It's a worthwhile goal; it's a worthwhile thing to pursue. The difficulty is resourcing this, because physicians, pharmacists, and nurses report the information they think you need to know. The four hours to put together one cysplatin case comes from experience and looking at many, many of these cases, and understanding what information I need, and specifically how to deal with differences in the information that's collected. Audiograms, the way you measure hearing, are done with different equipment, different standards, different thresholds across the country in different hospitals. Those kinds of differences have to be accounted for. If physicians just report reactions or Palm Pilot reports, it's not that useful. We need the in-depth information surrounding the case. If there's a way to identify the case, the physicians can give us a case and help us identify them, fine, but I can actually do that within hospitals fairly effectively now.
I would like to involve as many people as possible in adverse drug reaction reporting, but I think it's better to start small and then move to a bigger palette across the country and involve more and more practitioners. I think if you show some key successes with a few people, small projects, you'll get more people who want to participate and then a groundswell of participation continues. I think that's way better than building a national system of reporting and then having to staff all the sorting out of the reports. The difficulty with sorting out the reports is that they don't give you all the information you really need.