Those are very good points indeed. There is a difference of opinion, and we can't attribute it all to the industry.
I would step back first and ask a question that I think people tend to forget: why was the common drug review instituted in the first place? Did anyone ever say that the common drug review would make access to drugs common across the country? Everything I have read—
You might want to know that I was the first executive director of CCOHTA, the predecessor to CADTH, for the first seven years, so I have some idea of the provincial-federal play in this area. When the CDR was first talked about—and I think Dr. Morgan alluded to this—it was to make the review of drugs for formulary decision-making more efficient and to reduce duplication. Those were the first goals. To translate that into improved patient access or improved patient care, I would have to ask what one means by improved patient care. Was the assumption that decisions made previously jeopardized patients? Is that the assumption? Frankly, I don't know that.
To me, if anything, what the CDR has done is this. There's one submission, and there are standards for that submission. There are guidelines; they have to be met, so in that sense there's conformity with standards. The fear I have is that the standards are still so technical and clinical that other people's views and values don't get injected into it. I think that may be where the disconnect is coming, because you have standards that are based on very strong methodology.
I know you're running out of time, but I just want to make one comment. This just reminds me. My colleagues would hate me for this, but there's a joke that I like to tell: what's the difference between a methodologist and a terrorist? You can negotiate with a terrorist. In some cases I feel we're strapped because of the methodological development and we tend to forget that there are people. I think that's where really the disconnect comes.
As for the allegations that it isn't working, I would have to say, did we expect the common drug review would increase access to more drugs? Did we reasonably expect that? If we did that, we're making the assumption that we were denying people treatment before, and I just don't have the evidence to back that up. It may be the case. I think it now allows people to make decisions that are more defensible from a scientific point of view.