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Author Topic: FDA warns homeopathic manufacturers  (Read 2807 times)

ama

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FDA warns homeopathic manufacturers
« on: October 15, 2013, 07:38:45 AM »

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Consumer Health Digest #13-38
October 10, 2013

Consumer Health Digest is a free weekly e-mail newsletter edited by Stephen Barrett, M.D., with help from William M. London, Ed.D. It summarizes scientific reports; legislative developments; enforcement actions; news reports; Web site evaluations; recommended and nonrecommended books; and other information relevant to consumer protection and consumer decision-making.

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FDA warns homeopathic manufacturers

During the past seven months, the FDA has sent warning letters to at least seven homeopathic marketers. The letters mention:

The FDA's Compliance Policy Guide for homeopathic products states that only products intended solely for self-limiting disease conditions amenable to self-diagnosis (of symptoms) and treatment may be marketed over the counter (OTC).
Products named after a disease (such as "Infant Earache Drops" or "Vaginitis") that requires medical management or marketed with explicit claims (such as "useful for inflammations") that indicate a need for medical management cannot be marketed as OTC drugs.

The companies include

- Dolgencorp Inc. (1 product),
- Homeolab USA, Inc.,
- Insight Pharmaceuticals,
- LLC (1 product),
- MedTech Products (1 Product),
- Natural Medicine Associates (15 products),
- Standard Homeopathic Company (22 products), and
- Topco Associates LLC (1 product).

Standard Homeopathic was warned about faulty manufacturing procedures and 3 other products in 2011.
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Oregon board issues chelation-related warning

The Oregon Medical Board has issued a Statement of Philosophy regarding chelation therapy. The document states:

There is no scientific evidence that chelation therapy is effective for any medical condition other than heavy metal toxicity.
Post-chelator challenge ("provoked") urinary metal testing does not meet the standard of care for diagnosis of heavy metal toxicity.
Chelation should be administered only after making a diagnosis of heavy metal toxicity, which includes (a) a blood test or other accepted unprovoked test confirming the presence of heavy metals and (b) a careful determination that chelation therapy is appropriate for the particular patient.
Provoked testing is accomplished by collecting the specimen after administering a chelating agent that artificially and temporarily raises blood and urine levels.
[Barrett S. How the urine toxic metals test is used to defraud patients. Quackwatch, April 19, 2013] The American College of Medical Toxicology and the American Academy of Clinical Toxicology have jointly warned that "provoked" or "challenge" tests of urine are not reliable means to diagnose metal poisoning and have been associated with harm. The Board's action may have been generated by a case in which an autistic child had received several courses of chelation therapy for nonexistent "lead toxicity" diagnosed with provoked urine testing. The child's doctor escaped discipline, but the board's announcement suggests that, in the future, similar behavior will be considered unprofessional conduct.

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Chiropractic exposé published

Chiropractic Abuse: An Insider's Lament, published by the American Council on Science and Health, presents an insider's view of chiropractic history and education; economic abuse of patients; insurance fraud and abuse; laxness of chiropractic regulation; neck manipulation and stroke; suggestions for reform; how current and prospective patients can protect themselves; and much more. The author, Preston Long, D.C., Ph.D., has practiced chiropractic and served as a consultant to insurance companies for many years. The most unusual portions are Long's experiences as a student and his practical tips for insurance claims examiners. The book was edited by Stephen Barrett, M.D. and has a foreword by former National Council Against Health Fraud president William T. Jarvis, Ph.D. Discounted copies are available through Amazon Books.

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Continuing request for help from Dr. Barrett

In June 2010, Doctor's Data, Inc. sued Dr. Barrett because it didn't like what what he wrote about them on Quackwatch and in this newsletter. The events leading up to the suit are described at
http://www.quackwatch.org/14Legal/dd_suit.html
In November, 2011, about half of the allegations were dismissed, but discovery was permitted for more than a year. The rest of the suit will be ripe for dismissal by the end of this year, but the proceedings have been time-consuming and very expensive. Contributions to the defense fund can be made by mail or through
http://www.quackwatch.org/00AboutQuackwatch/donations.html

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Other issues of the Digest are accessible through
http://www.ncahf.org/digest13/index.html
[...]
=================================

Stephen Barrett, M.D.
Consumer Advocate
Chatham Crossing, Suite 107/208
11312 U.S. 15 501 North
Chapel Hill, NC 27517

Telephone: (919) 533-6009

http://www.quackwatch.org (health fraud and quackery)
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Editor, Consumer Health Digest
http://www.quackwatch.org/00AboutQuackwatch/chd.html
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ama

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  • Posts: 1276
Re: FDA warns homeopathic manufacturers
« Reply #1 on: October 15, 2013, 07:44:55 AM »

Das gucken wir uns doch mal näher an.  8)

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FDA

Inspections, Compliance, Enforcement, and Criminal Investigations
Enforcement Actions
Warning Letters
Enforcement Actions
Warning Letters
2013
 -
Dolgencorp Inc 9/19/13    
Department of Health and Human Services   Public Health Service
Food and Drug Administration
    New Orleans District
404 BNA Drive
Building 200 – Suite 500
Nashville, TN 37217
 
Telephone: (615) 366-7801
FAX:   (615) 366-7802


 
September 19, 2013
 
WARNING LETTER NO. 2013-NOL-19
 
UNITED PARCEL SERVICE
Delivery Signature Requested
 
Todd Vasos, CEO
Dolgencorp, Inc.
100 Mission Ridge
Goodlettsville, Tennessee 37072-2171
 
Dear Mr. Vasos:
 
This letter is to advise you the United States Food and Drug Administration (FDA) has recently reviewed your firm’s labeling and marketing information for the drug product, “Rexall Earache Relief Drops.” Based on our review, the product is in violation of the Federal Food, Drug, and Cosmetic Act (the Act). As described in more detail below, this product is misbranded under Sections 502 and 503 [21 United States Code (USC) 352 and 353] and in violation of Section 301 of the Act [21 USC 331].

 
The label, website, and other labeling demonstrate the intended uses of your product including, but not limited to, the following:
 
The product name, “Rexall Earache Relief Drops”
“Mercurius Solubilis . . . This ingredient addresses inflammation and pain in the inner ear”
“Relieves pain”
“[T]emporary relief from symptoms of earache . . .”
“[ S]timulate the human body’s ability to ease ear pain”
 
Based on these claims, your product is a drug, as defined by Section 201(g)(1)(B) and (C) of the Act [21 USC 321(g)(1)(B) and (C)], because it is intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man, and/or intended to affect the structure or any function of the body.
 
Although marketed to consumers as an over-the-counter (OTC) drug, Rexall Earache Relief Drops is a prescription drug under Section 503(b)(1) of the Act [21 USC 353(b)(1)]. Section 503(b)(1) of the Act [21 USC 353 (b)(1)] identifies criteria for determining the prescription status of a product. The product listed above is a prescription drug within the meaning of Section 503(b)(1) of the Act because it is intended to treat diseases that requires diagnosis and treatment by a physician or is intended to provide treatment for symptoms usually caused by an underlying disease process that requires diagnosis and treatment by a physician. Ear pain (earache) is not a currently recognized OTC indication in the final monograph for topical otic drug products (21 CFR 344) or in any approved OTC new drug application. [1]OTC treatment is inappropriate for ear pain because consumers cannot distinguish its symptoms from those of more serious disorders of the ear or adjacent tissues which are not amenable to OTC treatment and which can lead to serious injury if not accurately diagnosed and treated by a licensed healthcare professional.
 
Because this product is subject to 503(b)(1) of the Act, the product is misbranded under Section 503(b)(4) of the Act [21 USC 353(b)(4)] because the label fails to bear the symbol, “Rx only.”[2]
 
Rexall Earache Relief Drops is also misbranded within the meaning of Section 502(f)(1) of the Act [21 USC 352(f)(1)] because its labeling fails to bear adequate directions for use as that term is defined in 21 Code of Federal Registration Part 201.5. The indication for which the product listed above is labeled and marketed, i.e., treatment of ear pain or inflammation, is not appropriate for OTC use. If an indication requires the supervision of a practitioner licensed to prescribe drugs, adequate directions for use cannot be written for an OTC drug product for that indication.
 
Furthermore, the drug is misbranded within the meaning of Section 502(a) of the Act [21 USC 352 (a)] because its labeling is false or misleading because it represents the product as suitable for use by consumers to treat a condition which the Agency has found not appropriate for OTC drug treatment, and because it encourages OTC treatment for ear pain, but fails to distinguish among conditions that manifest with ear pain and that can lead to serious injury if not accurately diagnosed and treated by a licensed physician.
 
Your marketing of this misbranded product violates Sections 301(a) of the Act [21 USC 331(a)].
 
We recognize your product is labeled as a homeopathic drug with active ingredients measured in homeopathic strengths. The definition of “drug” in Section 201(g)(1) of the Act [21 USC 321(g)(1)] includes articles recognized in the official Homeopathic Pharmacopeia of the United States (HPUS), or any supplement to it. Homeopathic drugs are subject to the same regulatory requirements as other drugs; nothing in the Act exempts homeopathic drugs from any of the requirements related to adulteration, labeling, misbranding, or approval. We acknowledge many homeopathic drugs are manufactured and distributed without FDA approval under enforcement policies set out in the Agency’s Compliance Policy Guide entitled, “Conditions Under Which Homeopathic Drugs May be Marketed (CPG 7132.15)” (the CPG). As its title suggests, the CPG identifies specific conditions under which homeopathic drugs may ordinarily be marketed. Thus, in order to fall under the enforcement policies set forth in the CPG, a homeopathic product must meet the conditions set forth in the CPG. One of those conditions is compliance with Section 503(b) of the Act. Under the CPG, only homeopathic products intended solely for self-limiting disease conditions amenable to self-diagnosis (of symptoms) and treatment may be marketed OTC. Homeopathic products offered for conditions not amenable to OTC use must be marketed as prescription products.
 
The violations cited in this letter are not intended to be an all-inclusive statement of violations that exist in connection with your product. You are responsible for investigating and determining the causes of the violations identified above and for preventing their recurrence or the occurrence of other violations. It is your responsibility to assure that your firm complies with all requirements of federal law and FDA regulations.
 
You should take prompt action to correct the violations cited in this letter. Failure to promptly correct these violations may result in legal action without further notice, including, without limitation, seizure and injunction. Other federal agencies may take this Warning Letter into account when considering the award of contracts.
 
Within fifteen working days of receipt of this letter, please notify this office in writing of the specific steps that you have taken to correct violations. Include an explanation of each step being taken to prevent the recurrence of violations, as well as copies of related documentation. If you cannot complete corrective action within fifteen working days, state the reason for the delay and the time within which you will complete the correction.
 
Your response should be sent to Mr. Mark W. Rivero, Compliance Officer at the above address.  If you have any questions about the content of this letter please contact Mr. Rivero at (504) 832-1290, extension 1103.
 
Sincerely,
/S/
Patricia K. Schafer
District Director
New Orleans District

[1] The question of whether a product intended to treat ear pain should be available by prescription only or OTC is governed by § 503(b) of the FD&C Act, to which all homeopathic drug products are subject. Accordingly, the Agency’s conclusion that treatment or relief of ear pain is not an appropriate OTC indication is applicable to both homeopathic and non-homeopathic drugs marketed for that indication.
[2] The Agency's guidance, “Conditions Under Which Homeopathic Drugs May be Marketed (CPG 7132.15),” states that, in accordance with § 503(b)(1) of the FD&C Act, homeopathic drug products offered for conditions that require diagnosis or treatment by a licensed practitioner must bear the prescription legend, “Caution:  Federal law prohibits dispensing without prescription.”  This guidance was issued by the Agency in 1988.  In 1997, Congress enacted the Food and Drug Administration Modernization Act (FDAMA); Section 126 of FDAMA amended § 503(b)(4) of the FD&C Act to require that the label of a prescription drug must bear, at a minimum, the symbol “Rx only.”
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