Moving from opacity to transparency in pharmaceutical policy.

© 2008 Canadian Medical Association or its licensors 428 Physicians and patients should demand, and participants in the system should provide, transparency in all of the areas of drug approval and reimbursement (Table 1). The current situation, in which the evidence used to make decisions often remains secret and the decisions are not adequately explained to the public, is untenable. We wrote this commentary in response to the House of Commons Standing Committee on Health’s 2007 parliamentary review of the Common Drug Review program. Established in 2002 by the federal government, the Common Drug Review was charged with evaluating the cost-effectiveness of new outpatient drugs and to make recommendations to Canada’s publicly funded drug plans. Although many submissions to Parliament’s Standing Committee on Health legitimately criticized the Common Drug Review’s lack of transparency, we believe that the scope of both the criticism and the review itself was too narrow. We suggest that, from start to finish, the drug evaluation systems in Canada and elsewhere lack transparency. Transparency is important for several reasons. First, the availability of detailed information about a drug’s benefits and harms would allow interested individuals to review and analyze trial data themselves. If independent analysts come to the same conclusions as regulators and other decisionmaking bodies, confidence in the decision-making process would increase. Second, a lack of transparency always gives the impression that something is being hidden. The drug evaluation system would be perceived as being more legitimate if the public were aware of how and why decisions are made and had an opportunity to provide input. Governments might also benefit from increased public trust. Finally, increased scrutiny of the decision-making process might lead to better decisions.