Health committee  We could work out the probabilities of that and therefore have a rational basis for compensation. I'm not saying it would be easy. The rarity of all of this makes scientific work very difficult.

Health committee  No. [Technical difficulty—Editor] as I've said before, the competing probabilities in any causality statement that you make. What you can do is to do a genetic test so that you know that this gene causes this kind of problem, and then look at the family history and see whether this has occurred before in the family.

Health committee  We have that. It's in the meeting document and, as I say, a little amplified by our work, which is.... Yes, we have that, but the thing is that it's there to be as sure as possible. We can give the probabilities of other things being included, but you would never be sure that they were due to thalidomide.

Health committee  I have every human sympathy with it. I listened to the two witnesses, and I have a lot of sympathy, but you will open the floodgates. You will have lots and lots.... One of the things, for example, that has been found in the experimental work is that thalidomide causes an increase in clubfoot in animals—now, that's in animals.

Health committee  On symptoms, I'm always bothered by that question. As a human being, I want to give the benefit of the doubt to my patients. As a scientist, though, I have to say that if you don't know, for instance, whether or not someone has taken a particular drug, I don't see how you should ever say, “Well, this is caused by the drug.”

Health committee  To answer the second bit first, the criteria have been and still are the classic phocomelia and some others. I won't read them out, but there are half a dozen criteria that pick out the most obvious candidates who sometimes have other problems. They are pretty strict criteria, but they are dependent on a clinical view of the patient, rather than....

Health committee  I would go for genetic testing, but certainly physical examination. I don't see how you can reject someone without a physical examination. The one key factor, though, is going to be what are the conditions that have been reported in some of the thalidomide victims, such as ventricular septal defect in the heart, the so-called hole in the heart.

Health committee  Yes. They're known, and the genetic testing is relatively straightforward and gives a fairly clear result.

Health committee  Well, my difficulty is that I really have trouble...and I think this is what we all feel: if someone has severe limb reduction deformities—no arms, no legs—and it's due to a genetic cause, what do we do? Do they not get compensation? I think what we're doing is really trying to find out whether thalidomide caused this rather than thinking about their disabilities.

Health committee  I'm not familiar with the Canadian.... The only things I'm really familiar with are the U.K. and Swedish jurisdictions. They are about the same as you are. I think there's a feeling that people with some ocular disturbances and also a hearing disturbance with the loss of the external ear are more likely to be compensated in Europe now.

Health committee  That's what I feel as a human being and as a physician. As a scientist, I ask the question, “Was this caused by thalidomide?” I really would want proof that the mother had taken thalidomide at the right time.

Health committee  That's what I would guess because, as I say, we've done our scientific work on the basis of a fifty-fifty probability that the mother did take the drug and then on the other criteria that we all know about.

Health committee  Certainty is very elusive in medicine in general. The issue really is a rather rare one, in the sense that there are only a few weeks in those first three months of pregnancy when if someone took thalidomide there's a good chance that they would get the problem. Also, one thing we don't know is how many people took thalidomide during pregnancy and never got a problem.

Health committee  No problem. Go ahead.

Health committee  Yes. Of course, you should be able to view the work that was done in our meeting and after the meeting in relation to this, but the direct answer to your question is that we would be roughly 95% sure, given everything you've just said, that the person was damaged by thalidomide.