We can train physicians and nurses and pharmacists to do their reporting. In the United States, where MedWatch came in with great fervour that it would increase reporting in 1996, in 1997 there was a 50% increase in adverse drug reaction reporting as a result of the online registry that FDA set up for consumers and health professionals to contribute reports to. That improvement, hundreds of millions of dollars in the creation, results in one report every 336 years per physician and one report every 26 years for pharmacists. So pharmacists are actually much more effective at reporting than physicians.
But it's getting the quality of reports in a thorough and standardized way. It takes me four hours to put together a cisplatin deafness case. This is not an inconsequential amount of time and energy for a health professional to put together. We need professional surveillors. At the moment, your hospitals across this country all have a clinical pharmacist. Clinical pharmacists all have the mandate to report adverse reactions. It's part of their job descriptions, I would bet, for all of them. If it isn't, it should be there. Unfortunately, it's just one more task added on to the long list of things they already have to do.
The best way to do this is to get a handful of people together and make it grow from there. I have 13 people across the country, and in three years I have more than 9,000 cases and controls, more than 1,000 serious ADRs and more than 8,000 controls, which is what I need in order to look at the heterogeneity and response—13 people.