A Bill To Require Clinical Trial Disclosures

In response to the ongoing controversy over the lack of disclosure of clinical trial data, a Republican Congressman has introduced a bill that would require study results to be reported to ClinicalTrials.gov - the federal repository - regardless of whether the outcome is positive or negative. But there is more. The bill would also withhold federal grant funding to any entity that does not report results - and require repayment as a penalty.

“Public reporting of both positive and negative results will help other research be more effective and less duplicative," says Tom Green, a representative from upstate New York, in a statement in which he emphasizes the goal is to improve cancer research. "Enforcing the reporting requirement will not only lead to more available cancer research data, but also help every taxpayer dollar spent on research go further toward finding a cure.”

The move comes amid a growing fracas about unreported trial data. The Food and Drug Administration Amendments Act requires mandatory reporting of summary clinical trial results within one year of completion on ClinicalTrials.gov, a series of studies published in BMJ reported various problems. For instance, one paper found that only 22 percent adhered to the mandate (back story).

Last month, a pair of academics from the University of Minnesota School of Public Health examined 2,385 completed pediatric studies registered with ClinicalTrials.gov and found that only 29 percent were ever published. And only 53 percent that were financed by the National Institutes of Health were published. And publication that did occur, on average, took place two years after study completion (read this).

The issue has sparked debate about patient safety, the utility of meta-analyses for deciphering safety issues and obligations of drugmakers to physicians and patients. And a growing number of proposals have been suggested, such as creating an “external coordinating organization,” which would be independent and have legal resources to contract with drug and device makers for providing access to patient-level data, documents and case reports (read here).

Although current law requires research results conducted with federal money must be publicly reported, the enforcement mechanism is very weak and as a result not all research is reported, Reed notes in his statement. He adds, by the way, that any violation would also carry another penalty - a grant recipient that does not report trial results will be ineligible for future grants (here is the bill).

Hat tip to FDA Law blog

9 Comments

It is pretty discouraging when trying to find evidence from a payor's perspective and the list of trials completed is long but there are no published results. It provides no reason to approve use that might be justified in a small population and it might be a reason not to consider use at all. Pathway programs promote clinical trial participation but without publication of results there is no way to know if those choices were wise. Publication should justify funding...otherwise there is zero accountability on where the money went.
May 4, 2012 - 4:06pm
If it turns out that ALEC wrote this bill, I will never watch MSNBC again!

Hat tip to the Congressman.

May 4, 2012 - 4:59pm
The Pharma companies will legally rope-a-dope disclosure of unpublished studies they sponsored till the cows come home.

I'm not a lawyer and don't know what the discovery rules are generally for getting unpublished Pharma study data. But could the real benefit of this legislation be to the mal-practice trial attorneys who have an incentive to sniff around for what stinks behind the curtain?

May 4, 2012 - 6:18pm
Since Big Pharma doesn't rely on public funding for its research, I would respectfully tell Rep Green et al to go stick it where the sun don't shine, at least for starters.
May 4, 2012 - 11:10pm
OII-In the Minnesota study that Ed cites, 47% of the unreported studies were funded by the NIH. Is the NIH a division of Abbott?
May 5, 2012 - 11:03am
Maybe it's not such a bad thing if people are cutting back on publishing bs...? Fewer articles to retract...

http://retractionwatch.wordpress.com/

May 6, 2012 - 9:48pm
In some cases, this is another failure of FDA to appropriately regulate. I worked on a cancer product for a few years. All the positive studies are in the clinical study section of the label and they are actively promoted. But there were two much more recent failed studies that got buried. Abstracts and posters only. How is it not misleading to promote all the positive results without mentioning the failed studies. The FDA could force much more disclosure by holding certain promotion misleading if not accompanied by listing the failed studies.
May 7, 2012 - 8:37pm
I think much of this argument presupposes a rational, scientific discussion of the issues, in which all sides are heard and the truth comes out provided that companies would simply release all their data for reanalysis by those with fewer conflicts of interest. I think the reality is that between "publish or perish", academic careerism, and the eternal scrounging for grants, conflicts of interest appear in many forms, and industry has much to fear from academia even in situations in which its hands are clean.

As an example I would point to a pair of publications on Chantix cardiovascular risks one of which came out last year, and the other this last week.

The first publication concluded that that Chantix posed serious cardiovascular risks to all potential users, with a NNH for serious cardiovascular events of 28. The statistical assumptions in this paper, including applying the background rate of serious cardiovascular events in smokers with serious CV disease to a population not having CV disease, were roundly criticized in letters to the editor of the journal that can be seen on the CMAJ website. Nonetheless, the media saavy authors of this paper succeeded in having the conclusions of this paper prominently published in nearly every major news outlet, including this one. A year after its publication, this article still shows up among the first hits in a Google search on the word "Chantix", and more prominently than the more recent article below, which was published within the last week in a more highly regarded journal.

The second meta analysis was published last week. It appeared in BMJ, a first tier journal of the sort that one expects well-conducted studies about the safety of widely used drugs to appear in. There is no mention of this article on this website or that of most other major news sites.

So I'm sure these opinions will not be popular here, but I think its a reasonable issue to point out.

May 7, 2012 - 9:05pm
How lame of me to neglect to mention that the second study reached the opposite conclusion from the first.