Monday, April 6, 2009

End of an era for Pap smears?

Read the surprising results of a large-scale cervical cancer trial conducted in India. The New York Times has the story here.  Could this DNA-based assay for HPV spell the end of annual Pap smears in developed countries, and of lower quality cervical cancer tests in resource-poor settings?  If so, it would come as a welcome relief to millions of women, and require a dramatic revision of cancer screening guidelines.   Here's media from the article:


Wide enthusiasm is developing for the new DNA test among gynecologists, patients, and public health workers.   According to Mark Schiffman of the National Cancer Institute who wrote the NEJM editorial accompanying the article, "The implications of the findings of this trial are immediate and global.  International experts in cervical cancer prevention should now adopt HPV testing."

Sunday, April 5, 2009

FDA staffers vent to President

Check out this story about whistle blowing from inside FDA.  Thanks to a tip from PharmaGossip, we've learned of a letter sent by FDA insiders to President Obama on April 2, 2009. You can read the full text of the letter here. The letter was well timed to coincide with the appointment of the FDA's new commisioner, Dr. Margaret Hamburg, who many hope will inaugurate a new era of transparency and accountability at the agency.

The FDA staffers complain of a growing sense of frustration with the 'arbitrary and capricious' decision making at the upper echelons of FDA:
The latest example of wrongdoing was reported on March 23, 2009 from a Federal District Court Judge who ruled that FDA’s decision on the Plan B drug was “arbitrary and capricious because they were not the result of reasoned and good faith agency decision-making.” FDA’s top leaders at the Center for Drug Evaluation and Research (CDER) testified that they “didn’t have a choice, and . . . [weren’t] sure that [they] would be allowed to remain [in their positions if they] didn’t agree” to ignore the science and the law. To the contrary, they should be removed from their positions of authority precisely because they didn’t follow the science and the law. The judge further ruled that there was “unrebutted evidence that the FDA’s [decision] stemmed from political pressure rather than permissible health and safety concerns.” The “improper political influence” and the many “departures from its own policies” reveal that such FDA officials are incapable of ensuring integrity
and science at FDA.
They go on to report concern with the agency's culture of wrongdoing and coverup, saying 'FDA is fundamentally broken':
On January 7, 2009, FDA physicians and scientists wrote to Mr. John Podesta: “Through this letter and your action, we hope that future FDA employees will not experience the same frustration and anxiety that we have experienced for more than a year at the hands of FDA managers because we are committed to public integrity and were willing to speak out. Currently, there is an atmosphere at FDA in which the honest employee fears the dishonest employee, and not the other way around. Disturbingly, the atmosphere does not yet exist at FDA where honest employees committed to integrity and the FDA mission can act without fear of reprisal. … America urgently needs change at FDA because FDA is fundamentally broken, failing to fulfill its mission, and because re- establishing a proper and effectively functioning FDA is vital to the physical and economic health of the nation.”
It's unclear from my vantage point how many of these accusations are merited. But it's certain that at least some FDA employees (names blacked out in the letter, but judging from the size of the text block, appears to be 5-10 individuals) have honest concerns about the agency's current culture and future directions. We're hopeful that the coming weeks will shed more evidence about the mistakes that have been made, and how Dr. Hamburg intends to reinvent FDA with a commitment to institutional integrity.

Radio silence explained

You may have noticed sparse posting on this blog after announcing our newest Board of Directors additions in March.

Yet we've been keeping busy behind the scenes, as we've sharpened our focus on grant-writing and securing stable financing for our project. Here's a recap of some of our achievements last week:
  • We submitted our first grant application to Changemakers.net (an initiative of Ashokha Foundation) and have several more applications in process. In the spirit of full transparency, you can read our grant application in its entirety here.
  • We welcomed Umer Raffat, M.P.H., to Clinical Trials Wiki as our new V.P. of Finance/Strategy.
  • We are beginning an architectural overhaul of the site, expanding our database of publicly accessible clinical trials, and centering our content display and discussion forums around scientific publications from the clinical trial literature.
As you know, we're continuing work on this site alongside our day-to-day lives. Last week I started a rotation at the Brigham's Levine Cardiac Unit, which will keep me busy through the end of April, and am spending my weekends hunting for apartments in Murray Hill. While still mysteriously finding time to write and edit our grants, Brice is traveling France on what promises to be a life-changing trip. And, inspiring the envy of overachieving multi-taskers everywhere, Gaurav is working behind the curtain on technical development after his day job at a venture capital firm.

Please continue to send us your questions or feedback about our ongoing work on the site.