On January 26, FDA's Acting Chief Counsel, Elizabeth H. Dickinson, Esq., and FDA's Deputy Center Director for Policy, Center for Devices and Radiological Health ("CDRH"), Nancy K. Stade, Esq., spoke at the Annual Meeting of the Food, Drug and Cosmetic Law Section of the New York State Bar Association. Dickinson provided an overview of the year's hot legal issues and Stade offered her views on FDA's efforts for improving its medical review process and plans for the future.
Stade spoke first in a spirited debate between former FDA and current consultant Philip J. Phillips, Esq., President, Phillips Consulting Group, LLC, Professor Ralph F. Hall, Professor of Practice, University of Minnesota Law School, and Partner, Lauren R. Silvis, Esq., Sidley Austin LLP. Section 513 of the Food, Drug, and Cosmetic Act ("FD&C Act") mandates that, prior to marketing, FDA must classify all medical devices into one of three classes depending on the intended use, indications for use, and level of control necessary to ensure the safety and effectiveness of the device. Class I requires the least control, followed by class II, and class III requires the most control. Section 513(i) of the FD&C Act essentially states that if a new device is substantially equivalent to an already-marketed device or "predicate" device, the new device is given the same classification as the device already in the market and may be submitted as a "510(k)" submission, which is based on section 510(k) of the FD&C Act. If the new device is not substantially equivalent to any such device, the new device is placed in class III and requires a premarket approval application ("PMA") under Section 515 of the FD&C Act.
Over the years, the 510(k) process has become the most common and controversial pathway for bringing medical devices to market. FDA's definition of medical device includes products ranging from simple tongue depressors to pacemakers to laser surgical devices. Under the current 510(k) process, device manufacturers must notify FDA of their intent to market a medical device at least 90 days prior to launch. If FDA determines that the device is substantially equivalent to an existing 510(k) cleared device or other device that was on the market when the Medical Device Amendments were enacted in 1976, then it may proceed to market. If not, it must undergo pre-market approval as a premarket approval application ("PMA").
Important news for women using oral birth control products. Pfizer is recalling about one million packets of birth control pills in the United States because they may not contain enough contraceptive to prevent pregnancy.
"As a result of this packaging error, the daily regimen for these oral contraceptives may be incorrect and could leave women without adequate contraception, and at risk for unintended pregnancy," according to a Pfizer statement on
the U.S. Food and Drug Administration website.
Monthly doses contain 28 tablets total... 21 with contraceptive and 7 sugar pills. The pharamceutical company discovered that some of their blister packs had too many active tablets, some had too few and some had the tablets out-of-order.
Related:
7 Amazing Health Benefits of Sex
The recall involves 14 lots of Lo/Ovral-28 tablets and 14 lots of Norgestrel and Ethinyl Estradiol tablets.
Pfizer said the mix-up poses no health threat to women, but it urges those taking the affected products to "begin using a non-hormonal form of contraception immediately."
A company spokesperson told The Associated Press that the problem is the result of both mechanical error and a failure on the packaging line during visual inspections.
The pills in question were distributed nationwide.
Lot numbers of affected packs of Lo/Ovral®-28 (norgestrel and ethinyl estradiol)Tablets and Norgestrel and Ethinyl Estradiol Tablets (generic) follow on the table below:
NDC |
Product |
Lot |
Expiration |
Configuration/Count |
---|---|---|---|---|
24090-801-84 | LO/OVRAL® 28 | E15678 | 08/31/2013 | 6 Pilpacks® of 28 tablets each |
24090-801-84 | LO/OVRAL® 28 | E15679 | 08/31/2013 | 6 Pilpacks® of 28 tablets each |
24090-801-84 | LO/OVRAL® 28 | E15686 | 08/31/2013 | 6 Pilpacks® of 28 tablets each |
24090-801-84 | LO/OVRAL® 28 | E15687 | 01/31/2014 | 6 Pilpacks® of 28 tablets each |
24090-801-84 | LO/OVRAL® 28 | E15690 | 01/31/2014 | 6 Pilpacks® of 28 tablets each |
24090-801-84 | LO/OVRAL® 28 | E15698 | 01/31/2014 | 6 Pilpacks® of 28 tablets each |
24090-801-84 | LO/OVRAL® 28 | E15700 | 02/28/2014 | 6 Pilpacks® of 28 tablets each |
24090-801-84 | LO/OVRAL® 28 | E80434 | 07/31/2013 | 6 Pilpacks® of 28 tablets each |
24090-801-84 | LO/OVRAL® 28 | E80438 | 08/31/2013 | 6 Pilpacks® of 28 tablets each |
24090-801-84 | LO/OVRAL® 28 | F36908 | 02/28/2014 | 6 Pilpacks® of 28 tablets each |
24090-801-84 | LO/OVRAL® 28 | F36909 | 02/28/2014 | 6 Pilpacks® of 28 tablets each |
24090-801-84 | LO/OVRAL® 28 | F43915 | 03/31/2014 | 6 Pilpacks® of 28 tablets each |
24090-801-84 | LO/OVRAL® 28 | F43926 | 03/31/2014 | 6 Pilpacks® of 28 tablets each |
24090-801-84 | LO/OVRAL® 28 | F43927 | 03/31/2014 | 6 Pilpacks® of 28 tablets each |
24090-961-84 | Norgestrel 0.3 mg/Ethinyl Estradiol 0.03 mg | E15677 | 08/31/2013 | 6 Pilpacks® of 28 tablets each |
24090-961-84 | Norgestrel 0.3 mg/Ethinyl Estradiol 0.03 mg | E15704 | 01/31/2014 | 6 Pilpacks® of 28 tablets each |
24090-961-84 | Norgestrel 0.3 mg/Ethinyl Estradiol 0.03 mg | E15706 | 01/31/2014 | 6 Pilpacks® of 28 tablets each |
24090-961-84 | Norgestrel 0.3 mg/Ethinyl Estradiol 0.03 mg | E80440 | 08/31/2013 | 6 Pilpacks® of 28 tablets each |
24090-961-84 | Norgestrel 0.3 mg/Ethinyl Estradiol 0.03 mg | F16388 | 01/31/2014 | 6 Pilpacks® of 28 tablets each |
24090-961-84 | Norgestrel 0.3 mg/Ethinyl Estradiol 0.03 mg | F16390 | 02/28/2014 | 6 Pilpacks® of 28 tablets each |
24090-961-84 | Norgestrel 0.3 mg/Ethinyl Estradiol 0.03 mg | F22132 | 02/28/2014 | 6 Pilpacks® of 28 tablets each |
24090-961-84 | Norgestrel 0.3 mg/Ethinyl Estradiol 0.03 mg | F31330 | 02/28/2014 | 6 Pilpacks® of 28 tablets each |
24090-961-84 | Norgestrel 0.3 mg/Ethinyl Estradiol 0.03 mg | F36911 | 03/31/2014 | 6 Pilpacks® of 28 tablets each |
24090-961-84 | Norgestrel 0.3 mg/Ethinyl Estradiol 0.03 mg | F36913 | 03/31/2014 | 6 Pilpacks® of 28 tablets each |
24090-961-84 | Norgestrel 0.3 mg/Ethinyl Estradiol 0.03 mg | F43924 | 03/31/2014 | 6 Pilpacks® of 28 tablets each |
24090-961-84 | Norgestrel 0.3 mg/Ethinyl Estradiol 0.03 mg | F43925 | 03/31/2014 | 6 Pilpacks® of 28 tablets each |
24090-961-84 | Norgestrel 0.3 mg/Ethinyl Estradiol 0.03 mg | F43934 | 03/31/2014 | 6 Pilpacks® of 28 tablets each |
24090-961-84 | Norgestrel 0.3 mg/Ethinyl Estradiol 0.03 mg | F53238 | 03/31/2014 | 6 Pilpacks® of 28 tablets each |
http://www.fda.gov/Safety/Recalls/ucm289770.htm
###
More from
GalTime:
Mexicali Cheese of Woodhaven, NY produced cheese under persistent unsanitary conditions that contributed to Listeria monocytogenes contamination of the facility and the company's products, the FDA alleges in a complaint for permanent injunction filed Monday by the U.S. Department of Justice.
According to the FDA news release, Mexicali Cheese makes and distributes a variety of soft Mexican cheeses to grocery stores and supermarkets in New York, New Jersey and Connecticut. Mexicali Cheese's products include queso fresco [fresh cheese], queso oaxaca (Oaxacan cheese) and queso para freir [cheese for frying].
In October 2010,
an FDA warning letter said inspectors found Listeria monocytogenes in at least five locations inside the Mexicali processing facility. In August that year, the New York Department of Agriculture warned consumers not to eat any Queso Cotija Cheese from Mexicali because of possible Staphylococcus aureus contamination.
The injunction, if entered by the court, would stop the company and its officers from manufacturing and distributing food until they can bring their operations into full compliance with the Federal Food, Drug, and Cosmetic Act and FDA food safety regulations.
"FDA filed this complaint to protect the health of consumers," said Dara A. Corrigan, associate commissioner for regulatory affairs, in the agency's statement. "Working closely with New York's Department of Agriculture and Markets, we took this step to ensure that consumers do not eat potentially dangerous foods from this company."
10-state outbreak of Salmonella enteritidis infection in October and November 2011, the issue has received mounting attention from a variety of media outlets and blogs, including
the Huffington Post and
Marion Nestle at Food Politics.
JoNel Aleccia of msnbc.com
spoke with Dr. Robert Tauxe, the Center for Disease Control and Prevention's Deputy Director of Foodborne, Waterborne and Environmental Disease. In the interview, Tauxe explained the government's rationale behind withholding the name of the restaurant, a practice he said the CDC and Food and Drug Administration regularly follow in similar outbreaks.
The agencies' longstanding policy has been to identify companies linked to outbreaks only when the information will directly protect public health, such as in the case of an ongoing outbreak. The CDC also wants to avoid jeopardizing cooperation with companies that voluntarily release information during outbreak investigations.
In this case, according to the CDC the CDC and FDA chose not to identify the restaurant because the outbreak ended before investigators had enough information to release a report. In other words, no more people were at risk of catching the bug by the time the agencies pinpointed it.
Food safety attorney Bill Marler, who publishes Food Safety News,
dismissed that reasoning, noting that nearly all CDC investigations discover the source of an outbreak after the peak illnesses have passed. Identifying outbreak-associated restaurants reveals their food safety track record over time, he added.
To some food safety and public health experts, the ramifications of withholding the restaurant's identity extend beyond potentially harming a company's reputation.
Dave Theno, the former vice-president of technical services for Jack in the Box, said that identifying the restaurant in an outbreak lets related businesses respond accordingly, perhaps in ways government agencies would not predict. The Salmonella infections have been traced to a product -- likely fresh produce -- served at Restaurant A, but contaminated before it arrived.
"Let's say I own a restaurant and I happen to know my lettuce supplier also supplies Restaurant A. In the real world, as soon as the lettuce supplier hears from Restaurant A, he's going to call all his customers to tell them what's happening," Theno said. "But people don't always see every outbreak and don't always get notified. There are a lot of gaps in the system, to be quite honest."
Theno said that if other restaurant owners shared a mutual supplier with Restaurant A, they might not know they ever carried a contaminated product unless the government identified the outbreak's source.
Theno also wondered whether Mexican-style fast food restaurants not involved in the outbreak might suffer economic harm. By revealing only the type of chain, public health agencies might cause consumers to avoid all types of Mexican-style chains out of caution.
Craig Hedberg, Ph.D., professor of environmental health at the University of Minnesota, said that in the initial stages of an epidemiological investigation, revealing the name of an outbreak source can create unnecessary complications for the researchers. Not only do investigators want to be absolutely certain they pinpoint the right source, they need time to interview and vet victims before the public and the media scrutinize and otherwise influence the investigation.
Once the investigation has confirmed its source and an outbreak report is ready, however, the benefits of nondisclosure become less relevant, Hedberg said.
More importantly, he added, by not revealing itself, Restaurant A is missing an opportunity to publicly acknowledge and correct its mistake.
"We certainly all understand that foodborne illnesses occur and nobody wants to see that happen," Hedberg said. "But in the years I investigated outbreaks with the Minnesota Department of Health, our experience was that when a food producer or restaurant could stand up say, 'Yes, the outbreak happened, and this is what we're doing to prevent it again,' the public responds positively to that."
"Rather than run from the outbreak, the company needs to stand up and say, 'We can't always prevent everything, but this gives us a chance to review our practices and redouble our efforts to make sure this doesn't happen again,'" he added. "That almost always goes well with the public. You have to give credit to the public for understanding."
Hedberg referenced the 1994 outbreak of Salmonella enteritidis infection linked to Schwan's ice cream, made from ice cream mix contaminated in a supplier's tanker trucks. Despite not being directly culpable, Schwan's took responsibility and pledged to reform its food safety standards.
"Schwan's changed their processes in response to that outbreak and have become an important leader in the food safety arena since that time," Hedberg said."They weren't responsible, but rather than hiding from the public, they used that opportunity to really remake their whole food safety system."
Similarly, Theno instrumentally reformed Jack in the Box's food safety practices following the 1993 outbreak of E. coli O157:H7 linked to undercooked ground beef at their restaurants. He said the Restaurant A outbreak might provide an opportunity to reevaluate the precedent of nondisclosure for similar outbreaks moving forward.
"I've worked with Robert Tauxe and the FDA for years. I understand exactly where they are, but I don't happen to agree with it all," Theno said. "Perhaps it's time to look at this whole issue again, not in the crux of an outbreak, but with calm minds and with all the interested parties at the table and ask, 'Is there a better way to do this?' I don't have an answer to that, but I think it would serve everyone well."
In the United Kingdom, the Food Safety Agency that was established in the wake of the "mad cow" disease outbreak, amongst other food safety scares, was essentially dismantled with its portfolio being returned to Ministry of Agriculture (DEFRA).
In Canada, the number of CFIA inspectors was increased following the listeriosis outbreak of 2008 in which contaminated deli meats resulted in 20 deaths. However, the Canadian government is now cutting over 200 inspectors in a bid to save $25 million from the federal budget.
In the United States, the cutbacks have been deeper, with over 260 USDA offices being closed for a savings of $150 million per year.
In reaction, many consumer groups, the press and unions have pronounced the cutbacks as placing the public in danger through the governments neglecting their responsibilities.
The old question is thus posed: Does more government involvement, specifically in relation to inspector numbers, lead to a more effective food safety system?
A similar question is posed by criminologists in relation to police numbers and crime rates. Those on one side of the argument use statistics to show that an increase in police numbers results in decreased crime rates. However, what is missed is that an increase in policing is commonly preceded by a major event, such as 9/11 or when pre-existing crime levels are high.
In other studies, where no major event has occurred, it has been found that there is no correlation between police on the ground and crime rates.
The theory goes that high numbers of police on the ground lead to an increased level of crime detection but do little to prevent crime from occurring. As sociologists will indicate, crime rates are mostly affected by the environment, such as socio-economic factors and community cohesion - in effect the existing culture. To take the argument further, it is thought that increasing the level of policing can bring a siege-like atmosphere to a community and negatively affect the community cohesion.
Returning to food safety, we can make parallels between the effect of policing on crime rates and superimpose on the number of food inspectors and foodborne illness outbreaks. Specifically, inspector numbers increase or reorganization of agencies occurs following a major foodborne illness outbreak.
Yet, what is missed is that in the event of an outbreak, it is the industry response that is primarily responsible for enhancing food safety and not visits by an army of food inspectors. Nevertheless, food inspection does play a major role in containing outbreaks and follow-up investigations, although this is different from prevention.
Industry-led initiatives are the only way to enhance food safety
In the 1980s, there was a diverse range of food safety issues of concern. Foodborne illness rates were increasing, virulent pathogens such as E. coli O157 were taking hold, not to mention the BSE and problems with the emergence of drug-resistant microbes.
In response, a directive from President Clinton's administration set to prioritize food safety risks, reduce red tape and bureaucracy. The directive essentially empowered the industry to take responsibility for food safety by introducing HACCP, amongst other initiatives.
There is little debate that the initiatives were highly successful in reducing the incidence of foodborne illness with a progressive decrease in numbers since implementation.
A more recent example of industry-led initiatives is in relation to the use of antibiotics in animal production. Antibiotics have been commonly used in animal production to prevent infections, thereby leading to high growth rates. However, a negative effect of antibiotics has been the emergence of lethal antibiotic strains of pathogens such as Salmonella, amongst others.
The FDA has debated the banning of antibiotics for promoting animal growth for over 30 years. In late 2011, the FDA somewhat unexpectedly stepped back from banning antibiotics in animal production, which is counter to the actions taken over in the EU.
Many commentators saw this as a capitulation of the FDA to the lobbying pressure from the meat industry. However, the reality is that the meat industry has been proactive in reducing the use of antibiotics in animal production on the understanding that a staged reduction is required. Of course, this is not well-publicized but illustrates that only a successful antibiotic reduction program can be achieved if led by industry and not by government.
Empowerment of food safety is the key
The empowerment of industry to self-regulate always comes under criticism in the event of a foodborne illness outbreak. The knee-jerk reaction always appears to be more testing, more inspectors, more agencies etc.
In many ways, "tinkering" with the food safety system by government hinders the progress that has been made since 1995. Ultimately, industry-led initiatives will always be the most effective approach to improve food safety. Consequently, rather than increasing government inspection a more productive strategy is how to remove the weak links in the chain to prevent outbreaks from occurring in the first place.
Such a strategy is far from straightforward, as there is a need to understand the underlying basis for decisions made that ultimately led to critical errors of judgment in foodborne illness outbreaks.
For example, why do processors send out product known to be contaminated or perform practices that represent obvious food safety risks? In a broad sense, it can be proposed that the actions are through ignorance (lack of knowledge is perhaps a better term) of the risk, economic factors or, in a relatively low number of instances, bioterrorism or criminal intent.
Ironically, it is the latter group who have the greatest perception of empowerment given they are controlling events. In contrast, those that lack knowledge may have good intentions in producing high quality products, although fail to see the consequences. It is almost akin to a thought pattern of "nobody told me not to do it."
The current trend of clean labels, along with producers of organic products, can be classed in this group, where attempts to produce additive-free foods leads to food safety risks (for example, omitting nitrites to control Clostridium botulinum). Also included in this group are food handlers, quality assurance personnel and management whose main focus is to produce product as fast as possible with little thought of ownership or empowerment.
Workers have a tendency to lack empowerment, as they are told what to do and when to do it. This ultimately leads to a disconnect between the product and food safety. In the processing environment, workers are judged on how quickly the product can be processed regardless if the production line is producing ready-to-eat deli meat, cars or paper-clips.
Even if food violations occur, there is little incentive for the worker to raise concerns or to be empowered to make suggestions. When visiting processing plants, I sometimes ask the workers if they consume the products produced in the facility. In the majority of cases, the answer is no, due to their prior knowledge of the history of the product. Clearly those workers have a disconnect or lack of ownership with the product.
Akin to when the industry is highly regulated by government, the lack of empowerment by food workers throughout an organization ultimately leads to essentially passing-the-buck when it comes to food safety - an "it is not my problem" attitude.
It could be argued that empowerment is encompassed in the concept of a food safety culture. Yet "food safety culture" remains a relatively woolly term that lacks the nuts-and-bolts on how to change the behavior of those working in the food industry. There is frequent reference to increasing knowledge by training. However, knowledge and empowerment are very different.
Frank Yiannas introduced the term food safety culture, and noted the major challenges in changing worker behavior - after all, it does take a generation. Still every road starts with a first step and rather than look at the loss of government inspectors as entering the Dark Age we should look at this as an opportunity for industry to be empowered to take food safety initiatives to the next level.
------------------------
Dr. Keith Warriner is an Associate Professor within the Department of Food Science at University of Guelph, Canada.
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