Rapidly rising medication costs strain health-care systems worldwide. In 2018, Canada ranked 5th in per capita spending on pharmaceuticals. Canada’s Patented Medicines Price Review Board (PMPRB) changes—recently delayed a third time, but still set for implementation on January 1, 2022—would bring us down to the middle of 36 OECD countries. This sounds appealing, but be careful what you wish for. It reminds us of W.W. Jacobs’ story, The Monkey’s Paw, in which a family is granted three wishes by a cursed monkey’s paw. The consequences are unanticipated and horrifying. The price for granting a wish is the death of the son. PMPRB’s new regulations could be Canada’s monkey’s paw. Effective new agents for lethal diseases are emerging at a breathtaking pace, but analyses by the Canadian Centre for Health Economics and by Life Sciences Ontario suggest that PMPRB’s planned price reductions will further delay, or eliminate, Canada’s access to many new agents. This will translate into thousands of life-years lost and unnecessary suffering. It will disproportionately affect older Canadians, who are more likely to have cancer and be helped by effective new drugs. Canadians already wait too long for effective new therapies. PMPRB regulations will make this worse. High drug development costs drive pharmaceutical companies to apply for regulatory approval first in countries where there is a potential for profit. PMPRB’s regulations will drastically reduce profits in Canada. Many companies would also delay or avoid Canadian marketing to reduce the risk of low Canadian prices dragging down prices in larger markets. Since the intended PMPRB regulations were announced, there has been a significant decrease in drug launches in Canada compared to the U.S. and Europe, and the number of clinical trials that companies have launched in Canada have also declined significantly. Prices are high because drug development is risky. Only five to 10 per cent of new anticancer drugs entering clinical trials make it to regulatory approval. Profits from those that succeed must pay for the 90 to 95 per cent that are expensive failures. A pension fund, for example, would never invest in ventures with such a failure rate unless those losses could be recouped from those that succeed. All told, it costs about $2-billion and takes twelve years to bring a drug from discovery to approval. The cost of clinical research and labyrinthine processes drive approval delays and drug development costs. Delays cost lives; high drug development costs make for high drug prices. High development costs also mean that only a few large companies with deep pockets are likely to succeed, and this reduces competition. Regulation of clinical research is essential, but current regulatory approaches are much too expensive and are not cost-effective. We and others have published extensively on this. We have met with Health Canada and with members of the House and Senate about the urgent need for reform. Investment will dry up and progress will suffer dramatically if we force drug prices down without bringing down the costs of drug development. Government price controls in the 1970’s failed miserably because they were treating the symptom (inflation) rather than the underlying disease (too much money being printed by governments). Likewise, PMPRB is tackling the symptom (high drug prices) rather than the disease (clinical research regulations that urgently need a major overhaul). As they inevitably fail, the PMPRB price controls will magnify suffering and loss of life—especially among seniors. If governments are serious about bringing down drug prices, and creating meaningful pharmacare programs, they must tackle the regulatory morass strangling new drug development. Dr. David J. Stewart, medical oncologist at The Ottawa Hospital John-Peter Bradford, CEO of Life-Saving Therapies Network Ottawa, Ont.