I can speak more knowledgeably about the U.K. situation, so let me focus on it. When NICE, the National Institute for Health and Clinical Excellence, was created, it was with the view that priority setting for such things as health technology assessment reviews ought to involve a broader sector than what was traditionally driving the system, which was technical, clinical, and methodology experts. Experts reviewed, experts designed, experts made recommendations, and the public essentially bore the results or the brunt of those decisions.
They created something called the citizens council. I should point out that the citizens council does not get involved in review of individual products. What they do is look at the classes of drugs or technologies that are important to them, that ought to be examined, at the aspects, other than the very technical and scientific things that are measured in trials, that ought to be considered.
It was a nationwide advertisement that went out. People were invited to apply. I can't remember now whether it's 20 members that the citizens council has. They were selected on the basis of that process to represent the population of the U.K. I've attended two of their meetings. They include everything, to be representative, from an ethnic mix to unemployed, employed, ageāall of that.
They've come together, and it's phenomenal watching them work. They don't make any decisions about what ought to be listed or not. There was one in particular where they were dealing with orphan diseases. It was important for NICE, before it went out to commission trials, to understand what that meant to families of people with orphan drugs and what citizens felt.
What was important and good to see was that citizens, through this process, began to understand that all of these decisions are trade-off decisions. In a sense, the Health Canada licensing process is not a trade-off process; you can add any number, if you think it meets scientific standards. But the formulary coverage, CDR decisions, are trade-offs. When people in general understand that they are trade-offs, I think they're more accepting of these decisions.