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.