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FDA Transparency in an Inescapably Political World

Published online by Cambridge University Press:  01 January 2021

Abstract

Transparency requires more than disclosure of data. It requires a mechanism and policy for conveying information to the public. In order for the aims of the excellent report of the FDA Transparency Working Group to be realized, a publicity initiative will need to accompany the plan of action. The FDA will need to actively convey information about the evidence concerning benefit-risk profiles of drugs, sometimes pointing out misleading claims by manufacturers or sponsors. In other cases, the FDA will need to make available its procedures, including possible conflicts of interest, not only in drug approval, but also in guidance documents and in rulemaking. Transparency as a process of letting the public see into the agency should be accompanied by a proactive strategy of distributing information about the products regulated by the agency.

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

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References

FDA Transparency Working Group, “Blueprint for Transparency at the U.S. Food and Drug Administration: Recommendations to Advance the Development of Safe and Effective Medical Products,” Journal of Law, Medicine & Ethics 45, no. 4, Suppl. (2017): 723.CrossRefGoogle Scholar
Among the many contributions here, see Kesselheim, A. S. and Mello, M., “Confidentiality Laws and Secrecy in Medical Research: Improving Public Access to Data on Drug Safety,” Health Affairs 26, no. 2 (2007): 483491; Hey, S. P. and Kesselheim, A. S., “The FDA, Juno Therapeutics and the ethical imperative of transparency,” BMJ 354 (2016), available at <http://www.bmj.com/content/354/bmj.i4435> (last visited October 31, 2017).CrossRefGoogle Scholar
Hood, C., Heald, D., eds., Transparency: The Key to Better Governance? (New York: Oxford University Press, 2006); Meijer, A. J., “Introduction to the Special Issue on Government Transparency,” International Review of Administrative Sciences 78, no. 1 (2012): 3–9. Carpenter, D. and Moss, D. M., Preventing Regulatory Capture: Special Interest Influence in Regulation and How To Limit It (New York: Cambridge University Press, 2013); see the Conclusion for a discussion of the role of transparency policy in combating capture.CrossRefGoogle Scholar
Rubin, G. T., “GAO to Probe ‘Regulatory Capture’ at New York Fed,” Wall Street Journal, March 4, 2016.Google Scholar
Carpenter, D., Reputation and Power: Organizational Image and Pharmaceutical Regulation at the FDA (Princeton: Princeton University Press, 2010).CrossRefGoogle Scholar
Carpenter, D., “Corrosive Capture? The Dueling Forces of Autonomy and Industry Influence in FDA Pharmaceutical Regulation,” in Carpenter and Moss, supra note 4; Editorial Board, “Conflicts of Interest at the F.D.A.,” New York Times, April 13, 2015.Google Scholar
Hamburg, M. A. and Scharfstein, J. M., “The FDA as a Public Health Agency,” New England Journal of Medicine 360 (June 11, 2009): 24932495.CrossRefGoogle Scholar
Hwang, T. J., Avorn, J., Carpenter, D., and Kesselheim, A. S., “Quantifying the Food and Drug Administration’s Rulemaking Delays Highlights the Need for Transparency,” Health Affairs 33, no. 2 (February 2014): 309315. I recognize that the authors were focused upon drug development and review, yet as I remark below, rulemaking is deeply implicated in these activities, and vice versa.Google Scholar
The best example comes in the Drug Efficacy Study Initiative, which combined a retrospective review of old drug approvals, a confrontation with a number of new classes of therapeutics, and guidance and rule writing on the meaning of the efficacy requirement. See Carpenter, D., Greene, J., and Moffitt, S., “The Drug Efficacy Study and Its Manifold Legacies,” in Cohen, I. G. and Lynch, H. F., The FDA in the 21st Century: The Challenges of Regulating Drugs and New Technologies (New York: Columbia University Press, 2015); see also Carpenter, supra note 6, at chapters 5, 7, and 10.Another example in the generic drug domain would come in the development of guidances and new rules for bioequivalence judgments, which were developed at the same time that FDA faced a wave of new generic drug decisions; consult Carpenter, D. and Tob-bell, D., “Bioequivalence: The Regulatory Career of a Pharmaceutical Concept,” Bulletin of the History of Medicine 85, no. 1 (Spring 2011): 93–131.Google Scholar
Yackee, S. W., “Reconsidering Regulatory Capture During Agency Rulemaking,” in Carpenter and Moss, supra note 4. See Carpenter and Tobbell, supra note 10.Google Scholar
Id. (Yackee). For evidence that certain industrial interests benefit from participation in the notice-and-comment process in ways that aggregate to billions of dollars in differential benefit for bank holding companies, consult Libgober, B. and Carpenter, D., “Lawyers as Lobbyists: Why Banks Shape Rules,” working paper, Harvard University.Google Scholar
Carpenter, D., “Detecting and Measuring Capture,” in Carpenter and Moss, supra note 4.Google Scholar
See Carpenter, “Corrosive Capture?”, supra note 4; Pham-Kanter, G., “Revisiting Financial Conflicts of Interest in FDA Advisory Committees,” Milbank Quarterly (September 2014), available at <https://www.milbank.org/quarterly/articles/revisiting-financial-conflicts-of-interest-in-fda-advisory-committees/> (last visited October 31, 2017).+(last+visited+October+31,+2017).>Google Scholar
A range of conflicting memoranda were published relating to this case. Other procedural aspects of the decision were far less legitimate or desirable. Kesselheim, A. S. and Avorn, J. A., “Approval of a Problematic Muscular Dystropy Drug: Implications for FDA Policy,” JAMA 316, no. 22 (2016): 23572358.CrossRefGoogle Scholar
Chaloupka, F. J., Warner, K. E., and Acemoğlu, D., et al., “An Evaluation of the FDA’s Analysis of the Costs and Benefits of the Graphic Warning Label Regulation,” Tobacco Control 24, no. 2 (2014), available at <http://tobaccocontrol.bmj.com/content/24/2/112> (last visited October 31, 2017). On Nardinelli’s role in the tobacco deeming rule analysis, consult Ashley, E. M., Nardinelli, C., and Lavaty, R., “Estimating the Benefits of Public Health Policies That Reduce Harmful Consumption,” Health Economics 24, no. 5 (2015): 617–624. On the severe misapplication of health economics research in the Ashley et al. article, see “FDA Values Lost Pleasure from E-cigarette Rules,” Reuters, June 2, 2014, available at <http://www.cnbc.com/2014/06/02/fda-values-lost-pleasure-from-e-cigarette-rules.html> (last visited October 31, 2017).Google Scholar
Soumerai, S. B. and Avorn, J. A., “Principles of Educational Outreach (Academic Detailing) to Improve Clinical Decision Making,” JAMA 263, no. 4 (1990): 549556.CrossRefGoogle Scholar
Hwang, T. J., Kesselheim, A. S., Carpenter, D., Franklin, J. M., Wang, B., and Lauffenberger, J. C., “Failure of Investigational Drugs in Late-Stage Clinical Development and Publication of Trial Results,” JAMA-Internal Medicine 176, no. 12 (2016): 18261833.CrossRefGoogle Scholar