Drugs, Devices, and the FDA: Part 1
Open accessAbstract
Over the last 150 years, the U.S. Food and Drug Administration (FDA) has evolved from a small division of the U.S. Patent Office to 1 of the largest consumer protection agencies in the world. Its mission includes ensuring that new medical treatments reach the public as quickly as possible while simultaneously ensuring that new treatments are both safe and effective. In the face of urgent consumer need, the FDA has faced criticism that its processes are too lengthy and costly and that the time to new drug release is significantly longer in the United States than in other Western countries. Calls from the public to loosen FDA regulations to facilitate more rapid approval of drugs and devices have been countered by the occurrence of patient harm and deaths after some approved drugs have reached the marketplace. New drug and device approval in the United States take an average of 12 and 7 years, respectively, from pre-clinical testing to approval. Costs for development of medical devices run into millions of dollars, and a recent study suggests that the entire cost for a new drug is in excess of $1 billion. For investigators seeking approval for new drugs and devices, FDA processes can be formidable. This 2-part series is intended to provide an overview of the steps involved in bringing new drugs and devices through the FDA process. Part 1 concerns the process of new drug approvals. Part 2 continues with approval of medical devices.
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Combining organ, length of exposure, and sex, PPV between mice and rats hovered around 50%, which is no greater than random chance.
“Combining organ, length of exposure, and sex, PPV between mice and rats hovered around 50%, which is no greater than random chance (12).”
From Limitations of Animal Studies for Predicting Toxicity in Clinical Trials (2019) · cites this paper as [12]
The clinical-trials section discusses animal safety studies as a basis for initial human doses, but does not report predictive values between mice and rats. Searches for PPV, organ, exposure duration, sex, and interspecies toxicity found no passage addressing the claimed approximately 50% result or its comparison with chance. Page numbers were not available in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredOf those, only 60% successfully complete phase I trials.
“Of those, only 60% successfully complete phase I trials (16).”
From Limitations of Animal Studies for Predicting Toxicity in Clinical Trials (2019) · cites this paper as [16]
The ‘Phase I trials’ section describes the purpose and size of these trials but gives no completion rate. I searched the indexed copy for ‘60%’ and Phase I success rates; the Figure 1 caption discusses failure rates generally but does not state that 60% complete Phase I. No page numbers were available for these passages. (LLM, conf=0.73)
Experimental — accuracy not yet measuredReview of 37 chemicals in the U.S. National Toxicology Program concluded that toxicities other than carcinogenesis were not reproducible between rats and mice, between sexes, or compared with historic control animals.
“Review of 37 chemicals studied in the U.S. National Toxicology Program concluded that toxicities other than carcinogenesis were not reproducible between rats and mice, between sexes, or compared with historic control animals.”
From Limitations of Animal Studies for Predicting Toxicity in Clinical Trials (2019) · cites this paper as [12]
The clinical-trials section discusses animal safety studies and single-dose toxicity trials, but not a review of 37 National Toxicology Program chemicals. Searches for that review and for reproducibility across rats, mice, sexes, and historic controls found no passage addressing the claim. (LLM, conf=0.75)
Experimental — accuracy not yet measuredAverage positive predictive value from mouse to rat was 55.3% for long-term studies and 44.8% for short-term studies.
“Average positive predictive value (PPV) from mouse to rat was 55.3% and 44.8% for long-term and short-term studies, respectively.”
From Limitations of Animal Studies for Predicting Toxicity in Clinical Trials (2019) · cites this paper as [12]
The Clinical Trials section discusses animal safety studies and human trial phases, but does not report mouse-to-rat positive predictive values. Searches for both percentages and for mouse-to-rat predictive value in long- and short-term studies found no matching passage in our copy. (LLM, conf=0.75)
Experimental — accuracy not yet measured
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“Had dosing of participants been spread out over several days, reaction of the first subject likely would have led to termination of the trial prior to other participant exposures (37).”
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Cited by
Sorted by citations
Limitations of Animal Studies for Predicting Toxicity in Clinical Trials
Van Norman, G. A. (2019) · JACC: Basic to Translational Science · doi:10.1016/j.jacbts.2019.10.008 · Cited by 709 · see citing works
Self-citationNanoparticle protein corona: from structure and function to therapeutic targeting
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Van Norman, G. A. (2016) · JACC: Basic to Translational Science · doi:10.1016/j.jacbts.2016.06.003 · Cited by 223 · see citing works
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Phase II Trials in Drug Development and Adaptive Trial Design
Van Norman, G. A. (2019) · JACC: Basic to Translational Science · doi:10.1016/j.jacbts.2019.02.005 · Cited by 133 · see citing works
Replacing Animal Testing with Stem Cell-Organoids : Advantages and Limitations
Park, G., Rim, Y. A., Sohn, Y., Nam, Y., & Ju, J. H. (2024) · Stem Cell Reviews and Reports · doi:10.1007/s12015-024-10723-5 · Cited by 92 · see citing works
- Authors
- Van Norman, G. A.
- Venue
- JACC: Basic to Translational Science
- Publisher
- Elsevier BV
- Published
- 2016-04
- Volume
- 1
- Issue
- 3
- Pages
- 170-179
- ISSN
- 2452-302X (ISSN-L)
- PMC
- PMC6113160
- OpenAlex
- W2344408149
- Cited by
- 366
- References
- 4
- Citations by year
- 2026: 29 · 2025: 39 · 2024: 42 · 2023: 40 · 2022: 53 · 2021: 56 · 2020: 47 · 2019: 31 · 2018: 22 · 2017: 5 · 2016: 2
- FWCI
- 34.06
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- JACC Basic to Translational Science (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Health Professions › Health Information Management › Healthcare Regulation
- Health Sciences › Medicine › Physiology › Biomedical Ethics and Regulation
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
- Keywords
- FDA regulatory process, new drug approvals, medical device approval, drug development timelines, drug development costs, drug safety and efficacy, regulatory approval pathways
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