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Wednesday, May 8, 2024

New research reports on financial entanglements between FDA chiefs, drug industry

 An investigation published by The BMJ today raises concerns about financial entanglements between US Food and Drug Administration (FDA) chiefs and the drug and medical device companies they are responsible for regulating.

Regulations prohibit FDA employees from holding financial interests in any FDA "significantly regulated organization" and the FDA says it takes  seriously, but Peter Doshi, senior editor at The BMJ, finds that financial interests with the drug industry are common among its leaders.

Doshi reports that nine of the FDA's past 10 commissioners went on to work for the drug industry or serve on the board of directors of a drug company. That includes Margaret Hamburg, who led FDA between 2009 and 2015, but whose story is less well known.

Like her colleagues, Margaret Hamburg had relationships with FDA regulated companies before and after her stint at the FDA's helm, explains Doshi. But unlike her colleagues, Hamburg was allowed to hold  in Renaissance Technologies (RenTec), an exclusive hedge fund managed by her husband's company, which The BMJ has found consistently invested in FDA-regulated drug companies during Hamburg's time at the FDA.

Following a review by the Office of Government Ethics (OGE), and before becoming FDA commissioner, Hamburg pledged to resign from more than 10 non-profit organizations at which she held a senior position and from the board of a health care products supplier company, Henry Schein.

Hamburg's husband, Peter Brown, sold his stock in Johnson & Johnson and Merck, among others, and the couple divested from several fund holdings at RenTec.

But Brown kept his job at RenTec, and they were both allowed to keep their holdings in its flagship product, the Medallion Fund, which according to financial declarations, earned them more than $3 million between 2009 and 2010.

Both the OGE and FDA declined to provide The BMJ with any specifics about Hamburg's relationships with RenTec.

According to an unnamed "administration official" the couple were allowed to retain their holdings in Medallion because the fund is based on programming that "does not allow for human tracking or input except in rare instances."

But the degree to which the algorithm controlling Medallion operated without human input was called into question by a 2014 Senate investigation into the abuse of structured financial products, in which Brown explained that the algorithm was frequently modified by programmers.

Brown did not respond to The BMJ's request for an interview. However, a review of quarterly reports by The BMJ filed during Hamburg's tenure at FDA shows that RenTec held stock in three major drug companies—Amgen, Novo Nordisk, and AstraZeneca—at an average value of $518 million. Across 10 drug companies, the reports indicate average holdings of over $1 billion.

"The facts raise concerns over the adequacy of current rules governing financial holdings by FDA commissioners," writes Doshi.

Hamburg also declined an interview request from The BMJ, but emailed a response through her personal communications agent: "In my capacity as a physician and a government official, I have always taken my ethical obligations very seriously. Prior to my confirmation as FDA commissioner, the US Senate and the Office of Government Ethics (OGE) thoroughly evaluated any potential conflicts, including those that might arise as a result of my husband's position. Those potential conflicts were addressed in signed ethics agreements, and submitted financial disclosure reports were reviewed annually by the OGE during my tenure as commissioner."

More information: Investigation: Revolving doors: board memberships, hedge funds, and the FDA chiefs responsible for regulating industry, The BMJ (2024). DOI: 10.1136/bmj.q975


https://medicalxpress.com/news/2024-05-financial-entanglements-fda-chiefs-drug.html

Biden labor sec could be forcing taxpayers to foot $32B in Cal. jobless fraud: GOP senators

 President Biden’s labor head could be forcing US taxpayers to foot the bill for roughly $32 billion in unemployment fraud she caused when serving during the COVID-19 pandemic as California’s top labor official, Republican senators wrote in a Wednesday letter.

Sens. Bill Cassidy and Mike Crapo expressed concerns in a letter to Labor Secretary Julie Su about December Labor Department guidelines that may “allow California to shift the consequences of a still unknown amount of federal funds that was lost” by its Employment Development Department (EDD) during her tenure.

The $32.6 billion in COVID relief to fraudsters amounts to as much as one third of the total erroneous unemployment insurance payments, according to a Government Accountability Office report last September.

Labor Secretary Julie Su could be forcing US taxpayers to foot the bill for roughly $32 billion in unemployment fraud she caused when serving during the COVID-19 pandemic as California’s top labor official.Kimberly P. Mitchell / USA TODAY NETWORK

That’s more than double the annual budget of the US Department of Labor, the senators noted.

A California State Controller report also found that the state “had inadequate control over its financial reporting for federally funded unemployment insurance benefits,” making it difficult to determine the extent of the fraud.

The guidelines let states determine the extent to which funds lost to fraud are paid back — or waived entirely.

Sens. Mike Crapo (R-Idaho) and Bill Cassidy (R-La.) expressed concerns in a letter to Labor Secretary Julie Su about December Labor Department guidelines that may “allow California to shift the consequences of a still unknown amount of federal funds that was lost” by its Employment Development Department (EDD) during her tenure.Getty Images

Cassidy (R-La.) and Crapo (R-Idaho) said in May 1 testimony before the House Education and Workforce Committee that Su claimed states could only “waive non-fraudulent overpayments.”

“While serving as Secretary for the California Labor & Workforce Development Agency (LWDA), you waived basic fact-checking and fraud prevention requirements for federal pandemic-related unemployment insurance (UI) payments,” the senators wrote.

That decision contradicted US Labor Department guidance, they said, and California’s auditor added that it had made “repeated warnings” to EDD — but the department “did not bolster its fraud detection efforts until months into the pandemic, and it suspended a critical safeguard.” 

Cassidy and Crapo have demanded President Biden’s top labor official answer more than a dozen questions related to California’s process for determining its liability.The Washington Post via Getty Images

EDD ruled that it has taken all “reasonably necessary” steps to recoup the lost funds, making them all but forgiven if the new Labor Department guidelines are approved.

Cassidy and Crapo have demanded Su answer more than a dozen questions related to California’s process for determining its liability.

The Post has reached out to the Labor Department for comment.

https://nypost.com/2024/05/08/us-news/bidens-labor-secretary-could-be-forcing-taxpayers-to-foot-32b-in-unemployment-fraud-she-caused-in-california-gop-senators/

College anti-Israel agitators would be sent to Gaza under new House GOP bill

 A new House Republican bill would send any person charged and convicted for illegal activity on a college campus to Gaza for at least six months.

Rep. Andy Ogles, R-Tenn., introduced the bill on Wednesday alongside Reps. Randy Weber, R-Texas, and Jeff Duncan, R-S.C., in response to the ongoing anti-Israel demonstrations on college campuses across the country.

Several of those protests have turned violent, with clashes between police and activists, as well as hundreds of activists being arrested across multiple campuses.

While Ogles’ bill text does not mention Israel or the anti-Israel groups, it specifically targets unlawful activity on college campuses after Oct. 7, 2023, when Hamas militants invaded Israel in a surprise attack that killed over 1,000 people. 

Those convicted would be forced to serve a minimum six-month community service sentence in Gaza, where Israel is currently waging a brutal campaign to eradicate Hamas and rescue the remaining Israelis that terrorists took hostage in October.

“Students have abandoned their classes to harass other students and disrupt campus-wide activities, including university commencement ceremonies nationwide. Enough is enough,” Ogles told Fox News Digital.

Rep. Andy Ogles, R-Tenn., is leading the new bill.
Rep. Andy Ogles, R-Tenn., is leading the new bill.Getty Images

“That’s why I introduced legislation to send any person convicted of unlawful activity on the campus of an American university since October 7th, 2023, to Gaza to complete a minimum of six months of community service.”

Weber added, “If you support a terrorist organization, and you participate in unlawful activity on campuses, you should get a taste of your own medicine. I am going to bet that these pro-Hamas supporters wouldn’t last a day, but let’s give them the opportunity.”

The bill is likely to face uncertain odds in the House, where Republicans hold a razor-thin majority of just one seat. Even if it passed, the Democrat-controlled Senate will almost certainly ignore it.

It is an example, however, of the heightened tensions wracking the U.S. over Israel’s war with Hamas.

The new bill would send any person charged and convicted for illegal activity on a college campus to Gaza for at least six months.
The new bill would send any person charged and convicted for illegal activity on a college campus to Gaza for at least six months.Melissa Bender/NurPhoto/Shutterstock

The college protests here have garnered bipartisan criticism from virtually all Republicans and a significant number of Democrats, but progressives have continued to show strong support for the students and other activists on campus.

Comments by Rep. Ilhan Omar, D-Minn., for example, referring to some Jewish students as “pro-genocide” have earned her a GOP-led censure resolution, filed by Rep. Don Bacon, R-Neb., on Tuesday.

Her fellow “Squad” member, Rep. Rashida Tlaib, D-Mich., has also been censured for her comments about Israel in the wake of Oct. 7.

https://nypost.com/2024/05/08/us-news/college-anti-israel-agitators-could-be-sent-to-gaza-under-new-house-gop-bill/

Sarepta Seeks Label Expansion, Bigger Market for DMD Gene Therapy

 Sarepta Therapeutics is anticipating full FDA approval and a label expansion for its gene therapy, Elevidys, with the company indicating on its Q1 earnings call last week that a draft label is imminent. But the therapy has come under the microscope regarding its high cost and clinical effectiveness. 

Elevidys, which won accelerated approval for Duchenne muscular dystrophy (DMD) patients aged 4 to 5 in June 2023, has benefited Sarepta economically, pulling in over $200 million in 2023 and another $133.9 million in the first quarter this year. Whether it is of benefit to patients, however, depends on who you ask.

High Demand for Elevidys

DMD is one of the more severe forms of inherited muscular dystrophy, according to the National Institutes of Health. The disease is caused by mutations in the dystrophin gene, leading to muscle fiber degeneration and weakness. Debra Miller, CEO of CureDuchenne, told BioSpace that Elevidys, the first gene therapy for DMD, has been “tremendous” for families enrolled in trials and has demonstrated positive effects for patients.

Michael Kelly, the organization’s chief scientific officer, added that the FDA was “super brave” and made the right decision in giving Elevidys accelerated approval. “There is an enormous appetite in parents whose children are 4 to 5 to get access to this drug, and there is an equally enormous appetite for younger children . . . to get access to this drug. We’ve seen many examples of families that have undergone treatment and [are] seeing real, measurable benefits,” Kelly told BioSpace.

Uy Ear, vice president of U.S. healthcare—biotechnology at Mizuho Securities, told BioSpace that Elevidys’ uptake had been “pretty incredible.” However, Ear said that DMD patients are usually diagnosed at close to five years of age—close to the cutoff for Elevidys. Patients are aging out of the therapy, and Sarepta is essentially running out of patients, Ear said, so a label expansion is needed to get more patients on the treatment and continue the forward momentum. 

Sarepta is looking to expand access to Elevidys to DMD patients without an age restriction or ambulatory status.

According to Ear, if the FDA does grant full approval and a label expansion, the impact will be significant for DMD patients. “Many parents and physicians, in general, believe that you need to treat these patients as early as possible and as quickly as possible, primarily because as each day goes by . . . they lose muscle, and you want to preserve this,” he said.

Kelly added that full approval would allow for an easier pathway for other drugs in the pipeline for DMD to get approved. 

Benefit and Cost of Elevidys Questioned

But while some experts are bullish on approval, others have cited potential drawbacks and concerns about the gene therapy. David Rind, the chief medical officer of the Institute for Clinical and Economic Review (ICER), penned an article in JAMA last week in which he noted that Elevidys missed its primary efficacy endpoint in two studies but still netted approval. 

In briefing documents released prior to the May 2023 advisory committee meeting for Elevidys, the FDA stated that the measurement of levels of micro-dystrophin in the muscle tissue only provided information about the “expression of the transgene product in cells transduced by [the therapy], rather than insight into a pharmacologic effect on a biomarker in the pathway of the disease.” 

While acknowledging its potential, Rind told BioSpace it is too early to determine if micro-dystrophin is an effective biomarker.

“You’d like to know that micro-dystrophin has some effect on Duchenne muscular dystrophy before you call it a surrogate,” he said. “Normally, when we imagine a surrogate, there has been some connection between the thing you’re measuring and an outcome you care about. . . . Here, it’s a brand-new protein with no evidence that it affects the course of Duchenne muscular dystrophy, so it’s not a reasonable surrogate endpoint.”

Rind recommended the FDA insist on a carefully controlled, longer term or larger trial in order to determine if Elevidys is beneficial, “rather than accepting a therapy that failed in its clinical endpoints.”

In the JAMA article, Rind also called out the $3.2 million per dose price tag for the gene therapy as a significant point of contention. He said there is no scheme in the U.S. to deal with pricing issues.

It would be “unfortunate” if the FDA does move forward with an expanded indication, but it seems like a distinct possibility, Rind said.

Kelly said that while he understands the regulatory issues surrounding the therapy, there has been benefit reported by patients and parents. Ear noted that it is still too early to know what major issues or downsides exist with Elevidys, but that no major safety concerns have arisen to date.

“If you believe the videos and the parent reports and the doctor reports of how incredibly effective this gene therapy is, it’s hard to explain why it failed in this clinical trial,” Rind countered. “If it’s that good, why weren’t the primary outcome measures able to show that?”

Sarepta did not immediately respond to a request for comment from BioSpace.

Overall, experts are anticipating that the gene therapy will get across the final finish line, and Kelly said it would be “difficult to swallow” for the DMD community if a full approval and eventual label extension is not granted.

“Give the patient the choice in making the decisions and the treatment options,” Kelly said. “The families and individuals here are particularly well versed of the limitations [of the therapy].”

https://www.biospace.com/article/as-sarepta-s-elevidys-closes-in-on-full-approval-experts-weigh-in/