The Future of Drug Safety

Promoting and Protecting the Health of the Public

Author: Institute of Medicine,Board on Population Health and Public Health Practice,Committee on the Assessment of the US Drug Safety System

Publisher: National Academies Press

ISBN: 9780309133944

Category: Medical

Page: 346

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In the wake of publicity and congressional attention to drug safety issues, the Food and Drug Administration (FDA) requested the Institute of Medicine assess the drug safety system. The committee reported that a lack of clear regulatory authority, chronic underfunding, organizational problems, and a scarcity of post-approval data about drugs' risks and benefits have hampered the FDA's ability to evaluate and address the safety of prescription drugs after they have reached the market. Noting that resources and therefore efforts to monitor medications' riskâ€"benefit profiles taper off after approval, The Future of Drug Safety offers a broad set of recommendations to ensure that consideration of safety extends from before product approval through the entire time the product is marketed and used.

Challenges for the FDA:

The Future of Drug Safety, Workshop Summary

Author: Forum on Drug Discovery, Development, and Translation,Sally Robinson,Leslie Pray,Board on Health Sciences Policy,Institute of Medicine

Publisher: National Academies Press

ISBN: 0309109868

Category: Medical

Page: 128

View: 5400

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As the principal agency regulating food, drugs, medical devices, and biological products used by Americans, the U.S. Food and Drug Administration (FDA) serves one of the most critical consumer protection functions of the federal government. The FDA's reach is enormous, regulating products that represent roughly 25 percent of all consumer spending in the United States. Since 1992, however, federal funding for the agency has diminished, and the FDA's Center for Drug Evaluation and Research (CDER) currently relies on the fees it receives from the industry it regulates to fund the majority of its drug regulation functions. Prescription drug safety is receiving heightened press coverage and congressional scrutiny as a result of recent, highly publicized events, such as the recall of Vioxx because of its link to heart attacks, and the link between certain antidepressants (selective serotonin reuptake inhibitors, or SSRIs) and an increased risk of suicidal ideation in children. To address these concerns, the FDA in 2005 commissioned the Institute of Medicine (IOM) to conduct an independent assessment of the current U.S. drug safety system. In September 2006, the IOM committee released its report-The Future of Drug Safety: Promoting and Protecting the Health of the Public-which included 25 recommendations for improving the system for drug safety review. The committee identified four major vulnerabilities in the U.S. drug safety system: (1) chronic underfunding; (2) organization problems, particularly inadequate integration of pre-and postmarket data review; (3) a range of technical problems related to the insufficient quantity and quality of postmarket data and inadequate capability to systematically monitor the risks and benefits of drugs after marketing; and (4) unclear regulatory authority and insufficiently flexible regulatory tools. Since the IOM report was issued, the FDA has taken a number of steps toward implementing the recommended improvements. Like many government agencies, however, the FDA is financially strained by its existing responsibilities, and fully implementing the recommended improvements to the drug safety system would require significant financial commitments.The IOM report addressed some of the costs associated with its recommendations, but left many unanswered questions about the resources required to fully achieve the envisioned improvements. To better understand the types and magnitude of resources required to achieve the goals of the IOM report, the IOM's Forum on Drug Discovery, Development, and Translation convened a 1-day symposium in March 2007. Challenges for the FDA: The Future of Drug Safety, Workshop Summary explains the presentations and discussions in seven key areas: addressing the FDA's resource challenges; strengthening the scientific base of the agency; integrating pre- and postmarket review; enhancing postmarket safety monitoring; conducting confirmatory drug safety and efficacy studies; enhancing the value of clinical trial registration; and enhancing the FDA's postmarket regulation and enforcement.

The Future of Drug Discovery

Who Decides Which Diseases to Treat?

Author: Tamas Bartfai,Graham V. Lees

Publisher: Academic Press

ISBN: 0124095194

Category: Medical

Page: 376

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The Future of Drug Discovery: Who decides which diseases to treat? provides a timely and detailed look at the efforts of the pharmaceutical industry and how they relate, or should relate, to societal needs. The authors posit that as a result of increasing risk aversion and accelerated savings in research and development, the industry is not developing drugs for increasingly prevalent diseases, such as Alzheimer’s disease, untreatable pain, antibiotics and more. This book carefully exposes the gap between the medicines and therapies we need and the current business path. By analyzing the situation and discussing prospects for the next decade, the The Future of Drug Discovery is a timely book for all those who care about the development needs for drugs for disease. Provides an in-depth, broad perspective on the crisis in drug industry Exposes the disconnect between what society needs and what the drug companies are working on Analyses and projects over 10 years into the future Explains what it means for scientists and society Determines what is needed to be done to make sure that the industry responds to society's needs, remains commercially attractive and answers the question as to who decides which diseases to treat

Accelerating the Development of Biomarkers for Drug Safety

Workshop Summary

Author: Institute of Medicine,Board on Health Sciences Policy,Forum on Drug Discovery, Development, and Translation

Publisher: National Academies Press

ISBN: 9780309142311

Category: Medical

Page: 100

View: 3166

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Biomarkers can be defined as indicators of any biologic state, and they are central to the future of medicine. As the cost of developing drugs has risen in recent years, reducing the number of new drugs approved for use, biomarker development may be a way to cut costs, enhance safety, and provide a more focused and rational pathway to drug development. On October 24, 2008, the IOM's Forum on Drug Discovery, Development, and Translation held "Assessing and Accelerating Development of Biomarkers for Drug Safety," a one-day workshop, summarized in this volume, on the value of biomarkers in helping to determine drug safety during development.

Cardiac Drug Safety

A Bench to Bedside Approach

Author: Matthew J. Killeen

Publisher: World Scientific

ISBN: 9814317454

Category: Medical

Page: 174

View: 375

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At present, over 120 medications have been withdrawn from the major global pharmaceutical markets due to potentially lethal unwanted effects on the heart, namely ventricular fibrillation. With recent FDA guidelines recommending stringent testing of new pharmaceuticals on the heart, the importance of cardiac electrophysiology is affecting an increasing number of professionals in a range of industries. This book will equip readers with a clear and solid foundation in the fundamentals of electrophysiology and pharmacology of the heart, explore clinical disorders and treatments and relate this to the research and development of new medicines.Representing an integrative bench to bedside approach to understanding this critical drug safety phenomenon, this book begins with a comprehensive review of the mechanisms responsible for drug-induced arrhythmia, followed by an in-depth discussion of the current preclinical and clinical recording techniques. Additionally, a complete assessment of current methods to stratify cardiac risk in drug development is included. Most importantly, the book develops and outlines the novel strategies and key frameworks that increase the cardiac drug safety and drive down the risk of novel biopharmaceutical products in the future. Contents: Physiology of the Heart; Introduction to Electrophysiology: History, Ion Channels, Important Concepts; Electrophysiology of the Heart; Studying Cardiac Electrophysiology in the Laboratory and Clinic; Electrical Disorders of the Heart: From Cell to Bedside; The Impact of Cardiac Electrophysiology on Drug Development: History, Current Tests (Regulations, Requirements) and Their Shortcomings; Case Studies; The Future of Cardiac Drug Safety: Strategies to Reduce Risk and Ensure Continued Safety.

Predictive Toxicology in Drug Safety

Author: Jinghai J. Xu,Laszlo Urban

Publisher: Cambridge University Press

ISBN: 1139493094

Category: Medical

Page: N.A

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According to the Institute of Medicine (IOM) and U.S. Food and Drug Administration (FDA), 'developing new scientific approaches to detecting, understanding, predicting and preventing adverse events' was a critical path to the future of drug safety. This book brings together a collection of state-of-the-art chapters, written by experts in the drug safety field. It provides information on the present knowledge of drug side effects and their mitigation strategy during drug discovery, gives guidance for risk assessment and promotes evidence-based toxicology. Each specific area of toxicology relevant for drug discovery is discussed in detail, including theory, experimental approaches and data interpretation supported by comprehensive up-to-date references. Many chapters provide fascinating case studies, which are of general interest for those who have basic science training and are interested in how chemicals interact with the human body.

Ethical and Scientific Issues in Studying the Safety of Approved Drugs

Author: Committee on Ethical and Scientific Issues in Studying the Safety of Approved Drugs,Board on Population Health and Public Health Practice,Institute of Medicine

Publisher: National Academies Press

ISBN: 0309218144

Category: Medical

Page: 275

View: 3910

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An estimated 48 percent of the population takes at least one prescription drug in a given month. Drugs provide great benefits to society by saving or improving lives. Many drugs are also associated with side effects or adverse events, some serious and some discovered only after the drug is on the market. The discovery of new adverse events in the postmarketing setting is part of the normal natural history of approved drugs, and timely identification and warning about drug risks are central to the mission of the Food and Drug Administration (FDA). Not all risks associated with a drug are known at the time of approval, because safety data are collected from studies that involve a relatively small number of human subjects during a relatively short period. Written in response to a request by the FDA, Ethical and Scientific Issues in Studying the Safety of Approved Drugs discusses ethical and informed consent issues in conducting studies in the postmarketing setting. It evaluates the strengths and weaknesses of various approaches to generate evidence about safety questions, and makes recommendations for appropriate followup studies and randomized clinical trials. The book provides guidance to the FDA on how it should factor in different kinds of evidence in its regulatory decisions. Ethical and Scientific Issues in Studying the Safety of Approved Drugs will be of interest to the pharmaceutical industry, patient advocates, researchers, and consumer groups.

Antitargets and Drug Safety

Author: Laszlo Urban,Vinod Patel,Roy J. Vaz

Publisher: John Wiley & Sons

ISBN: 3527335110

Category: Medical

Page: 528

View: 8207

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With its focus on emerging concerns of kinase and GPCR-mediated antitarget effects, this vital reference for drug developers addresses one of the hot topics in drug safety now and in future. Divided into three major parts, the first section deals with novel technologies and includes the utility of adverse event reports to drug discovery, the translational aspects of preclinical safety findings, broader computational prediction of drug side-effects, and a description of the serotonergic system. The main part of the book looks at some of the most common antitarget-mediated side effects, focusing on hepatotoxicity in drug safety, cardiovascular toxicity and signaling effects via kinase and ion-channel & transporters anti-targets. In the final section, several case studies of recently developed drugs illustrate how to prevent anti-target effects and how big pharma deals with them if they occur. The more recent field of systems pharmacology has gained prominence and this is reflected in chapters dedicated to the utility in deciphering and modeling anti-targets. The final chapter is concerned with those compounds that inadvertently elicit CNS mediated adverse events, including a pragmatic description of ways to mitigate these types of safety risks. Written as a companion to the successful book on antitargets by Vaz and Klabunde, this new volume focuses on recent progress and new classes, methods and case studies that were not previously covered.

Cobert's Manual of Drug Safety and Pharmacovigilance

Author: Barton Cobert

Publisher: Jones & Bartlett Publishers

ISBN: 0763791601

Category: Medical

Page: 408

View: 9486

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Completely revised and updated, the Manual of Drug Safety and Pharmacovigilance, Second Edition is a how-to manual for those working in the fields of drug safety, clinical research, pharmacuetucal, regulatory affairs, government and legal professions. This comprehensive and practical guide discusses the theory and the practicalities of drug safety (also known as pharmacovigilance) and side effects, as well as providing essential information on drug safety and regulations, including: recognizing, monitoring, reporting, and cataloging serious adverse drug reactions. The Manual of Drug Safety and Pharmacovigilance, Second Edition teaches the ins and outs of drug safety in the industry, hospitals, FDA, and other health agencies both in the US and around the world, and presents critical information about what is done when confronted with a drug safety problem.

Children and Drug Safety

Balancing Risk and Protection in Twentieth-Century America

Author: Cynthia A Connolly

Publisher: Rutgers University Press

ISBN: 0813563895

Category: Business & Economics

Page: 260

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Children and Drug Safety traces the development, use, and marketing of drugs for children in the twentieth century, a history that sits at the interface of the state, business, health care providers, parents, and children. This book illuminates the historical dimension of a clinical and policy issue with great contemporary significance—many of the drugs administered to children today have never been tested for safety and efficacy in the pediatric population. Each chapter of Children and Drug Safety engages with major turning points in pediatric drug development; themes of children’s risk, rights, protection and the evolving context of childhood; child-rearing; and family life in ways freighted with nuances of race, class, and gender. Cynthia A. Connolly charts the numerous attempts by Congress, the Food and Drug Administration, the American Academy of Pediatrics, and leading pediatric pharmacologists, scientists, clinicians, and parents to address a situation that all found untenable.

FDA in the Twenty-First Century

The Challenges of Regulating Drugs and New Technologies

Author: Holly Fernandez Lynch,I. Glenn Cohen

Publisher: Columbia University Press

ISBN: 0231540078

Category: Business & Economics

Page: 528

View: 9954

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In its decades-long effort to assure the safety, efficacy, and security of medicines and other products, the Food and Drug Administration has struggled with issues of funding, proper associations with industry, and the balance between consumer choice and consumer protection. Today, these challenges are compounded by the pressures of globalization, the introduction of novel technologies, and fast-evolving threats to public health. With essays by leading scholars and government and private-industry experts, FDA in the Twenty-First Century addresses perennial and new problems and the improvements the agency can make to better serve the public good. The collection features essays on effective regulation in an era of globalization, consumer empowerment, and comparative effectiveness, as well as questions of data transparency, conflicts of interest, industry responsibility, and innovation policy, all with an emphasis on pharmaceuticals. The book also intervenes in the debate over off-label drug marketing and the proper role of the FDA before and after a drug goes on the market. Dealing honestly and thoroughly with the FDA's successes and failures, these essays rethink the structure, function, and future of the agency and the effect policy innovations may have on regulatory institutions abroad.

Safe and Effective Medicines for Children

Pediatric Studies Conducted Under the Best Pharmaceuticals for Children Act and the Pediatric Research Equity Act

Author: Committee on Pediatric Studies Conducted Under the Best Pharmaceuticals for Children Act (BPCA) and the Pediatric Research Equity Act (PREA),Board on Health Sciences Policy,Institute of Medicine

Publisher: National Academies Press

ISBN: 0309225507

Category: Medical

Page: 391

View: 1737

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The Best Pharmaceuticals for Children Act (BPCA) and the Pediatric Research Equity Act (PREA) were designed to encourage more pediatric studies of drugs used for children. The FDA asked the IOM to review aspects of pediatric studies and changes in product labeling that resulted from BPCA and PREA and their predecessor policies, as well as assess the incentives for pediatric studies of biologics and the extent to which biologics have been studied in children. The IOM committee concludes that these policies have helped provide clinicians who care for children with better information about the efficacy, safety, and appropriate prescribing of drugs. The IOM suggests that more can be done to increase knowledge about drugs used by children and thereby improve the clinical care, health, and well-being of the nation's children.

Mitochondria and the Future of Medicine

The Key to Understanding Disease, Chronic Illness, Aging, and Life Itself

Author: Lee Know

Publisher: Chelsea Green Publishing

ISBN: 1603587675

Category: MEDICAL

Page: 272

View: 1021

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With information for patients and practitioners on optimizing mitochondrial function for greater health and longevity Why do we age? Why does cancer develop? What's the connection between heart failure and Alzheimer's disease, or infertility and hearing loss? Can we extend lifespan, and if so, how? What is the Exercise Paradox? Why do antioxidant supplements sometimes do more harm than good? Many will be amazed to learn that all these questions, and many more, can be answered by a single point of discussion: mitochondria and bioenergetics. In Mitochondria and the Future of Medicine, Naturopathic Doctor Lee Know tells the epic story of mitochondria, the widely misunderstood and often-overlooked powerhouses of our cells. The legendary saga began over two billion years ago, when one bacterium entered another without being digested, which would evolve to create the first mitochondrion. Since then, for life to exist beyond single-celled bacteria, it's the mitochondria that have been responsible for this life-giving energy. By understanding how our mitochondria work, in fact, it is possible to add years to our lives, and life to our years. Current research, however, has revealed a dark side: many seemingly disconnected degenerative diseases have tangled roots in dysfunctional mitochondria. However, modern research has also endowed us with the knowledge on how to optimize its function, which is of critical importance to our health and longevity. Lee Know offers cutting-edge information on supplementation and lifestyle changes for mitochondrial optimization, such as CoQ10, D-Ribose, cannabinoids, and ketogenic dietary therapy, and how to implement their use successfully. Mitochondria and the Future of Medicine is an invaluable resource for practitioners interested in mitochondrial medicine and the true roots of chronic illness and disease, as well as anyone interested in optimizing their health.

Assuring Data Quality and Validity in Clinical Trials for Regulatory Decision Making:

Workshop Report

Author: Roundtable on Research and Development of Drugs, Biologics, and Medical Devices,Institute of Medicine

Publisher: National Academies Press

ISBN: 0309065941

Category: Medical

Page: 88

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In an effort to increase knowledge and understanding of the process of assuring data quality and validity in clinical trials, the IOM hosted a workshop to open a dialogue on the process to identify and discuss issues of mutual concern among industry, regulators, payers, and consumers. The presenters and panelists together developed strategies that could be used to address the issues that were identified. This IOM report of the workshop summarizes the present status and highlights possible strategies for making improvements to the education of interested and affected parties as well as facilitating future planning.

The Future of Nursing

Leading Change, Advancing Health

Author: Institute of Medicine,Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine

Publisher: National Academies Press

ISBN: 0309208955

Category: Medical

Page: 700

View: 8174

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The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system. At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year. Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles -- including limits on nurses' scope of practice -- should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care. In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.

Safe Medical Devices for Children

Author: Committee on Postmarket Surveillance of Pediatric Medical Devices,Board on Health Sciences Policy,Institute of Medicine

Publisher: National Academies Press

ISBN: 0309096316

Category: Medical

Page: 480

View: 7136

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Innovative medical devices have helped reduce the burden of illness and injury and improve the quality of life for countless children. Mechanical ventilators and other respiratory support devices rescue thousands of fragile newborns every year. Children who once would have died of congenital heart conditions survive with the aid of implanted pacemakers, mechanical heart valves, and devices that close holes in the heart. Responding to a Congressional request, the Institute of Medicine assesses the system for postmarket surveillance of medical devices used with children. The book specifically examines: The Food and Drug Administration's monitoring and use of adverse event reports The agency's monitoring of manufacturers' fulfillment of commitments for postmarket studies ordered at the time of a device's approval for marketing The adequacy of postmarket studies of implanted devices to evaluate the effects of children's active lifestyles and their growth and development on device performance Postmarket surveillance of medical devices used with children is a little investigated topic, in part because the market for most medical products is concentrated among older adults. Yet children differ from adults, and their special characteristics have implications for evaluation and monitoring of the short- and long-term safety and effectiveness of medical devices used with young patients.

Understanding the Benefits and Risks of Pharmaceuticals

Workshop Summary

Author: Institute of Medicine,Board on Health Sciences Policy,Forum on Drug Discovery, Development, and Translation

Publisher: National Academies Press

ISBN: 9780309179768

Category: Medical

Page: 98

View: 4197

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All pharmaceutical products have inherent risks, and their use involves trade-offs between their therapeutic benefits and their risks. However, the public has a limited understanding of the benefits and risks of drugs, and many individuals believe that drugs approved by the U.S. Food and Drug Administration (FDA) carry no risks. The FDA is responsible for evaluating and balancing the potential risks of drugs with their potential benefits. Assessing, managing, and communicating the benefit-risk profile of a pharmaceutical product is a complex and nuanced scientific, political, and sociological challenge. Once the assessment is made, the FDA is then responsible for managing how to communicate these risks and make healthcare decisions based on them. To explore these issues, the Forum on Drug Discovery, Development, and Translation conducted a public workshop entitled Understanding the Benefits and Risks of Pharmaceuticals, with the broad goals of gaining a better understanding of the current system used to evaluate benefit and risk, and to identify opportunities for improvement. This workshop was held in Washington, D.C., on May 30-31, 2006. The benefit-risk profiles of pharmaceuticals are constantly evolving as new data are collected throughout the life cycle of a drug. Discussions during the workshop focused on the following: (1) premarket assessment, during which clinical trial data are used to assess benefit and risk; (2) communication of that information to prescribing physicians and their patients; (3) healthcare decisions made by prescribing physicians and their patients; and (4) the accumulation of benefit-risk information from postmarketing experience, which feeds back into the other phases. Understanding the Benefits and Risks of Pharmaceuticals: Workshop Summary explains in detail the discussions during this workshop.

Innovative Approaches in Drug Discovery

Ethnopharmacology, Systems Biology and Holistic Targeting

Author: Bhushan Patwardhan,Rathnam Chaguturu

Publisher: Academic Press

ISBN: 0128018224

Category: Medical

Page: 480

View: 4112

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Despite considerable technological advances, the pharmaceutical industry is experiencing a severe innovation deficit, especially in the discovery of new drugs. Innovative Approaches in Drug Discovery: Ethnopharmacology, Systems Biology and Holistic Targeting provides a critical review and analysis of health, disease and medicine, and explores possible reasons behind the present crisis in drug discovery. The authors illustrate the benefits of systems biology and pharmacogenomics approaches, and advocate the expansion from disease-centric discovery to person-centric therapeutics involving holistic, multi-target, whole systems approaches. This book lays a path for reigniting pharmaceutical innovation through a disciplined reemergence of pharmacognosy, embracing open innovation models and collaborative, trusted public-private partnerships. With unprecedented advances made in the development of biomedically-relevant tools and technologies, the need is great and the time is now for a renewed commitment towards expanding the repertoire of medicines. By incorporating real-life examples and state-of-the-art reviews, this book provides valuable insights into the discovery and development strategies for professionals, academicians, and students in the pharmaceutical sciences. Analyzes the reasons behind historical drug failures to provide valuable insights on lessons learned Uses current scientific research to promote learning from traditional knowledge systems and through the integration of traditional and western medicines Discusses advances in technologies and systems biology to support the transition from formulation discovery to therapeutic discovery

Drug Discovery Toxicology

From Target Assessment to Translational Biomarkers

Author: Yvonne Will,J. Eric McDuffie,Andrew J. Olaharski,Brandon D. Jeffy

Publisher: John Wiley & Sons

ISBN: 1119053390

Category: Medical

Page: 584

View: 7686

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As a guide for pharmaceutical professionals to the issues and practices of drug discovery toxicology, this book integrates and reviews the strategy and application of tools and methods at each step of the drug discovery process. • Guides researchers as to what drug safety experiments are both practical and useful • Covers a variety of key topics – safety lead optimization, in vitro-in vivo translation, organ toxicology, ADME, animal models, biomarkers, and –omics tools • Describes what experiments are possible and useful and offers a view into the future, indicating key areas to watch for new predictive methods • Features contributions from firsthand industry experience, giving readers insight into the strategy and execution of predictive toxicology practices

Strengthening a Workforce for Innovative Regulatory Science in Therapeutics Development

Workshop Summary

Author: Forum on Drug Discovery, Development, and Translation,Board on Health Sciences Policy,Institute of Medicine

Publisher: National Academies Press

ISBN: 030922215X

Category: Medical

Page: 99

View: 7442

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The development and application of regulatory science - which FDA has defined as the science of developing new tools, standards, and approaches to assess the safety, efficacy, quality, and performance of FDA-regulated products - calls for a well-trained, scientifically engaged, and motivated workforce. FDA faces challenges in retaining regulatory scientists and providing them with opportunities for professional development. In the private sector, advancement of innovative regulatory science in drug development has not always been clearly defined, well coordinated, or connected to the needs of the agency. As a follow-up to a 2010 workshop, the IOM held a workshop on September 20-21, 2011, to provide a format for establishing a specific agenda to implement the vision and principles relating to a regulatory science workforce and disciplinary infrastructure as discussed in the 2010 workshop.