QuoteIn written testimony (PDF) for his confirmation hearing, Gottlieb pledged to run the FDA "as an impartial and passionate advocate for public health" guided by science. He said the "FDA's enforcement tools are a bedrock of its mission."
These initial numbers, however, have watchdogs such as Public Citizen's Carome worried that Trump's pledge to roll back red tape has reached the FDA—potentially endangering Americans who rely on the 17,000-employee agency to protect them.
Quote"I consider access to medicine a matter of public health," Dr. Gottlieb declared in a blog post
QuoteThe FDA has traditionally taken the position that the agency's sole role in medical-product approval is assessing safety and effectiveness, and that pricing is generally out of its purview.
Quotewhat they call red tape often consists of essential public protections that defend our lives, our futures and the rest of the living world. The freedom they celebrate is highly selective: in many cases it means the freedom of the rich to exploit the poor, of corporations to exploit their workers, landlords to exploit their tenants and industry of all kinds to use the planet as its dustbin.
Quoteone in, two out rule for regulation
QuotePromising to cut "red tape," business-friendly politicians evidently judged that cost concerns outweighed the risks of allowing flammable materials to be used in facades.
QuoteGovernments adopted slogans calling for the elimination of at least one regulation for each new one that was imposed, and the authorities in charge of fire safety took this to heart.
Quote"If there's a new regulation, they have to knock out two.
QuoteTrump met with business executives from some of America's largest companies and promised to cut regulation by 75 percent. He also ordered a freeze on all new and pending regulation at the federal level via a memorandum—save for emergencies relating to "health, safety, financial, or national security matters,"—until a Trump-appointed department head could review prospective regulations.
Quotethe economic costs of the two so-called deregulatory actions must equal or exceed the economic cost of the new regulation.
The "two-for-one" order, signed January 30, applies only to "significant" regulations with an economic impact exceeding $100 million or meeting other specified criteria, and it may be working in a counterintuitive way: Although it was touted as a way to roll back old rules, its main impact appears to be simply erecting obstacles to new regulations.
QuoteRegulations have costs, but they also have benefits. The smoke scrubbers in our example reduce toxic emissions and the resulting illnesses. Lives are saved, health care expenses are reduced, and some jobs are created in the manufacture of the scrubbers.
QuoteOver the past 35 years, federal regulations in most areas have been issued only if their benefits were shown to exceed their costs.
QuoteMakers of cardiac defibrillators, insulin pumps, breast implants and other medical devices might be able to delay reporting dangerous malfunctions to the Food and Drug Administration under an agreement heading for a vote in Congress.
QuoteThe deal is part of a pact between the F.D.A. and the $148 billion device industry.
QuoteA trade group for the generic-drug industry filed a lawsuit Thursday seeking to block Maryland's new state law aimed at curbing steep price increases for generic drugs, the first law of its kind in the U.S.
Quote
Mrs. Gardiner: Take care my love. That savors strongly of bitterness.
Quote
The food industry is moving to capitalize on the Trump administration's anti-regulation agenda by seeking to delay or do away with Obama-era rules governing the disclosure of calories, sugar, fiber and serving size, according to petitions filed with the Food and Drug Administration.
QuoteBloomberg: What about drugs like EpiPen, would you come out with new rules there to create more competition? [EpiPen, made by Mylan NV, is what's known as a drug-device combination, where both the medicine and the device that administers it can have patent protections.]
QuoteDonald Trump's three most likely picks for FDA Commissioner all favor loosening drug approval standards. Two are cronies of Peter Thiel, of which one believes that the FDA shouldn't require evidence of efficacy, only safety, and the other believes that a "Yelp for drugs" would do a better job than the FDA. The third candidate is a bona fide, honest-to-goodness pharma shill. If any of them becomes FDA Commissioner, drug safety standards will take a nosedive.
QuoteHe is currently a resident fellow at the conservative American Enterprise Institute, where he analyzes health policy, regulation and public health. He is on the Federal Health IT Policy Committee, a group that advises the Department of Health and Human Services on health care IT issues. His resume also boasts stints as the FDA's deputy commissioner, and at the Centers for Medicare and Medicaid Services as a senior official focused on new medical technologies.
QuoteAt his confirmation hearing in April, Dr. Gottlieb told senators that he believed in upholding the F.D.A.'s reputation as the world's "gold standard" for drug approval. If confirmed, he said then, he would be "an absolutely objective regulatory watchdog" and would not do anything that could "besmirch the agency" or undermine public confidence in its work.
Quoteearly tests on a small number of patients can suggest great promise, but subsequent, more robust studies often disappoint
QuoteAt best, the proposed budget suggests that the White House doesn't understand how the NIH and the FDA function. At worst, it suggests a disregard for the millions of patients who are desperate for the scientific innovations, lifesaving therapies, and safeguards that emerge from these agencies. Cutting the NIH by the magnitude currently proposed — a staggering $6 billion — would cripple the incredible scientific momentum the health care community has been enjoying.
QuoteEarlier this year, a raging controversy regarding a new drug spilled into the pages of a leading medical journal: the head of the U.S. Food and Drug Administration and another official publicly called for the retraction or correction of a peer-reviewed article about the drug. They didn't get their wish. Now, documents released by the FDA via a lawsuit shed light on the attempt — and show how tricky it can be to correct the official record.
Quote
TO: Robert M. Califf, M.D.
Commissioner of Food and Drugs
Food and Drug Administration
FROM: /Daniel R. Levinson/
Inspector Genera
l
SUBJECT: Early Alert: The Food and Drug Administration Does Not Have an Efficient and Effective Food Recall Initiation Process (A-01-15-01500)
QuoteWe found that FDA did not have an efficient and effective food recall initiation process that helps ensure the safety of the Nation's food supply. Specifically, FDA did not have policies and procedures to ensure that firms1 or responsible parties2 (collectively referred to in this document as "firms") initiated voluntary food recalls promptly. This issue is a significant matter and requires FDA's immediate attention.
QuoteTo help ensure the safety of the Nation's food supply, we recommended that FDA consider our findings when implementing the FDA Food Safety Modernization Act (FSMA) and follow its own procedures for monitoring recalls.
QuoteFDA generally relies on firms to voluntarily recall harmful articles of food.3 Before 2011, FDA did not have the authority to require a firm to recall certain articles of food. However, the FSMA added section 423 to the FD&C Act,4 which gives FDA the authority to order a firm to recall certain articles of food after FDA determines that there is a reasonable probability that the food is adulterated or misbranded and that it will cause serious adverse health consequences or death to humans or animals (this is commonly referred to as SAHCODHA). FDA has used its authority under FSMA twice.5
QuotePharmaceutical and ingredients manufacturers in China and India have come under intense scrutiny in recent years due to a series of disturbing events. In 2008, for instance, 246 deaths in the United States were linked to a fake ingredient from China that was found in the blood thinner heparin. China is now the world's largest supplier of active pharmaceutical ingredients.
QuoteThe FDA is currently part of the Department of Health and Human Services (HHS). Making it a Cabinet-level organization or finding another way to give it more autonomy would be a step in the right direction for public health, the former commissioners argued.
Quote"Between a Trump presidency and a radically pro-business Congress, the next few years may see a removal of numerous consumer protections," said Michael Jacobson, cofounder and president of the Center for Science in the Public Interest.
QuoteOne former FDA official, who spoke on condition of anonymity to speak candidly, said support for the "Right to Try" movement signals a broader disapproval of regulation.
QuoteUnger then got even more pointed: "Perhaps granting accelerated approval to drugs that show a mere scintilla of an effect on a surrogate endpoint represents a stroke of brilliance – one that will stimulate investment in the development of drugs for these disorders. But in my opinion, this approach should receive broader public (and FDA) input before being implemented."
QuoteThe Lancet's press release on this trial was very sensible; but the press release from UCL Institute for Child Health / Great Ormond Street Hospital made misleading allusions to benefit on real-world outcomes which never appeared anywhere in the academic paper.
Quote"I think embargoes that attempt to control sourcing are dangerous because they limit the role of the reporter whose job it is to do a full look at a subject," says New York Times former public editor Margaret Sullivan. "It's really inappropriate for a source to be telling a journalist whom he or she can and can't talk to."
QuoteFor example, the FDA assures the public that it is committed to transparency, but the documents show that, privately, the agency denies many reporters access—including ones from major outlets such as Fox News—and even deceives them with half-truths to handicap them in their pursuit of a story.
QuoteThere is an unlimited supply of safe but ineffective molecules that can be applied to just about any condition. If we allow them to be sold because they do no harm, and perhaps might help someone, that's what we are going to get—placebo-like drugs that are exorbitantly priced, and masquerade as the real thing.
QuoteHere is a short study of 18 new oncology drugs already given expedited approval by the US Food and Drug Administration (FDA). Of these, 13 were priced above $100K annually, and the most expensive, cabozantinib, did not improve overall survival and reduced quality of life compared to placebo. Thank goodness that we have Vinay Prasad and Bishal Gyawali blazing away at this, because it looks as if we can forget about any kind of regulation by the FDA.
QuoteSeveral high-profile hospitals were included in the list, including Los Angeles-based Cedars-Sinai Medical Center and Boston-based Brigham and Women's Hospital, for their failure to keep written medical device reporting procedures and to report adverse events.
QuoteEvery year in the U.S., doctor's offices and hospitals order billions of laboratory tests to measure everything from cholesterol levels in the blood to the presence of a gene thought to increase the risk of developing Alzheimer's disease. Physicians and patients typically assume that they can trust the results of these tests.
QuoteThrough a quirk of regulatory history, many such tests are not subject to the same medical standards as other tools used to identify risk for disease or to definitively diagnose a condition.
QuoteThe federal Food & Drug Administration puts lives at risk by not moving swiftly enough on food recalls, according to an ongoing audit of the recall program by the Office of Inspector General for the Department of Health and Human Services.
QuoteSpecifically, the audit found that the agency would negotiate voluntary recalls, but then fail to either prescribe or enforce any timeline, leaving it up to companies to decide the pace at which they would proceed.
QuoteBut health researchers have called the Cures Act "lipstick on a pig" and the "19th Century Fraud Act" for good reason. The bill offsets research spending by cutting public health spending. And critics worry the bill could seriously damage the regulatory authority of the Food and Drug Administration.
QuoteAs members of the National Physicians Alliance (NPA), we have been closely following the 21st Century Cures Act legislation and its potential impact on what "FDA approved" would mean for new drugs and devices. Our interest in the 21st Century Cures Act emerged from overarching concerns among ourselves and other alliance members that the FDA's mission to protect public health by "assuring the safety, efficacy, and security" of new treatments was being hijacked by the pharmaceutical and medical device industries.
Quote
The passage of the 21st Century Cures Act, which sailed through the House of Representatives last week on its way to a future White House signing ceremony, is due in no small measure to the activities of hundreds of patient advocacy groups and assorted other stakeholders that worked in overdrive the past two years pushing the bill to the finish line. Their lobbying and advocacy paid off with a 996-page bill that according to the Energy and Commerce Committee (whose slick lobbying campaign was also crucial) would "modernize" the FDA and its approval process while speeding the delivery of cutting-edge, lifesaving medicines to patients.
QuoteWhere was the dot connection between the 200 or so patient advocacy groups and their links to PhRMA?
QuoteThe Cures Act, formally known as H.R. 34 or the 21st Century Cures Act,1 passed overwhelmingly in the U.S. House of Representatives and Senate in the waning days of the 114th Congress and was signed into law by President Barack Obama on December 13, 2016.
Quotethe final provisions are well worth heralding, including increased support for state efforts to combat opioid abuse, new steps aimed at improving mental health services, and important changes affecting the Food and Drug Administration and the National Institutes of Health (NIH)
QuoteBasically, the pharmaceutical industry and its lackeys in Congress bought off biomedical research advocates with the promise of more funding to the NIH and to efforts to combat the opioid crisis in the US. The price was a hole host of industry-friendly provisions weakening the FDA and producing new expedited pathways for drug approval, as well as permission to promote off-label drug use.
QuoteExpect more Vioxx disasters, now that the 21st Century Cures Act threatens to turn the FDA into a puppet of the pharmaceutical and medical device industry
QuoteI've seen stories suggesting that "Cures" is all about perks for pharmaceutical companies, and that industry-funded advocacy groups are parading patients, like puppets, before legislators to promote the bill.
QuoteI support most of the "Cures" provisions, for three big-picture reasons.
Quote
More than 1,300 lobbyists roamed the halls of Congress on the Cures Act, and disclosure reports show most of them were working for pharmaceutical companies.
Quote
The $500 million designated for the FDA is meant to pay for the agency's new responsibilities under the Cures Act. There is virtually nothing in it to improve some of FDA's longtime problems.
The Government Accountability Office considers two of the FDA's areas of focus especially "high-risk": food safety and post-approval oversight of medical products that went through the fast track.
QuotePresident Donald Trump wants to remake the Food and Drug Administration. And he happens to have a "fantastic person" in mind to do it, he said Tuesday — someone who will turn the agency into an industry-friendly shop that cranks out new cures on the double.
QuoteThiel, a libertarian iconoclast, has repeatedly made the case that the FDA gets in the way of drug innovation by making it too difficult for new medicines to get to the market. Some of the FDA candidates he's identified — including Silicon Valley's Jim O'Neill and Balaji Srinivasan — have similarly argued that the agency should dump its requirement that drugs be proven effective before reaching the market, and that we'd be better off if the FDA operated more like a "Yelp for drugs."
QuoteIt took the infamous scandal around thalidomide, a morning-sickness medication that caused severe birth defects, to strengthen the FDA
QuoteThe regulations that oversee the prescription drug industry and protect consumers from dangerous products are surprisingly fragile and young.
QuoteResearchers who study the agency say the agency's standards are slowly and methodically being eroded — particularly with the forthcoming implementation of the 21st Century Cures Act.