Food and Drug Administration
FOOD AND DRUG ADMINISTRATION
One of the oldest U.S. consumer protection agencies, the Food and Drug Administration (FDA) protects the public from unsafe foods, drugs, medical devices, cosmetics, and other potential hazards. As part of the department of health and human services, the FDA annually regulates over $1 trillion worth of products, which account for one-fourth of all consumer spending in the United States. It also protects the rights and safety of patients in clinical trials of new medical products, monitors the promotional activities of drug and device manufacturers, regulates the labeling of all packaged foods, and monitors the safety of the nation's blood supply.
To ensure compliance with its regulations, the FDA employs over 1,000 investigators and inspectors who visit over 15,000 food-processing, drug-manufacturing, and other facilities each year. If it finds violations of law, the FDA first encourages an offending company to voluntarily correct the problem or to recall a faulty product from the market. If the firm does not voluntarily comply with the law, the FDA may take it to court and seek criminal penalties against it. The FDA may also seize faulty products, order product recalls, seek injunctive relief, impose fines, and take other types of enforcement action. Each year, the FDA declares about 3,000 products and 30,000 import shipments to be unacceptable in various ways.
The FDA employs over 2,000 scientists—including 900 chemists and 300 microbiologists—who provide the scientific evidence to back up its regulatory and inspection duties. These scientists analyze samples of products for purity and review test results of new products. The FDA itself does not do research for a new medical product. Instead, it evaluates the results of studies undertaken by the manufacturer.
History
Food production in the United States has been regulated since the late eighteenth century. Colonies and, later, states passed laws banning impurities from selected foods. In 1848, the United States began regulating imported drugs, under the Drug Importation Act (Ch. LXX, 9 Stat. 237). The enforcement of food and drug laws was first assigned to the Chemical Division of the new u.s. department of agriculture (USDA) in 1862 (12 Stat. 387).
The need for laws to regulate food and drug purity became increasingly urgent in the late nineteenth century, when substances such as opium, cocaine, and heroin were commonly added to medicinal elixirs and tonics. The need for government regulation was also made evident in Upton Sinclair's book, The Jungle, which exposed the unsanitary conditions of Chicago's meatpacking industry and shocked the nation. On June 30, 1906, Congress, with the support of President theodore roosevelt, passed two landmark pieces of Progressive Era legislation that strengthened the government's ability to protect consumers: the Food and Drug Act (34 Stat. 768 [21 U.S.C.A. § 1–15]) and the Meat Inspection Act (21 U.S.C.A. § 601 et seq.). The former prohibited interstate commerce in misbranded and adulterated foods, drinks, and drugs, and the latter addressed the unsanitary conditions and use of poisonous preservatives and dyes in the meatpacking industry.
In 1927, Congress authorized the creation of the Food, Drug, and Insecticide Administration within the U.S. Department of Agriculture. In 1930, the agency's name was changed to the current one, Food and Drug Administration (Agriculture Appropriation Act, 46 Stat. 976).
In 1937, 107 people died after taking the elixir sulfanilamide, a supposedly healing tonic. This tragedy prompted the passage of the next major reform of food and drug law, the Federal Food, Drug, and Cosmetic Act of 1938 (21U.S.C.A. § 301 et seq.). The FDA was then entrusted with the regulation of cosmetics and therapeutic devices and was authorized to do factory inspections. Even more importantly, the act required new drugs to be tested on animals and humans for safety before being marketed. In 1957, the Food Additives Amendment (Pub. L. 85-250, Aug. 31, 1957, Stat. 567) required the evaluation of food additives to establish safety, and in the following year, the Delaney Clause (Pub. L. 85-929, Sept. 6, 1958, 72 Stat. 1784) forbade the use in food of substances found to cause cancer in laboratory animals.
How the FDA Approves New Drugs
The process by which the Food and Drug Administration (FDA) approves drugs as safe and effective is generally long and complicated, though it may vary according to the type of drug and the nature of the illness for which it is being developed. The FDA refers to drugs under development as investigational new drugs, or INDs.
The evaluation of new drugs requires the skills of many different FDA scientists and professionals performing a wide variety of tasks. Biochemists and molecular biologists evaluate the basic chemistry and biology of new chemical compounds and molecular structures. Toxicologists assess the potential harm of proposed drugs, and pharmacologists study how these drugs affect the body and are broken down and absorbed by it. Computer scientists create electronic models that aid in the understanding of new chemicals. Physicians evaluate the results of clinical trials, assessing both the beneficial and adverse effects of the drugs. And statisticians evaluate the design and results of controlled studies.
It is an expensive and time consuming process, particularly for the company developing the drug, called a drug sponsor. A sponsor spends an average of $359 million for each new drug brought to market. Typically, the process takes eight and a half years and may be divided into roughly three stages: preclinical trials, involving animal and other laboratory tests (lasting one and a half years on average); clinical trials, involving tests on humans (five years); and FDA review (two years).
Preclinical Trials Once a sponsor has developed a drug, it must test the drug on animals in the laboratory. In doing so, the drug sponsor must follow FDA guidelines and regulations. These tests, also called preclinical trials, are usually done on more than one species of animals. FDA guidelines call for the inspection of animal laboratories every two years to ensure that they are being operated according to the administration's regulations.
After short-term lab testing has been performed and the sponsor has deemed its results adequate, the sponsor submits test data and plans for future clinical trials to the FDA. FDA scientists, together with a local institutional review board composed of scientists, ethicists, and nonscientists, then conduct a thirty-day safety review to decide whether to allow testing on humans. The vast majority of new drugs tested in the laboratory are rejected by either the sponsor or the FDA because they are unsafe or ineffective.
If the FDA indicates approval, the drug sponsor may begin clinical testing on humans. Even if a drug is approved for clinical trials, the sponsor continues animal testing of the drug in order to better understand the drug's long-term effects.
Clinical Trials Clinical trials are scientifically controlled studies in which the drug being tested is given to one group of patients, while another treatment, often a placebo (an inactive substance that looks like the drug being tested), is given to another group. Ideally, neither group of patients knows which is receiving the new drug and which is receiving the placebo.
The clinical trials, like the animal tests, examine what happens to the drug in the body, including whether it is changed, or metabolized, in the body, how much of it is absorbed into the blood, and how long it remains in the body. If human tests produce unexpected results, researchers may conduct further animal tests to better understand the drug.
Clinical trials proceed in three phases: Phase 1 involves testing primarily for safety and dosage level. Twenty to one hundred healthy patients are assessed over several months. If the results are within FDA safety guidelines, the trials proceed to phase 2.
Phase 2 involves a greater number of patients—up to several hundred—who have the condition that the drug is intended to treat. During this stage, which lasts from several months to two years, researchers attempt to determine the drug's effectiveness in achieving its stated purpose, as well as its safety. At the end of this phase, sponsors meet with FDA officials to discuss the best way to conduct the next phase of testing.
In phase 3, the most crucial stage of testing, the number of patients is expanded still further, to several hundred to several thousand, and the length of the study is increased to one to four years. This phase establishes the correct dosage of the drug and how it will be labeled, and provides further evidence regarding its safety and effectiveness.
Of one hundred drugs submitted for testing in humans, an average of seventy will pass phase 1. Of these seventy, on average, only thirty-three will remain after phase 2 testing, and twenty-five to thirty after phase 3. Finally, an average of only twenty will actually receive FDA approval.
Once the drug sponsor has completed clinical trials, it submits a new drug application (NDA) to the FDA, requesting approval to market the drug. This application consists of documentation detailing the chemical composition of the drug, the design of the trials, the results of the trials, and the means by which the drug is made and packaged.
FDA Review In assessing an NDA, the FDA undertakes its closest scrutiny of all during the drug approval process. Its principal goal during review is to determine whether the benefits of the new drug outweigh the risks. To reach this determination, the FDA examines the documentation provided by the sponsor and looks at samples of the drug.
If inadequacies are discovered in the NDA, the FDA may require additional information, further testing, or modified labeling. In cases where it is difficult to establish clearly whether the benefits of the drug outweigh the risks, a panel of outside experts is often consulted.
If the FDA approves the drug, the sponsor may begin manufacturing and marketing the drug immediately.
The FDA does not stop monitoring a drug once it has been marketed. It continues to evaluate the drug's safety and effectiveness through its program of postmarket surveillance. This program consists of surveys, the testing of product samples, and the analysis of reported adverse reactions.
Speeding Drugs to Those Who Need Them The FDA has longstanding policies allowing what it calls the compassionate use of new drugs for those in desperate need. Innovative cancer treatments, for example, have been made available to patients since the 1970s through the National Cancer Institute.
However, during the 1980s, the FDA came under increasing fire for its slow approval of new drugs. Particularly with the emergence of AIDS during the 1980s, the public outcry for fast delivery of innovative new drugs strengthened. As science produces ever more pharmaceuticals, the FDA is called on to review drug applications as quickly as is reasonably possible.
In response to the growing demand for speedy drug evaluation, the FDA has made significant changes in its review protocols. In 1987, for example, the agency adopted "expanded access" regulations, which permit certain drugs to be designated as treatment INDs. A treatment IND may be administered to patients even while it is still undergoing clinical trials. This program allows patients with no other alternatives to undergo a treatment that may benefit their health. By August 1994, twenty-nine agents had been designated treatment INDs, and by 1995, more than seventy-five thousand patients had received access to new therapies through this program. New drugs used to treat patients with AIDS are made available through a similar process known as the parallel track approach.
Identifying priorities is another method the FDA uses to provide more rapid access to promising new treatments. AIDS drugs, drugs that treat life-threatening or severely debilitating illnesses, and drugs that appear to offer significant improvements over existing therapies are classified as priority drugs and receive faster review than those classified as standard drugs. With priority drugs, the FDA typically becomes involved earlier in the development process, and is thereby able to more quickly review the relevant applications.
Drugs are also classified as to chemical type, so that those closely similar in structure to existing drugs will receive less intensive review than those with a molecular structure that has never been marketed before.
Accelerated approval is another mechanism for faster review of promising new drugs. Under this program, created in 1991, a product may be approved for limited use if it has been shown in trials to achieve particular results—such as lowering blood pressure or cholesterol. Drugs approved under this program include didanosine for AIDS, interferon beta-1B for multiple sclerosis, and DNase for cystic fibrosis.
The Prescription Drug User Fee Act of 1992 (Pub. L. 102-571, Title 1, Oct. 29, 1992, 106 Stat. 4491 to 4500) has also enabled the FDA to speed drug review. Under this law, fees paid by drug manufacturers are used by the agency to hire hundreds of additional review staff and buy improved equipment, including computers that make review more efficient.
The FDA is also attempting to streamline red tape and bureaucracy. In 1995, President bill clinton and Vice President albert gore, Jr., announced that twenty-one separate product license applications used by the FDA would be consolidated into one simplified form. This form would also be available in an electronic format, making it easier to distribute, prepare, and review.
Results indicate that these changes have led to faster approval of important new drugs. One signal success of FDA reform was the prompt approval of taxol, a treatment for advanced ovarian cancer that was approved in December 1992 after a record 5 months. By 1994, all new drugs were being approved by the FDA in a median time of 19 months, and priority drugs with important therapeutic uses were approved in an average of 10.4 months. In the late 1980s, by comparison, the FDA took an average of 27 months to approve new drugs.
In 1995, President Clinton established even more ambitious new goals for FDA approval. These goals, to be met by 1997, require the FDA to approve priority drugs within 6 months and standard drugs within 12 months.
In 1962, the Kefauver-Harris Drug Amendments (Pub. L. 87-781, Oct. 10, 1962, 76 Stat.780) were passed. These laws required drug manufacturers not only to show that their drugs were safe but also to prove that their drugs achieved the effects claimed. That same year, FDA regulations were shown to be effective after the drug thalidomide, for which the FDA had delayed approval, caused thousands of birth defects in western Europe.
In 1979, the FDA was made part of the Department of Health and Human Services (96 Stat. 668, 695). Other laws with major implications for the FDA's activities include the 1990 Nutrition Labeling and Education Act (Pub. L. 101-535, Nov. 8, 1990, 104 Stat. 2353), which requires all packaged foods to carry labels with nutrition information, and the Prescription Drug User Fee Act of 1992 (Pub. L. 102-571, Title 1, Oct. 29, 1992, 106 Stat. 4491 to 4500), which requires drug and biologics manufacturers to pay fees that support FDA assessment of their products.
Effective October 2002, the FDA implemented its National Organic Program (NOP) under the Organic Foods Production Act of 1990 (OFPA), 7 U.S.C. 6501 et. seq. The NOP sets the first national standards for the use of the label term organic on food items and products. Products that qualify as "100 percent organic" under NOP rules may use the "USDA Organic" seal on their principal display panel. The rules specifically prohibit the use of genetic engineering methods, ionizing radiation (irradiation), and sewage sludge for fertilization. In addition, all agricultural products that are labeled organic must originate from farms or handling operations that have been certified by a state or private agency accredited by the USDA.
Organization
The FDA carries out its activities through a number of subdivisions. The Center for Drug Evaluation and Research regulates the safety, effectiveness, and labeling of all prescription and over-the-counter drugs intended for human use. It also monitors drug advertising for accuracy, ensures the safety and rights of patients in drug studies, and distributes information on drug products to the medical community and the public.
The Center for Biologics Evaluation and Research regulates biological products, which include blood, vaccines, human tissues, and drugs derived from living organisms. It coordinates an AIDS program, which works to develop an AIDS vaccine and AIDS diagnostic tests. It also conducts research on the safety of blood and blood products and inspects manufacturing plants to ensure compliance with FDA standards.
The Center for Food Safety and Applied Nutrition develops regulations related to food, food additives and colorings, and cosmetics. The Center for Devices and Radiological Health seeks to ensure the safe use of potentially hazardous radiation such as that produced by X rays. It conducts research into the effects of exposure to radiation-producing medical devices and develops manufacturing standards for such devices.
The Center for Veterinary Medicine evaluates the safety of drugs and devices used on animals. The National Center for Toxicological Research assesses the biological effects of toxic chemical substances.
AZT: An Agent of Change for the FDA
Azidothymidine (AZT) is a celebrated example of speedy FDA approval of a new drug. The unusually swift approval of AZT during the early years of the AIDS (acquired immune deficiency syndrome) epidemic led to the creation of a new FDA category, treatment investigational new drug (treatment IND), that established new procedures for more rapid and flexible drug approval.
The pharmaceutical company Burroughs Wellcome first presented AZT as a new drug to the FDA in June 1985. Public fear of AIDS had increased dramatically during the previous few years, as had protests by AIDS activists who complained of slow FDA movement with regard to promising new treatments. Keenly aware of the need for swift decision making in the face of the deadly AIDS disease, the FDA approved phase 1 clinical trials of the drug within one week of the initial application.
Phase 1 testing of AZT, between July and December 1985, was promising, and phase 2, involving 300 patients in placebo-controlled trials, began in February 1986. After six months, 19 of the 137 patients in the group taking the placebo had died, whereas only 1 of 145 in the group taking AZT had died. The results were encouraging enough for the FDA to forgo further testing. The group taking the placebo was switched to AZT, and phase 3 testing, traditionally the most important step in clinical trials, was deemed unnecessary.
In September 1986, the FDA authorized the treatment of patients who wanted access to AZT, even before it had given approval to the drug. By the time approval for general public use came in March 1987, some 4,000 patients had already been treated with AZT, and thus the drug was already potentially extending the lives of hundreds of people.
Taking an example from its handling of AZT, the FDA in May 1987 created the treatment IND classification to facilitate faster approval and wider distribution of promising new therapies for life-threatening diseases. The rapid approval of AZT also proved greatly encouraging to the pharmaceutical industry, which could now hope to bring AIDS drugs to market much more rapidly and at lower cost.
cross-references
Acquired Immune Deficiency Syndrome.
Other offices of the FDA include the Office of Policy, the Office of External Affairs, the Office of Management and Systems, the Office of AIDS Coordination, the Office of Orphan Products Development, and the Office of Biotechnology. The administration operates six field offices, 21 district offices, and 135 resident inspection posts throughout the United States and Puerto Rico.
further readings
Branding, Frederick H. 2003. "Preparing for and Surviving FDA Inspections." Corporate Counsel's Quarterly 19 (January): 28–35.
Burkholz, Herbert. 1994. The FDA Follies. New York: Basic Books.
"Center for Drug Evaluation and Research." 1995. U.S. Food and Drug Administration (March 14). Available online at <www.fda.gov> (accessed March 13, 2003).
Clinton, Bill, and Al Gore. 1995. Reinventing Drug and Medical Device Regulations. National Performance Review series (April). Washington, D.C.: U.S. Government Printing Office.
——. 1995. Reinventing the Regulation of Drugs Made from Biotechnology. National Performance Review series (November). Washington, D.C.: U.S. Government Printing Office.
"FDA Mission Statement: Protect Public Health." 1995. U.S. Food and Drug Administration (March 30). Available online at <www.fda.gov> (accessed March 13, 2003).
Harmon, Daniel E. 2002. The Food and Drug Administration. Philadelphia: Chelsea House Publishers.
"Milestones in U.S. Food and Drug Law History." 1995. U.S. Food and Drug Administration (August). Available online at <www.fda.gov> (accessed March 13, 2003).
Parver, Deborah G. 1999. "Expediting the Drug Approval Process: An Analysis of the FDA Modernization Act of 1997." Administrative Law Review 51 (fall): 1249–66.
U.S. Food and Drug Administration. 1995. FDA Consumer: From Test Tube to Patient: New Drug Development in the United States. 2d ed. Washington, D.C.: U.S. Food and Drug Administration.
U.S. Food and Drug Administration Website. Available online at <www.fda.gov>.
U.S. Government Manual Website. Available online at <www.gpoaccess.gov> (accessed November 10, 2003).
Food and Drug Administration
FOOD AND DRUG ADMINISTRATION
FOOD AND DRUG ADMINISTRATION. The Food and Drug Administration (FDA) was the first regulatory agency established in the United States with consumer protection as its principal mission. Arguably, it is the only federal regulatory agency today whose basic charge has not been substantially altered in nearly one hundred years. Although the agency's responsibilities have grown enormously since Congress first defined food and drug adulterations as a danger to health and as consumer fraud in 1906, FDA remains a science-based regulatory agency responsible for protecting the public health through the regulation of foods, drugs, biological therapeutic products (i.e., vaccines), medical devices, cosmetics, animal feed, and radiation-emitting consumer products.
FDA began as a small, analytical chemistry unit in the U.S. Department of Agriculture, created after the Civil War to promote agriculture and assist farmers. A single chemist, whose job it had been to analyze fertilizers and agricultural chemicals for the Patent Office, was transferred to the new department in 1862 to continue his work on behalf of farmers and state agricultural extension services. In 1880, the chief chemist in the Bureau of Chemistry endorsed passage of a federal food and drug law, and his successor in 1883, Harvey W. Wiley, actively campaigned for the law. When it was finally enacted by Congress in 1906, the Pure Food and Drugs Act was often referred to as the Wiley Act.
Wiley led the bureau in an era in which the transforming trilogy of industrialization, immigration, and urbanization changed America from a nation of farmers into a nation dominated by business. The earliest successful commercial foods were either new altogether—like crackers—or tasty but time-consuming to prepare at home. Condiments such as mustard, catsup, relishes, jams, and jellies, and, later, tinned fruits, meats, and vegetables, were all newly available from a burgeoning prepared foods industry. Likewise, medicines for the inevitable indigestion (dyspepsia) and other ills stemming from a poor diet were some of the most successful patent medicines. Consumers, however, had little way of telling good products from bad. State laws were frequently inconsistent and ineffective. Meanwhile, canned foods exploded, patent medicines and standard drugs were often equally unreliable, catsups fermented, and mustards were often watered down. Even products labeled "pure" were often counterfeits; most "pure Vermont maple syrup," for instance, was made from Iowa corn syrup.
The Bureau of Chemistry found its niche in the Department of Agriculture by using its analytical chemical expertise to improve the U.S. marketplace. Wiley and the bureau chemists turned their attention to the food and drug products on the market, testing them for ingredient substitutions, omissions, or additions that would be defined as "adulteration" and "misbranding," under the 1906 act. Wiley's pioneering work on the safety of food preservatives led Congress to increase his bureau's budget and include special funds for human testing of early food additives (salicylic acid, benzoate of soda, boric acid, copper salts, saccharin). As it became clear that some producers would always take shortcuts to reduce costs (so long as the consumer could not detect the difference), support for a national food and drug law began to emerge and grow, supported by national women's groups, muck-raking journalists, state food and drug officials, and analytic chemists. Wiley's prowess as a "crusading chemist" became legendary. At a convention of hostile canners, for example, he single-handedly changed their minds about regulation by reminding them that what they made they should also be willing to eat.
At the height of Progressive-era politics, during the heyday of analytical chemistry, and in the midst of the bacteriological revolution, Congress transformed the Bureau of Chemistry into a regulatory agency, fully expecting that science would be the arbiter of both health and commercial issues. Signed on 30 June 1906 by Theodore Roosevelt, along with the Meat Inspection Act, which put inspectors into all of the nation's slaughterhouses, the 1906 Pure Food and Drugs Act is still considered by historians to be one of the most significant pieces of Progressive-era legislation. In 1927, the regulatory component of the Bureau of Chemistry became the Food, Drug, and Insecticide Administration, renamed the Food and Drug Administration in 1930.
Within the decade following passage of the 1906 Pure Food and Drugs Act, the consumer marketplace was transformed. Wiley felt strongly about certain issues, and highly contentious and even more highly publicized legal cases were fought over them. But it was the routine enforcement of the simplest adulteration and misbranding portions of the law that transformed the commercial landscape of the country. New federal food and drug inspectors worked with businesses, factories, and trade organizations to update equipment, institute basic sanitary procedures, and apply insights gained from the burgeoning science of bacteriology to safeguarding the nation's food and drug supply. Added to initial concerns about food additives, and in the wake of Pasteur's discovery of the microorganisms responsible for food fermentation as well as some diseases, came increasing concerns about microorganisms in food as a cause of disease. Under Wiley's leadership, the Bureau of Chemistry continued to identify products and pathogens that moved food safety from abstract speculation to concrete action. Wiley began to hire expert microbiologists who, in turn, helped transform the canning and egg industries and shape the new refrigeration industry, helping to insure safer food for all Americans. By the time Wiley left office, in 1912, many known commonplace dangers had been eliminated from interstate commerce, though threats such as botulism, mycotoxins, and e-coli were soon to be discovered. Improvements in the drug trade as well paved the way for extraordinary future advances in therapeutics.
By the 1930s, the 1906 act had become seriously outdated. A new multimillion dollar cosmetic industry, new food products and pesticides, new drugs and new classes of drugs including barbiturates and sulfa drugs, and changes in the field of advertising all made deficiencies in the Wiley Act increasingly apparent. With the active support of consumer advocates such as Consumer's Research and Consumer's Union, so-called "guinea-pig" muckraking journalists, women's organizations, and Eleanor Roosevelt herself, the old law was replaced during the New Deal with the 1938 Food, Drug, and Cosmetic Act. Propelling the new legislation through Congress and onto President Franklin Roosevelt's desk was a 1937 drug disaster. "Elixir sulfanilamide," which contained a poisonous solvent, diethylene glycol, killed over 100 people before the entire field force of the FDA could be dispatched to retrieve every ounce of the product. This episode generated support for an important new provision in the 1938 act requiring companies to perform pre-market safety testing of all new drugs and gain FDA approval before marketing them.
In 1940, the Food and Drug Administration left the Department of Agriculture to become part of a new Federal Security Agency; and in 1953, it was transferred to the Department of Health, Education and Welfare (DHEW). In 1968, FDA became a component of the Public Health Service (PHS). In 1980, education was removed from the DHEW's responsibilities, and it was renamed the Department of Health and Human Services (DHHS). During the 1960s, 1970s, and 1980s, the Drug Enforcement Administration, the Consumer Product Safety Commission, and parts of the Environmental Protection Agency and Federal Trade Commission were all created to extend consumer protection procedures pioneered by the Food and Drug Administration to stop illegal drug sales, recall dangerous consumer durable goods, set tolerances for agricultural chemicals, and control drug advertising.
Significant pieces of legislation broadening and extending FDA's premarket activities were enacted between 1958 and 1976. In the Food Additives Amendment of 1958 and the Color Additives Amendment of 1960, a pre-market approval system was established for food and color additives, requiring that such substances be shown to be safe, suitable, and non-carcinogenic. In 1961, a worldwide scandal erupted over the teratogenic drug thalidomide, responsible for thousands of birth defects in Europe and a few in the United States, where the drug was never approved for sale. In 1962, Congress significantly strengthened FDA's authority over drugs, charging it with assessing both the safety and efficacy of new drugs prior to approval. In 1976, medical devices were subjected to pre-market regulatory assessment, and a system devised to assess such devices in accordance with their perceived risks—three separate risk categories representing high, moderate, and low risks were established. In 1971, the PHS Bureau of Radiological Health was transferred to FDA, bringing with it responsibility for ensuring the safety of radiation-emitting consumer products such as televisions and microwave ovens. In 1972, regulation of biologic products, including serums, vaccines, and blood products, was transferred from the National Institutes of Health (NIH) to FDA.
FDA currently regulates approximately $1 trillion worth of products each year (including both domestic and imported goods), representing about 25 cents of every dollar spent by consumers each year. The agency's fiscal year 2002 budget is $1.553 billion, including $184 million in industry-assessed user fees. The FDA employs about 10,000 personnel in the Washington area and in 167 field offices throughout the United States and Puerto Rico. Included in the fiscal year 2002 budget is an increase of $151.1 million and 832 full-time employees for activities related to bioterrorism and emergency preparedness following the tragic events on 11 September 2001.
BIBLIOGRAPHY
Goodwin, Lorine Swainston. The Pure Food, Drink, and Drug Crusaders, 1879–1914. Jefferson N.C.: McFarland, 1999.
Junod, Suzanne White. "Food Standards in the United States: The Case of the Peanut Butter and Jelly Sandwich." In Food, Science, Policy and Regulation in the Twentieth Century. Edited by David F. Smith and Jim Phillips. London: Rout-ledge, 2000.
Maeder, Thomas. Adverse Reactions. New York: Morrow, 1994.
Marcus, Alan I. Cancer from Beef: DES, Federal Food Regulation, and Consumer Confidence. Baltimore: Johns Hopkins University Press, 1994.
Marks, Harry M. The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900–1990. Cambridge: Cambridge University Press, 1997.
Okun, Mitchell. Fair Play in the Marketplace: The First Battle for Pure Food and Drugs. Dekalb, Ill.: Northern Illinois University Press, 1986.
Swann, John P. "Sure Cure: Public Policy on Drug Efficacy before 1962." In The Inside Story of Medicines: A Symposium, Madison, Wis.: American Institute of the History of Pharmacy, 1997.
White, Suzanne. "The Chemogastric Revolution and the Regulation of Food Chemicals." In Chemical Sciences in the Modern World. Edited by Seymour H. Mauskopf. Philadelphia: University of Pennsylvania Press, 1993.
Young, James Harvey. Pure Food: Securing the Federal Food and Drugs Act of 1906. Princeton, N.J.: Princeton University Press, 1989.
Suzanne WhiteJunod
See alsoJungle, The ; Pure Food and Drug Movement .
Food and Drug Administration
Food and Drug Administration
What It Means
The Food and Drug Administration (FDA) is an agency within the U.S. Department of Health and Human Services that is responsible for protecting public health. By enforcing various laws and regulations, the agency guarantees the safety and effectiveness of foods, human and veterinary drugs, biological products (such as vaccines, blood products, and gene therapy), cosmetics, and products that emit radiation (including X-ray equipment, cellular phones, and microwave ovens). The agency may regulate products and substances by banning them completely, limiting their distribution, or placing restrictions on the way they can be marketed (or advertised). The FDA also strives to promote public health by funding scientific research and providing Americans with the accurate, science-based information they need to make important medical and dietary decisions.
In 2006 it was estimated that the agency oversaw the production and distribution of $1 trillion worth of goods per year, an operation that cost approximately $3 per taxpayer.
When Did It Begin
The FDA was created in 1906, when President Theodore Roosevelt (1858–1919) signed into law the Pure Food and Drug Act. Fraudulent (fake or ineffective) drugs and impure foods had long been a problem in the American marketplace, but in the late nineteenth century there was a marked rise in the prevalence of such misrepresented and adulterated (or tainted) goods. For example, many mothers unknowingly gave their sick children morphine, and grocers often simply deodorized rotten eggs. Such goods posed a threat to public safety, and legitimate manufacturers also feared that their own businesses would be ruined by a widespread loss of consumer confidence.
Before the FDA was created, such matters were addressed by the Division of Chemistry (later renamed the Bureau of Chemistry), which President Lincoln had established in 1862 as a part of the U.S. Department of Agriculture. While the division could investigate and conduct scientific studies into adulterated food and drug products, however, it did not have the authority to set and enforce rules (which in the U.S. government is called regulatory power).
A number of factors contributed to the establishment of the FDA as a regulatory agency in 1906. With the appointment of chemist Harvey Washington Wiley (1844–1930) as head of the Division of Chemistry in 1883, the government began to take a more aggressive role in identifying and studying the chemical additives and preservatives contained in food and drugs. Published between 1887 and 1902, Wiley’s 10-part study Foods and Food Adulterants generated considerable public outcry as well as demand for a federal law to prohibit the use of dangerous adulterants in, and the inaccurate branding of, food and drugs. Public concern was further inflamed by the muckrakers, investigative journalists who exposed the deceitful practices and appalling sanitary conditions of certain American businesses. Two landmark publications that led to the passage of the Pure Food and Drug Act (also known as the Wiley Act) were “The Great American Fraud,” a series of articles by Samuel Hopkins Adams (1871–1958) analyzing some of the country’s most popular medicines, which appeared in Collier’s magazine in 1905; and The Jungle (1906) by Upton Sinclair (1878–1968), a shocking portrait of a Chicago meatpacking plant.
The next major milestone in FDA history was the passage of the Federal Food, Drug, and Cosmetic Act in 1938. For several years Congress had been under pressure to make important modifications and updates to the Pure Food and Drug Act of 1906. Still, it was not until a medical disaster occurred in 1937 (wherein an untested antibiotic called Elixir Sulfanilamide resulted in the deaths of more than 100 people, mostly children) that the legislature was forced to act. Although it has been updated and amended considerably over the last several decades, the 1938 law still forms the foundation of the FDA’s jurisdiction and duties.
More Detailed Information
The FDA is headed by a commissioner, who is appointed by the president and confirmed by Congress. The agency is composed of five major centers: the Center for Drug Evaluation and Research (CDER), the Center for Biologics Evaluation and Research (CBER), the Center for Devices and Radiological Health (CDRH), the Center for Food Safety and Applied Nutrition (CFSAN), and the Center for Veterinary Medicine (CVM). The FDA as a whole is staffed by about 9,000 employees who work in and around Washington, D.C., as well as in field offices throughout the country.
The FDA’s activities fall into five major categories. The first of these is new product review, the process by which the agency tests the safety and effectiveness of a new product before it is approved for sale. This review is conducted for new human drugs and biological products (also known as biologics), complex medical devices, food and color additives, infant formulas, and animal drugs. Second, the FDA is responsible for monitoring these products after they reach the market (become available for sale), to make sure that they continue to be safely manufactured and transported and that no new health risks arise.
Third, the FDA establishes regulations and safety standards to guide manufacturers in the requirements for maintaining product safety and keeping citizens and the health-care community accurately informed. It requires that manufacturers provide truthful and informative labels on packaging for foods, over-the-counter medicines, dietary supplements, and other products, so that consumers can see the ingredients of a product, understand safe dosages, and have ready access to any other information they might need for safe and effective use of the product. The agency also works with foreign governments to make sure that products imported into the United States meet the FDA’s safety standards.
A fourth area of FDA activity is scientific research, which is conducted by the agency’s biologists, chemists, physicians, biomedical engineers, pharmacologists, veterinarians, toxicologists, and other specialists. Their findings are used as the basis for the FDA’s regulatory actions, to establish safety standards, to weigh the risks associated with potential “breakthrough” drugs (new products that may change the way certain diseases are treated), and to inform and educate the public. Although the FDA does not develop new products itself, its scientific findings certainly influence the advancements of the food, drug, medical, cosmetic, and veterinary industries.
Finally, the FDA engages in various enforcement activities. For example, in cases where one batch of a product turns out to be defective because of a manufacturing error, or unforeseen side effects are discovered in a product that was thought to be safe, the FDA may take one or more of the following measures. It may ask the manufacturer to recall the product (a recall is a public request for consumers to return a product that has been found to be contaminated, defective, or otherwise unsafe); it may officially withdraw approval (of a drug, for example); it may require changes to the product’s labeling; and it may issue warnings to doctors or other health-care professionals. If necessary, the FDA can also take legal action against those who deliberately violate the law.
Recent Trends
At the turn of the millennium, technological advances in food production, pharmaceuticals, genetic engineering, and other areas were occurring at a rapid pace. As a result, the FDA faced major challenges in protecting public health and safety. The agency was also concerned about developing preventative and response mechanisms for potential sudden health crises, which might include the spread of a dangerous foodborne illness like E. coli bacteria, the emergence of strains of antibiotic-resistant bacteria, and acts of biological terrorism that would introduce deadly agents such as anthrax or smallpox into the population. The continued growth of international commerce also presented new challenges for the FDA, requiring the agency to place a new emphasis on monitoring imports and cooperating with foreign regulators.
Food and Drug Administration
FOOD AND DRUG ADMINISTRATION
The U.S. Food and Drug Administration (FDA), an agency of the U.S. Department of Health and Human Services, advances the nation's welfare by protecting consumers against health hazards that usually are beyond an individual's control. The agency's origins go back to the 1906 publication of Upton Sinclair's best-selling novel The Jungle, which described in graphic detail the filth and unsanitary practices then prevailing at the Chicago stock-yards. The public's outraged response prompted the Congress to pass the Food and Drugs Act of 1906, the first federal law aimed at preventing interstate commerce in misbranded and adulterated foods, beverages, and drugs. Enforcement of this rather limited act was entrusted to the U.S. Department of Agriculture's (USDA) Bureau of Chemistry, which in 1930 became the FDA.
The weakness of the law was fully revealed in 1937, when a widely marketed toxic elixir of sulfanilamide killed 107 people, mostly children. Following another storm of public indignation, Congress passed the Federal Food, Drug, and Cosmetic Act of 1938 (FFDCA), which completely overhauled and greatly broadened the FDA's powers and responsibilities. The law's key provisions required new drugs to be shown to be safe before they could be marketed; defined adulterated and misbranded food; authorized standards of identity, quality, and fill-of-container for foods; and authorized the FDA to inspect facilities producing regulated products.
Even these sweeping provisions have failed at times to protect the public against new hazards, and Congress has strengthened the FFDCA by passing more than 200 amendments. Landmark additions to the act include the Kefauver-Harris Drug Amendments of 1962, which required manufacturers to prove that their medicines are effective as well as safe; the Medical Device Amendments of 1976, which extended similar requirements to medical equipment; and the FDA Modernization Act of 1997, which directed the agency to carry out its mission in close cooperation with other public health groups, both in the United States and abroad.
At the end of the twentieth century, the FDA's mandated responsibilities included ensuring the safety of the entire food supply (except for meat and poultry, which remained under the USDA's purview); making certain that all drugs, medical devices, vaccines, blood products, tissues for transplantation, and animal drugs and feeds are safe and effective when properly used; and assuring that cosmetics and devices that emit radiation do no harm. All of these products, which are manufactured, transported, warehoused, and retailed by more than 110,000 establishments, are worth about $1 trillion a year, or a fifth of all consumer expenditures. In 2000, the per capita cost of this protection was less than two cents a day.
The head of the FDA is the Commissioner of Food and Drugs, a presidential appointee who is confirmed by the Senate. About two-thirds of the FDA's 9,000 employees work in five product-focused centers. The FDA's Center for Food Safety and Applied Nutrition primarily ensures that food products do not contain hazardous pesticides or other contaminants, and that they are truthfully labeled. This center also works with producers to ascertain that genetically modified foods do not present a health risk. The other four centers— Evaluation and Research; Biologics Evaluation and Research; Devices and Radiological Health; and Veterinary Medicine—develop standards for product safety and effectiveness and make sure that the standards are met by reviewing the manufacturers' applications before allowing new health care products on the market.
In general, the application data must be derived from rigorously designed and controlled clinical trials that, for most drugs, include toxicity tests in animals, safety tests in healthy subjects, and studies of safety and effectiveness in large groups of patients. For the most complex drugs and devices, the FDA also relies on the recommendations of advisory panels of outside specialists who evaluate the products in public meetings. To be approved, each product's benefits must outweigh the risks of its use. Continued compliance of marketed products with FDA standards is ensured by the agency's inspectors, investigators, and food safety officers that are located in 174 communities from coast to coast and in Puerto Rico and by twelve national FDA laboratories.
The fast-growing U.S. dependence on imported food and health care products; the global spread of AIDS (acquired immunodeficiency syndrome); mushrooming international tourism; and the development of new, highly sophisticated food, pharmaceutical, and device technologies in the late 1900s greatly increased the complexity of the FDA's mission. To meet the new challenges, the FDA has developed strong scientific ties with academia and the private sector and worked closely with foreign governments to enhance public health standards around the globe. By the onset of the twenty-first century, the FDA's role had expanded from protecting hygiene at Chicago stockyards to promoting cooperation with product regulators all over the world.
Lawrence Bachorik
(see also: Benefits, Ethics, and Risks; Foods and Diets; Pharmaceutical Industry; United States Public Health Service [USPHS] )
Bibliography
Food and Drug Administration. From Test Tube to Patient. Available at http://www.fda.gov/cder/about/default.htm.
—— Milestones in U.S. Food and Drug Law History. Available at http://www.fda.gov/opacom/backgrounders/miles.html.
Food and Drug Law Institute (2000). Compilation of Food and Drug Laws. Washington, DC: Author.
Jackson, C. O. (1970). Food and Drug Legislation in the New Deal. Princeton, NJ: Princeton University Press.
Young, J. H. (1989). Pure Food. Princeton, NJ: Princeton University Press.
Food and Drug Administration
Food and Drug Administration
FDA Approves Silicone Breast Implants After 14-Year Ban
The Food and Drug Administration in November 2006 lifted restrictions on the use of silicone breast implants for cosmetic augmentation. The decision came 14 years after the agency had limited the use of these implants to reconstructive surgery and clinical testing. The reason for the change in the FDA's decision was that the newer types of implants were less prone to tears that could cause the implants to leak, which was a major problem when the agency decided to limit the use of the implants in 1992. The FDA now requires manufacturers to warn consumers that the implants are not lifetime devices, and that the vast majority of women to receive the implants will need to replace or remove them at some point in time.
In November 1991, the FDA held a panel meeting to review information about the safety and effectiveness of breast implants that were filled with silicone gel. After the meeting, the agency asked the industry to cease marketing these types of implants until the FDA could review the information that had been submitted. Within months of this meeting, the FDA denied approval of the marketing of the silicone implants for purposes of augmentation. However, the agency determined that these devices should be available for those who underwent breast reconstruction or replacement of existing silicone implants. Since this time, saline-filled implants have remained on the market.
In 1998, a major manufacturer of silicone implants, Dow Corning of Midland, Michigan, agreed to pay $3.2 billion over a 16-year period to settle the claims of more than 300,000 women who alleged that the silicone implants had harmed them due to leakage and ruptures. Some claimed that these devices were linked with connective tissue disease or cancer. Since the 1990s, several independent studies, including one by the Institute of Medicine, tested these claims. However, these studies have concluded that there is no convincing evidence that the implants were associated with either of these diseases. According to Daniel Schultz, the director for the Center for Devices and Radiological Health of the FDA, "The silicone breast implant is one of the most extensively studied medical devices. We now have a good understanding of what complications of can occur and at what rates."
Between 1998 and 2005, the FDA approved several applications by private companies to study the use of silicone implants. These companies, which include Allergan Corp. (formerly Inamed Corp.) of Irvine, California and Mentor Corp. of Santa Barbara, conducted numerous clinical trials of women who had received the implants. The companies compiled a body of scientific evidence that detailed the benefits and risks of silicone implants. The FDA reviewed these companies' studies, tests completed by independent scientific bodies, and reports from advisory bodies made up of outside experts. The agency also conducted thorough inspections each of the companies' manufacturing facilities to determine whether they comply with FDA standards.
The majority of the women in the studies reported that they were satisfied with the implants. However, the studies also identified some complications that women would need to consider when deciding whether to received these implants. Some of the problems include the following: many of the changes to the women's breasts are irreversible; rupture of a silicone implant is usually silent, which means that neither the woman nor her doctor will know that the implant has ruptured; and the woman will need regular MRI examinations to determine whether a silent rupture has occurred. Moreover, some women in the studies complained of hardening of the area around the implant, change in nipple sensation, and breast pain.
Despite some concerns expressed by health advocates, the FDA on November 17, 2006 approved the marketing of silicone implants. Women of all ages may receive implants for reconstructive purposes. However, only women ages 22 and up can receive implants for augmentation purposes. The FDA has maintained that the decision is in the best interests of woman. "FDA has reviewed an extensive amount of data from clinical trials of women studied up to four years, as well as a wealth of other information to determine the benefits and risks of these products," Schultz said. "The extensive body of scientific evidence provides reasonable assurance of the benefits and risks of these devices. This information is available in the product labeling and will enable women and their physicians to make informed decisions."
The agency attached several conditions to its approval. The companies that market these implants must conduct patient and laboratory stud-ies to determine the failure rates of the devices. These companies must also track each implant in order to notify patients and their doctors of updated product information, as well as other purposes. The FDA stressed that breast implants are not lifetime devices and that a woman receiving an implant will likely need at least one additional surgery during her lifetime. Researchers with the FDA point out that the implants are prone to breakdown within the body.
Commentators expect the reintroduction of silicone implants to increase the number of women who seek breast augmentation. In 2005, plastic surgeons reportedly performed 291,000 augmentations, representing a 37 percent increase from 2000. An additional 58,000 women had breast reconstructions last year. The typical cost for an augmentation procedure is about $8,000.
Critics of the FDA's decision point out that women must not only pay the cost for the initial implant, but must also pay tens of thousands more for the regular MRI screenings as well as the replacement surgeries that will be necessary once the implants have reached their life spans. Moreover, the fact that the FDA has mandated further studies proves that the FDA is aware of the dangers associated with the implants, according to these critics.
Food and Drug Administration
FOOD AND DRUG ADMINISTRATION
The Food and Drug Act of 1906, which prohibited the interstate trade of misbranded or tainted food, drinks, and drugs, was passed by Congress on the same day as the Meat Inspection Act. At this time there was no Federal Drug Administration, but there was a Bureau of Chemistry. In 1927 a separate enforcement agency known as the Food, Drug and Insecticide Administration was create and in 1930 it was renamed the Food and Drug Administration (FDA). In 1938 after five years of battle with Congress, the Federal Food, Drug, and Cosmetic Act was passed. According to the FDA's Web site, it contained the following new provisions:
- Extending control to cosmetics and therapeutic devices
- Requiring new drugs to be shown safe before marketing—starting a new system of drug regulation
- Eliminating the Sherley Amendment requirement to prove intent to defraud in drug misbranding cases
- Providing that safe tolerance is set for unavoidable poisonous substances
- Authorizing standards of identity, quality, and fill-of-container for foods
- Authorizing factory inspections
- Adding the court injunctions to the previous penalties of seizures and prosecutions
Later the FDA's jurisdiction was expanded to include microwaves and any radiation-emitting consumer products, as well as veterinary drugs and pet food. The agency monitors the manufacture, transportation, and sale of food and drugs. To ensure its efficiency, the FDA operates in 157 cities and employs approximately 9000 people. Among its employees are chemists, microbiologists, and investigators who visit 15,000 locations each year.
FDA inspectors visit businesses that are regulated by the FDA. If a problem exists, the FDA allows the company to voluntarily correct the problem or recall the faulty product. If the company refuses to cooperate, the FDA can go to court to force cooperation. Court action can include criminal prosecution if necessary.
In the area of drug control, the FDA does not conduct its own experiments but closely examines the results of the company's research. FDA inspectors conduct three types of inspections: study oriented, investigation oriented, and bioequivalence inspections. Study-oriented inspections are needed in case of new drug or new-product applications for approval. An investigator-oriented inspection may be ordered if other investigators looking at the same study think the findings are inconsistent. If one study is the sole basis for a marketer request, a bioequivalence study is conducted.
Once a drug or device is approved, the agency's responsibility does not end. The FDA monitors any complaints and looks for any adverse reactions associated with the product. As a result, approximately 3,000 products are recalled each year.
In addition to ensuring the quality of the product itself, the FDA has had a major influence on businesses
and the way goods are packaged. For example, medicines and products dangerous to children are now packaged in childproof bottles, and labels on containers of food products must list the nutritional contents and their amounts.
Any company that produces a product that is under the jurisdiction of the FDA has felt the pressure of its regulations, and complaints have been made about the slowness of the FDA's procedures. However, no country's citizens enjoy more protection regarding the products they use than U.S. citizens.
More information is available from the Food and Drug Administration, 5600 Fishers Lane, Rockville, MD 20857, or http://www.fda.gov.
see also Consumer Advocacy and Protection
bibliography
Food and Drug Administration. Frequently Asked Questions. Retrieved October 18, 2005, from http://www.fda.gov/opacom/faqs/faqs.html.
Food and Drug Administration. Information Sheets, "Guidance for Institutional Review Boards and Clinical Investigators". Retrieved October 18, 2005, from http://www.fda.gov/oc/oha/IRB/toc.html.
Food and Drug Administration. Milestones in United States Food and Drug Law History. Retrieved October 18, 2005, from www.fda.gov/opacom/backgrounders/miles.html.
Food and Drug Administration. Small Business Guide to FDA. Retrieved October 18, 2005, from http://www.fda.gov/ora/fed_state/Small_Business/sb_guide/default.htm..
Food and Drug Administration. Warning Letters. Retrieved October 18, 2005, from http://www.fda.gov/foi/warning.htm..
Val Hinton
Mary Jean Lush
Food and Drug Administration
FOOD AND DRUG ADMINISTRATION
Merck Settles Vioxx Lawsuits
The FOOD AND DRUG ADMINISTRATION (FDA) is charged with regulating prescription medications, assessing the effectiveness of new drugs and their safety. The FDA has come under fire after heavily-marketed drugs by large pharmaceutical companies were taken off the market because of dangerous side effects. Vioxx, a drug developed and marketed by Merck & Co., promised arthritis-sufferers relief from joint inflammation and pain without the side-effects of stomach problems which can be triggered by aspirin and other types of painkillers.
In May 1999, the FDA approved rofecoxib, the actual name of the drug, as safe and effective. In September 2004, Merck withdrew Vioxx because of concerns about increased risk of heart attack and stroke associated with long-term, high-dosage use. The FDA estimated that Vioxx might have caused over 27,000 heart attacks, 30 to 40 percent of which were probably fatal, in the five years it was on the market. The withdrawal of the drug did not end matters; individual and class action lawsuits were filed against Merck by individuals who claimed personal injury. In addition 29 states and the District of Columbia began investigations of Merck's advertising of Vioxx. In November 2007 Merck reached a $4.85 billion agreement that would allow the company to settle more than 95 percent of Vioxx lawsuits. In May 2008 the company entered into a $58 million multi-state agreement over alleged deceptive advertising.
Merck withdrew Vioxx in September 2004 after it discovered that taking the drug for 18 months or longer could double the risk of patients suffering a heart attack or stroke. An FDA study issued a few weeks later confirmed these findings. Withdrawing the drug was a financial blow to Merck, as annual sales of Vioxx totaled over $2.5 billion annually. The financial exposure from lawsuits soon became apparent. The first trial took place in 2005 in a Texas state courtroom, where Carol Ernst sued Merck for the heart attack and death of her husband Robert, a Vioxx user. Ernst's lawyers alleged that Vioxx caused the fatal cardiac arrhythmia and that Merck had suppressed information about the dangers of the drug. Merck denied that Vioxx caused deaths, on the grounds that these charges have never been proven. The company also denied allegations that it concealed information, pointing out that it voluntarily withdrew Vioxx from the market. Ernst prevailed, with the jury awarding her $24.5 million for mental anguish and economic losses and $229 million in punitive damages after finding that Merck acted recklessly in selling Vioxx despite having knowledge of the drug's heart risks.
At the time of the Ernst verdict, 4,000 Vioxx lawsuits had been filed. By late 2007 over 27,000 lawsuits were pending. Merck had vowed to fight all Vioxx lawsuits and had won some favorable verdicts. Jurors had decided in favor of the company 12 times and for plaintiffs five times, with five mistrials. In a major reversal, Merck announced on November 8, 2007 that it had reached a $4.85 billion deal to settle most of the Vioxx lawsuits. The company agreed to set up two funds. The first fund of $4 billon would cover claims for hear problems and the second fund of $850 million would cover stroke claims. Amounts to individuals will vary and all claims would be reviewed on an individual basis. The settlement was reached after securing approval from three of the four federal judges overseeing the coordination of more than 95 per cent of the litigation. Merck also said that it would continue to fight those individuals who do not agree to a settlement. The change in thinking by Merck reflected financial realties. The company had reserved $1.9 billion since 2004 to defend itself and it appeared litigation would go on for many years. Plaintiffs lawyers and their clients agreed to file their claims by early 2008, with the expectation that interim awards would be issued by August 2008.
The investigation of Merck's advertising of Vioxx by over half the states was triggered by the massive amounts of money Merck spent to promote the new drug and by its alleged concealment of health risks in its print and television ads. Merck spent hundreds of millions of dollars during the five years Vioxx was on market, focusing on direct-to-consumer televisions ads. This led to hundreds of thousands of consumers demanding prescriptions before Vioxx's side effects could be fully assessed. In May 2008 Vioxx entered into settlement with the states, paying $58 million. In addition, it agreed to submit all new television commercials for its drugs to the FDA for review and revision. In both settlements Merck did not admit to any wrongdoing.
Food and Drug Administration
Food and Drug Administration
Founded in 1927, the Food and Drug Administration (FDA) is an agency of the Untied States Public Health Service . One of the nation's oldest consumer protection agencies, the FDA is charged with enforcing the Federal Food, Drug, and Cosmetics Act, and other related public health laws. The agency assesses risks to the public posed by foods, drugs, and cosmetics, as well as medical devices, blood, and medications such as insulin which are made from living organisms. It also tests food samples for contaminants, sets labeling standards, and monitors the public health effects of drugs given to animals raised for food.
To carry out its mandate of consumer protection, the FDA employs over 9,000 investigators, inspectors, and scientists who collect domestic and imported product samples for examination by FDA scientists. The FDA has the power to remove from the market those foods, drugs, chemicals , or medical devices it finds unsafe. The FDA often seeks voluntary recall of the product by manufacturers, but the agency can also stop sales and destroy products through court action. About 3,000 products a year are found to be unfit for consumers and are withdrawn from the marketplace based on FDA action. Also, about 30,000 import shipments each year are detained at the port of entry on FDA orders.
FDA scientists analyze samples of products to detect contamination, or review test results submitted by companies seeking agency approval for drugs, vaccines, food additives , dyes, and medical devices. The FDA also operates the National Center for Toxicological Research at Jefferson, Arkansas, which conducts research to investigate the biological effects of widely used chemicals. The Agency's Engineering and Analytical Center at Winchester, Massachusetts, tests medical devices, radiation-emitting products, and radioactive drugs. The Bureau of Radiological Health was formed in 1971 to protect against unnecessary human exposure to radiation from electronic products such as microwave ovens.
The FDA is one of several federal organizations that oversees the safety of biotechnology , such as the industrial use of microorganisms to processes waste and water products.
In 1996, when the FDA declared that cigarettes and smokeless tobacco are nicotine-delivery devices, it took responsibility for regulating those products under the authority of the Federal Food, Drug, and Cosmetics Act. With regard to these products, the FDA has issued federal mandates concerning sales to minors, sales from vending machines, and advertising campaigns.
[Linda Rehkopf ]
RESOURCES
PERIODICALS
Gibbons, A. "Can David Kessler Revive the FDA?" Science 252 (April 12, 1991): 200–3.
Iglehart, J. K. "The Food and Drug Administration and Its Problems." New England Journal of Medicine 325 (July 18, 1991): 217–20.
ORGANIZATIONS
U.S. Food and Drug Administration, 5600 Fishers Lane, Rockville, MD USA 20857-0001 Toll Free: (888) INFO-FDA, <http://www.fda.gov>
FDA (United States Food and Drug Administration)
FDA (United States Food and Drug Administration)
The Food and Drug Administration (FDA), a Department of Health and Human Services agency, regulates the development, sale, and distribution of food products, prescription and over-the-counter drugs, cosmetics, and medical equipment. The FDA's reach is so extensive that one-fifth of all consumer dollars spent in the U.S. purchase a product regulated by the FDA. The goal of the FDA is to protect consumers by ensuring the safety of food and drug products sold in the U.S.
The FDA traces its history to 1862, when President Abraham Lincoln created a chemistry division under the Department of Agriculture. Congress created the modern FDA in 1906 with the passage of the Food and Drugs Act. The 1906 law gave limited power to the FDA to monitor the safety of food and drug products. In 1938, Congress expanded the power of the FDA by passing the Food, Drug, and Cosmetic Act. This act granted the FDA the power to test drugs and determine their safety and efficacy before allowing companies to sell the new drugs. The act also granted the FDA authority to regulate cosmetics.
While the FDA's primary task is to ensure food and drug safety, in recent years the agency has taken on an increased role in the fight against bioterrorism. The FDA is leading efforts to develop and produce vaccines and treatments plans to prevent or stop the spread of a bioterror attack. In this quest, the FDA must quickly test vaccines, so private companies can produce and stockpile vaccines.
The variety of possible pathogens (disease-causing microorganisms) that might be used in bioterrorism has tested the limits of the FDA. The administration must simultaneously assess the effectiveness of vaccines and treatments for anthrax, smallpox, botulism, plague, hemorrhagic fevers, and other potential bioweapons. Additionally, the FDA, in conjunction with the Centers for Disease Control, must take into account that terrorists might genetically alter existing pathogens to reduce the efficacy of current vaccines and treatments. The FDA plans to thwart potential terrorist attacks by expediting its approval process for new vaccines and drugs that could reduce the severity of a bioterror attack.
█ FURTHER READING:
ELECTRONIC:
Department of Health and Human Services. "United States Food and Drug Administration." <http://www.fda.gov> (May 2003).
SEE ALSO
Bioterrorism, Protective Measures
Food Supply, Counter-Terrorism
Salmonella and Salmonella Food Poisoning
Vaccination
FDA (United States Food and Drug Administration)
FDA (United States Food and Drug Administration)
Forensic science can involve the examination of foodstuffs and other items used by consumers. If contaminated or faulty, these items can cause illness or death.
Various federal government agencies participate in the regulation of consumer goods, which can involve the forensic determination of the circumstances surrounding accidents, illness outbreaks, or deaths. Principal among these is the Food and Drug Administration (FDA).
The FDA is an agency of the Department of Health and Human Services. Its mandate is the regulation of the development, sale, and distribution of food products, prescription and over-the-counter drugs, cosmetics, and medical equipment. The FDA's reach is extensive; one-fifth of all consumer dollars spent in the U.S. purchase a product regulated by the FDA. The goal of the FDA is to protect consumers by ensuring the safety of food and drug products sold in the U.S.
The FDA traces its history to 1862, when President Abraham Lincoln created a chemistry division under the Department of Agriculture. Congress created the modern FDA in 1906 with the passage of the Food and Drugs Act. The 1906 law gave limited power to the FDA to monitor the safety of food and drug products. In 1938, Congress expanded the power of the FDA by passing the Food, Drug, and Cosmetic Act. This act granted the FDA the power to test drugs and determine their safety and efficacy before allowing companies to sell the new drugs. The act also granted the FDA authority to regulate cosmetics.
While the FDA's primary task is to ensure food and drug safety, in recent years the agency has taken on an increased role in addressing the deliberate contamination of foods. The FDA is leading efforts to develop and produce vaccines and, in conjunction with agencies such as the Centers for Disease Control and Prevention , takes a role in the forensic investigation of food-borne outbreaks, especially if the outbreak can be traced to a breach in the food chain from the field to the consumer.
see also Escherichia coli ; Food poisoning; Pathogens; Toxins.