Eric Konnick, MD is an Affiliate Professor within the Genetics and Strong Tumors division of the Division of Laboratory Drugs and Pathology on the College of Washington. He has developed, validated, and verified quite a few manufactured and laboratory-developed exams throughout his 25-year profession. He’s board-certified in Anatomic and Medical Pathology and Molecular Genetic Pathology. Dr. Konnick is an Affiliate Medical Laboratory Director for the Seattle Coronavirus Evaluation Community and was extensively concerned in Emergency Use Authorization regulatory submissions of SARS-CoV-2. He’s Chair of the Skilled Relations committee for the Affiliation for Molecular Pathology, Chair of the CAP Genomic Drugs Committee, and is President of the Washington State Society of Pathologists.
So all perceive, would you please clarify what laboratory-developed exams (LDTs) are and supply examples of a majority of these exams?
First, AMP prefers to make use of the time period laboratory developed testing procedures (LDPs) as an alternative of LDTs since these exams are important scientific companies. LDPs are important laboratory companies which can be designed, developed, validated, carried out, and interpreted by board-certified professionals in regulated scientific laboratories. They’re getting used throughout a variety of purposes together with oncology, uncommon illness analysis, new child screening, infectious illness testing, and extra. Moreover, laboratories usually modify FDA-cleared or accredited check kits to enhance efficiency or develop the utility of the exams to their particular affected person populations. LDPs are usually not commercially manufactured, nor boxed and shipped as medical gadgets, and shouldn’t be regulated that manner. The licensed and board-certified people concerned in utilizing LDPs are extremely educated professionals, not producers.
The proposed rule threatens the flexibility of pros in scientific laboratories to create, adapt, and modify LDPs to fulfill sufferers’ wants, account for provide chain points, mirror advances in scientific understanding and follow requirements, and enhance efficiency traits.
Would you please describe why AMP and different organizations disagree with the FDA’s proposed rule to manage LDTs as medical gadgets?
AMP strongly opposes FDA’s proposal to manage these testing companies as medical gadgets. As detailed in our feedback, (1) the FDA’s proposed adjustments to the definition of an in vitro diagnostic product, and its plan to finish what it refers to as “enforcement discretion,” would lead to laboratory professionals being handled as producers. Laboratory professionals are board-certified healthcare suppliers who develop and rigorously make sure the analytic and scientific validity of their LDPs and who interpret their outcomes throughout the context of accessible affected person scientific data and different related check outcomes. Treating laboratory professionals as product producers is inappropriate and unjustified, and it’ll unequivocally hinder and hurt affected person care.
Do you suppose that present laboratory check validation and high quality administration necessities are ample, or would enhancements by different means be helpful?
AMP and our members have persistently advocated for up-to-date laws and steady high quality enchancment of the sphere. Now we have spent the previous 10 years collaborating with {many professional} societies, affected person advocates, diagnostic corporations, hospitals, educational facilities, impartial laboratories, regulators, and different stakeholders from throughout the nation to assist educate lawmakers on various proposals.
Now we have lengthy maintained that the involvement of appropriately educated and certified laboratory professionals is vital to the event of correct and dependable LDPs, in addition to for proper utilization, interpretation, and applicable utility of molecular check outcomes. The AMP proposal (2) modernizes the present Medical Laboratory Enchancment Amendments (CLIA) regulatory program and supplies assurance of high quality, analytical validity, and scientific validity. Our strategy would supply a much more applicable and environment friendly regulatory framework that ensures entry to obligatory affected person care whereas persevering with to foster speedy innovation and the promise of recent diagnostic applied sciences.
Affected person security has been recognized as a priority with LDTs by the FDA. What are your affected person care issues if these exams should endure FDA overview?
All LDPs needs to be correct, exact, clinically related, and monitored for continued high quality efficiency, and sufferers ought to obtain essentially the most applicable exams and procedures for his or her medical analysis and/or scientific situation. It’s unacceptable when any check doesn’t meet these requirements, and it’s important that this nation continues to have a federal regulatory strategy that works towards making certain that sufferers obtain the suitable and efficient degree of care.
It’s irresponsible of the FDA to make broad claims asserting that LDPs are low high quality and hurt sufferers when, the truth is, the information assist that the overwhelming majority of LDPs produce correct outcomes that efficiently contribute to the administration of affected person care. If there are any systematic issues in regards to the high quality of the vast majority of LDPs used for affected person care, that data can be obtainable primarily based on data acquired by third-party accrediting organizations who should confirm that CLIA requirements are met, check the proficiency of laboratories not less than on a biannual foundation, and report back to CMS when sufferers and/or the general public are in speedy jeopardy because of a laboratory error.
Additionally it is disingenuous to convey to the general public that FDA authorization would deter all hurt, and certainly, no single entity may. It is because of this that AMP as an alternative advocates for a multi-layered strategy the place CLLA, state, and third-party necessities work in live performance with a peer-review-based system and the curiosity of appropriately educated professionals to offer the very best care attainable for his or her sufferers.
The American public noticed firsthand how inappropriate FDA medical laws are for LDPs throughout the early days of the COVID-19 pandemic. FDA enforcement, allowed underneath the Public Well being Emergency declaration, prevented many laboratory professionals from mitigating the flaw within the first check equipment offered by the Facilities for Illness Management and Prevention. FDA’s use of the emergency use authorization course of overwhelmed the company, contributed to testing shortage, and eradicated the chance to instantly comprise and gradual the unfold of this extremely transmissible virus in these vital first weeks of the pandemic on this nation.
This similar entity shouldn’t be chargeable for regulating all LDPs for circumstances starting from infectious illnesses to most cancers.
The shortages within the laboratory workforce are well-known. How may the proposed regulation impression an already overburdened healthcare neighborhood?
If the proposed rule is finalized, there can be quite a few speedy and long-term penalties that might decimate the scientific laboratory neighborhood, disrupt affected person care, and limit coaching alternatives. Hospital-based scientific laboratories might don’t have any selection however to outsource scientific testing. As these facilities are vital for coaching pathologists, residents, medical college students, scientific laboratory scientists, technicians, PhDs, and scientific fellows, there shall be restricted capacity for the way forward for our workforce to be educated in areas which can be vitally necessary to basic laboratory drugs, not to mention personalised drugs. Whereas the consequences shall be felt in each area of america, AMP is particularly involved in regards to the impacts on underserved populations and rural communities that already wrestle with enough staffing by certified personnel.
Concerning molecular diagnostics, the Authorities Accountability Workplace discovered the medical genetic workforce to be fairly restricted with solely roughly 4,700 genetic counselors and 1,240 medical geneticists licensed to offer care in america in 2020. (3) As well as, the GAO experiences a median of solely seven genetic counselors for each 500,000 individuals and solely two medical geneticists per each 500,000 individuals. To handle the looming 20% retirement fee in laboratory personnel, plus the present 13% emptiness fee, over 25 skilled organizations fashioned the Medical and Public Well being Laboratory Workforce Coalition this yr. (4) There are additionally effectively publicized shortages of medical laboratory scientists, histotechs, and laboratory physicians (pathologists). Policymakers must put money into increasing the diagnostic and molecular laboratory workforce to fulfill the calls for of our healthcare system, which is able to solely develop as precision drugs utilization will increase, not implement guidelines that can scale back coaching alternatives for these professionals.
If the FDA’s proposed rule is finalized, it’s probably that the Company, corporations, and different organizations may also be seeking to rent people with laboratory experience to overview submissions and carry out different regulatory features. Given the present shortages and restricted coaching packages, it’s laborious to examine how each the scientific and regulatory features shall be accommodated. Whereas the FDA may rent non-laboratory professionals for some features, that might be a lot much less efficient and environment friendly, and would probably result in quite a few delays.
REFERENCES
(1.) Califf RM. Amp.org. Revealed 2023. Accessed December 19, 2023. https://www.amp.org/AMP/belongings/File/advocacy/AMP_LDT_Proposed_ Rule_Comments_FINAL_12_2_23.pdf?move=49.
(2.) Definitions ” Part 2. Definitions. Amp.org. Accessed December 19, 2023. https://www.amp.org/AMP/belongings/File/advocacy/Amendmentspercent20topercent20CLIApercent20modernizationpercent20legislativepercent20textpercent20 11_7_23percent20FINAL.pdf?move=42.
(3.) U.S. Authorities Accountability Workplace. Genetic companies: Info on genetic counselor and medical geneticist workforces. Gao.gov. Accessed December 19, 2023. https://www.gao.gov/merchandise/gao-20-593.
(4.) Medical and public well being laboratory workforce coalition. Mphlcoalition.org. Accessed December 19, 2023. https://www.mphlcoalition.org/.