Health Policy 1998;19:267-88. [The author responds:]

• Main Authors: Inuit J Investig Med, As I Underst, His Argument
• Other Authors: The Pennsylvania State University CiteSeerX Archives
• Format: Text
• Language: English
• Published: 2000
• Subjects: Canada; The Bench; First Nations
• Online Access: http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.600.3072; http://www.cmaj.ca/content/162/6/758.2.full.pdf

occur without bench research (espe-cially Canadian). But doesn’t his asser-tion overlook about 35 000 surgical, ed-ucational and health care trials, most of which required no prior bench re-search? And doesn’t he defeat his own argument with the 3 recent drug trials he does cite (2 led from Canada and the other with major Canadian collabora-tion)? PRISM-PLUS was conducted in 12 countries, HOPE in 16 and GUSTO in 10, but only 15 % of the references in these published studies were about bench research (which the investigators were comfortable to ex-trapolate from laboratories in just 8 countries), and 85 % of their cited justi-fication came from previous trials or clinical surveys. Second, the need to elucidate the molecular basis for diseases affecting our First Nations families is met by shipping appropriate specimens to the best laboratories in the world. It doesn’t require that the bench research be car-ried out in Canada; the performance of reverse transcriptase is the same in Ot-tawa, Omaha, Oslo and Oxford. In sharp contrast, the performance of the health care organizational elements that profoundly affect the compliance, co-morbidity, co-intervention, costs of care and consequent outcomes of pa-tients in randomized trials differs widely in these 4 sites, and these differences may require separate trials (and their associated economic analyses) in each country. Responding to my editorial1 on be-