It is true, for instance, that New Zealand has two cholesterol lowering drugs, while Quebec now has six. New Zealand has always refused to approve Celebrex and Vioxx, because their superiority over traditional anti-inflammatories has never been demonstrated, and also because, right from the beginning, it was suspected that Vioxx could cause cardiovascular problems. The data were there.
Study 090, for example, before the approval of Vioxx, showed that the people who took Vioxx had had three times as many heart attacks as those that took Naproxen or a placebo. Already the data indicated to New Zealand that these products should not be reimbursed and should not figure in the formulary.
A study conducted by Zhou and his colleagues at McMaster University showed that all the anticholesterols were equivalent with respect to secondary prevention. When there are already two or three drugs on the market, why approve a fourth, a fifth or a sixth, whose toxicity profile is unknown? That poses a number of problems.
Obviously we do not always have the data necessary for us to say that we have enough drugs of this type and that it has not been demonstrated that such and such a new drug is more effective than its competitor. Certainly some efforts need to be made in this regard.