INSIDE WASHINGTON: Is the FDA a broken agency?

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Posted on 3rd March 2009 by Gordon Johnson in Uncategorized

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Date: 3/3/2009

EDITOR’S NOTE — An occasional look at how Washington works — or doesn’t.
By RICARDO ALONSO-ZALDIVAR and MIKE BAKER
Associated Press Writers

WASHINGTON (AP) — Tainted peanuts. Unsterilized syringes. Salmonella in Mexican chili peppers. A contaminated blood thinner from China that sent patients into life-threatening shock.

Every few months, the Food and Drug Administration goes into fire-brigade mode, rushing to get control over another safety crisis. The agency that regulates products worth 25 cents of every dollar spent by U.S. consumers seems overwhelmed by its own mission.

Some say the FDA is broken, and others want to break it up — by moving food safety to a new office.

“You’ve got an agency that quite frankly is either non-functional, or dysfunctional, or maybe all of the above,” said Rep. John Dingell, D-Mich., who as the longest serving member of Congress has investigated many agencies, including the FDA.

“Bet yourself a new hat or a fine dinner that you are going to have a scandal a month,” Dingell added. “They are running around like a lot of headless chickens.”

Others, even some critics, see tentative improvements. Many defenders acknowledge the FDA is struggling.

“‘Broken’ is the kind of word that’s sort of a fighting word,” said Dr. Frank Torti, the cancer researcher serving as acting FDA commissioner. “We have recognized for a long time that more is needed. Because of a lack of (legal) authorities and inadequate resources, it’s really hard to do the job.”

Restoring the FDA’s reputation will be a major challenge for an Obama administration that strode into town promising competent government.

The decline didn’t happen overnight. There’s no single, simple cause. In 2007, an independent group of science advisers concluded that the FDA was in danger of failing in its mission. “American lives are at risk,” said their report. It wasn’t the first alarm.

As the pharmaceutical and food industries went global in recent years, the FDA fell behind on inspections. Its legal powers failed to keep up with fast-changing industries. Its own scientists said it grew too cozy with drug companies and tuned out signals of safety problems.

Money for research grew scarce. The agency struggled to answer such seemingly simple questions as how far from a cow pasture a farmer should plant his spinach patch to keep out bad germs. Internal computer systems were allowed to decay, although they are essential to monitoring drug safety trends or blocking shady imports.

The FDA drifted. During the Bush administration, it went long periods without a permanent commissioner who could be an advocate before Congress. Lawmakers piled new responsibilities on the agency, often without the funds to carry them out.

This past year’s safety problems — homegrown and imported — illustrate the FDA’s weakness.

Summer brought a salmonella outbreak blamed first on tomatoes, and later on hot peppers as well.

This winter, it was salmonella again, in peanut products. A small company’s apparent disregard for basic sanitation led to the recall of more than 2,800 foods that used its ingredients.

More than 2,100 people were sickened in these incidents. At least nine deaths have been blamed on tainted peanuts alone.

Last week, another problem surfaced. Federal prosecutors in North Carolina obtained guilty pleas from two employees of AM2PAT, a company that manufactured syringes in unsterile conditions and covered it up with phony paperwork.

Prosecutors say hundreds of patients were sickened and five died. The FBI is looking for the company’s owner, who may have fled the country.

Different products were involved in the incidents, but some of the same FDA shortcomings: inspections, legal authority and technology.

It was unclear how many foreign drug facilities fall under the FDA’s jurisdiction because one government database lists about 7,000 and another, 3,000.

Sending inspectors to China used to involve first waiting for permission from the Chinese government. The situation has improved, under a U.S.-China agreement that led to the opening of FDA offices there.

The tomato outbreak last summer underscored other kinds of gaps. Produce companies are not required to have a food safety plan. And the FDA lacks legal authority to require a system for tracing foods back to the farm. Investigators had to sift through piles of paper records as losses mounted for tomato growers. Dingell said the FDA looked like the Keystone Kops.

In the peanut butter outbreak, the FDA has been slowed because of the length of time it takes to identify positively a strain of salmonella. The agency wants to replace current lab tests that can take a week or more with technology that cuts the wait to a day or two.

FDA inspectors quickly descended on the small Georgia facility at the center of the peanut outbreak. But they didn’t get the whole story immediately. The FDA had to invoke bioterror laws to get lab reports that ultimately showed the company shipped tainted peanuts. Meantime, the agency had no authority to order a food recall.

“The FDA has been trying to do so much with so little for so long that they really have lost the vision of what would make an effective food safety program,” said Caroline Smith DeWaal, food safety director for the Center for Science in the Public Interest, which wants to set up a separate food agency.

Congress has been pumping more money into the FDA the last couple of years. And the Obama administration seems willing to consider big changes, especially on food safety.

The two leading candidates for FDA commissioner are physicians from outside the agency. One is Baltimore health commissioner Joshua Sharfstein, a pediatrician who has taken on the FDA over risks in children’s cough and cold drugs. The other is Margaret Hamburg, a bioterrorism expert who served in the Clinton administration and as New York’s health commissioner.

“One area where we could see bipartisan cooperation might be the strengthening of the FDA,” said Dr. Paul Stolley, a former department head at the University of Maryland medical center who had a stint as a visiting scientist at the FDA. “I don’t think ideological differences should interfere.”

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Baker reported from Raleigh, N.C.

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On the Net:

FDA Science Board report — http://tinyurl.com/yvnk28

Copyright 2009 The Associated Press.

NC body parts supplier's alleged fraud detailed

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Posted on 3rd March 2009 by Gordon Johnson in Uncategorized

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Date: 3/3/2009

By MIKE BAKER
Associated Press Writer

RALEIGH, N.C. (AP) — When a North Carolina company that collected human body parts for transplants and other medical procedures was shut down in 2006, federal regulators cited inaccurate paperwork and poor record-keeping.

But new court documents illuminate a more malicious story line: Federal prosecutors contend the company’s owner falsified medical histories, identities and blood samples of harvested cadavers to ensure the risky tissue could be sold.

Court papers accuse Philip Guyett Jr. of forging the age and cause of death of cadavers he gathered from North Carolina funeral homes because tissues can be rejected for a number of reasons to protect the health of transplant recipients. Prosecutors claim Guyett’s Donor Referral Services Inc. hid instances of disease or drug use and say that if Guyett knew a blood sample would be rejected, he would submit one from a different cadaver donor.

Guyett faces three counts of fraud. He has not been formally indicted, but the “criminal information” documents from prosecutors can only be filed with the defendant’s consent and typically signal a plea deal is forthcoming.

Guyett has previously denied any wrongdoing. His attorney declined to comment.

An arraignment is scheduled for Monday.

The new details renew concerns raised a couple of years ago after Guyett’s facility was shut down and in a separate case, a New Jersey company was accused of plundering corpses for body parts.

In the wake of those cases, thousands of Americans who had routine procedures like knee and back operations were urged to get tested for HIV and hepatitis. More than 1.3 million procedures each year use tissue from donated cadavers in what has become a billion-dollar industry.

The Food and Drug Administration said in 2007 it rushed inspections on all 153 companies that recover cadaver parts and found no major problems. Regulators oversee some 2,000 business that handle tissues and generally only inspect a few hundred each year. The agency declined this week to say whether transplants linked to Guyett led to illnesses, saying that information could only be released through a Freedom of Information Act request, which is pending.

Industry officials said no transplant recipients were affected, but worry there is still not enough federal regulation.

“The part that concerns myself and other state licensing boards is the idea that (the tissue recovery business) is still not regulated like transplantable organs are regulated,” said Paul Harris, executive director of the North Carolina Board of Funeral Service. “And I haven’t seen anything to indicate that it’s headed toward regulation.”

Transplantable organs are tested and regulated under a more rigorous system.

Robert Rigney, head of the American Association of Tissue Banks, said his group regulates member companies separate from the FDA, requiring onsite inspections and reviewing operating procedures. Companies voluntarily join the association, and while Rigney said the most transplantable tissues firms are members, Guyett’s business was not.

Rigney said he doesn’t think the FDA inspects new businesses soon enough, but said tissue transplant procedures are among the safest in medicine and that there hasn’t been a transmission of disease since 2002. He thinks the chances of another case like Guyett’s are minimal.

“What these people are accused of doing violates everything that we stand for,” Rigney said.

FDA spokeswoman Susan Cruzan said a 2007 report found no major deficiencies in the industry and a 2005 report found low risks for disease transmission in tissue transplants.

Guyett has been in trouble with authorities before. He was sentenced a decade ago to community service and probation after police accused him of pocketing cash from the sale of a cadaver. And while working in Las Vegas, Missouri police discovered human limbs in a leaky FedEx container Guyett’s company had shipped.

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On the Net:

American Association of Tissue Banks: http://www.aatb.org/

North Carolina Board of Funeral Service: http://www.ncbfs.org/

Copyright 2009 The Associated Press.

In switch, China courts accept tainted milk suits

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Posted on 3rd March 2009 by Gordon Johnson in Uncategorized

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Date: 3/3/2009

By ANITA CHANG
Associated Press Writer

BEIJING (AP) — For months, courts across China refused to accept the lawsuits from families whose children were killed or sickened in a tainted milk scandal. Now, in a turnaround, hundreds of families are planning to file suit after the country’s highest court this week said cases would be accepted.

The move signals a change in the way Beijing is handling fallout from the scandal, which killed at least six babies and sickened nearly 300,000 with kidney stones and kidney failure. A government-sanctioned compensation plan had been expected to ease public anger, but instead it gave embittered, outspoken parents across China a common cause.

“There will be lawsuits against all 22 dairy companies,” said Zhao Lianhai, who has rallied victims’ parents through a Web site he created.

He said Tuesday the 600-plus families involved want compensation for emotional harm as well as medical and other expenses — demands that go beyond the government’s one-time payouts.

But it was not clear how the government planned to handle the cases. One lawyer who filed a lawsuit this week on behalf of dozens of families said he was told the court was supposed to guide him toward the existing compensation plan.

Infant formula contaminated with the industrial chemical melamine was blamed in the scandal that was exposed last September. Unscrupulous middlemen are accused of adding melamine, which is high in nitrogen, to watered-down milk to fool quality tests for protein content.

The crisis highlighted the need for major overhauls to China’s food safety system, culminating in a law passed over the weekend that consolidates hundreds of regulations covering the country’s 500,000 food processing companies.

On Monday, Shen Deyong, executive vice president of China’s highest court, said courts will accept compensation cases in the scandal.

“The courts have done the preparation work and will accept the compensation cases at any time, ” Shen said in an online interview with the official People’s Daily Newspaper.

Already, Beijing attorney Li Jinglin said he filed an 8 million yuan ($1.2 million) lawsuit Monday in northern China’s Qingdao Intermediate People’s Court on behalf of 54 families. Their children became sick after drinking Shengyuan brand milk, whose parent company is based in Qingdao.

Li said he expected a response from the court this week. But he said a court official told him: “We have the responsibility of guiding you toward accepting the compensation plan from the companies involved … According to our situation, we are prepared to give the same amount of compensation as the dairies.”

A man in the propaganda department at the Qingdao court said he was not aware of the case.

Under the payout plan organized by the dairies, families whose children died received 200,000 yuan ($29,000), while others received 30,000 yuan ($4,380) for serious cases of kidney stones and 2,000 yuan ($290) for less severe cases.

More than 95 percent of victims’ families had accepted the money, Shen said in the interview.

Since the scandal broke, victims’ parents tried several times to file lawsuits, but courts refused to take their documents. Chinese courts often turn down class-action suits, preferring to deal with cases one by one to avoid running afoul of Communist Party officials, who ultimately control the judiciary.

At least 100 families who have already accepted compensation money plan to file lawsuits, lawyer Xu Zhiyong said, conceding that some could be rejected.

“Strictly speaking, after you sign the agreement accepting the compensation, you can’t file a case. But if you can prove that you were forced to accept the money, then you can sue,” he said.

One parent who took the money said it wasn’t enough, but he didn’t plan to fight on.

Luo Ming, whose 2-year-old daughter was diagnosed with kidney stones but apparently has recovered, said he spent 40,000 yuan ($5,850) in medical fees and travel costs and was forced to take six weeks of unpaid leave from his job as a machine designer in central Hunan province.

In January, local health authorities told him 2,000 ($290) in compensation was the best the family could expect.

It wasn’t enough, Luo said. But “my job has been affected, and the government hasn’t helped me. So I’m just going to give up.”

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Associated Press researcher Xi Yue in Beijing contributed to this report.

Copyright 2009 The Associated Press.