Health Care Reform

In order to keep our competitive edge, the Federal Drug Administration (FDA) is placing increased emphasis on strengthening both the field and application of regulatory science relative to pharmaceutical research, development, review, and post-market surveillance.  The FDA also has a mandate to recognize areas of unmet public health need and try to galvanize action to move appropriate new products through the pipeline and into the market.  The FDA has the responsibility, therefore, not just to review and approve products if the data support that decision, but also to follow these products once marketed to answer critical questions about efficacy and safety.  Examination of products across their life cycle enables not only the identification and analysis of emerging safety signals, but also facilitates the continual balancing of risks and benefits.

Research studies, both preclinical and clinical, that form the basis for approval of medical products are increasingly being performed in other countries and often in networks of other countries.   For this reason, international recognition of both the scientific appropriateness and ethical conduct of those studies becomes increasingly important to global regulatory bodies.  A key understanding is that if a safety concern develops for an approved drug, it does not necessarily reflect that a mistake was made.  It may instead reflect new emerging knowledge about that drug in practical use.  Regulatory safety has to be a dynamic process.  The desire is to proactively ensure that the right studies are done so that the best possible decisions result.  However, there isn’t always an absolute, clear decision to be made; resolution, therefore, requires a dynamic balancing of risks and benefits.  Questions need to be asked about whether certain subpopulations of patients may benefit from targeted use of a drug, or whether the safety concerns are sufficient to mean a more active withdrawal of a product from the market.   Advances in science and technology need to be better incorporated into the regulatory process, with a key area being safety science.   To continue to strengthen the science of regulatory safety, the need is to broaden not only the kinds of preclinical and clinical studies that can be done to deepen our understanding of safety, but also to broaden our understanding of how to apply and weight that data to further the science of risk management.

Source: Interview between Dr. Eli Adashi, Professor of Medical Science at Brown University and host of Medscape One-on-One, and Dr. Margaret Hamburg, Commissioner of the US Food and Drug Administration.  MedScape Today.

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Four proposals that address drug advertising and marketing issues, which have not been widely discussed, may be incorporated into the final health care reform bill.

1)  Of most concern to the pharmaceutical industry is a proposal to eliminate the tax deduction for drug advertising.  Direct-to-consumer (DTC) advertising is a prime target due to concern that DTC ads do not present an accurate picture of drug risks and benefits and that they drive use of new drugs before their safety is fully known.

2)  Health care reform bills in both the House and the Senate contain transparency provisions, akin to those in the Physicians Payments Sunshine Act of 2009, which propose for the disclosure of drug and device company payments to doctors to be federally mandated.

3)  Section 138 of the health care reform bill  bans the commercial use of “prescription information containing patient identifiable and prescriber identifiable data.”  If passed, Section 138 would end drug representatives’  current practice of tailoring their sales messages to each doctor’s prescribing history, which can put more pressure on doctors to prescribe newer, more expensive medications.

4)  The health care reform bill would authorize the FDA to evaluate whether use of a “drug facts box” format on drug labels – to more clearly present a drug’s benefits and risks – would improve health care decision making.  This  bill would also allow the FDA to set standards for comparative clinical effectiveness information to be included in drug labeling and advertising.

Source:  Health Reform Watch, 2 October 2009.

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