Docket Management
Docket: 02N-0209 - Request for Comment on First Amendment Issues
Comment Number: EC -382

Accepted - Volume 6

Comment Record
Commentor Dr. John Weeks Date/Time 2002-09-10 14:34:06
Organization John A. Weeks, MD Family Practice
Category Health Professional

Comments for FDA General
Questions
1. Are there arguments for regulating speech about drugs more comprehensively than, for example, about dietary supplements? What must an administrative record contain to sustain such a position? In particular, could FDA sustain a position that certain promotional speech about drugs is inherently misleading, unless it complies with FDA requirements? Does anything turn on whether the speech is made to learned intermediaries or to consumers? What is the evidentiary basis of such a distinction? promoting prescription drugs direct to consumer is misleading and sometimes frightening to my patients. Simply adding ask your doctor at the end of a 30 second commercial promotes burdensome demands on limited patient education time.
2. Is FDA's current position regarding direct-to-consumer and other advertisements consistent with empirical research on the effects of those advertisements, as well as with relevant legal authority? What are the positive and negative effects, if any, of industry's promotion of prescription drugs, biologics, and/or devices? Does the current regulatory approach and its implementation by industry lead to over-prescription of drugs? Do they increase physician visits or patient compliance with medication regimes? Do they cause patient visits that lead to treatment for under-diagnosed diseases? Does FDA's current approach and its implementation by industry lead to adequate treatment for under-diagnosed diseases? Do they lead to adequate patient understanding of the potential risks associated with use of drugs? Does FDA's current approach and its implementation by industry create any impediments to the ability of doctors to give optimal medical advice or prescribe optimal treatment? reducing the amount spent on TV advertising and reducting the retail cost to the patient would provice far better service to patients than struggling for market share with me too drugs.
3. May FDA distinguish claims concerning conventional foods from those relating to dietary supplements, taking into account limits on claims that can be made about foods in the Nutrition Labeling and Education Act, 21 U.S.C. 301, 321, 337, 343, 371? What must an administrative record contain to sustain or deny claims on food labels? How can information best be presented in a succinct but non-misleading fashion? To what extent do assertions in claims need qualifications or disclaimers added to the label to avoid any misconceptions that consumers may draw? Is there a basis to believe that consumers approach claims about conventional foods and dietary supplements differently? nutritional supplements, herbal supplements, OTC meds and prescription medications should all be held to the same standard of safety and efficacy.
4. Should disclaimers be required to be in the same (or smaller or larger) size of type and given equal prominence with claims? Is there any relevant authority or social science research on this issue? yes
5. How can warnings be made most effective in preventing harm while minimizing the chances of consumer confusion or inattention? Is there any evidence as to which types of warnings consumers follow or disregard? warnings on cigarettes seem particularly ineffective
6. What arguments or social science evidence, if any, can be used to support distinguishing between claims made in advertisements and those made on labels? Does the First Amendment and the relevant social science evidence afford the Government greater latitude over labels? there is much more subliminal content in video and print ads implying happy, attractive, healthy people use this product, etc.
7. Would permitting speech by manufacturer, distributor, and marketer about off-label uses undermine the act's requirement that new uses must be approved by the FDA? If so, how? If not, why not? What is the extent of FDA's ability to regulate speech concerning off-label uses? off label uses should be discussed with the patient's physician
8. Do FDA's speech-related regulations advance the public health concerns they are designed to address? Are there other alternative approaches that FDA could pursue to accomplish those objectives with fewer restrictions on speech? protection of safety is more important than the free marketplace of ideas when it comes to substances people will ingest or give to their children
9. Are there any regulations, guidance, policies, and practices FDA should change, in light of governing First Amendment authority? tobacco restrictions should be greater than current. Conversely all harmful recreational drugs could be allowed the same access to marketing.




EC -382