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Federal health advisory committees in the United States meet in public. Public speakers who travel to the Washington, DC, or Baltimore areas to attend meetings of the committees that advise the US Food and Drug Administration (FDA) or the Centers for Medicare & Medicaid Services (CMS) often have ties to companies with a financial stake in the outcome of the deliberations. In this issue of JAMA Internal Medicine, Abola and Prasad1 put numbers on a somewhat predictable finding. They analyze the characteristics of speakers at meetings of the FDA’s Oncologic Drugs Advisory Committee and find that a substantial proportion have financial associations with the company seeking marketing approval for a drug or medical device or an organization that receives financial support from the company.1 Most of the financial ties were disclosed, but not all.
It is understandably challenging to attract public speakers without vested interests to undertake the time, travel, and expense involved in attending a federal health advisory committee meeting. At such meetings, these speakers often tell anecdotal stories that, although informative, require evaluation in the evidence-based framework that is an essential part of advisory committee deliberations. The analysis by Abola and Prasad1 also suggests that advisory committee members and federal health officials should recognize that public speakers represent a nonrepresentative sample of speakers who may be biased toward a favorable view of the drug or medical device that is being discussed.
Comments by patients and public speakers are valuable at federal health advisory committee meetings. They offer an additional perspective to those of the patient representatives, in the case of the FDA, and patient advocates, in the case of the Medicare Evidence Development and Coverage Advisory Committee, who serve as members of the committees. A more robust selection system, however, would improve the objectivity and range of input to the FDA and CMS panels that conduct the agencies’ health advisory committee meetings. The FDA has recently initiated new programs to engage patients and to incorporate patient perspectives into its regulatory evaluations and decision-making.2 The FDA, CMS, and other federal health agencies should supplement public comments with systematic information about patient perspectives on medical products and patient-reported outcomes of their use.
Conflict of Interest Disclosures: Dr Steinbrook was a member of the Medicare Evidence Development and Coverage Advisory Committee from 2010 to 2012.
Steinbrook R. The Financial Associations of Public Speakers at Meetings of Federal Health Advisory Committees. JAMA Intern Med. 2016;176(3):391. doi:https://doi.org/10.1001/jamainternmed.2015.8092
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