The US Food and Drug Administration is stepping up oversight and enforcement activity for medical products, advising industry
to tighten up on data integrity and quality control to ensure compliance. "Enforcement will increase," warned Deborah Autor,
director of the Office of Compliance in FDA's Center for Drug Evaluation and Research (CDER), at the April annual meeting
of the Food and Drug Law Institute (FDLI). She pointed to a rise in injunctions, investigator disqualifications, and warning
letters, and advised companies to avoid the Big Stick by "being pro-active about compliance." Autor's staff has grown to 250
from 150 five years ago, which increases its ability to take regulatory action; CDER had issued almost 40 warning letters
as of April 14, 2009, nearly half of the total 87 sent out in 2008.
Principal Deputy Commissioner Joshua Sharfstein, who was acting commissioner pending confirmation of Margaret Hamburg, took
high-visibility enforcement actions to illustrate that a new sheriff is in town. Soon after coming to the FDA at the end of
March, Sharfstein initiated a fast and more aggressive recall of pistachio products when evidence appeared of salmonella contamination.
He also responded to criticism of the FDA's process for regulating medical devices by supporting a review of research requirements
for device classes.
The global swine flu outbreak provided another opportunity for Sharfstein to display a highly proactive approach. He authorized
emergency access to antiviral drugs and diagnostics, and established teams under Jesse Goodman, newly named deputy commissioner
for scientific and medical programs and acting chief medical officer, to facilitate the development of new vaccines, antivirals,
diagnostics, and other products needed in a pandemic.
As former director of the FDA's Center for Biologics Evaluation and Research (CBER), Goodman has been active in vaccine development
and global health issues. In addition to heading up the response to the flu outbreak, Goodman will oversee the FDA's National
Center for Testing and Research and agency public health and science programs, including pediatric therapeutics, combination
products, women's health, Critical Path programs, good clinical practices, and the Sentinel Safety initiative. The assignment
puts several hot topics on Goodman's plate, including comparative effectiveness research, biomarker identification, clinical
trial design, personalized medicine, and manufacturing science.
Congressional leaders also seek to bolster FDA leadership and authority. The Senate Health, Education, Labor and Pensions
(HELP) Committee and the full Senate moved quickly last month to confirm Harmburg as FDA commissioner, stressing the need
for a strong agency to deal with the swine flu outbreak, and food and drug safety issues.
HELP Committee Chairman Edward Kennedy (D-MA) and Sen. Charles Grassley (R-IA) also reintroduced legislation authorizing the
FDA to collect user fees to support more inspections of drug and medical product makers. The measure provides authority for
the agency to issue subpoenas and to detain suspect products. Domestic and foreign manufacturers of regulated products would
have to register with the FDA, including producers of active pharmaceutical ingredients.
The measure is similar to the drug section of legislation backed by Rep. John Dingell (D-MI), which is pending before the
House Energy and Commerce (E&C) Committee. E&C Chairman Henry Waxman (D-CA) has indicated greater interest in enacting only
the food safety portion of the bill, but even that would grant FDA subpoena authority for all regulated products.
BUILDING ON FDAAA
These legislative proposals would enhance the enforcement powers already expanded by the FDA Amendments Act (FDAAA) of 2007,
which authorized fines and criminal penalties for violative activity. So far, the FDA has not brought a case under these new
authorities, Autor said, "but when we need to use it, we will." She pointed to the agency's speedy action to halt production
of drugs by KV Pharmaceuticals, which resulted in a recall of 175 products and blocked shipment of thousands of lots. Data
integrity is critical, Autor emphasized, citing FDA use of its Application Integrity Policy against Indian manufacturer Ranbaxy.
Autor also promised to continue the FDA's campaign to remove unapproved drugs from the market, which has affected over 200
manufacturers and 500 products, and involved action against 12 classes of drugs. In March, the FDA cited nine companies for
marketing 14 unapproved narcotic products. "We still see industry as somewhat complacent" about this, she said, and wants
manufacturers to understand that all drugs must have FDA approval.