There are two things. To get a drug approved for the market, you simply need to compare it to a placebo and show that its has more benefits than the placebo has. But then to get the drug, especially on provincial public formularies, you need to prove minimally that you can get some bang for the buck if you accept reimbursement for the drugs. This is what we call health technology assessment. This is something a bit different from the approval process with Health Canada. This is with CADTH and the common drug review. Basically, we assess the cost of the drug versus the therapeutic benefits it can provide.
The way the system is now organized in Canada, the CADTH, the Canadian Agency for Drugs and Technologies in Health, provides recommendations to all provinces and based on that, the provinces decide if they will reimburse the drug. They ask themselves, do we get enough bang for the buck? Do they list the drug or not?
But the problem is not there. We have estimated that right now in the United States drug companies spend $61,000 per physician to promote new products. In France it's €25,000. In Canada we estimate it's at least $20,000 per physician to promote the new products. As soon as the drug gets listed, the issue becomes the way the drug is prescribed. Are prescribing habits by physicians such that they will respect evidence-based medicine or will it be more marketing-based medicine, based on promotional campaigns? Promotional campaigns are still very efficient right now. The problem is the health technology assessment must be organized as well with some way of influencing prescribing habits. For example, it can be through academic detailing and stuff.
We need to find some way of translating evidence-based medicine prescribing habits. Right now these prescribing habits are still influenced way too much by marketing campaigns. In the end, we have irrational habits. Atypical antipsychotics, for example, are not shown to have any more clinical benefits than older antipsychotics. They cost 10 times more.
But this problem is all over the place. This is what we're prescribing massively off label as well. These are the problems that we need to tackle. It's not just a question of more innovation, but how you organize the prescribing habits as well.