Absolutely. A lot of the comments that have been made have been about how you create that evidence base through an independent assessment as to which ones are more effective than others. My point was simply that some of the new biologic therapies are not perfect substitutes for each other. They're biologic formulations. The issue is that what works for one person may not work for another. Even when someone gets on an effective treatment regime, it may stop working for them after a number of years, so the issue isn't that they're perfect substitutes, in which case you could do, as you say, that evidence-based assessment. The question then becomes how we ensure, through that evidence base, that we understand the indications for which some drugs are appropriate, rather than simply listing one drug in a class. That was my fundamental point. Absolutely, it should be evidence-based in all cases.
What's making it more complicated now is that as with chemical compounds, we came up with generic substitutes. With biologic formulations, what are called “biosimilars” are coming to market, which are generally speaking much less expensive than the originator drug. For Remicade, which has been in existence for some time, there's a new drug called Inflectra that has now come to market. The big questions are, one, does the less expensive drug become the drug of choice when prescribing for new patients, and two, do people who are on a good treatment regime with the originator drug get forced to switch?
In the absence of evidence, and to your point, our position is that people shouldn't be forced to switch, but we do need better evidence as to the relative efficacy of these alternative treatment regimes.
I hope that's helpful.