I think you've probably heard from industry and its various representatives with those comments. They would say that about any process that reviews medicines to make transparent, evidence-based coverage decisions.
Industry doesn't like any of these processes around the world, because in some sense it's easier to have a free market for pharmaceuticals than to have an agency look at the science. But Canada's process is actually respected, and I think Canadian scientists who are engaged in these appraisals and assessments are respected.
On the lack of an appeal process, by default, the CDR has an appeal process because you can re-submit. Manufacturers are able to re-submit if there is new evidence brought to bear on a decision.
There are criticisms made of the CDR that are flatly not true.
On the international stage, Canada was invited to attend meetings of agencies like the CDR because Canada's process is respected. All processes around the world could use some improvement. Through actually collaborating and communicating with other processes, I think we're going to get there.
We learn from the success stories. For instance, I think the public participation on the Australian advisory committee truthfully informed the CDR's movement toward that kind of engagement. I think we could learn issues with respect to transparency and dialogue during a review process, for instance, from the process in the U.K.
I think I've written five papers on the CDR in the international context. Those are among the most requested papers internationally that I've written in my career, and I've probably written 50 or 60.