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Cablegate: Health Minister Announces Strategy On Cross-Border

This record is a partial extract of the original cable. The full text of the original cable is not available.




E.O. 12958: N/A


1. (U) Summary: Health Minister Dosanjh announced that the
GOC will take three steps to address the cross-border drug
trade: 1) create a drug supply monitoring network, including
input from both public and private stakeholders, to determine
whether there are drug shortages or threats to the Canadian
drug supply; 2) seek legal authority to ban bulk exports in
the event of a drug shortage or "when it is necessary to
protect the health of Canadians;" and 3) require an
established doctor-patient relationship for prescriptions.
Pharmaceutical industry associations are hailing this as a
good first step, while internet pharmacies are already up in
arms at the new attack on what Dosanjh deems the "unethical
conduct" of doctors' cosigning prescriptions. Dosanjh says
that it was never his intention to kill the internet pharmacy
industry and that he is sure that the industry "will adapt."
End summary.

Drug Supply Monitoring Network: More than anecdotal evidence

2. (SBU) Following months of hints and speculation, Health
Minister Dosanjh received Cabinet go-ahead to announce three
new initiatives to stem the flow of prescription drugs from
Canada to the United States. The first initiative is the
establishment of a drug supply monitoring network, to be
housed in Health Canada, which will work with the provinces,
territories and other stakeholders to provide Health Canada
with more comprehensive drug supply data. This initiative
should not require any legislative changes, and thus will be
the easiest for Health Canada to implement. (Note: An
industry contact suggests that Health Canada may encounter
resistance to monitoring at anything beyond a wholesale level
because of the commercial confidentiality involved.) In
declaring a threat to Canada's drug supply from cross-border
trade, Health Canada has frequently run into the difficulty
that there is limited empirical evidence of any drug
shortages. The formation of a drug supply monitoring network
will give Minister Dosanjh evidence beyond anecdotal accounts
from pharmacist associations and patients groups to support
his contention that the cross-border drug trade poses a
threat to Canada's drug supply.

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Bulk Export Bans "if and when necessary"
3. (SBU) Second, the GOC also intends to introduce
legislation to amend the Food and Drug Act to allow Health
Canada to ban bulk exports in the event of anticipated or
actual drug shortages (note: GOC is reacting to possible U.S.
legislation allowing bulk inports of drugs from Canada).
Despite questioning, Minister Dosanjh did not make it clear
whether the GOC intends to impose bans as soon as legislation
is passed or act only when there is a threat of shortage of
"prescription or other needed" medication. A pharmaceutical
company representative called this portion of the
announcement "ambiguous", and Minister Dosanjh further
muddied the waters by at first saying that the GOC would
"possibly introduce legislation" and then, under questioning,
saying that the GOC will definitely introduce legislation.
(Note: Local stakeholders inform us that the insistence on
modifying language rather than an outright ban may have come
from resistance at the cabinet level, possibly prompted by
the fact that an outright ban could block legitimate domestic
drugs produced for export to foreign markets.)

Unethical Conduct: Thou shalt not...kill the internet
pharmacy industry?

4. (U) Finally, in keeping with his previous insistence that
prescription cosigning is "unethical" (ref Ottawa 0525),
Minster Dosanjh intends to propose measures to "strengthen
existing federal regulations under the Food and Drugs
Act...to require an established patient-practitioner
relationship." This initiative prompted the most intense
questioning at the press conference, including repeated
questions at to whether the requirement of an established
patient-practitioner relationship would "kill the (internet
pharmacy) industry." Minister Dosanjh stated that he
"...never intended to kill the industry" and said that he was
"sure the industry would adapt." When pressed to clarify
what is meant by an established patient-practitioner
relationship, Dosanjh answered "A doctor-patient relationship
means a doctor-patient relationship" and explained that he
expected foot traffic by Americans traveling to buy drugs in
Canada to continue and that he would work to ensure that
Canadian snow-birds would still have access to drugs from
Canada. Representatives of the internet pharmacy industry
say that actions against cosigning would have a major impact
on their industry.

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