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Published in: Journal of General Internal Medicine 1/2008

Open Access 01-01-2008 | Perspectives

Who is Responsible for Evaluating the Safety and Effectiveness of Medical Devices? The Role of Independent Technology Assessment

Authors: Mitchell D. Feldman, MD, MPhil, Amy J. Petersen, PhD,MFA, Leah S. Karliner, MD, Jeffrey A. Tice, MD

Published in: Journal of General Internal Medicine | Special Issue 1/2008

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Abstract

Introduction

The global medical technology industry brings thousands of devices to market every year. However, significant gaps persist in the scientific literature, in the medical device approval process, and in the realm of postmarketing surveillance. Although thousands of drugs obtain approval only after review in randomized controlled trials, relatively few new medical devices are subject to comparable scrutiny.

Objective

To improve health outcomes, we must enhance our scrutiny of medical devices, and, without simply deferring to the Food and Drug Administration, we must ask ourselves: Who is responsible for evaluating the safety and effectiveness of medical devices?

Conclusions

Technology assessments by independent organizations are a part of the solution to this challenge and may motivate further research focused on patient outcomes.
Literature
3.
go back to reference Maisel WH. Medical device regulation: an introduction for the practicing physician. Ann Intern Med. 2004;140:296–302.PubMed Maisel WH. Medical device regulation: an introduction for the practicing physician. Ann Intern Med. 2004;140:296–302.PubMed
4.
go back to reference Monsein LH. Primer on medical device regulation. Part I. History and background. Radiology. 1997;205:1–9.PubMed Monsein LH. Primer on medical device regulation. Part I. History and background. Radiology. 1997;205:1–9.PubMed
5.
go back to reference Berenson A, Harris G, Meier B, Pollack A. Despite warnings, drug giant took long path to Vioxx recall. New York Times. 2004;A1:A32 (Nov 14). Berenson A, Harris G, Meier B, Pollack A. Despite warnings, drug giant took long path to Vioxx recall. New York Times. 2004;A1:A32 (Nov 14).
6.
go back to reference Becker C. Drug pullout. Massive recall of Vioxx poses logistical problems. Mod Healthc. 2004;34(42):17. Becker C. Drug pullout. Massive recall of Vioxx poses logistical problems. Mod Healthc. 2004;34(42):17.
7.
go back to reference Oberholzer-Gee F, Inamdar SN. Merck’s recall of rofecoxib—a strategic perspective. N Engl J Med. 2004;351(21):2147–9.PubMedCrossRef Oberholzer-Gee F, Inamdar SN. Merck’s recall of rofecoxib—a strategic perspective. N Engl J Med. 2004;351(21):2147–9.PubMedCrossRef
8.
9.
go back to reference McClellan M. Drug safety reform at the FDA—pendulum swing or systematic improvement? N Engl J Med. 2007;356:1700–2.PubMedCrossRef McClellan M. Drug safety reform at the FDA—pendulum swing or systematic improvement? N Engl J Med. 2007;356:1700–2.PubMedCrossRef
11.
go back to reference Wilensky GR. Developing a center for comparative effectiveness information. Health Aff (Millwood, VA). 2006;25(6):w572–85.CrossRef Wilensky GR. Developing a center for comparative effectiveness information. Health Aff (Millwood, VA). 2006;25(6):w572–85.CrossRef
12.
go back to reference Office of Device Evaluation. Annual report fiscal year 2005: U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration, Center for Devices and Radiological Health. 2005. Office of Device Evaluation. Annual report fiscal year 2005: U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration, Center for Devices and Radiological Health. 2005.
13.
15.
go back to reference Banerjee S, Van Dam J. CT colonography for colon cancer screening. Gastrointest Endosc. 2006;63(1):121–33.PubMedCrossRef Banerjee S, Van Dam J. CT colonography for colon cancer screening. Gastrointest Endosc. 2006;63(1):121–33.PubMedCrossRef
16.
go back to reference Feigal DW, Gardner SN, McClellan M. Ensuring safe and effective medical devices. NEJM. 2003;348(3):191–2.PubMedCrossRef Feigal DW, Gardner SN, McClellan M. Ensuring safe and effective medical devices. NEJM. 2003;348(3):191–2.PubMedCrossRef
17.
go back to reference Kessler L, Richter K. Technology assessment of medical devices at the Center for Devices and Radiological Health. Am J Manag Care. 1998;4:SP129-35.PubMed Kessler L, Richter K. Technology assessment of medical devices at the Center for Devices and Radiological Health. Am J Manag Care. 1998;4:SP129-35.PubMed
21.
22.
go back to reference Food and Drug Administration. Improving patient care by reporting problems with medical devices. Rockville, MD: U.S. Department of Health and Human Services, Food and Drug Administration; September 1997. Food and Drug Administration. Improving patient care by reporting problems with medical devices. Rockville, MD: U.S. Department of Health and Human Services, Food and Drug Administration; September 1997.
23.
go back to reference Food and Drug Administration. Managing risks from medical product use: creating a risk management framework. Report to the FDA Commissioner from the Task Force on Risk Management. Rockville, MD: U.S. Department of Health and Human Services, Food and Drug Administration; May 1999. Food and Drug Administration. Managing risks from medical product use: creating a risk management framework. Report to the FDA Commissioner from the Task Force on Risk Management. Rockville, MD: U.S. Department of Health and Human Services, Food and Drug Administration; May 1999.
24.
go back to reference Sheingold SH. Technology assessment, coverage decisions, and conflict: the role of guidelines. Am J Manag Care. 1998;4:SP117–25.PubMed Sheingold SH. Technology assessment, coverage decisions, and conflict: the role of guidelines. Am J Manag Care. 1998;4:SP117–25.PubMed
25.
go back to reference Maisel WH. Unanswered questions-drug-eluting stents and the risk of late thrombosis. N Engl J Med. 2007;356(10):981–4.PubMedCrossRef Maisel WH. Unanswered questions-drug-eluting stents and the risk of late thrombosis. N Engl J Med. 2007;356(10):981–4.PubMedCrossRef
27.
go back to reference Kessler L, Ramsey SD, Tunis S, Sullivan SD. Clinical use of medical devices in the ‘Bermuda Triangle.’ Health Aff (Millwood). 2004;23(1):200–7.CrossRef Kessler L, Ramsey SD, Tunis S, Sullivan SD. Clinical use of medical devices in the ‘Bermuda Triangle.’ Health Aff (Millwood). 2004;23(1):200–7.CrossRef
28.
go back to reference Farb A, Boam AB. Stent thrombosis redux—the FDA perspective. N Engl J Med. 2007;356(10):984–7 (Mar 8).PubMedCrossRef Farb A, Boam AB. Stent thrombosis redux—the FDA perspective. N Engl J Med. 2007;356(10):984–7 (Mar 8).PubMedCrossRef
29.
go back to reference Harrington RA, Ohman EM. The enigma of drug-eluting stents: hope, hype, humility, and advancing patient care. JAMA. 2007;297(18):2028–30.PubMedCrossRef Harrington RA, Ohman EM. The enigma of drug-eluting stents: hope, hype, humility, and advancing patient care. JAMA. 2007;297(18):2028–30.PubMedCrossRef
30.
go back to reference Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. USA: Institute of Medicine; March 1 2001. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. USA: Institute of Medicine; March 1 2001.
32.
go back to reference Guyatt GH, Rennie D. Users’ guides to the medical literature. JAMA. 1993;270(17):2096–7 (Nov 3).PubMedCrossRef Guyatt GH, Rennie D. Users’ guides to the medical literature. JAMA. 1993;270(17):2096–7 (Nov 3).PubMedCrossRef
33.
go back to reference Dawes M, Summerskill W, Glasziou P, et al. Sicily statement on evidence-based practice. BMC Med Educ. 2005;5(1):1.PubMedCrossRef Dawes M, Summerskill W, Glasziou P, et al. Sicily statement on evidence-based practice. BMC Med Educ. 2005;5(1):1.PubMedCrossRef
34.
go back to reference Oxman AD, Sackett DL, Guyatt GH. For the Evidence-Based Working Group. Users’ guides to the medical literature, I: how to get started. JAMA. 1993;270:2093–5.PubMedCrossRef Oxman AD, Sackett DL, Guyatt GH. For the Evidence-Based Working Group. Users’ guides to the medical literature, I: how to get started. JAMA. 1993;270:2093–5.PubMedCrossRef
35.
go back to reference Lord SJ, Irwig L, Simes RJ. When is measuring sensitivity and specificity sufficient to evaluate a diagnostic test, and when do we need randomized trials? Ann Intern Med. 2006;144(11):850–5.PubMed Lord SJ, Irwig L, Simes RJ. When is measuring sensitivity and specificity sufficient to evaluate a diagnostic test, and when do we need randomized trials? Ann Intern Med. 2006;144(11):850–5.PubMed
36.
go back to reference Tunis SR, Carino TV, Williams RD, Bach PB 2nd. Federal initiatives to support rapid learning about new technologies. Health Aff (Millwood). 2007;26(2):w140–9.CrossRef Tunis SR, Carino TV, Williams RD, Bach PB 2nd. Federal initiatives to support rapid learning about new technologies. Health Aff (Millwood). 2007;26(2):w140–9.CrossRef
37.
go back to reference Sugerman HJ. Summary: consensus conference on surgery for severe obesity. Surgery for obesity and Related Diseases. 2005;1:369–70.CrossRef Sugerman HJ. Summary: consensus conference on surgery for severe obesity. Surgery for obesity and Related Diseases. 2005;1:369–70.CrossRef
39.
go back to reference Tung R, Kaul S, Diamond GA, Shah PK. Narrative review: drug-eluting stents for the management of restenosis: a critical appraisal of the evidence. Ann Intern Med. 2006;144(12):913–9.PubMed Tung R, Kaul S, Diamond GA, Shah PK. Narrative review: drug-eluting stents for the management of restenosis: a critical appraisal of the evidence. Ann Intern Med. 2006;144(12):913–9.PubMed
41.
go back to reference Sackett DL. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest. 1986;89(2 suppl):2S–3S.PubMed Sackett DL. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest. 1986;89(2 suppl):2S–3S.PubMed
42.
go back to reference Schünemann HJ, Jaeschke R, Cook DJ, et al. An official ATS statement: grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations. Am J Respir Crit Care Med. 2006;174(5):605–14.PubMedCrossRef Schünemann HJ, Jaeschke R, Cook DJ, et al. An official ATS statement: grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations. Am J Respir Crit Care Med. 2006;174(5):605–14.PubMedCrossRef
43.
go back to reference Kassirer JP. On the take: how medicine’s complicity with big business can endanger your health. New York: Oxford University Press; 2005. Kassirer JP. On the take: how medicine’s complicity with big business can endanger your health. New York: Oxford University Press; 2005.
44.
go back to reference Boyd EA, Bero LA. Improving the use of research evidence in guideline development: 4. Managing conflicts of interests. Health Res Policy Syst. 2006;4:16.PubMedCrossRef Boyd EA, Bero LA. Improving the use of research evidence in guideline development: 4. Managing conflicts of interests. Health Res Policy Syst. 2006;4:16.PubMedCrossRef
46.
go back to reference Abelson R. Too soon to breathe easy? New York Times; May 4, 2006. Abelson R. Too soon to breathe easy? New York Times; May 4, 2006.
48.
go back to reference Saul S. Profit and questions on prostate cancer therapy. New York Times; December 1, 2006. Saul S. Profit and questions on prostate cancer therapy. New York Times; December 1, 2006.
Metadata
Title
Who is Responsible for Evaluating the Safety and Effectiveness of Medical Devices? The Role of Independent Technology Assessment
Authors
Mitchell D. Feldman, MD, MPhil
Amy J. Petersen, PhD,MFA
Leah S. Karliner, MD
Jeffrey A. Tice, MD
Publication date
01-01-2008
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue Special Issue 1/2008
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-007-0275-4

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