I don't think I can come up with a solution for the honourable member, but I'd like to address her concerns about how we can make the reviews more reflective of Canadian values.
For the non-physicians in the group, I think it's important to understand what we mean by evidence-based medicine and what we mean by levels of evidence.
I've provided some information to Carmen DePape, which she will have translated for you, and I believe you'll be able to have it for your review later this evening.
If you look at the level of evidence required to be what is called “class one evidence”, which is the highest level of evidence, you have to have a prospective, which means a study in the future; randomized, which means patients have equal chance of being on a placebo or the active drug; controlled clinical trials--and they have four other criteria for them. That is an awfully high bar to meet, and the conduct of the trial has to be absolutely perfect, with not an excessive amount of dropouts for the patients. But this is the bar that seems to be used with the common drug review, at least in my experience.
We do deal with patients in the real world. It is impossible, generally, to have a perfect trial. It is impossible to satisfy what every policy group will want as the most important outcome. And as we've heard from the patient group, other factors may not be taken into account, even in a pharmo-economic analysis performed by interested parties. They may not take into account things that she mentioned, such as the quality of life issues.
The fix to that is not really just abandoning the whole process, nor is it opening it up so that it becomes really a clash of advocacy groups and who has the loudest voice, because we are interested in distributive justice when we provide funding for treatments. It is looking at the evidence and acknowledging that we can't always have a perfect study.