Thank you for your work in establishing CPAC.
On your first question about JODR–CPAC interactions, one of the difficulties is that the membership of the oncology subcommittee of this JODR is kept secret. That's why there are difficulties in interaction. That's why they weren't at the meeting. Are we not going to know the credentials and membership of a group that's deciding the lives of thousands of Canadians? I think that's ridiculous. That's the first issue. Second, I think you need to encourage interaction at that level. There are other reasons for their not interacting, which I think you can break though. But I would encourage you to keep an eye on that.
As far as JODR versus CDR, the lesions of CDR could be replicated in either condition. You have to correct the lesions of transparency of membership, credentials, patient representation, what the decisions are really about, and the cost-effectiveness model. Those lesions exist no matter which way you go, and they have to be fixed.
Finally, I think those lesions apply to CDR in other diseases. If you fix them for JODR you can fix them for CDR. Get adequate representation. Get experts on the diseases who did the trials to testify to the committee and explain carefully--as we heard from Dr. Knox--why this drug is so important. Nobody on that committee must have realized that this was a breakthrough drug. They purposely excluded the investigators who proved that this was a breakthrough drug because somehow their testimony would be tainted or not believed. I think that speaks to the lack of competency and knowledge, and you have to repair that defect in CDR.
With JODR we don't have so much worry. It's well staffed by expert oncologists. But they should still hear from the investigators who proved that the drug was effective.