Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

WEDNESDAY, APRIL 23, 1997

Afternoon

Volume 4, Number 4

[ Page 2751 ]

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.

Oral Questions

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

[ Page 2752 ]

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 . . . . " Will the Minister of Women's Equality today stand up for the women of B.C. and oppose the Premier's dangerous expansion of gambling in British Columbia?

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 . . . . Eighty thousand of B.C.'s minimum-wage earners . . . . Sixty percent of those minimum-wage earners are women. We have put $86.6 million in pay equity adjustments for women in the public sector. We have added $32 million in wage increases for the lowest-paid workers in health and social services. Most of them are women. Our commitment is unparalleled.

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.

Petitions

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."

Motion without Notice

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.

Motions on Notice

Hon. J. MacPhail: I call Motion 56 that sits on the order paper in my name.

FEDERAL DRUG-PRICING LEGISLATION

Hon. J. MacPhail: I'll read the motion for the House.

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

[ Page 2754 ]

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 . . . . All they have to do is allege a violation of the notice of compliance. They don't have to prove it. They just have to allege the violation of the notice of compliance, and they get their patent extended automatically. Only drug companies have that protection. What that does is extend the patent by about another three or four years, and it prevents generic drugs from being introduced into the market.

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 . . . . It stunned me, but the drug company profits are twice as high as the profits of banks.

The public is outraged at the profits that the banks make, but it ain't nothing compared to the outrageous and excessive profits that these drug manufacturers are making. The people who are paying are patients -- and drug plans such as Pharmacare. To establish a national drug plan without these changes to Bill C-91 would continue to take dollars out of patients' pockets and put them into the pockets of national drug companies. Hon. Speaker, that's simply wrong.

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

[ Page 2756 ]

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

[ Page 2757 ]

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 . . . .

We've asked for it; we've never gotten it. They don't have it. They don't know whether their program is good or bad. They're just going to ram it in, like they do everything else here.

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 . . . . And let's not get confused with the generic substitution program, because I think that's very easy to do. It's very easy to confuse the generic substitution program with the reference-based pricing program. This side of the House has no problem with the generic substitution program, because basically the drugs are chemically the same: one's a generic and one's a brand name. We're talking about a different drug that may or may not have the same clinical benefit to the patient.

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 . . . . The industry is growing, and it's doing very well. In fact, the average number of employees in British Columbia companies for biotech has grown by as much as 86 percent in the last two years.

But she believes -- this is the chair of a Premier's committee that reported a couple of years ago -- that the patent changes that the Minister of Health supports would decimate the biotech industry here in B.C. So it begs the question of whether the Minister of Health is actually talking to the Minister of Employment and Investment before she goes ahead with these changes.

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 . . . . I have, and I've had to take prescription drugs. I admit that I don't take them properly. After two or three days, I start feeling better. I might skip a dose. I might stop my medication.

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 . . . . I'll use the X-ray machine as an example. We had X-ray machines, then we had CT scanners and then we had MRI machines. We could say that they're all me-too as well, but we know that that's progress.

The old X-ray and the MRI both show pictures of the body. You could say that's me-too technology too, but it's not. Let's look at rocket technology. You know the space shuttle wasn't just invented from scratch. It was built upon gradual innovations over decades as the original V-1 and V-2 rocket technology was improved. Each of these technological advances was built upon the success of its predecessor, and that's called progress.

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 . . . . They've agreed to review it, so let's hope they do the right thing.

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:

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 . . . . The hon. member from Delta in the opposition knows about this; he's a student of Canadian history. The government then was small-l liberal. The government amended the Patent Act "for the public good," said the amendment, to allow compulsory licensing of patented drugs. Generic companies can now manufacture drugs by paying a 4 percent royalty on net sales to the patent holder.

Multinational brand-name manufacturers started to lobby heavily for a reversal of the amendment. We hit the big guys. They couldn't make all this money and, greedily, they started to lobby right away to change it, much like I saw the oil industry lobby to change the national energy program many years later. It's the same thing, and they eventually won, because they got the money . . . .

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 . . . . Never underestimate the pharmaceutical association. They'll hire people away; they'll say . . . .

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 . . . . Maybe we had better have another look at this." So what the minister did was go down and remind

[ 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 . . . . They may be joined by their friends, the provincial Liberal Party of British Columbia, who also got donations from them. But I'll tell you something: if you put this before the Canadian people, as the Minister of Health of British Columbia has tried to do by going down to Ottawa and by presenting this motion in the House, the Canadian people will look at it and they will say: "Stop these multinational drug companies. Enough is enough. Go back to the old system. Get rid of Bill C-91. Save some money for Canadians."

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 . . . . If she was really looking out for the patients of British Columbia and the health of British Columbians, if that was her only motive, I'd probably be standing up here congratulating her, too. I'd be thrilled.

The member for Vancouver-Fraserview knows that what is taking place is exactly the concession that he and the members of the Liberal Party in Ottawa gained from the government at that time -- that this would be reviewed in five years. That's what's happening. The issue is at the committee stage. It's being reviewed by the committee, they're taking submissions, they'll make a recommendation to the minister and the government will act on that.

[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 . . . . Well, maybe he didn't have as much success fundraising -- I don't know -- but I would assume he paid for his campaign.

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 . . . . I think to allude that somehow the federal Minister of Health had been bought is extremely out of line. If ever a politician in this House has crawled out on a very, very thin branch, I would say that that member just did that.

I'm sure that when that member took over his riding association, there wasn't one penny in the account, not one penny, that was raised by "Bernie the Bagman," one of the most successful corporate fundraisers in the history of the New Democratic Party in British Columbia. I don't know if that happened, but it might have. I don't know. Maybe the member will clear us up on that sometime.

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 . . . . If that's what it was, I would agree with her. But you know what? That's not quite how it worked.

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 . . . . I saw the ad for Bill C-91 that we're paying I don't know how many tens of thousands of dollars to run on television. I thought: that's an odd thing for a government to advertise. It's just an unusual thing, and I questioned it. It was sort of an odd thing for the government to raise as an issue and do advertising on. So you know what we did?

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 . . . . What day was it? Yesterday? Surprise! Imagine the coincidence. This same hero from British Columbia . . . . There's another one; there's a hero in Saskatchewan.

The Minister of Health in Saskatchewan rose in his assembly yesterday and moved a motion that says: "That this assembly urge the federal Liberal government to repeal the drug patent legislation, a law which costs the province of Saskatchewan. . ." and on and on and on. So we've got Superwoman and we've got Superman. And, hon. Speaker, let me even show you the press release that Superman put out in Saskatchewan: "Cline seeks fair drug prices for consumers." Da-da-da!

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 . . . . It probably touched down in Regina and picked up the Minister of Health from Saskatchewan, and they went off together. I don't know if the leader of the opposition and the leader of the New Democratic caucus -- I think there are two of them in Alberta -- were on that flight. I haven't been able to find out yet. It's coming. I don't know if the Health critic from Manitoba was on that flight. We'll try to find out.

I don't know if the Health critic from Ontario was on that flight. I don't know if it was a charter and all the superheroes in British Columbia got on the same flight and went to Ottawa to stand up for British Columbians.

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 . . . . Perhaps he's misguided; I don't know. Maybe he didn't know that this was happening in Saskatchewan and in other places. If the minister had done what he said, if she was, in fact, the hero that he painted her to be, and if she had thought this up and was championing the health care of British Columbians, then I would stand up and congratulate her.

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 . . . . If you're looking at Kellogg's Corn Flakes, the generic is President's Choice or any other brand of cornflakes. What the government does in reference-based pricing is substitute a Twinkie for a cornflake. They are not the same thing. There's tons of proof of that, and I will make those points today.

What we are looking at here . . . . If we look at the Closer to Home

summary part of the B.C. Royal Commission on Health Care and Costs, what it says about prescription drugs is that three basic principles apply to the use of prescription drugs. First, the potential for an increase in the health status of the person must outweigh the risk of harm. Does that occur with all reference-based drugs? The answer is no. We use acid-blockers in reference-based drugs and consider them all the same. They are not the same. The biggest class of people using acid-blockers are on anti-inflammatory drugs. Only one acid-blocker will treat that condition, and it is not covered by reference-based drugs.

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."

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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 . . . .

They have shoved in reference-based pricing, which has been debated very little in this House, which many people don't understand and which the impacts and the studies show has an untenable nature.

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 . . . . " I don't hear any savings in that comment. "For this reason the planned survey of a group of physicians to try to assess these costs has been postponed for now. If further drugs are added to the scheme, we will be looking at what data we need to accurately cost and fully fund these changes."

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 blo