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Transparency has become the lead philosophy governing biomedical research and regulation. FDA and the National Institutes of Health are requiring more disclosure of financial relationships between industry and scientists and physicians.
Transparency has become the lead philosophy governing biomedical research and regulation. FDA and the National Institutes of Health (NIH) are requiring more disclosure of financial relationships between industry and scientists and physicians. Health reform legislation authorizes public access to much more extensive information on health-related activities, including formulary listings, out-of-pocket consumer costs, comparative studies, and payments from pharmaceutical companies to health professionals. Some members of Congress would like to go further and require public disclosure of prices charged for pharmaceuticals, as well as for hospital care and doctor visits.
OPENING THE BLACK BOX
FDA also has launched a Transparency Initiative to provide the public with more information on its policies and practices as a way to bolster confidence in its decisions. A new FDA-TRACK program will issue regular reports on the work and performance of 100 agency offices to better convey the broad scope of FDA responsibilities and accomplishments.
Phase 3, due this summer, will propose ways for FDA to improve communications with regulated companies, primarily by streamlining guidance development and increasing meetings with sponsors.
Phase 2, which was published May 21, 2010, includes 21 proposals for disclosing regulatory documents and actions to the public (available at http://www.fda.gov/). Some are quite far-reaching and will require Congressional action to implement.
One objective is to expand information on when medical product manufacturers seek FDA approval to launch clinical trials or to bring to market a new drug, biologic, animal drug, or medical device. FDA also wants to announce when such applications are withdrawn, rejected or delayed, and to release Complete Response (CR) letters that spell out why the agency is not approving a submission and what the sponsor needs to do to get to market.
Drug sponsors often elect to announce when they file an IND (investigational new drug application) or a license application to demonstrate that a development project is moving forward; the FDA Amendments Act of 2007, moreover, requires manufacturers to post information about ongoing clinical trials and their results on http://clinicaltrials.gov/. But FDA regulations currently prohibit release of most information on the status or substance of investigational products.
The task force proposes now that FDA disclose IND submissions, including name of sponsor, date of application, and anticipated indication and trade name. The agency also would indicate when an IND is placed on clinical hold or is terminated or withdrawn.
Similarly, FDA would provide comparable information on the status of market applications for new drugs and medical products. The agency now announces only when it approves a medical product for market; otherwise, information on when a manufacturer files such an application may be available if reported in company financial statements or included in FDA advisory committee review materials.
Now FDA seeks authority to disclose when a company files a market application or efficacy supplement, as well as when such applications are withdrawn or abandoned.
Related to this, the task force wants FDA to be able to explain that when a sponsor drops an application for an orphan drug due to internal business reasons, safety concerns, or regulatory issues, this should not deter another party from developing that needed therapy.
An important, and controversial, proposal is for FDA to release refuse-to-file notices and complete response (CR) or not-approvable letters. Sponsors often will issue a summary of a CR letter to acknowledge a delay in approval and outline a scenario for reaching the market in the future. But FDA wants to be able to fully explain its non-approval decisions, and investors and consumers support access to the agency's full statements.
However, the transparency panel decided not to seek disclosure of refusal or CR letters to generic drug manufacturers or for manufacturing and labeling supplements. These contain a great deal of trade secret information that is not so germane to drug development issues.
MORE ON ENFORCEMENT
The transparency task force also seeks to provide more information on manufacturer compliance and reporting activities. One plan is to disclose when FDA inspects a manufacturing facility or clinical research site, along with an indication of whether a site visit uncovers violations or problems requiring corrective action, or if the entity comes out clean.
FDA currently makes public some inspection reports that raise important safety or regulatory issues. Otherwise, interested parties have to request this information through the agency's freedom-of-information process, which can take months, if not years. FDA believes that inspection results may help manufacturers achieve compliance, as would expanded posting of untitled letters on the FDA website, as now is done with warning letters on more serious company violations.
An important initiative would require regulated companies to inform FDA when they conduct a product recall so that the agency can advise the public on what is being taken off the market, the number of items involved, and the cause of product defect.
At the same time, FDA wants to be able to clarify which similar products are not being recalled and when the recall is completed and terminated. Implementing this recall notice provision may require Congress to give FDA mandatory recall authority, which might be accomplished by expanding proposed food safety legislation awaiting action on Capitol Hill.
Another proposal would expand public access to adverse event reports through a more user-friendly information system. FDA also seeks to publish weekly listings of enforcement issues that are so important that the U.S. Department of Justice is taking the case to court.
A prime consideration of the transparency initiative, said Sharfstein in a press briefing, is to obtain an "appropriate balance" between expanded disclosure and ensuring confidentiality of trade secret information, which the task force considers key to maintaining investment in biomedical R&D.
The panel acknowledges that a company's manufacturing methods and product formulations are trade secrets and should remain private. But other data, such as clinical trial results and adverse event reports, may be more appropriate for disclosure. The task force wants to consider the public benefit in withholding or releasing such information, as well as the often heavy cost of redacting trade secrets from to-be-disclosed material.
While FDA is not proposing here to release raw data from clinical trials, as opposed to summary information, the panel suggests that access to such information might be useful in some situations. It may help sponsors identify new opportunities for developing products, for example, and inform health professionals of potential safety signals. FDA now does not release raw data files, even non-identifiable data, but is open to further discussion with outside organizations on the feasibility and benefits of doing so.
One factor guiding some FDA transparency proposals is the desire to harmonize US policies with those adopted by the European Medicines Agency (EMA). The Europeans already disclose when a company files a marketing application or withdraws one, as well as the agency's evaluation of the product.
The EMA also posts its reasons for denying approval of a new product or additional indication, similar to FDA's proposal for releasing CR letters.
Implementing many of the FDA transparency proposals will require legislative action, as well as new rulemaking.
In unveiling the task force plan, Sharfstein explained that the panel focused on what was the "right thing" to do, policy-wise, and not on the cost or feasibility of taking such action.
Now the task force will review public comments on these proposals, which can be submitted through July 20, and will conduct a legal and resource analysis for each item.
Commissioner Hamburg will make the final decision on which proposals can be adopted internally and where it makes sense for the agency to seek Congressional action for permitting more transparency in FDA decisions and documents.
Ms Wechsler is a Washington-based reporter specializing in federal and state healthcare issues.