Guest Post – Midnight Madness − The FDA Continues To Discount First Amendment Implications Of Restrictions On Off-Label Promotion

This guest post is from Liz Minerd, an associate at Reed Smith. She previously wrote the post on the FDA's off-label promotion meeting last November, so when she indicated that she'd like to write about the FDA's "Midnight Memo" on the same topic, we were only too happy to say "yes." So here is some in-depth analysis of the FDA's rather unusual decision to, in effect, comment on its own meeting. As always, our guest posters deserve all the credit, and any blame, for their efforts.

As this blog reported here, last week—two days before the change in administrations—the FDA released a memorandum entitled "Public Health Interests and First Amendment Considerations Related to Manufacturer Communications Regarding Unapproved Uses of Approved or Cleared Medical Products" available here. The Agency characterizes this 12th hour memorandum as a follow up to the two-day public meeting it held on November 9-10 regarding off-label promotion (or what the Agency refers to as "communications regarding unapproved uses of approved/cleared medical products"). In particular, the Agency claims that it is issuing this memorandum to provide "additional background" in response to frustrations expressed by certain speakers during the November meeting regarding the Agency's failure to adequately address the First Amendment in the public hearing notice.

However, the real purpose of the memorandum appears to be to set forth the Agency's justification for their current restrictions on off-label promotion before a new administration and a new FDA commissioner could have a chance to revisit them. Indeed, after briefly noting the First Amendment concerns raised at the November meeting, the Agency spends the first twenty pages of the memorandum detailing its oft-repeated policy justifications for its current restrictions before addressing any of the First Amendment jurisprudence that has called those restrictions into question. Its attitude is reflected in the memorandum's first case citation—to the dissent in United States v. Caronia, 703 F.3d 149 (2d Cir. 2012). [ Memorandum, at p. 2. fn. 3] The Agency's lengthy policy discussion demonstrates that the outgoing policymakers at the FDA find very little benefit in communications from manufacturers regarding off-label uses even, though it recites that off-label uses can be the standard of care in some circumstances. This attitude, that only the Agency can keep the public sufficiently safe, is classic governmental paternalism...