The Chilling Effect of Congressional Micromanagement on Drug Approvals

Ph03349iThere is an excellent opinion piece in the Wall Street Journal today called Grassley’s War on Cancer Patients – which though the content is right on, the headline is a bit off. 

The point of the article is that Congress in general, and Senator Grassley in particular, are overzealously reviewing FDA decisions to the point that it will have a chilling effect on the FDA’s ability to approve new drugs in the future.  It was written by Dr. Mark Thornton, former medical officer in the division of Oncologic Drugs at FDA.  His article focuses on the fact that in February Senator Grassley asked the GAO to review the FDAs decisions regarding the use of surrogate endpoints in the approval of three drugs, as reported here at Eye on FDA on March 5.   In fairness the request to examine the use of surrogate endpoints was broader than cancer, involving other therapeutic categories.  Senator Grassley’s war is less on cancer patients than on surrogate endpoints.

Nevertheless, the article is testament to the fact that zeal exists in Congress right now for second-guessing FDA decisions based on political expediency, rather than a fundamental medical and scientific understanding of surrogate endpoints.  In fact, members of Congress (MOCs) have, in general, looked for mistakes made by the FDA ever since the problems surfaced with COX-2s.  And since that time, the FDA has provided many, many reasons for MOCs to question the agency with respect to actions and inactions of the agency.

Still, the extent to which Congress is willing to micromanage individual drug approval decisions may reach a ludicrous level.  After all, if Congress is so good at scrutinizing the efficacy of government, our foreign relations would be a LOT better than they are right now.  I don’t think public confidence in the safety of drugs is going to be shored up by Congressional investigation into FDA decisions given the fact that public confidence in Congress itself is not exactly riding high.  Therefore, one has to question whether or not the risk of Congressional micromanagement of FDA decisions is worth the benefit, if there is one.

But also, with respect to surrogate endpoints, the fact is that much of the future development of drugs and pharmacogenomics and personalized medicine are going to have to rely on personalized medicine.  And, to Dr. Thornton’s point, there are a number of very promising oncologic drug candidates in the pipeline.   

The fact is, as Dr. Thornton pointed out, that surrogate endpoint approvals have brought us some major medical breakthrough’s and were created largely in response to the overwhelming desire by the HIV community to gain faster access to promising therapies.  That was in the 1990s.  Today in the 00’s, the emphasis is less on access than it is on safety.  For those patients waiting for the next breakthrough, Congressional micromanagement to second-guess FDA, particularly on surrogate endpoints is not only political folly, it may be medical folly as well.   

This entry was posted in Current Affairs. Bookmark the permalink.

1 Response to The Chilling Effect of Congressional Micromanagement on Drug Approvals

  1. Kerry Donahue says:

    FDA SAYS, “WAIT” TO DYING MEN
    COAST-TO-COAST PROSTATE CANCER DEMONSTRATIONS ON MAY 30th IN PROTEST OF FDA FAILURE TO APPROVE SAFE, EFFECTIVE IMMUNOTHERAPY
    On May 30, 2008, CareToLive will take to the streets with coast-to-coast protests in Chicago, New York, Philadelphia, Cleveland, Madison, Atlanta, Seattle, Dearborn, and Tampa. Joining us will be the Cancer Cure Coalition, the Abigail Alliance, and A Right To Live. We are asking all patient advocates to come out and attend a protest.
    1 in 6 men get prostate cancer. 75 American men die from it every day. The FDA has not approved a treatment for stage IV prostate cancer in over 43 years.
    CareToLive, a not for profit corporation, seeks transparency and accountability from the FDA, as to why they disregarded the advice of their hand selected Congressionally mandated Advisory Panel of experts, who voted Provenge overwhelmingly safe and effective. Without cause or explanation, in an unprecedented action, the FDA denied licensure. We are seeking immediate access to Provenge for all men with end stage prostate cancer.
    Over a year has passed, and 27,000 American men have died without hope, since the FDA denied the licensure of Provenge, an immunotherapy the FDA panel voted 17-0 safe and overwhelmingly voted effective. This is a noninvasive, non-toxic, immune building treatment, which works by employing your own body’s healthy cells to fight the cancer.
    Men like Eduardo Garcia, who have had the 3 treatments, have gone from being incapacitated, to living healthy, productive lives, for as long as seven years and counting. Dendreon, the company that perfected this treatment, also has similar treatments for breast, ovarian, colon, lung, kidney, and cervical cancers, in their sights.
    The dysfunctional FDA’s reason for delay has never been explained, as it was not science based, since survival and safety have been clearly demonstrated.
    CareToLive filed a Citizens Petition for the FDA to reconsider the wrongful denial, (the only recourse the FDA allows), on July 26, 2007. The FDA has failed to follow Federal regulation and to this day they have not properly responded to our Petition, which seeks immediate access to Provenge for these desperate men. The FDA also refuses to respond to the CareToLive Freedom of Information Act request, which they know would prove that a few FDA insiders, who cared more about serving their own interests, rather than the best interest of the patients, purposely sabotaged Provenge.
    “In memory of our members who have recently passed away, never having been given the chance Provenge recipient Eduardo Garcia had, we will continue to fight on, every day, in every way we can. Please come out and join us,” CareToLive spokesperson, Mike Kearney, said.
    LOCATIONS:
    Seattle, Washington — 1 PM PDT
    Westlake Park (Downtown) — 400 Pine St
    Coordinator – Jason Burdine jnaburdine@comcast.net
    Co-Coordinator – Monica Sagen – bikeriding2@yahoo.com
    Chicago, Illinois — 3 PM CDT
    ASCO / McCormick Place — 2301 S. Lake Shore Drive
    Coordinator – Sean Morgan – morgan2174@yahoo.com
    Co-coordinator – Arnie Mass – Ammass14@aol.com
    Cleveland, Ohio — 4 PM EDT
    Public Square outside terminal tower — downtown
    Coordinator – Kerry Donahue – bedonwahoo@aol.com
    Co-coordinator – Mike Bauman – jmb15mjb4@gmail.com
    Dearborn, Michigan — 3 PM EDT
    Rep. John Dingell’s Office — 19855 West Outer Drive — Suite 103-E
    Coordinator – Gregg Burch – ctl-dearborn-rally@live.com
    Madison, Wisconsin — 4 PM CDT
    Wisconsin State Capitol Building — 2 East Main Street
    Coordinator – Melody Davis – MDavis@caretolive.com
    Tampa, Florida — 3 PM EDT
    H. Lee Moffitt Cancer Center & Research Institute
    University of South Florida
    12902 Magnolia Drive
    Coordinator – Ardeis Scott, MD – ardeisfka@aol.com
    Philadelphia, Pennsylvania — 2 PM EDT
    2 PM Assemble and pass out flyers at 12th & Market Street for march to FDA at
    4 PM — 200 Chestnut Street U.S. Customhouse Building
    Coordinator – Mike Kearney – publicrelations@caretolive.com
    Co-coordinator- Rory Kearney – rk@caretolive.com
    New York, NY — 9 AM EDT
    Memorial Sloan-Kettering Cancer Center — 1275 York Avenue
    Coordinator – Kevin Ward – kward3@nyc.rr.com
    Atlanta, Georgia — 3 PM EDT
    Atlanta FDA Regional Office — 60 Eighth St. N.E.
    Coordinator – Bob Madden – rjmcanoe@aol.com
    Maitland, Florida, 32751 – 11 AM EDT FDA District Office – On the sidewalk in front of 555 Winderly Place
    Coordinator – Reggie Shribbs – rshribbs@cfl.rr.com
    For more information go to http://www.CareToLive.com

Comments are closed.