Terminally ill patients should be able to access medication that could help them, regardless of how far along that drug might be in the FDA's in-depth approval process, right? Yes, some states such as Colorado, Missouri and Lousiana have said. They've adopted so-called "right-to-try" laws that gives dying patients access to drugs that have passed only the first stage of the FDA approval process.
Yet these laws — which are modeled on a policy from the libertarian Goldwater Institute — are ultimately useless given that federal law trumps state law, according to Stanford scholars Patricia Zettler, JD, and Henry Greely, JD, in an opinion piece published recently in JAMA Internal Medicine. In addition, the laws are redundant, they write:
Since the late 1980s, patients with serious and terminal conditions have been treated with unapproved medical products. Following sharp criticism from AIDS access about blocking access to potentially effective, but unproved, treatments, as well as congressional intent, the FDA issued regulations that are intended to provide patients with faster access to novel drugs for life-threatening conditions… Although satisfying the agency's requirements may, at first glance, seem onerous, in practice the FDA very rarely rejects requests for expanded access.
Zettler, who formerly worked for the FDA, pointed out a link that is telling: During fiscal year 2012-2013, the FDA received 977 requests for "expanded access" (these requests may include more than one patient, Zettler said). It approved 974 of them.
None of the state or federal laws require a drug company to provide experimental drugs, and Zettler said she knows of only one - NeuralStem, Inc., a Maryland-based company that is developing therapies for central nervous system disorders - that intends to provide drugs under these laws. By skipping the FDA's process, the companies risk angering the FDA, whose favor they need for their drug approval, Zettler told me.
Why then these laws, which are currently also being considered in Michigan, Nevada and Arizona?
Well, Zettler told me, they're political no-brainers. Imagine the political rants: "So-and-so made my mom die faster," or "Joe Baloozabum opposes dying patients" - nope, that doesn't fly inside any Beltway. Many state politicians are also motivated by a "good faith desire to help people," Zettler said.
But she doubts that states have the expert staff needed to evaluate drug applications. And they don't have the legal green-light either, she said, pointing out a recent ruling blocking Massachusetts' attempt to ban a long-acting opiod.
Zettler said the state-based debates simply add a new wrinkle to a discussion that's been percolating for decades.
Previously: No one wants to talk about dying, but we all need to and Asking the hardest questions: Talking with doctors while terminally ill
Photo by Melanie Tata