Minerva

Voting behaviour on FDA committees and other stories . . .

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4241 (Published 03 July 2013) Cite this as: BMJ 2013;347:f4241

The US Food and Drug Administration (FDA) prides itself on the care it takes in selecting advisory committees and in the openness of its decision making process. These decisions can influence clinical practice worldwide. The order in which committee members speak and vote is determined by their seating position. A study in the American Journal of Therapeutics (2013, doi:10.1097/MJT.0b013e31821109d5) looks at the transcripts of Circulatory Systems Devices Panel meetings from 1997 to 2005. The researchers conclude that voting behaviour on FDA expert advisory committees is strongly associated with seating location. Those who speak first tend to swing the vote, which “suggests the presence of a possible social dynamic that is not addressed by existing FDA committee procedures.”

Many other social dynamics can distort medical decision making, and one that often exasperates Minerva is the tendency of doctors to do tests that lead to inappropriate prescribing for healthy people. Finding a serum level of total cholesterol above 6 mmol/L, for example, often elicits a statin prescribing …

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