It was a call. There are two members who sit on CEDAC. They're non-voting public representatives of CEDAC.
I think the public representation is an important question, and I just want to highlight some work about coverage processes in general—pharmaceuticals in health care and technology more broadly.
There is an interesting ethical framework referred to as the accountability for reasonableness, which sounds like a reasonable framework. It suggests that there are four criteria you would want to have for a decision-making process. First is that it has relevance, that it is using relevant criteria to make decisions. That, which Dr. Menon is referring to, is precisely when public engagement is important: engage the public in helping us determine what the criteria are for making a decision, but don't necessarily involve them in direct democracy, in the sense of making them make those tough choices. That's the responsibility of public servants and experts, frankly.
Publicity is another criterion in this framework; that is, that the rationale for decisions needs to be public. After you've made them, you should be able to defend them. The limiting factor on that criterion right now is confidentiality clauses enforced by the manufacturers. I don't think, frankly, Canada can go it alone on this one. We are going to have to cooperate internationally with other countries on how to develop what you might call a minimum data set, a minimum standard of transparency for decision-making processes, and require that manufacturers and other groups participate to that level of publicity or transparency.
The next question with respect to these criteria or this decision-making framework is revision. There should be opportunities, effectively, for appeals and for a reconsideration of decisions if there have been procedural problems.
Then finally there is enforcement. The decisions should be binding; there should be some mechanism by which they are enforced.
Canada's CDR does fairly well, or as well as it can in the context of our jurisdictional issues around drugs and the transparency limits due to confidentiality. Canada's CDR lives up pretty well to the others. The question of relevance of criteria and the involvement of patients in establishing those criteria is definitely worth pursuing.
They've done some work to include people in the committee. You might want to have a national citizens jury or panel to establish a list of criteria. In New Zealand, there are nine of them that they must consider. In Canada, maybe there would be 16, since that's how many drug plans we have.