[Recorded by Electronic Apparatus]
Tuesday, April 23, 1996
.1005 
[English]
The Chairman: I call the meeting to order. Good morning, everyone.
First of all, I want to explain the sparse numbers in the committee this morning. The House of Commons is sitting, of course. We had to shift the time of the meeting from 9 a.m. to 10 a.m. because of some other commitments that people had and because the rules of the committee require us to take evidence with three members of the committee present. I assure you that you not only have three, you have three quality members...well, at least two members of the committee.
Welcome, Pauline, Sharon.
I want to welcome, from the Medical Research Council, Dr. Friesen and his associates. It is good to have you, sir. We hope you've been well instructed by the clerk to give us the briefest of opening statements so we can have time to raise some questions with you.
Would you begin, sir, by introducing your colleagues and then making whatever statement you think fit.
Dr. Henry Friesen (President, Medical Research Council of Canada): Thank you very much, Mr. Chairman, for the opportunity to appear.
My colleagues with me today are Dr. Louise Desjardins, a program coordinator for the Network of Centres of Excellence; a very distinguished Canadian scientist, Dr. Claude Roy, who has joined the council as director of programs; and Mr. Guy D'Aloisio, the director of finance.
[Translation]
I thank your for your invitation to appear before your committee.
[English]
I come today to offer an overview of MRC's role, its funding, its directions, and some of the priority files that we are pursuing.
Ladies and gentlemen, you should know the MRC's base funding support provided by the parliamentary appropriations is very unique. It's unique because it covers the full spectrum of health sciences research support in Canada. It's national in scope. It creates the foundation for Canadian capacity and competitiveness in this field. There's no other fund support for health sciences like that.
MRC's peer review is the basis for the allocation of the support. It's an internationally recognized rigorous process, whose sole requirement is the criteria that must be met as criteria of excellence. It's the basis by which the council awards all grants and awards.
The peer review process is itself an interesting exercise. It engages the best Canadian scientists, not only Canadian scientists but also international scientists. Every application is reviewed by four or five scientists recognized as experts in their field, chosen from around the world. So it's an international benchmark that Canadian scientists who receive a grant must achieve.
[Translation]
Receiving a grant from MRC is perceived as a mark of excellence in the scientific community.
[English]
MRC's unique position in this regard in the Canadian context makes it an ideal partner to build consensus, to facilitate interaction, to enhance coordination, and to serve as a catalyst.
.1010
In the material we've provided, I think we set out for you the strategy that MRC is pursuing to see this base funding platform provided by the government as a platform for very substantial leverage and economic growth.
We see over the five-year period $1.2 billion provided by the government as being the platform to acquire and to build and grow another $2 billion of research enterprise in this country, a mixture from the public and private sector. That's an unprecedented leverage we have been able to achieve, and you should know that we are some distance towards meeting that very ambitious $2-billion goal.
It builds on the knowledge that there is a virtuous cycle that begins with the discovery process spawned and supported by the federal government's investment through MRC. That's the starting point. The network of centres of excellence is another example of that early process. It needs then to be nurtured and supported by a variety of other mechanisms, including venture capital.
One of the MRC-inspired initiatives, which has met with substantial success the last two years, is the Canadian Medical Discoveries Fund. Some 46,000 Canadians across Canada have invested in the expectation that this is an opportunity for growth and the creation of jobs and profit.
We see the government's investment as being an opportunity to ensure that the Canadian health care system is supported by sound scientific principles developed as a result of a rigorous research process that will ensure the continued high level of health care available for Canadians. In the end, not only will there be an opportunity to improve the health care system, but we see research as the foundation of progress and the basis of hope.
[Translation]
I know that you will agree with me that research is the basis of progress and hope.
[English]
Thank you. I would be pleased to answer questions on any matter that arises.
[Translation]
Mrs. Picard (Drummond): The government has announced in its last budget, for 1996, a $65 million investment in research. Could you tell me more about the action plan established for that investment? What will be the real goals of that $65 million investment and where will that money come from?
[English]
Dr. Friesen: Why don't we begin with the last part of your question, which is where will the money come from?
There are initially two partners. Health Canada is contributing $1 million a year for a five-year period. It's an endowment fund that was created and announced by Mr. Martin in the budget speech. MRC is investing $2 million per year for five years. That's $10 million, plus the $5 million from Health Canada, which is $15 million. Then the federal government found an additional $50 million of new money as an investment, prorated over five years at the rate of $10 million a year.
The objective of the fund is to encourage the health care sector to identify what works and what doesn't work. As you may know, most large enterprises invest a significant percentage of their business activity in research, seeing that as a necessary requirement to maintain a competitive position.
.1015
The same is true in the health care industry. We have a $70-billion health care industry. We have made the point, and the minister agrees, that we should see a concerted effort to invest a proportion of our health care dollars in research, to identify what in fact is beneficial as a result of scientific inquiry and scientific evidence. It's of interest, for example, that three years ago the U.K. decided that 1% of its entire health care budget should be devoted to this kind of activity.
So much of what happens still in health care practice is based on tradition as opposed to evidence. The government believes it's very important that we facilitate the process - and this is the starting point - to encourage other jurisdictions to join forces and gain the benefit of coordination and collaboration to see through research what is beneficial, what works, and what doesn't work. It's a very cost-efficient mechanism.
Let me give you one or two examples. A number of years ago there was a major surgical intervention that was widely accepted as being beneficial for individuals suffering from imminent stroke. There was an indication of blockage of one of the arteries. A surgical procedure was in place that was costing the North American system $200 million a year. A research project began that identified over a four- or five-year period that not only was the surgery unhelpful, it was harmful. More people who had the surgery died than those who didn't. That study cost $10 million. As soon as the results were out, this surgical intervention collapsed; it's no longer in vogue, it's not used, it saved the health care system $200 million a year - a $10 million investment saved over five years $1 billion.
That's the kind of activity this fund is intended to stimulate. We're challenging those who manage the health care system to make sure that research is an integral part of all their activity.
We believe district health authorities, the private sector, and life insurance companies pay out large sums of money for a variety of disabilities, when in fact the evidence for the rehabilitation program has not been shown to be useful.
Another good example is the Workers' Compensation Board: $20 million was being invested in a very elaborate expensive rehabilitation program for low-back injury. It turned out after a careful study was done, in fact there was no justification for this $20 million expenditure to the Workers' Compensation Board. The research study itself cost $5 million. That's the kind of study we expect to be stimulated by this fund.
In terms of the action plan, those discussions are under way within the federal government, with the provinces, and with the private sector. We believe, given the size of our health care industry, a very large investment is necessary to ensure that the objectives of the fund are reached.
The Chairman: Sharon.
Mrs. Hayes (Port Moody - Coquitlam): Thank you, Mr. Chairman.
I'm delighted to have you folks here. I do have some questions for you.
I've been looking at the estimates and reviewing some of the numbers. There are a number of areas I would like more information on, but I'll zero in on the main one. I found the estimates very weak on the description of the centres of excellence. Within the estimates you say there are five or six, depending on the timing of this, but the actual description of what they do, how they do it, and what their accountability is is definitely not here.
.1020
There are numbers here that make me ask some questions too. On page 6 of the estimates... In 1994-95 the main estimates indicated a $5 million estimate, which in the actual expenditure for that first centre of excellence went to $23 million when it finally was apportioned by the end of the year, made up in the supplementary estimates. Maybe we could have a review of that. I noticed the forecast for 1995-96 goes back to $17 million and then $14 million.
I guess I would ask why the great increase last year and how that can be cut back. If that was necessary, then what are your plans for making the adjustments in the next couple of years?
More specifically to the centres of excellence, could you describe what centres of excellence are supported by MRC now? What is the accountability for the centres of excellence? Is there a process? Is there a public record as to what they do and how they do it, and funding for each of them within this time, in either this year or the forecast funding, to reflect the forecasts in the estimates we see?
The other thing is that I believe the original mandate for centres of excellence was given in 1993, for four years, by Kim Campbell. Has that been extended? If so, what process has extended that commitment?
I'll start with that. If you could, be very brief, because I have more questions I would like to direct to you.
Dr. Friesen: Thank you very much. Those are very excellent questions.
In terms of the centres of excellence, we're now into a phase two part of that program. There was an initial phase one, when the fourteen centres of excellence were identified. It's a very elaborate, rigorous process. Centres of excellence is a unique Canadian program. It's an effort to try to stimulate the linkage between the Canadian scientific community, often housed in universities and hospital-based research institutes, with the private sector. In the past, so much of Canadian discovery that was first-rate and excellent was often exploited and developed by others outside of the country, lost to the Canadian economy.
This program was an attempt to stimulate that kind of activity and linkages within this vast country as opposed to individuals in Alberta or B.C. or wherever, operating on their own. This was an effort to link right across the full spectrum of the country, to demand, as a very important and unique component of the program, linkages with the private sector and ultimately leverage from the private sector investing into the program. There was a view that if the private sector chose to invest, it's very likely they'd exploit and develop and see the business grow. That in fact is happening.
Let me get down to the issue of accountability. The three councils, along with Industry Canada, manage this program. The three presidents, plus the Deputy Minister from Industry Canada, are the senior steering committee representatives who oversee the program, supported by a management committee from the councils. Each of these fourteen centres... An additional four were just added in the late part of phase two.
MRC has primary responsibility for six centres: full responsibility for a neuroscience centre, which has, in phase two, a $20.8 million budget; Respiratory Health Network, $10 million; Canadian Genetic Diseases Network out of the University of British Columbia, $14 million; two centres we share with NSERC, Canadian Bacterial Diseases Network out of UBC, $15 billion, and Protein Engineering Network out of Alberta, $16.8 million; and a new network, the Health Evidence Application and Linkage Network, which we share with SSHRC, at $8.6 million.
.1025
You asked a very specific question about the variation in the estimates. Perhaps I could invite our director of finance to try to clarify that. I think it comes about because of the start and ending of the two phases.
Mr. Guy D'Aloisio (Director of Finance, Medical Research Council of Canada): That's right. You indicated that additional money was granted through the supplementary estimates that year. Phase one was ending in 1994-95. At the time of the estimates, the $5.2 million was the only amount approved for phase one. Phase two of the program was approved in that interim. It went up to $23 million because it takes into account both the winding down of some projects and the renewal of others. In the subsequent years, that amount goes down to the point where it's stabilized according to the approved amounts.
So it really was a transitionary year that supplementary estimates had to come into play.
Mrs. Hayes: Okay.
We drop, for instance, from $23 million to $17 million. Is that funds eliminated or is that funds transferred into another account somewhere?
Mr. D'Aloisio: Are you talking about the subsequent years?
Mrs. Hayes: Yes.
Mr. D'Aloisio: The $17 million was the change you referred to in that schedule. In subsequent years it's the normal profiling of how those funds were approved for those networks over the subsequent years. There wasn't any transfer into or out of other sources or from other programs.
Mrs. Hayes: Specifically, two centres of excellence... Actually, I don't see them within these headings you've mentioned. My understanding is that there's a new women's centre of excellence location in B.C., for instance, or there is the AIDS centre of excellence at St. Paul's Hospital. Where do they come into these broader categories? Could you explain how that works?
Dr. Friesen: Yes. I suppose it's an unfortunate use of the same terminology for entirely different programs. Women's centres of excellence is a program that has been launched out of Health Canada. It is unrelated to the networks of centres of excellence as we're discussing it today and for which MRC has responsibility. The same would be true, to some degree, for the AIDS centre of excellence out of B.C. We do fund clinical trials out of that centre, but we don't fund the centre.
So I think the confusion arises from the use of the term ``centres of excellence'' more generically, more loosely. Technically there are fourteen networks of centres of excellence that we, the councils, manage. I've given you the headlines of those six for which we have primary responsibility.
Mrs. Hayes: Actually, that's very interesting. If I understand what you're saying, MRC and other councils do have centres of excellence but the centres of excellence in, say, B.C. or related to, say, women's health is entirely separate from that. They've taken the same name but their accountability, everything about them, is different.
Dr. Friesen: Yes. In the case of the women's centre, that is a Health Canada departmental initiative. MRC has no relationship, no responsibility and no accountability for that program.
Mrs. Hayes: Are you aware of what department that falls under?
Dr. Friesen: Health Canada.
Mrs. Hayes: But which department within Health Canada? You may not know. It's probably an unfair question.
Dr. Friesen: I believe there is a women's directorate in perhaps the health promotion branch, but I'd want to qualify that. The truth is, I'm not fully familiar with exactly which branch.
Mrs. Hayes: Carrying on, then, I have two fairly specific questions. I notice there are Governor in Council appointments. The salary levels on there vary terrifically. We have talked a bit about Governor in Council appointments here, and some of the lack of accountability, actually, in the appointment process. I notice the salaries go up to $170,000. There is no indication of the average on that particular line. I don't know if anyone would know the average. I'll ask that, and then I have another brief question if there's time.
.1030
Mr. D'Aloisio: There is one Governor in Council appointment at MRC, and that's the president and chief executive officer. There's only one on that schedule on page 35. We don't normally put the averages as a disclosure requirement on there when there is only one GIC appointment.
So the range goes from the lowest to the highest. If there is only one in any particular classification -
Mrs. Hayes: An average is very telling, then, right? That's what you're saying.
Mr. D'Aloisio: Exactly.
Dr. Friesen: There are other Governor in Council appointments, but they are all voluntary. All our council member appointments are GIC appointees, but all of them serve as volunteers. For some, that's a major commitment. Those who are in professional practice, for example, give up a very significant amount of time on behalf of the council.
The Chairman: Were you through? We're really out of time, but if you have a quickie you can go ahead, and then I'll hear from Paul.
Mrs. Hayes: I don't know how quick this will be.
You mentioned there's a group of experts, a group of five, that looks at the research grants. Is there an overall umbrella to determine which areas receive the priority in research funding in whatever area of health? What is the bigger priority besides the five people who look at the specifics?
Dr. Friesen: The priorities are determined by the scientific community at large. It's kind of a grassroots response to determining priorities. We rely on the wisdom and good judgment of individuals who see opportunity, who know the stage of the field. We receive 3,000 applications a year from the scientific community, who are of course eager to try to move the agenda forward.
I believe, and I think the council believes, no committee in Ottawa has unique wisdom and insight. We would rather delegate that very broadly across the country to the stakeholders, the scientists who are working in a variety of institutions, who are better aware of where likely progress is to be found.
So we rely on that collective input and respond to the applications that come from right across this country. Excellence in those applications ultimately is what determines the success.
Mrs. Hayes: You would have a group looking at, say, cardiovascular research. I assume someone gives them a number that says they can only approve 20, as opposed to somebody over here in gastrointestinal who can approve 15. What body determines what the actual approval rate would be? There must be a decision process for this.
Dr. Friesen: Yes, there is.
Mrs. Hayes: Where is that?
Dr. Friesen: A council makes that decision upon advice from a standing committee on science and research, which looks at the results delivered by these committees that have reviewed and rank ordered in any disciplinary area, like cardiovascular. They rate them according to the scientific criteria. The standing committee receives that advice and says they believe it's fair and equitable as given, and this application pressure - this percentage for this discipline - would be right, because the standard of excellence has been met as defined by the committees. That happens for each of the 28 different sectors' committees.
Mrs. Hayes: Is that guideline available for public purview?
Dr. Friesen: Yes, it is.
Mrs. Hayes: Could our committee see what the guidelines are for the delegation of those priorities?
Dr. Friesen: Surely.
Dr. Roy, would you care to elaborate on this from the field?
Dr. Claude Roy (Interim Director of Programs, Medical Research Council of Canada): Mrs. Hayes, what has been said by Dr. Friesen I think really reflects the overall policies. I think the first criterion for granting from the MRC is scientific excellence, pertinence and eventual impact of the discoveries, which are also taken into account when the grants are reviewed by the 28 peer-review committees.
.1035
As pointed out, the rate of funding is determined on a biannual basis - there are two competitions a year for operating grants - and this rating is dependent on the budget that is available. Over the past several years, in view of program review one and program review two... Through program review one there's been a 10% decrease in the MRC's overall budget, and for 1998-99 there'll be a further 3% cut. This has to be taken into account and has led to a decrease in the percentage of funding for research grants and awards given to trainees, because training is also an important mission of the Medical Research Council.
The Chairman: I'm going to have to cut you off, Sharon. You've had 18 minutes on a 10-minute round. You were doing so well there, you were on a roll.
Paul and then John.
Mr. Szabo (Mississauga South): Dr. Friesen, 20% of medical research funding comes from your council in terms of awards and grants. That means you, along with many other bodies under the purview of the federal government, come under the scrutiny of the lay public, some for partisan and some for other reasons. Please tell the committee how the research council conducts its affairs in a way that gives us confidence that the quality of those grants and awards and the propriety of making those grants and awards are truly appropriate in terms of the ultimate research value.
Dr. Friesen: The whole issue of accountability, of course, is at the forefront of every public body. You were right to observe the proportion of the council's overall contribution. The public sector provides $1 billion a year in support to health sciences research, while the private sector and other provide a $500 million, so it's $1.5 billion. Our contribution is $240 million or $250 million a year. So we're in a partnership with institutions, universities, hospitals and hospital-based foundations that by and large have their roots in community support. Toronto is a remarkable example of this phenomenon, where each of the major teaching hospitals has a very large research enterprise that now accounts for 70% of our research funding target.
Of course we are well aware of the need for accountability. We have a standing committee on ethics that evaluates, has guidelines and demands... Every research application that comes to us must be reviewed by a research ethics board at a local level that is required to have the lay public on it.
The care of animals is another issue that is very important in today's world. Again, every grant application must be reviewed by a research board that is charged with this area.
In addition, each of our committees is instructed, notwithstanding that there has been a local review of ethical issues, that if ethical matters are an issue of concern to the review committees, they must be raised and identified. We note those and review them and discuss them with the institutions if there is a serious issue.
Mr. Szabo: Our time is running out and I want to ask another quick question. In general, of the total awards and grants, what proportion or how many would be fully funding certain activities as opposed to partnerships?
.1040
Dr. Friesen: Regrettably, in today's world we are often unable to fully fund grants recommended by the peer review committee members. At the last competition, for example, the experts who sit on the adjudication committee were obliged to reduce the budgets by about 21% or 22%. We did that with some reluctance, because normally the peer review committees are fairly rigorous in their analysis of what is required. When the recommendations come forward they've already been pared down from what applicants asked for, so having to reduce them further is a problem.
The Chairman: Thank you.
Mr. Murphy (Annapolis Valley - Hants): Thank you for your presentation. I came a little late, so I may be asking a question that you anwered in your presentation.
Where are the council's top priorities at this point in time? What research is being done in the area of schizophrenia? What partnerships are you working with? Are there any partnerships in Nova Scotia? The last part of the question concerns prevention versus treatment. I'm looking for the percentages and where you sit with those.
Dr. Friesen: The MRC undertook a strategic review at the beginning of my term, just about four years ago, where we determined three major priorities. The council has a distinguished record. It's invested $3.2 billion over its 35-year lifespan, but until the review focused almost exclusively on biomedical research.
As a result of the review we recognized that was important the council broaden its vision to support the full spectrum of health research, including prevention, promotion, health services, outcomes research and psycho-social behavioural research. That decision was taken, notwithstanding that we had no additional funding. It was determined that we simply have to find the resources because it was important to do so.
The second was that while we would expand our vision, we would renew our commitment to fundamental basic science discovery research, because in the final analysis that's at the heart of progress.
The third was that we'd evaluate more rigorously and be more accountable than ever before, and we're endeavouring to do that. For example, an international review committee is coming next month to review the progress we have made. Are we going in the right direction? Are there corrective measures that should be taken to be even more accountable, more innovative?
In terms of schizophrenia, I think we were prodded, stimulated and challenged by Canada's Nobel laureat, Michael Smith, who, in a magnanimous gesture immediately after receipt of his Nobel Prize, turned over half of his money in support of schizophrenia research. We were pleased to partner with his effort.
As a result of his reminder of the underfunding, we have a number of initiatives. We have a Michael Smith chair in neuroscience for schizophrenia that was announced about a month ago here at the University of Ottawa. It went to a young Canadian scientist who I think will be very important in this field.
Last week I attended the award of the Killam Prize to Philip Seeman of the University of Toronto, who made the seminal discovery that dopamine receptors are probably very important in this field. Philip has been an MRC grant holder for 25 years, I think. He is one of Canada's outstanding scientists in this field.
But it's never enough, because the reality remains that far too many who suffer from this chronic long-lasting disease simply do not receive the kind of therapy that is desirable and optimal.
.1045
So we have a long way to go, but the priority is there. We have a partnership with the Schizophrenia Society of Canada. In the Atlantic provinces, Saskatchewan and Manitoba, the relative underfunding of research has been of concern to the council. We have created a regional partnerships program that gives those four regions special advantage in coming to the council. For every two dollars they bring we'll add, under different circumstances, an additional dollar. It's been a well-received program.
Prevention is important, of course, and promotion is important. I think the health services research fund, for example, can provide direction in that area to ensure that not only is knowledge generated, but new knowledge is adopted into practice. That is a really important issue.
Many of these issues are lifestyle issues and we all know that it's not easy to change people's behaviour and attitudes. At times it's a challenging, difficult matter. The one that first comes to mind is smoking. It's a deadly practice, yet despite the certain knowledge of that deadly practice, far too many, particularly young women, choose to take up that habit.
Mr. Murphy: On schizophrenia, as you're well aware one in a hundred suffers from this disease, and it's debilitating not only to the individuals and their families, but to the country. I've always wanted to ask this question of someone like yourself. How can we get the priority changed? How can we get schizophrenia and research in the area of schizophrenia higher on the priority list, given the carnage that happens with this disease?
Dr. Friesen: As I said, it's never enough. As a scientist I would say that the field of neuroscience - understanding how the brain works and doesn't work - is probably more advanced today than ever before, and the tools available to make the probing inquiries as to what has gone wrong have never been better.
So while I deplore the fact that we have made so little progress, I remain optimistic that we're now better positioned than ever before. In our council's activity, neuroscience is the biggest funding envelope by a good margin. In terms of Canadian strengths, capacity in neuroscience is probably one of our hallmarks. I think Canadians should know that there are some remarkable individuals in this field who have made outstanding contributions and are recognized worldwide. So neuroscience, including schizophrenia, is probably one of MRC's highest priority areas.
Mr. Murphy: Would it be possible to get a bit of a write-up on that? I would like that so that... I was in pyschiatry and mental health prior to coming here -
Dr. Friesen: I would be pleased to.
Mr. Murphy: - and I came here saying I would look into this whole thing.
Dr. Friesen: I invite you to keep prodding us.
Mr. Murphy: I will.
Dr. Friesen: Perhaps you could even join one of our neuroscience committees to see how the review process works. I would extend that invitation to all members of the committee. It's an interesting process.
[Translation]
Mrs. Picard: As you know HIV is one of our biggest health concern presently in Canada. When we arrived in 1992-93 Health Canada had promised to give its first priority to medical research on treatment of HIV. Last year, grants for treatment and research on that disease have been reduced. Can you justify those cuts?
[English]
Dr. Friesen: I can only speak about MRC's effort in this area. We fund research in a variety of areas related to HIV and AIDS, including the most fundamental kind of discovery research. Our council's commitment has not decreased. Overall, I think you're quite right to note that there has been a change in emphasis and in the mechanics of funding research in this area, but those changes are not a result of the council's activity.
.1050
Our council continues to fund HIV research at the same level. When I look at the data I would say that there's probably been a slight increase because some of the pump priming that took place earlier has developed a research capacity in Canada that didn't exist before.
Many of these investigators are now able to compete satisfactorily on a level playing field with the rest of the scientific community. Also, I think it's important to know that one of the discoveries arose out of a laboratory supported by MRC at an earlier point. A new drug that is now registered not only in Canada but in North America is one of the promising new therapeutic agents. It was picked up and developed by a Canadian company, BioChem Pharma, which is now capitalized at about$2 billion or $3 billion. It is one of the world's largest biotech companies. It has its roots back there in that small amount of funding, along with others, and that's the way the process works. It starts with these seminal discoveries. It's not quite clear where they fit and then suddenly it takes off in this blockbuster fashion.
The Chairman: Thank you, Dr. Friesen, and your colleagues for being with us this morning and helping us with our examination of the estimates.
This concludes this portion of the session. We'll take a moment shortly to allow the transition to the new set of witnesses.
[Translation]
I must leave now because of another commitment at 11 a.m. So, I invite my dear colleague Pauline to preside the rest of the meeting.
.1052
.1057
The Vice-Chair (Mrs. Picard): Welcome to the officials of Health Canada. It is always with pleasure that we welcome you to our committee Mr. Foster. I shall ask you to introduce the members of your organization and give us a short statement so that we shall have time for a few questions.
Mr. Kent Foster (Assistant Deputy Minister, Health Protection Branch, Health Canada): Thank you very much, madam Chair.
I wish to introduce
[English]
Mr. Dan Bondy, who is representing the Environmental Health Directorate this morning. The director general is not well today - it is a serious problem - and therefore cannot be here. It only happened yesterday. I regret that, but Dan will fill in for Mr. Roy Hickman.
Ms Barbara Benning is the director of strategic planning and drugs directorate renewal. The director general is in London, England, attending a conference of all medical drug directorate agencies around the world, so Barbara will fill in for that. Mr. Orvel Marquardt represents the Corporate Services Branch and is our financial expert. Hopefully, he can help us through the numbers and any questions you might have regarding numbers. Dr. Joe Lozos is the director general of the Laboratory Centre for Disease Control. Dr. George Paterson is the director general of the food directorate. And Mr. Weldon Newton is director of management and program support.
.1100
Madam Chair, members of the committee, it's a pleasure for the Health Protection Branch management team to be here to discuss with you the 1996-97 health protection program.
[Translation]
We are always conscious of the need to continuously provide the best government services for Canadian taxpayers dollars.
Health Protection Branch recognizes its responsabilities for the health and safety of Canadians and its budget of almost $200 million this year takes into account its cost recovery goals.
[English]
The estimates document itself covers extremely well our part in the minister's program and strategy for Health Canada. I think we are generally seen by the public as the regulatory arm of Health Canada, those responsible for removing unsafe products from the marketplace in our core businesses that my management team represents. Our work in the public sector, led by Dr. Joe Lozos and the Laboratory Centre for Disease Control, is less visible sometimes and less known, but key in our delivering of the complete health protection program.
The interaction between the sectors represented here and the specialist is substantial. It provides Canada, in my view, with a unique organization that can deliver faster than other jurisdictions, for example, who must work at at least the interagency level. A good example would be the United States, with the Food and Drug Administration working with another agency, their Center for Disease Control. We have both those components in our organization in health protection branch.
We're a large organization, with some 23,065 personnel, about 37% of Health Canada's staff and almost 75% of the science base, if one does not count the nursing staff in the medical services branch. The staff is instrumental in providing for the department, as well as for the health protection program, the evidence base for decision-making.
I think the public expects us to use our science-based programs to prevent or reduce risk to their lives while improving their quality of life and making them better-informed consumers and benefactors of the health protection program. This of course is key to all our efforts, and we are challenged to do this in the most cost-effective, non-intrusive way possible.
The challenges are many, and they are as varied as the sectors in which we work. From the international climate and activity point of view, all countries are finding it's too expensive to go it alone. Most countries want to share science and work in these sectors. Harmonization in the form of sharing work hopefully will lead to sharing standards and perhaps eventually even sharing product approvals.
As a branch we are currently working on mutual recognition agreements with the European Union, the United States and Mexico. The challenge of rapid science and technology developments pose an ever-present challenge. New science leading to new tests and better diagnostic techniques are often very expensive and entail extensive cost-benefit analysis.
Public expectations are often that they be able to immediately use these breakthrough developments. The balance we have to apply, of course -
[Translation]
The Vice-Chair (Mrs. Picard): As our members requested, we shall immediately start our questioning. So I shall ask you to conclude briefly.
Mr. Foster: Madam Chair, we are ready to answer your questions.
The Vice-Chair (Mrs. Picard): Madam Hayes.
.1105
[English]
Mrs. Hayes: I thank you. I will try to make these brief. Hopefully the answers will be brief as well.
The first question I would ask is about melatonin. It has been banned for sale in Canada due to health concerns. Is there scientific data to back up this banning?
Second, the purchase of a three-month's supply for personal use from the U.S. is still allowed in the case of melatonin. This seems quite inconsistent. Is it safe or is it not safe?
Mr. Foster: In the interests of being quick, I will ask Barbara Benning to give you a response.
Ms Barbara Benning (Head, Renewal Office, Drugs Directorate, Department of Health): Melatonin is considered a new drug in Canada. Anyone who would like to put it on the market must submit adequate information to prove it's safe and effective for the intended use. To date, I don't believe there is any case where someone has compiled that information, submitted it and therefore has melatonin legally on the market in Canada.
Mrs. Hayes: Is it the case, though, that you're allowed to bring in a three-month's supply from the U.S.? Is that a typical ruling in the meantime?
Ms Benning: Yes, that's our compliance policy to do with personal importation, a three-month's supply for any product that's not marketed in Canada.
Mrs. Hayes: Okay. Thank you for being brief.
Dental mercury fillings was the next subject I wanted to address. A recent scientific paper from HPB suggests limits on amalgam fillings. It's my understanding the paper was denounced by the agency that commissioned it, and different panel members have quit from that group. Could you give us some information on this and describe who's responsible for what has happened?
Mr. Foster: A proposal and a paper were put forward by the environmental health directorate, in fact by the medical devices bureau. A consultation was done. An expert committee was formed. It reviewed the proposal, which consisted of basically a risk assessment of the issue.
There was disagreement amongst the members of the committee. Although a consensus was reached, there was then some dissenting views on some of the recommendations made by the committee. They're very polarized. They're either on one side of the issue or the other. We have therefore determined that we will put together a risk assessment of our own, based on the data and the consultations we've done, and we will then make other proposals in terms of what we think should happen next.
Mrs. Hayes: When might that be expected? When can the public have some indication as to what the final recommendation of your department is?
Mr. Foster: I don't have the exact date, but I will ask Mr. Bondy if he has a date for us.
Mr. Dan Bondy (Director, Science and Research Support, Environmental Health Directorate, Department of Health): The actual position paper is expected in the spring. I don't have a specific date.
Mrs. Hayes: Spring of 1996?
Mr. Bondy: Yes. I don't have a date on when that might become public. That would depend, again, on how the scientific controversy is at that time. That's a date I have at this point at least.
Mr. Foster: Madam Chair, I would offer to get a date for the member and make it available to you. I just don't have a date at the moment. My director general is not here this morning. I'm sure he would have had a date. If you'd allow me that, I'd be happy to get it for you.
Mrs. Hayes: I'd appreciate that.
Another question I have is on something that has come to my attention fairly recently. Is the family violence initiative under the HPB umbrella?
Mr. Foster: No, it's under the health protection and programs branch. I would think you'd probably get a faster answer from them.
Mrs. Hayes: I'll save that for them, then.
I have another question I'd like to pose - and receive perhaps a brief answer on. The safety of the public is a responsibility of HPB. You've expressed that fairly succinctly in your statement, that it's the regulatory arm of health care, which of course is very important. It is many branches.
Certainly we've seen in a number of areas recently, including in the public media as well as in some inquires that are ongoing, that political decisions often interfere with or perhaps override scientific advice or scientists' opinion.
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I'd like to ask you a question. Should top HPB hierarchy have more scientists than political appointees?
Mr. Foster: I don't know if I can answer it yes or no. I'd prefer to say that you need the proper balance: the ability to manage these kinds of programs and the science on which it should be based.
At the director general level, I try to ensure that the levels of science and management are balanced. Hopefully one has a scientist who is capable of managing those things.
In terms of the overall program, we turn to whatever science is available in the world. It's worldwide. We consult with our trading partners. We consult with other institutions, other government departments, etc. We really may represent a small group, but our network is enormous. We have daily contacts with, for example, the Food and Drug Administration in the United States and the Centre for Disease Control in Atlanta.
I think the only sensible answer is you must have the right balance, and when you feel that balance is in jeopardy it needs to be examined.
Mrs. Hayes: For the record, do you know what the balance is now with respect to the hierarchy? What sort of representation is there of the scientific community as opposed to political appointments?
Mr. Foster: There are no political appointments within the Health Protection Branch. My position as a civil servant is one that is competed for. It is managed by the Public Service Commission, but I have no appointments. There are no political appointments within the Health Protection Branch.
Mr. Orvel Marquardt (Director General, Departmental Planning and Financial Administration Directorate, Corporate Services Branch, Health Canada): Could I add a point of clarification? It doesn't directly answer your question, but it gives you an indication at least. We have approximately 6,300 FTEs in the department. In the scientific and professional categories, there are 2,462, which is quite a large percentage of the total department.
Mr. Foster: In my branch in the science portion, there are some 1,200.
Mrs. Hayes: We've just heard from the MRC, which has one Governor in Council appointment. How many would be related to your department? Are there any?
Mr. Marquardt: We have two. It's listed in the estimates.
Mr. Foster: There are none in the Health Protection Branch.
Mr. Marquardt: There are none in HPB.
Mrs. Hayes: Thank you.
Mr. Murphy: Thank you for your presentation.
Recently there's been a fair amount of media attention on the issue of tuberculosis. I read, for instance, that it can be transmitted during airplane flights by people who are infected. What's the department doing in terms of preventing and controlling instances of tuberculosis in the country, and how are we managing the risks associated with travel and migration regarding the disease?
Then I have another short question. Brighter Futures comes to an end this year in terms of funding, and I'm wondering whether we're looking for future funding for that program for zero to six.
Mr. Foster: I'll turn to Dr. Lozos in a minute, who can describe our efforts against tuberculosis.
In terms of Brighter Futures, that belongs also to the health promotion and programs branch, but as we do have a portion of it, I'll ask Dr. Lozos to address it as well.
Dr. Joe Lozos (Director General, Laboratory Centre for Disease Control, Health Canada): Thanks very much.
Tuberculosis is undergoing an international increase of epidemic proportions, with about three million deaths a year estimated by WHO. We have adjusted to this epidemic by strengthening in-house capacity in LCDC over the last two years and have established two federal-provincial networks: an experts committee, and a federal-provincial tuberculosis control network.
We're leading an international 17-country surveillance system to look for resistance in tuberculosis and have agreements with Immigration Canada, Transport Canada, and Corrections Canada in areas where tuberculosis might in fact hit the country through travellers or through indigent populations that find themselves in prisons, for example.
We've strengthened our laboratory capacity, including genetic profiles that allow us to look for W strain, which is this resistant one that is unfortunately hitting parts of the United States.
Over the last two years these networks have been strengthened. We've produced standards, and we now have a national game plan on tuberculosis control.
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We have three programs that are covered under the Brighter Futures program. One is a sentinel surveillance system of health units that cover approximately 10% of the population. We use that network of health units to study what needs to be studied in acute problems like hepatitis C, streptococcus flesh-eating bacteria, and the like. The program for studying asthma in young people, for example, was supported by Brighter Futures.
We have a network of surveillance sentinels for cancer in children and a program for monitoring the health of newborn infants, a perinatal surveillance system. All three of these are supported out of Brighter Futures, at least in large part, and we would hope to continue them as that program is continued.
Mr. Murphy: With regard to the community development side of things, literacy and nutrition, as you say, we have a very extensive program where I'm from.
You mentioned there's another branch. Is that other branch going to be continuing the funding for Brighter Futures?
Mr. Marquardt: Yes, that program will continue, and you will have an opportunity to address that question specifically to Ms Kay Stanley, who will be appearing here Thursday morning. She will be quite able to talk about the entire CD initiative.
Mr. Murphy: Thank you.
The Vice-Chair (Mrs. Picard): Mr. Szabo.
Mr. Szabo: I have two areas of questions. The first has to do with biotechnology. I think the last time we spoke BST was an issue of high interest to a lot of people. What has happened with regard to BST since, and what, if anything, has changed in terms of the protection branch's attitude toward pursuing biotechnology innovations?
Mr. Foster: I would hope that our attitude is one of encouraging that science. Some of the biotechnological breakthroughs are mini-miracles to me. To be able to produce biotechnology to produce insulin, for example, to produce Factor 9 IX in blood products, these are enormous breakthroughs to me.
So it's not support exactly, but our enthusiasm for this particular area is high, and the amount of work we do in this area is also high. From the BST point of view, I don't believe anything has changed since our last appearance before the committee. Companies put products in front of us with hopefully the evidence that would convince us they are safe for use or safe for sale in Canada. In this case, that has not been done yet.
We have some products that have been reviewed. They're still under review, and additional information has been demanded of those organizations. When we're satisfied, we will make a finding on whether or not an NOC would be granted.
Mr. Szabo: The second and last area is with regard to probably the most pressing and urgent issue, the blood supply. The Krever inquiry is just at the interim report.
The issue of the section 13 notices issued by the inquiry and, in your view, whether or not the grounds for the government's legal challenge are valid... Generally, can you tell the committee, can you tell Canadians, what we're doing to restore public confidence in the blood supply?
Mr. Foster: In terms of the section 13 challenges, we have tried to make it understood that the Government of Canada decided the way the section 13 challenges were portrayed was unfair to some individuals who had not been given an opportunity to testify before Krever. Justice Canada is making that representation, and I believe those hearings will be on May 13.
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The Government of Canada has also made it clear that the section l3s are not being objected to on the basis of Krever's recommendations against organizations and the Government of Canada. It's just those individuals, and some 18 individuals are being represented in that action by Justice Canada.
Restoring the confidence people have in the blood products system in Canada is a major concern. The minister has a personal initiative that is actually underway this week. He'll be meeting with his counterparts from the provinces to look into the issues surrounding the blood system and Canadians' confidence in that system. I expect when that's concluded, we'll have direction from him to proceed to do all the things that we can to make this system safe.
I would say, though, that in all the findings to date, including those by Krever in his interim report and his safety audit report, the safety and level of safety of blood and blood products in the country is as good as that of any other western country in the world today. That's not to say we haven't worked hard on completing as many of the recommendations as we can.
The interim report by Krever had 44 recommendations, seven of which were directed at the federal government. All seven of those recommendations have been attended to by us, and we continue to work on those and other improvements to the safety of the blood system.
Mr. Volpe (Eglinton - Lawrence): Mr. Foster, I just have a very quick note on the estimates for drug safety quality and effectiveness. There is an indication of a substantial reduction from the 1995-96 forecast. In fact, it's about $39 million and change.
The largest change appears in the control of dangerous drugs, where we went from a 1995-96 forecast of $18 million-plus to almost $8 million in 1996-97. I noticed that in the explanations the decrease is related to program review one and the implementation of cost-recovery initiatives. I wonder if you would elaborate on that so those of us who might get the sense that we're abandoning a drug control strategy might have a better appreciation of the reason for the difference.
Mr. Foster: Yes, I'll try. I will ask Orvel to verify numbers with me, but let me deal first with the amounts of money in the prosecution fund.
I think the Canadian drug strategy has 19 players in it in terms of departments and other agencies. Part of it was a prosecution fund that allowed for the legal activity, payment for legal services, and so on in prosecutions.
Health Canada used to run that fund, but in truth the expenditures were really controlled by Justice Canada and the RCMP as part of the program in the Canadian drug strategy. We felt it made great sense to have all that in one area where one decision could be made. So that was being transferred, and shows as a $9 million-plus drop in the drugs directorate.
Orvel, do you want to add anything to that?
Mr. Marquardt: No, that's a significant amount, and that would obviously show as an increase in Justice's estimates, if you were to look at theirs.
Mr. Foster: In the amounts that relate to drops in appropriations, some two years ago we decided that we had to develop more independence of appropriation so that we could do the kinds of work involved in drug approvals that would lead to a stabilizing of the funds available to do that work. In that regard, we introduced a cost-recovery program. That cost-recovery program will generate something in the neighbourhood of $27 million in this particular period of time, and that $27 million will no longer be part of appropriations. So as we raise cost-recovery revenues, the appropriations are removed. That is another large change to the numbers in the drugs directorate.
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From a program review one and two perspective, perhaps I would ask Orvel to make a comment on its activity.
Mr. Marquardt: There were reductions related to program review against that particular activity. They only amount to about $3 million in total. So by far the larger drop is the reduction in the appropriation due to cost recovery, and the transfer to Justice of the prosecution fund.
Mr. Foster: Although the member did not imply this, I'd like to respond in terms of the performance of the drug directorate, which has improved dramatically over the past year. We can now say, without qualification, that we are world class standard and world class competitive, and we are aiming at making that even more efficient.
Mr. Volpe: I wonder if I could go back to the question of melatonin. When you give a permit to bring in the drug, at the same time do you provide an analysis of quality control at the source of the input? In other words, when you give the okay to a Canadian to bring in melatonin, do you have an analysis of the manufacturing and delivery mechanism of the producer?
Mr. Foster: If I could attempt to provide some clarification, the Food and Drugs Act regulations respond to a company that provides a product for us to review. In this case, some company would have to give the drug to us for review to see whether or not we would issue a notice of compliance. And that has not been done. No company has asked us to look at melatonin. So we are not doing any analysis or work on melatonin.
In terms of what the Food and Drugs Act and its regulations provide for, if we were to issue a notice of compliance, it would simply mean that that product, that drug in this case, could be sold legally in Canada. If individuals want to purchase drugs like melatonin for their personal use, it is not against the law from the point of view of the Food and Drugs Act and regulations.
So we would need someone to ask us to look at melatonin to be available for sale in this country so that we could do the work.
Barb, can you add anything to that?
Ms Benning: Maybe just in terms of people bringing in melatonin for personal use. It's not a question of us giving them a permit. It's a question of allowing a balance between personal choice, if you will, and marketing drugs in Canada, and the whole regulatory system for that.
We feel that at this point three months is an adequate sort of measure, which allows people the freedom to import drugs for their own use without going beyond the reason that we have the controls in the first place, in terms of health and safety.
So we're not giving permits for people to bring in those drugs. It's a personal choice, and they could come in.
Mr. Volpe: When it's a personal choice, a Canadian goes across to the States and is satisfied that the producer meets whatever regulations are appropriate in that country. When he goes to another country and finds that the packaging and quality control may be a little less severe, does Health Canada, the Health Protection Branch, assume any liabilities - I'm not sure I'm using the right term - if in fact the individual goes to a source whose packaging and quality control is less than rigorous?
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Ms Benning: I guess the point, again, is that we don't have a legal framework for action in this regard. I think we have tried to educate the public as much as possible about why melatonin is not allowed for sale in Canada, and how to look for drugs that are approved in Canada.
Mr. Volpe: I realize that the last two questions weren't on the estimates, but...
Mr. Foster: In any case, for the member, I might add that for the same reasons you've asked the question, I've asked the director general of the drugs directorate to do an assessment of precisely this issue. It's clear a lot of people think melatonin can do almost everything. We need to make an assessment of that. I've asked them to give me an assessment on that. I'm waiting for it.
[Translation]
The Vice-Chair (Mrs. Picard): Mr. Foster we have two more questioners. Madam Hayes please.
[English]
Mrs. Hayes: I want to go back to CDI, the child development initiative announced in 1992. This is its final year. It should be of great importance to this committee because of the study we're now doing, actually. It was intended to contribute to the health and well-being of young children at risk by supporting programs that anticipated and prevented problems for them.
I notice in this year's estimates there's been a $25 million increase for that initiative. The estimates also indicates there are final evaluations for the existing program in 1995-96 to assess the continued relevant success and cost-effectiveness of the initiative.
I realize that only a small portion of that - approximately 5%, I believe - is under the HPB. Could you tell us whether the programs directed by you were meeting their objectives and how that effectiveness was measured in terms of whether they met their objectives? Could you give us copies of those final evaluations - I presume they're imminent, because the evaluations are due - and tell us if any particular projects come to mind that were obviously very good or very bad?
Dr. Lozos: The money that the Laboratory Centre for Disease Control had out of this program created those infrastructures to which I referred earlier on. There was cancer surveillance, there was perinatal surveillance of newborn infants, there were asthma programs, and the sentinel system of health units.
All of our programs, these included, go through cyclical peer review. That is, I as director general encumber outside reviewers according to an academic-style evaluation of the program. All of them have gone through that program. That is over and above the annual program review that happens cyclically in the department.
Because this is infrastructure related to health intelligence and public health, we would continue these programs and challenge them constantly through steering committee mechanisms. That is, outside stakeholders, academics, provinces and other professional associations are on the steering groups of these various projects, and they dictate and direct the quality and content of the programs.
Mrs. Hayes: Will you be issuing an evaluation report to fall into the guidelines of final evaluations being put to these particular programs?
Dr. Lozos: Yes. The overall program is being evaluated by Kay Stanley...or drives the evaluation. Kay Stanley is the ADM who will be in front of this committee shortly, I believe. We have fed into her evaluation matrix.
Mrs. Hayes: So your specific input to that can only be through Kay.
Dr. Lozos: Yes, that's the way it has been. That evaluation is just completed. It will be reported over the next couple of weeks.
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Mr. Foster: I can't tell you whether or not copies are available, but I can find out. I'm sure Kay would be able to respond to that.
Mrs. Hayes: Do you anticipate any greater or lesser involvement percentage-wise, or will you go up in lock step with the extra money given to this initiative?
Mr. Foster: The portions Dr. Lozos has spoken to have again been funded for at full amounts. So I think our portion of that is, one, not being cut, and two, going to continue. I'd have to leave it to Kay to outline the rest of the moneys involved.
We're satisfied that what we're doing is the right amount in balance with the rest of the program, and I'm most happy that it's going to continue. We will be putting our case again when we review this a year's time from now, as well.
Mrs. Hayes: Are there any priorities in what your branch has been involved in, in this initiative, that you would recommend to this committee to look at in our investigation of the determinants for healthy children?
Mr. Foster: As I understand it, both Dr. Lozos and Mr. Hickman made an appearance before your committee with some suggestions along those lines.
Joe, do you recall?
Dr. Lozos: Specifics as far as broad determinants are concerned with these infrastructures I have described... The steering group is a broad group. It is not only medical people who look at disease and their causation, but looking at the broader effects... There are components, for example abuse of kids, in the perinatal surveillance system that would be of interest to you. I don't have that information with me, but I would be very happy to provide you with more information on that.
Mrs. Hayes: Because it's specifically in those areas, of course, that your evaluation would be of great importance to us in determining how we would deal with it, or if we would deal with it, I would think. So it goes back to that.
Thank you.
[Translation]
The Vice-Chair (Mrs. Picard): This will be my last question. The committee would like more information as regards three new health concerns: life-threatening allergies, particularly to foods such as nuts, eggs and dairy products; environmental sensitivities and chronic fatigue syndrome. Did you study those concerns and if yes how do you intend to deal with them?
[English]
Mr. Foster: Dr. Paterson will talk about les allergies.
Dr. George Paterson (Director General, Food Directorate, Health Canada): Thank you, Madam Chairman.
Food allergies are becoming more and more of a problem, particularly, as you know, peanuts and anaphylactic shock. What we've embarked on - at the moment it's really just doing the research and consultation with Agriculture and Agri-Food Canada - is the creation of a joint government-industry working group to isolate what are the key factors and key food ingredients that can cause severe allergies.
We anticipate over the next two to three months to have completed these consultations, to analyse them and to review them with our senior management as to what options we have and what priorities we should assess in terms of resource allocation.
At the moment we have been largely reactive in terms of identifying complaints and pulling products off the shelf. I think we have to move to a more proactive scenario and either as a combination of labelling or better manufacturing practices give the consumer more information in terms of what food products they're eating and whether there may be a severe allergy effect.
One of the things we've discovered is that this could be a bottomless pit in terms of minor allergies or reactions to it. So I think we have to assess what the key food allergens are and start with them first.
Mr. Foster: Do you want to mention the work with the restaurant association in terms of menus and so on?
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Dr. Paterson: Yes. Part of that sees the industry group, the Canadian Restaurant and Foodservices Association, working with them in terms of food service delivery and in terms of advising their customers, of giving out more information in terms of potential implications of foods they serve.
So it's not just the production end working with the industry. It's all done in the chain in terms of the Canadian Council of Grocery Distributors and the retailers at the retail end. And as Mr. Foster mentioned, it's the food service associations as well - the food service part of the industry.
Dr. Lozos: On chronic fatigue syndrome and multiple chemical sensitivities or environmental sensitivities, we've had the same problem. That is, both of these undoubtedly real problems are very complex. As of yet, there is no objective measure that could determine someone with chronic fatigue syndrome or someone with the chemical sensitivities, or that would be available for the purposes of public health surveillance.
We have mobilized two separate national consensus meetings, one on chronic fatigue syndrome and one on environmental sensitivities, at which we brought all of the experts together to try to come up with a position on what the next steps might be. On chronic fatigue syndrome, we actually also subsequently brought a group of experts together to try to come up with research proposals that they could submit to the national health research and development program of Health Canada and to the Medical Research Council to try to break the ground. That's the first step necessary to try to measure how much there is, and what it is in the population.
Irrespective of us bringing together some of the best researchers in Canada, that didn't materalize. So where we are on chronic fatigue syndrome at this point is at a distribution of our technical report to the scientific community. The ball has been put directly in the court of the basic science researchers to come up with some objective measure or case definition that we in public health can then pick up to take the next public health steps.
Similar activity occurred on environmental sensitivities, but we took an extra step with the environmental sensitivities. Together with another branch in Health Canada, we distributed very widely an educational orientation program of the proceedings of this workshop to psychiatrists, psychoanalysts, people who might be dealing with patients, with the public out there. We covered fields in which there might be an effect to tell them the results of our specialty consensus meeting, but we also wanted to prime them to look for the potential of chemical imbalances or environmental imbalances when they examine and treat their patients.
So that's where we are on those two situations, neither of which has national surveillance programs because neither has an objective test we can use.
[Translation]
The Vice-Chair (Mrs. Picard): Are they any other questions?
Then I will thank you, gentlemen, for having taken the time to come and answer our questions so kindly. Thank you.
The meeting is adjourned.