Well, in no particular order, the view of the Canadian Medical Association is that whatever drug review exists, it exists as an informative exercise based on outcomes, so it's evidence-based. The funding is a separate issue, which is a provincial-territorial responsibility, but the idea behind this is to produce a level of drugs that are generally accepted as being best in class, with some alternatives to allow for flexibility. It then becomes a separate issue as to how the provinces choose to fund those, and there are other options. You can't deal with the drug review simply in isolation, as just one fix, and we tried to allude to that in terms of the other elements we were talking about with rare drugs and catastrophic coverages. So I think you have to factor that into the mix.
How it's going to be funded is a separate issue in many respects. But we would see whatever drug review as being a lot bigger than it is at the moment, in terms of its staff and its ability to respond. We've heard from various witnesses, both today and on previous occasions, that the system is too slow and too cumbersome. That doesn't necessarily mean the system shouldn't be there; it means that perhaps it should be revised and altered in some way to make it more flexible and to make it work faster so that new drugs and first in class, which are difficult to deal with because there may not be anything with which to compare them, may need in the early stages some surrogate approach.
Ultimately what we're focused on is what happens at the sharp end with the patient. Does the patient get better with this drug in a more cost-effective, more humane way with the least side effects compared with existing treatments, or are the older treatments better?
The other thing about this, which I think people forget, is that rather than being an instructive arrangement, we as a profession would love to have access to these reviews and to this data, because by doing that and disseminating that, our physicians would be able to find the right drug for the right patient at the right time, which is what we're after.
The problem at the moment is that for most physicians in regular day-to-day practice, their main source of education on new pharmaceuticals is the lady or the gentleman from the drug company. Of course, they're not there to educate; they're there to sell. It's very difficult to get what we need, which is independent, arm's-length advice. Something like a review, funded at the federal level, would be untainted. It would be truly independent. It wouldn't have to deliver the funding, because that's a provincial responsibility. It would not be seen, by advocates for patients, as holding purse strings. Equally well, it would be at arm's length from pharmaceuticals, because it would not be open to the price deals that can be done on a provincial level.
So rather than throw out the baby with the bathwater, I think we need to change the bathwater, perhaps.
I hope that answers some of your questions. I realize I may have strayed a bit.