Sure. I address that a bit in my remarks. I think, again, like anything in life, one is balancing two risks and harms. My view would be that right now the kinds of studies that industry has to come in with to have their drugs licensed are sort of a minimal standard in most times.
Mr. Orr mentioned Trasylol, which is a drug to prevent bleeding in people with bypass surgery. I actually chaired the committee that suggested that the study that looked at Trasylol should stop, because it looked as if it was killing people, compared to the comparative drug. It's a good example, actually, because nobody was saying that Trasylol wasn't effective. There was actually very good evidence that it decreases the risk of bleeding. That's quite clear. The problem was that nobody did the big enough study for long enough to see what its effect upon mortality was, so industry was able to get Trasylol funded because it clearly was....
I slightly disagree with Mr. Orr. I think it's a big exaggerating to give you the sense that we don't know the benefits or the effects of most drugs. I think we do, but often it's these surrogate markers. It's great to know whether it decreases the risk of bleeding, but you sure want to know whether it's increasing the risk of death.
So obviously the down side.... I think I would be looking very carefully to make sure there isn't any marked decrease in the quality of the randomized trials that are required now, which I think is an absolute minimum. There might be some instances of terminal cancer or whatever, where you might be able to make that case, but I'd like to see those specified.
Let me just make one other comment and then I'll stop. That Trasylol study was actually funded by the Canadian Institutes of Health Research, because it was precisely the kind of head-to-head trial that Steve had mentioned drug companies were not interested in doing. They were not interested in comparing their active drug with the competitor's active drug. The Canadian Institutes of Health Research funded a total of seven randomized trials last year--seven. I don't know what they were about, but I'm sure all seven weren't about drugs.
I think one thing this committee should look at is increasing somehow—in our network we were suggesting we would fund more trials—or encouraging or providing the funds to the CIHR to be able to fund more of the kinds of studies you folks and Canadians would want to know about, which would provide the information about the benefits and risks of drugs.