Sure. I'm delighted to be here.
My name is Anne Holbrook. I am here in my role as a physician in a very small specialty in Canada called clinical pharmacology.
What you're discussing is actually core to my career. I want to take you a bit more—perhaps more than Katherine has from the policy side of it, though keeping that in mind—to what actually happens at our formulary committees that is problematic and back to the bedside, because we're looking after patients. There's not really a lot of disconnect between those roles, believe it or not.
I have this lovely power point presentation, which of course you can't see. My talk would have been more visual perhaps than discussion, which would have been better for you folks.
I was also charged to chat a little about evidence. I want you to know there is expertise required for all of these roles, of course, but the role of evidence comes from the pharmaceutical world and is probably at its zenith in the pharmaceutical world.
Everything you're discussing around health care has devolved from the drug world. The types of trials we need are very well established: knowing whether one drug is more effective than another drug. The type of economic evidence we need is very well established.
I'll give you some examples later of where we're trying to decide about a drug for rheumatoid arthritis, as well as lipid-lowering drugs and drugs for cancer. You have to have a common paradigm to look at those that's extremely well developed. This is not to say that it's not controversial and can't be played with in a certain way, but it is very well established. That's very important for us to continue and, as Katherine said, Canada has been among the leaders in the world.
What's problematic in our system now with regard to evidence is that drugs are coming to the formulary as fast as they can. As you can imagine, the manufacturers want to get a drug to market as quickly as possible. They've invested a lot of money. It's not usually as much as they say they have, but it's a lot.
It's often our role to deal with what is incomplete evidence. It's very common. The last drug I discussed has potential to cost the country $250 million a year. We do not know if it actually prevents cardiovascular events. We know it lowers lipids, but we don't know that it prevents cardiovascular events. Trying to decide if a drug is actually going to play out in the clinical world the way it has been advertised by the pharmaceutical industry is routine.
There are many other ways, which I think we'll just include in my brief.
In addition to the quality of evidence considerations, there are many other ways whereby evidence can be misleading. This misleading evidence, as you can imagine, often makes its way into the social media and the briefs that come to us. I'll leave that perhaps for the question period. I'm also happy to discuss anything further.
I'm sure that when you're all in your family doctor's office, somebody is scribbling on a pad or typing away, and it looks like a very simple act. One of my unique roles that I want to warn you about is that prescribing, which sounds very simple, is extremely complex and requires a lot of knowledge and skill.
At this point in time in Canada, there are over 13,000 drugs on the market. There are only nine to fifty hours in medical school devoted to prescribing. Prescribing now is not just about whether a drug will work for our society in general. It is much more about: for this particular person, with this set of diagnoses, comorbidities, socio-economics, values, and these other medications—forget the genetic profile for now; that's really not of much importance—is this drug going to be more beneficial than harmful for that patient?
These are very, very complex discussions. Therefore, one of my arguments in a public forum is always that we need a lot more clinical pharmacologists and specialization in this area of expertise. Since we're not training our physicians and prescribers as well as we should, some people have advocated that pharmacy be more involved. There's no doubt that pharmacists should be more involved in the vetting of prescriptions.
We can chat about this more. I do not believe that pharmacists should take over prescribing.