Problems with FDA Medical Device Approval Process Identified in New Studies
Two new studies have been published that are highly critical of the way the FDA approves medical devices for human use, saying that the agency requires too few clinical trials, and that often the data in those trials is suspect.
The new studies come as the FDA is under increasing scrutiny over how it decides which medical devices, such as pacemakers and stents, can be implanted in human beings. One study, conducted by researchers from the University of California and published this week in the Journal of the American Medical Association, found that two thirds of approved devices only went through one clinical trial before being unleashed on the market, and most of those trials involved less than 300 subjects. The other study, conducted by researchers from the FDA and Boston’s Beth Israel Deaconess Medical Center, will be published in the upcoming issue of the American Journal of Therapeutics, indicating that about 40% of the studies used to decide what devices are approved lack clear definitions of safety requirements.
The stakes in FDA’s medical device approval process are high following a 2008 Supreme Court decision in Riegel vs. Medtronic which determined that FDA approval can make medical device manufacturers immune from lawsuits for injuries caused by defective medical devices. As a consequence of that decision, thousands of pending medical device lawsuits have been dismissed, including cases filed on behalf of thousands of patients injured by the recalled Medtronic Sprint Fidelis defibrillator lead. Although the design of the Medtronic lead makes it prone to fracture or break, a federal judge ruled earlier this year that patient claims for medical expenses and other compensation are now barred because the FDA approved the device.
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Learn More“Premarket approval of cardiovascular devices by the FDA is often based on studies that lack adequate strength and may be prone to bias,” concluded the University of California researchers. They came to that finding after a review of 123 summaries of safety and effectiveness data for 78 high-risk cardiovascular devices approved from 2000 through 2007. The review found that 65% of the devices were approved after only one study, and 78% of the total number of studies had discrepancies between the number of patients enrolled and the number that was actually analyzed.
FDA officials have faulted the study for comparing the way medical devices are approved to the way drugs are approved, but the researchers say that the stakes are higher for medical devices, since patients can stop using drugs but dealing with faulty medical devices implanted in the body is a much more complex process. Industry officials say the researchers did not have access to all of the data provided to the FDA.
In the FDA and Beth Israel study, researchers found that the FDA used poorly defined safety and effectiveness goals, and studies had poor patient accounting, incomplete collection of patient information, and determined that the studies being conducted lacked representation by women, nonwhite populations and children.
“Manufacturers, regulators, and the clinical community should collaborate to address these study shortcomings to ensure that patients are treated with reliable, safe, and clinically useful medical devices,” researchers from that study concluded.
Since the Supreme Court ruling a number of agencies and studies have been focused on whether the FDA can actually carry the entire burden of being responsible for medical device safety. Uniformly, those studies have found the agency’s approval process lacking. This summer the Government Accountability Office (GAO) released a report that highlighted how FDA oversight of medical devices is inadequate, arguing that they are not an effective guardian of patient safety.
Congress is currently considering a bill called the Medical Device Safety Act of 2009, which seeks to clarify that FDA approval does not preempt lawsuits against medical device manufacturers, overturning the Supreme Court ruling. Opponents of the legislation say that enacting the Medical Device Safety Act of 2009 would stifle innovation and cannot be a substitute for strengthening the FDA.
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KARENJanuary 21, 2010 at 6:08 am
THE FDA HAS BEEN PROVEN OVER AND OVER AGAIN TO BE HAINIOUSLY NEGLIGENT TO THE AMERICAN CONSUMERS WELLFAIR. FROM UNETHICAL MONETARY COMPENSATION, STOCK COMPENSATION, LAVUOS GIFTS FOR PHYSICIANS AND TO SOME FDA EMPLOYEES UPON RECEIVING THE FDA'S APPROVAL. FROM RECALLED DOG FOOD, TOOTHPASTE, LEAD POISONING IN OUR CHILDRENS TOYS AND MOST DIFFINITELY IN THE MEDICAL PRODUCT AND DRUG INDUSTRY. WHEN DO [Show More]THE FDA HAS BEEN PROVEN OVER AND OVER AGAIN TO BE HAINIOUSLY NEGLIGENT TO THE AMERICAN CONSUMERS WELLFAIR. FROM UNETHICAL MONETARY COMPENSATION, STOCK COMPENSATION, LAVUOS GIFTS FOR PHYSICIANS AND TO SOME FDA EMPLOYEES UPON RECEIVING THE FDA'S APPROVAL. FROM RECALLED DOG FOOD, TOOTHPASTE, LEAD POISONING IN OUR CHILDRENS TOYS AND MOST DIFFINITELY IN THE MEDICAL PRODUCT AND DRUG INDUSTRY. WHEN DO YOU TURN ON YOUR TELEVISION AND NOT SEE THE ADVERTISEMENTS FOR MEDICAL AND DRUG PRODUCT DEFECTS AND RECALLS..... ALL OF YOU WHO HAVE BEEN INJURED HAVE BEEN VICTIMS OF THIS NEGLIGENCE..... SYNTHES /SPINE SOLUTION PRODUCT "PRODISC L" HAS AFFECTED MANY OF YOU DUE TO PRODUCT DEFECT. BUT YET IT HAS MET THE SO CALLED FDA APPROVAL AND THEY (OUR FDA) WEREN'T EVEN AWARE OF ALL THE PRE-TRIAL RESULTS AND FINANCIAL GAIN TO THE PHYSICIANS UPON GAINING THE THE "FDA'S" APPROVAL. IF WE DON'T GIVE CONTROL BACK TO THE CONSUMERS THE RIGHT TO SUE DUE TO FAULTY MEDICAL OR DRUG PRODUCTS OR USAFE COMMODITIES THROUGH THE MEDICAL DEVICE SAFETY ACT ...WE WON'T NEED TO WORRY ABOUT HEALTHCARE REFORM... WHO'S GOING TO TRUST OUR GOVERNMENT TO PROTECT US IF WE ALLOW THEM TO BE IMMUNED FOR THEIR NEGLIGENCE OR UNETHICAL PRACTICES.......OR IS THIS REALLY PART OF THEIR AGENDA?
dkrauseJanuary 4, 2010 at 10:22 pm
The opposite is also true. The FDA holds devices in a category too long which hinder competition. A class 3 device should have limited time frame to alow other manufacturers produce and compete. FDA allows manufacturer (s) to monopolize market.
PeterDecember 30, 2009 at 5:27 pm
Life Support Medical Devices, Sense, Pace, Rapid Pace, Shock.. Abiility to Pace via fully implantable devices has been studied/evaluated for nearly 50 years (Berkovits Research, Boston. Includes waveform use in Lown Cardioverter) "Sense" (R.Terry/W.Keller) near 45 years of success in all cardiac waveforn identification. "Shock" (B. Lown Boston) fully implantable 30+years. "Designs" goals=reliabili[Show More]Life Support Medical Devices, Sense, Pace, Rapid Pace, Shock.. Abiility to Pace via fully implantable devices has been studied/evaluated for nearly 50 years (Berkovits Research, Boston. Includes waveform use in Lown Cardioverter) "Sense" (R.Terry/W.Keller) near 45 years of success in all cardiac waveforn identification. "Shock" (B. Lown Boston) fully implantable 30+years. "Designs" goals=reliability, efficient use of available power, size. "Materials" (Nobel encasements). military grade components, "Functions" driven by Physican input.(Yes, some are highly paid consultants) from field studies. Class I Recalls have mostly been the result of component compromise not any intentional behavior or lack of quality control by Manufacturers. Tort /FDA only adds cost. But the two really creats jobs.
ShariDecember 30, 2009 at 3:43 pm
The FDA not only approves medical devices without adequate test and research data, they also approve drugs that are ineffective for their intended purpose and that have dangerous side effects. The generic drug for IMITREX (Dr Reddy's Sumatriptan) is absolute ineffective and the side effects include muscle weakness that will leave an individual unable to stand alone or walk. The nausea associate [Show More]The FDA not only approves medical devices without adequate test and research data, they also approve drugs that are ineffective for their intended purpose and that have dangerous side effects. The generic drug for IMITREX (Dr Reddy's Sumatriptan) is absolute ineffective and the side effects include muscle weakness that will leave an individual unable to stand alone or walk. The nausea associate with migraine headaches necessitates the need to ambulate and get to a bathroom quickly. The drug can leave an unsuspecting person in very dangerous position with the possibility of serious injury from falls when they attempt this and are unable to walk. Not to mention that one will also be left in sever pain from the ineffectiveness of the drug. You can't even get in your car to go the emergency room for care due to the serious side effects so you are just left to suffer with the intense pain of migraine pain unless you are fortunate enough to have someone come to care for you.