National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Ethical Issues in Studying the Safety of Approved Drugs: A Letter Report. Washington, DC: The National Academies Press. doi: 10.17226/12948.
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Ethical Issues in Studying the Safety of Approved Drugs: A Letter Report

Committee on Ethical and Scientific Issues in Studying the Safety of Approved Drugs

Board on Population Health and Public Health Practice

INSTITUTE OF MEDICINE
OF THE NATONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Ethical Issues in Studying the Safety of Approved Drugs: A Letter Report. Washington, DC: The National Academies Press. doi: 10.17226/12948.
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THE NATIONAL ACADEMIES PRESS
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract HHSF223200810020I between the National Academy of Sciences and the Food and Drug Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Additional copies of this report are available from the

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For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2010 by the National Academy of Sciences. All rights reserved.

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The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested citation: IOM (Institute of Medicine). 2010. Ethical Issues in Studying the Safety of Approved Drugs: A Letter Report. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Ethical Issues in Studying the Safety of Approved Drugs: A Letter Report. Washington, DC: The National Academies Press. doi: 10.17226/12948.
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“knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSITIUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Ethical Issues in Studying the Safety of Approved Drugs: A Letter Report. Washington, DC: The National Academies Press. doi: 10.17226/12948.
×

THE NATONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine


The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.


The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.


The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.


The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.


www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Ethical Issues in Studying the Safety of Approved Drugs: A Letter Report. Washington, DC: The National Academies Press. doi: 10.17226/12948.
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COMMITTEE ON ETHICAL AND SCIENTIFIC ISSUES IN STUDYING THE SAFETY OF APPROVED DRUGS

RUTH R. FADEN, PhD, MPH (Cochair), Philip Franklin Wagley Professor of Biomedical Ethics and Director,

Johns Hopkins Berman Institute of Bioethics

STEVEN N. GOODMAN, MD, MHS, PhD (Cochair), Professor of Oncology, Pediatrics, and Epidemiology and Biostatistics,

Johns Hopkins University Schools of Medicine and Public Health

ALASDAIR BRECKENRIDGE, MD, FRCP, Chairman,

Medicines and Healthcare products Regulatory Agency, London, UK

LISA EGBUONU-DAVIS, MD, MPH, MBA, Managing Director,

LED Enterprise, LLC

MIGUEL A. HERNÁN, DrPH, MD, Associate Professor of Epidemiology,

Harvard School of Public Health

GRACE M. LEE, MD, MPH, Assistant Professor of Population Medicine and Pediatrics,

Harvard Pilgrim Health Care Institute, Harvard Medical School, and Children’s Hospital Boston

MICHELLE MELLO, JD, PhD, Professor of Law and Public Health,

Harvard School of Public Health

ERIC M. MESLIN, PhD, Director,

Indiana University Center for Bioethics;

Associate Dean for Bioethics,

Indiana University School of Medicine

LARRY I. PALMER, LLB, Professor of Health Administration,

Virginia Commonwealth University;

Professor of Law,

College of William and Mary

BRUCE M. PSATY, MD, PhD, MPH, Professor of Medicine, Epidemiology, and Health Services and Codirector,

Cardiovascular Health Research Unit, University of Washington, Seattle, WA; Group Health Research Institute, Group Health Cooperative, Seattle, WA

THOMAS R. TEN HAVE, PhD, MPH, Professor of Biostatistics,

University of Pennsylvania School of Medicine

WILLIAM VAUGHAN, BA, Consultant to Consumers Union

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Ethical Issues in Studying the Safety of Approved Drugs: A Letter Report. Washington, DC: The National Academies Press. doi: 10.17226/12948.
×

STUDY STAFF

MICHELLE C. CATLIN, PhD, Study Director

JENNIFER A. COHEN, Program Officer

ALEJANDRA MARTÍN, Research Assistant

KRISTEN METHERD, Intern

KATHLEEN McGRAW, Senior Project Assistant

ALLISON L. BERGER, Senior Project Assistant

NORMAN GROSSBLATT, Senior Editor

ROSE MARIE MARTINEZ, ScD, Director,

Board on Population Health and Public Health Practice

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Ethical Issues in Studying the Safety of Approved Drugs: A Letter Report. Washington, DC: The National Academies Press. doi: 10.17226/12948.
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REVIEWERS

This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards of objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following for their review of this report:

Wylie Burke, MD, PhD, University of Washington

Susan S. Ellenberg, PhD, University of Pennsylvania School of Medicine

Arthur Levin, BA, MPH, Center for Medical Consumers

Roger J. Lewis, MD, PhD, University of California, Los Angeles, David Geffen School of Medicine

Bernard Lo, MD, University of California, San Francisco

Alastair J.J. Wood, MD, Symphony Capital, LLC

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of the report was overseen by Brian L. Strom, MD, MPH, University of Pennsylvania School of Medicine and Elaine L. Larson, PhD, RN, Columbia University. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of the report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of the report rests with the author committee and the institution.

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Ethical Issues in Studying the Safety of Approved Drugs: A Letter Report. Washington, DC: The National Academies Press. doi: 10.17226/12948.
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CONTENTS

Boxes

BOX 1

 

Charge to the Committee

 

1

BOX 2

 

Conceptual Framework for Analyzing the Ethics of Postmarketing Randomized Clinical Trials Required by the Food and Drug Administration: Four Central Classes of Considerations and Recommendations

 

3

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Ethical Issues in Studying the Safety of Approved Drugs: A Letter Report. Washington, DC: The National Academies Press. doi: 10.17226/12948.
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Margaret Hamburg, MD

Commissioner

US Food and Drug Administration

10903 New Hampshire Avenue Silver Spring, MD 20993-0002

Dear Dr. Hamburg,

In April 2010, the US Food and Drug Administration (FDA) asked the Institute of Medicine (IOM) to respond to five questions about ethical and scientific issues in studying the safety of approved drugs. FDA requested a final report on the five questions in 2011. In light of the scheduling of a joint meeting of FDA’s Endocrinologic and Metabolic Drugs Advisory Committee and Drug Safety and Risk Management Advisory Committee on July 13–14, 2010, FDA further requested a letter report addressing question 1 of the charge—“What are the ethical and informed consent issues that must be considered when designing randomized clinical trials to evaluate potential safety risks?”—by July 2010. The attached letter report, which has been reviewed in accordance with IOM review procedures, addresses that question.

Sincerely,

Ruth R. Faden

Steven N. Goodman

Cochairs,

Committee on Ethical and Scientific Issues in Studying the Safety of Approved Drugs

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Ethical Issues in Studying the Safety of Approved Drugs: A Letter Report. Washington, DC: The National Academies Press. doi: 10.17226/12948.
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The FDA requested that the IOM examine the ethical and informed consent issues that should be considered when conducting clinical trials to evaluate drug safety. This report outlines when and how the FDA should conduct clinical trials to protect the public's health and the health of trial participants.

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