Rob Merrifield

[Health, June 21st, 2005]

Mr. Speaker, when it comes to privately owned health clinics, one of the biggest customers is the federal government itself.

The Canadian Forces spent $1.3 million last year and $1.6 million the year before that. Like the Supreme Court, the Canadian Forces recognize that wait times in the public system are far too long, so they are sending their patients elsewhere.

Is the Prime Minister opposed to our soldiers getting care from private clinics?

[Question No. 145, June 20th, 2005]

With regard to the Canada Health Act: ( a ) does it permit the delivery of publicly funded, medically necessary health care services by privately owned health care clinics; and ( b ) has a province ever been penalized by the federal government under the act simply for contracting with privately owned clinics for the delivery of publicly funded health care services?

[Question No. 146, June 17th, 2005]

For groups under its direct jurisdiction (for example, Aboriginal Persons, RCMP, veterans, prisoners), does the government make payments to any privately-owned clinics, including the Shouldice Hernia Centre in Thornhill, Ontario, for the delivery of medically necessary health care services and if so, how much did the government pay for such services in 2003 and 2004 and at which clinics?

(Return tabled)

[Question No. 147, June 17th, 2005]

Do any of the terms of the first ministers health accords of 2003 and 2004 prohibit or discourage the provinces from contracting with privately owned health care clinics for the delivery of publicly funded, medically necessary health care services?

[Committees of the House, June 16th, 2005]

Madam Speaker, my hon. colleague brings up an issue that I never had an opportunity to address in my dialogue. That is the Patented Medicines Prices Review Board deals with patented medicines. The non-patented medicines side is not regulated at all in Canada.

If we ask Internet pharmacies how much of these unregulated pharmaceuticals are being utilized through the Internet, they would say just a fraction. In fact, the only reason they are there is because of convenience. When people from the United States need products, they are there for availability. It is not there because the products are cheaper product.

If we were to do a study between the price of generics in the United States and the prices of generic pharmaceuticals in Canada, we would find that ours are higher. That is of some debate, but we have looked at that as well.

Those are the facts as I see them. The reason we are not seeing the generics being purchased through the Internet validates my findings. If there was a differential in price, Americans would capitalizing on that difference.

One also has to understand that the difference between the Canadian dollar and U.S. dollar also gives an edge. Even if they were on par, we would see pharmaceuticals being exporting. However, they are not on par. We pay more for generics and less for brand name, but the bulk of the pharmaceuticals we use are brand name.

We have to do whatever we can to ensure that we stand on guard for Canadians and for cheaper pharmaceuticals. If it compromises price or availability, we have to step in. That is why this motion is so important

Even with those lower prices, we see that pharmaceuticals are the number one driver of costs in our health care system and will be for the foreseeable future. That is the urgency and that is why the debate is taking place. I look forward to my colleagues' speeches on this throughout the day.

[Committees of the House, June 16th, 2005]

Madam Speaker, the member has asked a number of questions. I will start with the last one about how this has placed at risk and compromised Canadians. It has in a sense, because the government's health minister has not dealt with this appropriately in a timely way, so some of the pharmaceutical companies, on their own, have started to pull back the availability of some of these products to the Internet and to Canadians. We are starting to see some shortages out there.

That is what I have always said. If it gets to the place where either the availability or the price of pharmaceuticals is comprised, we have to step in and do something. We are at that place right now. Do we need to kill it? No, we do not.

Getting back to his other comment on whether this is ethical or unethical trade, I have looked at this argument. The health committee has yet to report on it. Our report is not at all complete, but we are unanimous on this. All sides are unanimous on shutting down bulk sales. But as for the idea of whether it is unethical, the member is really saying that the patient-doctor relationship in the United States is not as valid as it is in Canada. If a doctor fills out a prescription here, people can go across the province to another pharmacy and have it filled. I do not see a lot of difference between that and what we are seeing with the Internet pharmacy. We can argue that both ways. We can say that it is illegal, that it must be prescribed by a doctor in Canada.

All of that is probably true and I have not come to a conclusion on it, but I fail to see the ethical dilemma here. I do not believe that doctors in the United States are inferior to the doctors in Canada. In fact, the other way around may even be true. I just do not think that is a fair and valid argument.

This is one of the balloons that the minister put in the air: that it is unethical. I do not think that is fair and I do not think it is accurate. Why does he not just say what the truth is? The truth is that it compromises our price and availability of product. If it does that, then let us deal with the potential growth of this industry. That is what shutting down bulk sales would do. We are not saying that it is the total solution but it is certainly a solution for the immediate term, which is what the legislation in the United States is about to compromise. We have to act and we have to act right now.

Why is it so urgent for us to be here? Because this is something that has to be done immediately. These pieces of legislation could pass in the upcoming weeks. Likely it will take until early fall before they will get through in the United States, but members can be assured that they are coming, not only at the federal level but also at the state level. It is important for us to deal with it and to deal with it now.

I think I have answered most of my hon. colleague's questions.

[Committees of the House, June 16th, 2005]

Mr. Speaker, I move that the 14th report of the Standing Committee on Health, presented on Monday, June 6, be concurred in.

It is a pleasure to ask the House to concur in a report on an issue that was debated in the committee for some time. We worked on this periodically throughout the winter. It was delayed at some points along the way because of other legislation but it is a very important issue.

As far back as November last year the minister suggested in public that this issue was his top priority and that he would act on it in a significant way as soon as he possibly could and yet we have seen nothing.

What has been amazing is that we have seen the minister throw a ball in the air almost on a weekly basis to see who will shoot at it waiting for some of the repercussions around the Internet pharmacy issue. However we see absolutely no action and we are seeing more and more delays.

The report deals with how we handle the issue appropriately. The issue of Internet pharmacies has become a significant one and the report calls for legislation to be adopted that would not allow bulk sales of pharmaceuticals to be exported from Canada into the United States.

There is a very good reason for that. One has to understand how the Internet pharmacy industry actually came into being, why it is there, how it is supported and under what mechanisms it is supported under law. First, in the United States there is a law against it. It is not legal to import pharmaceuticals into the United States but there is not a congressman, senator or politician in the United States who would stand up and say that gramma should pay twice as much for her pharmaceuticals as she is now paying. It becomes a political football and political issue more than anything else and that is why we are seeing some resistance for the United States to actually enforce the law that it has on its books.

Instead of that, we have seen the Internet pharmacy come into being about five years ago and start to progress in terms of the numbers. The intensity and the size of the industry has exploded over that time period to the point where we have sales figures of perhaps a little bit more than $1 billion a year, although no one is exactly sure of the amount. We actually saw signs over the last year where it has subsided somewhat. The last numbers I have show a decrease of about 10% over the last year.

How come it is there? Why did it come into being? Why would we sell pharmaceuticals from Canada into the United States? I think it is important to understand how the industry is fuelled. It came into being about five years ago. It is not for all pharmaceuticals. It is more for the brand name pharmaceuticals. Brand name pharmaceuticals in Canada are dealt with under the price market review board which decides how to set the price of pharmaceuticals. It takes the medium of seven different corporations and then it sets that as a price, so it is a regulated price in Canada.

A regulated price, by the way, is quite a bit different from what we have with our counterparts in the United States. In fact, it is somewhere between 30% or 40% cheaper than it is in the United States.

The Patented Medicine Prices Review Board has actually done a very good job for Canadians. It has supported lower prices for brand name pharmaceuticals in Canada and has been working very well over the last number of years affording Canadians a cheaper price for their pharmaceuticals.

There is another thing that is at play that we have to understand and that is the differential in the price between the Canadian dollar and the U.S. dollar, so the buying power for the U.S. dollar coming up to Canada also makes a significant difference in the buying power for those pharmaceuticals.

We can see that when the prices are artificially set lower in Canada compared to the United States, which has a free market on patent medicines, there is an industry that really is exploiting the difference between those two regimes on the pricing of brand name pharmaceuticals.

All pharmaceuticals are becoming increasingly used by our populations. I would suggest that the number one driver of costs of our medicare system in Canada and in the United States is the cost of pharmaceuticals. That is not going to go away fast. In fact, if we are looking for relief with regard to the Internet pharmacy or brand name pharmaceuticals being used in our society I think we are fooling ourselves. There is no one who would project that. As the baby boomer bubble hits our system they will be feeling their aches and pains much more as they age.

Our population has become quite dependent on pharmaceuticals. I am not against pharmaceuticals in any way. They have advanced the ability of Canadians to have relief from pain for a significant amount of time. In these last few decades we have seen some tremendous advancements in how we use pharmaceuticals and in the relief we have received.

I am not against pharmaceuticals but I am throwing some flags in the air because we have some problems with pharmaceuticals in Canada. In a study that came out last June, pharmaceuticals used in acute care centres were shown to be the cause of approximately 24,000 deaths per year from adverse events and mostly preventable adverse events. That is like a Boeing jet going down every week in Canada.

Unfortunately, this House has really not been too aware of the situation, which alarms me when the report proving this to be the case came out last June. However we have had few repercussions in the House or in society with regard to the problem. This is not only a problem that has been around for a significant amount of time but it is one that will only get worse if we do not address it.

Pharmaceuticals need to be used but they need to be used in appropriate ways. How we can do that and actually protect pharmaceuticals in Canada is another issue, which is the issue addressed in this committee report.

The issue was not studied intensely in committee but reference has been made to it over the last couple of years as we travelled across Canada. Last year it came up in Manitoba which is where Internet pharmacies started and where the bulk of Canada's Internet pharmacies sit. They employ over 5,000 individuals in Canada. However these Internet pharmacies are not just in Manitoba. They have expanded into British Columbia, Alberta and, to a lesser degree, into other provinces across Canada. It is a Canadian industry and it is a Canadian issue.

What we have seen over the last year is an expansion of Internet pharmacies to where they are being used more and more and, in fact, have exploded. It went from an industry with an estimated $400 million in sales in 2003 to over $1 billion in sales last year. When we see such a significant growth in an industry like this, it sets off all kinds of alarm bells.

However that is not really why this motion is in the House and it is not why the committee unanimously said that we should be bringing this forward. It is coming forward because of what is happening south of the border. In the United States, the senate and the congress have two or more pieces of legislation to change U.S. laws and allow Canadian drugs to legally enter the U.S., not just from the Internet pharmacy to the individual but to allow bulk sales.

We have a significant number of states in the U.S. starting to change their laws. In the last report I saw that 25 states were changing their laws or already had laws on the books to allow bulk sales of pharmaceuticals to be bought from Canada. Ten of those states have actually had that legislation passed and have them on the books at the present time.

Why the urgency? It is because we are seeing this push for the changing of laws in the United States.

Pharmaceutical companies are starting to kick back and we are seeing advertisements in the United States at the present time saying that drugs from Canada are very dangerous and that no one can be sure the drugs are really from Canada. These drugs could be from India or even from China. In fact, most of our pharmaceuticals are not really manufactured in Canada. They are imported from other places.

The controls on some of the brand name pharmaceuticals are coming from places where they do not meet the same kinds of tests nor the same kinds of standards that we have in Canada.

I see no evidence of that, and it is refuted by the Internet pharmacy people, but I think it would be fair to say that most of the drugs that are manufactured in the United States and come into Canada fall under our the prices review board. The board then significantly lowers the prices on these drugs for Canadians and then they are imported back into the United States. The pharmaceutical companies are saying that is unfair. Why would they bring their pharmaceuticals into a foreign country, have them fall under a review board just to have them come back into their country and destroy the market forces that are at play in a foreign country?

As members and as Canadians our first goal should not be looking after Americans. Our first goal should be looking after Canadians. We should respect both the availability of these products and the price of these products. If either of these is compromised then this House has to act. We should act swiftly, not sitting around throwing balls in the air and expecting that something will change or something will happen.

A while back the committee told the minister not to act on the issue until it had some indication of where it was at on the matter. The committee held meetings with both sides on the issue in an attempt to understand the dynamics of the situation. There were some significant reasons for the industry being there and some very good arguments as to why it should not be destroyed.

We have three choices. First, we could very easily kill the industry by just shutting it down. What would the repercussions be of destroying the industry? First, we would destroy all the jobs and all the opportunities for those jobs in Canada. I also do not believe it would be in the best interests of the United States. Right now most of these pharmaceuticals go to individuals in the United States who are outside of a health program or a pharmaceutical program in the United States. These are the people who cannot afford the drugs and who will not be buying the drugs at any rate from the United States because they cannot afford them.

We are supplying that relief valve to the market in the United States through the Internet. That is not a bad thing. In fact, the pharmaceutical companies are saying that they can live with that.

It is when we get into the bulk sales. This is where this industry is about to grow that it becomes a significant problem.

We could kill it but I do not think that would be productive. I do not think it would necessarily be fair for a free enterprise market which exists in Canada and the United States. I also do not believe that would be in the best interest of anyone.

Our second option is to leave it the way it is. However, if we do leave it the way it is we could see the situation explode over the next decade. We will see the numbers increasing as the laws in the U.S. change to allow these products into the United States, not only to individuals but also to states, in bulk lots. We could be looking at the situation exploding not just to a billion dollars a year, but to many billions of dollars a year. Therefore, it would destroy the industry.

This would have an impact. It would have an impact on our price market review board because it would no longer be able to control the industry. The pharmaceutical companies would say that it was foul play and they would be legitimate in saying that. Then they could say that they will not supply the Canadian market. Why would they when we are exploiting the market review in Canada and apply this rule to a foreign country.

Therefore I think the pharmaceutical companies would be quite legitimate in saying that it was not appropriate, but to leave it just the way it is, is not an option. We need to act and we need to act on behalf of Canadians because of supply and because of price.

We would either compromise the price and see the price jump or we compromise the supply and see availability drop. One of the two would happen if we were to leave it the way it is. Therefore that is not an option.

The third option would be to control it by trying to contain the industry. We could allow it to continue supplying jobs to Canadians and that relief valve to Americans but we must not allow it to grow to the place where it becomes prohibitive or an irritant and a threat to our availability and our price.

How we contain the situation becomes the magic of this argument and the magic of this whole industry. How in this House can we come together and do what is not necessarily political, whether we are a Conservative, a Liberal, an NDP or from the Bloc, but something that is in the best interest of all Canadians, which is to protect our pricing and our availability of products?

As I have said, as we move forward into the next decade of the 21st century we are going to use pharmaceuticals more than we ever have before. In fact, that is one of the problems we have. As a society, we have become so accustomed to using a pill every time we have a sore ankle, a sore knee or a problem of any kind that the first thing we say is “there is medication for that”.

We have become a society that is dependent on this, so much so that we believe there is a pill for every problem we have. The first thing we look for in our health care system is how we fix our problem with medication. Until we become a society which also understands that every pill has a problem, we are not going to have a fair balance and enough knowledge to understand how to use those medications appropriately.

At present, whether we look at the June study I mentioned earlier, on the 24,000 deaths per year in Canada, or at the abuses in our seniors' homes and the intensity and the amount of pharmaceuticals used there and the deaths being caused because of addiction to these medications, we are not going to be able to move forward in our health care system in the way that we should for Canadians.

Addiction to pharmaceuticals is, as I say, the other side of this. I introduced a private member's bill last session calling for any adverse events to be reported to Canadians so that we have an understanding of who is addicted and what kinds of adverse events are being created. Then we could actually deal with them. I think these are important things to look at when we see the number of deaths that are being caused because of this.

I want to close by imploring the House to consider the motion. As I have said, it comes from the health committee and has significant support. I say that because when we talked to the Internet pharmacy people, they agreed with the motion. They are saying to not let us get into bulk selling of pharmaceuticals. They are saying to stay out of it, that we do not need to go there. They say they just want to keep on with the business they have at the size they are at the present time.

They are calling for this. They are saying that this is a good move. The brand name pharmaceuticals are also saying that this is a very good move, that we need this to be able to stop the explosion of what could happen with the legislation coming in the United States.

No one on either side of the issue is saying that this is a bad motion. They are saying that it may not be totally satisfactory and it may not go far enough for some of the brand name pharmaceuticals, but so far everyone is saying that as far as shutting down bulk sales into the United States is concerned it is the way we should go.

Here is what I would say to the minister. Instead of throwing balloons into the air and trying to take his cue from the Prime Minister, who dithers on everything, as we have seen since he has come into office, instead of being Mr. Dithers too, the health minister should say, “Let us have some leadership and let us actually do something that is in the best interests of Canadians and the Canadian pharmaceutical industry”. And that is to shut down bulk sales of pharmaceuticals.

I know this rubs my colleagues on the other side the wrong way, but the truth is the truth and that is exactly what I am saying with regard to a health minister who said last November that this was his number one priority and he was going to fix the system. We have seen absolutely nothing to this point.

Let us get serious about fixing the problem, we say, and let those of us in this House take a look at this motion. I dare anyone to stand on the other side and say no, this is something we should not do. We should do this. We should do it now. We should give a directive to the health minister that this is where we need to go, because he does not seem to be able to get off the fence on this one.

Every colleague in the House should consider this motion in a serious way. That is why we have brought it here: to have the House concur with what the health committee has already agreed to. I implore everyone to consider this motion in a very serious way, because it is the right thing to do for Canadians, it is the right thing to do in the House and it is our obligation. Let us get it done and get it done today.

[Crystal Meth, June 15th, 2005]

Mr. Speaker, crystal meth is devastating individuals, families and communities in Yellowhead and across the nation. Fortunately, governments are beginning to wake up to this growing social menace.

Last week, ministers from the western provinces and the territories held a summit to tackle the problem. They are taking action and urging the federal government to do its part.

I have pushed this issue with my own private member's bill, Bill C-349, which would allow the RCMP to lay charges for the possession of crystal meth precursors. This persistence has paid off with the government's announcement on Friday of the proposed changes to the federal drug regulations.

A question that remains is how long will it take for the RCMP to have these tools at their disposal?

We also need tougher sentences for meth possession and trafficking, and minimum sentences so that those who destroy lives serve real time.

We need tougher enforcement and stronger laws. Thousands of lives hang in the balance.

[Committees of the House, June 14th, 2005]

Mr. Speaker, I have the honour to present, in both official languages, the 15th report of the Standing Committee on Health. The committee recommends that the federal government appoint the Auditor General to provide external performance audits on certain health related government foundations.

[Supply, June 7th, 2005]

Mr. Speaker, it is one of the frustrations that I believe everyone in the House has sensed over the last while. It is the lack of respect for votes that are taken in the House. We saw that frustration first-hand in the health committee with the issue of fetal alcohol syndrome. That is not the only one. There are many others.

It shows the amount of disrespect the House has even itself. It is not only the disrespect and cynicism Canadians for the House in the way that we have acted in the last while. That has to change or democracy will fail.

However, how do we look at prevention and how do we send the message more clearly to the health department, which I believe was the essence of the question? If we vote unanimously for the motion, that will send a very strong message to the government. If we are to have a national strategy, we will have to ensure that we put some feet to the fire. We must send a message to Health Canada.

It is great to see the Minister of Health here. I am hoping he will stand up and applaud this initiative. It is in his ballpark to deal with. I implore him to not only vote for the motion but to act on it. That is what Canadians need and that is what we have to do. We have to stop playing politics with health care and start doing what is in the best interest of Canadians. That is the reason they have charged us to come to the House. It is an honour to represent them from that perspective. Each and every one of us had better feel the weight of that and understand that the reason we are here is to speak on their behalf.