{"id":68395,"date":"2016-10-06T12:33:06","date_gmt":"2016-10-06T16:33:06","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=68395"},"modified":"2016-10-06T12:33:06","modified_gmt":"2016-10-06T16:33:06","slug":"what-to-do-the-final-rule","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2016\/10\/06\/what-to-do-the-final-rule\/","title":{"rendered":"what to do? the final rule?&#8230;"},"content":{"rendered":"<div class=\"small\" align=\"justify\">Recently, <em><font color=\"#200020\">FDA\/NIH\/clinicaltrials.gov<\/font><\/em> issued their long awaited reforms with something of a media blitz:<\/div>\n<ol><sup>             <\/p>\n<li><a href=\"http:\/\/jama.jamanetwork.com\/article.aspx?articleid=2553888\" target=\"_blank\" title=\"JAMA\">Toward a New Era of Trust and Transparency in Clinical Trials<\/a><\/li>\n<li><a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMsr1611785?query=OF\" target=\"_blank\" title=\"NEJM\">Trial Reporting in ClinicalTrials.gov &mdash; The Final Rule<\/a><\/li>\n<li><a href=\"https:\/\/www.statnews.com\/2016\/09\/16\/clinical-trials-reporting-rules\/?s_campaign=tw&#038;utm_content=buffer0374c&#038;utm_medium=social&#038;utm_source=twitter.com&#038;utm_campaign=buffer\" target=\"_blank\" title=\"STAT News\">New federal rules target woeful public reporting of clinical trial results<\/a><\/li>\n<li><a href=\"http:\/\/www.npr.org\/sections\/health-shots\/2016\/09\/16\/494231378\/hhs-issues-new-rules-to-open-up-data-from-clinical-trials\" target=\"_blank\" title=\"NPR\">HHS Issues New Rules To Open Up Data From Clinical Trials<\/a><\/li>\n<p>             <\/sup><\/ol>\n<div class=\"small\" align=\"justify\">I&#8217;m impressed that the <font color=\"#200020\">N.I.H.<\/font> and its <font color=\"#200020\">ClinicalTrials.gov<\/font> registry under the respective direction of <font color=\"#200020\">Francis Collins <\/font>[<font color=\"#200020\">NIH Director]<\/font> and <font color=\"#200020\">Deborah Zarin <\/font>[<font color=\"#200020\">ClinicalTrials.gov Director<\/font>] have done a good job of identifying the problems and clarifying loopholes. Dr. Collins focuses on the government funded studies and Zarin on ClinicalTrials.gov procedures. While I have something to say about their solutions [below], they&#8217;ve definitely taken a long look at the sins of the fathers and sent down some credible commandments. However, I can&#8217;t say that I was at all reassured by the FDA&#8217;s response. If they had a Press Release, I couldn&#8217;t find it. It wasn&#8217;t mentioned on their FDA blog. Here are the quotes from Robert Califf from the articles above:<\/div>\n<blockquote>\n<div align=\"justify\">From the <strong><font color=\"#200020\">STAT<\/font><\/strong> article [<a href=\"https:\/\/www.statnews.com\/2016\/09\/16\/clinical-trials-reporting-rules\/?s_campaign=tw&#038;utm_content=buffer0374c&#038;utm_medium=social&#038;utm_source=twitter.com&#038;utm_campaign=buffer\" target=\"_blank\" title=\"STAT News\">New federal rules target           woeful public reporting of clinical trial results<\/a>]:<\/div>\n<ul>\n<li>\n<div align=\"justify\">Federal officials said last year that they               wouldn&rsquo;t penalize offenders before clarifying the               reporting rules. Now that this is happening, &ldquo;I&rsquo;m               expecting a flood of trials to get registered,&rdquo; FDA               Commissioner Robert Califf told reporters during a               conference call. &ldquo;It would be pretty hard to hide that you               are doing a clinical trial or hide the result. &hellip; I&rsquo;m very               optimistic about this.&rdquo;<\/div>\n<\/li>\n<li>\n<div align=\"justify\">Yet not a single researcher or trial               sponsor has been fined or penalized, STAT reported &mdash;               though the Food and Drug Administration had the authority               to fine violators more than an aggregate $25 billion since               the law went into force in 2008.<\/div>\n<\/li>\n<li>\n<div align=\"justify\">Neither agency will add such staff,                   according to Califf, whose agency oversees                     private sector reporting, and NIH Director Francis                     Collins, whose agency is responsible for enforcement                     regarding NIH grant recipients as well as NIH staff                     scientists.<\/div>\n<\/li>\n<li>\n<div align=\"justify\">Califf said enforcement instead would be               folded into the FDA&rsquo;s existing bioresearch monitoring               program, which collects information related to clinical               trials during company inspections.<\/div>\n<\/li>\n<li>\n<div align=\"justify\">&ldquo;Typically, when the FDA believes there               may be a violation of the law, it sends a warning letter&rdquo;               for voluntary correction, Califf said. He expects this               method to handle most problems, and promised that the               public will have &ldquo;a good window of what&rsquo;s going on&rdquo; in               compliance actions.<\/div>\n<\/li>\n<\/ul>\n<div align=\"justify\">In the <strong><font color=\"#200020\">NPR<\/font><\/strong> article [<a href=\"http:\/\/www.npr.org\/sections\/health-shots\/2016\/09\/16\/494231378\/hhs-issues-new-rules-to-open-up-data-from-clinical-trials\" target=\"_blank\">HHS Issues New Rules To Open Up Data From         Clinical Trials<\/a>],<\/div>\n<ul>\n<li>\n<div align=\"justify\">&quot;This has been a very opaque world up               until to now,&quot; Food and Drug Commissioner Robert Califf               told reporters during an embargoed phone conference               Thursday. &quot;These are tremendous changes.&quot;<\/div>\n<\/li>\n<li>\n<div align=\"justify\">For studies that are regulated by the FDA,               companies can face fines of $10,000 a day if they don&#8217;t               comply with the existing rules. Those fines have not been               imposed, however, and the FDA will not have additional               funding to hire enforcement staff, Califf said. &quot;I really               believe that it won&#8217;t take much to get people to comply               with this once they realize how serious this is.&quot;<\/div>\n<\/li>\n<\/ul>\n<div align=\"justify\">And I wasn&#8217;t in love with this one either:<\/div>\n<ul>\n<li>\n<div align=\"justify\">Both agencies               will automate compliance checks             to ensure trials are properly registered and results             reported, and contact institutions as needed to provide all             the data required to bring their trials into compliance with             the law.<\/div>\n<\/li>\n<\/ul>\n<\/blockquote>\n<div class=\"small\" align=\"justify\">And that was all I could find from the FDA. I would cop to a&nbsp; charge of over-reading Califf&#8217;s comments, in a New York minute, but it&#8217;s even worrisome to me that that&#8217;s all I can find to read. Best I can tell, the FDA <strong><em><font color=\"#200020\">action<\/font><\/em><\/strong> will be to piggy-back onto some automated <em><font color=\"#200020\">NIH\/ClinicalTrials.gov<\/font><\/em> <font color=\"#200020\">automate[d] compliance check[er]<\/font>. Otherwise, I hear &quot;<font color=\"#200020\">don&#8217;t worry, <em><strong>they<\/strong><\/em><\/font> <font color=\"#200020\">will take care of it.<\/font>&quot; And, by the way, it&#8217;s the private sector that needs the <font color=\"#200020\"><em>over&middot;seeing<\/em><\/font> [&quot;<em><font color=\"#200020\">according to Califf, <\/font><strong><font color=\"#200020\">whose agency oversees                      private sector reporting<\/font><\/strong><font color=\"#200020\">, and NIH Director Francis                      Collins, whose agency is responsible for enforcement                      regarding NIH grant recipients<\/font><\/em>&quot;]. So I&#8217;m filing the FDA&#8217;s response under &quot;<em><font color=\"#200020\">wary<\/font><\/em>&quot; cross-referenced with &quot;<em><font color=\"#200020\">uh-oh!<\/font><\/em>&quot; This is how reform begins its decline to the state we&#8217;re in already.<\/div>\n<p class=\"small\" align=\"justify\">And in spite of being impressed that the <em><font color=\"#200020\">NIH\/ClinicalTrials.gov <\/font><a href=\"http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMsr1611785#page=4\" target=\"_blank\" title=\"summary of the final rule\">final rule<\/a><\/em> shows signs of some real effort and investigation, I question their solutions. There are two points in the life cycle of a clinical trial where data is entered into ClinicalTrials.gov &#8211; <strong><em><font color=\"#200020\">Registration<\/font><\/em><\/strong> and <strong><em><font color=\"#200020\">Results<\/font><\/em><\/strong>:<\/p>\n<p class=\"small\" align=\"center\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/1boringoldman.com\/images\/rct-system-3.gif\" width=\"520\" border=\"0\" height=\"241\" \/><\/p>\n<div class=\"small\" align=\"justify\">Here&#8217;s a shortened version of what the <em><a href=\"http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMsr1611785#page=4\" target=\"_blank\" title=\"summary of the final rule\">final rule<\/a><\/em> has to offer:    <\/div>\n<ul><sup>      <\/p>\n<li>\n<div align=\"justify\"><em><strong><font color=\"#200020\">Registration [the final rule]<\/font><\/strong><\/em>:<br \/>     <em><strong><font color=\"#200020\">when<\/font><\/strong><\/em> &#8211; &quot;Submission: Within 21 days after enrollment of the first trial participant. Posting: Generally, within 30 days after submission&#8230;&quot; <br \/>     <em><strong><font color=\"#200020\">what<\/font><\/strong><\/em> &#8211; &quot;Descriptive information about the trial: e.g., brief title, study design, primary outcome measure information&#8230;&quot;<\/div>\n<\/li>\n<li>\n<div align=\"justify\"><em><strong><font color=\"#200020\">Results [the final rule]<\/font><\/strong><\/em>: <br \/>     <em><strong><font color=\"#200020\">when<\/font><\/strong><\/em> -&quot;Submission: Standard deadline: Within 12 months after the date of final data collection for the prespecified primary outcome measures (primary completion date)&#8230;&quot; <br \/>     <em><strong><font color=\"#200020\">what<\/font><\/strong><\/em> &#8211; &quot;Outcomes and statistical analyses for each primary and secondary outcome measure by treatment group or comparison group, including results of scientifically appropriate statistical analyses performed on these outcomes, if any. Adverse event information: Tables of all anticipated and unanticipated serious adverse events and other adverse events that exceed a 5% frequency threshold within any group&quot;    <\/div>\n<\/li>\n<p>      <\/sup><\/ul>\n<div class=\"small\" align=\"justify\">I consider myself a reasonably well-informed consumer, and I&#8217;m disappointed for the following reasons:<\/div>\n<ul><sup>    <\/p>\n<li>\n<div align=\"justify\"><em><strong><font color=\"#200020\">Registration: <\/font><\/strong><\/em>Preregistration of the Primary and Secondary Outcome Parameters and the Methods by which they will be analyzed is an essential ingredient of a scientifically conducted clinical trial. Changing outcomes after the study is underway has been a major method used to deceitfully jury-rig the results [see ]. <em><strong><font color=\"#200020\">Ergo<\/font><\/strong><\/em> any effective reform must insure that a certified copy of that <em><font color=\"#200020\">a priori<\/font><\/em> <strong><font color=\"#200020\">Protocol<\/font><\/strong> and <strong><font color=\"#200020\">Statistical Analysis Plan<\/font><\/strong> is filed <u>before<\/u> the trial begins. Filing those things with the Results in case there are amendments is also fine, but does nothing to reassure us that these variables haven&#8217;t been changed. These documents have just been used in the submission to the Institutional Review Board, so they are at hand. Why not file them with the registration and post them on the public face sheet on <em><font color=\"#200020\">ClinicalTrials.gov<\/font><\/em>? To do otherwise is to start off with a <em><font color=\"#200020\">huge loophole<\/font><\/em> that has been chronically exploited.<\/div>\n<\/li>\n<li>\n<div align=\"justify\"> <em><strong><font color=\"#200020\">Results:<\/font><\/strong><\/em> While the Sponsors [PHARMA] have succeeded in holding on to their claima of keeping the raw data proprietary [secret], they have no such claim on the results. After all, it&#8217;s what they themselves publish in the journal articles they generate. The Results Database on <em><font color=\"#200020\">ClinicalTrials.gov<\/font><\/em> should have the results of the predefined Primary and Secondary Outcome Parameters clearly labeled. Any other Outcomes should be labeled &#8216;exploratory&#8217; or &#8216;non-Protocol&#8217;. In addition, since they have already been calculated for submission, there&#8217;s no reason to delay posting them. Posting results at the time of submission to the FDA is essential. Why? So Journal editors, peer reviewers, you and me can see them. <em><strong><font color=\"#660033\">And the whole point of this enterprise is to deal with the widespread corruption in the reporting of clinical trials in our literature!<\/font><\/strong><\/em><\/div>\n<\/li>\n<p> <\/sup><\/ul>\n<div class=\"small\" align=\"justify\">It would be the height of comedy to expect anyone to take the word of the PHARMA Sponsors that late-filed Protocol declarations are accurate or that the belated Results filings were the same as those reported to the FDA. The mis-reporting and non-reporting have been too ubiquitous and too destructive for that. So these filings need to be checked and certified, best done by the FDA who is the responsible and accountable agency in this case. <em><font color=\"#200020\">It&#8217;s time to evoke evidence-based medicine&#8217;s real meaning &#8211; evidence in the legal sense.<\/font><\/em> Stay tuned&#8230; <\/div>\n","protected":false},"excerpt":{"rendered":"<p>Recently, FDA\/NIH\/clinicaltrials.gov issued their long awaited reforms with something of a media blitz: Toward a New Era of Trust and Transparency in Clinical Trials Trial Reporting in ClinicalTrials.gov &mdash; The Final Rule New federal rules target woeful public reporting of clinical trial results HHS Issues New Rules To Open Up Data From Clinical Trials I&#8217;m [&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_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-68395","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/68395","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=68395"}],"version-history":[{"count":28,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/68395\/revisions"}],"predecessor-version":[{"id":68434,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/68395\/revisions\/68434"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=68395"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=68395"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=68395"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}