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Ikka T, Hatta T, Saito Y, Fujita M. Does the Act on the Safety of Regenerative Medicine in Japan ensure "safety"?: Implications of low adverse event reporting. Stem Cell Reports 2023; 18:2297-2299. [PMID: 37977143 PMCID: PMC10724052 DOI: 10.1016/j.stemcr.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023] Open
Abstract
Public document analysis reveals that the adverse events reported for therapeutic administration under the Act on the Safety of Regenerative Medicine (ASRM) in Japan are substantially fewer than those under the Pharmaceuticals and Medical Devices Act. This study highlights the flawed reporting mechanisms and unmet legislative intentions of the ASRM.
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Affiliation(s)
- Tsunakuni Ikka
- Division of Bioethics & Healthcare Law, Institute for Cancer Control, National Cancer Center Japan, Chuo-ku, Tokyo 104-0045, Japan; Division of Bioethics, Center for Research Administration and Support, National Cancer Center Japan, Chuo-ku, Tokyo 104-0045, Japan.
| | - Taichi Hatta
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Aoi-ku, Shizuoka 420-0881, Japan.
| | - Yoko Saito
- Division of Bioethics, Center for Research Administration and Support, National Cancer Center Japan, Chuo-ku, Tokyo 104-0045, Japan
| | - Misao Fujita
- Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research and Application (CiRA), Kyoto University, Sakyo-ku, Kyoto 606-8507, Japan; Institute for the Advanced Study of Human Biology (WPI-ASHBi), KUIAS, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan
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2
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Ikka T, Fujita M, Hatta T, Isobe T, Konomi K, Onishi T, Sanada S, Sato Y, Tashiro S, Tobita M. Difficulties in ensuring review quality performed by committees under the Act on the Safety of Regenerative Medicine in Japan. Stem Cell Reports 2023; 18:613-617. [PMID: 36827977 PMCID: PMC10031296 DOI: 10.1016/j.stemcr.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 02/25/2023] Open
Abstract
We outlined five studies regarding the quality of the review by committees based on the Act on the Safety of Regenerative Medicine. The findings raise serious concerns about the independence, integrity, and quality of reviews of therapeutic plans by these committees with inappropriately close relationships to medical institutions and companies.
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Affiliation(s)
- Tsunakuni Ikka
- Division of Bioethics & Healthcare Law, Institute for Cancer Control, National Cancer Center Japan, Chuo-ku, Tokyo 104-0045, Japan; Division of Bioethics, Center for Research Administration and Support, National Cancer Center Japan, Chuo-ku, Tokyo 104-0045, Japan.
| | - Misao Fujita
- Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research and Application (CiRA), Kyoto University, Sakyo-ku, Kyoto 606-8507, Japan; Institute for the Advanced Study of Human Biology (WPI-ASHBi), KUIAS, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Taichi Hatta
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Aoi-ku, Shizuoka 420-0881, Japan
| | - Tetsu Isobe
- Law School, Keio University, Minato-ku, Tokyo 108-8345, Japan
| | - Kenji Konomi
- Clinical and Translational Research Center, Keio University Hospital, Shinjuku-ku, Tokyo 160-0016, Japan
| | | | - Shoji Sanada
- Clinical and Translational Research Center, Kobe University Hospital, Kobe-city, Hyougo 650-0017, Japan
| | - Yuichiro Sato
- Faculty of Education, Tokyo Gakugei University, Koganei-city, Tokyo 184-8501 Japan
| | - Shimon Tashiro
- Department of Sociology, Graduate School of Arts and Letters, Tohoku University, Sendai, Miyagi 980-8567, Japan
| | - Morikuni Tobita
- Medical Technology Innovation Center, Juntendo University, Bunkyo-ku, Tokyo 113-8421, Japan
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Fujita M, Hatta T, Ide K. Current status of cell-based interventions in Japan. Cell Stem Cell 2022; 29:1294-1297. [PMID: 36055190 DOI: 10.1016/j.stem.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/02/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022]
Abstract
The Act on the Safety of Regenerative Medicine regulates cell-based interventions in Japan. Recent revisions to the law require disclosure of explanatory and consent materials for interventions seeking approval. In this Forum, we present an updated analysis of the status and challenges facing the Japanese regulatory framework.
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Affiliation(s)
- Misao Fujita
- Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research and Application (CiRA), Kyoto University, Sakyo-ku, Kyoto 606-8507, Japan; Institute for the Advanced Study of Human Biology (WPI-ASHBi), KUIAS, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Taichi Hatta
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Aoi-ku, Shizuoka 420-0881, Japan
| | - Kazuki Ide
- Division of Scientific Information and Public Policy, Center for Infectious Disease Education and Research, Osaka University, Suita, Osaka 565-0871, Japan; Research Center on Ethical, Legal and Social Issues, Osaka University, Suita, Osaka 565-0871, Japan
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Kim DS, Lee G, Cho H, Bae S. Regenerative Medicine in South Korea: Bridging the Gap Between Authorization and Reimbursement. Front Bioeng Biotechnol 2021; 9:737504. [PMID: 34527662 PMCID: PMC8435711 DOI: 10.3389/fbioe.2021.737504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/11/2021] [Indexed: 11/26/2022] Open
Abstract
Regenerative medicine (RM) has considerable potential to address the needs of aging-related and uncurable diseases. However, its incorporation into reimbursement of health insurance benefits poses many challenges, including uncertain evidence and insufficient investment. This paper examines the wide gap between manufacturers, regulatory bodies, and health technology bodies regarding reimbursements for RMs focused cell therapy products. In this mixed-methods study, we first analyzed the sales of RMs approved in South Korea. In addition to exploring beliefs related to the market value of RMs, in-depth interviews were conducted with 24 experts (17 from bio-industries, two from the regulatory body, three from a health technology assessment (HTA) body, and two from the Pharmaceutical Benefit Coverage Assessment Committee [PBCAC]). Lastly, we surveyed PBCAC members about the market value of RMs. In total, 15 of the 20 developed cell therapy products are on the market in South Korea, and amounted to 0.24% of total pharmaceutical expenditures in 2018. We identified a wide gap between stakeholders and regulators regarding the market value and pricing of RMs. The interviewees from the pharmaceutical manufacturer association raised the issue of rising manufacturing costs and proposed a specific pricing policy for RMs. To bridge the gap between approval and reimbursement, stakeholders demand an alternative framework of value-based pricing. Conditional health insurance reimbursement may be an alternative to the traditional process in order to generate evidence of the effects of RMs using “risk-based” or “outcome-based” approaches.
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Affiliation(s)
- Dong-Sook Kim
- Department of Research, Health Insurance Review and Assessment Service, Chuncheon, South Korea
| | - Geunwoo Lee
- Department of Research, Health Insurance Review and Assessment Service, Chuncheon, South Korea
| | - Hyungyung Cho
- College of Pharmacy, Ewha Womans University, Seoul, South Korea
| | - SeungJin Bae
- College of Pharmacy, Ewha Womans University, Seoul, South Korea
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Takashima K, Morrison M, Minari J. Reflection on the enactment and impact of safety laws for regenerative medicine in Japan. Stem Cell Reports 2021; 16:1425-1434. [PMID: 34019814 PMCID: PMC8190593 DOI: 10.1016/j.stemcr.2021.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 02/07/2023] Open
Abstract
Japan's Act on the Safety of Regenerative Medicine (ASRM) created an innovative regulatory framework intended to safely promote the clinical development of stem cell-based interventions (SCBIs) while subjecting commercialized unproven SCBIs to greater scrutiny and accountability. This article reviews ASRM's origins, explains its unprecedented scope, and assesses how it envisions the regulation of SCBIs. This analysis is used to highlight three key insights that are pertinent to the current revision of the ASRM: clarifying how the concept of safety should be defined and assessed in research and clinical care settings; revisiting risk criteria for review of SCBIs; and taking stronger measures to support the transition from unproven interventions to evidence-based therapies. Finally, the article reflects on lessons drawn from Japanese experiences in dealing with unproven SCBIs for international endeavors to regulate SCBIs.
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Affiliation(s)
- Kayo Takashima
- Uehiro Research Division of iPS Cell Ethics, Center for iPS Cell Research and Application, Kyoto University, Kyoto 606-8507, Japan; Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Chiba 277-856, Japan
| | - Michael Morrison
- Centre for Health, Law and Emerging Technologies (HeLEX), Faculty of Law, University of Oxford, Oxford OX2 7DD, UK; Institute for Science, Innovation and Society, School of Anthropology and Museum Ethnography, University of Oxford, Oxford OX2 6PN, UK.
| | - Jusaku Minari
- Uehiro Research Division of iPS Cell Ethics, Center for iPS Cell Research and Application, Kyoto University, Kyoto 606-8507, Japan.
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Tsai T, Ling T, Lee C. Adoption of Regulations for Cell Therapy Development: Linkage Between Taiwan and Japan. Clin Transl Sci 2020; 13:1045-1047. [PMID: 32407601 PMCID: PMC7719390 DOI: 10.1111/cts.12813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/04/2020] [Indexed: 11/28/2022] Open
Abstract
Although cell-based therapy has become a promising treatment, its practice and evaluation process remain unstandardized. Therefore, Japan initiated a dual-track regulatory framework for cell-based therapy aiming to promote and regulate the therapies to ensure that patients can access safe and effective treatments. Influenced by such pathway, Taiwan adopted the framework and initiated its own cell-based therapy regulation in 2018. This paper discusses how Japan has influenced Taiwan in developing regulations for cell-based therapy.
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Affiliation(s)
- Teng‐Huang Tsai
- PhD Program in Biotechnology Research and DevelopmentSchool of PharmacyTaipei Medical UniversityTaipeiTaiwan
| | - Thai‐Yen Ling
- Department of PharmacologyCollege of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Chung‐Hsi Lee
- Graduate Institute of Health and Biotechnology LawTaipei Medical UniversityTaipeiTaiwan
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Abstract
The Japanese government initiated sweeping reforms targeting regenerative medicine in 2014, accompanied by substantial investment into stem cell research and development. We survey the impact of these developments and discuss how the government is working to accelerate regenerative medicine while ensuring safety and efficacy.
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Affiliation(s)
- Douglas Sipp
- Keio University School of Medicine, Department of Physiology, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan; Keio University Global Research Institute, 2-15-45 Mita, Minato-ku, Tokyo 108-8345, Japan; RIKEN Center for Developmental Biology, 2-2-3 Minatojima Minamimachi, Chuo-ku, Kobe 650-0047, Japan; RIKEN Center for Advanced Intelligence Project, Nihonbashi 1-chome Mitsui Building, 15th floor, 1-4-1 Nihonbashi, Chuo-ku, Tokyo 103-0027, Japan
| | - Hideyuki Okano
- Keio University School of Medicine, Department of Physiology, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan; Keio University Global Research Institute, 2-15-45 Mita, Minato-ku, Tokyo 108-8345, Japan.
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Munsie M, Lysaght T, Hendl T, Tan HYL, Kerridge I, Stewart C. Open for business: a comparative study of websites selling autologous stem cells in Australia and Japan. Regen Med 2017; 12:777-790. [PMID: 29125016 DOI: 10.2217/rme-2017-0070] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Aim: This article examines online marketing practices of Japanese and Australian clinics offering putative autologous stem cell treatments. Materials & methods: We conducted google searches for keywords related to stem cell therapy and stem cell clinics in English and Japanese. Results: We identified websites promoting 88 point-of-sale clinics in Japan and 70 in Australia. Conclusion: Our findings provide further evidence of the rapid global growth in clinics offering unproven stem cell interventions. We also show that these clinics adopt strategies to promote their services as though they are consistent with evidentiary and ethical standards of science, research and medicine. Unless addressed, these practices risk harming not only vulnerable patients but also undermining public trust in science and medicine.
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Affiliation(s)
- Megan Munsie
- Centre for Stem Cell Systems, School of Biomedical Sciences, The University of Melbourne, Parkville, Australia
| | - Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, 119228, Singapore
| | - Tereza Hendl
- Center for Values, Ethics & the Law in Medicine, University of Sydney, Australia
| | - Hui-Yin Lynn Tan
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, 119228, Singapore
| | - Ian Kerridge
- Center for Values, Ethics & the Law in Medicine, University of Sydney, Australia.,Hematology Department, Royal North Shore Hospital, St Leonards, Sydney, Australia
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Lysaght T. Accelerating regenerative medicine: the Japanese experiment in ethics and regulation. Regen Med 2017; 12:657-668. [DOI: 10.2217/rme-2017-0038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
In 2014, the Japanese National Diet introduced new laws aimed at promoting the clinical translation of stem cells and regenerative medicine. The basic action of these laws is to allow the early introduction of regenerative medicine products into the Japanese market through an accelerated approval process, while providing patients with access to certain types of stem cell and cell-based therapies in the context of private clinical practice. While this framework appears to offer enormous opportunities for the translation of stem cell science, it raises ethical challenges that have not yet been fully explored. This paper critically analyzes this framework with respect to the prioritization of safety over clinical benefit, distributive justice and public trust in science and medicine. It is argued that the framework unfairly burdens patients and strained healthcare systems without any clear benefits, and may undermine the credibility of the regenerative medicine field as it emerges.
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Affiliation(s)
- Tamra Lysaght
- Centre for Biomedical Ethics, Yong LooLin School of Medicine, National University of Singapore, 119228, Singapore
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Lysaght T, Kerridge IH, Sipp D, Porter G, Capps BJ. Ethical and Regulatory Challenges with Autologous Adult Stem Cells: A Comparative Review of International Regulations. JOURNAL OF BIOETHICAL INQUIRY 2017; 14:261-273. [PMID: 28247202 DOI: 10.1007/s11673-017-9776-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 10/24/2016] [Indexed: 06/06/2023]
Abstract
Cell and tissue-based products, such as autologous adult stem cells, are being prescribed by physicians across the world for diseases and illnesses that they have neither been approved for or been demonstrated as safe and effective in formal clinical trials. These doctors often form part of informal transnational networks that exploit differences and similarities in the regulatory systems across geographical contexts. In this paper, we examine the regulatory infrastructure of five geographically diverse but socio-economically comparable countries with the aim of identifying similarities and differences in how these products are regulated and governed within clinical contexts. We find that while there are many subtle technical differences in how these regulations are implemented, they are sufficiently similar that it is difficult to explain why these practices appear more prevalent in some countries and not in others. We conclude with suggestions for how international governance frameworks might be improved to discourage the exploitation of vulnerable patient populations while enabling innovation in the clinical application of cellular therapies.
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Affiliation(s)
- Tamra Lysaght
- Centre for Biomedical Ethics, National University of Singapore, Level 2 Block MD11, Clinical Research Centre, 10 Medical Drive, 117576, Singapore, Singapore.
| | - Ian H Kerridge
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Medical Foundations Building K25, Sydney, NSW, 2006, Australia
| | - Douglas Sipp
- RIKEN Centre for Developmental Biology, 2-2-3 Minatojima-minamimachi Chuou-ku, Kobe, 650-004, Japan
| | - Gerard Porter
- School of Law, Edinburgh University, Old College, South Bridge, Edinburgh, EH8 9YL, Scotland
| | - Benjamin J Capps
- Department of Bioethics, Dalhousie University, 5849 University Avenue, Room C-315, CRC Bldg, PO Box 15000, Halifax, NS, B3H 4R2, Canada
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