Health committee  I didn't hear Bruce's presentation, but my knowledge is that Bruce is interested in figuring out if he can predict, on the basis of genetic susceptibility, particular people who are particularly at risk of certain adverse drug reactions. My sense is that if we could do that, it would be fantastic.

Health committee  Yes. As I said in my remarks, even if this post-marketing surveillance network were to be well funded, one would still need to make decisions about where one is going to concentrate. I would concentrate on areas that, on the basis of initial information from randomized trials, give concern over possible side effects.

Health committee  Sure. Thanks.

Health committee  Thank you very much. Good morning, everybody. Thanks for the opportunity to talk with you about the post-marketing surveillance of pharmaceuticals. By way of introduction, I'm a patient who consumes drugs, a physician who prescribes them, a researcher who studies their benefits and side effects, and a drug policy advisor.

Health committee  That's correct.

Health committee  First of all, I fully agree. I work at St. Michael's Hospital, which is an inner-city hospital in Toronto, and there are a lot of homeless folks around St. Mike's, many of whom have mental illnesses. My dad died of dementia, so I'm fully aware of the devastating effects of mental illness.

Health committee  Exactly, yes.

Health committee  There is an appeal process now. I've observed that every time, with maybe one or two exceptions, we recommended that a drug not be funded, it was appealed, and we reviewed that appeal. I would agree that the appeal should be more transparent and open, but that would mean the pharmaceutical companies would have to agree to allow all the information they submit to the CDR, which they frequently ask us to keep confidential, be open and public.

Health committee  That's an interesting question. I guess the question is what one is appealing. Is one appealing that the CDR got the science wrong? The CMA reps have almost been implying that the science is going to be clear-cut, and it ain't. Sometimes it's really clear-cut that a drug is fantastically effective and safe.

Health committee  I think Quebec has traditionally always had a more liberal view about the reimbursement of drugs. I've never sat on the Quebec drug reimbursement committee, so I can't really comment. I guess I'd make three comments about this general issue. One is that there's no question that one needs expertise in a particular disorder.

Health committee  This isn't an area I'm an expert in, but I would make two comments. First, as best as I understand it--and certainly I don't have any problem with those seven countries, although I can't rhyme them off to you--the legislation says the price in Canada can't be higher than the median price of those seven countries.

Health committee  Tarceva came before the CDR when I was the CEDAC chair, and to the best of my recollection, it was dealt with in the five months' time process, and to the best of my recollection it was recommended for funding under certain criteria. I don't know whether those criteria were the ones your mom would have had, but certainly, to my knowledge, it wasn't delayed.

Health committee  I honestly don't know how the industry spends its funds, in terms of the proportion that goes into advertising versus basic science research, etc. I think things are changing markedly with the emergence of biotech drugs, etc. What I would say is that eight or nine years ago industry reported that it cost them $300 million to produce one drug.

Health committee  Thank you, Mr. Chair. I'm the previous chair of the Canadian Expert Drug Advisory Committee, which I'll refer to as CEDAC. This committee recommends to the drug plans participating in the common drug review which drugs should be funded and which should not. I'm also a practising physician and a researcher, and like all of you, my family and I use the services of the health care system.

Health committee  Thank you very much. I've managed to spill my water here.