Human Subject Protection; Foreign Clinical Studies Not Conducted Under an Investigational New Drug Application, 22800-22816 [E8-9200]

Agencies

• Food and Drug Administration
• DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 73, Number 82 (Monday, April 28, 2008)]
[Rules and Regulations]
[Pages 22800-22816]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E8-9200]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

21 CFR Part 312

[Docket No. 2004N-0018]


Human Subject Protection; Foreign Clinical Studies Not Conducted 
Under an Investigational New Drug Application

AGENCY: Food and Drug Administration, HHS.

ACTION: Final rule.

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SUMMARY: The Food and Drug Administration (FDA) is amending its 
regulations on acceptance of foreign clinical studies not conducted 
under an investigational new drug application (IND) (non-IND foreign 
clinical studies) as support for an IND or application for marketing 
approval for a drug or biological product. The final rule replaces the 
requirement that these studies be conducted in accordance with ethical 
principles stated in the Declaration of Helsinki (Declaration) issued 
by the World Medical Association (WMA), specifically the 1989 version 
(1989 Declaration), with a requirement that the studies be conducted in 
accordance with good clinical practice (GCP), including review and 
approval by an independent ethics committee (IEC). The final rule 
updates the standards for the acceptance of foreign clinical studies 
not conducted under an IND and helps ensure the protection of human 
subjects and the quality and integrity of data obtained from these 
studies.

DATES: This rule is effective October 27, 2008.

FOR FURTHER INFORMATION CONTACT:
    Janet Norden, Office of Medical Policy, Center for Drug Evaluation 
and Research, Food and Drug Administration, 10903 New Hampshire Ave., 
Bldg. 22, rm. 4200, Silver Spring, MD 20993-0002, 301-796-2270; and
    Stephen Ripley, Center for Biologics Evaluation and Research (HFM-
17), Food and Drug Administration, 1401 Rockville Pike, suite 200N, 
Rockville, MD 20852-1448, 301-827-6210.

SUPPLEMENTARY INFORMATION:

Table of Contacts

I. Background
II. Overview of the Final Rule, Including Changes to the Proposed Rule
    A. Acceptance of Studies
    B. Supporting Information
    C. Waivers
    D. Records
III. Comments on the Proposed Rule
    A. Replacement of the Declaration With GCP
    B. Definition of Independent Ethics Committee
    C. Local Laws and Regulations
    D. Acceptance of Studies
    E. Definition of Good Clinical Practice
    F. IEC Review and Approval
    G. Onsite Inspection
    H. Data From Studies Not Conducted in Accordance With GCP
    I. Supporting Information
1. General Comments
2. Investigator Qualifications and Description of Research Facilities
3. Detailed Summary of Protocol and Results of the Study
4. Names and Qualifications of IEC Members
5. Summary of the IEC's Decision
6. Description of Informed Consent Process
7. Description of Incentives to Subjects
8. Description of Study Monitoring
9. Description of Investigator Training and Signed Written Commitments
    J. Waivers
IV. Implementation
V. Legal Authority
VI. Paperwork Reduction Act of 1995
VII. Environmental Impact
VIII. Federalism
IX. Analysis of Economic Impacts
    A. Objectives of the Final Rule
    B. Background on Current Situation Regarding Foreign Studies
    C. The Final Rule
    D. Costs of the Final Rule
    E. Benefits of the Final Rule
    F. Small Business Impact
1. Nature of the Impact
2. The Affected Industry
3. Alternatives to the Final Rule
4. Outreach
5. Conclusion
    G. References

I. Background

    In the Federal Register of June 10, 2004 (69 FR 32467), we 
published a proposed rule that would revise our regulations in part 312 
(21 CFR part 312) on the conditions under which we will accept non-IND 
foreign clinical studies as support for an IND, a new drug application 
(NDA), or a biologics license application (BLA). As discussed in 
section III.A of this document, we revised the language used to refer 
to an application (other than an IND) that may be supported by non-IND 
foreign clinical studies from ``NDA or BLA'' or ``marketing 
application'' to ``application for marketing approval,'' which we 
define as an application under section 505 of the Federal Food, Drug, 
and Cosmetic Act (the act) (21 U.S.C. 355) or section 351 of the Public 
Health Service Act (the PHS Act) (42 U.S.C. 262), to make it clear that 
the regulation also applies to foreign clinical studies supporting 
abbreviated new drug applications (ANDAs). Previous Sec.  312.120(a) 
stated that we generally accepted for review non-IND foreign clinical 
studies provided they were well designed, well conducted, performed by 
qualified clinical investigators, and conducted in accordance with 
ethical principles acceptable to the world community. With respect to 
such ethical principles, Sec.  312.120(c)(1) stated that for a foreign 
clinical study not conducted under an IND to be used to support an

[[Page 22801]]

IND or application for marketing approval, the study must have been 
conducted in accordance with the ethical principles stated in the 1989 
Declaration or the laws and regulations of the country in which the 
research was conducted, whichever represents the greater protection of 
the individual. Section 312.120(c)(4) set forth the text of the 1989 
Declaration.
    We proposed to replace the requirement that non-IND foreign 
clinical studies be conducted in accordance with ethical principles 
stated in the 1989 Declaration with a requirement that the studies be 
conducted in accordance with GCP. We proposed to define GCP as a 
standard for the design, conduct, performance, monitoring, auditing, 
recording, analysis, and reporting of clinical trials in a way that 
provides assurance that the data and reported results are credible and 
accurate, and that the rights, safety, and well-being of trial subjects 
are protected. GCP also would include review and approval by an IEC 
before initiating a study, continuing IEC review of ongoing studies, 
and obtaining and documenting freely given informed consent of study 
subjects.
    In the preamble to the proposed rule, we provided several reasons 
for our proposed change in requirements for non-IND foreign clinical 
studies. First, we noted that standards for protecting human subjects 
have evolved considerably over the past decade, as evidenced by 
revisions of the Declaration by the WMA's General Assembly and the 
issuance of several documents by the International Conference on 
Harmonisation of Technical Requirements for Registration of 
Pharmaceuticals for Human Use (ICH). We noted that the ICH document 
``E6 Good Clinical Practice: Consolidated Guideline'' (ICH E6), which 
we adopted for use as guidance for industry in 1997 (62 FR 25692, May 
9, 1997), includes a definition of GCP that shares many important 
ethical principles with the 1989 Declaration.\1\ However, we stated 
that the concept of GCP in ICH E6 provides more detail and enumeration 
of specific responsibilities of various parties, including monitoring 
of the trial and reporting adverse events. Although we did not 
specifically incorporate ICH E6 into the proposed revision of Sec.  
312.120, we stated that the standard of GCP that we proposed for Sec.  
312.120 was consistent with that in ICH E6 and was sufficiently 
flexible to accommodate differences in how countries regulate the 
conduct of clinical research and obtain informed consent, while helping 
to ensure adequate and comparable human subject protection.
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    \1\ICH E6 and other FDA guidances adopted from the ICH are 
available electronically at https://www.fda.gov/cder/guidance/
index.htm.
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    Another reason we stated for proposing to revise Sec.  312.120 was 
that the adoption of a GCP requirement for non-IND foreign clinical 
studies would help provide greater assurance of the quality of the data 
obtained from these studies. Although the Declaration states that it is 
unethical to enroll human subjects in poorly designed or conducted 
clinical trials, it does not provide guidance on how to ensure proper 
conduct of trials. We proposed the GCP provisions to help ensure data 
quality and integrity by, among other things, specifying that GCP 
includes providing assurance that data are credible and accurate and 
requiring the submission of information on study monitoring and 
conformance with protocols.
    Finally, we stated that deleting the reference in Sec.  312.120 to 
the Declaration was necessary to eliminate the potential for confusion 
about the requirements for non-IND foreign clinical studies that could 
result from potential revisions of the Declaration. We noted that the 
Declaration is a document that is subject to change independent of FDA 
authority and, therefore, could be modified to contain provisions that 
are inconsistent with U.S. laws and regulations. We further noted that 
although revisions to the Declaration could not supersede U.S. laws and 
regulations, the changes might be confusing for sponsors.
    We received 32 comments on the proposed rule, which we address in 
section III of this document.

II. Overview of the Final Rule, Including Changes to the Proposed Rule

    We are revising our regulations in Sec.  312.120 on the conditions 
under which we will accept as support for an IND or application for 
marketing approval (an application under section 505 of the act or 
section 351 of the PHS Act) a foreign clinical study not conducted 
under an IND.

A. Acceptance of Studies

    Under revised Sec.  312.120(a)(1), we will accept as support for an 
IND or application for marketing approval a well-designed, well-
conducted, non-IND foreign clinical study if it was conducted in 
accordance with GCP and we are able to validate the data from the study 
through an onsite inspection, if necessary.
    Under Sec.  312.120(a)(1)(i), GCP is defined as a standard for the 
design, conduct, performance, monitoring, auditing, recording, 
analysis, and reporting of clinical trials in a way that provides 
assurance that the data and reported results are credible and accurate 
and that the rights, safety, and well-being of trial subjects are 
protected. GCP includes review and approval (or provision of a 
favorable opinion) by an IEC before initiating a study, continuing 
review of an ongoing study by an IEC, and obtaining and documenting the 
freely given informed consent of the subject (or a subject's legally 
authorized representative, if the subject is unable to provide informed 
consent) before initiating a study. (An IEC is defined in Sec.  312.3 
as a review panel that is responsible for ensuring the protection of 
the rights, safety, and well-being of human subjects involved in a 
clinical investigation and is adequately constituted to provide 
assurance of that protection.) GCP does not require informed consent in 
life-threatening situations under limited circumstances, as specified 
in Sec.  312.120(a)(1)(i).
    Section 312.120(a)(2) states that although we will not accept as 
support for an IND or application for marketing approval a study that 
does not meet the conditions in Sec.  312.120(a)(1), we will examine 
data from such a study. We will do so because we require the submission 
of such data under applicable regulations for drugs and biologics 
(e.g., Sec. Sec.  314.50, 314.80, 600.80, 601.2 (21 CFR 314.50, 314.80, 
600.80, 601.2)) and because the data may have a bearing on the safety 
of a drug.

B. Supporting Information

    The final rule revises the regulations on the information that a 
sponsor or applicant who wishes to rely on a non-IND foreign clinical 
study to support an IND or application for marketing approval must 
submit to us to demonstrate that the study conformed to GCP. In 
response to comments, we revised Sec.  312.120(b) to make clear that a 
sponsor or applicant is not required to duplicate information already 
submitted in the IND or application for marketing approval. Instead, 
the sponsor or applicant may either submit the supporting information 
listed in Sec.  312.120(b) or provide a cross reference to another 
section of the submission where the information is located (see comment 
21 of this document).
    Under Sec.  312.120(b), the sponsor or applicant must submit the 
information described in paragraphs (b)(1) through (b)(11). In response 
to comments, we changed the information requirements in Sec.  
312.120(b)(6) and (b)(11) of the proposed rule as noted in the 
following description. Under Sec.  312.120(b), the

[[Page 22802]]

sponsor or applicant must submit the following information:
     The investigator's qualifications (Sec.  312.120(b)(1)).
     A description of the research facilities (Sec.  
312.120(b)(2)).
     A detailed summary of the protocol and study results and, 
if we request, case records or additional background data (Sec.  
312.120(b)(3)).
     A description of the drug substance and drug product, 
including the components, formulation, specifications, and, if 
available, the bioavailability of the drug product (Sec.  
312.120(b)(4)).
     Information showing that the study is adequate and well 
controlled (if the study is intended to support the effectiveness of a 
drug product) (Sec.  312.120(b)(5)).
     The name and address of the IEC that reviewed the study 
and a statement that the IEC meets the definition in Sec.  312.3 
(records supporting the statement, including the names and 
qualifications of IEC members, must be maintained by the sponsor or 
applicant and be available for agency review) (Sec.  312.120(b)(6)). 
(The proposed rule would have required submission to FDA of the names 
and qualifications of the IEC members that reviewed the study (see 
comment 25 of this document).)
     A summary of the IEC's decision to approve or modify and 
approve the study, or to provide a favorable opinion (Sec.  
312.120(b)(7)).
     A description of how informed consent was obtained (Sec.  
312.120(b)(8)).
     A description of what incentives, if any, were provided to 
subjects to participate (Sec.  312.120(b)(9)).
     A description of how the sponsors monitored the study and 
ensured that the study was consistent with the protocol (Sec.  
312.120(b)(10)).
     A description of how investigators were trained to comply 
with GCP and to conduct the study in accordance with the study 
protocol, and a statement on whether written commitments by 
investigators to comply with GCP and the protocol were obtained (any 
signed commitments must be maintained and available for agency review) 
(Sec.  312.120(b)(11)). (The proposed rule would have required sponsors 
and applicants to submit copies of any written commitments (see comment 
32 of this document).)

C. Waivers

    The final rule includes a provision (Sec.  312.120(c)) under which 
a sponsor or applicant may request that we waive any requirement in 
Sec.  312.120(a)(1) or (b).

D. Records

    In response to comments, we included in the final rule a provision 
on record retention requirements. Section 312.120(d) states that a 
sponsor or applicant must retain the records required by Sec.  312.120 
for 2 years after the agency's decision on an application for marketing 
approval for a drug or, if a study is submitted in support of an IND 
but not an application for marketing approval, for 2 years after the 
submission of the IND. The requirement to maintain appropriate records 
was implicit in the requirement, in proposed Sec.  312.120(a)(1)(ii), 
that FDA be able to validate the data from a study through an onsite 
inspection if necessary, and under the proposed rule, the record 
retention requirements of Sec.  312.57(c) would have applied to non-IND 
foreign clinical studies. However, we have concluded that it is 
appropriate to set forth record retention requirements specifically for 
these studies in Sec.  312.120(d) (see comment 24 of this document).

III. Comments on the Proposed Rule

    We received 32 comments on the proposed rule. Comments were 
received from manufacturers, trade associations, advocacy groups, 
foreign bioethics organizations, and individual health care providers, 
researchers, and consumers. Summaries of the comments received and our 
responses follow:

A. Replacement of the Declaration With GCP

    Section 312.120(a)(1)(i) of the proposed rule stated that we would 
accept as support for an IND or application for marketing approval a 
well-designed and well-conducted foreign clinical study not conducted 
under an IND if the study was conducted in accordance with GCP. The 
requirement for conducting a study in accordance with GCP would replace 
the former requirement in Sec.  312.120(c)(1) that such a study be 
conducted in accordance with the ethical principles stated in the 1989 
Declaration or the laws and regulations of the country in which the 
research was conducted, whichever represents the greater protection of 
the individual.
    At our own initiative, we revised the language used to refer to an 
application (other than an IND) that may be supported by non-IND 
foreign clinical studies to ``application for marketing approval'' 
instead of ``NDA or BLA'' or ``marketing application.'' Under Sec.  
312.120(a)(1), we further clarified that an ``application for marketing 
approval'' means ``an application under section 505 of the act or 
section 351 of the * * * PHS Act.'' Applications for marketing approval 
under section 505 of the act include both NDAs and ANDAs. The phrase 
``application for marketing approval'' tracks the language used in 
previous Sec.  312.120. We made these revisions to avoid speculation 
that this final rule differed in scope from previous Sec.  312.120, 
which was not our intention.
    (Comment 1) Several comments expressed support for adoption of the 
GCP requirement and deletion of the reference to the Declaration, for 
the following reasons:
     The proposed changes are appropriate measures to improve 
public assurance of the quality of the science and ethics supporting 
data for non-IND studies.
     Relying on GCP reflects the adoption of ICH E6 as a global 
standard for the conduct of sponsored clinical research.
     The 13 principles of GCP set forth in ICH E6 are very 
encompassing and are in line with the guidelines used for domestic 
studies.
     The principles of the Declaration are within GCP and form 
the basis for the ethical considerations in those guidelines.
     The change from the Declaration to GCP would update the 
standards for the acceptance of foreign studies and help ensure the 
quality and integrity of data obtained from such studies.
     Applying GCP standards to foreign studies not conducted 
under an IND brings logical symmetry with FDA regulation of studies 
conducted in the United States and ends the need to comply with the 
strict wording of the Declaration, which lacks the detail needed to 
describe usefully the intended compliance.
     The proposal to rely on GCP is a more coherent approach to 
the multitude of complex issues that arise in overseas research than 
the Declaration provides.
    (Response) We agree with the comments stating that the requirement 
to conduct studies in accordance with GCP will ensure that these 
foreign studies will be conducted in a manner that is comparable to 
that required for domestic studies conducted under an IND. We also 
agree that the principles of the Declaration are reflected in the 
concept of GCP codified in Sec.  312.120(a)(1)(i). We also agree with 
the comment that application of the GCP standard will protect human 
subjects while also enhancing the quality and integrity of data 
generated in these foreign studies.

[[Page 22803]]

    (Comment 2) One comment recommended that we give attention to the 
current development of international standards for the ethical review 
of clinical studies, including the work done by the Office for Human 
Research Protections (OHRP) (of the U.S. Department of Health and Human 
Services), the European Forum for GCP, the World Health Organization 
(WHO), and the Strategic Initiative for Developing Capacity in Ethical 
Review.
    (Response) We agree that it is important for us to monitor the 
development of international standards for the ethical review of 
clinical studies. However, for purposes of determining whether data 
from non-IND foreign clinical studies can be used in support of an IND 
or application for marketing approval under Sec.  312.120, we have 
concluded that it is appropriate to require that these studies be 
conducted in accordance with GCP for the reasons stated in section I of 
this document. Although the international standards noted by the 
comment are important, they are not legally binding on sponsors and 
applicants under Sec.  312.120, and incorporating these standards into 
our regulations would present the same problems as codifying a 
reference to the Declaration, as explained in our response to comment 4 
of this document.
    (Comment 3) Several comments opposed the proposal to delete the 
reference to the Declaration in Sec.  312.120. Several comments stated 
that the Declaration represents the international standard or paradigm 
for the ethical conduct of clinical studies and the protection of human 
subjects. One comment stated that the Declaration is a living document 
that remains extremely influential and forms the substance of what 
people understand as the guiding principles of ethical research.
    (Response) As stated in the preamble to the proposed rule, we 
believe that our GCP standard will ensure adequate protection of human 
subjects while providing the flexibility necessary to accommodate 
differences in how countries regulate clinical research and obtain 
informed consent. We acknowledge the prominence of the Declaration 
among international standards on the treatment of human subjects in 
medical research, but other national and international ethical 
guidelines for research, such as the Belmont Report and guidelines 
issued by the Council for International Organizations of Medical 
Sciences, also are important.
    The U.S. Government continues to support the Declaration's 
underlying principles. However, as discussed in our response to comment 
7 of this document, the U.S. Government does not fully support the 2000 
version of the Declaration because it contains certain statements that 
may be inconsistent with U.S. law and policy (e.g., concerning use of 
placebos in clinical trials). We believe that the requirement to 
conduct non-IND foreign studies in accordance with GCP, which includes 
a requirement to protect the rights, safety, and well-being of 
subjects, ensures adequate protection of subjects without a need for 
reference to the Declaration.
    (Comment 4) Four comments stated that our statement in the proposed 
rule that the Declaration can be modified independent of FDA authority 
does not provide a basis for deleting the Declaration. These comments 
stated that we acknowledged that revisions to the Declaration could not 
supersede U.S. laws and regulations. These comments added that FDA 
declared in 2001 (in our guidance on ``Acceptance of Foreign Clinical 
Studies'') that the reference to the Declaration in FDA regulations was 
to the 1989 version. One comment stated that the possibility that the 
40-year-old Declaration might become inconsistent with U.S. ethics 
regulations is minimal.
    (Response) The comments appear to misunderstand our statements 
concerning the effect of modification of the Declaration. As we stated 
in the preamble to the proposed rule, the Declaration was not 
established under our authority and is subject to change independent of 
our control. We proposed to remove from the regulations the 1989 
Declaration, which, because it was not the most recent version approved 
by the WMA, had the potential to cause confusion about the requirements 
for non-IND foreign clinical studies. The potential for confusion may 
increase with each subsequent revision of the Declaration. Moreover, 
initiating a rulemaking to revise Sec.  312.120 each time the 
Declaration is changed would be burdensome and would not be possible if 
the changes were inconsistent with U.S. law and policy. For these 
reasons, the comments' statements regarding modification of the 
Declaration do not support retaining a reference to the Declaration in 
Sec.  312.120.
    (Comment 5) One comment stated that eliminating the reference to 
the Declaration would damage international medical ethics and undermine 
the human rights approach and traditional foundations of research 
ethics in the Declaration, the Nuremberg Code, and the Universal 
Declaration of Human Rights. One comment stated that deleting the 
reference to the Declaration might send a message that FDA no longer 
supports high standards of ethics in research involving human subjects 
in foreign countries. One comment stated that the policy of 
unilaterally deciding not to rely on one of the most respected ethical 
documents is worrying. One comment stated that dismissing the relevance 
of the Declaration would encourage every other country to do the same.
    (Response) We disagree with these comments. We remain firmly 
committed to protecting the rights, safety, and well-being of subjects 
in both foreign and domestic research, and this commitment is reflected 
in Sec.  312.120, our IND regulations, and our guidance documents, 
including ICH E6. We do not believe that deleting the reference to the 
Declaration in Sec.  312.120 will damage international medical ethics 
or result in harm to research subjects because sponsors and applicants 
will need to comply with GCP, which includes protection of human 
subjects. It is also worth noting that the United States is not alone 
in declining to adopt the Declaration as the standard to apply. For 
example, the European Union (EU) recognizes the importance of the 
Declaration, noting in Directive 2001/20/EC on the implementation of 
GCP in the conduct of clinical trials that the ``accepted basis for the 
conduct of clinical trials * * * is founded in the protection of human 
rights and the dignity of the human being with regard to the 
application of biology and medicine, as for instance reflected in the 
1996 version of the Helsinki Declaration.'' Nevertheless, Directive 
2001/20/EC does not incorporate the Declaration in the articles of the 
directive. Similarly, we do not believe that codification of the 
Declaration in our regulations is needed to ensure that foreign studies 
used to support U.S. drug applications are conducted in accordance with 
high ethical standards.
    (Comment 6) Several comments stated that they preferred the 
Declaration over GCP (as described in ICH E6) as a standard for ethical 
principles. Several comments stated that the Declaration is produced by 
the WMA, which is comprised of 82 national medical associations, 
whereas ICH documents are the product of the regulatory authorities and 
pharmaceutical industries of the United States, the EU, and Japan. One 
comment stated that the Declaration is independent of any one nation 
and represents a consensus, albeit sometimes uneasy, between many 
different parties with many diverse interests. One comment stated that 
the ethical principles in the 2000

[[Page 22804]]

Declaration were produced under an international and democratic process 
conducted by the WMA. One comment stated that it is improper for FDA to 
dismiss the views of the academicians, researchers, and clinicians who 
comprise the WMA and who have adopted the Declaration provisions.
    (Response) Although we appreciate the significance of the 
Declaration, we do not agree that the manner in which it was adopted 
makes it the most appropriate standard for the conduct of clinical 
studies. In fact, our regulations do not require that studies conducted 
in the United States under an IND be conducted in accordance with the 
Declaration. Furthermore, although we have not incorporated ICH E6 into 
our regulations (see comment 9 of this document), we disagree with the 
comment's characterization of the process for developing ICH 
guidelines. Twenty-seven countries (the United States, Japan, and the 
25 member-states of the EU) participate in the ICH process, and Canada, 
Switzerland, and the WHO are observers. In addition to input from 
regulatory authorities and drug manufacturers, there is considerable 
opportunity for public health organizations, consumers, researchers, 
academicians, and others to comment publicly on proposed ICH 
guidelines, both before their adoption at the international level and 
before they are incorporated into the regulatory framework of 
individual ICH countries. Finally, by deleting the reference to the 
Declaration, we are not dismissing the views of WMA members regarding 
the protection of human subjects. Instead, we simply conclude that it 
is most appropriate and effective to ensure that studies are properly 
conducted by requiring compliance with GCP, as defined in Sec.  
312.120(a)(1)(i).
    (Comment 7) In objecting to the deletion of the reference to the 
Declaration, several comments cited the United States' objection to 
paragraphs 29 and 30 of the version of the Declaration adopted in 2000 
(paragraphs 29 and 30). Paragraph 29 states: ``The benefits, risks, 
burdens and effectiveness of a new method should be tested against 
those of the best current prophylactic, diagnostic, and therapeutic 
methods. This does not exclude the use of placebo, or no treatment, in 
studies where no proven prophylactic, diagnostic or therapeutic method 
exists.'' Paragraph 30 states: ``At the conclusion of the study, every 
patient entered into the study should be assured of access to the best 
proven prophylactic, diagnostic and therapeutic methods identified by 
the study.'' Several comments were critical of the United States' 
objection to paragraphs 29 and 30 and expressed concern about its 
impact on research subjects. On the other hand, one comment expressed 
opposition to paragraphs 29 and 30.
    (Response) Compliance with the GCP standard will ensure adequate 
protection of human subjects in foreign clinical studies while 
accommodating differences in local authorities' regulation of these 
studies. As stated in our response to comment 3 of this document, we 
cannot endorse the 2000 version of the Declaration. We believe that 
paragraph 29 is inconsistent with U.S. law and policy because it would 
impose a standard for the design of clinical trials that is different 
from the standard of ``adequate and well-controlled investigations,'' 
which the act requires us to apply. Paragraph 30 invokes issues of 
health care policy that are not directly related to FDA's mission of 
ensuring that medical products are safe and effective. In addition, we 
do not believe that this rulemaking is the proper forum for debating or 
resolving issues concerning particular paragraphs of the Declaration, 
such as use of placebo controls or continued access to therapy after a 
study is concluded.
    (Comment 8) Several comments stated that deletion of the reference 
to the Declaration will have an adverse impact on the populations of 
developing countries, who are vulnerable to abuse, exploitation, and 
negligence because of their relative poverty and lack of education. One 
comment stated that the proposed rule is consistent with FDA's 
purported purpose of weakening items in the Declaration related to 
protection of human subjects in developing countries. One comment 
stated that deletion of the Declaration would imply that FDA believes 
that non-U.S. study populations do not need access to study results or 
that non-U.S. populations could be studied and put at risk only to 
identify medical products that would benefit the U.S. population.
    (Response) We do not agree that deleting the reference to the 
Declaration will have a negative impact on research subjects in 
developing countries or result in less protection for subjects in 
foreign studies. Human subject protection is essential to GCP as 
defined in revised Sec.  312.120, which, among other things, requires 
the protection of the rights, safety, and well-being of trial subjects, 
and review and approval of studies by an IEC. We do not believe that 
referencing the Declaration in our regulations would provide additional 
protection to the populations of developing countries beyond the 
protections set forth in revised Sec.  312.120.
    (Comment 9) Several comments stated that ICH E6 is concerned 
primarily with procedural and technical issues, not overarching ethical 
issues. One comment stated that GCP does not encompass the range of 
concerns about the protection of human subjects that is provided for in 
the Declaration. One comment stated that while the Declaration focuses 
on researchers' ethical conduct and the primacy of patient welfare, ICH 
E6 focuses on the relations between researchers and pharmaceutical 
sponsors. One comment stated that ICH E6 is designed to improve data 
quality but is unconcerned with ethics.
    (Response) We disagree with the comments. Most importantly, we note 
that the definition of GCP contained in Sec.  312.120 is the standard 
that will apply to these studies, rather than the procedures set forth 
in ICH E6. The regulation requires, among other things, that the 
rights, safety, and well-being of subjects be protected, that an IEC 
review and approve (or provide a favorable opinion on) each study 
before initiation, and that subjects give informed consent.
    As for ICH E6 itself, protecting the interests of human subjects is 
one of its two fundamental purposes, along with helping to ensure the 
quality of data from clinical studies. The first paragraph of the 
introduction to ICH E6 states that compliance with GCP ``provides 
public assurance that the rights, safety, and well-being of trial 
subjects are protected, consistent with the principles that have their 
origin in the Declaration of Helsinki, and that the clinical trial data 
are credible'' (p. 6). In addition, the first principle of GCP listed 
in ICH E6 (section 2.1) is that ``[c]linical trials should be conducted 
in accordance with the ethical principles that have their origin in the 
Declaration of Helsinki, and that are consistent with GCP and the 
applicable regulatory requirement(s)'' (p. 8). Sections 3.1 and 4.3/4.8 
of ICH E6 address the responsibilities of institutional review boards 
(IRBs)/IECs and investigators, respectively, concerning matters related 
to the care and treatment of research subjects,\2\ including provisions 
on informed consent and medical care of subjects. Thus, although ICH E6 
does address procedural issues, ethical issues are another principal 
focus of the document.
---------------------------------------------------------------------------

    \2\ICH E6 at pp. 10-11, 14-15, 17-21.
---------------------------------------------------------------------------

    (Comment 10) Several comments recommended that FDA simply add to 
the regulations a requirement to comply with GCP rather than delete the 
reference to the Declaration. One comment stated that it understood the

[[Page 22805]]

need for data standardization and urged us to add GCP requirements 
without eliminating the reference to the Declaration. One comment 
stated that international studies, as they have been conducted in the 
past, can comply with both documents. Another comment stated that 
adherence to both documents would not cause the quality of these 
foreign studies to suffer. Several comments stated that the GCP 
guidance does not address conflict of interest or the need to publish 
results, which are both included in the Declaration. These comments 
stated that the two documents are complementary and that the 
regulations could require that affected studies comply with both 
documents.
    (Response) For the reasons stated previously in this document, it 
is no longer appropriate for Sec.  312.120 to require compliance with 
the Declaration, either the 1989 version, the current (2000) version, 
or some other future or past version. Moreover, we believe that because 
of the requirement in Sec.  312.120 that acceptable foreign studies be 
conducted in accordance with GCP, which includes ensuring that the 
rights, safety, and well-being of trial subjects are protected, a 
specific reference to the Declaration will not enhance protection of 
human subjects. Nor do we believe that Sec.  312.120 should address 
conflicts of interest or the need to publish study results. Other FDA 
regulations address conflicts of interest in these foreign studies (for 
example, the provisions on financial disclosure by clinical 
investigators in part 54 (21 CFR part 54) are applicable to studies 
submitted in support of an NDA, ANDA, or BLA under Sec.  314.50(k), 21 
CFR 314.94(a), and Sec.  601.2(a), respectively). With respect to the 
publication of study results, we note that section 801 of the Food and 
Drug Administration Amendments Act of 2007 (42 U.S.C. 282(j)(3)) 
provides for publication in a results data bank of the results of 
``applicable clinical trials'' under certain circumstances. In 
addition, we strongly encourage sponsors to seek publication in peer-
reviewed journals.

B. Definition of Independent Ethics Committee

    We proposed to add, under Sec.  312.3, a definition for IEC. We 
proposed to define IEC to mean a review panel that is responsible for 
ensuring the protection of the rights, safety, and well-being of human 
subjects involved in a clinical investigation and is adequately 
constituted to provide assurance of that protection. An IRB, as defined 
in Sec.  56.102(g) (21 CFR 56.102(g)) of this chapter and subject to 
the requirements of part 56 (21 CFR part 56), is one type of IEC.
    (Comment 11) Several comments stated that the proposed definition 
of IEC differed from the definition in ICH E6, and requested that we 
provide clarification of the term ``adequately constituted'' in the 
definition of IEC. One comment suggested either defining ``adequately 
constituted'' as ``if its composition and membership complies with 
[part] 56, subpart B of this chapter,'' or omitting ``adequately 
constituted'' from the definition of IEC, making it consistent with the 
definition in ICH E6. Other comments suggested defining IEC as in 
section 1.27 or 3.2 of ICH E6.
    (Response) The requirement in Sec.  312.3 that the IEC be 
``adequately constituted'' emphasizes the importance of the IEC having 
appropriate expertise to perform its critical role in the protection of 
human subjects. As described in the preamble to the proposed rule, we 
would consider an IEC to be adequately constituted if it ``includes a 
reasonable number of members with the qualifications and experience to 
perform the IEC's functions (see, e.g., section 3.2.1 of the Good 
Clinical Practice guidance [ICH E6])'' (69 FR 32467 at 32468). Such an 
``adequately constituted'' IEC is responsible for ensuring the 
protection of the rights, safety, and well-being of human subjects 
involved in a clinical investigation. Although the definition of an IEC 
in ICH E6 does not include the term ``adequately constituted,'' ICH E6 
defines an IEC as being ``constituted of medical/scientific 
professionals and nonmedical/nonscientific members whose responsibility 
it is to ensure the protection of the rights, safety and well-being of 
human subjects'' (section 1.27). We view our proposed definition of IEC 
as consistent with the definition of IEC in ICH E6 but at the level of 
specificity and detail appropriate for regulation. We recognize that 
the organization and membership of IECs may differ among countries 
because of the local needs of the host country, but we believe that 
such variation should not affect an IEC's ability to perform its 
functions. Our regulations must be sufficiently flexible to accommodate 
differences in how countries regulate the conduct of clinical research, 
including the composition of an IEC. Therefore, we will not 
specifically define IEC membership in the regulations or require that 
an IEC comply with the requirements in subpart B of part 56, or with 
the recommendations for membership in ICH E6. However, we would 
consider an IEC that is constituted to comply with part 56 or with ICH 
E6 to be ``adequately constituted.'' In fact, the definition of IEC in 
Sec.  312.3 clarifies that an IRB, as defined in Sec.  56.102(g) and 
subject to the requirements of part 56, is one type of IEC. For these 
reasons, we decline to omit ``adequately constituted'' from the 
definition of IEC in Sec.  312.3.

C. Local Laws and Regulations

    (Comment 12) Some comments stated that the proposed rule would 
delete the provision in former Sec.  312.120(c)(1) requiring that 
foreign clinical research be conducted according to the laws and 
regulations of the country in which the research was conducted, when 
such laws provided for greater protection of human research subjects 
than the principles of the Declaration. Some comments stated that 
deleting the reference to compliance with local laws of the host 
country supported the notion that FDA could accept data collected in 
violation of those laws.
    (Response) We do not agree that deletion of this provision will 
lead to FDA accepting studies not conducted in accordance with local 
laws. Sponsors, IECs, investigators, and research sites and/or 
institutions are all responsible for complying with the local 
requirements for conducting research, including any requirements that 
may be more stringent than the requirements in Sec.  312.120. A host 
country may deny a sponsor's request to conduct research in the country 
if the sponsor does not comply with local requirements, or may stop a 
study that is in progress in violation of the host country's laws. New 
Sec.  312.120 sets forth U.S. standards for acceptance of foreign 
clinical studies in support of an IND or application for marketing 
approval, including that the study be conducted in accordance with GCP. 
We are confident that these standards provide for the protection of 
human subjects, and we will accept a study only if these standards are 
met. In addition, sponsors or applicants that currently conduct 
clinical trials in accordance with ICH E6 would comply with local 
requirements because ICH E6 states that one of the principles of GCP is 
that clinical trials be conducted consistent with the applicable 
regulatory requirements (i.e., any laws and regulations addressing the 
conduct of clinical trials of investigational products of the 
jurisdiction where a trial is conducted).
    (Comment 13) One comment stated that although proposed Sec.  
312.120 referenced general GCP standards, it did not clarify whether 
GCP as interpreted by the host country was at all relevant to 
acceptance of data or whether the

[[Page 22806]]

ethics committee that must be used was one approved by the host 
country.
    (Response) The host country's interpretation of GCP is relevant to 
these non-IND foreign clinical studies because the host country 
requires the sponsor to comply with its laws. However, we will only 
accept data from studies that we determine were conducted in accordance 
with GCP as described in Sec.  312.120(a)(1)(i). As to whether the IEC 
must be approved by the host country, if a host country requires by law 
that the host country approve the IEC, the sponsor would need to comply 
with that requirement. However, we will not specifically require in 
Sec.  312.120 that an adequately constituted IEC be approved by the 
host country. We do not believe that such approval is essential to 
ensuring the quality of data or the protection of human subjects. 
Therefore, this matter is left to the discretion of the host country.
    (Comment 14) One comment recommended including a provision in Sec.  
312.120 to continue to allow a sponsor to document that the study was 
conducted in a country where the laws and regulations already provide 
for strict adherence to the principles of GCP, which would clearly 
provide for the assurance of protection of human research subjects and 
quality of clinical data. As support for this approach, the comment 
stated that clinical trials conducted in Europe must now meet the 
requirements of the EU Clinical Trials Directive and its implementing 
guidance for the conduct of clinical trials under GCP.
    (Response) We believe that the supporting documentation required 
under Sec.  312.120(b), combined with an onsite inspection if 
necessary, will provide us with the ability to determine if a foreign 
clinical investigation was conducted in accordance with GCP. If the 
country adheres to the principles of GCP and the study complied with 
those principles, this should be reflected in the documentation 
submitted to us. Therefore, it is not necessary to add a provision as 
suggested by the comment.

D. Acceptance of Studies

    (Comment 15) One comment stated that the proposed rule should be 
consistent with FDA's 1998 guidance ``FDA Approval of New Cancer 
Treatment Uses for Marketed Drug and Biological Products'' (New Cancer 
Treatment Guidance). The comment stated that section III.B of the New 
Cancer Treatment Guidance allows certain data to be submitted to us 
without additional data collection, auditing, or analyses by a 
pharmaceutical company submitting a marketing application, depending on 
the quality and credibility of the institutions providing such data.
    (Response) We do not agree that this rule and the New Cancer 
Treatment Guidance concern the same issues. Although the guidance 
addresses the submission of certain data without the applicant being 
subject to auditing, this is applicable only to data from studies 
conducted by independent cancer clinical trials organizations that have 
well-established and publicly available procedures for research data 
management, monitoring, and auditing, and a track record of high-
quality research (e.g., U.S. National Cancer Institute-sponsored 
cooperative cancer research groups and other highly credible 
organizations that have no commercial interest in study outcomes). The 
guidance does not address the submission of foreign clinical data and 
is limited in scope to drugs for treating cancer. We will not accept 
foreign clinical studies in support of an IND or application for 
marketing approval except as set forth in Sec.  312.120.
    (Comment 16) One comment recommended including the following 
statement in Sec.  312.120 to reduce the potential regulatory burden: 
``The information to be provided in support of the IND does not need to 
be submitted to FDA throughout the study. The supporting information 
may be provided at the time the clinical study report is filed to the 
FDA in support of an NDA and/or made available upon request.''
    (Response) We do not agree that including such a statement in Sec.  
312.120 is necessary because the submission and reporting requirements 
are already clear. Information required under Sec.  312.120 to be 
submitted in support of an IND or application for marketing approval 
would be submitted at the time the application is submitted to the 
agency. Once an application is pending before the agency, the 
applicable reporting requirements for INDs, NDAs, ANDAs, or BLAs under 
part 312, 314, or 601 (21 CFR parts 314 and 601), apply.

E. Definition of Good Clinical Practice

    For the purposes of Sec.  312.120, we proposed, in Sec.  
312.120(a)(1)(i), to define GCP as a standard for the design, conduct, 
performance, monitoring, auditing, recording, analysis, and reporting 
of clinical trials in a way that provides assurance that the data and 
reported results are credible and accurate and that the rights, safety, 
and well-being of trial subjects are protected. We also proposed to 
require that GCP include oversight by an IEC and obtaining informed 
consent of subjects.
    The final rule clarifies the limited circumstances in which GCP 
would not require informed consent. The proposed rule stated that GCP 
does not require informed consent in life-threatening situations when 
the IEC reviewing the study finds that the conditions present are 
consistent with those described in Sec. Sec.  50.23 or 50.24(a) (21 CFR 
50.23 or 50.24(a)), or when the measures described in the study 
protocol or elsewhere will protect the rights, safety, and well-being 
of subjects and ensure compliance with applicable regulatory 
requirements. We explained in the preamble that this provision would be 
consistent with the GCP guidance, which recommends that a legally 
authorized representative provide informed consent or that the 
requirement of informed consent be waived under such circumstances. In 
the final rule, we have made more explicit two conditions that were 
implicit in the proposed rule: The IEC review must occur before 
initiation of the study and the IEC must find that informed consent is 
not feasible.
    In addition, we deleted the provision referring to the IEC ensuring 
compliance with applicable regulatory requirements. Upon 
reconsideration, we recognized that the reference to ``applicable 
regulatory requirements'' was not clear. We had not described the 
requirements we considered to be applicable, and without additional 
clarity, the phrase did not provide additional protections for subjects 
in the study. Therefore, we decided that the provision would be clearer 
without this phrase.
    (Comment 17) Several comments requested confirmation that 
compliance with ICH E6 would be adequate to assure compliance with 
Sec.  312.120 and questioned whether citing compliance with ICH E6, 
rather than submitting the supporting documentation required under 
312.120(b), would be acceptable. One comment requested that we waive 
requirements in the proposed rule for any study conducted in EU member 
states, provided the member can submit a EudraCT (a database of 
clinical trials in the EU) number, and for any studies that have been 
conducted in Japan under Japanese Good Clinical Practices. One comment 
stated that the rule should explicitly require following ICH E6 because 
imposing a U.S. standard ``consistent with'' an international standard 
seemed insufficient. One comment recommended that if Sec.  312.120 does 
not specifically require following ICH E6, we should acknowledge in the 
final rule or subsequent guidance that ICH E6 should be taken into 
account as one GCP

[[Page 22807]]

standard that we find acceptable, and describe in what ways the 
standard set forth in Sec.  312.120 differs from that in ICH E6.
    (Response) As noted in the preamble to the proposed rule, we have 
already incorporated many of the principles of GCP into our existing 
regulations. However, we have not specifically incorporated all of ICH 
E6 into our regulations, and we will not do so in Sec.  312.120, for 
several reasons. First, for one of the same reasons that we deleted the 
reference to the Declaration from Sec.  312.120, we do not believe that 
it is appropriate to reference in a regulation a document that is 
subject to change independent of our control. Second, although we 
adopted ICH E6 in 1997 for use as guidance for industry, there are 
other international documents that provide acceptable standards for 
GCP. Specific incorporation of ICH E6 into Sec.  312.120 would 
constrain our ability to accept data from non-IND foreign clinical 
studies from countries that use other comparable GCP standards. 
Finally, ICH E6 contains a level of detail and specificity that is not 
appropriate for regulations. We believe that the GCP standard in Sec.  
312.120 is appropriate because it provides sufficient flexibility to 
accommodate differences in how countries regulate the conduct of 
clinical research, while still ensuring adequate and comparable human 
subject protection. Therefore, we do not require that sponsors or 
applicants follow ICH E6, but a study conducted in compliance with ICH 
E6 would meet the GCP requirements in Sec.  312.120. However, for the 
agency to evaluate such a study, the information required under Sec.  
312.120(b) must be submitted. It would not be adequate to simply submit 
a statement that ICH E6 or Japanese GCP were followed, or to provide 
only a EudraCT number.

F. IEC Review and Approval

    Proposed Sec.  312.120(a)(1)(i) stated that GCP includes review and 
approval (or provision of a favorable opinion) by an IEC before 
initiating a study and continuing review of an ongoing study by an IEC.
    (Comment 18) One comment stated that the requirement for review and 
approval by an IEC does not guarantee protection of the participants 
unless the guidelines that the IEC must follow are stated explicitly 
and are not weaker than the Declaration.
    (Response) We disagree. Although Sec.  312.120(a)(1)(i) requires 
review and approval of a clinical study before initiation, the 
regulation does not specify the procedures that the IEC must follow 
because different procedures offering equivalent human subject 
protection may be followed in different countries. As previously 
stated, we believe that the GCP standards in Sec.  312.120, including 
the requirement for review and approval by an IEC, are and should be 
sufficiently flexible to accommodate differences in how countries 
regulate the conduct of clinical research, while ensuring adequate and 
comparable human subject protection.

G. Onsite Inspection

    Proposed Sec.  312.120(a)(1)(ii) would have required, as a 
condition of acceptance of a study submitted under this section, that 
we be able to validate the data from the study through an onsite 
inspection if we deem it necessary.
    (Comment 19) One comment recommended that we give attention to the 
current development of national and regional (e.g., European Medicines 
Agency) inspections outside the United States and the role they might 
play in providing public assurance for the quality of data and the 
protection of human subjects.
    (Response) Although this rule does not address the process for 
conducting inspections outside the United States, we can review and 
consider information from inspections by foreign authorities. However, 
if deemed necessary, we are also able, under Sec.  312.120(a)(1)(ii), 
to conduct an onsite inspection to validate the data from a study.

H. Data From Studies Not Conducted in Accordance With GCP

    Proposed Sec.  312.120(a)(2) stated that although we will not 
accept as support for an IND , NDA, or BLA a study that does not meet 
the conditions of Sec.  312.120(a)(i), we will examine data from such a 
study.
    (Comment 20) One comment requested that we clarify the meaning of 
proposed Sec.  312.120(a)(2). The comment asked if this provision means 
that a sponsor should submit studies conducted on the investigational 
product but differentiate studies that comply for FDA review of safety 
and efficacy, or that we will review noncompliant studies as 
supportive.
    (Response) The provision states that we ``will not accept as 
support'' for an IND or application for marketing approval a study that 
does not meet the conditions of Sec.  312.120(a)(1) (i.e., a 
``noncompliant'' study). Nonetheless, a sponsor or applicant of an IND 
or application for marketing approval must submit all studies and other 
information required under applicable FDA regulations for drugs and 
biologics, including ``noncompliant'' studies. We would review 
information from ``noncompliant'' studies because they might have 
bearing on the safe use of the product. In the application, a sponsor 
or applicant should identify any studies that do not meet the 
conditions of Sec.  312.120(a)(1).

I. Supporting Information

    Proposed Sec.  312.120(b) would have required a sponsor or 
applicant submitting a non-IND foreign clinical study in support of an 
IND, NDA, or BLA to submit, in addition to information required 
elsewhere in parts 312, 314, or 601, supporting information that 
describes the actions taken to ensure that the research conformed to 
GCP.
1. General Comments
    (Comment 21) Some comments stated that certain of the proposed 
requirements for submission of supporting information in Sec.  
312.120(b) are not entirely consistent with guidance provided in other 
relevant ICH documents. One comment requested that we confirm that 
conducting a study in accordance with ICH E6 and reporting and 
submitting the study according to ICH E3 (``Structure and Content of 
Clinical Study Reports''), ICH M4 (``Common Technical Document for the 
Registration of Pharmaceuticals for Human Use''), and FDA's 
corresponding guidance documents satisfies all the requirements of 
proposed Sec.  312.120(b). In addition, the comment requested that in 
cases where the requirements in Sec.  312.120(b) differed from ICH E3 
and M4 standards, we consider modifying the requirements, thereby 
allowing sponsors to submit IND and non-IND studies according to a 
single standard.
    (Response) Conducting a study in accordance with ICH E6 and 
reporting and submitting the study according to ICH E3, ICH M4, and 
FDA's corresponding guidance documents would not satisfy all the 
requirements of Sec.  312.120(b). The supporting documentation required 
in Sec.  312.120(b) must describe the actions the sponsor or applicant 
took to ensure that the research conformed to GCP. This supporting 
documentation will supplement information required elsewhere in parts 
312, 314, or 601. If any of the supporting information is already 
included in another section of the IND or application for marketing 
approval, the sponsor or applicant would not be required to submit this 
information more than once. We revised Sec.  312.120(b) to clarify 
that, in submitting the description of the actions taken to ensure that 
research conformed

[[Page 22808]]

to GCP, the sponsor or applicant is not required to duplicate 
information already submitted in the IND or application for marketing 
approval. Instead, the description submitted must provide either the 
supporting information required in Sec.  312.120(b)(1) through (b)(11) 
or a cross-reference to another section of the submission where the 
information is located.
    In some cases, it would be necessary to supplement studies 
submitted according to ICH E3 and M4 with additional information to 
adequately describe the actions the sponsor or applicant took to ensure 
that research conformed to GCP. ICH E3 provides advice on structuring 
and reporting data from a clinical trial, and ICH M4 provides advice on 
the organization of information in an application. These documents, 
unlike ICH E6, were not developed to address GCP.
2. Investigator Qualifications and Description of Research Facilities
    Proposed Sec.  312.120(b)(1) would have required submission of the 
investigator's qualifications, and proposed Sec.  312.120(b)(2) would 
have required submission of a description of the research facilities.
    (Comment 22) One comment stated that we were imposing an additional 
regulatory burden by requiring a description of the investigator's 
qualifications and a description of the research facilities. The 
comment stated that the information provided should be similar to that 
currently provided to FDA by sponsors for studies conducted under an 
IND.
    (Response) We do not agree that the rule would impose any 
additional regulatory burden related to investigator's qualifications 
and description of research facilities. Section 312.120(b)(1) and 
(b)(2) of the final rule are unchanged from previous Sec.  
312.120(b)(1) and (b)(2), so there is no greater or lesser regulatory 
burden compared to what was previously required. In addition, we 
believe that assessment of the qualifications of the investigators and 
the adequacy of the research facilities are important factors in 
determining the reliability of the data generated by the study. IND 
sponsors are required to submit information about investigator 
qualifications and the name and address of the research facilities 
(whether domestic or foreign) to be used for each protocol (Sec.  
312.23(a)(6)(iii)(b)). This rule does not require more information 
about investigator qualifications from sponsors of non-IND foreign 
studies. However, we generally are less likely to be familiar with the 
research facilities in which those studies are conducted. Therefore, we 
believe that it is appropriate to require a description of the research 
facilities for these studies to help us determine the adequacy of the 
facilities and to prioritize the need for an onsite inspection.
3. Detailed Summary of Protocol and Results of the Study
    Proposed Sec.  312.120(b)(3) would have required submission of a 
detailed summary of the protocol and results of the study. In addition, 
the sponsor or applicant would have been required to submit case 
records maintained by the investigator or additional background data, 
such as hospital records or other institutional records, if requested 
by FDA.
    (Comment 23) One comment recommended that we modify the requirement 
in proposed Sec.  312.120(b)(3) to allow sponsors to follow ICH E3, in 
which annex I, ``Synopsis,'' provides the template for the detailed 
summary of the protocol.
    (Response) We do not agree that submitting only the Synopsis from 
annex I of ICH E3 would be adequate to meet the requirements in Sec.  
312.120(b)(3) because the synopsis would not provide sufficient detail 
about the study protocol or results. Therefore, we have not modified 
the requirement as suggested by the comment. Although following ICH E3 
is not required, an integrated, full clinical study report submitted in 
accordance with ICH E3 would be acceptable for meeting the requirements 
for providing summaries of the study protocol and results in Sec.  
312.120(b)(3). In addition, sponsors and applicants must submit 
information required elsewhere in parts 312, 314, or 601.
    (Comment 24) One comment indicated that the reference to ``hospital 
records'' in Sec.  312.120(b)(3) suggests that we could request 
hospital records instead of a description of medical records maintained 
by an investigator, which might lead to data privacy concerns. One 
comment stated that the requirements for recordkeeping by investigators 
described in ICH E6, which it said were comparable to the requirements 
for investigator recordkeeping in Sec.  312.62, should be included in 
the final rule.
    (Response) Proposed Sec.  312.120(b)(3) was unchanged from previous 
Sec.  312.120(b)(3). If we need source documents such as hospital 
records to verify data, these records must be available during an 
onsite inspection or provided upon request. If the necessary records 
are not available, we might not accept the study as support for an IND 
or application for marketing approval. We believe that informed consent 
documents should notify subjects that regulatory authorities will have 
direct access to the subject's original medical records for 
verification of clinical trial procedures and data, which is consistent 
with ICH E6, section 4.8.10(n). However, if a sponsor or applicant 
cannot disclose foreign records because it is prohibited by foreign 
law, the sponsor or applicant and FDA would need to agree upon an 
alternative validating procedure if the agency is to rely on the data.
    With respect to investigator recordkeeping, this rule does not 
address individual investigator responsibilities, but rather describes 
the requirements for sponsors or applicants who are submitting non-IND 
foreign clinical studies in support of an IND or application for 
marketing approval. Sponsors or applicants are responsible for ensuring 
that their investigators meet their responsibilities. As originally 
proposed, the retention requirements in Sec.  312.57(c) for records and 
reports required under part 312 would have applied to records required 
under this rule. However, we decided to clarify the record retention 
requirements applicable to records required under this rule and 
incorporate the provision directly into Sec.  312.120. Accordingly, we 
have added the following provision at Sec.  312.120(d): A sponsor or 
applicant must retain the records required by this section for a 
foreign clinical study not conducted under an IND as follows: (1) If 
the study is submitted in support of an application for marketing 
approval, retain records for 2 years after an agency decision on that 
application; (2) if the study is submitted in support of an IND but not 
an application for marketing approval, retain records for