Marcus Powlowski

Mr. Speaker, I want to thank the member for his intervention, although I ended up feeling a little confused. He started off talking about Liberal policies stalling and stifling major projects. In this bill, my understanding is that both the impact assessment and the permitting would be done concurrently and over the course of a year. I would think that would address his problem with our stalling major projects. Then he went on, and it seemed that at the end he was criticizing the one year as not being enough. Exactly where does the member stand on the one-year timeline to get projects approved?

Mr. Speaker, if we as Canadians ask ourselves what things, what events, define who we are as a people, I think we would be hard-pressed to find anything more quintessentially Canadian than the triumphant moment when the captain of the Stanley Cup-winning team hoists the cup over his head. It is the moment many of us grow up dreaming about. Very few of us actually get to live that dream. However, one of my constituents did last Sunday, as Jordan Staal accepted the cup on behalf of the Carolina Hurricanes, hoisted it in the air and, for a moment, became king of Canada. Not only that, but he won the Conn Smythe Trophy as the playoff most valuable player. Sincerely, I think a lot of Canadians would agree with me in saying that life does not get any better than that. I offer my congratulations to Jordan, and we look forward to him bringing home the cup this summer.

Mr. Speaker, I have the honour to present, in both official languages, the first report of the Special Joint Committee on Medical Assistance in Dying, entitled “Medical Assistance in Dying and Mental Disorder as the Sole Underlying Medical Condition: A Complex and Challenging Conversation Among Canadians”. I would like to thank all members of the committee, including members from the opposite side of the House, for their valuable contribution to the report.

Mr. Speaker, I talked about this bill a month or so ago at some length, and I am certainly not going to try to repeat that right now. I would like to, first and foremost, thank everybody here for staying up and being here, and the many people who actually seem to have read and understood the legislation. I have to say that a lot of the comments that we received, especially from the other side, were excellent comments. I have certainly taken them to heart. I would also like to thank those people with some experience with the program or those with family members who have benefited from the program. It is those kinds of experiences more than anything else that have motivated me in writing this bill. I would like to thank the very many people who helped me draft this bill, which I did not do the first time around. Let me start off with the SickKids hospital in Toronto. The Hospital for Sick Children is the number one ranked children's hospital in the world. I dare say, if our country ought to be good at one thing, it would be looking after the health of kids. I am really proud to have, at one point, actually studied at the SickKids hospital. It came to me a number of months ago with a number of valid concerns about the special access program and has been of tremendous assistance to me in drafting this legislation. I know I cannot refer to anyone in attendance in the gallery, but if I could I would refer to some people from SickKids, namely Dr. Charlotte Hepburn and Katherine Aldred. There are a couple of people who I do not think are here, Tamana Hafid and Rida Anmol, who are lawyers who work for the hospital. Let me also mention tangentially RareKids‑CAN. They worked along with SickKids in drafting this bill. I also want to thank my colleagues at Sainte‑Justine Hospital in Montreal who helped me a great deal with this bill. I especially want to thank the hospital's excellent chief pharmacist, Denis Lebel. I would also like to thank Catherine Litalien and Dr. Nguyen. I would also like to thank the doctors and pharmacists at a number of hospitals across Canada: Princess Margaret; Health Sciences Centre Winnipeg; Alberta Children's Hospital; BC Children's Hospital; Dr. Nigro and Dr. Del Paggio at Thunder Bay Regional Health Sciences Centre, who contributed in different ways to this; and Mrs. Lori Anderson and Dr. Philip Kuruvilla. Let me briefly mention a couple of the concerns that came up, both today and the other day, in debate. One of them was a concern about the two-doctor override and having too much faith in two doctors. From my experience at the MAID committee, I certainly share the concern about having too much faith in doctors. I think part of the answer lies in the regulation of the profession, particularly with specialists. The law requires two people with the requisite knowledge; they would be specialists. Certainly, if we are going to question their behaviour of prescribing things that may be inappropriate, the appropriate body to address that issue would be the Royal College of Physicians and Surgeons. I would also point out that in the law itself there is a section that allows the minister to prohibit the use of a drug if they believe the use poses a risk to health. I have, as a result of the concerns, suggested and would entertain an amendment that it be three physicians rather than two. I would also suggest there is a possibility that the advisory board, which would advise on a pre-approved drug list, would also advise the minister with respect to the special access program and have a role in recommending to the minister that perhaps there should be restrictions on the use of a drug under the program. Lastly, the issue of controlled substances is very important to me as well. I would hate for this law to fuel the fires of the drug problem that is ravaging our country. I will work with the members of the opposition on the issue to make sure there is no diversion. I will work with the members on the opposite side on all the provisions, because certainly there is a lot of work to be done here. I will do my best to work with everyone to that end.

moved that Bill C‑265, An Act to amend the Food and Drugs Act (List of Therapeutic Products Pre-approved for Special Access), be read the second time and referred to a committee. Mr. Speaker, Canadian physicians are, at times, even in life-threatening situations, prevented from using the drugs they believe they should be using. My private member's bill looks to change this by making significant changes to the special access program, or SAP. These changes would considerably reduce the red tape associated with the program, create a pre-approved drug list for medications frequently requested and approved, and allow pharmacies to stock many life-saving medications in anticipation of their use. Furthermore, it would transfer the authority to make difficult decisions about whether to use an unapproved drug in a life-threatening situation, where the evidence of the efficiency of that drug is unclear, to the expert clinicians rather than the bureaucrats in Ottawa. The SAP was created under the food and drug regulations. It states that medications not approved by Health Canada may be made available for medical emergencies, which Health Canada interprets as “serious or life-threatening conditions when conventional therapies have failed, are unsuitable, or unavailable” in Canada. Why are medications not approved by Health Canada? There are several reasons. Sometimes these are medications that are still undergoing clinical trials, but at times there are medications that have gone through vigorous testing. For example, the Princess Margaret Cancer Centre in Toronto told me that they are frequently part of big, randomized control trials. It can take four years from the time those trials show efficacy to the time they are actually able to give those medications to people. On average, it takes Health Canada a year to a year and a half longer than the FDA to approve a medication. For other medications, including, at times, medicines that have been previously approved in Canada, or medicines for rare diseases, the Canadian market is simply too small or the profit margin is too slim for manufacturers to want to seek approval in this country. Many drugs that are available under the SAP have been widely used for years. For example, IV caffeine, which is routinely used in neonates, was, for a long time, available only through the SAP. Similarly, ibuprofen lysine, which is a treatment for patent ductus arteriosus in premature infants, has been used for over 30 years, but again, only through the SAP. IV methadone, to prevent narcotic withdrawals in ventilated patients, has been available in the United States for over 20 years, but in Canada it still requires the special access program. As well, for drugs for rare diseases, the number of patients who have been treated may be too small to be able to statistically prove efficacy, which is what is required for Health Canada approval. Currently, medications that have not been approved by Health Canada can be accessed through the SAP or an N-of-1 clinical trial, with one patient, which is an even more cumbersome process. The SAP and the clinical trial process need to be reformed. Before telling this House some of the troubling stories as to why, let me say that I know there are a lot of really good people working for Health Canada. When I talked to clinicians about the SAP, many told me that, in general, Health Canada people were really good. However, many pharmacists, particularly pharmacists working in children's hospitals, told me about having to spend considerable time each week faxing or on the phone with the SAP, often for drugs they have been using for years. They repeatedly have to fax requests for the same medication the same week. Setting up a clinical trial with an N of 1, which is required for rare diseases and experimental drugs, is even more cumbersome and costly, so much so that one children's hospital told me they simply do not have the resources to do that. In another case, an ICU doctor at a children's hospital told me of spending six hours resuscitating a child with liver failure and bleeding esophageal varices. For four hours during that time, the pharmacist was on the phone trying to get approval for a drug that is the first-line treatment for this condition in the United States. They had it on hand, but it required SAP approval. Finally, they got it. The child lived. However, the clinician told me that had that child been on that medication to begin with, the child would have never been in that situation. In addition, I have heard of numerous cases of progressive neurological diseases in children where access to a medication that would have significantly delayed the progression of the disease was refused, stayed or significantly delayed by requiring it to go through the clinical trial process. This is even though, as one pediatric neurologist told me, if a kid is started on this medication while the kid is still able to walk, the child will continue to be able to walk, and if it is started while the kid is still is able to speak, the kid will continue to be able to speak, but if this is not done, the child will not be able to. Infectious disease people were particularly critical of the current program. One hospital told me about a neutropenic child, which means they have a low white blood cell count and are susceptible to infection, who had sepsis due to a drug-resistant organism. The hospital had the antibiotic, but it was only available through the SAP program. It was 5:30 at night and neither the SAP program nor the manufacturer were available. As a result, the child was only started on the antibiotic the next morning, 18 hours later, even though the evidence clearly shows that antibiotics ought to be started in the first hour in this situation. Another infectious disease specialist told me of having a patient in their ICU, again due to a drug-resistant organism. The patient was in their thirties. The drug could only be accessed through the special access program. It took seven days for approval. Unfortunately, the patient died one day before that. This specialist told me this was not uncommon. He also said that, if Health Canada did not think there was a problem, it was because it did not have to look family members in the eye and tell them that their loved one died when there was a treatment that could have saved the patient. In another case, a newborn with a mother who was HIV positive, the child should have received antiretrovirals within six hours. They applied, and the antiretroviral was given at 15 hours, even though it was yet to be approved. Health Canada finally came through with the approval 48 hours after it was requested. Someone from Alberta Children's Hospital sent me a very nice email. They told me they had recently conducted a retrospective review of all patients who received two antibiotics before and after the introduction of a future use pilot. This pilot enables hospitals to use on-hand stock and immediate treatment when certain criteria are met. Basically, it is similar to the pre-approved drug list in my bill, Bill C-265. They found that the program significantly reduced time-to-drug initiation from the time of request. In the case of one antibiotic, it was a little over seven days, and in the case of another, it was over 10 days, and both were reduced to less than an hour from the time of diagnosis. Of note, the pre-approved drug list in my bill would be akin to the future list program. The pharmacists, in their letter, concluded, “while we do now have these two antibiotics as future-use, the institutional approval to stock them took approximately six months per application, and there remain additional critical antimicrobials that are not included in the pilot.” They concluded, “Bill C-265 would go a long way towards addressing these issues.” I will give one last case. In pediatric ICUs, when there is a kid who will not stop seizing, they like to use pentobarbital, which is the go-to drug in the United States, but it is only available here under the special access program. Instead, they use phenobarbital in really high levels because it is simply easier to access. Access to medications under the SAP is often denied because the drug is somewhere on an ongoing clinical trial. Yes, where possible, people should go in clinical trials. However, in some cases, this creates considerable hardship for the patient. For example, I had one friend who had cancer. His brother had to bring him back and forth from Thunder Bay to Duluth to get chemotherapy because the special access program denied him access. Similarly, I heard from the pediatric hospital in Montreal that it has to send patients to Toronto because the randomized control trial is in Toronto. I trust my bill would go a long way in addressing all of these issues. Toronto's Hospital for Sick Children, the number one ranked children's hospital in the world, came to me with its problems with the special access program a number of months ago, and I said, “Why don't you write me a PMB?” The first version of the PMB was in fact the hospital's, and it has gone through several reincarnations since. Sick Kids has certainly had a lot of input. I also want to thank my colleagues who work at Sainte-Justine Hospital in Montreal, who helped me a lot with the bill. I would also like to thank Princess Margaret in Toronto, the Health Sciences Centre in Winnipeg, the BC Children's Hospital, London Health Sciences Centre, the William Osler Health System in Brampton and the Thunder Bay Regional Health Sciences Centre. I thank all the clinicians, pharmacists, lawyers and administrators who helped me draft this bill. This is as much their bill as it is mine. I would also like to thank William Stephenson, law clerk and drafter extraordinaire, for his magic in turning ideas into actual laws. What would the bill do? It would do a few things. First, it would establish a pre-approved drug list. Pharmacies could stock medications on this list in anticipation of their use and medications could be used without prior approval. There would be a requirement for notice afterwards. Presumably, the pre-approved drug list would include pretty well all the drugs in the scenarios I just talked about. I would also suggest that some of the chemotherapy drugs that it takes Princess Margaret four years to be able to use could be on the list. A committee of experts would advise the minister as to what drugs ought to be on the list. Furthermore, the minister would be able to limit the use of drugs on the pre-approved drug list. For example, they could limit the use of antibiotics to infectious disease specialists or require that they be used in certain settings, like an ICU, or that they be used only by doctors with certain qualifications. For other non-approved products, either for use in the emergency treatment or for the prevention of the progression of serious or life-threatening conditions, this requirement would remain. The special access program would still exist. However, the bill would explicitly address many of the current problems associated with the system. For example, once implemented, Health Canada could not deny someone access to a drug simply because a randomized controlled trial was going on somewhere in the world, all other available and approved drugs have not been tried or the evidence for the use of the drug was dated. These are all reasons I hear of frequently for access to a drug being denied. In addition, importantly, the act would create a presumption, which would be determinative when the evidence for use of a drug may be unclear. This presumption would allow two clinicians with the requisite expertise in the field to override a denial if they attest to the treatment plan as being the one in the best interest of the patient, to the benefits outweighing the risks and to the patient having given full and informed consent knowing of a higher risk with an unproven drug. The drug approval system needs to be improved for other reasons. For example, treatments in cancer are now targeted to the specific genetic sequence of that cancer, so being able to expeditiously do a randomized controlled trial and show statistical evidence of the efficacy of a drug rapidly is pretty well impossible. We need a drug approval system that is more nimble than what we currently have. In conclusion, to deny someone who may be dying access to a medication that expert clinicians believe might help them is, I think, cruel. I also think that most Canadians would agree that the decision of whether to try such a drug when the evidence is unclear is best left to clinicians with an expertise in the area rather than bureaucrats in Ottawa. I do have a word of caution. We also need to protect the public from unsafe medications and from the predatory marketing of pharmaceuticals. Health Canada certainly has a duty to look after the public interest. We must, as much as we can, continue to safeguard against the marketing of drugs that have not been proven. In addition, we do not want the SAP to be used as an end run around our drug approval system, and I have tried to put in provisions to ensure that in this legislation. There are competing interests involved, and what is required is compromise. I believe this bill is such a compromise. I again thank all those who helped me and all members who are here for coming out on a Friday afternoon.

Mr. Speaker, that is a difficult question. There is, as I recall, a provision that would allow the minister to restrict the use of a drug to protect the public interest. We certainly have to ensure, and I think this is most important, that there is no diversion of those drugs. There are examples, and I would suggest one would be IV methadone, which perhaps should be on the pre-approved drug list to only be used for ICU patients who are already on methadone and would otherwise be going into withdrawal. There are good reasons we might want to put that on the list, but I understand the member's concerns. It would certainly be something we could talk about when it goes to committee.

Mr. Speaker, I thank my colleague for this great question. People who work at Sainte‑Justine Hospital in Montreal helped me a lot with this bill. It is challenging to identify jurisdiction when it comes to health. The two levels of government each have a role to play in this field. The provinces are responsible for regulating medical professions, while the Government of Canada has responsibility over prescription drugs.

Mr. Speaker, I would like to thank the hon. member for asking me another question in French. It is a good question, but I find it difficult to answer it in French. It might be better if I answered it in English. This is something that I struggled with. We do not want companies to have their drugs go on the pre-approved drug list rather than seeking approval for them. There are provisions that would allow the minister to require the company to give reasons why the companies are not seeking approval from Health Canada and to remove the drug from the pre-approved drug list if it thinks it is necessary. I contemplated the possibility of putting penalty provisions in if a company were to use this process to circumvent authorization by Health Canada—

Mr. Speaker, it is mostly the pharmacists who have to spend the hours and hours going through the process. The pre-approved drug list should greatly simplify the process to access drugs. I will say that families across Canada are frustrated with this program.

moved for leave to introduce Bill C-265, An Act to amend the Food and Drugs Act (List of Therapeutic Products Pre-approved for Special Access). Mr. Speaker, I rise to introduce my private member's bill, an act to amend the Food and Drugs Act with respect to the list of therapeutic products pre-approved for special access. My PMB would reform the special access program, which would allow doctors to access medications that are not approved yet by Health Canada. I will give an idea of the problem the bill seeks to address. A pediatric ICU doctor recently told me about spending six hours trying to resuscitate a child, the first four hours of which were spent trying to access a drug which is available only through this program, even though that drug is considered first-line therapy in the United States. This should not have happened. It should not happen in the future. The bill would reduce the red tape associated with this program and also leave the decision in life-threatening situations as to whether to use a drug not yet approved by Health Canada to the clinicians, not to bureaucrats in Ottawa. I would like to thank SickKids, the sick children's hospital in Toronto, which co-wrote the first draft of the bill with me. I would also like to thank all the other children's hospitals that had a lot of input. I would like to thank the member for Kitchener South—Hespeler, an ICU doctor, for seconding the bill. (Motions deemed adopted, bill read the first time and printed)

Mr. Speaker, I would note that some of the organizations that support this agreement are Cereals Canada, the Canadian Agri-Food Trade Alliance, the Wheat Growers Association, the Canadian Cattle Association and Soy Canada. That is a lot of agricultural associations. This seems to be a good deal for Canadian farmers. I do not know what trade barriers existed before with Indonesia, so could the member help explain how this is going to benefit Canadian farmers?

Mr. Speaker, I rise to pay tribute to a cornerstone of the Thunder Bay community, a great Canadian and a friend, Stephen Wright. Stephen used to say that his hobby was people, and he led his life that way. It was all about service to the community. He worked with Hockey Canada. He created PRO Kids to support underprivileged kids' participation in sports. He led no fewer than five winning political campaigns. Stephen was a tireless advocate for health care in northwestern Ontario. He was chairman of the board of Thunder Bay Regional and helped to bring it both a medical school and a cardiac care unit. To every endeavour, Stephen brought his characteristic wisdom, patience, compassion and sense of humour. Stephen represented the very best of Canada. His impact on Thunder Bay and those who knew him will be felt for many years to come. We thank Stephen for all he did, and we miss him.

Mr. Speaker, a few weeks ago I was in Fort Frances attending a municipal event. When I arrived at the Super 8 hotel, the very sheepish attendant apologized profusely, telling me there was a hockey tournament on and that it might be a little bit noisy. Yes, there was an under-13 AA tournament. Sure enough, it was noisy at times, with a bunch of raucous 12-year-olds playing floor hockey in the stairwells, while at the same time, their parents sat on the first floor pretending they were drinking ginger ale out of coffee cups. As I listened to the halls filled with the laughter of kids, and as I saw the parents having a good time with a bunch of people they previously hardly knew, all while it was 30 below outside and the wind was blowing, I realized, and this is with sincerity, what a wonderful thing minor league hockey tournaments are and how much they are a part of our identity and the Canadian culture. Everyone who puts them on, even the refs, who I sometimes criticize, should keep up the good work. I thank them.

Mr. Speaker, today is World AIDS Day, a day to remember the 42 million people who have died: our neighbours, friends and relatives. AIDS is an ongoing pandemic. It used to be a death sentence, but the discovery of antiretrovirals has really changed everything, turning AIDS, when treated, into a chronic disease. Making these drugs affordable to millions of people worldwide has been one of the greatest scientific and humanitarian triumphs of all time, yet today our progress faces a grave threat as major donors slash international assistance and HIV funding. The impact has been devastating. For example, in South Africa, treatment initiation has fallen 30%. The funding cuts could create a whole new wave of disease and tens of thousands more deaths. This is why our government's recent $1-billion pledge to the global fund is so welcome. As many wealthy nations backtrack on their commitments, we need to unite globally to ensure that decades of progress in fighting this terrible disease do not unravel.

Mr. Speaker, we get it. We do not agree on the issue of spending, but does the member not agree that the reality is that President Trump is going to be here for a while? The tariffs exist, much as we are trying to fight them. They are going to affect our economy. There is going to be a downturn in the economy. There are going to be more people on EI and more people relying on social assistance, which costs us money. Is this really a good time to start cutting spending, which would otherwise create those jobs that will stimulate our economy?

Mr. Speaker, is it a time to invest or a time to be frugal? Maybe the right answer is that it is a bit of both. First, we are in the fortunate financial position of being able to invest, create jobs, build infrastructure and stimulate the economy. According to the IMF, Canada's net debt-to-GDP ratio in 2025, if we look at all levels of government, is by far the best in the G7. In addition, our deficit-to-GDP ratio is second only to that of Japan. As a result, the director of the IMF has said that Canada and Germany alone in the G7 are in the fiscal position to be able to invest in order to spur the economy, in what is otherwise a time of global economic downturn. Our government also wants to decrease spending while at the same time investing more. We want to invest in order to create jobs, both directly and indirectly. We want to invest in building local infrastructure for things like roads, sewage and water, in order to build the homes Canadians need and want. We also need investment in road, rail and ports so we can efficiently get goods to market, which is increasingly important as our best trade partners have enacted all of their trade barriers. The budget projects that our capital investments will rise to nearly $60 billion in 2030, nearly double the $32 billion this year. Let us talk about some of the investments I like and that are good for my riding. Over 10 years, $51 billion will go toward the build communities strong fund to build local infrastructure. I will certainly try to use this money to build some of the things I would like built in my riding, for example, Fort William First Nation's chronic care home and a toll-free bridge between International Falls and Fort Frances. I would also really like some of the money to go toward things like hockey rinks. I, like a lot of Canadians, spend the winter watching my kids play hockey and drinking Tim Hortons coffee in aging arenas that need upkeep. Ports are also important. Thunder Bay is a port city, and as my favourite teacher in high school used to say, we owe our existence to the fact that we are an entrepot, which means a place where goods go from rail and trucks to boats, or vice versa. I am happy to say that the budget provides $5 billion to create the trade diversification corridors fund, which is money for ports, rail and roads. On a related note, the budget announced over $600 million for CBSA. This is in addition to the previous $1.3 billion, and it allows CBSA to hire 1,000 new officers, which will in turn allow it to open new custom facilities in a number of ports along the Great Lakes St. Lawrence Seaway. Currently, the only port on the seaway that allows customs clearance of container traffic is the port of Montreal, which creates a bottleneck: Boats go from Europe to Montreal in 10 days and then may end up waiting 10 days in order to clear customs. In addition, the lack of other inspection stations results in thousands of trucks on the 401 to the Trans-Canada Highway carrying containers that could be brought far closer to the destination directly by boat. I have spoken to the port authorities in Hamilton, Picton, Windsor and Goderich. They are all ready and eager to start handling more container traffic, the big obstacle being a lack of CBSA facilities. I know that the port of Thunder Bay is in a very similar situation. Critical minerals are also something near and dear to the hearts of the people in my riding. Frontier Lithium and Mitsubishi are looking to open the first lithium mine in northwestern Ontario, with the refinery to be in my riding. In a recent speech to the mining community, the Minister of Natural Resources made a statement that I think is worth repeating; he said that we all remember the awful situation President Zelenskyy found himself in a few months ago at the White House, where he was told, “you have no cards to play”. We as a country have lots of cards to play. We have a lot of natural resources, including critical minerals that are needed for the defence industry and for the green transition. Developing these resources will create jobs. It will also mean that, to the degree possible, we will no longer be as dependent on fair-weather friends. A priority for the government will be to help more critical mineral projects get to a final assessment decision within a two-year window. The budget proposes to provide $2 billion to create the critical minerals sovereign fund. The fund will make strategic investments in critical mineral projects and companies. In addition, the budget includes $370 million to create the first and last mile fund, which is a fund that would support the development of critical mineral projects and supply chains with a focus on getting near-term projects into production as soon as possible. The fund would also absorb the critical minerals infrastructure fund, providing $1.5 billion to support clean energy and transportation infrastructure projects related to critical minerals development. Forestry is a sector we all know is hurting. I grew up outside Thunder Bay in an area where most of my friends were the children of Finnish Canadian bush workers. Forestry is practically in our DNA. Last October, the U.S. imposed a 10% tariff on softwood lumber, which is in addition to the pre-existing duties, bringing the total tax on Canadian softwood lumber to over 45%. Our forests are one of our most valuable assets. In the long term, I think things look good for the industry. We and the Americans will continue to need lumber in order to build homes. In addition, our government will seek to use more wood in government-funded projects; encourage the development of things like cross-lamination, which would allow more building with wood and less reliance on concrete and steel; and encourage the development of novel uses for wood fibre, for example, biofuels. Although in the long term things look pretty good for the sector, the problem is obviously the short term and surviving the existing tariffs and duties. To help with that and to get the sector through this period, our government has created the $5-billion strategic response fund and regional tariff support measures. Also in the budget is, as of today, up to $1.2 billion in loan guarantees administered by the Business Development Bank of Canada to provide financial support to help companies maintain and restructure their operations; $500 million to renew and expand existing programs for the sector, focused on market and product diversification; and $50 million for re-skilling and income supports for affected softwood lumber workers. Alstom is currently involved in negotiating a single-source contract for the purchase of Toronto's line 2 subway cars, which will be built, I am happy to say, primarily in Thunder Bay. To some extent, the decision to have the cars built in Thunder Bay paved the way for the commitment the government has made, in the budget, that with federal procurement, we will as much as possible buy Canadian. There is no damn way the cars should ever be built in the United States, and I trust that when we replace the existing Via Rail fleet outside the Quebec-Windsor corridor, those trains will also be built in Canada, primarily in Thunder Bay, with some work also going to La Pocatière and to Kingston. I am a doctor, and I still practise once in a while, so what is in the budget for health care? There is $5 billion for health infrastructure, as well as money for, and this is important, credentialing. When I was an intern in Toronto in 1986, I used to joke that if I had a problem, I should ask the person mopping the floor, because they were probably a doctor from Brazil or Guatemala. Really, not a lot has changed in the intervening years with respect to credentialing, despite the fact that a lot of Canadians do not have a family doctor, particularly in rural areas. That has begun to change, and with the budget, we propose to provide $97 million towards establishing a foreign credential recognition action fund to work with the provinces to improve foreign credential recognition and bridging programs to help foreign-trained professionals, particularly in health care, meet Canadian standards. In this context, I would like to acknowledge two provincial programs that I think have been particularly successful in churning out doctors: PACE, the Physician Assessment Centre of Excellence in Halifax, and a one-year bridging program for foreign trained doctors run by the Manitoba College of Physicians and Surgeons and the University of Manitoba. These are programs we ought to emulate in other areas like northern Ontario. Last, Canada has historically underfunded research and development in comparison to other places. The international talent attraction strategy and action plan will go a long way to address underfunding. Every cloud has a silver lining. This is absolutely a time to start poaching top-notch American talent. The budget provides $1.7 billion for a suite of recruitment measures, including $400 million for a complementary stream of research infrastructure to be used by this new talent. In conclusion, I like the budget. It is good for Thunder Bay—Rainy River. I suggest that it is also great for Canada.

Mr. Speaker, I would like to thank my colleague for mentioning two things. One is Afghanistan. I, too, have worked a lot on that file. I think it is still an open file, and we have a lot more to do on it. A lot of people in Afghanistan who worked with our forces are still trying to get into this country, and I would certainly like to work toward that. In terms of the people, especially Canadians, who have been educated overseas, the health committee is currently studying that. We are looking at it, and we want to get those people here. They are Canadians and want to work in Canada. We have the need for it. We have to help, and with this money, hopefully we will open the doors to allow those people to work in Canada, which is what we all want on all sides of the House.

Mr. Speaker, I think I know what my colleague is referring to. When there is a trade dispute with the United States, particularly with respect to forestry and dumping, and companies have paid money, which is sitting in the United States Congress, they would like to access that money. I can certainly appreciate that, but I think our government has announced a whole range of measures allowing companies to borrow money, which will hopefully help them get through the next few years. We realize that it is worth loaning money to these companies, partly because we believe that, hopefully, some of that money will eventually come back to them.

Mr. Speaker, overwhelmingly, what our government wants to do is come to an agreement with the United States in order to reduce the tariffs on softwood lumber. That is absolutely critical. However, in the meantime, I think we have put a lot of measures in place, including some of the things that were announced by the Prime Minister today. For example, one thing the Prime Minister announced today was working with rail companies to try to reduce freight rates for Canadian steel and lumber by 50%. He also talked about the importance of using Build Canada Homes to use more Canadian lumber to try to offset the fact that we are not as able, obviously because of tariffs, to sell lumber to the United States. As much as we have tried to provide an alternative market for building with wood in Canada, the reality is that the United States is 10 times the size of our economy, and it is very difficult with the domestic market alone to make up for the deficit caused by the United States not buying as much Canadian lumber.

Mr. Speaker, the member talked about believing in people. She talked about the importance of the creativity of our ancestors when they came to the country and about how they created this country. I agree with all of that, but what does she think of the fact that our budget would provide $1.7 billion for a suite of recruitment measures to recruit top-level scientists, innovators and doctors to our country? Is that a good idea, or is that, too, as she would say, ludicrous spending?