October 21, 2014

FDA Rolls Out Aggressive 510(k) Revision Plan

Under attack from consumers for being too lax and from industry for being too stringent, the FDA today unveiled its controversial and long-awaited 510(k) plan it hopes will improve the review process for “certain innovative, lower-risk medical devices.”

Like most government wonks, the agency focused on numbers from the start. Today’s plan contains not 24 or 26, but 25 specific actions it plans to take. Those include:

  • Clarifying when clinical data should be submitted in a premarket submission, guidance that will increase the efficiency and transparency of the review process,
  • Establishing a new Center Science Council of senior FDA experts to assure timely and consistent science-based decision making.

An ambitious rollout plan is outlined here:

Publicly, most device industry groups are cautiously praising the FDA, with a few exceptions, such as AdvaMed’s Stanford University report. Privately, most device makers tell us FDA is going overboard and will stifle medical innovation.

Today’s actions will result in “a smarter medical device program that supports innovation, keeps jobs here at home, and brings important, safe, and effective technologies to patients quickly,” Jeffrey Shuren, M.D., J.D., director of the FDA’s Center for Devices and Radiological Health (CDRH), told reporters in a conference call this afternoon.

Before marketing most lower-risk medical products such as certain catheters or diagnostic imaging devices, manufacturers must provide the FDA with a premarket notification submission.

In September 2009, CDRH set up two internal working groups to address concerns relating to the premarket notification process — industry argued that the 510(k) process was unpredictable, inconsistent and opaque, while consumers and health care professionals argued that the review process wasn’t robust enough. At the same time, CDRH also asked the independent, nonprofit Institute of Medicine to study the program. That review is still underway.

Reported by Michael Causey – you can read his other posts here.

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FDA 2011 Regulatory Climate: Cloudy, With a Chance of More Regulation

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Last year we put on our weather forecaster’s hat and called for greater FDA enforcement of medical devices in 2010. For the most part, I’d argue we got that right.

Unfortunately for us amateur prognosticators, 2011 is looking cloudier – and weirder. While the FDA has sent some signals that it intends to take enforcement matters more seriously, we have also seen the agency behaving a bit oddly when it comes to its efforts to improve 510(K) regulation and make the agency more “transparent” to John Q. Public.

Let’s take a look at some of the FDA’s Greatest Hits of 2010:

  • The Kids Think They Are Alright: It’s not the year’s biggest issue by a long shot, but the dismissal of several senior media experts and their replacement by Young Turks with little or no FDA-related experience does suggest the FDA may be getting more political and less interested in real science. While hope springs eternal, this doesn’t bode well for an open or especially skilled department in 2011.
  • Cloudy Transparency: A clumsy FDA attempt to tout transparency when no one was watching oddly-timed “transparency” news release from the FDA isn’t really the best time to tell the world you want to open up and apply tougher metrics on your performance. Still, that’s just what the FDA did with an August 31, 2010, release touting its new “organizational performance management system” called FDA-TRACK. It promised to monitor FDA accountability and transparency and will monitor more than 100 FDA program offices through data from key performance measures established each year. Just don’t tell anyone.
  • CDRH Likes Itself: For the year, CDRH gave what kids in school would consider a B+ with an 86% completion rate in a new report, the Center for Devices and Radiological health says it accomplished 86 percent, or 92 of 107 actions it pledged to complete in Fiscal Year 2010.
  • 510(k) Regulation is Either Onerous or Marvelous: An AdvaMed funded report from Stanford sparked controversy –and a testy FDA response – when it concluded that device companies pay a heavy price in terms of time and money when it comes to FDA compliance. That’s the well-researched and well-argued thrust of the big study from Stanford that also said American firms and consumers were at a disadvantage compared to those in Europe. The debate on the cost and hurdles for medical device regulatory compliance will certainly continue into 2011.
  • Hamburg Talks Tough. A new FDA report suggests the agency is trying to get some of its regulatory swagger back after budget cuts and brain drains hampered much of its work in the George W. Bush years. In October, FDA Commish Margaret A. Hamburg M.D., said the agency proposes to build on what it calls the success of the Critical Path Initiative and other projects by leading an effort to advance regulatory science through its new Regulatory Science Initiative.

All in all, it looks like the FDA is still struggling to find its identity as we enter 2011. Will it become a more aggressive, strident regulatory agency? Will it slip back into relative lethargy? Worst scenario: Will it become more aggressive with less experienced inspectors and other professionals at the helm?

Watch this space in 2011.

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AdvaMed Tries Public Diplomacy to Handle Swinging FDA

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

One of the most entertaining aspects of those great Rocky boxing movies is the impossible number of punches fighters land in each round. In Rocky Balboa , for example, the challenger throws more than sixty punches in the first round…that comes out to a punch about every three seconds.

As we’ve been showing in some recent blogs, it appears AdvaMed and the FDA are looking to start their own fighting franchise.

When FDA’s Jeffrey Shuren, director of the Center For Devices and Radiologic Health, recently labelled AdvaMed’s 510(k) study “highly flawed,” here he landed a pretty good hook to the jaw. But AdvaMed got up off the canvas today (Dec. 2), though it went more for a diplomatic Tai Chi approach by trying to take the FDAs energy and moving it in another, less industry-threatening direction.

“AdvaMed is pleased that Dr. Shuren’s remarks are a strong statement recognizing the need to improve CDRH’s effectiveness in supporting innovation and with his commitment to an interactive premarket review process that is predictable, consistent, transparent and timely,” commented AdvaMed President and CEO Stephen J. Ubl.

Ubl said Shuren’s comments “reflect support for common sense 510(k) reform recommendations that will address some of the most critical problems at the Center – recommendations for enhanced guidance and standard operating procedures, greater transparency and clarification of review requirements, and increased training for Center staff and industry.”

AdvaMed’s Ubl strained himself to put a good face on FDA’s tough public reaction to its Stanford Survey. “As the reform process moves forward, we look forward to continuing to work cooperatively with Dr. Shuren and his staff. There are a number of areas where broad support for needed changes exists. These points of agreement should serve as a foundation for future reform efforts. Such an approach would improve the 510(k) process and would avoid proposals that could have a negative impact on innovation and patients.” So, who would win in a computer fight? Rocky or Bruce Lee? Guess we’re going to find out.

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The Empire Strikes Back: FDA Blasts New 510(k) Study

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

It may not be quite as epic as the intergalactic battles in the Star Wars saga, but it’s still heating up to be a pretty juicy fight.

This week, the FDA took the relatively unusual step of publicly and directly challenging an interesting and controversial study conducted by Stanford University but funded by The Advanced Medical Technology Association (AdvaMed) that says FDA regulatory policies are stifling medical device innovation and costing those companies much more than counterparts in Europe.

Pointing to what he called “several significant flaws,” FDA spokesman Dick Thompson said the study “compared apples to oranges because companies come to the FDA earlier in the device development cycle than they do in the EU,” as reported by Devices & Diagnostics Letter.

FDA also criticized what it characterized as a low response rate for the study. Some 20 percent of the more than 1,000 companies contacted actually responded. Thompson suggested the relatively low response rate could have produced biased results.

Not surprisingly, medical device folks we’ve spoken with by and large heartily endorse the AdvaMed/Stanford report’s findings. Consultants and former FDA inspectors also tell us it’s generally on target, though they are less vehement than medical device personnel.

The study was released Nov. 18. AdvaMed President Stephen Ubl that day commented, “this report is a wake up call for those who want to promote medical innovation and preserve American jobs.” He also said the study “shows that timely patient access to new technologies and industry competitiveness are being held back because of inefficiencies that must be addressed. We urge FDA to review the findings of this study and we are committed to working with them to address these issues.”

Well apparently FDA did review them, and came to quite a different conclusion.

HOW BADLY IS THE 510K PROCESS BROKEN?

In September, AdvaMed released a study it said demonstrated the “ strong safety record of FDA’s premarket review process for low- and moderate-risk devices. That study, conducted by the research firm Battelle Memorial Institute, found that of the nearly 47,000 medical devices cleared by FDA through the 510(k) process since 1998, only 0.16 percent were involved in a serious recall event.

“This study highlights the remarkable safety record of FDA’s 510(k) process,” said AdvaMed Chairman James V. Mazzo, president of Abbott Medical Optics.

AdvaMed is on record saying it backs recommendations regarding increased reviewer training, development of additional guidance, and greater communication of reviewer decision rationale could address these deficiencies that result in delays and inconsistencies in the program.

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Earth to FDA: Medical Device Compliance is Really Expensive

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Sometimes it takes an independent study to confirm what everyone kind of already knew or suspected: Device companies pay a heavy price in terms of time and money when it comes to FDA compliance. That’s the well-researched and well-argued thrust of a big new study from Stanford.

The survey of more than 200 medical device companies found some sobering results. For starters, FDA turnover presented many of them with a hassle: 44% said they had to deal with the departures of sometimes key FDA folks handling their premarket approval. And more than a third, or 34%, said that appropriate FDA staff was not present at key meetings.

Makers of high risk devices seeking premarket approval said it took them an average 54 months from first communication with the agency to getting approval. In Europe, that average is 11 months.

Now let’s talk money.

The average cost to bring low-to-moderate risk 510(k) products to market was $31 million, reported medical device companies. The FDA accounted for a whopping $24 million of that via direct and indirect compliance activities.

Higher-risk devices reported a sticker price of $94 million, with $75 million of that linked to the FDA.

“For U.S. companies, these mounting costs are unsustainable in a venture-backed industry where less than one out of four medtech start-ups succeed, 50 percent of all reported exits, [such as an acquisition or initial public offering] are less than $100 million, and the total pool of available investment capital is shrinking.”

In the 1950s and early 1960s politicians made a lot of a so-called “Missile Gap” between the United States and the U.S.S.R. Today, this report points to a “Device Lag” between the U.S. and Europe. “In some cases, the device lag [between US and European approval] reached up to 70 months.”

In the coming weeks, we’ll get some more experts to weigh in on this issue. Stay tuned.

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CHI White Paper Delicately Slams FDA 510(k) Review Proposal

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Yes, “delicately slams” is something of a contradiction in terms, but that’s really the best way to describe a new white paper from the California Health Institute (CHI) that takes pains to diplomatically say the FDA is about to really screw up device innovation in the United States.

A great chart on Page 7 of the white paper asserts, “less than one percent of devices that were cleared by the 510(k) process had been recalled.” It cites data that found “a total of 89 recalls in a five-year period out of an average of 19,873 submissions.”

In other words, the system needs a tweezer, not a sledgehammer.

“As the FDA, IOM and Congress consider reforms to 510(k), including some viewed as controversial—restricting use of multiple and split predicates, consolidating concepts of “indication for use” and “intended use,” creation of a subset of Class II devices, rescission authority, etc.—careful and deliberative consideration must be given to ensure that the process does not become more cumbersome, complex and costly, to the detriment of medical technology investment, innovation, and, ultimately, patient care,” CHI sums up in the white paper, “Upcoming Changes to the 510(K) Process: New Approval Pathways and the Impact on Medical Device Development and Innovation.”

510(k) approval is huge for medical device firms. A glance at some company press releases just this week from Affymetrix, Beckman Coulter, Boston Scientific, and AutoGenomics demonstrates how high the business stakes are for these and other companies. For some, it means the difference between a great or poor quarter (and a CEOs relative job security) and for others it can determine whether the company remains in business or goes under.

The FDA has a pretty good searchable database that as of today contains listings of 510k approvals through September.

CHI and others are hoping that list won’t start getting shorter. We’ll keep you posted on this ongoing battle.

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Critics Slam FDA 510(k) Review Changes as Politically-Driven

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Grandstanding or Good Government? Besides the nice alliterative ring to it, that about sums up the heated debated surrounding the FDA’s recent proposed modifications to its 510(k) medical device review process. The proposed changes would “greatly (affect) innovations and public health in California,” argued the California Healthcare Institute. No one asked CHI, but I assume they believe the changes would impact the same innovation from sea to shining sea (not forgetting Alaska and Hawaii).

Taking the broader geographical view, the Advanced Medical Technology Association (AdvaMed) hedged its bet a bit by urging the agency to keep on keeping on with its proposed changes to the premarket review program for low- and moderate-risk medical devices by building on what’s already there. AdvaMed then went on to say it was worried by the breadth of FDA’s proposals for change. They also said the FDA moves could stifle innovation.

AdvaMed advised the FDA to focus on areas where there is general consensus, such as increased reviewer training, development of more specific guidance documents to give industry a clearer picture of expectations, and improvements to the review pathway system.

The 510(k) process is the clearance mechanism by which the vast majority of such medical technologies are brought to market, CHI notes. In the last year alone, 3,000 new devices were cleared under the 510(k) process. It is a long-standing, proven mechanism that allows medical device developers to bring new products to market based on data on existing devices, known as predicates, that have already been proven safe and effective, CHI adds.

In comments submitted to FDA in response to the agency’s release in August of more than 60 proposals to change the 510(k) process, AdvaMed said that instead of implementing an extensive list of potentially disruptive proposals, FDA should focus on the proposals the agency has advanced that enjoy broad agreement, such as: increased reviewer training, development of specific guidance documents, and improvements to the de novo review pathway.

CHI:  “We agree that regulatory improvements can and should be made to increase efficiency, predictability and consistency of the 510(k) clearance process. However, we are particularly concerned that a number of the proposals on the table may result in a slowdown in innovation, which would lead to job loss and fewer innovations for the patients who need them.” In addition to filing its comments, CHI joined with LifeScience Alley, the Medical Imaging and Technology Alliance (MITA) and the Medical Device Manufacturers Association (MDMA) to submit a complementary set of points. This joint effort recognizes the importance of the 510(k) system to the future of medical technology innovation across the country.

By working together, MITA says it believes a reformed clearance process can be adopted that promotes innovation, enhances regulatory predictability, improves patient safety and protects public health.

MITA believes it is important for the FDA to provide additional detail about the provisions in order to adequately assess their impact and urges prioritization of the broad scope of proposed changes. Additionally, MITA encourages the FDA to allow stakeholders sufficient time to thoroughly evaluate and respond to each specific proposal through public comment opportunities and in-person meetings.

It’s worth noting that groups like AdvaMed and MITA have to be cautious in their criticism of FDA. It’s a little like doing a big public harangue against the IRS, and then wondering why you got audited. But knee-device maker ReGen was apparently angry enough over the FDA’s decision to rescind its 510(k) approval to go public. Very public. In their own statements and in extensive media coverage in the Wall Street Journal and elsewhere, they made it clear they think recent FDA actions are driven by politics, not good policy.

As reported in the Journal, a “political agenda” is driving the agency’s moves against ReGen’s knee device, called Menaflex, according to CEO Gerald Bisbee. “The agency’s clearance of Menaflex has become a political football and the FDA is not playing by the rules,” he said.

Not surprisingly, FDA disagrees, saying its actions were good policy that “send the right message” to the device industry.

CHI’s more sedate comments, submitted to the FDA’s Center for Devices and Radiological Health (CDRH), came in advance of CDRH Director Dr. Jeffrey Shuren’s scheduled town hall meeting in Irvine, Calif. on Oct. 7, a critical chance for industry and patients to express their ideas for regulatory reform that will promote investment, innovation and job creation in the state of California. Shuren’s visit to Irvine marks the last of three CDRH Town Hall Meetings held this fiscal year.

Other locations included Bloomington, Minn. and Boston.

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FDA Makes Moves to Fix Flawed 510k Review Process

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Weighing patient safety against encouraging medical innovation is no easy task. The FDA has been struggling with it off and on, mostly on, since its creation in 1906 (yes, I had to look it up). It took very gross meat and a crusading Upton Sinclair to force the FDA’s very existence. Hopefully we won’t need anything so dire to effect some positive change this time around.

Over the past decade most critics have said the agency has been too understaffed to effectively regulate the F(ood)and D(rugs) of its name. When it comes to assessing its medical device activity, it’s a bit tougher to analyze. But that just might get a little bit easier. Last week the FDA unveiled two big evaluations containing recommendations that address three key objectives of the agency’s public health mission as it relates to medical devices – foster device innovation, create a more predictable regulatory environment, and enhance device safety.

The Center for Devices and Radiological Health (CDRH) assessment consists of two preliminary reports. The first focuses on ways to strengthen and clarify a premarket review process called the 510(k) program for medical devices that do not need to undergo a full premarket approval review. The second evaluates CDRH’s use of science in decision-making, with an eye toward adapting to new scientific information, while maintaining regulatory predictability necessary for innovation.

The two documents overlap in several places and cross-reference information. Both are available here.

“Having FDA 510(k) clearance is a big milestone, one which further validates” a company’s products, notes WellDoc CEO Ryan Sysko. He’s just been through the 510(k) approval process with a happy outcome (approval in July).

“We found the FDA to be very open and willing to talk, willing to offer guidance,” Sysko says. His advice to other young companies is “first thing, call the FDA, talk about your product and what it is trying to accomplish, and get a sense of the regulatory climate.”

Make sure the FDA understands your technology or product so they can better understand how doctors and patients use it, stresses Sysko. Also it important to put quality system programs in place early on and have strong employee training programs, Sysko adds. “It is absolutely critical to show the FDA your good work, too” he emphasizes. FDA on audits wants to see SOPs, document control, training records, among other items, and you’d better be ready to demonstrate it.

Back to what the FDA did last week.

CDRH established two staff committees on these issues in late 2009 as part of its 2010 strategic plan. The committees collected and reviewed input from public meetings, open dockets, data analyses, and input from CDRH staff over the course of several months to prepare the complementary evaluations.

We’ve heard from some medical device firms that scream bloody murder (off the record, of course) about how cumbersome and counter-intuitive the FDA’s 510k system has been. Even the agency admits that “concerns have been raised both inside and outside of the FDA about whether the current 510(k) program achieves its goals of making safe and effective devices available to the public while fostering innovation. Concerns about the program have centered on whether it allows devices to enter the market without sufficient safety and effectiveness evidence and whether a lack of predictability, consistency, and transparency is hindering device development.”

In other words, the FDA seems to understand that the system is broken. Is this a fix? Most say it is a good start, if nothing else. “The challenge the FDA will face is how do we take what’s being accomplished with technology while ensuring patient safety,” Sysko says, noting it’s obviously easier for Apple or Google to launch a new innovation than it is for medical device companies.

FDA makes some effort to defend itself, specifically CDRH, in its announcement. “CDRH uses science to guide its regulation of medical devices across the total product lifecycle,” notes the agency release. “At any stage of that lifecycle, new, unfamiliar or unexpected scientific information may arise that warrants a change in the FDA’s thinking, expectations, and actions.” CDRH says it is trying to find the right balance between the ability to adapt its approach as new science emerges and to provide predictable regulatory pathways.

“Taken together, these preliminary reports show a smarter FDA – an agency that recognizes both sides of our mission to protect and promote public health,” said CDRH Director Jeffrey Shuren, M.D. “The agency is ready to make necessary improvements to support device innovation while assuring patients receive safe and effective devices.

“Even with our significant outreach, it’s important to remember that these recommendations are preliminary,” said Shuren. “CDRH opened another public docket to receive additional comments on both reports. We will make a decision on which recommendations to adopt only after a thorough review of additional comments.”

While the agency has a prime directive to protect patient safety, it doesn’t want to slow or even destroy a medical device that’s ready to roll and ready to help patients. But the agency has often been accused of slowing innovation to the detriment of patient safety. It’s a balancing act, to be sure, and we should at the minimum give the FDA for addressing this and trying to come up with a good solution.

Selected recommendations and the key public health objectives they address include:

Fostering Device Innovation

  • The 510(k) report recommends major improvements to the regulatory pathway for lower-risk novel devices that cannot be cleared through 510(k) but which do not warrant the more rigorous premarket approval review applied to higher-risk devices. The report calls for major reforms in the implementation of this process – called the de novo classification process. The recommendations include streamlining the process and clarification of CDRH’s expectations for submissions that undergo this type of review.
  • The science report recommends that CDRH make better use of scientific experts outside of the agency by developing a web-based network of external experts using social media technology. This network would help CDRH staff leverage outside knowledge without serving in an advisory capacity.

Enhancing Regulatory Predictability

  • The 510(k) report recommends that CDRH develop a guidance document defining a subset of moderate-risk (Class II) devices, called Class IIb, for which clinical or manufacturing data typically would be necessary to support a substantial equivalence determination. This guidance document would help clarify what information submitters should include in their 510(k) submissions so that they can plan accordingly. In addition, this would also help the center’s review staff obtain the type and level of evidence necessary to make well-supported decisions without as much need for time-consuming follow-up requests for information.
  • The science report recommends use of a standardized “Notice to Industry” letter that would generally be issued as a “Level 1 – Immediately in Effect” guidance document to quickly communicate when CDRH has changed its premarket regulatory expectations due to scientific information that has emerged about a certain device type. CDRH currently communicates this kind of information through individual interactions during the review process, which can lead to delays. These letters would provide greater clarity to affected manufacturers, in a timelier manner, about CDRH’s expectations with respect to a particular group of devices.

Improving Patient Safety

  • The 510(k) report recommends that CDRH consider revising regulations to explicitly require 510(k) submitters to provide a summary of all scientific information known or that the submitter should reasonably know regarding the safety and effectiveness of the device under review. This is not required now for 510(k) submissions and, as a result, relevant information may not be included in an initial submission. This summary would help CDRH review staff to more efficiently make decisions, and potentially avoid extensive follow-up inquiries and questions.
  • The 510(k) report recommends that CDRH develop a guidance document that clarifies when a device should not be used as a predicate, such as when the device has been removed from the market because of safety concerns. The report also recommends that the center consider issuing a regulation that would clarify the circumstances under which the center would exercise its authority to rescind a 510(k) clearance to remove an unsafe device from the market and preclude its use as a predicate and also consider whether additional authority is needed.
  • Both reports recommend that CDRH build upon public databases to include meaningful, up-to-date information that supports good decision making and promotes the safe use of devices. This could be accomplished by improving the current 510(k) database so that it includes summaries of FDA review decisions, current labeling and photos. In addition, the science report recommends that CDRH build upon the existing transparency website to provide more immediate information on how devices are regulated.

For more information:
CDRH Preliminary Internal Evaluations

CDRH Device Approvals and Clearances: 510(k) Clearances

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FDA to Medical Device Companies: Forget Global Warming, it’s About to Get Really Cold

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Geologists, archeologists and the like usually examine things in terms of hundreds of thousands of years: Think the Paleolithic Era which they measure from the introduction of stone tools by pre-humans or hominids such as Homo Habilis about 2.6 million years ago, to the introduction of agriculture around 12,000 years ago. That’s nearly the whole time folks like us have been walking around the planet on two legs.

But for us FDA watchers, those trends tend to be a bit shorter in duration. For example, just as Earth goes in and out of ice ages into relative warm periods and back to colder climates, it looks like we’re coming out of a 20-30 year period of relatively light FDA regulation into something new and, for medical device companies, a little scary.

Device makers, pharmaceutical companies and even food manufacturers “got used to a certain regulatory treatment from the FDA in the past twenty to thirty years,” notes industry expert and Creo Quality LLC Principal Jon Speer.  Translation: The FDA generally went a little easier on the industries it regulates.

But that sound you hear might be the ice freezing up again.  As spelled out recently in an excellent Minneapolis Star Tribune commentary by Arne Carlson about possible FDA alterations to the way it regulates medical devices, “changes should accelerate innovation, not hamstring it. Medical device companies, physicians and venture capitalists are investing time and money on new devices, agreeing to clinical study rules the agency outlines at the start. But in too many recent cases, the FDA has delayed its feedback to the companies, then determined in the end that the company needs to meet new milestones before the agency will consider clearing the device. That isn’t right.”

And earlier this week at an FDA “Town Hall” meeting that’s part of a three-city listening tour many speakers lamented a lack of predictability in the FDA approval process, which they say chokes funding for start-up companies. Device makers detailed what they criticize as bloated timelines and an unprepared, unresponsive agency staff that is often hostile to industry input.

Is it time for medical device companies to panic? Yes and no.

“At present I do not believe there are any new rules affecting device innovation; there is however a fear of new rules to come,” says Sheppard Mullin Partner at Peter Reichertz. “In addition, there is a new attitude at FDA resulting from fear of Congressional oversight as well as newer less experienced employees who tend to be stricter and more conservative in their review of premarket notifications,” he adds.

But Reichertz sees this going further, “FDA seems bent on making changes to the 510(k) process that would make it more difficult to either develop improvements in currently marketed devices by their current manufacturers, as well as to allow for the development of products that improve on existing products due to fear of what they refer to as ‘device creep’. While changes in these rules are not yet known, all of the industry assumes that it will make it more difficult to innovate, and companies may already be deciding not to proceed with innovation because they are not sure what the new scheme will require.”

“I can see both sides of the equation,” notes Speer. He points out that the FDA is charged with protecting consumers while medical device companies are under investor pressure to get their products to market. Get more of his insight by following his Twitter postings.

But potential FDA moves are making it “extremely challenging for start-ups,” Speer notes. He works regularly with medical device companies to help negotiate the increasingly treacherous FDA regulatory minefield.  He cites anecdotal examples of companies that recently waited 267 days for FDA clearance, and another that even had a predicate product already in the market, yet still waited almost 100 days for agency approval.

“In the last 18 months medical device companies have come under tremendous additional regulatory scrutiny,” suggests Jerry Chase, CEO with Lantronix (NASDAQ:LTRX), a provider of equipment that network-enables medical devices (both embedded and external to the human body). He’s worked with a lot of medical device companies that produce infusion pumps and glucose meters, and seen them cowering over potential FDA rules they fear will stifle their innovations.

Stressing that he shares the FDA’s goals to protect patients, Chase called on the FDA to listen carefully to the concerns of the medical device industry. “The FDA needs to understand that what it seems to be proposing now is too broad” and is more likely to ill-serve consumers by slowing valuable medical devices rather than protect the public. He remains optimistic, though. “Obstacles can be opportunity,” Jerry says.  For more, check out Jerry’s blog.

Meantime, if you are a medical device company, it might be time to hone your arguments for a healthy debate with the FDA. And don’t forget to bring a really warm coat.

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Jury Still Out on FDA Move to Alter Expert Panel Protocol

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Folks we’ve heard from are not entirely sure what to make of the FDA’s recent announcement that it will change the way its expert panels review and discuss data and information during public hearings on medical devices under review for premarket approval. The changes are effective May 1, 2010.

As a standalone move, most medical device firms we heard from (off-the-record) aren’t that impressed — yet. But if this signals more changes afoot, then we might actually speed up and improve the medical device approval process.

FDA says the changes were prompted by an increasing number of medical device advisory panel meetings in recent years. In 2008, there were 10 panel meetings covering 14 major topics. In 2009, there were 17 meetings on 20 topics, and 2010 is on track to surpass those numbers, according to the FDA’s Center for Devices and Radiological Health (CDRH).

The increased activity has created challenges for CDRH and the way it operates panel meetings, the agency said in a press release. In accord with current agency policy and guidance for advisory committees, the changes address staffing issues, voting procedures and other items related to information presentation and flow of discussion.

“I don’t see how the changes below can speed up the process,” says medical device consultant Kenneth L. Ripley.

“These changes are expected to empower the agency to make more effective decisions that are informed by more clear and focused discussion by panel experts,” said CDRH Director Jeffrey Shuren, M.D.

At first glance, consultant Brad Ryba doesn’t believe these changes will have much impact on the overall device approval process. “If anything it may give the individual panel members more of a voice.” His verdict: “Time will tell if this is the first in a series of changes that may have a greater impact.”

In the past, panel discussions have not always reflected a panel’s final vote on approvability, the FDA says. Now, instead of voting on the approvability of premarket approval applications, including conditions of approval, the panel will vote on the safety and effectiveness of a device and the device’s risk versus its benefit.

Kenneth applauds this move, “The clinical experts can concentrate their collective opinions on clinical utility and FDA can make the final decision on approval.”

“By making this change in voting procedure, panel members will address key scientific issues during their discussions, which will be reflected in their votes,” Shuren said. “The change also will allow panel members to address issues related to their area of expertise instead of regulatory issues that may be unfamiliar to them.”

Kenneth also raises another important issue, “One area for the manufacturer that has been a severe problem in the past is, not predicate creep but, protocol creep. You make a deal with the FDA/clinical advisors on a protocol at point A and, some years later, come back to panel with the results. Now, the panel does not like your protocol. It would be really nice to get a solution to this.”

In addition, panels will vote by ballot instead of by a show of  hands. While the votes will be publicly tallied so that panel members can be identified by their vote, the ballot process allows each panel member to cast his or her vote without immediate influence by other votes.

There are many issues involved in the FDA’s review of a medical device. Historically, the FDA’s presentations to panels included comments on approvability. With the changes, the FDA’s presentations will continue to include reviews of the agency’s data analysis, but will no longer include comments on approvability.

Before the changes, the agency medical device reviewers presented a unified, consensus analysis of supporting data. Now, reviewers will present together with data and analysis, the range of scientific opinion in the group. This move will allow more in-depth discussion on safety and effectiveness and risk versus benefit of the device under consideration.

The FDA and CDRH will continue to evaluate panel procedures and make changes when necessary. A detailed description of changes to panel operations can be found at here.

Kenneth has a caution here, though, “One very important issue left untreated here is that of panel member ties to industry and impartiality.”

Maybe they’ll address that next time around?

For more information:

FDA Advisory Committees: Medical Devices

Medical Devices Advisory Committee

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