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Do Off-Label Drug Practices Argue Against FDA Efficacy Requirements? Testing an Argument by Structured Conversations with Experts

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Author Info

  • Klein, Daniel

    ()
    (Department of Economics)

  • Tabarrok, Alexander

    ()
    (Department of Economics)

Abstract

The Food, Drug and Cosmetics Act of 1938 with amendments in 1962 is inconsistent regarding FDA certification of a drug’s efficacy. The act requires efficacy certification for the drug’s initial (“on-label”) uses, but does not require certification before physicians may prescribe for subsequent (“off-label”) uses. Are there good reasons for this inconsistency? Using a sequential online survey we carried on a “virtual conversation” with some 500 physicians. The survey asked whether efficacy requirements should be imposed on off-label uses, and almost all physicians said no. It asked whether the efficacy requirements for initial uses should be dropped, and most said no. We then gently challenged respondents asking them whether opposing efficacy requirements in one case but not the other involved an inconsistency. In response to this challenge we received hundreds of written commentaries. This investigation taps the specialized knowledge of hundreds of physicians and organizes their insights into challenges to the consistency argument. Thus, it employs a method of structured conversations with experts to test the merit of an argument. Is the consistency argument a case of “foolish consistency,” or does it hold up even under scrutiny?

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Bibliographic Info

Paper provided by The Ratio Institute in its series Ratio Working Papers with number 28.

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Length: 45 pages
Date of creation: 20 Dec 2003
Date of revision:
Handle: RePEc:hhs:ratioi:0028

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Related research

Keywords: Food and Drug Administration; drug approval; efficacy requirements; off-label uses; on-label uses; certification; liberalization;

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  1. Keith, Alison, 1995. "Regulating Information about Aspirin and the Prevention of Heart Attack," American Economic Review, American Economic Association, vol. 85(2), pages 96-99, May.
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