Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-25T05:12:29.141Z Has data issue: false hasContentIssue false

Neither protective nor harmonized: the crossborder regulation of medical devices in the EU

Published online by Cambridge University Press:  07 July 2020

Holly Jarman*
Affiliation:
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
Sarah Rozenblum
Affiliation:
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
Tiffany J. Huang
Affiliation:
Columbia University, Department, New York, New York, USA
*
*Corresponding author. Email: [email protected]

Abstract

To what extent does inadequate market regulation contribute to poor health outcomes? A series of prominent scandals involving harmful medical devices has made improving the regulation of these devices an urgent problem for the European Union (EU). This is, however, a specific example of a general phenomenon. The EU remains first and foremost a large and integrated market within which the EU institutions have considerable regulatory authority. Even if there is little EU commitment to a health or social policy agenda, its use of that regulatory authority shapes health care cost and quality and should be understood as health policy. We use data from EU-level and national policy documents to analyse the EU's current regulatory framework for medical devices and assess its likely future efficacy. Despite revising the medical devices directive to require more stringent pre-authorization requirements for high-risk medical devices and improvements in post-market surveillance, the key underlying problems of market fragmentation and patient safety persist. Without strong and consistent support for the implementation of the new directive, the likely result is the status quo, with significant consequences for health in Europe.

Type
Article
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Altenstetter, C (2008) Medical Devices: European Union Policymaking and the Implementation of Health and Patient Safety in France. London: Routledge.Google Scholar
Assemblée nationale (2019) Rapport d'Information déposé en application de l'article 145 du Règlement par la Commission des Affaires sociales, en conclusion des travaux de la mission d'information relative aux dispositifs médicaux et présenté par MM. Julien Borowczyk et Pierre Dharréville, Députés. Paris: Assemblée nationale. Available at http://www.assemblee-nationale.fr/15/rap-info/i1734.asp (6 March 2019).Google Scholar
Cour de Cassation (2018) Première Chambre Civile. Arrêt n° 610 du 10 octobre 2018.Google Scholar
Department of Health (UK) (2011 a) Letter on ‘PIP silicone gel breast implants’ from the Chief Medical Officer, Professor Dame Sally C. Davies. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/215242/dh_132011.pdf (23 December 2011).Google Scholar
Department of Health (UK) (2011 b) Message from Chief Medical Officer about breast implants. Available at https://www.gov.uk/government/news/message-from-chief-medical-officer-about-breast-implants (23 December 2011).Google Scholar
Department of Health (UK) (2012 a) Poly Implant Prothèses (PIP) Breast Implants: Interim Report of the Expert Group. London: Department of Health and Social Care. Available at https://www.nhs.uk/news/2012/01January/Documents/pip-report.pdf (6 January 2012).Google Scholar
Department of Health (UK) (2012 b) Poly Implant Prothèse (PIP) Silicone Breast Implants: Review of the Actions of the Medicines and Healthcare products Regulatory Agency (MHRA) and Department of Health (Howe Report). Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/216537/dh_134043.pdf (14 May 2012).Google Scholar
Department of Health (UK) (2012 c) Poly Implant Prothèse (PIP) Breast Implants: Final Report of the Expert Group (Keogh Final Report). (18 June 2012).Google Scholar
Department of Health (UK) (2012 d) Government Response to the House of Commons Science and Technology Committee Report of Session 2012–13: Regulation of Medical Implants in the UK and EU. (December 2012).Google Scholar
DG Enterprise and Industry (2009) Clinical evaluation: a guide for manufacturers and notified bodies. MEDDEV. 2.7.1 Rev.3.Google Scholar
Doyle-Price, J (2019) House of Commons debate on licensing of medical devices. Hansard 654, Col. 861 (12 February).Google Scholar
European Commission (2012) The Safety of PIP Silicone Breast Implants. Report of the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) (1 February 2012).Google Scholar
European Commission (2013) Preliminary Opinion on the Safety of Poly Implant Prothèse (PIP) Silicone Breast Implants (2013 update). Report of the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) (25 September 2013).Google Scholar
European Commission (2014) SCENIHR – Scientific Committee on Emerging and Newly Identified Health Risks, Scientific Opinion on the Safety of Poly Implant Prothèse (PIP) Silicone Breast Implants (2013 update), Bruxelles: European Commission (12 May 2014).Google Scholar
European Society of Cardiology – ESC (2018) Engaging with the New European Regulatory Landscape for Medical Devices: Challenges and Opportunities. Summary Report. Available at https://www.escardio.org/static_file/Escardio/Advocacy/Documents/ESC%20Medical%20Devices%20Meeting%20summary%20report_Final%2021052018.pdf.Google Scholar
European Union (2013) Implementing Regulation (EU) n°920/2013 of 24 September 2013 on the designation and the supervision of notified bodies under Council Directive 90/385/EEC on active implantable medical devices and Council Directive 93/42/EEC on medical devices.Google Scholar
European Union (2017 a) Regulation 2017/745 on medical devices (EU MDR).Google Scholar
European Union (2017 b) Regulation 2017/746 on in vitro diagnostic medical devices (EU IVDR).Google Scholar
Fahy, Nick, Hervey, Tamara, Dayan, Mark, Flear, Mark, Galsworthy, Mike, Greer, Scott, Jarman, Holly and McKee, Martin (2020) Assessing the potential impact on health of the UK's future relationship agreement with the EU: analysis of the negotiating positions. Health Economics, Policy and Law, 118. doi: http://dx.doi.org/10.1017/S1744133120000171Google ScholarPubMed
FDA (2000 a) Meeting of the General and Plastic Surgery Devices Panel, March 2nd. Official Transcript.Google Scholar
FDA (2000 b) Warning Letter, Poly Implant Protheses. June 22nd.Google Scholar
Greer, SL, Fahy, N, Rozenblum, S, Jarman, H, Palm, W, Elliott, HA and Wismar, M (2019) Everything you always wanted to know about European Union health policies but were afraid to ask.Google Scholar
Hancher, L and Sauter, W (2012) EU Competition and Internal Market Law in the Health Care Sector. Oxford: Oxford University Press.Google Scholar
Heneghan, C (2018) Updated EU Medical Device Regulations: do they make a difference? BMJ EMB Spotlight Blog. (25 November 2018).Google Scholar
Heneghan, C, Thompson, M, Billingsley, M and Cohen, D (2011) Medical-device recalls in the UK and the device-regulation process: retrospective review of safety notices and alerts. BMJ Open 1, e000155.Google ScholarPubMed
Hervey, TK and McHale, JV (2015) European Union Health Law: Themes and Implications. Cambridge: Cambridge University Press.Google Scholar
House of Commons (2018) Sarah Barber, ‘Surgical mesh implants. House of Commons Briefing Paper 8108’. Available at https://researchbriefings.parliament.uk/ResearchBriefing/Summary/CBP-8108 (18 April 2018).Google Scholar
House of Commons Health Committee (2012) PIP Breast Implants and Regulation of Cosmetic Interventions. Sixteenth Report of Session 2010–2012, HC1816, London. Available at https://publications.parliament.uk/pa/cm201012/cmselect/cmhealth/1816/1816.pdf (21 March 2012).Google Scholar
House of Commons Science and Technology Committee (2012) Regulation of medical implants in the EU and UK. Available at https://publications.parliament.uk/pa/cm201213/cmselect/cmsctech/163/16304.htm (17 October 2012).Google Scholar
Hunt, J (2018) Statement on medicines and medical devices safety review. Hansard vol. 636, Col. 166 (21 February 2018).Google Scholar
Hwang, TJ, Sokolov, E, Franklin, JM and Kesselheim, AS (2016) Comparison of rates of safety issues and reporting of trial outcomes for medical devices approved in the European Union and United States: cohort study. BMJ 353, i3323.Google ScholarPubMed
Inspection générale des affaires sociales – IGAS (2018) Audit de la maîtrise des risques sanitaires par l'Agence nationale de sécurité du médicament (ANSM). Tome I: rapport définitif de synthèse (Octobre 2018).Google Scholar
International Consortium of Investigative Journalists -ICIJ, Simon Bowers (2018 a) A global investigation reveals the rising human toll of lax controls and testing standards pushed by a booming industry. Available at https://www.icij.org/investigations/implant-files/medical-devices-harm-patients-worldwide-as-governments-fail-on-safety/ (25 November 2018).Google Scholar
International Consortium of Investigative Journalists – ICIJ, Simon Bowers (2018 b) How lobbying blocked European safety checks for dangerous medical implants (25 November 2018).Google Scholar
Lahiri, A and Waters, R (2006) Logoregional silicone spread after high cohesive gel silicone implant rupture. Journal of Plastic, Reconstructive and Anaesthetic Surgery 59, 885886.Google Scholar
Loi n°2011–2012 du 29 décembre 2011 relative au renforcement de la sécurité sanitaire du médicament et des produits de santé.Google Scholar
McHale, JV (2018) Health law, Brexit and medical devices: a question of legal regulation and patient safety. Medical Law International 18, 195215.Google Scholar
Medical Devices (Amendment etc.) (EU exit) Regulations (2019). (SI 2019/791).Google Scholar
Medical Devices Regulations (2002) (SI 2002 No 618, as amended).Google Scholar
MHRA (2010 a) Medical device alert MDA/2010/025. Available at http://www.mhra.gov.uk/home/groups/dts-bs/documents/medicaldevicealert/con076500.pdf (31 March 2010).Google Scholar
MHRA (2017) Guidance: Notified Bodies for medical devices. [Updated June 2017].Google Scholar
MHRA (2018) Statutory guidance: current MHRA fees. Available at https://www.gov.uk/government/publications/mhra-fees/current-mhra-fees (Updated 3rd August 2018).Google Scholar
National Joint Registry (2019) About Us. Available at http://www.njrcentre.org.uk/njrcentre/About-the-NJR (23 March 2019).Google Scholar
Neerhof, R (2019) The use of conformity assessment of construction products by the European Union and national governments: legitimacy, effectiveness and the functioning of the Union market. In Rott, P (ed.), Certification – Trust, Accountability, Liability. Cham, Switzerland: Springer, pp. 73106.Google Scholar
NHS Digital (2018) Breast and Cosmetic Implant Registry: October 2016 to June 2018 Data Summary. https://files.digital.nhs.uk/05/5C8321/BCIR%20Report.pdf.Google Scholar
Sage, A, Huet, N and Rosnoblet, J-F (2012) Special Report: The French breast implant scandal. Reuters (2 February 2019).Google Scholar
Yukhananov, A (2011) Insight: FDA warned PIP on breast implant safety in 2000. Reuters. December 28th. Available at https://www.reuters.com/article/us-breastimplants-fda/insight-fda-warned-pip-on-breast-implant-safety-in-2000-idUSTRE7BQ03M20111228.Google Scholar