HEAL Committee Meeting

STANDING COMMITTEE ON HEALTH

COMITÉ PERMANENT DE LA SANTÉ

EVIDENCE

[Recorded by Electronic Apparatus]

Thursday, May 6, 1999

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[English]

The Chair (Mr. Joseph Volpe (Eglinton—Lawrence, Lib.)): I call the meeting to order. Pursuant to Standing Order 81(4) and the orders of the House of February 26, 1999 and March 25, 1999, we are studying the main estimates for 1999-2000 under Health Canada and the “Report on Plans and Priorities” for Health Canada, sessional paper number 8520-361-201.

Now that we've finished with the formalities, I want to bid a very special welcome to the ladies and gentlemen from Health Canada. I'll go through a quick introduction.

First of all, on behalf of the committee, and especially on my own behalf, thank you very much for making the effort to come here on such short notice. I know our notice was short because I'm familiar with the process we had to go through in order to get some of you here. I'm especially appreciative of the fact that you put together the information and the package you want to share with us, because we think as a committee it's going to be very instructive for us to put some of our questions and concerns in the appropriate context, as some of your colleagues will appear before us later this month. For that, I thank you.

For colleagues around the table, I want to reinforce what I just said in terms of the function of these three groups as I see it. They're here essentially to give us an overview of some of their functions. I think in at least one case it is a relatively new area—relatively new from an organizational perspective. Is that you, Denis?

Mr. Denis Gauthier (Assistant Deputy Minister, Information, Analysis and Connectivity Branch, Health Canada): Yes.

The Chair: Okay.

It might not be the actual fit for us for some of the questions the committee members might normally have, but this is not to discourage any committee members from asking any questions, poignant and pointed and whatever. It's just to advise us all that their function is perceived, at least from their part, to be a little bit different as per the indications we gave.

That having been said, let me go through some of the introductions quickly. I'll ask for support in making the introductions from the individuals who are going to give the presentations.

By the way, normally we have a five-minute period of presentation, and then we get into questions and answers. We have a couple of people who have urgent timetables that need attention. Denis, you're one, and the other one is Mr. John Cummins.

[Translation]

Ms. Pauline Picard (Drummond, BQ): Mr. Chairman, you are suggesting we give five minutes to our guests for their presentations and that we then move to questions. I have some reservations about this approach. I think we're here to hear from our witnesses, rather than to question them. We only found out at the very last minute that they could come and meet with us today, and we did not have enough time to prepare questions. We have not yet had our briefing sessions on the new divisions set up by the department. I would like you to give them more time. Some questions may arise, but for the time being, I feel a little uncomfortable about the approach you are suggesting. I would prefer to hear from them, and take notes for the time being. Later, at another meeting or when the Minister comes to meet with us, we will be able to ask them more intelligent questions. I would find that difficult at the moment.

The Chairman: As always, Ms. Picard, I will readily agree to your request. Rather than give our witnesses five minutes, I will give them 10, but not more than 15. All right?

Ms. Pauline Picard: All right.

[English]

The Chair: That will give us time to get Denis out of here quickly, and it will give John Cummins an opportunity to ask at least one question.

Is that fair, John?

Mr. John Cummins (Delta—South Richmond, Ref.): Yes, that's fine. Thank you very much.

The Chair: Mr. Gauthier is the assistant deputy minister of the information, analysis, and connectivity branch.

You're accompanied here by at least two other people. Do you want to make those introductions?

[Translation]

Mr. Denis Gauthier: With me are Jerry Lee, the Director of the Infrastructure System Management Division, and Gregory Hunter, the Director of the Information Resources Management Division.

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The Chairman: You have only two people with you? Is Mimi Breton not here?

[English]

Ms. Catherine Stewart (Director, Policy Development and Coordination Division, Health Promotion and Programs Branch, Health Canada): I'm Cathy Stewart. I'm with the health promotion and programs branch, and I'll be making the presentation on behalf of the branch.

With me today are David Fransen, the director general of the population health directorate; Janet Davies, representing the strategies and systems for health directorate; Mimi Breton from the hepatitis C division; and Hervé Leblanc, who is the director of financial services for the branch.

The Chair: Okay. I'm sorry; it's just that I had everybody organized differently on this sheet, so I jumped over.

Where is Gérard Séguin?

Mr. Joel Weiner (Acting Director General, Policy, Planning and Coordination Directorate, Health Protection Branch, Health Canada): I'm Joel Weiner, the acting director general of policy, planning, and coordination in the health protection branch.

I have with me today Mr. Gérard Séguin, who is the director of finance in our branch, and Dr. Moe Hussain, who is the director of planning. Some of my colleagues from the operating directorates, Jan Pound and Paul Mayers, are available as well, from the therapeutic products program and from the foods directorate.

The Chair: Great. Thanks a lot. I think the clerk and staff were trying to see whether I was awake. They put a special sequence in here just to see whether I would either catch on or be caught up. Obviously I was caught up.

[Translation]

You have the floor, Mr. Gauthier.

Mr. Denis Gauthier: Thank you very much, Mr. Chairman. I will make my remarks in French, because I prepared my notes in French, but I will be pleased to answer your questions in either English or French.

As you know, a key component of the federal health strategy is to make better use of information and research on health. At all levels of the health care system—governments, health care professionals and even users—decisions should be based on facts. The establishment of an integrated health information and knowledge infrastructure in Canada is one of the essential conditions for increased, improved use of this information.

As you mentioned, Mr. Chairman, a new branch has been established at Health Canada—the Information, Analysis and Connectivity Branch. It combines in a single entity three essential components of the information spectrum: the creation of strong information management and technology networks inside and outside the department; the production of knowledge and information through analytical research; and the dissemination of this material through the information highway.

The branch is relatively new—it was just set up in mid- November. Its mandate is to encourage decision-making based on facts, not on anecdotes, at all levels of the Canadian health care system. Our objective is to improve the analytical basis of decision making.

Our second objective is to promote the proper use of information technology in the context of knowledge management—that is, foster the imaginative use of the information highway in the area of health.

Our third objective is to promote, within the Department of Health, the establishment of a dynamic learning culture based on solid analysis.

The branch is made up of four directorates, three of which are completely new, and the fourth of which has existed for one year. It is called the Information Management Services Directorate, and it formerly came under the Corporate Services Branch. It is responsible for planning, running and coordinating the department's information management program, for establishing and managing an appropriate technological architecture, and for designing and implementing computer initiatives, strategies, technologies and policies within the department. The information management infrastructure of the department is the input in the production of information and knowledge on health.

We could now talk about the output—the Office of Health and the Information Highway—which makes recommendations and manages policy and program implementation frameworks so as to define a national strategy for the Canada Health Information Network. This Office, which was set up in 1997, is currently managing the Canadian fund for health infostructure, which was given a 50-million dollar budget. It is responsible for the new funds from the 1999 budget to be used to strengthen the use of modern computer technology for communicating information on health. This includes initiatives such as telehealth, telehealth care and the connectivity of regional health centres.

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The Office also follows up on recommendations made by the Advisory Council on Health Infostructure, which delivered its final report to the Minister of Health in February. It provides research, analytical and support services for Health Canada's Health Information Network, which includes the Canadian Health Network and the National Health Surveillance Network and the Health Information System of the First Nations. This Office is also responsible for coordinating activities with the provinces and territories so as to promote the development of a national health information highway strategy. To this end, the Office works to establish safe procedures for transferring information. It seeks to ensure that when policies on the health information highway are developed, steps will be taken to protect privacy, to harmonize the work with provincial policies in the field, and to ensure the compatibility of these systems should provinces develop their own telehealth systems. This atmosphere of harmonization and compatibility will enable us to connect the systems to each other. It will also ensure that we meet the accountability requirements set out in part 3 of the social union agreement.

We established a new directorate very recently, which includes a director general and a few young employees. It is really the innovative component here: the name is the Applied Research and Analysis Directorate. It is to develop and carry out a strategic research program on medium- and long-term health issues. The results of this research work are to form the analytical, fact- based foundation on which we should base the solutions to the major issues regarding health policies and programs. The ultimate objective of this directorate is to establish within Health Canada an internal capacity to carry out research, to assimilate the results of external research and to integrate the analysis and research on health policies into the design and development of policies designed to maintain and improve Canadians' health. This is to be done according to procedures comparable to those in place in other departments. We established this directorate because we noticed that Health Canada had no internal analytical capacity.

The fourth directorate is rather a secretariat, which reports to me since I assumed my duties at Health Canada. This secretariat will support the work of the interim management committee of Canadian health research institutes. As you know, the federal budget set aside funding to change the health research methodology in Canada to make our approach more multidisciplinary and more integrated. The methodology combines biomedical research, health services research, clinical research and social sciences research with a view to establishing a series of multidisciplinary institutes. This advisory committee is chaired by Dr. Henry Friesen, and its mandate is to develop the legal and conceptual frameworks that should be in effect beginning April 1, 2000. That summarizes the duties of this new directorate.

The Chairman: Thank you, Mr. Gauthier.

Ms. Stewart.

[English]

Ms. Catherine Stewart: Thank you very much, Mr. Chairman.

On behalf of Health Canada's health promotion and programs branch, I'd like to thank you very much for the opportunity to present this information to you about the branch.

As you probably know, HPPB is a program branch within Health Canada. It undertakes a broad range of activities aimed at the entire Canadian population but also aimed at specific population groups and high-risk groups.

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The branch's mission is to enable Canadians to take action on their health and the factors that influence it. We do this by engaging and mobilizing Canadians to act on conditions and risk factors affecting their health.

In the current fiscal year, the total budget is $240 million, and this doesn't include initiatives that were announced under the federal budget.

The branch undertakes three primary roles. The first is promoting an understanding of and action on the broad determinants of health across all sectors of Canadian society. I'd like to pause for a minute and just talk a little about that.

What I mean by taking action on the broad determinants of health is that health is determined by more than just health services and lifestyles. It is actually influenced by a very broad range of factors in the economic, social, and physical environment, and more important, by the interaction between those factors. For example, if you look at the physical environment and its interaction with healthy child development, you can see there are some rather profound possibilities for impacts on child health.

The second role is providing strategic national leadership on specific health issues and in relation to specific populations—and I'll touch a bit more on that—and then working with Canadian communities and institutions on the development of resources and tools, such as public education resources. David Fransen has brought a selection that you might like to have a look at. Other resources include Internet-based information, which is developed in collaboration with Denis Gauthier's branch and others; and clinical practice guidelines aimed at professional education.

The branch is currently focused on four major areas of action.

The first is healthy child development. As I mentioned, this is a critical determinant of health.

The second is healthy aging. This relates to healthy aging of the current population of seniors, as well as promoting healthy aging in the future, when Canada can expect that a fairly significant proportion of its population will be older and will require different health and community services.

The third is enhancing the national capacity to respond to current and emerging health issues. I'll talk a little more about those in a minute.

The fourth area is a bit different from the other three in that it's aimed at the development of an integrated health system that incorporates principles of health promotion and action and broader determinants of health.

In terms of healthy child development, the programs provide support for families. They foster healthy, safe, supportive, and social environments for children and their families. The major focus is on early child development in the years zero to six, but we also promote an integrated approach to the development of youth aged 12 to 19.

The programs in this area are the aboriginal head start program; the Canada prenatal nutrition program, which is to be expanded under the budget announcement; the community action program for children; the family violence prevention initiative; the centres of excellence for children's well-being; and a number of other examples that David Fransen can tell you more about.

The second area is in relation to healthy aging. As I mentioned, this is a concern for us for people who are currently seniors, but probably more important, to prepare for the aging of the population. The aim in this particular area of action is to integrate the work on healthy aging with chronic disease prevention, looking at cancer, diabetes, osteoporosis, and various dementias. This would also include work on the heart health initiative, the breast cancer initiative, and more recently, prevention and screening of other forms of cancer, most particularly prostate cancer, cervical cancer, ovarian cancer, and colorectal cancers. Again, David can give you more information on some of these activities.

The third area is to respond to a number of current and emerging health issues using a population health approach—that is, looking at what are the broad factors in the environment that would assist in prevention of health problems. So it takes into consideration socioeconomic, behavioural, physical, and biological factors, as well as the health care system itself.

The population health approach focuses on an upstream, preventative approach. It looks at supportive environments for healthy living. Specific HPPB efforts are related to HIV and AIDS; the Canadian breast cancer initiative, as I mentioned; hepatitis C; fitness and active living; the tobacco control initiative; and joint work with the provinces, the Canadian Institute for Health Information, and Statistics Canada on population health indicators. One of the initiatives announced in the budget is the Canadian population health initiative, which is part of a number of activities related to improving the information base.

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The fourth area of action is contributing to the development of an integrated health system. We play a very strong role in this area, together with our colleagues in the policy and consultation branch, the health protection branch, and IACB as well, which is Denis Gauthier's branch. We work very closely with the provinces and territories.

We have a particular emphasis on health services in relation to rural and remote areas and on improving access for Canadians who live in rural and remote areas. We're working with the provincial and territorial governments to address workforce issues as they relate to rural areas, where there are some distribution issues, and also to look at the supply of doctors and nurses across the country. In the context of rural health, we are also very interested in information technologies, particularly telehealth.

The last focus in this area of action is improving access to information for Canadians in relation to the Canadian health network, which is intended to be an Internet-based system that will provide information to the public on health promotion, disease prevention, and health services. It will be supplemented by other modes for people who do not have ready access to the Internet, such as a 1-800 line.

I'll stop there. In essence, the emphasis is on prevention and on a “broad determinants of health” approach.

The Chair: Thank you very much. We'll go to Joel Weiner.

[Translation]

Mr. Joel Weiner: Thank you, Mr. Chairman. I will be making my statement in English, but I am quite prepared to answer your questions in French or English.

[English]

I'm going to try to provide an overview of what the health protection branch does. To focus on individual initiatives would take us several hours, because we're a pretty large organization. The point I really want to make is that we have an incredible breadth of activity.

Many people who look at the health protection branch compare us to four agencies in the United States. We are said to be essentially the Canadian equivalent of the Food and Drug Administration, the Centers for Disease Control and Prevention, the Environmental Protection Agency, and the Consumer Products Safety Commission, because our activities cover all of those areas, and operationally, we're organized into four program directorates that essentially correspond to the activities of each of those U.S. agencies.

The Laboratory Centre for Disease Control is basically the Canadian equivalent of the Centers for Disease Control and Prevention, headquartered in Atlanta. Its main job is to undertake disease surveillance on a consistent and ongoing basis and to elaborate on disease prevention strategies in conjunction with partner branches in Health Canada, other federal departments in Ottawa, the provinces, and often also with international agencies. In addition, quarantine responsibilities under the Quarantine Act are fulfilled by LCDC.

The second major operating unit we have is the therapeutic products directorate, and it essentially is the equivalent of the Food and Drug Administration, at least on the drug side. It is responsible for ensuring that blood, pharmaceuticals, and medical devices are safe, effective, and of high quality. It also has regulatory responsibilities with regard to narcotics and restricted substances.

On the food side, we're not entirely equivalent to the Food and Drug Administration, because as members of the committee will know, a couple of years ago the Government of Canada consolidated all of the food inspection activities that were undertaken by three separate departments of government—namely, Health Canada, Agriculture Canada, and the Department of Fisheries and Oceans—into a new Canadian Food Inspection Agency. So, unlike the FDA, we do not have a responsibility for conducting inspection activities.

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What we do have, though, is the responsibility for setting the policy and standards and for auditing the performance of the Canadian Food Inspection Agency. We also have a number of activities under way in such areas as nutrition and the analysis of the chemical properties of foods, along with a number of related issues, all of which are concerned with ensuring the food supply in Canada is safe and nutritional.

The third operating directorate is the environmental health directorate, and once again there are a number of discrete kinds of activity centres. For example, there is the product safety bureau, an organization that migrated to Health Canada in 1993. It used to be part and parcel of the former Department of Consumer and Corporate Affairs. It is responsible for administering the Hazardous Products Act. Everything from the space between the bars in babies' cribs to the use of plasticizers in teething devices to the flammability standards for children's pyjamas and other kinds of hazardous and toxic products that consumers would encounter is the regulatory responsibility of the product safety bureau.

The environmental health directorate also houses our office of tobacco control, which is responsible for administering all of the regulations and implementing the administrative policy of the Government of Canada with regard to smoking.

There is also an area that deals with toxicity of chemicals, polymers, and other substances, mainly in connection with the provisions of the Canadian Environmental Protection Act.

The last directorate is the one I have the privilege of heading at the moment, and it is the newest part of the health protection branch. It's called the policy, planning, and coordination directorate. We were established less than a year ago, and I think members of the committee will be interested to know why.

Clearly, with the range of discrete activities I've just described, the real challenge is how to coordinate and integrate them into a cohesive health protection program. That's a management challenge that has to be supported by a corporate policy and planning function that works hand in hand with the specialized operating unit and tries, as I said, to coordinate and integrate them into a cohesive health protection program. That's our goal, and I would like to believe that in the less than one year we've been in operation, we have contributed in some way toward achieving that goal.

Members should also be aware of the fact that the establishment of this policy, planning, and coordination directorate was paralleled by another initiative to improve the management and operations of the health protection branch, and that is the transition initiative, which the minister launched about a year ago and with which members of the committee may be familiar. We have published a number of documents, and we have been engaging in consultations across the country. The objective here is to ensure that the health protection branch has the capabilities—scientific, financial, and human resource-based—to address the health risks to Canadians in the 21st century.

There is a very ambitious change initiative, which I think is the best way to describe it, and we call it health protection branch transition. In conjunction with the establishment of the policy, planning, and coordination directorate, you have a systematic and rigorous effort on the part of the department to ensure that this important health protection capacity is as good as it possibly can be.

We have prepared some material

[Translation]

in English and in French in order to explain our activities to you.

[English]

As I've indicated, it's such

[Translation]

a range of activities

[English]

that it's hard to know where to start in pointing at specific initiatives.

Maybe it is worth while, before I close, to say something with regard to our transition initiative. We're working in conjunction with the provinces in improving the disease surveillance capacity.

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Disease surveillance is an activity that cannot possibly be done by the federal government. There is clearly a collating and an analytical and information-disseminating capacity that can be done at the federal level, but the raw epidemiological data comes to us from the provinces. So the national disease surveillance system is clearly a federal-provincial enterprise.

Another facet of our transition exercise is to improve the risk management framework, which we use, as do regulatory agencies around the world, to make our decisions. The risk management framework is essentially a step-by-step, rigorous system of asking questions and factoring in all kinds of considerations. We're embarked on a very ambitious project to modernize that framework and thereby improve our decision-making capacity.

A third element that's very important to mention is how we should and will engage the public. One of the very clear stools in our transition initiative, one of the legs of that whole enterprise, is public involvement. We have been out consulting with Canadians about what their expectations are, and more important perhaps what their needs are, in terms of information from us and participation with us in the development of plans and programs. We hope to have some significant changes to put in place.

The last major element of our transition exercise is a consolidation and modernization of our legislative framework. In some cases that's perceived as a bad thing. Our view is that it's an absolutely critical and vital thing. Diseases are emerging; old diseases that we thought were conquered are re-emerging. The world has been globalized. Diseases are being transferred everywhere.

New technologies are coming onstream at a faster and faster rate, and in our view, the capacity we have to help protect the health and safety of Canadians is going to be in part dependent on the kind of legislative capacity we have. That's why legislative overhaul or modernization is an important element of this transition initiative.

Thank you.

The Chair: Thank you, Mr. Weiner.

When you say you do consultation with the public, what fora do you use—what mechanisms?

Mr. Joel Weiner: Under the Government of Canada's guidelines for regulation-making, for example, we're absolutely obliged to have public consultations. This includes a range of activities, from, for example, publishing in parts I and II of the Canada Gazette—and there are obligatory periods during which we have to wait and receive comment—to actually going out and having face-to-face encounters with people in formal consultation sessions. In between, we have a number of techniques, including the use of advisory committees.

What we heard during our transition consultations was not that we're not doing the public involvement and consultation, but that we're not doing it as well as we could be doing it. We have very deliberately gone out to Canadians and talked to them, as I said earlier, about their needs and their expectations and are trying to convert that input into some very solid proposals for some programs that will improve our ability to engage citizens and involve the public in our work.

The Chair: Thank you.

Mr. Cummins.

Mr. John Cummins: Thank you very much, Mr. Volpe.

I have a couple of brief questions, and they have to do with the recent Auditor General's report on the use of the anti-malarial drug mefloquine by Canadian troops in Somalia.

Canadian troops are required to take that drug. The Department of National Defence obtained the drug because it agreed to participate in the safety monitoring study. That safety monitoring study should have been monitored by the health protection branch, and yet the Auditor General notes that Health Canada had approved the terms of the clinical trial for the drug, but it made no attempt to ensure that the protocol, with its reporting requirements and procedures to protect the patient's well-being, was being followed. That's a serious condemnation of your process and procedures, and I wonder if you'd care to comment on that.

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Mr. Joel Weiner: As a starting point, I would say we're committed to good management practices, and good management practices mean taking note of the assessments of our work—either the internal assessments we do or the assessments done externally, particularly those by the Auditor General. In this particular case we've had a report submitted to us, and we're looking at it very seriously to try to determine whether there is a need to make some changes in our operational procedures, and if so, to make them.

Mr. John Cummins: But in your response to the Auditor General, you say it's Health Canada's policy that the monitoring of study protocols rests with the sponsor of the clinical trial—in other words, the manufacturer. It seems to me that licensing a drug for use by the Canadian public and allowing the manufacturer to oversee that licensing is just bizarre. Is this the process you intend to follow?

Mr. Joel Weiner: With the permission of the chair, I would like to invite my colleague from the therapeutic products program, Jan Pound, who is the manager of the office of strategic planning, communications, and quality, to respond to the member's questions, please.

The Chair: She's quite welcome.

Ms. Jan Pound (Manager, Office of Strategic Planning, Communications and Quality, Health Canada): I appreciate your concern about that issue.

The response that was published by the Auditor General is somewhat incomplete. In addition to the manufacturer's monitoring, there are other systems in place. The system for clinical testing of drugs in Canada is based on a partnership approach, you could say, involving the clinical practitioners, the institutions under the auspices of which these testings are conducted, as well as the manufacturers and us. It's a multi-level, tiered responsibility.

Obviously our role is in reviewing the protocol for the testing and ensuring the protocol meets the requirements to protect Canadians. The implementation of the protocol and the monitoring of it are the primary responsibility of the manufacturer, but the institutional review boards are also in place to ensure these are being conducted properly at the practitioner level, and there are also drug monitoring protocols in place in various institutions to ensure this happens.

We recognize that we have a limited capacity to monitor. We cannot monitor at the institutional level or at the practitioner level. That's a provincial responsibility. Our responsibility is of course in interacting with the manufacturer, and we try to do that to the best of our capacity.

We are at present reviewing the processes for clinical trials in Canada, and we have a reform initiative under way. We've had several consultations over the last two to three years, and in our plans for this coming year, it's anticipated that we will put forward a new mechanism as well to enhance this capacity.

Mr. John Cummins: Back in October 1994 I raised this issue in Parliament, and it was raised in the media as well. You requested of the manufacturer that they provide you information on the safety monitoring study. You found out in 1994 that the protocol had not been complied with, and yet you did nothing. That's frightening, because the fact that you did nothing at that time, after there had been serious problems with the drug's use in Somalia, suggests that the Canadian public was not well served by the health protection branch.

Ms. Jan Pound: I can't speak directly to the 1994 request obviously, but I will enquire. Certainly we are aware that there's an ongoing requirement for manufacturers to submit adverse drug reaction reports. DND did submit those to us, and we did see them also when the manufacturer made the formal application for approval of this drug in Canada. So there are mechanisms, built upon the clinical trial process, that are incorporated into the drug approval process. I can only speak in generalities to that issue.

The Chair: We will go on to Madame Picard.

[Translation]

Ms. Pauline Picard: Mr. Chairman, I would like to ask Ms. Pound a question on the same subject.

This week, the newspapers reported that Health Canada reportedly approved the hormone Revelor H without it ever being studied by the Agriculture Committee. According to a scientist who works in your department, this hormone which Health Canada approved causes certain problems in animals, including the excess growth of mammary tissue in females. This hormone is going to wind up in the animals that Canadians are going to eat, without there even being some labelling on these products to warn people that these animals have ingested a hormone. As we all know, the European countries refuse to buy animals that contain hormones, whether this be bovine somatotropin or any other type of hormone. When we allow this type of hormone to be used in animals, we eliminate some markets.

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What is the Health Protection Branch's current position with respect to Canadians? Why has this hormone been approved without it even having been studied by the Standing Committee on Agriculture?

Mr. Joel Weiner: I will answer your questions since they pertain to the work done by the Bureau of Veterinary Drugs, which is part of the Food Directorate and not the Therapeutic Products Directorate.

[English]

We are aware from newspaper accounts, as members are, that apparently a report has been published in Europe with some information regarding the toxicity of that particular product. We are trying to get our hands on the full report. We have only seen public accounts. The last time I checked, which was late yesterday afternoon, we had not yet had the full report.

With respect to the use of the product in Canada, it has been approved since the early 1990s. It was approved because it went through the rigorous drug approval process we have in place. As far as we are aware, there has been no indication that the decision we took to allow it to go to market was the wrong decision, but as part and parcel of our regulatory responsibilities, we're constantly monitoring... well, the world, for that matter.

We're looking at scientific information that is being published on an ongoing basis, either in peer review journals or put out by other regulatory agencies or coming out of university research. A big challenge we have—and we think we're up to it—is to stay on top of all of the scientific facts.

We are waiting to get this particular report, and we will look at it and make a decision at that time, once we have apprised ourselves of the information in it and have been able to evaluate it.

[Translation]

Ms. Pauline Picard: Mr. Weiner, earlier, you stated that you were proactive about consulting Canadians in order to know their needs and be able to meet them in satisfactory fashion. I do believe that Canadians do not want synthetic hormones to wind up in the animals they eat, and even less in milk. Consequently, I don't understand why we are reading about such news in the papers. I always say that where there is smoke, there is fire. According to one scientist, the impact of this hormone is incredible. Your employee is muzzled because she works in your department. She cannot talk to the media. It has already been proven that this hormone causes malformations in the animals. When these animals wind up on the butcher's table and we purchase the meat, we won't even know what it contains. This is a cause for alarm, and I hope that you will give some thought to the matter.

Mr. Joel Weiner: First of all, I should point out that about three months ago we refused to approve a product because of its unacceptable side effects in animals.

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[English]

I am talking about rBST, where the regulatory decision was clearly taken because of a thorough assessment. It took nine years.

The point I'm trying to make is that we have one objective, and that is to satisfy ourselves that products we are giving notices of compliance to are in fact safe for humans, and in the case of veterinary products, safe and efficacious for animals.

With respect to the issues you're now talking about, namely

[Translation]

the concerns of the public with respect the biotechnology products here, in Canada, and I believe throughout the world, the regulatory agencies are now consulting the general public so that the regulation process will consider the people's point of view.

Ms. Pauline Picard: Why don't you make it mandatory that the product packaging contain a label indicating that an animal has ingested such a hormone? This is what Canadians are calling for right now. This also applies for all of the other transgenic products. Most people want to know what is contained in the products they eat. I would like you to take their concerns into consideration.

Mr. Joel Weiner: If I may, I would like to invite my colleague, Paul Mayers, who is responsible for biotechnology issues and who works for the Food Directorate, to answer your question.

[English]

The Chair: Mr. Mayers.

Mr. Paul Mayers (Acting Director, Bureau of Microbial Hazards, Food Directorate, Health Protection Branch, Health Canada): Thank you, Mr. Chairman.

The issues related to biotechnology and the issues you raise related to labelling continue to be issues we struggle with in Canada, and by no means have we resolved those issues. In fact we have continued to take the public stance that the labelling position in Canada is one that continues to evolve and requires further public consultation. Consultation has happened on this issue for a number of years, and while that consultation has taken place and we have results from that consultation, there appears to be a polarized view related to those results.

The results of the consultations suggest that Canadians continue to support an approach of labelling that addresses issues of health and safety, and that issues of consumer choice are appropriately addressed through more voluntary approaches to labelling, as opposed to mandatory approaches.

However, surveys have been conducted by different organizations that suggest a very different position from the results of the consultations the government has run, so we are not in a position to take a final decision regarding what the appropriate labelling policy is for products of biotechnology.

A dialogue has to continue with Canadians, and of course one of the challenges is reaching out directly to individual Canadians, as opposed to solely through proxy by particular groups that represent a particular mandate when they bring their opinions to the table.

Interestingly, in that regard, there was a recent citizens' conference, where individuals participated in a conference on biotechnology and provided recommendations. They too struggled with the issue of labelling and did not recommend mandatory labelling for all products of biotechnology. They also did not recommend that the Canadian position remain what it is. They recognized that it is a very challenging issue and that further discussion is required.

[Translation]

Mr. Joel Weiner: May I add a few words, please?

Ms. Pauline Picard: Yes.

Mr. Joel Weiner: As you know, just under a year ago, the government announced the new Canadian Biotechnology Strategy, which provided for the creation of a new advisory committee, the Canadian Biotechnology Advisory Committee, which is chaired by Mr. Arnold Naimark, who is from Guelph University, if my memory is correct.

[English]

I think the government's objective is to have this new advisory committee up and running as soon as possible.

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The objective of the new Biotechnology Advisory Committee is, first, to be extremely broad-based and to have a much wider range of voices and expertise around the table than has been the case in the past; and secondly, to have it address a number of, I guess we could call them social and ethical and legal issues surrounding biotechnology.

As Mr. Mayers has indicated and as you well know, these are in fact issues that have been discussed and debated in Canada for some time, and not only here, but in other countries. You've made reference to developments in Europe. It is clearly the government's expectation that this new Biotechnology Advisory Committee will be an important instrument in helping to resolve that debate.

[Translation]

The Chairman: Thank you.

[English]

I guess that means we're not going to get any labelling legislation in the near future.

He didn't answer, so I guess I'm right.

[Translation]

Ms. Pauline Picard: This might be an interesting question for the committee members, Mr. Chairman.

[English]

The Chair: We're not laughing at you there. It's just that we've been discussing the issues we're going to tackle, so it appears you've just made a big hit with Madame Picard. She's going to propose that at our next operations meeting.

Ms. Minna.

Ms. Maria Minna (Beaches—East York, Lib.): Thank you, Mr. Chairman.

I would like to ask Ms. Stewart to talk a little bit about the healthy children program.

I heard you say you are focusing on ages zero to six. I'm quite familiar with all of the programs that have to do with prenatal, CAPC, and what have you. What sort of evaluation does the department do in terms of the outcomes with CAPC, let's say?

Ms. Catherine Stewart: I'm going to ask my colleague, David Fransen, to respond to that, if that's okay.

The Chair: That's fine.

Mr. Fransen.

Mr. David Fransen (Director General, Population Health Directorate, Health Promotion and Programs Branch, Health Canada): Is the evaluation of CAPC in particular your interest?

Ms. Maria Minna: I'm interested in CAPC, prenatal nutrition, and are others, but those in particular—those that deal with children, the ones we have across the country. I have a lovely map here with little hearts across the country.

I'm very familiar with the programs. I have them in my riding, and as you know, the caucus is very involved with the issue, especially through the HRDC subcommittee on children and youth at risk and the whole issue of child development. I'm very much interested in knowing, as we look at policies in that direction, what sort of evaluation mechanism we have in place now and how we are doing in those programs.

Mr. David Fransen: It is obviously a real concern of ours too. I think it would be fair to say we're constantly evolving. We are further along in some cases, say with CAPC, than we are in others, such as aboriginal head start, for example.

We have evaluation frameworks in place. We have preliminary data in the case of CAPC, but I would say it's still early days, given the stage of the program itself. It's not until we have been able to observe over an extended period of time the experiences of participants in the program—the children—that we'll have a sense of what the outcomes will be.

What we can tell at this point—and it's mostly by comparison with the national longitudinal survey of children and youth, the NLSCY—is that we are having an impact in particular on the population we have been targeting, which is mothers at risk and pregnant women at risk. When we look at some of the results, we see that we're hitting our target population. So in that sense we can begin to see that we're having an impact.

What I'm trying to say is, as to the impact on the children themselves, it's too early to say, because we've only had the programs in place for a short time. It's not until these children get into their older years that we can begin to have that kind of good sense.

The Chair: So it's as you go along; is that it?

Mr. David Fransen: Oh, yes, absolutely.

Ms. Maria Minna: Do your evaluation and monitoring include any specific on-the-ground focus with respect to children in terms of measurement of readiness to learn? Are there any pilots on the ground following specific children, or are you just doing it across the board? Are there pilots across the country that you've chosen—a certain number that you're following specifically and measuring along the way as you go?

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Mr. David Fransen: The answer to that would be both.

Specifically on the issue of readiness to learn, I would defer to my colleagues at HRDC, where they have projects in that particular category and have a few demonstration projects under way now. They'd be able to speak more specifically to that aspect.

Our aboriginal head start program, for example, which is a pre-kindergarten program for aboriginal children aged three to four years, is a fairly structured program. In each case, if you were to go to any aboriginal head start site across the country, you would find a fairly consistent pattern in terms of the curriculum of what these children are experiencing in the four half-days a week they are in that particular site. It is very consciously an attempt to prepare them for the educational system.

Ms. Maria Minna: Are you able to check across the country, not only the value of the program, but the targeting? In other words, are you able to tell whether or not we're hitting the targets we have set up? I guess what I'm trying to ask is whether it is a hit-and-miss, because some groups in the community happen to apply, while others may be just as needy but happen not to be within an area that is applying. That's one question.

Mr. David Fransen: Are we getting the most needy?

Ms. Maria Minna: Are we getting to the kids who need it?

The other question is this. If you were to change or improve prenatal nutrition or CAPC in any way, what would that be?

Mr. David Fransen: Let me answer the first question first and I'll see how we get to the second one.

Are we hitting our target population? The answer is yes. Are we hitting all of them? The answer is no, primarily because of lack of resources. We do what we can within the resources available.

Let me say a little bit about how we do decide on where the sites are established. In each province, we enter into an agreement with the provincial government. A protocol is signed at the ministerial level with each province in order to allow this activity to go on.

Within the context of each protocol, a joint management committee is established, which means it's a federal-provincial body, so there are officials from both sides, as well as other stakeholders—concerned people who know about the issue area—who then sit and decide on the applications that come in to set up the various sites. In their minds, of course, they're going to be thinking, where are the neediest? What is the credibility of the group coming before us? Is it a credible proposal? Can they deliver the service they're proposing to deliver? Is it in an area we think needs to be done?

Satisfying those criteria at that joint management committee level is how these sites get decided on. Within the resources available, we are hitting the right sites. But can we do more? Yes.

Ms. Maria Minna: How would you change the program if you were to change it?

Mr. David Fransen: Which one?

Ms. Maria Minna: Let's say CAPC. I could use prenatal, but let me take CAPC as one. If you were to improve a program and you could do something to make it more effective, what would you do?

Mr. David Fransen: We're now getting into policy territory.

Ms. Maria Minna: Yes, it's to help us develop policy.

Or is this out of bounds, Mr. Chairman? I don't think so.

The Chair: You may be a little bit over, because I think the answer is that it is a really good program that wouldn't be hurt by more money.

Madame Desjarlais.

Ms. Bev Desjarlais (Churchill, NDP): One gentleman mentioned the public consultations and surveys that have taken place over the last number of years in regard to the Canadian public's view on labelling of foods that have been affected by additives, so to speak. Do you have copies of those surveys and consultation results? If you're referring to them, are they readily available so that we can see exactly what the results were and how many there have been?

• 1210

Mr. Paul Mayers: Yes. The Canadian Food Inspection Agency has put together a summary of all of the government-led consultations on the issue of labelling, and that is available both in hard copy and on their web site.

Ms. Bev Desjarlais: Those are government-led ones. I got the impression from you that there have been others as well, and that you're referring to those in making your assessment as to whether or not to provide labelling. Are those readily available also?

Mr. Paul Mayers: Yes. There has been a series of studies by individual groups, and in some cases simply by research organizations that have surveyed. Those results have been published, are available, and have been used for consideration in developing policy in this area.

Ms. Bev Desjarlais: So that is something that's available together within the health protection branch, so someone could ask for the compilation.

Mr. Paul Mayers: That's correct.

Ms. Bev Desjarlais: In regard to the biotechnology strategy, which you touched on a bit, you mentioned the advisory group that's going to be dealing with how we go though this. What's the makeup of the advisory committee? I know you indicated a fellow from Guelph will be leading it. What's the intent of who's going to be on that advisory committee? Rather than just a broad spectrum, I would like to know specifically what—

Mr. Joel Weiner: The starting point is this. Up until 1997 or 1998, there was in place in Canada something called the national biotechnology strategy. When the government made a decision to renew it, it made a number of collateral decisions. One of those decisions was to change the name from the national biotechnology strategy to the Canadian biotechnology strategy. Another was to recognize that the advice being given, in an institutionalized way, to government on biotechnology tended to come mainly from industry and tended to be focused largely on economic development issues, and that clearly in the current context there was a vital need to start taking into account, discussing, and debating social, ethical, legal, and a range of other issues.

So as a very deliberate part of the Canadian biotechnology strategy, which the government formally announced I think in the summer of 1998, the Government of Canada issued news releases and documentation and quite explicitly said it was going to take all the criticism about the kind of advice being given to it on biotechnology to heart, and would try to address it by establishing—and I'm using the words in the news release, but they're meaningful here—a far more broadly based body than had been previously in place. I should have at the tip of my tongue all the details about the mandate, but they're not there.

You may be aware of the fact that among the other decisions the government took, one was to establish a new Canadian Biotechnology Secretariat. And there is now a coordinating body, with representatives from the major biotechnology departments, of which Health Canada is clearly one. This Canadian Biotechnology Secretariat has a web site, and on that web site are all of the details, including, I might point out, the nomination papers and requests for nominees for this new biotechnology advisory body.

The biotechnology ministers—Minister Rock, Minister Vanclief, the Minister of Natural Resources, the Minister for International Trade, the Minister of the Environment, and the Minister of Industry—are the new coordinating committee of biotechnology ministers. They selected the first chair of this biotechnology committee, and his first task of course is to help the process of populating this advisory body with real individuals.

So a very public call for nominations has gone out. There is a set of nomination forms, and people can self-nominate or be nominated. This process is just now starting to unfold. All I can do is either undertake to get you all of the documentation that will help explain what the mandate of this new body is, or suggest that you can access it very easily by contacting the Canadian Biotechnology Secretariat or accessing their web site. But we'll certainly be pleased to help in this respect.

• 1215

The Chair: If you could pass that on to the clerk, we'd be pleased to distribute it to all members.

Do you have one last question, Madame?

Ms. Bev Desjarlais: Yes, and I'll try to keep it short. I'd like to follow up on Ms. Minna's question about the follow-up on the programs that are available.

On the aboriginal head start program and the children who are in it, what exactly is going to be the process of following up? I've been to a number of them within my riding, and I know some of the kids who are there. How will you follow up to know whether or not you have students or kids through the years who have gone to the aboriginal head start program?

Mr. David Fransen: You're asking one of the key questions of evaluation, and this is always a sensitive issue, particularly so in the case of aboriginal head start.

We will handle this at the local level through program consultants out of regional directors' offices, who will work together with the managers of the various program sites and within the community to continue to meet with these people. Am I missing the question?

Ms. Bev Desjarlais: I think so, because you indicated that you can't judge until later on how things have happened within these different programs.

I chose the aboriginal head start. Before it started up, there must have been some thought as to how to evaluate it later on. Are we going to, when they register in school, question whether or not they were part of an aboriginal head start program or any other preschooling type of program? Are we going to request that representatives in those areas follow up through the school system? What's the intent regarding how the follow-up is going to be done? Or is it just going to be that we're providing this program and hopefully things will get better later on?

Mr. David Fransen: I can't tell you the details or the specifics of how that monitoring is going to be done. I can get that information for you. We have that, but I don't have it off the top of my head.

The Chair: Madam Stewart, do you want to take a crack at this?

Ms. Catherine Stewart: I'm not sure I can give you details right offhand, but Hervé Leblanc has advised me that the original program was a pilot program and the evaluation was not as comprehensive. But we are preparing to launch, through Richard Budgel in David's area, a more comprehensive evaluation. So perhaps the easiest thing would be for us to follow up with details, because it is still under development.

The Chair: We'd be happy to receive any details you have through our clerk, and then we'll distribute it to other members. Thank you.

Madam Caplan.

Ms. Elinor Caplan (Thornhill, Lib.): Thank you. I have a number of questions.

I'd like to go back to the questions around mefloquine. I went to Africa last year, and I took mefloquine. It was a drug that was prescribed. So I was a little surprised with some of the answers and at the suggestion that the drug has not been approved in Canada.

Ms. Jan Pound: In my understanding, the drug has been approved in Canada.

Ms. Elinor Caplan: When was it approved?

Ms. Jan Pound: I'd have to check the exact date, but I believe it was the year after the troops had it. I'm not sure.

Ms. Elinor Caplan: That would be about 1992 or 1993?

Ms. Jan Pound: The troops had it a couple of times, so I'm not sure which... No, it wouldn't be that early. It would be more around 1994 or 1995, I believe.

The Chair: According to the Auditor General, it would have been 1993, just for clarification.

Ms. Jan Pound: Okay.

Ms. Elinor Caplan: I just want to make sure I understand this. The Auditor General of Canada plays a very important oversight and look-back role, and the period of time he was looking at was the time during which the troops were sent to Somalia. The drug was given to them as part of a clinical trial to protect them. The drug was not fully approved in Canada. But is it fully approved today?

Ms. Jan Pound: Yes.

• 1220

Ms. Elinor Caplan: From his recommendations, are changes being proposed for how clinical trials in those kinds of situations are conducted? Because this was not just a standard clinical trial; this was through the Department of National Defence, which wanted to protect Canadian soldiers going to Africa. Is that not the case?

Ms. Jan Pound: That's true.

The difficulty we have with some drugs of this type that National Defence gets involved with is that there really isn't a large market in Canada for some of these products. They may well need them for the troops, but there's no intention for a manufacturer to market them here. So they have to get them through a special access program, which is one venue for making unapproved products available.

But if a large number of people are involved, we prefer to have them through a clinical trial, or in this case a special type of clinical trial called a safety monitoring study. A clinical trial has certain parameters for including subjects and specific, defined conditions under which they can participate in the trials so that we can get accurate data as a result to help us assess that drug in an expanded population.

When the troops are going over, the conditions may not be appropriate for inclusion in the normal clinical trial setting, so we have this expanded protocol for safety monitoring. That's the way the troops got this particular drug.

Did I...

Ms. Elinor Caplan: No.

Ms. Jan Pound: We are looking at that process, and that was what I tried to convey about the fact that we've had consultations on clinical trial reform.

There are a lot of conflicting positions about clinical trials. Can we have drugs earlier and in more expanded populations so that Canadians have the benefit, and yet how can we control the exposure so that Canadians are indeed protected? We always have to strike this balance.

But certainly we're looking at all of these aspects, including the auditing capability. Audit is a very difficult thing to do at the patient level, so where can we best spend resources on auditing, and how can that best be carried out? Within the mandate we have right now, we really would be restricted to the manufacturing level, so we ask ourselves, how do we best put that into play, working in the partnership situation?

We are looking at requiring increased resources, and everybody around this table is looking at resources. But it's a very small portion of what we do. Approving drugs for general marketing is a much larger portion. We're looking at how we can manage the risk most efficiently, effectively, and economically.

Ms. Elinor Caplan: That's very helpful. It was important for me to understand that what we were talking about here was a situation of trying to protect Canadian troops who were going into an area...

I think you take the drug because of malaria.

Ms. Jan Pound: That's right.

Ms. Elinor Caplan: And the drug was approved shortly after this took place.

Ms. Jan Pound: It had been previously approved in other jurisdictions, too. It was on the cusp of approval. We had a submission in, so we probably knew a little more about the risks of it than we know about other things that are still in clinical testing.

Ms. Elinor Caplan: Why wouldn't it have been approved under a special access provision in that?

Ms. Jan Pound: Because of the large number of troops who would be getting it. We wanted to have some more control and a more formalized process so that there would be collection of data on adverse drug reactions and that sort of thing. Generally special access is reserved for single patients with their physician, so it's an individual patient. There was a clinical trial ongoing, so we were able to extend, have another arm of that clinical trial.

Ms. Elinor Caplan: Thank you. That's really helpful information.

We hear the term “risk management” a lot, and I thought you might spend a few minutes explaining for the committee that terminology. I think we all know we live in a society that is not risk-free, and Health Canada's mandate is the protection of Canadians. So within that, could you just spend a few minutes on the notion of risk management and your approach to that?

Mr. Joel Weiner: Thank you.

Risk management is a way of doing business, and it's a way of doing business as efficiently and as effectively as possible in order to protect the health and safety of Canadians.

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In some quarters there has been a suggestion that maybe risk management is a substitute for health protection. The fact is that as we use it in the health protection branch and as it's used in regulatory regimes and agencies around the world, it's a method of doing business to achieve aims or mandates, and our mandate is health protection.

We have had a very explicit risk management framework in the public domain since 1993, telling people how we try to do our business. The public domain in which we're doing business is changing tremendously every year, it seems. It became quite apparent to us that the 1993 version of our risk management framework had to be updated.

One reason was simply that we had to figure out how to take account of these sorts of non-science issues. They weren't as much of a question mark in our minds or in other regulatory minds in 1991, 1992, and the early part of 1993, as we were developing the risk management framework. Clearly that's one factor. We're spending an awful lot of time thinking about what to do with the non-science issues. What do we do in an environment where we know there is not always scientific certainty? How do you do business in order to achieve your objectives?

We've been very influenced by developments in other jurisdictions. A number of years ago the President of the United States commissioned a national commission to essentially develop a more modern risk management methodology. We've been influenced by that as well.

If I can put it in its simplest dimension, it's a step-by-step way of thinking about and asking questions and having a checklist to ensure that all the parameters you need to have information about in making a health protection decision are in hand. At the same time, you need the hard-core scientific evidence.

When you have all that, you move into what is called a risk assessment phase, trying to decide how much of a risk a particular hazard actually presents, while trying to maybe prioritize that risk alongside other risks that are in the public environment.

Then we move into the third phase, which is actual risk management. Once you have the information and you've assessed it using this kind of rigorous analytical technique, you decide on what your options are for managing the risk.

We speak in the risk management business of a toolbox of risk management options. They can range from proactive education and public awareness campaigns, particularly of the kind our colleagues in the health promotion branch are experts in, to absolute regulatory and legislative approaches. In between those two alternatives, there's a broad range of other kinds of interventions.

The trick basically in risk management is to figure out which of that array of tools should be most appropriately deployed to address a particular risk, the assessment of which you hopefully have in hand as accurately as possible.

I hope that helps.

The Chair: Thank you very much.

Mr. Hill.

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

Ms. Breton, I'm interested in the current number of victims, according to the departmental calculations, of hepatitis C, both within the window period of 1986 to 1990 and outside the window. Would you have the current estimates for me?

Ms. Mimi Breton (Executive Director, Hepatitis C Division, Health Promotion and Programs Branch, Health Canada): Within the window the number is between 8,900 and 14,900. These are estimates.

Mr. Grant Hill: Yes, that's understood.

Ms. Mimi Breton: That would be the range.

Mr. Grant Hill: And how many would there be outside the window period?

Ms. Mimi Breton: Outside the window, I think currently in Canada there are close to 300,000 people with HCV.

Mr. Grant Hill: I'm interested particularly in the figures relating to transfusions.

• 1230

Ms. Mimi Breton: I think between 27,000 and 45,000 people were infected through the blood system.

Mr. Grant Hill: Those numbers are estimates, admittedly, but do you feel fairly comfortable with them now? There was a much broader range some time ago.

Ms. Mimi Breton: Those estimates are based on the best information so far. Lots of people don't know they've been infected with HCV, because it's a very slowly evolving disease and there are no symptoms in the first stages. That's why those are our best figures. They're based on the Remis study.

Mr. Grant Hill: Do you have an estimate of the numbers of tainted blood victims who have died in the last year?

Ms. Mimi Breton: I do not have that information.

Mr. Grant Hill: This is a rather broader question, and I'm not sure just who to address it to. Health Canada attracts some of our finest scientists—people who are really keen to work in a very important area. There seems to be a problem with these scientists when new data comes to light. In some cases the data, the information, is so fresh and new that we don't know how to handle it. The scientists tell me they feel in some cases this data is not well handled by Health Canada.

I don't mean this in a critical way, because you don't want to scare the life out of people when new data comes along; you want to be fairly sure the data is reasonable to look at. I think of CJD, for instance. We've said over and over again there's no evidence of transmissibility by blood. New data is showing up weekly, and this morning we have said we're going to take fairly major action.

There seems to be no way for a scientist to get a hearing without getting slapped by either the political masters or the bureaucratic masters—gagged in some cases. I'm looking for a solution to that so that a scientist who has new information but doesn't want to go to the press or to an opposition politician and doesn't want to raise the issue in a volatile way, yet still wants the information to come to the fore, has a mechanism, an ombudsman, a whistle-blower—I hate the phrase—some forum where they won't lose their seniority or their job because they've spoken out in good faith.

I'm not just posing this for an answer directly today. If you have thoughts and ideas on that, I would be very interested in knowing about them privately later. It's too volatile an issue to talk about here in this forum.

The Chair: I'm not sure if we can ask all of our presenters for that kind of response, but if there are some thoughts and reflections on that issue as it has appeared, that would be acceptable.

Mr. Joel Weiner: Speaking on behalf of the health protection branch, where the bulk of the scientists are in Health Canada, I can say quite explicitly that this is a question we have been asked before and are actively pursuing in terms of developing an answer.

You may be aware, for example, that the Senate committee—or the committee in the other place, I think is the appropriate expression—that deals with agriculture and forestry had a very explicit recommendation in its recent report on rBST and the drug approval process, calling essentially for a dispute resolution mechanism. It quoted the assistant deputy minister of the health protection branch, Dr. Losos, as basically saying that in any scientific enterprise, there will be differences of opinion, and it's a management challenge to figure out how to deal with them. We have some ideas, and I'm sure Dr. Losos will be happy to make himself available to discuss them with you.

But I can assure you, sir, it is something we are very cognizant of. It is an issue we're moving fairly aggressively to address.

The Chair: Thank you, Mr. Weiner. Maybe we'll take you up on that suggestion.

• 1235

Mr. Joel Weiner: My colleague, Mrs. Pound, has also reminded me that the Minister of Health has established a Science Advisory Board. Among its various activities, it looks at how we address things like that. In the context of those conversations, suggestions are being made about a chief scientist, for example, and a dispute resolution or an alternate dispute resolution mechanism. All of these suggestions are being actively looked at.

Our starting point is that there has to be a process of communication and a starting premise that sometimes in the world of science there is not certainty. The trick then is, how do you deal with those situations in which the uncertainty...

We could get into a long discussion about the use of the precautionary principle, Dr. Hill.

We recently spent two days in an intensive workshop with the senior management of the health protection branch and representatives of the European Union, Directorate XXIV. On behalf of the European countries, they are also asking themselves the same kinds of questions.

So a precautionary principle, a dispute resolution mechanism, a Science Advisory Board, and a chief scientist are among the range of things we're looking at as a means of addressing the very issue you mentioned.

The Chair: I hope Mr. Hill is satisfied with that response, as a committee member and as a doctor.

This committee member, as a member of the great unwashed, is impressed by the fact that the more we hear answers like that—and this is a positive comment—the more we are impressed with the fact that scientific proof is never certain. What happens is we have consensus rather than certainty. So I'm glad you clarified that for me.

Madame Desjarlais.

Ms. Bev Desjarlais: This question is in regard to the warning that came out last year about the toys that shouldn't be used. It was interesting to note that the health protection branch's recommendation came out not saying which ones shouldn't be bought, but which ones were okay. I'm curious about why it was done that way rather than indicating which ones weren't acceptable.

Mr. Joel Weiner: That was an announcement put out by our product safety bureau. Unfortunately I don't have the assistance of a colleague from the product safety bureau. I can certainly undertake to get the answer to that question, but I don't have it available now.

Ms. Bev Desjarlais: Okay. On a personal basis, I found it very misleading. I had the advantage of having the list of the ones that weren't acceptable, but for the Canadian consumer, I thought it was somewhat misleading.

I have another question in regard to the person from the Guelph Veterinary College who's going to be on the advisory board. Do you know offhand if that veterinary college receives any kind of support from industries that would come under question in regard to the advisory board's search for information?

Mr. Joel Weiner: I may have misled the committee in saying Dr. Naimark is from Guelph. I have a mental block. I should know that, because biotechnology is one of the files I'm responsible for managing. I'm not sure that he's from Guelph and I'm sure that he's a veterinarian. In fact, I think not.

What I can tell you, though, is that he has an eminent reputation. I can certainly get you his résumé as soon as I get back to the office, or it's available on the Canadian Biotechnology Secretariat web site. He's an eminent scientist and a distinguished academic. I would expect that—

The Chair: He's above reproach and above suspicion of conflict. Good. Thank you very much for clarifying that.

Ms. Bev Desjarlais: In regard to the surtax placed on tobacco products a few years back, and tying in the dollars coming in from that surtax, my understanding from the estimates is that $20 million has been out there in an annual anti-smoking campaign. I'm wondering how that relates to the amount of surtax on the tobacco products that have been coming in, compared to the amount that's going into a campaign against anti-smoking.

I'm not sure who wants to take this question.

• 1240

Ms. Janet Davies (Director, Strategies and Systems for Health Directorate, Health Promotion and Programs Branch, Health Canada): I can speak to the tobacco control initiative. The surtax was applied for three years, starting in 1994. In those three years, it brought in about $65 million to $70 million a year. The surtax was extended, but not at the same rate. I have to commit to talking to my colleagues at Finance and getting back to the committee on the projected levels.

The tobacco control initiative is an initiative funded over five years at $20 million.

Ms. Bev Desjarlais: Thank you.

The Chair: We'll have Madame Picard and then Madame Minna.

[Translation]

Ms. Pauline Picard: My question is for Ms. Breton. With respect to the $300 million paid to the provinces to help provide health services to hepatitis C victims, what did you use to determine the percentage of victims by province? For example, we are told that there are 15% in Quebec.

The Chairman: Ms. Breton.

Ms. Mimi Breton: No money has yet been transferred to the provinces.

Ms. Pauline Picard: But there is an envelope of $300 million for health care in the provinces. Quebec is in a unique position because it is already providing health care and will probably provide compensation; however, I suppose that you did determine the percentage of the $300 million in a certain way. For example, in Ontario, it will be 20%, in Alberta, 10%, etc.. How did you determine the percentage of victims in each province?

Ms. Mimi Breton: This agreement was negotiated with the provinces. At the present time, we are awaiting their signature for what we call the services transfer. The percentage is being discussed. Unless I am mistaken, we used the estimates of infection derived from the same sources as Remis to determine the rate of infection in each province.

Ms. Pauline Picard: I don't think that this is the correct answer. Excuse me, but there is an analysis—

The Chairman: Ms. Breton has already committed herself to providing us with the most recent information. As soon as she has all the documents, she will send them to the committee. All right?

Ms. Pauline Picard: All right. Thank you. I would now like to ask Mr. Gauthier a question.

The Chairman: Yes, continue.

Ms. Pauline Picard: Mr. Gauthier, in your own words, could you define the actual mandate of this new division, describe its structure and its staffing level? I am somewhat lost, and I'm wondering whether this new structure is an internal creature, or whether it will establish links with the provinces. Do you gather data? When you talk of analytical capacity, what does that mean? I really don't understand this very well.

Mr. Denis Gauthier: It is a little bit all of that; it brings together four functions, as I have already said. The easiest function to understand, which already exists, is computer services. This comprises support for the infrastructure, and support to internal applications, and to the e-mail and voice message systems, to provide electronic support for our internal activities. The division comprises several hundred employees.

As for the three other functions, one is relatively new while the two others are completely new. The Health I-Way Office is a relatively new function, and my colleague who is in charge of this is present. The primary objective of this Office is to promote the growth of the health information highway in Canada, and it uses a number of approaches. It provides leadership and interfaces with the provinces because the health information highway will be developed by the provinces.

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There are a number of initiatives throughout Canada, such as telehealth, patient electronic files, the electronic record identifier or the identification, or telehealth services at home; there are many Canadian initiatives.

We could allow these initiatives to develop on their own, but then there would be no compatibility and no possibility of transfer among the regions. We are trying to promote the compatibility of all of these initiatives through interprovincial advisory committees. These are leadership activities.

The budget also allocates funds to promote the use of information technologies in the health field. This is an $80 billion industry which, compared to other similar sized or even smaller industries, nevertheless accounts for 9.3% of Canada's GDP; this is quite high.

There is a lot of slippage in the use of modern information communication technology. There will be programs to remedy this. There is one called the Health Information Support Program, which aims to promote the development of prototypes. We provided the first funds for this program at the beginning of the year.

There will be other programs that will no longer apply to prototypes, since we are now going to the implementation stage. Namely, projects that will last. We are presently consulting with the provinces and stakeholders to determine what would be the best way—

Ms. Pauline Picard: Excuse me for interrupting you. Does this mean that you will be providing your support for a given type of operation that is to take place in Montreal and a specific expert in Vancouver? Is it through information that support will be provided to enable someone to conduct an operation in Montreal while at the same time communicating with a specialist in Vancouver?

Mr. Denis Gauthier: Yes, it can be this type of program. Developing a global and compatible health I-way in Canada would costs billions of dollars.

Ms. Pauline Picard: Yes.

Mr. Denis Gauthier: What were talking about is investing approximately $60 million. We wanted help to develop this type of project. If there was a desire in Montreal to implement a project to link all the hospitals in the Metropolitan region for the electronic transfer of medical files, so that someone in the emergency department at St-Luc Hospital could have access to his file which is with a doctor in the west of Montreal, we might perhaps invest in this type of project so that, subsequently, the best practices would be shared with the rest of the Canadian health system.

Then there are all the federal-provincial issues that I mentioned a while ago, related to security, interoperability, etc. That's it for the Health I-Way Office.

The two other functions, which are entirely new, are to create an analysis and applied research branch. The objective is to conduct research in health policy, that is, to develop internal capacity. I am not talking about the scientific side, since that is very well covered by Health Canada; I am referring, rather, to research on policy outcomes, accountability, etc.

In the past, there have been several evaluations of the analytical or policy development capacity in the Canadian government. Some departments fare very well in this regard, others are lacking; it is also a question of human resources.

For several years, the Policy Research Initiative has looked at horizontal issues in the government and has diagnosed and analyzed these issues in policy development. A number of projects that have analyzed the capacity of various departments have shown that Health Canada did not have this capacity or, at least, did not have it in a coordinated manner.

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The purpose is try to develop an internal research and analysis group that would give us the capacity that would have the same effect, for example, as Human Resources Development Canada has with respect to labour market policies, Industry Canada on microeconomic policies in the context of free trade and investment, or the Department of Finance with respect to its structural or microeconomic analysis.

The purpose is, therefore, to build this in-house. It's a little bit like research and development; you have to do a bit in order to understand it. By doing this in-house, we will be in a better position to understand what is being done elsewhere. A great deal has been done, but it is not linked in an in-house way.

There are liaison and transfer activities pertaining to the work done in Canadian research institutes and universities. We want to establish intellectual transfer activities and not simply subsidize research. We want to be able to exchange ideas and the results of research, understand the research, assimilate it and pass it on to our colleagues to help them better define and adjust their programs.

The last function, which is the baby, is the secretariat for supporting this major transformation taking place in Canadian health institutes. The secretariat is a group comprising 15 people whose purpose is to support the advisory committee, to advise the minister on how to define these Canadian institutes, to choose them and to determine what their principle and themes will be, because they will be thematic institutes. This therefore covers this whole issue of supporting the work of the advisory committee, which has about 35 members.

The other function pertains to legislation. We have to prepare a bill for April 1 of next year. There is this whole issue of the government machinery that the advisory board— This is an internal function of the government.

The Chairman: Thank you.

[English]

Ms. Elinor Caplan: Could I share some information with Madame Picard?

The Chair: Okay, go ahead.

Ms. Elinor Caplan: On the question you asked about how the infection numbers were developed, it's my understanding that there was an expert committee. Quebec was represented on that committee, and they developed a formula that determined the number of infections of persons in each province. That was how they determined there was approximately 15% for Quebec.

The Chair: Ms. Minna.

Ms. Maria Minna: Thank you.

For the health protection branch, I have a particular interest in the health of women's sanitary products, tampons in particular. I've been approached by a number of people, and I have been doing some research for a while now, on the safety and the level of carcinogens there. I'd like you to tell me how they're tested. Do we do any testing at all, or do we rely entirely on the manufacturers and the protocols we have with them?

The information I have is that in the U.S. there are at least three bills going through various parliaments, because the public is not content that they are in fact safe and feels the manufacturers are perhaps not being straightforward. How do we ensure these products... I'd like to know more about that.

Mr. Joel Weiner: I can only undertake to get you the information as expeditiously as possible. We could do that in the next day or two. I just don't have that information at my fingertips.

There are different ways we test different products. Sometimes it's an audit method; sometimes it's an actual laboratory-based method. I don't know what circumstances apply in the case of this particular product.

The Chair: This question came up by the same member and another member at least six or seven months ago, and the department undertook to give us some information at that time. It has not crossed my desk, although perhaps it might have crossed somebody else's desk. I'm wondering whether you can indicate to your department and the appropriate bureau that an answer is more than timely right now. We'll have the clerk follow up in about a week.

Mr. Joel Weiner: Absolutely.

Ms. Maria Minna: Could you let me know whether we at Health Canada do any testing directly ourselves or not, or if we rely entirely on the manufacturers' testing? I know we have protocols and what have you, but my sense is there's still a certain level of carcinogens and that they're not as safe as, say, pure cotton.

Mr. Joel Weiner: Okay. I will personally undertake to ensure that the clerk of the committee is provided with the information and it is forwarded to you. If it doesn't come, you can find me in the book.

Ms. Maria Minna: Thank you, Mr. Chairman.

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The Chair: Thank you, Madam.

Madame Breton, do you want to have a clarification as well?

Ms. Mimi Breton: It's not a question. I would like some complementary information from Madame Picard.

[Translation]

The chair of the committee was Mr. Remis, and a report outlining the findings of the task force is available through the LCDC, the control laboratory.

Ms. Pauline Picard: Will you send it to us?

Ms. Mimi Breton: Yes.

Ms. Pauline Picard: Fine. Thank you.

[English]

The Chair: I want to thank all of you for coming and staying so patiently right up until now. I thought we were going to finish about an hour ago, but obviously the chairman was wrong yet again.

Thank you for your fulsome answers. I'm sure they will help all committee members as they prepare for the next set of discussions that will lead up to a thorough analysis of the estimates.

So Mr. Weiner, Mr. Gauthier, Madam Stewart, to the three of you, and to all your colleagues, thank you very much.

The committee is adjourned to the call of the chair.