Angry Toxicologist

I’ve been AWOL this week on SB; life, apparently, is not concerned with what is convienent for you. Anywho…

The House on thursday passed the FDA reform bill (H.R. 3580) by a huge margin (405-7) and the Senate passed it last night by a voice vote. As an aside, Sen Burr (R-NC) placed a hold on it but obiviously that didn’t end up stopping the passage. Pres. Bush will probably sign it today. And it’s a good thing, too. The FDA said it would have to send permanent layoff notices to about 20% of it’s workforce if the legislation didn’t pass by today.

So, you might ask, what does any of this mean? How did things change? I try to answer what I can.

We don’t know
The thing is over 420 pages. Nobody understands all of the implications completely. In fact, this is one of the gripes that Sen Burr had (and perhaps a reasonable one).

Drugs for Kids
The Pediatric Research Equity Act, the Pediatric Medical Device Safety and Improvement Act, and the Best Pharmaceuticals for Children Act were all reauthorized with some changes. Basically, the idea behind these parts is to entice drug makers to do pediatric studies on their drugs so that they can be authorized for child use. If they do the studies, the drug is granted six months of market exclusivity, which as you can imagine, can amount to a huge amount of money. The Senate version originally had 3 months for big moneymaking drugs and the Dems in the house had wanted to make it less than six months. This was compromised out in the house version to make sure it would have broad support to get it passed. No one denies that BPCA works – 132 studies have been done since its enactment and 120 resulted in labeling changes (meaning that uses for children were found or that safety problems were identified). The question was whether the exclusivity was too long. Good people are on either side of this question; shorter exclusivity means better access to cheaper generics, but nobody knows if the shorter exclusivity would be enough to entice Pharma to do the studies. I think it probably would.

Money, Money, Money….MONEY!
Drug companies pay money when they submit a drug application for marketing. In return, the FDA has to review the submissions within a set period of time. The compromise that was made would have $225 million over 5 years go to the agency to hire drug reviewers and put safety programs in place (~150 million for devices, too). As I mentioned before, they would have run out of money real soon without it. A lot of people think that this is a real bad idea (taking money from industry to pay reviewers). I don’t and here’s why: 1) they get the money whether they approve or not. Saying yes doesn’t get you more, and saying no doesn’t cut you off. 2) The money isn’t specifically for certian reviewers; it goes into a big FDA pot and they use it where they need it. 3) If taxpayers had to foot the bill, the FDA would be woefully understaffed.

Increased Surveillance
As part of the approval, FDA used to require studies to be done post-approval to follow up on safety concerns. However, they didn’t have the authority to do anything if the company decided not to do it. That’s fixed, they can now levy fines. Also the FDA will not be tracking safety with sytesm (Risk Evaluation and Mitigation Strategy is one part) that aren’t exactly clear to me how they will shake out (it doesn’t look like anyone else knows either right now).

Fewer People on Advisory Panels Allowed to Have Drug Company Ties.
Pro: Duh. Con: Sometimes the experts in the field have all done research with $ from the company whose drug is under review. This is many times the case for niche drugs; and researchers have to make a living (Burr gripe #2 – well, it was his gripe #3 but his gripe #2 is below)

Clinical Trial Results Made Public
Pro: No more secret corportate studies that hold important data. Con: Will people who don’t understand how to interpret a study get the wrong conclusion and make bad choices? The con was another of Sen Burr’s gripes.

This is a major improvement overall. Studies that no one knows about are what cause things like Vioxx (if it was handled in a open manner, it still may be on the market, but only for those who it is appropriate for). As for people freaking out, I’m of the opinion that it’s great for people to be able to read up on things and ask their doctor about what they have read. I think there will be enough caveats on the webpages that people will get the idea that they need to talk to someone about these things. This may even force doctors to keep up with research in their field. That said, I do see the concern, but I think the pros outweigh the cons.

Direct to Consumer Ads
will be regulated more seriously but the Agency still didn’t get the authority to yank them like a lot of safety advocates wanted. That sucks but it’s really minor.

Labeling
This is complex so I’ll do a whole ‘nother post on this. Basically the FDA is now the king of labeling (over companies and over states). There are issues about over-warning creating a diluting of the serious warnings versus ‘we should give people all the warnings’ type thinking.

All in all it looks like a pretty good piece of legislation. I’ll post more as I read more of it and some of the implications of safety surveillance become apparent.

Oh, and happy Friday!

Comments

#1 Watt de Fawke
September 21, 2007

Are people who do the drug companies huge favors allowed to later quit to take a hugely lucrative cushy job with a drug company which can afford to give them lavish salaries because their help made the company tons of money?

If so, not so good news.
#2 foreign online pharmacies
September 21, 2007

I liked alot of this legislation as well. I particularly like how clinical trial results must be made public and the increased surveillance after a drug has hit the market. There has been a couple high profile cases that could have been avoided had the FDA kept a more diligent watch after releasing a drug to the market. I don’t like how the drug companies will be signing the paychecks for the FDA, that has led to many of the problems the FDA is currently experiencing. But hey, what can you do. The money has to come from somewhere, and there is no one with deeper pockets than big pharma.
#3 Phil Boncer
September 21, 2007

[i]We don’t know — The thing is over 420 pages. Nobody understands all of the implications completely. In fact, this is one of the gripes that Sen Burr had (and perhaps a reasonable one).[/i]

This is a real problem with legislation in general. These bills are too long, too complicated, and the legislators who vote on them often don’t take the time to read and understand the entire thing.

There’s a group called Downsize D.C. that is working primarily on getting a bill passed that will require legislators to read, or listen to a reading of, any bill before voting on it. I think it is intended to also require any bill to be publicly posted for comments for some period before voting on it. These would be good things.

PhilB
#4 Scott
September 27, 2007

Ever wonder why health care is expensive? This is why.

downsizedc.org
#5 Adult Forum
January 16, 2008

Great comment guidelines. I think you�re on the right track here. Some of those comments should go somewhere else.
#6 New Dilantin Information
March 14, 2008

All I know is that Pfizer was allowed to change their formula for Dilantin with the FDAs approval. What this means to consumers is that, if you don’t tollerate the new medication, you are either going to have seizures or become toxic (either of which can cause death). There are plenty of people that are very very sick. This is an epilepsy maintenance drug. You cannot just stop taking it. If you get sick you have to switch medications, and that is no easy thing to do. It takes time to find a therapeutic level without becoming toxic. Not all medications work for all people. If you try one and it does not work, you get to begin again. There is no way to describe what it feels like to be that sick. The horrible part is that they changed the drug without changing the name. The prescriptions were written for Dilantin specifically so blood serum levels don’t get screwed up. By not changing the name, people got a drug they could not use, that made them sick, and Pfizer made a sale. They will tell you that it is exactly the same medication. It is not. I could go into the ways it is different but the point is that the FDA allowed this fraud to be committed, endangering a group of epilepsy patients, ruining their quality of life and running up their bills and the bills of their insurers. Sick sick behavior by the FDA and a company that claims to have the health of their consumers in mind. I am curious, why would the FDA allow such a dangerous practice and then not act on the adverse reactions being reported? How can we trust that any medication will not be changed without warning to it’s consumers?
#7 Gamefly
January 4, 2010

I liked alot of this legislation as well. I particularly like how clinical trial results must be made public and the increased surveillance after a drug has hit the market.
#8 nakliyat
April 2, 2010

These bills are too long, too complicated, and the legislators who vote on them often don’t take the time to read and understand the entire thing.
#9 e okul
April 14, 2010

I think you�re on the right track here. Some of those comments should go somewhere else.
#10 av tüfekleri
June 19, 2011

PS Weisman’s book is primarily about what would happen if there were no people on Earth (how fast our works would or would not decay); it’s quite facinating from a science-only standpoint.
#11 otomatik av tüfekleri
June 19, 2011

Shandooga – you’re such a troll. With the utter miscomprehension of biology and evolutionary theory you’ve displayed over the years, is there really any call for you be on science blogs when you know that no one here will agree with you or appreciate your misguided ID/creationist arguments?
#12 cambalkon
June 19, 2011

I liked alot of this legislation as well. I particularly like how clinical trial results must be made public and the increased surveillance after a drug has hit the market.
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