Hostname: page-component-848d4c4894-8bljj Total loading time: 0 Render date: 2024-06-19T15:14:08.108Z Has data issue: false hasContentIssue false

Blueprint for Transparency at the U.S. Food and Drug Administration: Recommendations to Advance the Development of Safe and Effective Medical Products

Published online by Cambridge University Press:  01 January 2021

Abstract

Background

The U.S. Food and Drug Administration (FDA) traditionally has kept confidential significant amounts of information relevant to the approval or non-approval of specific drugs, devices, and biologics and about the regulatory status of such medical products in FDA’s pipeline.

Objective

To develop practical recommendations for FDA to improve its transparency to the public that FDA could implement by rulemaking or other regulatory processes without further congressional authorization. These recommendations would build on the work of FDA’s Transparency Task Force in 2010.

Methods

In 2016-2017, we convened a team of academic faculty from Harvard Medical School, Brigham and Women’s Hospital, Yale Medical School, Yale Law School, and Johns Hopkins Bloomberg School of Public Health to develop recommendations through an iterative process of reviewing FDA’s practices, considering the legal and policy constraints on FDA in expanding transparency, and obtaining insights from independent observers of FDA.

Results

The team developed 18 specific recommendations for improving FDA’s transparency to the public. FDA could adopt all these recommendations without further congressional action.

Funding

The development of the Blueprint for Transparency at the U.S. Food and Drug Administration was funded by the Laura and John Arnold Foundation.

Type
Symposium Articles
Copyright
Copyright © American Society of Law, Medicine and Ethics 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

U.S. Food and Drug Administration, FDA Transparency Initiative: Draft Proposals for Public Comment Regarding Disclosure Policies of the U.S. Food and Drug Administration (May 2010) (hereinafter “FDA TTFR”).Google Scholar
See FDA’s Progress Report on the Transparency Initiative, available at <http://www.fda.gov/AboutFDA/Transparency/TransparencyInitiative/ucm273854.htm> (last visited July 12, 2017).+(last+visited+July+12,+2017).>Google Scholar
For example, in a case involving a request for clinical trial and related data for FDA approvals of sofosbuvir (Sovaldi®, Gilead) and sofosbuvir/ledipasvir (Harvoni®, Gilead) under the Freedom of Information Act, the FDA has produced thousands of pages of documents from clinical study protocols to adverse event data. See e-mail from Cortelyou C. Kenney, Counsel of Record in Treatment Action Group v. FDA, No. 15-cv-976 (D. Conn. Sept. 20, 2016), to Amy Kapczynski, Professor of Law, Yale Law Sch. (Oct. 25, 2016 04:26 EST) (on file with authors). FDA does not comment on ongoing litigation.Google Scholar
This paper does not cover many other possible issues of transparency at FDA. For example, it does not cover issues of transparency about disagreements within FDA, an area in which the Agency has made important progress in recent years. It does not cover transparency about FDA’s internal timelines. The paper does not address veterinary medical products, tobacco products, or food. It does not cover most communications between companies and FDA, including such industry submissions as Periodic Benefit-Risk Evaluation Reports and Periodic Safety Update Reports. In addition, the focus on a practical transparency agenda means that the members of the FDA Transparency Working Group may individually support additional recommendations for transparency not included in this paper.Google Scholar
FDA’s definition of trade secret is: “A trade secret may consist of any commercially valuable plan, formula, process, or device that is used for the making, preparing, compounding, or processing of trade commodities and that can be said to be the end product of either innovation or substantial effort. There must be a direct relationship between the trade secret and the productive process.” 21. C.F.R. 20.61(a).Google Scholar
The report’s recommendations aim to improve proactive disclosure of information by FDA. As a result, the report does not specifically address implementation at FDA of the Freedom of Information Act, a law that provides the opportunity for citizens to request information. In general, FDA policies and regulations that limit proactive transparency also limit the Agency’s ability to share information in response to a request under the Freedom of Information Act.Google Scholar
The relevant regulations include: 21 C.F.R. §312.130(a) (non-disclosure of Investigational New Drug applications for drugs); §601.50 (non-disclosure of Investigational New Drug applications for biological products); §812.38(a) (non-disclosure of Investigational Device Exemptions applications); §314.430(b) (non-disclosure of New Drug Applications prior to approval); §601.51(b) (non-disclosure of Biologics Licenses Applications prior to approval); §814.9(b) & (c) (non-disclosure of Pre-Market Approval applications prior to approval); and §807.95(b) (non-disclosure of 510(k)s where the submitter of the 510(k) certifies that the submitter’s intent to market the device is confidential commercial information).Google Scholar
The ‘sponsor’ of a product subject to FDA regulation is usually the company that controls the rights to that product. A ‘biologic product’ generally is a type of drug that is produced from a biologic source, such as a living cell.Google Scholar
21 C.F.R. §812.30(IDEs),§312.40 (Investigational New Drug applications).Google Scholar
21 C.F.R. §312.42(a) (“A clinical hold is an order issued by FDA to the sponsor to delay a proposed clinical investigation or to suspend an ongoing clinical investigation.” (emphasis added)).Google Scholar
FDCA §505(b)(5), 21 U.S.C. §355(b)(5).Google Scholar
Despite the difference in names, which exists for historical reasons, FDA’s review process is similar for both New Drug Applications and Biologics License Applications.Google Scholar
A PMA is “approved” by FDA; a 510(k) is “cleared” by FDA. Several factors, including the equivalence to previously approved devices and the risk of the device, determine whether a device requires a PMA or 510(k). For a low to moderate risk device where there is no existing predicate device that is not within a device type that is class III, a sponsor can submit a de novo.Google Scholar
FDA, Guidance for Industry: Expedited Programs for Serious Conditions—Drugs & Biologics (May 2014), available at <http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM358301.pdf> (last visited July 12, 2017).+(last+visited+July+12,+2017).>Google Scholar
The Orphan Drug Act of 1983 (ODA) is codified as amended at FDCA §§525-529, 21 U.S.C. §§360aa-360ff. The ODA provides priority review only for potential treatments for rare pediatric diseases. FDCA §529, 21 U.S.C. §360ff. An orphan drug designation does not “alter the standard regulatory requirements and process for obtaining marketing approval.” FDA, Designating an Orphan Product: Drugs and Biological Products, available at <http://www.fda.gov/forindustry/developingproductsforrarediseasesconditions/howtoapplyfororphanproductdesignation/default.htm> (last visited July 12, 2017).+(last+visited+July+12,+2017).>Google Scholar
Pub. Law 114-255 (Dec. 13, 2016), §3033.Google Scholar
FDCA §515(d)(5), 21 U.S.C §360e(d)(5); FDA, Expedited Access for Premarket Approval and De Novo Medical Devices Intended for Unmet Medical Need for Life Threatening or Irreversibly Debilitating Diseases or Conditions: Guidance for Industry & FDA Staff (April 13, 2015), available at <http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM393978.pdf> (last visited July 12, 2017).+(last+visited+July+12,+2017).>Google Scholar
Pub. Law 114-255 (Dec. 13, 2016), §3051.Google Scholar
FDCA 505A, 21 U.S.C. §355a.Google Scholar
21 C.F.R. sec. 20.100 contains a list of specific FDA regulations that provide for non-disclosure of particular milestones in the regulatory process.Google Scholar
FDA proactively releases to the public the ‘background package’ that is provided to an advisory committee. 21 C.F.R. §314.430(d)(1) (disclosure of “selected portions of the safety and effectiveness data” in connection with advisory committee consideration of an New Drug Application); §601.51(d)(1) (similar provision for Biologics License Application advisory committees); §814.9(d)(1) (similar provision for Pre-Market Approval Application advisory committees); FDA, Guidance for Industry: Advisory Committee Meetings — Preparation & Public Availability of Information Given to Advisory Committee Members (August 2008), available at <http://www.fda.gov/downloads/regulatoryinformation/guidances/ucm125650.pdf> (last visited July 12, 2017).+(last+visited+July+12,+2017).>Google Scholar
Under federal law, FDA is not permitted to disclose trade secret information to advisory committees.Google Scholar
FDCA §526(c),21 U.S.C. §360bb(c)(“Notice respecting the designation of a drug under subsection (a) [as an orphan drug] shall be made available to the public.”)Google Scholar
For example, on August 29, 2016, FDA designated a drug intended to treat neuroblastoma as an orphan drug. On FDA’s website, however, the drug was identified only as ‘131-I-8H9 monoclonal antibody.’ National Cancer Institute, Drug Dictionary: Iodine I 131 monoclonal Antibody 8H9,” available at <https://www.cancer.gov/publications/dictionaries/cancer-drug?cdrid=380753> (last visited July 12, 2017).+(last+visited+July+12,+2017).>Google Scholar
See FDA TTFR Draft Proposals at page 37. Supra note 1.Google Scholar
FDA TTFR Draft Proposals 8, 9 and 10. Supra note 1.Google Scholar
These include Informa PLC, IMS Health, Evaluate Group, Pharmaprojects, and Springer Nature.Google Scholar
PAREXEL International, Biopharmaceutical R&D Statistical Sourcebook 2012/2013, Parexel International Corp., 2012.Google Scholar
European Medicines Agency, Guide to Information on Human Medicines Evaluated by European Medicines Agency: What the Agency Publishes and When,” available at <http://www.ema.europa.eu/docs/en_GB/document_library/Other/2016/05/WC500206484.pdf> (last visited July 12, 2017).+(last+visited+July+12,+2017).>Google Scholar
E.g., Juno Therapeutics, Juno Therapeutics Places JCAR015 Phase II ROCKET Trial on Clinical Hold, Press Release, November 23, 2016, available at <http://ir.junotherapeutics.com/phoenix.zhtml?c=253828&p=irol-newsArticle&ID=2225491>. (last visited July 12, 2017)..+(last+visited+July+12,+2017).>Google Scholar
Typically, companies provide information about clinical holds without comment from FDA. See, e.g., Reuters, FDA Places Some Seattle Genetics Drug Trials on Hold after Four Deaths,” December 27, 2016, available at <http://www.reuters.com/article/us-seattle-genetics-fda-idUSKBN14G13V> (last visited July 12, 2017).+(last+visited+July+12,+2017).>Google Scholar
In addition to written requests for pediatric studies under the Best Pharmaceuticals for Children Act, FDA is authorized to require submission of pediatric study plans for new drugs and biologics under the Pediatric Research Equity Act. See FDCA §505B, 21 U.S.C. §355c. Others have recently called for these pediatric study plans to be made publicly accessible, as they provide important clinical information that can accelerate pediatric research and improve pediatric care. See Bourgeois, F. T. and Hwang, T. J., “The Pediatric Research Equity Act Moves Into Adolescence,” JAMA 317, no. 3 (2017): 259260.CrossRefGoogle Scholar
FDA TTFR Proposals 8, 9, and 10. Supra note 1.Google Scholar
Depending on the type of marketing application, these letters have different names (e.g., ‘refuse to file’ ‘refuse to accept, not approvable, or denial). A different procedure is followed for 510(k)s.Google Scholar
FDCA §505(l)(2), 21 U.S.C. §355(l)(2).Google Scholar
Section 505(l)(2)(A) of the FD&C Act (21 U.S.C. 355(l)(2)(A)) states: “(l)Public disclosure of safety and effectiveness data and action package … (2)Action Package for Approval.— (A)Action package. —The Secretary shall publish the action package for approval of an application under subsection (b) or section 262 of title 42 on the Internet Web site of the Food and Drug Administration— (i) not later than 30 days after the date of approval of such application for a drug no active ingredient (including any ester or salt of the active ingredient) of which has been approved in any other application under this section or section 262 of title 42; and (ii) not later than 30 days after the third request for such action package for approval received under section 552 of title 5 for any other drug.”Google Scholar
21 U.S.C. §355(l)(1). This section outlines that ‘safety and effectiveness’ data included in a New Drug Application must be disclosed to the public when the New Drug Application has been abandoned, or FDA determines that the New Drug Application is not approvable, or FDA withdraws approval of the New Drug Application, or on the first date an Abbreviated New Drug Application using the drug covered by the New Drug Application as the Reference Listed Drug (RLD) could be approved. This provision is qualified, however, by the phrase: “unless extraordinary circumstances are shown.”Google Scholar
Kesselheim, A. S. and Mello, M. M., “Confidentiality Laws and Secrecy in Medical Research: Improving Public Access to Data on Drug Safety,” Health Affairs 26, no. 2 (2007): 483491.Google Scholar
In the case of an New Drug Application or Biologics License Application, this letter is known as a ‘Complete Response Letter.’ For pre-market approval, this letter is known as a ‘Not to Approve Letter.’ In the case of a 510(k), a different procedure is followed, and the letter is known as an ‘Additional Information Letter,’ or ‘Not Substantially Equivalent Letter’ (NSE). The only time a Complete Response Letter is generally released is in the case that the product is eventually approved. On rare occasions, a Complete Response Letter may be disclosed as part of a background package for an advisory committee. Applications for Approval to Market a New Drug; Complete Response Letter; Amendments to Unapproved Applications. 73(133) fed. reg. 39588, at 39601 (July 10, 2008) (noting “our long-standing presumption that before approval or tentative approval, the existence of an application is confidential commercial information”). Not Substantially Equivalent letters and Additional Information letters are not released even if FDA eventually clears the device.Google Scholar
FDA TTFR Proposals 11, 12, 13, & 15.Google Scholar
Lurie, P., Chahal, H. S., Sigelman, D. W., Stacy, S., Sclar, J., and Ddamulira, B., “Comparison of Content of FDA Letters Not Approving Applications for New Drugs and Associated Announcements from Sponsors: Cross Sectional Study,” BMJ 350 (2015): h2758.CrossRefGoogle Scholar
Securities Exchange Commission, Biotech Company Misled Investors about New Drug’s Status with FDA, Press Release, March 29, 2016, available at <https://www.sec.gov/news/pressrelease/2016-59.html> (last visited July 12, 2017) (charging AVEO Pharmaceuticals with violations of federal securities laws by omitting to disclose to investors that FDA had called for new clinical trial).+(last+visited+July+12,+2017)+(charging+AVEO+Pharmaceuticals+with+violations+of+federal+securities+laws+by+omitting+to+disclose+to+investors+that+FDA+had+called+for+new+clinical+trial).>Google Scholar
EMA, “European Public Assessment Reports: Background & Context,” available at <http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/general/general_content_000433.jsp&mid=WC0b01ac058067fa25> (last visited July 12, 2017).+(last+visited+July+12,+2017).>Google Scholar
E.g., European Medicines Agency Committee for Medicinal Products for Human Use, dasiprotimut-t Assessment Report EMA/314727/2015 (April 23, 2015), available at <http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Public_assessment_report/human/002772/WC500190039.pdf> (last visited July 12, 2017).+(last+visited+July+12,+2017).>Google Scholar
FDA, “Availability of Masked & Deidentified Non-Summary Safety & Efficacy Data; Request for Comments,” Federal Register 78, no. 107 (June 4, 2013): 33421, at 33422Google Scholar
NHLBI Biologic Specimen & Data Repository Coordinating Center (BioLINCC), available at <https://biolincc.nhlbi.nih.gov/home/> (last visited July 12, 2017).+(last+visited+July+12,+2017).>Google Scholar
Coady, S. A. and Wagner, E., “Sharing Individual Level Data from Observational Studies and Clinical Trials: A Perspective from NHLBI,” Trials 14 (2013): 201.CrossRefGoogle Scholar
FDA TTFR Proposals 11, 12, 13, and 15. Supra note 1.Google Scholar
Generic Pharmaceutical Association (GPhA), Generic Drug Savings in the U.S. (2015), available at <http://www.gphaon-line.org/media/wysiwyg/PDF/GPhA_Savings_Report_2015.pdf> (last visited July 21, 2017).+(last+visited+July+21,+2017).>Google Scholar
A generic drug is approved based on its ‘bioequivalence’ to a previously approved drug, which is known as the ‘Reference Listed Drug’ (RLD).Google Scholar
Special Committee on Aging, U.S. Senate, Sudden Price Spikes in Off-Patent Prescription Drugs: The Monopoly Business Model That Harms Patients, Taxpayers, and the U.S. Health Care System (December 2016); Gupta, R., Kesselheim, A. S., Downing, N., Greene, J., and Ross, J. S., “Generic Drug Approvals Since the 1984 Hatch-Waxman Act,” JAMA Internal Medicine 176, no. 9 (2016): 13911393.CrossRefGoogle Scholar
Public Health Service Act §351(k), 42 U.S.C. §262(k).Google Scholar
FDA does post applications related to Paragraph IV Patent Certifications, which are submissions made one year before the expiration of data exclusivity protections. However, information naming the individual applicants is not disclosed. See “Paragrah IV Patent Certifications,” available at <http://www.fda.gov/downloads/drugs/developmentapprovalprocess/howdrugsaredevelopedandapproved/approvalapplications/abbreviatednewdrugapplicationandagenerics/ucm293268.pdf> (last visited July 12, 2017).+(last+visited+July+12,+2017).>Google Scholar
FDA TTFR Draft Proposal 10. The Task Force did not address biosimilars, which Congress had authorized only two months before release of the TTFR.Google Scholar
FDA TTFR pp. 47-48.Google Scholar
Helfand, C., “FDA Swats Down Teva’s EpiPen Copy, Putting Mylan in Cruise Control,” Fierce Pharma, March 1, 2016, available at <http://www.fiercepharma.com/sales-and-marketing/fda-swats-down-teva-s-epipen-copy-putting-mylan-cruise-control> (last visited July 12, 2017).+(last+visited+July+12,+2017).>Google Scholar
Editorial, “Anaphylactic Political Shock,” Wall Street Journal, August 24, 2016.Google Scholar
FDA TTFR Draft Proposal 10. Supra note 1.Google Scholar
Sharfstein, J. M. and Psaty, B. M., “Evaluation of the Cardiovascular Risk of Naltrexone-Bupropion: A Study Interrupted,” JAMA 315, no. 10 (2016): 984986.CrossRefGoogle Scholar
Kesselheim, A. S. and Avorn, J., “Approving a Problematic Muscular Dystrophy Drug: Implications for FDA Policy,” JAMA 316, no. 22 (2016): 23572358.CrossRefGoogle Scholar
Center for Drug Evaluation and Research, FDA, Minutes of the Meeting of the Peripheral and Central Nervous System Drugs Advisory Committee (April 25, 2016), at 222, available at <http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/PeripheralandCentralNervousSystemDrugsAdvisoryCommittee/UCM510390.pdf> (last visited July 12, 2017).+(last+visited+July+12,+2017).>Google Scholar
Sharfstein, J. M. and Charo, A., “The Promotion of Medical Products in the 21st Century: Off-label Marketing and First Amendment Concerns,” JAMA 314, no. 17 (2015): 17951796; Avorn, J., Sarpatwari, A., and Kesselheim, A. S., “Forbidden and Permitted Statements about Medications--Loosening the Rules,” New England Journal of Medicine 373, no. 10 (2015): 967–973.CrossRefGoogle Scholar
21 C.F.R. §20.82 (FDA Commissioner has discretionary authority to disclose any or all of a record otherwise exempt from disclosure if the disclosure is “in the public interest” and is necessary for the Agency “to pursue its regulatory activities without disruption.” The regulation specifically exempts trade secrets and commercial or financial information that is privileged or confidential, any information for which disclosure would constitute a clearly unwarranted invasion of personal privacy, and any record that is prohibited from public disclosure by statute.) FDA might also consider taking enforcement action if the inappropriate comments represent misbranding under the Food, Drug, and Cosmetic Act.Google Scholar
FDA TTFR at 49. Supra note 1.Google Scholar
FDA TTFR Draft Proposal 16. Supra note 1.Google Scholar
International Conference on Harmonisation (ICH), Guidance for Industry: Structure & Content of Clinical Study Reports (July 1996), available at <http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM073113.pdf> (last visited July 12, 2017).+(last+visited+July+12,+2017).>Google Scholar
FDCA §505(o), 21 U.S.C. §355(o) (PMRs for drugs and biologics).Google Scholar
FDCA §506B, 21 U.S.C. §356b (PMCs for drugs and biologics).Google Scholar
Reynolds, I. S., Rising, J. P., Coukell, A. J., Paulson, K. H., and Redberg, R. F., “Assessing the Safety and Effectiveness of Devices After US Food and Drug Administration Approval: FDA-Mandated Postapproval Studies,” JAMA Internal Medicine 174, no. 11 (2014): 17731779. FDCA §522, 21 U.S.C. §3601 (device surveillance studies); 21 C.F.R. §814.82 & §814.126 (post approval studies for PMA and Humanitarian Use devices).CrossRefGoogle Scholar
In appropriate circumstances, such as in medical product reviews and safety warnings, FDA has released non-summary data and information from clinical and nonclinical trials. FDA does disclose information on the status of postmarket requirements, postmarket commitments, and post-approval device studies. FDA, Postmarketing Requirements and Commitments: Reports, available at <http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Post-marketing-PhaseIVCommitments/ucm064436.htm> (last visited July 12, 2017). FDA, Post-Approval Studies, available at <http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/PostmarketRequirements/PostApprovaStudies/default.htm> (last visited July 12, 2017) and <http://www.fda.gov/medicaldevices/deviceregulationandguidance/guidancedocuments/ucm070974.htm> (last visited July 12, 2017).+(last+visited+July+12,+2017).+FDA,+Post-Approval+Studies,+available+at++(last+visited+July+12,+2017)+and++(last+visited+July+12,+2017).>Google Scholar
21 C.F.R. §314.430(c) (prohibiting release of data or information from unapproved applications if the existence of the application has not been publicly acknowledged); §314.430(e)(2) (summaries released after approval “do not constitute the full reports of investigations…on which the safety and effectiveness of the drug may be approved”).Google Scholar
FDA TTFR Draft Proposal 17. Supra note 1.Google Scholar
Institute of Medicine, Sharing Clinical Trial Data: Maximizing Benefits, Minimizing Risk (2015), available at <https://www.nap.edu/catalog/18998/sharing-clinical-trial-data-maximizing-benefits-minimizing-risk> (last visited July 21, 2017). See also Krumholz, H. M., Bourne, P. E., and Kuntz, R. E. et al., “Data Acquisition, Curation and Use for a Continuously Learning Health System: A Vital Direction for Health and Health Care,” National Academy of Medicine, September 19, 2016, available at <Data Acquisition, Curation and Use for a Continuously Learning Health System: A Vital Direction for Health and Health Care> (last visited July 12, 2017).+(last+visited+July+21,+2017).+See+also+Krumholz,+H.+M.,+Bourne,+P.+E.,+and+Kuntz,+R.+E.+et+al.,+“Data+Acquisition,+Curation+and+Use+for+a+Continuously+Learning+Health+System:+A+Vital+Direction+for+Health+and+Health+Care,”+National+Academy+of+Medicine,+September+19,+2016,+available+at++(last+visited+July+12,+2017).>Google Scholar
Mello, M. M., Francer, J. K., Wilenzick, M., Teden, P., Bierer, B. E., and Barnes, M., “Preparing for Responsible Sharing of Clinical Trial Data,” New England Journal of Medicine 369, no. 17 (2013): 16511658; PhRMA & European Federation of Pharmaceutical Industries & Associations (EFPIA), Principles for Responsible Data Sharing: Our Commitment to Patients & Researchers (July 18, 2013), available at <http://phrma.org/sites/default/files/pdf/PhRMAPrinciplesForResponsibleClinicalTrialDataSharing.pdf> (last visited July 12, 2017). See also the Yale University Open Data Access (YODA) Project, available at <http://yoda.yale.edu/> (last visited July 12, 2017).CrossRefGoogle Scholar
Clinical Study Data Request, available at <https://clinicalstudydatarequest.com> (last visited July 12, 2017).+(last+visited+July+12,+2017).>Google Scholar
Boutron, I., Dechartres, A., Baron, G., Li, J., and Ravaud, P., “Sharing of Data from Industry-Funded Registered Clinical Trials,” JAMA 315, no. 24 (2016): 27292730.CrossRefGoogle Scholar
European Medicines Agency, Policy on Publication of Clinical Data for Medicinal Products for Human Use (Policy 0070), October 2, 2014, available at <http://www.ema.europa.eu/docs/en_GB/document_library/Other/2014/10/WC500174796.pdf> (last visited July 12, 2017).+(last+visited+July+12,+2017).>Google Scholar
Guidance for Industry, Postmarketing Studies and Clinical Trials — Implementation of Section 505(o)(3) of the Federal Food, Drug, and Cosmetic Act, available at <http://www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation/guidances/ucm172001.pdf> (last visited July 12, 2017).+(last+visited+July+12,+2017).>Google Scholar
NHLBI Biologic Specimen & Data Repository Coordinating Center (BioLINCC), available at <https://biolincc.nhlbi.nih.gov/home/> (last visited July 12, 2017).+(last+visited+July+12,+2017).>Google Scholar
Coady, S. A. and Wagner, E., “Sharing Individual Level Data from Observational Studies and Clinical Trials: A Perspective from NHLBI,” Trials 14 (2013): 201.CrossRefGoogle Scholar
The European Medicines Agency aims to publish marketing authorizations, line extensions, and extensions of product indication applications 60 days after the European Commission decision and following the publication of the European Public Assessment Report (EPAR). Withdrawn applications are published 150 days after the receipt of the withdrawal letter. European Medicines Agency — Marketing authorization — Clinical data publication <http://www.ema.europa.eu/ema/?curl=pages/special_topics/general/general_content_000555.jsp> (last visited July 12, 2017).+(last+visited+July+12,+2017).>Google Scholar
PhRMA, “Comments on Food and Drug Administration Transparency Task Force,” August 7, 2009.Google Scholar