{"id":50583,"date":"2014-10-09T00:15:16","date_gmt":"2014-10-09T04:15:16","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=50583"},"modified":"2014-10-09T06:36:18","modified_gmt":"2014-10-09T10:36:18","slug":"anything-but-over","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2014\/10\/09\/anything-but-over\/","title":{"rendered":"anything but over&#8230;"},"content":{"rendered":"<div align=\"justify\">Tom Jefferson is a researcher\/reviewer with the Cochrane Collaboration. He was involved throughout in the Tamiflu story and the Cochrane meta-analysis of the Tamiflu Trials. He&#8217;s as good a resource as we might find for understanding what the EMA&#8217;s recent policy decision really says:           <\/div>\n<blockquote>\n<div align=\"center\" class=\"big\"><a target=\"_blank\" href=\"http:\/\/blogs.bmj.com\/bmj\/2014\/10\/07\/tom-jefferson-emas-release-of-regulatory-data-trust-but-verify\/\">EMA&rsquo;s release of regulatory data &mdash; trust but verify<\/a><\/div>\n<div align=\"center\" class=\"big\"><strong><font color=\"#0066ff\">British Medical Journal blog <\/font><\/strong><\/div>\n<div align=\"center\" class=\"middle\">by Tom Jefferson<\/div>\n<div align=\"center\" class=\"small\">7 Oct, 14<\/div>\n<p>The European Medicines Agency [EMA] has <a href=\"http:\/\/www.ema.europa.eu\/docs\/en_GB\/document_library\/Other\/2014\/10\/WC500174796.pdf\">now released the final version of its policy<\/a>  on the prospective release of clinical reports of trials, which  are&nbsp;submitted by sponsors&nbsp;to support&nbsp;marketing authorisation  applications [MAAs].&nbsp;The agency has said that it will&mdash;at a future  date&mdash;determine how to release individual participant data [IPD].<\/p>\n<div align=\"justify\"><strong><font color=\"#200020\">Scope<\/font><\/strong><br \/>                The policy&mdash;to become effective from 1 January 2015&mdash;explains what will be  released and how. Full clinical study reports will not be  released.&nbsp;Rather, selected parts of clinical study reports will be  released, including the &ldquo;core report&rdquo; [although this is not labelled as  such in the text], the&nbsp;statistical analysis plan, protocol and its  amendments, and a blank case report form. [To those familiar with  clinical study reports, these are sections 1-15, 16.1.1, 16.1.2, and  16.1.9 of <a target=\"_blank\" href=\"http:\/\/www.ich.org\/fileadmin\/Public_Web_Site\/ICH_Products\/Guidelines\/Efficacy\/E3\/E3_Guideline.pdf\">the ICH E3 guidelines<\/a>.]&nbsp;The policy document does not explain why full&nbsp;clinical study reports will not be released.<\/div>\n<\/blockquote>\n<div align=\"justify\">This <font color=\"#200020\">&laquo;core report&raquo;<\/font> for the CSR [Clinical Study Report] is what I was worried about [<a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2014\/10\/03\/beyond-the-blind\/\">beyond the blind&hellip;<\/a>]. And it for sure won&#8217;t have the IPD [Individual Participant Data]. Having the <font color=\"#200020\">&laquo;statistical analysis plan, protocol and its  amendments&raquo;<\/font> is a good thing. But does it pass the Rolling Stones test?<\/div>\n<ul>\n<div align=\"justify\" class=\"small\"><em><font color=\"#200020\">         You can&rsquo;t always get what you want <br \/>                  But if you try sometimes<br \/>                  Well you just might find<br \/>                  You get what you need<\/font><\/em><\/div>\n<\/ul>\n<div align=\"justify\">Ask me in February 2015&#8230;<\/div>\n<blockquote>\n<div align=\"justify\"><strong><font color=\"#200020\">Redactions<\/font><\/strong><br \/>                The EMA&rsquo;s policy states: &ldquo;The Agency respects and will not divulge CCI  [commercially confidential information]. In general, however, clinical  data cannot be considered CCI.&rdquo;&nbsp; That said, commercially confidential  information will be redacted, &ldquo;where disclosure may undermine the  legitimate economic interest of the applicant\/market authorization  holder&rdquo; and in&nbsp;items&nbsp;that may facilitate identification of trial  participants. Sponsors will have primary responsibility for redacting  study reports for EMA&rsquo;s approval prior to their being made accessible  under the new policy.<\/div>\n<\/blockquote>\n<div align=\"justify\">This is the part that got to <a target=\"_blank\" href=\"http:\/\/www.alltrials.net\/news\/ema-removes-some-restrictions-from-its-data-sharing-policy\/\"><font color=\"#990000\">AllTrials<\/font><\/a>:<\/div>\n<ul>\n<div align=\"justify\" class=\"small\"><em><font color=\"#200020\">The policy puts primary responsibility for redacting information into  the hands of trial sponsors. This means that they get to suggest which  information submitted to the EMA should be kept hidden. The EMA has a  policy that the information in clinical trial reports should not  generally be considered commercially confidential [this is echoed in the  EU Clinical Trials Regulation] but it may never become clear which  information is being kept hidden. <br \/>        <\/font><\/em><\/div>\n<\/ul>\n<div align=\"justify\">As it should&#8230; <\/div>\n<blockquote>\n<div align=\"center\"><img loading=\"lazy\" decoding=\"async\" width=\"66\" height=\"18\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/snip.gif\" \/><\/div>\n<p align=\"justify\">The policy is a landmark, as for the first time it ensures access to  clinical study reports of drugs&nbsp;that have obtained a MAA or on which a  decision has been made. The EMA may be the first regulator to allow such  access and the Nordic Cochrane Centre, the European Ombudsman, and the  EMA deserve credit for that.<\/p>\n<p align=\"justify\">There&rsquo;s a lot of good news for researchers&nbsp;in the final version of the policy. Gone is the <a target=\"_blank\" href=\"http:\/\/blogs.bmj.com\/bmj\/2014\/06\/13\/tom-jefferson-and-peter-doshi-emas-double-u-turn-on-its-peeping-tom-policy-for-data-release\/\">&ldquo;Peeping Tom&rdquo; clause<\/a>  of &ldquo;viewing only&rdquo; access to data&mdash;described by users of comparable  policies as &ldquo;science through a periscope&rdquo;&mdash;and there is no trace of a  threat of legal proceedings for those who produce research that is  disagreeable to sponsors.<\/p>\n<p align=\"center\"><img loading=\"lazy\" decoding=\"async\" width=\"66\" height=\"18\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/snip.gif\" \/><\/p>\n<div>In <a target=\"_blank\" href=\"http:\/\/blogs.bmj.com\/bmj\/2014\/06\/13\/tom-jefferson-and-peter-doshi-emas-double-u-turn-on-its-peeping-tom-policy-for-data-release\/\">a previous post <\/a>I  urged users to&nbsp;adopt Reagan&rsquo;s maxim of &ldquo;trust but verify&rdquo; when reading  the EMA&rsquo;s policies. Ultimately, we will not know how usable and  transparent this policy is until it has been in use for some time.<\/div>\n<\/blockquote>\n<div align=\"justify\">I was prepared to say at this point that Tom&#8217;s report adds some disappointments, but that I stick to my guns that it&#8217;s a leap forward [<a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2014\/10\/03\/beyond-the-blind\/\">beyond the blind&hellip;<\/a>]. But when I went to the <a target=\"_blank\" href=\"http:\/\/www.alltrials.net\/news\/transparency-risks-misuse-of-data-says-commissioner-due-to-oversee-regulation-of-medicines-in-eu\/\"><font color=\"#990000\">AllTrials<\/font><\/a> site to clip their comment, I found <a target=\"_blank\" href=\"http:\/\/www.alltrials.net\/news\/transparency-risks-misuse-of-data-says-commissioner-due-to-oversee-regulation-of-medicines-in-eu\/\">this<\/a> [see also <a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2014\/09\/17\/a-coup-detat\/\">a <em>coup d&rsquo;\u00e9tat&hellip;<\/em><\/a>, <a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2014\/09\/20\/the-other-shoe\/\">the <em>other shoe<\/em>&hellip;<\/a>]:<\/div>\n<ul><span class=\"small\"><\/p>\n<div align=\"justify\"><em><font color=\"#200020\">Yesterday, the likely European Commissioner  for industry who will oversee the regulation of medicines and the EMA  said there are risks that need to be balanced with greater clinical  trial transparency. MEPs have been questioning the candidates for the  new European Commission and, if approved by MEPs, Elzbieta Bienkowska  will lead the industry department [DG ENTR].<\/font><\/em><\/div>\n<p align=\"justify\"><em><font color=\"#200020\">The new president of  the European Commission, Jean-Claude Juncker, recently moved the  responsibility for the regulation of medicines <a target=\"_blank\" href=\"http:\/\/www.alltrials.net\/news\/incoming-eu-president-has-moved-regulation-of-medicines-to-industry-department\/\">from the health to the industry department<\/a>.  When asked whether this move would allow industry lobbying to affect  drug regulations, Ms Bienkowska said, &ldquo;All my professional experience  shows that I am lobbyist-proof. I&rsquo;m absolutely lobbyist-proof&rdquo;. <a href=\"http:\/\/www.eurolabour.org.uk\/industry-commissioner-medical-devices-elzbieta-bienkowska-health\" target=\"_blank\">Glenis Willmott MEP said<\/a>,  &ldquo;It is disappointing Ms Bienkowska didn&rsquo;t answer directly whether or  not she thinks pharmaceutical and medical devices should really be in  the health commissioner&rsquo;s portfolio.&rdquo;<\/font><\/em><\/p>\n<div align=\"justify\"><em><font color=\"#200020\">Ms Willmott also asked Ms  Bienkowska if she will ensure the EMA&rsquo;s commitment to greater clinical  transparency will continue. Ms Bienkowska replied that clinical trial  transparency is important for Europe; &ldquo;however, you have to look at the  other side and ensure there are adequate levels of safety when it comes  to the potential misuse of data.&rdquo; We&rsquo;ve heard this claim before and <a target=\"_blank\" href=\"http:\/\/www.alltrials.net\/find-out-more\/faq\/#q8\">we responded on our &ldquo;Myths &amp; Objections&rdquo; page<\/a>. MEPs will vote to appoint the candidates to the European Commission on 22nd October.<\/font><\/em><\/div>\n<p><\/span><\/ul>\n<div align=\"justify\"><img loading=\"lazy\" decoding=\"async\" width=\"51\" hspace=\"4\" height=\"69\" border=\"1\" align=\"left\" src=\"http:\/\/1boringoldman.com\/images\/machiavelli.gif\" \/>This battle is anything but over.&nbsp; In <a href=\"http:\/\/1boringoldman.com\/index.php\/2014\/09\/20\/the-other-shoe\/\">the <em>other shoe<\/em>&hellip;<\/a> I ended with a picture of <span class=\"st\">Niccol&ograve; di Bernardo dei Machiavelli<\/span>, the author of <a href=\"http:\/\/en.wikipedia.org\/wiki\/The_Prince\" target=\"_blank\">The Prince<\/a> &#8211; the Renaissance treatise on how to gain and wield power at any cost. I think of him once again this evening. There is no stopping place for the cause of Data Transparency. PHARMA is always in the background. They have unlimited resources and teams of people being well-paid to spend their days working whatever angles are necessary to win the day and allow PHARMA to hold onto control of the data from clinical trials. <img decoding=\"async\" hspace=\"4\" height=\"91\" border=\"1\" align=\"right\" src=\"http:\/\/1boringoldman.com\/images\/willmott.jpg\" \/>It&#8217;s not paranoia that leads me to this cynical conclusion, it&#8217;s self-evident experience. The only thing to say is that their offering this much consistent resistance says that we&#8217;re fighting the right battle. And by the way, endless thanks to <strong><font color=\"#200020\">MEP Glenis Willmott<\/font><\/strong> [see <a href=\"http:\/\/1boringoldman.com\/index.php\/2013\/02\/05\/on-the-right-track\/\">on the right track&hellip;<\/a>]. She&#8217;s a true champion for the cause [and it is <font color=\"#200020\">a cause<\/font>]&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Tom Jefferson is a researcher\/reviewer with the Cochrane Collaboration. He was involved throughout in the Tamiflu story and the Cochrane meta-analysis of the Tamiflu Trials. He&#8217;s as good a resource as we might find for understanding what the EMA&#8217;s recent policy decision really says: EMA&rsquo;s release of regulatory data &mdash; trust but verify British Medical [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-50583","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/50583","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=50583"}],"version-history":[{"count":31,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/50583\/revisions"}],"predecessor-version":[{"id":50614,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/50583\/revisions\/50614"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=50583"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=50583"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=50583"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}