Krever: the recommendation not followed

I read with interest Kumanan Wilson's commentary on the contributions of the report of the Krever Commission to public health in Canada.1 Of Justice Krever's 50 recommendations, it was the first (no-fault compensation for people who experienced injuries through the blood system) that was close to his heart.2 He considered that recommendation to be part and parcel of the precautionary principle because it would have served to balance the pressures of extreme risk aversion (by regulatory bodies and health care agencies, among others) with the need to move ahead with new treatments or to respond to unanticipated challenges. It put the dignity of patients first. Regrettably, it has not been adopted.

Krever recognized that blood is not another drug but rather a complex biological product that can never be completely characterized. Given this fact, his first recommendation was remarkably prescient. As we enter the world of targeted biopharmaceuticals, more and more of our therapies begin to look like blood products in their subtle complexity. My guess is that we are going to have to revisit the issue of no-fault compensation as part of a complete reframing of our drug development process, lest we stifle innovation or drive the costs of new drugs to unaffordable levels.