Only 1 Week until Go Live of EU-Wide Clinical Trials Information System

Remember the Clinical Trials Regulation? Much time has passed since its publication in 2014. No worries if your memory fails you: we have discussed the Clinical Trial Regulation at length in this article appeared on the Indian Law Journal of Law and Technology. If you prefer a shorter summary, you may read here what the European Medicines Agency has prepared for you.

The actual entry into force of the Clinical Trials Regulation depended on confirmation of full functionality of the Clinical Trials Information System (CTIS) through an independent audit, which occurred on April 21, 2021. Now, the go-live date for the CTIS will be on January 31, 2022. Information on the go live planning can be found here.

The Clinical Trials Regulation was born to address the prior directive’s shortcomings, and particularly to target the goals of harmonization and simplification in this field, also with a view of making Europe a competitive region in the global clinical trials market. Good luck to the CTIS: we hope the Clinical Trials Regulation keeps its promises!

Can the Medical Device and Pharma Italian Sectors Be “Influenced”?

Influencers are everywhere these days. Are they allowed to influence patients and doctors in the healthcare sector?

Pharmaceuticals. With regard to pharmaceutical products, the answer appears to be no. In fact, according to section 117 of Legislative Decree No. 219/2006, advertising of medicinal products must not include recommendations from scientists, healthcare professionals or persons widely known to the public.

A minor and partial derogation was allowed by the administrative court of the Lazio Region, which stated that the sole presence of a well-known person, who does not show any preference for a certain medicine nor gives advice, in an advertising message, does not per se trigger the violation of the legislative prohibition.

Medical Devices. A different conclusion can be reached in connection with medical devices.

In fact, the guidelines issued in connection with advertising of medical devices, expressly allow the use of testimonials, provided that (i) the advertisement is authorized by the Italian Ministry of Health, and (ii) the influencer does not express any advice or recommendation, also implicitly, in connection with the device itself.

But what about an influencer, who shares details of a health treatment by posting photos or videos? Is that advertising or freedom of expression?

The IAP (Institution of Advertising Self-Discipline) is starting to reflect upon the borders between advertising messages and private user’s content. A case-by-case analysis should be carried out, taking into account the context, the form of the presentation and the absence of commercial elements, such as trademarks.

Our conclusion. While our entire life seems to be easily influenced, the Italian legislation and case law is committed to shield us from such influence, at least in connection with our health.

Valeria Ramponi / Giulia Titola

Much HEALTH and happy holidays to you all!

As the second year of the pandemic draws to a close, it is easy to find reasons to complain: they sometimes come conveniently arranged in alphabetical order (Delta, Omicron…)!

But we also want to remember the many things we are grateful for: vaccines, for example, but especially your friendship and support in 2021.

May 2022 be a good year to you and your loved ones. May you face 2022 armed with hope, courage, empathy, resilience and joy.

The Gitti and Partners life sciences team.

Facial Recognition Technology: Are We Close to a Turning Point?

When people think about facial recognition technology (“FRT”), they immediately imagine the use of their faces to unlock their smartphones. But this technology is far more complicated, useful and potentially dangerous.

First, it is important to understand the difference among “facial detection”, “facial characterization”, “facial identification” and “facial verification”. Such terms have been defined by the non-profit organization Future of Privacy Forum (https://fpf.org/wp-content/uploads/2019/03/Final-Privacy-Principles-Edits-1.pdf) as follows:

  • Facial detection simply distinguishes the presence of a human face and/or facial characteristics without creating or deriving a facial template.
  • In facial characterization the system uses an automated or semi-automated process to discern a data subject’s general demographic information or emotional state, without creating a unique identifier tracked over time.
  • Facial Identification is also known as “one-to-many” matching because it searches a database for a reference matching a submitted facial template and returns a corresponding identity.
  • The last one, facial verification, is called “one-to-one” verification because it confirms an individual’s claimed identity by comparing the template generated from a submitted facial image with a specific known template generated from a previously enrolled facial image.

There are many possible uses of facial recognition. In the private sector FRT may be used to keep track of employees’ time and attendance, identify shoppers’ patterns inside stores, implement smart homes, etc. In the public sector, FRT may be used to monitor protests, identify suspects in security footage, check claimed identities at borders, etc.

This relatively new technology brings, besides a wide range of possible implementations, significant concerns regarding privacy, accuracy, race and gender disparities, data storage and security, misuse. For instance, depending on the quality of images compared, people may be falsely identified. In addition to that, in its current state, FRT is less accurate when identifying women compared to men, young people compared to older people, people of color compared to white people. Privacy is certainly another concern: without strong policies it is unclear how long these images might be stored, who might gain access to them or what they can be used for; not to mention that this technology makes far easier for government entities to surveil citizens and potentially intrude into their lives (see “Early Thought & Recommendations Regarding Face Recognition Technology”, First report of the AXON AI and policing technology Ethics Board https://www.policingproject.org/axon-fr).

Once the possible implementations and the related risks are understood, the worldwide lack of regulation becomes even more surprising.

Within the European Union, the General Data Protection Regulation obviously applies to FRT. Furthermore, “Guidelines on Facial Recognition” have been released on January 28, 2021 by the Consultative Committee of the Council of Europe with regard to automatic processing of personal data (https://rm.coe.int/guidelines-on-facial-recognition/1680a134f3). This latter document includes:

  • Guidelines for legislators and decision-makers;
  • Guidelines for developers, manufacturers and service providers;
  • Guidelines for entities using FRT;
  • Rights of data subject.

When it comes to Italy, particular attention has been drawn by several decisions of the Italian Data Protection Authority on the topic. Recognizing the innovative potential of FRT as well as its riskiness for individual rights, the Authority adopted a more permissive approach regarding the private sector’s use of FRT, while issuing stricter decisions with regard to the use of FRT by public authorities. For instance, the Authority allowed the use of FRT by police forces for purposes of identifying individuals among archived images, but prohibited real-time surveillance using the same technology (see https://www.garanteprivacy.it/web/guest/home/docweb/-/docweb-display/docweb/9040256 and https://www.garanteprivacy.it/web/guest/home/docweb/-/docweb-display/docweb/9575877). On the other hand, the Authority allowed one airport to implement FRT for purposes of improving efficiency in the management of the flow of passengers, so long as images of individuals were not stored (see https://www.garanteprivacy.it/web/guest/home/docweb/-/docweb-display/docweb/8789277).

The European Commission, in light of the complexity of the situation and the necessity of a strong and harmonised legislative action, presented on April 21, 2021 its “Proposal for a Regulation of the European Parliament and of the Council laying down harmonised rules on artificial intelligence” (https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A52021PC0206). This Proposal was already the subject, on June 18, 2021, of a EDPB and EDPSs’ joint-opinion (https://edpb.europa.eu/our-work-tools/our-documents/edpbedps-joint-opinion/edpb-edps-joint-opinion-52021-proposal_en), in which they called for a general ban on the use of FRT for:

  • Automated recognition of human features in publicly accessible spaces;
  • Categorization of individuals into clusters according to ethnicity, gender, etc., based on biometric features;
  • Inference of individuals’ emotions.

What the European Commission is doing is an example of a more globally widespread legislators’ attitude towards artificial intelligence in general and FRT in particular. These technologies are more and more in our lives and are constantly evolving. Consequently, there is an increasing request, both from public and private subjects, for clear rules to govern this new technology and ensure that individual rights are safeguarded. Hopefully in the next months/years the situation will become clearer.

Flavio Monfrini / Michele Galluccio

Repeal of Patent Linkage in Italy is on the Horizon

The patent linkage is the practice of linking the marketing authorisation of medicinal products, their pricing or reimbursement, or any other generic drug approval, to the patent status of the original reference product.

On 4 November 2021 the Italian Council of Ministers approved the draft law for the market and competition for the year 2021 (the “Draft Law”), by means of which by the end of this year the Italian Government intends to modify, update and renovate the regulatory framework of several critical sectors of the economic life of the country, amongst which energy, transportation, entrepreneurship and healthcare.

With the aim of removing barriers to market entry for generic medicines, the Draft Law inter alia provides for the abolition of the patent linkage, finally bringing Italy, on this point, in line with the EU law and the other European countries.

Indeed, the Draft Law repeals article 11, paragraph 1, of Law no. 189/2012 (the “Balduzzi Decree”), pursuant to which generic drugs cannot be included in the list of the medicines reimbursed by the Italian National Health Service before the expiry date of the patent or of the supplementary protection certificate of the corresponding originator’s product.

Because it establishes a patent linkage, said provision of the Balduzzi Decree is generally held in breach of the EU law, according to which regulatory bodies, when granting a marketing authorisation for a medicine, setting its price, and determining its class of reimbursement, cannot consider the patent coverage, but only the quality, safety, and efficacy of medicines.

In the last decade the Italian association of generic drug manufacturers (Assogenerici), several patient advocacy groups and even the Italian Competition Authority had tried to push the Italian Government to repeal article 11, paragraph 1, of the Balduzzi Decree, but without success. Now, probably also under the EU Commission’s pressures to comply with the requirements it set in the framework of the aids given to Italy to face the economic and social consequences of the Covid-19 pandemic, the Italian Government decided to finally remove the patent linkage.

The purpose of the measure provided by the Draft Law is to allow manufacturers of generic medicines to carry out all the negotiation procedures for price and reimbursement to be ready to enter the market as soon as the patent expires, and so to increase the competition in the healthcare sector.

The Draft Law will be soon submitted to the Italian Parliament, where it will be discussed and where it might be subject to several and significant amendments. We will see whether the abolition of the patent linkage will be eventually approved and will therefore become law.

U.S. vs Italy Healthcare Fraud Laws

I am happy to announce that the article that Marc Raspanti and Pamela Coyle Brecht of Pietragallo Gordon Alfano Bosick & Raspanti, LLP and I have authored has been published in Compliance Today: https://bit.ly/3Cs9HOI , a publication of the Health Care Compliance Association.
This is Part 1 of a three-part series discussing the similarities and differences between the U.S. and Italian healthcare fraud, waste, and abuse laws.
Keep an eye out for Part 2 and Part 3 of this series that will be published in the December and January issues of Compliance Today.