[Quality indicators artificial intelligence]

The ability of some artificial intelligence (AI) systems to autonomously evolve and the sometimes very limited possibilities to comprehend their decision-making processes present new challenges to our legal system. At a European level this has led to reform efforts, of which the proposal for a European AI regulation promises to close regulatory gaps in existing product safety law through cross-sectoral AI-specific safety requirements. A prerequisite, however, would be that the EU legislator does not only avoid duplications and contradictions with existing safety requirements but also refrains from imposing exaggerated and unattainable demands. If this were to be taken into consideration, the new safety requirements could also be used to specify the undefined standard of care in liability law. Nevertheless, challenges in the context of provability continue to remain unresolved, posing a risk of rendering the legal protection efforts of the aggrieved party ineffective. It remains to be seen whether the EU legislator will address this need for reform with the recently proposed reform of product liability law by the Commission.

[Ethical principles for the design of a clinical trial in oncology]

Clinical research in the area of cancer is of utmost importance in order to improve patient care, both in terms of overall survival and quality of life. The implementation of clinical trials on medicinal products, now falling under EU Regulation 536/2014, is conditioned on prior scientific authorisation from the French National Agency for the Safety of Medicines and Health Products and a favorable ethical opinion from a Research Ethics Committee (REC).

OBJECTIVE

The objective of this work is to report on the main problematic issues identified during the evaluation of oncology dossiers by the REC in order to present the expected elements and thus optimise the evaluation procedures.

METHODS

The National Conference of the Research Ethics Committees analysed the questions raised by the REC during their evaluation of clinical trials of oncology drugs submitted to the European information system in 2022.

RESULTS

Out of a total of fourteen dossiers, nine were subject to ethical questions on the protocol and all dossiers required modifications to the information documents.

DISCUSSION

The heterogeneous quality of the dossiers reminds the need to submit well-argued, methodologically robust protocols with supervised research procedures that are safe for the participants. The drafting of information documents needs to be thoroughly reconsidered in order to present clear, concise, loyal and respectful documents for patients' rights.

Expert Consideration on Regulatory Aspects for Perinatal Derivatives in Clinical Settings

Perinatal derivatives (PnD) are drawing growing interest among the scientific community as an unrestricted source of multipotent stem cells, secretome, and biological matrices. They are useful for the treatment of diseases that currently have limited or no effective therapeutic options, but they require the development of regenerative approaches. With this development, the question of regulation of donation, processing, and distribution has therefore become more important. Within the European Cooperation in Science and Technology (COST) community, we compiled a group of international experts on PnD technologies, who revised and compared existing EU national regulations. Notably, despite clear European directives, each EU Country has developed their own implementation and standard levels for cell- and tissue-based therapies. To enable extended applications of PnD treatments within the EU community and worldwide, harmonization is highly recommended. This paper aims to provide an overview of the various options available to introduce PnD into clinical practice. For this purpose, the different aspects resulting from (1) the type of PnD, (2) the amount of available data, (3) the degree of manipulation, and (4) the intended application and the process toward a possible commercialization will be presented. In the future, it will be important to find a balance between regulatory requirements and the best medical quality of the PnD product.

The Regulatory Landscape of New Health Technologies and Nanotechnologies: The Role of Complexity of Nanosystems

Herein we present the modern issue of new health technologies that emerge in Medicine and Therapeutics, with regard to their development, regulatory framework, approval, and post-approval monitoring. The European law and legislation distinguish the various subcategories of health technologies in medicinal products, medical devices, biotechnological products, advanced therapy medicinal products, and nanomedicinal products. Each of these categories presents its own distinctive characteristics, based on principles that regard the development technology and intended therapeutic use, and, as a result, is defined by a unique regulatory framework inside the European legislation environment. New health technologies are a key of twenty-first-century knowledge, science, and economy and a part of society growth and economic development, while at the same time they present significant challenges, mainly through matters that regard their safety, efficacy, and value for the public. In this environment, the concept of complexity of living and artificial systems arises, as part of their nature, but also as a perspective that will give answers regarding their dynamic behavior, evolution, and overall quality.

Clinical Trial Authorisation: A Final Look Back to Better Appraise the New European Regulation

The implementation of the new European Clinical Trial Regulation on 31 January 2022, is a major step to promote clinical research in Europe. The French National Agency for Medicines and Health Products Safety (ANSM) proposes to share some key aspects of the preparation for the application of the Regulation initiated in 2017 and to discuss shared indicators that should be considered to monitor clinical trials opportunities on a territory with regards to access to innovation for patients and attractiveness for sponsors. New criteria based on the time from the first request for authorisation to the first inclusion could be of particular interest to appraise the implementation of the European Clinical Trial Regulation.

Regulation 536/2014 and its beneficial impacts on academic clinical research in Italy. Closing the loop

Regulation (EU) No 536/2014 (Clinical Trial Regulation, CTR) offers two precious tools to academic clinical research in Italy:

- The right to transfer not-for-profit clinical trials data and results for registration purposes, and co-sponsorship.

- The right to transfer data reduces the time needed to make innovative therapeutical agents and therapies accessible to the patient.

Co-sponsorship, on the other hand, allows the establishment of a partnership between entities with different missions, ideals and attitudes, sharing – nevertheless - the same ultimate goal: meeting the patient's medical needs. Co-sponsorship facilitates collaboration among experts, which allows knowledge sharing, thus guaranteeing, to each contributor, recognition for their own contributions to a complex activity such as a clinical trial.

However, the above-mentioned Regulation poses important challenges, especially in terms of infrastructural efficiency, which is demanding, especially for those entities suffering organizational inadequacies: unfortunately, inefficiency is sometimes a structural problem in the academic clinical environment. This publication focuses on the specific innovative aspects introduced by CTR. It also highlights the possible difficulties to be addressed by their implementation.

•

Regulation (EU) No 536/2014 offers two precious tools to academic clinical research in Italy:

The right to transfer not-for-profit clinical trials data and results for registration purposes, and co-sponsorship.

The right to transfer not-for-profit clinical trials data and results reduces the time needed to make the innovative therapeutical agents and therapies accessible to the patient.•

Co-sponsorship facilitates the collaboration among experts, which allows knowledge sharing.

A critical review of effect modeling for ecological risk assessment of plant protection products

A wide diversity of plant protection products (PPP) is used for crop protection leading to the contamination of soil, water, and air, which can have ecotoxicological impacts on living organisms. It is inconceivable to study the effects of each compound on each species from each compartment, experimental studies being time consuming and cost prohibitive, and animal testing having to be avoided. Therefore, numerous models are developed to assess PPP ecotoxicological effects. Our objective was to provide an overview of the modeling approaches enabling the assessment of PPP effects (including biopesticides) on the biota. Six categories of models were inventoried: (Q)SAR, DR and TKTD, population, multi-species, landscape, and mixture models. They were developed for various species (terrestrial and aquatic vertebrates and invertebrates, primary producers, micro-organisms) belonging to diverse environmental compartments, to address different goals (e.g., species sensitivity or PPP bioaccumulation assessment, ecosystem services protection). Among them, mechanistic models are increasingly recognized by EFSA for PPP regulatory risk assessment but, to date, remain not considered in notified guidance documents. The strengths and limits of the reviewed models are discussed together with improvement avenues (multigenerational effects, multiple biotic and abiotic stressors). This review also underlines a lack of model testing by means of field data and of sensitivity and uncertainty analyses. Accurate and robust modeling of PPP effects and other stressors on living organisms, from their application in the field to their functional consequences on the ecosystems at different scales of time and space, would help going toward a more sustainable management of the environment. Graphical Abstract Combination of the keyword lists composing the first bibliographic query. Columns were joined together with the logical operator AND. All keyword lists are available in Supplementary Information at https://doi.org/10.5281/zenodo.5775038 (Larras et al. 2021).

Saving the most lives-A comparison of European triage guidelines in the context of the COVID-19 pandemic

In March 2020, the rapid increase in severe COVID-19 cases overwhelmed the healthcare systems in several European countries. The capacities for artificial ventilation in intensive care units were too scarce to care for patients with acute respiratory disorder connected to the disease. Several professional associations published COVID-19 triage recommendations in an extremely short time: in 21 days between March 6 and March 27. In this article, we compare recommendations from five European countries, which combine medical and ethical reflections on this situation in some detail. Our aim is to provide a detailed overview on the ethical elements of the recommendations, the differences between them and their coherence. In more general terms we want to identify shortcomings in regard to a common European response to the current situation.

Health-related claims in food supplements endorsements: a content analysis from the perspective of EU regulation

OBJECTIVES

Based on the legal framework regulating the advertisement of food supplements in the EU, the aim of this article is to analyse the relationship between the presence of endorsers, the different types of health-related claims (H-RCs) and product content information.

STUDY DESIGN

We applied a quantitative approach based on the content analysis of all radio spots broadcast throughout 2017 on full-service radio stations in Spain.

METHODS

A corpus of 10,556 radio spots was obtained of the three radio stations with the highest audience levels (165 without repetitions). We incorporated data on the accumulated broadcast frequencies to supplement the content analysis specific to each radio spot with its weight in relation to the overall advertising discourse. We developed a coding scheme to assess the type of endorser, the types of H-RCs, and the product content information.

RESULTS

Results show that European directives are breached in different ways. Healthcare experts prevail in disease claims, although they are prohibited. Celebrities are the most widely used endorsers (25%) in the function and reduction of disease risk claims. In addition, although these types of claims require substantiation by authorised ingredient, 73% of H-RCs lack this information.

CONCLUSIONS

The high presence of illicit H-RCs and endorsers, such as physicians, and the omission of compulsory product information suggest that public administrations must apply stricter monitoring and sanctioning mechanisms to dissuade advertisers from further breaches of the law and to protect consumers. Implications for public health policy are made.

[Medical devices industry: the problem of clinical evaluation reports]

In order to achieve regulatory compliance and acquire authorisation for sale in Europe, each medical device must be supported by a clinical evaluation report (CER) which documents the clinical evaluation process in its entirety. This is not a new requirement but highly publicised scandals caused by defective medical devices increased scrutiny of notified bodies (the organisations designated by the European Union to evaluate medical device compliance) meaning they are more liable and must strengthen their inspections of medical device manufacturers. Manufacturers are already under increased pressure due to the new EU Medical device regulation published in 2017. The scope of the new regulation requires many manufacturers to evaluate the documentation for their whole product portfolio. CERs are an important part of regulatory compliance and are also one of the biggest challenges for manufacturers who do not have sufficient resources and do not dedicate enough time to this task. This article examines the background of this requirement while offering medical device manufacturers advice for successful clinical evaluation reports.

European Regulatory Framework and Safety Assessment of Food-Related Bioactive Compounds

A great variety of functional foods, nutraceuticals, or foods with bioactive compounds are provided nowadays to consumers. Aware of the importance of the safety aspects, the food industry has to comply with different legal requirements around the world. In this review, the European regulatory framework for food-related bioactive compounds is summarized. The term 'bioactive compound' is not defined in the European regulations, however, since they can be part of food supplements, fortified foods, or novel food, they are included within the legal requirements of those corresponding types of foods or supplements. Lists of authorized compounds/foods appear in the correspondent regulations, however, when a new compound/food is going to be launched into the market, its safety assessment is essential. Although the responsibility for the safety of these compounds/foods lies with the food business operator placing the product on the market, the European Food Safety Authority (EFSA) carries out scientific evaluations to assess the risks for human health. To facilitate this procedure, different guidelines exist at the European level to explain the tier toxicity testing approach to be considered. This approach divides the evaluation into four areas: (a) toxicokinetics; (b) genotoxicity; (c) subchronic and chronic toxicity and carcinogenicity; and (d) reproductive and developmental toxicity.

Cadmium mass balance in French soils under annual crops: Scenarios for the next century

Human populations are threatened by chronic exposure to the Cd accumulated in foods after being taken up from soils by crops. To decide whether and to what extent it is necessary to reduce the Cd content in cultivated soils, one needs to understand and predict its evolution. We therefore simulated the Cd mass balance in the soils under annual crops in France and in its 22 regions for the next century, following six scenarios of agricultural practices or regulatory conditions. If current cultivation practices are maintained, the average Cd content would increase by about 15% after a century, due to the input of Cd with P fertilizer applications. This represents around 85% of the soil Cd inputs and is nearly twice the Cd output caused by leaching and crop offtake. These results conflict with those recently obtained at the European level, due to three factors: the higher rate of P application in France than in Europe, a higher Cd content in the P fertilizers applied in France and a lower Cd leaching in French soils. Strict application of the good practices for P fertilization would stabilize the future soil Cd content at its present level. Assuming the current excessive P fertilization, the enforcement of a regulation limiting Cd content in the P fertilizers, as proposed by the European Union, would lead to a lesser increase in soil Cd, by 1.6% to 3.9% after a century. The combination of P fertilization good practices and Cd content limitation in P fertilizers would lead to a decrease in soil Cd content of between 3.0% to 5.2%. Organic agriculture would lead to an evolution of soil Cd content similar to that of conventional agriculture applying good practices. The accuracy of the mass balances could be ameliorated by a better assessment of Cd leaching.

Life cycle environmental evaluation of kettles: Recommendations for the development of eco-design regulations in the European Union

Between 117 and 200 million kettles are used in the European Union (EU) every year. However, the full environmental impacts of kettles remain largely unknown. This paper presents a comprehensive life cycle assessment of conventional plastic and metallic kettles in comparison with eco-kettles. The results show that the use stage contributes 80% to the impacts. For this reason, the eco-kettle has over 30% lower environmental impacts due to a greater water efficiency and related lower energy consumption. These results have been extrapolated to the EU level to consider the implications for proposed eco-design regulations. For these purposes, the effects on the impacts of durability of kettles and improvements in their energy and water efficiency have been assessed as they have been identified as two key parameters in the proposed regulations. The results suggest that increasing the current average durability from 4.4 to seven years would reduce the impacts by less than 5%. Thus, improving durability is not a key issue for improving the environmental performance of kettles and does not justify the need for an eco-design regulation based exclusively on it. However, improvements in water and energy efficiency through eco-design can bring relevant environmental savings. Boiling the exact amount of water needed would reduce the impacts by around a third and using water temperature control by further 2%-5%. The study has also considered the effects of reducing significantly the number of kettles in use after the UK (large user of kettles) leaves the EU and reducing the excess water typically boiled by the consumer. Even under these circumstances, the environmental savings justify the development of a specific EU eco-design regulation for kettles. However, consumer engagement will be key to the implementation and achievement of the expected environmental benefits.

European regulation for therapeutic use of stem cells

The regulation for the use of stem cells has evolved during the past decade with the aim of ensuring a high standard of quality and safety for human derived products throughout Europe to comply with the provision of the Lisbon treaty. To this end, new regulations have been issued and the regulatory status of stem cells has been revised. Indeed, stem cells used for therapeutic purposes can now be classified as a cell preparation, or as advanced therapy medicinal products depending on the clinical indication and on the procedure of cell preparation. Furthermore, exemptions to the European regulation are applicable for stem cells prepared and used within the hospital. The aim of this review is to give the non-specialized reader a broad overview of this particular regulatory landscape.

Evolution of Gluten Content in Cereal-Based Gluten-Free Products: An Overview from 1998 to 2016

The treatment of Celiac disease consists in a strict lifelong gluten-free (GF) diet. As the ingestion of small amounts can have damaging complications, there has been an ongoing discussion regarding the safe threshold for dietary residual gluten. The aim was to analyze the evolution of gluten content in cereal-based GF foodstuffs (n = 3141) from 1998 to 2016 measured by the enzyme-linked immunosorbent assay (ELISA) technique. Eight categories were defined: flours, breakfast cereals/bars, bakery, pasta, breads, dough, snacks, and yeasts, and these were divided into GF labeled-foods (GF-L) or reportedly GF foodstuffs, but not certified (GF-NC). Gluten-detection was decreased over time in line with the evolving European regulations about food information and gluten content claims. This decline started sooner in GF-L products than in GF-NC. As a whole, gluten was detected in 371 samples, with breakfast cereals/bars being the most contaminated group. Snacks and yeasts changed from being high gluten-detected samples to being totally GF over the years. The downside is that, of contaminated samples, those in the low levels of gluten detection range have decreased while flour samples containing over 100 mg/kg gluten have risen in the 2013-2016 period. Obtained data confirm that GF cereal-based foods are becoming safer but gluten control must be maintained.

Moving toward a paradigm shift in the regulatory requirements for pediatric medicines

Over the past two decades, there has been growing concern over the lack of proper medication for children. This review attempts to evaluate the current progress of EU Pediatric Regulation made since 2007. The lack of properly evaluated pediatric medication has for long been a source of concern in the European Union. The drugs that were used in the past were often not properly evaluated, and dosage was arbitrarily calculated. Therefore, it was necessary to establish the Pediatric Regulation (EC no. 1901/2006) in the EU which would mandate research for pediatric drugs. Current legislations in place not only require mandatory research by pharma industry but also have guidelines to direct the quality of pediatric research performed. The main aim of this regulation was to advance high-quality research and development of pediatric drugs, thereby increasing the availability of safe and effective drugs for children. It also aimed to improve the information available on existing pediatric drugs. It has been 9 years since the pediatric regulation was framed. The pharma industry now sees pediatric research as an integral process of development. Drug companies which develop plans for a new drug, new form of drug, new indication, or new route of administration for adults are obliged to integrate in their development plan similar research for pediatric populations as well.

CONCLUSION

It is hoped that the implementation of the current legislation will be reflected better in the future by the marketing of better and safer drugs for the pediatric population. The upcoming assessment to the European Commission in 2017 will further inform us on the impact after 10 years implementation of the legislation. What is Known: • The lack of properly evaluated pediatric medication has for long been a source of concern in the European Union. • Therefore, it was necessary to establish the EU Pediatric Regulation which would mandate research for pediatric drugs. What is New: • It has been 9 years since the pediatric regulation was framed, and the teething problems are slowly being overcome and the regulation is being used with increasing confidence. • As the Regulation is due for revision in 2017, this paper gives a current perspective on the impact of the regulation on availability and access to medicine for children.

Adaptive paediatric investigation plans, a small step to improve regulatory decision making in drug development for children?

Different arguments have been put forward why drug developers should commit themselves early for what they are planning to do for children. By EU regulation, paediatric investigation plans should be agreed on in early phases of drug development in adults. Here, extrapolation from adults to children is widely applied to reduce the burden and avoids unnecessary clinical trials in children, but early regulatory decisions on how far extrapolation can be used may be highly uncertain. Under special circumstances, the regulatory process should allow for adaptive paediatric investigation plans explicitly foreseeing a re-evaluation of the early decision based on the information accumulated later from adults or elsewhere. A small step towards adaptivity and learning from experience may improve the quality of regulatory decisions in particular with regard to how much information can be borrowed from adults. © 2016 The Authors. Pharmaceutical Statistics Published by John Wiley & Sons Ltd.

Biocide leaching during field experiments on treated articles

BACKGROUND

Biocidal products can be sources of active substances in surface waters caused by weathering of treated articles. Marketing and use of biocidal products can be limited according to the European Biocidal Products Regulation if unacceptable risks to the environment are expected. Leaching of active substances from treated articles was observed in field experiments to obtain information on leaching processes and investigate the suitability of a proposed test method.

RESULTS

Leaching under weathering conditions proceeds discontinuously and tends to decrease with duration of exposure. It does not only mainly depend on the availability of water but is also controlled by transport processes within the materials and stability of the observed substances. Runoff amount proved to be a suitable basis to compare results from different experiments. Concentrations of substances are higher in runoff collected from vertical surfaces compared to horizontal ones, whereas the leached amounts per surface area are higher from horizontal surfaces. Gaps in mass balances indicate that additional processes such as degradation and evaporation may be relevant to the fate of active substances in treated articles. Leached amounts of substances were considerably higher when the materials were exposed to intermittent water contact under laboratory conditions as compared to weathering of vertically exposed surfaces.

CONCLUSIONS

Experiences from the field experiments were used to define parameters of a procedure that is now provided to fulfil the requirements of the Biocidal Products Regulation. The experiments confirmed that the amount of water which is in contact with exposed surfaces is the crucial parameter determining leaching of substances.

Cosmetovigilance: definition, regulation and use "in practice"

Cosmetovigilance is a recent concept. The term itself has just been indexed. It is a form of health public surveillance with a public health objective; it therefore differs from the surveillance carried out by industrialists, who aim at the safety of the product for commercial purposes, and differs from peer surveillance (Revidal-Gerda), whose purpose is medical. Cosmetovigilance concerns cosmetic products. The 2006 European resolution has laid the ground work for a cosmetovigilance system based on case notifications. As of 2013, the new European regulation requires that serious undesirable effects reported to the competent authority should be transmitted to the competent authorities of the other Member States and to the person responsible for the cosmetic product. Two problems are yet to be solved: causality assessment and reporting categories. Cosmetovigilance systems are genuine means of obtaining information on the safety of cosmetic products and their ingredients. They can be used by Europe to check that new directives ensure a high level of safety. Cosmetovigilance makes it possible to rule out or control potentially hazardous ingredients and can thus set our minds at ease about the products placed on the market.

Progress review of the European Paediatric Regulatory Framework after six years of implementation

The EU regulation (EU 1901/2006 Paediatric Regulation) that entered into force in 2007 has changed the field of medicinal drug development for children in the EU. Five years after its implementation a large number changes due to this regulation have been incorporated by Pharmaceutical Industry considering the development of new candidate drug. This report is a review of changes already implemented and the aspects of paediatric drug development, which still needs to be addressed in future working in the fields to provide better medicines for children.

The informal European Parliamentary Working Group on Risk--history, remit, and future plans: a personal view

On September 5, 2012 the inaugural meeting of the European Parliamentary Working Group on Risk (WGR) took place in the European Parliament in Brussels. It is chaired by Mrs. Julie Girling (U.K. Conservative), Member of the European Parliament (MEP), and involves some 10-12 other MEPs representing a wide array of European political parties from across the EU member state countries, including Sweden, the Netherlands, and Hungary. The WGR is supported by a small secretariat reporting directly to Julie Girling MEP. In this background article of WGR, I discuss the background to why WGR was set up, the remit of the committee, and some of its possible future plans. I do this very much in a personal capacity, having suggested the formation of the committee in the first place and persuaded Mrs. Girling to chair it.