That is a major question. How do we increase the degree to which adverse events are reported? Even when you compel a doctor, a pharmacist, or a hospital to report events, systems tend to report, in the best situations, on average about 10% of adverse events. Mechanisms to increase reporting include possibly compelling and making it legislation, but are more likely to be active about it. The notion of having trained personnel dedicated within institutions to track and monitor ADRs is a mechanism that might work. In Canada we might then have a network of hospitals across the country in which, at least in the emergency room, there was a trained pharmacist whose responsibility was really to look for adverse events. That's one way to dramatically increase the sensitivity with which we collect this information.
Dr. Carleton's network effectively does that within children's hospitals.
There are other mechanisms. Mary Wiktorowicz, who is speaking next week, can tell you about international experience with that.