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Tales of Avandia:  Evidence, Regulation, and Clinical Practice  Harry M Marks Institute of the History of Medicine Johns Hopkins University Center for Clinical Trials, JHSPH September 1, 2010
 
Avandia Issues ,[object Object],[object Object],[object Object]
Pre-Avandia Issues ,[object Object],[object Object],[object Object],[object Object]
ROAD MAP ,[object Object],[object Object],[object Object],[object Object]
The Spectrum of Diabetes, c 1967 Camerini-Davalos Excerpta Medica (1967)
“ What may be regarded as prediabetic today will later be shown to be a clear manifestation that  the disease is present.” -JW Conn, The Banting Memorial Lecture 1958 Diabetes 7 (1958), 355
The Spectrum of Diabetes, c 1967 Camerini-Davalos Excerpta Medica (1967)
 
Orinase Ad: Annual  Increases in Rx
Oral Hypoglycemic Agents ,[object Object],[object Object],[object Object],[object Object],[object Object]
FDA’s Rules for  Surrogate Endpoints ,[object Object],[object Object],[object Object],[object Object],Federal Register 57 (1992): 58942-58958
1962 Drug Amendments  "No person shall introduce into interstate  commerce any drug,  unless they have  demonstrated whether or not the drug is  safe and effective   for use  under the  conditions prescribed, recommended or  suggested in the proposed labeling thereof."
FDA: Action options ,[object Object],[object Object],[object Object]
“ He said, she said”
Limitations of Nissen meta-analysis ,[object Object],[object Object],[object Object],[object Object]
Limitations of RECORD study ,[object Object],[object Object],[object Object]
 
“ These sponsored [web] links make representations  and/or suggestions about the efficacy of avandia … but fail to  communicate  any  risk information.  This  omission of risk information is particularly concerning as… Avandia [has a] boxed  warning.”   -Michael Sauers [FDA] to GSK, March 26, 2009
GSK’s Proposed Labeling 7/09
Avandia Vote, July 14, 2010 ,[object Object],[object Object],[object Object],[object Object]
“ He said, she said”
Questions  and  Answers

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Evidence, Regulation and Clinical Practice of Avandia

  • 1. Tales of Avandia: Evidence, Regulation, and Clinical Practice Harry M Marks Institute of the History of Medicine Johns Hopkins University Center for Clinical Trials, JHSPH September 1, 2010
  • 2.  
  • 3.
  • 4.
  • 5.
  • 6. The Spectrum of Diabetes, c 1967 Camerini-Davalos Excerpta Medica (1967)
  • 7. “ What may be regarded as prediabetic today will later be shown to be a clear manifestation that the disease is present.” -JW Conn, The Banting Memorial Lecture 1958 Diabetes 7 (1958), 355
  • 8. The Spectrum of Diabetes, c 1967 Camerini-Davalos Excerpta Medica (1967)
  • 9.  
  • 10. Orinase Ad: Annual Increases in Rx
  • 11.
  • 12.
  • 13. 1962 Drug Amendments "No person shall introduce into interstate commerce any drug, unless they have demonstrated whether or not the drug is safe and effective for use under the conditions prescribed, recommended or suggested in the proposed labeling thereof."
  • 14.
  • 15. “ He said, she said”
  • 16.
  • 17.
  • 18.  
  • 19. “ These sponsored [web] links make representations and/or suggestions about the efficacy of avandia … but fail to communicate any risk information. This omission of risk information is particularly concerning as… Avandia [has a] boxed warning.” -Michael Sauers [FDA] to GSK, March 26, 2009
  • 21.
  • 22. “ He said, she said”
  • 23. Questions and Answers