November 30, 2015

FDA’s Action Plan Demands Some Industry Action, Too

Patrick Stone

Patrick Stone, President, TradeStoneQA

“The following Pharmaceuticals FY 2015 Action Plan (the Action Plan), developed by the Office of Regulatory Affairs (ORA), the Center for Drug Evaluation and Research (CDER), and the Center for Veterinary Medicine (CVM), is intended to facilitate operational and program alignment as FDA transitions to distinct commodity-based and vertically-integrated regulatory programs with well-defined leads, coherent policy and strategy development, and well-designed and coordinated implementation.

That’s the FDA’s plain Jane version of its 2015 Action Plan. But let’s look at some interesting wrinkles not necessarily contained in the document.

The Pharmaceuticals Inspectorate will change the way FDA inspectors conducts audits and how many audits will be conducted in a years’ time. There are some interesting things to note here: First, the Center for Biologics (CBER) is noticeably not included in this reorganization effort. Second, district offices will not be at the helm when it comes to which drug firms get inspected and how compliance OAI & VAI cases are handled. Third, CDER will be assuming the lead role and Center compliance teams will be responsible for industry corrective action plans.

prescription drugsTraditionally, the district compliance team for the drug company took the lead role in compliance strategy and remediation. But now, the inspectors conducting drug audits will be dedicated and certified to conduct inspections. This will reduce errors and enhance the quality of inspections domestically and internationally. This will also increase the number of observations (483 notice of observations), warning letters, and consent decrees.

When a generalist inspector conducts a drug audit they may miss a system wide failure or process control deviation due to a lack of training. By contrast, when a professional team of inspectors with dedicated drug training for a drug firms system conduct an audit, those same compliance issues are not usually missed. This is a positive step in the right direction however building the new drug teams and training them accordingly will take years.

Quality by design (QbD) implementation is looming so this will also affect the training requirements from a system based approach to a QbD approach.

Don’t be caught off-guard by this new way of doing things. The FDA is making some changes here, and regulated firms need to make sure they understand them.

Patrick Stone is the author of Bubble Gum Badge – An FDA His-Story. You can also follow him on Twitter.


Brookings Looks to Advance Medical Device Postmarket Surveillance System

Michael Causey, Editor & Publisher,

Michael Causey, Editor & Publisher,

Patients and medical device innovators will benefit if the United States is able to launch a National Device Postmarket Surveillance System (MDS), says a new report by the Brookings Institution with input from a wide swath of public-private players including the Office of Surveillance and Biometrics Center for Devices and Radiological Health.

The Brookings paper, “Strengthening Patient Care: Building an Effective National Medical Device Surveillance System,” calls for an MDS that’s responsible for coordinating medical device postmarket evidence activities, then builds and facilitates access to a network of data partners. The report also stresses, however, that the MDS should not work in a vacuum. Instead, it should be built upon and coordinate with existing public and private sector programs to better leverage existing expertise and resources.

Brookings envisions a system that collaborates with other groups to support other high-priority evidence needs that may benefit from the same infrastructure, including product tracking and utilization, clinical quality improvement, and economic analysis of medical device-related care.

medicaldeviceThe Brookings Planning Board (PB) suggests the new MDS be implemented and managed by a wide array of stakeholders. But none of this is going to happen overnight. The PB envisions a seven-year rollout, with the first two years devoted to an incubator project tasked with developing a five-year MDS implementation plan.

Ideally, the incubator project would be initiated by the FDA. The report lays it out pretty clearly. “Without some initial seed funding and active FDA engagement, it will be difficult to assure the purpose and sustain the momentum necessary for other stakeholders to fully engage in the development of MDS.”

Finding funds won’t be easy, the report authors acknowledge. For example, the FDA does not currently have any specific appropriations dedicated to paying for the initiative. Congress enacted legislation in 2012 mandating the agency expand the Sentinel system to include medical devices. Unfortunately, folks on Capitol Hill didn’t come up with or identify other sources for the cash to fund it. The PB calls for “more explicit Congressional support” to support and fund the infrastructure required to emerge with a robust system of medical device surveillance in this country.

While Washington’s culture of gridlock isn’t exactly encouraging, maybe the prospect of safer medical devices developed in a climate that encourages innovation is the kind of thing a few of them can actually support on the same day. We’ll see.


FDA CDRH Enforcement: Agency Eases Up a Bit at Home, Looks Overseas

Michael Causey, Editor & Publisher,

Michael Causey, Editor & Publisher,

Quality system surveillance inspections dropped about 3% in 2013, the FDA’s Center for Devices and Radiological Health (CDRH) says in its latest stats. It’s not sure why, exactly, but posits it’s due to an increase in inspections overseas. That drains away resources for domestic doings.

It’s worth noting that the overall number of inspectional observations dropped by 17 percent in FDA’s latest stats from 2013. FDA’s most frequent inspectional observations remained consistent, with Corrective and preventive action procedures (CAPA) leading the way, followed by complaint reviewing, receiving and evaluating. The trio was rounded out by problems with quality audits to assure quality systems are in compliance. Not much new there. Still, it’s important to know.

For the first time since 2009, the number of warning letters issued by CDRH dropped according to the agency’s most recent annual stats. Fewer than 5% of domestic firms and over 15% of foreign firms inspected received warning letters. That might sound good to US-based device makers, but as manufacturing moves more and more overseas, those higher stats are becoming their problem, too.

FDAlogoUntil we receive more recent numbers, we’ll have to look for anecdotal evidence suggesting any deviation in the FDA’s regulatory focus in 2014 or 2015. So far, it’s looking like business as usual.

Let’s take a quick look at some recent warning letters to better illustrate the point:

While FDA’s overseas inspections have tended to focus on India and China, CDRH hit Spanish-based DIMA, a manufacturer of slings and incontinence mesh products, with a warning letter for insufficient environmental controls and other good manufacturing practice (GMP) shortcomings. CDRH hit the form for not having change handling procedures that were up to the mark, and failure to demonstrate that a CAPA it opened ultimately did not require corrective actions.

Back in Tonawanda NY, CDRH’s January 23 warning letter to Praxair criticized the firm for not having clear definitions for what qualified as a reportable event. Further, the agency said the company did not require verification of validation of CAPAs. Praxair makes gas flow products that regulate oxygen flow.


FDA FastStats: A Look Back at 2013 Medical Device Warning Letters and Quality System Deficiencies


Training Management Best Practices for Emerging Life Science Companies

Jeff Mazik

Jeff Mazik, Vice President, Life Science Solutions, AssurX

No matter how good your written policies are, or how clean a facility you operate, or how successful you are in the marketplace, it can all fall apart without a strong handle on your organization’s training needs and ability to effectively manage a training program. Ensuring that your staff is properly trained to do their work is a basic expectation for regulatory bodies in the life science industries. In order to manage this extremely important activity, your organization must:

  • Properly identify and maintain training requirements
  • Manage all associated training activities
  • Identify, provide, and manage training materials and locales
  • Be able to successfully report on an individual’s training history
  • Ensure outstanding training needs are being completed in a timely manner
  • Ensure training is effective

Implementing a best practice solution for training management is essential to help an emerging life science company ensure compliance and quality. Regulatory agencies in the life science industries demand that your company has proper controls in place that ensure your staff, employees and non-employees are properly trained, that their training is documented, and that changes that require re-training are properly maintained, communicated, and rolled out, resulting in auditable documented training.

trainingblogUtilizing an electronic training management system is preferable, but regardless of the system, there are a few things one must begin to compile to be ready to implement a structure that helps a training organization or human resource staff successfully manage training. Another important goal here is the ability to create an environment where a change to a training requirement results in an immediate and logical set of training tasks to be assigned to affected trainees. This is essential in ensuring ongoing quality within your organization’s training environment.

So how does one begin creating such an environment? The first step is understanding your own organization’s training landscape. Your organization has a number of people, each may play multiple roles (this is especially true with start-ups), and, as such, each role has its own training needs and requirements. Also contained in this landscape are many training elements that need to be managed. These include documents and courses that might be required. You will need to gather this information and get it into a structure that allows the easiest management as changes occur. Also, it is imperative that you have a good idea of how changes will be handled as they will inevitably occur and also to identify how these changes will be communicated.

Once you have a good understanding of your current landscape, the next step is to follow a four step process to identify and structure the data so as to be ready to manage the training for your organization. Let’s take a look at each step:

  1. Requirement Building. The goal of this step is to identify and document all training elements (documents and courses) that are required to achieve a specific requirement (e.g. Manager Requirements, Sterile Cleaning requirements, General Human Resource requirements, etc.)
  2. Role Identification. The goal of this step is to identify the roles/major activities that are present in your organization (e.g. Shift Manager, Line Operator, Employee, etc.)
  3. Role-to-Requirement association. The goal here is to take the defined requirements, and assign them to the Roles identified. Note that some roles have multiple requirements to complete. For example: the “Shift Manager” may have both the “Sterile Cleaning” requirement and “Manager” requirements assigned to him/her
  4. Identify employee’s role(s). The goal here is to assign the identified role (or roles) to the individuals, showing which roles they perform for our company. (For example, John Smith serves in the “Shift Manager” and “Employee”)

When completely implemented, if a new training document (for example) is added to a requirement, all employees whose role incorporates that requirement will now be required to be trained. Or if a person changes roles within an organization, the act of assigning that role to that person will trigger the need for new training and assign it to that person.

This four step approach provides you with a very powerful way to manage training in your organization. It helps you organize training by roles for an employee or contractor, but it also helps you organize requirements for those roles. In effect, you are now able to manage your complete employee and contractor training in a grouped fashion.

Importance of Automation:

At first glance, to manually manage these lists in a spreadsheet or other common office tool can be very overwhelming. That is where implementing a training management solution, configured to handle training management particularly, helps out tremendously. Advantages of using a training management solution include:

  1. Immediate email notification whenever new training is required (triggered by adding or changing of roles, requirements, courses, or documents)
  2. Ensure timely staff training (due dates tracked and charted, reminders sent)
  3. Ensures appropriateness of staff training (only those affected get training notification)
  4. Easily manage changing training requirements
  5. Quickly identify “who-needs-what” training
  6. Easily identify outstanding delinquent Training and escalate to management, if necessary

Plus, there are many advantages if the training management system is integrated within the company’s document management system. Examples include:

  1. Automatic training notifications generated as a document revision becomes available for training
  2. Overall paper reduction
  3. Ensures user is accessing and training on the current version of the document
  4. Training documents can be provided online via a “click” (potentially minimizes users need to hide old versions of documents)

Bottom line: if implemented accordingly, using this four step approach within a best practice training management system results in an environment where people are trained to do the job they have been hired to do.

Note on resources:

Many start-ups and emerging companies in the life science industries are constrained in a number of ways — notably in funds and resources. This can present many hurdles in trying to get a useful training management system in place. In order to minimize costs and expending copious resources, some options to consider include: selecting a solution that can effectively address multiple business or quality needs to increase ROI, a solution that provides a lower cost option of hosting off-site (e.g., cloud-based solution), one that utilizes non-proprietary infrastructures, and one that can be configured without requiring programming resources.

Other items to be aware of:

A best practice approach for implementing an electronic training management system also includes these other important attributes. They are true needs that best of breed quality management systems will provide:

Communication: Automatic assignment of training when requirements change and then communicates those assignments effectively.   Notification to users of coming-due uncompleted training tasks, and course registrations.

Client experience: The electronic system should incorporate end-user functionality that increases performance and acceptance such as: including built-in instructions within the process itself as well as visual hints or cues that make it obvious to the user where the document is in the process and what to do next. Also, it’s preferable to use dashboards displaying only data pertinent to the user.

Control: As with any validated system, changes to the process need to be controlled and managed under change control procedures. Also, control of business processes is key. The system should provide seamless integration and flow to other quality and/or business processes, such as to document management, or to provide CAPA generated re-training tasks.

Compliance: The electronic system must meet all applicable regulatory requirements (e.g. 21 CFR Part 11). Also, implementing reminders and escalations when tasks are due (or late!) helps you to stay in compliance to objectives and agreed upon timelines.

Configurability: The solution you use should be easily configured, maintained, and updated, breaking you from a strong reliance on costly programmers, consultants, and specialized IT resources to make a change or to add a step to the process.

The above is a summary of a Webinar conducted recently titled “Training Management Best Practices for Emerging Life Science Companies”. If you are interested in getting more details Training Management Best Practices and to view a demonstration of a Web-based solution that meets these best practice elements, please request a replay of the 60-minute Webinar here.


Quality Takes Time, FDA’s CDER Reminds Drug Makers

Michael Causey, Editor & Publisher,

Michael Causey, Editor & Publisher,

Scholars still debate how long it took to build the Great Wall of China, but it’s generally agreed it was built in stages between the Fifth Century B.C. and the Sixteenth Century A.D.. The Great Pyramid of Giza took about twenty years to construct, according to ancient historians, but it must be remembered that Egypt’s rulers were pretty rough on their non-volunteer workforce. Deadlines had a deeper meaning back then.

By contrast, the Center for Drug Evaluation and Research (CDER) quality initiative has been with us some ten years, or about the time it took to build the Panama Canal. Both projects have had to dig through – and around – a lot of muck. At the peak of work, excavators in Panama carved out the equivalent of the English Channel Tunnel every 14 weeks. It’s not fair to hold the agency to that same standard.

Pharmaceutical manufacturingInstead, let’s acknowledge that FDA just completed its own new structure called the Office of Pharmaceutical Quality (OPQ). Less bricks and mortar than a shift in human capital, the OPQ will take on some of the functions and staff at the Office of Pharmaceutical Science (OPS), take some preapproval and surveillance inspections duties from the Office of Compliance (OC), and absorb some of the inspection-related activities for bioequivalence/bioavailability and non-clinical studies from OC’s Office of Scientific Investigations. The idea is to make the drug review more integrated with FDA and improve communications both ways.

The agency hopes OPQ will streamline the processes that monitor drug quality throughout the product lifecycle, including drug application review, post-approval improvements, and surveillance and inspections of global manufacturing facilities.

OPQ was built, in part, in response to the falling number of drug-related product recalls over the past few years. FDA believes OPQ will help it better organize and quantify the state of manufacturing at drug facilities in the US and abroad. FDA’s recently been pushing a new approach to quality metrics, as highlighted by CDER’s Russell Wesdyk. His presentation outlines CDER’s revised way of looking at surveillance and adoption of quality metrics that promote the use of a common language to improve measurement.

According to Wesdyk, quality metrics will be used to assist segment sites and producers based on risk when it comes to inspection and reviews. But it won’t issue “restaurant style grades” reporting how one facility stacks up against industry groupings. Wesdyk encourages any interested parties to reach out to him as FDA’s thinking evolves. That’s a good thing.

Remember, it’s not as if the Panama Canal doesn’t require some maintenance now and then. The FDA’s got the right idea here.

The alternative is to build something and then forget about it. We’ve all seen how that usually turns out.  Take a look at the Pyramid of Giza lately?


FDA’s CDER Unveils Ambitious 2015 Wish List

Michael Causey, Editor & Publisher,

Michael Causey, Editor & Publisher,

The holidays came a little early for the folks at the Center for Drug Evaluation and Research (CDER). They just released their sometimes optimistic, but always enlightening guidance wish list and overall priorities for 2015. Let’s take a look.

CDER Director Janet Woodcock recently said these are her agencies “front burner” priorities:

  • Implementing and clarifying statutory provisions on drug compounding.
  • Meeting Generic Drug User Fee Amendments (GDUFA) review goals that went into effect Oct. 1 last year.
  • Continue the build out of Office of Generic Drugs “super office.”
  • Build out the Office of Pharmaceutical Quality.
  • Implement and continue to develop Program Alignment Group agreements with the Office of Regulatory Affairs.

She singled out the implementation of a new process, data and document management IT system as a “big deal” goal this year

But there’s plenty more on FDA’s big front burner:

  • Respond as needed and participate in “21st Century Cures” legislative activities.
  • Rapidly re-evaluate regulation of drug advertising and promotion.
  • Execute immediate actions required by the Sunscreen Innovation Act and implement a longer-term plan.
  • Respond to Ebola outbreak.
  • Issue final guidances on abuse-deterrent opioid formulations.

She’s also hoping to fill more than 600 staff vacancies and recruit for a slew of executive positions.

prescription drugsWoodcock’s ambitious goals include five more bulleted pages of additional “important” priorities ranging from implementing a biosimiliars program, working on the Drug Label Improvement Initiative and developing a strategic plan for managing a growing pile of drug imports.

In the agency’s spare time, the plan is to issue nearly fifty guidances in advertising, biopharmaceuticals, biosimiliars, clinical medical/pharmacology/statistical/drug safety, electronic submissions, generics, and labeling, among others. Each of these guidances are already under development, CDER said earlier this month.

It’s certainly important to have goals, and a person’s reach should exceed their grasp, etc, but there’s also the problem of over-promising and under-delivering.

FDA’s got a big front burner but maybe not enough cooks, or oven space, to get it all done in 2015. We’ll keep an eye on it and report back throughout the year. Bon appetit.


Got Safe Beef? New Report Suggests the US Doesn’t

Michael Causey, Editor & Publisher,

Michael Causey, Editor & Publisher,

The next time you want a cheeseburger, you might consider hopping a plane and flying to Germany. Or France. Or New Zealand. Basically, anywhere but the United States of America.

Almost across the board, the US ranks at the bottom (“regressive”) for produce traceability programs as ranked by a new Institute of Food Technologists (IFT) report.

IFT checked out 21 countries and rated them “Progressive,” “Moderate,” or “Regressive” based on a handful of criteria.

While the landmark Food Safety Modernization Act of 2010 (FSMA) is expected to improve things here in America, “development of regulations are still in the early stages,” the study noted. Technically, the study is called “Comparison of Global Food Traceability Regulations and Requirements.” That’s quite a mouthful, pun intended. An earlier IFT powerpoint presentation also examined this important issue.

FSMA was signed into law by President Obama on January 4, 2011. FSMA was designed to give the Food and Drug Administration (FDA) new power to regulate the way foods are grown, harvested and processed. The law grants FDA a number of new tools, the most important of which is mandatory recall authority. But that’s all in the future. The IFT report tells us what’s going on right now.

Where to start when reading the report? The ranking of 21 countries (EU, China, Japan and a few elsewhere including Brazil and the land of the Kiwis) found that the US was only one of two major beef exporters without mandatory red-meat traceability systems. It also lagged behind most of the group with a weak consumer access program.

Generally, countries in the EU (France, UK, Germany, Ireland et al) led the group. That’s thanks, in part, to tough standards imposed in 2005 that include mandatory traceability programs for food, feed, food-producing animals and any other substance incorporated into food or feed.


The US did achieve some distinctions — pretty much all bad. For example, it joined China as the only countries rated regressive when it comes to the breadth of products regulatory traceability regulations.

The US, China and Canada are also the only members of another not-so-attractive-club: Regressive electronic livestock traceability programs.

In its summary, the report diplomatically notes the obvious: The US “trails most other nations.”

Let’s wrap this up on something of a positive note.The US did make the top category for voluntary traceability programs. An optimist might say US meat exporters are significantly exceeding their nation’s relatively lax regulatory requirements. Pessimists might still urge you to think twice before buying that next cheeseburger, chicken sandwich, or tilapia in America — at least until the FSMA kicks in.


FDA FastStats: A Look Back at 2013 Medical Device Warning Letters with Quality System Deficiencies

In our latest infographic analysis, today’s post highlights medical device warning letters with quality system deficiencies. Surprisingly, warning letters were actually down 12.2% from 2012. However, they are almost double the number (77) issued in 2009. Are we looking at a downward trend? The jury’s still out. The highest number of warning letters issued in the past 10 years was in 2012, with a total of 164. The lowest was 2007, with only 74 warning letters issued.

FDA FastStats 2013 - Warning Letters



FDA FastStats: A Look Back at 2013 Medical Device 483 Observations

As we approach the end of 2014, we will take a look back at FDA’s stats on various topics sourced from their Case for Quality initiative. The FDA believes that the following type of information will:

  • Help industry improve medical device quality by sharing common observations
  • Identify possible areas of emerging concern, and
  • Possibly help firms avoid warning letters

Our first in the series of infographics is 483 inspectional observations.



FDA’s Local Offices Flex Regulatory Muscle

Michael Causey, Editor & Publisher,

Michael Causey, Editor & Publisher,

In our latest round-up, it was the District Offices turn to chime in on medical device company alleged shortcomings.

As expected, FDA is shifting more and more of its regulatory focus toward Medical Device Reporting (MDR). In an October 1 letter, the agency’s Baltimore District Office hit Baltimore-based Electronic Development Labs for not having an MDR procedure. Bad idea.

The company may not have recovered very well, either. “The adequacy of your firm’s response dated November 20, 2013, cannot be determined at this time,” FDA’s warning letter said. “Your firm’s response indicates that the development of an MDR procedure was added to a list of action items. In order to determine adequacy, FDA must receive a copy of the MDR procedure for review.” Electronic Develop makes the NervoScope.

The agency also gently encouraged the company to look into eMDR.

As we’ve noted before, FDA eMDR Final Rule requiring manufactures and importers to submit electronic Medical Device Reports (eMDRs) to FDA was published on February 13, 2014. The requirements of this final rule will take effect on August 14, 2015. If a firm is not currently submitting reports electronically, FDA politely encourages it look into it on FDA’s web page devoted to eMDR.

The FDA demonstrated its ongoing interest in CAPA in an October 7 letter from its Los Angeles Office to Alpha Medical, a maker of angiographic balloon catheters.

warning640After Alpha tried to respond to a September inspection, FDA made it clear the reply needed some work. Example: “CAPA 104 was opened on January 10, 2013, concerning non-conformities regarding balloon extension air leaks. The CAPA report references multiple root causes for these leaks; however not all of these potential causes were analyzed and investigated.”

The agency went on, “Your records reference that personnel were retrained, but the corrective actions for which they were retrained were not documented. Additionally, this CAPA was closed on February 22, 2013 without documentation that an effectiveness check was performed.

In an October 10 letter from the Cincinnati District Office, local regulators challenged West Lake Enterprises, maker of medical gas pressure regulators and suction regulators, with CAPA and other violations, including installation that’s not in conformity with the Current Good Manufacturing Practice (CGMP) requirements of the Quality System (QS) regulation. The company responded, and FDA came back with additional questions.

The Denver District Office joined in with an October 28 letter to Xanacare Technologies, maker of SimulCare II, a therapeutic lamp/nerve stimulator/massager. The agency hit them for several issues, including problematic design control, device history records (DHR) and complaint handling. As of late October, the agency said it had not received a response from Xanacare.