Health Committee on April 30th, 2007

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

My next question is for Mr. Hryniuk.

I have a quote in front of me by Dr. Terrence Sullivan, president and CEO of Cancer Care Ontario. It says:

This is an attempt to say let's put all the information on the table, let's bring the best people, let's bring the highest standards of evidence. And let's bring transparency to the process, including patient participation.

So could you explain to me how the JODR compares to and differs from the CDR in terms of process, expertise, and standards of evidence, and how they're going to bring transparency to the drug review process? How will the new process differ from what CDR does? Does the JODR have a timeframe they have to act within? Is there a spot for both of the bodies?

[Dr. William Hryniuk]

On the last question, one or the other but not both. The differences are that CDR has published the names and credentials of their membership that adjudicates the subcommittee of CED, the Ontario.... The new JODR does not. We don't know who they are.

CDR has published some information on why they made their decisions; the JODR successor doesn't. We don't have any reports from them publicly, of what led to their considerations. CDR was very poor in having expertise from oncology. JODR promises to have much more expertise, but perhaps not all the expertise they need. Neither committee looks at post-marketing surveillance of the drugs or at whether their decisions were actually, when they approved the drug, accurate and true, that they really did work.

So I would say that in the balance it's equipoise. The JODR is presently constituted. Notwithstanding what Dr. Sullivan said, those are promises; at the moment they're just promises. I think we need to make sure they turn into reality.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Does the rest of the panel agree with Mr. Hryniuk's statement that there's room for one but not both of these bodies?

[Barry Stein]

I don't think anybody could judge that at this particular stage. We're very early on in the process. No decisions have been rendered. No submissions have been made.

In fairness to the JODR and to Dr. Sullivan, I think there's an opportunity that shouldn't be missed. Assuming that this process is going to go forward, what we have to ensure is that the lessons from CDR are learned and that we mitigate the experiences of CDR.

Bottom line? We have to see if it'll provide further access.

[Dr. William Hryniuk]

But Barry, you can't have two committees now looking at oncology drugs. We're just talking about oncology drugs.

I'm not saying we should get rid of CDR for the other drugs, just oncology drugs.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Okay.

[Barry Stein]

My understanding is that the JODR would have the exclusive domain over oncology.

[Dr. William Hryniuk]

Yes. I'm just saying one committee, but please, not two.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

We'll now move on to Dr. Bennett.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Thank you very much for this.

Is the JODR for all drugs that oncologists might want to use? When there's a new drug, how do you decide which committee it goes to?

[Dr. William Hryniuk]

All of the oncology drugs would be judged by--

[Carolyn Bennett, Liberal, St. Paul's, ON]

But there are lots of immune drugs. There are lots of drugs that oncologists use. Do you guys get to decide which group you want to see it, whether you want it...?

[Dr. William Hryniuk]

If the provinces are asked to fund an old drug for a new indication, it would come to JODR.

For example, there are 400 drugs in the pipeline. Not all of them are unique. But there are 400 potential applications for about 60 new drugs. So Nexavar, which we've talked about for kidney cancer, could be considered next for another indication. That would also come--

[A voice]

Liver cancer.

[Dr. William Hryniuk]

For liver cancer. It may be highly effective there. But in order to fund it for that indication, it would have to go to JODR.

[The Chair, Conservative, Rob Merrifield]

One more answer.

[Debbie Milliken]

Just as a clarification, in terms of what JODR is looking at within its scope, it's essentially drugs for active treatment of cancer, both oral and intravenous drugs, for new chemical entities and new indications for the older drugs. The--

[Carolyn Bennett, Liberal, St. Paul's, ON]

But say if there was an interferon, or something that would be used for lots of things, if oncologists wanted to use it, you could choose to have it go through JODR?

[Debbie Milliken]

For the oncology indication, it would go through JODR if it was for cancer treatment.

[Carolyn Bennett, Liberal, St. Paul's, ON]

And would it go through CDR for the other indications?

[Debbie Milliken]

It may.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Come on.

Who asked for JODR? You guys were obviously very frustrated with CDR. How did we get this extra thing so that, obviously, any given drug might have to go through both places? And if you were going to design a system, wouldn't you fix the other one rather than create another one?

[The Chair, Conservative, Rob Merrifield]

Does anybody want to try that one?

[Dr. William Hryniuk]

First of all, a particular drug can have many indications in many diseases. If it was for diabetes, it would go through the CDR, but if it's for cancer, let's say cancer of the left ear, it would go to JODR. The funding for each individual indication is the responsibility of the province, right? So they may pay for drug X for disease Y but not drug X for disease Z. They base the evidence proving the drug is effective--