What the Implant Files Are Not Telling

The investigation.  The “Implant Files” is a global investigation carried out by reporters in 36 countries under the lead of the International Consortium of Investigative Journalists (https://www.icij.org/investigations/implant-files/). The project, which attracted significant worldwide attention over the last few weeks as articles and reports were published, purported to show how the medical device industry failed to place on the market safe products and ultimately harmed a significant number patients.

Regrettably the way the investigation has been reported by several media outlets and the conspiracy theories underlying certain articles leave the readers without a clear understanding of the issues on the table and the policies behind the current regulatory framework.

The approval process.  For instance,  while the investigation was conducted globally, many articles published by European consortium members focused their attention on the lack of a centralized authorization procedure for the marketing of medical devices in the EU and argued that a loose regulatory framework enabled manufacturers to sell unsafe devices on the European market.

The absence of a centralized marketing authorization procedure for medical devices in Europe is depicted as a failure of European lawmakers, influenced by the medical device lobby. However, none of the articles reporting on the investigation provides readers – who may not be familiar with the authorization process – a clear and complete picture of the rationale and public healthcare policies behind the current regulatory framework. Most notably, the Implant Files investigation fails to explain the benefits for patients of a faster launch of innovative devices on the market. Neither they show any meaningful and documented difference in terms of patient safety between the EU and the US, where a centralized authorization procedure administered by the FDA is in force. The fact that the investigation concerns the US as much as the rest of the world is probably a good indication that the type of approval procedure does not per se guarantee patients’ safety and an effective healthcare system.

The new regulation.  As to the timing of the investigation, it comes at a moment of transition when the new EU medical device regulation has already been enacted but has not yet begun to unfold its innovative potential in the industry.  Yet, the Implant Files investigation seems to assume that the new regulation will have no impact on the industry and the approval/vigilance system as a whole. The investigation does not really delve into the changes and improvements brought by the new regulation, which has in fact already addressed many of the issues raised by the Implant Files. Among such innovations, new and improved vigilance measures and an increased accountability for notified bodies should be certainly taken into consideration.

Further, the investigation neglects the public discussions and exchanges that occurred throughout the EU (and the world) in the years that preceded the enactment of the new regulation, when the truth is that its provisions have been at the center of the public healthcare discourse for years, have been debated among experts, stakeholders and lawmakers in full transparency, have been reported by newspapers and specialized media. The alleged “scoop” seems a few years late.

The current vigilance system.  Lastly, one of the major flaws of many articles reporting on the investigation is that they give readers the idea that no meaningful vigilance system exists today. This is of course not correct. Italy, for instance, has a long-standing nation-wide register of approved medical devices marketed in its territory kept by the Ministry of Health. The same Ministry transparently shows on its website all safety notices and field actions carried out in Italy. The tool is easily searchable and can be found on the very first page of the medical device directorate’s site. 

Not only the Implant Files investigation failed to accurately report the existing vigilance and transparency measures, but created their own medical device database, allegedly aimed at providing the public with full access to data submitted by patients and reporters. 

Does the Implant Files investigation really benefit patients?  At the moment one cannot but wonder if this project really does provide patients with complete, accurate and independent information that can be useful for their health and wellbeing.

Is a public database, entirely managed by a private consortium, really empowering patients? How the database is managed, how the uploaded information is vetted and updated, for which purposes the uploaded information can be used by patients? Shouldn’t we work on improving a public, transparent system, managed by officers and professionals who have the scientific and regulatory expertise that is needed to address all issues involved, rather than building on a new, uncontrolled and unaccountable tool that could potentially distort patients’ behavior? The media would do a better service to the public opinion by giving a balanced, informative and articulate picture of the facts, rather than spreading sensationalistic news that would make anyone with an implanted device panic (and click on the article!).

 

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