by Erin A. Lawrence

The number of drug shortages has escalated to a record of over 250 this year. The Associated Press reported this past December that at least 15 patient deaths were attributable to drug shortages since mid-2010.

by Julie E. Kurzrok

heart.jpgOn December 16, FDA approved EXCOR®, the first ventricular assist device (“VAD”) designed for use in children. Berlin Heart, a closely-held German company, designed the mechanical heart device, which is already approved for use in Europe and Canada. FDA designated the device as a Humanitarian Use Device, which means it is used to treat or diagnose a disease affecting less than 4,000 people in the United States each year.

FDA approved EXCOR® under the Humanitarian Device Exemption (“HDE”), which allows for approval without efficacy studies, and only requires a demonstration that the probable benefit of the device outweighs the risks from its use and that the device does not pose an unreasonable or significant risk of illness or injury. The applicant must also show, for example, that there is no comparable device available to treat the disease.

EXCOR® is a mechanical cardiac support system designed specifically for children with congenital or other heart defects that prevent their hearts from pumping enough blood into their bodies. EXCOR® consists of one or two external pumps connected to tubes which are implanted into the ventricles and major arteries, and a separate driving unit. Each external pump controls one ventricle. The device comes in different sizes to accommodate newborn babies through teenagers, and functions to bridge patients while they await a heart transplant. According to FDA, “[I]n infants, the median waiting time for a donor heart is 119 days [and] . . . 12-17 percent of children and 23 percent of infants die while on the wait list for a heart transplant.”
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by Kyle Deighan

moneystackofcoins.jpgDrug shortages have become a major problem in the United States, resulting in countless people unable to obtain essential medications, as we have previously reported here. However, outside the obvious implications for those desperately in need of hard-to-find life-saving drugs, another troubling issue has also come to light: prescription drug price gouging. Reports of unscrupulous drug manufacturers selling medications in short supply at huge markups abound, and these so called “gray market” distributors have thankfully not escaped Washington’s watchful eye.

Senator Jay Rockefeller (D-W.V.), in a statement to the Senate Committee on Finance, discussed the price gouging phenomenon:

One disturbing side effect of the current shortage of many drugs to treat cancer and perform surgery is the parallel “gray market” that has sprung up to take advantage of health care providers’ urgent need to treat their patients. As documented in an August 2011 report prepared by the Premier health care alliance, gray market vendors sell drugs that hospitals are not currently able to acquire through their normal distribution networks. These vendors take advantage of supply shortages to sell the drugs at huge markups. In a survey of solicitations that hospitals actually received from gray market vendors in April 2011, Premier found that the gray market companies were selling drugs to hospitals at prices that were an average of 650% higher than the prices the hospitals normally paid.

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by Scot B. Pittman

Thumbnail image for worlddevice.jpgLast Thursday, Senators Chuck Grassley (R-Iowa), Richard Blumenthal (D-Conn), and Herb Kohl (D-Wis.) introduced the Medical Device Patient Safety Act, which aims “to enhance Food and Drug Administration oversight of medical device recalls [and] to provide conditional clearance of certain medical devices.” The proposed legislation sets forth a program by which FDA is to gather information regarding device recalls ordered under 21 U.S.C. § 360h(e) and information submitted when a device is corrected or removed under 21 U.S.C. § 360i(g). According to the Bill, FDA is to use this information “to proactively identify strategies for mitigating health risks presented by defective or unsafe devices.” The program should gather any information FDA deems appropriate, which would at least include: trends in the recalls, the most frequently recalled devices, the causes of the recalls, the time needed to complete the recall, the time FDA needs to terminate the recall, whether there have been recall audit checks, and persons who have been subjected to the most recalls.

The Bill dictates that FDA is to develop “explicit criteria” to evaluate if an individual has sufficiently complied with a recall, and FDA is to document the bases for any recall terminations, which it shall publish within 180 days of the termination. According to The Gray Sheet, members of the device industry have voiced support for an improved device recall process claiming that FDA has been “slow to classify recalls or announce when a recall has been successfully completed.” (Senate Bill Would Allow 510(k) Condition of Clearance Studies – The Gray Sheet, Dec. 19, 2011.) AdvaMed’s Executive Vice President of Technology and Regulatory Affairs, Janet Trunzo, stated, “FDA could do more to enhance the clarity and consistency of its recall process, and we are pleased that the agency has a number of initiatives underway in this area.”

Support for the Bill’s proposals is not unanimous; however, as some industry representatives claim the Conditional Clearance section is unnecessary. This part of the Medical Device Patient Safety Act would add Section 510A to the Federal, Food, Drug, and Cosmetic Act to allow for the conditional clearance of medical devices approved pursuant to Section 510(k). Currently, FDA lacks significant resources and authority to perform such monitoring. The Agency can only require post-approval studies for Class III PMA devices and certain 510(k)-cleared and PMA-approved devices. Under the proposed Bill, FDA would have the authority to rescind an approval if an applicant failed to meet the conditions for approval.
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burningcigar.jpgOn December 16, a group of Senators sent FDA a letter urging FDA to prohibit the use of flavorings in cigars. The letter was signed by Senator Frank Lautenberg (D-N.J.) joined by Senators Dick Durbin (D-Ill.), Sherrod Brown (D-Ohio), Jeff Merkley (D-Ore.), and Richard Blumenthal (D-Conn.).

According to the letter, more than 13 million Americans smoke cigars, including an estimated 1.8 million high school students and 475,000 middle school students. Unlike cigarettes, which FDA regulates under the 2009 Family Smoking Prevention and Tobacco Control Act (“the Act”), FDA has so far chosen not to regulate cigars as “tobacco products.”

Cigars and little cigars or “cigarillos” are like cigarettes because they contain tobacco and are intended to be smoked, so they arguably contain the same ingredients that were described in the Act as “inherently dangerous and cause cancer, heart disease, and other serious adverse health effects” and are addictive because they contain nicotine, “an addictive drug.” Another purpose of the Act was to reduce smoking by “young people,” including minors, who may be tempted to smoke, particularly when tobacco products contain non-tobacco-type flavors.
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by Howard Rosenberg

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The EU ban on stem cell patents, issued in an October 2011 Court of Justice of the European Union (“CJEU”) opinion, continues to generate controversy and input from a wide variety of viewpoints. This week Aurora Plomer, professor of law and bioethics at Sheffield University argued that the ban not only imperiled Europe’s competitiveness but also the protection of human rights.

The professor attacked the decision from a legal perspective arguing the ruling suffered from several flaws. She stated that the drafting history of the EU directive on biotechnological inventions, showed that the intention was never to render unpatentable lawful research and that there isn’t a uniform pan-European view on what respect for human dignity means with regard to human embryos, contrary to the position taken by the Court of Justice. She also pointed out that the ruling was inconsistent with the settled law of the European Court of Human Rights in that that court has applied a “margin of appreciation” doctrine in relation to the rights of the embryo accepting that the status of the embryo can differ from state to state.

The CJEU’s decision, binding on all member states, was that the concept of a human embryo had to be understood in a very wide sense ensuring respect for human dignity and, consequently, stem cell lines whose derivation required the destruction of human embryos were not patentable under European law. However, if the European Convention on Human Rights has no requirement for a consistent application or understanding of embryonic human rights amongst the EU member states then the CJEU’s decision may well be at odds with it. According to Professor Plomer,. the CJEU ruling raises important questions about the compatibility of EU law with the European Convention on Human Rights, which the EU is bound to respect.

Professor Plomer also felt that the ban would deter investment and frustrate the EU’s goal of harmonising laws to speed up the development of regenerative treatments that are anticipated to offer huge therapeutic potential, e.g. in Alzheimer’s and Parkinson’s disease.
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by Kyle Deighan

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The Third Circuit on Monday heard oral arguments on the legality of a settlement between several pharmaceutical companies in In re: K-Dur Antitrust Litigation. Under the 1997 agreement, patentee Schering-Plough Corp. (now part of Merck & Co. Inc.) made a $60 million payment to generic companies Upsher-Smith Laboratories Inc. and ESI Lederle. At Monday’s argument, Merck argued that the agreement was not to delay the generics entry into the market, but rather for a separate licensing agreement.

The suit, which was initiated in 2001, was brought by direct purchasers alleging that the agreements delayed generic versions of the blood pressure medication K-Dur 20 and violated the Sherman Act. Last year, a lower court determined that the agreements were not per se unlawful. Monday, Merck argued that reverse payment settlements often benefit consumers by allowing generics to enter the market sooner, before a patent’s expiration date.

According to amicus appellant the Federal Trade Commission (“FTC”), so-called reverse payment agreements significantly delay generic entry into the market. They estimate that generic entry is delayed an average of 17 months as a result of these agreements. FTC argued that the decision should be vacated and sent back to the district court to determine whether the payment was to delay generic entry, or whether it was in fact for a licensing agreement.
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by Scot Pittman

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This coming Friday, December 16, 2011, the Food and Drug Administration will hold a public meeting to discuss and solicit comments regarding its December 7th Federal Register Notice titled “Proposed Recommendations for a User Fee Program for Biosimilar and Interchangeable Biological Product Applications for Fiscal Years 2013 Through 2017.” This proposal is the result of numerous discussions among FDA, the regulated industry, and public stakeholders. FDA will continue taking public comments through early January and has until January 15, 2012 to make any changes before submitting the agreement to Congress.

The proposed recommendations outline anticipated user fees and set forth performance goals and procedures for the biosimilar product review program (see previous post here). Overall, the proposal recommends collecting initial and annual fees aimed at getting the biosimilar review program up and running. FDA has stated that it will need $20 million in non-user fees to support the biosimilar review program before it will spend the user fees it collects. FDA is authorized to spend user fees on activities related to the review of biosimilar submissions, which will cover activities in the pre-submission, review, and post-approval stages.

The program proposes the following types of user fees: (1) biosimilar product development (BPD) fees; (2) marketing application fees; and (3) establishment fees and product fees.

BPD fees would come in two types. First, an initial BPD fee will be due on the same day an investigational new drug application (IND) is submitted or within five days of FDA granting a request for a BPD meeting (explained below). The initial BPD fee is retroactive and will apply to applicants who have previously submitted biosimilar INDs. The initial BPD fee for a product will cover all proposed indications. The fee is to be equal to 10 percent of the fee established for a human drug application under PDUFA for that year. Second, there will be an annual BPD fee due on or before October 1 of every fiscal year until the sponsor gets its marketing application approved.
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Whose seafood is your seafood, or, more appropriately, how do you know the fish you ordered is the fish you ordered? In October, FDA approved a new DNA barcoding system that can identify fish species similar to a supermarket scanner to prevent mislabeling of locally produced and imported seafood in the United States. Reportedly, other national regulators are considering adopting similar measures, which are described as fast, reliable, and cost-effective.

In most cases, the DNA barcoding system should prevent restaurant patrons from consuming inferior fish from the one that they thought they were consuming. In other cases, it may prevent unwanted health consequences for individuals who may be allergic to specific types of seafood, including exotic species that are banned. Just in 2007, several individuals became seriously ill following consumption of illegally imported toxic pufferfish from China that had been mislabeled as monkfish to circumvent U.S. import restrictions.

Seafood mislabeling is notorious. For example, a a pair of high school students in New York found 25% of the fish that they sampled around New York was incorrectly labeled as higher-end-type seafood.
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by Kyle Deighan

Friesian-Holstein.jpgAccording to Representative Louise M. Slaughter (D-NY), the United States Food and Drug Administration (“FDA”) “has not acted in the best interest of public health, and continues to postpone, prolong, and de-prioritize important measures that are necessary to protect the American people.” Rep. Slaughter expressed her displeasure with FDA in a letter dated November 28th, 2011, in which she addressed several concerns with FDA’s approach with regard to antibiotic use in agriculture.

Rep. Slaughter’s letter highlighted three major concerns: