![]() | The examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject.(March 2019) |
A drug recall removes a prescription or over-the-counter drug from the market. Drug recalls in the United States are made by the FDA or the creators of the drug when certain criteria are met. When a drug recall is made, the drug is removed from the market and potential legal action can be taken depending on the severity of the drug recall. [1]
Drug recalls are classified in the US by the FDA in three different categories. Class I recalls are the most severe and indicate that exposure and/or consumption of the drug will lead to adverse health effects or death. Class II recalls refer to drugs that induce temporary and/or medically reversible health effects. Class III recalls occur when adverse health effects are not likely to occur when consuming the drug or being exposed to it. [1]
There are also market withdrawals [2] and medical device safety alerts'. [2] Market withdrawals occur when a product has a minor violation that does not require FDA legal action. Medical device safety alerts occur when there are unreasonable safety risks associated with using a product. [1]
A more comprehensive list of drug recalls worldwide can be found here: List of withdrawn drugs.
Mrs. Winslow's Soothing Syrup introduced as a soothing agent for both humans and animals, but was primarily advertised to help soothe teething babies. Though not directly affiliated with the FDA, Mrs. Winslow's Soothing Syrup was denounced by the American Medical Association in 1911 via their article titled "Baby Killers." The syrup was sold until as late as 1930 in the United Kingdom. [3]
In 1971, Diethylstilbestrol (DES) was recalled from the market. It was intended to be used to prevent prenatal problems during pregnancy. Women who took DES were shown to have a greater chance of having breast cancer. [4] It is estimated that 5 to 10 million persons were exposed to DES until its recall in 1971. Both mothers and second generation daughters are confirmed to have adverse side effects from DES. [5] Daughters of DES Mothers are more than twice as likely to form breast cancer and are 2.4 times as likely to be infertile. Sons of DES mothers have displayed side effects like genital abnormalities, non-cancerous Epididymal Cysts, and infertility. [5] The Third Generation of people exposed to DES are just now entering into an age where reproductive problems and abnormalities can be studied. No viable results currently exist. [6]
The FDA will issue different levels of recall depending on the severity of the effects. From most to least severe, there is Class I, Class II, and Class III (defined above). There is also market withdrawal which occurs when a drug does not violate FDA regulation but has a known, minor default. The producer must either fix the default or take the drug off the market. [7]
Drugs and medical devices are typically recalled if the product is defective, contaminated, contains a foreign object, fails to meet specifications, mislabeled, or misbranded. [8] Misbranding was the most common reason for pharmaceutical recalls in 2015, accounting for 42%. [9]
This graph charts the rise in drug recalls by class in the United States from 2004 to 2014 with data from Regulatory Affairs Professionals Society [10] [11]
The recall process in the United States follows three approximate phases. Distinct difficulties arise depending on the type of drug being recalled.
Drug recalls can be initiated by the producing firm or the FDA, and those launched by the FDA can be either mandatory or voluntary. This is applicable not just to drugs but all products covered under the FDA. [7]
A firm submitting a recall to the FDA must provide all relevant information about the specific drug, including but not limited to: product name, use, description, and at least two samples of product (including packaging, instructions, inserts, etc.).
The firm must explain the problem they found with the product, how they found this problem, and the reason the problem occurred. For example, if the firm finds a leaking pipe near a product assembly line and tests for batches of the drug produced on that line are positive for contamination, they would submit that as the reason to how they believe their products came to be affected. After submitting a field report, the potential risks will be assessed. [7]
In processing the recall, a Health Hazard Assessment will be conducted by the FDA to determine the recall class (defined above). Level, notification, instructions, mechanics, impacts on economy, and individual consumer must all be considered in determining recall strategy. Level of recall refers to which part of the distribution chain to which the recall is extended (wholesale, retail, pharmacy, medical user, etc.). Notification is the way consumers are alerted to the recall. In cases of a severe health hazard, a press release must be promptly issued. The FDA recommends a written notification, so consumers will have lasting documentation. There are guidelines for notification depending on type; these types include: mail, phone, facsimile, e-mail, media. Instructions and mechanics are information provided to the consumer regarding appropriate action for the recall. The instructions include if the product is to be returned, and if so, where and how they should return the product. It is important to consider the recalled drug’s place in the market, should the recall lead to market shortages. [7]
The FDA will conduct an Effectiveness Check to determine the success of the recall. The drug will either undergo controlled destruction or reconditioning (i.e. relabeling with the correct label). Status reports are conducted throughout the recall to determine effectiveness.
The root cause of the recall must be addressed and corrected to prevent future occurrences. After all corrective action is acknowledged and carried out, the FDA can terminate the recall. [7]
OTC, prescription, and compounded drugs (drugs tailored to a specific patient) each pose unique challenges to the recall process.
Over the counter drugs are widely distributed and there is no direct link between company and consumer. Recalls are typically only advertised online and in the media, so consumers are subject to their own awareness. Lot numbers indicated on the packing allow only those affected to participate in recall.
Prescription drug recalls are made simpler because they follow supply chain: the manufacturer notifies the pharmacy who notifies the patient. However, since there is not a lot/batch number on packaging, recalls must rely on date ranges (date the prescription was filled) whose inaccuracy may lead to higher costs.
Compounded drugs are simple to recall because there is a direct link to patient. Despite the seeming simplicity, the offending component is typically identified across multiple drug classifications, expanding the recall. [9]
Although incomplete, this list highlights some changes in United States government policy that have had an effect on drug recalls.
The National Childhood Vaccine Injury Act of 1986 recognized the threat of injury and death that vaccines can pose. It allowed for financial compensation of the family should such threats come to light, and it increased vaccination safety precautions. If the federal compensation is not sufficient or not granted, this act allowed patients to take legal action for vaccine injuries. This is relevant to drug recalls because a vaccine producer is responsible for reparative damages if their vaccine causes injury and was not recalled.
The Food and Drug Administration Modernization Act of 1997 was passed in order to streamline the FDA to meet standards of efficiency expected by the 21st century. In regards to drugs, the act lowered the regulatory obligations of pharmaceutical companies, allowing them to rely on one clinical trial for approval. It is still the assumption, however, that two trials are necessary to determine safety and effectiveness.
In addition to lower regulatory hurdles, the act allowed for the advertisement of “off label” uses. The effects of this could be unnecessary overuse of the product by consumers and larger profits for the firm. Apropos to medical devices, private for-profit firms were allowed to review the products instead of the FDA. [12]
The 21st Century Cures Act would allow for faster approval of certain drugs, which could result in additional recalls. [13] It passed both houses of Congress and was signed into law by US President Barack Obama on December 13, 2016. [14]
In 2015, 45 new drugs were passed by the FDA, which is more than double than the approval rate 10 years ago. The 21st Century Cures Act could make this number a trend rather than aberration by expediting approval through lower standards, much like the FDA Modernization Act of 1997. [9] The rationale behind the act is that urgency trumps risk for “breakthrough” medical devices. The act would allow producers to submit data other than official clinical trials for consideration, such as case histories. It would also allow reviews to be done by third parties instead of the FDA. Debates stem from the fact that approval could be based on anecdotal rather than scientific evidence. [12]
This act is debated due to the FDA’s seemingly close relations with medical device producers. The two industries collaborated to write proposals for lobbying for the legislation of this act. The FDA is supposed to be neutral in its actions, but representatives from Johnson & Johnson, St Jude Medical, and CVRx Inc. (large medical device suppliers) were all in attendance for the collaborative meetings. [15]
The United States Food and Drug Administration is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food safety, tobacco products, caffeine products, dietary supplements, prescription and over-the-counter pharmaceutical drugs (medications), vaccines, biopharmaceuticals, blood transfusions, medical devices, electromagnetic radiation emitting devices (ERED), cosmetics, animal foods & feed and veterinary products.
Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid prescription. In many countries, OTC drugs are selected by a regulatory agency to ensure that they contain ingredients that are safe and effective when used without a physician's care. OTC drugs are usually regulated according to their active pharmaceutical ingredient (API) rather than final products. By regulating APIs instead of specific drug formulations, governments allow manufacturers the freedom to formulate ingredients, or combinations of ingredients, into proprietary mixtures.
Health Canada is the department of the Government of Canada responsible for national health policy. The department itself is also responsible for numerous federal health-related agencies, including the Canadian Food Inspection Agency (CFIA) and the Public Health Agency of Canada (PHAC), among others. These organizations help to ensure compliance with federal law in a variety of healthcare, agricultural, and pharmaceutical activities. This responsibility also involves extensive collaboration with various other federal- and provincial-level organizations in order to ensure the safety of food, health, and pharmaceutical products—including the regulation of health research and pharmaceutical manufacturing/testing facilities.
The regulation of therapeutic goods, defined as drugs and therapeutic devices, varies by jurisdiction. In some countries, such as the United States, they are regulated at the national level by a single agency. In other jurisdictions they are regulated at the state level, or at both state and national levels by various bodies, as in Australia.
Ranitidine, sold under the brand name Zantac among others, is a medication used to decrease stomach acid production. It is commonly used in treatment of peptic ulcer disease, gastroesophageal reflux disease, and Zollinger–Ellison syndrome. It can be given by mouth, injection into a muscle, or injection into a vein. In September 2019, the probable carcinogen N-nitrosodimethylamine (NDMA) was discovered in ranitidine products from a number of manufacturers, resulting in recalls.
The United States Federal Food, Drug, and Cosmetic Act is a set of laws passed by the United States Congress in 1938 giving authority to the U.S. Food and Drug Administration (FDA) to oversee the safety of food, drugs, medical devices, and cosmetics. The FDA's principal representative with members of congress during its drafting was Charles W. Crawford. A principal author of this law was Royal S. Copeland, a three-term U.S. senator from New York. In 1968, the Electronic Product Radiation Control provisions were added to the FD&C. Also in that year the FDA formed the Drug Efficacy Study Implementation (DESI) to incorporate into FD&C regulations the recommendations from a National Academy of Sciences investigation of effectiveness of previously marketed drugs. The act has been amended many times, most recently to add requirements about bioterrorism preparations.
Sibutramine, formerly sold under the brand name Meridia among others, is an appetite suppressant which has been discontinued in many countries. It works as a serotonin–norepinephrine reuptake inhibitor similar to a tricyclic antidepressant. Until 2010, it was widely marketed and prescribed as an adjunct in the treatment of obesity along with diet and exercise. It has been associated with increased cardiovascular diseases and strokes and has been withdrawn from the market in 2010 in several countries and regions including Australia, Canada, China, the European Union, Hong Kong, India, Mexico, New Zealand, the Philippines, Thailand, the United Kingdom, and the United States. However, the drug remains available in some countries.
A medical device is any device intended to be used for medical purposes. Significant potential for hazards are inherent when using a device for medical purposes and thus medical devices must be proved safe and effective with reasonable assurance before regulating governments allow marketing of the device in their country. As a general rule, as the associated risk of the device increases the amount of testing required to establish safety and efficacy also increases. Further, as associated risk increases the potential benefit to the patient must also increase.
An adverse effect is an undesired harmful effect resulting from a medication or other intervention, such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. The term complication is similar to adverse effect, but the latter is typically used in pharmacological contexts, or when the negative effect is expected or common. If the negative effect results from an unsuitable or incorrect dosage or procedure, this is called a medical error and not an adverse effect. Adverse effects are sometimes referred to as "iatrogenic" because they are generated by a physician/treatment. Some adverse effects occur only when starting, increasing or discontinuing a treatment. Using a drug or other medical intervention which is contraindicated may increase the risk of adverse effects. Adverse effects may cause complications of a disease or procedure and negatively affect its prognosis. They may also lead to non-compliance with a treatment regimen. Adverse effects of medical treatment resulted in 142,000 deaths in 2013 up from 94,000 deaths in 1990 globally.
The Center for Veterinary Medicine (CVM) is a branch of the U.S. Food and Drug Administration (FDA) that regulates the manufacture and distribution of food, food additives, and drugs that will be given to animals. These include animals from which human foods are derived, as well as food additives and drugs for pets or companion animals. CVM is responsible for regulating drugs, devices, and food additives given to, or used on, over one hundred million companion animals, plus millions of poultry, cattle, swine, and minor animal species. Minor animal species include animals other than cattle, swine, chickens, turkeys, horses, dogs, and cats.
The United States Food and Drug Administration (FDA) Office of Criminal Investigations (OCI) provides the FDA with a specific office to conduct and coordinate its criminal investigations.
Direct-to-consumer advertising (DTCA) refers to the marketing and advertising of pharmaceutical products directly to consumers as patients, as opposed to specifically targeting health professionals. The term is synonymous primarily with the advertising of prescription medicines via mass media platforms—most commonly on television and in magazines, but also via online platforms.
The Center for Devices and Radiological Health (CDRH) is the branch of the United States Food and Drug Administration (FDA) responsible for the premarket approval of all medical devices, as well as overseeing the manufacturing, performance and safety of these devices. The CDRH also oversees the radiation safety performance of non-medical devices which emit certain types of electromagnetic radiation, such as cellular phones and microwave ovens.
President of the United States George W. Bush signed the Food and Drug Administration Amendments Act of 2007 (FDAAA) on September 27, 2007. This law reviewed, expanded, and reaffirmed several existing pieces of legislation regulating the FDA. These changes allow the FDA to perform more comprehensive reviews of potential new drugs and devices. It was sponsored by Reps. Joe Barton and Frank Pallone and passed unanimously by the Senate.
The following outline is provided as an overview of and topical guide to clinical research:
The Food and Drug Administration is a federal agency of the United States, formed in 1930.
The Food and Drug Administration Safety and Innovation Act of 2012 (FDASIA) is a piece of American regulatory legislation signed into law on July 9, 2012. It gives the United States Food and Drug Administration (FDA) the authority to collect user fees from the medical industry to fund reviews of innovator drugs, medical devices, generic drugs and biosimilar biologics. It also creates the breakthrough therapy designation program and extends the priority review voucher program to make eligible rare pediatric diseases. The measure was passed by 96 senators voting for and one voting against.
The 21st Century Cures Act is a United States law enacted by the 114th United States Congress in December 2016 and then signed into law on December 13, 2016. It authorized $6.3 billion in funding, mostly for the National Institutes of Health. The act was supported especially by large pharmaceutical manufacturers and was opposed especially by some consumer organizations.
The distribution of medications has special drug safety and security considerations. Some drugs require cold chain management in their distribution.
Consumer Health Laws are laws that ensure that health products are safe and effective and that health professionals are competent; that government agencies enforce the laws and keep the public informed; professional, voluntary, and business organizations that serve as consumer advocates, monitor government agencies that issue safety regulations, and provide trustworthy information about health products and services; education of the consumer to permit freedom of choice based on an understanding of scientific data rather than misleading information; action by individuals to register complaints when they have been deceived, misled, overcharged, or victimized by frauds.