Health committee  I'll give you a brief answer to that, if I may. To begin with, the whole issue of quality of life and values are not identical. Quality of life is in fact measured scientifically in many of the drug and even non-drug technology trials. There are validated methods of doing that, to see if there is an improvement in quality of life in a particular patient population.

Health committee  I would feel exactly the same way. From the point of view that I bring here, as a researcher, I don't have the answer to the question. Quite frankly, personally, I'm here today to speak to you because of drugs. I spent the first 10 weeks of this year in hospital, six of those weeks in intensive care.

Health committee  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?

Health committee  I can't remember the exact number, but some European agencies look at generics as well.

Health committee  I can't answer extensively across all countries. The problem with rare diseases—and some of them will fall into the catastrophic disease category as well because of the cost—is that there is not a lot of scientific evidence that can be generated to help make the kinds of decisions that CDR has, because if a disease is very rare, there's going to be a small patient base for it, and so to do a trial to collect enough data to make meaningful conclusions is next to impossible.

Health committee  Maybe, I would say. Looking at what the common drug review has or has not achieved, I think people tend to forget, when they criticize the common drug review, that prior to the common drug review each province had some mechanism, as everybody knows. Has that changed decision-making?

Health committee  But I cannot see how there would be one single formulary that all provinces would deal with in a similar way.

Health committee  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.

Health committee  Dr. Morgan might know more about the process. I believe there are two public members on the CEDAC. As far as I know, it was a call that went out on the website. I'm not sure about the process that was used to select them.

Health committee  The short answer would be yes. It's how to do it that would be the challenge. There are some real challenges, in that these trials, which are typically called phase three trials, which are the human, reasonably large-population trials on the basis of which an application for licensing is submitted, take time.

Health committee  I have a couple of points. One is that the difference in numbers typically comes from having many more of a certain class of drug in a formulary in one place than in another. New Zealand is a case in point, where there are fewer of a certain type of drug on the formulary. The advantage of having choice is that one could use that to differentiate in prices among products in a class, and I think that's done now in places in Canada.

Health committee  Thank you, Mr. Chair, and thank you to the committee for this invitation to be here today. In fact, I'm filling in for someone who I think you actually wanted, who happens to be a young colleague of mine with whom I have done most of this work. Her name is Tania Stafinski, and I do want to mention her.

Health committee  It behooves her to say that since I'm actually her supervisor. But I do want to give her credit and go on record as saying that most of this work was done with her, but she's unable to be here. So I hope I can contribute meaningfully to your deliberations and decisions as you come to a close.