At the same time, the current approach for monitoring drug quality is generally considered to be obsolete because more active pharmaceutical ingredients (APIs) and drug products are produced and imported from overseas (see sidebar, "Global enterprise"). Janet Woodcock, director of FDA's Center for Drug Evaluation and Research (CDER), told the US House of Representatives' Energy and Commerce Committee (E&C) in May 2008 that inspections alone cannot fully evaluate the capability of manufacturing facilities to generate safe, high-quality products. And "borders can no longer be the first line of defense," said Murray Lumpkin, FDA deputy commissioner for international and special programs, at the Drug Information Association (DIA) annual meeting in June 2008. He explained that US authorities can't "inspect out" bad products at the border, they can only check that quality has been built in to a product during manufacturing.
FDA Commissioner Andrew von Eschenbach acknowledges that the agency will never have enough resources to inspect all facilities frequently enough to catch all safety and quality problems. The commissioner is traveling around the world to promote regulatory cooperation and capacity building and to establish FDA foreign offices better able to monitor local drug production and export activities.Seeking standards
These developments are spurring more collaborative inspection initiatives by regulatory authorities and broader support for systems to ensure the quality and safety of medical products. International standards for good manufacturing practices (GMPs) are in the works, along with risk-based approaches that focus resources on monitoring products that are more likely to harm patients if they are contaminated or compromised. Regulatory authorities are collaborating and sharing information about domestic manufacturers and inspection findings to better target resources at high-risk areas and reduce redundant oversight activities that waste resources. The regulators also want drugmakers to take full responsibility for component and product failures and to increase investments in controls and oversight of foreign suppliers.
The heparin case also has put drug-importation issues high on FDA's priority list. Ranbaxy (Gurgaon, India) recently was hit with charges of fraudulent conduct, fabrication of stability and bioequivalence information, and attempts to conceal GMP violations, stemming from a 2006 inspection of the firm's Paonta Sahib, India, plant. FDA sent the company a Warning Letter, and the US government is suing Ranbaxy to gain access to a full audit report by consultant Parexel. Officials believe the report will document the distribution of adulterated and misbranded products, including antiretrovirals for US international AIDS-treatment programs.