HEAL Committee Meeting

STANDING COMMITTEE ON HEALTH

COMITÉ PERMANENT DE LA SANTÉ

EVIDENCE

[Recorded by Electronic Apparatus]

Wednesday, February 11, 1998

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[English]

The Chair (Ms. Beth Phinney (Hamilton Mountain, Lib.)): Ladies and gentlemen, I call the meeting to order. It's the 16th meeting of the Standing Committee on Health. We're doing a study of natural health products.

We are privileged to have with us three groups today. I'm going to start in the order we have it printed on the paper. From the Ontario Herbalists' Association we have Keith Stelling and Mona Rainville. From the Guilde des Herboristes we have Marie Provost and Valérie Lanctôt-Bédard. Is Florence Jullion not here?

Ms. Marie Provost (Vice-President of the Board, Guilde des Herboristes): No, she is sick.

The Chair: Okay. From the Canadian Academy of Herbal Medicine we have Linda Brosseau.

Welcome. I think you know the ground rules. Keep your talk to around five minutes each. If you have other things to say, they will probably come out in the questioning. Each member wants to get his or her time in. When the members are doing their questioning they will each get five minutes, but that includes your answer, so sometimes they may ask you to please shorten your answer because they may have two or three questions, so please cooperate in that way.

Again, I will start in the order in which I introduced you. Keith, are you going to start, or Mona?

Mr. Keith Stelling (Editor, Canadian Journal of Herbalism, Ontario Herbalists' Association): I'll start.

Honourable members of the House of Commons, ladies and gentlemen, herbal medicine is the oldest and most natural form of medicine in existence. Its safety and efficacy have been demonstrated over the centuries in every country. Even in our own country, Canada, we have 10 centuries of successful use of herbal medicine. Our native people survived using indigenous plants.

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Today's herbalists are the custodians of this ancient wisdom. Like all complementary practitioners, they believe that following the whole pattern already provided by nature is the easiest and safest way to find the template for human healing.

His Royal Highness the Prince of Wales has once again called for cooperation between orthodox and complementary practitioners in his recently published The Prince of Wales' Initiative Report.

Already in Britain, members of the National Institute of Medical Herbalists are running herbal clinics inside NHS hospitals, and fund-holding general practitioners make routine referrals to herbalists, especially when patients are not able to tolerate the side effects of chemical pharmaceuticals.

In the United Kingdom, both the University of Wales and the University of London offer a four-year B.Sc. program in herbal medicine.

Clinical herbal medicine has many successes today, especially in the area of liver pathologies, dermatology and stress-related ailments. In France, for example, the work of oncologists Dr. Jean-Claude Lapraz and Christian Duraffourd at the Hôpital Boucicaut in Paris have demonstrated the ability of medicinal plants, used in conjunction with conventional cancer treatments, to eliminate many of the side effects of chemotherapy and radiotherapy and to lengthen survival rates and lower recurrence statistics.

In addition to the obvious benefits to the patients, this translates into potential savings in the millions of dollars in costs associated with treatment, recurring treatment and hospitalization.

Promising work is also being done on hepatitis C, but the trained herbalists need continued and unrestricted access to all herbs to be effective.

Holistic herbal practitioners, as a matter of course within their discipline, take the time to listen carefully to the patient to determine where in his life the natural pattern is going wrong. Is it faulty nutrition, lack of proper exercise or inability to manage stress? The herbalist looks for the underlying cause of the complaint and the patient is encouraged to participate in the healing process by taking responsibility for his or her own health and beginning the beneficial practice of personal preventative health care.

It is important to distinguish between professional care, in which the patient benefits from the quality of the herbalist's training and clinical experience, and self-medication with over-the-counter industrially manufactured products. Nor are medicinal plants to be confused with other non-botanical products such as melatonin, DHEA or glandulars. None of these has had long-term traditional use, and none has stood the test of time insofar as efficacy and safety are concerned.

While it is appropriate to allow public access to most plants that are of a gentle nature and part of a well established folk medicine tradition, concerns are often raised about those plants that may be of a critical dosage or for those with specific contraindications. For example, convalaria majalis L., or lily of the valley, is very useful to trained herbal practitioners but inappropriate for over-the-counter sale.

Legislators in the United Kingdom have established the most cost-effective regulating solution. Under the 1968 Medicines Act, apart from a short list of poisons—such plants that the herbalists don't even use, hemlock for example—almost all the plants used in traditional folk medicine are allowed for over-the-counter sale.

The herbalists are also given the responsibility for administering those herbs that are dosage critical or inappropriate for self-administration. The act specifies that the herbalist must hold a consultation with the patient in a place that is not open to the public—not a shop—and use his professional judgment to determine the appropriate herbal treatment.

Herbalists have been protected under English law since the charter of Henry the VIII, in which they are specifically allowed to prepare their own remedies from plants. Although Henry the VIII's charter does not mention Canada by name, it legalizes the practice of herbal medicine by any “person being the King's subject, having knowledge and experience of the nature of Herbs, Roots and Waters...within any part...of the King's dominions...without suit, vexation, trouble, penalty, or loss of their goods”.

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More recently, the 1994 statutory instruments specifically exempt herbalists from licensing requirements that would have been imposed upon them by the European Community. This was the result of public furore in support of herbalists.

Specific considerations for practitioners of herbal medicine may seem of little economic significance, but it must be pointed out that the great breakthroughs in modern herbal medicine have been produced by well-trained clinical herbal practitioners, not by industrial product formulators or the scientific research community.

Canadian health consumers want to be sure that herbal products available to them in the marketplace are free from contamination, substitution, inappropriate formulation and misidentification. Government and industry support for the training of Canadian phytotherapists and phytotechnicians will contribute in the short term to our international competitiveness and benefit our long-term goal of a healthier population.

Canada's herbalists deserve the same protection as those in Great Britain and Australia. Herbal medicine and the trained professionals who practise it responsibly are an asset to the health of Canadians.

In conclusion, I would like to commend the Minister of Health, the Hon. Allan Rock, for giving us this opportunity to discuss these important issues within the context of our Canadian parliamentary system. I would suggest that the social, ecological, medical and fiscal advantages of examining and encouraging the role of phytotherapy are without precedence in their importance to the health and well-being of Canadian consumers of health care services, and that includes virtually every Canadian.

Thank you.

The Vice-Chair (Ms. Elinor Caplan): Thank you very much.

We'll have all the presentations and then move to questions.

Next is Marie Provost.

[Translation]

Ms. Marie Provost: Good afternoon. I would like to present to you today the views of the Guilde des herboristes, an association that was established in Quebec in 1995 and has over 250 members directly involved with medicinal plants either professionally or personally.

Our organization is young. Nevertheless, its members include many herbalists who have been in professional practice for 15, 20 or 25 years. Our participation today is very important to us, because we do not see medicinal plants as a theoretical issue, a potential market or a future project. We work and use medicinal plants every day.

We would like to start by demonstrating that Canadians use and will continue to use medicinal plants. Thus, it is in our interest that the legislation be viable, reflect reality and respect people's freedom of choice regarding health care. We want a proper legislative framework for the practice of herbal medicine in order to avoid promoting the illegal, underground use of medicinal plants.

We think medicinal plants occupy an important place in the Canadian health care system, one that complements medical treatment without preventing people from having access to the treatment provided by doctors and pharmacists.

There's no doubt that people are turning increasingly to alternative health treatments, both because of the failure of modern medicine to deal with chronic health problems and other problems that are poorly handled by conventional medicine, and to prevent and treat certain common, minor problems that do not require drugs initially, but may require them later.

It is important to note that medicinal plants cannot and must not be classified and treated as drugs.

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First of all, we would like to draw your attention to the fact that medicinal plants are safe. For example, one million cups of German chamomile tea are drunk every day throughout the world. While this is not scientific evidence, it is reasonable proof that these plants are safe. Nevertheless, according to Canadian law, chamomile should be classified as a drug, because it has a recognized, clinically proven therapeutic effect.

When we consider the toxicity of a plant, we cannot focus on one of its active ingredients alone that has been tested in the laboratory on rats. We must try to look at the genuine risk to health when herbal products are consumed, because that is what we are talking about here. We must distinguish between active ingredients taken from a plant and the plant itself, just as everyone here distinguishes between caffeine, and the coffee we drink.

In addition, it is technically impossible for manufacturers and distributors to treat the plants as drugs, first of all, because of the origin of medicinal plants, which come from the earth, which are agricultural products, not products manufactured in a laboratory. There's also the fact that plants, such as the camomile I mentioned earlier or peppermint, are used in bulk. It would be a serious step backward for freedom in Canada if herbal teas with therapeutic effects like drugs were to be regulated.

This would lead us to a totally inconsistent system, which categorizes substances differently depending on the form they take. Garlic, ginger and cayenne are considered condiments and become drugs when they are in capsules form, for example.

We therefore think it is absolutely clear that plants must be classified according to their toxicity, and not according to their therapeutic effect, as is done for drugs. A third category, between food and drugs, should be created for non-toxic plants with therapeutic effects.

We fully recognize the need to control and classify medicinal plants. We also recognize that many substances, which are not customarily used by herbalists, must be classified as drugs. However, we suggest that a Canadian botanical pharmacopoeia, with specific criteria for evaluating and classifying plants, be created. We recognize that plants should not automatically be classified in this category, but rather studied and categorized by a standing committee of experts on medicinal plants.

Clearly, this leads to the following question: who are the experts on medicinal plants? Pharmacists readily recognize that they need education on medicinal plants. That is very commendable. It is wonderful that pharmacists can have information about medicinal plants in order to better treat their patients, but we cannot consider them experts. Experts are herbalists, phytotherapists, botanists and ethnobotanists—people who work with, study and know about medicinal plants. Pharmacists and doctors are, rather, outside experts who could be called upon to act as consultants.

We would like to see the creation of a Canadian botanical pharmacopoeia made up of non-toxic plants with recognized therapeutic uses based on scientific and clinical evidence or traditional uses. The details could be set out in monographs in which the plant would be identified, together with the doses and parts of the plant to be used, the various types of extracts, their uses, the counter-indications and drug interactions. Some of this work has already been very well documented because many industrialized countries deal with medicinal plants using the categories of traditional medicine.

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The legislative and administrative framework of this third category and the committee of experts must be completely independent of the Drugs Directorate, because of the way in which medicinal plants work, which requires that they be dealt with specifically and separately from drugs.

We should remember that the public risk is very low, and the ways in which medicinal plants work are significantly different from the ways in which drugs work.

We therefore expect new regulations to guarantee the quality of products in use, to guarantee that the information is no longer distributed underground, but openly, and that it is fair and adequate, and that it guarantees the survival of traditional herbal medicine.

We expect the Act to sanction that every year Canadians use, process, grow, prescribe, and distribute medicinal plants. This is part of a movement by consumers to assume responsibility for their health and to exercise their freedom of choice in health matters. Thank you.

[English]

The Vice-Chair (Ms. Elinor Caplan): Thank you very much. We appreciate your presentation.

The next speaker is Ms. Linda Brosseau.

[Translation]

Ms. Linda Brosseau (Professor, Canadian Academy of Herbal Medicine): Good afternoon. My name is Linda Brosseau and I am with the Canadian Academy of Herbal Medicine, which is a school located in Montreal that trains people to become herbalists. The school has been in existence for over 14 years; we're beginning our 15th year.

We have seen hundreds of students at our academy, people who live from the daily use of medicinal plants, people who recommend them to their friends and family—I do and all the academy's administrative staff do as well. So we are talking about hundreds and hundreds of people who, in the last 15 years, have been closely involved with medicinal plants.

On Friday we were invited to testify before this committee. We thank you for the invitation. However, we were not able to submit a brief, because of the short time we had. Consequently, we held a brief meeting on the weekend, and I will be reporting the results of that meeting to you today.

[English]

The Vice-Chair (Ms. Elinor Caplan): You're welcome to submit a written brief in the future, if you wish. Just direct it to the clerk.

[Translation]

Ms. Linda Brosseau: Thank you.

We reached two conclusions. After years of using medicinal plants and practising herbalism, we realized that the Food and Drugs Act, which currently controls the use of medicinal plants, is out of date. We would go so far as to say that not only does it limit Canadians' right to use the type of medicine they prefer, it also harms them in that bottles containing herbal products cannot mention any counter-indications, for example. It has often happened that students, friends or others to whom these products were recommended had some doubts about them. Many people prescribe their own treatment without having the proper information, because the quality of the information available is not uniform.

Personally, I have seen products that could not be distributed in one store, but could be distributed in another store two blocks down the street. So the Act is not always enforced consistently, because of the very nature of medicinal plants, which work in a particular way, as Ms. provost and Mr. Stelling explained earlier. They are more than food products, but they are not synthetic drugs as defined and envisaged by the Act.

We therefore concluded that there must be a third category in the Act, a middle category, whatever it is called, that would enable us to describe and control the use of medicinal plants.

We at the Canadian Academy of Phytotherapy also believe that we need an act and we need certain parameters. We also think that all these details must be worked out consistently.

Moreover, the Academy does not think the use of medicinal plants should be substituted for traditional medicine—quite the contrary—however, we believe medicinal plants have a major role to play in the area of prevention. Thus we need an intermediate category, and we reached the same conclusions as the Guilde des herboristes—namely that a committee of experts in the field must be established.

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Of course, it would have to be made up of people from the community—herbalists—people who use plants, people who treat themselves using plants, and people with concrete expertise in this field.

The committee would define the monographs and the main rules. I can tell you that to some extent the scientists are on our side and that a great deal of work on medicinal plants is being done by scientists.

There is no need to reinvent the wheel and redo what has already been done. This has been done in Europe and elsewhere, including countries such as Australia. We can start from this basis, and also take into account the whole traditional aspect of plant use. Ms. Provost mentioned chamomile, but we could also mention other plants such as linden, verbena, and so on, which have been used for thousands of years. Moreover, millions of people who came along before us use them.

We think it is urgent that the Act be changed, to ensure the fair, effective and also safe use of plants, because the information available varies considerably from place to place. Thank you for your attention.

[English]

The Vice-Chair (Ms. Elinor Caplan): Thank you very much for your presentation. Is there another presenter?

Just to repeat, anyone who would like to submit a brief to the committee is welcome to do so. Just present it to the clerk and it'll be circulated and will become part of the record.

We're going to begin questions. Dr. Hill.

[Translation]

Mr. Grant Hill (Macleod, Ref.): Thank you for your testimony. I have a question for Ms. Provost. How many people practice this profession in the region you represent?

Ms. Marie Provost: How many people do we represent?

Mr. Grant Hill: Yes.

Ms. Marie Provost: If we were talking about professionals, there would be about 200 to 250 people who use plants professionally and make their living in this way. If we are talking about other users, there are obviously many more. You are referring to Quebec?

Mr. Grant Hill: Yes.

Ms. Marie Provost: Well of course there are many more secondary users. If we are talking just about herbalists, phytotherapists or naturopaths who use medicinal plants in their daily practice, there must be several hundred.

Mr. Grant Hill: And what training do these people have?

Ms. Marie Provost: The training is definitely inadequate. Some training programs have been established. For example, there is the Phytotherapy Academy, which provides excellent training. However, since medicinal plants do not come under an Act, anyone, at any time, can do anything at all with medicinal plants.

Clearly, asking for a legal framework requires that we set training standards and approve existing programs or change them to make them more acceptable.

Mr. Grant Hill: Thank you.

[English]

Mr. Stelling, in your brief you talk about Great Britain and a much better regime. Could you tell us how different it is from the Canadian situation?

Mr. Keith Stelling: Yes. To begin with, I was the first Canadian to qualify as a member of the National Institute of Medical Herbalists in England by studying in England for four years and doing clinical work there. There are over 200 members of that institute in England, and as I have mentioned already, under the 1968 Medicines Act herbalists are protected and allowed to practise provided they have a consultation with the patient and use their own judgment to provide the medicine required.

British law is a little different in that it tends to allow people to do things that aren't harmful generally and it assumes that most people do know what they're doing with the herbs they use, individuals. That would certainly apply to Canadians as well nowadays, because the public is well-informed.

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Under the 1968 Medicines Act the public in Britain is allowed access to just about everything except a very few plants. I've provided the very short list for you in the information. That list covers plants that are dose critical, that perhaps would not be used by the herbalist or the phytotherapist in conjunction with other things or that are not appropriate for that patient at that time.

It's very important to realize that a properly trained herbalist doesn't use burdock root, for example, to treat acne even though in all the books may say that it's a good cure for acne. We would first attempt to give them dandelion root so that they would not be dumping a lot of unwanted waste products into the bloodstream, which flares up the acne in the first place. There's a procedure in treating the patient. Herbal medicine can do pretty wonderful things, maybe even miracles, but it's only done through experience and a lot of training.

Mr. Grant Hill: So with respect to the British idea, then, about leaving things alone if they're not harmful, would you transpose that to Canada if you had your way?

Mr. Keith Stelling: Yes, I think that would be an appropriate move to make. In Britain there hasn't been any difficulty with that law since it was passed in 1968 and in fact it's been reinforced with the 1994 statutory instruments. I think it works, but I think you also have to realize that the standard of practitioners has to be elevated as well, as my colleagues have said. We have to differentiate between those who have taken this thing seriously and those who are maybe practising some other modality and adding a lot of strings to their bows.

The Vice-Chair (Ms. Elinor Caplan): Thank you very much, Dr. Hill.

Monsieur Dumas.

[Translation]

Mr. Maurice Dumas (Argenteuil—Papineau, BQ): You brought back some memories when you mentioned chamomile. I remember when I was young, and that was quite a while ago, my mother used to store dried chamomile flowers in a small metal container. My mother was Belgian, and perhaps that was a tradition that she had brought from Belgium. But that isn't the purpose of my question.

You spoke about herbalists, naturopaths and phytotherapists who are responsible for monitoring the quality of herbal products, and at some point you say that you would like to stress the good will of most small and medium-sized Canadian herb producers, who want to offer quality products. Myself, I think that good will is not enough. And when you say "the vast majority", that also raises some concerns. Would that mean that there are charlatans out there, or people who do not have the ability to assess the quality of those products?

Ms. Marie Provost: I think that's obvious in an industry where there really isn't any regulating going on. I myself have been a small manufacturer in this industry for 20 years, and I can tell you that in theory, the law is very strict, but its enforcement is extremely erratic, and as a result, we self-monitor.

There are always people in an industry who just want to take advantage of the situation, make money by offering anything, people that you refer to as charlatans. We would like to stress that the vast majority of manufacturers in Canada are small or medium-sized companies that offer top-notch products and are ready to cooperate with a committee, which would not be composed solely of manufacturers, but which would also include herbalists or people who do not have commercial interests. Most of them would be quite willing to collaborate with the government so that the law is stricter. It is quite probable that people are manufacturing just anything, right now, in any old way. We would like to see monitoring so that doesn't happen.

At present, what we are seeing is not so much the presence of dangerous products on the market. Rather, we are seeing products on the market that do not contain what they say they contain. For example, I could sell you a bottle of ginseng for $28.95 that does not contain a single gram of ginseng. Do you see what I'm driving at? That's how the charlatans are operating, but we think they are a minority.

Mr. Maurice Dumas: Earlier you were also talking about schools of herbal medicine. Are there many in Montreal or in Quebec?

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Ms. Marie Provost: There aren't many in Quebec. Actually, most herbalists got their training outside the country. Mr. Stelling went to England to study, whereas myself I went to study in the United States. That's what most of the old herbalists did.

The young herbalists, the up and coming generation, are studying in a structured school such as the Académie de phytothérapie or are doing their training with herbalists evenings or weekends. The ones who take a crash course and then call themselves therapists are the ones who use burdock to treat acne, which you shouldn't do. So you can see why I was saying a few moments ago that we agreed that a better structure is needed.

But the two go hand in hand. If no one is interested in setting requirements for a diploma in herbal medicine, because there is no area of practice reserved for herbal medicine, people will not need to get a diploma, unless they really want to be professional. Once again, it all depends on the people and the companies that produce good products because they want to. Herbalists are looking for serious training because that is what they want, and we would like the government to step in and set some minimum requirements.

[English]

The Vice-Chair (Ms. Elinor Caplan): Thank you very much.

Mr. Myers, you're next, and then Ms. Wasylycia-Leis.

Mr. Lynn Myers (Waterloo—Wellington, Lib.): Thank you, Madam Chair.

I was interested, Mr. Stelling, where, on page 14 of your booklet, it says preventative natural therapies should be encouraged as a key to cutting public health care costs. Has that ever been quantified? Do you have a handle in terms of the kind of money that could be saved here? I'm assuming that's what you're saying.

Mr. Keith Stelling: Yes, that's what I'm saying, exactly, and I'm glad you've noted that point.

I don't think any studies have been done in Canada at all. I'm sure there are studies on preventative medicine all over the world. Certainly the fact that the U.K. government is investing in what they call “soft medicine”, or natural forms of medicine, within the national health system would indicate that direction, yes.

Mr. Lynn Myers: So that is something we should try to do, or perhaps, if possible, get a handle on.

Mr. Keith Stelling: It certainly would be a good idea.

Mr. Lynn Myers: I also have a question for the Guilde des Herboristes people from Montreal.

I was really interested in your notion of a Canadian botanical pharmacopoeia. Can you elaborate on that? How would that be developed? How would it be monitored? How would it be added to or subtracted from, as needed? How do you see that being envisaged?

[Translation]

Ms. Marie Provost: Obviously, we could base ourselves on botanical pharmacopoeia that are already in existence in other countries. For example, there is a botanical pharmacopoeia in Britain, and various countries have specific ones. So the models do exist. We would like this pharmacopoeia to include all the details that would specifically identify the therapeutic agents so we can ensure, first of all, that the herbal product that is being sold is safe, and secondly, that it does have the therapeutic effect claimed.

Let's take the example of our well-known chamomile flowers. If we gather the flowers at the wrong time, or if we use chamomile leaves rather than chamomile flowers, we lose the therapeutic usage. For that reason, it is important for such considerations to be clearly set out in a basic structure so that these products can be developed.

Secondly, the standards vary a great deal. Consequently, with our manufacturing practices, which currently are those used by the pharmaceutical industry, obviously the inspectors have a great deal of trouble dealing with the fact that our raw materials come directly from the field.

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In contrast, good manufacturing practices say nothing about the maximum amount of weeds allowed in raw materials, which is an important consideration for a botanical product. So there should be specific criteria for that.

For the most part, these criteria are technical, such as microscopic and macroscopic identification, to keep certain substances from being mixed in with various botanicals or replaced by the substances. The plant should be properly identified, which is not always easy when you are dealing with a dried plant. For this reason, microscopic and macroscopic identification is needed. All these very technical considerations already exist, and we would like a committee to endorse these criteria.

We have studied a number of pharmacopoeia, but we do not want to adopt any of them in their entirety. We should look at them and observe them, and then define the therapeutic uses and the contra- indications, which a committee could endorse on the basis of the existing literature. I would like to reiterate that there already is a great deal of literature, which has been very well supported, and over the past 10 years, a great deal of work has been done in this area at the international level.

[English]

The Vice-Chair (Ms. Elinor Caplan): Thank you very much. Ms. Wasylycia-Leis.

Ms. Judy Wasylycia-Leis (Winnipeg North Centre, NDP): Thank you, and I'd like to thank all the presenters for your very thorough overview on this matter.

I have a couple of questions. My first question is, are you all members of the Canadian Coalition of Herbal Associations? The reason I'm asking that is that Michael Vertolli, who appeared before our committee representing the Canadian Coalition of Herbal Associations, is also on the advisory panel looking at the development of a regulatory framework for natural health products. So I'm wondering first of all if there's one voice that speaks for all herbal associations in this country or not, and second, what your opinion is of the draft framework—if you've seen it—as delivered to this committee on February 3. That's one question. I'll do it all at once and then you can pick and choose.

My other question is this. Many of those who have appeared before this committee who are users, consumers or beneficiaries of herbal medicine have said to us that we don't need to change the legislation at all, we don't need to set up a separate category. We need to stop all these unnecessary restrictions on products that have been deemed safe for thousands of years. We need to enforce the regulations now so you deal with the question of labelling, dosage and the substitution of products. And we need some sort of capacity in the federal government for a scientific overseeing of the herbal marketplace. So my question to you is why do we need legislation? I think you're very clear, Keith, in terms of legislation. Why do we need legislation?

Mr. Keith Stelling: I think one of the reasons we need legislation is to make sure we don't have products that are contaminated, contain herbs that are substitutions or plants that are misidentified. In order to do that, the European system as it exists and also the British system require that there be a strict following through of the botanical identification of the plant from the field right until the product. This is something that's not done in Canada, and it's something that is almost embarrassing and will cause accidents eventually, and has already, by our not requiring the botanical name, the scientific name, for all the products that are on the market.

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It's very important that we have labelling that's parallel or similar to that of the British compendium. Some of the European monographs also require certain kinds of labelling.

For example, consider herbal laxatives. Those would be plants such as senna. Germany and France require, according to the British Herbal Compendium, that a warning be put on the label of those products to tell people that there are other ways of improving constipation, i.e., drinking water, increasing exercise, and taking more fibre. That's a requirement of the government on every product.

In Canada, the problem is that we have many of those products that are distributed by pyramid sales, and many of them contain laxatives, a lot of laxatives. Those laxatives, in any case, are addictive.

A herbalist such as I would never use a laxative. That's the last resort. But if you have over-the-counter sales, then that's the first thing the person thinks of. So with some help that way, there would be a better safety net.

There's another thing that Dr. Frank Chandler suggested when we were on the expert advisory committee together. He said we should set up, perhaps with one of the universities, a proper scientific laboratory for testing the properties of the medicinal plants that are in the products. Apparently at the moment that's not really being done.

Another thing that would improve the whole situation would be if Canadian industry were to share research the way the British Herbal Medicine Association does. This association is a group of manufacturers who share research and also participate in ESCOP, the European Scientific Cooperative on Phytotherapy, which is again a research-sharing body. These are manufacturers who are producing and not competing with one another in that way.

Am I getting anywhere near an answer to your question?

The Vice-Chair (Ms. Elinor Caplan): Thank you very much. That was a very complete answer. You've used up all of the time, but there will be another round.

Mrs. Ur.

Mrs. Rose-Marie Ur (Lambton—Kent—Middlesex, Lib.): Thank you, Madam Chair. You'll have to excuse me for some questions that I may ask. I'm on the committee, but unfortunately the other committee I'm on conflicts with this.

I've been reading quickly all the material you provided. I find something rather interesting. Maybe it's just a coincidence. In all the material, it's always the affordability before the preventative aspect. I would hope it would be the good part, and then the affordability would come second.

Mr. Keith Stelling: I think we have to explain that herbalists are usually idealists. When we come to people who are spending the nation's cash, we think we have to be practical. So we're stressing affordability, but certainly in the long term you're improving the health and the well-being of Canadians. That's the underlying—

Mrs. Rose-Marie Ur: Being a health care professional, I guess I see the opposite.

Mr. Keith Stelling: I think we do too.

Mrs. Rose-Marie Ur: I find it interesting—maybe I can refer to your brochure here—that you personally make up your medication, your herbal products. How many providers of natural health care grow the product and also put the products together? Is this a common practice?

Mr. Keith Stelling: I'm afraid it's very, very uncommon. I'm one of the few inside the institute even who still does it. But I believe—I always have—that we want to maintain that knowledge in Canada. That's why I went over to England to train: I wanted to bring it back.

We need to be able to do that to survive if we need at some point.... What happens if our currency hits the rocks and we can't get international exchange? That was one of the things that was a concern for the British during the war, when imports were very difficult and they started to rely on some of the native medicinal plants from the British Isles.

Mrs. Rose-Marie Ur: Let's look at your brochure, “Your Visit to the Herbalist: Self-Diagnosis or Self-Treatment”. When someone goes to you in the clinic, do you draw blood? What do you do? Do you look at that person? Do you look at their eyes to see whether they're yellow or white? What determines what that person needs? What determinants do you use?

Mr. Keith Stelling: I sit down with the patient for an hour and a half every time in the first instance, and a hour every time after that, and I take the whole history of the case from the beginning.

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If I can give you an example, one gentleman who is still alive who came to see me near the beginning of my practice thought he had a bleeding pile or hemorrhoid. I said that he could have some herbal treatment for a hemorrhoid for two weeks, but if it was not better when he came back again, then he did not have a bleeding hemorrhoid or pile and he would have to go to the doctor. Eventually, after two weeks when nothing had changed—he was still bleeding—we persuaded him to go to the doctor. It was a lot of persuading, because this is part of the public that doesn't normally visit doctors. The doctor sent him straight to the surgeon; the surgeon sent him straight to the hospital; and he had a tumour taken out of his rectum within approximately two weeks.

If I hadn't been able to listen to him and be suspicious—because we are taught those warning signs in medicine in our training—then that man probably wouldn't be alive today.

Mrs. Rose-Marie Ur: Is that normal practice by all herbalists?

Mr. Keith Stelling: I think all herbalists are very, very careful. That's the trouble with us. We're extremely conservative. We'll give you a pinch of something rather than a teaspoon.

A witness: We have no insurance.

Mrs. Rose-Marie Ur: I was reading all your credentials. Is there an apprenticeship program or an internship program after you've done your schooling, and how long is that?

Mr. Keith Stelling: Yes, there is indeed. It's approximately another half-year, and at the end of that apprenticeship you're required to sit an examination in front of members of the institute and medical doctors—I think on mine there was even a psychiatrist—and examine the patient and prescribe the medicine that would be appropriate.

Mrs. Rose-Marie Ur: Who determines that it's appropriate?

Mr. Keith Stelling: In my case it is the National Institute of Medical Herbalists. Those are phytotherapists and herbalists who have been trained at the School of Phytotherapy with a four-year training, or the University of Exeter or the University of Wales now, and also the University of London. These are people who have been very widely experienced in their professions and who have contributed a lot.

Mrs. Rose-Marie Ur: I see you mention Great Britain and Australia and other countries. What are Canadian schools lacking to provide the same equivalent?

Mr. Keith Stelling: High standards.

I have to agree with Marie Provost. We need encouragement. We need to get this onto a university level, I believe.

Just by way of the danger of practising herbalists, let's remind ourselves that pharmacists don't know anything about these plants, but they've suddenly invaded the pharmacies. They have to sell them.

There was an error not long ago in my area where the pharmacist prescribed to the person in the store the wrong kind of ginseng; instead of eleuthrococcus sinticosus for women, he gave her something for men, a different kind.

Mrs. Rose-Marie Ur: I've also heard the same—

The Vice-Chair (Ms. Elinor Caplan): Your time is up, Mrs. Ur.

Dr. Hill, did you have a question? I don't have you on the list.

Mr. Grant Hill: Yes, I do indeed.

I'm quite interested in the products that aren't on the market in Canada today that should be. I've got your list of the things that are allowed and disallowed in Britain and in Australia. Could you compare what is allowed here and what is not with the situation in Britain?

Mr. Keith Stelling: Well, at the moment it seems to me that everything is allowed, and all sorts of products that I've never seen before have suddenly inundated the health food stores. So I don't know what is not allowed. I would have to get some clarification on that from Health Canada, because I don't know.

Normally one would think that poisonous plants such as hemlock, for example, the poisonous group, would not be allowed.

I'm not sure that I understand the question.

Mr. Grant Hill: You've answered my question very well, because you've pointed out the fact that the regulatory framework in Canada for your group is very relaxed. We're hearing from many other groups that the regulatory framework is restrictive and narrow and many products are not allowed.

Mr. Keith Stelling: I think the board is sporadic, and I'm referring to the present moment. If I had talked to you a year ago, when I was terrified that the RCMP was going to shut me down for dealing in drugs, I would have given you a different idea, because then we had a list of plants that we couldn't touch, including cayenne pepper...and how that was going to be taken off restaurant items. I don't know.

[Translation]

Ms. Marie Provost: The theoretical framework of the current legislation is there, but enforcement of the law is totally erratic and really unpredictable.

• 1630

As Mr. Stelling was saying, we talk to each other quite a bit. Canadian herbalists consult each other to try to understand what herbs are allowed this month, what herbs are not allowed, and what we should do this summer, and what we will not be able to do this fall, and the list goes on.

Although the legislative framework is very restrictive, enforcement of the law isn't always so, although sometimes it is, and when you have a practice such as Mr. Stelling's or when you are a small manufacturer, this is extremely stressful, and it keeps you from managing your day to day activities properly. This problem led to some small companies shutting down, because they couldn't deal with the stress and the lack of understanding anymore.

We try to get the infamous list that Mr. Stelling mentioned from Health Canada periodically, but they just give us the runaround. It's all very vague, very fuzzy.

Mr. Grant Hill: Does Health Canada have experts in this area?

Ms. Marie Provost: Personally, I haven't met any. No, not really. As far as I know, they don't have any experts in medicinal plants. I believe there was one, Dr. Awang, who used to work for Health Canada, but he isn't there anymore. He is an expert in medicinal plants.

As far as I know, there are not any experts for the time being and this is noticeably the case in the application, not of the Act but of certain regulations. Certain plants are prohibited in Canada when they are allowed in the rest of the world merely because of an improper interpretation given to an old text or a mistake in identifying the correct botanical species. So there aren't any experts.

Mr. Grant Hill: In your opinion are there any serious problems with medicinal plants as far as morbidity and mortality is concerned?

Ms. Marie Provost: No, not at all. Have you heard testimony from a lot of witnesses about the many cases of mortality brought on by medicinal plants in Canada? There was some business about some people supposedly dying because of ephedra but whenever precise information on such fatalities was asked for, no proof or documentation was submitted.

There was, I believe, one death and a few relatively serious incidents resulting from the consumption of ephedrine whose active ingredient is the alkaloid of the ephedra. But that would be like saying that coffee is dangerous because it contains caffeine when caffeine is clearly not being taken by the spoonful. We do not sell ephedrine, or ephedra, in fact, since it is forbidden by the legislation but that is something different.

Mr. Grant Hill: Thank you.

[English]

The Vice-Chair (Ms. Elinor Caplan): Thank you very much.

[Translation]

Mr. Drouin.

Mr. Claude Drouin (Beauce, Lib.): I'd also like to thank you for coming to make such a clear presentation to our committee.

I'd like to know, Ms. Brosseau, whether your school is the only one to provide training to herbalists in Canada or whether there are any others?

Ms. Linda Brosseau: No.

Mr. Claude Drouin: Are there others?

Ms. Linda Brosseau: Yes, certainly. The Academy of Herbal Medicine is a Montreal school that attempts to provide the best training possible. But no, that is not a particular responsibility we have been given. There is no particular school in charge of the training of herbalists in Canada. There are schools that provide this type of teaching but as was previously explained, there is no real standard and each does the best it can according to its knowledge and abilities.

Mr. Claude Drouin: But what are your requirements for the training of herbalists?

Ms. Linda Brosseau: In the Canadian Academy of Herbal Medicine our number one requirement is to have a B.A. We want our students to have a university degree because our teachers are specialists. We have 350 hours of anatomy and physiology, for example, and these courses are provided by specialists with university degrees in the subjects. Those who are responsible for nutritional training are nutritionists. They are all specialists in their field.

This means that our courses are at the university level. They require four years of full-time study. It's very demanding. That's why the minimum requirement is a DEC, in the absence of a B.A., so that the student will be able to keep up.

Mr. Claude Drouin: Thank you.

Ms. Provost, you referred to a minimum framework. Why a minimum framework? Couldn't we have the safest framework possible? I'd like to be sure I understand what you mean by "a minimum framework".

• 1635

Ms. Marie Provost: I talked about a minimum framework as a basic framework and I'd like to stress the safety and non-toxicity of the substances we work with. At the very least we must ensure that what we are talking about is what we want to sell and we must establish criteria to distinguish between what is toxic and what is not. That is the very least from the safety point of view.

When I talk about a minimum framework, I'm also referring to the fact that in the application of herbal products there is a whole range of concentrations. Let me take the example of a plant that is very popular at the present time, echinacea. You know that this plant can be sold as a simple herbal product and there can also be a higher standard or different concentrations with a standardized extract guaranteeing a minimum amount of the active principle.

When we talk about a minimum framework, we are referring to a minimum level of guarantee provided in the sale of herbal products: there is a lot of echinacea which is the right part of the plant harvested at the proper moment without it being a pharmaceutical product, in other words the extract of the active principle of this particular plant. There is a difference between the minimum framework as far as the plant as such is concerned and a more refined extract.

Mr. Claude Drouin: Would you be favourable to having Health Canada establish regulations for training as well as the appropriate criteria to ensure that the product is properly identified?

Ms. Marie Provost: For the identification? Yes. We are asking Health Canada not to transfer the administration of a third category to the Drugs Directorate which, in our view, is no more qualified to regulate medicinal plants than food. We do however believe that standards must be defined by an appropriate committee of experts.

Mr. Claude Drouin: Would the experts be chosen by you or...?

Ms. Marie Provost: The experts would be appointed by the government of Canada. I'm not particularly familiar with the administrative and government structure but I can say that we do not claim that we should be able to chose our experts ourselves.

At the same time, we do expect the experts to be recognized as experts. We would like fair representation on the committee of experts and I think that there are fully competent and independent people who could sit on the committee.

Mr. Claude Drouin: Thank you. Thank you, Madam Chair.

The Chairman: Thank you, Mr. Drouin.

[English]

As I have no one else on the list at this time, I'd like to take the opportunity to ask a few questions. Ms. Wasylycia-Leis will go next.

I thought I might take the chance to sum up what I have heard, and then you can see if I've heard it correctly. If not, please feel free to say that's not what you've asked for.

I've heard you say you believe there should be assurance for the Canadian public that herbal products are safe, are of good quality, and that there is an alternative process within Health Canada for the assessment of these products, because they are neither food nor drug under the existing Food and Drugs Act. Health Canada needs expertise, whether it's within or a panel or some method of judging, as part of this alternative process. Herbal products can be harmful and high-risk and poisonous or no risk; there's a range, often depending upon the concentration or the very nature of the plant. You mentioned hemlock as one example of a poison. So you would expect that there would be a clear list of those things that fell into that, whether banned or severely harmful...that would be accompanied with warnings or not permitted for use.

• 1640

The last point you made was about professional regulation of individuals. That one, I would point out, is in provincial as opposed to federal jurisdiction, so it's not something this committee can deal with.

The question I would ask you is in the one area I don't think I heard you address, and that has to do with claims the products make. It's a simple question. Do you believe products that make a claim should be required by this alternative process to prove their claim?

Mr. Keith Stelling: The fact that the European regulations already allow certain claims would probably speed us along the way...rather than reinventing the wheel.

The Vice-Chair (Ms. Elinor Caplan): They allow certain claims without proof...or what you're saying is that there's international evidence that could be accepted.

Mr. Keith Stelling: Yes. Based on the ESCOP monographs, the German monographs, and the European research that has been done, but also the British herbal pharmacopoeia and the compendium, of course.

The Vice-Chair (Ms. Elinor Caplan): Make this yes or no. Do you think if a claim is made, evidence should be produced to back up the claim?

Mr. Keith Stelling: The evidence already exists in the traditional information that is available.

The Vice-Chair (Ms. Elinor Caplan): So your answer would be yes; yes, but not necessarily to the same standard as pharmaceuticals. Is that—

Mr. Keith Stelling: Yes, on the basis of our traditional usage as we have it documented.

The Vice-Chair (Ms. Elinor Caplan): So yes, but within an alternative process that doesn't hold it to the same efficacy requirements as pharmaceuticals.

Ms. Mona Rainville (Member, Ontario Herbalists' Association): Madam Chairman, I'm glad you bring up this point, because it is the crux of the problem. At present, according to the law, herbal medicines must comply with the same regulations as pharmaceuticals; i.e., man-made materials. The problem in that compliance resides in the fact that man-made materials are substances totally foreign to the human body. They have to be investigated. They have to be tested first on animals and eventually through clinical trials—lengthy, costly, with ethics codes and what not—that are not suitable for God-made material; God-made materials that have been around for, in many cases, more than centuries, thousands of years.

When we're talking about herbal medicine, we are talking about a tradition; and by definition a tradition is proven. If the answer to your question is yes, then understated to this “yes” we must understand that the standards through which herbal medicines are proven are daily applications through thousands, millions of herbalists throughout the world. That is reflected in the names of the plants we use: Calendula officinalus, for example, where “officinalus” means “as used medicinally”.

So, yes, of course some guidelines must be adhered to in order to prevent false claims by would-be opportunists coming into the field. Absolutely. But does this mean herbalists must be restricted to the same clinical trials as manufacturers of new substances have to adhere to? I think not.

The Vice-Chair (Ms. Elinor Caplan): Ms. Wasylycia-Leis.

Ms. Judy Wasylycia-Leis: I still don't have a clear answer to this whole issue of why we need a third category, or legislation to create a new category. If you can put in place regulations to guarantee quality assurance or botanical authentication, if you can put in place proper criteria to evaluate all products on the basis of authentic herbal products, and not substitutes, with no contaminants added; if you can address the issue of toxicity; and if you can enforce, through existing regulations, proper labelling, then why do we need another category, and legislation?

• 1645

Ms. Mona Rainville: First of all, let me explain who I am. I'm a lawyer. I'm also a herbalist, and have been for 27 years. I'm also a homeopath. I wear many hats.

As a lawyer, I can tell you that no law exists in a vacuum. Right now the Canadian legal context is such that when you bring in a herb from a foreign country, by law it has to be sprayed at the point of entry with fungicides, etc. So right away we have a problem there.

We also have a problem within the existing law, the Food and Drugs Act. The Food and Drugs Act was promulgated at a point in time when pharmaceutical companies were becoming mavericks in the field of health. Certain concessions were granted within that law that make it very difficult for anyone else to function—for example, annex A; for example, the definition of “practitioner”; for example, all the 1,057 different annexes referring back to this particular act, which essentially all deal with man-made material or devices, none of which reflect at all the reality of herbal medicine in its context and its application.

There are different ways we can actually legislate and ensure efficacy and safety to the Canadian public and provide a structure that would allow herbal medicine not only to continue to exist but also to thrive and to become an adjunct to the existing medical therapies also available to Canadians.

I understand the honourable Grant Hill has proposed, or will be proposing, a bill modification, but if we were to take the existing act and essentially use scissors and scotch tape to make modifications to this act, that's all we'd have—makeshift legislation that basically does not address at all the framework required to deal with herbal medicines. It is not the suitable instrument.

Britain has recognized this. The Europeans have recognized this. Australia has recognized this. Fortunately, at this point in time we are able to draw experience from various other legislations that, I assure you, are totally valid and seem to work perfectly well. We should actually use those models. We don't have to reinvent the wheel.

To answer your question, then, no, the current Food and Drugs Act cannot simply be modified, because it was not designed to encompass, ever, herbal medicine. In 1958, as a matter of fact, the Canadian pharmacopoeia, which was a herbal pharmacopoeia, was abolished to essentially make room for man-made materials.

So we're in fact saying that maybe in 1958 we threw away the baby with the bathwater. It's time to wake up and possibly go back, admit that perhaps we were a bit hasty, and provide guidelines and a legislative framework that would allow herbal medicine to thrive.

The Vice-Chair (Ms. Elinor Caplan): Thank you very much for your presentation.

We have time for only one more question. Research has asked to pose a question. With the approval of the committee, I thought I'd allow the researcher to pose a question.

Is that agreed?

Some hon. members: Agreed.

Mr. Gérald Lafreniere (Committee Researcher): I'm wondering if you guys would propose a different regulatory framework for products that are in their natural state as opposed to products that have been synthesized—in other words, in dosage form.

Mr. Keith Stelling: I certainly would want to make the distinction—and certainly the British legislation does make that distinction—between the plants in their original form, which we feel probably have a lot safer area of activity, because the natural plant contains buffers, tannins, mucilages and all sorts of other constituent elements that protect against the overactivity of the main constituent. When you single out one constituent you get into trouble, and that, as far as we're concerned, is the trouble with synthetic pharmaceuticals and their side effects.

• 1650

The Vice-Chair (Ms. Elinor Caplan): Thank you very much for an excellent, thought-provoking presentation.

Mr. Joseph Volpe (Eglinton—Lawrence, Lib.): Madam Chair, perhaps I might be allowed just a very brief comment.

The Vice-Chair (Ms. Elinor Caplan): The parliamentary assistant would like to make a comment.

Mr. Joseph Volpe: Secretary.

The Vice-Chair (Ms. Elinor Caplan): Parliamentary secretary, sorry. That's my provincial background.

Mr. Volpe, parliamentary secretary.

Mr. Joseph Volpe: I enjoyed the presentations and I thank you for them. Some of my colleagues might think this is a little superficial and frivolous, but I couldn't help commenting to myself that this has to be the youngest group of people who have appeared, and then I looked at the qualifications of some of the individuals present. You triggered it, Madam Rainville, when you said you have been a herbalist for 29 years, and I said okay, so the clock works in reverse.

Do you do this because all you do is treat yourselves with herbs or is there a special...?

Some hon. members: Oh, oh!

The Vice-Chair (Ms. Elinor Caplan): On that note, the committee stands adjourned. Thank you.

The meeting has adjourned.