Okay, first of all, I think it's true that women are guinea pigs, but so are men and so are children in this environment, in that we're using drugs while having a limited understanding of their safety and effectiveness. Then we use them in the real world, so to speak, and develop a larger understanding of their collective value or concern.
Cost-effectiveness is a very difficult issue to deal with. I sit on CEDAC, the CADTH expert advisory committee that looks at cost-effectiveness. I can tell you personally that I find it an extremely difficult task, because we're looking at data from short-term clinical trials. In most cases we're talking about eight to twelve weeks of data by the time a drug enters the market. There can be more than one trial of that duration—sometimes longer, but often not. But uncontrolled experiments--in other words, the data on the use of drugs without a control group, just the post-market experience of users—are not very helpful in ultimately determining the drugs' cost-effectiveness.
So what we really need is much better data, longer-term data. I suggest that as a country of roughly 30 million people, we are not going to be able to change the international circumstances sufficiently and still receive, in many cases, the benefits of pharmaceutical products in ways that maybe the United States could muster with its buying power and its population.
What I would suggest is that we take an approach that recognizes our national health system, our collective ability to care for each other, which is phenomenally helpful in embedding networks and looking at post-market surveillance, and then when these drugs come on the market—and we presume their cost-effectiveness—we provide them under a framework that evaluates their true cost-effectiveness. It is better that we know ten years from now that a drug is cost-ineffective, and we stop paying for it, than to spend the next ten years wondering whether it is and talking about this ten years later, which is the current state of affairs.
I have spent more than fifteen years working with the provincial drug plan in British Columbia, a very frustrating fifteen years, in many cases, because there isn't a lot of interest in that kind of approach to drug coverage.