Clinical trials and the origins of pharmaceutical fraud: Parke, Davis & Company, virtue epistemology, and the history of the fundamental antagonism.

This paper describes one possible origin point for fraudulent behavior within the American pharmaceutical industry. We argue that during the late nineteenth century therapeutic reformers sought to promote both laboratory science and increasingly systematized forms of clinical experiment as a new basis for therapeutic knowledge. This process was intertwined with a transformation in the ethical framework in which medical science took place, one in which monopoly status was replaced by clinical utility as the primary arbiter of pharmaceutical legitimacy. This new framework fundamentally altered the set of epistemic virtues-a phrase we draw from the philosophical field of virtue epistemology-considered necessary to conduct reliable scientific inquiry regarding drugs. In doing so, it also made possible new forms of fraud in which newly emergent epistemic virtues were violated. To make this argument, we focus on the efforts of Francis E. Stewart and George S. Davis of Parke, Davis & Company. Therapeutic reformers within the pharmaceutical industry, such as Stewart and Davis, were an important part of the broader normative and epistemic transformation we describe in that they sought to promote laboratory science and systematized clinical trials toward the twin goals of improving pharmaceutical science and promoting their own commercial interests. Yet, as we suggest, Parke, Davis & Company also serves as an example of a company that violated the very norms that Stewart and Davis helped introduce. We thus seek to describe one possible origin point for the widespread fraudulent practices that now characterize the pharmaceutical industry. We also seek to describe an origin point for why we conceptualize such practices as fraudulent in the first place.

The Dobson-Rawlins pact and the National Institute for Health and Care Excellence: impact of political independence on scientific and legal accountability.

This analysis considers whether the independence of the National Institute for Health and Care Excellence (NICE), while safeguarding guidelines from commercial lobbying, may render NICE legally and scientifically unaccountable. The analysis examines the role of judicial reviews and stakeholder consultations in place of peer review in light of current debates concerning the depression guideline.

How Should a Physician Respond to a Patient's Pain When New Opioid Prescribing Laws Limit Shared Decision Making?

This commentary responds to a case and examines pragmatic concerns about operating a busy outpatient practice in compliance with new laws that regulate opioid prescribing. Specifically, the article considers how regulating opioid prescribing can influence the therapeutic alliance in patient-physician relationships and how innovations in decision science can facilitate shared decision making given time constraints.

Should a Law Governing the Pharmaceutical Market Be Ethically Examined Based on Its Intent or Its Practical Applications?

Prescription drug prices are a top health care concern among US consumers. Although this issue is at the forefront of current policy discussions, it is not new. In 1984, the Drug Pricing Competition and Patent Term Restoration Act (colloquially, the Hatch-Waxman Act) addressed drug pricing concerns. This article argues that Hatch-Waxman properly applies utilitarian principles to complex issues of biopharmaceutical development by balancing innovation and availability. However, the statute's efficacy has been marred by so-called pay-for-delay arrangements, which disrupted that carefully constructed equilibrium. This article also argues that the 2013 US Supreme Court holding in Federal Trade Commission v Actavis, Inc appropriately restored the utilitarian balance initially achieved by Hatch-Waxman.

Reflexões bioéticas acerca da inovação em Nanomedicamentos / Reflexiones bioéticsa acerca de la innovación en Nanomedicamentos / Bioethical Reflections on Innovation in Nanomedicines / Reflexions bioètiques sobre la innovació en nanomedicaments

A nanotecnologia vem se desenvolvendo de forma exponencial na área farmacêutica, prometendo grandes benefícios, entretanto, pode estar sujeita a riscos intrínsecos relacionados a esta ciência. Neste artigo é realizada uma reflexão acerca dos desafios enfrentados pelos órgãos regulatórios em função da ausência, ou ainda, incipiente legislação, especialmente no Brasil, visto que os documentos disponíveis em relação a regulamentação, não incluem especificações para nanomedicamentos, os quais apresentam alterações na dimensão e constituição, e consequentemente comportamento diferente de medicamentos convencionais. A contingência envolvendo o desenvolvimento de nanomedicamentos e a gestão dos riscos para a vida humana e o meio ambiente fazem com que a bioética seja invocada de forma a analisar quais os impactos decorrem deste proceso

Nanotechnology has been developing exponentially in the pharmaceutical area, promising great benefits, however, it may be subject to intrinsic risks related to this science. In this article, a reflection is made on the challenges faced by regulatory agencies due to the absence or incipient legislation, especially in Brazil, since the available documents in relation to regulation do not include specifications for nanomedicine, which present changes in the dimension and constitution, and consequently different behavior of conventional drugs. The contingency involving the development of nanomedicine and the management of the risks for human life and the environment, cause bioethics to be invoked in order to analyze the impacts of this process

La nanotecnología se está desarrollando de forma exponencial en el área farmacéutica, prometiendo grandes beneficios, sin embargo, puede estar sujeta a riesgos intrínsecos relacionados a esta ciencia. En este artículo se reflexiona sobre los desafíos enfrentados por los órganos regulatorios en función de la ausencia, o aún incipiente legislación, especialmente en Brasil, ya que los documentos disponibles en relación a la reglamentación, no incluyen especificaciones para nanomedicamentos, los cuales presentan alteraciones en la dimensión y la constitución, y consecuentemente un comportamiento diferente de los medicamentos convencionales. La contingencia que involucra el desarrollo de nanomedicamentos y la gestión de los riesgos para la vida humana y el medio ambiente hacen que la bioética sea invocada para analizar qué impactos se derivan de este proceso

La nanotecnologia s'està desenvolupant de forma exponencial en l'àrea farmacèutica, prometent grans beneficis; no obstant això, pot estar subjecta a riscos intrínsecs relacionats amb aquesta ciència. En aquest article es reflexiona sobre els desafiaments que enfronten els òrgans reguladors en funció de l'absència, o d’una legislació incipient, especialment al Brasil, ja que els documents disponibles en relació a la reglamentació no inclouen especificacions per a nanomedicaments, els quals presenten alteracions en la seva dimensió i constitució, i conseqüentment presenten un comportament diferent al dels medicaments convencionals. La contingència que involucra el desenvolupament de nanomedicaments i la gestió dels riscos per a la vida humana i el medi ambient fan que la bioètica hagi de jugar un paper a fi d’analitzar quins impactes es deriven d'aquest procés

The unsteady state and inertia of chemical regulation under the US Toxic Substances Control Act.

After 40 years, the 1976 US Toxic Substances Control Act (TSCA) was revised under the Frank R. Lautenberg Chemical Safety for the 21st Century Act. Its original goals of protecting the public from hazardous chemicals were hindered by complex and cumbersome administrative burdens, data limitations, vulnerabilities in risk assessments, and recurring corporate lawsuits. As a result, countless chemicals were entered into commercial use without toxicological information. Few chemicals of the many identified as potential public health threats were regulated or banned. This paper explores the factors that have worked against a comprehensive and rational policy for regulating toxic chemicals and discusses whether the TSCA revisions offer greater public protection against existing and new chemicals.

Aspectos éticos y legales relativos al tratamiento de muestras biológicas humanas en ensayos clínicos con medicamentos. Propuesta de criterios de evaluación para los Comités Éticos de Investigación Clínica / Ethical and legal aspects related to the management of human biological samples in clinical trials. Proposal of evaluation criteria for clinical research ethics committees

La Ley 14/2007 de Investigación Biomédica incluyó algunas referencias a los ensayos clínicos que provocaron ciertas dudas en relación con su aplicación en este contexto. Estas dudas no han quedado resueltas de manera definitiva con la publicación del Real Decreto 1716/2011. No quedan determinados los procedimientos o condiciones específicas en este ámbito para la transferencia de muestras a otros países o para la recepción y utilización en centros españoles de muestras obtenidas en el extranjero. Tampoco se han establecido las condiciones para la solicitud de muestras biológicas para investigaciones futuras después de la finalización de un ensayo. Los comités éticos de investigación clínica se enfrentan con incertidumbre a situaciones complejas en su tarea de evaluación de los ensayos clínicos, que incluye la valoración de las condiciones de utilización de muestras biológicas. El objetivo de este trabajo es proponer una interpretación sistemática de la normativa aplicable a la utilización de muestras biológicas en el contexto de los ensayos clínicos con medicamentos (AU)

The Spanish biomedical research Law 14/2007 contains some references that raised some doubts with regard to its application in clinical trials. These doubts have not been definitely resolved with the publication of Royal Decree 1716/2011. There are no established procedures or specific conditions for the transfer of biological samples between Spain and other countries or the use of samples from other countries in clinical trials in Spanish centers. There are also no established conditions for the use of biological samples or for the request of biological samples for future investigations within clinical trials. Clinical research ethics committees face complex situations with uncertainty in their task of assessing clinical trials, including the evaluation of the conditions of use of biological samples. The aim of this paper is to propose a systematic interpretation of the applicable regulations for the use of biological samples in the execution of drug clinical trials (AU)

Prescripción off-label inducida. Responsabilidad ¿compartida? / Induced off-label drug prescribing. Shared responsability?

La prescripción off-label es una práctica tan frecuente como incorrectamente manejada por los pediatras. Solo dos de cada diez pediatras completan todos los pasos necesarios para el registro correcto del uso off-label de medicamentos para niños. Es necesario conocer conceptos básicos relacionados con esta práctica, especialmente cuando se trata de una prescripción inducida, por sus connotaciones éticas y legales (AU)

Although off-label prescribing is common practice among pediatricians, it is surprising how rarely it is carried out properly. Only two out of ten pediatricians complete all the steps necessary for the correct registration of off-label drug use in pediatric patients. It is necessary to know the basic concepts related to this practice, especially when it comes to induced prescribing, due to its ethical and legal connotations (AU)

Towards a genealogy of pharmacological practice.

Following Foucault's work on disciplinary power and biopolitics, this article maps an initial cartography of the research areas to be traced by a genealogy of pharmacological practice. Pharmacology, as a practical activity, refers to the creation, production and sale of drugs/medication. This work identifies five lines of research that, although often disconnected from each other, may be observed in the specialized literature: (1) pharmaceuticalization; (2) regulation of the pharmaceutical industry; (3) the political-economic structure of the pharmaceutical industry; (4) consumption/consumerism of medications; (5) and bio-knowledge. The article suggests that a systematic analysis of these areas leads one to consider pharmacological practice a sui generis apparatus of power, which reaches beyond the purely disciplinary and biopolitical levels to encompass molecular configurations, thereby giving rise not only to new types of government over life, but also to new struggles for life, extending from molecular to population-wide levels.

Reglamento (UE) nº 536/2014 sobre los ensayos clínicos y colectivos vulnerables / Regulation (EU) NO 536/2014 on clinical trias and vulnerable groups

Se realiza una completa revisión de lo establecido normativamente para los ensayos clínicos en pacientes vulnerables. Para ello se toma como base la última normativa europea, es decir, el Reglamento (UE) no 536/2014 del Parlamento Europeo y del Consejo sobre los ensayos clínicos de medicamentos de uso humano, y por el que se deroga la directiva 2001/20/ce (texto pertinente a efectos del EEE). Se comprueba en todo aquello no derogado lo relacionado con los pacientes vulnerables de la anterior normativa europea de la Directiva 2001/20/CE DEL PARLAMENTO EUROPEO Y DEL CONSEJO de 4 de abril de 2001 y las correspondientes trasposiciones a la normativa española en el Real Decreto 223/2004, de 6 de febrero de 2004, por el que se regulan los ensayos clínicos con medicamentos y en la Ley 29/2006, de 26 de julio, de garantías y uso racional de los medicamentos y productos sanitarios (AU)

A complete review of the normative established for clinical trials in vulnerable patient is performed. To do that, the basis is the last European norm, that is, the Regulation (EU) No 536/2014 of the European Parliament and of the Council of 16 April 2014 on clinical trials on medicinal products for human use, and repealing Directive 2001/20/EC (Text with EEA relevance). It is checked all related to vulnerable patients from the previous European norm. Directive 2001/20/EC of the European Parliament and of the Council of 4 April 2001 and the corresponding transpositions into Spanish law by Royal Decree 223/2004 , of February 6, 2004 , whereby clinical drug trials and Law 29/2006 of 26 July, on guarantees and regulates use rational use of medicines and health products (AU)

Counterfeit medicine. A threat to health. Legal situation / El medicamento falsificado. Una amenaza para la salud. Situación legal

The existence of substandard, spurious, falsely labelled, falsified and counterfeit (SSFFC) medical products is an unacceptable risk to public health, becoming an emerging problem in recent years. However, we should be aware that the phenomenon of counterfeiting is not a novelty since such practice coexists with human beings since time immemorial. In the present work we will do a partial analysis of counterfeiting situation from a legislative point of view and will analyze how various legal and non-legal instruments have been used trying to resolve this issue in the European context

La existencia de medicamentos falsificados es una realidad. Se trata de un problema emergente en los últimos años. Sin embargo, hemos de ser conscientes que el fenómeno de la falsificación no es un hecho novedoso ya que tal práctica convive con el ser humano desde tiempos pretéritos. En el siguiente texto se realizará un análisis parcial de la situación de los mismos desde su punto de vista legislativo y se analizará cómo se han utilizado diversas herramientas jurídicas y no jurídicas para intentar solventar esta problemática existente a nivel comunitario

Mifepristone (RU486) in Australian pharmacies: the ethical and practical challenges.

OBJECTIVE: The recent legalization of mifepristone has given women in Australia a new option for termination of pregnancy. Pharmacists are well positioned to provide information and supply mifepristone for patients. However, there are ethical and legal concerns in Australia regarding the supply of mifepristone, as pharmacists may choose to conscientiously object to supplying mifepristone and are subject to differing abortion laws between states and territories in Australia. The objective of this study was to explore attitudes and knowledge of Australian pharmacists about mifepristone. STUDY DESIGN: Semistructured interviews were conducted with 41 registered pharmacists working in a pharmacy or hospital in Sydney, Australia. When data saturation was achieved, audiotaped transcripts were deidentified and transcribed verbatim. Data were thematically analyzed using a framework approach for applied policy research and categorized into the following themes: contextual, diagnostic, evaluative and strategic. RESULTS: Analysis of the transcripts yielded four themes: (a) pharmacists' contextual view on pregnancy termination, the role of the pharmacist and impact on the pharmacy workplace; (b) diagnostic reasons for differing views; (c) evaluation of actual and perceived pharmacy practice in relation to the supply of mifepristone and (d) strategies to improve pharmacists' services, awareness and education. CONCLUSION: Australian pharmacists in this study perceived themselves to have a potentially important role as medicine experts in patient health care and safety in medical termination of pregnancy. However, there was a general lack of clinical, ethical and legal knowledge about medical termination of pregnancy and its legislation. IMPLICATIONS: To ensure patient safety, well-being and autonomy, there is an imperative need for pharmacist-specific training and guidelines to be made available and open discussion to be initiated within the profession to raise awareness, in particular regarding professional accountability for full patient care.

[Legal debate about the definition of medical device and of medicinal drug for human use]. / Jogvita az orvostechnikai eszköz és a gyógyszer fogalmának értelmezésérol.

On 3 October 2013 the European Court of Justice made a decision regarding the interpretation of definitions of medical devices (Directive 93/42/EC) and medicinal product for human use (Directive 2001/83/EC), based on the Article 267 TFEU preliminary ruling. Orv. Hetil., 2014, 155(11), 429-433.

Financiación de medicamentos: Los aspectos jurídicos / Financing of drugs: legal aspects

El derecho a la protección de la salud impulsa al poder ejecutivo a establecer una política sanitaria conducente, dentro de los principios de equidad, calidad y participación ciudadana, a la promoción del uso racional del medicamento y a adoptar medidas dirigidas a que la prestación farmacéutica, por el Sistema Nacional de Salud, se realice a precios razonables y con un gasto publico ajustado, dentro de la necesidad de optimizar los recursos disponibles. En la actualidad el Estado de Bienestar alcanzado en nuestro país se hace cada día más gravoso, de aquí que para garantizar la sostenibilidad del Sistema Nacional de Salud el Estado español haya promovido una reforma sanitaria a través de normas, entre otras, el Real Decreto Ley 16/ 2012 del cual analizamos el impacto y consecuencias más destacables en el sector farmacéutico

The right to health protection encourages the Executive to establish a leading health policy according to the principles of equity, quality and citizen participation, to promote a responsible use of drugs and to adopt measures in order to make the provision of pharmaceutical care affordable and with reasonable public health expenditure by the Spanish National Health System as part of the need of optimizing the available resources. Nowadays, the welfare state achieved in our V country is progressively more expensive. Hence, in order to guarantee the sustainability of the Spanish National Health System, the Spanish government has promoted a health reform through standards, among others the Royal Decree-]Law16/ 2012, of April 20, 2012. From this Royal Decree-] Law we analyze the impact and the most noteworthy consequences in the pharmaceutical sector