[Reblog] JAMA papers raise questions about FDA drug and device approval

JAMA papers raise questions about FDA drug and device approval.

JAN24 2014

Posted by Gary Schwitzer in FDA

An important series of papers was published in the Journal of the American Medical Association this week.

“Clinical Trial Evidence Supporting FDA Approval of Novel Therapeutic Agents, 2005-2012,” by Dr. Joseph Ross and colleagues, concluded that the quality of clinical trial evidence used by the FDA as the basis of approving new drugs varies widely.  A couple of interesting data points:

• in the seven-year period of analysis, 37% of drugs were approved on the basis of a single pivotal trial.
• trials using surrogate end points as their primary outcome formed the exclusive basis of approval for 45% of drugs approved. (See our primer, “Surrogate markers may not tell the whole story.”)

In an opinion piece,  “Opening the FDA Black Box,” Drs. Steven Goodman and Rita Redberg said the study:

“…raises a host of questions needing further exploration. Despite the FDA requirement for evidence from a minimum of 2 randomized clinical trials supporting an effect on health outcomes, 37% of product approvals were based on only 1 trial, 53% of cancer trials were nonrandomized, and an active comparator was used in only 27% of non–infectious disease trials. Surrogate end points were used in almost all approvals via the accelerated approval process and in 44% of nonaccelerated approvals. Trials were comparatively short, with most lasting less than 6 months, even those assessing chronic treatments for chronic diseases. Cancer drugs, perhaps predictably, were more often approved via the accelerated process and with weaker designs.”

Another paper looked at the reasons that FDA marketing approval for new drugs was delayed or denied.

And a fourth paper looked at FDA regulation of medical devices, “a process that has received relatively little attention,” according to Goodman and Redberg, who continued:

In USA Today, Liz Szabo wrote a good summary of the JAMA papers under the headline, “Not all FDA-approved drugs get same level of testing: Evidence behind FDA-approved drugs and devices often has major limitations.”

Read the entire article here

Related Resources

• ClinicalTrials.gov

ClinicalTrials.gov is a registry and results database of publicly and privately supported clinical studies of human             participants conducted around the world.
When available, study results information is included in the study record under the Study Results tab. See How to Find Results of Studies for more information on finding results entered in the results database.

Results (after 2008, only those required by US federal requirements) include
–Participant data (how many started the trial, dropped out, etc)
—  Information about participants (age, gender, blood pressure readings, etc)

[Speaking of gender…]

Good to know, most drugs can affect women and men differently

    —   Outcome (results of taking the drug plus any placebo), with statistics

    –Adverse effects , serious and other (this was not required before 2008)

• Evaluating Health Information (from my personal Google site)

  • Research Articles Summarized for Us All

  • How to Read a Research Paper

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[Reblog] JAMA removes cover art, and why that matters

From time to time I glanced at JAMA cover art when working at various libraries.
Never quite understood the art. However, now I feel like part of JAMA’s soul is diminished….

From the 6 November 2013 Kevin MD article by JEFFREY M. LEVINE, MD

Beginning in 1964 the Journal of the American Medical Association (JAMA) started publishing full color images of art on its cover accompanied by insightful essays.JAMA’s former editor, George Lundberg, wrote that this was part of an initiative to inform readers about nonclinical aspects of medicine and public health, and emphasize the humanities in medicine. Now after almost 50 years of covers that displayed over 2,000 pieces of art, JAMA has taken a great leap backwards and replaced the cover art with a pedestrian table of contents. The cover art that once distinguished JAMA from an array of leading medical journals has been demoted to an inside page, eliminating one of the more visible, inspiring beacons that once linked the humanities to medical science.

The cover art was always important to me. As a teenager envisioning my future, I saw copies of JAMA on my uncle’s desk. He was a medical doctor, and for me the JAMAcovers joined the visual arts to the science of medicine and gave me inspiration. As the years passed, I enjoyed seeing the distinguished covers of JAMA in medical libraries, and frequently picked them up to read the commentary. Glancing from the scientific articles to the essays on the cover art, my vision of the combination of art and medicine was validated. Over the years I received JAMA in my office and tacked many of my favorite covers to the wall by my desk.

The art swept across the vast panorama of civilization and human history. Just about any painter you can imagine has been featured on a JAMA cover. In addition the covers displayed Japanese Ukiyo-E prints (February 4, 1998), a 15th Century Apothecary Treatise (September 8, 1999), and African bronze statuary (April 6, 2011). One of my favorites was the photo of the Lewis Chessmen, a set that was carved from walrus ivory in the 12th Century and found in the Outer Hebrides off the coast of Scotland (February 16, 2011).

…

Read the entire article here