HEAL Committee Meeting

STANDING COMMITTEE ON HEALTH

COMITÉ PERMANENT DE LA SANTÉ

[Recorded by Electronic Apparatus]

Thursday, April 2, 1998

• 0923

[English]

The Chair (Ms. Beth Phinney (Hamilton Mountain, Lib.)): I'll call the meeting to order. We're a little late getting started, so I think we'd better get going.

This is meeting 34 of the Standing Committee on Health, on Thursday, April 1, 1998, and we're doing a study of natural health products.

We have the Canadian Chiropractic Association with us this morning, represented by Dr. David Peterson, Dr. James Meschino, and Costa Papadopoulos. We also have John Apse, a barrister, a lawyer, and a trademark agent. He's the first person representing that group of people.

Gentlemen, if you can keep your comments relatively short, it then gives lots of time to the members for questions. I'm sure if you have extra things to add, they'll come out during the questioning.

So we'll start with the Canadian Chiropractic Association presentation, then we'll have Mr. Apse, and then move to the members.

David, are you starting?

Dr. David Peterson (President, Canadian Chiropractic Association): Yes, I am. Thank you, Madam Chair.

I want to say, first of all, that it's a real honour and privilege for us to be able to present before this standing committee this morning. Thank you for allowing us this privilege.

If I may, I would just like to further introduce my associates here today. Mr. Costa Papadopoulos is the manager of professional affairs and health policy for the Canadian Chiropractic Association, and Dr. James Meschino is a practising chiropractor and our resident expert in this field. He has his master's degree in science, in nutrition and biology. He's on the post-graduate faculty at the Canadian Memorial Chiropractic College. He's the director of health promotion for Extendicare (Canada), as well as a wellness correspondent for CTV's Canadian Living. He is a practitioner and co-director at the Centre for Heart and Metabolic Studies in Toronto.

• 0925

I understand this group has been meeting for a fair amount of time at this point and that you've received numerous presentations from a number of interest groups.

I'd like to begin my remarks by saying that chiropractic is in somewhat of a unique position. I think there are many in the complementary and alternative health care fields who would say that chiropractic is part of the establishment, whereas there are those in the medical community who would say that chiropractic is a complimentary or alternative health care provider. In many respects we have our foot in both camps, so I think this morning we can bring a unique perspective to this question of alternative health care and natural health care products.

You have before you this morning the brief we have prepared. In my opening remarks I will just outline some of the points, beginning with the unique role chiropractic plays as Canada's largest natural health care profession.

The Canadian Chiropractic Association is the umbrella organization representing the chiropractic profession in Canada. There are over 5,000 doctors of chiropractic in Canada, and our association represents over 80% of those through membership. For decades we have supported the fundamental right of Canadians to make informed health care choices, and we believe Canadians must continue to have the greatest access possible to the use of natural health care products as part of their overall health care.

Chiropractic is the largest drugless primary contact health care profession. There are chiropractic acts in all ten provinces as well as the Yukon territory. This is legislation that recognizes chiropractic as a primary contact, self-regulating health care profession.

Our doctors currently receive a minimum of seven years of post-secondary education, which includes training in nutritional counselling and the use of health care products. They are assessed in their competency in all areas in both national and provincial examinations.

In 1996 we did a fairly extensive survey of our profession. We noted that in that year, approximately three million Canadians consulted chiropractors. Approximately one-third of those, or one million Canadians, received some nutritional counselling or advice. For over a hundred years, doctors of chiropractic have pioneered and continued to offer a natural, conservative, non-invasive, preventative, holistic approach to health care. When we talk about natural health care products, this is really at the heart and soul of what chiropractors do and what we believe in.

In 1986 we established the Canadian Chiropractic Protective Association, which provides professional liability protection for our members. Since that time, there have been no complaints received relative to the use of natural health care products. We believe that millions of Canadians have used natural health care products, in association and in consultation with their chiropractors, with no compromise of safety. We therefore believe it is unnecessary to initiate a major regulatory overhaul to a system that has been safe and working well and that has allowed Canadians to be able to make health choices on products they wish to use.

Overhauling the system with the inclusion of unreasonable and inappropriate regulatory mechanisms—which I don't believe are in the books—could potentially eliminate a large number of health care products from the marketplace. However, as we are regulated and legislated, we also believe as a profession that public safety and health care is paramount.

We do feel there is a need to address the diversity of natural health products and the multitude of providers recommending their use and to ensure that there is a distinction between products that are in the public domain and those that are potentially high risk and should be used only under the auspices of qualified health care providers. There is empirical evidence suggesting that the combination of certain foods or drugs with natural health products can have adverse effects, thus making certain natural health care products higher risk under certain situations.

• 0930

Natural health products and proper nutrition are integral parts of holistic health. It's clear that natural health products are not drugs in the traditional sense as defined by the Food and Drugs Act. They do not fit into the biomedical, reductionist paradigm of health care intervention in which certain synthetic components are targeted at isolated physiological and anatomical structures. Therefore, in the public interest and to ensure freedom of choice, the CCA recommends that this crucial distinction between a drug and a natural health care product be clearly understood and applied to all issues of the regulatory review of natural products.

The Canadian Chiropractic Association is in substantive agreement with the proposals of the Advisory Panel on Natural Health Products, as submitted on February 3, that natural health care products are unique and that the current regulatory structure does not address this uniqueness. We agree in principle with the need for a conceptual framework as proposed by this advisory panel for the purpose of addressing high, medium, and low risk in the interests of public safety. However, we feel there could be some confusion when we look at three categories. We would therefore recommend that there be two categories: high risk and non-high risk. I believe we should pursue the examples of countries that currently have such a system, identify them, and examine them as potential models.

We agree that the definition for a high-risk natural health product proposed by the advisory committee is workable, and we recommend that an extensive, consensus-based process to identify high-risk natural health products be struck. More importantly, we agree with the requirements of high-risk products needing to meet more restrictive regulatory requirements and be made available through the intervention of qualified health professionals or practitioners.

In the context of regulation, the CCA has no objection to the establishment of another category for natural health products, i.e., not food or drugs. However, with this is the recommendation that—and this is key—only high-risk natural health products comprise this third category that would require regulation. In the interests of rights and freedoms of Canadians, all other health products that are not deemed a high risk must be left in the public domain. Therefore, critical to this process is a classification of those natural health products that are deemed high risk and those that are deemed not high risk.

The CCA strongly endorses regular scientific scrutiny for high-risk natural health products. However, these products must be differentiated from prescription medication, and under no circumstances should there be a commonality for their evaluation and assessment. Natural products are fundamentally unique and distinct from pharmaceuticals. Consequently, regulatory paradigms and evaluation mechanisms must also be different. A unique, distinct regulatory agency for natural health products is essential.

With regard to health care claims, only natural products that have an adequate level of scientific evidence should be able to make claims on labels and in marketing information. We strongly believe in that.

As mentioned previously, we feel the public should have access on their own to natural health products that do not pose a high risk. However, for the use of high-risk natural health products, to ensure the highest possible degree of public safety, we strongly recommend that only qualified health providers can make such products available to the public in the course of health care consultations. We recommend that, to be deemed qualified, health care providers must, first, be regulated and licensed by provincial legislative acts; second, have the statutory authority to diagnose, and be trained in diagnosis for the purpose of understanding the indications and contraindications on the use of natural health products; and third, go or have undergone educational training by completing curricula or certification courses that include appropriate training in natural health products and holistic care interventions. We believe these are the minimal standards that will ensure that high-risk health products are safely used by the public. Theses mechanisms will also ensure that in the remote cases of adverse effects, appropriate reporting procedures will ensue.

• 0935

It is also imperative that qualified health providers, as defined above, be key members of the proposed regulatory agency for high-risk natural health products, in addition to scientists with expertise and skill in research methods and design for natural health products.

Balancing freedom of choice and safety for the best interests of Canadians is a very complex issue. We have adhered to two fundamental concepts. First, Canadians should have the freedom to choose the way they wish to maintain and improve their health, and second, governments and regulated health care providers must ensure that the highest standards of safety and quality are adhered to in the provision of health care services.

Realizing that the majority of natural health products does not pose significant risk, these should be left in the public domain to the greatest extent possible for the public to be able to access on their own as they see fit.

However, we recommend that a regulatory agency at the federal level must be established to undertake, as we see it, three important tasks: one, to separate the high-risk products from the non-high-risk products on a continual basis; two, to regulate those natural health products that are found to be of high risk; three, to investigate adverse reactions to natural health products reported by consumers and providers.

In closing, we'd also like to add that we feel every effort must be made, through Health Canada and through the appropriate health care professionals or providers, to educate the general public about how to make informed decisions on the use of natural health products. As in the use of non-prescriptive medication and foodstuffs, we feel the general public has the capacity and inclination to make rational judgments on the ingestion of non-high-risk health care products. We believe that through this approach you have provided freedom of choice for Canadians while at the same time ensuring the safety of Canadians who choose to use natural products.

At the end of the opening remarks we'd be happy to answer any questions you may have, but at this point I want to thank you for your attention to this presentation.

The Chair: Thank you.

Mr. Apse. It's a totally different subject, but we're good at adapting.

Mr. John Apse (Individual Presentation): Thank you very much.

By way of introduction, I once worked in the Health Protection Branch, but I'm not one of the disgruntled ex-employees of the Health Protection Branch.

Some hon. members: Oh, oh.

An hon. member: That's a change.

Mr. John Apse: Thank you.

I have worked as a consultant in food and drug regulatory law since I left the branch way back in 1978, and I've worked extensively with both herbal medicine manufacturers and the conventional pharmaceutical industry. I'm here basically as a private citizen. I'm not here on behalf of anyone. That's probably why I'm still a lone practitioner.

In the old days they used to peddle snake oil off the backs of wagons. Today we have the hocus-pocus of science, where claims are made for everything, for every disease condition imaginable, from liver conditions to cures for cancer. We have hundreds of products out there. There are literally tons of literature everywhere, on the Internet and everywhere else, providing all kinds of information.

Who, then, is the guardian? Somewhere, I submit, ladies and gentlemen, we must have a health protection branch that deals with safety and efficacy.

Much has been made of separate agencies and much has been made of all the difficulties that have occurred, but perhaps putting it in context, the herbal industry, the natural products industry, has evolved over the last few years. It has become a fairly large and burgeoning industry, with a lot of economic interests. A lot of products have legitimate claims. A lot of products don't.

You are caught in the middle of this evolution, where there are almost adversarial relationships among the various groups, the Health Protection Branch and the industry. They say they're over-regulated and the Health Protection Branch says, “We have to protect the public.”

• 0940

It's unfortunate that even at this time these groups have not coalesced into one solid organization. It is still evolving and will take some time to do so. Additionally, the Health Protection Branch, for the first time in 25 or 30 years, started to undergo changes a few years ago. These changes are still ongoing.

Undoubtedly you heard the news today about expert advisory committees, where it's suggested that there is undue corporate influence. In today's environment there are advisory committees of people who are specialists in their own area and there are those the government consults, which are quite separate and apart.

It's impossible for any regulatory agency in the “constraint” environment you have today to be able to operate without advisory committees of some kind, with experts. If you look at the Internet, you'll see all these advisory committees, which consist of various experts in various areas. There are tons of them, but none of them are from industry. They can't operate without that. As you will see from my recommendations in this paper, I've suggested that there be some kind of expert advisory committee structure.

I was very interested in the presentations made just before mine. I would put it to you this way: efficacy was not highlighted and has not been highlighted, and yet it remains an issue.

Imagine. We have a safe, natural toothpaste laying claim to preventing cavities. It's safe, but what standard of efficacy is there? The same as other toothpastes? The same as fluoride toothpastes? Well, no. People say “we can do with less”. Five years later you get a whole bunch of consumers with cavities. Surely the same standard of efficacy must be applied to that type of product, just like it is for an ordinary toothpaste. You can't have something appearing five years down the road.

Something was mentioned about high-risk products and efficacy and the standards to which it had to be proven.

Today when I drove in from Kemptville, where I live, I saw an ad in front of a natural health food store saying, “Pyruvate to reduce weight”. There isn't one scintilla of evidence that pyruvate helps to reduce weight—by any standard. But it's there.

Or you have a favourite herbal remedy now for the treatment of prostate enlargement. You take it for a long time. Surely, prostate enlargement is a serious condition, and surely, the standards of efficacy, if you take this herb for three or four years, must be fairly high, because you take other medications only for a week or two.

Let me give you another example. Where do the ingredients for herbal medicines come from? Many come from the Far East. Picture this: here's a poor little Thai girl running around barefoot with a can slathering stuff with pesticides and herbicides. Has anybody ever asked the questions about what the levels are in these products? Has anybody checked them? Is there a quality control check on these things?

Admittedly, I think the Health Protection Branch maybe goes overboard on good manufacturing practices for some of those items in relation to products, but there must be a standard that these products must meet if they are to be out there in the marketplace. Foods have limitations on pesticides and herbicides and so should these products. The reason I'm using that as an example is to say, yes, there must be quality control.

We talked about Chinese herbal remedies and making these available. If you go into Vancouver stores, you will see them chock-a-block full with all kinds of things. There is a terrible shortage of bear bile products or bear gall bladder in China. They've contracted with the German government to try to find alternative sources, synthetic sources, but if you walk into a health food store or a Chinese herbal remedy store, you'll find everything from soup to nuts there.

Has the Health Protection Branch seized all of these all the time? As I say in my brief, I think they have been reasonably sensitive, but because of legal situations it's been made more difficult for them.

• 0945

In all of this, my recommendation is basically that there must be some standard of efficacy for self-limiting, minor conditions, as in the conventional OTC industry. There should at least be the same standard or a similar one. There must be safety, and I don't think anybody disagrees on that. There must be some good manufacturing standards.

Because the industry is fledgling, the association must get its act together and come together like a professional association, not like a bunch of varied interests that make it very difficult for the Health Protection Branch. If you look at the consultation record of the Health Protection Branch under access to information, as I did, I think you will find that the number of hours spent with the natural products has been far in excess of what the market perhaps warrants. So there is that element.

Good manufacturing practices must be instituted—maybe not the same strict ones that exist for dangerous pharmaceuticals, but there must be some order in the marketplace.

I submit to you, ladies and gentlemen, that it must be the Health Protection Branch. We have to have a signpost for safety and efficacy. I would just remind you, as members of Parliament—all of you—about “tuna-gate”. A minister was forced to resign because he overturned an inspector's decision that the product didn't smell right. I think the onus on you today is very important, because at the back of it you have to see this ghost of safety and efficacy coming to bear. Look at the toothpaste example.

I do believe your recommendations should include that there be a separate group within the Health Protection Branch. Yes, they should have some standards. Yes, they should be developed. But it will take time. It will take four or five years of perhaps difficult relations from time to time, until the industry and everybody else becomes accustomed to it.

I think the Health Protection Branch has been unfair because it has imposed a sudden regulatory regime on that industry, which is what caused these hearings to begin with. There is some give and take in that sense, but I don't think there's much choice. We can't afford another agency, we have to be sensitive to the ethnic groups, and we have to deal with health hazards and seize products as the situations arise.

I don't envy your job. I've tried to organize my submission in such a way that it makes recommendations, and I'm not going to go through those things in detail. I used the herbal medicine example. I used the prostate example.

I've also said that, legally, I don't think the Food and Drugs Act gives anybody the authority to put something on the label saying, “These claims have not been approved by the Health Protection Branch”. Can you imagine being exempted from the requirement of the Food and Drugs Act and its regulations? I can't. I don't think that's a starter.

I've gone through a whole host of different examples, some with a bit of drama, admittedly, but I'm trying to focus on two or three things. You have a tough job, and I've tried to make my comments in such a way that perhaps you could make some recommendations.

On that note, I rest.

The Chair: Thank you to both groups.

It's quite helpful to get some suggestions now, because we've had a lot of people come in complaining. It's good to hear some suggestions on where we should be going.

Mr. Hill.

Mr. Grant Hill (Macleod, Ref.): Thank you very much.

I thank you all for presenting. My first question is for Dr. Peterson. Is there anything in the chiropractic association that prevents a chiropractor from having these products in his office and selling them there?

Dr. David Peterson: No, there isn't, but I'm going to ask Dr. Meschino if he could address that question.

Dr. James P. Meschino (Chiropractic Expert on Nutrition and Wellness, Canadian Chiropractic Association): To my knowledge, chiropractors across the country tend to dispense non-pharmaceutical substances to their patients at their discretion. That's the answer. If you want to know whether I think it's a good idea or not, you could ask me that.

• 0950

Mr. Grant Hill: That was my second question.

Dr. James Meschino: As a practitioner, I've never done it, but I don't have a problem with those who do because I think about the citizens wandering around the country going into health food stores and pharmacies who are at the mercy of the clerks in health food stores, who are probably less educated.

I taught most of the chiropractors in this country their nutrition courses, and I know that pharmacists are very under-educated because I also teach some re-licensing seminars on vitamin and mineral metabolism in Ontario. So I would think if a chiropractor felt strongly that they were directing a patient to a product that was of some quality and they had some assurance it was going to be useful to that patient, to sell it in their office and monitor the patient's response and progress in regard to the use of the substance isn't necessarily a bad idea. If you say, “What kind of ethical practice is that? You're selling a product on top of your service. Should that be done?” Until we can straighten out all this other stuff, I don't think it's really a problem. Naturopaths do it, and chiropractors have more education in the area than pharmacists, by and large. Only 15% of chiropractors actually do this, just so you know how low the percentage is.

Mr. Grant Hill: All right. So you don't look upon this as a conflict of interest, in your judgment.

Dr. James Meschino: Provided a proper work-up has been done on the patient and you've assessed, to the best of your ability and the skills you have available, either a need because the patient may be showing signs of deficiency, or you feel that through primary intervention with a natural product it may help to reduce risk of early stage disease that may be developing, or you may want to reverse early stage disease— I'll point to the study out of Tufts University, Dr. Nelson, United States Department of Agriculture, published in the journal of the American Medical Association about two years ago.

They took 50 post-menopausal women who were not on estrogen replacement therapy, assessed their dietary intake, and made sure the women who did not have at least 1,000 milligrams a day of calcium in their diets were given that through supplementation of calcium carbonate. Then they put them on a five-station resisted weight training program and monitored them for 12 months. They saw that after one year there was increased bone mineral density in the lumbar, spine, and femurs. It's the first time ever, in any of the medical literature, that there has been evidence that post-menopausal women could gain bone mineral density. Even with estrogen replacement, all they can do is slow down the rate of loss.

So if a chiropractor who is trained in musculoskeletal and osteoporosis management feels the patient should be on a calcium supplement, where they're happy with the product because it has good bio-availability and they entertain this type of practice management, I think it's actually honourable that they would take it upon themselves to help the patient in this synergistic area of musculoskeletal health.

The Chair: Short question.

Mr. Grant Hill: To Mr. Apse, who has talked about the guardianship of the HPB—I've asked a number of people this—could you explain how the melatonin issue looks like a guardianship issue? Melatonin is banned from sale here in Canada by the Canadian health food industry, yet it can be imported from another jurisdiction for personal use. That makes no logical sense to me. Maybe you could explain it.

Mr. John Apse: There is a limitation under the Food and Drugs Act and regulations that permits importation for personal use only. For whatever reason, they have seen fit not to do away with that provision. It becomes very difficult for the Health Protection Branch to regulate in today's environment, where the borders are so porous from Europe and the United States, while going the other way to the United States they're very tight. Going to Europe, they're not so tight, but they are there.

So anyone who wants to can import for his personal use. They've warned that there is a health hazard, and I guess to that extent they're saying you've decided to take your own risks and that's it.

Mr. Grant Hill: To my knowledge, they're the same risks taken by Canadians in Canada. The risk is reasonable.

Mr. John Apse: In the eyes of the Health Protection Branch, I guess it thinks the risk is not reasonable because of the health hazard it presents. Allowing it in amounts to them saying, well, here it is; there's a health hazard with respect to it.

• 0955

Let me ask you this—

Mr. Grant Hill: You shut down the personal importation from the U.S., since it seems—

Mr. John Apse: I could not legally shut them down today.

Mr. Grant Hill: Would you change the law?

Mr. John Apse: Would I change the law? No, I would not, because by the same token, if I had a prescription drug approved in the States but not in Canada, it can't be imported into Canada, but for personal use, it may be. So it's a question of relative risk, I suppose, because there are tons of products out there. Chitosan or chitomax is an example. It basically reduces fat absorption but also reduces the absorption of other nutrients. It's considered a new drug—wrongly, I think. Health Protection Branch has said they consider it a health hazard because it keeps other nutrients from being absorbed. I don't know if that's right or wrong. It's available in almost every health food store out there, and the only way they respond is by going in and seizing it based upon complaints by competitors.

The Chair: Dr. Meschino, do you want to make a comment? You look as though you do.

Dr. James Meschino: I thoroughly agree with Mr. Apse. I think in the case of melatonin, you have something that could be deemed questionable. You can look at it two ways, because the hazards of the substance have not been that well documented, and there is tremendous potential benefit, as there would be for certain levels of hormone replacement therapies.

The pineal gland makes less and less melatonin as we age, as part of the age-related decline. There are a number of functions of melatonin. It's a neurotransmitter that may induce sleep and help you get into deeper levels of sleep, such as delta sleep, so that older people would feel more rested. It's the strongest brain antioxidant to quench free radicals, and may help to safeguard against the oxidative damage that could lead to Alzheimer's disease and other neurodegenerative conditions.

So it might actually prevent some serious problems. It's a powerful antioxidant that stimulates immune system activity as well. I wouldn't be so quick not to allow people to use it in doses that are reasonable. The problem with the product is that the doses are unreasonable. You don't put 3 milligrams of melatonin into your body. You might put in 0.3 milligrams, or 0.5 milligrams. That would give your brain the same levels of picograms it would normally utilize after the first passage through the liver, which would hydroxylate about 80% of the melatonin entering the body.

The Chair: Dr. Meschino, can you comment on whether you think the individual should be able to bring it in across the border?

Dr. James Meschino: I believe they should be able to.

The Chair: But it still should be banned here.

Dr. James Meschino: If you can bring it in, then I think you should be able to manufacture it in the host country. I don't understand this at all. I mean, I would have a bigger concern with DHEA, androstenadione. I also agree that pyruvic acid has no benefit.

The Chair: Okay. Mr. Myers.

Mr. Lynn Myers (Waterloo—Wellington, Lib.): Thank you, Madam Chair.

On page 10 of your submission, at the very bottom, you say that every effort must be made to educate the public, etc. I wonder if you could elaborate on what you had in mind with respect to that. Education, I think, is a key component. Can you elaborate on that?

Dr. David Peterson: Yes, education is a key component. We believe there are many benefits the general population could realize by having a program directed at this level, much the same as we've seen in ParticipACTION, where government has encouraged physical activity. I think at the same level, the government can encourage the general population to be aware of the health benefits of eating properly, practising proper nutrition as far as the preventative and wellness aspect of health goes. There's the other factor when we look at self-treatment in certain areas with non-high-risk natural health products.

There are a lot of things that can be done in this area. It's simply a matter of educating the public in the use of which products to use and how to use them. We believe our consumers out there are able to make these choices if they're provided the information.

Mr. Lynn Myers: Thank you. You also stated—

The Chair: Mr. Apse wanted to answer that.

Mr. John Apse: It's all right. I'll wait.

• 1000

Mr. Lynn Myers: I think Dr. Meschino wanted to add something to that too.

Dr. James Meschino: If I could just take you back to that comment, very quickly, Health Canada puts out a document from their scientific review committee that then becomes the basis for Canada's Food Guide. It's brilliantly written, it's researched properly, and it's referenced properly.

You may want to consider having a similar document for the safe and general application of nutritional supplements, putting together a review committee from a multi-disciplinary standpoint, agreeing on what efficacy is, what standardized grades are, and what the general use of these nutritional compounds at levels above the RDA would be. Allow the consumer to make decisions where you have low-risk products. Where there are high risks you'd want to have a qualified health practitioner make that decision.

Mr. Lynn Myers: I wanted to get to the high-risk products again, Dr. Peterson. In your testimony, you said that you thought a third category for high-risk would be appropriate. With respect to efficacy, what did you have in mind? Do you take Mr. Apse's point, by the way, that there is a real concern with lack of efficacy and the testing therein?

Dr. David Peterson: Yes. I found that an interesting comment, and I agreed with most of what he said. We are definitely concerned with efficacy, and you'll find that in our submission we talked about quality controls and standards.

The point we wanted to make in the oral submission was that particularly where there are claims made in regard to high-risk substances, should they be backed up with rigorous scientific evidence? Efficacy is an important part of this, at all levels, and in many respects we were piggy-backing on the advisory panel's recommendation. I didn't want to go through all of that, where they talked about the whole issue of efficacy, but we are in substantive agreement with their recommendations in this area.

Mr. Lynn Myers: If I might, Madam Chair, to Mr. Apse, I was very interested in your comments about struggling with this whole issue of efficacy and such. You argued that we should, as a group, I think, recommend that it be put in place in terms of testing. Is that true or did I misinterpret what you said?

Mr. John Apse: Yes. My contention was that if you make a claim, you must have some evidence of efficacy. In some cases that might be a bit limited, if it's for minor, self-limiting conditions that go away after a few days and you take something for relief. That's fine. You can have a lower standard.

But if you make a claim for something like a prostate enlargement and the consumer is going to take this substance for three, four or five weeks or months, then certainly you need a higher standard of efficacy. But there must be something. Why put a claim on there that has no bearing on efficacy? Why put a claim on there at all? In that case we might as well simply say that the Health Protection Branch has no business in these products, nor does any agency.

Mr. Lynn Myers: Further to your recommendation 5 on page 11, which I think goes back to the quality control issue, your “slathering of pesticides” example, how would you determine that in fact this product did not have pesticides on it? Wouldn't it be one thing for people to say simply, “we didn't use this stuff”?

Mr. John Apse: There are several ways it could be determined. One way is to have a certificate of origin. If the certificate of origin of the product showed the United States or Canada, or another country where pesticides were more regulated, that would be fine. If the certificate of origin showed Thailand, China or some of those places where they still use DDT, where they still use various products—a recent treaty was signed about limiting the use of those—where the dosage or the rate of application is not controlled, then I think there is an onus on someone to check that there are no herbicides or pesticides left in the product. I think the onus is on the manufacturer to begin with, but somewhere along the road it's on the Health Protection Branch.

It would be very interesting to obtain the herbicide residue levels for, say, spices, with respect to what testing they've done in the last few years. I think you'd be quite interestingly surprised.

So that's how that mechanism could work.

Mr. Lynn Myers: How do we say to people who have given us testimony with respect to traditional Chinese medicine that we don't accept their 5,000 years of history and tradition? What do we say to them? I think you're saying something different.

Mr. John Apse: I guess you could say I'm schizoid, but the ethnic community and their importations, particularly, let's say, the oriental one, have a lot of traditions, some of them unsafe, some of them hazardous. In the case where a hazard is discovered, I think the Government of Canada owes a duty to resident Canadians to seize the product and deal with it.

• 1005

In the other situations, I think they probably should be sensitive and simply forebear from seizing. Let them be out there. I know that's a difficult one and I don't know how best to answer it. I'm sure the people in Vancouver from the Health Protection Branch, the inspectors, tear their hair out all the time, because on one side they have a Human Rights Commission decision—the Beaver decision I believe it is—and on the other side there are sensitivities that they've really let these people alone. I don't know how to deal with that except on a local level and leave it to the judgment of the government to some degree.

If you put everything in legalese and absolutely impose everything on the legalese, then you can shut down anybody. To me there's a fine balance and I wouldn't want to be in HPB's shoes. Somebody is going to say, you seized my product, you didn't seize his product, etc. But there has to be a sensitivity.

Mr. Lynn Myers: Thank you.

The Chair: We have to stop now.

Mr. Lynn Myers: The doctor wanted to respond very quickly.

The Chair: All right. Please keep it short, whoever is going to respond.

Dr. James Meschino: Before we get too paranoid about that subject, in terms of cancer risk—and that's why you'd be concerned with pesticides—the Journal of the American Medical Association estimate that less than 1% to 2% of all cancers in North America are induced by contaminants in the environments. Before you get so nervous about pesticides, keep in mind that in juxtaposition to cigarette smoking, which accounts for 30% of all cancer deaths, and alcohol, 3%, and other lifestyle factors, the risk is really significantly low. There should be some way to evaluate it and keep it at a minimal level, but in terms of real risks to society presently, it's not deemed to be that risky.

Mr. John Apse: I have one comment. Surely it's not the risk in natural products. Surely it's the perception of the public that a natural product is free from pesticides and herbicides. Surely that's the issue.

The Chair: Thank you.

Judy, I know it's the right order for you to go next, but would you mind if Elinor went first? I'm going to leave and she's going to take the chair.

Ms. Judy Wasylycia-Leis (Winnipeg North Centre, NDP): No problem.

The Chair: Elinor.

Ms. Elinor Caplan (Thornhill, Lib.): Thank you very much. I'd like to ask some questions just to see if we have a consensus, and because the Hansard can't pick up head nodding I'll note when I see head nodding, because I think it's time for us to look for that consensus.

We've talked about the role of Health Canada. Is there a consensus that it is the role of Health Canada, the regulator, to determine level of risk? Does anybody disagree that this is a legitimate role for Health Canada?

Everybody agrees; heads are nodding.

Mr. John Apse: Yes.

Dr. David Peterson: With some qualification, I might add. As we describe in our submission, this regulatory agency should be composed of and include those members who would normally deal in these products.

Ms. Elinor Caplan: The issue of having appropriate expertise is of course one we've heard over and over again. You can't have risk assessment or assessment by people who don't have the expertise, and we noted that as an issue.

Dr. David Peterson: With that qualifier, I would agree.

Ms. Elinor Caplan: The point is well taken. It was that qualifier that those who are assessing the risk have the expertise to be able to make appropriate judgments. I think we all agree with that.

There were three other points. On the answer to the question of who's the guardian of the public interest when it comes to risk assessment and issues of safety, quality, and efficacy, we believe there's an appropriate role for the regulator. Having said that, the question was raised around the notion of disclaimer when it came to efficacy. My question is, if you have a low-risk product that meets safety standards, and I would include in safety standards the guidelines around herbicides or whatever else you wanted to be concerned about— You could have a list of all the things that have to meet the safety standards. The good manufacturing practice standards and so forth are quality.

• 1010

Once we have assessments of low-risk products, I think consumers are saying they don't think these products should be held to the same standard of efficacy that high-risk drugs are held to, and maybe on a low-risk product, especially if we want to keep the cost affordable for consumers, a disclaimer that says “Health Canada is not vouching for the efficacy of this product” may be an appropriate compromise. Is there any comment on that?

Dr. James Meschino: I think it's excellent.

Ms. Elinor Caplan: You think what's excellent?

Dr. James Meschino: I think it's an excellent proposal to say they might in the United States but here Health Canada does not promote the use of this product for the treatment of any particular condition.

Ms. Elinor Caplan: So the whole notion of a disclaimer on low-risk products is something you think we could be discussing at the same time.

Mr. John Apse: I have only one comment. Does that mean the low-risk product makes no claim?

Ms. Elinor Caplan: That's the issue, and the one question I've been asking many of the people who came forward is whether they believe a product that makes a claim should have to provide evidence appropriate to the claim. Everyone says yes. We've only had one person so far who said no. If we believe you should have to provide evidence appropriate to the claim, the issue is what that appropriate evidence is, whether that relates to the risk or the claim you are making, and whether that evidence should include 5,000 years of experience for traditional Chinese medicine, for example, or ayurvedic medicine.

Mr. John Apse: In my written submission, I have made reference to the homeopathic medicines where there has been some kind of modus vivendi established between the government and the homeopathic medicines, where it permits them to make certain claims for minor self-limiting conditions, provided they provide two homeopathic references.

I alluded earlier to the fact that this industry is in sort of developmental flux. It would not be very hard for everybody to sit down and develop guidelines on how to deal with various issues, products, and claims. Indeed, it may not be necessary to have some kind of statement on a product that HPB or Health Canada does not condone this product, whatever else. I do not like that idea and think it's a terrible slip backwards. It's simply saying “Sorry consumer, we leave it all up to you”. That's fair enough in some circumstances but there are other ways of doing that.

It's already happening. All you have to do is go out there and see a product that may not have many pharmacological properties and the literature right beside it says it's good for all these conditions. Are you going to deal with that as a branch? Probably not. It's very difficult. You can't stop free speech. So that's still out there and it will continue to be out there.

Ms. Elinor Caplan: I think what we're discussing here is protection of the public and the role of the regulator in those three things. There's general consensus on safety and quality. The issue for us is on natural therapeutic products that look like drugs, make claims like drugs, and have dosage requirements that go beyond saying eight glasses of water a day is good for you. I don't think anybody would consider that to be a dosage.

What is the efficacy role for HPD, recognizing that's where it gets very expensive? If you start to require double-blind studies on things that are low risk, you're effectively taking them off the market.

Mr. John Apse: Once you have an association that is all congruent and well organized— Even today there are efforts under way to develop herbal guidelines in various areas by pharmacists and various other bodies, and there's an increased interest in curriculum education. Out of that would come much the same as standard labelling. Monographs exist for Aspirin, Tylenol, and all these products. Those could be developed for the families of those products as well.

• 1015

Ms. Elinor Caplan: My last question is this. Is there support for either Canadian monographs or a Canadian herbal pharmacopoeia type of document?

I see all the heads nodding; does anybody disagree?

Dr. David Peterson: I just wanted to make one comment on that previous question on identifying claimers. We put in our submission that we feel it's important to identify those products that are deemed to be of high risk, and the regulation on them would be quite restrictive in dosages, quality, and standards, and who can provide and dispense them. The rest, deemed to be of low risk, can be left in the public domain.

Ms. Elinor Caplan: After the low risk has been assessed by the regulator.

Dr. David Peterson: Exactly, and consumers can choose.

Ms. Elinor Caplan: And it's in the low-risk area that you say disclaimers are okay to keep the cost down.

Dr. David Peterson: Yes.

Dr. James Meschino: As for the way you expand the label claims that go on in this country, I don't think you would hold it up to the same scrutiny as that for a drug, because no one has the money to do that. They're not pharmaceutical companies. The body of evidence really builds through epidemiological studies, cross-cultural epidemiological studies, longitudinal and prospective studies, retrospective studies, lab evidence, and cultural human tissues studies with the agent applied in a high-risk situation. Then you go to intervention trials, which are costly to run.

So that regulatory body would have to look at the body of evidence for a particular product and say that saw palmetto in a dose of 85% to 95% of a standardized grade of fatty acids and sterols may be helpful in the reduction of an enlarged prostate.

I think the label claim looks something like that where you do have control studies on this product but maybe not sufficiently as you would have for a drug. But I think to not let the consumer know that there is a body of evidence that is this strong and building is also unfair to the consumer.

The Chair: Thank you very much.

Ms. Wasylycia-Leis.

Ms. Judy Wasylycia-Leis: Thank you very much.

First, I have a couple of questions to our representatives from the Canadian Chiropractic Association. I apologize for missing part of your presentation.

I'd like to hear from you as professionals how the current regulatory approach to natural health products affects you on a day-to-day basis. How does it hamper you from practising your discipline? We've talked a lot about people generally and access to products, but I'm wondering whether for you it's a question of not getting access to products you would like to recommend to your patients. Is it that there are costs beyond the reach of people who see you? Is it that you would like to prescribe things that you're unable to do now? How does it affect you in a direct, personal way?

The second question for you is this. You recommend clearly the third category, the third regulatory approach. Have you looked at any other option? Is there anything else you could live with? This has been sort of the essence of our discussion over the last little while.

To Mr. Apse, again, I didn't hear everything you said, but what I did hear was that basically you're saying the regulatory and legislative framework is okay the way it is. My question to you is, so why are we here? What have we been doing for the last four months?

We didn't ask to do this. The minister recommended that we study this. There was obviously a problem.

Is it because decisions were being made within the department that fell outside that statutory regulatory framework and therefore caused the outrage and concern, or is it because they were actually applying the Food and Drugs Act as it now stands, causing the outrage in conjunction with a burgeoning growth in the area of natural health products?

Dr. David Peterson: Okay. I'm going to refer the first question to Dr. Meschino. That's his area of expertise. The second question, I'm going to refer to Mr. Papadopoulos because that's his area of expertise as well.

Dr. James Meschino: In response to your first question, chiropractors are primary contact practitioners right across Canada. One of the things the profession recognizes is that the population is aging. If you look at demographics, the principal health care issues we face are around cancer, cardiovascular disease, diabetes, and osteoporosis, and you're well aware of that.

• 1020

Where you have primary prevention strategies through a lifestyle modification that could reduce the rate and incidence of these diseases by educating patients and making available to them products that might ward off these problems, you could save the health care system billions of dollars. Many Canadians go to chiropractors looking for alternative ways of getting healthy. It's not just drugs and surgery. They're looking for more holistic models, and chiropractors are in a position to help deliver those models because of the training they have and the training they receive at a continuing education level. To restrict certain products—and I'll just use one quickly as an example—would, I think, actually be hurting the ability to delivery a service. It would also be hurting the health care system from a cost standpoint.

The RDA for vitamin E is about 12 international units a day. It's enough to prevent your red blood cells from breaking down. But if you look at the nurses' health study, the health professionals' follow-up study, and the study recently published by Dr. Hodis in the Journal of the American Medical Association, we see strong evidence that people taking a dose of 100 international units a day or more of vitamin E actually may reduce the risk of cardiovascular episodes by 40% in very long longitudinal studies. When Dr. Hodis did bypass surgery on his patients and gave them vitamin E and a cholesterol-lowering drug, they showed a tremendous efficacy in preventing recurrence of cardiovascular restenosis.

For chiropractors to have access to recommend vitamin E at a level that would be considered more pharmacologic, on 100 to 400 IUs a day, it is important if they have patients whom they feel would benefit, but it is also important to understand the level of toxicity. Once you go beyond 800 IUs a day, your platelets may not be able to clot in time and you could have a haemorrhagic stroke. You need somebody with enough knowledge in the area of the pharmakinetics of these drugs. At 12 IUs a day that's very low risk, at 400 it may be optimal in terms of disease prevention, and at 800 or more it might be a high-risk substance. Chiropractors have the training, so I think they should have access to that application.

Mr. Costa Papadopoulos (Manager, Professional Affairs and Health Policy, Canadian Chiropractic Association): In regard to the question on the regulatory agency that we recommend, you are questioning if there is another model we could live with. I think the main point, the main concern is that for natural health products, there has to be recognition that they are unique. They are not drugs, so the current regulatory mechanisms— Natural health products have more of a long-term effect, a more preventative effect in nature. They don't have the allopathic model of a drug for one condition at one time, boom, and which can control its RCTs.

To put all the natural health products under the category “drugs” would, I think, be inappropriate. That has to be a really important point in our presentation—just the whole paradigm around which natural health products are regulated. We do recommend regulation; however, it's a regulation that's not under the current way in which pharmaceutical agents are regulated.

The Vice-Chair (Ms. Elinor Caplan): So you are calling for an alternative process for the evaluation of those products that are now considered foods, that make claims, but may have dosage and come in capsule form—that sort of thing.

Mr. Costa Papadopoulos: Yes.

The Vice-Chair (Ms. Elinor Caplan): It's just an alternative process.

I want to thank you for appearing before the committee.

Ms. Judy Wasylycia-Leis: Could Mr. Apse just answer that last question?

The Vice-Chair (Ms. Elinor Caplan): Of course.

Mr. John Apse: Your question was, “Gee whiz, you say everything is fine, so why are we sitting?” Well, on page 12 or 13 of my presentation, I deal with the issue. The answer I give is that all the regulations they have passed in the last year or two have been very extensive. All of a sudden, everybody's tightened down. They have to license the product. They have to license the premises. There are problems with claims, with the burgeoning industry. All of those things have come together to create what I call a problem. HPB applied things suddenly, of course, whereas these things should be done gradually, over a number of years, in my opinion. To get a modus vivendi in an industry that's coming up takes a long time. It takes four or five years.

Is the regulatory framework adequate? Yes, I think it is. Let's just talk about what was mentioned here about these natural remedies or natural medicines or whatever you want to call them. If something like that, however innocuous, is to be taken over a long period of time, there must be some kinds of data somewhere. Maybe there's just a literature reference or two, and maybe they'll accept less. I made a recommendation that the vitamin issue and mineral issue be resolved by a special committee reporting directly to the minister.

Ms. Judy Wasylycia-Leis: Thank you.

The Vice-Chair (Ms. Elinor Caplan): I'd like to thank you all for appearing this morning and for your excellent presentations. They will be helpful to the committee in our deliberations.

• 1025

The committee is having a teleconference. It's going to take us a few minutes to set it up, so I'll adjourn the committee now. We'll take a break for approximately five or six minutes and reconvene as soon as the teleconference is ready to go.

I just want to make sure I have agreement from the committee. The presenter on the teleconference is one individual from one organization. In order to have time to discuss the other things on our agenda, is there agreement that this individual be given the amount of time that's usually available for one organization, which is approximately 20 minutes?

Some hon. members: Agreed.

The Vice-Chair (Ms. Elinor Caplan): Agreed, and then we'll have the rest of the time to discuss other matters before the committee.

We stand adjourned. Thank you.

• 1026

• 1041

The Vice-Chair (Ms. Elinor Caplan): Could I ask the committee to reconvene? Our time is limited and there are three presenters. If it's okay with you guys, we'll spend about ten minutes to half an hour, no more, on this, so we'll have lots of time for— Okay.

For the committee, we're going to start a videoconference from Halifax.

I'd like to welcome the three presenters to the health committee. As you know, we're studying the issue of natural health products. We will ask each of you to make a presentation of approximately five minutes in length. Then, after you've all made your presentations, we'll open it up for questions from the committee. Is that acceptable to you?

My information is that the first presentation is from Margaret D'Arcy, but if you've organized yourselves in some other way, that's acceptable.

Ms. Margaret D'Arcy (Treasurer and Chairperson, Citizens for Choice in Health Care Nova Scotia): Nancy Smithers will go first.

The Vice-Chair (Ms. Elinor Caplan): All right. Would you introduce yourself, Nancy, as you begin?

Mark, when it's your turn, just let us know what association you're from.

Welcome, Nancy. Do you want to begin?

Ms. Nancy Smithers (Director, Citizens for Choice in Health Care—Canada, Inc.): Good morning, everyone. My name is Nancy Smithers and I'm the owner of Naturally Nova Scotia, a company that grows and manufactures herbal products on a 250-acre farm on the eastern shore near Lawrencetown, Dartmouth, Nova Scotia.

All our products are guaranteed organic. Their purity has attracted the interest of nutraceutical industry players in Japan, Europe, and Latin America. We are working towards ISO 9000 standings in our manufacturing practices and we are working with the National Research Council on the testing and development of standards for our products.

Naturally Nova Scotia also supports the research of Dr. David Pitt of UBC into the antioxidant and anti-aging properties of dandelion.

We are committed to research and development so we can continue to bring effective, innovative products to the market. I believe our approach represents a model for the Canadian natural health products industry.

I am pleased to have this opportunity to speak to you about the urgent need for changes to the regulations of the natural health products industry in Canada.

There's an explosion in the natural health products industry and many new companies are being formed in Canada to meet this growing demand. Unfortunately, the existing regulations do not properly serve the interests of Canadian health products consumers or the companies that serve them.

At the moment, there are no standards for manufacturing practices to ensure the purity and quality of preparations. There are no labelling requirements to notify consumers of the exact contents of products or to warn of potentially dangerous interactions with drugs. Manufacturers are not allowed to make any claims regarding the therapeutic benefits of products, leaving consumers to navigate the packed shelves of the health products stores armed only with their own knowledge and the advice of the store clerk.

This situation must change. Canadian consumers must be both protected from impure or improperly manufactured products and empowered to use quality products. The industry must be appropriately regulated to allow those companies that are committed to producing top quality, effective products to flourish.

Industry-appropriate good manufacturing practice requirements must be established to ensure the safety and purity of natural health products. Companies should be licensed and monitored on a regular basis to ensure they comply with the standards and to maintain their operating licences.

Industry-appropriate labelling requirements must be established. Products must be what they say they are without contamination or adulteration and labels must disclose all ingredients so consumers can make informed decisions. Product labels should also be required to warn consumers of any known contraindications so they do not run the risk of suffering a potentially dangerous drug interaction. For example, St. John's Wort should not be taken in conjunction with anti-depressant medications.

• 1045

Manufacturers must also be allowed to state the benefits of a product on the label in the form of a claim that does not overstate the benefits and leave a consumer relying on a product when in fact they should be seeing their doctor.

Less than therapeutic and less than high-risk products must be required to meet appropriate safety standards, as guaranteed by good manufacturing practices. A product bearing such a claim should also be required to include a disclaimer on the label stating the claim has not yet been evaluated by Health Canada. This disclaimer requirement is crucial to the health of the Canadian natural health product industry.

The cost of government validation of less than therapeutic claims would be extremely high and would have to be added to the cost of the products. This would make Canadian products so expensive that consumers would go elsewhere and order their products through mail and the Internet. This is currently a legal practice under the import for personal use policy and should remain so to protect the freedom of individuals.

In order to save the Canadian industry, however, we must be allowed to remain competitive. We must not be forced to spend large sums of money validating claims through excessive, inappropriate, and far too expensive cost-recovery requirements in the form of excessive product licensing costs. Most herbal products have been in traditional use for hundreds or thousands of years. In effect, they have been clinically proven in large populations over long periods of time. Their benefits are well known and documented in countless herbals and they are known to be safe.

Another crucial component of effective regulation of the burgeoning health product industry is the establishment of a separate category for natural health products. Herbs, vitamins, amino acids, and homeopathic remedies are not foods and they are not drugs. They are currently regulated by the food directorate, which has imposed restrictions that limit the access of consumers to valuable products they need to maintain their health. Nowhere is this more true than in the chronically ill population.

A separate and distinct natural health products directorate, staffed by people who are knowledgeable and experienced in the field of natural health, is required to ensure that Canadians have appropriate access to safe and effective products at a reasonable cost.

Natural health products and complementary health services are currently discriminated against by Canada's health care system. None of these products or treatments are covered by government insurance programs, with a few exceptions, nor are they appropriately tax deductible.

Natural health products that have been recommended to a patient by a licensed or licensable health care professional, such as a chiropractor, naturopath, massage therapist or a practitioner of traditional Chinese medicine or ayurvedic medicine, should be fully deductible from the patient's income tax. Right now, there's a 3% threshold of income tax deduction, limited solely to conventionally recognized prescriptions.

Consumers are increasingly wary of pharmaceuticals and are demanding safe, natural treatments, yet they are systemically limited in their ability to access them. This systematic discrimination is particularly hard on the chronically ill, who cannot be helped by conventional means and who are taking responsibility for their own healing by pursuing complementary health care treatments. This situation should be rectified immediately. Health care expenses for complementary and natural health care treatments, as provided or recommended by a licensed or licensable practitioner, should be fully tax deductible.

In conclusion, we are standing at the threshold in the natural health products industry in Canada. We can either move forward and create a sensible and favourable regulatory environment that ensures Canadians have access to safe and effective properly manufactured and labelled natural health products, or we can step back and close the door on a fledging industry with tremendous economic potential and force Canadians to seek the products they want and need outside our borders and outside the influence of our standards. It is imperative that we move forward and institute the changes I have outlined today.

Thank you.

The Vice-Chair (Ms. Elinor Caplan): Thank you very much.

Next presentation.

Ms. Margaret D'Arcy: I'm basically backing up Nancy Smithers.

Good morning. My name is Margaret D'Arcy and I'm president of the Citizens for Choice in Health Care in Nova Scotia. This is the largest citizens' grassroots group in Canada for health care. It now has groups throughout Atlantic Canada, Ontario, Saskatchewan, Alberta, and British Columbia. It has been the most effective and active citizens' group in the country and is responsible for provincial and federal activity.

• 1050

To protect consumers we must make sure that manufacturers use quality and effective products. There must be standards for good manufacturing for the sake of purity and the safety of the consumer. Companies must comply with manufacturing standards. Appropriate labelling of products is essential. All ingredients must be listed on the label of each product, and there should be necessary warnings on labels if there are any problems with the product that the consumer should know about. Manufacturers could state the benefits of each manufactured product but should not be allowed to overstate. If a claim has not been evaluated by Health Canada, the consumer should not be so informed.

A separate category for natural health products is required. Health Canada needs a separate division for natural health products staffed with knowledgeable people who understand the field and have sympathy for the consumer. Last but not least, consumers need to have natural health products and complementary health services treated in the same manner by provincial, federal, and private health plans, as conventional medicine and conventional health services are treated in this day and age. They should also be fully tax deductible.

The consumer needs to be able to make an educated choice for his or her medicine and medical services and not be discriminated against just because he or she makes the choice of wanting complementary medicine and natural health products. Not every patient reacts favourably to conventional medicine. For some of us, our bodies cannot cope with conventional medicine. What are we to do? Who will help us? Why should we be discriminated against just because this is a fact in our lives?

Thank you.

The Vice-Chair (Ms. Elinor Caplan): Thank you very much, Margaret.

The last presentation please.

Mr. Mark Taylor (Nova Scotia Herbalist Association): Hello, my name is Mark Taylor. I'm here representing the Nova Scotia Herbalist Association. I'm going to be speaking on a report that the Nova Scotia Herbalist Association prepared for your committee.

The main point that the Nova Scotia Herbalist Association would like to convey to your committee is that standard medicine and alternative medicine are two distinct and separate paradigms. Any solution your committee is seeking has to incorporate this fundamental concept of the separate paradigms. While Canada has one set of national statistics, we have many political parties. These parties don't represent an absolute truth, they represent an interpretation of known facts. This, we believe, is the very same principle as is occurring in alternative health and standard health; they are two representations of facts as we know them. Similarly, with religions, we all have one set common history and yet many religions have sprung forth from a base set of facts.

The Nova Scotia Herbalist Association has prepared in its report a comprehensive set of six recommendations that we believe would help your committee to arrive at an equitable solution to the problems you are faced with. I'd like to go over those six points now.

The first point we propose is that a permanent professional core body be established to evaluate and qualify alternative health in Canada. Such a body should be called the holistic health council.

The second recommendation the Nova Scotia Herbalist Association makes is that a single vetted risk category be defined for products of the holistic health system, where both the public and the government can be satisfied as to their safety. These two first points are the main points you would be interested in, and we think form the core of the solutions you are looking for.

The third and fourth points we would like to add are in the promotion of all areas of alternative health. We believe that alternative health advocates should be hired by the federal government to work with provinces to map and finance appropriate holistic methods of health delivery.

The fourth point is that prompt and sufficient funding be allocated to the holistic health council over and above its self-financing capability for research, study, and investigation of alternative health.

• 1055

The last two points are to further advance the idea that alternative health is a distinct entity and paradigm unto itself.

The fifth point is that funding be available to accredited schools and universities for the purpose of training holistic technologists and other skilled personnel as the holistic health council may determine.

The sixth point is that federal hospital accreditations demand inclusion of holistic advocates to be available to patients.

The six points, all told, represent a recognition and application of alternative health as a distinct paradigm in Canada.

Thank you.

The Vice-Chair (Ms. Elinor Caplan): Thank you very much for your presentations.

I'm going to call now on members of the committee to ask questions.

Mr. Elley, you're first.

Mr. Reed Elley (Nanaimo—Cowichan, Ref.): Thank you very much, Madam Chair.

Thank you very much for appearing before us via this video teleconference hook-up.

I'm interested in some of the proposals, particularly as I heard Margaret D'Arcy and then the gentleman from the herbalist association. It seems to me you're advocating far more government interference in the natural products sector when you start asking for government funding, for more interference in this whole area.

Now, I may be getting you wrong; maybe you'd like to elaborate a little bit more on that. I'm concerned about hearing people like you asking for a lot more government funding for these things, because quite frankly, when government gets involved, you're going to be far more regulated than you ever were before.

Can you comment on that, either one of you, Margaret D'Arcy or Mark Taylor?

Mr. Mark Taylor: I'd like to say that it doesn't involve any more government bureaucracy that I can see, and it certainly doesn't involve any extra government funding. The holistic health council, for example, would be self-financing. The funding I'm referring to is merely a reallocation or a re-prioritization of existing funding, putting money—

Mr. Reed Elley: To come out of— We all know government's been cutting back on funding to health care systems. It's one of the reasons we're in a health care crisis in this country.

So where would this funding come from? How can you allocate nothing from nothing? Where is it going to come from?

Mr. Mark Taylor: As I understand it—and let's just say health spending in total—anytime you're spending money on standard medicine, when you work towards preventing illness and disease in the first place you're saving money hand over fist. I would redirect moneys that are going towards the standard paradigm into the alternative paradigm.

Mr. Reed Elley: Thank you.

The Vice-Chair (Ms. Elinor Caplan): Mr. Myers.

Mr. Lynn Myers: Thank you, Madam Chair.

I want to start with you, Mr. Taylor. Your first two points were very interesting, the first being the professional, permanent, core-body holistic health council. Can you review exactly what it would do?

Specifically, I think I heard you talk about quality, good manufacturing practice, etc. I think I heard you say safety as well. I'm interested in whether or not efficacy would be part of their review in addition to those others.

Mr. Mark Taylor: Sorry, but it was probably Margaret D'Arcy's report that used those specific terms.

The holistic health council would be a self-financing body based on certifications and compliances, as would be certified organic products now. There would be a fee for certification. Alternative hospitals, alternative health education institutions, practitioners, and people making products would pay a fee for a particular type and category of alternative health products.

The holistic health council would be responsible for vetting these products, and it would be self-financing through its vetting process.

Mr. Lynn Myers: When you said “vetting”, and that they would evaluate and qualify, I thought inherent in that would be quality and safety. Or am I missing the point?

Mr. Mark Taylor: No, absolutely.

• 1100

As for vetting, they are the best body. They would be the best body to determine quality and safety. It would be a vetting process, and you couldn't improve upon that.

Mr. Lynn Myers: Just on that point with respect to the vetting process and risk category, how do you determine what's low risk and what's high risk?

Mr. Mark Taylor: You ask the council to establish the scale of risk, high and low. They would determine the degree of risk. Then they would certify according to what they think is the degree. Then people could purchase the product in a knowing manner.

Mr. Lynn Myers: I wonder if Margaret D'Arcy could also reply to that.

Ms. Margaret D'Arcy: Basically, I agree with Mark. We're looking for categories and groups to be set up to monitor what is being manufactured. Is that the question you wanted?

Mr. Lynn Myers: I'm interested in safety, quality, and efficacy, and I'm wondering how you would deal with those.

Ms. Margaret D'Arcy: We would set up boards with people who are knowledgeable about the alternative supplements and who would be judging and deeming what is a good product and what is not. I think you have an establishment already set up now, don't you?

The Vice-Chair (Ms. Elinor Caplan): Could I just try to clarify? I think the question being asked, as I understand it, is: are you proposing a self-regulatory model or do you see a role for Health Canada?

Mr. Mark Taylor: I see no regulations other than to protect certification names. For example, in certified organic products, you're protecting the certified organic name. So there should be only a small amount of regulation to protect names. That's pretty much it for regulations.

The Vice-Chair (Ms. Elinor Caplan): So you're requesting deregulation. There would be no regulation except for name protection?

Mr. Mark Taylor: Pretty much.

The Vice-Chair (Ms. Elinor Caplan): Okay.

Mr. Mark Taylor: Let the alternative health group stand on its own.

Mr. Lynn Myers: I have a quick question for Nancy Smithers.

I think in your opening remarks you spoke about research and development being important. I think you said you were a model. I guess you're referring to your own company in that regard.

Ms. Nancy Smithers: Yes.

Mr. Lynn Myers: Could you elaborate on those two points: you as a model and the importance of research and development?

Ms. Nancy Smithers: I believe there is not a lot of research out there in herbs, like in dandelions, St. John's Wort, and echinacea. There are a few articles published but there is not enough research being done.

I am working with Dr. David Pitt at UBC and doing some research into herbs. We plan to have this published in journals and things like that.

The Vice-Chair (Ms. Elinor Caplan): Thank you very much.

Mr. Lynn Myers: I think you said in your opening statement that you are a model for others. I wondered what you meant by that.

Ms. Nancy Smithers: What we do at my farm is grow our herbs there. We're very careful. We're certified organic. We are working towards ISO 9000. We're trying to do everything properly to make sure that our product at the market has the efficacy such that everything is perfect when it comes out, nobody will be injured by it, and that it's a perfect product, as perfect as you can get.

The Vice-Chair (Ms. Elinor Caplan): Thank you, Mr. Myers.

Ms. Wasylycia-Leis.

Ms. Judy Wasylycia-Leis: Thank you very much.

You're all representatives of different organizations within I believe the province of Nova Scotia. Can you give me a sense of what the extent of usage is in the province of Nova Scotia in terms of herbal products, traditional aboriginal medicines, and general health products across the board? Can you give me a ballpark figure in terms of the percentage of usage in alternative products, and have you seen a growth in this whole area in recent years?

Ms. Nancy Smithers: I can answer that on my own, being a manufacturer. I launched my line in 1995, and I'm doubling my production every year. I'm more than doubling my production every year. I think that shows that people are becoming more aware. People are asking. I have a lot more people phoning the farm trying to find out about alternative medicine.

• 1105

Ms. Judy Wasylycia-Leis: Are there any other comments? Has anyone else noticed any changes in the climate around this whole issue lately or in the last number of years? I'm trying to get a sense of general public interest in the area, how representative your groups are of broader population, and if you're reflecting the views of the whole cross-section of people involved in natural health products. What's the general consensus coming out of the province of Nova Scotia?

Mr. Mark Taylor: I think interest in alternative health is very high, and it's growing all the time. It's spanning broad sections of society, from medical personnel right through to all occupations. It's growing and everybody's interested.

Ms. Judy Wasylycia-Leis: Thank you very much.

My other question has to do with the follow-up on Lynn Myers' questioning, around how we as a committee can best work towards ensuring freedom of choice to consumers at the same time as we play an active role in terms of the safety and quality of the product.

One of the most recurrent themes before this committee is that within the Health Protection Branch we need the expertise to ensure scientific surveillance and botanical authenticity and we need the ability to play a role in terms of warnings, labelling, dosages, and possible side effects. Would you support that general thrust or are you looking at another whole direction for this field?

Mr. Mark Taylor: I think HPB, if it takes advice, should take advice on alternative health products from an alternative health body. Any advice it takes otherwise would be poor advice.

Ms. Judy Wasylycia-Leis: Just as a supplementary to that, could one ensure that capability within the Health Protection Branch if in fact people were brought in who have expertise in the various aspects of the natural health products area?

Mr. Mark Taylor: I don't see the Health Protection Branch taking a very active and distinct role in this. I see them as empowering a holistic health council. Then the Health Protection Branch can work on the advice of the council or can oversee the council.

For example, the Nova Scotia Herbalist Association has proposed not a third category of product, not food, drug, and a third category; it's actually proposing the two categories, food and drug, and then a vetted risk area, which is essentially another animal entirely. The vetted risk area is just a measure of risk that is overseen by the holistic health council.

I see any power that HPB may have as having the power to yank products out of the vetted risk area and stick them into the drug area or the food area, where regulation is strict and there's a history of action on that type of product. But otherwise there should be a non-distinct area that is called “vetted risk”, and people can choose from that grouping of products with complete safety and complete knowledge of those products.

The Vice-Chair (Ms. Elinor Caplan): Thank you very much for your presentation. We appreciate you taking the time and effort to make representations to our committee. I can assure you that the committee will be studying these matters over the next few weeks and will take into consideration the representations you've made.

If you have any further information you want to send to the committee or you think of something after the fact that you'd like us to know, you can send it to our clerk. We'll be happy to receive it.

The committee is now going to go into an in camera session. The video teleconference is now over. Thank you very much.

[Editor's Note: Proceedings continue in camera]