Health committee  Not that I know of.

Health committee  I'll take the question in my role as a physician rather than as chair of the PMPRB, because I think your objective is a very valid one and good one, and it's very current. There are all kinds of difficulties in implementing a very good mandatory reporting system for adverse reactions.

Health committee  It is mandated in Ontario that a physician must report to the Ministry of Transport if a certain individual is not able to drive a motor vehicle. Then the ministry asks the patient what their problem is. If we have somebody with unstable diabetes, angina, seizures, or whatever, we are obliged to tell the Ministry of Health that person has a condition that would preclude their driving a motor vehicle.

Health committee  That's the only way you're going to get a high level of compliance.

Health committee  Somebody would have to ask them.

Health committee  I don't think so.

Health committee  Not really. At the family doctor level there are probably many adverse reactions. At the moment, if a serious adverse reaction occurs the physician is obliged to inform the Ministry of Health or the medical officer of health of his municipality. That's an ethical obligation, but it's not mandated by law.

Health committee  I really have no comment on that.

Health committee  Mr. Fletcher, the questions you're posing are the obvious ones in the current context of what we're discussing here today. It would be extremely difficult, because compliance with the prescription is one of the big problems the medical profession faces. In the context of a clinical trial, where everybody is being surveyed and you come to the clinic and the nurse checks you and they look in the pill bottles to see how many are left and so on, it's very easy to come to a conclusion that this dose or this medication is effective.

Health committee  I'm not sure I totally understand your question. Could you rephrase it?

Health committee  I don't know the answer to that. Your point is why reinvent the wheel if some other country or organization has come to some kind of arrangement in terms of what we're thinking of doing.

Health committee  I don't know the answer to that, Mr. Fletcher.

Health committee  The issue of post-marketing surveillance and the reporting or evaluation of adverse reaction is something relatively new, at least to our organization. We're invited here today presumably to give our opinion from the point of view that we come from, but we've never been approached in any direct way to get involved with this.

Health committee  Mr. Fletcher, as a matter of fact, our particular prices are compared with...I think somebody mentioned the European Union. We have seven countries that have similar health care systems to our own, with whom we compare the prices. It may be--

Health committee  As I see it, there is no easy answer to that question.