DEBATES OF THE LEGISLATIVE ASSEMBLY(Hansard)
WEDNESDAY, APRIL 23, 1997
Afternoon
Volume 4, Number 4
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The House met at 2:05 p.m.
Prayers.
G. Brewin: In the precinct today is a group of students who are here from Bothel, Washington, United States. They are here with their teachers and some family members. Would the House please join me in making them all very welcome. Welcome to Canada.
Hon. J. Cashore: Visiting today in the gallery are two residents of Victoria, Ida Smith and Ruth Martin, who is the mother-in-law of my long-suffering assistant, Bob Peart. Please make them welcome.
R. Neufeld: Well, I beat the cabinet to the punch today. [Laughter.] I'd like to introduce to the House my best friend and a supporter, LaVerne Neufeld.
Hon. D. Zirnhelt: Here from the city of Williams Lake is a man who is a city councillor, Paul French. Would the House please make him welcome.
L. Stephens: Visiting in the precincts today are my son Mark Stephens and his friends Debbie Smith, Lynnell Johnson and Mike Hildebrand. Would everyone please make them welcome.
S. Orcherton: Joining us in the gallery today to view the proceedings and listen to the debates and discussions in this House is a resident of my constituency, Johanne Mathyssen. I ask the members present to make her welcome.
F. Gingell: Joining us in the Legislature today are two constituents, one with a famous voice that us older members know very, very well. I ask all members of the House to welcome Mr. Roy Jacques and his wife Lila. Roy Jacques was the voice of the news in British Columbia, particularly the 9 o'clock evening news when CKWX was the most listened-to station in the province. I ask everyone to make them welcome.
Hon. J. MacPhail: I am delighted to have with us today students from Templeton mini-school, a school in my riding. They are accompanied by their teacher, Mr. Kuniss. They will be here throughout the day, so I would ask that when you run into them, please make them welcome.
J. Doyle: I'm very pleased today to have in the gallery good friends of our party and our government who have lived in Kimberley and Kaslo and are now residents of Victoria: Sonny and Agnes Nomland. Please make them welcome.
WOMEN AND GAMBLING
L. Stephens: The National Council of Welfare has released a report on the effects of gambling in Canada. Will the Minister of Women's Equality tell us if she agrees with the findings of the report?
Hon. S. Hammell: The 1996 survey done here in British Columbia indicates that there has been no increase in problem gambling in this province from 1993 to 1996. We know that in B.C., 26 percent of the people have smoking addictions, and that is a problem; 15 percent of the people have alcohol addictions, and that is also a problem; 4 percent of the people have gambling addictions, and that is also a problem. The government is dealing with smoking and dealing with alcohol
Interjections.
The Speaker: Order, members. Please wrap up, minister.
Hon. S. Hammell: The government is dealing with smoking and with alcohol addictions in both women and men. The government, for the first time, plans to spend $2 million on a program to treat people with addictions to gambling. This will be one of the highest-funded programs of its kind. The people of B.C. don't want more studies; they want action, and that's what we're doing.
L. Stephens: Well, can the minister tell this House if she has even read the report?
Hon. S. Hammell: There are pathological gamblers and people with gambling problems, but that
Interjections.
Hon. S. Hammell: I have read the report from the Liberal opposition, a study done by Julian Somers, commissioned by the Liberal Party, which advises them: "Legalized gambling offers a variety of significant benefits to a majority of citizens, those who gamble and those who do not."
C. Clark: This minister talks about action, and the mission statement for her ministry's own policy and evaluation branch states that it exists to "ensure that the issues relating to women's equality are reflected in policy and programs throughout the government."
My question to the Minister of Women's Equality is: why has she failed to do a study on the negative impacts of gambling on women, when she spends $1 million a year and has a whole branch of her ministry that is set up to do exactly that?
Hon. S. Hammell: We don't need more studies to know that a small percentage of the population has a problem with gambling. Women Against Violence Against Women use the charitable money that they have accessed through gaming. In 1991 they received $32,000 in gaming money. These are women against violence against women. They received $29,000 from casino revenue in 1992. In 1995 they received casino revenue of $36,000. Hon. Speaker, $130 million goes to the community agencies around this province, including women who are fighting violence against women.
[2:15]
C. Clark: The minister talks about how much money she's going to be able to raise from gambling, when we know that each problem gambler costs the government $30,000 to treat. I'll quote from the mission statement for the minister's own department again. It says that her department is supposed to ensure that all government policies promote economic equality and prevent violence against women. So I'd ask this minister: when will she start doing her job? When will
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she start standing up for women, and when will she stand up for herself and tell this government that she opposes expanded gambling because of the negative impacts that it will have on women?
Hon. S. Hammell: Does the member support the recommendations from the Liberal Party report on gaming, or does the Liberal member suggest that we ban gaming from this province? You can't have it both ways. You can't lobby for gambling jobs and accept money from gambling lobbyists.
K. Whittred: The National Council of Welfare issued a report on gambling which states: ". . .spouses of pathological gamblers are more likely to have nervous breakdowns or engage in substance abuse
Hon. S. Hammell: This government cannot be criticized in their support for women. Their record on supporting economic equality and preventing violence against women is unparalleled -- unparalleled in the province, unparalleled in the country. The first thing this government did was initiate a Stopping the Violence program, and it has spent over $100 million on stopping the violence against women.
Our commitment to women is unparalleled. We have increased the minimum wage by $2 an hour, and that's for
K. Whittred: The National Council of Welfare report quotes another survey on the impact of gambling on families. This study was called "The Impact of Pathological Gambling on the Spouse of the Gambler." It says that 76 percent of the spouses of compulsive gamblers have eating disorders.
Faced with the avalanche of research into the negative effects of increased gambling on women, can the minister tell the House why she won't stand up for B.C.'s women and oppose the Premier's dangerous gambling expansion?
Hon. S. Hammell: A small percentage of B.C.'s population has problems with gambling, and to this government's credit, there has been no increase in the number of problem gamblers in this province from 1993 to 1996. That comes from the same study as the one the hon. member mentioned yesterday.
Women-serving organizations access the $130 million that gambling provides. That is very important money to women's organizations and the women who are fighting violence.
The real roots of violence against women are power and control, and this morning
Interjections.
The Speaker: Order, members. Minister, will you please wrap it up.
Hon. S. Hammell: Hon. Speaker, we have done two things this week on prevention of violence: one is to announce a harassment education program, and the second is to announce a gun amnesty. We are taking action, and that's what the people want us to do.
S. Hawkins: On August 6 the Ottawa Citizen reported that in order to gamble at Casino Rama in Orillia, some parents left their children alone in cars or wandering around in the parking lot while they gambled. The situation became so bad that Casino-Rama officials made an announcement over the loudspeaker requesting all such parents to leave the casino.
My question is to the Minister of Women's Equality. Can the minister tell the House why, when faced with horror stories from increased gambling, she won't oppose the Premier's dangerous gambling expansion?
Hon. S. Hammell: There has been gaming in British Columbia for over two decades. British Columbians gamble not only in B.C.; they gamble
Interjections.
The Speaker: Members, the minister has a rather soft voice, and if we have too much noise I simply can't hear it. So I would ask you, please, to let me hear the answer.
Hon. S. Hammell: We have been gaming in British Columbia for over two decades. People in British Columbia also go down south to Washington, to Las Vegas -- to Nevada -- to gamble. The government is proposing a modest increase, but we don't need a bunch more studies to know that a small percentage of the population has a problem with gambling. We are establishing a new gambling program that gets into dealing with addictive gambling, along with setting the minimum age at 19.
The Speaker: Minister, I think
Hon. S. Hammell: Women's issues cut across the spectrum of government business
Interjections.
The Speaker: Minister, I think that does indeed answer the question. I'm going to ask you to resume your seat, if you will.
S. Hawkins: The National Council of Welfare cites another report, which states that 82 percent of the wives of pathological gamblers got so angry with their husbands that they wanted to kill, hurt or incapacitate them.
My question, again, is to the Minister of Women's Equality. When will she acknowledge the damage that gambling does to women and families, and oppose the Premier's dangerous gambling expansion?
Hon. S. Hammell: Just as prohibition -- which I assume now these people are saying -- didn't stop alcoholism, it's clear that banning gambling won't stop pathological gambling. If there is a game, people who have a problem with gambling will find it.
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British Columbians expect that when we identify a problem, we will deal with it, not study it to death. We've taken action to help problem gamblers and will monitor gambling in the population through continued updating of the baseline study.
A. Sanders: Yesterday the Minister of Women's Equality showed a shocking, incomparable ignorance of the social costs that gambling extracts from women and families. The studies have been done, and they do show an incredible cost. "Women and Compulsive Gambling" found that one-third of pathological gamblers are women. The study also found that 68 percent of pathological female gamblers eventually engage in illegal activities. My question to the supposed Minister of Women's Equality is: why does she not stand up to her Premier and his gambling deputy and say no to this ill-conceived plan?
Hon. S. Hammell: The hypocrisy is shocking. You have a member who lobbies for gambling jobs, and you've got a group that accepts money from gambling lobbyists. You've got a bunch of pious people that say they are worried about women's issues. Not once have they brought anything up, and they would get rid of the ministry the first chance they had.
Interjections.
The Speaker: As dispassionately as I can, I want to advise the House that the bell ends question period.
R. Thorpe: I rise to present a petition from the water rate payers of Naramata. These very concerned citizens have been under extreme personal stress, and they remain very concerned regarding possible future financial decisions. These decisions will have a significant impact on their lives. I ask this government to hear the voices of these 426 citizens.
R. Neufeld: I rise to present a petition on behalf of the citizens of 240B Road, Grand Haven, British Columbia.
"We, the residents of Grand Haven, are extremely concerned about a proposed sour gas drilling site located in close proximity to a populated area, which includes schools and is downwind from the proposed site. Long-term health hazards and horrendous odours are associated with any emission of H2S. This request has the support of other communities involved, plus the Peace River regional district. We request the immediate intervention of the Minister of Employment and Investment, who must address our specific concerns prior to a drilling permit being issued to Kaiser Energy."
Hon. J. MacPhail: I request leave to move a motion to establish a special committee.
Leave granted.
Hon. J. MacPhail: I move that a special committee be appointed to monitor and evaluate the progress of the work of the Ministry for Children and Families in respect of recommendations arising out of the Gove inquiry into child protection, and that the special committee so appointed have the powers of a select standing committee and also be empowered to: (a) appoint of their number one or more subcommittees and to refer to such subcommittees any of the matters referred to the committee; (b) sit during a period in which the House is adjourned, during the recess after prorogation until the next following session and during any sitting of the House; (c) adjourn from place to place as may be convenient; (d) retain such personnel as required to assist the committee; (e) permit minority opinions in a report of the committee; and shall report to the House as soon as possible, or following any adjournment, or at the next following session, as the case may be; to deposit the original of its reports with the Clerk of the Legislative Assembly during a period of adjournment; and, upon resumption of the sittings of the House, the Chair shall present all reports to the Legislative Assembly.
The said special committee is to be composed of Ms. Gillespie, Messrs. Kasper and Hartley, Ms. Kwan, Ms. McKinnon, Mr. Coell and Mr. Neufeld.
[2:30]
Motion approved.
Hon. J. MacPhail: I call Motion 56 that sits on the order paper in my name.
Hon. J. MacPhail: I'll read the motion for the House.
[Be it resolved this House support the British Columbia government's position before the Parliamentary Standing Committee on Industry, which calls on the Government of Canada to change Bill C-91 in a manner that supports and protects innovative drug research, promotes fair market competition and reduces drug costs in order to ensure the health, safety and financial well-being of Canadians come before the interests of the drug industry.]
It's very timely that this Legislature enter into debate on this resolution and, I would hope, reach unanimous support in favour of the resolution. And the timing is this: the federal House's Industry Committee is now reviewing the effects of Bill C-91, a bill that was passed by the Mulroney government in 1993. We also anticipate the federal government will call an election in the coming weeks, and in the course of that election. . .we have knowledge today from the Minister of Health, David Dingwall, that he and his government are contemplating very seriously the establishment of a national drug program.
We also know that this federal government commissioned the National Forum on Health, and the National Forum on Health has recommended to the federal government that there be a national drug program. In fact, the National Forum on Health suggested that the national drug program be modelled after the one that exists here in British Columbia. So it is very important that this House unanimously urge that committee to recommend changes to Bill C-91 that will actually allow for a national drug program.
The committee is the Industry Committee, which was disappointing to our government. They were treating the pharmaceutical industry the same as any other industry, and it was not the Health Committee that reviewed the effects of Bill C-91. But in that context, our government went to Ottawa and
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still made a presentation before the Industry Committee, asking that the committee consider the full range of issues relating to the drug industry and that they review the effects of Bill C-91 within the broader context of patient care.
We urged the committee to consider the serious concerns that we have here in British Columbia about how multinational drug companies currently operate in Canada. We recognize that drug companies exist to make profits. But, frankly, drugs are not just another commodity. We're not talking here about other Industry Committee review products such as shampoo or toasters; we're talking about an essential element of the Canadian health system. We urged them to consider that the large multinational drug companies have had their way in the past and now is the time for all of that to stop. It's time to put the interests of patients ahead of drug company profits.
Today, clearly, this Legislature can consider that we are at a crossroads. We can urge the committee in Ottawa, which is considering these matters right now, that they have a chance to do much more than simply rubber-stamp the status quo. They now have the right to choose between serving the interests of patients or ignoring patients and instead continuing to fill the pockets of multinational drug companies.
The National Forum on Health says we must have a national drug plan for Canadians, and British Columbia agrees and is prepared to play a leadership role in bringing one about. But a viable national drug plan simply will not be possible as long as Bill C-91 stays as it is today. Those costs would simply be too great. If the committee is not prepared to make the necessary changes to Bill C-91, then a national drug program will not be viable, and the future of B.C.'s Pharmacare program will continue to be threatened.
If we extrapolate the most conservative estimates of the Queen's University study, a widely respected and recognized study, Bill C-91 is costing Canadians hundreds of millions of dollars every year. British Columbians alone are paying about $40 million in excess drug costs each year, directly because of Bill C-91. It's $40 million that we say could be better spent expanding Pharmacare benefits. Frankly, that $40 million would pay for a year's worth of life-saving insulin for 20,000 diabetics. It would pay for 2,500 heart operations, and it would be enough to provide 8,000 cancer patients with treatment for a year. So the cost of Bill C-91 is very real, and it has put B.C.'s Pharmacare program at risk.
I hope that this House will urge the committee to have the courage to amend Bill C-91 and make other changes that more effectively regulate the multinational drug companies. Then it will be possible to move forward on a viable national drug plan.
British Columbia has already developed initiatives that could play a big role in the success of a national drug plan. Over recent years we have worked very hard to improve and protect Pharmacare, but we no longer can do it alone. When we appeared before the committee reviewing Bill C-91, our government focused on two major areas of concern: excessive prices of new drugs, and excessive and inappropriate drug use. The prices of most new drugs being introduced in Canada are excessive, particularly new drugs that are not significant breakthroughs. I know that some of the hon. members in the Legislature will be talking about that further today.
I want to make it clear that the government of British Columbia strongly supports patent protection for breakthrough drugs. We have a thriving biotechnology industry here in B.C., and we're well aware that developing totally new medicines is a risky business. Canadians badly need basic research into conditions such as Huntington's chorea or Alzheimer's disease, where there currently is no drug therapy. Patent protection for breakthrough drugs is essential if we're going to encourage high-quality research into new drugs.
Think of what our Canadian science has accomplished in the past with Banting and Best's discovery of insulin. We have a rich research tradition, producing such recent breakthrough drugs as 3TC for AIDS patients. These breakthroughs have benefited patients as well as the industry. They're valuable and should be encouraged.
Unfortunately, instead of focusing on research into areas where there are few or no drug therapies, the multinational drug companies instead focus on researching and marketing drugs that differ only marginally from what's already on the market. And that is because it is cheaper to develop me-too's. They can be brought to market and produce significant profits more quickly. That's what is protected by Bill C-91. More than 90 percent of new drugs introduced each year into Canada are me-too's or line extensions. Fewer than one in ten represents a real drug breakthrough. That's not our establishment; that's the health protection branch in Ottawa, which makes the determination about whether a drug is a breakthrough drug or a me-too drug.
Because me-too drugs offer no significant therapeutic improvement over existing drugs, riding on the coat-tails of true innovations, me-too's don't deserve the same patent protection or the same level of introductory pricing as true breakthroughs. Bill C-91 must be changed to encourage innovation and not the imitation of 90 percent of the drugs.
We also told the committee, and they had already heard from others, that price increases for regulated drugs have been modest in recent years. However, those claims suffer from one major flaw. A record of low price increases is absolutely meaningless if the introductory prices are unreasonably high in the first place. This is what happens consistently, particularly in the case of me-too drugs.
I can give you one example, and it's based on the daily cost to our Pharmacare program here in British Columbia. Toradol was probably the fifteenth or sixteenth non-steroidal anti-inflammatory drug. Like other me-too's, there was no evidence that it was superior to Ibuprofen, which costs 3 cents a day to treat each patient. However, Toradol's introductory price was 61 cents a day -- 20 times as much. So here you can see how skilful marketing can capture a substantial market share in the absence of any therapeutic advantage. From 1992 to 1995, Toradol was prescribed 165,000 times versus 140,000 for the much more cost-effective Ibuprofen.
Our concern about high prices goes beyond patent-protected medications. There's also a problem with pricing of drugs that aren't patented but are produced by only one supplier because they have a particularly specialized or small market. Patients requiring such medication are often at the mercy of big drug companies. These drugs are susceptible to unreasonably high prices and at times have been the subject of outrageous price increases.
We actually tabled two letters that highlighted the problem. One dealt with the issue of Activase, which is a potent clot-buster that's changed the way we manage the acute phase of a heart attack. Hoffman-La Roche recently imposed a $500 price increase for each dose, raising the price to $2,700. In this case the drug company had actually given up the patent to escape the Patent Medicine Prices Review Board regulatory authority. The prices review board only has the capability of
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dealing with patent products. In this case, the drug company, a single supplier, gave up that patent protection and then jacked up the price by $500 per dose.
That practice has been recently regulated by the federal government, but this price hike is not covered by the recent regulation -- and that price hike will cost British Columbians $680,000 on an annual basis in extra costs for this drug alone. Hon. Speaker, I will tell you, this legislation is not a partisan issue. The saving of $680,000 is an issue that everyone in this Legislature should be able to agree with.
Myasthenia gravis is a rare and chronic neurological disorder that used to be universally fatal. Drugs were developed over 40 years ago, and the drugs, taken on a daily basis, can restore normal function. In 1995 another single-source supplier arbitrarily tripled the price of these drugs to patients suffering from myasthenia gravis. Again, the regulatory framework of Bill C-91 provides no recourse for this outrageous price inflation. It's because of examples like this that we believe the regulation of drug prices should be extended to include single-source drugs that don't have patent protection. It's a simple change that the federal government can make, and they can do it now.
Another contributor to unreasonably high drug costs is the unfair Bill C-91 barriers that stand in the way of generic competition once patent protection for a drug has expired. This is a complex issue, so I urge the House to bear with me. Bill C-91's notice-of-compliance provisions cause unreasonable and unnecessary further delays to the introduction of lower-cost generics for patients. This is a provision that exists nowhere else in Canadian patent law. It really strips the rights of generics and provides special protections to brand-name drugs. It could be eliminated by the federal cabinet today at the stroke of a pen, and it should be eliminated.
Just for the benefit of the House, a notice of compliance is where a drug company has to serve notice that they're complying with all the regulations around the manufacture of a drug. What Bill C-91 gives pharmaceuticals that no other manufacturer has is
Another barrier to generic market entry is "evergreening," the practice of taking out additional patents strategically timed to extend the effective period of patent protection. For instance, enalapril, a commonly used anti-hypertensive, has more than 40 separate patents on it. Each one of those patents can be alleged to have a notice-of-compliance violation against it, which can extend the patent for an unbelievable time and therefore prevent a generic drug from entering the market.
[2:45]
Neither of these examples stand up to the test of common sense that an average Canadian patient would expect of them. So whether we're talking about me-too's or breakthroughs, excessive prices or barriers to generic entry, the result is the same. The multinational drug companies are getting protection unlike any other industry. As a result, they have the highest profit margin of any manufacturing sector. This statistic came as a
In B.C. we're doing our best to deal with the failings of Bill C-91 and the federal government's cuts to health transfer payments, although today there's excellent news coming from the federal Minister of Health. He has promised to not extend the cuts in transfer payments; he said he will stop the cuts in transfer payments. I would hope this means that in 1998 and 1999, the federal Liberals, if re-elected, will actually withdraw their cuts of $300 million that they will impose on our province next year.
An Hon. Member: It's good that you're keeping this non-partisan, eh?
Hon. J. MacPhail: The hon. member is saying non-partisan. What I'm actually doing is agreeing with the federal Liberal government, but clearly he hasn't been paying attention. Neither have the members opposite, so I hope they're actually paying attention, hon. Speaker.
Our Pharmacare program is under tremendous pressure as increasing new drug prices and the proliferation of expensive me-too drugs have really increased financial pressures. I want to share with you the progress we've made in B.C. to protect and expand our drug program.
I'll start with our reference drug program, the first of its kind in Canada. Under this program, when several medications are proven equally effective, Pharmacare will pay for the one that's most cost-effective. The program does not limit what the physician can prescribe. For example, if there's a reason for a second-line medication, Pharmacare will still cover the cost on the recommendation of a physician.
The reference drug program protects British Columbians from the cost of expensive me-too drugs in certain areas of common drug therapy. It does this by using the best scientific evidence to determine the most cost-effective therapy for a given condition. The program is projected to save $74 million in the first two years alone. In this way, the very limited public dollars can provide the greatest possible public benefit. Pharmacare covers therapies that have been proven effective. In fact, over 99 percent of all prescriptions prescribed by all physicians are filled just as the doctor prescribes. That's good news for doctors, and that's good news for patients.
Now, the reference drug program -- no question -- has been attacked by the multinational drug companies. But it is working for British Columbians. The National Forum on Health observed: ". . .given the balance of economic interests, it is probably not too far-fetched to suggest that the probable effect on drug costs of any public or private reimbursement policy can be gauged by the tone and vigour of the industry's response." I guess we're successful, because they're taking us to court over and over again. But the savings have been used to extend Pharmacare coverage for patients with cystic fibrosis and multiple sclerosis.
The reference drug program is a success for B.C., but the reality is that in the long run it has to be supported by action from our federal counterparts. If B.C. is to continue protecting our Pharmacare plan, and if we're going to create a sustainable national drug plan, we can only do it with changes to Bill C-91. So we have urged the federal government to bring
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down prices of new drugs for patients by limiting protection for me-too drugs and discounting the introductory price of me-too's. They should help patients get lower-cost generic alternatives sooner, by cabinet immediately eliminating the notice-of-compliance linkage provision and stopping the abuse of patent protection represented by evergreening. They should protect patients who need specialized drug therapies by expanding pricing regulation to also cover single-source unpatented drugs.
This brings me to my second major area of concern: excessive and inappropriate drug use because of the marketing practices of the multinational drug companies. This is a concern that Bill C-91, in its review, can address when it's broadened by this federal government. The pharmaceutical industry in Canada spends more on marketing than it does on research. In 1995 they spent 16 percent of sales on marketing, compared to just 12 percent of sales on research and development. That works out to $950 million spent on marketing, more than we spend on all 16 medical schools in Canada. That statistic is shameful.
Recent articles in the Canadian Medical Association Journal have raised serious concerns about the self-regulation of drug company marketing to physicians. In Canada, regulation of marketing by multinational drug companies is very limited. But even with that, the enforcement of the current self-regulation is deficient. Right now Canadian physicians get most of their information on new drugs from drug company sales agents or advertising. I had an excellent discussion about these matters with the B.C. Medical Association earlier this week. Every year, the drug companies spend an average of $20,000 per doctor on marketing. Physicians need and deserve accurate and unbiased information about new drugs, something that I had an excellent discussion with the BCMA on. They need information that's free from the marketing hype.
The reality is that the drug industry marketing is intended to encourage more drug use, not necessarily appropriate drug use. The current marketing practices of the multinational drug companies put physicians in a very difficult position. At the inception of medicare, the average physician needed to know about fewer than 200 different drugs. Today physicians face an array of more than 2,500 different drugs, with more coming out every month. Drug industry marketing known as commercial detailing, aimed at doctors literally bombards doctors with narrowly focused promotional materials. Free drug samples are part of this marketing strategy. Powerful antibiotics -- for example, the quinalones -- are handed out as free samples. There have been studies to show recently that the unnecessary use of these samples is contributing to the alarming rise in antibiotic resistance in the community.
An appropriate professional relationship between doctors and the drug industry must begin in medical school. We have an example which we can follow. Hamilton's McMaster Medical School has set an important precedent by restricting drug company promotional activities in the faculty. We're very honoured to have the former dean of medicine from McMaster University as the dean of medicine for University of British Columbia now. So we are at an opportune time in British Columbia to take a lead in doing exactly what McMaster Medical School has already done.
But we're not concerned just about marketing targeted at physicians. We're equally concerned about the potential damage of drug companies' advertising aimed directly at us, our kids and our relatives, as consumers. British Columbians want education about prescription drugs, not advertising. Drug advertising directed at consumers has only one purpose, and that's to increase drug sales. Anyone who tries to argue otherwise will sound remarkably similar to the tobacco industry, which has long denied that its marketing is done to increase sales. But we only need to look at the U.S. experience, which has direct-to-consumer marketing, where in just a few short years the money spent by drug companies on direct consumer advertising has increased tenfold.
We can pick up those magazines here in British Columbia right now. They are magazines that are imported from the United States. There is no censoring done. So you, hon. members, and your families are getting this advertising right now. It is unbelievable to look at some of the drugs that are being marketed directly to consumers. I hear from doctors every day who say that they have patients arriving in their offices with magazine advertisement cutouts, and they're saying: "Here, doctor, I want this drug, please." We simply cannot allow a greater intrusion of that kind of advertising to spread into Canada.
I'd like to share with you what we're actually doing to provide independent science-based information about drugs. We've developed three initiatives as alternatives to dependence on drug company marketing. First, there's the therapeutics initiative that brings together physicians and pharmacists to assess new drugs and provide physicians with independent information on their clinical effectiveness based on the best scientific evidence.
Second, we've initiated the pharmaco-economics initiative, designed to independently assess the relative cost-effectiveness of different drug therapies.
And third, we've supported a demonstration project on the North Shore called the community drug utilization program. It offers physicians an unbiased alternative to drug industry marketing, to enhance the quality of prescribing. As part of this project, unbiased health professionals actually visit the physicians to provide accurate information on drugs without any sales pitches. The doctors and the ministry have agreed that hundreds of thousands of dollars have been saved in Pharmacare costs because of this project.
So just as with drug prices, hon. Speaker, we need national action on limiting drug advertising. The federal government should regulate drug industry marketing targeted at physicians. They should introduce national therapeutic and pharmaco-economic initiatives, such as COHTA -- the Canadian Office of Health Technology Assessment -- which exists now, as well as expand the use of successful strategies such as academic detailing, which is where health professionals go directly in an unbiased way -- not supported by any one drug company -- to talk to physicians about drug education. The federal government should prohibit direct-to-consumer advertising. They should restrict drug company promotion at Canadian medical schools.
These measures will put science ahead of salesmanship, to improve prescribing in Canada. They put the needs of patients ahead of profits for multinational drug companies. Bill C-91 isn't just an industry issue. It's about the health of all Canadians. A viable national drug plan for all Canadians is essential, but it won't be possible if Bill C-91 remains unchanged. The parliamentary committee examining this in Ottawa now has the power to make a difference for the millions of Canadians who at one time or another depend on drug therapy.
I would just say on behalf of all British Columbians -- and, really, patients across this country -- that we have a
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unique opportunity as a Legislature to stand up for patients and for a national drug plan. We are a wealthy province; we can take the lead in Canada. We can urge a government that I think is ready to make change. I think the government in office in Ottawa now is truly ready to change Bill C-91. I hope we can unanimously resolve to urge the federal government to make these changes to Bill C-91 that our government has recommended. We will truly be putting patients ahead of profits when we do that.
S. Hawkins: I'd like to move an amendment to the motion.
The Speaker: Please proceed.
S. Hawkins: Hon. Speaker, I'd like to move that the motion be amended by adding the following:
[and this House support the introduction of researched and proven initiatives which enhance the partnership in British Columbia between academics, health care providers, industry and government; encourage prospects for research and development investment and future job creation in British Columbia; and, most importantly, put the health needs of British Columbians first.]
The Speaker: Member, given that I haven't seen this motion before, I'm going to ask you to proceed with your comments and give me an opportunity to review it to see whether it is indeed in order.
S. Hawkins: Thank you, hon. Speaker. Well, this side of the House certainly shares concerns with many groups regarding increasing drug costs. Certainly we understand that the benefits that were to flow from Bill C-91 were research and development and educational grants. Again, this province appears not to have received its fair share of these benefits. It appears that a lot of these benefits have flowed to central Canada more than to B.C. Certainly the members on this side of the House would support anything that will help the people of Canada and British Columbians to obtain drugs at a reasonable price to meet their health needs. I'm sure every member of the House would be supportive of measures that do that.
[3:00]
But I do have some very serious concerns regarding this motion and the effect of some of the initiatives that the minister is advocating. I have serious concerns about the way this debate has come before the House. I don't think this is a responsible way to be making public policy. On behalf of the government and the people of B.C., the minister takes initiatives to Ottawa and then brings them back to this House for us to endorse before we've even debated them. I don't think that's a very responsible way to debate something like this. The presentation goes to Ottawa before it ever comes to this chamber, before any of the discussions go to this Legislature's Select Standing Committee on Health. Before reference-based pricing is ever debated in this chamber, it goes to Ottawa. I think that is a very irresponsible way to make public policy and to have a debate.
Mr. Speaker, the minister states that she speaks in the interests of patients. She claims: "Over recent years, we have worked hard to improve and protect Pharmacare." I refer the minister to her news release of November 18, 1996. On that date, there was a news release coming from this minister announcing a change in Pharmacare policy, to allow for only 30 days' coverage for a prescription rather than 100 days. That same day, Pharmacare unilaterally delisted 25 widely prescribed drugs without consultation with physicians, pharmacists or patient groups, and it restricted four other medications to the special authority process in order for patients to receive these drugs as benefits. This process of delisting and restricting access is hardly consistent with the goal of improving Pharmacare.
Now, this minister also refers to the reference drug pricing program as the first of its kind in Canada. This side of the House has concerns about this pricing program because, frankly, it's unproven and unresearched. We have asked the other side of the House for studies and for their research, but it has not been provided. The member for Richmond East stood here two weeks ago and asked the other side of the House for the basis of their drug-pricing program. We still have nothing.
What the minister neglects to say is that the program has been tried in Germany, and it failed to control drug costs. It was tried in Italy, and it failed to control drug costs. It was tried in a number of jurisdictions in the United States, and guess what: it failed to control drug costs. In the U.S., restricted drug formularies have been directly linked to increases in emergency room visits, increases in doctors' office visits, increases in hospitalization and increases in the number and costs of drugs prescribed.
In B.C., the government has unwisely initiated the program without first having the data measurement techniques in place to track whether this limitation of the ability of patients to receive prescribed drugs increases their utilization of health care and hospital admissions. What I mean here is that there's nothing in place to say whether we change this patient's medication. There's nothing to track whether this patient comes back to the doctor six times or 16 times because there are problems with drug reactions, or whether this patient goes into the hospital because of complications or visits an emergency room because there are problems. There's nothing to track that. So we have no research. It's unproven; it's unresearched. We don't know whether it's working, and they want us to endorse it without it ever having been debated in this chamber.
We have indirect evidence that reference drug pricing increases doctors' visits in B.C., because this government requested and was granted the authority to increase the Medical Services Plan by $10 million, through a special warrant, to offset the costs incurred by the increased visits required for special authority drug plans. We just did that a few weeks ago.
You know, I've got a letter here from the president of the BCMA to his members saying that an additional $10 million will be added to the available amount this year, with $5 million going into the base for next year. And guess what: they're saying it saves money. For example, this covers all costs associated with the introduction of calcium channel blockers and ACE inhibitors reference-based pricing initiatives. They're saying it saves money, but we have proof here that they added money to the MSP budgets, because the doctors are filling out forms for special authority -- a make-work project -- to get permission from this government to give patients the drugs they need. It's unbelievable.
This side of the House believes it's inappropriate to fundamentally change the way health care is provided without putting in place the necessary steps to measure the outcome of
[ Page 2758 ]
the interventions, whether good or bad. Let's do a study. Let's find out if it's good or bad. Let's not just put it forward and then take it to Ottawa and say it's good for B.C. and for everyone. We don't even know if it's good for B.C.
This government says that health care costs are increasing every year. They say their program is saving health care dollars. Well, if you put blinders on and look at it very narrowly, yes it is. If that's all you're going to put into a budget for those drugs and that's all you're going to charge, that is going to save you there. But, again, we have no evidence of where it's impacting on other parts of the health care system -- like in increased hospitalizations, increased visits to emergency rooms and increased visits to the doctor's office. If we had that evidence in front of us
As an example, there was a discussion forum for health care providers in Vancouver in February. One of the presenters, a Dr. Bloomberg, presented data that dozens of significant adverse clinical reactions -- that means damaging to patients -- were reported to Pharmacare as a result of patients being switched from their previous nitroglycerin medications for angina and heart pain to the cheaper reference product, Isordil isosorbide. The existence of these severe clinical reaction reports were not disputed by the Ministry of Health consultants in attendance, Dr. Rick Hudson and Dr. John Sloan. However, the Ministry of Health continues to deny that the drug policy results in direct harm to some patients. It's unbelievable.
Now, reference-based pricing compares the clinical effectiveness of drugs and compares clinical outcomes, assuming that the drugs are taken properly -- okay? So you go to your doctor, and he or she gives you a prescription for something. Then you take it to a pharmacist, and the pharmacist says that this is not in our reference-based pricing program, but we do have six drugs in this group and they all work the same. So if you want the drug that your doctor ordered, you're going to have to go back to your doctor and have him fill out a special authority form or else we're going to substitute it with this.
Assuming that the patient takes it properly and doesn't react to this different drug
Let me give you an example. Asthma can be effectively treated using inhaled steroid medications. You've seen people use a puffer, an inhaler. Generic low-dose steroid inhalers are available for use with asthma, and treatment may require four puffs of a cheaper medication to be inhaled every four hours to achieve the same benefit of a higher-dosed but higher-priced steroid medication inhaled two puffs every 12 hours. In a clinical study, the outcome of these two treatments may be the same if the medications are taken correctly as prescribed. But in the real world -- let's talk about the real world -- where people forget to take their medications, the patient who is required to take 24 puffs of medication per day is far more likely to miss dosages and not take his or her medication the way it's prescribed. If doses are missed, the asthma gets out of control and might require a visit to emergency or hospitalization and more visits to the doctor.
The drug savings that seem to be apparent from the use of the cheaper drug are lost, because the compliance and the efficacy aren't there. And we don't have any research that's tracked that. We know that health costs are rising every year. That could very well be due to this policy that this government has implemented, but we don't know that, because we have no data. The Canadian Cardiovascular Society has gone so far as to say that reference-based pricing -- the policy that this government is advocating -- of cardiovascular medications -- that's heart medications -- is "putting the lives and the health of British Columbians at risk."
The government points to the therapeutics initiative, a group of physicians and pharmacists who assess new drugs based on independent scientific evidence. This is the same minister that told me last year in estimates that the therapeutics initiative gets $100,000 in government funding. How independent is that? In truth, the therapeutics initiative has distanced itself from the reference-based policy of this government, and it is not involved with the government's reference-based pricing. That's what they tell me. So where are they getting their advice from? In addition, many of the recommendations coming from the therapeutics initiative are controversial. They're often based on conflicting scientific information, and they don't always have the endorsement of specialist associations.
This side of the House believes that therapy should be based on an evidence-based evaluation of outcomes, and this approach is missing in the way that Pharmacare policies have been introduced, altered, changed, delisted and restricted. There's been very poor consultation, and we cannot support policies that are unresearched and unproven.
The Minister of Health wants "a vision that puts patients before profits, science before salesmanship and leadership before lobbying." I suggest her vision ought to put patients ahead of the Pharmacare budget -- science, instead of unproven social experimentation and leadership, before political profiling. Most of all and most importantly, patients should come before politics, and in the opinion of this side of the House that is not what's happening here. But I'll let another member of this side of the House address that question, because there seems to be a bit of an agenda to this motion coming before the House.
Mr. Speaker, this government has failed miserably to forge a partnership among academics, health care providers and industry to work for a common goal of optimal drug therapy for the people of British Columbia who need it. Instead, this government has adopted strategies of exclusion. They're antagonistic and they're confrontational. The very words of the minister's motion are unnecessarily antagonistic to an industry that employs citizens in B.C., pays taxes in B.C. and contributes to research and development educational grants in B.C.
As well, the policies of this government are restricting providers from using the necessary tools to serve their patients. For a surgeon, the necessary tools are operating spaces and hospital beds. We've even seen surgery cancelled in this province for the lack of a single packet of sutures. That's pitiful; that's shameful. For non-surgical specialists, the necessary tools are access to prescription drugs which may have very subtle but very important differences. And these side effects -- the side-effect profile of drugs -- are not the same for every patient. Patients are individuals. I'd like to remind the minister that patients are vulnerable to the insensitive policies of this government.
The B.C. Pharmacy Association has taken a position opposing Pharmacare's reference-based pricing policy. From
[ Page 2759 ]
what I understand, they do so for the following reasons: they say that reference-based pricing puts economics before health, and they say that pharmacists are not consulted. Well, what a surprise! I mean, this government doesn't consult anybody.
[3:15]
Interjections.
S. Hawkins: That was not a surprise.
Utilization was not addressed. They said: "Reference-based pricing is an unnecessary move to address escalating Pharmacare costs. Considerably more health care dollars could be saved right now if the government was willing to address problems concerning improper drug utilization." They say that reference-based pricing is working towards two-tiered health care. You know, that's an interesting concept, because the members opposite says they don't believe in two tiers. And you know what? Their policy of reference-based pricing is absolutely two-tiered. Think about it. If you go to your doctor and get the prescription that the doctor orders and have the money to fill it, you can have the drug the doctor ordered for you. But if you can't afford that drug, you have to take the drug the government orders for you. So those who can will get it, and those who can't won't. Those who can pay -- those who can afford the better drug -- will get the drug their doctor ordered. Those who can't afford the better drug will get the drug the government ordered.
Interjections.
S. Hawkins: That's what the B.C. Pharmacy Association says. It says that it's leading towards two-tiered health care.
An Hon. Member: Who would believe them, eh?
S. Hawkins: Well, jeez -- the B.C. Pharmacy Association are professionals who are specialists in drugs, but the government knows better what drugs a patient should be on.
Interjections.
The Speaker: Order, members.
S. Hawkins: It says:
"With reference-based pricing, patients can pay the difference in price between the medication they want and the one Pharmacare will pay for. This is possibly an early step towards two-tiered health care in B.C., where those who can afford" -- now listen carefully -- "to pay extra will receive a better quality of health care than poorer British Columbians."
It's unbelievable.
The B.C. Pharmacy Association also has concerns about reference-based pricing and says that therapeutic options may be limited: "With reference-based pricing, patients may find that the array of therapeutic options available at pharmacies will gradually be limited to only those products paid for by Pharmacare." And they give an example, Lasix, which is a diuretic:
"Lasix, 80 milligrams, commonly used for controlling high blood pressure, has disappeared from pharmacy stocks since it was dropped from Pharmacare coverage by the low-cost alternative program. Pharmacies cannot afford to stock products which are not often used, and wholesalers and manufacturers will eventually limit this distribution, as well."
What happens, then, is that pharmacies can't afford to keep that stock, so it's depleted. If for some reason that drug becomes something that's going to be used again, they have to find a wholesaler or whoever to supply it, and they end up paying more because they will only buy smaller amounts. If you buy larger amounts, you get them cheaper; if you buy smaller amounts, they're more expensive. That cost is also passed on to the consumer. You know, it just doesn't make sense.
Again, they say therapeutic options may be limited, and they're starting to see that effect already. They also have a concern about special authority delays:
"Although patients can attempt to stay on their current medications by getting a special authority request from their physician, there is no guarantee of approval, and the process can take up to 48 hours or more. This affects poorer patients the most, as they cannot afford to pay the extra cost to stay on their current medication while waiting for approval."
It's shameful.
I have a letter here from the Canadian Association of Retired Persons. They have some grave concerns over the issue of reference-based pricing. They say: "It is our considered view, based on the reading we have done on this subject, that the next phase of the program, scheduled January '97, is even more worrisome, in that it specifically targets drugs used to treat cardiovascular problems." The minister might be interested to know -- and I think she is quite aware -- that the Canadian Association of Retired Persons did a study. I've got the summary right in front of me of their findings on reference-based pricing, and I'm sure the minister is going to be getting the study in the next day or so.
There were two samples done: a doctors' sample and a pharmacists' sample. In the doctors' sample, a total of 254 telephone interviews were conducted in a random sample of B.C. GPs, internists and cardiologists. Of the 82 percent of doctors -- being GPs, internists and cardiologists -- who have changed prescriptions due to reference-based pricing of ACE inhibitors or calcium channel blockers, 88 percent report that their patients have experienced at least one problem because their medication was switched. And the most common problem, as reported by 72 percent of these doctors, is an acceleration or worsening of symptoms. Other problems include: various side effects of the new medication, 58 percent; patient non-compliance -- meaning they weren't taking their medication right -- 47 percent; and emergency room medication, 17 percent.
It's interesting, because this is the only study we've seen. The government hasn't provided us with any evidence. If they've got better evidence, perhaps they'd like to share it with us. This study was done just recently, and this is the only one we've seen. It says that the government's program is not working for patients. In fact, it's making patients worse. They're saying it makes patients
Some Hon. Members: Name your source.
S. Hawkins: I was given this by CARP.
Interjections.
The Speaker: Order, members, please. I think we have too many conversations going on.
I also want to give the member for Okanagan West a ruling on her motion. Would you take your seat for a moment, please, member.
I have struggled somewhat with the amendment. I notice that there is no opposition to the amendment from the govern-
[ Page 2760 ]
ment side, but, as you know, my job is to judge amendments on the basis of our own rules, practices and procedures in this House. In my considered judgment, the amendment goes much beyond the scope of the motion on the order paper. It doesn't follow from that motion, and it could indeed stand as a separate motion -- and I make that last point especially to advise the member that that is a remedy. I'm not trying, by the by, to curtail the debate in any way. What the member is saying seems to me perfectly in order, given the broad compass of the motion on the order paper, but I must rule the amendment out of order.
Having said that, Okanagan West, please carry on.
S. Hawkins: I want to point out that the pharmacists' sample was also done in this study. A total of 250 telephone interviews was conducted. It was a random sample of B.C. pharmacists who worked in non-hospital pharmacies. I'd like to point out that of the 94 percent of pharmacists who have changed prescriptions due to reference-based pricing of ACE inhibitors or calcium channel blockers -- which are high-blood-pressure medications -- 84 percent are aware that their patients have had one or more problems. These problems range from patient confusion, which was reported by 71 percent, to various side-effects, reported by 39 percent, to emergency-room admissions, reported by 9 percent.
That's what I was saying before. We have no evidence that this policy is actually saving money. It might be saving money if you look at it very narrowly in the drug program, because that's all Pharmacare will pay. But when you look at other areas of the health care system, we don't know how this policy is increasing hospital admissions, doctor-patient visits and emergency room visits. Those all impact on the cost of the health care system, as well.
This study is telling us that the pharmacists who were called are aware that there are problems. Patients are having to go into emergency, patients are having to go see their doctors more often and patients are ending up in hospital with respect to the drugs that were changed on them. So, again, it's very difficult to support a policy that does that.
This House is probably aware of a lady -- her name is Alice Kembel -- who was widely reported on in the capital here. She's a Nanaimo woman who has had two heart bypasses and two angioplasties, and she can't be operated on any further. She's also on welfare. She can't afford the additional $40 per month it would cost to purchase her non-reference-based drugs, and the reference-based policy does nothing to help her. Her doctor, by the way, sits on the therapeutics initiative committee -- the committee that the minister says advises her government on this policy. He was also one of the 40 doctors in Nanaimo that took an ad out over New Year's saying that they refused to fill out the special authority form and that they were rejecting the government's reference-based pricing policy because it did not benefit their patients.
I also have a letter from a patient, and I'm going to read it. It's from a Colin Macpherson from Prince George:
"I don't know whether your B.C. section has yet covered this province's" -- it's a letter to the editor, actually -- "reference-based pricing policy for prescription drugs, but I thought it might be interesting to let you know some of our experiences with it."I was first diagnosed with moderately high blood pressure when I was 30 years old, and in the intervening 30 years I have been prescribed a number of different medications with less than satisfactory results: either no effect at all or too many unpleasant side effects.
"Now my doctor has selected an ACE inhibitor which is working perfectly, but it is not one of the ones the geniuses in Victoria, who obviously consider they know more about medicine than he does, will agree to pay for in the Pharmacare plan. I admit I do not know whether their recommended variety might also work, but I'm supposed to risk my health and possibly even need expensive hospital treatment at the whim of a bunch of arrogant politicians and their desk-bound bureaucrats?"
He's a very frustrated person.
We have concerns as well about some of the other effects that the minister's initiatives, which she took to Ottawa, might have on B.C. Certainly one of them is the research and development angle. A couple of years ago, the chair of the Premier's industry committee reported that biotech was doing very well here in B.C. The chair of that committee stands up today and says that the changes to Bill C-91
I also want to address the issue the minister was talking about of me-too drugs. I just want to talk a little bit about me-too drugs. Captopril is an example of what would be called a breakthrough drug. It was a brand-new drug in a brand-new category of blood pressure medications. It was discovered over ten years ago. It is ordinarily taken three times a day to be effective.
I should say that high blood pressure is a condition a lot of Canadians have. It is one of the few conditions that is not treated very well. Patients have a hard time complying with medication and understanding what it means to them, because it's something they don't think about a lot. It's not like a lesion that they see or a condition that they're aware of all the time, because it's a very silent kind of condition.
[3:30]
After captopril was developed ten years ago, another drug called enalapril was developed a few years later. It was a product innovation that allowed for twice-daily dosing. So we had a drug that was taken three times a day, and then a better drug came along that was twice-daily dosing for high blood pressure. It would also be considered a me-too drug, since it wasn't the first product of its type. Now we have several new drugs in this category that have been developed to have longer durations of activity to allow for once-daily dosing. These innovations and improvements are also me-too drugs. But not all me-too drugs are imitations; for example, many are incremental improvements and innovations building on an original product. Original breakthrough products often have the greatest side-effect profile and the lowest patient acceptance rating. The innovations that follow improve on the original product. The minister claims that scientific evidence is considered when reference-based drug restrictions are implemented.
[W. Hartley in the chair.]
Scientific research has been done as well on the issue of taking medication properly. I want to talk about that for a
[ Page 2761 ]
minute. Taking medication properly is referred to as compliance, in medical terms. Researchers in 1984 showed that when the identical drug is given in a once-daily versus a twice-daily formulation, drug compliance improved from 81.5 percent to 93 percent. Another study done in 1986 showed that among elderly patients with high blood pressure, 94 percent of patients took once-daily medication correctly, but compliance fell to 74 percent among patients taking medications three times a day.
This government's reference drug pricing policy makes the assumption -- and it's a very significant assumption -- that drugs will be taken correctly when Pharmacare and its committees make judgments about the comparability of drug effects. I can provide the minister with studies -- and I'm sure her ministry has the studies, if they have all the research. That assumption has been shown to be wrong in clinical studies that are more than a decade old. They found that the patients don't always take their medications right. Reference drug pricing and the low-cost alternative program are forcing some patients to take medication multiple times a day, and that will make compliance suffer. But Pharmacare has ignored the pertinent scientific research on drug compliance, and it assumes that all drugs will be taken according to instructions. If you've ever been sick
What we need is patient education. I don't think it's entirely correct to say we need to replace drugs with other drugs. We need to make sure that patients are educated and take their medication properly. But it seems that Pharmacare doesn't really seem to care about patient compliance, because their policies don't reflect a concern to help patients take their medication properly. You might ask the Ministry of Health if they keep statistics on how many hospitalizations result directly from medication errors at home. But you know what? They have chosen not to do that. And if they have, they're not sharing their study.
The word "progress" is defined as "steady movement or improvement toward a goal." It shows a lack of understanding of how scientific and technological progress occurs to suggest that only breakthrough drugs deserve protection as intellectual property. I would argue that innovations or improvements on the original idea are equally deserving of that protection. I'll just give an example, maybe, because science
We don't have progress with the kinds of policies that this government is implementing. In fact, this government put some psychiatric medications on their reference-based pricing program. And when the psychiatrists pointed out to the ministry -- after all, their experts had advised them and everything -- that this set the treatment for psychiatric patients back 40 years, they agreed to review it. I mean, we have experts in the field actually treating patients and
We agree that true breakthrough technology should be promoted and protected, but we disagree with this minister's efforts to stifle progress, to interfere with innovation and to penalize improvement. The changes to Bill C-91 that this minister advocates, as I've said before, could decimate our own province's blossoming biotech industry. I'm wondering if the minister is actually talking to the Deputy Premier, who has Employment and Investment and who is encouraging biotech. The chairman of the biotech committee says that the Minister of Health's initiatives could decimate their industry. Maybe they should have got together and talked before she flew off to Ottawa.
I just want to say that this side of the House does support investment and protection of innovative drug research. We believe in the promotion of fair market competition and reduction of drug costs to ensure that the health, safety and financial well-being of Canadians is protected. We also support leadership in forming partnerships between academics, health care providers, industry and government to cooperatively arrive at the optimal therapy for patients in this province and to reduce drug waste and overutilization. We support enhanced research and development in the science and tech sector, and we support the right of companies such as British Columbia's biotech companies to protect their intellectual property through appropriate patent protection durations. And we are prepared to consider every patient on a surgical or cancer treatment wait-list, and every patient who is denied access to prescription drugs because of restrictive government policies, as vulnerable people who deserve more caring and more compassion. At least this side of the House believes in putting patients first.
What we support are amendments to Bill C-91 that adhere to the principle of the introduction of researched and proven initiatives which enhance the partnerships in British Columbia between all the stakeholders: academics, health care providers, industry and government. We want to encourage prospects for research and development investment in future job creation in British Columbia, and, most importantly, we want to put the needs of British Columbians first. So I move that the motion be amended by adding the following:
[and that the initiatives stated above be based on proven research and enhance the partnership in British Columbia between academics, health care providers, industry and government; encourage prospects for research and development investment and future job creation in British Columbia; and, most importantly, put the health needs of British Columbians first.]
On the amendment.
I. Waddell: I have a few brief remarks to make on this debate. First of all, let me say that I am totally disappointed in the remarks of the hon. member for Okanagan West, who was speaking for the opposition. It sounded right out of the song sheet of the Pharmaceutical Manufacturers Association of Canada; they must have written the speech.
Interjections.
Deputy Speaker: Order, members. I'm already finding it difficult to hear the speaker.
Interjections.
I. Waddell: If the hon. members are listening, they might learn something on this.
[ Page 2762 ]
That same association hired Judy Erola, who was a former federal Liberal cabinet minister, to be their spokesperson to oppose provincial governments and to oppose those of us in Canada who want decent prices for drugs.
I was waiting to hear in the member's speech the Liberal opposition's position on the motion. I'm still listening; I didn't hear very much about it. There was talk about partnership and reference pricing. What do reference pricing and partnerships have to do with Bill C-91? Nothing. You've got to deal with the politics of the situation and with what Bill C-91 really means to British Columbians.
I would have thought that the member for Okanagan West might have got up and said: "We're proud of a Health minister who flies to Ottawa and takes a strong position for British Columbians." I thought that the opposition might stand up and say: "We support a national drug plan. We will do what we can to see that it happens, and we will pressure our federal colleagues to make sure that it happens." But no way. We heard a long, rambling speech on other aspects of medicare in the province.
I remind the hon. member to deal with the motion. Here's what the motion said:
"Be it resolved this House support the British Columbia government's position before the Parliamentary Standing Committee on Industry, which calls on the Government of Canada to change Bill C-91 in a manner that supports and protects innovative drug research, promotes fair market competition and reduces drug costs in order to ensure the health, safety and financial well-being of Canadians come before the interests of the drug industry."
I would think you would applaud a minister who took the overnight flight -- the "cardiac flight" they call it -- to Ottawa to appear before a House of Commons committee in the dying days of a government there to stand up for Canadian consumers and for people who use these drugs.
I want to tell the opposition, if I might, a few things about Bill C-91, because I actually had the opportunity to vote on the original Bill C-91.
An Hon. Member: Which way did you vote?
I. Waddell: I voted against it.
When I was the Member of Parliament for Port Moody-Coquitlam from 1988 to 1993, the bill came before the House of Commons. And let me tell you, when that bill came before the House of Commons, the federal Liberal Party -- which was sitting on my right in the House of Commons -- and the New Democratic Party led the charge against this bill. We were allies against the bill, and I want to return to that in a little bit. But I want to tell you where the bill came from, the real reason why Bill C-91 came into being.
What happened was that Mulroney made a deal with the drug companies. It was a big Mulroney deal. Look at Stevie Cameron's book, On the Take, and you can see some of the details about this. The deal was this on Bill C-91: firstly, the government would extend patent protection to the multinational drug companies -- and that would cost a lot of money, especially for the provinces which were paying for this through their health care systems; and secondly, there would be some promised investment by international drug companies, mainly in the Montreal area. This is the outside part of the deal. There were other parts of the deal which probably involved contributing to election campaigns and making donations to the Tories' election campaign, but I'll come back to that in a few minutes.
[3:45]
At the time, the opposition in the House of Commons said that this was outrageous -- for a number of reasons. One was that you couldn't trust large multinational companies to do that kind of investment in Montreal or any other area. You can see that the Premier is now dealing with Alcan, and it's part of the same deal. You can't trust these companies to do the investment as promised, unless you really nail them down to do it. And there's some evidence that they never really did this investment in the Montreal area or in other places in Canada. They never really lived up to the deal that they took a Canadian government up on.
The second problem was that the people who paid the price for the Mulroney deal
Interjection.
I. Waddell: If the hon. member from Whistler would just listen for a minute, I'm trying to explain to him the origins of Bill C-91 -- which is the main part of the motion. So if he just listens and shuts up for a minute, he might actually learn something.
Interjections.
Deputy Speaker: Members, before the point of order
T. Nebbeling: I resent the
Deputy Speaker: Would the member take his seat, please.
I wanted to interject at this point anyway, so thank you for doing so. I want to remind all members that we are here to debate an issue. The only way we can do that is through the Chair, with one speaker maintaining the floor so that I can both hear him and understand him. So could all members take that into consideration, please.
T. Nebbeling: I would like a retraction of the expression used by the member as far as me speaking to him or speaking to him through you. I don't want to be told to shut up in this House by anybody.
Deputy Speaker: Thank you, member. I'm sure all members will take that into account.
G. Farrell-Collins: Mr. Speaker, a retraction was asked for. Under our standing orders, a retraction should be offered, or the member can remove himself from the House.
Deputy Speaker: If there indeed was a comment made, I apologize -- I didn't hear that. I would ask the member for Vancouver-Fraserview to comment.
I. Waddell: I'd like to continue my speech. I'm prepared to acknowledge
Deputy Speaker: Member
I. Waddell: I'm prepared to withdraw any comments that I made that the hon. member may have taken another way.
Deputy Speaker: Thank you.
I. Waddell: But I ask the hon. member to listen to what I've got to say. I was there; I voted on Bill C-91. He constantly
[ Page 2763 ]
heckles and talks. He wasn't there. He might learn something about the origins of this bill and why it impacts on British Columbia. I asked him to listen, and surely that's not unreasonable.
At the time, in 1991, a number of people appeared before committees, including the Canadian Health Coalition. Those were federal committees, approaching a federal bill. The Canadian Health Coalition and the Medical Reform Group had this to say about the C-91 legislation as it then was:
"On the contrary, there is good reason to believe that the elimination of compulsory licensing will only serve to drive up the cost of prescription drugs. If this happens it will have serious negative effects on the ability of the provinces to continue with their drug programs in their present form, and the eventual losers will be Canada's elderly and poor. Therefore we recommend the government abandon its plan to proceed with Bill C-91."
I recall a colleague in the House of Commons -- not from the same party but also in opposition -- whose name is David Dingwall. He's the present Minister of Health. He got up and quoted from some of the statements of the committee. He got up in the debate and opposed Bill C-91, and he cited some of the concerns we had. One of the interesting aspects of that was that senior citizens came before the committee. I'll just quote from a brief that I pulled from the committee hearings on Bill C-91, which was the federal bill in 1992. The Canadian seniors group, which was called One Voice Seniors Network, said this:
"Since 1969 Canadians have seen firsthand the advantages of a competitive system of patent protection and compulsory licensing, which permits the development of generic drugs at lower cost."
I'll come back and explain how that system worked in a minute.
"The comparisons with the American consumer drug costs provided in the recent report of that country's general accounting office show clearly that all Canadians -- those requiring medications and those that pay for the benefit of drug programs through taxes -- pay considerably less, while the industry, both the brand-name and generic manufacturers, continues to show strong growth and profitability. Governments, for their part, have been able to manage drug costs, to a degree, by negotiating on the free market, using the buying power of their formularies to obtain better prices. Why would we wish to change a system that works to everyone's advantage? Why would a government so openly committed to the concept of competition move to restrict free market activity in the pharmaceutical sector? And yet that's what Bill C-91 proposes."
So you had a situation where seniors came and identified right away that we were going to have increased prices.
Let me try to explain the backgrounder to the original Bill C-91. In 1969, when we had a federal Liberal government that was actually liberal
Interjection.
I. Waddell: Yeah, the Pharmaceutical Manufacturers Association.
"In 1982 the Eastman commission" -- perhaps the minister can check if that's Wayne Eastman, the present Liberal MP from P.E.I. -- "estimates that in one year alone, Canadians saved $211 million by using generic rather than brand-name drugs." Well, that's a lot of money.
In 1987 the Mulroney government got into power and passed Bill C-22, and I remember Bill C-22. That's why Bill C-91 is tied into Bill C-22 on the federal scene:
"Bill C-22 restores most patent protection to brand-name drugs, ensuring market exclusivity for ten years. Under the bill, a drug is granted a set period of market exclusivity once the drug enters the market, regardless of the development period."
So there we were. They were getting away with the patent protection.
Then, in February of 1993, in the dying year of the Mulroney government, Bill C-91 came in, ending Canada's compulsory licensing system altogether. They completed the rout. The multinational drug companies won.
"All licences for generic equivalents pending after December 20, 1991, are revoked. Pharmaceuticals are now treated on the same basis as other inventions and intellectual property, with 20-year patents."
In 1997: "The Queen's health policy research unit. . .estimates that C-91 will cost consumers and taxpayers between $3.6 billion and $7.3 billion by the year 2010." That is why the Minister of Health for the province of British Columbia -- if I might say this: gutsy minister -- went to Ottawa and fought this battle for the consumers of Canada.
Now, we fought this in the opposition -- I like to think we were a real opposition in those days. We fought it, and we got into Ottawa because there was a large group of New Democrats in Ottawa in those days and there were some Liberals that were inclined to work with us. We couldn't beat the bill, because we were a minority, but we did get a concession. The concession was a five-year clause so that we could look at the bill again. Well, guess what: five years have passed, so now the committee of the House of Commons is looking at this bill. That's why the minister went to Ottawa to put this before the committee: to get the now Liberal government to change the bill.
So what's going to happen? Are they going to change it or not? Well, we had a little look here at what this
Interjections.
I. Waddell: Just have a look. I have some figures here. You know what? Between 1993 and 1995, here's what they gave to the Liberal Party of Canada -- not that old left-wing Liberal Party, but this party. You know, when they're in opposition, Liberals in Ottawa talk like social democrats; when they're in government they become conservatives.
Between 1993 and 1995, 3M Canada Inc. gave $10,598,420 to the federal Liberals; Astra Pharma Inc., $8,985,240; BioChem Pharma Inc., $1,369,400; Boehringer Ingelheim (Canada) Ltd., $2,619,420; Bristol-Myers Pharmaceutical -- you've heard of them -- $4,794,150; Burroughs Wellcome, one of the largest drug companies in the world, based in North Carolina, gave $8,290,890; Glaxo Wellcome Inc., $89,537,890. Wow!
The federal Liberals are now saying: "Well, wait a minute. Maybe what we said back in 1991 when we were there with little Waddell and these other people, banging against the drug companies
[ Page 2764 ]
them. She can't say this to the committee, but I can. She has to be polite. She's a minister of the Crown. She goes down there and says, in a polite way, why they should change Bill C-91. But the problem that the Liberals are faced with is: what are they going to do? They've got Sandoz Canada giving $2,900, and the Pharmaceutical Manufacturers Association of Canada -- the whole group -- $35,039,170.
An Hon. Member: What's the total?
I. Waddell: The total is $243,235,410. That's a lot of campaign funds, my friends.
The pharmaceutical companies may be here. They may put money
Hon. J. MacPhail: I ask leave to make an introduction.
Leave granted.
Hon. J. MacPhail: I'd just like to welcome to the legislative chamber today students from the Templeton mini-school. I welcomed them to the Legislature earlier, but they hadn't arrived. So I'm delighted that they can join us today on a very, very important issue and hear the debate, and I would ask the House to please make them welcome.
G. Farrell-Collins: It is fortunate that the students are here, because oftentimes what goes on in this House isn't real debate. This one of those few occasions where we actually get into a real debate and there's an exchange back and forth, and it's a little more active.
In preparing for this, I came across some interesting things, and I'll talk about them in just a minute. I want to address, for a moment, some of the comments made by the member for Vancouver-Fraserview. I don't profess to be an expert in the health care field. I have colleagues around me who are experts and who have spent, in some cases, more than a decade studying and learning, and continue to do that to this day. These colleagues have dealt with patients, have treated patients, have prescribed pharmaceuticals for patients and have the best interests of the patients at heart. When it comes to health care and what's best for the patients of British Columbia, I rely to a great extent on their wisdom and knowledge. I tend not to rely upon the political comments and political statements of the Minister of Health or of the member for Vancouver-Fraserview.
I do want to talk a little bit about what the member said. He talked about the courageousness of the Minister of Health, as if she woke up one day and said: "You know, I feel really strongly about Bill C-91, and I'm going to go to Ottawa and tell them: 'It's my decision. I thought of this.' I feel strongly about it, so I'm going to go to Ottawa and I'm going to tell this standing committee what it's all about."
Interjection.
G. Farrell-Collins: Well, I think it would be pretty gutsy, too. If it had been something that she'd thought up on her own, something that she was doing as an individual, as a Health minister
[4:00]
An Hon. Member: Well, what's your position?
G. Farrell-Collins: You'll see our position when we vote.
Interjections.
G. Farrell-Collins: I can tell the member now, if he likes. We'll be supporting the motion, if it gives him any consolation. But I think what's key is to listen to the comments and warnings issued by the very knowledgable members of the opposition -- one so far and others to follow -- who have real experience with patients and prescribing pharmaceuticals.
I think the member for Vancouver-Fraserview, in prejudging the work of the committee, is out of line. He's not out of order, but he's certainly out of line. He's served on committees before. He's sitting on a committee right now. As the chair of the Aboriginal Affairs Committee, he asks us not to prejudge the findings of that committee. In all sincerity, he means it. So when he asks members opposite not to prejudge the results of that committee, why would he then stand in the House and so vehemently -- and, I think, in such a negative way -- prejudge the committee in Ottawa? Why would he do that? Why would he draw into disrepute and use innuendo to attack the Minister of Health, someone who he said was his colleague -- not the Minister of Health from British Columbia, but the Minister of Health from Ottawa -- and infer that somehow he can be bought? Why would he do that? I wonder why.
I don't know. When donations from the unions or donations from individuals flow into the government party, as they do in the millions of dollars, and when they flowed into that member's campaign, as I'm sure they did in the tens of thousands of dollars, to run what was a
Interjection.
G. Farrell-Collins: The member reminds me that the previous member for that riding
An Hon. Member: The bagman.
G. Farrell-Collins: I thank the member for Vancouver-Quilchena for reminding me. He was known in this House as "Bernie the Bagman." "Bernie the Bagman" used to funnel his
[ Page 2765 ]
corporate donations through the Nanaimo Commonwealth Holding Society. Now, I wouldn't even think of questioning whether or not, when this member inherited the nomination, he also inherited some of those funds. I don't know. I'm not saying it happened, and I would never say it happened, because I don't know.
But the inferences made by the member for Vancouver-Fraserview, coming from the riding he does, with the history he has
But more important is the inference that if somebody donates to a campaign, then something is owed to that person. I don't know if that's the way the NDP works, but it sure isn't the way the opposition works. Lots of people donate funds to election campaigns: individuals, unions, associations, organizations, businesses. Most of them do it voluntarily. However, there were some charities in Nanaimo who did it involuntarily, I might add.
I don't know how it works in the member's party. I don't know how it works in his riding. If that's the way it works in the New Democratic Party, then I'm really afraid of what's going on. In the New Democratic Party, if you get a donation from someone and there's something other than good government expected to be granted in return, then we've got a real problem. I'm not saying that happens on his side. But if that's what he's saying happens on this side of the House, then I think he does a disservice to all members of the Legislature. And that was certainly the inference he was making.
Now, I want to come back to the issue at hand: to the amendment to the motion and, more importantly, to the comments by the member for Vancouver-Fraserview. He stood up and told us about the member for Vancouver-Hastings, who is the Minister of Health, going into the phone booth, putting on her Superminister cape, racing off to Ottawa at the speed of a speeding bullet and standing up for British Columbians. What a great job that was. And the individual initiative she took as a minister of the Crown, the individual initiative that she brought forward to do that, is something
Let me tell you how it worked. In preparing for this debate, we did a little bit of research, because there is a federal election campaign coming in British Columbia -- not only in British Columbia but everywhere. If it was just in British Columbia, that would be one thing, but it's a federal election in every province of Canada.
I saw the television ad with the hero from Vancouver-Hastings -- the Minister of Health, Superwoman
Interjections.
G. Farrell-Collins: No, wait for it. You know what we did? We looked at Orders of the Day in some other jurisdictions. We looked at Orders of the Day in the province of Saskatchewan. In Saskatchewan, just days ago
At the same time that the Minister of Health was taking her own initiative, was thinking up this great idea to defend British Columbians from the drug companies, on the same flight
You know what I think this thing on Bill C-91 is? I think that the hero sitting opposite me, the Minister of Health, is using tens of thousands, if not hundreds of thousands, of British Columbia health care dollars, which should be going into health care, to find and promote an issue for the New Democratic Party of Canada.
Interjection.
G. Farrell-Collins: I hear the member speak, and I hope he'll engage in the debate, because I'm always anxious to hear what he has to say. But, hon. Speaker, imagine this: at a time when waiting lists are going through the roof, at a time when members have to stand up in this House to get action on a cardiac case, at a time when the wait-lists are out of control, at a time when cancer patients -- as the member tells me -- are going to Bellingham to get cancer care, and at a time when they're rallying on the front steps of the Legislature, what's the Minister of Health doing? Is she out there talking to the people and to the cancer patients that were there on Saturday? No.
You know where she was? She was cutting a TV ad to help raise an issue for the federal NDP, for Alexa McDonough, who doesn't even register on the polls. If what the member for Vancouver-Fraserview said what was true
But when you look at the documents, when you look at the press release, when you look at the similarities to the speeches that were given in Saskatchewan less than 24 hours ago, when you look at the contents of this press release and the one that the minister did herself, one has to question whether or not this is a real attempt to look out for patient
[ Page 2766 ]
care. Is this a real attempt to look out for patient care and health care in British Columbia, or is this an attempt by the New Democratic Party in British Columbia to run the federal election campaign for Alexa McDonough on the backs of people who need health care in British Columbia?
I'm glad that the government has indicated its intention to vote in favour of our amendment. I'll be glad to stand up and support the motion as amended. But I wish it had been done in a different way. I wish it was genuine. I wish it was real. I wish it wasn't some cynical attempt to use health care dollars that should be going to patients to help get the federal NDP elected in British Columbia.
T. Stevenson: It's a pleasure to speak on this resolution. I'm a little disturbed, I must admit, because initially I thought we were going to have a non-partisan discussion. But I see that the opposition has turned it into a rather partisan discussion, and therefore I thought I'd possibly follow suit.
Really, this reminds me of the last election. I don't know about the rest of you, but it kind of comes down to whose side you are on. Are you on the side of ordinary British Columbians -- on the side of patients -- or are you on the side of multinational corporations and the large drug companies? That's what this is about. It's about being on the side of multinational corporations.
I was somewhat taken aback to learn just recently that the Liberal Party of British Columbia did, in fact, receive large, substantial donations from drug companies: $7,000 from Glaxo, $5,000 from the Pharmaceutical Manufacturers Association. The hon. member for Kamloops-North Thompson was speaking with the newspaper there, Kamloops This Week, and he was asked about this. And he said: "Well, nobody buys a position from us with just contributions." Well, if that's the case, there will be no problem with this member standing up and speaking about the pharmaceutical corporations and, of course, voting in favour of this resolution.
I was also somewhat concerned when I heard today that the British Columbia Nurses Union had been trying to contact the Liberal Health critic for not one day, not two days, not one week, not two weeks, but three weeks. When they were contacted today, they still hadn't heard from her. They had been asking for her position on this very important issue, Bill C-91. As of yet they haven't heard, although today we heard a rather long discourse that had little to do with the resolution and a lot to do with political positioning. I want to point out that while she was positioning, she talked at great length about reference-based pricing which, unfortunately, has little to do with this debate.
[4:15]
I want her to know that there are many people who are not only pleased but very, very pleased that reference-based pricing is in British Columbia, and they have had no problems. In fact, we have more problems with the doctors trying to understand it. I have a letter that we received from the office of the director of Pharmacare. I thought I might just read it into the record, because it's quite typical of the letters that we've been getting. It reads:
"I just wanted to write you a note to tell you that I had a wonderful experience with your Pharmacare staff. I recently found out that my grandmother was on a reference-based drug and that she was paying the entire amount for it. I tried several times to convince her doctor to apply for a special authority for her, and I always got an emphatic no from the doctor."Feeling a little intimidated, I called Pharmacare and was connected directly with one of your pharmacists, Gillian Lagnado. She explained thoroughly the process of applying for the special authority, and the requirements my grandmother had to meet before it could be approved. She tried several low-cost alternatives, only to find they didn't work or that she had severe allergies and severe reactions to them. So it seemed that the only obstacle left was her unruly doctor. I explained to Gillian that my grandmother's arthritis often reduced her to tears, primarily due to the three operations to one of her knees, and there was a language barrier that was probably preventing her from conveying her needs to the doctor.
"Gillian then offered to call the doctor, to tell him of my concerns and to see, once again, if he would apply for special authority. My hopes were not high. At 9 a.m. the next morning I had a message on my answering machine that not only had the doctor said yes to the special authority, but it had already been put into the computer. Needless to say, I was thrilled. Gillian was very pleasant to deal with. She was efficient and, as far as I'm concerned, she accomplishes the impossible. She was not obligated to call the doctor, yet she did. Perhaps she could sense my desperation. Gillian is a remarkable asset to the Pharmacare team, and I'm happy that I had the pleasure to deal with her. My family and I would like to thank you, and pass on our thanks for amazing service."
So indeed, the system is working very well. Obviously there are glitches at times, but overall this system is saving $74 million, that goes directly back into health care and goes directly back into drugs. In my riding we have many people who are on new breakthrough drugs. These are protease inhibitors and some are on AZT. These drugs are of tremendous significance in the AIDS community. They are the type of breakthrough drugs that we as a government are supporting and that the moneys from the savings from reference-based pricing are going back into. These drugs cost anywhere up to $25,000 a person and $25 million per year.
So I find it somewhat difficult to listen to the rhetoric we've heard from the Liberal opposition when they know very well, as we know, that we're up against very large multinational corporations that are making substantial, actually obscene, profits -- double the profits that banks receive. Yet we hear this kind of defence over and over again for these pharmaceutical companies.
It is our hope that the opposition will indeed stand and vote as one in this House today, and we have had indications that they will. But in getting there, it seems that they have decided -- rather than make this a non-partisan issue -- to try to make it a political issue again. That's a shame, because if they do vote in favour, we are possibly closer together than we imagine. Possibly we all understand what these multinational drug companies have been doing and what they have been getting away with for far, far too long in this country; and it's been at the expense of ordinary Canadians like us.
It is my pleasure to have spoken on this issue this afternoon.
A. Sanders: I'd like to point out a couple of things about the motion before us and why I support the motion with the amendment.
First of all, members on the opposite side of the House have been referring to this as a mirror image of Bill C-91, federally, which it most definitely is not. In Bill C-91, federally, there are probably very few who would not agree with having that altered. However, the B.C. version also includes reference-based pricing, and this is a made-in-B.C. policy that is not similar across the country. What we would find by changing to Bill C-91 would be innovative research. It would encourage drug competition and it would control drug costs. However, reference-based pricing in British Columbia does exactly the opposite.
One thing that has been brought up by the previous speaker that's very important to point out is that there are
[ Page 2767 ]
two arguments: one is the use of generic drugs versus pharmaceutical preparations that are non-generic; the second is looking at pharmacy companies as if these pharmaceuticals are big bad people and the generic-drug companies are not. There is not a single generic-drug company in British Columbia that is a kitchen-table operation. Every single generic-drug company in B.C. is a multinational company, and there is no difference between who is getting the money, whether it's a generic or a name-brand medication.
What is happening, and what ties into the importance of this particular thesis, is that one could construe from this that we are lobbying on behalf of the generics. It is a known fact that the former Minister of Finance, Elizabeth Cull, is the generic-drug lobbyist for B.C. I think we have to get that one off the table, in terms of: are we lobbying for generics or for name-brand medications?
I have an impression that some people don't understand the difference between the two. If you're looking at a generic
What we are looking at here
Secondly, drug therapy should be provided to the residents of B.C. at the lowest cost necessary to meet their needs. That has not happened under reference-based pricing, because people who cannot get a special authority -- and I as a physician have had many special authorities rejected -- cannot get those medications and have to pay for them themselves. What that does is create a two-tiered pharmaceutical situation: for people who have extended medical health who are on Pharmacare, and the working poor who do not collect the benefits from any of those programs. They do not get the drugs anymore, and that is the case.
Thirdly, no resident should be denied access to drug therapy because of the inability to afford treatment. That's happening in British Columbia. If you are working-poor and you cannot get special authority for an antibiotic or for an antihypertensive that you require, then you have to pay for it. You did not have to pay for it before the NDP government came to power in B.C. Now that the NDP government is here, with reference-based pricing those same people are paying for drugs they did not pay for three years ago.
There are some areas that are much more important than others. Basically, right now we have four or five categories of referenced-based drugs. The minister pointed out one in the case of Toradol. She said: "Why do we need a sixteenth anti-inflammatory? They're all the same." Unfortunately, she needs to do a bit more research, because they are not all the same. Toradol is one of the ones that is very good at controlling pain. For people who are addicted to narcotic substances, that particular anti-inflammatory is often used for pain control in a patient who could potentially be a narcotic abuser. It works for their pain control in a way that is not seen with Naprosyn, which is the only drug that is covered by referenced-based pricing. In addition, if you take Naprosyn, which is the reference-based drug, you often have significant gastric side effects that you may not have with one of the other ones that is a single-day preparation. Therefore you have more gastric bleeds, more people in hospital beds, more people requiring surgery or blood transfusions, more people occupying ICU beds and some requiring surgery.
So if you're going to look at the price of referenced-based pricing and say it saves money, then you have to add in all of those other conditions: the visits to the emergency, hospitalization time, repeat visits to doctors. You have to add that all in and ask: has it really saved money? I submit to you that it has shifted money laterally. It's like taking out your groceries in two grocery carts instead of one, and saying you're going to save money by buying them this way. That's ridiculous. It's counterintuitive logic. I don't think people will buy this as time goes on.
Let's look at one of the letters that came to the Vancouver Sun in 1997, and what this gentleman says:
"Reference-based pricing is not about substituting generic drugs for brand-name drugs. It is about taking patients off medications that have been successful in treating their condition and permitting whole classes of pharmaceuticals to be replaced by a single drug which evidence shows is unlikely to provide control of their disorder. Reference-based pricing has been tried. . .in Britain, Germany, the United States, New Zealand, Australia and Japan. Many of the studies involve tens of thousands of patients, and the scientific protocols have been exemplary. The results have been almost universally devastating, and reveal two consistent patterns. First, reference-based pricing is associated with a substantial increase in illness. Second, reference-based pricing is associated with large increases in overall health costs. One study, involving 12,900 patients, showed that reference-based pricing resulted in 160 percent more prescriptions, 83 percent more visits to the doctor, 161 percent higher drug costs and a huge increase in visits to the emergency department."
Another large study from Harvard showed a 50 percent increase in office visits and a 17-fold increase in drug costs. Do those responsible for this program in B.C. not read the readily available world literature before embarking on a program that they have decided to proceed on in spite of itself?
[4:30]
Let's look at the cardiovascular drugs. The cardiovascular drugs and the protocols put in place by reference-based pricing are not agreed with by the association of cardiologists and cardiovascular surgeons. These are the people who deal with these problems and these patients every day, and they write the letter to support that.
"As a cardiologist in active practice, I'd like to voice some concerns that I have about the policy of reference-based pricing of cardiovascular drugs. . . . My main objection to this policy is that it is dangerous when applied to cardiovascular drugs. A number of my patients were harmed with the switch from nitroglycerin patches to oral nitrates, including one patient who had to be admitted with unstable angina" -- heart pain -- "following the medication change."
I also have a letter from a doctor in my constituency, Dr. Grant Pagdin, who had a patient infarct the day after they changed the medication to the reference-based oral nitrates.
"My experience is not a unique one, and many of my colleagues have had patients who've come to harm by the NDP reference-based pricing policy. I have particular concerns when it is applied to calcium channel blockers due to the differences of the drugs in this class. It is hard to imagine that calcium channel blockers are being considered therapeutically equivalent."
[ Page 2768 ]
It is inevitable that some patients will come to harm when they are switched from a stable state on one of these medications to a different medication that is therapeutically different. Again, it's the same thing as Kellogg's versus President's Choice corn flakes: they are not equal to a Twinkie. This is what reference-based pricing says. It is not logical and it's unconscionable.
I have a number of other objections to this program, including the fact that similar programs elsewhere have failed to achieve the expected costs savings and, in many instances, have increased overall costs. I find it surprising that the committee -- which imposed these rules on us -- increased the costs. Other objections to the program include the fact that it encourages a two-tiered medical system, that awful phrase that the NDP never associates with itself and tries to plaster on other members of this House.
This objection also raises the issue of who is legally liable when patients come to harm. The Supreme Court of Canada has said that doctors' prime responsibility in treating a patient is to the patient and not to government cost-cutting measures. Other objections include shifting costs to physicians and pharmacists and the confusing rules of the program. The program is meant to apply to uncomplicated high blood pressure. But only a small number of people with high blood pressure have what's called uncomplicated blood pressure. There is no doubt the program has been, and will be, generalized to many cardiovascular patients in British Columbia.
In its position paper of October 30, 1996, the Canadian Cardiovascular Society suggested some alternatives to reference-based pricing, including substitution of exact-copy generic drugs, strong national price controls on prescription drugs, public education to improve patient compliance with medication and improved prescribing guidelines for physicians. Surely these alternatives could have been explored first, before a system that is untried and unproven -- and where it has been put into effect, has failed -- is introduced like a blanket onto every British Columbian with a life-threatening condition.
This is going to cause harm to B.C. patients, contrary to the minister's feelings that it will save them money. It will cause harm especially to the elderly. It's important for all of us not to lobby for any pharmaceutical industry, but let's all remember that the general pharmaceuticals are multinational as well, and they should be looked at equally, on equal value. Reference-based pricing, which this government has shoved into the grocery cart to buy with the rest of it that is good, the rest in Bill C-91 that is needing alteration
I think what we need to do is look at the ethical implications of reference-based pricing on patients and how it applies to patient care. I think that the policy we have in place in British Columbia, regardless of what the Ministry of Health or the Minister of Health says, is a policy that has adverse effects on patient care and causes inadequate treatment based on cost of medication, not on efficacy and not on system of delivery.
The minister has said that reference-based pricing will save money. Yet many studies show that it just shifts the money laterally into other services: the emergency services, the physician's office, the hospital. The BCMA district newsletter states: "Our budget has been increased to cover extra costs associated with reference-based pricing for initiatives announced by January 1, 1997
If you're looking at reference-based pricing, it's very important to look at the patient -- not at the government's cost-saving plans, not at their desire to promote generics over pharmaceuticals, not at who their friends are, not at anything other than what happens to patients. Before reference-based pricing, the NDP only raised our taxes; now they want to raise our blood pressure. The B.C. Pharmacare program will do that, basically, in the area of the antihypertensive drugs that have been put on reference-based pricing. In the first year Pharmacare divided the drugs into classes. The cheapest drug in a class is called the reference drug. Pharmacare will only pay for that one drug and not any other. If you need a more expensive drug, then you pay the difference, which has contravened the royal commission report that says that no one should be denied access to drug therapy because of an inability to pay.
Unfortunately, the cheap drug -- the reference drug -- can give some people considerable grief. They are not exactly the same. Some very important differences can be demonstrated in the antihypertensive classes. The side effects, the drug-drug interactions, allergic reactions and other medical conditions can make the reference drug intolerable. Some of the reference drugs for blood pressure control, in fact, can promote depression. This is not a side effect of some of the ones that are not covered. For people who have a depressive tendency, this can be an important therapeutic difference.
Sometimes the cheap drugs just don't work. These problems are common in family physicians' offices. In the case where complication makes the use of a reference drug impossible, your doctor has to send a special authority form to Pharmacare and plead for full coverage of a more expensive drug. Two days later an answer is returned and necessitates a second trip to the doctor's office. Then, even if your doctor knows that the costly drug is better for your health and well-being because they know your personal history, a bureaucrat at the end of a fax machine can refuse that request and tell the patient to pay up.
In 1996, Pharmacare asked a panel of experts on high blood pressure if medications in that area could realistically be put into the model of reference-based pricing and still provide quality patient care. With so many drugs used to treat high blood pressure, there was no simple reference drug. And after deliberation, the expert panel hired by Pharmacare arrived at the unanimous decision of "No." Treatment for blood pressure was too complex to be boiled down to a simple reference-based drug. Medical treatment is not a cookbook approach the way government would like it to be. The panel that Pharmacare hired told them that no hypertensive drugs could be put on reference-based pricing, and they went ahead and did exactly that.
January '97: Pharmacare will only allow diuretics and beta blockers to be prescribed for high blood pressure. These are cheap drugs. That's why they're allowed to be prescribed. However, when they are useful, they work fine. When they are not useful, they don't work. And there are a huge number of conditions that patients with high blood pressure have that
[ Page 2769 ]
have heart pain because you've got narrow arteries, you cannot take beta blockers. You need to have some of the medications that are not on reference-based pricing. Diabetes: you can't take beta blockers. Heart failure: you can't take beta blockers. Yet this is the only medication covered on reference-based pricing. It is the only medication that cannot be refused by a bureaucrat in the Ministry of Health when the patient applies for it.
[The Speaker in the chair.]
Other things that are caused by beta blockers
Reference-based pricing will only pay up to $27 a month for some of what are called calcium channel blockers. If you use one of these drugs and you have double the dose, the money has to come out of your pocket. The cost is approximately $37 a month. For an elderly person on that medication who cannot take a beta blocker, it will cost him approximately $40 a month to pay for his own medication.
One in five British Columbians has high blood pressure. This is not a rare condition like myasthenia gravis, where you have one in 10,000 people. This is a very, very common condition. In the good old days your family doctor could take your blood pressure, prescribe a medication that would lower your blood pressure, minimize the side effects that you would have to endure, keep your energy up and allow you to be as healthy as possible. That was then and this is now, under NDP reference-based pricing. In 1997 a bureaucrat with no vested interest or accountability for the well-being of an individual can make a medical decision in B.C. on behalf of a patient, overriding a general practitioner, overriding a specialist, overriding everybody. Some bureaucrat with a bachelor of pharmacy can have a decision reversed.
The bottom line of this program is cost, and for that side of the House to confuse that with good health does not make sense. They are two different issues. If you want to talk about generics and pharmaceutical brand names, that's fine. Don't shove in this other project, this other program -- this other agenda, which is a totally different story -- and thrust it on the backs of British Columbians without them recognizing until they get sick that they have a real problem on their hands.
[4:45]
At best, reference-based pricing will cause you no problem. But at its worst, it can cause additional trips to the doctor, more paperwork, more waiting and ultimately more money out of your pocket. A program that does not show any savings in other countries has been adopted carte blanche in this program and has not been debated in the House since its introduction -- except for today, several years later. This is a program that does not need to be supported. It needs to be reflected on by all of us, for the good of the province, instead of being lumped into this argument on Bill C-91.
G. Brewin: It gives me great pleasure to rise in this debate. It's a very interesting and -- I must say I'm pleased to see -- a relatively good-humoured debate on essentially the issue of Bill C-91. I rise in support of the actions that our government has taken. I am very, very proud of our Minister of Health, who went to Ottawa and put on the federal government agenda, if you like, our position and the position of British Columbia. It's a very, very important issue.
It's been interesting listening to the debate as it has unfolded. The member for Vancouver-Little Mountain raised a point about what this was all about and seemed to be questioning why this was happening. All I can say is that I'm very glad this issue was raised, not only because of the significance of it and its importance to the people of British Columbia -- to ordinary people, in terms of the cost of the drugs they get -- but because now we know where the Liberals stand. That's a very useful point. Up to now that was not clear; it was not known. As we saw from groups like the BCNU -- who were trying to find out from the Liberal opposition and from their critic where they stood in terms of the broad coalition that has come together in opposition to Bill C-91 -- the official position up to that point was silence. And now we know, so this did a good thing.
This is a very good thing, in fact, that the government has done, among the many good things we've done -- to put this on the agenda so that we can all
But then, in the course of the discussion, they got kind of picky again. That was too bad, because it certainly took away from their main thrust, which was that it seemed that they were going to support all this. I think that's a very good idea.
I think there are some things that must be said about Bill C-91 that are important. I remember the debate that raged back in '92 and '93 when the federal government -- the Tory government at the time -- was putting this in and when the Liberals, who were in opposition, were making very large noises and trying to defeat it, which they were not successful in doing. We all need to draw our attention again to what Bill C-91 is all about, because we have heard a lot
Bill C-91 fails patients and really does stand in the way of building a national drug program, which we on this side of the House, with others across this country -- every other province -- believe should be put in place. Bill C-91 caved in, it seems, to the drug companies and has failed to ensure that they deliver on their promises to provide stable prices for new drugs, to provide job growth and to make Canada a major player in pharmaceutical research and development.
On that point, it has come to my attention that apparently the drug companies promised to put something like 10 percent of profits into research. I have learned that in British Columbia, they've only put 3 percent into research. I think that's quite shocking, and I would very much like to know that we are pointing that out to the drug companies.
[ Page 2770 ]
I would also hope that our Liberal colleagues -- with all that influence that they may have, given the support they get from the pharmaceutical companies -- would then say to the pharmaceutical companies: "Gee, thanks for your support in the elections and things. We'd like you to do something, and that is to get your research up to snuff. Let's get up to that 10 percent you promised you were going to do" -- and which they haven't done. So we would solicit the opposition's support as we try to get that research. They have said that they, of course, want this to happen, and I don't doubt that they do.
So what have we got? Drug prices: where are they? Drug prices are, by almost any account, out of control. And they are, by and large, so controlled by the pharmaceutical companies -- through bills like C-22 in '93 and C-91 -- that something has to be done. We cannot leave it to the drug companies; we cannot leave it to the medical profession; we cannot leave it to that whole world. We all must be involved -- citizens, the community, the broad coalition that was talked about earlier -- in seeing that Bill C-91 and our health care system respond to the patients' needs that we all know -- every one of us -- are really important.
Bill C-91 jeopardizes the survival of every provincial drug plan in the country, let alone the hope -- as I mentioned earlier -- of establishing a viable national drug plan, as has been recommended by the National Forum on Health. I think this is really important. Our Pharmacare plan is so important to us and to all our citizens, for it does provide opportunities for us to have a health care system that does indeed provide for all. It provides for poor folks, it provides for seniors, it provides for disabled people and it provides for all of us when our moment comes -- when we have need of drug support and drug therapy.
I think that the fact that this has been raised -- that Bill C-91 is before a committee at the federal level and that we have spoken up strongly against what they're doing -- is significant and demonstrates very clearly where New Democrats stand in this country. I'm proud that the opposition is prepared to join us on that but disappointed that they weren't there at the table making their own presentation. But if they want to tag along with us, that's great. I think that's just terrific, and we support them.
One of the reasons that it is of concern to me has to do with my constituency. Victoria-Beacon Hill has wide demographics across the whole of it, but in two particular communities -- James Bay and Fairfield -- seniors make up close to 50 percent of the population. I have a report submitted by the national organization called One Voice, and they presented a petition to the legislative committee on Bill C-91. In it they make some very important points about seniors. They say:
"We pointed out. . .that over 40 percent of seniors live below the poverty line, yet are paying user fees for drugs they must take. Documented studies show that often, when people can't afford the cost, they simply don't take the medication. And the result is very obvious: a deterioration or a crisis which inevitably requires a far more expensive intervention by the acute care system, not to mention loss of independence and the ability to manage one's own well-being. This is far costlier to the public health system than good therapeutic management. . . . "
That's through Pharmacare, through getting these drug companies to pay attention to their duties and their responsibilities to the community, not to their shareholders or to the multinational interests that they support.
In closing, I just want to reiterate that the effect of Bill C-91 -- Bill C-22, initially -- is that it drives up Pharmacare costs in this province. We can't afford that, and we must speak out. We must do what we can to change that. We see it as an off-loading mechanism on, again, the poor, women, the disabled and seniors, and we must continue to fight against that. We see this as, without doubt -- I'm afraid to say it -- very much a sweetheart deal with the drug companies. It is a bit of a shame that it was a Tory government that brought it in and that the Liberal opposition of the day that criticized it and that are now the government
Again, another very important part of what Bill C-91 will make difficult is the development of a national drug plan. It is so important that we have a common front in support of our communities -- that this plan begin to take shape. We must continue to do that.
Finally, in British Columbia and in Canada we have without doubt the best health plan in the world. We must not let it be eroded by the kind of suggestions, ideas and thoughts that are being promulgated through Bill C-91. I want to urge us all to keep our courage at the sticking point and to stay with this idea of telling the federal government that Bill C-91 needs major renovations or, in fact, to be withdrawn, so that a better review can take place.
C. Hansen: What this resolution is all about is
But there are some other issues around this that I want to address. As speakers from this side of the House have emphasized over and over again this afternoon, this is about what is best for patients. But I think we also have to make sure that government policies and initiatives that come forward from the Health ministry are consistent with other strategies that the government is putting forward and that they are not working at cross-purposes with other strategies. We also must ensure that the best interests of health care, the best interests of patients and the best interests of all British Columbians are looked out for not only in the short term but in the long term as well. As the motion states
The other side of the House has talked about this issue as if it's patients versus big multinational corporations. I think we have to be careful to clarify what is meant by that. We have in British Columbia some of the finest manufacturing companies, and we have some of the finest research companies. These are not big multinational corporations; these are homegrown British Columbia companies. Many of them are very small, many of them are very innovative, and many of them are just at the start of their growth when it comes to research and innovation.
I'd like to go back two years to when this government introduced a science and technology strategic plan. When it was announced just under two years ago, one of the areas
[ Page 2771 ]
research that has great potential in British Columbia. These are not multinational corporations. This is an opportunity for science in British Columbia. This is an opportunity for young British Columbians who are now going through to get science degrees to have real, meaningful careers in this province in the future.
If I can just quote from another section here that talks about this biotechnology aspect, it says: "These industries not only provide added value to B.C.'s natural resource sector but present new opportunities for regional economic diversification."
[5:00]
I want to quote the woman who was made chair of the Premier's Advisory Council on Science and Technology, Dr. Julia Levy, who is probably one of the most reputable scientists in this province. She said that if the patent legislation is weakened, investment in Canada's biotech industry will move elsewhere. I think, hon. Speaker, this is one of the reasons why the amendment to this motion is so vitally important, because we want to proceed in developing these policies with a recognition for the industries that we have in this province. Yes, we want to protect patients; yes, we want to have the best health care system for the most efficient cost possible. But we also have to recognize that we have a burgeoning biotech industry in this province, and we have to make sure that the strategies that come out of one part of government aren't working at cross-purposes with the strategies in other parts of government.
I have a memo from Quadra Logic Technologies Inc., which is Julia Levy's company, in their brief on Bill C-91 to the standing committee in Ottawa. It says in this memo: "We strongly support the existing legislation and regulations with respect to the protection of intellectual property and the need to seek international harmonization of such laws." That's not to say that there aren't ways that patent protection can be improved upon to make health care and pharmaceuticals more cost-effective. But in doing so, let's make sure that we're not killing off a new, viable, vital industry in this province.
Speaking of technology funding, I want to refer to two press releases that came out of the Ministry of Employment and Investment a year ago. We saw an example earlier from my colleague the member for Vancouver-Little Mountain, when he talked about the press releases coming out of Saskatchewan and British Columbia. Somebody is plagiarizing somebody here. Here are two press releases. They are both dated March 18, 1996. One says:
"'Our government recognizes the importance of fostering a strong science and technology sector in British Columbia,' said the Employment and Investment minister. 'Helping these companies with research and development funding today will lead to new value-added, knowledge-based industries in B.C. and the good family-supporting jobs those industries will create.'"
That's a good sentiment.
But we have another press release on exactly the same day. You know, I've often heard that one of the things we have to be very careful of in government is that parliamentary secretaries don't contradict their ministers. They should be using the same line. Here we have a quote from the Parliamentary Secretary to the Minister of Employment and Investment:
"'Our government recognizes the importance of fostering a strong science and technology sector in British Columbia,' said the Burnaby-Edmonds MLA. 'Helping these companies with research and development funding will lead to knowledge-based, value-added industries in B.C., which in turn will lead to good family-supporting jobs.'"
I think that the parliamentary secretary should be complimented, not only for not giving a different line from his minister but for using exactly the same words on the same day in two different press releases. I think that's a phenomenal coincidence.
There's a quote in the Minister of Health's presentation to the standing committee that I want to read. She said: "British Columbians want education about prescription drugs, not advertising." That's from the Minister of Health's April 17, 1997, submission to the select standing committee. I think that's something that we can applaud on this side of the House too.
The minister talked in her presentation about not making this a political issue. I think that she can prove it's not a political issue to all of us. She can stand up for what she said in her own submission by withdrawing the ads that she's put on television, which do more to promote her own image than to educate the public about health care issues in this province. If she were to withdraw that advertising, to save that money, to redirect that funding into health care, patient care and reducing waiting lists, then she could demonstrate to the public of British Columbia that she's not trying to play politics with an issue such as this.
Until such time, we have every reason to believe that there's some blatant politics being played with this issue. We hope that as they proceed forward with policies in this area, they look at the broader issues of job creation in British Columbia -- strategic industries that should be nurtured and grown. And at the same time, let's make sure that we put patients first.
G. Wilson: In rising on this motion, I intend to be, perhaps uncharacteristically, brief.
The amendment to the motion that is before us is certainly worth supporting, because it strengthens the original motion. I believe the original motion is worth supporting because I think it would express the interests and concerns of all British Columbians who are quite concerned that the government -- which not so long ago in opposition took such a strong stand against the proposed changes now outlined in Bill C-91 -- now find themselves promoting precisely the very documents that they were opposed to when in opposition.
I don't intend to restate what has been stated well by many members in the House but to say that I disagree with one issue: that this is not a political issue. It is a political issue. It speaks very much to the heart of what people in Canada and British Columbia expect from politicians, and that is honesty and commitment to principle.
Notwithstanding the impact that this bill will have with respect to the cost of drugs and the access to and ensurance of health and safety of people in Canada who require drugs for treatment for medical disease, what concerns me most of all about Bill C-91 is the hypocrisy that we see existing in the federal government today, as they are government, as opposed to where they were when they were in opposition. We've seen it in Bill C-91. We saw it on NAFTA; we've seen it on the GST; we've seen it now with the MAI. For those who say this is not a political issue, I completely disagree. It speaks to the very heart of what makes parliamentary democracy and open debate important in Canada.
What will be significant from the vote that is taken in this House is that it will bring
[ Page 2772 ]
together members from a New Democratic Party, a Liberal Party, a Reform Party and a PDA -- all different in their political perspective -- standing together, I believe, in support of this motion, directing to the federal government our concern at the level of hypocrisy that that government is demonstrating on the basis of what it said it would do when it was in opposition and stood for election, and what it is doing today as government.
This is very much a political issue. It is to our credit that members from every different political party stand united to say Bill C-91 is bad legislation and should not proceed. And the people of British Columbia will stand united in opposing it.
M. Sihota: Actually, I wasn't going to enter this debate, until the leader of the PDA stood up and said this is a political issue. Given that it's a political issue, I'd rather make some political comments. I want to make some comments with regards to what we've heard from the other side of the House for the last couple of hours here in this chamber, particularly from two members who have now departed -- the member for Vancouver-Quilchena and the member for Okanagan West -- and who spoke to this issue on behalf of the Liberal Party.
First of all, it's amazing to listen to the members opposite. They come in here
What's amazing is what they didn't say. Under the legislation that we're talking about in this House, the pharmaceutical companies are supposed to ensure that 10 percent of revenue goes towards research and development, and developing those biotechnology industries in provinces like British Columbia. Under the legislation, 10 percent is to be made available to those companies so they can create jobs in provinces like British Columbia. You know, hon. Speaker, those companies are putting in only 3 percent in British Columbia. They're mandated in the legislation to put in 10 percent, they said they would put in 10 percent, and they're putting in only 3 percent. Not one member of the opposition, who would like us to believe they're opposed to Bill C-91, stood up here and criticized the pharmaceutical industry for not putting in the full 10 percent that they promised they would.
I don't want to jump to conclusions, but maybe the fact that they didn't stand up here and criticize the pharmaceutical industries has something to do with the fact that last year the B.C. Liberal Party provincial wing received $5,000 from the Pharmaceutical Manufacturers Association. Given the way they've been behaving for such a small investment, it's amazing what kind of representation they've been getting in this House this afternoon.
An Hon. Member: It must be a reference-based contribution.
M. Sihota: That's right -- a reference-based contribution.
Now, throughout the course of this debate, the members opposite have stood up and taken the time over and over again to say they are opposed to reference-based pricing. Well, fair enough. I guess they are entitled to do that, and I'll come to that entitlement in a few minutes. Either the penny hasn't dropped or the research hasn't been done, but not one of them has stood up and asked publicly why it is that we have reference-based pricing here in British Columbia. There are two reasons why we have reference-based pricing here in British Columbia: (1) because Bill C-91 exists, so government was forced to react to that legislation by bringing in this system of reference-based pricing; and (2) because of federal cutbacks that force this government to bring those kinds of changes forward.
The hon. members opposite won't stand up here and criticize Bill C-91, but they'll criticize reference-based pricing. They won't criticize their federal colleagues in Ottawa for these massive cuts in transfer payments that have had this negative impact on health care here in British Columbia. So if they're not prepared to criticize Bill C-91 -- which not one of them on that side of the House has done, and if they're not prepared to criticize their friends in Ottawa with regard to those transfer payment cuts, then I'd like to know from the members opposite: what is their alternative? What would they suggest? What would they do to deal with this problem of federal transfer cuts and Bill C-91, the combination of those two events?
Interjection.
M. Sihota: The hon. member says they don't have a plan. That's the problem: they have a plan, and they don't want to stand up here in this House and talk about that plan. The Leader of the Opposition talked about that plan in Nanaimo during the course of the election campaign. What did he say? They forget there was an election campaign almost a year ago here in British Columbia. But in Nanaimo, hon. Speaker, you know what he said? He said: "$6 billion is enough." That's his plan: six billion dollars is enough. He would underfund health care by almost $2 billion. And if that side opposite
They forget. I saw them all on TV. There they were signing the pledge -- every one of them putting their autographs on that pledge on TV. And what were they saying? They said: "I pledge we'll only spend $6 billion on health care" -- underfund it by $2 billion. What would that have done to our health care system? It would have devastated the health care system. It's a good thing that British Columbians saw to it that they stayed in the opposition and that we -- a party that believes in medicare, that believes in a universal health care system -- were elected to ensure that those values remain mainstream values here in British Columbia, unlike other parts of the country. Six billion dollars -- a $2 billion cut
Hon. Speaker, it's amazing listening to some of the arguments that they put forward. Just about every member that's spoken so far on the opposite side sort of holds up that study from the Canadian Cardiovascular Society. They hold up that study, and they say: "Well, this just proves that the system the provincial government has brought forward doesn't work." They cite that one study.
[5:15]
Well, I want to cite a study from the Centre for Evaluation of Medicines, which looked at that very study from the Canadian Cardiovascular Society. They said:
"The January edition of the Canadian Journal of Cardiology contained three articles on reference-based pricing of prescription drugs, a policy recently endorsed by British Columbia" -- meaning our government. "Each article deviates from the usual high standards of the journal and thus warrants critique. The background paper" -- which is what the hon. members opposite have been referring to -- "published adjacent to the[ Page 2773 ]
position paper is produced by two employees of the pharmaceutical industry" -- and they put it ever so politely -- "who have a commercial conflict of interest as evaluators of reference-based pricing policy."
You know, I'm used to heckling in this house, hon. Speaker. It's quiet opposite. I wonder why. They're numb, because they realize that the very study that they've been citing -- that they say undercuts government's argument -- has been produced by two employees of the pharmaceutical industry. They've been conned by their friends who donated $5,000, the Pharmaceutical Manufacturers Association of British Columbia.
I see that the Health critic is in, so let me just repeat the point on the cardiology study.
Interjections.
M. Sihota: You won't have a better
Interjections.
M. Sihota: You know, the hon. member, who learned a little bit about conflict of interest a couple of months ago, knows that the truth hurts.
Let me read this again. They're talking about the Canadian Cardiovascular Society; they've been citing their report over and over in the House. And the Centre for Evaluation of Medicines says
Interjections.
M. Sihota: The hon. member should just settle down so that the Health critic can listen to this. "Each article deviates from the usual high standards of the journal and thus warrants critique. The background paper published adjacent to the position paper" -- which is what the hon. member for Okanagan West was citing -- "is produced by two employees of the pharmaceutical industry
Then, of course, if you can't win the argument on the merits, you do it on fear. The members opposite were referring to the B.C. Pharmacy Association. They said: "Oh no, if we have this, we'll have two-tier medicine here in British Columbia." Here's the party that wanted to cut $2 billion out of our health care budget -- $2 billion -- which inevitably would have taken us to two-tier medicine. Here's the party that said: "Six billion dollars is enough." I look forward to the critic saying it during estimates. "Six billion dollars is enough. That's our position, hon. members; we don't need any more." They say it's going to be two-tier medicine. Well, they don't get it.
Again let me help them, because I know that over the last little while we've seen deficiencies in their research. We know that
Interjections.
M. Sihota: They make the argument about the two-tiered system, so I want them to hear this. The way the system works is that if you go in and see your physician, and if your physician says to you that you require medicine that is not generic, then you will get that medicine. The system will pay for that.
I've had dozens of constituents come into my office, and every time they've come in, we've been able to remedy their problem, because on this side of the House we understand how the system works. They don't; there's no doubt about it. With all
Interjections.
The Speaker: Members, perhaps we could have just a little more order. Member, please continue.
M. Sihota: With all the lack of understanding over on that side of the House, given the desperate need for training on the side of the opposition, if I may say so, I think the "citizens' panel report on MLA compensation" made a mistake. Rather than having a transitional allowance when members leave, they should have provided for a training allowance for members opposite, so when they first get elected they can learn how to do their job and become familiar with these kinds of policies.
Hon. Speaker, I want to talk about a couple of other issues that relate to all of this.
Interjections.
M. Sihota: Well, no, I've dealt with them. They now know that the biotech industry is underfunded by 7 percent. They now know how reference-based pricing works. They now know what the Canadian Cardiovascular Society had to say. They now understand, of course, the relationship in terms of how this program ought to function.
You know, they should stop playing on the fears of seniors, because I think it's one of the worst arguments one can make. They make the argument in this chamber over and over again: "Oh well, you know what this means. This means that seniors will have drugs that they don't need, that they're going to flood the hospital emergency rooms in British Columbia with all these kinds of problems." They say we haven't quantified the costs of that occurring.
An Hon. Member: Show us.
M. Sihota: I'm going to show you something, hon. member, if you listen to this. We have saved $74 million by bringing in reference-based pricing -- $74 million. Now that they've asked, hon. Speaker, I want them to hear this. That is a net figure, so we have had net savings of $74 million. We have done that system. It is pure hyperbole and fearmongering on the opposite side to suggest that somehow our hospital rooms and our health emergency facilities are being flooded by people coming into those facilities because of drug overpricing.
Now let me make one other point. I've listened to everyone over there. Not one of them has had the
So I want the members opposite to be true to what they're saying. They've stood up one after the other and spoken against what it is that we put on the floor here for the Legislature this afternoon in terms of criticizing Bill C-91. Not one has uttered the words: "Bill C-91 is bad legislation." Not one on the opposite side has uttered the words: "We stand opposed to Bill C-91."
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Not one of them has said: "Our Liberal friends in Ottawa were wrong to allow Bill C-91 to exist." Not one of them has said, "Those health care cutbacks drove us to Bill C-91" -- with the exception, of course, of the leader of the PDA. Not one of the Liberal members has stood up in this House and said that. That being the case, I trust that they will be true to their words and that they will vote against this motion.
W. Hurd: It's always a pleasure to join the debate, particularly following the member for Esquimalt-Metchosin, who preaches the government gospel in the House. I just want to say at the outset that it's important to understand what's happening back in Ottawa. Bill C-91 is being reviewed by a standing committee. Now, can you. . .? We had
Interjections.
The Speaker: Members, I know it is almost 5:30. The level of enthusiasm has been rising consistently for the last hour. But could we please allow the member the courtesy of an audience. Member, please continue.
W. Hurd: What we had was the Minister of Health from British Columbia appearing before a select standing committee. I ask the members opposite to reflect on how many times in this House a member of the executive council in this chamber has appeared before a standing committee of this House to testify on any bill -- any bill. They don't believe in that here, with this executive council, with this government. They don't believe that select standing committees need to review any legislation that they put forward. It's not a fact.
Now, you know, there's no doubt that lower- and middle-income British Columbians who don't have the benefit of a drug plan are impacted by high drug costs. In my riding, it happens all the time. People who have limited incomes tell me they're paying $700 or $800 a month for prescription drugs that they require to maintain their lifestyles. I understand that.
And I understand that the role of this committee is to review whether Bill C-91 is having the major impact on driving up those costs, what the balance is between research into new drugs that are required to sustain people in their lifestyles
Hon. Speaker, I asked you to contrast what's happening with what happens around here. I remember the day that reference-based pricing was brought in by this government in this assembly, because there were representatives of the pharmaceutical industry here that day to meet with all parties in the Legislative Assembly: the government, the opposition and the third party at that time. Before they had a chance to meet with this government to propose any alternatives to reference-based pricing, the deal was done. The announcement was made. I remember that they left the assembly; their work was done.
That's how the government consults. They campaign against banks and big corporations and pharmaceutical companies. They like to divide British Columbians. They don't consult; they divide. That's the way they operate.
You know, I heard the member for Esquimalt-Metchosin stand up and talk about the contributions made by big drug companies to the campaigns of the Liberal Party, so I decided to bring into the assembly today a copy of the Hospital Employees Union newsletter. I have some quotes I want to read into the record from the newsletter, the "Guardian," which says: "The activist. . .were part of a sophisticated political action initiative by HEU that saw the union commit significant resources to re-elect [the Premier] and ensure that a collective agreement" and our jobs would be protected.
The government of this assembly has never come clean as to how much money that sweetheart deal with the Hospital Employees Union is costing the patients of this province. They've never come up with a number. I challenge the members opposite to come up with a number and tell the people in this House: how many drugs will that buy? How many patients will that provide for? Not an answer.
I keep moving through the newsletter. A provincial executive member of the union was taken off the job to run a campaign for the NDP. Imagine that! Can you imagine if a representative of the pharmaceutical industry had come into the Liberal Party and run one of the campaigns and bankrolled it? Can you imagine what would happen from the members opposite?
An Hon. Member: Hypocrites!
W. Hurd: Well, it's hypocrisy -- pure and simple.
Interjections.
[5:30]
W. Hurd: Well, hon. Speaker, the former Minister of Health is with us today. I recall that when it came to signing that sweetheart deal with the HEU, he was pulled out of the negotiations. He didn't have anything to do with them. It was the Premier who negotiated that deal on behalf of the government. I've always been surprised that the Premier of the province would be called in to negotiate a deal with the health care unions in British Columbia. I never quite understood it, but I'm not one to cast aspersions at the members opposite. It was obviously an important deal for the government, for the Premier of the province to be called into the negotiations and to override the normal process of collective bargaining with a public sector union.
To hear the members opposite talk about campaign contributions, knowing that only through a huge hole in the Election Act could this kind of stuff even happen
Interjections.
W. Hurd: Mr. Speaker, I commend the newsletter to the members opposite. They should look at the newsletter to find out what key role this union played in the election of an NDP government. They're not shy about the role they played; they're not shy at all.
I've confronted it so many times in this assembly over the last six years. It's absolute blatant hypocrisy when it comes to matters of health care in our province. There was a study released today that summarizes bed closures in the province over the last four years -- under a government that protects health care.
An Hon. Member: Federal cuts.
[ Page 2775 ]
W. Hurd: Well, the fact of the matter is that we've seen beds closed across the province. We've seen a government that maintains it's protecting health care, and the opposite is the case.
The generic-drug policy is a classic case in point. The fact of the matter is that, along with a generic-drug policy, we're also seeing the number of drugs actually covered by the Pharmacare program reduced. We're seeing drugs reduced because, understandably, the Pharmacare program claims it can't afford them. But it's important to understand that the water is getting shallower, and the number of drugs covered is getting fewer. That's what's happening to the program.
To hear the members opposite talk about protecting health care
Now, as I said at the outset, there's no doubt that high drug costs are having an impact on the lives of ordinary British Columbians, particularly those with long-term disabilities or those with medical conditions that require them to take prescription drugs. I've had a lot of calls; I'm sure many members of the assembly have had a lot of calls. And I have high hopes that this committee in Ottawa is listening to the recommendations of not only the Minister of Health in British Columbia but probably also the Minister of Health in Ottawa. He may well be making representations to the same committee about changes that are needed. I have no doubts that that consultative model will arrive at a fair and equitable solution which ensures that new drugs are developed and that research continues, yet at the same time finds some way to control the escalating and spiralling costs of drugs. It's a way of doing business that perhaps this government could learn something about.
I'd like to see our own committee looking at the effects of drug costs in British Columbia. I'd like to see a committee of this Legislative Assembly reviewing the generic-drug policy of this government. Any chance that's going to happen before this session is over? Not much of a chance. I'd like to see the Minister of Health in this assembly appear before a select standing committee and tell this House what she feels is happening to drug prices in British Columbia. I have no illusions that that will happen, either.
I think this is a motion that is useful. I think it's important for us to state our position clearly in British Columbia. But, Mr. Speaker, listening to the members opposite go on and on and on about themselves being the defenders of the health care system rings hollow when you see what's happening in hospitals, in waiting rooms and in emergency wards across this province.
J. Weisgerber: I rise to speak, first of all, in support of the motion and the amendment that were put forward. I think they're sensible; I think they're reasonable. I wonder why we have spent almost five hours in this Legislature debating that point. I wonder, with all of the pressing issues facing British Columbia, issues that are within the jurisdiction and control of this government, within the area of responsibility of this government
I have to wonder: what's the motivation? Why are we doing this today? Why are we not dealing with health issues in British Columbia? Why are we not spending more time worrying about the travel problems of northern British Columbians, rather than what the federal government is doing with Bill C-91? It appears to me, as I listen to members opposite, that the British Columbia government has, through the Minister of Health, addressed many of these issues through reference-based pricing.
Now, I happen to disagree with the other members on this side of the House. I support reference-based pricing -- and I have. But having said that, it seems to me that the government has indeed responded to the threat that's represented by Bill C-91. So why, then, should we get ourselves in a great tizzy about Bill C-91 if in fact we've adopted a remedy, a solution: reference-based pricing?
I hear the minister say: "Well, yes, but it's this advertising; it's this obscene advertising that these pharmaceutical companies would do." And I think: are these the same people who ran TV ads with respect to the issue? Is it the same government that spent a significant amount -- and I think I'll be guilty of understatement -- of public funds in the run-up to the last provincial election? That advertising wasn't so obscene at that time, at least according to members opposite. They saw no reason not to spend hundreds of thousands, perhaps millions, of taxpayers' dollars in order to promote the government. So I think it rings just a little bit hollow to hear the Minister of Health complain, protest so vigorously, about the advertising done by pharmaceutical companies.
Mr. Speaker, I find myself with the uncomfortable feeling that we've been drawn into the federal election debate today. I fear that we hear the members opposite talking about a national drug plan as if that were part of the platform of the government of the day. We know whose platform that is, and we know why it's being supported. We know why the motion was tabled in Saskatchewan yesterday. With all of the critical issues facing British Columbia, we have instead today dedicated an afternoon in the Legislature to promoting the interests of federal parties -- and I'll put it in the plural -- in the legislative debate.
We saw, after the minister spoke, the used-to-be-MP from Fraserview very quickly jump to his feet and tell us with great passion his fond memories of his involvement with Bill C-91 when it came in. We witnessed just now the wannabe Member of Parliament from White Rock jumping up to defend the position of his federal party and the way it's handling Bill C-91.
I think it's tragic, quite honestly, that we didn't raise this motion in a very general way at 2:30, perhaps have a short introduction by the minister -- not that tirade that we were subjected to for half an hour -- followed by a nice, sensible response from the opposition and the unanimous support of the House, and then move on to deal with the business of the province, rather than spend a whole day here attempting to prop up the New Democratic Party's federal run and seeing the Liberals drawn into defending their cohorts in Ottawa.
With all due respect, Mr. Speaker, I think we have shortchanged the people of British Columbia with the tone of the debate, the direction of the debate and the focus of this House as it relates to the interests of the people of British Columbia.
Hon. P. Ramsey: Hon. Speaker, I didn't intend to participate in this debate, but I did want to rise, first in response to my colleague from Peace River South. I must say that, contrary to what he said, I found this afternoon's debate a refreshing break from some of the rhetoric that we hear.
[ Page 2776 ]
This, hon. members, is a real issue about a real problem that has real effects on how we deliver health care to British Columbians. How the federal government deals with patent protection for drugs will affect, fundamentally, the ability of this province and every province in the country to deliver high-quality health care, and, ultimately, it will affect the health care that each one of us receives. This is a real issue, and I'm pleased to rise and speak in favour of the motion and in favour of the amendment to it proposed by the opposition.
I must say, though, that hearing the Liberal opposition on this, I thought I had wandered into a convention of the Pharmaceutical Manufacturers Association of Canada. I must say, Judy Erola can retire. The member for Okanagan West is ready to replace her as the advocate for the multinational drug companies. That is a great shame. There are real issues involved here, and having a Liberal opposition that wants to be a shill for the PMAC position on drugs in this country is a great, great shame.
They seem to believe, as the PMAC would have people believe, that every new drug, patented and manufactured, is a huge therapeutic advance. That's false. They should know it. Independent evaluation by Health Canada -- not by this government, by Health Canada -- says that less than 10 percent, at most 5 to 6 percent, represent any therapeutic advance in drugs on the market. There is no significant impact except on the pocketbooks of those who have to pay for it, on the health systems that
The second thing that they would have us believe is that the drug companies are actually delivering on what they said they'd do under Bill C-91 and investing in research.
S. Hawkins: You didn't hear what I said.
Hon. P. Ramsey: I support their amendment because it's about time to hold the drug companies accountable for what they said they were going to do and have refused to do since Bill C-91 was introduced.
Here we have a pharmaceutical industry that spends $20,000 per doctor to market their drugs. In British Columbia, that means they spend $140 million a year marketing drugs. They spend perhaps $25 million in research. This is a ludicrous waste of resources.
Finally, time and again we've heard these opposition members spout the PMAC line on the efforts of this government to substitute scientific evidence in how it formulates its drug programs, as opposed to drug company advertising. We're proud, on this side of the House, of the efforts we've made to make scientific evidence the basis for drug policy in this province. So I would trust, hon. member, that since the Liberal opposition has spoken so firmly in support of this PMAC and so against any substantive revision to Bill C-91, that they will have the courage of their convictions, stand up when the vote is called and vote against the motion.
[5:45]
G. Plant: I'm delighted to have the opportunity to rise and speak in this debate. I spent the first part of the debate asking myself what it was about, and I must say that I asked myself that question in the context
An Hon. Member: And your side was talking.
G. Plant: Wait. There'll be an answer to the question. In the context of this issue that I ask myself about frequently, which is the general problem of federal and provincial relations in this country and the pressing and urgent need for some kind of constitutional reform, some kind of restructuring in the way that we do business here in Canada
Frankly, I have found it difficult to come up with good, interesting, innovative new ideas as answers to these questions. In what is practically a unique moment for me, I am in a position of gratitude to the government this afternoon, because I have learned a new technique. I have discovered a new tool for implementing constitutional reform and change and amendment in this country. The moment happened when I heard the member for Victoria-Beacon Hill, who also, I think, was temporarily not entirely sure about what the debate was about. She stood up and said: "I'm glad to be here, because what we're doing here is essentially debating Bill C-91."
There it was. There's the answer. We don't have to worry about constitutional reform. We can debate federal legislation in this House. Let's go for it; let's not hold back. Let's deal with the Coast Guard, let's deal with the Criminal Code, let's deal with all those difficult issues of federal
I think it is entirely appropriate, from time to time, for us as private members to come forward and take advantage of the opportunity that exists under the rules of this House to make statements on federal legislation. It happens all the time. Members on both sides of the House exercise their opportunity to do that. But that's not what we had here today. We had a very special opportunity. We had the opportunity to debate a motion, not brought forward by a private member but brought forward by someone who has control of the agenda of this House, and she gets to decide what we debate and when we debate it.
And who is that? That is the leader of the House, who happens to be the Health minister. I'm grateful to her for having given us the opportunity to assist in the federal NDP election campaign by debating these important issues. But frankly, I think there's something we could have done today that would perhaps have been a less adventurous step down the road to constitutional reform. It would perhaps have been more mundane; it would perhaps have been more constructive. We could have debated the public business of the government of British Columbia, not the business that we were engaged in. That's all I have to say.
Hon. J. MacPhail: I'm pleased to be able to rise and give summary to the debate. I must begin by thanking the hon. member for Peace River South for finally turning the issue to what had not been addressed at all by the members opposite, which was the area of marketing. While I know that it was a stretch for him to compare it to advertising by government, I know he was just kidding.
But the issue here is a very serious one that has not been resolved by the reference drug plan by any means. What our government has had to do, which is simply not understood by the Liberal opposition, is bring in reference drug plans to
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control the exorbitant increases in drug prices, and that's still not enough. It's still costing us $40 million above what we save each and every year, because of Bill C-91. So for the member for Richmond-Steveston, who thinks that somehow this isn't a provincial issue, I'm sure his constituents will be mortified to see his lack of understanding about the fact that the federal government gets to be a shill for the drug companies and that it's every British Columbian that pays for it. Every single British Columbian pays for it to the tune of $40 million a year extra. That's not the research of a provincial government; it's the research of Queen's University that is completely, widely and unequivocally accepted: that the direct costs to British Columbians in excessive drug prices as a result of Bill C-91 is $40 million per year. That's what we're debating here today.
We're not debating the Liberal opposition being the shill for the PMAC and opposing a reference drug plan. We're not doing that at all. We're talking about two things: patient care and drug prices. Unfortunately, even after two and a half hours, the Liberal members opposite still don't get it. That means that we're losing an opportunity for them to join with us to maybe save the taxpayers $40 million -- if the Liberal government hears us -- by making some changes to Bill C-91.
The discussion has been useful; the discussion has been timely. And again, it's probably because the Liberal members are out of touch with Ottawa. But the committee meetings are going on right now. The decision is being made by the committee in Ottawa. We have a unique opportunity to save taxpayers $40 million. The lack of understanding by the Liberal members opposite about their ability to influence drug prices is devastating to me. The only direction they can influence drug prices is to allow them to skyrocket, in defence of the pharmaceutical association, and that is devastating to patient care in this province.
I am very pleased that finally some members opposite did address the issue of marketing of the drug, because, of course, the Liberal members opposite didn't even understand the issue, let alone address it. We have a very serious concern here, and there is a unique opportunity for British Columbia legislators to unanimously urge the federal government to put in place direct-to-consumer marketing controls. That will assist patient care by limiting the excessive drug use and excessive prescribing in this province. And I'll tell you something: I actually have had these discussions with the BCMA -- not reading letters of last year, not talking about conversations that we had at home over the dinner table, but real discussions this week with the BCMA -- and they too share the concerns around direct-to-consumer marketing. They are horrified that that might be brought into British Columbia, and I am so pleased to be able to join with my government colleagues in urging the federal government to take action around this issue.
I suspect, actually, that the Liberal members opposite will speak out of one side of their mouth and raise their hands for another, because they know the public is concerned about excessive drug costs. They know they are outraged at the pharmaceutical manufacturers for making profits double that of the banking industry. They know they have to stand up for their constituents. They know that if they don't support this motion, they will never again be able to stand up and talk about patient care. So I urge every single member in this House to see their way to good sense, to stop making a show for the drug companies, to forget about who donated to your campaign and to support this motion.
[6:00]
Amendment approved unanimously on a division. [See Votes and Proceedings.]
Motion approved unanimously on a division. [See Votes and Proceedings.]
Hon. J. MacPhail moved adjournment of the House.
Motion approved.
The House adjourned at 6:01 p.m.