011, obviously, Health Canada took those recommendations very seriously. We've completed, actually, the majority of the action items that were recommended. We can certainly provide more follow-up details to the committee on that.I think that what is being proposed in Bill C-17 is actually completely in line with the OAG report. In fact, we have already started, as the minister alluded to, to move some of our priorities, change the way we are doing our business. I referred to some of the efficiencies that we find around electronic reporting, with large IT systems that help us to manage that information.You also referenced a time lag in terms of information coming in and being able to provide a signal assessment. Again, that will be enabled and be even stronger with new systems. I think as well with the fact that we won't need to be negotiating on some of the authorities like recall, for example, where it does take more time for us to get information out to the public, we will see ourselves saving time in that regard. Our capacity to communicate, to take that information and communicate it externally to Canadians, to pharmacists, to practitioners who need it, I think will clearly be enabled.C-17, An Act to amend the Food and Drugs ActDepartment of HealthInformation disseminationTherapeutic products379594637959473795948RonaAmbroseHon.Edmonton—Spruce GroveLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (0940)[English]You mentioned that you could provide the committee with information about what steps have been taken to meet the recommendations of the Auditor General from 2011. I'd like to take you up on your offer and ask that you provide that information to the committee, Ms. Lamar. Could you do that?C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795949AnneLamarAnneLamarAnneLamarAnne-LamarInterventionMrs. Anne Lamar: (0940)[English]Yes.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795950LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1814JamesLunneyJames-LunneyNanaimo—AlberniIndependentBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LunneyJamesD_CPC.jpgInterventionMr. James Lunney (Nanaimo—Alberni, CPC): (0940)[English]Thank you, Minister and officials, for being with us today.Minister, I think a lot of people would be surprised to learn from your earlier remarks that it's been nearly 50 years since patient safety legislation has been significantly updated. This seems to be a worldwide phenomenon that there are great gaps in the information on safety and effectiveness of drugs used in real-world settings. More information is needed on the safety and effectiveness of pharmaceuticals when used by the diverse patient populations, and outside the controlled, experimental environment of clinical trials. I was wondering if you would be able to elaborate for the committee on how Health Canada currently undertakes post-market surveillance activities. What kind of improvements are here in Bill C-17, in Vanessa's law?C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products379595437959553795956BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0940)[English] I'd be happy to outline the current approach. It does demonstrate a contrast with what Vanessa's law hopes to deliver. As I mentioned in my opening remarks, we do need to recognize, and I fully believe, that Canada does have one of the most rigorous drug approval systems in the world for drugs and medical devices. This system does ensure, as far as possible, the safety of these products before they're marketed. Before a pharmaceutical product reaches the market it must satisfy strict safety, efficacy, and quality evidence requirements. Health Canada's team of scientists thoroughly review and evaluate all of the evidence that is provided. Once they've determined that the benefits of the pharmaceutical product outweigh the risks, the department will issue an authorization allowing the pharmaceutical product to be legally available for Canadians to use under specific conditions. However, and that's where Vanessa's law comes in, once these products are on the market, we currently have limited ability to gather information about these products and to take action when a problem arises. When Health Canada does issue a market authorization to allow a pharmaceutical product to reach the Canadian market, the department monitors these products to detect any new risks. This work includes the collection and evaluation of adverse drug reaction reports submitted by industry, patients, caregivers, and health care professionals. We also have a review of periodic safety updates that are submitted by manufacturers, an analysis of information gathered from various sources such as medical and scientific literature, other regulatory agencies internationally, and manufacturers. You can see that we're doing the best we can possibly do with the powers we have, and that does go quite far, but as many members of the committee know, in the bill before you today there is room for improvement. The scientists and those who work on this issue relish the thought of having more authority and more powers to be able to act in this area. It was only recently that I announced that Health Canada would start posting summaries of after-market drug safety reviews on its website, which was a great initiative. These reviews provide a plain language description to Canadians with respect to what was assessed, what Health Canada discovered, and what action it took. This new approach allows the department to share information gathered from the scientific literature, health care professionals, the manufacturers, and other international regulators. These drug safety summary reviews make Health Canada an international leader in the transparent posting of this kind of information, now ahead of both the United States and the European Union. However, as I've said, Canada's overall safety system for drugs is based on legislation that is over 50 years old now, and lags behind many international regulatory counterparts. While we've taken action to strengthen post-market drug safety, we still do not have key legislative authorities or tools needed to efficiently further protect the health and safety of Canadians. Vanessa's law will provide us with that. It will provide us with the legal weight to help better protect the health of families. For example, as we already discussed, adverse drug reactions to pharmaceutical products are estimated to account for one quarter of emergency room visits in our hospitals, and most adverse drug reactions are vastly under-reported. This is why, as I've said, Vanessa's law includes measures that will require mandatory adverse drug reaction reporting from health care institutions. It will also give our government the tools needed to recall a drug or require a label change. I will use the example of Diane-35. People ask why this takes so long. Journalists are asking why it is taking so long for us to come out with the action we promised on Diane-35. A lot of it was because we had to negotiate with the manufacturer and that took months. In this instance, now that we have these authorities, we don't have to negotiate. We were able to take the action we wanted to take on Diane-35. We had a checklist and worked with the associations that were involved with the drug to disseminate very good information to physicians to make sure they were not prescribing Diane-35 off label, and the manufacturer did cooperate with us. It did take us a number of weeks, even months, to be able to reach that point. That's just one example of why it's important that we have these authorities, so that Health Canada not only has the information but they have the weight, then, to act on it as quickly as possible. (0945)I do think this legislation will make a great deal of difference in the lives of Canadians, but also for the department. They look forward to having these extra tools to do their jobs.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products379595737959583795959379596037959613795962379596337959643795965379596637959673795968379596937959703795971379597237959733795974JamesLunneyNanaimo—AlberniBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (0950)[English]I'm trying to focus the questions on material that started coming to us in anticipation of witnesses being heard, in order to get your reaction, at least in general, to what we might be hearing at committee. I think the committee is of a mind that should it be required, we could call you back later, based on what we've heard from witnesses, because there might be some clarification needed.I have a couple of questions. First, it's very clear that the minister can recall something. What about suspension? It seems to me that the bill doesn't really address the issue of suspension. Was there consideration made of the need to have suspensions as well? Also, how would you see it differently from a recall? That's one question.On the other question, we did get some information just very recently from MEDEC, which is the medical technology association. I haven't read all of the info that they put out, because we just got it yesterday, but they are concerned about the fact that the bill doesn't address single-use medical devices, which they say is quite a problem. Devices are manufactured and are intended for one use, but apparently what really happens out there is that they are reused and reused, including by hospitals. There's that issue as well. I wonder if you had contemplated that being covered in the bill in terms of single-use medical devices.Those are the two questions right now.C-17, An Act to amend the Food and Drugs ActDepartment of HealthMedical and assistive devicesProduct recallsTherapeutic products3795987379598837959893795990BenLobbHuron—BruceDavidLeeDavidLeeDavid-LeeInterventionMr. David Lee: (0955)[English]Mr. Chair, on the first issue about suspension, when putting in measures at either the legislative or regulatory level, you need to look at what the instrument does. Recall is introduced at the act level. Suspension is something that Health Canada can do under the current regulations. It really has to do with how the authorization works. As Health Canada approves a product out on the market, it does so with a threshold. It looks at the product and it says that the benefits outweigh the risks and the chemistry is okay.If we see something that gives us concern, then we can reach for a suspension, and that will still be effective under this current set of proposals. You're really looking for.... If we start to see that there's a serious risk introduced and the drug shouldn't be sold anymore, then we can invoke suspension. Recall, though, is also where you need to reach into the market and pull the product back from the market or correct it.C-17, An Act to amend the Food and Drugs ActDepartment of HealthProduct recallsTherapeutic products37959913795992LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (0955)[English]Just to be clear, then, a suspension doesn't necessarily mean that the product can no longer be sold?C-17, An Act to amend the Food and Drugs ActDepartment of HealthProduct recallsTherapeutic products3795993DavidLeeDavidLeeDavidLeeDavid-LeeInterventionMr. David Lee: (0955)[English]No. Suspension does mean that it can't be sold anymore. The authorization allows you to sell. There's a prohibition in law that says that you don't sell unless you have an authorization.C-17, An Act to amend the Food and Drugs ActDepartment of HealthProduct recallsTherapeutic products3795994LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (0955)[English]A suspension would be that you can in effect take it off the market for a period of time while there is further clarification and testing, whereas with a recall it's just gone. You take it off presumably for good, or...?C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3795995DavidLeeDavidLeeDavidLeeDavid-LeeInterventionMr. David Lee: (0955)[English]Yes. Recall is usually when we need to reach into the market and say something is so dangerous right now we need to remove it from supply. It usually comes back to the manufacturer usually from pharmacy and from retail. That's different from suspension. Suspension just says don't sell any more into the system.C-17, An Act to amend the Food and Drugs ActDepartment of HealthProduct recallsTherapeutic products3795996LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (0955)[English]But there might still be product out there that's being sold.C-17, An Act to amend the Food and Drugs ActDepartment of HealthProduct recallsTherapeutic products3795997DavidLeeDavidLeeDavidLeeDavid-LeeInterventionMr. David Lee: (0955)[English]Usually when there's a suspension we will advise the whole drug system and people will appreciate that there is a stop. Sale includes distribution, so technically speaking, you shouldn't see more of the drug going out to any one particular patient when we suspend.Having said that, sometimes it is so dangerous you really need to remove it from pharmacy shelves and that would be recall.C-17, An Act to amend the Food and Drugs ActDepartment of HealthProduct recallsTherapeutic products37959983795999LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (0955)[English]No, I get that. It was just more the suspension element that I wasn't quite so clear on.What about in terms of the single-use medical device?C-17, An Act to amend the Food and Drugs ActDepartment of HealthMedical and assistive devicesTherapeutic products37960003796001DavidLeeSupriyaSharmaSupriyaSharmaSupriya-SharmaInterventionDr. Supriya Sharma: (0955)[English]We are talking about the reuse of single-use devices. If it sounds like an oxymoron it's because it is.The idea from our perspective is that if a product is for single use there should be good reasons that it's for single use and it should be labelled as such. We do have symbols on medical devices and wording on medical devices for products that are for single use.Sometimes those products that are for single use are then reused, reprocessed, and refurbished. Some of those are legitimate. For example, in a hospital if you have surgery that's taking place and you have a number of total knee replacements and you open up different sizes. If you don't use them they can be re-sterilized and used again.The concerns that are coming now is if you actually send it off to a facility and they somehow change that device, so it's not longer that same device, or there might be new risks that are introduced.From Health Canada's perspective, if a product can be safely reused and reprocessed, then the company that manufactures it is in that unique position to know all about that product and to be able to tell us this is how it should be reused or reprocessed and that should be on the label.C-17, An Act to amend the Food and Drugs ActDepartment of HealthMedical and assistive devicesTherapeutic products37960023796003379600437960053796006LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (0955)[English]They're not under the bill. These devices are not within the definition of these therapeutic products. Is that correct?C-17, An Act to amend the Food and Drugs ActDepartment of HealthMedical and assistive devicesTherapeutic products3796007SupriyaSharmaSupriyaSharmaSupriyaSharmaSupriya-SharmaInterventionDr. Supriya Sharma: (0955)[English]They are. The concerns that we have right now are.... For example, let's say we have a product that's for single use and it's going out and it's being reused and there are concerns about that. We don't have a way to then compel the manufacturer to study that or to change the label to reflect that. That would be included in the bill.The concerns that we have, though, are that the product should be used based on the label and we should have information that we can see in Health Canada to assess how they should be used, whether it's for single use or for reprocessed devices.C-17, An Act to amend the Food and Drugs ActDepartment of HealthMedical and assistive devicesTherapeutic products37960103796011LibbyDaviesVancouver EastBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/71688EveAdamsEve-AdamsMississauga—Brampton SouthLiberal CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/AdamsEve_CPC.jpgInterventionMs. Eve Adams: (1000)[English]Mr. Chair, I'd like to split my time with Mr. Lunney.I have a question regarding the birth control pills that made headlines recently, both Alesse and Diane-35. Do you feel that the legislation and the definitions within the current proposed legislation go far enough to enable Health Canada to recall products like Alesse or Diane-35? The issue with Diane-35 was that it was off-label use and people were taking it for far too long. With Alesse the issue was that there were really ineffective medications in the pack, so basically placebos. People thought they were taking a prophylactic and there was no use in taking it and some unwanted pregnancies ensued. Do you feel this legislation would allow you to circumvent that type of problem or to act speedily should something like that happen again?C-17, An Act to amend the Food and Drugs ActDepartment of HealthDrug use and abuseTherapeutic products3796014379601537960163796017BenLobbHuron—BruceSupriyaSharmaSupriyaSharmaSupriya-SharmaInterventionDr. Supriya Sharma: (1000)[English]There are a number of parts of the legislation that would have helped in both those situations. The first part is really what we talked about in terms of the recall. Again, for the vast majority of companies when Health Canada said they would like a recall, they do recall. The issue is if we don't get that consent, if they don't want to recall. Again, down to the patient level.... This gives us the authority to say they must recall. That's one part of it.The other part of it really speaks to getting information around off-label use. Again, off-label use certainly is within the purview of practitioners. They need to be able to make decisions for their individual patients. What the legislation does is it gives Health Canada the authority to get information on off-label use.If there is an off-label use out there that's potentially introducing risks, then we have the ability to ask a company to study it, to get information and then to use that information to make changes to the label or to communicate to people so that when they're actually making decisions about their health they are doing that with the benefit of all the information that they need.C-17, An Act to amend the Food and Drugs ActDepartment of HealthDrug use and abuseProduct recallsTherapeutic products3796018379601937960203796021EveAdamsMississauga—Brampton SouthEveAdamsMississauga—Brampton South//www.ourcommons.ca/Parliamentarians/en/members/71688EveAdamsEve-AdamsMississauga—Brampton SouthLiberal CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/AdamsEve_CPC.jpgInterventionMs. Eve Adams: (1000)[English]Some have raised the concern that currently this legislation would only allow Health Canada the power to recall a therapeutic product if it presents a serious or imminent risk of injury to health. In the case of Alesse, for instance, where the drug was simply ineffective or a placebo, that was not how Health Canada interpreted it. They didn't consider that a serious adverse health consequence. They deemed that a lifestyle impact. I go back to my question. Do you feel as though this legislation gives you broad enough powers to act in the interests of Canadian patients and consumer safety?C-17, An Act to amend the Food and Drugs ActConsumers and consumer protectionDepartment of HealthTherapeutic products37960223796023SupriyaSharmaDavidLeeDavidLeeDavid-LeeInterventionMr. David Lee: (1000)[English]We've taken this question up and really searched carefully through the language, the threshold that you need to use for recall, and we absolutely think that, looking at Alesse, we would be able to effect recall on the language that we've proposed. A failure to work in that case would also constitute grounds for a recall. We have run that through our assessment.C-17, An Act to amend the Food and Drugs ActConsumers and consumer protectionDepartment of HealthTherapeutic products3796024EveAdamsMississauga—Brampton SouthEveAdamsMississauga—Brampton South//www.ourcommons.ca/Parliamentarians/en/members/71688EveAdamsEve-AdamsMississauga—Brampton SouthLiberal CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/AdamsEve_CPC.jpgInterventionMs. Eve Adams: (1000)[English]Perfect. I think Canadians want to know that we're not going to get bogged down in definitions, but that we have the ability to act immediately for the benefit of Canadian consumers.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3796025DavidLeeDavidLeeDavidLeeDavid-LeeInterventionMr. David Lee: (1000)[English]That's what we would do.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3796026EveAdamsMississauga—Brampton SouthEveAdamsMississauga—Brampton South//www.ourcommons.ca/Parliamentarians/en/members/1814JamesLunneyJames-LunneyNanaimo—AlberniIndependentBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LunneyJamesD_CPC.jpgInterventionMr. James Lunney: (1000)[English]Nearly 10 years ago I raised an issue about deaths in the hospital. Currently there are an estimated 1,400 deaths per year with C. difficile in the hospitals...common classes of medications, proton-pump inhibitors, acid suppressants.... I was told then that CNISP, the nosocomial infection surveillance program, would get to the bottom of it, but amazingly, they did not collect the data on the meds they were on at admission. I understand we're working now to get that corrected, and they're going to actually collect the data. That would be very helpful.I have a question that maybe you can answer, and I'll direct this to Dr. Sharma. Labels...there are warning devices out there. There's a fact sheet on C. difficile. In 2004 when I raised it the first time, there was a great two or three paragraphs at least explaining the biological plausibility and why taking people off these meds might be an important way to reduce the risk, 40% to 270% we now know, of contracting an infection that could take your life. The warnings got weaker. After the DSEN, the drug safety and effectiveness network, reported just a short time ago confirming the concerns I've been raising for 10 years, amazingly, PHAC moved to take the warning, even the one liner, off the three-page fact sheet on C. difficile. Can you explain how that's possible?C-17, An Act to amend the Food and Drugs ActDepartment of HealthInformation disseminationPackaging and labellingTherapeutic products3796030379603137960323796033BenLobbHuron—BruceSupriyaSharmaSupriyaSharmaSupriya-SharmaInterventionDr. Supriya Sharma: (1000)[English]In terms of the Public Health Agency of Canada report or the fact sheet, I think you would probably have to direct that to them. If there's a question for Health Canada, I'd happily be able to take that.C-17, An Act to amend the Food and Drugs ActDepartment of HealthInformation disseminationTherapeutic products3796034JamesLunneyNanaimo—AlberniJamesLunneyNanaimo—Alberni//www.ourcommons.ca/Parliamentarians/en/members/1814JamesLunneyJames-LunneyNanaimo—AlberniIndependentBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LunneyJamesD_CPC.jpgInterventionMr. James Lunney: (1000)[English]I would assume you would sort of talk to each other and I thought one of you perhaps was involved with PHAC.However, the warnings were weaker. We need strong regulatory response on that. I understand we're going to have much better tools now, but I'm talking about the tools that were available to communicate to doctors that were a little more cumbersome. It seems to many that the fact that tools were missing meant that people were actually not collecting data or they were looking the other way to avoid problems.C-17, An Act to amend the Food and Drugs ActDepartment of HealthInformation disseminationTherapeutic products37960353796036SupriyaSharmaSupriyaSharmaSupriyaSharmaSupriya-SharmaInterventionDr. Supriya Sharma: (1005)[English]Certainly the provisions in the bill, as we mentioned, give us more flexibility in terms of collecting data. It really comes down to two parts of it. One is that there are powers in the bill that actually ask companies to do reassessments. You can have a situation that's going on for a period of time; you can have one look at the data, but that may not be sufficient. It's really looking at that body of data, being able to drill down, and being very specific to look for specific issues.The other part of it is to then ask for new data, whether it's studies or whether it's new information that needs to come to bear to make those decisions. I think when you have more information, then we can do the analysis and we can make sure, as we do and endeavour to do, that the labels reflect exactly the state of information that—C-17, An Act to amend the Food and Drugs ActDepartment of HealthInformation disseminationTherapeutic products37960373796038JamesLunneyNanaimo—AlberniJamesLunneyNanaimo—Alberni//www.ourcommons.ca/Parliamentarians/en/members/1814JamesLunneyJames-LunneyNanaimo—AlberniIndependentBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LunneyJamesD_CPC.jpgInterventionMr. James Lunney: (1005)[English]I've been putting information for 10 years in front of Health Canada, and there's no action.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3796039SupriyaSharmaBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/35663TerenceYoungTerence-YoungOakvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/YoungTerenceH_CPC.jpgInterventionMr. Terence Young: (1005)[English]Thank you very much, Mr. Chair.In October 2013 Marit McKenzie of Calgary died of a blood clot in her lungs after taking Diane-35, which is one of the newer generations of birth control pills, for acne. She was preparing for her school formal. This use was not proven safe and effective; it was off-label use prescribed by her doctor. Tragically, because she bought it at Shoppers Drug Mart, she had no safety warning of blood clots and so she died. Shoppers Drug Mart is recorded in the Toronto Star as saying they didn't issue a warning because they didn't want to frighten consumers about rare adverse effects, so they robbed her of the opportunity to make an informed decision.By law in Alberta, the maximum damages Shoppers or the drug company would have to pay for such a loss is $85,000. So in normal risk management practices why would they warn patients? It hurt sales, and if something terrible happens, they only have to pay $85,000 anyway. I joined the minister recently to announce the transparency framework, and the media took a mixed approach. They gave credit that it was a good idea, for example, in the Toronto Star, but then they criticized it because all drug reviews weren't going to be published right away, which I thought was very unfair. This is a huge change. If drug reviews for Diane-35 had been published and open, I suspect Marit Mackenzie would have had a proper safety warning and might have decided to not take Diane-35 at all.Could you please comment on the transparency framework, on the change of publishing drug reviews, and why it makes sense to publish the ones for which there is not an established safety profile, the newer drugs, or one that appeared to have a risk, rather than go to the trouble of printing all of them now? A drug review can be up to 10,000 pages, and then it has to go for translation. There's a tremendous cost and timeframe to do that. Would you comment on the fact that—I hope you agree with me—it makes sense to publish the ones where there's an apparent risk first and then go to the others?C-17, An Act to amend the Food and Drugs ActConsumers and consumer protectionDepartment of HealthInformation disseminationTherapeutic products37960423796043379604437960453796046BenLobbHuron—BruceAnneLamarAnneLamarAnne-LamarInterventionMrs. Anne Lamar: (1005)[English]Thank you for the question.As you are aware, the minister has made her intention known that we will be publishing drug summaries moving forward, as well as making the full reports available upon request. We are trying to provide information that is meaningful to the people who are requesting and looking for that information. The drug summaries, for example—because as you've noted, the reports themselves are very, very dense and technical—will provide very, very plain language information that will be available to everyone, and particularly consumers, so they have a very good understanding of what the implications of using that drug may be, and of course they will then be able to discuss that with their practitioner.On the other hand, in the consultations we've been doing with all of our stakeholders, we do know there are other groups, academics, for example, that are very, very interested in seeing the more fulsome reports of our safety assessments. We are committed to making those public. Of course we have to be mindful of potential information that we may need to redact, but really our goal is to make those as public as possible, with minimal oversight in terms of what would be removed from those reports.C-17, An Act to amend the Food and Drugs ActConsumers and consumer protectionDepartment of HealthInformation disseminationTherapeutic products379604737960483796049TerenceYoungOakvilleTerenceYoungOakville//www.ourcommons.ca/Parliamentarians/en/members/35663TerenceYoungTerence-YoungOakvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/YoungTerenceH_CPC.jpgInterventionMr. Terence Young: (1005)[English] I assume you have the resources to make that happen.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3796050AnneLamarAnneLamarAnneLamarAnne-LamarInterventionMrs. Anne Lamar: (1005)[English]We do.C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3796051TerenceYoungOakvilleTerenceYoungOakville//www.ourcommons.ca/Parliamentarians/en/members/35663TerenceYoungTerence-YoungOakvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/YoungTerenceH_CPC.jpgInterventionMr. Terence Young: (1005)[English]Ms. Lamar, could you please describe how Vanessa's law will make drugs safer for children in Canada?C-17, An Act to amend the Food and Drugs ActChildrenDepartment of HealthSafetyTherapeutic products3796052AnneLamarAnneLamarDavidLeeDavid-LeeInterventionMr. David Lee: (1010)[English]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—C-17, An Act to amend the Food and Drugs ActChildrenDepartment of HealthSafetyTherapeutic products379605537960563796057TerenceYoungOakvilleTerenceYoungOakville//www.ourcommons.ca/Parliamentarians/en/members/35663TerenceYoungTerence-YoungOakvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/YoungTerenceH_CPC.jpgInterventionMr. Terence Young: (1010)[English]Could you explain to the committee what a signal is?C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3796058DavidLeeDavidLeeDavidLeeDavid-LeeInterventionMr. David Lee: (1010)[English]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.C-17, An Act to amend the Food and Drugs ActChildrenDepartment of HealthSafetyTherapeutic products37960593796060TerenceYoungOakvilleBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/43WayneEasterHon.Wayne-EasterMalpequeLiberal CaucusPrince Edward Island//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/43/EasterWayne_Lib.jpgInterventionHon. Wayne Easter (Malpeque, Lib.): (1010)[English]Thank you, Mr. Chair.I have two questions, and I see the bells are ringing.Dr. Bennett asked a question earlier on the ability of Health Canada to communicate with physicians in a rapid and effective way. The process, as I understand it, is very slow at the moment now in case of emergency. I think, Ms. Lamar, she felt that you didn't have enough time to respond or that you didn't get to respond when she was here.Second, in the interest of time, Mr. Chair, this question is for Mr. Lee. I've had experiences with family members who are on a fairly extensive drug regime. When there are new drugs added, general practitioners will say, “Okay, we'll go with a new drug.” I can tell you about one experience in which a person was on 28 pills—I don't know how many drugs—and after a near-death experience and after review, that dropped to 12 pills a day, and the person was a changed person. There was an adverse reaction to one drug with another which created severe problems.Is there anything in this bill that will deal with that situation? Sometimes it's not just a certain drug, but it is the application of that drug in conjunction with other remedies that are being taken by the individual.Those are my two questions, with the first one for Ms. Lamar.Adverse drug reactionsC-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3796063379606437960653796066379606737960683796069BenLobbHuron—BruceAnneLamarAnneLamarAnne-LamarInterventionMrs. Anne Lamar: (1010)[English]Thank you for the question.Coming back to some of my earlier comments, I think one of the things that we have working in our favour now is that we work in an environment that has an enormous number of venues for communication. There are many platforms to communicate, and social media is very helpful and instrumental in getting our communication messages out.In terms of when we do have health and safety information that we need to pass along, we really take a system-wide approach. We are not only communicating with physicians. Of course, practitioners are our key target audience for us, but we also use the College of Physicians network, for example, and pharmacists and retailers as well. We try to reach out to organizations that are also having face-to-face interaction where products are sold. In the case of a recall for example, we also work with retailers and pharmacists who are actually distributing that product so they are also aware. We actually do fairly regular evaluations, if I can call it that, of our risk communications processes to ensure that they are effective, that they're timely and that we are meeting the needs of those we provide them to. We have numerous ways of communicating electronically. We use old-fashioned technology, networks and phones, as well. We also do a lot of direct interaction with health care practitioners. Adverse drug reactionsC-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3796070379607137960723796073WayneEasterHon.MalpequeDavidLeeDavidLeeDavid-LeeInterventionMr. David Lee: (1010)[English]On the second question about a new drug coming in and a person taking many drugs, that can happen. Clinical trials don't always tell us how the therapies will react together. I think one of the big promises from the proposals is the institutional reporting, because as patients go in and they're taking a number of medications, seeing that very early is very important, so if there is a reaction between a new drug coming out and other drugs that are already out there, we can try to pick that up. The quality of reporting could increase in that environment. Right now, if you get an adverse reaction and then you look at it, the patient could be on four or five drugs, and have a number of medical conditions. It's hard, looking at that, to tell what happened. These new powers of being able to follow up and really study and verify and to do it in a disciplined way is really what we're trying to move through in Vanessa's law. Adverse drug reactionsC-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products379607437960753796076AnneLamarWayneEasterHon.Malpeque//www.ourcommons.ca/Parliamentarians/en/members/43WayneEasterHon.Wayne-EasterMalpequeLiberal CaucusPrince Edward Island//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/43/EasterWayne_Lib.jpgInterventionHon. Wayne Easter: (1015)[English]To come back to Ms. Lamar, there is no question there are all kinds of platforms out there to communicate now, but in an emergency situation, one needs to ensure the message gets through. If I can use even MPs as an example, we have so many platforms now for people to communicate with us, we sometimes miss them. Somebody thought they'd get to you on Facebook, or somebody else thought they'd get to you on Twitter, while somebody else thought they would get to you through your website or by e-mail. With all these different channels of communications, what we find in our racket—and it's not to be critical of the health area—is sometimes the messages can be missed. Is there any emergency line or tool of communication that is being looked at or could there be improvements that you can think of?C-17, An Act to amend the Food and Drugs ActDepartment of HealthInformation disseminationTherapeutic products37960773796078DavidLeeAnneLamarAnneLamarAnne-LamarInterventionMrs. Anne Lamar: (1015)[English]I'm going to ask Dr. Sharma to provide you with some more details. C-17, An Act to amend the Food and Drugs ActDepartment of HealthTherapeutic products3796079WayneEasterHon.MalpequeSupriyaSharmaSupriyaSharmaSupriya-SharmaInterventionDr. Supriya Sharma: (1015)[English]To start, I think you're absolutely right. When the bill first came in, there was no Twitter; there was no Facebook. People got information in very different ways. It's still that way, I think. When we're talking with practitioners and physicians out in the community, people want to get information in different ways. We've now gotten to the point where there are so many different platforms and different places where you can get that information. That's why at Health Canada what we're doing around the drug products is we're really trying to consolidate all that information.One of the initiatives as part of the transparency initiative is something we're calling the drug product register. It actually will take all that information and put it in one place. When we have emergency information that we need to get out to practitioners, we have an e-mail push. People subscribe to that, if that's the way that they want to get the information. We have the Healthy Canadians website now and things get tweeted out. Also, if we really need to reach all practitioners, we do have resources that we can go to that actually keep repositories of information for all practitioners across Canada. In that emergency setting, if we need to do that, we can do that. The issue for us, though, is what is the most effective way to communicate. It may be through existing channels. We're doing a lot of work on the effectiveness of risk communications, going out to end users to ask how they want to get information and what's useful to them. Then we'll package it accordingly. C-17, An Act to amend the Food and Drugs ActDepartment of HealthInformation disseminationTherapeutic products3796080379608137960823796083AnneLamarBenLobbHuron—BruceSuzyMcDonaldSuzy-McDonaldInterventionMs. Suzy McDonald (Director General, Workplace Hazardous Materials Directorate, Healthy Environments and Consumer Safety Branch, Department of Health): (1820)[English]Thank you.The GHS is not a system that Canada would sign on to. It's a system that Canada did help to develop at the United Nations. We were one of the key countries involved, along with many other countries. It's a system whereby each country can choose to adopt the GHS or any portions of the GHS. So it's not something that we've signed on to, but we are choosing to implement it here in Canada.Does that respond to your question?Budget 2014 (February 11, 2014)C-31, An Act to implement certain provisions of the budget tabled in Parliament on February 11, 2014 and other measuresClause-by-clause studyDepartment of HealthGovernment bills376177837617793761780JamesRajotteEdmonton—LeducNathanCullenSkeena—Bulkley ValleyJasonWoodJason-WoodInterventionMr. Jason Wood (Director, Policy and Program Development, Workplace Hazardous Materials Directorate, Healthy Environments and Consumer Safety Branch, Department of Health): (1830)[English]My colleague Mr. Morales has additional information to add, but essentially, the amendment being proposed is redundant to the existing sections of the bill as proposed.Currently, proposed section 14 says that if you're going to import a product, it needs to be compliant with the regulations. The amendment being proposed is adding some text indicating, “unless exempted by the regulations”. The effect of that amendment is essentially nothing. There's no additional impact of that amendment. Essentially, it would still cause us to have to create, in the regulations, the exemption we're talking about now. So the exemption raised by the Canadian Consumer Specialty Products Association with respect to labelling a product after it's been imported would still have to be created in the regulations.Budget 2014 (February 11, 2014)C-31, An Act to implement certain provisions of the budget tabled in Parliament on February 11, 2014 and other measuresClause-by-clause studyDepartment of HealthGovernment bills37618523761853SuzyMcDonaldJohnMcKayHon.Scarborough—GuildwoodGuylaineMontplaisirGuylaine-MontplaisirInterventionMs. Guylaine Montplaisir (Chief Information Officer, Corporate Services, Department of Health): (0910)[Translation]Good morning and thank you, Mr. Chair.I am Guylaine Montplaisir, the chief information officer for Health Canada.It is a great privilege for me to be here today. I want to thank you for the opportunity to present the Health Canada approach and progress to date with open data.I am pleased to report that Health Canada's open data efforts have led to the release of 71 data sets which are currently on data.gc.ca. This number fluctuates relatively dynamically as we clean the data sets submitted and add new ones.Out of all government departments, Health Canada has the sixth highest number of data sets published on the open data portal. The majority of these data sets are related to drug products, natural health products, nutrient value of common foods, medical devices, adverse reactions and notices of compliance.[English]Health Canada is extremely pleased that some of our published data sets were used in the recent CODE event, the Canadian Open Data Experience appathon, and one of the applications that was placed among the finalists—it was called Munchables—was developed using Health Canada's data set on nutrient values and common foods. The application, if it were ever to be used, would actually enable Canadians to make better decisions about the food they eat and to make healthy food choices, which is one of our goals.At the outset, Health Canada focused its efforts on publishing data sets that were already readily available on our other Health Canada sites. Our initial approach to identifying data sets for publication to the open data portal was to rely heavily on subject matter experts across our organization to come forward with data they wished to publish. Our approach evolved over time to the point that we're now actively seeking and soliciting data sets from the program areas, especially in high-value categories such as those that were identified in annex B of the G-8 Open Data Charter in June 2013.We continue to reach out directly to program areas to identify additional data sets.[Translation]In summer 2013, Health Canada undertook the development of a vision document to guide future activities around open government, including open data. This effort intended to generate engagement and conversations about open government within the organization. This document outlines proposed approaches to finding data, such as soliciting input from stakeholders, evaluating web statistics to determine visits and searches of our Internet sites, and analysis of past access to information requests received. A full-year analysis of our web statistics placed the Canada Food Guide and the drug product database among the top searches.Our vision clearly articulates Health Canada's commitment to open government. That means a commitment to foster greater health program transparency by the Government of Canada, the health regulator; provide Canadians with opportunities to participate in federal health policy development; steer innovation in health and life sciences; and ultimately encourage Canadians to make better informed decisions about their health.[English] The document also clearly enunciates a number of guiding principles, those most relevant to our open data agenda being openness, quality first, and stewardship.On the openness front, we will strive to improve data and information sharing within and between organizations and cultivate a culture of “open by default” to dismantle silos and expand the data and information that is shared publicly.On the quality first front, the data and other electronic information that we release to the Canadian public will be prioritized, easy to understand, and published in a convenient, machine-readable format that supports reuse. When we started publishing to the portal, when the first version of the portal was created, we were publishing in the format that the data existed in. Today, because we want to be open by default, we create the information in the format that is machine-readable. Today, 60% of our data is published in the format of CSV, comma-separated values.On stewardship, the third principle, our plan will focus on building the long-term infrastructure and capacity to identify, manage, and make available the data that is solicited and captured by Health Canada on behalf of the Canadian public while fulfilling mandated responsibilities and activities.In order to successfully implement the open government directive once it becomes effective this summer, Health Canada will establish a number of essential operational conditions, such as: putting in place an operational mechanism for the rigorous analysis of information and data that will respect to privacy, confidentiality, security and ownership before the data is placed in the public domain; maintaining an enterprise data set inventory, and we have already begun doing so; and establishing a process with the active participation of all program areas to help facilitate and prioritize their release. We will also recognize the need for sound identification and evaluation processes.(0915)[Translation]Going forward, Health Canada will continue to explore options to increase the availability of data on data.gc.ca. Work will be undertaken to facilitate the integration of Health Canada data with other sources such as energy projects data and weather data, which affect health. This data will serve as the basis for applications that private industry can develop and make available to the public for use at home and on mobile devices. We will look to improve access to our data through the implementation of an application program interface for our more dynamic datasets, such as[English]recalls in safety—in good French—[Translation]to ensure Canadians have access to our most current data on an ongoing basis.We will also continue to provide timely responses to stakeholder feedback with regard to the open data sets Health Canada has posted to the open data portal. [English]We will continue to identify data themes or clusters and prioritize their release, as part of the forthcoming open government action plan 2.0. Identifying and prioritizing data themes and clusters for public release will be based on two main principles: relevance to the Health Canada mandate and strategic outcomes; and responsiveness to what Canadians want and need to know.Accordingly, analysis of the program alignment architecture and the strategic outcomes, as outlined in the Health Canada report on plans and priorities, will be the basis for categorizing information and data content. Stakeholder information needs will continue to be informed by environmental intelligence gathered from ongoing business operations, including stakeholder feedback, web metrics analysis, social media monitoring, as well as information release and analysis from our key international counterparts.[Translation]Mr. Chair, that concludes my opening remarks.I appreciate the opportunity to be before the committee and am ready to address any questions you may have.Canadian Open Data ExperienceDepartment of HealthFederal governmentFreedom of informationOpen data374309637430973743098374309937431003743101374310237431033743104374310537431063743107374310837431093743110374311137431123743113374311437431153743116374311737431183743119Pierre-LucDusseaultSherbrookePierre-LucDusseaultSherbrooke//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionThe Vice-Chair (Ms. Libby Davies (Vancouver East, NDP)): (0845)[English]We'll call the meeting to order. We're very delighted to welcome the Minister of Health here at our committee. Welcome, Minister Ambrose. We're here to deal with the main estimates today, and we look forward to hearing you. I believe you're staying for an hour. If you can stay longer, we'd be very delighted, because then we can ask you more questions. I know that your officials will be here for the two hours.I'd like to call vote 1, which means that we now invite the minister to make her remarks.Thank you.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37434093743410374341137434123743413RonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionThe Honourable Rona Ambrose (Minister of Health): (0845)[English]Thank you, Madam Chair, and good morning to all the committee members. It's a pleasure to be here with you.[Translation]Thank you for the invitation to discuss the main estimates for Health Canada, the Public Health Agency of Canada, the Canadian Institutes of Health Research and the Canadian Food Inspection Agency.[English]I'm joined by George Da Pont from Health Canada, our deputy minister; Krista Outwaite and Dr. Greg Taylor from the Public Health Agency of Canada; Dr. Alain Beaudet, who is here from the Canadian Institutes of Health Research; and Dr. Bruce Archibald from the Canadian Food Inspection Agency.You're right, Madam Chair; after I depart you'll be in good hands with the officials. I'm sure they'll be happy to take more questions from the committee.Before I begin my remarks on the main estimates, I would like to take a moment to commend this committee on the great work you've done recently. I know right now you're undertaking a current study on the health risks and harms from marijuana. I have a particular interest around the concerns of the health risks associated with children. I also want to thank you for the work you've done on prescription drug abuse. It's not an emerging issue; this issue has arrived. It is very much a public health issue here in Canada and in the United States. You've heard from many health officials across the border. I thank you for your recommendations. I know we've already acted on some of them. I look forward to acting on others.On the current study you're doing right now, obviously as Minister of Health I am very concerned about the health risks associated with smoking marijuana, but particularly for our children and youth. I think it's important to know that Health Canada does not endorse the use of marijuana, nor has it approved it as a drug or medicine. I think that's an important message to send and for kids to understand.When we have discussions around medicinal marijuana, it's important for young people to understand that while there is a program in place, this program has been put in place to respond to a court decision. Health Canada does not endorse the use of marijuana, nor is it approved as a drug in Canada, or as a medicine. This is an important message to counter the normalization around the use of it and some of the misperceptions that kids have. I understand you've heard from them.I have been pleased that you've invited a number of organizations to your session, including the Canadian Medical Association and others who are raising similar concerns around the health risks. I've been reassured to hear that you've been seeking advice from very well-informed and credible medical experts—Michel Perron, who is the head of the Canadian Centre on Substance Abuse, and others, including researchers, in particular from the University of Ottawa and elsewhere, have also been speaking out about these well-established health risks. So I thank you for that good work. I think what's coming out of this committee is important because it's credible evidence from those who are close to this issue and dealing with young people. I think that informs some of the work we do going forward.I will now briefly go to the main estimates, and my priorities for the health portfolio, before answering questions. As Minister of Health, I'm very focused on improving Canadians' health and working with all partners to ensure that Canadians can continue to access the health services and products they need in a safe way. The department is providing services that are important to Canadians, such as stronger safety systems for health products and food, continued support for mental health research, and improved access to quality health services to first nations and Inuit.Health Canada's main estimates for 2014-15 outline $3.66 billion in spending, which is designed to help Canadians maintain and improve their health. This represents a net increase of $365 million over last year. The increase is due mainly to the stabilization of first nations and Inuit health program funding, which accounts for $311 million, as well as the implementation of the very successful B.C. tripartite framework, which accounts for $63 million. However, as members of the committee know well, main estimates do not reflect our recent budget investments, and economic action plan 2014 has several important investments that do continue to deliver on our government's commitment to the health and safety of Canadians. In fact this year's budget announced almost $400 million to strengthen Canada's food safety system and better protect Canadian families. These investments will support the hiring of over 200 additional inspectors with CFIA and other staff, improve our systems to detect and respond to risks, and continue programming that keeps our country free of dangerous animal diseases that affect human health.(0850)I was of course thrilled to hear the leader of the opposition say that this was good news in the budget with regard to food safety and that this was a good idea. Of course, I couldn't agree more.Since I last appeared before you, I've also held round tables to hear what Canadians have to say about nutrition information. I raise this because there's a lot of discussion and interest in this from members and from the media around nutrition information and healthy eating.We've also launched a regulatory transparency and openness framework for Health Canada so Canadians can easily find relevant drug facts and information about medicines that have been approved in Canada. Working with the CFIA, I have also announced the healthy and safe food for Canadians framework. This framework describes how the government is working to inform consumers about healthy and safe food choices, minimizing food safety risks, and protecting Canadians when unsafe foods enter the marketplace, with our ability, of course, to recall them quickly.I'd also like to spend a few moments talking about Canada's health care system, the pressures that it's facing, and the action we are taking.[Translation]Canadians are among the healthiest people in the world, living longer and enjoying more quality years in good health than ever before. And we are living in a time and place of remarkable progress in healthcare.[English]And indeed our government is providing the highest recorded health transfer dollars in history to provinces and territories. This record funding will reach $40 billion annually by the end of the decade and provide stability and predictability to the system. In fact, since we formed government, health care transfers have increased to the provinces by almost 50%, but there are also important issues that we need to continue to address. We simply must do more to ensure that our health care system is innovative and delivers the care that Canadians need and want, and ensure our system is sustainable for the long term.[Translation]Since my appointment, I have had the privilege to meet and hear from Canadians across the country about our healthcare system.[English]I've also met front-line staff workers and even had a chance to work with residents for a day in Toronto at St. Joe's Health Centre to understand the important work they do and the challenges they face. I've heard from Canadians that they feel that the system needs to adapt to changing economic, demographic, and technological pressures. They need to know that we are working to improve the health system and ensure its sustainability, not just for themselves but for generations to come. These concerns reinforce the most critical challenge facing Canada's health care system, and that is its long-term sustainability. The reality is that more money is not going to fix the inefficiencies in our health system. Currently we spend 11.2% of our GDP on health care, significantly more than many other countries, and, left unchecked, some experts like David Dodge suggest that by 2031, public and private spending on health care could be 15% of our GDP, or higher.I believe the key to the long-term sustainability of our health system is innovation. We need to make better use of our existing resources and target best practices. This means breaking down barriers, tapping into creative minds, and working collaboratively to improve the productivity, efficiency, and responsiveness of the health care system.To that end, a few months ago I announced the creation of an expert panel to find the most promising innovations in health care, not just here but abroad, whether they are technologies or models of care. This panel will focus on finding innovative solutions to these challenges and informing our future policy decisions. It will also identify promising innovations within Canada and abroad, as I've said, that have the potential to reduce growth in health spending while improving care, and it will recommend ways the federal government can better align its efforts to support such innovations.I look forward to the advice of this panel. It will be invaluable in guiding us toward a sustainable and responsible health care system that meets the needs of Canadians now and to the future. I look forward to announcing more details about the panel to you very soon.(0855)[Translation]All jurisdictions in Canada are starting to focus on innovation within the healthcare system, and we are making progress.[English]Our government plays a key role in these efforts. On the research front, we invest almost $1 billion annually to support Canada's best health researchers and trainees through the Canadian Institutes of Health Research. I am particularly pleased with our investments in Canada's strategy for patient-oriented research. SPOR, as we call it, in which the CIHR plays a key leadership role, is a coalition of federal, provincial, and territorial partners, patients, researchers, and industry, all dedicated to ensuring that the right patient receives the right intervention at the right time.I was pleased that in budget 2014 we committed to ongoing support of this initiative when we increased its investment by $15 million. This will help support the expansion of SPOR as well as the creation of the Canadian Consortium on Neurodegeneration in Aging and other health research priorities.Of course, building partnerships among governments, industry and others in the private sector, the health care community, and academia will be critical going forward. We've extended a challenge to the private sector to partner with us and the non-profit sector to invest in public health objectives specifically and to co-create initiatives that help make Canadian society and workplaces healthier. l am pleased to say that we've had a great response from non-profits and from the corporate sector to step up for this challenge. Examples of this would be that through our partnership with Air Miles for Social Change and the YMCA, gym members receive Air Miles reward miles if they reach certain physical activity milestones on a weekly basis. We're testing whether this incentive-based approach leads to longer-term behaviour change.We've also partnered with Canadian Tire, LIFT Philanthropy Partners, and the CBC for what we're calling The Play Exchange in order to appeal directly to Canadians themselves for healthy living ideas that we want to put into action. That's because we know that Canadians are among the most resourceful and innovative people in the world, so we're tapping into their ingenuity as well. We had a chance to launch this initiative during the Winter Olympic Games and we have seen great participation so far. By joining forces with both the public and private sector, we are fostering innovation, making the most of our resources, amplifying the impact on our communities, and creating environments that help make the healthier choice the easier choice.Madam Chair, I'll end my comments there. I am happy to take any questions from members.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015MarijuanaPatented Medicine Prices Review BoardPublic Health Agency of Canada374341437434153743416374341737434183743419374342037434213743422374342337434243743425374342637434273743428374342937434303743431374343237434333743434374343537434363743437374343837434393743440374344137434423743443374344437434453743446374344737434483743449LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin (Chicoutimi—Le Fjord, NDP): (0855)[Translation]Thank you very much, Madam Chair.I also thank the minister for joining us. I would like to ask her to give brief replies to all my questions, given that I have a number of questions to ask.[English]If, unfortunately, the answers are not very short, I will have to cut her off, and I don't want to do that.My first question for you, Minister, is this. When we had government officials before the committee in November, they mistakenly said that no application for mifepristone had been made, but in fact it had been submitted to Health Canada for over a year. The drug is approved in 57 countries, including the U.S.A. The medical community even calls it the gold standard of care. Considering that safe access to abortion is a fundamental right in Canada, could the minister confirm that Health Canada's approval process for mifepristone will be fully independent and be based on science alone?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthDrug review processMain estimates 2014-2015MifepristonePatented Medicine Prices Review BoardPublic Health Agency of Canada374345237434533743454374345537434563743457LibbyDaviesVancouver EastRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0855)[English]Yes, I'd be happy to answer that question. Of course, I do understand that the last time officials were here, that information was there; I know that the deputy minister addressed that issue to the committee. In terms of drug approval processes, this drug like every other is under an approval process whereby decisions are made by scientists within Health Canada, not by politicians or ministers. Under the Food and Drugs Act and its regulations, manufacturers submit applications for the approval of drugs to Health Canada, and the timing of the reviews for drug submissions varies depending on the information provided by the manufacturer.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthDrug review processMain estimates 2014-2015MifepristonePatented Medicine Prices Review BoardPublic Health Agency of Canada37434583743459DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (0855)[English]So it will be independent?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743460RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0855)[English]Yes.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743461DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (0855)[English]Thank you so much.My next question is this. The main library at Health Canada has been closed, and the library's physical collection has been moved. Can the minister confirm that she is aware that understaffed and under-resourced libraries present a liability for the department, putting the health of Canadians in danger?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthLibraries and archivesMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37434623743463RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0855)[English]What I can tell you is that I've been reassured by the department that the change to digitize our library services means that more Health Canada officials and bureaucrats will be able to access those documents, and so they see it as very positive. All of the documents are accessible and available to employees through our library services.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthLibraries and archivesMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743464DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (0900)[English]Well, in fact managers at Health Canada admitted that changes to the departmental library services would lead to risks to the department's credibility and its ability to produce evidence-based decisions. Was the minister aware of these concerns?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743465RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0900)[English]As I said, I've been reassured by the department that employees maintain free access on a broad electronic database of publications and can request any item that is not yet available electronically. You should know that the entire library collection remains accessible to all Health Canada employees, whether through loan request or electronically via the National Research Council.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37434663743467DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (0900)[English]But before, I believe, there were 40 researchers working at the library, and now there are only six of them. Do you honestly believe that they will be able to produce more research and make it more available, with so many fewer people on staff? Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743468RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0900)[English]I appreciate your comments, but officials have reassured me that this is a good decision, because more people will be able to access the documentation.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743469DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (0900)[English]Okay, then. Thank you for the answer.Here is my next question. Canada's first nations and Inuit face significant barriers when accessing dental care, and they experience much higher rates of dental disease, but we have heard of significant concerns with the rules and requirements of the program responsible for ensuring their dental care, the non-insured health benefits program. These rules can cause delays in treatment and increases in transportation costs and can deter follow-up treatment. All of these effects have direct impacts upon patients' health.Can you confirm that you plan to have a joint review for the non-insured health benefits program to ensure that it is meeting its goals and is meeting the needs of first nations and Inuit people in Canada?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthFirst NationsMain estimates 2014-2015Non-Insured Health Benefits ProgramPatented Medicine Prices Review BoardPublic Health Agency of Canada374347037434713743472RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0900)[English]Yes, I can confirm that we're in discussions related to a review.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthFirst NationsMain estimates 2014-2015Non-Insured Health Benefits ProgramPatented Medicine Prices Review BoardPublic Health Agency of Canada3743473DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (0900)[English]Do you have a timetable for when that study will start and when it should be complete?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743474RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0900)[English]No. I discussed this a number of weeks ago with Chief Atleo, and we made a commitment to him and to the AFN for this review. In fact, the review was already something we were looking forward to doing.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743475DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (0900)[English]Do you believe that this joint review will start before the election?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743476RonaAmbroseHon.Edmonton—Spruce GroveGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont (Deputy Minister, Department of Health): (0900)[English]Perhaps I can add a few comments on timing.AFN is in the process of finalizing its own internal views on the review. I understand they will do it over the summer, and then we would be in a position to start the process after that.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthFirst NationsMain estimates 2014-2015Non-Insured Health Benefits ProgramPatented Medicine Prices Review BoardPublic Health Agency of Canada37434773743478DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (0900)[English]Thank you very much.My next question is to the minister again. As you must know, the problem of drug shortages has gotten worse. Doctors and pharmacists say they are spending more and more of their time scrambling to make up for drugs in short supply and to find substitutes.What actions have you taken as this problem has continued to spiral out of control? Give me a short answer, please.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPrescription drugsPublic Health Agency of Canada374347937434803743481GeorgeDa PontRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0900)[English]Sure. We all worry about drug shortages, obviously. Drug shortages are not just an issue in Canada; they are a global problem, which we take very seriously.We established a stakeholder steering committee on drug shortages. It is co-chaired by us and the Province of Alberta, with all provinces and territories as part of it. As part of that committee, we're working with drug companies. We have a pan-Canadian strategy to manage and prevent shortages and reduce their impact. We have seen real progress and we have announced increased communication strategies. Plus, as you know, if the drug companies see a drug shortage coming, they alert us. We put it—Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPrescription drugsPublic Health Agency of Canada3743482374348337434843743485DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (0900)[English]But it is not mandatory. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743486RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0900)[English]It is not mandatory, Mr. Dany Morin: Should it be?Hon. Rona Ambrose: I have said many times that if it's not working, we will make it mandatory. I have told the provinces that; I have signalled that to industry. We are obviously keeping a close eye on this, and if we feel that it is not sufficient.... It was an agreement among the multi-stakeholder committee that this would be a voluntary approach, but I've told everyone very clearly that from the federal point of view, if it is not working effectively we will move to a mandatory system. I can tell you that we have already begun formal consultations.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743487374348837434893743490DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (0900)[English]Thank you.Here is the last question. Resistance to antibiotics is a growing public health issue and falls directly under the responsibility of your ministry. I'd like to ask what action has been taken to protect public health and to monitor this issue.AntibioticsCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37434913743492RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/72006DavidWilksDavid-WilksKootenay—ColumbiaConservative CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/WilksDavid_CPC.jpgInterventionMr. David Wilks (Kootenay—Columbia, CPC): (0905)[English]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?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPrescription drugsPublic Health Agency of CanadaSafety37434973743498374349937435003743501LibbyDaviesVancouver EastRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0905)[English] 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.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPrescription drugsPublic Health Agency of CanadaSafety374350237435033743504374350537435063743507DavidWilksKootenay—ColumbiaDavidWilksKootenay—Columbia//www.ourcommons.ca/Parliamentarians/en/members/72006DavidWilksDavid-WilksKootenay—ColumbiaConservative CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/WilksDavid_CPC.jpgInterventionMr. David Wilks: (0905)[English]As you're aware, the court rulings in 2001 have required the government to allow legal access to marijuana for those authorized by a physician. However, the use of marijuana and the system that allowed homegrown ran amok, shall I say, and is contrary to the concerns of doctors and certainly the police community as well. In fact, over the past few weeks, this committee has heard from doctors and researchers on the serious and harmful effects associated with marijuana use. Their testimony has revealed the damaging effects on the developing brain and the harm it inflicts on communities.As a retired police officer, I'm concerned about the existence of marijuana in our community, and especially its negative effects on young Canadians. Can you please tell the committee what our government is doing to protect the health and safety of Canadian families and communities with regard to this?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015MarijuanaPatented Medicine Prices Review BoardPublic Health Agency of CanadaSafety37435083743509RonaAmbroseHon.Edmonton—Spruce GroveLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0910)[English]Sure.I think the health committee study that you've done has really articulated the risks to youth well, particularly the health risks to youth. The issue of normalization of smoking marijuana is one that concerns me greatly. I worry about the discussion around legalization because it insinuates that this is a healthy thing to do and it's an acceptable thing to do if and only you're over the age of 18. That's not a great message for kids. It's not a great message for youth. We know that every year more research comes out about the health impacts of smoking marijuana. So there is a concern there. On the issue of grow ops and the medical marijuana program, we've brought a lot more discipline and rigour to the program in a number of ways, especially bringing in commercial operators that are approved by the RCMP and have a great deal of security around them, and ending home grow ops, which, as you know, were a real problem in a lot of communities. We did have to make changes to this program. In fact, I will say it was not a well-run program. I'm glad that we have made changes to it. The average approval for a licence for marijuana for an average patient was between 45 and 90 joints a day, which is completely unacceptable. We need to have medical supervision and physician supervision, which is what we're asking for now.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015MarijuanaPatented Medicine Prices Review BoardPublic Health Agency of CanadaSafety3743511374351237435133743514LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry (Vancouver Centre, Lib.): (0910)[English]Thank you very much, Madam Chair.Welcome, Minister. I will put a preamble, as my colleague did, in that I have so many questions to ask you, I would really appreciate it if your answers could be short. I'll try to keep my questions short.The report on plans and priorities identifies about $7.7 million to be allocated to the immunization program at the Public Health Agency of Canada. There are declining rates of vaccination in this country. We know in some areas it's as low as 60%. I know that you have said, Minister, that you've put on an online system for parents who have vaccinated their kids to keep track of their vaccinations. I don't think that's good enough, because you're preaching to the converted here. I'm wondering if you have a plan with that $7.7 million to find a way to ensure that the vaccination rates go up to the 95% that it used to be—if possible 100%, but we know that's never possible. I think it's really important, because we're only waiting for an accident to happen. Measles outbreaks can kill children. I think this is a really urgent problem. I want to know what you're going to use that money for and how you're going to address the non-vaccination rates.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthImmunizationMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of CanadaVaccination programs37435183743519374352037435213743522LibbyDaviesVancouver EastRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0910)[English]I agree with you completely. It's a very disturbing trend that we're seeing with parents who are refusing to vaccinate their children, making decisions based on misinformation—for instance, that vaccines cause autism, when we know clearly that they do not. Vaccines, in fact, save lives. Just today, in Edmonton, in my hometown, another case was announced, and this was a child who had not been vaccinated.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthImmunizationMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of CanadaVaccination programs3743523HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (0910)[English]Do you have a plan, Minister?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743524RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0910)[English]We have the national immunization strategy. We are reaching out. We work very closely with the public health officers across the country. We work closely with the provinces and territories. We have a coordinated approach to vaccine purchasing, to vaccine education, to leadership in the event of outbreaks or emerging vaccine safety and supply issues. We are doing everything we can, but I do encourage you to also speak out. All of us need to speak out, because there's a great deal of misinformation out there in this anti-vaccine movement and trend. The more education and awareness we can do, the better. And we are doing that.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37435253743526HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (0910)[English]The provinces have some tools that they can use, and I hope you will work with the provinces—Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743527RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0910)[English]Yes.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743528HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (0910)[English]—to make those tools national.Now, the 2014 budget changed the funding formula for transfers to provinces to a per capita formulation. This means that funds will not only be allocated based on population: it will only be allocated based on population. We know that demographics are a huge issue in which we could have some provinces with very high costs for seniors, etc. One of the problems we have is that now that you've done this, it will mean, for example, that Alberta gets almost $1 billion in transfers this year when they have a very low seniors population. Yet a place like Nova Scotia gets $17 million; they have very high aging populations in the Atlantic, as they do in my province of British Columbia.Do you intend to find a way to equalize the transfers based on demographics? If you don't, provinces will in fact not be able to address the needs of their population anymore because you've moved the formula from needs and demographics into a simple per capita basis.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of CanadaTransfers to provinces and territories3743529374353037435313743532RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0915)[English]I think the per capita formula is a fair one. I do think it is.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of CanadaTransfers to provinces and territories3743533HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (0915)[English]I disagree with you.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743534RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0915)[English]There are always issues when you decide on a funding formula. But I do believe, when you look at the level of funding in this funding formula, this is a record funding that will reach $40 billion by the end of the decade. Health transfers have increased by almost 50%, and the transfers continue to grow on an escalator of 6% per year over the next three years.I say that because the good news is that we've seen from the Canadian Institute for Health Information's most recent report that total health spending growth in the provinces is actually starting to slow down. That's a good thing. That means provinces, and those who are responsible for this direct spending of health services in their jurisdictions, are starting to look at ways to create efficiencies and look at sustainability. That's positive.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of CanadaTransfers to provinces and territories37435353743536HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (0915)[English]But health outcomes is not a black and white equation, Minister. Because health spending goes down in the province, it doesn't suddenly mean that quality and timely access to care is being given. I also think this is a gross inequity. I just wondered if you had a plan to fix it, and obviously you don't, because you think it's a good idea.Now, I want to suggest that the $41.2 billion that was put back into health care over this last decade ending in 2014 was put in by, as you well know, a Liberal government with a 6% escalator clause. That brought up health transfers to the provinces and the federal part of health funding to 20%. The change, when you go to the 3% in 2017, is going to continue now to bring down the health portion of funding so that, as the Parliamentary Budget Officer said, it is going to drop to 13% from 20% in the next 20 years. This will mean, given that the government continues to say that health is a provincial jurisdiction, that the ability to deliver good care to people will depend on the province in which you live, as we've already heard from the Canadian health reports out of CIHI, etc.So the question is what are you going to do? This is going to mean that medicare is at risk now. Are you going to take steps to make sure that the funding remains at 20% or at least goes up to 25%? Because the track you are on is going to decrease funding to 13% of the federal share.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743537374353837435393743540RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0915)[English]Let's be clear; for the next three years, health transfer increases are projected to continue to rise at more than double the rate of spending in the provinces and territories.I do believe there is a consensus in this country that more money is not going to fix the problem. We have a 6% escalator. We have growing spending rates. Provinces are doing very good work to bring that spending in check, not because they are cutting, but because they know they want a sustainable health system. If we want to address that directly, we need to look at better ways of delivering care and innovative technology. We need to look at innovation in our system. When we look at countries comparable to Canada that are spending less by getting better results, we know that there are inefficiencies in our system that we can address. I'm very optimistic that, working with the provinces and territories, we will find those solutions for better care and more innovative care. I know those solutions are there and I know my provincial and territorial colleagues have also committed to an innovation framework to ensure that we have a strong and sustainable system.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada374354137435423743543HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (0915)[English]But your provincial and territorial colleagues have been asking for a meeting with the Prime Minister so that they can look at the innovation that was promised in the 2014 health care accord, which was a whole transformative change. It didn't happen because you walked away from the table.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743544RonaAmbroseHon.Edmonton—Spruce GroveLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/35663TerenceYoungTerence-YoungOakvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/YoungTerenceH_CPC.jpgInterventionMr. Terence Young (Oakville, CPC): (0915)[English]Thank you, Chair.Welcome, Minister.Fourteen years ago my daughter, Vanessa Young, died tragically from a heart arrhythmia due to the prescription drug Prepulsid, which was deemed not safe and later removed from the market. In fact it was removed from the U.S. market three days after she died.Vanessa's death and the deaths of many others could have been prevented with stronger safety warnings on labels and clear communication with doctors. Moreover, during our study on prescription drug abuse, a number of witnesses ranging from doctors to researchers testified that there needs to be stronger label warnings and restrictions put in place on prescription drugs that clearly identify addictive properties and potential adverse drug reactions.Minister, several important steps have been taken to strengthen patient safety in Canada. Can you inform the committee on what is being done to strengthen drug and patient safety in Canada to better protect all Canadians from the potentially dangerous consequences of adverse drug reactions?Adverse drug reactionsCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37435493743550374355137435523743553LibbyDaviesVancouver EastRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0920)[English]Sure. A great deal of the work is being done because of your leadership, Mr. Young, so thank you very much for your question. As you know, we not only committed to introducing new patient safety legislation in our Speech from the Throne, we also did that recently with the introduction of Vanessa's law late last year. I just want to thank you for the great work you've done in leading the awareness around drug safety issues. You have obviously been a very powerful advocate on this.But stories like your daughter's really do remind us all about the serious consequences that pharmaceutical drugs can have and the role that the regulator has to ensure—that's Health Canada's role and the role of government—that we have strongest possible safety systems in place to ensure that we're preventing other families and patients from going through an experience like your family's in suffering such a terrible loss.Of course, Health Canada is responsible for reviewing all drugs for sale in Canada to ensure that they are safe and effective, but the powers included in Vanessa's law will ensure that we are able to take that to a new level. We must continue to remain vigilant, even after the law passes. Health care institutions, of course, are not currently required to report adverse drug reactions, as you noted for example, and there exists no authority to order label changes or packaging if we feel that additional information or studies are required around a particular safety issue we might find. And of course, as you know, Vanessa's law will address that.Science and medicine have evolved considerably in the last 50 years, as we know, since the Food and Drugs Act was last updated. I believe Canada does lag behind our international regulatory counterparts, which have improved patient safety through their enhanced regulatory oversight of products on the market. But Vanessa's law will bring us in line with where we should be, and in fact it will take us even further. We are going to be introducing, through Vanessa's law, tough new fines for those who don't comply in addition with any of the measures that we're putting in place. The law allows for quite significant penalties, as you know, including jail time. Just to put it into perspective, a previous fine would be about $5,000 a day. As you can imagine, that's about the same as somebody could be fined for littering under some municipal bylaws. When Vanessa's law comes into force, we'll change that to $5 million a day. I think that sends a strong message to pharmaceutical companies about the need to work with us on safety.Vanessa's law also speaks to the importance that we place on ensuring that Canadian patient safety remains paramount. As a government and as a regulator, I hope that all parties will support this bill. I was very pleased to see when you spoke in the House that you did receive the support of all parties. I know there has been an interest from members, including yourself, for potential amendments, and we're open to those, as I said. I look forward to seeing those amendments and working with members to strengthen the bill even further.Adverse drug reactionsCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada374355437435553743556374355737435583743559TerenceYoungOakvilleTerenceYoungOakville//www.ourcommons.ca/Parliamentarians/en/members/35663TerenceYoungTerence-YoungOakvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/YoungTerenceH_CPC.jpgInterventionMr. Terence Young: (0920)[English]Thank you.Our committee recently undertook a study on the troubling rise in prescription drug abuse. We heard expert witness testimony from doctors, pharmacists, regulatory bodies, law enforcement officials, first nations leaders, and parents on the scope and severity of prescription drug abuse, as well as some suggested solutions to the problem.One of the problems we kept hearing about was a lack of awareness among Canadians about the risks associated with prescription drugs that can be addictive. We also heard from experts that proper storage and disposal of prescription drugs was paramount to protecting against the un-prescribed consumption of these drugs. We heard in fact that teenagers in some communities actually go and grab a bunch of pills out of their parents' medicine cabinet and throw them in a bowl, and this is called a “pill party”, which is extremely dangerous.Minister, the problem of prescription drug abuse is a problem that impacts many Canadians and their families. Can you inform this committee on the work being done to address the problem of prescription drug abuse in Canada?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthDrug use and abuseMain estimates 2014-2015Patented Medicine Prices Review BoardPrescription drugsPublic Health Agency of Canada3743560374356137435623743563RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0925)[English]Sure. Thank you very much.Thank you to the committee for the work you did on this as well. This is a major public health issue and we have been raising more awareness of it, reaching out to the medical community. We recognize that prescription drug abuse is a growing problem in Canada. I am very concerned about it.We are actively working with the provinces and territories as well to address this issue. We have worked with them. As you know, some of them have drug monitoring programs, others don't, but I know they are endeavouring to put that in place.I'm also pleased to note that just recently in our budget we committed to extending our national anti-drug strategy to include the fight on prescription drug abuse, which I think is an important one. This includes educational measures; prevention and treatment services, particularly in aboriginal communities; and also improved surveillance. This will build on actions we've already taken to tighten licensing rules for pharmaceutical companies that will help to prevent drugs like oxycontin from being illegally distributed. This includes implementing strict controls in the public drug plan that's administered by Health Canada, including maximum monthly and daily drug limits, monitoring the usage of certain drugs to address potential misuse, and real-time warning messages to pharmacists at the point of sale.One of the other things that was important that we did was to reach out to the medical community—Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthDrug use and abuseMain estimates 2014-2015Patented Medicine Prices Review BoardPrescription drugsPublic Health Agency of Canada37435643743565374356637435673743568TerenceYoungOakvilleLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0925)[English]Sure.I think one of the most important things we did was reach out to the prescribers themselves. For the first time we put everyone in a room to talk about what we can do together, what the health community and what the medical community can do. We held a symposium, and there is a lot of work being done collaboratively to tackle this issue. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37435703743571LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/31234ClaudeGravelleClaude-GravelleNickel BeltNew Democratic Party CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/GravelleClaude_NDP.jpgInterventionMr. Claude Gravelle (Nickel Belt, NDP): (0925)[English]Thank you, Madam Chair. Thank you, Minister, for being here. We've covered a lot of ground and a lot of different subjects here so far this morning. I'd like to talk about something that we haven't mentioned yet, and that is dementia. I have a personal interest in dementia. As you are probably aware, there are 747,000 Canadians who have dementia right now, and that number is expected to grow to 1.4 million by 2030. Presently it's costing Canada's health care system $33 billion per year, and that is expected to rise to $293 billion per year. Madam Minister, can you tell me, do you support a national strategy for dementia?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDementiaDepartment of HealthMain estimates 2014-2015National Strategy for DementiaPatented Medicine Prices Review BoardPublic Health Agency of Canada37435753743576374357737435783743579LibbyDaviesVancouver EastRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0925)[English]I'm interested in a national strategy, but I have approached the provinces, and there is no consensus for the creation of one. What we will do with the provinces is continue to work with them in any way that we can, but we do have our own federal plan, if you want to call it that, to work on dementia. There is a great deal of work that's being done in Canada. As you know, we have joined forces, even internationally with our G-8 counterparts, to commit to finding a cure for dementia by 2025. We've now invested close to $1 billion in dementia research and Alzheimer's research, so there is a lot of work being done at the federal level. As you know, we've expanded our patient-oriented research to create the Canadian Consortium on Neurodegeneration in Aging to tackle the growing onset of dementia and related illnesses. So there are a number of actions that the federal government is taking. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDementiaDepartment of HealthMain estimates 2014-2015National Strategy for DementiaPatented Medicine Prices Review BoardPublic Health Agency of Canada374358037435813743582ClaudeGravelleNickel BeltClaudeGravelleNickel Belt//www.ourcommons.ca/Parliamentarians/en/members/31234ClaudeGravelleClaude-GravelleNickel BeltNew Democratic Party CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/GravelleClaude_NDP.jpgInterventionMr. Claude Gravelle: (0925)[English]Thank you. How many provinces have you met with?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37435833743584RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0925)[English]I meet with all of the provinces together at our federal-provincial-territorial meetings. On this particular issue I worked with my co-chair from Alberta and asked him to approach the rest of the provinces. As I said, some provinces have their own. For instance, Quebec has a very good seniors plan that includes dementia, and they're not interested in working on a national strategy. But that does not stop us from working with the provinces and supporting them, particularly with the research they need, so that they can put in place practical programming at the local level. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37435853743586ClaudeGravelleNickel BeltClaudeGravelleNickel Belt//www.ourcommons.ca/Parliamentarians/en/members/31234ClaudeGravelleClaude-GravelleNickel BeltNew Democratic Party CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/GravelleClaude_NDP.jpgInterventionMr. Claude Gravelle: (0925)[English]You keep mentioning research. Research is good, and I agree totally with research. We want more research. But what about early diagnosis and prevention? I think that's also important. What about training for the dementia workforce? What about support for caregivers? Those are all important things. Can you tell me why we can't get that done?You said that you've met with some of the provinces, so which provinces are not in agreement with a national strategy?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37435873743588RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0930)[English]Provinces are doing good work in their own area of jurisdiction, and we want to support them in any way we can. For instance, we are supporting 44 research projects on Alzheimer's disease and related dementia in universities and hospitals. You asked, where is the training? Much of that does result in the support for the appropriate training and the appropriate practice on the ground. That is one of the ways we can support the good work of the provinces. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37435893743590ClaudeGravelleNickel BeltClaudeGravelleNickel Belt//www.ourcommons.ca/Parliamentarians/en/members/31234ClaudeGravelleClaude-GravelleNickel BeltNew Democratic Party CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/GravelleClaude_NDP.jpgInterventionMr. Claude Gravelle: (0930)[English]You mentioned research again, and I totally agree with you that research is good. Research is good. But what about the caregivers? Why can't we help the caregivers? Why can't we help the doctors, especially the older doctors? They're not necessarily trained in detecting dementia and working with dementia patients. Why can't we do more? Research is fine, but we have to do more. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37435913743592RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0930)[English]I know you're passionate about this issue, but I think we have to recognize that the research that we do actually informs what is the best way, the best practices that are then used by physicians. That's what they look to. They look to finding out from research what is the best practice for them to use to identify Alzheimer's, for instance, or to identify the onset of dementia. That's what they look to us for and that is what we do to support the practical information that they need. I can ask Dr. Alain Beaudet to perhaps speak specifically to some of these issues. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37435933743594ClaudeGravelleNickel BeltAlainBeaudetAlainBeaudetAlain-BeaudetInterventionDr. Alain Beaudet (President, Canadian Institutes of Health Research): (0930)[English]Well, I can only concur, Minister. You're talking about the issue of prevention and early recognition. We're funding a lot of things. For instance, what are the right biomarkers? What are the standards in terms of the early deterioration that you can see through, for instance, brain imagery? In terms of caregivers, what are best standards of care? A big part of the CCNA will actually be looking at funding standards of care, models of care.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDementiaDepartment of HealthMain estimates 2014-2015National Strategy for DementiaPatented Medicine Prices Review BoardPublic Health Agency of Canada37435953743596RonaAmbroseHon.Edmonton—Spruce GroveLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/71693WladyslawLizonWladyslaw-LizonMississauga East—CooksvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LizonWladyslaw_CPC.jpgInterventionMr. Wladyslaw Lizon (Mississauga East—Cooksville, CPC): (0930)[English]Thank you very much, Madam Chair.Thank you, Minister, for being here with us today.Minister, I often hear that Canada has one of the safest and healthiest food systems in the world. This is very encouraging to hear, as one of the most important things for Canadian families is the safety of the food that is put on the dinner table. Indeed, Minister, I've heard and I've been very pleased to see that the number of food safety inspectors continues to rise as a result of the investments in the Canadian Food Inspection Agency that our government has been making. Could you please inform this committee on our government's latest investments in food safety?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthFood safetyMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743601374360237436033743604LibbyDaviesVancouver EastRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0930)[English]Thank you very much for that, MP Lizon.Let me begin by saying that you're right, Canada has one of the safest and healthiest food systems in the world. In our recent budget we further reinforced this by delivering almost $400 million to strengthen Canada's food system. This is in addition to the more than half a billion dollars we've already invested in various food safety initiatives since 2008. It includes enhancing food inspection programs and also hiring more on-the-ground food inspectors. Indeed, since 2006 there has been a net increase of over 750 inspectors, and of course the recent budget commits to hiring even more inspectors.But other measures, I think, are important to highlight. We've brought into force tougher penalties for those companies that violate our food safety system. I think that's important. We have enhanced controls on E. coli; new meat labelling requirements as well that speak to safety; and more than 750 new inspectors, as you know. Of course, Canadians have concerns about food that is imported, so we're making sure we have the right measures in place to crack down on unsafe food imports. Canadians need to know that is being done, and it is.The feedback from this work has been tremendously positive. In fact, I would say that we've come a long way in making sure that we have the right people in place to do this work. But we will continue to strengthen the food safety system.We also have recently launched our safe food for Canadians action plan. This is working very well and it's delivering the peace of mind I think that Canadian families expect and deserve. In fact, the Food and Consumer Products of Canada has said that these changes are going to further enhance Canada's reputation as a global food product safety leader.In that spirit, we brought together all the players that we think contribute to food safety under one roof. As you know, we have made a policy change as it relates to the Canadian Food Inspection Agency. I think this is simply good policy. We've brought the Canadian Food Inspection Agency into the Health portfolio. That means that Canadians can be assured not only that we have one of the safest food systems in the world but we will also be focused on encouraging Canadians to eat healthy food. They can rest assured that the safety of food will always come first, will always trump trade or any industry issues.We're also working, as you know, to expand our food-borne illness surveillance program, known as FoodNet. It's very important in that we can communicate with public health officers and others around the country to ensure that risks are identified quickly so that we can deal with them quickly. This is a system made up of surveillance sites. It helps track our food-borne illnesses at their sources. Scientists then use this data collected to communicate important information to governments, industry, and Canadians. That in turn helps us to prevent any disease from occurring.Essentially this program tracks food poisoning and traces illnesses back to their source, which is important because we're trying to work on the preventive side of things, not just to be reactive, be it food, water, animals, or any combination of these. With that information in hand, I think the agency can then determine which sources are actually making Canadians ill at the source.Expanding FoodNet Canada will improve food safety surveillance and assist our partners across all levels of government and industry when it comes to taking the right preventative measures to help keep our food system safe. There's a great deal of work being done, and we'll be doing more.Thank you.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthFood safetyMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37436053743606374360737436083743609374361037436113743612374361337436143743615WladyslawLizonMississauga East—CooksvilleLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (0935)[Translation]Thank you very much.[English]Minister, regarding food safety, can you tell us what is being done to monitor the truth of claims on food packaging? I know you talked about this issue earlier.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthFood labellingFood safetyMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37436213743622LibbyDaviesVancouver EastRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0935)[English]Food labelling?Mr. Dany Morin: Yes.Hon. Rona Ambrose: Well, I personally believe that Canadians want more information on their labelling. I launched a consultation, not necessarily with industry, as we've done in the past, but with Canadians, especially parents who do all the shopping. How do they feel about our food label? Do they understand it? Does it make sense to them? Does it mean anything to them? We had a really great response. We did an online consultation with Canadians, and we also did round tables. Of course, we will also do consultations with stakeholders, such as health groups, about what they think needs to be changed.So we're working, just putting all that information together, and we'd like to see what we can do to make our nutritional information on packaging more relevant to Canadians.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthFood labellingFood safetyMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37436233743624374362537436263743627DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (0935)[English]Thank you, yes, because some of those claims on food packaging can be not so truthful. Are you proactively testing whether these claims are accurate when they put those health claims on food packaging?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743628RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0935)[English]Yes. CFIA and Health Canada both do that.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743629DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (0935)[English]That's fantastic. Thank you very much for the answer.My next question will be about mental health. We know that workplace mental health problems cost the Canadian economy billions every year. You have expressed support in principle for the national strategy on mental health developed by the Mental Health Commission of Canada.Are you aware of whether the government has plans to adopt the Mental Health Commission's national standard for psychological health and safety in the workplace?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Mental healthPatented Medicine Prices Review BoardPublic Health Agency of Canada374363037436313743632RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce GroveKristaOutwaiteKrista-OutwaiteInterventionMrs. Krista Outhwaite (Acting Deputy Head and Associate Deputy Minister, Public Health Agency of Canada): (0935)[English]Yes, Minister, I would be happy to.Very briefly, the workplace standard for mental health is something that the Treasury Board Secretariat is looking very closely at. In fact, it is encouraging a small group of departments and agencies to pilot this program. The Public Health Agency is looking very closely at that, possibly also Health Canada, to see if we can work with the Treasury Board Secretariat to look at the adoption of this on a pilot basis with a view to perhaps a broader adoption. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Mental healthOuthwaite, KristaPatented Medicine Prices Review BoardPublic Health Agency of Canada37436353743636RonaAmbroseHon.Edmonton—Spruce GroveDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (0940)[English]Thank you very much. I do believe it is a pressing issue, so I would much appreciate it if you could work with your colleagues at the Treasury Board to make sure we can put that into effect as soon as possible. Thank you.I'll go back to my antibiotic resistance question. If you remember the preamble, basically I'm going to ask the question again. Can the minister or her officials explain what steps would be taken if our antibiotics prove to be insufficient?AntibioticsCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37436373743638KristaOutwaiteRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0940)[English]As you know, it is a very complex issue that requires a multi-sectoral collaboration, which is under way. I can reassure that you we are working with governments, with human and veterinary health, pharmaceutical, agriculture, and the food sectors to address the public health threats from AMR. These include surveillance, research, public awareness, and the development of guidelines and policy instruments.I can also tell you that at the upcoming World Health Assembly we are co-sponsoring a resolution on the need to take further action on AMR. We're working with our U.K. colleagues, who are obviously seen as leaders in the response to AMR, on important AMR research through the Canadian Institutes of Health Research. We're also working with the provinces and territories and other stakeholders, as I mentioned, to strengthen our surveillance of AMR in hospitals, in communities, and in the food chain.AntibioticsCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37436393743640DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (0940)[English]I do understand that you work closely with all those experts, but the resistance to antibiotics is a growing problem. Even though you're monitoring the situation, if it's getting out of control, what steps right now in Canada have you decided to put in place if our antibiotics prove to be insufficient?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743641RonaAmbroseHon.Edmonton—Spruce GroveLibbyDaviesVancouver EastGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor (Deputy Chief Public Health Officer, Public Health Agency of Canada): (0940)[English]I'd be delighted to comment.As you're aware, antibiotic resistance is something that occurs naturally. When you get a new antibiotic, that happens. We have guidance to physicians. We've been doing that so that it's more targeted and there are more appropriate prescribing practices. We're working with the agricultural sector to assist in terms of the same on the animal side of that.There are some really innovative new approaches to treatment, some designer vaccines, for example. There are some new technologies where they actually produce antibodies. So that may actually replace that. It's a big issue, and we're working in a whole variety of areas— AntibioticsCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743644374364537436463743647RonaAmbroseHon.Edmonton—Spruce GroveLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1814JamesLunneyJames-LunneyNanaimo—AlberniIndependentBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LunneyJamesD_CPC.jpgInterventionMr. James Lunney: (0940)[English]Thank you, Madam Chair. Minister, thank you so much for being with us today.I just wanted to mention first how much I appreciate the efforts you're making. You spoke briefly to this regarding drug safety and transparency as well as Vanessa's law and the changes that is bringing in, which are actually world-leading. I think there's been tremendous movement on that file.I wanted to ask you to briefly address innovation, because you've been a champion for innovation from day one in the file, and I've heard you speak to this on numerous occasions. I know there's a long way to go. I appreciate that we're working with the provinces and, I think, there are some examples already. I'm wondering if you can provide us with some examples of how innovation is showing promising avenues of delivering better health care to Canadians. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743650374365137436523743653LibbyDaviesVancouver EastRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0940)[English]Sure. I'd be happy to. Of course a big part of innovation is research, and we're the largest single investor in health research in Canada, obviously, investing close to a billion dollars a year through the Canadian Institutes of Health Research. These funding commitments result in about 13,000 innovative health researchers doing great work across this country. But of course related to that are 10,000 different projects. When you look at this kind of research, you see advances in care around dementia, cancer research, HIV/AIDS, and many other things.Obviously research has a great deal to do with making sure we're going in the right direction when we look at inputting money into particular best practices or standards of care or innovative technologies. So I'm pleased that we're making progress on that front. Of course, outside of CIHR, we've also invested a great deal of money into neuroscience research, and we see quite a bit of work being done there.I think one of the best examples of innovation happening among the provinces, the federal government, post-secondary institutions, and research institutions is the strategy for patient-oriented research, which is designed to ensure that patients receive the right treatment at the right time. It puts research into the hands of health care providers. It's what health care providers want, and it focuses on health challenges that are identified by the provinces and territories themselves. We then use research to bridge that gap and support them.These have been excellent projects. At the FPT table in October, there was unanimous support to continue doing this kind of collaborative work, so in the budget we renewed funding for strategic patient-oriented research, which is a very innovative way of approaching work we can do with the provinces. We have to continue to do that. The provinces and territories and I agree that we should keep working on an innovation framework to look at how we can share best practices across the country, identify excellence in different parts of the health care system, and build on those.There is a lot of good work being done. I'm very optimistic. I know that people have a lot of negative experiences sometimes in the health care system, but I think we can take those and turn them into positives if we can identify where things went wrong. I do sense from the provinces that they are very keen to work on innovation. They're doing this work with us on the strategic patient-oriented research. We'll continue to do that, and we're going to look for other ways we can partner with them and with research institutions to target that level of excellence. We want good research, but we also want really good patient outcomes, which is what this kind of strategy is about.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada374365437436553743656374365737436583743659JamesLunneyNanaimo—AlberniJamesLunneyNanaimo—Alberni//www.ourcommons.ca/Parliamentarians/en/members/1814JamesLunneyJames-LunneyNanaimo—AlberniIndependentBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LunneyJamesD_CPC.jpgInterventionMr. James Lunney: (0945)[English]Okay.I understand there was a program—I heard you speak at the economic forum—applying a questionnaire on common infections in hospitals. I think was developed with the Canadian Foundation for Healthcare Improvement. Just by having the staff ask appropriate questions and follow up, they were actually able to reduce urinary tract infections and other common things that take seniors into hospital, where they get some very serious outcomes. So you're looking for better outcomes.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Nosocomial infectionsPatented Medicine Prices Review BoardPublic Health Agency of Canada37436623743663LibbyDaviesVancouver EastRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (0945)[English]Yes, better outcomes, and identifying where those best practices are and sharing them. We live in a federation. That's our reality. There are a lot of really good things happening in different provinces that other provinces are not aware of. So we're working really hard to create those networks and we're doing good work there. Sharing best practices is a very practical way in which we can help those on the front lines deliver better care.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Nosocomial infectionsPatented Medicine Prices Review BoardPublic Health Agency of Canada3743664JamesLunneyNanaimo—AlberniJamesLunneyNanaimo—Alberni//www.ourcommons.ca/Parliamentarians/en/members/1814JamesLunneyJames-LunneyNanaimo—AlberniIndependentBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LunneyJamesD_CPC.jpgInterventionMr. James Lunney: (0945)[English]Great. There was another one I was aware of whereby they simply developed questionnaires for the staff to engage people in their life, in what their life was formerly, especially in the case of seniors in institutional care. They kept them off of a lot of medications that would just put them out of communication with the world around them, and the unnecessary use of medications to subdue people was eliminated simply by engaging them in their life and helping the staff to develop best practices in that realm. Those are simple things, but they're making a big difference in quality of life for patients.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada374366537436663743667RonaAmbroseHon.Edmonton—Spruce GroveLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/31234ClaudeGravelleClaude-GravelleNickel BeltNew Democratic Party CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/GravelleClaude_NDP.jpgInterventionMr. Claude Gravelle: (0950)[English]Thank you, Madam Chair.Thank you to the witnesses for being here.I'm going to stick with my favourite subject—dementia, Alzheimer's. We heard the minister say that she has met with the provinces on this issue, and some of the provinces don't agree or don't want to take part in a national dementia strategy. Can you tell me what provinces the minister has met with, and what provinces don't agree?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDementiaDepartment of HealthMain estimates 2014-2015National Strategy for DementiaPatented Medicine Prices Review BoardPublic Health Agency of Canada374367637436773743678LibbyDaviesVancouver EastKristaOutwaiteKristaOutwaiteKrista-OutwaiteInterventionMrs. Krista Outhwaite: (0950)[English]Thank you, Chair, for the question.I believe the minister commented on the fact that she'd had a conversation with her provincial-territorial co-chair, Minister Horne, who is from Alberta, on the question. I can tell you that in point of fact, that particular question first came to us at the international dementia summit, which was held in London in December 2012. Minister Horne agreed to discuss this with his PT colleagues, and my understanding is that's in the process of unfolding. I don't personally have knowledge of those conversations that he's having with his PT colleagues.In reference to the point you made earlier around research and, again, referring to the international summit convened by the U.K. on dementia, it is very much the view that, for all of the issues you mentioned, research is key. We don't have the solutions we need to address these very important questions and issues, and research is key. It's not only fundamental research, but applied research, to help health care workers, to help people who are suffering from the condition to live better lives, as well as prevention and mitigation.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDementiaDepartment of HealthMain estimates 2014-2015National Strategy for DementiaOuthwaite, KristaPatented Medicine Prices Review BoardPublic Health Agency of Canada3743679374368037436813743682ClaudeGravelleNickel BeltClaudeGravelleNickel Belt//www.ourcommons.ca/Parliamentarians/en/members/31234ClaudeGravelleClaude-GravelleNickel BeltNew Democratic Party CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/GravelleClaude_NDP.jpgInterventionMr. Claude Gravelle: (0950)[English]I think I mentioned to the minister that we're all in favour of research. Research is good. Nobody is against research. But we have to do more. What are we going to do to help the caregivers? Research is not going to solve the problem for caregivers. We have to do more for caregivers. We have to do more for training the workforce. Why can't we do more?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchCaregivers and health care professionalsDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37436833743684KristaOutwaiteKristaOutwaiteKristaOutwaiteKrista-OutwaiteInterventionMrs. Krista Outhwaite: (0950)[English]These are tremendously important questions you're asking. Again, I am struck by the fact that the very questions you're raising today were also raised at the dementia summit, not only by those who are working very hard in the field but also by those who are suffering from these conditions. Provinces and territories—in their respective jurisdictions responsible for health care delivery—are doing their very best to deal with the issues as they're manifested within their particular jurisdictions. There are initiatives under way that are grounded in research but also informed by the work that the department is doing with provinces and territories to look at how health care generally can be improved. It may even factor into the innovation work that is being undertaken by provinces and territories, as well as what the minister is talking about.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchCaregivers and health care professionalsDepartment of HealthMain estimates 2014-2015Outhwaite, KristaPatented Medicine Prices Review BoardPublic Health Agency of Canada37436853743686ClaudeGravelleNickel BeltClaudeGravelleNickel Belt//www.ourcommons.ca/Parliamentarians/en/members/31234ClaudeGravelleClaude-GravelleNickel BeltNew Democratic Party CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/GravelleClaude_NDP.jpgInterventionMr. Claude Gravelle: (0955)[English]Canada does a lot of work with the provinces for cancer. There's a cancer partnership. I don't see any reason we can't do the same thing for dementia.I want to quote from Mimi at the Alzheimer Society of Canada. She's talking about dementia:It's coming upon us fast and furious....As baby boomers age, age is one of the risk factors [and] we're seeing a major increase in people with disease at a younger age. Early on-set is absolutely devastating to a family when you think of a 40-year-old getting the disease.Caregivers are working an estimated roughly 444 million unpaid hours per year. That's a loss of income of $11 billion per year. That's a lot of money.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada374368737436883743689KristaOutwaiteLibbyDaviesVancouver EastAlainBeaudetAlain-BeaudetInterventionDr. Alain Beaudet: (0955)[Translation]Once again, I can only reiterate the importance of fully understanding the reasons for it and of seeing how we can help caregivers.Let me remind you that, next September, Canada and France will host one of the G8 summits, the one following the London summit. The summit will specifically examine the best ways to collaborate on an international scale with the industrialized world, the world of medical devices and information technology, so that we can find ways to better assist caregivers in particular.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchCaregivers and health care professionalsDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37436923743693LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1814JamesLunneyJames-LunneyNanaimo—AlberniIndependentBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LunneyJamesD_CPC.jpgInterventionMr. James Lunney: (0955)[English]Thank you, Madam Chair. Thanks again to our officials for being here.I want to start with you, Ms. Outwaite, as the acting head of the Public Health Agency of Canada right now, with the unfortunate departure of Dr. Butler-Jones, who is phasing out, I understand, after his circumstances have impaired his ability to continue. We certainly respect the work he's done at the agency over these years.We're talking about innovation. We've had some discussion already about prescription drug issues and how to get a handle on the overuse of prescriptions. You're, of course, aware of the issue that I have been raising for a number of years. In fact, I think the first time I asked this question on the record was when Ujjal Dosanjh was minister in 2005. I'm talking about proton pump inhibitors and C. difficile infections. There are an estimated 1,400 deaths a year. We don't have complete figures every year in Canada. It's clear these drugs are overused. I've been asking about the Canadian nosocomial infection surveillance program. Nosocomial, of course, is hospital-based, for those who aren't familiar with the language.It seems to me I was told that in that area they were going to get to the bottom of the issue by looking at the issue in teaching hospitals. But somehow they failed to collect data at that time on the meds they were on at admission. It seems to me that would be a very simple thing to correct. Would you agree?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Nosocomial infectionsPatented Medicine Prices Review BoardPublic Health Agency of Canada374369637436973743698374369937437003743701LibbyDaviesVancouver EastKristaOutwaiteKristaOutwaiteKrista-OutwaiteInterventionMrs. Krista Outhwaite: (0955)[English]First, I'd like to thank you for your kind words about Dr. Butler-Jones. He is, indeed, a leader in the field of public health and certainly to all of us at the Public Health Agency.To your second question and comment with respect to Clostridium difficile and the Canadian nosocomial infection surveillance program, if I may, I'm fortunate to have with me a colleague, the deputy chief public health officer, Dr. Gregory Taylor. Gregory has worked closely in these areas. I'd like to turn to Gregory to respond.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Nosocomial infectionsOuthwaite, KristaPatented Medicine Prices Review BoardPublic Health Agency of Canada37437023743703JamesLunneyNanaimo—AlberniJamesLunneyNanaimo—AlberniGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor: (0955)[English]Very quickly, the CNISP, as you referred to, was set up as a surveillance system. It wasn't set up as a research system. And what you're looking for is some research. I think there's lots of evidence to suggest an association. It's that causal proof that needs to be the next step of looking at the evidence of that.We are going to work with CNISP. We're trying to expand and enhance CNISP; it seems relatively easy to add that question, as you've said. We're going to work with the folks at AMMI, the Association of Medical Microbiology and Infectious Disease, who are the folks who work in the hospitals that do that data collection, to see if we can add it as part of that and take advantage of the existing networks and do a little bit of research with the surveillance network.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Nosocomial infectionsPatented Medicine Prices Review BoardPublic Health Agency of Canada37437053743706JamesLunneyNanaimo—AlberniJamesLunneyNanaimo—Alberni//www.ourcommons.ca/Parliamentarians/en/members/1814JamesLunneyJames-LunneyNanaimo—AlberniIndependentBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LunneyJamesD_CPC.jpgInterventionMr. James Lunney: (1000)[English]Thank you. You'd be aware, of course, that the drug safety and effectiveness network reported back that, in fact, there's a strong association.On CIHR, or Canadian Institutes of Health Research, I see you've made a remarkable transformation here. The money used to be almost all dedicated to investigator-initiated health research. But I see your second is priority-driven health research. On the same issue, we have a promising, but not established yet, use of probiotics as a preventative measure, not as a treatment measure, for C. difficile. But the study done, right out of a hospital here, nine years experience in Montreal as a lead agency, had 95% reduction in C. difficile. It hasn't been confirmed with other studies, because many use underpowered probiotics. This is nearly 100 billion CFUs administered through Bio-K Plus. Would that be a possibility as a priority-driven health research, which is designed, as I see, targeted research to address challenges facing Canadians, where we might be able to engage CIHR to take some of our worst hospitals where there's a high incidence of C. difficile and actually check out the preventative measures—36 hours after starting antibiotics, they get a probiotic—and eliminate a high percentage of these infections?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37437073743708374370937437103743711GregoryTaylorAlainBeaudetAlainBeaudetAlain-BeaudetInterventionDr. Alain Beaudet: (1000)[English]Very rapidly, the answer is yes, and we've started.I'm proud to report that when I was president of the Fonds de recherche en santé du Québec, before holding this current job, I called upon CIHR when there was the scare of C. difficile in Quebec—as you know, a few years back—to work with CIHR to develop a major program of research on ways to diagnose early and find new ways of treating C. difficile. The probiotics studies that you referred to was some of the work that we funded at the time. It is part of our priority research in what we call emerging threats.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37437123743713JamesLunneyNanaimo—AlberniLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/35663TerenceYoungTerence-YoungOakvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/YoungTerenceH_CPC.jpgInterventionMr. Terence Young: (1000)[English]Thank you. Thank you, everyone, for being here today.Mr. Da Pont, I wanted to ask you about new drugs on the market. As you know, all drugs cause adverse drug reactions, and new drugs on the market do not have an established safety profile. They're essentially in phase four of testing. In the U.S., one in five new drugs put on the market will either have a new high level of warning—the highest level of warning, a black box warning—put on the label within two years, or actually be taken off the market for harming patients.Vanessa's law will create an obligation for health care institutions to report all serious adverse drug reactions. This is great as an early warning system, but also while a drug is on the market to get warnings from doctors that a drug could be causing liver damage or heart arrhythmias, etc.These wonderful people take care of us, and I mean it sincerely; they are wonderful people. My own brother is a surgeon, a tremendous surgeon. The problem is that our doctors refuse to accept responsibility to report adverse drug reactions, the serious ones. They don't want to do it, and there are a whole range of reasons they don't. I recently met the incoming president of the Canadian Medical Association and asked for help on it: this information is lifesaving information. Do you have any ideas or any comments on how we might encourage our health care professionals, let them know the critical importance of reporting serious adverse drug reactions, and encourage them to report them so we can get this information early and get risky drugs either off the market or get proper safety warnings put on the labels?Adverse drug reactionsCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada374371637437173743718374371937437203743721LibbyDaviesVancouver EastGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1000)[English]Thank you for that.As you've noted, a big start, obviously, is Vanessa's law, which will make mandatory reporting on adverse drug reactions from hospitals and institutions. Within Health Canada we are organizing ourselves to actually have better capacity, then, to take those reports, analyze them and, of course, put out information, as required, to the medical community.In terms of encouraging more adverse drug reaction reporting from individual physicians, we do try to do that. We work, as I'm sure you know, with the Canadian Medical Association and a variety of other associations, the colleges, to encourage that.One of the things we would like to do is move to a more electronic system, a simpler mechanism for reporting to make it easier. We hope that will help.Adverse drug reactionsCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743722374372337437243743725TerenceYoungOakvilleTerenceYoungOakville//www.ourcommons.ca/Parliamentarians/en/members/35663TerenceYoungTerence-YoungOakvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/YoungTerenceH_CPC.jpgInterventionMr. Terence Young: (1005)[English]Thank you.Mr. Da Pont, I'm sure you and your senior staff have been following the testimony we've heard on our study on opioids, addictive drugs. We heard that Purdue Pharma marketed OxyContin and oxycodone in the 1990s illegally, fraudulently, by telling doctors that it was not addictive, or that it wasn't as addictive as other drugs.The president of Purdue Pharma actually came before our committee by his own request. I pointed out that his company had paid a $635-million fine in the U.S. to settle criminal charges for doing that, and how much harm the drug had caused. And I think he admitted.... I quoted a number of $23 billion in sales since 1995 of OxyContin worldwide. I asked him, being that his drug, OxyContin, oxycodone, has caused such a high number of addictions and so much human misery—500 Ontarians die a year from addictions related to OxyContin and oxycodone—if his company would consider matching the $45 million that the federal government put into our recent budget to help treat people who are addicted to opioids and help prevent further addictions.I just wondered, have you heard anything about that, or any response to that? You haven't by chance received a cheque of $45 million from Purdue Pharma, have you?Voices: Oh, oh!Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37437263743727374372837437293743730GeorgeDa PontGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1005)[English]Not as of yesterday.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743731TerenceYoungOakvilleTerenceYoungOakville//www.ourcommons.ca/Parliamentarians/en/members/35663TerenceYoungTerence-YoungOakvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/YoungTerenceH_CPC.jpgInterventionMr. Terence Young: (1005)[English]Okay. Thank you.With regard to health care transfers, health care transfers have been growing 6% a year, and they'll continue to grow after 2017. They're at a record number of $32 billion—$32.1 billion this year—and they'll be at a record number in 2018. But we know that in some of the provinces, the rate of increase in their spending has gone down, so there seems to be a spread there. In other words, we're giving them more money for health care than they're actually spending. Do you have any idea where the money that they're not spending in health care is going? Are there any restrictions on that at all? Or can they just take the money and spend it on anything they want?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of CanadaTransfers to provinces and territories374373237437333743734GeorgeDa PontLibbyDaviesVancouver EastGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1005)[English]The transfer doesn't have specifics attached, obviously, to what the money is for. That downward trend is pretty recent. It just started in the last year or two. It is encouraging, and it should give the provinces more flexibility to deal with some of the chronic issues like continuing problems with wait times and so forth.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of CanadaTransfers to provinces and territories3743736LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1005)[English]Thank you very much, Madam Chair.I want to pick up on Mr. Young's question with regard to OxyContin. I think, as we well know, this is all...having made that statement and seeing that Canada is now the number one country in the world with regard to OxyContin abuse.Can you explain to me the rationale as to why the government and Health continue to give an okay to six generic companies to produce this particular drug when the U.S. is no longer doing it and other countries are no longer doing it? It doesn't make any sense to me to, on the one hand, put millions of dollars into some sort of prevention and surveillance and tracking when the drug, the one that everyone is begging the minister and the Department of Health not to give any approvals to...have gone ahead and given approvals to six new generic companies. I don't understand it. It just defies any kind of common sense. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPrescription drugsPublic Health Agency of Canada3743739374374037437413743742LibbyDaviesVancouver EastGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1005)[English]That decision was taken, but when it was taken in terms of allowing OxyContin to remain on the market—and having allowed it on the market, if there are generic versions available it's very hard to deny them—at that time a number of stronger restrictions were put in place in terms of the licensing for reporting, for diversions, and so forth. We have been monitoring that very closely. From that monitoring we haven't seen any spike or increases yet.But as the minister has said I think on a number of occasions, it is a significant concern. That's why there's going to be significant additional investment in dealing with prescription drug abuse. I would say the minister has also indicated that an important component of this is to look at options for tamper resistance that would also be a factor in helping.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPrescription drugsPublic Health Agency of Canada37437433743744HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1005)[English]Thank you for that answer. I don't agree; I think if other countries can decide that they will no longer allow for generic OxyContin, we could. I don't know what our reasons are for not doing this. Many countries, such as Scandinavia and Switzerland, have a HAT program, which is obviously heroin replacement therapy. The studies that have been done by NAOMI and SALOME in Canada have shown very clearly that for a small group of patients who are addicted to heroin and who are not responsive to methadone, they can benefit from prescriptions of diacetylmorphine. I know that the department itself has actually agreed that it should be allowed under the SAP program, that it should be given to doctors who ask for this prescription. The minister has said no. Can you tell me if there is any move to let the minister read or to show the minister the clinical trials that are telling her that this is going to drive these people who cannot respond to anything other than diacetylmorphine and heroin, to go back on the streets and get street drugs again, when they could be treated with a pharmaceutical product that has been proven to be so internationally out there? Is there an answer to that? Dr.Taylor, maybe you can answer it.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743745374374637437473743748GeorgeDa PontGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1010)[English]Maybe I'll start, and then if Dr. Taylor has comments he can add them.To my understanding, the science and the clinical trials are not yet as clear-cut as you're suggesting. As you know, that is really one of the main purposes of the clinical trial that's currently under way. That clinical trial will end I understand in the next year or year and a half. We will see from the results of that clinical trial whether the evidence is actually there. That's the whole purpose of the trial. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37437493743750HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1010)[English]I understand that, but it's also my understanding that the department suggested that this drug be allowed and the minister said no to it.There is one other thing I wanted to ask, and it's to CIHR. You're reforming your funding and grant review programs. The new foundation scheme is going to give you a new set of two existing grant cycles. It would mean that there would be two applications and three distinct review stages. In 2015 and 2016, between the ending of the old cycle and the new cycle, there's a three-month shortfall in which many people who are doing the research and the granting cannot have the money to hire and keep their staff.How are you going to address that particular and specific problem, a very practical problem actually? Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada374375137437523743753GeorgeDa PontLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionThe Vice-Chair (Ms. Libby Davies): (1010)[English]A very brief reply, please, because we are just about at time.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743754HedyFryHon.Vancouver CentreAlainBeaudetAlainBeaudetAlain-BeaudetInterventionDr. Alain Beaudet: (1010)[English]Well, very briefly, you're right; these reforms—and by the way, Canada has recently been commended in a PNAS article for these reforms—mean that we're going for a set of grants from two competitions a year to one competition a year, and that explains the so-called gap that you're talking about. You're absolutely right; it's not six months as it used to be. We managed to reduce it to three months, and it affects a very small number of individuals, between 75 and 100 in the whole country. We've negotiated with the presidents of the U15 universities, research-intensive universities, to ensure there's no disruption of the work of these individuals for this period.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743755LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionThe Vice-Chair (Ms. Libby Davies): (1010)[English]Okay. Thank you very much, Dr. Beaudet.We'll now go back to Dr. Morin.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37437563743757AlainBeaudetDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (1010)[English]Thank you very much.Regarding maternal health, in Canada maternal death rose from 6 per 100,000 births to 11 per 100,000 births between 1990 and 2013. Many European countries and Japan have mortality rates in single figures. Why are today's Canadian women more likely to die in childbirth than their mothers were?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDeliveryDepartment of HealthMain estimates 2014-2015Mortality ratesPatented Medicine Prices Review BoardPublic Health Agency of Canada37437583743759LibbyDaviesVancouver EastGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1010)[English]Sorry, where are you quoting from?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743760DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (1010)[English]A CBC report.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743761GeorgeDa PontGregoryTaylorGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor: (1010)[English]I don't think that's consistent with the surveillance information we're collecting. Are you talking about maternal deaths?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDeliveryDepartment of HealthMain estimates 2014-2015Mortality ratesPatented Medicine Prices Review BoardPublic Health Agency of Canada3743762DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (1010)[English]Well, it will be a pleasure to find the information and give it to you.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743763GregoryTaylorLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionThe Vice-Chair (Ms. Libby Davies): (1010)[English]Maybe Dr. Morin can supply the information to the officials. You can look at it, and then send something back if you dispute it.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743764DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (1010)[English]If the CBC report is indeed true, it is highly concerning.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743765LibbyDaviesVancouver EastGregoryTaylorGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor: (1010)[English]Absolutely. I'd love to see that information, please.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743766DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (1010)[English]Okay. My next question.... Time is running out.Regarding diabetes, diabetes rates are set to double in Canada in the next 25 years. Last year your diabetes prevention strategy was blasted by the Auditor General of Canada for having no timeline, no goals, and no objectives, and for spending more on administration than on community programs. Can you tell us how you have fixed the program?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthDiabetesMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37437673743768GregoryTaylorGregoryTaylorGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor: (1015)[English]I'll answer that.Our diabetes program—and we're well aware of what you said, that diabetes is increasing—is trying to move upstream and trying to move away from.... We originally were looking at treating diabetics and assisting with that guidance, which we've done. We're starting to focus upstream to prevent diabetes. The risk-factor approach is looking at physical activity and nutrition to try to encourage people to adopt healthy lifestyles and reduce levels of obesity to try to preventing the onset of diabetes. At the same time we've done some really innovative work that led us to the innovation agenda with CANRISK. That's a screening questionnaire that we've partnered with drugstores. People can pick them up in Shoppers Drug Mart in particular, who are very proud to partner us with this. Folks can answer this simple questionnaire, see if they're at risk for diabetes, and then see their doctor and follow up to have interventions focused on reducing the risk factors. We believe in prevention, that Canadians would not want to get diabetes at all rather than have better treatment. It doesn't mean you have to ignore them; you have to focus on the folks who have diabetes. But I think going upstream and looking at the risk factors combined is a much more effective approach to prevent the diabetes onset to begin with.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthDiabetesMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743769374377037437713743772DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (1015)[English]But since the Auditor General of Canada said the comments I conveyed to you, have you modified the programs to respond to his concerns?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743773GregoryTaylorGregoryTaylorGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor: (1015)[English]We've addressed that. We're continuing to work with the Auditor General. We discussed this issue with him just last week, and we're making it much more targeted. We put it under the rubric of our integrated chronic disease strategy, so it makes sense, it's connected, and has its own targets, as well. So we're well on the track of addressing all of those issues.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743774DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (1015)[English]Okay, on track, but you haven't yet implemented any of his recommendations.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743775GregoryTaylorGregoryTaylorGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor: (1015)[English]We're almost done. We've met almost all of them.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743776DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (1015)[English]Okay. I'm looking forward to seeing those new changes.So what are you doing to prevent diabetes, particularly in the most vulnerable communities? I fully agree with you that prevention is the key, but we know that in vulnerable communities in Canada it is very hard to prevent.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37437773743778GregoryTaylorGregoryTaylorGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor: (1015)[English]As I say, a lot of our programs are targeted to those. Risk factors are extremely important, and determinants of health are important. I believe Health Canada has a targeted aboriginal diabetes strategy.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743779DanyMorinChicoutimi—Le FjordGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1015)[English]Yes, we do. We have, as just mentioned, a targeted diabetes strategy that we invest in. It's part of what's covered off, obviously, by some of the funding here in the main estimates, and we continue to work with aboriginal communities to help them put the resources in place to deal with this issue.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743780GregoryTaylorDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (1015)[English]Okay. This is my last question for you. We have heard troubling news of the possible spread of the infectious Middle East respiratory syndrome coronavirus. Can you tell us what the Public Health Agency is doing to monitor this public health threat?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Middle East Respiratory Syndrome coronavirusPatented Medicine Prices Review BoardPublic Health Agency of Canada37437813743782GeorgeDa PontGregoryTaylorGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor: (1015)[English]I'd be delighted to answer that question.This is very much in the media these days. I did five interviews on that yesterday alone. We are very well prepared for that. We have equipped laboratories across the country to detect this. That's coming out of our national laboratory, where we've equipped them and assisted them to do that. We've got guidance in working with physicians for heightened awareness. That means that when they're seeing somebody with symptoms that are compatible, they're asking for the travel history, asking whether somebody has been in the Middle East. They're doing the tests to confirm and be sure.We have our quarantine officers who have worked to train border services and folks at the airports and crossings to look for disease like that. We've been working very carefully and very closely with the WHO. In fact, Canada's providing leadership. A doctor in our agency, Dr. Theresa Tam, is the co-chair of the emergency committee that just met. As you're aware, it was declared yesterday that this was not an emergency concern. That information is based on—Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Middle East Respiratory Syndrome coronavirusPatented Medicine Prices Review BoardPublic Health Agency of Canada374378337437843743785DanyMorinChicoutimi—Le FjordLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/71693WladyslawLizonWladyslaw-LizonMississauga East—CooksvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LizonWladyslaw_CPC.jpgInterventionMr. Wladyslaw Lizon: (1015)[English]Thank you, Madam Chair.Again, welcome and thank you for coming here today.On prescription drug abuse and misuse, one of the issues that we deal with and that I think should be addressed more strongly is the safe disposal of not only prescription drugs but prescription drugs in particular. Last Saturday I had a chance to attend the community event organized by the Peel Regional Police. It's a great day of fun where they show equipment and show the way they work. I always, when I have a chance, want to brag about the local police. It's a great police force. But one of the things they were doing was collecting unused prescription drugs. I don't know how much they collected. They did this last year as well. It's part of the initiative supported by the chiefs of police. What advice would you have on how we can raise awareness? I think there are still too many people who think that you can just simply throw this in with your trash, or flush it down the toilet or down the sink. I know if you check different websites you can find instructions on which ones you can, which ones you cannot, but nobody reads this. My simple question is this: should part of the labelling state how to safely dispose of it? This could be a simple “Don't throw it away with the trash”. Perhaps you can expand on that and elaborate on it.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthInformation disseminationMain estimates 2014-2015Patented Medicine Prices Review BoardPrescription drugsPublic Health Agency of Canada374379037437913743792374379337437943743795LibbyDaviesVancouver EastGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1020)[English]Well, that an interesting idea. You mentioned national take-back day, and actually this year there were many, many more sites. It's expanded significantly. I actually checked yesterday to see if we have the stats yet of how much was collected, but they're still being compiled. I would expect it will be significantly better than last year. One of the key things the minister mentioned in her remarks around prescription drug abuse was that among the things being done and contemplated with the new investment that was in the 2014 economic action plan is more emphasis on education, from the perspective of both educating physicians on prescribing practices and educating the public on the dangers of prescription drug abuse. I think an interesting idea is whether we should look at more information on safe disposal. I don't know, Dr. Taylor, if you had anything to add.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthInformation disseminationMain estimates 2014-2015Patented Medicine Prices Review BoardPrescription drugsPublic Health Agency of Canada374379637437973743798WladyslawLizonMississauga East—CooksvilleGregoryTaylorGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor: (1020)[English]I'd be delighted to add to that. I think the drug take-back day is very positive. I would worry a little bit that by having it focused by the police this would be seen as a little bit punitive by folks. We've been working with some of the drugstores, as I mentioned earlier—Shoppers for many years has had a policy that they will always take back drugs—putting a positive spin on it: it's not abuse, but just get rid of that stuff, because there's inadvertent misuse of drugs like that. When we did the announcement at Shoppers for the day last Saturday, I had a chance to talk to some of the executives. They collect hundreds of tonnes of drugs. They dispose of it more appropriately so it's not being flushed down and released into the environment. My understanding now is that more and more drugstores will take them back. Certainly for Canadians, I can relate to this; when my mother died I had bags of drugs. What would I do with them? I walked down to the local pharmacy and asked what I could do with them, and they were delighted to take them back. It's about having the pharmacist play an educational role with patients who've been prescribed drugs, that when you have unused drugs, just bring them back to us, and with the children of elderly parents, who accumulate a lot of drugs, that this is a very safe place, no questions asked, just bring the stuff back and we'll get rid of it.I think it's a really important issue that you're bringing up, that we, as Canadians, need to encourage people to get rid of the stuff. It's bad for the environment; it can be misused. Earlier, one of the members said that children do this for parties, but a lot of elderly folks don't know what drugs they have or why they would take that, particularly folks with early dementia. So getting rid of those is just a really good way to reduce the risks to a lot of Canadians.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthInformation disseminationMain estimates 2014-2015Patented Medicine Prices Review BoardPrescription drugsPublic Health Agency of Canada37437993743800374380137438023743803GeorgeDa PontLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/71693WladyslawLizonWladyslaw-LizonMississauga East—CooksvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LizonWladyslaw_CPC.jpgInterventionMr. Wladyslaw Lizon: (1020)[English]Quickly on the same topic, when we were doing the studies, one issue that was brought before the committee was that with prescription drug misuse or abuse there is a problem of inadequate training of doctors. Can you comment on this?Adult education and trainingCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthDoctorsMain estimates 2014-2015Patented Medicine Prices Review BoardPrescription drugsPublic Health Agency of Canada37438053743806LibbyDaviesVancouver EastGregoryTaylorGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor: (1020)[English]At one of the round tables the minister mentioned, which I was at, and the president of the Canadian Medical Association and several other physicians were at, there were some pain control specialists present. They are very keen to change and produce better guidance for doctors when they're prescribing. As a physician myself, when I used to prescribe things there was precious little guidance concerning pain medication. I think it's very important that specialists help some of the general practitioners. The CMA is very much dedicated to doing that. Adult education and trainingCanadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthDoctorsMain estimates 2014-2015Patented Medicine Prices Review BoardPrescription drugsPublic Health Agency of Canada37438073743808WladyslawLizonMississauga East—CooksvilleLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1020)[English]Thank you. I want to pick up on a question that was asked earlier. I'm asking about infant mortality rates. It has been quoted that, for a country with a high socio-economic status among our peer groups in the OECD, our infant mortality rates are shockingly high. How do we account for that, and what is being done to deal with it?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthInfantsMain estimates 2014-2015Mortality ratesPatented Medicine Prices Review BoardPublic Health Agency of Canada3743811374381237438133743814LibbyDaviesVancouver EastGregoryTaylorGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor: (1020)[English]My understanding is that there are methodological issues with the OECD study and that our methodology wasn't the same as theirs. Looking at the methodology we've been using, the rates have not done that.We're working hard to figure out what was wrong in terms of the OECD, but primarily that comparison is not valid because of methodological issues in tracking. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthInfantsMain estimates 2014-2015Mortality ratesPatented Medicine Prices Review BoardPublic Health Agency of Canada37438153743816HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1020)[English]Yes, but instead of also wondering why and checking up on whether or not the OECD has used the right methodology, since a methodology ranks everyone according to the same methodology the question is whether anyone has tried to find out why the rate is so high or why it could possibly be so high and to find out ways to deal with this instead of just blaming the investigator.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743817GregoryTaylorGregoryTaylorGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor: (1025)[English]We're not blaming the investigator. The actions are based on evidence. Our evidence doesn't support that study's findings. Our evidence suggests that infant mortality rates are still good. We have a number of children's programs—CAPC, Aboriginal Head Start—that are targeted to improve children and infant mortality. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37438183743819HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1025)[English]Well, we agree to disagree, because we also use OECD rankings, when Canada does well, to shout from the rooftops how well we're doing; yet when it shows that we're not doing well, there isn't that kind of critical thinking that asks why this is so. Even if the methodology is in question in this particular instance, why is this so, is there any truth, and what can we do to deal with it? We know that some of those rates are attributed to aboriginal infant mortality rates and we know that poverty and lack of housing are really big issues. This is a shameful blot on Canada's record, and I would like to hear that the ministry of health and the Public Health Agency are looking at causes and at solutions. Health is more than just research; it's more than just what numbers say. It's about the lives of people in this country. I would like to see some more due diligence done on this. Thank you. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743820374382137438223743823GregoryTaylorLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1025)[English]Okay, thank you. I noticed that the minister spoke about a strategy for making labelling more easily readable by the public. I think that's a good thing, so I commend her for that and I commend you for it. But I want to know why there is still resistance, despite advisory committees and advisory groups, to mandatory labelling of salt and sugar and with regard to certain foods that we know are unhealthy. People aren't able to determine, when they read the label, how much salt and how much sugar they're getting, and how much trans fat. Why is it that we do not look at international guidelines for the amount of sugar and trans fats? We have twice the amount of salt that any other country has. Why is this not part of the new labelling regime?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthFood labellingMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada374382537438263743827LibbyDaviesVancouver EastGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1025)[English]Actually, it is part of the new labelling regime and of the consultations the minister was talking about. It's not just on making it more readable; it's also on the content. One thing that has come out in the early round of consultations is exactly what you said: capturing things such as sugar better. So it's both the content of the label and the readability. It's quite broad. Concerning guidelines, we are obviously working with the World Health Organization, which as I'm sure you know has started a broader process on consultations about appropriate guidelines for sugar. On that, we are basing our guidance on science, and this is one of the mechanisms. As you know, I'm sure, sodium, trans fat, and sugar are currently all on the nutritional food table. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthFood labellingMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743828374382937438303743831HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1025)[English]Are they mandatory? You were told that they should be seven years ago and it has not been done. That's my question.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743832GeorgeDa PontGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1025)[English]My understanding is they are mandatory.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743833HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1025)[English]They're not mandatory.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743834GeorgeDa PontLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/891DaveMacKenzieDave-MacKenzieOxfordConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/MacKenzieDavid_CPC.jpgInterventionMr. Dave MacKenzie (Oxford, CPC): (1025)[English]Thank you, Madam Chair.Thank you to the panel for being here.I'm not a regular member of the committee, but it's interesting for me to sit in.One of the things that I know in life is if we don't put money into research and innovation, we keep doing the same things over and over with the same results, and I think health care has been one of those things where innovation and research have led us to great advances in many things. Some of the research and the innovation is actually from our own country and we should be very proud and yelling from the rooftops about it. When I look at some of these things from a pure layman's perspective, laparoscopic surgery, cataract surgery, all of those things are now meaning fewer hospital stays for patients. That has to be good for everybody.It would seem to me that more money in research and innovation is far better than just throwing money into the system expecting the same results. I welcome what the minister has said here. I am just convinced that this is the right approach to take. More money doesn't fix a bad system. We need the innovation and research to do that, and I think you're on that path.I would just say one little thing, Dr. Taylor: the police aren't punitive. Having said that, I understand a wise person's panel has been struck by the minister. Can you tell us how that is moving forward? What can we expect going forward with some of the things from that panel?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada374383837438393743840374384137438423743843LibbyDaviesVancouver EastGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1030)[English]My expectation is that the minister will be making an announcement around that very topic in the near future.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743844DaveMacKenzieOxfordDaveMacKenzieOxford//www.ourcommons.ca/Parliamentarians/en/members/891DaveMacKenzieDave-MacKenzieOxfordConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/MacKenzieDavid_CPC.jpgInterventionMr. Dave MacKenzie: (1030)[English]Okay. I thank you.The another area that we see frequently, certainly in my home province of Ontario, is that money in health care has not necessarily gone to health care. The federal government does not have controls over the province in the administration of delivery of its health care system. When we look at what we could do with innovation and research with money, how do we better work together with our provinces on the delivery, which is their responsibility? How do we better work with them to try and provide some direction or guidance?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthGovernment accountabilityMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37438453743846GeorgeDa PontGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1030)[English]In my experience, not all provinces want direction and guidance, but the main mechanism is as the minister noted—the regular meetings that she has with all of the provincial health ministers. They identify areas of common concern, areas where they can work together. Prescription drug abuse is one, or looking at bulk buying of drugs. There is a variety of things that are carved out in that process, where the federal government and the provinces work together, looking at, as the minister said, having the innovation panel looking at this more broadly and seeing what ideas there are for best practices and things that we could adopt, either best practices that are already under way in some part of this country or from abroad. I think that will be a catalyst, hopefully, to look at some of these issues on a broader basis.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthGovernment accountabilityMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37438473743848DaveMacKenzieOxfordDaveMacKenzieOxford//www.ourcommons.ca/Parliamentarians/en/members/891DaveMacKenzieDave-MacKenzieOxfordConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/MacKenzieDavid_CPC.jpgInterventionMr. Dave MacKenzie: (1030)[English]I think it's important that Canadians recognize that the federal government does not have that power or that direction to deliver to provinces. It's up to the provinces to deliver that. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743849GeorgeDa PontGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1030)[English]Yes.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743850DaveMacKenzieOxfordDaveMacKenzieOxford//www.ourcommons.ca/Parliamentarians/en/members/891DaveMacKenzieDave-MacKenzieOxfordConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/MacKenzieDavid_CPC.jpgInterventionMr. Dave MacKenzie: (1030)[English]I think sometimes that gets lost in this place here especially. Your role is not one to tell the provinces how to spend the money. We do send them the money in the transfers on the health and social side of things, but the actual direction on how to spend it is the responsibility of the provinces, and how they do it or don't do it becomes their responsibility.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743851GeorgeDa PontGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1030)[English]Exactly.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743852DaveMacKenzieOxfordDaveMacKenzieOxford//www.ourcommons.ca/Parliamentarians/en/members/891DaveMacKenzieDave-MacKenzieOxfordConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/MacKenzieDavid_CPC.jpgInterventionMr. Dave MacKenzie: (1030)[English]Certainly more research and innovation in just those two areas that I as a layman would understand has to mean tremendous savings in the provincial health care systems in hospital stays for patients.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743853GeorgeDa PontLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (1030)[English]Thank you very much. I'll continue my questions to Dr. Taylor. We had an interesting discussion about the MERS-CoV. First of all, thank you for saying that you do monitor this very closely. I want to make sure, are you working with the provinces to ensure we are prepared nationwide?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Middle East Respiratory Syndrome coronavirusPatented Medicine Prices Review BoardPublic Health Agency of Canada374385837438593743860LibbyDaviesVancouver EastGregoryTaylorGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor: (1030)[English]Absolutely. We have a variety of mechanisms to work with the provinces and certainly directly with the public health network. I co-chair the council of that. This is a topic of great concern. In fact, we have a special meeting with all the chief medical officers of health on Friday, tomorrow, to address this very issue. We're watching the measles outbreaks and how to best deal with that, and MERS-CoV as well, and the topic of H7H9, H5. These things are consistently followed. Those are formal mechanisms. We have informal mechanisms at the technical level where we're constantly in touch with the provinces and territories. Typically, for example, the chief medical officer will call me or send me a personal e-mail in a particular province. You saw the things in the media yesterday. We were given a heads-up by the province, very personally, very quickly. So it's a variety of formal mechanisms and informal mechanisms that keeps us well connected across the country.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Middle East Respiratory Syndrome coronavirusPatented Medicine Prices Review BoardPublic Health Agency of Canada374386137438623743863DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (1030)[English]Do you feel that you have enough resources to ensure an appropriate emergency response?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743864GregoryTaylorGregoryTaylorGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor: (1030)[English]Yes, we are well resourced to do that. We work with the provinces and territories; this is that joint capacity that exists. Over the last few years, the provinces and territories have also built their own capacity. We now have three different public health agencies across the country. My understanding is that some of the provinces are toying with creating their own, again, so from a resource perspective, I think Canada is very well positioned.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37438653743866DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (1030)[English]Thank you.I would like to go back to maternal health. I have the data that I didn't have before and that you don't have either. On May 6 the World Health Organization released a report concerning the millennium development goals that the United Nations set for 2015. The report is pretty clear that, if we look at the number of maternal deaths per 100,000 live births over a 20-year period, there were six per 100,000 in 1990, seven in 1995, seven in 2000, 11 in 2005, and 11 maternal deaths per 100,000 live births in 2013. The statistics are there. What do you have to say?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743867374386837438693743870GregoryTaylorGregoryTaylorGregoryTaylorGregory-TaylorInterventionDr. Gregory Taylor: (1035)[English]I say that we need to get that report and take it very seriously and see whether there are any underlying issues that we need to address. Thank you for bringing it to our attention. I was unaware of that report, and we will most certainly follow it up very closely. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743871DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (1035)[English]What is very troubling about this is that worldwide the death rate has fallen by 45%—that is, globally since 1990—and that in Canada it is on the rise. So please look into this. It would be great if you could get back to us on this issue.My next question is about food safety. We have heard conflicting numbers on the resources allocated to food safety inspection in this country. We know that the 2012 budget involved $56 million in cuts and the layoff of 308 staff members. Now an almost 10% decrease in projected spending is predicted. Can you tell us clearly the number of staff at CFIA in 2011? Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthFood safetyInspections and inspectorsMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada374387237438733743874GregoryTaylorBruceArchibaldBruceArchibaldBruce-ArchibaldInterventionDr. Bruce Archibald (President, Canadian Food Inspection Agency): (1035)[English] I don't have the 2011 number with me, but I do have it for 2012 and 2013.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743875DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (1035)[English]Please tell us.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743876BruceArchibaldBruceArchibaldBruceArchibaldBruce-ArchibaldInterventionDr. Bruce Archibald: (1035)[English]The total number of staff in 2012 was 7,291. In 2013 it was 7,119, which is a slight decrease. But I would also point out that the number of the inspection staff increased over that same time period; it went from 3,534 to 3,577. So you're right, there was a reduction in the overall budget as a result of budget 2012, but the agency looked at a number of different places to find efficiencies and did not reduce the inspection staff or any of the food safety activities. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthFood safetyInspections and inspectorsMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37438773743878DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (1035)[English]So if I understand correctly, there was no decrease in the number of inspectors?Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743879BruceArchibaldBruceArchibaldBruceArchibaldBruce-ArchibaldInterventionDr. Bruce Archibald: (1035)[English]There actually was a slight increase.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743880DanyMorinChicoutimi—Le FjordDanyMorinChicoutimi—Le Fjord//www.ourcommons.ca/Parliamentarians/en/members/71380DanyMorinDany-MorinChicoutimi—Le FjordNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinDany_NDP.jpgInterventionMr. Dany Morin: (1035)[English]Okay, good.How about the number of inspectors working on raw meat processing lines, such as XL beef? Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37438813743882BruceArchibaldBruceArchibaldBruceArchibaldBruce-ArchibaldInterventionDr. Bruce Archibald: (1035)[English]I don't have the specific numbers, because we don't break it down that way in our counting; often inspectors will do multiple tasks, working on different areas. But we have increased our inspection in the meat program as well as in a number of other areas across the board. Overall, the number of people working in facilities, particularly in meat facilities in Canada, has increased. Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743883DanyMorinChicoutimi—Le FjordLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1814JamesLunneyJames-LunneyNanaimo—AlberniIndependentBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LunneyJamesD_CPC.jpgInterventionMr. James Lunney: (1035)[English]Thanks very much.Continuing on the matter we were discussing earlier, prescription overuse of the proton-pump inhibitors, they estimate that 70% of the people taking these meds should not be. They shouldn't be taking them for heartburn. This is where the regulator's role is so important. If the patient is on a PPI, the evidence under the literature is a 40% to 275% increased risk—40% to 275%—and it's dose-dependent and time-dependent. I think you'd see that as what was found in the DSEN report, Drug Safety and Effectiveness Network. Although they didn't give the numbers, that's on the FDA website.Further, if they're on those meds, not only do they have increased risk of infection, but they also have three times the risk of the worst complications, which includes unnecessary bowel surgery. Of course, extended hospital stays are costing us hundreds of millions of dollars across the country. But also the research shows that if they're on those medications, not only is there an increased risk of infection and increased risk of complications, they also have five times the increased risk of death. That's the worst outcome. So I hope you understand the urgency I attach to that.The number one thing on your Public Health Agency website is “elderly”, especially over age 80, but it's well known that the elderly have reduced stomach acid; it's part of the normal aging process, and puts them at a higher risk. It's really the same issue as acid suppression.There's an immense urgency to taking some action on this. I hope you understand why, when we talk about CNISP, maybe it was designed for surveillance, but we should be collecting data on this. We can't wait another 10 years to start helping people avoid these risks of unnecessary death in the hospital and hundreds of millions of dollars in expenditures. We're hoping to be more nimble as we look at ways at innovating.There are big concerns about antibiotic overuse. Of course, the risk of recurrence if you're on a PPI when you're in the hospital is 42%. With vancomycin, I think it's 25%; and in the new drug DIFICID it is 15%. Back to Dr. Beaudet, this why there is urgency to check out prevention with the probiotic, and I hope you'll be on board in advancing that. If we can avoid these infections with such a simple thing, it's much easier than a fecal transplant, might I say, in managing it later on.Finally, you're working with physicians, with CMA and with the Choosing Wisely Canada program, on this. They're talking about the appropriate use of medical imaging and antibiotic use. It seems to me, after my conversation with Dr. Chris Simpson, as my colleague mentioned, the head of the CMA, that this might be a way to help physicians engage with their patients on the unnecessary use of these meds for managing dyspepsia. Could you comment briefly on that program, Choosing Wisely Canada?Then I'll hand it over to my colleague.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchChoosing Wisely CanadaDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743888374388937438903743891374389237438933743894374389537438963743897DavidWilksKootenay—ColumbiaLibbyDaviesVancouver EastGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1040)[English]I don't think there is a response. As you've just noted, we are working with the CMA, and, through them, the colleges, on Choosing Wisely, which is intended to put into the hands of physicians more information and education on prescribing practices.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchChoosing Wisely CanadaDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743900LibbyDaviesVancouver EastJamesLunneyNanaimo—Alberni//www.ourcommons.ca/Parliamentarians/en/members/1814JamesLunneyJames-LunneyNanaimo—AlberniIndependentBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LunneyJamesD_CPC.jpgInterventionMr. James Lunney: (1040)[English]I hope you'll agree, Mr. Da Pont, that it starts with the appropriate warnings from Health Canada, because the hospitals depend on those warnings, as do the doctors.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743901GeorgeDa PontGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1040)[English]Yes.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743902JamesLunneyNanaimo—AlberniLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/35663TerenceYoungTerence-YoungOakvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/YoungTerenceH_CPC.jpgInterventionMr. Terence Young: (1040)[English]In 2010 Eli Lilly was in court in the United States and was asked to produce any evidence that their drug, a powerful anti-psychotic, Zyprexa, helped Alzheimer's patients. They provided seven studies with no evidence. Zyprexa and Johnson & Johnson's drug, Risperdal, are being used widely in our long-term care facilities on seniors for Alzheimer's, when there is no evidence it helps them at all. There is evidence, proven in court by their own studies, that those drugs, particularly Zyprexa, increase the risk of death for our seniors by 200% to 300%. Zyprexa causes diabetes. It also numbs out our seniors. They fall out of bed. They break a hip. They're dead six months later. So our seniors in North America are literally—literally—dying in our long-term care facilities, taking a drug that offers them no medical benefit, but that—Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada374390737439083743909LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/35663TerenceYoungTerence-YoungOakvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/YoungTerenceH_CPC.jpgInterventionMr. Terence Young: (1040)[English]—increases their risk of death by 200% to 300%. I just wondered if the Public Health Agency has any influence or can help with this problem.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada37439113743912LibbyDaviesVancouver EastLibbyDaviesVancouver EastGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1040)[English]This probably would be with Health Canada, as the regulator. I'm not familiar with the issue you've raised. Perhaps, though, we can get back to you separately or through a letter to the committee.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of Canada3743914LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionThe Vice-Chair (Ms. Libby Davies): (1040)[English]Thank you, Mr. Da Pont. You can provide the information to the committee.I'd like to thank the officials for being here today for the main estimates. We will proceed directly to the votes. There are two ways to do this. We could go through each vote, and there are 10 votes. Or, if the committee concurs by unanimous consent, we could just go down to two votes, and I presume possibly go on division. It's up to the committee. Is there agreement that we basically do the votes together? Okay. Thank you very much. I don't see anyone objecting to that.Shall the votes before the committee, less the amounts approved in the interim supply, carry?CANADIAN INSTITUTES OF HEALTH RESEARCHVote 1—Operating expenditures..........$47,112,396Vote 5—The grants listed in the Estimates..........$932,143,424(Votes 1 and 5 agreed to on division)HEALTHVote 1—Operating expenditures..........$1,774,856,975Vote 5—Capital expenditures..........$31,656,363Vote 10—The grants listed in the Estimates and contributions..........$1,683,745,108(Votes 1, 5, and 10 agreed to on division)PATENTED MEDICINE PRICES REVIEW BOARDVote 1—Program expenditures..........$9,949,348(Vote 1 agreed to on division)PUBLIC HEALTH AGENCY OF CANADAVote 5—Capital expenditures..........$6,100,596Vote 10—The grants listed in the Estimates and contributions..........$253,014,798(Votes 5 and 10 agreed to on division)CANADIAN FOOD INSPECTION AGENCYVote 1—Operating expenditures and contributions..........$470,029,881Vote 5—Capital expenditures..........$24,264,263(Votes 1 and 5 agreed to on division) The Chair: Shall the chair report the main estimates to the House?Some hon. members: Agreed.An hon. member: On division.The Chair: Thank you very much to everybody.The meeting is adjourned.Canadian Food Inspection AgencyCanadian Institutes of Health ResearchDecisions in committeeDepartment of HealthMain estimates 2014-2015Patented Medicine Prices Review BoardPublic Health Agency of CanadaRecorded divisions3743915374391637439173743918374391937439203743921374392237439233743924374392537439263743927374392837439293743930374393137439323743933374393437439353743936374393737439383743939374394037439413743942374394337439443743945GeorgeDa PontCarlaVentinCarla-VentinInterventionMs. Carla Ventin: (1715)[English]What I was referring to is that Agriculture and Agri-Food Canada provided $17.4 million to Health Canada specifically for food regulatory reform, and that worked very well. As I mentioned earlier, we saw a lot of improvements with food additives.So the approval process for this was sped up. That was extremely important. Why is it important? It is because you cannot encourage innovation in Canada if it may take up to 10 years to get your product approved. I'm not talking about compromising safety, because safety is a priority not only of the government but also of companies, of course. To encourage innovation by food manufacturers, you want to be able to say that once you actually produce some innovative product, it will take x amount of time to get it on store shelves. The problem is these delays. In Growing Forward 2 there were no funds provided to Health Canada to modernize the food regulations. It is a bit odd that Agriculture Canada would be providing money to another department, but that's just the way our industry is governed. Our home is in Agriculture and Agri-Food Canada, and Health Canada holds our regulations.Agricultural productsApplication processBacklogsCompetitionDepartment of HealthFood and beverage manufacturing industryFood safetyGovernment assistanceGovernment expendituresInnovationRegulation37273723727373372737437273753727376MarkEykingHon.Sydney—VictoriaMarkEykingHon.Sydney—VictoriaCarlaVentinCarla-VentinInterventionMs. Carla Ventin: (1725)[English]Thank you.It's interesting how it does come back to regulations. What we hear time and again from our member companies is that they are developing innovative products. Do I know what they are? Are they on product shelves? No, they are not, because these innovative products are not being approved in a timely way by Health Canada. So we do have these new products and they are being developed, but because the regulations aren't up-to-date and can't accommodate this, they don't get to product store shelves.I agree; it's a pretty big thing. Actually it was interesting, I was just reading a statistic on consumers, and yes, consumers do want innovative, more healthful products in our industry. Our different member companies are working toward that.In a recent study that I read—I think it was a C.D. Howe Institute on the sticker price—it mentioned that Canadian consumers have one-third less selection of products in Canada versus in the U.S. That's interesting. I do attribute the regulatory issues—Agricultural productsApplication processBacklogsCompetitionDepartment of HealthFood and beverage manufacturing industryInnovationRegulationResearch and researchers3727402372740337274043727405PierreLemieuxGlengarry—Prescott—RussellPierreLemieuxGlengarry—Prescott—RussellHilaryGellerHilary-GellerInterventionMs. Hilary Geller (Assistant Deputy Minister, Healthy Environments and Consumer Safety Branch, Department of Health): (0845)[English]No, it's just me.Department of HealthHealthMarijuana3709738BenLobbHuron—BruceBenLobbHuron—BruceHilaryGellerHilary-GellerInterventionMs. Hilary Geller: (0845)[English]Thank you, Mr. Chair, for the opportunity to appear before the committee to discuss the health risks of marijuana use.My name is Hilary Geller. I'm the assistant deputy minister of the healthy environments and consumer safety branch at Health Canada. My colleagues are responsible for various programming aspects that collectively support the government's ongoing efforts to protect Canadians from the health risks associated with illicit drug use.Robert Ianiro is the director general of the controlled substances and tobacco directorate, and he can discuss questions regarding Health Canada's role in regulating controlled substances such as marijuana. Cindy Moriarty is the executive director of health programs and strategic initiatives, and she is involved in Canada's national anti-drug strategy programs.In my remarks this morning, I will provide a brief overview of the principal drug control legislation in Canada, and following this, some surveillance data regarding the health impacts of marijuana use, including knowledge regarding public awareness of the associated risks of using marijuana.I understand that you'll be having the opportunity to hear from research experts, as well as representatives from national and other health care organizations over the course of your study. I'd just like to say that at Health Canada we do not perform the kind of basic research that they do. However, we do rely very heavily on their work and the advice of their experts to help inform us when we make decisions around drug scheduling, youth outreach, and Canada's participation in various international drug policy fora.As the committee begins to examine the harms associated with marijuana use, it may be helpful to have an overview of the legislative framework that governs controlled substances like marijuana. The Controlled Drugs and Substances Act, the CDSA, is Canada's federal drug control statute. It provides a legislative basis for the control of substances that can alter mental processes and that may cause harm to the health of an individual or to society when abused or diverted to the illicit market. Hundreds of substances are regulated under the CDSA. Those substances range from prescription opioids, like codeine and morphine, to street drugs, like crystal meth.The CDSA fulfills Canada's international obligations under three United Nations drug conventions, all of which aim to ensure access to controlled substances and the chemicals that are used to make them for legitimate medical, industrial, or scientific purposes, while subjecting them to tight controls to reduce the opportunity for diversion from the legitimate supply chain. So the CDSA has a dual purpose: protecting public health and maintaining public safety.The act also sets out the offences in the form of direct prohibitions on many activities involving controlled substances, such as production, possession, distribution, import, or export. In this regard, of course, legitimate activities are allowed, but they're only allowed when they're authorized through regulation or an exemption from the act. The act also sets out the penalties for offences.As you may know, Canada is one of four countries that have some form of a medical marijuana regime. This regime exists under the new, as of last June, marijuana for medical purposes regulations. These regulations enable access to marijuana for medical purposes to individuals who have the support of a health care practitioner. However, dried marijuana is not an approved drug or medicine in Canada, and Health Canada does not endorse its use. Notwithstanding that the courts require Canada to provide reasonable access to a legal source of supply of marijuana for medical purposes, the recreational use of the drug remains illegal under the terms set out in schedule II of the CDSA.Substances regulated under the CDSA are grouped into six schedules. In determining whether a substance should be added to one of the schedules to the act, and to which schedule, Health Canada considers six factors: international requirements and trends in control or scheduling; the chemical and pharmacological similarity to other substances that are already listed under the act; addiction liability and the potential for abuse of the drug; evidence of the extent of actual abuse in Canada and internationally; risk to personal and public health and safety; and legitimate use—therapeutic, scientific, industrial, or commercial.The UN conventions, to which I just referred, form the basis of the global drug control regime as it exists today and the general prohibitions on activities involving marijuana. Canada is consistent with most other countries in having marijuana regulated as a controlled substance. In fact, marijuana has been regulated as a controlled drug in some form or other in Canada since 1923. Since 1996 it has been listed in schedule II of the CDSA, which includes the plant itself, its derivatives, preparations, and similar synthetic preparations.(0850)Emerging information suggests that marijuana is stronger today than it was in the past. As a result, the potential for harm to physical and mental health may also be greater today. While the evidence detailing the increasing potency of marijuana is largely based on U.S. and European data, there are indications that the situation in Canada is similar. Information obtained from Health Canada's drug analysis service provides some evidence that the levels of THC in marijuana steadily increased between 1988 and 2010. This evidence is consistent with data seen in other jurisdictions and suggests a significant increase in the THC levels in marijuana available today, in contrast to a few decades ago.When considering the increased potency of marijuana, it is also worth noting the high rates of reported marijuana consumption among Canadians who seek to access drug treatment services. In the 2014 “National Treatment Indicators Report”, the Canadian Centre on Substance Abuse reports that cannabis is the second most commonly used illicit drug among individuals accessing publicly funded treatment services.In addition to the impact on treatment services, hospital administrative data provides important information on the impact marijuana use is having on the health system. Data collected by the Canadian Institute for Health Information on marijuana-related hospitalizations show a steady year-over-year increase in the total number of cases where a diagnosis is related to marijuana. For example, in 2008-09, 11,800 admissions to hospitals across Canada were related to marijuana. The number nearly doubles when looking at the same data from 2012-13, when over 21,000 admissions were linked to marijuana use.Knowing that marijuana is stronger today than it was in the past is important when you consider that marijuana is the most commonly used illegal drug in Canada. Data from Health Canada's 2012 Canadian alcohol and drug use monitoring survey shows that 10.2% of the general population reported using marijuana in the past year, and that men are nearly twice as likely to report using it as women.Rates among youth are about two times higher compared with adults, with 20.3% reporting having used marijuana in the past year. Canadian youth are among the highest users of marijuana when compared to their peers in other developed countries. This is despite the fact that rates of use among youth in Canada have been declining over the past number of years.It is clear that Canadians are using marijuana more than any other illicit drug. It is equally clear that Canadians, particularly young Canadians, are not aware of the health risks associated with marijuana use and that they view it as a relatively harmless substance.For example, the 2009-10 health behaviour in school-aged children study, administered by the Public Health Agency of Canada, showed that among youth in grades 9 and 10, 25% reported using marijuana in the past 12 months; 10-12% reported using it three or more times in the past 30 days; and a substantial number of youth reported that they felt there were slight or no risks when they were asked about the potential health risks.In addition, a public opinion survey conducted as a part of our national anti-drug strategy confirmed that while parents and youth are aware of the risks and harms associated with drugs like cocaine, crack, ecstasy, and crystal meth, very few identified marijuana as being harmful. Notwithstanding the evidence that Canadians and youth in particular do not associate a high degree of risk with marijuana use, under the national anti-drug strategy the government has prior experience and success in educating youth and parents about the harms of illicit drug use.In an evaluation of the national anti-drug strategy mass media campaign a couple of years ago on the harms of using hard street drugs, it was shown that there were positive results. For example, 25% of parents who saw the TV ads talked to their children about the harms of drugs. There was also an increase in the number of youth who said they understood, knew about the potential effects of illicit drug use on relationships with their family and their friends, and looked for further information. In addition, one in five kids who saw the ads took some action, most talking to or warning friends about the dangers of drugs.The progress made under the national anti-drug strategy to inform youth and parents about the dangers of hard street drugs can inform new efforts to help Canadians understand the harms and risks associated with marijuana use, and to help clarify any confusion resulting from the public debates surrounding medical marijuana in Canada and legalization in the United States.(0855)Health Canada's national anti-drug programs are already enabling stakeholders to better understand the effects of marijuana use, in particular on youth. For example, the Minister of Health recently announced funding of $11.5 million over five years to the Canadian Centre on Substance Abuse to reduce drug use among youth, including for research into the impact of marijuana on brain development and impaired driving.In addition, in an effort to engage key stakeholders and experts in the field,Minister Ambrose met with leading researchers and health care professionals yesterday, on April 30, to discuss the scientific evidence on the health impacts of marijuana use by youth, as well as to identify strategies for raising the awareness of Canadians as to its risks.In conclusion, while rates of marijuana use in Canada remain high, and there is evidence that Canadians are not as well-informed about the risks of marijuana use as they are about other illicit drugs, the national anti-drug strategy and its successes provide us with a strong foundation upon which to take action to address the harms associated with marijuana, particularly among youth, and more broadly to better inform Canadians and assist them in making healthy choices for themselves and their families.Thank you.Controlled Drugs and Substances ActDepartment of HealthHealthMarijuana370974137097423709743370974437097453709746370974737097483709749370975037097513709752370975337097543709755370975637097573709758370975937097603709761370976237097633709764370976537097663709767BenLobbHuron—BruceBenLobbHuron—BruceRobertIaniroRobert-IaniroInterventionMr. Robert Ianiro (Director General, Controlled Substances and Tobacco Directorate, Healthy Environments and Consumer Safety Branch, Department of Health): (0915)[English]Thank you for the question. Thank you, Hilary.In regard to the two approved products that Ms. Geller referred to as Sativex and Cesamet, I'll just situate things. As I'm sure everyone knows there's a very rigorous process in place for the approval of drug products in Canada under the Food and Drugs Act around safety, efficacy, and quality. Specifically, the two that were mentioned were Sativex and Cesamet. Sativex is a cannabis-based medicine and it really is indicated quite specifically. It contains both THC and cannabidiol, and it really is indicated for specific treatment, an adjunctive treatment for symptomatic relief of neuropathic pain for adults who suffer from multiple sclerosis. So that is what it is specifically indicated for.In the case of Cesamet, it is a synthetic cannabinoid, therefore it is manufactured synthetically and it's administered orally. It has antiemetic properties, which have been found to be of value in the management of some patients who are dealing with nausea and vomiting, who are undergoing cancer chemotherapy. Those are two examples of the only two drug approvals that our colleagues in the health products and food branch have approved and given notices of compliance and issued drug identification numbers to. But again, when we speak about the benefits, clearly the indications of those two drugs are quite specific to certain conditions.Department of HealthHealthMarijuanaPrescription drugs37098433709844370984537098463709847HilaryGellerHedyFryHon.Vancouver CentreHananAbramoviciHanan-AbramoviciInterventionMr. Hanan Abramovici (Senior Scientific Information Officer, Office of Research and Surveillance, Department of Health): (0930)[English]Your question was with regard to maternal cannabis use and if there are effects on the fetus. There have been a few limited studies, longitudinal studies, that have looked at that, and they found some subtle long-term effects on children born to mothers who had used cannabis during pregnancy. What those long-term effects were, the actual impact in everyday life, I'm not sure they were clearly demonstrated, but in terms of laboratory measures of cognition and other neurocognitive faculties, they found subtle impairments in certain aspects of memory among children who were born to mothers who had used cannabis during pregnancy.Department of HealthHealthMarijuanaPregnancy3709882BenLobbHuron—BruceBenLobbHuron—BruceDebraGillisDebra-GillisInterventionMs. Debra Gillis (Acting Director General, Interprofessional Advisory and Program Support, First Nations and Inuit Health Branch, Department of Health): (0905)[English]Thank you, Mr. Chair and members of the committee.I am here this morning to provide you with an overview of Health Canada's role and work on the subject of scope of practice for health professionals. I'd like to begin by stating that scope of practice is defined in many ways by different players in the health care system, both at the national and provincial levels, including ministries of health and education, regulatory bodies, credentialing bodies, national and provincial professional associations, education bodies, and employers. Broadly speaking, “scope of practice” refers to the roles, functions, tasks and activities, professional competencies, and standards of practice that licensed health care professionals are authorized to perform in a specific field. By this I mean that each regulated health profession has a scope of practice statement that describes in a general way what the profession does and the methods that it uses. The scope of practice statement is not protected in the sense that it does not prevent others from performing the same activities. Rather, it acknowledges the overlapping scope of practice of the health professions, and therein is the challenge, because health professions often practise as a team. The result is that the scope of practice for each health professional is enacted according to the needs of the patient and the practice environment in which he or she works. Consequently, the actual scope of practice—that is, what happens in day-to-day practice—may vary substantially across health care settings and sectors as well as according to the patient population being served.The provinces and territories play a major role in scopes of practice. They make the decisions about how best to optimize the scopes of practice of health professionals working within their jurisdictions. They are responsible for health professional legislation and regulation, payment mechanisms, education, and health human resources planning, all of which impact scopes of practice.The federal government plays a supportive role in this area through research, health human resources programming, related regulatory responsibilities, and working within established scopes of practice for the delivery of care to federal populations. The federal government is committed to ensuring a health system that is responsive to the needs of Canadians and that Canadians have access to the care they need. To this end, we support efforts in health human resources management that allow professions to work to their optimal scopes of practice in a number of ways. Firstly, the federal government is responsible for national enabling legislation such as the Controlled Drugs and Substances Act, which supports health professions to practice to their full scopes as set out in provincial or territorial legislation. Specifically, Health Canada introduced the new classes of practitioners' regulations that came into force on November 1, 2012. These regulations authorize midwives, nurse practitioners, and podiatrists to prescribe, administer, and provide controlled substances, with some exceptions, provided they are already authorized to do so under provincial or territorial legislation.Secondly, Health Canada facilitates the advancement of optimal scopes of practice in collaboration with provinces, territories, and key stakeholders in various ways including, for example, by providing $24 million in funding to advance the adoption of team-based care through initiatives such as the Canadian Interprofessional Health Collaborative; by providing $6.5 million in funding to McMaster University to evaluate team-based approaches to health care delivery; by providing advice to deputy ministers of health on the planning, organization, and delivery of health services through the federal-provincial-territorial committee on health workforce; and by partnering with the Canadian Institutes of Health Research to support a best brains exchange on March 14 of this year on optimal scopes of practice.Best practicesCaregivers and health care professionalsDepartment of HealthFirst Nations and Inuit Health BranchHealth care system36130673613068361306936130703613071361307236130733613074BenLobbHuron—BruceDebraGillisDebraGillisDebra-GillisInterventionMs. Debra Gillis: (0910)[English] Thirdly, as a provider of services to federal populations, including to first nations and Inuit, federal inmates, and the Canadian Forces—as you have heard—the federal government has a direct role to play in championing novel approaches to health care delivery, including with respect to scopes of practice. Given this, I will now turn specifically to Health Canada's role in first nation communities. Working to improve the health outcomes of aboriginal peoples is a shared undertaking among federal, provincial, territorial governments, and aboriginal partners. Health Canada's role involves supplementing and supporting provincial and territorial health services to provide culturally appropriate health programs and services that work to improve the health status of first nations and Inuit communities. To fulfill this role, Health Canada funds or directly provides public health, health promotion and disease prevention, addiction and mental health, and home and community care on all first nation communities, and primary care services in 85 remote and isolated communities. Regulated health professionals and unregulated health workers make up the almost 10,000 strong workforce. Regulated professionals include registered nurses, nurse practitioners, licensed practical nurses, dentists, dental hygienists, dental therapists, nutritionists, pharmacists, physicians, and environmental health officers. Health Canada requires its health professionals who provide direct services in first nation communities to be licensed in the province or territory in which they work and to maintain good standing with the regulatory body.However, in remote and isolated first nation communities with limited direct access to physician or even nurse practitioner support, registered nurses delivering direct primary care services often provide a broader range of health services and functions than would be authorized by provincial legislation on scope of practice .The need to address the legislated scope of practice of registered nurses working in these remote communities, while ensuring safe care and protecting the licences of nurses, is addressed in various ways across Health Canada's regions. For example, the Province of British Columbia has introduced a certified RN designation that defines additional education requirements and broadens the scope of practice for isolated and remote communities, and we require nurses to obtain that certification.Saskatchewan has introduced new nursing standards specifically addressing primary care service delivery in northern communities that will authorize RNs to take on additional functions.In Alberta first nation communities, a collaborative and consultative practice model, accessed on site or via telehealth, between nurse practitioners and registered nurses has permitted the safe, timely, and high-quality delivery of primary care services that align with provincial nursing scope of practice legislation. In Quebec, provincial legislation has been introduced to delegate or transfer authority for RNs to provide primary care. Working with provincial partners, Health Canada has introduced practice directives or ordonnances collectives that align with the legislation.In Manitoba and Ontario, a provincially recognized delegation process permits the alignment of Health Canada's employment functions of RNs with the provincially defined scope of practice.(0915)To mitigate the risk of nurses working outside their scope of practice, Health Canada has recently reviewed its nursing delegation tools, specifically the first nations and Inuit health branch's clinical guidelines for nurses in primary care and the nursing station formulary and drug classification system. This review identified a need to revisit and update these tools to ensure alignment with provincial frameworks, and we are in the process of doing so.Further, Health Canada provides education and training to all nurses working in primary care to ensure they have the skills and necessary certifications to provide safe care. All nurses are required to take, within a period of time after joining the federal government, a primary skills training course covering the expanded care needs. Health Canada also makes sure that nursing staff in remote and isolated locations have direct phone or video access to a physician at all times to discuss diagnosis and treatment, and to authorize treatment such as prescription medications.We are also implementing the recommendations from an internal study on health service delivery models in remote and isolated first nation communities, which will further support an alignment with the provincial scope of practice legislation for health care providers in primary care services. The measures being implemented include the introduction of collaborative and interdisciplinary teams; the introduction of providers not currently included in primary teams, such as X-ray technicians and pharmacy technicians; the increased presence of nurse practitioners; and the increased use of e-health services.In closing, Health Canada will continue to undertake activities to address scope of practice issues to support improved health care in first nation communities. In terms of Health Canada's broader role, I would emphasize that we will continue to collaborate with the provinces and territories and to facilitate the sharing of knowledge and best practices in support of their efforts to optimize the scopes of practice of health care professionals.Thank you very much.Aboriginal peoplesBest practicesCaregivers and health care professionalsDepartment of HealthFirst Nations and Inuit Health BranchHealth care system36130753613076361307736130783613079361308036130813613082361308336130843613085361308636130873613088DebraGillisBenLobbHuron—BruceHasanHutchinsonHasan-HutchinsonInterventionDr. Hasan Hutchinson (Director General, Office of Nutrition Policy and Promotion, Health Products and Food Branch, Department of Health): (1540)[Translation]Thank you, Madam Chair and members of the committee. I am pleased to be here today with my colleagues from the Public Health Agency of Canada, Canadian Institutes of Health Research, and Status of Women Canada. We recognize that eating disorders are a very worrisome mental health problem. Today I will talk about Health Canada's healthy eating initiatives. While these initiatives do not directly address eating disorders, they are specifically designed and implemented to minimize unforeseen and adverse consequences, such as encouraging poor eating habits.[English] Healthy eating plays an important role in promoting health and reducing the risk of nutrition-related chronic diseases. Health Canada has a national leadership role to play in supporting healthy eating through the development of nutrition policies and guidelines, enhancing the evidence base to support policy decisions, monitoring and reporting on what Canadians are eating, and providing Canadians with information through awareness and education initiatives that help them make informed and healthy eating decisions. While developing national nutrition policies and health promotion initiatives, we work to ensure that there are no unintended negative consequences. Every effort is made to provide consumers with positive nutrition messages that focus on health and well-being, and not on weight, as weight preoccupation is a hallmark of eating disorders like anorexia nervosa and bulimia nervosa. I'll provide a few examples of Health Canada's healthy eating initiatives that put the focus on health and not weight. “Eating Well with Canada's Food Guide” is likely the most well-known national nutrition resource developed by Health Canada. The food guide promotes a pattern of eating that will meet nutrition needs, promote health, and minimize the risk of nutrition-related chronic diseases. It is designed to help explain to Canadians what healthy eating means. It is an important tool that underpins nutrition and health policies and standards across the country and serves as a basis for a wide variety of nutrition initiatives. In the development of Canada's food guide, energy balance was of course a key consideration in the development of the food intake pattern, especially in light of the rising rates of obesity among Canadians. Despite this, though, Health Canada did not support a focus on calorie counting in the development of the food guide. Our approach was supported by many other public health stakeholders as well. In 2011 the FPT Ministers of Health endorsed actions taken and future directions of the framework document “Curbing Childhood Obesity: A Federal, Provincial and Territorial Framework for Action to Promote Healthy Weights ”. While the framework is a call to reduce childhood obesity, not one of its 10 recommended actions promotes or supports weight-loss diets, calorie counting, or other weight-focused efforts. Health Canada's healthy eating awareness and education initiative provides clear and consistent healthy eating messages for Canadians. Early phases of the campaign promoted better understanding of nutrition labelling. While the current phase of this healthy eating initiative is aimed at supporting healthy weights, the public messages and media focus encourage healthy eating habits, particularly through the development of food skills. The emphasis on food skills, not body weight, was very intentional. Let me conclude by stating once again that eating disorders are a serious mental health disorder. Nutrition promotion policies, programs, and messages such as those developed by Health Canada, which focus on health and well-being and not on weight and calories, play an important role in the prevention of disordered eating. (1545)[Translation]So concludes my presentation, Madam Chair. I will gladly answer any questions committee members might have.Canada's Food Guide to Healthy EatingCurbing Childhood Obesity: A Federal, Provincial and Territorial Framework for Action to Promote Healthy WeightsDepartment of HealthEating disordersFood labellingInformation disseminationJuvenile obesityMental healthNutritionWeight lossWomen35465843546585354658635465873546588354658935465903546591354659235465933546594MarlaIsraelHélèneLeBlancLaSalle—Émard//www.ourcommons.ca/Parliamentarians/en/members/9135MassimoPacettiMassimo-PacettiSaint-Léonard—Saint-MichelIndependentQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/PacettiMassimo_Lib.jpgInterventionMr. Massimo Pacetti: (1025)[English] Okay, that's what I thought. But the CETA agreement does not specifically address this regulation. It has to be done with Health Canada. Canada-European Union Comprehensive Economic and Trade AgreementDepartment of HealthEuropean UnionFree tradeRare and orphan diseasesRegulation3544456DurhaneWong-RiegerDurhaneWong-RiegerDurhaneWong-RiegerDurhane-Wong-RiegerInterventionDr. Durhane Wong-Rieger: (1025)[English]Right now, Health Canada has already proposed the orphan drug regulatory framework, and we're pleased with it because it actually does take the best of what's available—Canada-European Union Comprehensive Economic and Trade AgreementDepartment of HealthEuropean UnionFree tradeRare and orphan diseasesRegulation3544457MassimoPacettiSaint-Léonard—Saint-MichelMassimoPacettiSaint-Léonard—Saint-Michel//www.ourcommons.ca/Parliamentarians/en/members/35600BenLobbBen-LobbHuron—BruceConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/LobbBen_CPC.jpgInterventionThe Chair (Mr. Ben Lobb (Huron—Bruce, CPC)): (1530)[English]Good afternoon, ladies and gentlemen. Welcome to our health committee, meeting number six.This afternoon we are honoured to have the Minister of Health here, Minister Ambrose. She's agreed to be here for an hour to go over the supplementary estimates. She has some of her colleagues from the department here as well.Minister, you have some opening comments, and then you know the routine as far as questions and answers go. After the minister is done, we'll suspend for two minutes, and then we'll continue with our questions and answers from other people within the department. The last ten minutes we'll allocate to voting on the estimates.Thanks, everybody, for being here. And thank you to the clerk for arranging to pull a few strings to get this large meeting room, so we can fit everybody in.Without any further ado, Minister Ambrose, it's your time.Department of HealthSupplementary estimates (B) 2013-201435079473507948350794935079503507951RonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose (Minister of Health): (1530)[English]Thank you, Mr. Chair and members of the committee. Thank you for the invitation to discuss supplementary estimates (B) for the health portfolio.I'd also like to congratulate you, Mr. Chair. I know you have taken over this position recently. Thank you for that. I wanted to say a big thank you to Joy Smith, who I know chaired this committee with great success for quite a long time. I know you'll be working hard to build on her strong record.I have with me some members of a couple of departments. Of course, we have the deputy minister of Health Canada, George Da Pont; our associate deputy minister from the Public Health Agency of Canada, Krista Outhwaite; and Dr. Bruce Archibald from the Canadian Food Inspection Agency. Thérèse Roy is here as well, the CFO from the Canadian Institutes of Health Research, on behalf of Dr. Alain Beaudet.I've also brought with me today, for interest's sake, something we just announced recently. I'll allow the clerk to pass it out. It's our new healthy and safe food for Canadians framework. This is the culmination of a lot of work, bringing CFIA under the health portfolio, as you know.I understand also that the committee is undertaking a very important study on the growing problem of prescription drug abuse. I'd like to thank you for this work and say to you that after the meetings I've had with provinces and territories, this is not only an emerging issue, I think it's a pressing issue. I very much look forward to reviewing the report.Do you need me to say I'm tabling this?Department of HealthDrug use and abusePrescription drugsSupplementary estimates (B) 2013-2014350795235079533507954350795535079563507957BenLobbHuron—BruceBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1530)[English]As you know, members, in the recent Speech from the Throne, our government committed to expanding the national anti-drug strategy to address this very issue of prescription drug abuse. And I know that your work here at committee will provide much needed information on this important topic.[Translation]This is my first appearance before the committee as Minister of Health, so I would like to take a few moments to discuss how I will be approaching my role in general, before getting into some priority areas.[English]As evidenced in budget 2013 and also reiterated in the recent Speech from the Throne, health is a key priority for the government. In my opinion, one of the keys to success is finding new and better ways of working together. I can assure the committee that fostering partnerships and building relationships with the provinces and territories, with medical associations and health professionals, will be fundamental tenets of my time as health minister. This is noteworthy because we know there is nothing more important than good health.Federally, we play a vital role when it comes to promoting healthy living, preventing chronic diseases, protecting Canadians from harm, innovating through research, and providing leadership on national health issues. But of course we can't do any of this alone. We all have a role to play when it comes to improving the health of Canadians.A key achievement of our government has been to increase health transfers to the provinces and territories to unprecedented levels. Our record funding will reach $40 billion by the end of the decade, providing stability and predictability to the system. These transfer dollars support the provinces and territories in addressing the health concerns of their residents and allow all jurisdictions to focus on innovative solutions to their health care needs. As the new federal health minister, I take that responsibility very seriously, and I'm committed to each aspect of the portfolio. However, today I'd like an opportunity to highlight four key areas of interest before getting into the details of the portfolio's supplementary estimates. These include addressing family violence, fostering innovation in health care, working with partners on healthy living and injury prevention, and providing Canadians with healthy and safe food.As I have in the past, I will continue to shine a spotlight on family violence, an important issue, and encourage Canadians to be part of the solution. Family violence, as you know, can wreak physical and emotional havoc on individuals, families, and communities. Violence in any form reverberates across our society, and of course across the economy as well. According to Justice Canada, spousal violence alone costs society at least $7.4 billion annually. Of that, approximately $6 billion was spent on medical treatment and psychological services alone.(1535)[Translation]From my perspective, family violence is a health matter—just as much as a criminal one.[English] To help address it, as you know, we have the federal family violence initiative that connects the work of 15 federal departments and agencies. The Public Health Agency of Canada is leading this work to make sure this initiative is focused on priorities that make a difference to Canadians.Another focal point I'd like to touch on centres around innovation, technology, and research, all of which are obviously linked. At the federal-provincial-territorial health ministers meeting in early October in Toronto, I was very encouraged to hear from my colleagues that they've expressed their desire to make health care innovation our top priority in working together. It was also obviously well received at the annual meeting of the Canadian Medical Association as a priority for physicians. Federally, our government supports research and innovation through a range of initiatives. Most notably, of course, is the fact that we are the single largest investor in Canadian health innovation.On any given day, thousands of federally funded research projects are under way involving more than 13,000 Canadian researchers. These researchers are developing cutting-edge technologies designed to help improve our health care system. We will continue to invest in research and innovation so that together with the provinces and territories we can continue to improve the quality, accessibility, and sustainability of our system so that it's there for Canadians when and where they need it.On another note, ensuring that Canadian children and youth get the healthiest start in life is a key priority for our government. One in three children in Canada right now are overweight or obese. On average, only 12% of Canadian children take part in enough physical activity on a daily basis. These are truly alarming statistics. In the recent Speech from the Throne, our government committed to working with our provincial and territorial counterparts, as well as the private and not-for-profit sector, to support Canadian children and youth in leading healthy active lifestyles.[Translation]Awareness and momentum are growing. We are seeing strong leadership across the country to work towards the common objective.[English]Through the Public Health Agency of Canada, we are now mobilizing with groups like Canadian Tire, Right to Play, Maple Leaf Sports and Entertainment, Air Miles, and the YMCA. By leveraging our resources and theirs and ideas across sectors, we're laying a foundation for sustainable change.Another area of interest and focus that I have, and the department is working on, revolves around injury prevention, a topic of such importance that it was also specifically highlighted in the recent Speech from the Throne. Unfortunately, preventable injury is the leading cause of death for Canadians aged 1 to 44 years. Often considered accidents, preventable injuries are far more common than people think, and of course all are most often predictable and most often preventable. Preventable injury is also a concern from a health equity perspective. An injury can happen to anyone at any time, but children, youth, seniors, aboriginal people, and those of low socio-economic status carry a higher burden of injury than other Canadians. By working together and leveraging our resources, we can reduce the number of preventable injuries in this country and make a real, tangible difference in the lives of Canadians. Going forward, we will continue to build on new partnerships, raise awareness about injury prevention, and give Canadians the tools they need to live safer, healthier lives.I also want to touch upon the issue of healthy and safe food for Canadians and why this is such a focus for our government. As committee members know, Canadians are fortunate to have a world-class food safety system. But that said, we must always be looking for ways to improve it. Earlier this fall our government moved the Canadian Food Inspection Agency into the broader health portfolio. This decision takes the three federal authorities responsible for food safety—the CFIA, the Public Health Agency of Canada, and Health Canada—and places them under one umbrella. We did this because food safety is not only a top priority for our government, but we do feel that by better connecting these three entities, we are improving the way we manage food safety, as well as regulating, sharing information, and communicating with Canadians about food safety. One of the accomplishments stemming from that reorganization was the recent release of the document I just shared with you: the healthy and safe foods for Canadians framework. This framework outlines the portfolio's work on food safety as it pertains to three key pillars: promotion, prevention, and protection. With this in place, Canadians can have greater confidence in the food they buy and eat. We're also improving food recall warnings by making important information easier to understand and more accessible by tapping into such things as social media. Whether it's Facebook, Twitter, or other tools, we are also trying to provide Canadians with essential, easy to understand information whenever and wherever they need it.Now, under the healthy and safe foods for Canadians framework, we have all the researchers, inspectors, scientists, and public health officers working together with a common goal.As outlined in the recent Speech from the Throne, we will continue and we are committed to strengthening Canada's food inspection regimes and ensuring that our food safety and recall system remains one of the best in the world. As l've mentioned, with respect to this appearance, the agency is seeking an additional $39.9 million to further enhance its ability to maintain increased frequency of food inspections in meat processing establishments, improve online service delivery, and fund inspection verification teams.To conclude, Mr. Chair, l'm proud of the vital role our government plays in health care in this country. As Minister of Health, l'm committed to investing in health promotion by working with provinces, territories, and other partners, of course, on delivery of high-quality, cost-effective health care, by promoting innovation and health research, and by providing federal leadership on the areas that matter a great deal to Canadians. Once again, thank you for inviting me to speak with you today. My officials and I are pleased to take any questions you may have.Thank you.Canadian Food Inspection AgencyDepartment of HealthDomestic violenceDrug use and abuseFamily Violence InitiativeFederal-provincial-territorial relationsFood safetyGovernment assistanceHealth care systemHealthy and Safe Food for Canadians FrameworkInnovationInspections and inspectorsMedical researchNational Anti-Drug StrategyPhysical activity and fitnessPrescription drugsProduct recallsPublic Health OntarioSafetySocial networking sitesSupplementary estimates (B) 2013-2014Transfers to provinces and territoriesYoung people350795935079603507961350796235079633507964350796535079663507967350796835079693507970350797135079723507973350797435079753507976350797735079783507979350798035079813507982350798335079843507985BenLobbHuron—BruceBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies (Vancouver East, NDP): (1540)[English] Thank you very much, Chairperson. Maybe you could give me a heads up when I have about three minutes left.First of all, thank you, Minister Ambrose, for appearing before the committee today, your first appearance as health minister. Welcome. It's a pleasure to see you.I listened very carefully to your presentation and noted that an issue you actually didn't address, which I think is a very serious concern for Canadians, is the question of drug safety. In actual fact, Health Canada doesn't have the power to recall prescription medications. To us, that's another example on a long list of drug safety issues that have plagued your department for years. You're obviously a newcomer to it, but this is definitely not a new issue.We've had numerous Health Canada warnings about safety and effectiveness for birth control, antibiotic, and blood pressure medications, but the concern is that there isn't actually a recall provision that exists. In addition, Health Canada doesn't follow up on adverse drug reaction reports, even when they're filed by family members when people feel that someone has died or have had a terrible reaction to a drug. There's been a lot of coverage about this issue. Some of the media have done extensive research on it, and it certainly does seem to be a major shortcoming. My question, therefore, is when will Health Canada upgrade its drug safety protocols to ensure that medications Canadians are taking are safe, and that unsafe medications can be removed from the market immediately? I do have one other question for you as well. Department of HealthPatientsPrescription drugsSafetySupplementary estimates (B) 2013-2014350799235079933507994350799535079963507997BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1540)[English]I will try to be quick then.I appreciate that, and I understand the concerns that Canadian families have experienced over adverse drug reactions. Of course, you probably know one of our members of Parliament is here, elected for that very reason, and we work closely with him on this issue.We introduced in our Speech from the Throne a commitment to moving forward with patient safety legislation. I can't get into the details of the legislation, but I want to reassure you that we are working closely with multiple stakeholders, including patient safety advocates, to ensure that we do get this right. We'll have a chance as well for that legislation to come before committee. I have also recently asked Health Canada to begin to publish more transparently their drug reviews. I think that's important information that regular Canadians should have access to. Some of it is difficult to understand, but I don't think that should be a reason to not make it available to Canadians, and of course to researchers and physicians who would like to have that level of information. I hope to see a template from Health Canada soon on what that would look like, so we can ensure that we do publish that data more transparently when it comes to drug reviews. Of course, when it comes to adverse drug reactions, that's something we also hope to address in the patient safety legislation.Department of HealthPatientsPrescription drugsSafetySupplementary estimates (B) 2013-20143507998350799935080003508001LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1545)[English]We certainly look forward to seeing that information, because there's no question that when you analyze this issue, we're lagging far behind the drug safety measures in, for example, the U.S. and Europe. I'd now like to ask you a second question concerning your recent decision to intervene and, in effect, ignore the experts in your own department who had given approval under the special access program for the SALOME trial in Vancouver. One of the things that really bothered me about this is that both you as minister and your office publicly said on a number of occasions that the SAP is for rare diseases or terminal illnesses. According to your own website, “...practitioners treating patients with serious or life-threatening conditions when conventional therapies have failed, are unsuitable, or unavailable.” Now, that's clearly within the realm of what the SALOME trial was about. It was also very disturbing that you repeatedly referred to illicit drugs, when in actual fact, diacetylmorphine is actually a clinically produced medication. I'm aware that Health Canada, before coming to its decision under SAP, sought the advice of Michael Lester, an independent expert who has specialized in opiate dependence treatment for nearly 20 years. In fact, in a recent report in 2013 that he did for Health Canada, he called prescription heroin “a promising treatment of last resort” for this population, noting that there is no other next step for people who have failed multiple treatment attempts with methadone. It is all very disturbing that this intervention was made at a political level, particularly in light of the information I've given you. So I guess my question is, why have you allowed politics to trump evidence-based medicine when the process was in place? Clearly, a decision was made based on expert evaluation, and as a result, because of your political intervention, I would say that people's lives are at risk and a very vulnerable population is left hanging out there with basically a political decision made by yourself. Maybe you can answer for that.Department of HealthDrug addiction treatmentHeroinSpecial Access to Drugs and Health Products ProgramStudy to Assess Longer-term Opioid Medication EffectivenessSupplementary estimates (B) 2013-20143508002350800335080043508005RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1545)[English] First of all, in regard to the SALOME trial, these requests under the SAP are not, as you know, the SALOME trial. The SALOME trial is separate. That research is ongoing and was actually approved by our government. In terms of the physicians who made this request, you should know that in the past when a request like this was made, it was denied. Under the special access program, as you know, Health Canada can approve emergency access to certain medicines for Canadians with rare diseases or terminal illnesses. The intent of that program was not—Department of HealthDrug addiction treatmentHeroinSpecial Access to Drugs and Health Products ProgramStudy to Assess Longer-term Opioid Medication EffectivenessSupplementary estimates (B) 2013-201435080063508007LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1545)[English]That's actually not the case. It's life-threatening conditions.Department of HealthSupplementary estimates (B) 2013-20143508008RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1545)[English]I appreciate that. I know you quoted one person with 20 years' experience in the addictions world. I'll quote another.Department of HealthSupplementary estimates (B) 2013-20143508009LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1545)[English]That's from your website, actually.Department of HealthSupplementary estimates (B) 2013-20143508010RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1545)[English]I've read it.I'll also quote another addiction specialist, who's been researching in this field for 20 years, who says, “Heroin treatment is unsafe and...does not address the treatment needs....” For this very small, vulnerable group of people I support treatment, I support intervention, and I support recovery programs. We know that these kinds of addictive drugs are very dangerous. I believe that drug treatment should be focused on ending drug use, not on maintaining drug use, and supporting these people to recover and lead a drug-free life.As well, you also know, as do many physicians, that there are safe alternatives available to giving heroin to someone who's addicted to heroin. If I had a request to give cocaine to someone addicted to cocaine through the special access program, or LSD.... I could go through the whole list—that is the list of substances that we have now disallowed under the special access program. But I can tell you, as far as I know, we've never received any requests for that. In the past, any request for this substance was denied.Department of HealthSupplementary estimates (B) 2013-20143508011350801235080133508014LibbyDaviesVancouver EastBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/71688EveAdamsEve-AdamsMississauga—Brampton SouthLiberal CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/AdamsEve_CPC.jpgInterventionMs. Eve Adams (Mississauga—Brampton South, CPC): (1545)[English]Thank you.Thank you very much, Minister, for joining us here today to review the supplementary estimates with our committee.As you kindly noted, our committee is currently undertaking a study of prescription drug abuse. In the last few weeks, we've heard quite a bit of testimony about the scope of this problem and some of the challenges that lie ahead in addressing this very serious issue.Our Conservative government has a very strong, proven track record when it comes to illicit drug use, addressing that through our national anti-drug strategy. I'm hoping that through the study we'll be able to look at some promising strategies on how we can best address prescription drug abuse.Would you be kind enough to comment on what our government has done to date as it relates to prescription drug abuse and where you think the future lies in addressing this issue?Department of HealthDrug use and abuseNational Anti-Drug StrategyPrescription drugsSupplementary estimates (B) 2013-201435080183508019350802035080213508022BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1550)[English] Thank you very much for the question. I'm very encouraged that the committee is engaged on this issue, because I think it is a very serious one. As you've probably seen from some of the statistics, Canada is now, I think, number two in the world in prescription drug abuse. While a lot of the work lies at the provincial level, we're working cooperatively with the provinces and territories on what we can do together to address this problem. We have levers, obviously, at the federal level as well. The abuse of certain prescription drugs I think represents a very serious health and safety issue in Canada, and one that we committed to addressing, as you know, in the Speech from the Throne. I, myself, and probably many people in this room, have seen and heard the heartbreaking stories of people who have become addicted to prescription drugs, starting with a prescription they needed for back pain, and it has literally ruined their lives. Unfortunately, we haven't had enough focus on this area, given its seriousness. I know it's a growing problem, and we are working very diligently with the provinces and territories to address it. We do have to cooperate with them, obviously. We've committed in the Speech from the Throne to expanding our national anti-drug strategy to include prescription drug abuse, and not just illicit drug abuse, which I think is important. This action will help build on the work we've already done to tighten such things as licensing rules around drugs such as OxyContin to prevent their being illegally distributed. These include tightened controls on companies that produce drugs like OxyContin to ensure that proper care is taken when they're manufactured, but also when they are distributed. In terms of our own policy levers within Health Canada, we've also used our public drug plan, which is run by Health Canada. We now have maximum monthly and daily drug limits, we monitor the use of certain drugs to address potential misuse, and we also have real-time warning messages to pharmacists at the point of sale when we see issues. On top of the good and very helpful and cooperative work that we're doing with partners, I also encourage provinces, territories, and medical professionals to develop their own complementary strategies, and some of them are doing this. We all have a responsibility to fight this issue. This includes sharing of information that demonstrates that we know—obviously I don't know the extent of the issue—that there is some evidence that some people are doctor shopping and that doctors are prescribing too much. Too much ends up in someone's medicine cabinet and sits there for months. Unfortunately, sometimes kids get their hands on it, take it to school, and sell it. We really need to raise more awareness around this. But there also have to be measures in place to make sure that doctors are also accountable for some of the misuse. If information is known about this happening, then Health Canada needs to be informed, and if we are informed, then we can take the necessary steps to stop these irresponsible practices. There are obviously a number of stakeholders involved here. We are working with all of them. We very recently met with a number of them to bring them together in what will be, when we move forward, the first time that all of these stakeholders will be addressing this issue together. I think that's a really good first step, and there will be great information coming out of this committee to build on that work. Department of HealthDrug use and abuseNational Anti-Drug StrategyPrescription drugsSupplementary estimates (B) 2013-2014350802335080243508025350802635080273508028350802935080303508031EveAdamsMississauga—Brampton SouthEveAdamsMississauga—Brampton South//www.ourcommons.ca/Parliamentarians/en/members/71688EveAdamsEve-AdamsMississauga—Brampton SouthLiberal CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/AdamsEve_CPC.jpgInterventionMs. Eve Adams: (1550)[English]Thank you. Let me move to innovation. You noted in your opening comments that our federal government is the nation's largest investor of research and innovation in the country. That is a very proud legacy to have. I'm particularly focused on the results of those types of investments. Perhaps you could highlight for us some of the outstanding results that you've seen to date. Canadian Institutes of Health ResearchDepartment of HealthElectronic health recordsInnovationMedical researchPatientsSupplementary estimates (B) 2013-201435080323508033RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1555)[English] The Canadian Institutes of Health Research is really an amazing research organization, and the support they're giving to Canadian researchers across the country is phenomenal. In my short time as health minister I've had an opportunity to see that. I'm sure you've heard on this committee from many of those innovative health researchers. It's close to 13,000 presently, and at times it has been higher. So whether it's investing in research in diabetes, personalized medicine, aboriginal health, mental health—of course, the list goes on. We've invested recently $100 million in Brain Canada for neuroscience, and we've also created the pathways to health equity for aboriginal peoples. We have recently, not that long ago, launched the strategy for patient-oriented research, which is a great initiative, working closely with the provinces and territories, which sees additional money going to the territories to support their particular specific innovation priorities. So it's a great opportunity for the federal government to use our research capacity to support the provinces in the areas where they need help, making sure patients are getting the right kind of treatment at the right time. It also focuses on including patients in the research itself, which has been obviously welcomed by patients' advocates. I think it really helps bridge the gap between research evidence and health care practice, which has been very well received across the country. We just launched the first initiative of this kind in Alberta, and there are a number more that will follow. Obviously, Canada has been a leader on research on HIV. Whether it's new ways to prevent chronic diseases...our support has been providing the resources needed for that work as well. The deputy wants me to tell you that we've also invested $2.1 billion today for electronic health records. Obviously that's a huge issue for the provinces and territories because they're delivering health services on the ground, and that is a huge undertaking that has seen great success. We know that there have been a lot of challenges in different jurisdictions on electronic records, but Infoway has an impeccable record, not only from the Auditor General, but recently they just won an international award for project management. So we're glad to see the $2 billion investment actually helping people, helping those who deliver health services on the ground do it better and in a more sustainable way.Canadian Institutes of Health ResearchDepartment of HealthElectronic health recordsInnovationMedical researchPatientsSupplementary estimates (B) 2013-201435080343508035350803635080373508038EveAdamsMississauga—Brampton SouthEveAdamsMississauga—Brampton South//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry (Vancouver Centre, Lib.): (1555)[English] Thank you very much. Welcome, Minister.There were some questions asked by my colleague Ms. Davies that I wanted to expand on. The first one had to do with the SAP and the removal of the decision by the department to allow for diacetylmorphine to be used with certain patients, These patients are a very select group. They do not respond to methadone or to suboxone or to any of those other things, and they actually only seem to respond to heroin. This comes from the NAOMI trials and other trials, as well as SALOME.Now, if these patients cannot get this, what they do is go back to heroin, which at the moment is only available on the street. So the question is, is withholding this heroin from them a good approach? It's a start to treatment and to getting them off and getting them on lower doses, which has been shown to work in Europe and in Australia and across the world for quite a long time now. This would help these people to get off the drug eventually and save their lives, because if they go back on the street, they're back to petty crime and to injections of heroin that can kill them.This is a life-threatening problem. Can you quickly tell me about that? That's my first question.I want to allow you to answer them all, so I'm just going to give them to you. The second one has to do with research on HIV. I think it's interesting to note that you're spending a great deal of money on research on HIV, but I wondered if you have met with and have decided that it is a good time to look at the highly active antiretroviral program going on in British Columbia, which has now been adopted by China, by Brazil, by the United Kingdom, and by France. With this program, people who are deemed to be HIV-positive are given a drug whose effect is that by the end of the first two doses they no longer create enough virus to infect others. It's known, therefore, as treatment as prevention. I know that the Canadian government has never paid any interest to this, which is kind of sad since we should be really proud of it. This is Banting and Best work that is being done. That's my second question.My final question is this: you're taking on the food inspection agency, which I think is a good idea. I've always believed that it should be in one place and that PHAC should in fact be in charge of this. So I think it's fine, but I wondered, when you do so, are you going to look at some of the recommendations that came out of the report that the United States had asked that Canada do? This is about prevention strategies and oversight and technical training and better-trained inspectors and looking at research on preharvest ways of dealing with things. Are you going to look at how we get a faster way of getting the information to the public and collaborating with stakeholders? Those were four big areas that the recommendations addressed, and I wonder if you're going to address this when we get there, because this is a really severe problem. People could die. Fortunately, people only got sick, but people could die from E. coli or listeriosis or salmonella, any one of the things that we can find in foods. Now that it's turned over to Health Canada, we should be better able to deal with this in an appropriate and effective manner. Can you tell me whether you are going to look at those recommendations or not?AIDS and HIVAntiretroviral drugsCanadian Food Inspection AgencyDepartment of HealthDrug addiction treatmentFood safetyHealthy and Safe Food for Canadians FrameworkHighly Active Antiretroviral TherapyInformation disseminationSpecial Access to Drugs and Health Products ProgramSupplementary estimates (B) 2013-201435080423508043350804435080453508046350804735080483508049BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1600)[English]That's a lot of questions.First, on the SAP program, I'll reiterate my view that the intent of the special access program is not to provide addictive drugs to those who are addicted. I will continue to focus on intervention, safe intervention, safe alternatives, treatments, and recovery for those who are addicted.As for the HIV, you're right. We are a leader in HIV spending. We have spent half a billion dollars to address HIV/AIDS since 2006, and the Public Health Agency has done incredible work in that area. There's also the HIV vaccine initiative with Bill and Melinda Gates that we have funded.I'm going to ask Krista to say a few words about that. But before I do, I would just touch on the healthy and safe food for Canadians framework. I think it was a very good public policy decision to bring CFIA under the Health portfolio. Already, we have interaction between CFIA and public health officers at the provincial level. So you hit the nail on the head. It's all about information-sharing and making sure that it's not just about agriculture but also about public health. We're seeing a great response from the provinces and territories. We recently launched another part of our FoodNet Canada set-up in Alberta. We now have them in B.C., Alberta, and Ontario, and we hope to have more. It is all about collaboration and information sharing. The sooner we can get that information to the public health officers from the inspectors, the better. That's exactly why we've done this. We see a great collaboration.I'll ask Krista to speak.AIDS and HIVAntiretroviral drugsCanadian Food Inspection AgencyDepartment of HealthDrug addiction treatmentFood safetyHealthy and Safe Food for Canadians FrameworkHighly Active Antiretroviral TherapyInformation disseminationSpecial Access to Drugs and Health Products ProgramSupplementary estimates (B) 2013-201435080503508051350805235080533508054HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1600)[English] Thank you.Mr. Chair, through you, when Ms. Outhwaite answers my questions.... I specifically asked about HAART. I don't want to know what you're spending money on. I want to know why we haven't looked at HAART, which is so successful in British Columbia and has been adopted around the world. I also wanted to get, if possible, an answer from someone about the fact that diacetylmorphine and hydromorphone are two substitution products. They are pharmaceutical products, so why have they been taken off the SAP? Maybe you can answer that. Other than the political answer, I'd like to get the scientific answer, because it hasn't followed the evidence base at all.AIDS and HIVAntiretroviral drugsDepartment of HealthHighly Active Antiretroviral TherapySupplementary estimates (B) 2013-20143508055350805635080573508058RonaAmbroseHon.Edmonton—Spruce GroveKristaOuthwaiteKristaOuthwaiteKrista-OuthwaiteInterventionMrs. Krista Outhwaite (Associate Deputy Minister, Public Health Agency of Canada): (1600)[English]Perhaps, Chair, I'll start with the question with respect to the work of Dr. Montaner and the Province of British Columbia in treatment as prevention in the field of HIV/AIDS research and research into interventions. It's very interesting work, and in fact the Public Health Agency of Canada has been following it very closely. Our director general of infectious diseases, Dr. Howard Njoo, has actually travelled to British Columbia to meet with Dr. Montaner to participate in information sharing, research-findings sharing exercises to determine how this fits into the overall spectrum of responses to HIV/AIDS in this particular country. It was also an interesting topic that came up at the international AIDS conference in Washington in 2012. You're quite right in pointing to this as a potentially promising area, certainly of great interest, in British Columbia. As you know, the Public Health Agency looks at a variety of responses to HIV/AIDS, certainly surveillance, certainly research into the best interventions, etc., and this may form part of the response to that more generally.AIDS and HIVAntiretroviral drugsDepartment of HealthHighly Active Antiretroviral TherapySupplementary estimates (B) 2013-201435080593508060HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1605)[English]I just wanted to know why, if other countries are taking this and if the World Health Organization said okay, it isn't happening.Department of HealthSupplementary estimates (B) 2013-20143508061KristaOuthwaiteBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/31267LaurieHawnHon.Laurie-HawnEdmonton CentreConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/HawnLaurie_CPC.jpgInterventionHon. Laurie Hawn (Edmonton Centre, CPC): (1605)[English]Thank you very much, Mr. Chair.Thank you, Minister Ambrose and all your officials, for being here. Apparently I do mean “all your officials”. That's quite a crowd.Everybody here has been touched by mental health in one way or another, whether it's depression or Alzheimer's. I lost an aunt to Alzheimer's, and I know other people who have been touched by it. With one in five Canadians suffering some form of mental health.... Obviously, it has serious effects on all of our lives, whether it's us personally or people we know and love. There has been some good work going on by our government to support mental health research, and funding through your portfolio, and these dollars have gone a long way toward developing resources needed to tackle those issues. Can you talk about some of those mental health research programs that we've undertaken and some we might be planning in the future?Alzheimer diseaseDepartment of HealthMental healthMental Health Commission of CanadaSupplementary estimates (B) 2013-20143508066350806735080683508069BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1605)[English] Sure, I would be happy to do that. You're right in saying mental health affects everyone. I think the more we know about it, the more we recognize that it is part of every aspect of health care. It really is, and it's an area where research grows, and the more research we have, I think the better interventions we see, which is great. Obviously we've made significant investments in mental health, both on the research side and the promotion side. We created, of course, the Mental Health Commission of Canada, which has developed a national strategy for ensuring best practices across the country.I would say that Alzheimer's is one of the foremost challenges to mental health today, and it's been a key investment target for our government through the Canadian Institutes of Health Research. We've invested more than $146 million now in research specific to Alzheimer's disease and related dementias, including nearly $27 million in one year alone, in 2011-12. We have also created the Canadian Consortium on Neurodegeneration in Aging, which was launched in March of this year. This particular initiative brings together all of the relevant Canadian expertise and acts basically as a research hub for all aspects of neurodegenerative processes affecting cognition, including Alzheimer's. We are also active at the international level. CIHR is very active in supporting research through what's called the international collaborative research strategy for Alzheimer's disease. This particular strategy's goal is to prevent or delay the onset of Alzheimer's through early intervention and diagnosis. It's also focused on improving the quality of life for those who are afflicted and for their caregivers, which is interesting. As you well know, caregivers are deeply affected when their loved ones develop dementia and Alzheimer's. It also improves access to quality care and enables our health system to deal more efficiently with the rising number of affected individuals. It seems to me, from what I've seen, that it's working. To date, we've been able to leverage an initial $13.4 million to over almost double that—actually more than double that—through international partnerships, so it helps us to partner with other countries and other organizations. Through our federal responsibilities, which is in aboriginal communities, of course, we have also invested significantly. We've committed over $260 million annually now to target mental health issues in aboriginal communities, and our budget last year announced an additional $4 million specifically for mental health services for first nations. So all of this, I think, plays a big part in dealing with mental health issues. These investments obviously ensure not only that our health researchers have the resources they need, but that then, of course, corresponds with innovative strategies and also on-the-ground support for those who are practitioners and physicians. Alzheimer diseaseDepartment of HealthMental healthMental Health Commission of CanadaSupplementary estimates (B) 2013-2014350807035080713508072350807335080743508075350807635080773508078LaurieHawnHon.Edmonton CentreLaurieHawnHon.Edmonton Centre//www.ourcommons.ca/Parliamentarians/en/members/31267LaurieHawnHon.Laurie-HawnEdmonton CentreConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/HawnLaurie_CPC.jpgInterventionHon. Laurie Hawn: (1605)[English]Thank you.PTSD is not just an affliction of the military but of any first responder and other people throughout society. Can you talk a little bit about the coordination between Health Canada and DND, particularly on dealing with mental health issues that DND is concerned about, and PTSD writ larger? Department of HealthDepartment of National DefencePost-traumatic stress syndromeSupplementary estimates (B) 2013-2014Veterans35080793508080RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1605)[English]I'll let Krista say a few words more specifically, but just recently I was really thrilled—if that's the word—to see that the Canadian Institutes of Health Research is funding research projects dealing with those who have experienced IED explosions and other explosive-type environments, to study how that affects our soldiers returning from battle, and that's very promising. The more research we have, the better information to actually deal with those who are suffering from PTSD.Would you like to say a few more words on the work that we do at DND, Krista?Department of HealthDepartment of National DefencePost-traumatic stress syndromeSupplementary estimates (B) 2013-2014Veterans35080813508082LaurieHawnHon.Edmonton CentreKristaOuthwaiteKristaOuthwaiteKrista-OuthwaiteInterventionMrs. Krista Outhwaite: (1610)[English]Yes, thank you. I'd be delighted to. As you know, the Public Health Agency of Canada is busy these days working on the implementation of bill C-300, An Act respecting a Federal Framework for Suicide Prevention. This is where our relationships with colleagues such as National Defence come into play very significantly. They're working with us and developing this suicide prevention framework at the federal level, the federal framework, and being very helpful in that respect. They are also partnering with us to look at what tools and innovative developments can be brought to bear to meet the needs of mental health promotion generally, but also specifically for military families and DND personnel. It's a very important area of work, and we are delighted that they are coming to the table in the way they are to work with us on this.C-300, An Act respecting a Federal Framework for Suicide PreventionDepartment of HealthDepartment of National DefencePost-traumatic stress syndromeSupplementary estimates (B) 2013-2014Veterans350808335080843508085RonaAmbroseHon.Edmonton—Spruce GroveLaurieHawnHon.Edmonton Centre//www.ourcommons.ca/Parliamentarians/en/members/31267LaurieHawnHon.Laurie-HawnEdmonton CentreConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/HawnLaurie_CPC.jpgInterventionHon. Laurie Hawn: (1610)[English] Are you paying special attention to the military, obviously, but also to first responders, through public safety and so on, and obviously fire, police, and so on? Are they kind of wrapped up in the same bit of cooperation?Department of HealthEmergency response and emergency respondersPost-traumatic stress syndromeSupplementary estimates (B) 2013-20143508086KristaOuthwaiteRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1610)[English]In terms of pandemic response, or in terms of PTSD?Department of HealthSupplementary estimates (B) 2013-20143508087LaurieHawnHon.Edmonton CentreLaurieHawnHon.Edmonton Centre//www.ourcommons.ca/Parliamentarians/en/members/31267LaurieHawnHon.Laurie-HawnEdmonton CentreConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/HawnLaurie_CPC.jpgInterventionHon. Laurie Hawn: (1610)[English]No, in terms of the first responders, who do respond just as—I mean, military are first responders in many ways and they suffer the same kinds of traumatic incidents.Department of HealthSupplementary estimates (B) 2013-20143508088RonaAmbroseHon.Edmonton—Spruce GroveKristaOuthwaiteKristaOuthwaiteKrista-OuthwaiteInterventionMrs. Krista Outhwaite: (1610)[English]Yes.Department of HealthEmergency response and emergency respondersPost-traumatic stress syndromeSupplementary estimates (B) 2013-20143508089LaurieHawnHon.Edmonton CentreLaurieHawnHon.Edmonton Centre//www.ourcommons.ca/Parliamentarians/en/members/31267LaurieHawnHon.Laurie-HawnEdmonton CentreConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/HawnLaurie_CPC.jpgInterventionHon. Laurie Hawn: (1610)[English]Your “yes” is actually to public safety and so on?Department of HealthSupplementary estimates (B) 2013-20143508090KristaOuthwaiteKristaOuthwaiteKristaOuthwaiteKrista-OuthwaiteInterventionMrs. Krista Outhwaite: (1610)[English]Yes, they would be part of that larger family. Yes.Department of HealthSupplementary estimates (B) 2013-20143508091LaurieHawnHon.Edmonton CentreLaurieHawnHon.Edmonton Centre//www.ourcommons.ca/Parliamentarians/en/members/31267LaurieHawnHon.Laurie-HawnEdmonton CentreConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/HawnLaurie_CPC.jpgInterventionHon. Laurie Hawn: (1610)[English]Back to the Canadian Mental Health Commission for a minute. That was an initiative that has gotten off the ground very well. Is that meeting expectations? You talked about the international area a bit. Are they hooked in pretty closely with similar international organizations for research and sharing of information?Data sharingDepartment of HealthMental healthMental Health Commission of CanadaSupplementary estimates (B) 2013-20143508092KristaOuthwaiteRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1610)[English]I specifically mentioned the dementia issue.Department of HealthSupplementary estimates (B) 2013-20143508093LaurieHawnHon.Edmonton CentreKristaOuthwaiteKristaOuthwaiteKrista-OuthwaiteInterventionMrs. Krista Outhwaite: (1610)[English]You're referring to the government support and implementation of the Mental Health Commission and how it's functioning.Data sharingDepartment of HealthMental healthMental Health Commission of CanadaSupplementary estimates (B) 2013-20143508094RonaAmbroseHon.Edmonton—Spruce GroveLaurieHawnHon.Edmonton Centre//www.ourcommons.ca/Parliamentarians/en/members/31267LaurieHawnHon.Laurie-HawnEdmonton CentreConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/HawnLaurie_CPC.jpgInterventionHon. Laurie Hawn: (1610)[English]Yes. How are they working with international partners with similar mandates in terms of sharing information and research?Data sharingDepartment of HealthMental healthMental Health Commission of CanadaSupplementary estimates (B) 2013-20143508095KristaOuthwaiteKristaOuthwaiteKristaOuthwaiteKrista-OuthwaiteInterventionMrs. Krista Outhwaite: (1610)[English]The Government of Canada, in addition to the Mental Health Commission of Canada, has really been reaching out significantly to partners around the world to work on this important issue. I should also say the Mental Health Commission of Canada has seen many countries come to them to understand and learn from the work of the Mental Health Commission here in Canada.The development of the first strategic plan for mental health has been received very positively, and in fact I would be remiss if I did not mention that Canada has been active in bringing this forward at the World Health Assembly—the topic of mental health. We've sponsored meetings and discussions, and the work of the Mental Health Commission, as well as all the partners, whether they're governmental or private sector, have factored into those discussions. And other countries are very keen to see what we're doing.Data sharingDepartment of HealthMental healthMental Health Commission of CanadaSupplementary estimates (B) 2013-201435080963508097LaurieHawnHon.Edmonton CentreBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/681WayneMarstonWayne-MarstonHamilton East—Stoney CreekNew Democratic Party CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MarstonWayne_NDP.jpgInterventionMr. Wayne Marston (Hamilton East—Stoney Creek, NDP): (1610)[English]Thank you, Mr. Chair. Welcome, Minister. We're pleased to have you here with us today.A recent report from the Public Health Agency of Canada referred to more than 200,000 Canadians acquiring antibiotic-resistant infections while seeking treatment, and close to 8,000 Canadians die of these infections annually. I have tried to put these things into frame from personal experience. Recently, you may have recalled in the House, I spoke of my wife having surgery. She was scheduled for four days and she wound up with 13 days because she picked up an infection. Fortunately, antibiotics dealt with it.This brings me to a point I'd like to make. My background is in the labour movement, and a lot of the work I did had to do with hospital unions and their representatives. A lot of Canadian hospitals are unionized, and in that environment they have a health and safety committee. If they're going through their daily work and they find a problem with procedures, they don't have to risk a confrontation with a manager. They can go through their union, which raises it as a health and safety concern. What I'm concerned about today is there are often times that work is contracted out to cleaning services, where you have a $10-an-hour employee, a part-timer, who is reluctant to raise issues because where he's contracted, he's easily disposed of by his manager—not necessarily the hospital. It opens the door to failure within the cleaning system when we're looking at those people who have acquired the resistant pathogens out there. Canada's chief public health officer believes that 70% of infections could be prevented, and of course where the national role comes in is with a monitoring system of some sort. There have been complaints. I understand that doctors have pointed out that the federal government has offloaded the collection of this data to the provinces. Again, as you can see, that balances off with my earlier comments. How does the government explain that there's a 1,000% increase in these infections in Canada when places like the United Kingdom have cut their infection rate by half, with the leadership of that particular government? Is the minister prepared to address the concerns these doctors have in making sure that up-to-date information is provided to them?Department of HealthNosocomial infectionsPatientsSupplementary estimates (B) 2013-201435081023508103350810435081053508106BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1615)[English]Well, I would just start by saying yes. And the Public Health Agency of Canada is actively engaged with provincial partners, monitoring the spread of infection. Any reports of disease surveillance are verified with outside medical experts, and they're regularly shared with key stakeholders. But they do have a rigorous process they go through before they post that information. I'm happy to let Krista expand on that.But what I will say to you is that in this situation, on the labour side, anyone who is a patient and has been a patient, including myself, expects that people follow health and safety procedures, regardless of being unionized or non-unionized, obviously. But Krista can elaborate a little more on that because I know she has an issue she'd like to raise.Department of HealthNosocomial infectionsPatientsSupplementary estimates (B) 2013-201435081073508108WayneMarstonHamilton East—Stoney CreekKristaOuthwaiteKristaOuthwaiteKrista-OuthwaiteInterventionMrs. Krista Outhwaite: (1615)[English] Mr. Chair, the topic of antimicrobial resistance is an extremely important one. It's emerging in terms of discussions at the World Health Organization. The U.K. is providing some interesting insight into this particular area. In fact, all countries now are really putting a focus on antimicrobial resistance, for all of the reasons the member has brought to the table. In this country, the Public Health Agency of Canada has a bit of a unique surveillance program in which we actually look for resistant microbiological agents—bacteria and things like that—in hospitals and health care settings. We do that with the cooperation of a number of hospitals across this country. We work very actively to get the results of that surveillance out to the public health community, which needs it and uses it as quickly as we can. It takes a little while, as the minister was mentioning, to make sure that the data are accurate, valid, and appropriate and that we protect any concerns with respect to individual patient information. We absolutely want to do that. But once we've done that process, we give that data over, as I say, to the public health community. We are also working very actively to make sure that we also introduce the outcomes of those surveillance programs on our website as quickly as we can, which is I think the issue the member was pointing to.Department of HealthNosocomial infectionsPatientsSupplementary estimates (B) 2013-2014350810935081103508111RonaAmbroseHon.Edmonton—Spruce GroveWayneMarstonHamilton East—Stoney Creek//www.ourcommons.ca/Parliamentarians/en/members/72006DavidWilksDavid-WilksKootenay—ColumbiaConservative CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/WilksDavid_CPC.jpgInterventionMr. David Wilks (Kootenay—Columbia, CPC): (1615)[English]Thanks, Chair.Thanks to you and all your staff, Minister, for being here.I'm going to carry on with the conversation that Ms. Fry and Ms. Davies had picked up on. You spoke in your opening remarks about healthy living and said further that protecting Canadians from harm is part of your mandate, as is ensuring that both licit and illicit drugs are dealt with in a manner that is responsible for all Canadians.Recently, injection sites have been in the spotlight, and specifically how communities should have a say in their placement. As a former police officer, I think it's only fair that people have the right to say whether one is in their community or not. I wonder if you could comment from your perspective on the Respect for Communities Act and what it's trying to accomplish, and then, further to that, on the importance of treatment, recovery, and support.C-2, An Act to amend the Controlled Drugs and Substances ActDepartment of HealthDrug addiction treatmentSafe injection sitesSupplementary estimates (B) 2013-20143508117350811835081193508120BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1615)[English] Sure, I'm happy to do that. I appreciate the question.The legislation you're talking about with regard to supervised injection sites, the Respect for Communities Act, is being debated in the House right now. We introduced it last month. This legislation will give law enforcement, municipal leaders, and local residents a voice, all of whom have asked for a voice before the permit is actually granted for a supervised drug injection site in the area. This went to the Supreme Court, and in a 2011 Supreme Court ruling the justices were crystal clear. They ordered that I, or any health minister, must consider specific factors when reviewing applications that grant exemptions under our drug laws. In other words, we must look into specific factors before allowing a permit for a supervised drug injection site. One of the five factors named in the ruling is expressions of community support or opposition. I do not, nor should I, ignore any of the factors named in the court's ruling. I think it makes good sense. I am required by the Supreme Court to consider community opinions in the process, and that information needs to be made available to me by the organization if it's seeking to build such a site.I should say that there is no one now seeking to build such a site, but this bill also requires that these organizations submit the relevant scientific information demonstrating the effectiveness of illicit drug treatment at the proposed site as part of their application.I think that all parties, or at least those with whom we have consulted, agree that this kind of information must be provided to decision-makers when assessing a permit of this kind. This information will be provided along with details about the resources of the proposed site and about how these resources will be used for drug treatment. Knowledge about the level of community support and the treatment options that are available will also help determine the merits of each application.This is reasonable and it is also mandated by the Supreme Court, so that is what is in the bill. Those stakeholders who have been dealing with this issue for many years deserve a say in where these sites would be if we receive an application for them, so we are moving on this. The Supreme Court has ruled. We believe our communities deserve nothing less than to have a voice in that, and the Supreme Court has agreed.I do encourage everyone to support the legislation and move it along. Our government has invested quite a bit of money in drug treatment and recovery. I am of the belief that we spend a lot of time talking about a very small piece of the drug problem when we talk about supervised injection sites. There are literally hundreds of thousands, if not millions, of Canadians across the country who are either in recovery or suffering from addictions. A lot of them feel shame and they don't want to speak openly about their addictions and their need for recovery. We need to speak more about it because they need to feel comfortable about coming forward to seek help and intervention. That is one of the messages that I bring, as the health minister in my tenure. We need to get people out of addiction, into recovery, and into the right kinds of treatment programs. Sometimes it takes years. Sometimes it takes multiple attempts. People talk about it not working, even after two tries. Sometimes it takes 15. As a police officer, you have seen this first-hand. Eventually, though, people can get up on their own two feet, recover, and lead a productive life.The message is to not give up on people, any people, particularly those who are most vulnerable.Department of HealthDrug addiction treatmentSafe injection sitesSupplementary estimates (B) 2013-2014350812135081223508123350812435081253508126350812735081283508129350813035081313508132DavidWilksKootenay—ColumbiaBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/71477IsabelleMorinIsabelle-MorinNotre-Dame-de-Grâce—LachineNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinIsabelle_NDP.jpgInterventionMs. Isabelle Morin (Notre-Dame-de-Grâce—Lachine, NDP): (1620)[Translation]I would like to thank the minister for being here today. I quite enjoyed your speech.You mentioned safe and healthy food for Canadians. You said a great deal about safety, regulation, providing information and communications, but you did not discuss food in and of itself. Yet, in the United States, the Food and Drug Administration has ordered the American food industry to begin to gradually eliminate trans fats from processed food. I think this is a good measure.In this country however, the government is not listening. Even in your own department, certain experts have recommended the regulation of food processing and ensuring such foods contain less fat and salt. I believe these measures would improve the health of Canadians. I am not talking simply about influencing their food choices. Here in Canada, our cereal contains much more salt than it does in the U.S., and the quantity of trans fats found in processed food is truly unbelievable.Why have we not followed the U.S. example and that of many other countries by taking similar measures? When will we be able to implement such measures?Department of HealthFood labellingNutritionSupplementary estimates (B) 2013-20143508135350813635081373508138BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1620)[English] I don't know what you find, but in speaking to at least my cohort, more and more people want increased amounts of information about what they eat—the food they buy when they go to the store. They want more nutrition labelling, not less. I find that especially parents shopping for kids want to know if there is an allergen in this food, what ingredients are in it. It is even beyond nutritional information. This is why our government has announced in the Speech from the Throne that we will be consulting with Canadians about nutrition labelling. We will be working with CFIA, the Public Health Agency, and Health Canada together, to see what we can do better to support people in making good nutritional decisions.On trans fats, there has been a lot of movement. Canada, as you know, moved to a voluntary system for trans fats. We've seen a huge improvement—Department of HealthFood labellingNutritionSupplementary estimates (B) 2013-201435081393508140IsabelleMorinNotre-Dame-de-Grâce—LachineIsabelleMorinNotre-Dame-de-Grâce—Lachine//www.ourcommons.ca/Parliamentarians/en/members/71477IsabelleMorinIsabelle-MorinNotre-Dame-de-Grâce—LachineNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinIsabelle_NDP.jpgInterventionMs. Isabelle Morin: (1625)[Translation]I am sorry to interrupt you, but we do not have much time.I agree with you. I think transparency in labelling is very important. Furthermore, I also believe we should change the food itself. It is not enough to say that it contains salt. Canada should commit to reducing the amount of salt in these foods.Unfortunately, most of the people around me would be unable to tell me what the daily maximum dose of salt and trans fats is. However, we could go beyond this and ask the industry to reduce the amount of sodium and trans fats in the food they are producing. This is what we should do. It is not enough to be transparent. We must be proactive and ask that sodium and trans fat levels be reduced.You yourself must recognize how important this is. In that perspective, when can we expect to see Health Canada take action?Department of HealthSupplementary estimates (B) 2013-20143508141350814235081433508144RonaAmbroseHon.Edmonton—Spruce GroveRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1625)[English]It's not only Canada's food guide; there are also incredible amounts of information that we provide to Canadians on www.healthycanadians.gc.ca. We have a nutrition facts education campaign that was launched in 2010 that talks about the nutrition facts table, how to read it and understand it. We've worked with industry to reduce the amount of trans fats in Canadian food and in promoting better labelling.As a result of that, in a very short period of time we have seen Canadians' intake of trans fats decreased over 60% in just a couple of years. In fact, we know now from ongoing testing that in some segments of our population the intake of trans fats is reduced by almost 90%. So I think we're on a good track.There are also early signs that decreasing sodium levels in some important food categories is happening. As you know, experts set those levels. What we do is try to disseminate all that information to people so they can make good choices. We literally can't be at the table with people and their salt shaker, but we can advise them on why they should not be using too much salt on their food. We do that widely. Promoting healthy options does get results. We have very good promotional awareness campaigns making sure that physicians have adequate resources to give to patients, nutritionists, and we do disseminate that information. We've seen great results because of that.Department of HealthSupplementary estimates (B) 2013-2014350814535081463508147IsabelleMorinNotre-Dame-de-Grâce—LachineIsabelleMorinNotre-Dame-de-Grâce—Lachine//www.ourcommons.ca/Parliamentarians/en/members/71477IsabelleMorinIsabelle-MorinNotre-Dame-de-Grâce—LachineNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinIsabelle_NDP.jpgInterventionMs. Isabelle Morin: (1625)[Translation]Do you not believe it would be worthwhile to have regulations about salt consumption? You yourself said that we could not sit down with people for every meal. Yet, we know that generally speaking, more educated people will take the time to read nutritional information, unlike less educated people. Should we not help people and improve their health by committing to regulating trans fat and salt levels in food? We know that will allow us to save enormous amounts of money in health care.Department of HealthSupplementary estimates (B) 2013-20143508148RonaAmbroseHon.Edmonton—Spruce GroveBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/71693WladyslawLizonWladyslaw-LizonMississauga East—CooksvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LizonWladyslaw_CPC.jpgInterventionMr. Wladyslaw Lizon (Mississauga East—Cooksville, CPC): (1625)[English]Thank you very much, Mr. Chair.Minister, thank you for coming and meeting with us here today, and all the officials.Minister, in your previous role as minister responsible for the Status of Women, you were a great and strong advocate for ending all forms of violence against women. As I understand, you continue this in your new capacity and portfolio as Minister of Health through the programs offered in the department in that area. This is very encouraging, since this is an issue that all the parties can agree on and should work together to address.You highlighted in your opening remarks that the issue of family violence is one that you want to focus on. Can you please provide the committee with an update on the work you are doing with the Ministry of Health to keep the issues of family violence or issues related to family violence at the forefront?Department of HealthDomestic violenceSupplementary estimates (B) 2013-20143508152350815335081543508155BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1630)[English] I appreciate that comment. Not only in my role as minister for the Status of Women previously, but throughout my whole life I've been involved in this issue, advocating for more awareness around it. Our government has had an opportunity to bring a more holistic approach to the issue of family violence, whether it's child sexual abuse or intimate partner violence or honour violence. Family violence takes many forms, but the reality is that it is a public health issue. The consequences are far-reaching, both societally and also economically. I mentioned the Justice Canada report that came out a year ago, which found that just in terms of intimate partner violence, the cost to society is $7.4 billion, and that's just for going to the emergency room with a broken arm or seeking psychological help. Let's remember that most women do not seek medical help, and even more so do not seek psychological help. I would say that the cost is obviously much higher. We know that aboriginal women are suffering and experiencing violence at a much higher rate than non-aboriginal women—at least 3.5 times higher. They're much more vulnerable to becoming victims of family violence. That of course has profound financial and social impacts on them, their community, and their families.Not only does it affect physical health; it affects mental health. It puts a huge strain on day-to-day personal activities, but also business activities. It leads to loss of work. All of that affects our communities and our economy, and it obviously has a huge impact on the public health care system. The Public Health Agency of Canada has a clear mandate in this area, with responsibility for what is called the federal family violence initiative. That coordinates 15 different departments that have a role to play in any family violence. We are working right now to make sure that we're prioritizing all of this and are focusing our priorities in the right way.I'm glad to say that the Canadian Institutes of Health Research is also now doing research in the area of family violence, with $8.5 million over five years to look at gender-based violence and family violence and its impacts. So we all have a role to play. I have reached out to the provinces and territories, to the medical community, to physicians, to the Colleges of Physicians and Surgeons, asking all of the stakeholders what we can do together to advance awareness and prevention of family violence. I look forward to working with the committee on this issue and I look forward to the Public Health Agency coming forward with what I know will be some good opportunities to raise awareness on this issue. You're right in saying that it affects everyone. It's one of those issues that is talked about a lot. It is finally not a private issue, but has become a public policy issue. We still don't do enough to coordinate across the country on this, and we look forward to doing that.Department of HealthDomestic violenceSupplementary estimates (B) 2013-2014350815635081573508158350815935081603508161350816235081633508164WladyslawLizonMississauga East—CooksvilleWladyslawLizonMississauga East—Cooksville//www.ourcommons.ca/Parliamentarians/en/members/71693WladyslawLizonWladyslaw-LizonMississauga East—CooksvilleConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/LizonWladyslaw_CPC.jpgInterventionMr. Wladyslaw Lizon: (1630)[English]Maybe quickly I'll ask one of the officials, then, how the collaboration with provinces and territories on this issue is going so far.Department of HealthDomestic violenceFederal-provincial-territorial relationsSupplementary estimates (B) 2013-20143508167BenLobbHuron—BruceRonaAmbroseHon.Edmonton—Spruce Grove//www.ourcommons.ca/Parliamentarians/en/members/25447RonaAmbroseHon.Rona-AmbroseEdmonton—Spruce GroveConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/42/AmbroseRona_CPC.jpgInterventionHon. Rona Ambrose: (1630)[English]I would just say one thing. Interestingly, provinces are doing, each in their own capacity, different levels of work in this area. They're encouraged to know that we want to work together on information sharing and whatnot. But I look forward to a better opportunity to see the provinces wanting to engage us on this. Department of HealthDomestic violenceFederal-provincial-territorial relationsSupplementary estimates (B) 2013-20143508168WladyslawLizonMississauga East—CooksvilleWladyslawLizonMississauga East—Cooksville//www.ourcommons.ca/Parliamentarians/en/members/35600BenLobbBen-LobbHuron—BruceConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/LobbBen_CPC.jpgInterventionThe Chair: (1635)[English]Thank you very much. That should conclude the minister's time. I thank the minister and her staff for being present here for an hour. I'd also like to thank my colleagues for keeping their questions tight and to the time and for asking them in a respectful manner.We will suspend for a couple of minutes. Those who need to leave may do so. When we resume we'll have the departmental staff here to answer questions for about 40 minutes, and then we'll have 10 minutes to go over the supplementary estimates and vote on them. We are suspended. (1630)(1635)The Chair: We'll call the meeting back to order. We welcome our colleagues who are here from the various departments throughout Health Canada. We'll get started in just a few minutes. We're going into our five-minute rounds. Ms. Davies will start off, and then we'll rotate through our regular session. I'd like to remind my colleagues and anyone in the audience that if you have a mobile phone, please set it to “silent” or “vibrate” so that we don't hear it ringing during the question and answer period. I'd also ask that no pictures be taken with your mobile phones during the committee meeting—just to be clear. As I said, we'll go till about 5:20, and at that time we'll conclude this portion of our meeting and we'll go through supplementary estimates. I thank you in advance. Ms. Davies, you have five minutes to start, please.Department of HealthSupplementary estimates (B) 2013-201435081703508171350817235081733508174350817535081763508177350817835081793508180WladyslawLizonMississauga East—CooksvilleLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1635)[English] Thank you very much to officials who are remaining, because there are obviously a lot more questions that we have. I actually want to focus my five minutes on the most recent issue of the Canadian Medical Association Journal, where a very strong editorial was written expressing their concern about the fact that RU-486, mifepristone—which is basically a medical abortion pill—has not yet been approved in Canada. It is registered in 57 countries. It's a pill that provides very safe access for a medical abortion, particularly for women in rural and remote countries. I think there's a lot of concern, and certainly when we see an editorial in the Canadian Medical Association Journal questioning why it hasn't been approved in Canada and why it's taking so long.... It's very timely that you're here, and hopefully we can get some answers on that. The subtext of it is that more and more people are very concerned that there is an increasing politicization of medical decisions in Canada. We just had a little back-and-forth about the special access program and the SALOME trial program. There is a lot of concern that this is yet another example where we see the politicization of what should be an expert medical decision. Obviously this pill that's been approved in other countries is extremely important in terms of access and safety for women, so what's the holdup in Canada? Why have we not approved it, and why is it still sitting there to the extent that the Canadian Medical Association Journal now feels compelled to write a very strong editorial about it?AbortionDepartment of HealthPharmaceuticalsSupplementary estimates (B) 2013-201435081813508182350818335081843508185BenLobbHuron—BruceGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont (Deputy Minister, Department of Health): (1640)[English]The answer is relatively simple. To date, no company has applied to market the product in Canada. Obviously if we receive such an application, we would study very much the data, the experience in other countries, and we would try to deal with it as quickly as possible. AbortionDepartment of HealthPharmaceuticalsSupplementary estimates (B) 2013-201435081863508187LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1640)[English]Given that it has been registered in other countries and approved.... I know it's been available in the U.S. since 2000, so it has a history, and it's not a new drug, although, as you point out, it's not yet being used in Canada. How long would that process take if there were an application made?Department of HealthSupplementary estimates (B) 2013-20143508188GeorgeDa PontGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1640)[English]I can't speculate on how long it would take. It would depend on the application.But in this case, given widespread use, given lots of data from other countries, I would expect it would go faster than normal applications. Department of HealthSupplementary estimates (B) 2013-201435081893508190LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1640)[English]Okay. I'd just like to ask some questions about the very major changes that are going to take place to the medical marijuana program, which are going to come in next March. I don't know about you, but we've had lots of emails from people. There are a number of concerns, but the ones that hit the top of the list are these: first of all, the new program will eliminate personal production; second, there is a lot of concern about the cost going from $1.80 a gram to $5 a gram and up to $8.80 per gram; and third, what have commonly been referred to as the compassion clubs or the community-based dispensaries are completely knocked out of the new system. I just wonder if any of the officials here today can comment on why the decision was made to eliminate personal production, particularly for low-income people. As well, why was the decision made to, in effect, eliminate the community-based dispensaries that do have their own association, they have quality control, and they're very professional about what they do? It seems a shame to waste the expertise, the knowledge, and the local access they've developed, basically putting patients first. We're going to lose that under this new system.Department of HealthMarihuana Medical Access RegulationsMarijuanaMedical techniques and proceduresSupplementary estimates (B) 2013-20143508193350819435081953508196BenLobbHuron—BruceGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1640)[English]Again, let me offer a few comments on that. The reason that a new approach was taken and a new program was put in place is because the existing model of personal production had very significant diversion from its intended purpose. And both municipalities and law enforcement were raising significant issues. We very much realize the importance of having access. We believe that with the new system, which will be based on licensed producers, which will also have strong quality control processes in place that will be subject to regular inspection and will have careful tracking, we'll find that appropriate balance between ensuring that people have access to marijuana for medical purposes, but also taking into account the legitimate public safety and community concerns that were raised. In terms of your question on price, it remains to be seen how that works out in terms of the marketplace. But what I can say is that the existing program right now is very heavily subsidized. We believe the new program will be a significant improvement. Department of HealthMarihuana Medical Access RegulationsMarijuanaMedical techniques and proceduresSupplementary estimates (B) 2013-201435081973508198350819935082003508201LibbyDaviesVancouver EastLibbyDaviesVancouver East//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1640)[English] Could I interrupt? Apparently there was an application made in Canada for the RU-486. There was an application made, so maybe you could check that.Department of HealthSupplementary estimates (B) 2013-20143508202GeorgeDa PontGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1640)[English]I will double-check that, because the information I received was the opposite.Department of HealthSupplementary estimates (B) 2013-20143508203LibbyDaviesVancouver EastBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1640)[English]Could we ask Mr. Da Pont if he would get back to the committee about whether or not there is an application? Thank you.Department of HealthSupplementary estimates (B) 2013-20143508207BenLobbHuron—BruceBenLobbHuron—BruceGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1640)[English]Yes, I certainly will. Department of HealthSupplementary estimates (B) 2013-20143508209BenLobbHuron—BruceBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/59226EarlDreeshenEarl-DreeshenRed DeerConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/DreeshenEarl_CPC.jpgInterventionMr. Earl Dreeshen (Red Deer, CPC): (1640)[English]Thank you very much, Mr. Chair.I welcome our guests today.As a food producer, I'm extremely proud of what we've done as far as ensuring food safety goes. Certainly, we're world renowned for what we do. We've been involved with ParlAmericas and in discussions with Central America and South America in talking about food security and food safety. Of course, they look to Canada as a model.But we still need to remain vigilant. Of course, food safety is important to all Canadians, and just as it's important that Canadian consumers remember their lessons from home economics class on proper food preparation, it's also important that those companies that handle our food prioritize food safety as well. So the fact that the Canadian Food Inspection Agency has been transferred from the agriculture department to Health is truly a logical statement. I know that Ms. Fry spoke about that earlier.Could you comment on the work that has been done so far to improve food safety even further?Canadian Food Inspection AgencyDepartment of HealthFood safetyInspections and inspectorsSupplementary estimates (B) 2013-201435082123508213350821435082153508216BenLobbHuron—BruceBruceArchibaldBruceArchibaldBruce-ArchibaldInterventionDr. Bruce Archibald (President, Canadian Food Inspection Agency): (1645)[English]Thank you for the question. There are a number of areas in which I think the government has made some significant investments in terms of improving Canada's overall food safety system, which, as you mentioned, is already highly regarded throughout the world. I think some of the more recent investments that have been announced, coming out of a review of various programs, include the establishment of inspection verification teams that are going to help us improve the overall performance of Canada's entire food inspection system. This allows us to establish various teams across the country to move in and work on evaluation and ensure that the system is actually meeting its various objectives, and to continue to make investments to look at Canada's overall prevention and detection of food-borne diseases through our listeria response to the Weatherill report in terms of inspection in various areas. We've also continued to make investments in the meat area, with a daily presence of inspectors in all our federally inspected meat facilities, to ensure that we comply not only with our own requirements, but also with international requirements that facilitate trade. As well, we continue to work with Health Canada and the Public Health Agency of Canada to improve detection of and response to food-borne outbreaks.As you mentioned, I think there has always been good cooperation between the agency and the department and the Public Health Agency. I think these new reporting relationships actually allow us to strengthen that going forward in terms of our cooperation and working together.Those are just a couple of examples of areas where we continue to make investments to further strengthen the system.Canadian Food Inspection AgencyDepartment of HealthFood safetyInspections and inspectorsSupplementary estimates (B) 2013-2014350821735082183508219350822035082213508222EarlDreeshenRed DeerEarlDreeshenRed Deer//www.ourcommons.ca/Parliamentarians/en/members/59226EarlDreeshenEarl-DreeshenRed DeerConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/DreeshenEarl_CPC.jpgInterventionMr. Earl Dreeshen: (1645)[English]We've heard comments about some dollars coming out of CFIA when they were talking about food inspectors, but of course it had nothing to do with that. There was actually an increase in food inspectors and millions of dollars in new funding in order to help and prepare, so some of the things we heard from other sides have perhaps confused the issue.Could you expand somewhat on the Safe Food for Canadians Act and the things that are happening there? I see a lot of that included in this brochure the minister presented to us, and of course this is something that many Canadians should take a look at. As I say, it's going back to what you should have learned in your home economics classes about how much you cook your food and the cleaning of the food and so on. I think that's important.Could you expand upon that a little and give us a bit of an idea about what this brochure is and what it does to help Canadians?Department of HealthFood and beverage manufacturing industryFood safetyRegulationS-11, An Act respecting food commodities, including their inspection, their safety, their labelling and advertising, their import, export and interprovincial trade, the establishment of standards for them, the registration or licensing of persons who perform certain activities related to them, the establishment of standards governing establishments where those activities are performed and the registration of establishments where those activities are performedSupplementary estimates (B) 2013-2014350822335082243508225BruceArchibaldBruceArchibaldBruceArchibaldBruce-ArchibaldInterventionDr. Bruce Archibald: (1645)[English]Yes, absolutely. I'm going to ask my colleague Paul Mayers, who is our associate vice-president in policy and programs, to expand a bit on that.Department of HealthFood and beverage manufacturing industrySupplementary estimates (B) 2013-20143508226EarlDreeshenRed DeerPaulMayersPaulMayersPaul-MayersInterventionMr. Paul Mayers (Associate Vice-President, Programs, Canadian Food Inspection Agency): (1645)[English] Thank you very much for the question.As the minister noted in her remarks, the framework focuses on promotion, prevention, and protection. Those three elements together reflect the work of not just the Canadian Food Inspection Agency but our colleagues in Health Canada and the Public Health Agency of Canada, in terms of an overall focus on strengthening Canada's already excellent food safety system. In the context of the Canadian Food Inspection Agency, as we look across that framework, one particular area that I'll draw attention to is the Safe Food for Canadians Act and the work we're doing currently under the action plan to bring the legislation into force. We've undertaken a significant consultative effort with Canadians around improvement, and a centrepiece to that is an improved food inspection system. Even though the food inspection system in Canada is strong, we recognize that there are opportunities to further strengthen that system to enhance the tools available to our front-line inspection staff, to ensure we have an integrated approach to information, to strengthen the support for our front-line staff in terms of decision-making, and to strengthen the risk basis for our system.We're very proud of founding our decisions on science. We're building on that by introducing a strengthened focus on risk to guide the application of our inspection resources, so they have the greatest impact as we undertake our business in order to provide that protection for Canadians.Canadian Food Inspection AgencyDepartment of HealthFood and beverage manufacturing industryFood safetyRegulationSupplementary estimates (B) 2013-201435082273508228350822935082303508231BruceArchibaldBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/71717JayAspinJay-AspinNipissing—TimiskamingConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/AspinJay_CPC.jpgInterventionMr. Jay Aspin (Nipissing—Timiskaming, CPC): (1650)[English]Thank you, Mr. Chair.Welcome to our guests today.I'd like to pursue a few questions with regard to CFIA, so I guess they would be addressed to Mr. Archibald and/or Mr. Mayers.CFIA's authorities to date are just under $720 million, and it has requested almost $40 million in transfers and adjustments in these two supplementary estimates. There is about one-quarter of the requested funds, according to the supplementary estimates document pages 2 to 9, that are to go to maintaining an increased frequency of food inspections in meat processing establishments.When and how did the frequency of inspections of meat processing establishments increase?Canadian Food Inspection AgencyDepartment of HealthFood safetyInspections and inspectorsSupplementary estimates (B) 2013-201435082343508235350823635082373508238BenLobbHuron—BruceBruceArchibaldBruceArchibaldBruce-ArchibaldInterventionDr. Bruce Archibald: (1650)[English]There was an international audit done in 2009 that identified a number of areas where Canada was doing inspection in various meat processing facilities for both domestic and international use. One of the audit findings concluded that there needed to be more presence in terms of the facilities to ensure we were meeting all our domestic and international requirements.As a result of that, there was an initial investment in budget 2010 of $26 million over two years to deal with a daily presence of inspection at all federally inspected meat processing establishments, both export and domestic. We expanded the number of inspectors and supervisors of program specialists and the training related to that. The request in supplementary estimates that you see for this is a continuation of that work, a continuing daily presence for 2012-13, as well as going forward in 2013 and 2014.The original work was a result of an audit that was done. The government made investments, and part of the supplementary estimates request is to continue that work. Canadian Food Inspection AgencyDepartment of HealthFood safetyInspections and inspectorsSupplementary estimates (B) 2013-2014350823935082403508241JayAspinNipissing—TimiskamingJayAspinNipissing—Timiskaming//www.ourcommons.ca/Parliamentarians/en/members/71717JayAspinJay-AspinNipissing—TimiskamingConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/AspinJay_CPC.jpgInterventionMr. Jay Aspin: (1650)[English]CFIA is a partner with Health Canada and PHAC in two initiatives listed in these supplementary estimates: enhancing the ability to prevent, detect, and respond to food-borne illnesses; and streamlining government import regulations and border processes for commercial trade. Approximately $15 million is requested in these supplementary estimates for the two initiatives combined.Could you please describe CFIA's role in these two initiatives?Canadian Food Inspection AgencyDepartment of HealthFood safetyImportsSupplementary estimates (B) 2013-201435082423508243BruceArchibaldBruceArchibaldBruceArchibaldBruce-ArchibaldInterventionDr. Bruce Archibald: (1650)[English] I'm going to ask Paul to respond to this one.Department of HealthSupplementary estimates (B) 2013-20143508244JayAspinNipissing—TimiskamingPaulMayersPaulMayersPaul-MayersInterventionMr. Paul Mayers: (1650)[English]Thank you.Let me start with the second in terms of import control. The focus on strengthening Canada's import controls stems from the interests that Canadians have expressed in greater assurance that foods imported into Canada meet Canadian requirements. So the Canadian Food Inspection Agency has been enhancing its activities in terms of import control as a direct response to that interest expressed by Canadians. The Government of Canada has invested in CFIA in order to enable that activity, and again, as noted in other areas, the supplementary estimates reflect our ability to continue that work. What we have done with that investment focuses on carrying out blitzes in collaboration with our colleagues at the Canada Border Services Agency, in carrying out targeted activities in response to where we've identified potential areas of risk associated with foods, particularly foods imported from countries whose food safety systems are weaker than our own. Canadians have indicated their interest in this and the agency has responded.The other aspect that you note, in terms of our investigative capacity in collaboration with our colleagues in the Public Health Agency...it allows us to respond to food-borne illness events in terms of investigation, leading ultimately to the withdrawal from the market of suspect products demonstrated to be associated with such events. These actions, again consistent with the framework the minister has announced, enabled the protection element the minister noted. Canadian Food Inspection AgencyDepartment of HealthFood safetyImportsSupplementary estimates (B) 2013-20143508245350824635082473508248BruceArchibaldJayAspinNipissing—Timiskaming//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1655)[English] Thank you very much, Mr. Chair. I want to go back to a question I had asked earlier. I gather that you didn't have the time to answer it because my time was up. I don't think I would get disagreement from any one of the officials around the table that in fact if you are going to make good public policy, or if you are going to make any kind of good health decisions, then you have to look at evidence. Evidence drives it all. Outcome drives everything. I had asked earlier about HAART, the active antiretroviral programs that go on in British Columbia. British Columbia is the only province in Canada that has this program. It has caused a decrease. If we're talking about outcomes, then, what is it we're seeing in terms of evidence? The evidence is that British Columbia, since it adopted this program, is the only place—the only province, place, anywhere in North America—where the number of new cases of HIV is going down dramatically. Everywhere else, in every other province in Canada, and in the United States, it is going up, remarkably up. In fact, I would like to tell you that in 1995 there were 18 cases per 100,000 in British Columbia. Now there are six cases per 100,000. That's a huge drop. In Saskatchewan, for example, there were two per 100,000 in 1995. There were 16 per 100,000 in 2011. Everywhere, in every jurisdiction, this has been proven to be important. We know that the medication stops the transmission of the virus because the virus is gone. It is not present in the blood. I would hope that given the cost of taking care of every patient with new HIV, this would become a really important thing for the Canadian government to adopt, or for anyone to keep looking at, when this has been going on now for quite a while in British Columbia. In fact, Brazil has adopted this policy wholeheartedly. The United Kingdom has adopted this treatment wholeheartedly. France has adopted the treatment wholeheartedly. We also see that the U.S. is already onside to adopt it wholeheartedly. This should be, as I said, a triumph for Canada. This is a Canadian initiative, done here, built here. We should be proud of this. No one wants to even speak to the people from the BC Centre for Excellence in HIV/AIDS. Well, no one at the political level; I'm sure bureaucrats have been speaking. What is it that prevents, with such remarkable outcomes, Health Canada from even looking at this in a way that...?You can say that we're continuing to assess it, but it's been assessed. It's been assessed internationally. Peer reviews have shown that it works. The World Health Organization is saying that everyone should adopt it. China has adopted it, for crying out loud. I just want to know why, when we could save lives and save costs in the health care system for every new case that we don't get, we are doing this. We could take that money and put it elsewhere in the system. I just want to understand what is driving the decision to completely ignore and not adopt this when British Columbia is now being asked to international conferences. British Columbia is not Canada, but British Columbia is being asked to come and sit at the table with other nation-states. Can someone explain this to me?AIDS and HIVAntiretroviral drugsDepartment of HealthHighly Active Antiretroviral TherapySupplementary estimates (B) 2013-20143508252350825335082543508255350825635082573508258350825935082603508261350826235082633508264350826535082663508267BenLobbHuron—BruceKristaOuthwaiteKristaOuthwaiteKrista-OuthwaiteInterventionMrs. Krista Outhwaite: (1700)[English]I'll perhaps just add to my previous response. It's an important question that you're raising. I would also like to introduce our deputy chief public health officer, Dr. Greg Taylor, who may also wish to make a few comments. There is no doubt that the work in British Columbia, the work of Dr. Montaner, is very interesting, promising, and is delivering results in that particular context. I would say to the committee and to the member that we are not ignoring that work, not at all. In fact, it is a topic of discussion not only with our partners in the HIV/AIDS sector, the ministerial advisory committee on the federal initiative, as well as the national partners that we engage with on HIV/AIDS, but also with our provincial and territorial partners. British Columbia is bringing the concept to the table, and it forms part of the discussion of our public health network council in terms of how to best place this, how to look at this, in the array of responses to HIV/AIDS that this country is undertaking. As I mentioned in my previous comments, this is also a topic of conversation, as the member has pointed out, at the World Health Organization, the World Health Assembly, and we also looked at it at the International AIDS Conference. There have been advancements in the area of HIV/AIDS. People who have this disease are living much longer than they used to, and we are encouraged by that. Also, there has been huge progress made in terms of maternal transmission. Fewer and fewer children are contracting the disease. AIDS and HIVAntiretroviral drugsDepartment of HealthHighly Active Antiretroviral TherapySupplementary estimates (B) 2013-20143508268350826935082703508271350827235082733508274HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1700)[English] I'm sorry, Ms. Outhwaite, but I know all this, and I think most of us know that.I'm saying that this is not simply treatment that keeps people living longer with the disease; this prevents the disease from being transmitted. It would seem to me to be the first thing one would want to do. British Columbia has done it, with the success that I'm showing you here. They have brought down the rate of new cases by 60%. We have 4,000 new cases a year here in Canada. If we can bring that down by 60%, it would be a remarkable thing.Department of HealthSupplementary estimates (B) 2013-201435082753508276KristaOuthwaiteBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1700)[English]Sorry. I'm still not getting the answer I want. Department of HealthSupplementary estimates (B) 2013-20143508278BenLobbHuron—BruceBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1700)[English]“Looking at it” is not a good answer. I'm sorry.Department of HealthSupplementary estimates (B) 2013-20143508280BenLobbHuron—BruceBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/71477IsabelleMorinIsabelle-MorinNotre-Dame-de-Grâce—LachineNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinIsabelle_NDP.jpgInterventionMs. Isabelle Morin: (1700)[Translation]Thank you very much, Mr. Chair.I have one quick question, and I will share the rest of my time with my colleague.Mr. Mayers, you told us about the three P triangle in public health: promotion, prevention and protection. Promotion seems to be very important. As the minister said earlier, a great deal is done to promote healthy food, nutritional value and so forth. Prevention and protection require regulations. How would you balance these three aspects? As fas as I know, there is no balance. One seems far more important for the department than another.We know that European standards are considerably higher than ours. Why can't Canada have the same standards as Europe when it comes to healthy food?Department of HealthFood safetyHealthSupplementary estimates (B) 2013-20143508286350828735082883508289BenLobbHuron—BrucePaulMayersPaulMayersPaul-MayersInterventionMr. Paul Mayers: (1705)[English]I might disagree that the European standards for food are significantly different than they are in Canada. Certainly among all countries, one finds modest differences. But the reality is that our European colleagues work very closely with us in the area of food standards under the United Nations Committee Codex Alimentarius, the international standard-setting body for foods. Canada, like the European Union, often bases its standards on Codex Alimentarius standards. Our European colleagues have a very rich trading relationship with us here in Canada, and while there are certainly some modest differences across many areas of the food supply, we are recognized by the European Union as equivalent. The focus is on not identical but equivalent outcomes, and that's critical to our success.Department of HealthFood safetyHealthSupplementary estimates (B) 2013-20143508290IsabelleMorinNotre-Dame-de-Grâce—LachineIsabelleMorinNotre-Dame-de-Grâce—Lachine//www.ourcommons.ca/Parliamentarians/en/members/71477IsabelleMorinIsabelle-MorinNotre-Dame-de-Grâce—LachineNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinIsabelle_NDP.jpgInterventionMs. Isabelle Morin: (1705)[Translation]I do not quite agree with what you said about standards.Since we do not have much time and I would like to leave some time for my colleague, I would like you to tell me about the relationship between promotion, prevention and protection. After which my colleague can have the rest of my time.Department of HealthSupplementary estimates (B) 2013-201435082913508292PaulMayersPaulMayersPaulMayersPaul-MayersInterventionMr. Paul Mayers: (1705)[English]The question you pose on promotion, prevention, and protection is not a question solely for the Canadian Food Inspection Agency, because all the agencies represented here have and play an active role in that regard. As Canada's largest regulator, we at the Canadian Food Inspection Agency are particularly focused on the prevention and protection elements of the framework. When you posed the question about balance, the balance is achieved across all three partners, as opposed to only one partner. At CFIA, we are more heavily focused on the regulatory elements, regulatory requirements, and enforcing those requirements, while others in the portfolio use promotion, so it is the balance achieved across all three that ultimately reflects the full suite of activities under the framework.In our context, the Safe Food for Canadians Act and its regulations form our core.Department of HealthSupplementary estimates (B) 2013-20143508293350829435082953508296IsabelleMorinNotre-Dame-de-Grâce—LachineWayneMarstonHamilton East—Stoney Creek//www.ourcommons.ca/Parliamentarians/en/members/681WayneMarstonWayne-MarstonHamilton East—Stoney CreekNew Democratic Party CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MarstonWayne_NDP.jpgInterventionMr. Wayne Marston: (1705)[English]Thank you, Mr. Chair.I'll pose my first question to Mr. Da Pont.There's been a lot of commentary lately that some departments have not spent their full budget from 2012–13. Has this department spent its full budget in that budget year?Department of HealthLapsed fundsSupplementary estimates (B) 2013-20143508297350829835082993508300PaulMayersGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1705)[English] No, we had a bit larger than usual carry-forward. Every department doesn't spend its full budget every year. Last year Health Canada had a larger carry-forward than normal, and that was due largely to some change trends in the first nations and Inuit health program, where spending didn't develop as we had projected.Department of HealthLapsed fundsSupplementary estimates (B) 2013-20143508301WayneMarstonHamilton East—Stoney CreekWayneMarstonHamilton East—Stoney Creek//www.ourcommons.ca/Parliamentarians/en/members/681WayneMarstonWayne-MarstonHamilton East—Stoney CreekNew Democratic Party CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MarstonWayne_NDP.jpgInterventionMr. Wayne Marston: (1705)[English]Health Canada right now is requesting almost $3.2 million in additional funds to prevent, detect, and respond to food-borne illnesses. It shares that role with CFIA and others. What I'm interested in is, what activities are associated with prevention, detection, and the response to these illnesses? What will those dollars buy?Canadian Food Inspection AgencyDepartment of HealthFood safetySupplementary estimates (B) 2013-20143508302GeorgeDa PontGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1705)[English]It complements the response that was given by CFIA to the earlier question. The Health Canada role is to set standards and policies, and then CFIA implements those standards and policies. The specific funding and the enhancements for Health Canada are to work on reviewing standards. It's to increase our capacity to do health hazard assessments. When you have a potential food recall, it's Health Canada that assesses the risk, and then CFIA takes appropriate action. Finally, some of the money is also spent on the scientific side to develop new tests and models that would help us to detect some of these pathogens faster than would otherwise be the case.Canadian Food Inspection AgencyDepartment of HealthFood safetySupplementary estimates (B) 2013-20143508303WayneMarstonHamilton East—Stoney CreekWayneMarstonHamilton East—Stoney Creek//www.ourcommons.ca/Parliamentarians/en/members/681WayneMarstonWayne-MarstonHamilton East—Stoney CreekNew Democratic Party CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MarstonWayne_NDP.jpgInterventionMr. Wayne Marston: (1710)[English]Is any part of that added cost related to the fact that CFIA is now in the health portfolio?Department of HealthSupplementary estimates (B) 2013-20143508304GeorgeDa PontGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1710)[English]No, there's been no change in the responsibilities between Health Canada, the Public Health Agency of Canada, and CFIA, so it was not generated by that. In fact, those are responsibilities that the various departments and agencies shared prior to CFIA's coming to the portfolio.Department of HealthSupplementary estimates (B) 2013-20143508305WayneMarstonHamilton East—Stoney CreekBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/71688EveAdamsEve-AdamsMississauga—Brampton SouthLiberal CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/AdamsEve_CPC.jpgInterventionMs. Eve Adams: (1710)[English]Thanks very much.I noted that the supplementary estimates reflect a rather sizable increase for patient-oriented research and food inspection and a decrease for travel in the ministry. Could you speak to that last item, the decrease in travel expenses?Department of HealthMedical researchPatientsSupplementary estimates (B) 2013-201435083083508309BenLobbHuron—BruceGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1710)[English]I can do that for Health Canada, and colleagues may wish to respond for their own elements. You'll see that there's a decrease of about $1.1 million in travel. Within Health Canada, we work very hard to try to find the best efficiencies we can. What that means is that we're using far more video conferencing. We're looking at alternatives to get our job done without doing as much travel as we did before, so it reflects an efficiency savings.We do, however, undertake all of the critical travel that's required. We put in place an internal process to monitor that and ensure that the critical stuff gets done.Department of HealthMedical researchPatientsSupplementary estimates (B) 2013-2014350831035083113508312EveAdamsMississauga—Brampton SouthEveAdamsMississauga—Brampton South//www.ourcommons.ca/Parliamentarians/en/members/71688EveAdamsEve-AdamsMississauga—Brampton SouthLiberal CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/AdamsEve_CPC.jpgInterventionMs. Eve Adams: (1710)[English]There are still investments being made to patient-oriented research, for instance. Would these be new moneys?Department of HealthSupplementary estimates (B) 2013-20143508313GeorgeDa PontGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1710)[English]Yes, and I think colleagues would want to speak to that. Jane.Department of HealthSupplementary estimates (B) 2013-201435083143508315EveAdamsMississauga—Brampton SouthJaneAubinJaneAubinJane-AubinInterventionDr. Jane Aubin (Chief Scientific Officer and Executive Vice-President, Research and Knowledge Translation, Canadian Institutes of Health Research): (1710)[English]The patient-oriented strategy led by CIHR on behalf of the government was initiated in 2011. Through our collaborations with the provinces, we've ramped up activities and made great progress over the last year. The new moneys are to allow us to continue to roll out the specific programs that come under the patient-oriented strategy, including, as the minister mentioned in her remarks, the support units that are jurisdictionally based, provincially based, and territorially based. The first four have been adjudicated by an international panel. The first was announced in Alberta just about a week ago, and announcements on the others that have been adjudicated will be coming up shortly. Others are sending in their business plans, which will also be adjudicated. We need to continue to roll them out across the country.Canadian Institutes of Health ResearchDepartment of HealthMedical researchPatientsSupplementary estimates (B) 2013-20143508316GeorgeDa PontEveAdamsMississauga—Brampton South//www.ourcommons.ca/Parliamentarians/en/members/71688EveAdamsEve-AdamsMississauga—Brampton SouthLiberal CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/AdamsEve_CPC.jpgInterventionMs. Eve Adams: (1710)[English]Thank you.One final question: when it comes to prescription drug labelling, could you advise us of the changes that Health Canada has made?Department of HealthPackaging and labellingPrescription drugsSupplementary estimates (B) 2013-201435083173508318JaneAubinGeorgeDa PontPaulGloverPaul-GloverInterventionMr. Paul Glover (Associate Deputy Minister, Department of Health): (1710)[English]With respect to prescription drugs, we are working to make sure that the information that's contained, both for physicians and for consumers, is significantly easier to read. So we're introducing a series of steps. By means of these, the prescribers can make sure they have the information to determine the appropriate course of action for the patient. They know when to use it and when not to use it. They will know the potential side effects so they can make an informed choice. We're also working to make sure that this information is easier for consumers to understand, so they can participate in a dialogue with their physicians.In addition, as the minister said, we're looking to make summaries of our drug safety reviews available. We hope to have the first one later this fiscal year. That's an important step in furthering transparency.Department of HealthPackaging and labellingPrescription drugsSupplementary estimates (B) 2013-201435083203508321GeorgeDa PontEveAdamsMississauga—Brampton South//www.ourcommons.ca/Parliamentarians/en/members/71688EveAdamsEve-AdamsMississauga—Brampton SouthLiberal CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/AdamsEve_CPC.jpgInterventionMs. Eve Adams: (1710)[English] I will ask one final question and split my time with the Honourable Laurie Hawn.Finally, the investments that we'll be transferring to the provinces will reach an historic $40 billion by the end of the decade.Could you briefly speak to the assistance we're providing to provinces and territories so that they can roll out their priorities, especially when it comes to health human resources?Department of HealthSupplementary estimates (B) 2013-2014Transfers to provinces and territories350832235083233508324PaulGloverGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1710)[English]Let me start, and then colleagues may wish to elaborate.As you've noted, there is now stable, predictable funding, creating a known envelope within which the provinces can do planning. In addition, the government continues to make significant investments in a number of other areas.As the minister noted in her remarks, there have been investments of more than $2 billion to date in Canada Infoway. The provinces and territories match a chunk of that money for specific projects and are focused very much on getting eHealth and electronic medical records in place. There are also the significant investments of about $1 billion a year from CIHR as well.The minister has met with her provincial colleagues and is looking for areas of collaboration in which we can continue to support them and the improvements they're trying to make in their actual health care delivery.Department of HealthSupplementary estimates (B) 2013-2014Transfers to provinces and territories3508325350832635083273508328EveAdamsMississauga—Brampton SouthLaurieHawnHon.Edmonton Centre//www.ourcommons.ca/Parliamentarians/en/members/31267LaurieHawnHon.Laurie-HawnEdmonton CentreConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/HawnLaurie_CPC.jpgInterventionHon. Laurie Hawn: (1715)[English]Thank you. And thanks for saving a couple of minutes for me. I just have one quick question. A number of times over the last several years I've had conversations with Dr. Louis Francescutti, who is the head of the Canadian Medical Association. He had some pretty firm opinions that we could save massive amounts of money in the injury prevention area. I'm curious to know whether he has brought any of those ideas to Health Canada, or to whoever is involved, and what we may be doing with those.Department of HealthSafetySupplementary estimates (B) 2013-201435083293508330GeorgeDa PontGeorgeDa PontGeorgeDa PontGeorge-DaPontInterventionMr. George Da Pont: (1715)[English]Krista will address that.Department of HealthSupplementary estimates (B) 2013-20143508331LaurieHawnHon.Edmonton CentreKristaOuthwaiteKristaOuthwaiteKrista-OuthwaiteInterventionMrs. Krista Outhwaite: (1715)[English]Thank you, Mr. Chair, for the important question.There's absolutely no doubt that the newly elected president of the CMA is firmly focused on injury prevention as one of his areas of interest.As you would know, this government invested in the Active and Safe injury prevention initiative a couple of years back. It was a program designed to run over two years to raise awareness and build some interest in this particular area and to encourage other partners in the private sector to come to the table to work on such important issues as preventing concussions in sport, safe swimming practices, particularly in first nations communities, helmet protection for ATV use among the Inuit in northern territories, as well as working with parachutes and the Lifesaving Society of Canada, so that they can better reach communities in their areas. We are now exploring with Parachute Canada what more work can be done.Department of HealthSafetySupplementary estimates (B) 2013-2014350833235083333508334GeorgeDa PontLaurieHawnHon.Edmonton Centre//www.ourcommons.ca/Parliamentarians/en/members/31267LaurieHawnHon.Laurie-HawnEdmonton CentreConservative CaucusAlberta//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/HawnLaurie_CPC.jpgInterventionHon. Laurie Hawn: (1715)[English]He was talking a lot about the workplace, and as you know, he's very passionate about it. He was pointing to examples of countries—I can't remember the countries, but a number of countries around the world—that have implemented some of the programs he has been promoting, apparently with very dramatic results. I'm wondering whether we have encouraged, and if not whether we could encourage, some movement in that direction.Department of HealthSupplementary estimates (B) 2013-201435083353508336KristaOuthwaiteKristaOuthwaiteKristaOuthwaiteKrista-OuthwaiteInterventionMrs. Krista Outhwaite: (1715)[English]Our colleagues at Labour Canada are very much engaged in that particular area, ensuring that programs are working not only for the federal community but for employees wherever they find themselves.Department of HealthSupplementary estimates (B) 2013-20143508337LaurieHawnHon.Edmonton CentreLaurieHawnHon.Edmonton Centre//www.ourcommons.ca/Parliamentarians/en/members/35600BenLobbBen-LobbHuron—BruceConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/LobbBen_CPC.jpgInterventionThe Chair: (1720)[English] We'll resume the meeting. Now we're into the real detail of the meeting, supplementary estimates.I want to ask the committee their opinion first, and then we'll get into this.There are ten different line items to vote on. We can do them individually or we can lump them all together in one amount. I can ask for the unanimous consent of the committee to vote on one dollar amount, one line item, and then I'll also ask your permission to report back to the House of Commons.Are there any thoughts on lumping these ten dollar amounts into one?The NDP supports that.Ms. Fry, what is the view of the Liberals on that?Department of HealthSupplementary estimates (B) 2013-2014350834335083443508345350834635083473508348BenLobbHuron—BruceHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/35600BenLobbBen-LobbHuron—BruceConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/LobbBen_CPC.jpgInterventionThe Chair: (1720)[English]On the estimates. We have ten line items to ask from. We can do ten in a row or we can just do it in a lump sum.Department of HealthSupplementary estimates (B) 2013-20143508350HedyFryHon.Vancouver CentreHedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1589HedyFryHon.Hedy-FryVancouver CentreLiberal CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/FryHedy_Lib.jpgInterventionHon. Hedy Fry: (1720)[English] Let's do it in a lump sum.Department of HealthSupplementary estimates (B) 2013-20143508351BenLobbHuron—BruceBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/35600BenLobbBen-LobbHuron—BruceConservative CaucusOntario//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/44/LobbBen_CPC.jpgInterventionThe Chair: (1720)[English]Okay, thank you very much. That's good. I like how everybody has come to a consensus here. We have 10 line items. My trusty clerk has them all listed. I'll ask for the committee's unanimous consent. Shall all the votes under the supplementary estimates (B) carry?HEALTHDepartmentVote 1b—Operating expenditures..........$235,479,489Vote 5b—Capital expenditures..........$1Vote 10b—The grants listed in the Estimates and contributions.........$101,958,206Canadian Food Inspection AgencyVote 11b—Operating expenditures and contributions..........$27,973,639 Vote 13b—Capital expenditures..........$4,924,955Canadian Institutes of Health ResearchVote 15b—Operating expenditures..........$859,268Vote 20b—The grants listed in the Estimates..........$14,000,000Public Health Agency of CanadaVote 45b—Operating expenditures..........$19,719,028Vote 50b—Capital expenditures..........$1,081,962Vote 55b—The grants listed in the Estimates and contributions..........$1(Votes 1b, 5b, 10b, 11b, 13b, 15b, 20b, 45b, 50b, and 55b agreed to)The Chair: Shall the chair report votes 1b, 5b, 10b, 11b, 13b, 15b, 20b, 45b, 50b, and 55b under Health to the House?Some hon. members: Agreed.The Chair: Thank you very much.That concludes this meeting. Thank you for your attendance and your attention.The meeting is adjourned.Decisions in committeeDepartment of HealthSupplementary estimates (B) 2013-2014350835235083533508354350835535083563508357350835835083593508360350836135083623508363350836435083653508366350836735083683508369350837035083713508372350837335083743508375HedyFryHon.Vancouver Centre//www.ourcommons.ca/Parliamentarians/en/members/1598LibbyDaviesLibby-DaviesVancouver EastNew Democratic Party CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/DaviesLibby_NDP.jpgInterventionMs. Libby Davies: (1545)[English]But do you have a budget at this point to actually implement the strategy from Health Canada?Department of HealthDrug use and abuseGovernment assistanceNational Anti-Drug StrategyPrescription drugs3494166MichelPerronMichelPerronMichelPerronMichel-PerronInterventionMr. Michel Perron: (1545)[English]Not that I'm aware of from Health Canada. Health Canada can respond about what they're prepared to put on the table for that, but I know they are very much engaged—and certainly on the first nations side they are very present. The fact that they are having these discussions with FPT ministers of health and that it's in the throne speech and has expanded the reach of the national anti-drug strategy to allow for the inclusion of prescription drugs, I think, bodes well. So what all of that amounts to I can't speak to specifically.Department of HealthDrug use and abuseGovernment assistanceNational Anti-Drug StrategyPrescription drugs34941673494168LibbyDaviesVancouver EastBenLobbHuron—Bruce//www.ourcommons.ca/Parliamentarians/en/members/71477IsabelleMorinIsabelle-MorinNotre-Dame-de-Grâce—LachineNew Democratic Party CaucusQuebec//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/MorinIsabelle_NDP.jpgInterventionMs. Isabelle Morin (Notre-Dame-de-Grâce—Lachine, NDP): (1610)[Translation]Thank you very much, Mr. Chair.I want to thank the witnesses for joining us today.Mr. Perron, at the end of your presentation, you put forward three recommendations, the last of which had to do with the commitment of the resources you need.Could you elaborate on those resources? Are you talking about human or financial resources? For the committee's benefit, I would like to understand what your needs in this area are.Department of HealthDrug use and abuseGovernment assistancePrescription drugs34942733494274BenLobbHuron—BruceMichelPerronMichelPerronMichel-PerronInterventionMr. Michel Perron: (1610)[Translation]Okay.The CCSA needs resources to support the implementation of the strategy and, more specifically, to coordinate the working groups we listed earlier—the five working groups and the action teams. We have requested financial support from Health Canada to be able to take on that role....Department of HealthDrug use and abuseGovernment assistancePrescription drugs3494278IsabelleMorinNotre-Dame-de-Grâce—LachineIsabelleMorinNotre-Dame-de-Grâce—Lachine//www.ourcommons.ca/Parliamentarians/en/members/72006DavidWilksDavid-WilksKootenay—ColumbiaConservative CaucusBritish Columbia//www.ourcommons.ca/Content/Parliamentarians/Images/OfficialMPPhotos/41/WilksDavid_CPC.jpgInterventionMr. David Wilks (Kootenay—Columbia, CPC): (1615)[English]Thank you, Mr. Chair.Thanks to the witnesses for being here today. Mr. Perron, it appears that several recommendations in the First Do No Harm strategy have both CCSA and Health Canada listed. Would you explain further how CCSA's mandate differs from that of Health Canada's? Since we are looking at identifying the federal role, we want to make sure that there is no duplication of effort. Would you talk about that for a while? Then I have one more question after that.Canadian Centre on Substance Use and AddictionDepartment of HealthDrug use and abusePrescription drugs3494298BenLobbHuron—BruceMichelPerronMichelPerronMichel-PerronInterventionMr. Michel Perron: (1615)[English]Thank you, sir.Actually, that's a very good question because people often ask about the difference between the two. If we go back to the CCSA Act, which was circulated, our role is really about bringing together all levels of government, and the not-for-profit and private sectors. Our job is ensuring that the efforts and investment that Health Canada wishes to place on the table vis-à-vis on issue can best be leveraged with other levels of government—but also with those other components.CCSA's role is really about bringing together that national band of organizations and advance it beyond that of one particular department or level of government. It has worked well in other areas and has allowed the federal government and other levels of government to more precisely undertake what they see as their specific role, as opposed to having to take on all aspects of it.Did you want to comment further on that, Paula?Canadian Centre on Substance Use and AddictionDepartment of HealthDrug use and abusePrescription drugs34943003494301DavidWilksKootenay—ColumbiaPaulaRobesonRobertIaniroRobert-IaniroInterventionMr. Robert Ianiro (Director General, Controlled Substances and Tobacco Directorate, Healthy Environments and Consumer Safety Branch, Department of Health): (1530)[Translation]Thank you, Madam Chair, for the opportunity to appear before the Standing Committee on Health to speak to this important issue.My name is Robert Ianiro, and I am the director general of the Controlled Substances and Tobacco Directorate in the Healthy Environments and Consumer Safety Branch of Health Canada.[English]I am with several of my colleagues, all of whom are responsible for programs that collectively support the government's ongoing efforts to protect Canadians against the risks associated with prescription drugs.Dr. John Patrick Stewart is the senior medical director in the Health Products and Food Branch and is able to speak to Health Canada's role in establishing and maintaining prescription drug accessibility while decreasing the risk of abuse associated with certain drugs. I am also joined by Ms. Debra Gillis and Ms. Sandra Bruce, both directors general from the First Nations and Inuit Health Branch, who are able to speak to the range of activities under way to protect and promote the health of first nations and Inuit.[Translation]As committee members will be aware from various media reports and other sources, prescription drug abuse is a public health and safety issue in many areas across the country. It has been marked by increases in rates of consumption and, in many cases, addiction and death due to overdose. While there is little national-level data on prescription drug abuse presently available in Canada, there is growing evidence of the nature and scope of the problem.[English]You have probably heard media reports about OxyContin and fentanyl. These drugs are potent opioids frequently used for the relief of moderate to severe pain. According to the International Narcotics Control Board, Canada is currently the world's second largest consumer of opioids per capita, second only to the United States. Opioid pain relievers have been used for the treatment of cancer pain and in palliative care settings for many years. However, in the 1990s, these drugs started to be marketed for treatment of chronic non-cancer pain, like back pain and arthritis. OxyContin quickly emerged as one of the top prescribed opioids for pain management. Unfortunately, OxyContin became very popular for non-medical use due to the euphoric high that users obtain by crushing and injecting this drug. Shortly thereafter, communities began reporting public health concerns related to the abuse of OxyContin, as well as public safety concerns related to its diversion from legal sources to the illicit market. There is growing evidence that prescription drugs have become popular among youth, and that they increasingly represent a path to addiction for both youth and adults.(1535)[Translation]There is growing evidence that prescription drugs have become popular among youth, and that they increasingly represent a path to addiction for both youth and adults. According to the most recent Youth Smoking Survey, prescription drugs are now the third most commonly used group of substances among Canadian youth, after alcohol and marijuana.[English]Several overarching factors contribute to the growth of this problem. While Canadians understand the dangers involved with illicit drug use, there is not the same understanding of the harms related to prescription drugs. Prescription drugs are commonly perceived as safe. This misconception directly affects consumer practices on use, storage, and disposal of prescription medications. The second factor relates to inappropriate prescribing practices. Prescribers, including those from the College of Physicians and Surgeons of Ontario, have acknowledged that their lack of knowledge and training for pain management has contributed to the growth of the problem. According to a Canadian study conducted in 2009 on curricula in health professional education, veterinary students receive five times the training on this subject than medical students.[Translation]As a result, some Canadians leave their physicians' offices with prescriptions for inappropriate or excessive quantities of powerful medications without proper information about these drugs, and without the appropriate follow-up from their healthcare team.[English]As a consequence, the demand for treatment for opioid dependence has increased in many jurisdictions. In Ontario, admissions to publicly funded substance abuse centres rose by 129% between 2004 and 2011.Finally, lack of awareness of safe storage and disposal practices is an important driver. There is evidence that the home represents a common point of access to medications for abuse for many Canadians. Many unused and expired medications remain in unlocked medicine cabinets, making them vulnerable to diversion and abuse.For example, the results from the 2011 Ontario student drug use and health survey indicated that 67% of youth in Ontario who reported misusing prescription drugs obtained them from within the home as a result of a prescription from a family member.Effectively combatting prescription drug abuse requires a coordinated and comprehensive response across a broad range of sectors. Federal, provincial and territorial governments share responsibility for addressing prescription drug abuse. The provinces and the territories are responsible for the delivery of health care services, which includes providing treatment services, and through regulatory colleges and licensing bodies for establishing training requirements and practice standards for health professionals.This point is reinforced in the recent national prescription drug abuse strategy developed by the Canadian Centre on Substance Abuse, called First Do No Harm. [Translation]Provinces and territories have expressed willingness to collaborate with Health Canada to address the issue. Early opportunities for collaboration to support better collection and sharing of information, and improve prescribing practices, were recently endorsed by federal, provincial and territorial ministers of health this past October.(1540)[English]Health Canada's role in preventing prescription drug abuse supports that of the provinces and the territories. This is realized through our role as a regulator under the Food and Drugs Act and the Controlled Drugs and Substances Act, and as a service provider for first nations and Inuit. I will take a few moments now to speak about Health Canada's role in ensuring the overall safety of drugs on the market, including safeguards that are in place to promote proper use. Under the Food and Drugs Act and its regulations, a new drug will be issued market authorization if, after a risk-based decision-making process, Health Canada determines that the drug demonstrates an acceptable level of safety, substantial efficacy, and high quality. The regulations require that a manufacturer file a new drug submission with substantial data to support the safety, efficacy, and quality of the drug for its intended use.[Translation]Based on the information submitted, Health Canada scientists determine whether the data meet the current standards to support approval and whether a drug should only be available through a doctor's prescription.[English]Information on addiction and abuse potential is taken into consideration during the review process. If a drug has a significant risk of addiction and/or abuse, substantial data supporting the efficacy of the drug must be shown in a serious condition, such as severe pain, to justify the risks.Additionally, through the approval of the final product monograph, information on the potential for addiction and abuse is communicated to health care providers and consumers. Physicians are advised to prescribe and handle such drugs with caution, assess patients for their clinical risks for abuse or addiction prior to prescribing the drug, and routinely monitor patients for signs of addiction and abuse. The product monograph further contains information for the consumer about the dangers of a drug with addiction and abuse potential. Patients are advised to take the medication only as indicated by the treating physician, to tell their doctor if they have questions or concerns about addiction or abuse, and to keep the medication safe, and to never give it to anyone else as it may be abused and cause serious harm, including death.Manufacturers may also be required to implement a specific risk management plan as a condition for approval. Such plans may include monitoring of events related to abuse and addiction once the drug is on the market, as well as education materials for health care professionals and patients.Once a drug is on the market, Health Canada monitors its safety through surveillance of serious side effects reported within and outside Canada. As new information becomes available about side effects, the product monograph is updated to inform physicians and patients about the new safety information. The risk management plan can also be altered to address changes in risks, or a drug can be removed from the market if experience with the drug shows that its benefits no longer outweigh its risks.Several drug classes, such as opioids, central nervous system stimulants and depressants, cannabinoids, and nicotine-like compounds are already well known to be potentially addicting and have abuse liability.To this end, Health Canada put in place a guideline to assist manufacturers in conducting studies assessing whether a new drug produces acute effects such as euphoria, or drug-liking effects that could lead to addiction or abuse. Results of such studies are required to be included in drug submissions, and help guide benefit-risk assessments and decisions relating to drug approval, scheduling under the Controlled Drugs and Substances Act, prescribing information within the product monographs, information for the consumer, and risk management plans.Through this work, Health Canada works to establish and maintain prescription drug accessibility, while decreasing the risk of abuse associated with certain drugs. Protecting the health of Canadians remains the primary concern. Public awareness among prescribers, dispensers and patients about the problems with drugs that are addictive or that could be abused promotes good medical practices, fosters dialogue, and more importantly, helps ensure patient access to effective medications while protecting them and others from the potential harms of these types of drugs.(1545)[Translation]I will now speak briefly to some of Health Canada's work to ensure that First Nations and Inuit have access to health services, including mental health and addictions programs, and to prevent prescription drug abuse in First Nations communities.[English]While there is limited data available, some first nations have reported significant challenges with the abuse of prescription drugs.To respond to the serious problem of substance abuse, Health Canada invests approximately $92 million annually in addictions prevention and treatment programming. This investment includes funding to support a network of 55 treatment centres, as well as drug and alcohol prevention services in over 550 community-based prevention programs.Of note, in 2013-14 Health Canada worked in close partnership with the Ministry of Health in Ontario as well as the Chiefs of Ontario, and invested $2 million to support first nations communities in Ontario where the problem of prescription drug abuse is most acute.Health Canada's investments in addictions and treatment programs are part of a larger effort to provide first nations and Inuit with a comprehensive system of mental wellness services. Health Canada also administers the non-insured health benefits program, NIHB. It provides coverage for a limited range of medically necessary goods and services, including prescription drugs, to eligible first nations and Inuit.[Translation]Over the last decade, the non-insured health benefits program has introduced a wide range of client safety measures to prevent and respond to potential misuses of prescription drugs to help ensure that First Nations and Inuit clients can get the medications they need without being put at risk.[English]Examples of these measures include sending automated real-time warning and rejection messages to pharmacies to alert them to situations of potential misuse when a client attempts to fill a prescription that requires a pharmacist's intervention before the claim can be processed. It also includes placing restrictions on the coverage of drugs of potential abuse, including those that present health risks or risk of diversion, and introducing dose limits that limit the amount of a particular drug that a client can receive per day.To detect patterns of potential inappropriate prescribing and dispensing and other safety concerns, the NIHB program has a formal surveillance program called a prescription monitoring program, PMP. Though the PMP was originally introduced in 2007 to focus on clients who have been double doctoring, it has since been expanded to address clients who are on high doses of one or more drugs of concern.Clients whose drug utilization profiles indicate that they are at high risk of misusing certain drugs—opioids, stimulants, or benzodiazepines—are placed in the PMP. Clients listed in the PMP face restrictions in terms of the approval process for these drugs.Since November 2012, the NIHB has been using the findings of the surveillance work to engage prescribers to gain insight into the reasons behind high doses of opioids and benzodiazepines, and work with them to impose restrictions, taper doses, and encourage the use of alternative non-opioid medications as appropriate.Preliminary results of these initiatives indicate that the impact is positive. In the last 12 months the number of high-dose benzodiazepine clients has decreased by 36%, and the number of high-dose opioid clients has decreased by 7.5%.(1550)[Translation]Going forward, the non-insured health benefits program will continue to monitor the use of opioids and other drugs of concern. It will continue to adjust existing limits and introduce new restrictions and measures as appropriate.[English]NIHB will also continue to work closely with physicians, other prescribers, pharmacists, and other public drug plans in our efforts to ensure the safe use of prescription drugs among first nations and Inuit clients.Madam Chair, I would like to close my remarks today by spending a few moments talking about the Controlled Drugs and Substances Act and Health Canada's role in the national anti-drug strategy.[Translation]The Controlled Drugs and Substances Act, or the CDSA, provides a legislative framework for the control of substances that can alter mental processes and that may cause harm to the health of an individual or to society when diverted to an illicit market or used illicitly. The CDSA has a dual purpose to protect public health and maintain public safety. It prohibits activities such as the production, sale and possession of substances such as opioids, unless authorized for legitimate medical, scientific or industrial purposes through regulations or exemptions. It includes offences and penalties that range from a fine to life imprisonment.[English]The CDSA has a number of regulations that are relevant to the discussion of prescription drug abuse. The regulations provide a framework to facilitate the use of prescription drugs for medical treatment. Compliance and enforcement also form an important part of the drug control objectives of the CDSA. Health Canada is active across the regulated supply chain to verify compliance with the CDSA and its regulations. For example, licensed dealers comply with regulations setting out reporting and record-keeping requirements, as well as security measures aimed at minimizing diversion. Pharmacists are required to maintain records of controlled substances purchased and are accountable for prescriptions dispensed. [Translation]As a final comment, I would like to highlight some of the lessons learned under the national anti-drug strategy, a strategy based on three key areas of action—prevention, treatment and enforcement—which I believe are informative in identifying actions to address prescription drug abuse.[English]Under this strategy, we have seen marked progress in discouraging youth from using illicit drugs and in supporting innovative treatment services for individuals addicted to illicit drugs. For example, the government led a successful mass media campaign entitled “DrugsNot4Me” to raise awareness among youth and parents about the dangers of illicit drugs. This campaign saw impressive results. Youths are now more likely to say that they would refuse to take illegal drugs, and more parents engage their teens in discussions about the risks of taking drugs. The government has also made significant progress, working in partnership with law enforcement, to prevent the production and diversion of illicit drugs. The national anti-drug strategy and its successes provide a strong foundation upon which to support action to prevent prescription drug abuse. In light of the recent Speech from the Throne commitment to expand its scope, work is under way to assess how the prevention, treatment, and enforcement successes of the national anti-drug strategy can be applied to addressing this issue. [Translation]Thank you, Madam Chair.Controlled Drugs and Substances ActDepartment of HealthDrug addiction treatmentDrug review processDrug use and abuseFederal-provincial-territorial relationsFirst NationsInuitNational Anti-Drug StrategyNon-Insured Health Benefits ProgramOxycodonePrescription drugsYoung people34630663463067346306834630693463070346307134630723463073346307434630753463076346307734630783463079346308034630813463082346308334630843463085346308634630873463088346308934630903463091346309234630933463094346309534630963463097346309834630993463100346310134631023463103346310434631053463106346310734631083463109346311034631113463112346311334631143463115346311634631173463118346311934631203463121346312234631233463124JoySmithKildonan—St. PaulJoySmithKildonan—St. PaulJohn PatrickStewartJohnPatrick-StewartInterventionDr. John Patrick Stewart (Senior Executive Director, Therapeutic Products Directorate, Department of Health): (1600)[English]I can speak from the licensing perspective around labelling. Certainly, when a drug comes in for approval and it's clear that it has addictive or abuse potential, we spend a fair bit of time looking at the labelling and ensuring that when the product is authorized on the market the labelling is clear to both the prescribers and the pharmacists, and that in part three of the product monograph for consumers or patients, the risks of abuse and the potential outcomes of that abuse are clear, so if they're looking for information around the product it's there in the product monograph. We also make recommendations around how it should be stored, how it should be disposed of, and that sort of information. That information allows consumers, if they look for it, to be aware of the dangers of leaving the product around for others to use who don't understand those risks, and for the actual user to not inadvertently use it inappropriately and run into issues associated with that.Department of HealthDrug use and abusePackaging and labellingPrescription drugs34631673463168JoySmithKildonan—St. PaulRobertIaniroDebraGillisDebra-GillisInterventionMs. Debra Gillis (Acting Director General, Interprofessional Advisory and Program Support, First Nations and Inuit Health Branch, Health Canada, Department of Health): (1615)[English]Yes, I'd be pleased to answer that question, Madam Chair.We have recently conducted a study within our NNADAP, the national native alcohol and drug abuse program, treatment centres to really look at the extent of prescription drug and polydrug use of people seeking treatment through these centres. We have found that about 30% of all people entering the treatment centres use opioids in addition to alcohol. Some could be using other types of illicit drugs as well. So it's about 30% of those.Through the increased knowledge around prescription drugs and the increased evidence that there are actually possibilities of working with and treating prescription drug abuse as part of an overall treatment program, we are seeing an increase in the demand for prescription drug abuse treatment in the NNADAP treatment centres. We've had a very high success rate actually, Madam Chair. In the research that we have done, we've found that 72% of the clients who entered those treatment programs with an opioid use problem left without an opioid use issue. They terminated the use. Of that small number of clients who didn't, almost 90% reduced the use.Department of HealthDrug addiction treatmentDrug use and abuseFirst NationsInuitNational Native Alcohol and Drug Abuse ProgramPrescription drugs3463225346322634632273463228JoySmithKildonan—St. PaulJoySmithKildonan—St. PaulINTERVENTIONParliament and SessionDiscussed TopicProcedural TermCommitteePerson SpeakingProvince / TerritoryCaucusParticipation TypeSearchResults per pageOrder byTarget search languageSide by SideMaximum returned rowsPagePUBLICATION TYPE