Personal Health

FDA Approved Drugs Despite Fraudlent Testing

A major allergy and respiratory management company knowingly produced flawed clinical trials of FDA approved drugs currently on the market.
A major allergy and respiratory management company knowingly produced flawed clinical trials of FDA approved drugs currently on the market a Texas physician is charging.Trials of Singular, Serevent, Foradil, Flovent, Xolair, Accolate and Xopenex conducted at the Tucson, AZ facility of Vivra Asthma & Allergy were corrupted by protocol violations and outright falsifications says Robert Davidson, MD, a former clinical research subinvestigator at the facility.San Mateo, CA-based Vivra Asthma & Allergy was the nation's largest respiratory disease physician practice until a merger with Lakewood, CO-based Gambro in 1997 and with El Segundo, CA-based DaVita in 2005.In aggressive study subject recruitment schemes in the late 1990's, patients with abnormal EKGs, multiple risk factors for coronary artery disease, arrhythmia, pulmonary embolism and rheumatic fever histories, acute illnesses and even pituitary tumors were enrolled with impunity in trials that earned investigators as much as $10,000 per patient charges Davidson. Patients were "prescreened" for asthma drug trials with medically unnecessary pulmonary function tests (PFTs) without their knowledge or consent and had medication dosages reduced in apparent efforts to qualify them for the lucrative trials.Staff could be seen to enter rooms where placebo and real drugs were mixed, unblinding and invalidating entire studies sent to the FDA as data for new drug applications.The brazen "study buddy" and "cross over" arrangements, as staff referred to them, included churning or serial enrolling of patients into clinical trials despite risks to their health and early terminations, coercing unwilling patients to participate and direct falsification of patient study diaries say documents filed by Davidson in a federal complaint.Millions use expensive asthma drugs "proved" safe in clinical trials and rushed through the FDA only to receive new warnings as they're "tested" on the public.In 2006 the FDA added black box warnings on Serevent and Foradil--tested at Vivra and elsewhere--for increasing the risk of asthma-related death after a large clinical trial revealed such hazards it was stopped. Singulair, also tested at Vivra, is under FDA investigation for suicidal side effects and its warning labeled was strengthened four times in 2007. Raxar, an antibiotic tested at Vivra, was withdrawn altogether in 1999 after links to 13 deaths. What unsafe drugs would look like, many ask.FDA inspections of the Vivra Tucson facility where Jay Grossman, MD served as principal investigator (P.I.) from 1993-2000 confirm the clinical subterfuge."On multiple occasions over the last 8 months the P.I. strongly counseled the S.I. [sub investigator] to NOT mention potential risks of study participation to potential study subjects, (such as arrhythmia, drug-drug interaction, etc.) so as to not 'scare them away'," reads a report from a May 5 though June 28, 1999 FDA inspection obtained underthe Freedom of Information Act."Coordinator stated that subject called to say she could not participate in a 12-hour a day study due to her schedule," the report reads elsewhere. "P.I. called the subjects [sic] estranged husband to say that they had to get the disease under control."Elsewhere in the report a patient is said to have experienced a "severe adverse event" and been hospitalized after being enrolled in a study despite the "clear study exclusion" of maintenance inhaled corticosteroid therapy. The patient had "recently" been used in another Vivra study the report notes.FDA reports from a 1999 inspection at the Tucson Vivra facility also document missing informed consent forms, clinical records changed to minimize alcohol and cigarette consumption and records rewritten, postdated and ripped up by Dr. Grossman according to staff witnesses.Reached by telephone, communications officials at Gambro and DaVita were unable to discuss the trials. Dr. Grossman did not respond to faxed and email messages.Questions have also been raised about the billing procedures of Vivra, which was acquired by Gambro in 1997. Pulmonary function tests were performed on all patients regardless of medical necessity states former Vivra Tucson nurse Joanne Wray in court documents--amounting to a time and money saving gratuity for drug companies, shouldered by insurers, to prevent costly" screening failures" when studies began.In 2000, Gambro agreed to a $40 million settlement for submitting false claims to Medicare, Medicaid and TRICARE and entered into a Corporate Integrity Agreement with the Department of Health and Human Services only to have to agree to another settlement for $350 million in 2004.Yet despite the irregularities and red flags, clinical trials at the Vivra Tucson facility which still appear in the New England Journal of Medicine and the Annals of Internal Medicine, were not stopped by the FDA, institutional review boards, trial sponsors, contract research organizations or the Justice Department. Nor was the facility's clearance to conduct trials revoked.In fact FDA inspections were actually delayed to facilitate the new drug applications the studies were for--like clearing a plane with mechanical problems for takeoff to not hold up travelers. This "safety last" policy is a expected outgrowth of the 1992 Prescription Drug User Fee Act (PDUFA) that allows drug companies to pay the FDA to accelerate approvals, says Davidson."It takes time to obtain a properly administered, formal informed consent with full disclosure of risks and benefits and that slows study-subject recruitment and ultimately, delays the time to obtain market approval from FDA," says Davidson. "It is virtually certain that there have been deaths of US citizens because of the fraudulent or seriously-flawed clinical research PDUFA encourages. Nor is FDA likely to revoke expedited market approvals because that would be tantamount to admitting that they 'goofed.'"When presented with 51 allegations of Vivra's medical wrongdoing in 2000, the Arizona Board of Medical Examiners also did not act, calling the evidence "insufficient to support a violation" of Arizona Revised Statutes.This is not the first time bogus, pay-to-play research, fast tracked through the FDA, that endangers study subjects and the public's health has surfaced. Recently Alabama physician Anne Kirkman Campbell began serving a sentence in a federal prison in Lexington, KY for clinical trials she conducted of the controversial, antibiotic Ketek, linked to liver failures and deaths.Campbell "got greedy" and enrolled her own family, staff and more than one percent of the adult population of the town of Gadsden AL in clinical trials wrote the St. Petersburg Times in 2007.Despite revelations of Campbell's fraud and problems found at other study sites by regulators while the drug was being tested, Ketek sailed through the FDA and was approved on April 1, 2004.
Martha Rosenberg is a columnist and cartoonist who frequently writes about the impact of the pharmaceutical, food and gun industries on public health. A former medical copywriter, her work has appeared in the Boston Globe, San Francisco Chronicle, Los Angeles Times and Chicago Tribune, as well as on the BBC and in the original National Lampoon.