Yes, thank you, and thanks for pointing out that typo. It's always good to be on the record when you're doing that.
It is “surrogate markers”, and what we mean by that is that drugs are often approved for licensing and are submitted to drug plans for coverage on the basis that they affect a biologic organism within the body. They have some effect on sensitive process. So for instance, a drug might be approved because it lowers your cholesterol level or lowers your blood pressure.
We have reason to believe that the surrogate marker—that is, the lowering of cholesterol or blood pressure—will in fact result in the desired health outcome, which is the lowering of the risk of cardiovascular disease, heart attack or stroke. In many cases, we receive drugs that are approved on the basis of surrogate markers—or what sometimes are called “subclinical markers”—that have not been validated.
For instance, we just heard about the COX-2 inhibitors. When they first came to market, the safety profile of those drugs was much touted with respect to gastrointestinal bleeds and ulcerations. That risk profile was actually based on subclinical bleeds or subclinical risks; that is, ones that had to be inspected by a physician using a scope, not ones that were reported by patients. Later on, it was discovered that in fact some of those medicines don't have the benefits that were touted with respect to the gastrointestinal risks, and of course we later discovered the cardiovascular risk as well.