Physicians and patients expect that when medications are prescribed
correctly for labeled indications and are used as directed, these medications
generally will have beneficial effects and will not cause significant harm.
This confidence in pharmaceutical products reflects trust in the effectiveness
and integrity of the drug approval and monitoring process.
However, the current approval process for drugs and biological agents
in the United States has come under intense scrutiny, most notably because
of concerns about influence from industry. For instance, since adoption of
the 1992 Prescription Drug User Fee Act, which augmented the budget of the
Food and Drug Administration (FDA) by charging “user fees” to
pharmaceutical firms,1 the FDA has received
approximately $825 million in fees from drug and biologic manufacturers from
fiscal years 1993 through 2001.2,3 During
that time, median approval times for standard (ie, “nonpriority”)
drugs decreased from 27 months in 1993 to 14 months in 2001, but as an inevitable
consequence of faster approvals, drug recalls following approval increased
from 1.56% for 1993-1996 to 5.35% for 1997-2001.2 In
addition, an investigation of 18 FDA expert advisory panels revealed that
more than half of the members of these panels had direct financial interests
in the drug or topic they were evaluating and for which they were making recommendations.4
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