The following points suggest implications for policy development. Confronting Conflict of Interest Little in the background material supplied indicates adequate attention to the problem of conflict of interest. Any attempt to further erode the drug company responsibility to fund its own research, by way of allowing charges to patients or third parties for nonvalidated drugs, should be resisted. Such payment should at most be permitted on behalf of the marginal cost of producing the drug consumed in fact. Many REBs have taken the position that to satisfy this partnership, companies must agree to supply those research subjects who had been assigned to placebo with the test drug if the trial's results are positive.
Drug research involves a further partnership as well, with the Canadian public and government.
Drug companies take advantage of a favourable tax and financial climate, and a sophisticated health-care infrastructure, supported by the taxpayer. Reciprocity and equity suggest that companies be made to understand that open-label supply of experimental drugs in conformity with policy and ethics is part of the cost of doing business in Canada. This has particular relevance to another aspect of the problem of access to experimental drugs that has not been addressed. Outside of those studies on HIV disease itself, it has become common, and even routine, to find that HIV-positive persons are excluded from clinical studies. These and other questions are currently being considered by Canadian REBs and by networks of Canadian researchers, yet these groups are given no formal consideration in the background documents and have not been assigned any role to play.