Charles Piller

First published July 6th, 2018

The Food and Drug Administration (FDA) says its rules, along with federal laws, stop employees from improperly cashing in on their government service. But how adequate are those revolving door controls? Science has found that much like outside advisers (see main story, p. 16), regular employees at the agency, headquartered in Silver Spring, Maryland, often reap later rewards—jobs or consulting work—from the makers of the drugs they previously regulated.

FDA staffers play a pivotal role in drug approvals, presenting evidence to the agency’s advisory panels and influencing or making approval decisions. They are free to move to jobs in pharma, and many do; in a 2016 study in The BMJ, researchers examined the job histories of 55 FDA staff who had conducted drug reviews over a 9-year period in the hematologyoncology field. They found that 15 of the 26 employees who left the agency later worked or consulted for the biopharmaceutical industry.

FDA’s safeguards are supposed to keep the prospect of industry employment from affecting employees’ decisions while at the agency, and to discourage them from exploiting relationships with former colleagues after they depart. For example, former high-level employees can’t appear before the agency on the precise issues they regulated—sometimes permanently, in other cases for a year or two.

Through web searches and online services such as LinkedIn, however, Science has discovered that 11 of 16 FDA medical examiners who worked on 28 drug approvals and then left the agency for new jobs are now employed by or consult for the companies they recently regulated. This can create at least the appearance of conflicts of interest.

In 2009, for example, an FDA panel weighed whether the agency should approve AstraZeneca’s widely prescribed antipsychotic drug quetiapine (Seroquel) for a wider range of conditions. The panel heard from health policy expert Wayne Ray of Vanderbilt University in Nashville, who described his research linking the drug to sudden cardiac death when used with certain other medications. Ray recalls “an FDA staff member who gave a very negative presentation on our paper.” And according to the meeting transcript, the agency’s then-Director of Psychiatric Products Thomas Laughren, who was instrumental in shepherding Seroquel and similar drugs through the review process and personally signed their FDA approvals, also challenged Ray’s results and defended AstraZeneca’s clinical trial findings in the discussion that followed. The company’s “analysis should have been able to pick up a difference in sudden cardiac death, and they didn’t find any difference between drug and placebo,” he said.

Ray told Laughren and the panel that AstraZeneca had pooled data from all its trials as though the data were one data set, causing a well-known statistical error called Simpson’s paradox. To take the company’s conclusion “as definitive” would be “very dangerous,” Ray said, according to the transcript. Laughren responded by calling sudden death “a pretty definitive event.”

Read the full article here.