The perverted irony of Health Canada's Special Access Programme

The Oxford English Dictionary defines the word “irony” as “a state of affairs that appears perversely contrary to what one expects.” A recent description of the use of Health Canada's Special Access Programme (SAP) to obtain breast implants1 is by all means “perversely contrary” to what we expect from the SAP — or is it?

The SAP is designed for patients with serious or life-threatening conditions and who require “emergency” and/or “compassionate” access to drugs not authorized for use in Canada, when conventional therapies have “failed, are unsuitable, or are unavailable.”2

According to the news story,1 67% of SAP requests annually are for breast implant devices, and over the past 5 years, the SAP has approved over 21 000 requests for silicone implants. The cosmetic surgeons interviewed explained that “small breasts” and “slight rippling of the skin through saline implants” are the medical conditions for which implants are sought through the SAP.

In April 2005, we applied to the SAP for “emergency” access to 2 experimental drugs on behalf of 6 patients with advanced AIDS who could no longer derive a clinical benefit from the anti-HIV drugs available in Canada. SAP denied our application and all appeals.

Hence, we question the raison d'être of the SAP and its mode of operation. One of our patients died during this 10-month battle, but no one has ever died from “small breasts” or “slight rippling of the skin.” Without disparaging the difficulties experienced by women who need breast implants, we cannot contain our moral outrage at the ineffectiveness of the SAP in dealing with this truly life-threatening matter.