Furberg Says Bextra Similar to Vioxx - Fired From FDA Panel
According to a piece in the Wall Street Journal, Curt D. Furberg, a professor at Wake Forest University in Winston-Salem, North Carolina, was removed from an FDA panel reviewing the safety of COX-2 inhibitors. These are drugs of the same class as the recently withdrawn painkiller Vioxx, which was found to be causing tens of thousands of heart attacks.
Furberg looked at the data and found similarities between Vioxx and Pfizer's Bextra. Incredibly, when he expressed his preoccupation about the obvious similarities, he was removed from the panel as "biased". Now the FDA seems to have a very strange idea indeed of what constitutes bias. While having financial and other ties to the drug maker whose drugs are to be evaluated seems to be quite acceptable, expressing an opinion about the drug under consideration, especially if negative, is deemed to be bias and leads to immediate excommunication.
"Even as the Vioxx casualties are still being counted, even as FDA's conduct is under Congressional investigation, the FDA office of new drugs has taken action to obstruct evidence-based safety evaluation of Bextra, Pfizer's CO2 drug", comments Vera Hassner Sharav of the Alliance for Human Research Protection, AHRP.
While the British government is planning to reform its own watchdog agency, announcing "sweeping changes to the medicines watchdog body after years of criticism and pressure, banning those who sit on its central licensing committee from having any personal or financial interests in pharmaceutical companies", the FDA seems determined to continue its cozy relationship with drug makers. Apparently the agency cares more about the profits of pharma companies than about the safety of the medicines they approve or about the lives of those who rely on the the FDA to function as a watchdog.
Sharper teeth for medicines watchdog,
is the title of an article by Guardian health editor Sarah Boseley. According to that report, both members of the main drug licensing committee as well as those taking part in advisory bodies providing expertise about specific illnesses "would in future have three months to sell their shares and end their potentially lucrative consultancy agreements with drug companies."Compare that with the FDA, which, according to Vera Hassner Sharav "continues moving in the opposite direction: the FDA gives waivers from conflict of interest regulations to advisory panel members who have financial interests in the companies whose drugs they evaluate." Sharav says that "the agency bans those who analyze the evidence and find the drugs unsafe."
Here is what the Wall Street Journal reports:
THE WALL STREET JOURNAL
FDA Removes Panel Member From Drug Review
By ANNA WILDE MATHEWS and SCOTT HENSLEY
November 12, 2004A researcher who publicly questioned the safety of Pfizer Inc.'s painkiller Bextra was removed from a Food and Drug Administration advisory panel that will review it and similar products next year.
Curt D. Furberg, a professor at Wake Forest University, Winston-Salem, N.C., said he was informed by the agency that he no longer will participate in the meeting in which the committee will examine the safety of Cox-2 inhibitors, the class of drugs that includes both Bextra and Vioxx, a painkiller that Merck & Co. recently withdrew from the market. Dr. Furberg said he was told by the FDA that his invitation was rescinded because he was quoted in the New York Times as saying Bextra appeared similar to Vioxx and that Pfizer sought to suppress that information.
"They'd said because I had taken a public position, I was disinvited," Dr. Furberg said. He added that he felt he wasn't biased, and he was "trying to be evidence-based" in making findings about Bextra from an analysis of data. "I collected the information to get evidence to contribute to the debate, I drew a conclusion, and I'm off," he said. Dr. Furberg said he still is on the FDA's drug safety and risk management advisory committee, but won't be part of the February Cox-2 meeting.
Sandra Kweder, acting director of the FDA's office of new drugs, said the agency routinely screens advisory committees for possible conflicts, including intellectual as well as financial interests. "If he's already expressed a particular point of view, and especially written a paper on it, it would be difficult to expect him to come to such a meeting and be objective about the subject," she said. Dr. Furberg still could speak before the panel as part of the public-comment period, she said.
The panel is set to review the safety of Bextra and Celebrex, another Pfizer drug, as part of an examination of Cox-2 inhibitors. Vioxx was withdrawn from the market in September by Merck following a clinical trial showing that after 18 months, patients taking it had a higher risk of heart attacks and strokes.
Dr. Furberg was quoted in coverage of an analysis he helped to do that found that patients taking Bextra might be at higher risk for heart attack or stroke.
Pfizer called the findings "unsubstantiated." A Pfizer spokeswoman said the company had nothing to do with Dr. Furberg's departure from the panel. "Pfizer would never intervene in any way with the FDA's regulatory process," she said.
Write to Anna Wilde Mathews at anna.mathews@wsj.com and Scott Hensley at scott.hensley@wsj.com
Update 15 November 2004 - Center for Science in the Public Interest castigates FDA for applying different standards for industry friendly experts as opposed to critical ones. Information courtesy Vera Hassner Sharav of AHRP:ALLIANCE FOR HUMAN RESEARCH PROTECTION (AHRP)
Promoting Openness and Full Disclosure
FDA’s inexplicable actions -- the latest being the removal of Dr. Curt Furberg from an FDA advisory committee for alleged “intellectual conflict of interest” -- demonstrate hypocricy and intellectual dishonesty.
Dr. Furberg independently analyzed the scientific data, concluding: “The result is [Bextra] looks like Vioxx, and we need to be careful. Pfizer is basically saying 'Our drug is safe until we have more information,' and my position is the opposite. I am saying we need to know it is safe before we use it on a large scale.”FDA’s action against Dr. Furberg contrasts sharply with the agency’s record of tolerance of major financial conflicts of interest of its advisory panel members. See press release from Science for the Public Interest. Our own example is of a more recent vintage: from FDA’s Feb 2, 2004 advisory committee that deliberated about the safety of SSRI antidepressants for children and adolescents—in particular the suicidal risk linked to these drugs.
Dr. Andrew Leon was a member the FEB 2 advisory panel. However, Dr. Leon was also a member of the American College of Neuropsychopharmacology (ACNP) Task Force that issued an unsubstantiated pronouncement, January 21, 2004, reassuring the public at a publicized press briefing that antidepressants were proven “safe and effective” for youth.
The ACNHP pronouncement was in the form of an Executive Summary without any substantiating data. It was made available only through ACNP’s public relations firm, GYMR. Underscoring the commercial nature of the ACNP pronouncement at a publicized press briefing, GYMR notes:
“Our media events are successful because we have a nose for news. We know how to take the language of science and medicine and transform it into the more understandable language of health. We advise clients of the best dissemination strategy for their news and make sure that the message they deliver is compelling, documented and contributes to other national dialogues in a real and meaningful way.”
In addition to Dr. Leon, Dr. David Shaffer, also of the ACNP Task Force was an invited FDA presenter.
Below is an excerpt from FDA’s advisory committee meeting transcript:
http://www.fda.gov/ohrms/dockets/ac/04/transcripts/4006T1.htm
p. 1717 ... In addition, FDA would also like to note
18 that one member of the Psychopharmacologic Drugs
19 Advisory Committee, Andrew Leon, and an FDA
20 speaker, David Shaffer, were members of the
21 American College of Neuropsychopharmacology ACMP
22 Task Force that has recently issued a preliminary
23 report on SSRIs and suicidal behavior in youth.
24 This task force reviewed published and
25 unpublished data from controlled trials in youth,
p. 18
1 data from epidemiological studies, and data from
2 autopsy studies.
3 Based on their preliminary review, they
4 concluded that the available evidence does not
5 suggest that SSRIs increase the risk of suicidal
6 behavior in youth and with depression, however,
7 they acknowledge that their conclusions are
8 preliminary and they recommend that the pertinent
9 data available to pharmaceutical companies and FDA
10 be rapidly made available to ACMP and others, so
11 that they may be independently evaluated.
12 In the event that the discussions involve
13 any other products or firms not already on the
14 agenda for which FDA participants have a financial
15 interest, the participants' involvement and their
16 exclusion will be noted for the record.
17 With respect to all other participants, we
18 ask in the interest of fairness that they address
19 any current or previous financial involvement with
20 any firm whose product they may wish to comment
21 upon.
November 15, 2004
http://www.gooznews.com/Center for Science in the Public Interest
The Food and Drug Administration advisory committee that met last September to consider approving AstraZeneca’s new anti-clotting drug Exanta had two major issues on its agenda. Did it work and did the occasional case of liver poisoning make Exanta unsafe?
A key expert sitting on that panel was Dr. Paul Watkins, a liver toxicity expert at the University of North Carolina. He took part in the discussion, but could not vote. The FDA limited his role because he sits on the advisory boards of two competing firms, one of which paid him more than $50,000 a year, according to a transcript of the meeting posted on the FDA website.
Watkins was not alone. Of the 14 members holding the fate of Exanta in their collective hands that day (the FDA almost always follows the advice of its advisory committees), ten disclosed relevant conflicts of interest at the meeting. None of the other nine were denied a vote.
They ranged from chairman Dr. Jeffrey Borer, who serves on the steering committee of a competitor, to University of Minnesota heart specialist Dr. Alan Hirsch, who listed eight corporate consulting and speaking relationships, several of which were with AstraZeneca’s competitors. “That was about the longest conflict of interest statement I can remember,” joked Borer, whose day job is at the Weill Medical College of Cornell University.
The Watkins case is the most significant, however, because it highlights inconsistencies in how the FDA evaluates conflicts of interest and bias among the scientists sitting on its dozens of advisory panels. Industry critics are being held to a higher standard than physician-scientists who frequently consult for industry.
Last week, the agency bounced Dr. Curt Furberg of Wake Forest University from a meeting that will take place next February to evaluate whether all Cox-2 pain relievers cause the same heart problems that forced Merck to withdraw Vioxx from the market. Furberg, a well regarded drug safety expert and a frequent industry critic, had been quoted in the New York Times a day earlier suggesting his analysis of Pfizer’s Bextra trials showed it may cause the same heart problems as Vioxx.
The FDA’s acting chief for drug evaluation, Sandra Kweder, in ordering his removal claiming Furberg’s comment indicated he was “biased.” Adding insult to injury, she invited Furberg to present his evidence to the committee, but precluded him from taking part in the discussion.
The agency’s treatment of Furberg stands in stark contrast to its treatment of Watkins only two months earlier. Watkins has a long history of bringing an industry-oriented bias to FDA proceedings.
Watkins is typical of many of the physician-scientists who sit on FDA committees. When he sits on a committee, he has his numerous conflicts of interest waived. And whether he’s sitting on the committee or appearing before it as an expert witness, he brings a distinct point of view to the committee’s deliberations.
In March 1999, for instance, Watkins, then at the University of Michigan, appeared before an FDA advisory panel as an expert witness to argue that the liver toxicities associated with the diabetes drug Rezulin were rare and usually associated with other conditions. One of the two patients who died in clinical trials drank 12 beers a day, he pointed out. “It’s reasonable to assume that both patients probably had underlying liver disease that reduced their ability to survive the drug related injury,” he said.
The client sponsoring his appearance before the committee was the drug’s manufacturer, Warner-Lambert. A year and over 60 deaths later, the FDA pulled the drug from the market.
Watkins stuck to his theme of individual susceptibility during the September meeting considering AstraZeneca’s anti-clotting drug Exanta, whose generic name is ximelagatran. Claiming that 13 of 16 drugs withdrawn by the FDA in recent years for safety problems involved potentially predictable susceptibilities, Watkins told his fellow committee members that the liver problems that popped up in the ximelagatran trials “suggest to me a genetic component.
“I would applaud any efforts the company would do either retrospectively or prospectively to get genomic DNA to help us get some of the answers to these questions,” he said. At the end of the day, the committee – its voting members, that is – elected to send the drug back for more data after concluding its toxicities outweighed its benefits.
Meanwhile, the FDA’s action in Furberg’s case went beyond the requirements of the law. The Federal Advisory Committee Act prohibits scientists with conflicts of interest from serving on the more than 200 science advisory committees sprinkled across the federal government. The law does allow agencies to waive those conflicts when a scientist’s expertise is needed to fill out the committee. That exemption is routinely invoked by the FDA.
There is nothing in the law, however, that prohibits “biased” scientists from serving on advisory committees. It only requires that scientists who have strong points of view be balanced by someone reflecting an alternative perspective.
“FACA requires that federal advisory committees be fairly balanced in terms of the points of view and the functions to be performed, and the courts have interpreted this requirement as providing agencies with broad discretion in balancing their committees,” the Government Accountability Office wrote in a report last April. “It is important that committees are perceived as balanced in order for their advice to be credible and effective.”
Ironically, Furberg and Watkins have served on an FDA advisory panel together. In 2002, both men played important roles on a committee evaluating whether unintentional overdoses of some over-the-counter pain killers like acetaminophen cause liver problems. At the outset of the meeting, its chairman waived a reading of all the participants’ conflicts of interest. “Because general topics impact so many institutions, it is not prudent to recite all potential conflicts of interest as they apply to each participant,” Louis Cantilena, chairman of the nonprescription drugs advisory committee, said.
Indeed, the law covering conflicts of interest is much less strict when it is applied to advisory committees that are discussing broad issues rather than individual companies' products. But that technicality seems to have been overlooked in the Furberg case.
The FDA’s drug safety committee that meets in February will be evaluating the safety of all Cox-2s, not just Vioxx or Bextra, which was the subject of Furberg’s most recent study. A close reading of Furberg’s comments in the original Times story indicates he was only referring to one drug – not the entire class. “Basically, we showed that Bextra is no different than Vioxx, and Pfizer is trying to suppress that information,” Furberg was quoted as saying after reporting his study’s results to an American Heart Association meeting in New Orleans.
Furberg sounded a conciliatory note after Kweder announced his removal. He wouldn’t object “if it’s the same rule they apply to others."
- = - = - = - = - = - = - = -
See also:Pfizer takes painkiller Bextra off market, FDA wants warnings on others
Thursday, April 7, 2005 - BY CONNIE CASS - ASSOCIATED PRESS
WASHINGTON - The painkiller Bextra was taken off the market Thursday, and the government wants other drugs in the same class to carry the strongest possible warnings about increased risk of heart attack and stroke among the millions of people who rely on them.The Vioxx scandal: damning Senate testimony reveals drug company, government complicity
Several scientists testifying before the Senate Finance Committee on November 17 provided substantial evidence that the drug company Merck and the US Food and Drug Administration (FDA) knew of safety problems years before the drug Vioxx was withdrawn from the market.Shake-up for drug licensing body - BBC News
A new code of conduct has been drawn up for the Medicines and Healthcare products Regulatory Authority (MHRA) body responsible for licensing.FDA removes arthritics drugs critic from advisory panel meeting - Medical News Today
Criticism upset FDA, doctor says - Boston Globe
FDA Bars Critic From Meeting - Washington Post
Furberg said yesterday he was concerned that "higher-ups" in the FDA wanted to silence him. "I think they're trying to control criticism at the committee meeting," he said. "The fact that I've commented on the issue should be irrelevant. I've done research and some analysis here, and think I'm the most qualified to comment on the data, but now they're going to take me away. It doesn't make much sense."HMO Bans Pfizer's Cox-2 Inhibitor Bextra
January 30, 2005 - The largest HMO in the United States has banned the dispensing of the arthritis painkiller Bextra made by Pfizer, because it could possibly up the risk of heart attacks and strokes in some patients. It's the first time Kaiser Permanente has banned the use of a drug approved by the US Food and Drug Administration.
posted by Sepp Hasslberger on Saturday November 13 2004
updated on Friday December 10 2010URL of this article:
http://www.newmediaexplorer.org/sepp/2004/11/13/furberg_says_bextra_similar_to_vioxx_fired_from_fda_panel.htm
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October 07, 2004 - Sepp Hasslberger
