Date: 20080306
Docket: T-427-06
Citation: 2008 FC
308
Ottawa, Ontario, March 6, 2008
PRESENT: The Honourable Justice Johanne Gauthier
BETWEEN:
SOLVAY PHARMA INC. and
ALTANA PHARMA AG
Applicants
and
APOTEX INC. and
THE MINISTER OF HEALTH
Respondents
REASONS FOR JUDGMENT AND
JUDGMENT
[1]
This is an
application brought under section 6(1) of the Patented Medicines (Notice of
Compliance) Regulations, SOR/93-133 (the Regulations), by which the
applicants Solvay Pharma Inc. and Altana Pharma AG collectively as Altana seek
an Order prohibiting the Minister of Health from issuing a Notice of Compliance
under the Food and Drug Regulations, C.R.C., c. 870, to the respondent
Apotex Inc. for the production and marketing of enteric coated tablets of
pantoprazole sodium in 20 mg and 40 mg strengths until after the
expiration of Canadian Letters Patent 2,092,694 (the '694 Patent) and 2,089,748
(the '748 Patent). Apotex intends to market its tablets under the trade name
“Apo-Pantoprazole”.
[2]
Altana Pharma AG, a German
company, is the owner of the '694 and '748 Patents. The company was formerly
known as Byk Gulden Gmbh. At the hearing, the Court was informed that the
company has again changed names and now operates as Nycomed Pharma Gmbh.
[3]
Solvay Pharma Inc. is
Altana Pharma AG Canadian licensee with respect to the patents in question.
Pursuant to the Regulations, the patents are listed against an
enteric coated formulation of pantoprazole sodium manufactured and marketed by
Solvay under the trade name PANTOLOC. The formulation is available in 20 mg and
40 mg dosage strengths.
[4]
Pantoprazole itself
is a known compound for which the Canadian Patent (4,758,579) expired on June 19, 2005.
[5]
The '748 Patent was
filed in Canada on August 23, 1991, and published on March 5, 1992. It generally relates to novel pharmaceutical compositions
combining pantoprazole (or one of its salts) as one of the medicinal
ingredient, useful for the treatment and prevention of gastrointestinal
diseases caused or exacerbated by H. Pylori (Hp) and secreted
gastric acid.
[6]
The '694 Patent was
filed in Canada on September 6, 1991, and published on April 2, 1992. In their respective memoranda, the applicants submit that
the patent “discloses pantoprazole, has direct activity against Hp and
describes the formulation that is best for this direct action”, whereas Apotex
construes the patent to relate to compositions, including those that are
simultaneously resistant and not resistant to gastric juice, for combating Hp
itself and thereby treating diseases of the stomach and intestine caused by Hp.
[7]
In its 88 page Notice
of Allegation (NOA) dated January 18, 2006, Apotex made numerous allegations
which can generally be regrouped as follows:
i) the patents were improperly listed
and/or their claims were irrelevant;
ii) the patents would not be
infringed if the NOC applied for was issued to Apotex for its Apo-pantoprazole
tablets;
iii) the patents are invalid based
on various grounds which included ambiguity, claims too broad, lack of sound
prediction, anticipation, obviousness, etc...
[8]
This application was filed on March 9, 2006. It is the first
application in respect of this drug and these particular patents to be heard on
the merits.
[9]
After the filing of the evidence (12 affiants for Altana and 9 for
Apotex)
and the cross examination of most of those affiants, the issues were narrowed down
but still required a five-day hearing.
[10]
The parties provided useful compendia of the relevant evidence; both
advised the Court that all the evidence relevant to the issues still to be
determined were included therein. Nevertheless, the Court did review all of
the experts’ affidavits as well as the cross-examination transcripts relevant
to infringement and the eligibility issues.
[11]
For the reasons that follow, the Court found that the application must
be dismissed because the applicants have failed to establish that Apotex’
allegations of non-infringement are not justified.
I.
Background and Drug Chemistry
[12]
By way of background
information, the pantoprazole compound
at issue in these proceedings and the medicinal use(s) to which it has been put
warrant brief comments. [This information, as related in the passages below, is
not contested by the parties.]
[13]
The term “ulcer”
describes an open sore or lesion in the tissue of the body. Gastric ulcers
affect the stomach, while duodenal ulcers affect the duodenum, which is part of
the small intestine. Such ulcers are both included in the more general
description of peptic ulcers, a term often used in the medical literature.
[14]
Pantoprazole is a
member of a benzimidazole class of compounds. It is a potent gastric acid
inhibitor or “anti-secretory agent”, which came into wide use as a medicine in
the treatment of gastric and duodenal ulcers in the early 1990s, initially in
the German market. The medical literature describes pantoprazole as a
proton-pump inhibitor (PPI), with reference to its mechanism of action; the
drug interferes with the secretion of gastric acid from the parietal cells of
the stomach, where gastric acid is produced, to the stomach itself. It
accomplishes this by inhibiting the enzyme which acts as the “pump”, H+,
K+-ATPase. Other PPIs which function similarly include the
benzimidazoles, omeprazole and lansoprazole, both of which have been the
subject of NOC proceedings before this Court. See for example Abbott Laboratories
Ltd. v. Canada (Minister of Health), 2006 FC 1411, [2006] F.C.J. No. 1766
(QL); AstraZeneca AB v. Apotex Inc., 2007 FC 268, [2007] F.C.J. No. 933
(QL); AB Hassle v. Genpharm Inc. 2003 FC 1443, [2003] F.C.J. No. 1910
(QL). The first PPI on the market was omeprazole. This benzimidazole class
which includes omeprazole was discovered around 1979 and that particular
compound came to the market in the late 80’s.
[15]
Up until the
mid-1980s, prevailing medical wisdom held that the stomach was an essentially
sterile environment, owing to its acidity. Excess acid and factors such as diet
or smoking were thought to be the causes of gastric and duodenal ulcers.
Accordingly, such ulcers were treated with acid inhibitors, namely histamine-2
receptor antagonists, which interfere with the formation of acid in the gastric
parietal cells, and later with the more potent PPIs.
[16]
This conventional
wisdom was first put into doubt by Drs. Warren and Marshall (the latter of whom
provided expert testimony on behalf of the applicants in these proceedings) in
the June 4, 1983 issue of The Lancet, wherein they posited a link
between diseases of the gastrointestinal tract with the presence of bacteria.
In 1984, the positive results of a follow-up study were published in the same
journal.
[17]
The bacteria observed
by Warren and Marshall
was then known as Campylobacter Pylori but was later renamed Helicobacter
Pylori (Hp). Over the next decade, additional research by Marshall
and Warren and others in the field provided stronger evidence of a link between
gastrointestinal ulcers and the presence of Hp, such that by the early
to mid-1990’s a pathogenic association between the two was generally recognized
by gastroenterologists and medical doctors. In 2005, Warren and Marshall shared
a Nobel Prize in recognition of their discovery of Hp and its pathogenic
relation to gastritis and gastrointestinal ulcers.
[18]
In his affidavit
evidence introduced by Altana, Dr. Joerg Senn-Bilfinger, a senior Altana
researcher named as a co-inventor on the European patent corresponding to the '694
Patent at issue in these proceedings, relates that by 1989 it was understood
how Hp managed to thrive in the acidic environment of the stomach. The
bacterium contains an enzyme which catalyzes the transformation of urea in
stomach acid into ammonia; ammonia so formed provides the bacterium with a
neutral microenvironment, sheltering “the bug” from the surrounding gastric
acid. This much is not disputed by Apotex’ witness Dr. Howden (who otherwise disagrees
with Senn-Bilfinger over sound prediction).
[19]
With the discovery of
Hp and the mounting evidence of its relation to gastrointestinal ulcers,
beginning in the mid-1980s researchers in the field turned their attention to
the development of treatment regimes which would directly combat Hp
infection, alongside PPI or Histamine-2 inhibiting acid suppressant regimens. This meant a new focus on
antimicrobial agents and various combinations thereof. The numerous prior art
documents at issue in these proceedings speak to the intensity of research
activity in the field at the relevant time, providing some context for the '694
and '758 Patents.
[20]
Today, it appears to
be generally accepted that the best method of treating an asymptomatic Hp infection
or an Hp positive gastric or duodenal ulcer is to eradicate Hp by
means of a combination therapy, be it so-called bismuth triple therapy, bismuth quadruple therapy (i.e.,
bismuth and antibiotics) or a PPI triple therapy (i.e., a PPI plus two
antibiotics).
[21]
Not all gastric and
duodenal ulcers are caused or exacerbated by Hp infections. The parties
agree however that the majority of such ulcers not associated with the use of
non-steroidal anti-inflammatory drugs (NSAIDs) are Hp associated. There
is some conflicting evidence as to the exact percentage in question. Solvay
claims that 70-90% of gastric ulcers and 90 % of duodenal ulcers not associated
with NSAIDs are associated with Hp, while Apotex puts the numbers at 50%
and 60% respectively. Obviously, the exact numbers are not decisive of anything
at issue here. There is also some evidence that the number of Hp associated
ulcers is diminishing in developed countries such as Canada. On the other hand, there may be an increase of NSAID-associated
ulcers, given the increased use of such NSAIDs by an aging population. There is
also some evidence of an increase of peptic ulcers not associated with Hp or
NSAIDs. Again, this is merely part of the context and is not determinative of
any of the issues here.
[22]
There is no evidence
before the Court as to the comparative size of the group of ulcers associated
with the use of NSAIDs versus ulcers associated with Hp infection or
other diseases. There is little evidence before the Court on the relative
frequency of prescriptions for triple therapy which include pantoprazole for
ulcers associated with Hp infection versus those for pantoprazole alone,
either for the treatment of NSAID associated ulcers or for other gastrointestinal
diseases where a reduction of gastric secretion is indicated, such as GERD,
reflux esophagitis (see other indications listed in the Pantoloc product
monograph).
[23]
The Court notes
however that Apotex’ expert Mr. Brown indicated during his cross-examination
that at least in Manitoba,
where all prescriptions are included in a central database (the Drug Program
Information Network), his impression was that the vast majority of prescriptions
written for Pantoloc or pantoprazole sodium were for the drug alone and not as an
element of a triple therapy regime, meaning that the drug was prescribed most
often for indications such as GERD and reflux esophagitis, which do not require
Hp eradication. (see Mr. Brown’s comments at questions 55-67, and
182-187 of the cross-examination transcript). This appears to be in line with
the evidence referred to in Abbott Laboratories Ltd. v. Canada (Minister of
Health) (2006) 55 C.P.R (4th) 48, where Justice von Finckenstein
was dealing with an application relating to lansoprazole, another PPI used in
triple therapy for the treatment of ulcers and other gastrointestinal disorders.
In that case, Abbott had produced evidence in respect of the actual use of its
lansoprazole product (Prevacid) which indicated that the compound was sold
for various uses in the following percentages: (a) GERD 52%, (b)
Dyspepsia/Heartburn 29%, (c) Peptic Ulcer 4% (presumably Abbott included here gastric
and duodenal ulcers not associated with NSAIDs), (d) NSAID-induced ulcer 3%,
(e) others 12 %. Again, this information is not determinative of any of the
issues here, but it certainly puts them in proper context.
II.
Construction of the Relevant Claims
[24]
Before considering
the allegations with respect to eligibility, infringement or invalidity, the
Court is required to construe the patent at issue from the perspective of a
person skilled in the art when it first became public. The principles
applicable to such construction are clear. They were enunciated by the Supreme
Court of Canada in Whirlpool v. Camco Inc. 2000 SCC 67, [2000] 2 S.C.R. 1067 and Free World
Trust v. Électro Santé Inc. 2000 SCC 66, [2000] 2 S.C.R. 1024. Those principles are also discussed in Pfizer
Canada Inc. v. Canada (Minister of Health) (2005) 46 C.P.R. (4th) 244 at paras. 29 to 48, and more
recently in Eli Lilly Canada v. Apotex Inc., 2008 FC 142, [2008] F.C.J. No. 171 (QL), at paras. 25 -33.
[25]
There was a broad consensus between the parties’ respective
experts that the nominal person skilled in the art whose perspective the Court
should adopt for purposes of construction would be either a gastroenterologist
or infectious diseases specialist, or a general practitioner knowledgeable
about ulcers, Hp, and gastrointestinal disorders (see paragraph 8 of
Altana’s Memorandum and paragraph 14 of Apotex’). Drs. Fennerty and Marshall
also remarked that some of the information in the patents, particularly in the ‘694
patent, would be addressed to drug formulators; this was also the position of
Drs. Hopfenberg and McGinity, themselves formulators.
A. The '748 Patent
[26]
The '748 Patent was
published on March 5, 1992. Several of the parties’ experts commented on the
construction of claims 15 and 16, particularly Drs. Graham and Thompson for
Apotex, and Drs. Marshall, Wolman and Fennerty for Altana. These claims read
as follows:
15. Use of the pharmaceutical composition
defined in any one of claims 1-14 for the regulation of a gastrointestinal
disorder.
16. Use of the pharmaceutical composition
defined in any one of claims 1-14 for treating duodenal or gastric ulcer
relapse.
[27]
Having considered
this evidence and reviewed the patent as a whole, the Court must decide, as a
matter of law, on its correct construction. The pharmaceutical compositions described in claims 1-14
all include two essential elements: pantoprazole or a pharmaceutically
acceptable sort thereof and a Helicobacter-inhibiting antimicrobial agent
(HIAMA).
[28]
HIAMA is a term
defined in the patent disclosure as a natural, synthetic, or semi-synthetic
compound or mixture thereof which is effective in eradicating Hp organisms. There is no dispute that when
this term is used in the claim it may include a combination of more than one
antimicrobial agent.
[29]
The only other
essential element in claim 15 is that such compositions be used for the
regulation of a gastrointestinal disorder.
[30]
Although the word
“gastrointestinal disorder” is not particularly qualified or restricted in
claim 15, the Court agrees with the applicants' experts that it would be
understood by a person skilled in the art to refer to those disorders caused or
exacerbated by Hp
and the secretion of gastric acid. At the hearing, Apotex agreed that, for the
purpose of this proceeding, that is the construction that should be adopted by
the Court.
[31]
The word “regulation”
in claim 15 is not a term of art; it thus had no special meaning for a person
skilled in the art at the relevant time. According to the Canadian Oxford
Dictionary, the verb “regulate” in this context would normally be taken
to denote the “keeping of a biological function regular” or “the maintenance of
health.” It is evident that to various degrees, most of the experts struggled
with the term. The difficulty here arises from the fact that this word is juxtaposed
with the phrase “gastrointestinal disorder” and is not used at all in the
disclosure, which refers rather to the “treatment” or “prevention” of gastrointestinal
disorders.
[32]
Despite this, all
experts were required to approach the term’s construction with a mind willing
to understand. The Court agrees with the statement of Justice Roger Hughes in Pfizer
Canada Inc. et al v. Minister of Health et al., 2005 FC 1725, (2006), 46
C.P.R. (4th) 244, at para. 53, that ambiguity is a conclusion of
last resort.
[33]
Having examined the
evidence of each of the experts (see, for example, the evidence collected under
Tabs 2 and 3 of Apotex' Compendium and the evidence on patent construction in
the Applicant's Compendium at Tabs 23, 24, and 25) the Court concludes that in
context, “regulation” means the treatment of gastrointestinal disorder through
the combined action of pantoprazole acting as an anti-secretory PPI, and a HIAMA defined by
its ability to eradicate
Hp.
[34]
With respect to claim
16, it refers to the same compositions described in claims 1 to 14, and thus
contains the first two essential elements of claim 15. Its third essential
element lies in the use of those compositions for the treatment of gastric or
duodenal ulcer relapse.
[35]
The experts are in
agreement that “treatment” in that claim necessarily involves the eradication
of Hp. Considering that the compositions in question are said to lower
the relapse rate observed by treatment with pantoprazole alone, the Court is
satisfied that here, “treatment” of relapse in fact means or refers to the
“prevention” of relapse, given that the actual treatment of the gastrointestinal
disorder itself (which includes gastric and duodenal ulcers), be it a first
time occurrence or the result of relapse, is already covered in claim 15.
[36]
As is the case with
respect to claim 15 (paragraph 30 above), the Court prefers Altana’s evidence
and finds that duodenal and gastric ulcer relapse in claim 16 would also be
read as limited to those ulcers caused or exacerbated by Hp, as it was
affirmed by Drs. Fennerty and Marshall (see tab 20 of the applicant’s compendium).
B. The '694 Patent
[37]
The relevant claims are
claims 3, 6 and 13, which read as follows:
3. Drug
formulation containing 5-difluoromethoxy-2-[3,4-dimethoxy-2-pyridyl)methylsulphinyl]-1H-benzimidazole
or a pharmaceutically tolerated salt thereof simultaneously in a form which is
resistant to gastric juice and in a form which is not resistant to gastric
juice.
6. A
Helicobacter bacteria treatment oral composition comprising
5-difluoromethoxy-2-[3,4-dimethoxy-2-yridyl)methylsulphinyl]-1H-benzimidazole
or a pharmaceutically tolerated salt thereof, together with a pharmaceutically
acceptable carrier.
13. A
Helicobacter pylori treatment oral composition comprising 5-difluoromethoxy-2-[3,4-dimethoxy-2-yridyl)methylsulphinyl]-1H-benzimidazole
sodium, together with a pharmaceutically acceptable carrier.
[38]
It is not disputed that
claim 3 has the following three essential elements:
(1) a formulation containing
pantoprazole; (2) the formulation being designated to be partially not
resistant to gastric juice; (3) the formulation also being partially resistant
to gastric juice.
[39]
All experts agree that there
is no limitation on claim 3 to a specific use of those compositions.
[40]
With respect to
claims 6 and 13, it is not disputed that the essential elements of the claims
are:
(1) a formulation of
pantoprazole;
(2) for use as an antimicrobial;
(3) to treat Hp infections
and diseases arising therefrom.
The
parties are also agreed that these use claims (Shell Oil type claims) cover all
formulations of pantoprazole, even those entirely resistant to gastric acid. It
is not disputed that that the word “comprising” means “including,” Thus, such
formulations could include other medicinal ingredients. In fact, the
disclosure, at the first paragraph of page 5, provides for the use of
pantoprazole with other antimicrobials (non-essential elements).
Eligibility for listing on the
patent register
[41]
As a preliminary matter, it should be noted that the Regulations
applicable here are the “old” ones, as they stood prior to the modifications
which came into force on October 5, 2006. It should also be noted that this
case does not raise any issue of timing with respect to eligibility.
[42]
Apotex states that as recently illustrated in Abbot Laboratories v.
Canada 2006 FC 1588, at paras. 116-134, affirmed 2006 FCA 187, paras.
32-45, Pfizer Canada Inc. v. Apotex Inc., (2005) 43 C.P.R. (4th)
81 at para. 169-178, Astra Zeneca A.B. v. Apotex Inc. (2007) 60 C.P.R.
(4th) 199 at para. 106, patent claims that are either ineligible or
irrelevant to a second person's submission cannot provide the basis for a
prohibition order. Thus, the issue can and should be considered by the judge
hearing the application filed pursuant to subsection 6(1) whether or not the
second person has filed a motion pursuant to subsection 6(5) of the Regulations.
[43]
In its Notice of Allegation (NOA), which was filed before the Supreme
Court of Canada issued its decision in AstraZeneca Canada Inc. v. Canada
(Minister of Health), 2006 SCC 49, [2006] S.C.J. No. 49 (QL), Apotex
included most of the arguments it now raises in respect of the eligibility or
relevance of the '748 and '694 patents, namely:
a. with respect to the '748
patent
(i) the patent contains no claim for the medicine contained in Pantoloc
or Apo-pantoprazole, as the patent covers only combinations of
pantoprazole and HIAMA;
(ii) no NOC has been issued for the use of pantoprazole sodium in a 20mg
dosage strength for the combination therapy covered by the '748 patent;
(iii) claims 15-16 are not relevant to Apotex's Abbreviated New Drug
Submission (ANDS), as Apotex only seeks bio-equivalence with the 40 mg tablet
of Pantaloc used for monotherapy. It is thus not working the patented invention
disclosed in the '748 patent (non-application of subsection 5(1) of the Regulations.)
b. with respect to the '694
patent
(i) the patented invention is for new oral drug forms (partly
non-resistant to gastric juice), whereas no NOC was issued for such forms to
Altana.
Apotex does not compare its product to a product on the market that embodies
this patented invention. It is not early working the invention, as required for
the application of subsection 5(1) of the Regulations.
(ii) claims 3, 6 and 13 are irrelevant to Apotex's ANDS as no NOC was
issued for a formulation covered by claim 3 and/or for Pantaloc as an
anti-microbial. This is particularly true with respect to the 20 mg dosage
strength of Pantoloc, against which Altana now says the '694 patent was listed
in 2003 (pursuant to submission no. 087266).
[44]
In its application, Altana took the position that the Court has no
jurisdiction to deal with such issues because they are not relevant to the
grounds enumerated at subsection 5(1)(b) of the Regulations which, in
its view, are the only grounds that can be addressed in the NOA. Also, the
legislator has provided at subsection 6(5) for a specific remedy to deal with
such issues because, among other things, of the different burden of proof that
applies to them. Altana notes that, as the applicant, it has the burden of
establishing that the allegations in the NOA are not justified, whereas it is
Apotex that has the burden of establishing that these patents should not have
been listed; this is why these arguments must be raised by way of a distinct
motion which will also allow for the filing of evidence by Altana in response
of Apotex’ evidence.
[45]
At the hearing, Altana was asked to respond more specifically to the
substance of Apotex' arguments.
[46]
With respect to Apotex’ argument that it is not early working either
patented invention and that therefore, subsection 5(1) of the Regulations would
not apply at all to the proposed Apo-pantoprazole, Altana submits that this
argument does not accord with the Supreme Court of Canada decision in AstraZeneca
as construed in Ferring Inc. v. Minister of Health 2007 FC 300, (2007)
55 C.P.R. (4th) 271 at page 299, affirmed 2007 FCA 264, 2007 F.C.J.
No. 1138 (F.C.A.) (QL). According to Altana, in Ferring the Federal
Court of Appeal confirmed that a second person must address all patents listed
before the filing date of its ANDS (in this case, September 9, 2005). There is
no dispute that here the '748 and '694 patents had been listed against NOCs
issued for Pantoloc prior to that date.
[47]
Secondly, Altana argues that the application of the early working
requirement discussed in AstraZeneca and Ferring applies only to
claims for the medicine itself. It would be inconsistent to apply them to
use claims, given that pursuant to section C.08.002.1 of the Food and Drug
Regulations, a generic filing an ANDS need only show bioequivalence of its
drug to the reference product, and is not required to practice the use claimed
as part of its submission.
[48]
Finally, Altana argues that in serving its NOA, Apotex has acquiesced
to the Minister's decision requiring it to address the '748 and '694 patents
pursuant to subsection 5 (1) of the Regulations. Thus, Apotex should have
raised its objections via an application for judicial review of the Minister's
decision, as indeed it did in Court file T-2100-07.
[49]
Insofar as the eligibility of the '748 patent is concerned, Altana
submits that there is an appropriate link between the NOC issued for its 40 mg
tablets on March 10, 2000 (pursuant to submission no. 55738) and that, as
noted by the Minister of Health in his letter dated July 30, 2007, the '748
patent is eligible for listing as the combination covered by said patent is
expressly set out in the approved indications for Pantaloc, and the patent
allows for the separate administration of the other active ingredients (the HIAMAs).
[50]
Furthermore, the '694 patent was properly listed in respect of the NOC
issued on October 15, 2003 (pursuant to submission no. 087266), for the use of
PANTALOC 20 mg tablets in the prevention of ulcers induced by NSAID in patients
with a need for continuous NSAID therapy and having an increased risk of
developing gastrointestinal damage, because a person at "increased
risk" would be understood to include a reference to Hp infection.
[51]
Once the patents are properly listed, it is Altana’s position that
Apotex is required to address them for all dosage strengths (40 and 20 mg), as
dosage strength is irrelevant to the Regulations unless there is some
restriction in that respect to be found in the claims of the patents themselves,
which is not the case here.
[52]
In response to the jurisdictional issue raised by Altana, Apotex
replied that even accepting that it has the burden of proof with respect to eligibility
and relevance, Altana had full notice of its position and had an opportunity to
file all of its evidence, as was done by first persons in those cases mentioned
above at paragraph 33, where the Court actually dealt with those issues without
the generics having made a motion under section 6(5)(a).
Jurisdiction to consider
eligibility in the absence of a motion under 6(5)(a)
[53]
The Court will start its analysis by noting that Apotex’ NOA was filed
long before the Supreme Court of Canada decision in AstraZeneca and the
Federal Court of Appeal decisions in Ferring and Wyeth Canada v.
Ratiopharm Inc., 20076 FCA 264, [2007] F.C.J. No. 1062 (QL). As
indicated in paragraph 63 of Ferring (trial decision), at that time
there was no mechanism in place to determine whether or not a generic
manufacturer was required to address any particular listed patent. Thus, the
Court does not accept Altana's argument that Apotex had acquiesced to anything
by filing its NOA. There is no evidence before me as to whether the Minister
would have agreed to the use of the new mechanism put in place sometime after
November 2006, because by then, the present application had already been filed.
[54]
That said, having reviewed the three cases cited by Apotex (see
paragraph 41 above), the Court is not satisfied that either this Court or the
Federal Court of Appeal have in point of fact indicated that the eligibility of
a patent for listing or early working issues (the application of paragraph 5(1))
may be decided as a matter of law on the sole basis of an application made
pursuant to subsection 6(1) of the Regulations, in the absence of a motion
under subsection 6(5). The relevant passage in Astrazeneca was clearly
in obiter, while that in the Pfizer case was arguably so, considering
that it was not incorporated into Justice Mosley’s actual conclusions in that
case, at paragraph 179.
[55]
Certainly, the Federal Court of Appeal, when reviewing Justice Elizabeth
Heneghan's decision in Abbott Laboratories, above, at paragraphs 44-45,
appears to have carefully refrained from dealing with the issue of eligibility,
opting to confirm the application judge's decision on the basis that she was
correct in finding that there was no relevant claim for a medicine or use of a
medicine before her, i.e., no relevant claim against which to assess the
validity of the allegation per subparagraph 5(1)(b)(4) of the Regulations
(see paragraphs 66 and 67, below).
[56]
The Court was initially attracted to the view that the filing of a
motion under subsection 6(5) of the Regulations was more in the nature of a
procedural vehicle for the quick dismissal of applications rather than a matter
of substance and jurisdiction, if the application for prohibition was filed in
response to a NOA that expressly included the second person’s arguments on eligibility,
such that the first person would have a full opportunity to know the case to
meet and to file evidence in response. (In that respect, the Court notes that
except for the letter of the Minister dated July 30, 2007, there is no
indication that Altana sought and was refused the opportunity to file reply
evidence pertaining to the patents’ eligibility for listing, as nothing of the
sort was discussed in Prothonotary Tabib's decision of June 15, 2007, or in
Justice Pierre Blais’ Order of August 28, 2007, 2007 FC 857). Moreover, costs
could normally be used to discourage second persons from raising listing in the
application itself, given that the filing of a subsection 6(5) motion early in
the process is the only way to avoid useless prohibition proceedings, as was
noted by the Federal Court of Appeal in Wyeth at paragraph 39.
[57]
However, on a closer review of the wording of subsection 5(1), it
appears that the legislator, although clearly aware that the propriety of a
patent’s listing could become contentious (he included subsection 6(5)), did
not leave any room for the addition of allegations other than those listed
there.
Indeed it would change the nature of an application under subsection 6(1) if
the first person had to deal with issues that are left to the whim of the
author of the NOA. The sequence normally applicable to the filing of evidence
is already difficult. It would become almost impossible to manage if new
issues involving a different burden of proof could be added.
[58]
In fact, the reasoning of the Federal Court of Appeal in Apotex v.
Canada (Minister of Health), (2000) 3 C.P.R. (4th) (F.C.A.) 1,
where it was held that a generic manufacturer cannot by means of a judicial
review obtain an order forcing the Minister to remove an improperly listed
patent, was to the effect that the Regulations provide a comprehensive scheme,
albeit an imperfect one, which includes a specific process to deal with
improperly listed patents, that is, the filing of a motion pursuant to
subsection 6(5). In addition, with the inclusion paragraph 6(10)(b), the
legislator provided for potential awards of costs having regard to the improper
listing of a patent, to say nothing of the possibility of seeking damages
pursuant to section 8 of the Regulations.
[59]
Recently, the Federal Court of Appeal reiterated in Wyeth, at
paragraph 34, that a generic drug manufacturer may initially be required to
address every patent listed, even those that are improperly listed, and that
the possibility to contest an improper listing by way of a paragraph 6(5)(a)
motion does not arise until a prohibition application has been commenced.
[60]
At paragraph 36, the Court in Wyeth also stated:
A motion under paragraph 6(5)(a)
is not analogous to a motion for summary judgment or a motion to strike
proceedings, and cannot be governed by the principle from David Bull
Laboratories (Canada) Inc. v. Pharmacia Inc., [1995] 1 F.C.
588 (F.C.A.) that an application normally will not be struck out on a motion
before the hearing. The purpose of a paragraph 6(5)(a) motion is to remove from
consideration in a prohibition application any patent or patents that should
not have been listed. That purpose can be achieved only if the motion is made
and dealt with prior to the hearing on the merits of the application.
Indeed, a motion under paragraph 6(5)(a)
cannot be assimilated to a motion for summary judgment or a motion to strike
because it doesn't broach the questions normally at issue in the application
itself. This is why it should normally be dealt with prior to the hearing on
the merits of the application, although as indicated by Prothonotary Tabib in
her order in file T-738-06 dated October 24, 2007, this cannot always be
achieved or accommodated.
[61]
With respect to the early working arguments and the application of paragraph
5(1)(b), the Court cannot accept Apotex' proposition that AstraZeneca
stands for a wider proposition than the one submitted by Altana. Apotex
referred the Court to paragraph 57 of Ferring (trial decision), which
cites para.39 of AstraZeneca. However, the arguments raised by Novopharm
before Justice Roger Hughes and the Federal Court of Appeal in Ferring
were essentially the same as those raised here (see para. 111 of the trial
decision), with the difference that they arose in part because the innovator
had listed its patent for new uses after the filing of the ANDS but in respect
of NOCs issued prior to that filing. Even if Novopharm argued that it was
clearly not making use of the patented invention (the new use was not even
listed when they filed their ANDS) and no NOC had been issued to the innovator
for that use, Justice Hughes was nevertheless clear that it was still required
of them to file an NOA, as they were subject to paragraph 5(1)(b). To
come to that conclusion, he again specifically quoted, at para. 112, the
passage from Astrazeneca relied upon by Apotex here. The Federal Court of
Appeal affirmed this decision on this point. On the basis of these decisions,
the Court finds that Apotex had no choice but to file its NOA and to address
the issues specifically listed at subsection 5(1) of the Regulations.
[62]
The difficulty here is that the cumulative conditions (especially the
last one) for the application of paragraph 5(1)(b) set out in Ferring,
at para. 59, call for a review of the relationship between the patent list and
the NOC pursuant to which the comparator drug has been marketed in Canada.
[63]
Had the matter arisen after the Minister instituted the patent list
review initiated after AstraZeneca and the Wyeth decisions, the
latter might have decided that the '694 patent could not be listed at all, or
that the '748 patent could only be listed against the March 10, 2000 NOC
(submission no. 055738) applicable to the 40 mg tablet only.
[64]
But this is not what happened and there is no mechanism in the Regulations
that enables the Court to decide such issues outside of judicial review
proceedings.
[65]
Altana argues that these issues are akin to eligibility issues, and
must be decided as part of the subsection 6(5) motion. I agree.
[66]
Thus, in light of the above, the Court concludes that it has no
jurisdiction to consider eligibility issues (section 4) or the early working
issues. However, as mentioned above, pursuant to subparagraph 5(1)(b)(iv),
the Court must consider whether the claims that are still at issue in respect
of infringement are claims for the medicine itself or for the use of the
medicine because as mentioned, these are the only relevant claims that need to
be addressed in the NOA and which can justify a prohibition order if Apotex’
allegations of non-infringement are not justified.
[67]
In this particular case, Apotex did not allege in its NOA that claims 15
and 16
were irrelevant and need not be addressed because they were not claims for the
medicine itself or the use of the medicine in Pantoloc, the only comparative
drug used as reference for the purpose of demonstrating bioequivalence. In the
absence of such allegations, the Court cannot consider this argument. With
respect to the ‘694 Patent, Apotex’s allegations in respect of irrelevant
claims at pages 53 and 54 of its NOA deal only with claim 3, presumably because it is
quite obvious that claims 6 and 13 are Shell Oil type claims intended to cover
a particular use of pantoprazole.
[68]
Having considered claim 3, the Court finds that indeed it is not a claim
for pantoprazole or pantoprazole sodium or its use. However, this finding is
not determinative in this case, because as it is explained hereinafter (at
paragraphs 204-222) , even if the Court were to accept that claim 3 is a
relevant claim for the purpose of subparagraph 5(1)(b)(iv), Altana has
not established that the allegations of non-infringement in Apotex’ NOA in
respect of this claim are not justified.
Eligibility issues
[69]
Normally I would not say more in respect of eligibility issues, but here
Apotex has three recent decisions in which those issues were decided by the
application judges, without the second persons having filed motions under
subsection 6(5) of the Regulations. It is trite law that jurisdiction is a
matter of law reviewable on the standard of correctness. It would therefore be
appropriate to add some comments on the merits of the issue, in the event that
I am wrong in finding that the Court has no jurisdiction to review them.
[70]
The relevant NOCs and the patents listed against them are as follow:
40 mg Tablets
Submission No.
and Date
|
NOC Issue Date
|
Reason for Supplement
|
Used to list
748 patent
|
Used to list
694 patent
|
055738
April 9, 1998
|
March 10, 2000
|
New Indication: In combination with
appropriate antibiotics, eradication of H.pylori infection associated
with an active duodenal ulcer
|
Yes
|
Yes
|
057926
August 31, 1998
|
March 10, 2000
|
New Indication: Maintenance treatment of
patients with reflux esophagitis
|
No
|
No
|
066552
April 20, 2000
|
March 2, 2001
|
New Indication: Treatment of symptomatic
gastro-esophageal reflux disease (GERD) such as acid regurgitation and
heartburn
|
Yes
|
Yes
|
20 mg Tablets
057926
August 31, 1998
|
March 10, 2000
|
New Indication: Maintenance treatment of
patients with reflux esophagitis
|
Yes
|
Yes
|
087266
Sept 22, 2003
|
October 15, 2003
|
New Indication: Prevention of
gastrointestinal lesions induced by non-steroidal anti-inflammatory drugs in
patients with a need for continuous NSAID therapy
|
Yes
|
Yes
|
[71]
As noted, for their listing to be valid, first there must be a
relationship between the patented invention described in the '748 and '694
patents and the various NOCs or the particular NOC against which they were
listed (AstraZeneca, para. 39; Wyeth Canada v.
Ratiopharm Inc., [2007] F.C.J. No. 462 (at para. 22),
affirmed [2007] F.C.J. No. 1062 (at para. 29).
a) The Patented Inventions
[72]
To define the patented invention the Court must, as indicated by the
Supreme Court of Canada in Bristol-Myers Squibb Co. v. Canada
(Attorney General), [2005] 1 S.C.R. 533 (Biolyse)
at para. 52, look at the whole of the patent, not only the claims (Wyeth
(trial decision), at paragraph 21).
[73]
Having considered the disclosure of the '748 patent as well as all of
its claims, the Court is satisfied that the patented invention is a novel
pharmaceutical composition combining pantoprazole or one of its salts and a
HIAMA (one or more), such components being administered concurrently or
non-concurrently, for the treatment and prevention of gastrointestinal
disorders caused or exacerbated by Hp and secreted gastric acids.
[74]
With respect to the '694 patent, there is some dispute as to what
constitutes the patented invention, as noted above. The disclosure discusses a
great number of compounds under the rubric “formula 1” and specifically
references 94. Pantoprazole is but one of these. However the claims only cover
pantoprazole [and its salts].
[75]
For Apotex, the invention relates only to new oral drug forms of
pantoprazole useful in the treatment of diseases of the stomach and intestines
caused by Hp, whereas for Altana the invention relates to the use of
pantoprazole as an antimicrobial useful in the treatment of Hp infection
and diseases of the stomach or the intestine caused by Hp.
[76]
According to Altana, the claims covering particular drug forms, such as
claim 3, address a preferred embodiment of the patented invention, as those
formulations are particularly useful to enhance the antimicrobial action of
pantoprazole.
[77]
Having reviewed the disclosure and the claims, the matter is certainly
not evident. On the one hand, under the heading “Scope of application of the
invention” on the first page of the patent, the invention is said to relate to
"new oral drug forms,” to be “employed for the treatment of diseases of
the stomach and/or intestines caused by Helicobacter bacteria." Further
along on the same page, the invention is said to relate “to the use of
compounds of formula 1 and their pharmacologically tolerated salts for the
preparation of medications to be administered orally for combating helicobacter
bacteria."
[78]
Claims 3 and 20 and their dependent claims (except claims 26 – 31) all
cover drug forms where the pantoprazole composition is in a mixed form that is
substantially resistant to gastric juice as well as substantially non-resistant
to gastric juice. There is no restriction as to their use.
[79]
On the other hand, claims 1, 2, 6-10, 13, 14-19 and 26 - 31 cover the
use of tablets, capsules, pellets, etc. of pantoprazole when used for treating
or combating helicobacter bacteria or Hp. Claims 1 and 13 are
unrestricted as to form, while claims 2, 7 and 14 are. Claims 26 through 31 are
restricted to the particular form covered by independent claim 20 (or its
dependent claims).
[80]
Turning back to the disclosure, on page 4 of the patent, after listing a
variety of orally administered “medicament” forms (tablets, capsules, etc…) the
patent describes it as “advantageous” for the forms listed “to be such that
they readily dissolve in gastric juice and release the active compound in the
stomach.” The disclosure continues: “For combined treatment of gastric
diseases which are based both on an increased secretion of gastric acid and on
damage to the stomach by Hp, there may also be mentioned those drug
formulations to be administered orally which contain active compounds of the
formula 1 in a form which is resistant to gastric juice and in a form which is
not resistant to gastric juice simultaneously in an individual dose”.
[81]
At page 5 the disclosure notes, "if the compounds of formula 1 are
to be employed for the treatment of diseases of the stomach based on the
presence of Helicobacter pylori, the medicaments to be administered can also
contain … active constituents of other groups of medicaments.”
[82]
Finally, after noting that it has been found, surprisingly, that
compounds of formula 1 are considerably more active against Helicobacter
bacteria in an acid medium than in a neutral medium, the patent disclosure
states that "the invention thus preferably relates to the use of
such compounds for the preparation of medicaments which are not in a
formulation which is resistant to gastric juice and are to be administered
orally for combating Helicobacter bacteria.” (My emphasis.)
[83]
It is also clear from the disclosure and the claims that the
formulations of pantoprazole may include other antimicrobials even though these
are not essential elements of any of the claims.
[84]
In view of the foregoing, and not without difficulty, the Court
concludes that the patented invention is the use of pantoprazole as an
antimicrobial to treat Hp infection (or helicobacter bacteria) and
gastrointestinal diseases arising therefrom.
[85]
Currently, the ‘748 and the ‘694 patents are listed against two NOCs
issued for the 40 mg tablets of Pantoloc pursuant to SNDS no. 055738 and 066552.
The patents are also listed against two NOCs issued for the 20 mg tablets of
Pantoloc pursuant SNDS no. 057926 and 087266. (See paragraph 70 above)
[86]
All of the NOCs issued for Pantoloc identify the medicine or medicinal
ingredient in that drug as pantoprazole sodium. The form is listed as “tablet
enteric coated”, and the drug is classified under the therapeutic class “H+, K+
-ATPASE INHIBITOR”.
[87]
There is no evidence and neither party argued that in light of
jurisprudential developments in the time since they were listed, the ‘748 and
‘694 patents should or could be listed against the NOCs issued pursuant to SNDS
nos. 066552 or 057926.
[88]
At the hearing, Altana argued that the ‘748 patent was properly listed
against the NOC issued pursuant to the SNDS no. 055738 (40 mg tablets) presumably
because the applicants recognized that this was the only way they could comply
with the requirement for a linkage between the patented invention and the NOC and
paragraph 4(2)(b) of the Regulations. In respect of the ‘694 Patent,
Altana focused on the fact that it was properly listed against the NOC issued
in 2003 pursuant to SNDS no. 87266 for the 20 mg tablets only. However, when
these arguments were put in writing and filed on the last day of the hearing[19],
Altana modified its position and also argued that the ‘694 Patent was properly
listed against the SNDS no. 55738 for the 40 mg tablets.
Analysis
[89]
To begin with the ‘694 patent, the NOC issued pursuant to SNDS no.
087266 refers to the prevention of lesions induced by NSAIDS. Thus, at best
this indication refers to asymptomatic Hp infection.
[90]
In arguing that there is a relationship between this new indication and
the 694 Patent, Altana relies on the evidence of Dr. Wolman, who states that
the prevention
of NSAID ulcers in patients at “increased risk” would be understood to refer to
Hp positive patients. Hence, the relationship with the use of
pantoprazole as an antimicrobial to combat Hp infection.
[91]
The Court is not swayed by this line of reasoning. First, the Court
prefers the evidence adduced by Apotex in respect of what a physician would
normally understand the reference to “increased risk” to mean. In his affidavit
at paragraph 57, Dr. Grant Thompson states that when Apo-pantoprazole is used
for the prevention of NSAID-induced gastrointestinal lesions, its indicated
dosage (20 mg) is not consistent with a regimen intended to treat or combat Hp
infection. Hence, the reference to “increased risk” would not be a
reference to the presence of Hp but rather to old age, being female, and
a prior history of NSAID induced upper G.I. injury. Second, Dr. Wolman’s
opinion is inconsistent with exhibit “I” of his affidavit (Ontario Guidelines
for Peptic Ulcer Disease), wherein the phrase “users…at high risk for
developing NSAID-related ulcers” is explained in brackets as follows: “i.e.,
>65 years old, history of ulcers or HI bleeding, and or / cardiovascular
disease).” Any reference to Hp infection is notably absent. Dr.
Wolman’s opinion is also inconsistent with the pharmacotherapy text put in evidence as exhibit
“E” to his affidavit by Altana’s other expert, pharmacist Ronald Elliott, which
clearly indicates at page 710-711 that Hp is not an “established risk
factor” for NSAID-induced ulcer but merely a possible one. Having considered
Dr. Wolman’s cross-examination on these issues, one can only conclude that the
issue is at best controversial.
[92]
In sum, if the thin evidence adduced by Altana in respect of a tenuous link
to the patented invention were sufficient to satisfy the relationship
requirement set out by the Supreme Court of Canada in Astrazeneca, it
would reduce the Court’s inquiry to a useless exercise not at all in line with
the intention of the legislator and the aim of the regulatory scheme. The
Court is satisfied that Apotex has established on a balance of probabilities
that there is no linkage between this particular NOC and the patented invention
in ‘694, or its claims.
[93]
Turning now to SNDS no. 055738 (40 mg tablet) and the NOC associated
with it, the question here is whether the indication added for the eradication
of Hp infection associated with an active ulcer is relevant to the patented
invention as defined in para. 83 above. As noted earlier, it is clear that even
if the ‘694 Patent allows for the use of pantoprazole with antibiotics, the
latter cannot be construed as essential elements of either the patent claims or
the patented invention. Thus, reference to a combination therapy in itself cannot
support the conclusion (like it could or would for the ‘748 Patent) that a
proper relationship exists between the NOC in question and the patented
invention of the ‘694 Patent.
[94]
In the combination therapy described in that indication, there is no
reference to the particular role played by Pantoloc or pantoprazole. The
classification of Pantoloc under the therapeutic class “H+K+ -ATPase Inhibitor”
indicates that it is approved only as a PPI. The Court notes furthermore that
the Pantoloc Product Monograph begins with a note that reads “as with all
proton pump inhibitors, when Pantoloc (pantoprazole sodium) is prescribed
in combination with… for the eradication of H. Pylori infection…” (My
emphasis.)
[95]
The uncontradicted evidence of Dr. Hopfenberg
(see paragraphs 90-94 of his affidavit), which is based on the description of
the drug form in the NOC (i.e., “enteric coated tablets”), the Pantoloc Product
Monograph and the dissolution tests for Pantoloc attached to Dr. McGinity’s
affidavit, is to the effect that the drug is approved for a single dosage form
that would not fall within the parameters of claim 3, or for that matter any of
the ‘694 claims dealing with mixed dosage forms.
[96]
Dr. Marshall stated on cross-examination that an acid-resistant dosage
form of pantoprazole is consistent with its use as a PPI, and not consistent
with its use as an anti-Helicobacter drug (at page 2315 applicant’s record, and
the end of paragraph 37 of his affidavit). Also, there does not appear to have
been any change to the dosage form of Pantoloc, either prior to or after the
indication for Hp infection associated with an active ulcer was added;
[97]
The “Indications and Clinical Use” section of the monograph also begins
with the comment that “Pantoloc (pantoprazole sodium) is indicated for the
treatment of conditions where a reduction of gastric acid secretion is
required”; (my emphasis), this wording remains the same as it was prior to
the addition of the new indication pursuant to SNDS no. 55738.
[98]
Not only does the Product Monograph make no express reference to
Pantoloc’s purported approval as an antimicrobial or antibacterial, but under
the heading “Microbiology” at pages 21-22
the monograph actually discloses the following:
Pantoprazole alone was without
effect on helicobacter pylori infection, while in combination therapy
with the antibiotics, pantoprazole had a potentiating effect on the elimination
rate of helicobacter pylori infection.
[99]
Under the heading “Consumer Information,” the monograph is even more to
the point: “What it does: PANTOLOC works by reducing the amount of acid made in
your stomach.” Even if as suggested by Altana, the drug could play both roles
at the same time, one would expect a mention of it.
[100] Finally,
the Court has considered Altana’s explanation of how pantoprazole purportedly
acts as an antimicrobial even when administered in an entirely enteric coated
tablet. The theory is that the drug would bypass the stomach, be absorbed
through the intestine, and then be distributed throughout the body including
the parietal cells, where it would be chemically activated. From there,
activated pantoprazole would be secreted to the acidic luminal part of the
stomach along with any remaining inactivated pantoprazole, where it would act
against Hp. While this is all well and good as a theory, it is only
that. The Court prefers the evidence of Dr. Howden, which indicates that even
today there is no evidence that PPIs can be secreted in their “activated” form
from the parietal cells to the stomach. Rather, it appears that following
uptake in the parietal cells, PPIs bind with the proton pump and are
essentially “stuck” there. This is the presumed basis of their antisecretory effect.
Dr. Howden also commented that even if activated pantoprazole could somehow be freed
from its bond with the proton pump, it is unlikely that it would ever
“translocate” to find its way from the stomach’s gastric glands to the stomach
mucosa, where Hp lives. This evidence is in line with the position
taken by Dr. Fennerty, an expert presented by Altana to comment on validity
issues only but who wrote on this subject (see his cross-examination, questions
729 and 735).
[101] In
light of these considerations and based on the teaching of the Federal Court of
Appeal in Wyeth, above, the Court must conclude that the ‘694
Patent is not eligible for listing against any NOC issued in relation to either
the 20 mg or the 40 mg tablets of Pantoloc.
[102] To
summarize, the Court is satisfied that Apotex has established on a balance of
probabilities that the role played by Pantoloc in the indication for
combination therapy added pursuant to the 055738 SNDS is that of a PPI. This
role is in line with the position taken by Altana as to the function of
pantoprazole in the combination therapy covered by the ‘748 Patent.
[103] The
arguments presented by each side in respect of the ‘748 Patent are not as clear
because they seem to address in the same breath both the link between the patented
invention and this particular NOC, as well as the nature of the claims required
for listing pursuant to paragraph 4(2)(b).
[104] In
its NOA, Apotex’s eligibility allegations are to the effect that no SNDS
submitted for Pantoloc supports the listing, and that otherwise, if the 055738
SNDS does support the listing, they would in any event only need to address the
‘748 Patent in relation to the particular dosage strength (i.e. 40mg) covered
by the associated NOC. They also refer to Biolyse.
[105] That
said, in its application, in addition to arguing a lack of jurisdiction as
noted earlier, Altana denies the absence of a link. Altana maintains that the
‘748 Patent is properly listed pursuant to paragraph 4(2)(b), because it
contains a claim for the medicine or the use of the medicine (see paragraph 24
of the Notice of Application).
[106] At
the hearing, it was not disputed that in fact the ‘748 Patent does not contain
any claim for the medicine in Pantoloc itself, which is a known compound
(pantoprazole). What appears to remain at issue then is the existence of a proper
linkage with the patented invention supporting listing of the ‘748 Patent, and
whether or not the ‘748 Patent includes a claim for the use of the medicine.
[107] It
is in this context that Altana urged the Court to consider the letter of Health
Canada’s Therapeutic Product Directorate dated July 30, 2007. This general
correspondence refers to an earlier letter of June 18, 2007, that was not
produced or included in the authorities. It does not contain “a decision” on
any specific matter, but rather an explanation of an earlier position taken by
the Directorate, of which no details were given.
[108] The
reasoning of the Directorate is to the effect that “patents claiming the use of
a medicine in combination with one or more other medicines are eligible for
listing against that medicine where the use of the said combination is found in
the indication section of the drug approved Product Monograph and the patent
allows for separate administration.”
[109] It
is not clear from this document whether the Directorate is referring to the linkage
requirement for listing, or to the nature of the claim required under paragraph
4(2)(b) of the Regulations. Although both issues relate to eligibility,
they are quite distinct. If in fact the Directorate was referring to the
nature of the claims in the ‘748 Patent for the purpose of paragraph 4(2)(b),
there is no explanation as to how it construed claims such as claims 15 and 16.
[110] The
Court can certainly follow the Directorate’s reasoning if it is referring to
the existence of an appropriate link between the patented invention in the ‘748
Patent and the NOC issued as a result of SNDS no. 55738. In effect, for that
purpose one may have regard to the indications, if any, listed in an NOC. There
is little doubt in the Court’s mind that for that purpose, here the indication
in the NOC does provide an appropriate link.
[111] It
is not so clear, however, that one can consider indications in an NOC for the
purpose of determining what “medicine” it covers and whether or not a patent proposed
for listing includes a claim for the medicine itself or for the use of the
medicine identified in a particular NOC.
[112] The
Directorate’s wording, particularly the phrase “claiming the use of a medicine
in combination with one or many other medicines” could be taken to mean that
the Directorate construed claims such as 15 and 16 as claims for the use of the
medicine pantoprazole itself, or that it construed the claims as claims for the
use of the novel pharmaceutical compositions set out in claims 1-14. If the
latter, and assuming that the Directorate is discussing paragraph 4(2)(b)
as opposed to the requirement for a proper linkage, one can only understand the
Directorate’s position to imply that it construes the word “medicine” in the
phrase “claim for the use of the medicine” in paragraph 4(2)(b) to mean
something different than what it means in subsection (4)(1) and that there is
no need for correspondence.
[113] Certainly,
the Court cannot follow the Directorate’s lead or reasoning if it construed
claims 15 and 16 as claims for the use of pantoprazole. For the reasons set
out above under the heading “Construction,” there is absolutely no doubt in the
Court’s mind that the use covered by those claims is that of the novel
pharmaceutical composition(s) containing all of the essential elements
described therein. As indicated, the patented invention is the novel
composition containing the different medicines, and the claims relating to
their use are only there to cover other aspects of this invention. It is
important not to deal or treat these compositions as if they were mere
aggregations, for a simple aggregation is not a patentable invention.
[114] If
the Directorate’s reasoning is based on the interpretation of the word “medicine”
in paragraph 4(2)(b) referred to above in paragraph 112, it is certainly
not supported by any legal authorities and it raises concerns.
[115] There
appears to be only two decisions that may have some bearing on the issue. At
the hearing, Apotex made reference to Pfizer Canada Inc. v. Minister of
Health, (2006) 55 C.P.R (4th) 161 at para. 8, 9, 10, 12, 16-20,
aff’d (2006) 55 C.P.R. (4th) 187 (FCA), and Abbott Laboratories
v. Attorney General of Canada (2007), 58 C.P.R. (4th) 30 at
para. 47-57, arguing that these decisions stand for the proposition that the
medicine in the claims referred to in subsection 4(2)(b) must match the
medicine in Pantoloc.
[116] Apotex
argues that the decision of the Federal Court of Appeal in Pfizer is on
all fours with the present case, while Altana took the position that both cases
are clearly distinguishable on their facts and do not contain any teaching that
this Court should or can apply here.
[117] In
respect of Pfizer, Apotex says that according to its review of the ‘726
Patent at issue in that case which was entitled “Combination Therapy,” it
included claims providing for the separate administration of the distinct
medicinal ingredients or active medicines that were essential parts of the
combination covered (claims 18-45).
It is on that basis that it submits that the Court of Appeal’s finding at
paragraph 6 of its decision is determinative of the issue in the present case.
That paragraph reads as follows:
In the Federal Court and in this
Court, the Minister argued that the 726 patent cannot be listed against Norvasc
because the 726 patent does not contain a claim for amlodipine besylate or
for the use of amlodipine besylate. The Judge accepted the Minister’s
argument as correct. I agree.
(My emphasis)
[118] The
Court is not satisfied that the Federal Court of Appeal had in mind the
argument presented by Altana here when it reached its conclusions in Pfizer
(see particularly paragraph 8-11). Moreover, in Pfizer the position of
the Federal Court of Appeal was perfectly in line with the one taken by the
Minister, whereas Altana says that its position is based on an interpretation
adopted by the Minister.
[119] Having
carefully examined these authorities and the Regulations themselves, there are
two questions in respect of which the decision of Justice Anne Mactavish in Abbott
Laboratories is helpful here.
[120] First,
the Court agrees with the analysis of Justice Mactavish at paragraph 47-54,
which indicates that the medicine referred to in paragraph 4(2)(b) of
the Regulations in the phrase “claims for the medicine itself or for the use of
the medicine” is the medicine referred to in subsection 4(1), and is the
medicine identified in the NOC issued in respect of the drug (here Pantoloc).
[121] Like
Justice Mactavish, the Court finds that the legislative scheme makes it clear
that NOCs “are issued in relation to drugs that contain specifically stated
medicines.” (My emphasis.) We all know that the forms used for NOCs, ANDS
and SNDS all expressly contain a specific box for that purpose.
[122] Also,
and despite the differences in the issues and facts in Abbott Laboratories,
the Court finds that the concerns expressed by Justice Mactavish at paragraph
50 of her reasons are relevant here. She said:
In subsection 5(1) of the PM
(NOC) Regulations, generic manufacturers must make allegations with respect
to specific medicines. It would not be possible to do this and considerable
confusion would result, if the “medicines” in question were not specifically
identified in New Drug Submissions and subsequently issued Notices of
Compliance.
All this to say that a second
person should be able to determine the medicine in a drug for which a patent
claims a use pursuant to paragraph 4(2)(b) by simply consulting or
searching the NOC database by medicine.
[123] In
respect of combination patents, following the interpretation proposed by Altana,
an innovator could list a combination patent like the ‘748 Patent against many
different drugs for the same combination of medicinal ingredients which would
be identified by different medicines in their NOC. For example, in this case
pantoprazole and the two specific HIAMAs in a single dosage (claim 12);
pursuant to Pfizer and Abbott, the NOC would necessarily have to identify
in the section entitled “medicines” pantoprazole and the two HIAMA it
contained.
[124] However,
Altana could also opt to sell a medicament package including Pantoloc and the
two HIAMAs. In such a context, one imagines that the medicament package would
have to list all of the medicinal ingredients included on the NOC.
[125] Alternately,
and as is the case here, Altana could simply choose to sell Pantoloc alone and to
list the ‘748 Patent against that drug under an NOC referring only to
pantoprazole sodium as the medicinal ingredient, listing the other essential “medicines”
of the novel composition in the “indications.”
[126] It
could also, if it had such a product, list the ‘748 Patent against any
antibiotic or antibacterial drug fitting the description of a HIAMA, and the
NOC would identify that as the active medicine without reference to
pantoprazole, which would then be referenced only in the indications.
[127] This
being said, it can be readily seen that such an interpretation could also degenerate
easily into more litigation, over what an appropriate indication for the
purpose of listing a combination patent should be. In this case, Altana argues
that the indication for duodenal ulcer and gastric ulcer, which is also found
in its Pantoloc product monograph, in fact directs or indicates that pantoprazole
sodium should be used in combination with antimicrobials. If this were so, does
it then follow that the Minister would have had to list the combination patent
even if there were no specific reference to clarithromycin and amoxicillin in
the indication? How would he then go about verifying the safe use of the
combinations?
[128] One
can also foresee litigation on eligibility over the notion that a patent allows
for separate administration of a combination’s components. Does that mean that
listing is available to all patents where a combination, although claimed as a
composition in the patent, can be administered separately? Or does it apply
only when the products can be administered non-concurrently? If the latter,
what is the maximum difference in time, if any? Should it be the five minutes
referred to in the patent, the two hours, the ten hours or the twenty-four
hours, or more? The issue is not trivial, being that at some point the
“composition” will inevitably start to resemble a mere aggregation that may not
be patentable.
[129] Finally,
by listing the ‘748 Patent against an NOC that only identifies one medicinal
ingredient, the first person may benefit from the regulatory scheme and draconian
freeze provided for in the Regulations, even in cases where the second person’s
proposed monograph makes no reference whatsoever to the express indication
providing for the combination, an element viewed as essential to justify the
listing of this patent by the Directorate. Thus the legislative scheme would
be extended to an ANDS that makes no express reference whatsoever either in the
medicinal ingredient or the indications to the other medicines covered by the
use claimed in the ‘748 Patent.
[130] The
Court is sensitive to the need to construe the Regulations in a manner
that will avoid the easy bypassing of an invention covered by a combination
patent (which is presumably the Minister’s concern). But at the same time, one
must ensure that generic products which include only a medicine that is just
one essential element of the novel compositions claimed, and that do not
specifically refer to the use of the other medicines in their ANDS (which
includes their proposed monograph), are not unduly subjected to an extension of
the innovator’s monopoly.
[131] It
may be that the only practical solution would be to require separate New Drug
Submissions (NDS) for pantoprazole alone and pantoprazole in combination with
specific HIAMAs (as opposed to a simple SNDS in the latter case), but that is
not for the Court to decide. Other avenues may be available to the Minister to
achieve the two objectives referred to above. Simply put, in this case and in
respect of ‘748 Patent, the solution alluded to in the letter of July 30 is not
satisfactory having regard to the actual wording of the Regulations.
[132] As
it was noted by the Supreme Court of Canada in Biolyse at paragraph 12,
the remedy provided for in the Regulations is not the only protection
granted a patentee, who continues to benefit of the usual remedies for
infringement available under the Patent Act. The Court doubts very much that
this scheme, which has already been described as imperfect, should be made any
more complex.
[133] There
is no need in my view to comment on Apotex’ additional arguments on eligibility.
III.
Infringement
3.1 Legal principles
[134] An application pursuant to subsection
6(1) of the NOC Regulations is not an action for infringement. Hence in
the present case, the Court only needs to determine whether the facts, assumed
or proved, and the legal assertions made by the second person in its NOA
justify its specific allegation of non-infringement (Hoffmann-La Roche Ltd.
v. Canada (1996), 70
C.P.R. (3d) 206 (FCA), and Merck Frosst Canada Inc. v. Canada (Minister of
Health) (1994), 55
C.P.R. (3d) 302 (FCA)).
[135] The Federal Court of Appeal has closed
the debate over the interpretation of subsection 5(1)(b)(iv) of the NOC Regulations,
stating that they are intended “to prevent only infringement by (or
infringement induced or procured by) generic drug producers who make
abbreviated new drug submissions containing one of the stipulated comparisons
to an existing drug product” (Pharmascience Inc. v. Sanofi-Aventis Canada
Inc. (2006), 53 C.P.R.
(4th) 453 at paras. 54-58). This was confirmed again in Sanofi-Aventis
Canada Inc. v. Apotex Inc. (2006), 55
C.P.R (4th) 388 (at paras. 16-19).
[136] To establish infringement of a use claim
in an infringement action, normally the following elements must be established
(AB Hassle v. Canada (Minister of Health) (2001), 16 C.P.R. (4th) 21 (at para. 61), (Dableh v.
Ontario Hydro (1996), 63
C.P.R (3d) 129 (FCA) (at para. 43):
a) An
act of infringement was completed by the direct infringer;
b) The
act of infringement was influenced by the inducing party to the point that,
without said influence, infringement would not take place;
c) The
inducing party must know that its influence would result in the completion of
the act of infringement.
Although other formulations of the test
have been used, it is clear that the inducer must have done something that
leads the direct infringer to infringe.
[137] In this respect, in the context of
applications under the NOC Regulations, it has been held that to
establish inducement or procurement, mere sale by a second person is not
sufficient. As Justice Sexton pointed out in AB Hassle v. Canada (Minister of National Health and
Welfare) (2002), 22
C.P.R. (4th) 1, 2002 FCA 421, “Something more is required. Something
active must be done; mere passivity or even knowledge that one’s product will
likely be used in direct infringement of a patent is not sufficient" (Aventis
Pharma Inc. v. Apotex (2005), 45
C.P.R. (4th) 449 (at para. 32); Pfizer Canada Inc. v. Apotex (2005),
43 C.P.R. (4th) 81 at
paras. 167-168). Justice Karen Sharlow in Sanofi-Aventis Canada Inc. v.
Novopharm Ltd. (2007), 59 C.P.R. (4th) 24 summarized the
case law on the subject as follows:
[9] Those
cases establish that an allegation of non-infringement of a claim for the use
of a medicine is justified if the generic drug manufacturer is seeking a notice
of compliance only for a use that is not within the new use claim and the
evidence fails to establish that the generic drug producer will infringe the
new use claim by inducing others to prescribe or use the generic product for
that new use.
[10]
Infringement of a use claim by a person other than a generic drug manufacturer
may occur because of the "off label" use of drug products. For
example, if a notice of compliance is issued to Novopharm to permit it to
market its generic ramipril product for use in the treatment of hypertension,
and if a physician were to prescribe the Novopharm product, or a pharmacist
were to dispense it, for one [page28] of the uses claimed in the 089 patent or
the 948 patent (despite the fact that no such use has been approved even for
Altace), the physician or pharmacist may be infringing the claims of the 089
patent or the 948 patent. However, Novopharm would not necessarily be
implicated in those acts of infringement by the physician or pharmacist. Unless
Novopharm is so implicated, the infringement by the physician or pharmacist
would not be the kind of infringement that can support the granting of a
prohibition order under the NOC Regulations.
[11] A
generic drug manufacturer may be implicated in the infringement by others of a
claim for a new use of a medicine if the generic drug manufacturer induces that
infringement. Infringement by inducement may be established, for example, by
inferences reasonably drawn from the contents of the product monograph for the
generic drug product, or evidence relating to the dosage form of the generic
product, or its labeling or marketing. However, an inducement to infringe
generally cannot be inferred from a mere reference to the new use in the
product monograph, for example, in the course of explaining contraindications
or drug interactions, or as part of a list of scientific references.
[138] The parties are agreed that a full review
of the case law on the subject reveals that applicants only succeeded in
meeting the burden of proof referred to by Justice Sharlow in the passage cited
above in two instances: AB Hassle v. Genpharm Inc. (2003), 243 F.T.R. 6, aff’d (2003) 38 C.P.R (4th) 17 (F.C.A.); Abbott
Laboratory Ltd. v. Canada (Minister of Health) (2006), 55 C.P.R (4th)
48, aff’d (2007) F.C.A. 251.
[139]
One should add Proctor
and Gamble Pharmaceuticals Canada. v. Canada (Minister of Health), [2002] F.C.J. No. 1018, (Genpharm) because even though
Justice Marshall Rothstein’s interpretation of subsection 5(1) of the NOC
Regulations in that case was not followed, the Federal Court of Appeal in Pharmascience,
above, noted at paragraph 59 that Genpharm was correct in result (see
also Sanofi-Aventis at para.10).
[140] The
Court has closely examined these decisions as well as those listed by the
parties where inducement was not established and the allegations of
non-infringement were found to be justified. This exercise brings into
perspective the Federal Court of Appeal’s recent statements in Novopharm,
above, particularly at para. 11.
[141] The most relevant evidence considered in Genpharm
is described at paragraphs 31 to 39 of the decision. In that case,
Genpharm’s product monograph made specific reference to a dosage that could only
be consistent with the patented new use of the medicine, despite the fact that
the indications listed corresponded with the medicine’s old uses. The packaging
was similar to that of Proctor and Gamble’s Didrocal product, which embodied
the new use, as opposed to Didronel, its product which embodied and was
marketed for the old use. There were moreover other statements as well as voluntary
omissions in Genpharm’s monograph which, when evaluated against the information
in Proctor and Gamble’s monograph, clearly signaled Genpharm’s intention
that its product be used for the patented new use.
[142] As noted by Justice Rothstein at para. 35,
the only credible reason for Genpharm to have compared its product to Didrocal
instead of Didronel as its reference product was that “Genpharm wished to keep open to itself
the option of having its product used in the treatment of osteoporosis,” that is, the new use. Finally, there was
evidence that the market for the old uses was small and diminishing.
[143] In AB Hassle v. Genpharm Inc, the
Court was dealing with an application relating to omeprazole, a PPI in the same
class as pantoprazole. It involved two patents: the ‘668 patent number which
claimed the use of omeprazole as an antimicrobial for the treatment of Hp
and Hp-related ulcers and the ‘762 patent covering the use of a
combination of omeprazole and antibiotics for the treatment of peptic ulcers
caused by an Hp infection. In respect of both patents, Justice Carolyn
Layden-Stevenson concluded that Genpharm’s allegations of non-infringement were
not justified, as its monograph contained passages from which she was ready to
infer an intent that its product be used for the patented new use.
[144] Justice Layden-Stevenson’s key findings
of fact are summarized at paragraph 155 of the decision. She accepted
Genpharm’s argument that its product monograph covered only old uses under the
heading “Indications and Clinical Use.” However, she found at subparagraph 155(k),
that three specific passages in the monograph were problematic. The first
referred to the use of omeprazole with an antibiotic, the second was a direct
reference to the treatment of ulcers caused by bacteria and the third, which
she noted to be the most blatant, specifically described the results of studies
conducted on H. pylori positive and negative patients.
[145] Since Justice Layden-Stevenson’s
inference that said passages would induce direct infringement was supported by
the evidence before her, the Court of Appeal upheld her decision in respect of
the ‘668 and ‘762 patents, with Justice Marshall Rothstein noting at paras. 22
and 23 that the passage dealing with H. pylori studies was included
by way of an amendment to the original product monograph proposed by Genpharm,
and that Genpharm had failed to provide any evidence explaining the amendment.
This even though it had originally filed an expert affidavit that was clearly
misleading, as it expressly stated that there would be no mention whatsoever of
H. pylori infection in its product monograph.
[146] This brings me to the last case which,
Altana submits, is also the one most on point. Altana urges the Court to adopt
the finding of Justice Konrad von Finckenstein in Abbott, and conclude
that inducement can be inferred from the reference to “gastric ulcer and
duodenal ulcer” in Apotex’ monograph for Apo-pantoprazole.
[147] In Abbott, Justice Von
Finckenstein was dealing with an
application relating to lansoprazole, another PPI in the same class as
omeprazole and pantoprazole. It was known and used for the reduction of gastric
acid secretion. The ‘741 patent before the Court covered the use of
lansoprazole as an antimicrobial, alone or in combination with other antimicrobials,
for the prevention or treatment of infectious diseases caused by H. pylori.
This patent appears to be quite similar to the ‘694 patent before me here,
however no combination patent comparable to the ‘748 Patent was at issue in Abbott.
[148] Under the somewhat misleading title of
“Novopharm’s Marketing Strategy” at para.47, the Court reviewed the
uncontradicted evidence of the applicant’s experts as to what would likely
happen under the Ontario drug benefit formulary system and in the
private payer market, and concluded that Abbott had established on a
balance of probabilities that direct infringement would occur were the Minister
to issue Novopharm a NOC.
[149] Based on the evidence before him, Justice
von Finckenstein made
various findings of fact relevant to the issue of inducement. At para. 30, he
found that lansoprazole is a PPI used for the prevention or treatment of
patients with H. Pylori infections among other indications, and that it
is sometimes used by itself (monotherapy),
or with another medication (dual therapy) or as part of triple therapy
(together with two antibiotics). He noted that the triple therapy is the gold
standard. He also found that there were three major causes of ulcers, namely: 1) H. Pylori
which causes approximately 90% of duodenal ulcers and 80% of gastric ulcers, 2)
NSAID and 3) Zollinger-Ellison Syndrome, and other hyper-secretory states.
[150] In his decision, Justice von Finckenstein
is silent as to the purpose of lansoprazole when used in triple therapy.
However, given his reference to the use of the drug alone to prevent and treat
patients with H. Pylori infections, and given the wording of the claims
under review in the ‘741 patent, presumably he was satisfied that it was used
as an antimicrobial in that context.
[151] The
indications in Novopharm’s product monograph were for the use of lansoprazole
in the treatment of conditions where a reduction of gastric acid secretion is
required. The list of conditions was generally similar to the one found in Apotex’
proposed monograph for Apo-pantoprazole, except that it included a reference to
the healing and treatment of NSAID-associated ulcers in addition to their
prevention. Although the monograph for Prevacid (the Abbott product) was not
before the Court, according to the Canadian Compendium of Pharmaceutical
Specialties (“CCPS”), it included an additional indication directed to the
eradication of H. Pylori. Despite the absence of a reference to this
indication in Novopharm’s product monograph, Abbott argued (as does Altana
here) that for all intents and purposes, the indication for “gastric ulcers and
duodenal ulcers” would be understood to cover ulcers caused by an H. Pylori
infection.
[152] Finally,
the proposed label for Novo-Lansoprazole included dosage instructions that
could only refer to the triple therapy regimen (twice daily for one
week).
[153] Based
on the evidence of experts before him including that of Dr. Graham, Justice Von
Finckenstein found that Novopharm’s monograph was set out as a prescription for
triple therapy. Additionally, as the evidence indicated that gastric or
duodenal ulcers caused by something other than H. Pylori were rare, the
Court found it hard to understand why these indications for GU and DU were the
very first two bullets in the product monograph. In the result, it was
found that the monograph and the label would be encouraging physicians to
prescribe Novo-lansoprazole in circumstances which would infringe Abbott’s
patent.
[154]
At paragraph 59, the Court concludes that:
“Given
the nature of the proposed PM, and label for Novo-Lansoprazole and in light of
the evidence of likely infringement presented by Mr. Gavura and Ms. Ingram I
have no hesitation in finding that the allegation of Novopharm is not
justified.”
[155]
The Federal Court of Appeal upheld the decision on the basis that the
judge had applied the appropriate case law. He knew the legal test to apply,
and it was open to him on the evidence before him to infer that physicians
would be encouraged or induced by the product monograph and the label (dosage)
to prescribe the generic product for the patented use. Given the applicable
standard of review, the Court of Appeal concluded that it was not open to it to
reassess the evidence (see paragraph 31).
[156]
Keeping in mind the cases referred to above, the Court will now proceed
to apply their teachings to the facts of this case.
3.2 Infringement of claims 15
and 16 of the ‘748 Patent
[157] In this case, Apotex alleges in its NOA
that it will not be making, using or selling its tablets of sodium pantoprazole
as part of the triple therapy combination, the use of which is claimed in the
'748 Patent. Apotex also alleges that claims 15 and 16 of the '748 Patent will
not be infringed, since its Apo-pantoprazole tablets will not be marketed or
promoted to doctors, pharmacists or others for use in combination with a HIAMA,
or as part of a medicament package comprising said agent. Moreover, given that
the indications, clinical uses and dosage regimens set out in Apotex’ draft
product monograph are distinct from those indicated with respect to
pantoprazole triple therapy, its 20 mg and 40 mg tablets shall not infringe any
of the claims of the '748 Patent.
[158] Altana submits that it has established,
on a balance of probabilities, through the evidence of Dr. Donald Low, Dr.
Stephen Wolman, Dr. Linda Dresser, Mr. Jean-Yves Julien, Mr. Ronald Elliott and
Dr. Ruth Corbin (and the two surveys carried out by her firm), that direct
infringement by doctors, pharmacists and patients will occur, should Apotex
obtain an NOC and market its Apo-pantoprazole product in accordance with its
proposed product monograph.
[159] At the hearing, Apotex conceded that indeed the Court
could assume that at least one or some pharmacists would dispense Apotex’ 40 mg
tablets of pantoprazole when filling prescriptions for triple combination
therapy written by doctors, whether such prescriptions referenced Pantaloc or
pantoprazole sodium. This would be to treat a patient with a gastric or
duodenal ulcer caused or exacerbated by Hp.
[160]
The applicants have thus
passed the first hurdle in establishing indirect infringement where many first
persons have failed in the past; AB Hassle v. Canada (Minister of National Health and
Welfare), (2001) 16
C.P.R. (4th) 21, aff’d 2002, 22 C.P.R. (4th) 1, H. Lundbeck A/S et al. v.
Minister of Health et al.,
(2003) 30 C.P.R. (4th) 97, Pfizer Canada Inc. v. Apotex
Inc., (2005) 43 C.P.R. (4th) 81.
[161]
Turning to the second step of the analysis, there are differences in the
evidence before the Court in this case and what was before Justice von
Finckenstein in Abbott. One of the most notable is that the dosage
indicated in Apotex’ product monograph with respect to gastric and duodenal
ulcers is 40 mg daily for two to four weeks. As will be explained, the Court is
not satisfied that the applicants have established on a balance of
probabilities that this dosage could in any way be construed as referring to
the standard triple therapy regimen of 40 mg twice daily for one week.
[162] Thus, the only question here is whether
the Court can infer inducement on the sole basis that Apo-pantoprazole is
indicated for the treatment of conditions corresponding to an old use, but for
which the preferred treatment is now the patented combination therapy.
[163] Evidently the draft product monograph
for Apo-pantoprazole is a key source of indicia as to Apotex’ conduct and
intentions. However in my view, it is speculative to say that Justice von
Finckenstein would have reached the same conclusion as he did in Abbott had
the only element before him been a reference to gastric ulcer and duodenal
ulcer in the product monograph. That said, in the present matter it is for the
Court to make up its own mind on the basis of the evidence before it, which I
will turn to now.
3.2.1 The Apo-pantoprazole draft product
monograph and inducement
[164] Altana relies on an answer of its expert
microbiologist Dr. Donald Low during his re-examination, for its argument that
the dosage recommended by Apotex in its product monograph could apply to the
use of pantoprazole in combination with antimicrobial agents for the treatment
of Hp. (Low’s cross-examination at question 384 of the Application
Record, volume 6, tab 15, page 1463) It is worth citing in part the passage in
question:
383
Q. In the
Apo PM, you were looking at the dosing
section. There was a question in respect of DU and GU, gastric ulcer and
duodenal ulcer, and recommended dosage, and monotherapy regime under the dosing
section in respect of those two indications.
I
believe you indicated in your answer, and I had difficulty understanding it,
something about a monotherapy regime in the dosing section.
Can
you clarify whether that would—if there were a monotherapy regime in the dosing
section in the Apo PM, whether that would restrict a doctor to such a regime
R/F MR.
BRODKIN: Don’t answer the question. You have asked him a question. You
proposed the answer to him, and you have asked him whether he would agree,
which is inappropriate, as you know.
At
this point, whatever answer you get, in my respectful submission, is improper
and irrelevant. Now you have to answer, because I can’t stop you.
384
Q. Yes. Please carry on and answer, Doctor.
A.
I think that the dosage that is recommended in the monograph is the dosage that
could be used either alone or in combination with antimicrobial agents for the
treatment of Helicobacter infection.
[165] The Court cannot accept this evidence.
This because first, in response to a previous question (questions 183-184) he
had no apparent difficulty understanding, Dr. Low stated clearly that nothing
in the dosing and the product monograph contemplated a triple therapy regime,
and this after taking some time to consider the whole Apo-pantoprazole
monograph. Second, the answer excerpted above was not responsive to the
question asked, which was already quite leading. Finally, in his affidavit Dr.
Low himself refers to the triple therapy recommended by the Ontario
Guidelines for Peptic Ulcer Disease and
Gastroesophageal Reflux (exhibit K to his affidavit), which like the
triple therapy described in Dr. Wolman’s affidavit at paragraphs 62 and 63,
clearly entails a dosage of 40 mg twice daily for seven days. This is also the
recommended dosage for Hp infection in the Pantoloc monograph. If it was
meant to say that one could use 40 mg daily to treat an Hp infection,
Dr. Wolman said in his cross-examination that no doctor would treat Hp
by prescribing pantoprazole alone.
[166] This triple therapy dosage was not only
acknowledged by Dr. Wolman, but it was used as the basic premise for the
pharmacists’ survey commissioned by Altana and informed the opinions of their
expert pharmacists
[167] Indeed, the only way we can reconcile Dr.
Low’s answer with his other statements is to assume that he was referring to
only the strength of the tablet (40 mg) rather then the regimen prescribed,
i.e. once daily for two to four weeks.
[168] In light of the above, the Court finds
that the dosage indicated by Apotex in its proposed monograph is the standard
dosage for the healing of ulcers when pantoprazole is used alone as a PPI. It
is not the usual and standard dosage for pantoprazole in the context of a
triple therapy regimen for ulcers caused or exacerbated by H. Pylori infection,
or for the treatment of the H. Pylori infection itself.
[169] Accordingly, in that respect at least, the
Court is satisfied that if Apo-pantoprazole were to be prescribed and dispensed
as part of the standard triple therapy dosage regimen, as Apotex has conceded
it likely would be, this would constitute “off-labeling.”
[170] Moving to another aspect of the
information contained in Apotex’ draft Product Monograph, the starting point
for the opinions of several of Altana’s experts with respect to inducement was
the notion that the link between Hp and gastric duodenal ulcer
development and recurrence is generally known in the medical community.
[171] Dr. Low opines that because the draft
product monograph contains indications for conditions known to be
manifestations of Hp infection, it directs clinicians and other
health care professionals
to use the product for the treatment of Hp in combination with an
antimicrobial agent, in accordance with the existing triple therapy treatment
described in documents such as the Ontario Guidelines. Likewise,
Dr. Stephen Wolman, a gastroenterologist, is of the view that Apotex’ product
monograph informs gastroenterologists and clinicians that the drug is
suitable for the treatment of Hp, since it indicates that the drug is
appropriate for the treatment of disorders which clinicians and physicians know
to be caused by Hp. As mentioned above, Dr. Wolman also opines that
the indication for the prevention of gastrointestinal lesions induced by
NSAID’s in patients with a need for continuous NSAID treatment, who have an
increased risk of developing NSAID-associated upper gastrointestinal lesions,
would be understood as an Hp-related indication. He then gives his view
of the impact of Apotex’ product monograph on physicians (and others), and
concludes that Apotex would inevitably infringe the claim of the ‘748
and ‘694 Patents that cover the use of pantoprazole whether in combination with
antimicrobials or alone. Dr. Wolman does not explain how he came to his view on
how other physicians in general (other than gastroenterologists) or pharmacists
would react to the product monograph; presumably it would be on the basis of
his contacts with students in his capacity as Assistant Professor of medicine
at the University of Toronto. Nor does he detail on what basis he was assessing
infringement. This is a problematic omission, as it becomes impossible to
assess how he understood the difficult concept of inducement and the need
to make inferences in the absence of hard data which he obviously didn’t have.
In sum, it appears he was ready to take a great leap in this respect, which
does little for his credibility.
[172] In addition to the evidence of those two
physicians, Altana relied on the evidence of three pharmacists whose testimony
is directed mainly to the question of direct infringement (i.e., drug
interchangeability and reimbursement, etc...), a question with which the Court
need not deal as mentioned above. That said, and although none had undertaken
any kind of survey, each of these experts also commented on how Apotex’ product
monograph would be read and understood by pharmacists in general (excepting Dr.
Dresser). Surprisingly, in their affidavits none of them considered the impact
of the dosage information contained in the monograph or even mentioned whether
such information would affect their views, even though Apotex’ NOA clearly sets
out that the marketing, promotion and sale of Apo-pantoprazole would be
undertaken in accordance with the dosage regimens set out therein. The omission
is all the more surprising in that Dr. Julien, on cross-examination, described
such information in a monograph as “important” (at question 316)
[173]
The affidavit of Dr.
Linda Dresser, a hospital pharmacist and a specialist in infectious disease
pharmacotherapy, stands out from the others, in that Dr. Dresser was asked to
form an opinion as to whether pantoprazole would be “effective” in the
treatment of Hp, and to assume among other things that pharmacists and
doctors had been advised in writing by Altana that Apotex had stated during the
approval process that its pantoprazole product shall not be used for combating
or treating Hp.
[174]
Although her affidavit
gives the impression that she also gives an opinion as to how other pharmacists
working in hospitals would construe the product monograph, during
cross-examination, when discussing matters clearly addressed in her affidavit
(at para. 10) Altana’s counsel made it clear that Dr. Dresser “was not being
presented as an expert on what other people would think about these things”
(Dresser cross-examination, question 184). It is also notable that
Dr. Dresser was the first expert to prepare her opinion on the basis of a
comparison between the Pantaloc and Apo-pantoprazole monographs.
[175]
During her
cross-examination (where in my view Altana’s counsel was overly protective;
this impacted on the Court’s ability to assess her position on relevant issues)
and having reviewed the indications and dosage recommended by Apotex in its
product monograph, Dr. Dresser confirmed that, in fact, Apotex was not telling
her “one way or the other whether or not it [Apo-pantoprazole] can be used to
treat H.pylori.” (cross-examination, questions 357, 385, 389, 398, 442 and
486).
[176]
It is notable that
Dr. Dresser concludes that the Apo-pantoprazole tablets would be effective and
would be dispensed at her practice site if available, even assuming that Apotex
were to represent to the Minister that its product “shall not be used for
combating or treating Hp”. – (i.e. something akin to a warning that the product
was not intended or sponsored by Apotex for that use and that it was not
authorized by the Minister for such use.)
[177]
Dr. Dresser’s answers
to certain questions in cross-examination certainly shed some light on why this
is so. In effect, it appears from her answers to questions 459 and 462, where
Dr. Dresser notes the absence in the monograph of a warning or instructions
against the use of Apotex’ product to treat Hp, that she would be
looking for a warning in respect of the effectiveness or safety of the product
and for evidence in that respect. This is in line with her conclusion at
paragraph 13 of the affidavit which is directed to the effectiveness of the
product.
[178]
There is no evidence
before the Court that Apotex’ product is not effective or is unsafe for use
against Hp infections. There is no evidence that, in the absence of such
information, Health Canada would even allow the type of warning or
instructions discussed by Dr. Dresser. This illustrates once more the
difficulty of determining a question of patent law (justification of non-infringement
allegations and inducement) on the basis of the monograph, a document the primary
if not sole purpose of which is to address health and safety issues. When
health professionals refer to a warning or lack of warning against a specific
use, it is difficult to imagine that they are contemplating anything other than
a health and safety related warning. In such a context, the Court should be
careful in making any inferences from the absence of warning in the monograph.
[179]
Altana also filed the
affidavits of Mr. Jean-Yves Julien and Mr. Ronald Elliott. They are both
pharmacists, the former in Quebec and the latter in Ontario. Most of their evidence deals with drug substitution
practice in their respective provinces, and is primarily relevant to direct
infringement. Although both said that Apo-pantoprazole’s indication for gastric
and duodenal ulcers would inform or direct pharmacists that the drug may be
used for the treatment of Hp, on cross-examination, Mr. Julien acknowledged
that the dosage regimen recommended in Apotex’ product monograph would readily
be recognized by him and other pharmacists as differing from that appropriate
to triple therapy and as unsuitable for “standard” treatment of Hp infection
(questions 237-232), while Mr. Elliott acknowledged that Apotex' product
monograph did not recommend triple therapy and that the dosage information
would be understood not to apply to gastric and duodenal ulcers associated with
H. Pylori (questions 309, 313).
[180] Both pharmacists also commented on how
they anticipated Apotex would market Apo-pantoprazole, but here again, on
cross-examination Elliott admitted that he had no expertise in pharmaceutical
marketing (question 390), while Julien was made to clarify that he is not privy
to Apotex’ marketing plans for Apo-pantoprazole, nor has he ever seen any of
the company’s plans for other products (questions 32, 34). Mr. Elliott claimed
that he simply based his comments on common sense and the hypothesis that what
occurred with omeprazole would occur with pantoprazole (question 394). The
soundness of this hypothesis was seriously put in question in cross-examination,
given that Apotex’ omeprazole product is not listed as interchangeable with the
brand name product (Losec) on the current Ontario Drug Benefit Formulary for Hp
associated ulcers
(question 427).
[181]
Finally, Altana filed
two affidavits of Dr. Ruth Corbin who was asked to design and implement a
survey of physicians in Ontario and Quebec to determine their prescribing
practices in certain circumstances, and a survey of pharmacists in those same
provinces to determine the extent to which pharmacists presented with a
prescription for pantoprazole sodium (written as such, or alternately as Pantaloc)
in a triple therapy combination suitable for treating H pylori
associated ulcer, would dispense the generic version, were such a generic
available.
[182]
Contrary to what is
alleged at paragraph 128 of the applicants’ memorandum, the physicians’ survey
is not at all useful to establish a causal link between the type of
prescription written in the context of the survey (where the physicians were
asked to assume that a generic product existed and were read the indications in
Apotex’ proposed monograph over the phone) and Apotex’ actions. This for
several reasons, the most important being that those results cannot be compared
to how these physicians would have written their prescriptions if no generic
product had been on the market at all.
In answer to a query from the Court, Altana confirmed the absence of evidence
on this point.
[183]
In the absence of
such evidence, the Court cannot determine if, as it was argued by Altana,
the indications in Apotex’ proposed monograph could lead physicians to change
their prescribing practices, or if what they wrote was influenced by their
understanding of the indications in the monograph.
[184]
With respect to the pharmacists’
survey, nowhere does Dr. Corbin say that her mandate was to test whether the
indications read over the phone to the pharmacists without any details as to
the dosage regimen proposed by the generic, had any real impact on their
decision.
Nevertheless, Altana argues that the answers given to the open ended questions
included in the survey (included verbatim in the material annexed to Dr.
Corbin’s affidavit) give insight into the reasoning of the survey respondents
and enable the Court to make the reasonable inference that any prescription
written that would allow the dispensation of the proposed generic pantoprazole
(and any dispensation of it by pharmacists) is the result of the information
contained in the monograph that was read to the participants in the survey. The
Court has very carefully reviewed all those answers as well as the
cross-examination of Dr. Corbin and it is simply not satisfied that it should
make such an inference.
[185] For its part, Apotex presented the
evidence of Dr. Thompson, a gastroenterologist, who clearly states in his
affidavit that he rejects the opinions of Dr. Wolman and Dr. Low as to how
physicians would understand Apotex’ product monograph. He considers that the
product monograph, when read as a whole and with particular attention to the
dosage recommendation, negates any suggestion that the drug is being put forth
for use in combination with antimicrobials or as an anti Hp agent.
[186] Apotex also submitted the evidence of
Kenneth Brown, a pharmaceutical consultant (and a pharmacist who practiced in Manitoba) having an expertise in provincial formularies and
regulatory matters at the provincial and federal levels. Most of his evidence
relates to direct infringement and interchangeability issues. In that respect,
he was well qualified to comment on such topics, even for provinces other then Manitoba.
[187] The Court is also satisfied that Mr.
Brown is qualified to discuss restrictions on the sale and marketing of
Apo-pantoprazole Apotex would face were an NOC for the product to be issued in
this case. (affidavit, para. 15 and question 102 of the cross examination).
[188]
However, some of Mr.
Brown’s evidence in respect of indirect infringement is problematic. Although
he can give his own views as to how he would read Apotex’ monograph and perhaps
even how pharmacists in Manitoba would do the same, he is not licensed to
practice in Ontario and Quebec. Hence his comments on the evidence of
Mr. Julien and Drs Elliot and Dresser can be given little if any weight. That
said, Mr. Brown’s view that a pharmacist would instantly identify whether an Hp
eradication regimen or an ulcer healing regimen has been prescribed, since
the former would include antimicrobial agents along with pantoprazole, is
certainly not out of line with the results of the surveys carried out by Dr.
Corbin’s firm on behalf of Altana in Quebec and Ontario. Likewise, Mr. Brown’s
statement that pharmacists would be aware that the Apo-pantoprazole monograph
does not contain a specific indication for Hp per se accords with
the evidence of Mr. Julien and Mr. Elliott, both of whom made similar comments
on cross-examination. Mr. Brown’s other comments can only be taken as a
personal opinion on how he would read the product monograph. On this point, he
places particular emphasis on Apo-pantoprazole’s general indication for
conditions “where reduction of gastric secretion is required.” Given that this
statement appears before the listing of specific indications, Mr. Brown
considers that the monograph does not suggest or infer that the product should
be used either alone or in combination with antimicrobials for the purpose of
treating Hp infections. For Mr. Brown, this is confirmed by the regimen
indicated under the heading Dosage and Administration, which he readily
identified as treatment for the healing of gastric or duodenal ulcer, as
opposed to combination triple therapy indicated to cure or treat the cause of
ulcers.
[189]
Ms. Conroy, another
of Apotex’ experts who practices as a pharmacist in Ontario, was particularly candid and open during her cross-examination.
She readily admitted that she and other pharmacists would be aware that a
large portion of ulcers are associated with Hp infection, but she
remained of the view that nothing in the Apo-pantoprazole product monograph
directs to the use of the product in the treatment of such infections,
especially in a triple therapy regimen. She was also of the view that
pharmacists readily distinguish between therapeutic regimens involving PPIs
alone and PPIs in combination with antibiotics. This is certainly borne out by
the results of the survey carried out on behalf of Altana.
[190]
Ms. Conroy brought to
the Court’s attention that in its Reason for Use (RFU) codes, the Ontario Drug
Benefit Formulary distinguishes between the use of a drug to treat peptic
ulcers or NSAID-induced ulcer prophylaxis (RFU 297) and its use for the
treatment of Hp positive peptic ulcers (RFU 295).
[191]
The point to be taken
here is not so much that the formulary would prevent dispensation of the
generic product to private-system users, but rather that one cannot simply
assume that a general reference to the treatment of peptic ulcers or gastric
and duodenal ulcers implies the treatment of Hp infection.
[192]
Having gone over the
medical professionals’ evidence in some detail, the Court finds it remarkable
that there is no clear indication, even from the applicants' experts, that
their prescribing or dispensing practices are actually influenced in any way by
the information found in generic product monographs. When asked by the Court to
point to the evidence indicating that physicians generally do look at product
monographs, Altana could only cite the cross-examination of Dr. Thompson, who
acknowledged that he receives such product monographs at his office and
sometimes consults them. With respect to pharmacists, Altana could not point to
any cogent evidence on this point. According to the applicant, that pharmacists
do consult product monographs is implicit in all of the experts’ opinions. The
Court begs to differ. Mr. Julien readily admitted that a pharmacist does
not consult product monographs as often as a physician (he did not indicate how
often he thinks they would do so) and only that he personally “might” consult
Apotex’ product monograph. Mr. Elliott, who apparently had been dealing extensively
with omeprazole products, had never read Ratiopharm’s product monograph,
although it was the first generic to bring a generic version of omeprazole to
market. He also admitted to not having read Pantaloc's product monograph prior
to his involvement in the present case. As for Dr. Dresser, her answers in
cross-examination would indicate that she has reviewed generic product
monographs in her capacity as a consultant rather than as a pharmacist
(questions 60, 61).
[193]
Be that as it may,
Altana also argues that when physicians and pharmacists do consult product
monographs, they do not compare the monograph of the innovator to that of the
generic. That much is clear but the Court must agree with Apotex that this is
not the point of the comparison it has put forward.
[194]
In effect, as the
Court is examining the monograph to determine Apotex’ real intentions, it is
certainly relevant to consider the efforts it made to “scrub it clean” of any
reference to Hp or the use of pantoprazole with antibiotics.
[195]
The Court did
consider Altana’s argument that Apotex could have excluded from its indications,
the treatment of Hp associated ulcer and that some inference about
Apotex’s real intention could also be made from the fact that gastric and duodenal
ulcers occupy the first two bullets in that section. The Court believes that
the placement of those indications could also be explained by the fact that the
generic copied not only the reference product but also its monograph (see Ferring
(trial decision) at paragraph 124).
[196]
According to Dr.
Wolman’s evidence, the advantages of triple therapy were well established even
in 1996, when the first NOC issued for Pantoloc. Nevertheless the first product
monograph for Pantoloc
indicated it could be used alone for the treatment of gastric ulcers and
duodenal ulcers, recommending daily administration of a 40 mg dosage strength
for two weeks in the former case and four weeks in the latter, to be repeated
if necessary.
[197]
The 1998 CCPS
reproducing the relevant portion of the Pantaloc monograph cautions that the
product should be prescribed only at the recommended dosage until
adequate long-term clinical data is available.
The indications and recommended dosage are exactly those found in Apotex's
proposed product monograph. More current monographs for Pantoloc still include
the conventional monotherapy treatment for gastric ulcers and duodenal ulcers,
but omit the cautionary notation as to dosage. In any event, it is not disputed
that Health Canada is still satisfied that pantoprazole monotherapy as
indicated in the Pantoloc monograph meets their health and safety requirements.
Nor is it disputed that such monotherapy would still be suitable to treat
gastrointestinal ulcer where treatment is not directed to an Hp infection
and its eradication.
[198]
As noted earlier, if
triple therapy is now the preferred treatment, it is not because conventional
PPI monotherapy does not heal all ulcers as well as before, but because it has
the added advantage of preventing relapse in most cases of those ulcers that
are caused or exacerbated by Hp, and is thus more cost-effective.
[199]
It remains unclear to
the Court, even after a careful review of the medical literature put in evidence,
whether monotherapy would not be employed in those admittedly rare cases where
triple therapy has failed to eradicate an Hp infection for whatever
reason or is not suitable for a given patient.
[200]
The Court must always
keep in mind the arch principle of patent law applicable in NOC proceedings as
well as infringement actions, that the public should not be deprived of its
ability to use known products for known uses on the basis of patents for new
uses of such products.
[201]
In the end, the Court
is not able to conclude from the evidence before it that Apotex intends to
market its tablets for use as part of the triple therapy regimen. Altana has
not otherwise established any causal link between Apotex’ actions (and its
proposed monograph) and the direct infringement the Court was asked to assume.
[202]
The court concludes
that Altana has not met its burden of establishing that the allegations of
non-infringement in respect of those claims are unjustified.
3.3
Infringement of Claim 3 of the ‘694 Patent
[203]
Assuming here that
this is a relevant claim for the purpose of paragraph 5(1)(b)(iv), there is no
dispute that Apotex' proposed tablets will contain pantoprazole sodium in a
form that is at least partially resistant to gastric juice (see paragraph 37
above). The dispute centers on the third essential element of this claim,
whether it will also be in a form which is partially not resistant to gastric
juice.
[204]
Both sides agree that
a tablet with pantoprazole on the enteric coat would be covered by claim 3 (see
graph at paragraph 69 of Dr. Hopfenberg’s affidavit). However, they disagree on
whether pantoprazole dispersed within the enteric coat would be in a form that
is not resistant to gastric juice.
[205]
The applicants argue
that Apotex’ NOA was insufficient to allow them to show that the
non-infringement allegation in respect of this claim was not justified, because
Apotex failed or refused to provide them with sample tablets for testing. In
his affidavit dated July 6, 2006 (exhibit “A” to Dr. McGinity’s affidavit of
August 3, 2006), Dr. McGinity states that the information provided to him does
not rule out the possibility that Apotex’ tablets will infringe. In reply,
Apotex filed the affidavit of Dr. Hopfenberg, who disagrees with Dr. McGinity
for reasons that will be discussed shortly. The applicants say that the Court
should prefer the evidence of Dr. McGinity because he is an experienced
formulator who has actually worked with and published on benzimidazole
formulations, whereas Dr. Hopfenberg on cross-examination could not recall
whether he had in fact ever actually worked with such compounds.
[206]
In substance, Dr.
McGinity affirms that Apotex cannot establish on the sole basis of the
dissolution tests “produced as part of Apotex ANDS” that its tablets will not
include pantoprazole within or on the enteric coat (see his paragraph
12). Dr. McGinity says that such formulation would not be resistant to gastric
juice. There is no indication whatsoever that Dr. McGinity was asked by Altana
to review all of the contents of Apotex’s ANDS
before giving his opinion. In his affidavit of July 6, 2006, he refers to only
three documents that he was asked by counsel to review (see paragraph 7),
which are all filed as exhibits to his affidavit, these being the ‘694 Patent,
the dissolution tests and a document entitled “Drug Release” (an excerpt from the
publication USP XXI). Beyond his statement that Apotex’ dissolution tests do
not rule out the presence of pantoprazole in or on the enteric coating, Dr.
McGinity does not discuss how pantoprazole would or might get there. He does
not say whether he contemplates an intentional application as part of the
manufacturing process, or simply that amounts of pantoprazole could find their
way into or onto the enteric coating as an incidental effect of the
manufacturing process or equipment used by Apotex (whether by accident or otherwise).
[207]
Dr. McGinity notes
that the tests performed appear to have been conducted "using the USP
dissolution test method for enteric articles." He states at paragraph 21
of his affidavit that: (i) the short half-life of pantoprazole; (ii) the acidic
conditions of the test method; and (iii) the duration of the test method in the
acid stage (i.e., 120 minutes) lead to the inevitable result that any
pantoprazole that was present in an unprotected form in the Apotex tablets
would not be found at the conclusion of the acid phase 3 of the USP test
method.
[208]
Although Dr. McGinity
had a copy of all the test results (which also include a buffer stage), he
specifically addresses only the results of the acid stage, stating simply that
the details in the remaining pages of his exhibit “C” (the test results) do not
alter his opinion that the results reported would be substantially the same
regardless of whether pantoprazole in an unprotected form was present or not in
the Apotex tablets. Thus, he concludes that to determine whether or not Apotex’
tablets fall within claim 3 of the ‘694 patent, he would need an actual sample
of the tablets.
[209]
The applicants state
that because samples were not part of Apotex' ANDS and were not actually put
into evidence by Apotex, they have brought a number of motions to compel the
production of such samples which have all failed. In the circumstances, they
argue that the Court should apply the common law presumption that “where a
party fails to lead evidence of a fact that it is in a better position to
establish, the Court will infer that the facts are adverse to that party’s
interest” (AB Hassle et al. v. Apotex Inc. (2002), 21 C.P.R. (4th)
173, aff’d (2003) 29 C.P.R. (4th) 23). The applicants submit that
they have established that this information is not in their possession and is
within the knowledge of Apotex. (Eli Lilly and Co. v. Nu-Pharm Inc.
(1996), 69 C.P.R. (3d) 1 (F.C.A.), 18-19).
[210]
The relevant portion
of the NOA on this issue is at page 58 and reads as follows:
Additionally,
with respect to claims 3, 4 and 5, each of these claims include as an
essential element that sodium antoprazole be contained within a formulation
that is simultaneously in a form that is resistant to gastric juice and in a
form that is not resistant to gastric juice. We shall not infringe these claims
since our tablets comprise sodium pantoprazole contained within a single form
of formulation. Additionally, since our tablet formulation contains an outer
enteric coating it is resistant to gastric juice. Also, since our tablets
contain an outer enteric coating the sodium pantoprazole contained within them
will be within a formulation or form that is resistant to gastric juice.
Therefore, our tablets shall not comprise sodium pantoprazole contained in a
formulation that is simultaneously in a form that is resistant to gastric juice
and in a form that is not resistant to gastric juice.
[211]
Dr. Hopfenberg’s
evidence which is based on a review of, among other things, Apotex’s Master
Formula as well as the dissolution test (both documents were included in
Apotex’s ANDS) says at paragraph 43, that “… the formulation-related subject
matter of claims 3 to 5 of the ‘694 Patent is restricted to an oral drug
formulation comprising mixed dosage forms.”
[212]
He then adds that
“as discussed in the above quoted passage of the NOA and as confirmed in the
Master Formula, Apotex’s tablets comprise sodium pantoprazole contained
exclusively within a single dosage form comprising an outer enteric coating
which would render the tablets resistant to gastric juice.”
[213]
After a vigorous
cross-examination, Dr. Hopfenberg remained categorical that tablets prepared in
accordance with Apotex’ Master Formula could not be in the form depicted at
paragraph 69 of his affidavit, wherein pantoprazole sodium is contained within
the tablet core and is disposed on the surface of the enteric coating (e.g., at
questions 161-162). He testified that all of the pantoprazole sodium that was
assayed in Apotex’s tablet during its manufacture (based on the Master Formula)
was accounted for in the buffer stage of the dissolution test. According to
him, this was indisputable evidence that none of the pantoprazole sodium
intended to be included in the core of Apotex’ tablet found its way onto the
enteric coating (see questions 303-307, 311, 319-326, 351-362, 375).
[214]
Although Dr.
Hopfenberg agreed that howsoever pantoprazole were to find its way onto the
tablet’s enteric coating, the result would fall within claim 3 of the ‘694
patent, he very clearly refused to accept the theory put forth by applicants'
counsel during his cross-examination, that pantoprazole sodium dust could find
its way there during manufacture of the tablets.
[215]
He was also very
solid when his opinion was challenged on the basis that he had not himself
tested Apotex’ tablets or seen Apotex’ equipment.
[216]
With respect to Dr.
Hopfenberg’s expertise, having carefully reviewed his curriculum vitae and the
transcript of his cross-examination, the Court is satisfied that he is an
expert in the relevant field and has extensive experience with pharmaceutical
formulations and drug delivery systems. The fact that Dr. Hopfenberg did not
recall during his cross-examination having worked with benzomidazoles is not
sufficient for the Court to prefer Dr. McGinity’s evidence to his,
especially where there is no evidence that the latter considered all the
information provided by Apotex, particularly the Master Formula, before
reaching his conclusion.
[217]
Moreover, there is no
credible evidence that the matters to which Dr. Hopfenberg testified required
in depth knowledge of the specific characteristic of pantoprazole or
benzomidazoles. The Court notes that even if Dr. Hopfenberg has not actually
worked with benzomidazoles, he has acted as an expert in several cases
involving benzomidazoles such as omeprazole and lansoprazole.
[218]
Having considered the
relevant passage of the NOA in the light of the evidence provided by Drs.
McGinity and Hopfenberg, the Court finds that Altana has not established that
Apotex’ NOA was insufficient. Nor has Altana succeeded in showing that Apotex
failed to provide sufficient information to enable them to put forward evidence
establishing that Apotex’ allegation of non infringement of claim 3 (which
specifically states that Apotex’ tablet contains pantoprazole in a single
dosage in an enteric protected form) is not justified.
[219]
As Altana failed to
provide any evidence as to how pantoprazole sodium would find its way into or
onto the tablets formulated in accordance with the Master Formula provided by
Apotex, the situation here is akin to the one before Justice James Russell in Astrazeneca
AB v. Apotex Inc., [2004] F.C.J. No. 476. Like in that case, Altana’s has
merely raised a vague theoretical doubt. The applicant cannot rely on Apotex’
decision not to cross-examine Dr. McGinity to make up for the failure to put
forth evidence in chief detailing its contention. The Court is not willing in
this case to make an adverse inference from the fact that Dr. McGinity was not
cross-examined. A second person does not have to address in its NOA possible
theories that are no more than speculation (Astrazeneca AB v. Apotex Inc,
[2005] F.C.J. No. 842 , at para. 11, affirming Justice Russell’s decision on
this specific point; Pfizer Canada Inc. v. Novopharm Ltd. (2005), 42
C.P.R. (4th) 97 (FCA) at para. 28)
[220]
Given that the
applicants have not established to the Court’s satisfaction that they did not
have in their possession the information necessary to deal with the allegation
of non infringement, there is no need to discuss any further the application of
AB Hassle and the presumption referred to above at para. 144.
[221]
As a result of the
above, the Court concludes that Altana has not met its burden of proving that
this allegation is not justified.
3.4 Infringement of claims 6 and 13 of
the ‘694 Patent
[222] Although
Apotex conceded that Apo-pantoprazole would likely be used by patients in the
context of triple therapy, it is very clear that it was never conceded that
such tablets would have any antimicrobial effect in that context. For reasons
already addressed when discussing the role of Pantoloc in the new indication
added to the Product Monograph in 2003 (paragraphs 94-102), the Court is not
satisfied that Altana has established that Apo-pantograzole tablets would play
such a role. As a matter of fact the Court
found that this was not so.
[223]
In any event, even if the Court were to assume that direct
infringement was also established in respect of the ‘694 Patent, the Court’s
earlier conclusion applies here as well; that is, Altana has failed to
establish, on a balance of probabilities, that Apotex’ allegations that its
“tablets would not be marketed or promoted to doctors, pharmacists or others to
be used in combination with another antibiotic as part of a regimen for
combating, treating or eradication of Helicobacter or Helicobacter pylori
bacteria” are not justified.
[224]
The Court’s finding with respect to Dr. Wolman’s evidence
on the implications of Apo-pantoprazole’s indication for the prevention of a
NSAID-associated ulcers (see paragraphs 90-91) is also relevant.
[225]
The Court also finds that there is nothing in Apotex’
monograph that refers to or deals with the treatment of asymptomatic Hp
infections. In effect, here it is clear that Apotex is not seeking an NOC for
pantoprazole as an antimicrobial, for its proposed monograph contains no
microbiology section. This is particularly relevant with respect to the use of
the Apo-pantoprazole tablets alone in accordance with the dosage regimen
recommended in the product monograph.
Conclusion
[226]
At the hearing, the Court sought the parties’ views as to
whether there was a good reason to address the issue of validity if the Court
came to the conclusion that the application had to be dismissed on another
ground such as subparagraph 5(1)(b)(iv) of the Regulations. Altana made it
clear that it did not see any need for validity issues to be addressed, and in
fact that it was not seeking such a determination.
[227]
Apotex was given some time to reflect on its position, and ultimately
advised the Court that it felt that it would be disadvantaged in respect of
possible future ANDS if the application was not dismissed on the basis of the
patents’ invalidity or ineligibility for listing.
[228]
The Court took note of these comments and considers that it
should adopt a principled approach. Applications under section 6(1) of the
Regulations are intended to be summary proceedings and their purpose is to
determine whether a prohibition order should be issued. Such applications are
not to be treated or transformed into proceedings for declaratory judgments in
respect of all issues raised in an NOA. Furthermore, given that my decision to
dismiss the application is clearly based on a finding in respect of the
allegations of non-infringement, any further comment would be in obiter.
Despite this, pursuant to the recent decision of the Federal Court of Appeal in
Sanofi-Aventis Canada Inc. v. Novopharm Ltd., 2007 FCA 163, in respect of the patents at issue such comments would
bind any judge hearing any other current applications involving Altana and
another generic, even if the evidentiary record in those applications might be
quite different and issues of patent validity could be determinative.
[229]
In view of the foregoing, the Court finds that the
application must be dismissed with costs on the basis that Altana failed to
establish that the allegations of non-infringement are not justified.
[230]
The parties made no representations in respect of costs.
Apotex shall have until March 14, 2008 to file its representations if any in
that respect (maximum five (5) pages) and Altana shall have five until March
21, 2008 to respond to such submissions (maximum five (5) pages).
JUDGMENT
THIS COURT
ORDERS AND ADJUDGES that
1.
The
application is dismissed with costs.
2.
A
further order in respect of costs will be issued after receiving the
submissions of the parties within the time set out in my reasons.
“Johanne Gauthier”
ANNEX “A”
Brief Biographies of
Expert Witnesses
Applicants’
Expert Witnesses
Dr. Donald E. Low, MD
Dr. Donald E. Low is the Microbiologist-in-Chief at Mount Sinai Hospital and is Professor of
Microbiology and Medicine at the University of Toronto. He is
also head of the Division of Microbiology, Department of Laboratory Medicine at
the University of Toronto and
the Chief of the Toronto Medical Laboratories and Mount Sinai Hospital
Department of Microbiology. Dr. Low has been recruited by the Government of
Ontario to act as Medical Director of the Ontario Public Health Laboratory
during its transition into the upcoming new Public Health Agency of Ontario.
Dr. Low is a fellow of the Royal College of Physicians and Surgeons
of Canada and completed his undergraduates and postgraduate training in
Medicine, Medical Microbiology and Infectious Diseases. He currently holds
numerous other staff appointments at hospitals throughout Ontario as well as appointments to various
committees and advisory boards that deal with microbiology.
Dr. Low has been involved in research and clinical treatment of
patients suffering from microbial infections since as early as 1981 and has
published well over 300 articles in the field of medical microbiology and
infectious diseases in international peer-reviewed journals. Dr. Low is in the
top 1% of individuals cited in his field of publication. Furthermore Dr. Low is
on the editorial boards of the journals entitled Antimicrobial Agents and
Chemotherapy, The Journal of Infectious Disease, and the Canadian Journal of
Infectious Disease, He is a reviewer of the New England Journal of Medicine,
and Nature Medicine, and the Journal of Chemotherapy. He is one of 12 voting
members of the Clinical Laboratory Standards, in the United
States, which sets standards for antimicrobial
testing, interpretation and reporting. These guidelines are used by diagnostic
laboratories and industry in North America and in countries worldwide.
Dr. James W. McGinity
Dr. James W. McGinity is a tenured Professor of Pharmacy at the
College of Pharmacy, The
University of Texas at Austin.
Since 1985, Dr. McGinity has held the Johnson and Johnson Centennial Chair of
Pharmacy. Dr. McGinity received his B. Pharm. degree in 1967 from the
University of Queensland,
Brisbane, Australia and his
Ph.D. degree in Physical Pharmacy from the University
of Iowa in 1972.
Dr. McGinity has been teaching since 1973 and has been a faculty
member at the College of
Pharmacy, University of Texas
at Austin, Texas since 1976. Dr. McGinity has held the positions of Assistant and
Associate Professor of Pharmacy, Assistant Director and Director of the Drug Dynamics
Institute and Area Coordinator for the Pharmaceutics Area and Division Head of
Pharmaceutics. Since 1985, Dr. McGinity has been a Professor of Pharmacy at
the University of Texas at Austin. As well, he is currently the
Division Head of Pharmaceutics and the Director of the Drug Dynamics
Institute.
Dr. James W. McGinity’s research is primarily focused on solid oral
dosage forms including aqueous film coating and tablet technology. In
addition, Dr. McGinity has conducted research and published in other areas,
including pre-formulation, materials science, pharmaceutical processing, and
topical and emulsion technologies.
Dr. James W. McGinity has also consulted for innovator and generic
pharmaceutical companies all over the world on issues related to analytical
chemistry, content uniformity issues, processing, scale up, materials science,
film coating, drug stability and pre-formulation issues. Dr. McGinity’s
consultancy has included a wide variety of issues, from the discovery of the
new chemical entity to the large-scale manufacture of the marketed product and
has included assisting pharmaceutical companies with regulatory filings.
Dr. James W. McGinity is currently C.E.O. of PharmaForm, L.L.C. in Austin, Texas. PharmaForm L.L.C. is a
research and development company that works with both innovative and generic
pharmaceutical companies in association with the areas of expertise identified
above. The work of PharmaForm L.L.C. in resolving formulation issues has
resulted in the filing of several patents and patent applications. Dr.
McGinity is a named inventor on some of these patents and patent applications.
Dr. Jorg Senn-Bilfinger
Dr. Jorg Senn-Bilfinger has been engaged in Chemistry for more than
40 years. He began his career with an apprenticeship in chemistry in 1962 with
the pharmaceutical company Dr. Karl Thomae (now Boehringer Ingelheim), based in
Biberach, Germany. He received his Diploma Degree in Chemistry from the University of
Stuttgart, Germany in 1975 and his Doctorate Degree in Chemistry from the
University of Stuttgart, Germany in 1978.
Thereafter, he joined Byk Gulden Lomberg Chemische Fabrik GmbH (“Byk
Gulden”), the predecessor company to Altana Pharma AG, now Nycomed GmbH. During
the early 1980’s, Dr. Senn-Bilfinger participated on team at Byk Gulden with
Dr. Hartmann Schaefer and his colleagues. Their work as a team led to the
invention of the drug known worldwide as pantoprazole. Dr. Senn-Bilfinger is a
named co-inventor on a number of the original patents for pantoprazole. Until
December, 2001, Dr. Senn-Bilfinger was the Head of the Department responsible
for Medicinal Chemistry – Gastrointestinal at Nycomed GmbH (formerly Altana
Pharma AG). He is currently the Director of External Chemistry at Nycomed GmbH
(formerly Altana Pharma AG).
Dr. Senn-Bilfinger has served on the IUPAC Subcommittee for
Medicinal Chemistry and Drug Development as a member since 2002. He is an
Honorary Professor of Medicinal Chemistry and a member of the chemistry faculty
at The University of Stuttgart, Germany and is a frequent lecturer on the topic
of Medicinal Chemistry at the University of Stuttgart.
Dr. Senn-Bilfinger is credited with numerous patents and
publications including studies on the mechanisms of action of so-called Proton
Pump Inhibitors (PPIs), particularly those of the “prazole”-type (e.g.
pantoprazole, omeprazole, iansoprazole, raberprazole and the like).
Dr. Stephen Wolman
Dr. Stephen Wolman is a staff gastroenterologist at the Toronto General Hospital. He has been practicing as a gastroenterologist in Toronto since 1982. He received his
medical degree in 1974 as well as his training in Internal Medicine and
Gastroenterology at the University of. From 1980 to 1982 Dr. Wolman trained as
a Research Fellow at the London School of Hygiene and Tropical Medicine. Since
1982, he has been a staff physician at the Toronto
General Hospital and an Assistant Professor of
Medicine.
Mr. John D. Macdonald
Mr. Macdonald is the President and Founder of DBR Canada Inc.,
(“DBR”), a consulting company dealing exclusively with issues related to
formulary reimbursement of drugs, vaccines, and medicals devices in Canada.
Prior to founding DRB in 2001, Mr. Macdonald worked in the
pharmaceutical industry for over 30 years. His work in this industry spanned
sales, public affairs, and governmental relations. His responsibilities
included the development of plans and the management of teams to achieve
formulary listings at the provincial, federal, and private payer levels. In
the course of his work, he has files drug formulary submissions in every
province in Canada. Mr.
Macdonald has extensive expertise in the area of provincial formulations and
related drug reimbursement schemes.
Ms. Linda Dresser, Pharm.D.
Linda Dresser is currently a clinical pharmacy practitioner in
infectious diseases at North York General Hospital.
Prior to January 2007, she was a Research Coordinator and Clinical Infectious
Diseases Pharmacy Specialist at Mt. Sinai Hospital in Toronto
where she practiced as a hospital pharmacist. As well, she is currently a
Assistant Professor at the Leslie Dan Faculty of Pharmacy at the University of Toronto. She has been a hospital pharmacist since 1988, working and
training at various hospitals in Canada and the United
States, including at the Clinical Pharmacokinetics
Laboratory (CPL) of the Millard Fillmore Suburban Hospital/SUNY at Buffalo, and
at the McMaster University Medical Centre, Hamilton Ontario. Linda Dresser has a doctor of
Pharmacy (Pharm.D.) degree from Wayne State University in Detroit, MI and a 2-year post-doctoral research fellowship in infectious
diseases pharmacotherapy from the CPL/SUNY at Buffalo. Her work at North
York General Hospital, on a
day-to-day basis, as was also the case at Mt. Sinai Hospital,
includes working with doctors from the Infectious Diseases Service, where she
makes recommendations regarding antimicrobial therapy, supervises the
dispensing of prescriptions, precepts and teaches residents and students and
conducts clinical research.
Professor Barry Marshall, M.D.
Professor Barry Marshall is a NHMRC Senior Principal Research Fellow
and Clinical Professor of Microbiology and a Clinical Professor of Medicine, at
the University of Western
Australia; as well as a Professor of Research in Internal Medicine, independent
research faculty, at the University of Virginia in the United States of America.
Along with Dr. J.R. Warren, Dr. Marshall is the winner of the Nobel
Prize for physiology or medicine in 2005. Drs. Marshall and Warren were
awarded the Nobel Prize in medicine due to their discovery that gastritis and
peptic ulcers arise from an infection of the stomach caused by the bacterium Helicobacter
pylori (abbreviated H. pylori, and previously-known at various times
as Campylobacter pyloridis, Campylobacter pylori, C. pyloridis and C.
pylori). Mr. Marshall’s research into H. pylori began in 1981 when he
started collaborating with Dr. Warren regarding his discovery that bacteria
were found in gastric biopsy samples from patients with gastritis, something
previously thought impossible.
Professor M. Brian Fennerty, M.D.
Professor Brian Fennerty is currently a tenured Professor of
Medicine and Section Chief of Gastroenterology at the Department of Internal
Medicines at the Oregon Health
& Science University (“OHSU”).
He is on the Editorial Advisory Board for many journals including Alimentary
Pharmacology and Therapeutics, and Gastroenterology & Hepatology, and
is an editor of journals, including Reviews in Gastroenterological Disorders
and JournalWatch Gastroenterology. M. Brian Fennerty is also the author or
co-author of at least 146 peer-reviewed articles, including several regarding
diseases caused or exacerbated by H. pylori.
Dr. Renate Fischer M.D.
Renate Fischer has been engaged in the practice of medicine for more
than 30 years. She graduated with a degree in medicine from the University of
Koln, Germany in 1971. In 1973, she received her Approbation as a licensed
physician and completed her doctoral thesis.
Thereafter, she was engaged as a Postdoctoral Fellow at the Huntington Memorial Hospital in Pasadena, California during the period of 1973-1977. In 1979, she joined Byk
Gulden Lomberg Chemische Fabrik GmbH (“Byk Gulden”), later known as Altana
Pharma AG, now Nycomed GmbH. During the period 1979-2001, Renate Fischer was
engaged in international clinical research at Byk Gulden. In this role, her
duties included being a principal investigator in a number of clinical studies
with pantoprazole conducted by Byk Gulden. Her current position at Nycomed GmbH
(formerly Altana Pharma AG) is as Director of Scientific Affairs LOC Germany.
Renate Fischer is credited with a number of publications including
book chapters, full papers and abstracts. Many of these publications relate to
the clinical experience of Byk Gulden and/or Altana Pharma AG, now Nycomed
GmbH, with pantoprazole.
Mr. Ronald J. Elliott
Ronald J. Elliott has practiced as a pharmacists in the Province of Ontario since 1973. In addition to being the Pharmacist and Owner of a
Shopper’s Drug Mart in St. Thomas, Ontario, Mr. Elliott has, over the last 35
years, has employed and worked with over 35 pharmacists and has trained 12
pharmacy interns. He has also been for the past 4 years a guest lecturer of 3rd
year pharmacy students and international pharmacy graduates at the University of Toronto.
He has served as a member of the Council of the Ontario College of
Pharmacists from 1985-1993, and served as the President in 1989-1990. The
Ontario College of Pharmacists is the self regulating body charged with the
regulation of the practice of pharmacy in Ontario. He is also a member of the National Advisory Committee on
Pharmacy Practice, a committee of the National Association of Provincial
Regulatory Authorities.
Mr. Elliott is a member of the Canadian Pharmacists Association,
having served as a Member of the Board from 1997 to date and as the President
in 2001-2002. He served as the President of the London and District Pharmacists Association in 1979. He is also a member
of the American Pharmaceutical Association, and a Fellow of the American
Society of Consultant Pharmacists.
Dr. Ruth Corbin
Ruth Corbin is the Chief Executive Officer of CorbinPartners Inc., a
marketing science company founded in 1994, which conducts social science
research about marketing and consumer behaviour and provides analysis for
business decisions. In 2006, Ruth Corbin’s firm was awarded the “Best in
Class” prize by the Canadian Market Research and Intelligence Association
(MRIA) for its integrated program of research on brand equity. The award
presentation cited exemplary standards of validity and reliability.
Ms. Corbin has also held executive positions responsible for
research and investigations for three international corporations, including
Vice-Chairman, Leger Marketing, Managing Director, Kroll Worldwide and
President, Kroll Canada, and
Chief Operating Officer, Angus Reid Group. In 2006, she was awarded the
designation of Certified Market Research Professional from the Market Research
and Intelligence Association. Throughout her career she has specialized in
intellectual property, marketing research and business analysis. She has been
personally involved in the design, execution and analysis of at least 1,500
research studies, including telephone surveys, mall intercept surveys,
door-to-door surveys, media content analysis, and intellectual property audits
for a multitude of national and international corporations, law firms,
governments and public institutions.
Ruth Corbin holds a Ph.D. in Psychology from McGill University (1976), an M.Sc. degree
in Psychology from McGill
University (1973), a B.Sc. degree in Mathematics from the University of Toronto (1972) and in 2005 she received an LL.M. degree in Intellectual
Property from Osgoode Hall Law School of York University. She has taught in the
areas of market research, statistics and consumer behaviour and intellectual
property at Osgoode Hall Law School, Carleton University and the University
of Toronto
In 2000, Ruth Corbin she co-authored a reference textbook on social
science evidence in litigation published by Carswell, entitled Trial by
Survey.
Mr. Jean-Yves Julien
Mr. Julien is a Pharmacy and Health Care Management Advisor who has
been a licensed pharmacist in the province of Quebec since 1967. He has been involved
in purchasing and dispensing pharmaceutical products for hospitals and
community pharmacies in Quebec
for more than 35 years.
Amongst other positions held, from 1968 to 1979 he was elected as a
board member for the Quebec Order of Pharmacists. In that capacity he was
involved in various committees working on the Pharmacy Act and Bylaws
revisions. One of the outcomes of this work, for which he contributed is that
in 1974, under the Pharmacy Act, pharmacists in the province
of Quebec were given the authority to substitute
prescription drugs. Further, in June 2003, he was elected, for a two-year term,
as President of the Quebec Order of Pharmacists (Licensing Body). The Quebec
Order of Pharmacists is the licensing body for pharmacists in Quebec. At the time he served as
president, their members numbered over 6200 pharmacists. The main
responsibility of the Quebec Order of Pharmacists is protection of the public
through the regulation and control of the pharmacy practise in the province.
In his capacity as President, he dealt with various issues with regards to drug
prescribing rules, substitution and generic products. Jean-Yves Julien also
had to deal with substitution guidelines in relation with Code of Ethic rules
as well as administrative rules.
Respondent’s Expert Witnesses
Ms. Catherine Conroy
Catherine Conroy is a graduate of the University
of Toronto, Faculty of
Pharmacy 1979. She has practiced pharmacy for 27 years and is currently
practising at Shoppers Drug Mart in Mississauga, Ontario. She has worked at 8 different pharmacies since being
licensed to practice pharmacy. Over the past 27 years, she has worked with at
least 30 to 40 different pharmacies. Ms. Conroy has also been involved for 10
years as a teaching associate with the Faculty of Pharmacy at the University of Toronto in their Structured Practical Experience Program Ms. Conroy was
also a preceptor for interns and students (domestic and international
graduates) over the years.
Dr. Colin William Howden, M.D.
Dr. Colin William
Howden is a Professor of Medicine in the Division of Gastroenterology at
Northwestern University Feinberg School of Medicine and Attending Physician at
Northwestern Memorial Hospital
in Chicago, Illinois. Dr. Howden attained his M.D. Degree from the University of Glasgow in 1985 and is
certified by the American Board of Internal Medicine in Internal Medicine
(1995) and Gastroenterology (2005). He is accredited in the United Kingdom by the Joint Committee on
Higher Medical Training in General (Internal) Medicine (1991), Gastroenterology
(1991) and Clinical Pharmacology & Therapeutics (1991). He is licensed to
practice medicine in Illinois,
South Carolina (license currently and voluntarily inactive) and the United Kingdom. Dr. Colin Howden is a
member of numerous societies and edited and refereed a number of journals and
publications.
Dr. Howden has
authored more than 160 articles in peer reviewed publications, and has given
approximately 200 presentations to societies. He has edited, co-edited or
co-authored, guidelines books and contributed several book chapters.
Dr. David Yates Graham
Dr. David Yates
Graham is a Professor of Medicine and Molecular Virology and Microbiology at
Baylor College of Medicine in Houston, Texas. He also serves as Chief of the
Digestive Disease Division in the Department of Medicine at Baylor College of
Medicine and Chief of the Gastroenterology Section at the Veterans Affairs Medical Center in Houston, Texas.
Dr. Yates Graham attained his M.D. Degree from Baylor University College of
Medicine in 1966. His post-graduate training included: Internship at Ben Taub General Hospital and Veterans Administration Hospital, Houston,
Texas in 1966-1967; Residency in Internal Medicine at Baylor Affiliated
Hospitals, Houston, Texas in
1969-1971; and a Fellowship in Gastroenterology at Baylor Affiliated Hospitals,
Houston, Texas in 1972-1973. He was certified by the Subspecialty Board –
Gastroenterology in 1975.
He has held the
title of Professor of Medicine at Baylor College of Medicine since 1983 and Professor
of Molecular Virology and Microbiology at Baylor College of Medicine since
1989. From 1983 to 1989 he held the title of Professor of Virology at this same
institution. Prior to his appointment as a Professor, he served as an Associate
Professor and Assistant Professor.
Dr. Yates is also
a member of numerous societies, recipient of several honours and awards and on
the editorial board or a review for numerous journals. He has authored more
than 700 scientific articles and over 60 letters, and has contributed to more
than 90 books.
Dr. W.
Grant Thompson
Dr. W. Grant
Thompson is a Professor Emeritus (Medicine) at the University of Ottawa, Ottawa. Ontario. He
obtained his Medical Degree from the University of Toronto in 1960. His postgraduate training includes residencies
in medicine and gastroenterology at the Montreal
General Hospital in Montreal, Quebec and the Vancouver General Hospital in
Vancouver, British Columbia. He
was an R. Samuel McLaughlin Fellow conducting Research at the Royal Postgraduate School in London, England.
He was a Fellow of the Royal College of Physicians and Surgeons of Canada and
the American College of Physicians. He remains a Senior Fellow of the American College of Gastroenterology, the
American Gastrointestinal Association, and a life member of the Ontario Medical
Association and the Canadian Medical Association.
Dr. W. Grant
Thompson received his Certification in Gastroenterology from the Royal College
of Physicians and Surgeons of Canada in 1971. From 1980-1983, he was a Member
of the Gastroenterology Specialty Committee of the Royal College of Physicians
and Surgeons of Canada and a Member and Chairman of its Examining Board in
Gastroenterology.
Dr. Thompson has
been Chief of the Division of Gastroenterology at the University of Ottawa and the Ottawa Civic Hospital, as
well as the Program Director of the Gastroenterology Training Program at the University of Ottawa. He had previously
held the positions of associate and assistant Professor of Medicine and
Lecturer in Medicine at the University of Ottawa. He is a current and past member of
numerous societies and committees.
Dr. W. Grant
Thompson has received a number of awards and has been a reviewer or editor for
numerous panels, organizations and journals. He has also authored a number of
books related to gastrointestinal disorders and approximately 275 scientific
and lay articles dealing mainly with functional bowel disease.
Dr. Thompson
retired from clinical practice in June 30, 1999.
Mr. Kenneth
Brown
Mr. Brown is a
pharmaceutical consultant providing policy, program and strategic advice to
federal and provincial governments, the pharmaceutical industry and to health
professionals. He has familiarity with the manner in which certain drug
submissions are made, and drugs are listed on provincial formularies, in
particular, the Manitoba Drug Benefits and Interchangeability Formulary
Mr. Brown
obtained his B.Sc. in Pharmacy from the Faculty of Pharmacy at the University of Manitoba in 1966. From 1966
to 1973, he practised as a community pharmacy manager. In addition, during this
time, he was a teaching assistant at the Faculty of Pharmacy at the University of Manitoba. Between 1976 and 1979, he was executive coordinator of the
Canadian Conference on Continuing Education in Pharmacy, and editor and
publisher of the National Home Study Pharmacy Correspondence Program.
In 1973, he was
appointed Secretary to the Manitoba Drug Standards and Therapeutics Committee.
He was also a Member and Chairperson of the Federal/Provincial/Territorial
Pharmaceutical Issues Committee. In those positions, he provided strategic
policy and program advice to Health Canada, the Patented Medicine Prices Review Board, and the
Federal/Provincial/Territorial Advisory Committee on Health Services. Since
1998, he has acted as a pharmaceutical consultant to the pharmaceutical
industry, provincial and federal governments, drug program insurers, health and
legal professionals, database managers and professional associations.
Professor
David H. Sherman
Professor David
Sherman is currently the John Gideon Searle Professor of Medicinal Chemistry
(College of Pharmacy) at the University of Michigan. He also holds
appointments as a Professor in the Departments of Chemistry (College of Literature, Science, and the
Arts) and Microbiology & Immunology (Medical School) at the University of Michigan.
He served as
Director of the Center for Microbial Physiology and Metabolic Engineering at
the University of Minnesota and
for one year, in 1997, (while on University sabbatical leave), he served as
Senior Director of ChromaXome Corporation, in San
Diego, California. He co-founded and has served as the
Chief Technical Consultant and chairman of the scientific advisory board of
Acera Biosciences, Inc. since 1999. He has served as the Director of the Center
for Chemical Genomics, Life Sciences Institute at the University
of Michigan since 2004.
He received a
B.A. in Chemistry (with Honors) from the University of California, Santa Cruz, in 1978; and a Ph.D. in Organic Chemistry from Columbia University
in 1981 and was a postdoctoral researcher from 1981 to 1984. From 1984 through
1990, he was a Research Scientist at Biogen Research Corporation (1984-1987)
and the John limes Institute in Norwich, U.K. (1987-1990). From 1990 through 2000, he was a Professor in
the Department of Microbiology and BioTechnology Institute at the University of Minnesota. In 2003, he was received the John Gideon Searle Professorship in
Medicinal Chemistry (College of Pharmacy), and was appointed Professor in the
Departments of Chemistry (College of Literature, Science and the Arts) and
Microbiology & Immunology (Medical School) at the University of Michigan.
Dr. Sherman is a
member of a number of societies and has served as a referee for a number of
journals as well as a grant reviewer. During his academic career he has taught
in the fields of medicinal chemistry and microbiology and has published over
100 peer-reviewed research publications in the fields of synthetic organic
chemistry, bioorganic and medicinal chemistry, molecular microbiology,
microbial pathogenesis, biochemistry and enzymology.
Professor
Harold B. Hopfenberg
Professor Harold
B. Hopfenberg is the Camille Dreyfus Professor Emeritus of Chemical and
Biomolecular Engineering and Director Emeritus of the Kenan Institute for
Engineering, Technology & Science at North Carolina State University.
He received a
S.B. degree in June 1960; a S.M. degree in June 1961; and a Ph.D. in January
1965, each in Chemical Engineering from the Massachusetts Institute of
Technology. From 1967 through 1974 he became a Professor of Chemical
Engineering at North Carolina State University, Raleigh, North Carolina acting as Head of
Department from 1980 to 1987. From 1980 to 1992 he held various positions at
North Carolina State University
including Associate Dean of the College of Engineering, Executive Assistant to the
Chancellor for Institutional Advancement and for one year, Vice Chancellor for
Institutional Advancement. Dr. Hopfenberg and was subsequently Director of the
William R. Kenan, Jr. Institute for Engineering, Technology & Science.
In addition, Dr.
Hopfenberg has acted as a consulted with the Alza Corporation and at various
times from 1972 to the present, he served on the editorial advisory boards of a
number of journals.
Mr. Robert
L. Klein
Mr. Klein is the
President and Co-Founder of Applied Marketing Science, Inc. (“AMS”), a market
research and consulting firm with offices in Waltham, Massachusetts. He received a Bachelor of Science degree in
Mechanical Engineering in 1966 from the Massachusetts Institute of Technology
(“MIT”), Cambridge, Massachusetts, and a Master of Science degree in 1968 from the MIT Sloan School
of Management. He served as a commissioned officer in the US Public Health
Service from 1968 to 1970.
In 1970, he
joined Management Decision Systems, Inc. (“MDS”), where he was Senior Vice
President responsible for the development of market research models and
measurement tools. In 1985, he became Executive Vice President of IRI with
responsibility for custom consulting and market research projects outside the
world of consumer package goods.
In 1989 started
AMS, which has since been conducting market research on a wide range of both
consumer and business products and services. He is a member of a number of
societies and has been involved in the development of over 1000 surveys of
different types. He is the author or co-author of 20 articles or publications
related to market research, including several published in the area of
intellectual property.
Ms. Rosemary A. Bacovsky
Rosemary A.
Bacovsky is the President of Integra Consulting Ltd., a position she has held
since 1996. Prior to this, she was the Director of Pharmacy Services at the
Health Policy Branch, Population Health Division of Alberta Health. She
obtained her Master of Health Services Administration degree in 1997, her
Master of Pharmacy degree in 1985, and her Bachelor of Science degree in
Pharmacy in 1977, each from the University of Alberta. After obtaining her Bachelor of Pharmacy degree, and
while attending for her graduate degrees, she practised as a pharmacist at the
Cross Cancer Institute and Redwater General Hospital.
From 1988-1990
and 1996 to present, she provided pharmacy consulting services to a number of
clients, including for government, hospitals, and the pharmaceutical industry.
For one year, while the Director of Pharmacy Services from August 1995 to
September 1996, she managed the drug component of the Blue Cross Non-Group
Plans, and developed policy on cost-containments strategies for three revisions
of the Alberta Health Drug Benefit List (now known as the Alberta Health and
Wellness Drug Benefit List – the “Alberta DBL”) to meet various budget targets.
Ms. Bacovsky has also been involved in other matters relating to provincial and
national drug formulary listings and interchangeability of drug products.