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研究生: 蘇顯騰
Su, Hsien-Teng
論文名稱: 論美國申請新藥上市核准的有效性判斷及其相關問題之研究
Study on the Effectiveness Judgment of Approving the Application for New Drugs and It’s Related Issues in U.S.
指導教授: 侯英泠
Hou, Ing-Ling
學位類別: 博士
Doctor
系所名稱: 社會科學院 - 法律學系
Department of Law
論文出版年: 2019
畢業學年度: 107
語文別: 中文
論文頁數: 454
中文關鍵詞: 新藥上市申請療效有效性藥品有效性宣稱實質證據隨機化盲法對照組優效性等效性非劣效性統計上顯著性臨床上顯著性標示/標籤標籤外使用標示不實虛偽不實誤導的虛偽請求法共享罰金之訴
外文關鍵詞: claim of effectiveness, substantial evidence, statistical significance, clinical significance, off-labeling use, False Claim Act
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  • 本論文主要係討論美國新藥申請上市核准的有效性判斷及其相關問題研究,分為六章,第一章:緒論;第二章:美國核准新藥上市法制及其內涵;第三章:美國申請新藥上市核准的有效性判斷;第四章:美國新藥核准上市後有效性的行政監管法制;第五章:美國新藥獲准上市後有效性的司法監管法制:第六章:結論。
    本論文的主要貢獻,係於第三章首先提出「藥品的有效性宣稱理論」,闡明一項藥品在客觀上可能的療效範圍與申請人所決定要申請上市核准的有效性之內容、水準及範圍不同。而申請人就其藥品所宣稱的有效性之內容、水準及範圍,在規範面要求應以「實質證據」證明其藥品的有效性,所謂「實質證據」係由具領域內專業知識及經驗之專家進行充分且受良好控制之臨床試驗所取得之數據,並得由FDA之專業知識及經驗之專家作成公正負責地作成該藥品在其標示或所擬議之標示的使用條件下,具有其宣稱所表示要具有的效果之結論所組成之證據。其有關之細節內容,本論文均從美國法制作了相當精細地探討,並詳實正確地援引規範依據,本文也從科學面向如何證明一項藥品的有效性,包括顯著性試驗、等效性試驗、優效性試驗及非劣效性試驗。並從FDA審查及法院判決實務,再得出藥品有效性的兩個重要核心內涵:統計上顯著性與臨床上顯著性,本論文於此也做出有意義的討論,並對藥事法的研究作出貢獻。
    本論文的第四章,係從行政監管觀點,提出「藥品的有效性宣稱理論」、「藥品上市前核准或許可理論」與「藥品據實標示理論」,作為藥品獲准上市後有效性行政監管的界限,以及作為「標示上使用」及「標示外使用」(習慣上稱為「標籤外使用」)的推論與分析之基礎。「標示外使用」是就獲准上市之藥品作未經FDA核准的使用,在立法政策上,醫師的「標示外處方」被承認為醫學實踐的一部分,FDA不得加以干預或限制,但醫師除處方以外之「標示外使用」(如銷售、廣告、促銷)並非屬於醫學實踐的一部份,仍受「食品藥品及化妝品法」(FDCA)關於「標示不實」(misbranded)規定的規範。製造商的「標示外使用」則應受FDCA關於「標示不實」規定的規範,為法所禁止的行為(21 U.S.C.§§331,333),但藥品製造商的標示外使用,除直接銷售、促銷藥品外,亦有間接的方式如分發討論其藥品之標示外使用科學期刊或教科書重印本(即「持久性材料」),贊助繼續醫學教育(CME)或醫學研討會或論壇活動,並分發上開持久性材料或有意地在會議中提出或突顯其藥品的標示外使用之問題。就此,究係屬傳播真實且有益的科學資訊?抑係非法的標籤外促銷行為?應否受聯邦憲法第一修正案之言論自由(商業性言論)的保護,在美國引起許多的訴訟案及學界爭議。什麼是「標示外使用」的本質?贊成論與反對論」之理由又是什麼?雖然美國聯邦地方法院在W.L.F. v. Friedman案(1998)及聯邦上訴法院在United States v. Caronia案(2009),先後宣告FDA發布的各項指引文件及FDCA之標示不實規定均違憲無效,並認定製造商的「標示外之促銷」屬於真實的、非誤導的,且為合法的言論,但本論文則從各種觀點持反對論之見解,認為該藥品製造商對其藥品的「標示外之促銷」,係一項虛偽不實的、誤導的,且為不合法的言論。
    再者,本論文於第五章,係從司法監管的觀點,探討美國「虛偽請求法」(The False Claim Act)責任及侵權行為法的嚴格責任法制,對於藥品製造商為「標示外促銷」行為,誘使醫師為標示外處方及藥師標示外調劑向美國Medicare或Medicaid請求償付,應否負虛偽請求之民事賠償責任?此外,本論文也介紹美國FDA或司法部就此的執法政策及其成效。最後,該標示外促銷,係對於藥品的標示上未為「充分的使用說明」「充分的不安全使用警告」之行為,應否負侵權行為責任?本論文也作了詳細的分析與討論。尤其,本論文認為在FDCA領域之藥品的標示外促銷之「虛偽性」,使Medicare或Medicaid或其他保險計畫除了少數例外之情形,均不將藥品的標示外使用列入償付項目,例如「覆蓋的門診藥品」(covered outpatient drugs)。藥品製造商就其藥品的標示外促銷,誘使醫師作標示外處方,並透過處方箋的某種合規之記載,而造成政府或Medicare或Medicaid系統的償付者,構成醫療保健欺詐,該藥品製造商就此應負FCA責任。由此觀之,FDCA領域之藥品的標示外促銷的「虛偽性」與FCA領域之提出對政府償付請求的「虛偽性」,兩者相關,但並非同一,且違反FDCA的行為,未必違反FCA,被告應否負擔FCA責任,應就該項對美國政府的償付請求本身是否具有「虛偽性」加以判斷。
    本文最後結論,總結本文的精要,並與我國藥事法作相關法制作比較,並提出建議。本文囿於篇幅,討論範圍,僅限於「藥品」,不包括醫療器材。

    Doctoral Dissertation Title
    Study on the Effectiveness Judgment of Approving the Application for New Drugs and It’s Related Issues in U.S.
    Author’s Name:Hsien-Teng Su
    Advisor’s Name:Ing-Ling Hou, Dr. jur.
    Department & College:Department of Law, National Cheng Kung University

    SUMMARY
    The theme of this dissertation is to discuss the effectiveness Judgment of approving a new drug application and it’s related issues in U.S.. First, from the industry perspective, to explore the sponsor how to design and conduct adequate and well-controlled investigations and the applicant how to determines the effectiveness claim of a drug and its conditions of use, level and scope. Second, from the normative side, to discuss how to prove the applicant's effectiveness claim of the drug and the indications and conditions of use contained in the labeling with substantial evidence and it’s quantity. Then, from the scientific viewpoint, to investigate how to prove the effectiveness of the drug with the designs of investigation, and why it is necessary to be statistically significant and clinically significant as an important connotation of drug effectiveness. Secondly, from the perspective of administrative regulation and judicial supervision after the listing of a new drug, the issues related to the approved on-labeling and the unapproved off-labeling are discussed, especially the relationships between the drug manufacturer ’s off-labeling use and the misbranded provision in FDCA, and the complex issues of the off-labeling promotion and commercial freedom of speech protected by the First Amendment. Finally, to discuss the question of whether the drug manufacturer's off-labeling use should bear the responsibility of False Claim Act and the product liability of the tort.
    Key words: claim of effectiveness, substantial evidence, statistical significance ,clinical significance, off-labeling use, False Claim Act
    INTRODUCTION
    This dissertation mainly discusses the effectiveness judgment and related issues of approving a application of new drug (NDA) in the United States. It is divided into six chapters, the first chapter: the introduction; the second chapter: the U.S. approved new drug listing legal system and its connotation; the third chapter: the effectiveness judgment of approving a application of new drug (NDA) in U.S. ; Chapter 4: How to regulate the effectiveness of a new drug in the United States after the approval of the listing ; Chapter 5: The judicial regulatory system for the effectiveness of new drugs approved for listing in the United States: Chapter VI: Conclusions.
    The main contribution of this dissertation is to firstly put forward the "the theory of the claim/purport of effectiveness for drug " in the third chapter, to clarify that the scope of the objectively possible therapeutic efficacy of a drug is different from the content, level and effectiveness of the applicant's decision to apply for listing approval. The applicant's requirements for the efficacy, content and scope of the drug's claims should be demonstrated in the form of "substantive evidence". The term “substantial evidence” means evidence consisting of adequate and well-controlled investigations, including clinical investigations, by experts qualified by scientific training and experience to evaluate the effectiveness of the drug involved, on the basis of which it could fairly and responsibly be concluded by such experts that the drug will have the effect it purports or is represented to have under the conditions of use prescribed, recommended, or suggested in the labeling or proposed labeling thereof. Its relevant details, this paper will make a fairly precise discussion from the U.S. law, and have invoked the normative basis in a detailed and correct manner. This article also explains how to prove the effectiveness of a drug, including the significance test, the equivalence test, the superiority test, and the non-inferiority test. And from the FDA review and court judgment practice, and then draw two important core connotations of drug effectiveness: statistical significance and clinical significance, this paper also makes a meaningful discussion, and contributes the study of the drug law.
    The fourth chapter of this dissertation puts forward the "the theory of claim of effectiveness for drug", "drug premarket approval or clearance theory" and " the theory of drugs labeling should based on approved content " from the perspective of administrative regulation, as the boundaries of administrative regulation of the effectiveness for a drug after it is approved for listing, and as the basis of inference and analysis of "on- labeling use" and "off-labeling use" (commonly known to as "off-label use"). "Off-labeling use" is a approved drug for unapproved use . In the legislative policy, a physician's "off-labeling prescription" is recognized as part of medical practice, and the FDA should not intervene or limit it. But a physician's "off-labeling use" (such as sales, advertising, promotion) other than prescriptions is not part of the medical practice and is still regulated by the "misbranded" provisions of the Food, Drug, and Cosmetic Act (FDCA). The drug manufacturer's "off-labeling use" is subject to the FDCA's "misbranded" provision, which is prohibited by the FDCA(21 U.S.C.§§331,333), but the drug manufacturer's off-labeling use, in addition to direct sales, promotion of drugs, there are also in indirect ways to distribute a scientific journal or textbook reprint (i.e. “enduring material”), to sponsor the continuing medical education (CME) or the activity of medical seminars or forums, and to disseminate the enduring materials or to present or highlight intentionally the issue of the off-labeling use of it's drug at meetings. For this circumstance,“is this a true and useful scientific information?”or“Is it illegal to off-labeling promotion? Whether it should be protected by the freedom of speech (commercial speech) of the First Amendment, has caused and raised many lawsuits and academic disputes in the United States. What is the essence of "off-labeling use"? What is the reason for the theory of "the pros and cons of off-labeling use" ? Although the United States District Court in the W.L.F. v. Friedman case (1998) and the Federal Court of Appeal in the United States v. Caronia case (2009), it had declared respectively that the guidelines issued by the FDA and the FDCA's misbranded provisions are unconstitutional, and found that the manufacturer's “off-labeling promotion” is a true, non-misleading, and legal speech, but this dissertation holds the opinion of opposition from various viewpoints, and think that the drug manufacturer’s “off-labeling promotion” of it’s drug is a false, misleading, and illegal speech.
    Furthermore, in the fifth chapter, this dissertation explores the liability of the "The False Claim Act(FCA)" and the strict liability of Tort in common law from the perspective of judicial supervision, and the "off-labeling promotion" for pharmaceutical manufacturers to induce the physician and the pharmacist to present the false claim of the U.S. Medicare or Medicaid reimbursement for the off-labeling prescription /dispense . Should there be a civil liability for the false claim? In addition, this dissertation also introduces FDA or the Ministry of Justice's enforcement policy and its results in the U.S.. At last, the off-labeling promotion is not a "adequate use instructions" or "full unsafe use warning" for the labeling of drugs. Should it be held liable for infringement of tort ? This dissertation also makes a detailed analysis and discussion. In particular, this dissertation thinks that the “falsity” of off-label promotion of drugs in the field of FDCA does not allow Medicare or Medicaid or other insurance plans to include the “off-labeling use ” of drugs in reimbursement items (such as “covered outpatient drugs ”) with a few exceptions. The drug manufacturer's off-labeling promotion of its drug, inducing the physician to make an off-labeling prescription, and causing the government or Medicare or Medicaid system to pay through a certain compliance record of the prescription, constituting medical health care fraud, the drug manufacturer should be responsible for FCA. From this point of view, the "falsity" of the off-labeling promotion of drugs in the FDCA field and the "falsity" of the FCA field for the claim of government's reimbursement are related, but not the same, and the violation of FDCA does not necessarily violate the FCA. Whether the defendant should bear the responsibility of the FCA should rely on whether the reimbursement claim to the U.S. government itself has "falsity" to judge.
    The final conclusion of this dissertation summarizes the essentials of this paper and compares it with the relevant laws of Pharmacy Law of R.O.C.(TAIWAN)and makes some recommendations. This dissertation is limited to the paper length, the scope of discussion is only limited to "drug" and does not include medical device.
    MATERIALS AND METHODS
    The literature collection of this dissertation mainly uses the "data collection method". First, to find out the laws and their subsidiary regulations related to the effectiveness of drugs in the U.S., including the FDCA of 1938/1962, the FDAMA, and the PHSA, and its subsidiary regulations, including“Investigational New Drug Application” (21 CFR Part 312), “Applications For FDA Approval To Market A New Drug” (21 CFR Part 314), “Labeling” (21 CFR Part 201), and “Prescription Drug Advertising” (21 CFR Part 202) and so on. Second, to collect relevant guidance documents issued by the FDA, such as “Guidance for Industry- Providing Clinical Evidence of Effectiveness for Human Drug and Biological Products.(1998)”, “Non-Inferiority Clinical. Trials to Establish. Effectiveness. Guidance for Industry(2016)”, etc., and Relevant guidelines issued by ICH, such as "E9: Statistical Principles for Clinical Trials (1998)", " E10: Choice of Control Group and Related Issues in Clinical Trials(2000) "etc.. Again, for specific research subtopics (such as off-label use, false requests, etc.), browse the official websites such as FDA, NCBI, SSRN or N. Eng.J.Med., databases of scientific journals, and law reviews of law schools or universities in the U.S. and then the outdated regulations or FDA Notices through the Federal Register or the Library of Congress website. Finally, the jurisprudence of the Federal Courts is available on the Find Law or through Google search. Then, the various information and materials collected will be studied or read. The research subtopics of this dissertation will be analyzed through the "inductive method" to understand the research connotation and direction of each subtopics of the professional science, statistics and law. Furthermore, from the process of translate and read the federal court's decisions, learn how the American society operates the court, how the specific disputes attack and defend, the perspective of thinking, and the court's explanation of precedents and legal reasoning methods, all of which help to think about the breadth and depth of the problem. And then use the "deductive method" to analyze the various aspects of the problems involved in the subtopics areas and their possible solutions.
    RESULTS AND DISCUSSION
    The results of this dissertation is to to put forward three theories of "the theory of the claim/purport of effectiveness for drug ", "drug premarket approval or clearance theory" and " the theory of drugs labeling should based on approved content " as the basic structure of this dissertation . First, based on the ""the theory of the claim/purport of effectiveness for drug ", the scope of the "objective efficacy" of a drug and the "subjective efficacy " claimed by the applicant are distinguished. The applicant should propose the substantial evidence to demonstrate the scope of the "subjective efficacy " claimed, together with the corresponding conformity labeling (including label, inner/outer package and package insert), is submitted to the FDA for approval and listing, and after being reviewed and evaluated by the FDA to confirm its safety and effectiveness in use, it will be approved for listing. Based on the ""drug premarket approval or clearance theory",the applicants should market their drugs only with approved the scope of the "claims of effectiveness " and labeling of their drugs. Once the drug has been approved for marketing, the applicant (mainly the drug manufacturer) has an obligation to comply with the “the theory of drugs labeling should based on approved content ”, if it exceeds the range described or not described in the labeling, will constitute " off-labeling" . The "off-labeling use" of the drug is essentially a test that proves to be ineffective, and proves to be effective with inadequate trial or not tested at all, and has a high risk of safety and efficacy in use. In the regulatory policy, FDA will also prohibit the “off-labeling use”to implement the integrity and consistency of the drug regulatory system and to ensure the safety and effectiveness of the drug. FDCA stipulates that if a labeling relates to “false or misleading" or "the lack of adequate instructions for use or adequate safety warnings" should be considered as "misbranded". The "off-labeling use" not only violates the FDCA's misbranded provisions and constitutes a criminal offence, but also the "off- labeling " promotion, dissemination and distribution should be considered as a " false, misleading and illegal " commercial speech, unprotected by the First Amendment, and even the "off-labeling use" of drugs, have caused to submit a false claims to the government or health care plans , resulting in a unnecessary or improper reimbursement, and also causing problems with FCA liability. If therefore caused the patient's injury, the drug manufacturer will bear a product liability of tort in common law.
    CONCLUSION
    1. The safety and effectiveness of the drug is the FDCA's core. When the applicant
    Submits s NDA to FDA, he should present the “substantial evidence” together with the corresponding conformity labeling to demonstrate the safety and effectiveness of the drug.
    2. The "off- labeling " promotion, dissemination and distribution should be considered as a " false, misleading and illegal " commercial speech, unprotected by the First Amendment.
    3. The "off-labeling use" of drugs, have caused to submit a false claims to the government or health care plans for reimbursement, and the drug manufacturer would or might be liable for a FCA liability, and even bear the product liability of tort in common law.

    目錄 第一章 緒 論...................................................................................1 第一節 研究動機與目的..........................................................................................1 第一項 研究動機..................................................................................................1 第二項 研究之目的..............................................................................................4 第二節 研究方法......................................................................................................5 第三節 研究範圍......................................................................................................7 第四節 研究背景與問題的提出............................................................................10 第二章 美國核准新藥上市法制及其內涵 ..................................13 第一節 美國管制藥品的法制史概述....................................................................13 第一項 1938年以前之藥品管制立法................................................................13 第二項 1938年食品藥品及化妝品法................................................................15 第三項 1962年食品藥品及化妝品法修正案....................................................16 第四項 1962年以後之藥品管制立法................................................................17 一、1966年通過「公平包裝和標示法」...............................................18 二、1983年通過「聯邦反篡改法」.......................................................18 三、1984年通過「藥品價格競爭和專利期限恢復法」.......................18 四、1992年通過「處方藥使用者費用法」...........................................19 五、1997年通過「食品和藥品管制局現代化法」...............................19 六、2002年通過「公共衛生安全和生物恐怖主義準備和反應法」...20 七、2004年通過「生物保護法」...........................................................20 八、2016年12月13日通過「21世紀治療法」..................................20 第二節 美國新藥申請程序概觀.............................................................................21 第一項 試驗用新藥申請(INDA)...................................................................22 第一款 臨床前研究.........................................................................................22 第二款 臨床試驗.............................................................................................22 壹、臨床試驗之意義....................................................................................22 貳、臨床試驗之申辦人及相關人................................................................22 一、申辦人.................................................................................................22 二、試驗計畫主持人.................................................................................23 三、契約上研究組織.................................................................................23 參、試驗計畫書............................................................................................24 肆、臨床試驗之申請與核准........................................................................24 伍、臨床試驗之分期....................................................................................25 第三款 試驗用藥品的擴大使用.....................................................................26 壹、擴大使用的意義....................................................................................26 貳、申請擴大使用試驗用藥品之標準........................................................27 參、申請擴大使用試驗用藥品之類型........................................................27 一、個別病患,包括緊急使用................................................................27 二、中型規模之病患族群.........................................................................28 三、治療用途之試驗用新藥或治療計畫.................................................29 肆、試驗用藥品的擴大使用與病患的試驗權............................................30 第二項 新藥上市核准申請.................................................................................30 第一款 新藥上市核准申請的種類.................................................................30 壹、新藥上市核准申請(NDA)...............................................................30 貳、簡式新藥上市核准申請(ANDA)...................................................32 參、生物產品許可證之申請(BLA)........................................................33 肆、補充的新藥申請(SNDA) ....................................................................33 第二款 新藥上市核准申請的程序.................................................................34 第三款 新藥的加速審查程序.........................................................................36 壹、快速通道指定.......................................................................................36 貳、突破性治療開發指定...........................................................................36 參、加速核准...............................................................................................36 肆、優先審查指定.......................................................................................37 第三節 需要FDA核准與欠缺FDA核准的藥品類別........................................37 第一項 1938年和1962年立法.........................................................................37 第二項 藥效研究實施計畫(DESI)...............................................................39 第三項 處方藥總結提要....................................................................................41 第四項 新的未經核准的藥品............................................................................42 第五項 非處方(OTC)藥品審查....................................................................42 第三章 美國申請新藥上市核准的有效性判斷...........................45 第一節 概 論 ........................................................................................................45 第一項 美國藥品有效性的法制簡史................................................................45 第二項 FDA的藥效研究實施計畫(DESI).......................................46 第三項 探討藥品有效性的三個面向............................................................48 第四項 本文所欲研究的藥品有效性之主題....................................................50 第五項 本文研究方法及研究範圍....................................................................51 第二節 美國的藥品和生物產品申請上市之核准法制........................................52 第一項 美國的藥品申請上市之核准法制......................................................52 第二項 美國的生物產品申請上市之核准法制..............................................54 第三節 從產業面向探討藥品的有效性........................................................56 第一項 藥品的有效性宣稱.............................................................................57 第二項 藥品的有效性.....................................................................................59 第一款 藥品的有效性並非一項法定的標準..............................................59 第二款 該藥品的有效性實際上是一項虛幻的法定標準............................60 第四節 從規範面向探討如何證明藥品的有效性...............................................60 第一項 充分和受良好控制的試驗....................................................................60 第一款 充分和受良好控制的試驗之內涵....................................................61 第二款 充分和受良好控制的試驗之主要特徵............................................61 第三款 符合充分和受良好控制的試驗的某些例外情形.............................63 壹、關於安慰劑對照組的例外情形...........................................................63 一、安慰劑同時併行的對照組(Placebo concurrent control)............63 二、劑量比較同時併行的對照組(Dose-comparison concurrent control)...........................................................................................63 三、無治療同時併行的對照組(No treatment concurrent control)...64 四、活性治療同時併行的對照組(Active treatment Concurrent control)...........................................................................................64 五、歷史對照組(Historical control)..................................................64 貳、關於盲法與隨機化的某些例外情形..................................................64 第四款 依黃金標準能否確保藥品的有效性................................................65 壹、黃金標準無法防止多次試驗的進行..................................................65 貳、發表偏差..............................................................................................66 第五節 實質證據...................................................................................................67 第一項 實質證據之定義...................................................................................67 第二項 實質證據之組成...................................................................................68 第一款 充分的和受良好控制的試驗...........................................................68 第二款 應由合格專家來評估所涉及藥品的有效性...................................69 第三款 能由合格專家公平負責地作成藥品具有宣稱效果之結論...........69 第三項 實質證據在證據光譜中的定位...........................................................70 第六節 證明藥品有效性所需要的實質證據之數量...........................................71 第一項 原則上:需要提出兩個充分的及受良好控制的試驗.......................71 第二項 例外情形:僅需要提出一個充分的及受良好控制的試驗...............72 第一款 從現有的研究推斷............................................................................73 第二款 藉由從相關研究數據獨立證實一項新用途的單一研究................73 第三款 來自單一研究的有效性證據............................................................73 第三項 1997年FDA現代化法的特別修訂規定.............................................74 第四項 關於生物產品部分.................................................................................75 第七節 從科學面向探討如何證明藥品的有效性.................................................76 第一項 科學上證明藥品有效性的試驗設計.....................................................76 第一款 顯著性試驗.........................................................................................77 壹、顯著性試驗之意義................................................................................77 貳、顯著性試驗之假設檢定........................................................................77 第二款 優效性試驗.........................................................................................78 壹、優效性試驗的意義................................................................................78 貳、優效性試驗與顯著性檢驗的差別.........................................................78 參、使用優效性試驗的考量........................................................................78 肆、優效性試驗的假設檢定.........................................................................79 伍、關於優效性臨界值的選擇....................................................................80 陸、數據分析................................................................................................81 第三款 等效性試驗.........................................................................................81 壹、等效性試驗之意義................................................................................81 貳、使用等效性試驗的考量........................................................................82 參、等效性試驗的內涵................................................................................82 肆、等效性的假設檢定................................................................................83 伍、檢定力分析............................................................................................84 第四款 非劣效性試驗.....................................................................................85 壹、非劣效性試驗之意義............................................................................85 貳、使用非劣效性試驗的考量....................................................................85 參、非劣效性試驗的內涵............................................................................86 肆、關於非劣效性臨界值的選擇................................................................87 伍、關於檢驗的靈敏度................................................................................89 第二項 統計上顯著性.........................................................................................90 第一款 統計上顯著性的意義.........................................................................90 第二款 統計上顯著性作為證明藥品有效性的法定要求之要素.................92 第三款 統計上的顯著性是否能證明藥品的有效性.....................................93 第三項 臨床上顯著性.........................................................................................93 第一款 臨床上顯著性之意義.........................................................................94 第二款 臨床上顯著性之測量.........................................................................95 第三款 臨床上顯著性作為證明藥品有效性的法定要求之要素.................98 第四款 在法規範上如何規定臨床上顯著性.............................................101 第五款 在實務上適用臨床上顯著性的爭議..............................................103 壹、United States v. Rutherford一案(1979)........................................103 貳、Warner-lambert v. Heckler一案(1986).........................................104 參、United States v. 225 Cartons一案(225 CartonsⅡ)(1989).........104 肆、Serono Lab. v. Shalala一案(1998)................................................106 伍、小結.....................................................................................................109 第六款 欠缺臨床上顯著性標準對申請人的困擾.......................................110 第八節 結 語........................................................................................................111 第四章 美國新藥經核准上市後有效性的行政監管法制........119 第一節 概 論........................................................................................................119 第一項 藥品的有效性宣稱的理論...................................................................120 第一款 藥品的有效性宣稱的理論基礎.......................................................120 壹、由誰決定藥品的「有效性宣稱」內容及範圍.................................120 貳、FDA負有審查及評價藥品有效性宣稱之職責................................120 第二款 藥品的有效性宣稱理論的開展......................................................121 壹、藥品的有效性宣稱理論所涉及之層面............................................121 貳、發生標示外使用的可能原因............................................................122 參、標示外使用的發現............................................................................125 第二項 藥品上市核准或許可理論.................................................................126 第一款 藥品上市前核准或許可制度.........................................................126 第二款 藥品核准或許可上市的意義、性質及範圍.................................126 壹、藥品核准或許可上市的意義...........................................................126 貳、藥品核准或許可上市的性質...........................................................127 參、藥品核准或許可上市的範圍...........................................................128 第三款 藥品核准或許可的撤銷或廢止.....................................................129 壹、核准或許可行政處分的撤銷或廢止.................................................129 貳、美國聯邦行政程序法的一般規定.....................................................129 參、聯邦食品藥品及化妝品法的特別規定.............................................130 肆、小結.....................................................................................................131 第三項 藥品據實標示及廣告理論..................................................................131 第一款 藥品標示/標籤的意義.....................................................................131 第二款 藥品標示的內容與格式之特殊要求..............................................134 壹、關於處方藥資訊的最顯著部分........................................................134 貳、完整的處方資訊................................................................................134 第三款 藥品標示的目的與功能..................................................................135 壹、藥品標示的目的................................................................................135 貳、藥品標示之功能................................................................................136 第四款 藥品據實標示及廣告之義務..........................................................137 第二節 關於新藥經核准上市後的有效性監管法制.........................................138 第一項 藥品獲准上市前的監管法制.............................................................139 第二項 藥品獲准上市後的監管法制.............................................................139 第一款 對藥品本身的安全性與有效性監管..............................................140 壹、對藥品本身的安全性與有效性監管................................................140 貳、藥品監視資訊系統............................................................................141 參、藥品回收......................................................................................142 一、藥品回收的意義..............................................................................142 二、藥品回收的方式..............................................................................142 (一) 自願回收......................................................................................142 (二) 非自願回收..................................................................................142 1、FDA要求回收..........................................................................143 2、FDA命令回收..........................................................................143 3、FDA強制回收要求..................................................................144 4、根據同意令之命令回收...........................................................144 三、藥品回收的分類..............................................................................144 第二款 對藥品之標示不實的監管...........................................................145 壹、藥品標示不實的監管法制沿革........................................................145 貳、藥品的有效性宣稱與被核准之範圍................................................145 參、關於藥品標示不實的監管法制........................................................146 肆、關於藥品標示不實的判斷因素........................................................148 伍、標示外使用是否為法律所禁止的標示不實行為............................148 陸、關於藥品標示外廣告或促銷或其他方式的監管............................150 第三項 FDA的管制規則............................................................................151 壹、處方藥廣告規則對處方藥廣告的限制.............................................151 貳、藥品之預期的用途.............................................................................151 參、關於副作用、禁忌症和有效性資訊的真實陳述.............................152 第三節 藥品標示上使用與藥品標示外使用....................................................152 第一項 藥品標示上使用與藥品標示外使用..................................................153 第一款 藥品標示上使用..............................................................................153 第二款 藥品標示外使用..............................................................................153 壹、標示/標籤外使用的意義...................................................................153 貳、標示外使用與醫學上軼聞證據........................................................154 第二項 醫師的標示外使用與製造商的標示外使用.....................................154 第一款 醫師的標示外使用..........................................................................154 壹、醫師對藥品的處方權受州法規範....................................................154 貳、醫師作為「專業之中間人」............................................................155 參、醫師的處方權得基於專業自主決定................................................156 肆、醫師的「標示外處方」是否為聯邦法或州法所禁止....................156 一、FDCA對於醫師「標示外處方」的規定.....................................156 二、FDA對於FDCA的解釋...............................................................157 三、就醫師標示外處方的限制部分.....................................................158 四、就醫師的標示外銷售、廣告或促銷部分.....................................159 伍、United States v. Evers一案................................................................159 一、案例事實.........................................................................................159 二、聯邦地方法院之判斷.....................................................................161 三、聯邦上訴法院之判斷.....................................................................161 (一)本件應審究之爭點.................................................................162 (二)就是否違反第301條第(k)項部分...................................162 (三)就是否違反第502條第(f)項第(1)款規定部分.........163 (四)就該法第502條第(f)項第(1)款的兩個重要例外 部分......................................................................................164 (五)將第301條第(k)項的兩個要素放在一起考慮..............167 陸、小結...................................................................................................168 第二款 藥品製造商的標示外使用.............................................................169 壹、製造商的藥品標示外使用與補充新藥申請(SNDA)................169 貳、藥品製造商提出補充新藥申請的考量因素...................................170 參、藥品製造商的標示外使用係法律所禁止的標示不實行為...........170 肆、藥品製造商的標示外使用之特殊類型...........................................171 伍、藥品製造商的標示外使用與憲法的商業言論自由保障...............172 第三項 藥品製造商之標示外使用的贊成論與反對論.................................172 第一款 藥品製造商之標示外使用的贊成論.............................................173 壹、提出補充申請的費用過高...............................................................174 貳、補充新藥申請審查程序過於繁瑣冗長...........................................174 參、原申請新藥的專利權期間即將到期...............................................174 肆、基於某些治療領域的實際需要.......................................................175 伍、透過標示外促銷,可提供醫師和公眾真實的和可靠的資訊.......176 陸、法院判例支持公開傳播有關重要治療方法的科學和醫學資訊...177 第二款 藥品製造商之標示外使用的反對論.............................................178 壹、標示外使用,常被證明是有害的...................................................178 貳、FDA長久的執法經驗顯示標示外使用會遭濫用..........................179 參、依FDCA規定,當然會推導出反對標示外使用的解釋..............180 肆、標示外使用是未經充分的和受良好試驗的臨床試驗證明...........180 伍、標示外使用將會破壞FDA對於藥品監管的整體性與一致性........181 陸、提供醫師和公眾真實的和可靠的資訊非必要透過藥品製造商 之手......................................................................................................181 第三款 標示外使用的折衷論..................................................................181 壹、從醫師的角度言..................................................................................181 貳、從藥品製造商的角度言......................................................................182 第四節 FDA對藥品製造商標示外促銷的執法政策.......................................183 第一項 對於傳播某些已發布的原始數據重印的產業指引.........................183 第二項 產業資助的參考文本傳播指引.........................................................184 壹、指引之目的..........................................................................................184 貳、傳播參考文本之情況..........................................................................185 參、例外......................................................................................................186 第三項 受產業支持的科學和教育活動之產業指引...................................186 第四項 FDAMA改變FDA的執法政策.......................................................188 第五項 2009年良好重印本操作規範.............................................................190 第一款 2009年良好重印本操作規範之目的..............................................191 第二款 FDA對於2009年良好重印本操作規範之建議............................192 壹、重印本/文章/參考出版物之類型.......................................................192 貳、傳播科學和醫學資訊的方式.............................................................193 第五節 藥品製造商對FDA執法政策的挑戰....................................................194 第一項 Washington Legal Foundation v. Kessler一案(1995).........................195 第一款 WLF(I)案例事實摘要......................................................................195 第二款 哥倫比亞特區聯邦地方法院之判決理由......................................196 壹、會員資格............................................................................................196 貳、切相關性............................................................................................196 參、個別會員的參與................................................................................197 肆、耗盡原則............................................................................................197 伍、成熟度................................................................................................197 陸、終局性.............................................................................................198 第二項 Washington Legal Foundation v. Friedman一案(1998)..................201 第一款 WLF(Ⅱ)案例事實摘要.................................................................201 第二款 哥倫比亞特區聯邦地方法院之判決理由...................................201 壹、在當前第一修正案判例法之下,製造商贊助CME和分發持久 材料的分類........................................................................................201 一、製造商贊助CME和分發持久材料屬於言論或行為?..............201 二、由於食、藥產業被廣泛監管,該指引文件處理完全可監管的 言論不受聯邦憲法第一修正案所涵蓋?.....................................202 三、純粹的言論或商業言論?..............................................................205 貳、商業言論檢驗標準之適用..................................................................210 一、該言論既非不法的,亦非本身誤導的..........................................210 (一)該言論並非不法的.................................................................210 (二)該言論不是誤導的(/引人錯誤的).....................................211 1、「可能誤導的」言論是否為「誤導的言論」.....................211 2、該言論須「本身具有誤導性」...........................................212 3、一項尚未獲得FDA核准之宣稱,是否被推定為不真實或 誤導性的言論...........................................................................212 4、藥品製造商有無參與或未經請求而發送重印本...........213 5、該治療宣稱能否符合重要的科學協議標準......................214 6、FDA指引文件規範的言論屬性.........................................215 二、該政府的利益是重大的...............................................................216 (一)由於害怕該項資訊將被醫師誤用,該政府無法正當化該 指引........................................................................................217 (二)政府在迫使製造商使標籤外治療成為標籤上方面確實具 有重大利益..............................................................................218 1、被告政府的論點......................................................................218 2、原告的論點..............................................................................219 3、法院的認定 ............................................................................219 三、在要求製造商提出補充申請以獲得新使用的核准方面,該指引 文件直接促進重大的政府利益..................................................220 (一)對商業言論限制必須直接和具體的促進該政府的利益......220 (二)藥品製造商規避提出後續核准補充申請的原因考量..........220 (三)什麼誘因使藥品製造商必須提出後續核准的補充申請......221 (四)法院的認定..............................................................................221 四、該指引文件是違憲的,因為它們比必要的更為廣泛..................221 參、結論.....................................................................................................223 第三項 Washington Legal Foundation v. Henney一案(1999)........................226 第一款 WLF(Ⅲ)案例事實摘要...............................................................226 第二款 聯邦哥倫比亞特區地方法院判決理由........................................229 壹、Central Hudson案件檢驗標準之適用....................................................230 貳、該言論既不是非法的,也不是本身誤導的..........................................230 參、政府具有重大的利益..............................................................................231 肆、在該FDAMA中所包含的政策僅有一項直接促進該政府在鼓勵製 造商尋求FDA核准標籤外使用的重大利益........................................232 伍、該項補充申請要求是違憲的,因為其對言論的負擔比需要的大得多233 陸、結論..........................................................................................................234 第三款 聯邦哥倫比亞特區上訴法院判決...................................................237 第四款 WLF(Ⅳ)案聯邦哥倫比亞特區地方法院更審判決........................241 壹、原告請求之性質.................................................................................241 貳、該被變更的禁制令之範圍.................................................................241 參、FDA的2000年3月16日公告........................................................243 肆、結論.....................................................................................................243 第四項 Thompson v. Western States Medical Center一案(2002)..................244 第五項 Sorrell v. IMS Health, Inc.一案(2011)..................................................247 第六項 United States v. Caronia一案(2012)....................................................249 第一款 案例事實..........................................................................................249 壹、Orphan公司製造之藥品Xyrem及其適應症.................................249 貳、Orphan公司的標籤外促銷行為......................................................249 參、FDA之蒐證及起訴............................................................................250 肆、法院判決結果及上訴理由.................................................................250 第二款 聯邦第二巡迴區上訴法院之判決理由...........................................251 壹、言論對意圖之證據(Speech versus Evidence of Intent)..............251 貳、起訴Caronia的言論..........................................................................252 一、可適用的聯邦憲法第一修正案法律原則...................................253 二、適用..............................................................................................254 (一)加強的審查(Heightened Scrutiny)...............................255 (二)Central Hudson案審查標準................................................256 1、直接促進.................................................................................256 2、狹窄地裁制(Narrowly Drawn)...........................................258 參、結論...................................................................................................260 第七項 本文對上述聯邦法院判決之評析.....................................................260 第一款 藥品製造商之「標籤外促銷」是否為真實的言論.......................263 壹、合法的、真實的、非誤導的言論要受第一修正案保護的理由.....263 貳、聯邦法院對製藥商之「標籤外促銷宣稱」的真實性判斷及其 影響.....................................................................................................264 一、聯邦法院對製藥商之「標籤外促銷宣稱」的真實性判斷........264 二、聯邦法院對製藥商之「標籤外促銷宣稱」的真實性判斷的 影響.................................................................................................265 (一) 「軼事證據標準」或「實質證據標準」,哪一個會破壞 FDCA對藥品監管體制的一致性與完整性?........................265 (二) 採「真實性推定」,將使藥品陷入無人監管的醫療訛詐 之地............................................................................................267 參、該標籤外促銷宣稱之真實性推定,欠缺認識論的及科學的基礎269 肆、一項藥品療效的宣稱尚未獲得FDA核准,應否被推定為不真實 的言論...............................................................................................271 一、申請人就其藥品的標籤上宣稱,應以實質證據證明...............271 二、該實質證據應受到合格專家間「重要的科學協議」之支持.....272 三、經FDA核准,乃為確保藥品標籤外宣稱的真實性所必要之 程序.................................................................................................273 四、FDA的主張有無誇大其在宇宙中的整體位置............................273 伍、關於藥品製造商「標籤外促銷」之真實性的證明責任分配.........274 一、聯邦最高法院之見解:政府應負證明責任..................................274 二、FDCA規定:申請人就其「藥品的有效性宣稱」應負證明責任274 第二款 該藥品製造商之標籤外促銷是否為合法的言論...........................275 壹、聯邦法院的見解.................................................................................275 一、Friedman案法院之見解.......................................................275 二、Caronia案法院之見解.................................................................276 贰、本文的評釋及分析..............................................................................277 一、該「標籤外促銷」,是否為FDCA所禁止的不合法言論............277 (一) 依FDCA第505條第(a)項、第301條第(d)項規定之 觀點............................................................................................277 (二) 依FDCA第502條第(a)或(f)項規定之觀點...........278 二、Whitaker案法院之見解.........................................................279 (一) Whitaker案事實摘要..............................................................279 (二) Whitaker案聯邦上訴法院之判決理由(就憲法上請求部分)279 三、該「標籤外促銷宣稱」,得否作為標示不實的使用證據.......281 四、該Caronia案法院規避Whitaker案法律見解之適用.............282 五、該Caronia案法院之理由前後矛盾..............................................283 六、該Friedman案法院論斷的邏輯思維方式及其盲點...................284 (一) 該Friedman案法院論斷的邏輯思維方式..............................284 (二) 該Friedman案法院論斷的邏輯思維的盲點.............................285 七、FDA的主張有無構成「同義反復」循環論證之謬誤.................285 (一) Friedman案的問題點,究係函攝?抑係循環論證?..........285 (二)關於什麼是被禁止的「標示不實」行為,係國會的立法決定286 第三款 該藥品製造商之標籤外促銷是否為誤導的言論...........................287 壹、聯邦法院的見解.................................................................................287 一、Friedman案法院之見解.................................................................287 二、Carronia案法院的見解..................................................................287 貳、本文之評釋及分析.............................................................................288 一、關於傳播標籤外使用之資訊是否為一種誤導的言論.................288 (一) 可能誤導的言論與本身誤導的言論.........................................288 1、「可能誤導的」言論是否為「誤導的言論」........................288 2、該言論須「本身具有誤導性」..............................................288 (二) 傳播標籤外使用之資訊是否為誤導的言論..........................289 二、關於藥品「標籤外促銷」是否為一種誤導的言論.....................290 (一) 虛偽不實的與誤導的的相互辯證關係....................................290 (二) 標籤外使用容易產生誤導或引人錯誤....................................291 (三) 因一項藥品的宣稱而成為誤導的言論之類型........................291 1、因標籤上宣稱而成為誤導的言論.......................................291 2、因標籤外宣稱而成為誤導的言論................................292 三、一項標籤外促銷是否為誤導的言論之證明責任分配..............293 (一) 應由藥品製造商負擔證明責任的情形..................................293 (二) 應由FDA負擔證明責任的情形............................................293 第四款 聯邦法院混淆醫事法與藥事法的分際......................................293 壹、聯邦法院之見解............................................................................293 一、Friedman案法院之見解..............................................................293 二、Caronia案上訴法院的見解........................................................294 贰、聯邦法院混淆醫事法與藥事法的分際........................................294 (一) 就醫事法部分........................................................................294 (二) 就藥事法部分.........................................................................295 第五款 對該標籤外促銷之限制,是否超過服務公共利益所必要的程度296 壹、「標籤外促銷」容易在商業動機驅動之下被濫用...........................296 貳、醫師接受藥品的專業資訊,不一定要透過藥品製造商之手.........296 參、FDCA限制或禁止「標籤外促銷」,未逾越必要程度之範圍.......297 肆、限制標籤外促銷是違憲的論點,忽視FDCA的真正目的............297 伍、Caronia案判決充滿了缺陷...............................................................297 第六款 關於「安全港條款」的議題...........................................................298 壹、安全港條款的意義與功能.................................................................298 一、安全港條款的意義..........................................................................298 二、安全港條款的功能.........................................................................298 貳、安全港條款如何適用於製造商傳播持久性材料和支持CME活動299 參、在藥品「標籤外使用」領域,需要設「安全港條款」的理由.....301 一、從藥品製造商之觀點言..................................................................301 二、從FDA之觀點言............................................................................301 (一)從抽象的思路探求FDA需要安全港條款的可能性..................301 (二)從實際的觀點觀察FDA對於安全港條款的態度......................302 第六節 結 語........................................................................................................304 第五章 美國新藥獲准上市後有效性的司法監管法制.............313 第一節 概說..................................................................................................313 第二節 虛偽請求償付之民事責任...................................................................315 第一項 民事虛偽請求法的歷史....................................................................315 第二項 現行民事虛偽請求法...........................................................................317 第一款 民事虛偽請求成立要件..................................................................317 第二款 請求(claim).................................................................................319 第三款 明知之定義.....................................................................................320 第四款 虛偽的或詐欺的.............................................................................320 第三項 民事虛偽請求法的責任理論.............................................................321 第一款 傳統的FCA案例類型................................................................321 第二款 Qui Tam訴訟的新主要類型..........................................................322 壹、最佳價格...........................................................................................322 貳、標籤外使用促銷...............................................................................324 參、設施瑕疵.........................................................................................325 第三款 Qui Tam訴訟的進行........................................................................326 壹、誰有權利提起一件Qui Tam民事訴訟......................................326 一、由美國司法部長代表政府提起..................................................326 二、由私人提起訴訟............................................................................326 貳、由私人提起qui tam訴訟的程序.....................................................326 一、應送達起訴狀副本及相關證據及資訊給政府.............................326 二、該政府應於送達後60天或聲請延長的時間內決定是否加入 訴訟.............................................................................................327 三、排除其他人以同一事由加入訴訟或提起一件相關訴訟.............328 參、Qui Tam訴訟的當事人之權利.......................................................328 一、若為政府進行訴訟之情形..........................................................328 二、若為該提起訴訟之人單獨進行訴訟之情形...............................329 三、證據開示將會妨礙民、刑訴訟的調查或訴訟程序的處理........329 四、當事人對於政府在另一訴訟之其他替代措施的權利與效力.....329 第四款 對Qui Tam訴訟原告的獎勵...........................................................330 壹、由政府進行私人所提起之訴訟的情形.............................................330 一、提起訴訟之私人應獲得的獎勵比例.............................................330 二、非由提起訴訟之人提供資訊的獎勵比例.....................................330 三、將勵的項目及費用負擔來源.........................................................331 貳、由提起訴訟之人單獨進行訴訟之情形.............................................331 一、私人獲得獎勵的比例.....................................................................331 二、將勵的項目及費用負擔來源.........................................................331 參、該提起訴訟之人曾計劃並發起對政府為虛偽請求的情形.............331 肆、所提起之訴訟是無意義、無理纏訟或出於騷擾目的之情形.........332 第五款 禁止提起某些Qui Tam訴訟...........................................................332 壹、對於聯邦法院管轄權的限制.............................................................332 一、該訴訟係因武裝部隊成員的服役行為所引起者.........................332 二、該訴訟係基於政府所已知之證據或資訊對某些政府重要人員 所提起者........................................................................................332 三、該訴訟係基於政府已是某訴訟程序主體的一方當事人之指控 或交易者................................................................................333 四、該訴訟基於已被公開揭露之相同指控或交易者.......................333 (一) 原則上.......................................................................................333 (二) 例外情形....................................................................................333 五、其他人以同一事由加入訴訟或提起一件相關訴訟者.................334 貳、對於適用司法管轄權禁止條款的實務分析....................................334 第六款 費用支出的負擔...............................................................................336 壹、政府對某些費用不負責任...............................................................336 貳、被告勝訴時的費用及開支之負擔.................................................336 第七款 報復性行動之救濟.................................................................336 壹、總則.................................................................................................336 貳、救濟.....................................................................................................337 參、提起民事訴訟的限制.........................................................................337 第三節 藥品製造商促銷標示外使用的FCA責任............................................337 第一項 United States ex rel. Franklin v. Parke-Davis案...........................337 第一款 案例事實摘要................................................................................337 壹、事實概述..........................................................................................337 貳、符合Medicaid償付條件之藥品...................................................338 參、Parke-Davis的藥品作標籤外使用及造成政府的償付.................338 肆、Parke-Davis僱用「醫藥學術專員」執行標籤外使用促銷業務..339 伍、Parke-Davis 違反Medicaid的反回扣條款...................................339 陸、政府加入Qui Tam訴訟................................................................340 第二款 法院的裁定理由.........................................................................340 壹、原告之聲請....................................................................................340 貳、聯邦地方法院之民事裁定理由.......................................................341 一、關於未能提出詐欺具有特殊性部分......................................341 (一) 聯邦民事訴訟規則第9條第(b)項適用於FCA qui tam請求341 (二) 揭露............................................................................................342 (三) 指控的充分性............................................................................343 1、Neurontin...............................................................................343 2、退伍軍人管理局..................................................................345 3、Accupril..............................................................................345 二、未能說明一項請求........................................................................346 (一) 聲請駁回之標準.......................................................................346 (二) 造成提出虛偽的Medicaid請求..............................................346 (三) 回扣請求(Kickback claim).................................................350 (四) 臨床試驗....................................................................................352 三、結論與命令....................................................................................352 參、法院關於聲請簡易判決之裁定....................................................353 第二項 Franklin v. Parke-Davis案的爭點探討............................................355 第一款 藥品製造商造成被提出的責任...................................................355 壹、造成被提出責任的當事人.............................................................355 貳、關於「明知」的證明.....................................................................356 參、關於「造成被提出」的因果關係鏈..................................................358 第二款 對於Medicaid償付所提出的請求之虛偽性................................358 壹、對政府所提出的支付請求應為「虛偽的」或「欺詐的」...........358 貳、標籤外促銷「造成被提出」償付請求之「虛偽性」之探討.......358 第三款 FCA作為執行FDCA的一項工具.....................................362 壹、FDCA並無違法行為的民事損害賠償規定..................................362 貳、FCA作為執行FDCA的一項工具.............................................362 第四節 政府對醫療保健產業之虛偽請求的執法活動.....................................363 第一項 概說...................................................................................................363 第二項 美國及私人就健康保健領域違反FCA的執法活動.....................364 第五節 關於藥品製造商的標籤外促銷行為的民事責任................................385 第一項 美國的產品責任法制概觀................................................................385 第一款 美國法上的產品責任原則.............................................................385 第二款 美國產品責任之瑕疵類型.............................................................386 壹、製造上之瑕疵...................................................................................387 貳、設計上瑕疵.......................................................................................387 參、指示或警告上之瑕疵.......................................................................387 第三款 製造人之產品責任抗辯事由.........................................................387 壹、使用者之不當行為抗辯事由...........................................................388 貳、無責任抗辯事由...............................................................................388 一、現有科技水準之抗辯...................................................................388 二、有經驗之使用者抗辯...................................................................388 三、專業中間人抗辯...........................................................................389 四、有經驗的中間人抗辯...................................................................389 五、散裝供應商抗辯與原料或零件供應商抗辯...............................389 六、不可預期之不合理風險抗辯.......................................................389 參、其他特別抗辯事由............................................................................390 (一)信賴購買者設計規格抗辯...................................................390 (二)符合政府規範抗辯...............................................................390 (三)聯邦優先權抗辯....................................................................391 (四)司法拒絕政府標準抗辯........................................................391 第二項 美國之藥品及醫療器材產品責任法制.............................................391 第一款 藥品與醫療器材之瑕疵類型..........................................................392 壹、製造上之瑕疵....................................................................................392 貳、設計上瑕疵........................................................................................392 參、指示或警告上之瑕疵........................................................................393 第二款 藥品或醫療器材之製造人的產品責任抗辯事由..........................393 壹、無可避免之不安全抗辯....................................................................394 貳、專業中間人抗辯................................................................................394 參、符合政府規範抗辯與聯邦優先權抗辯............................................395 第三款 藥品或醫療器材之製造人產品責任之實務判例..........................396 壹、Medtronic, Inc. v. Lohr案................................................................396 貳、Riegel v. Medtronic, Inc.案..............................................................398 參、Wyeth v. Levine案.............................................................................399 肆、小結....................................................................................................400 第三項 製造商處方藥標籤外使用和產品責任..........................................401 第一款 處方藥的標籤外使用.....................................................................401 壹、製造商的藥品標籤外使用之產品責任............................................402 貳、由藥品標籤外使用所造成的傷害產品責任....................................403 第二款 藥品標籤外使用之產品責任判例..................................................404 壹、Robak v Abbott Laboratories案.......................................................404 貳、Hahn v Richter案.............................................................................405 第三款 對藥品標籤外使用之產品責任判例評釋......................................405 壹、對Robak v Abbott Laboratories案的評釋部分................................405 貳、對Hahn v Richter案的評釋部分.....................................................406 第六節 結 語.....................................................................................................406 第六章 總 結...............................................................................409 第一節 本論文所研究的問題點與研究成果摘要....................................409 第二節 本論文的研究成果對於我國藥事法制的啟示.................................413 第一項 關於新藥的申請上市核准要件方面...................................................413 第一款 美國法制...........................................................................................414 第二款 我國法制...........................................................................................414 第二項 關於藥品製造商之標示/標籤外促銷部分..........................................416 第一款 美國法制...........................................................................................416 第二款 我國法制...........................................................................................418 第三項 關於虛偽請求健康保健計畫給付方面...............................................420 第一款 美國法制...........................................................................................420 第二款 我國法制...........................................................................................421 參考文獻.......................................................................................425 甲、中文部分..........................................................................................................425 一、書籍...........................................................................................................425 二、期刊.............................................................................................................425 三、論文............................................................................................................425 乙、英文部分.........................................................................................................426 A、Law...............................................................................................................426 B、Regulation....................................................................................................430 C、ICH..............................................................................................................432 D、Decision........................................................................................................433 E、FDA Report and Guidance..........................................................................442 F、European Union............................................................................................445 G、TEXT BOOK..............................................................................................446 H、Paper............................................................................................................446 表目錄 表4-1有關藥品標示外使用的資訊得被傳播的條件.................................306 表4-2 FDA對藥品製造商標示外促銷的各項產業指引與訴訟對應表....309 表4-3經核准之藥品有效性的行政監管細目.............................................311 圖目錄 圖3-1一項試驗用新藥/新藥的療效可能範圍圖........................................113 圖3-2安慰劑優效性研究的可能結果.........................................................115 圖3-3顯示對照藥品-試驗藥品差異的NI研究的可能結果.....................116 圖3-4顯示有效對照藥品-試驗藥品差異的一項NI研究之可能結果......117

    參考文獻
    甲、中文部分:
    一、書籍:
    【Chapter 3】
    1. 林惠玲、陳正倉,統計學方法與應用,雙葉書廊有限公司,上、下冊(2011年4月4版增訂)。
    2. 陳敏,行政法總論,作者自行發行,神州圖書經銷,頁342、392(2003-3版)。

    二、期刊:
    【Chapter 1-2】
    1. 蘇顯騰,論未經核准之試驗用藥品的擴大使用法制--以美國法制為論述核心,成大法學,第34期,第157-239頁(2017年12月)。
    【Chapter 3】
    1. 黃欽、趙明,對臨床試驗統計學假設檢驗中非劣效、等效和優效性設計的認識,中國臨床藥理學雜誌 第23卷第1期,頁65(2007年1月(總第105期))。
    【Chapter 4】
    1. 林子儀,言論自由的理論基礎,台大法學論叢,第18卷,第1期,第239-240 頁(1988)。

    三、論文:
    1. 廖建瑜,論臺灣處方藥仿單外使用之管制,國立成功大學法律系博士論文,第31-38頁(2013)。
    2. 蔡立群,論現代產品責任法抗辯事由-以美國法之瑕疵類型為中心,中國文化大學法律學研究所碩士論文,頁78-82(2008)。
    乙、英文部分:
    A、Law:
    【Chapter 1-2】
    1.21st Century Cure Act, Pub.L.114–255.
    2.21st Ccentury Cure Act, Sec.3001.,incorporated into FDCA Sec. 569C(c)(21 U.S.C.360bbb-8c(c)).
    3.21st Ccentury Cure Act, Sec.3023.,incorporated into FDCA Sec.505E(b)(21 U.S.C.355f (b)).
    4.70(2) Food Drug Law J.315,315-317(2015).
    5.CDER,CDER Approval Times for Priority and Standard NDAs and BLAs Calendar Years 1993–2016,Pub. L. No. 59-384, 34 Stat. 768 (1906).
    6.702-03(codified as amended at 42 U.S.C. §§ 262(a), 264 (2012)).
    7.Drug Amendments of 1962, Public Law 87-781, 76 Stat.780.(1962).
    8.Drug Amendments of 1962 Secs. 107 (c)(4).
    9.Drug Amendments of 1962, Public Law 87-781, 76 Stat.780.
    10.Drug Amendments of 1962 Secs. 107 (c)(2)(4),(c)(3)(B),Public Law 87-781,76 Stat. 780.
    11.FDCA of 1938, 201(p),(p)(1)(2).(21 U.S.C. 321(p),(p)(1)(2)).
    12.FDCA of 1938, 505(b).(21 U.S.C. 355(b)).
    13.FDCA of 1962, 505(b),(d)(5),(e)(3).(21 U.S.C. 355(b),(d)(5),(e)(3))
    14.Federal Anti-Tampering Act,U.S.C. TITLE 18.
    15.FDCA §201(aa)(p)(1962)(21 U.S. Code §321(aa)(p))
    16.FDCA of 1938, 201(p)(1)(2)(21 U.S.C. 321(p)(1)(2)).
    17.FDCA of 1938, 201(p),(p)(1) (21 U.S.C. 321(p),(p)(1)).
    18.FDCA of 1962, 505(b) (21 U.S.C. 355(b))
    19.The Prescription Drug User Fee Act (PDUA)(H.R.6181,).
    20.Public Health Service Act (1944) , ch. 373, §§ 351, 351(a), 361, 58 Stat. 682, 702-03(codified as amended at 42 U.S.C. §§ 262(a), 264 (2012)).
    21.Pub. L. No. 59-384, 34 Stat. 768 (1906).
    22.Pub. L. No. 75-717, 52 STAT 1040(1938).
    23.Pub.L.No.105-115., the Food and Drug Administration Modernization Act(FDAMA)of 1997.
    24.S.Res.287, The Drug Price Competition and Patent Term Restoration Act of 1984.
    25.15 U.S.C. Chapter 39 - FAIR PACKAGING AND LABELING PROGRAM.
    26.21 U.S.C. Section 371(a).
    27.21 U.S.C.§355(b),(b)(1),(d),(d)(2)(5),(i)(1)(4),(j)(1)(2).
    28.21 U.S.C. Section 360J(f).
    29.21 U.S. C.§393(1)(2).
    【Chapter 3】
    1. Federal Food and Drugs Act of 1906, Pub. L. No. 59-384, 34 Stat. 768 (1906).
    2. Federal Food, Drug , and Cosmetic Act of 1938, FDCA Public Law 75-717, 52 STAT 1040(1938)(Sec. 201(p)(1)(2), 505(b) (21 U.S.C. 201(p)(1)(2), 355(b)).
    3. Drug Amendments of 1962, Pub.L.No.87-781, 76 Stat.780.(1962)(Sec. 107(a)(b)).
    4. Federal Food, Drug , and Cosmetic Act of 1962,(Sec 107(c)(2) (3)(B). (c) (4), 201(g)(1) (p) ,505(b), (d)(5) ,(e)(3)(5), (d)(7), (j)(4)(C)(ii) )(21 U.S.C. 321(g)(1) (p).355(b)(5), (d)(5), (e)(3)(5),(d)(7), (j)(4)(C)(ii)) Pub.L.No.87-781, 76 Stat.780.(1962)
    5. Public Health Service Act, (58 Stat. 682, As Amended Through P.L. 115-123, Enacted February 9, 2018) (Sec. 351(a)(i)(1)(262(a)(i)(1))
    6. Food and Drug Administration Amendments Act of 2007, (Sec. 801)
    7. FDA Modernization Act of 1997, Pub. L. No. 105-115, § 113, 111 Stat. 2296 (42 U.S.C. 282(j)(3)(A))(2012)).
    8. 21st Ccentury Cure Act, (Sec.3001.,incorporated into FDCA Sec. 569C(c)(21 U.S.C.360bbb-8c(c)).
    【Chapter4】
    1.Administrative Procedure Act §§2(a),(e), 9, §706(2)(B) (Pub. L. No.404-79).
    2.FDCA §201(I)(k)(m)(n)( 21 U.S.C. 321(I)(k)(m)(n)).
    3.FDCA §301(a)(b)(c)(d)(k)(21 U.S.C. 331(a)(b)(c)(d)(K)).
    4.FDCA §303(a)(21 U.S.C. 333(a)).
    5.FDCA §423(21 U.S.C. §350l)
    6.FDCA §501(21 U.S.C. 351).
    7.FDCA §502,(a)(1),(f),(f)(1)(21 U.S.C. 352,(a)(1),(f),(f)(1)).
    8.FDCA §503(b)(2).
    9.FDCA §505(a), (e)(1) (2) (3) (4) (5), (k)(1) ( 21 U.S.C. §355(a), (e)(1) (2) (3) (4) (5), (k)(1)).
    10.FDCA§505(a),(C)(5)(A)(B)(D),(d)-(e),(e)(k)(1),(e)(1)(2)(3)(4) (5),(k)(1)(o)(3), ( 21 U.S.C.§355(a), (C)(5)(A)(B)(D),(d)-(e),(e) (k)(1),(e)(1) (2) (3) (4) (5),(k)(1),(o)(3)).
    11.FDCA §505-1(a)(1)(21 U.S.C.§355-1(a)(1)).
    12.FDCA §518(e)(21 U.S.C. §360h(e))
    13.FDCA §535(a)(21U.S.C. 360ll).; 21 C.F.R.1000–1050.
    14.FDCA §551(21 U.S.C. §360aaa(a)).
    15.FDCA §569D (21 U.S.C. §360bbb-8d).
    16.FDCA §908(c) (21 U.S.C. §387h(c)).
    17.FDCA §1006 (21 U.S.C. 396).
    18.FDAMA,§503A, 21 U. S. C. §353a ,111 Stat. 2328(1997).
    19.FDAMA Section 401(a) ((a) IN GENERAL.—Chapter V (21 U.S.C. 351 et seq.)
    20.Public Health Service Act (PHS Act) §351(d) (42 U.S.C. 262(d))( Recall of product presenting imminent hazard; violations)
    21.Public Health Service Act(PHS Act) §361(42 U.S.C. 264); 21 CFR Part 1271.440(Orders of retention, recall, destruction, and cessation of manufacturing).
    22.The Fair Packaging and Labelmg Act §10(c).
    23.Vt. Stat. Ann., Tit. 18 § 4631(e)(4).
    24.21st Century Cures Act(Dec.13, 2016) , Sec. 3037(HEALTH CARE ECONOMIC INFORMATION.), Section 502(a) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 352(a)). , P. L.114–255, 130 STAT. 1033.
    25.The Federal Food and Drugs Act (1906), Pub. L. No. 59-384, 34 Stat. 768.
    26.21 U.S.C.§§331(a)(z), 331et seq.,333(a), 352(n)(3),353(b)(1)(B),(b)(2).,355(a),(d) paragraph 2,
    27.21 U.S.C.§350a(f).
    28.21 U.S. C.§350l.
    29.21U.S.C§§360aaa et seq.
    30.21 U.S.C.§360aaa(a),(b)(1)-(6),(c).
    31.21 U.S.C.§360aaa-1.
    32.21 U.S.C.§360aaa-4(b)(1).
    33.21 U.S.C. § 360aaa-3(d).(按此項條文現已隨著FDAMA五年授權到期失效,而予以刪除)
    34.21 U.S.C.§396(b).
    【Chapter 5-6】
    1.The Civil False Claims Act of Mar. 2, 1863, ch. 67, 12 Stat. 696 (current version at 31 U.S.C. §3729 (2018)).
    2.The Federal Civil Penalties Inflation Adjustment Act of 1990.(28 U.S.C. 2461 note; Public Law 104–410).
    3.21 U.S.C. §§331(a) & (d), 332(a), 333(a), 334(a)
    4.28 U.S.C. 2461 note; Pub.L. No. 104-410.
    5.31 U.S.C. §3729(a),(a)(1) (A)-(G)-(3), 9(b),(b)(1)(2) (2018).
    6.31 U.S.C. §3730(a)(b)(1)-(5)(c)(1)-(5),(d)(1)-(4)(A) , (f), (h)(1)-(3) (2018).
    7.31 U.S.C. §3731(b)(1)-(2)(2018).
    8.42 U.S.C. §§1396b(i) (10), 1396r-8,(k) (3), (6),(c)(1)(C), (g) (1) (B) (i).
    B、Regulation:
    【Chapter 1-2】
    1.21C.F.R. Part 312 Investigational New Drug Application(IND). (2016)
    2.21 C.F.R. Part 314 Applications For FDA Approval To Market A New Drug (NDA). (2016)
    3.21 C.F.R. §312.3(b) . (2018)
    4.21 C.F.R. §312.50. (2018)
    5.21 C.F.R. §312.52(b). (2018)
    6.21 C.F.R. §312.20 ,(a)(c). (2018)
    7.21 C.F.R. §312.23. (2018)
    8.21 C.F.R. §312.40,(b)(2018). (2018)
    9.21 C.F.R. §312.21,(a)-(c). (2018)
    10.21 C.F.R. §312.32(c)(i). (2018)
    11.21 C.F.R. §312.42(a)(b)(1)(2). (2018)
    12.21 C.F.R. §314.2. (2018)
    13.21 C.F.R. §314. (2018)
    14.21 C.F.R. §130.40 (currently 21 C.F.R.§310.6),. (2018)
    15.21C.F.R. §330. (2018)
    16.21 C.F.R. §333. (2018)
    17.21 C.F.R. §310.502. (2018)
    【Chapter 3】
    1.Rules and Regulations:C.F.R. 130.4(c)(1)(i), 28 Fed. Reg. 6377, 6378 (June 20, 1963).
    2.Rules and Regulations: New Drugs, 39 Fed. Reg. 9750, 9755 (Mar. 13, 1974)
    3.21 C.F.R. 130.40 (currently 21 C.F.R. 310.6)(Oct 31, 1972)
    4.21 C.F.R. 202.1(e)(1).(3)(i) (2018)
    5.21 C.F.R. 312.23(a)(6) (2018)
    6.21 C.F.R. 314.125(b)(5) 126(a) (b)(2)(c) (i) (4)(5) (e) (v) (2018). .
    7.21 C.F.R. 314.50(d)(5)(ii) (2018)
    8.21 C.F.R. 314.92(1) (2018)
    9.21 C.F.R. 202.1 (e)(4) (ii)(b) (2018)
    10.21 C.F.R. 202.1 (e) (2)(7)(ii) (4)(ii)(b) (6)(vii)(2018)
    11.21 C.F.R. 330.10 (a)(4) (ii) (2001)
    12.21 C.F.R. 600.3 (s)
    13.21 C.F.R. 601.25 (6)(2) (ii) (d)(2) (2012).
    14.21 C.F.R. 1271.3 (d)
    15.21 C.F.R. 1271.10(a) (2015).
    【Chapter4】
    1.21 C.F.R. Subpart A--General Provisions, Sec. 1.3(a).
    2.21 C.F.R.§101.14.(c).
    3.21 C.F.R. Part 107, Subpart E.
    4.21 C.F.R.§201.5
    5.21 C.F.R.§201.6(a)(b).
    6.21 C.F.R.§201.56(a)(1)(2)(3),(d).
    7.21C.F.R.§201.57(a)(b)(c),(c)(6)(i), 314.70 and 601.12.
    8.21 C.F.R.§201.80.
    9.21 C.F.R.§201.100, (c)(1).
    10.21 C.F.R.§201.115
    11.21 C.F.R.§201.128.
    12.21 C.F.R.§202.1 (e)(3)(i),(e)(4)(i)(a) ,(e)(6)(i), (xi) (same).
    13.21 C.F.R.§216.23.
    14.21C.F.R.§300.50.
    15.21 C.F.R.§310.515.
    16.21 C.F.R.§314.80.
    17.21 C.F.R.§314.81(b)(2),(b)(2)(i).
    18.21 C.F.R.§810.
    【Chapter 5】
    1.21 C.F.R. §312.7.
    2.Fed. R. Civ. P. §§9(b), 12(b)(6)
    C、ICH:
    【Chapter 1-2】
    1.ICH, E9 Statistical Principles for Clinical Trials,1.2 Scope and Direction.
    2.ICH, E10 Choice of Control Group and Related Issues in Clinical Trials.

    【Chapter 3】
    1.ICH, E4 Dose-Response Information to Support Drug Registration
    2.ICH, E5(R1)Ethnic Factors in the Acceptab -ility of Foreign Clinical Data.
    3.ICH, E6(R2): Guideline For Good Clinical Practice, 6. Clinical Trial Protocol and Protocol Amendment(s).
    4.ICH, E9 Statistical Principles for Clinical Trials.
    5.ICH, E10Choice of Control Group and Related Issues in Clinical Trials;
    6.ICH, E17General principles for planning and design of Multi-Regional Clinical Trials.
    D、Decision:
    【Chapter 1-2】
    1.Weinberger v. Hynson、Westcott&Dunning,Inc, 412 U.S. 609,610(1973).
    【Chapter 3】
    1.Chevron U.S.A. Inc. v. Natural Resources Defense Council, Inc., 467 U.S. 837, 104 S. Ct. 2778, 81 L. Ed. 2d 694(1984).
    2.FMC Corp. v. Unmack, 699 N.E.2d 893, 896(N.Y. 1998).
    3.300 Gramatan Avenue Associates v State Division of Human Rights, 45 NY2d at 180 181).
    4.Laws v. Celebrezze , 368 F.2d 640., cited by Mastro v. Apfel, 270 F.3d 171, 176 (1966) (4th. Cir. 2001).
    5.Painting Co. v. NLRB, 298 F.3d 492, 499(6th Cir. 2002).
    6.Serono Laboratories, Inc. v. Donna E. Shalala, et al., and Ferring Pharmaceuticals Inc., 158 F.3d 1313(D.C. Cir. 1998).
    7.United States v. 225 Cartons, 871 F.2d 409, parapraph 28-39,45(1989).
    8.United States v. Rutherford, 442 U.S. 544, 553, 99 S. Ct. 2470, 61 L. Ed. 2d 68(1979).
    9.United States v. Shonubi, 895 F. Supp. 460, 471(footnote4)(E.D.N.Y. 1995) .
    10.Warner-lambert v. Heckler, 787 F.2d 147, paragraph 32(3d Cir. 1986).
    11.Weinberger v. Hynson、Westcott&Dunning,Inc, 412 U.S. 609,610 (1973).
    【Chapter4】
    1.Aetna Life Ins. Co. v. Haworth , 300 U.S. 227, 240-41, 57 S.Ct. 461, 81 L.Ed. 617(1937).
    2.Action on Smoking and Health v. Harris, 655 F.2d 236, 239 (D.C.Cir.1980).
    3.Amax Land Co. v. Quarterman, 181 F.3d 1356, 1365 & n. 6(D.C.Cir.1999).
    4.Aspirin Foundation of America, Inc, 740 F.2d 21 , at 34 (D.C. Cir. 1984).
    5.Ashcroft v. ACLU, 542 U.S. 656, 665, 669 (2004).
    6.Association of National Advertisers, 44 F.3d at 728,731.
    7.AT & T v. FCC, 978 F.2d 727, 731-32(D.C. Cir.1993).
    8.Board of Trustees of the State University of New York v. Fox, 492 U.S. 469, 477,478,481, 109 S. Ct. 3028,3035. 106 L. Ed. 2d 388(1989).
    9.Board of Trustees of Leland Stanford Junior University v. Sullivan, 773 F. Supp. 472, 474(D.D.C. 1991).
    10.Bolger v.Youngs Drug Products Corp., 463 U. S. 60, 71, n. 20 (1983).
    11.Brown v. Entm't Merchs. Ass'n , 131 S.Ct. 2729, 2738 (2011) .
    12.Carey v. Brown, 447 U.S. 455, 465(1980) .
    13.Cent. Hudson Gas & Elec. Corp. v. Pub. Serv. Comm'n of N.Y. , 447 U.S. 557, 563–64 (1980).
    14.Ciba-Geigy Corp.v. U.S. Environmental Protection Agency, 801 F.2d 430, 434,435(D.C.Cir.1986).
    15.City of Houston v. Hill, 482 U.S. 451, 459(1987).
    16.Central Hudson Gas and Electric Corp. v. New Service Comm'n of New York (447 US 557,563,569,100 S. Ct. 2343, 65 L. Ed. 2d 341.)(D.C.Cir.1988)
    17.City of Cincinnati v. Discovery Network, Inc., 507 U.S. 410, 423, 426, 113 S. Ct. 1505, 123 L. Ed. 2d 99 (1993).
    18.DeFreese v. United States, 270 F.2d 730 (5th Cir. )(1959), cert. denied, 362 U.S. 944, 80 S.Ct. 810, 4 L.Ed.2d 772 (1960).
    19.Doe v. Bolton, 410 U.S. 179, 197, 93 S. Ct. 739, 35 L. Ed. 2d 201 (1973).
    20.Dun & Bradstreet, Inc. v. Greenmoss Builders, Inc. , 472 U.S. 749, 759 n. 5, 105 S. Ct. 2939, 86 L. Ed. 2d 593(1985).
    21.Edenfield v. Fane, 507 U.S. 761, 770,771,775, 113 S. Ct. 1792, 123 L. Ed. 2d 543(1993).
    22.First National Bank of Boston v. Bellotti, 435 U.S. 765, 777,784, 785,98 S. Ct. 1407, 55 L. Ed. 2d 707(1978).
    23.Friedman v. Rogers, 440 U.S. 13, 99 S. Ct. 887, 59 L. Ed. 2d 100(1979).
    24.Florida Bar v.Went for It,Inc.,515 U.S. 618,635,115 S.Ct. 2371,132 L. Ed. 2d 541(1995).
    25.FDA v. Brown & Williamson Tobacco Corp., 529 U.S. 120, 133(2000).
    26.Friends of the Earth, Inc. v. Laid law Environmental Servs. (TOC), Inc., 528U.S. 167, ----, 120 S.Ct. 693, 708, 145 L.Ed.2d 610 (2000).
    27.Greater New Orleans Broad. Assoc. v. United States, 527 U.S. 173, 194 (1999).
    28.Holder v. Humanitarian Law Project, 130 S.Ct. 2705, 2724(2010).
    29.In re R.M.J., 455 U.S. 191, 200,202,203,102 S. Ct. 929, 937,71 L. Ed. 2d 64(1982).
    30.Ibanez v. Florida Department of Business and Professional Regulation , 512 U.S. 136, 146, 114 S. Ct. 2084, 129 L. Ed. 2d 118(1994) .
    31.In re Kessler , 100 F.3d 1015(D.C.Cir.1996).
    32.In Nutritional Health Alliance v. Shalala, 953 F. Supp. 526,529 (S.D.N.Y. 1997).
    33.Kordel v. United States, 335 U.S. 345, 351, 69 S.Ct. 106, 110, 93 L.Ed. 52 (1948).
    34.Keyishian v. Board of Regents, 385 U.S. 589, 603, 87 S. Ct. 675, 17 L. Ed. 2d 629(1967).
    35.Laboratories v. Gardner, 387 U.S. 136, 148, 87 S. Ct. 1507, 1515, 18 L. Ed. 2d 681,30(1967).
    36.Linmark Assoc., Inc. v. Willingboro , 431 U.S. 85, 97, 97 S. Ct. 1614, 52 L. Ed. 2d 155(1977) .
    37.McKinney v. Alabama , 424 U.S. 669, 683 (1976).
    38.National Council for Improved Health v. Shalala, 893 F. Supp. 1512, 1516-17(D.Utah 1995).
    39.New York Times v. Sullivan, 376 U.S. 254, 266, 84 S. Ct. 710, 11 L. Ed. 2d 686(1964).
    40.Ohralik v. Ohio State Bar Ass'n(436 U.S. 447, 455-56,98 S.Ct. 1912.) (1978).
    41.Public Citizen Health Research Group v. Commissioner, Food & Drug Administration.
    42.Pittsburgh Press Co. v.Pittsburgh Comm'n on Human Relations,413 US 376,93 S.Ct.2553,37 L. Ed.2d 669(1973).
    43.Pacific Gas and Electric Co. v. Public Utilities Comm'n of California , 475 U.S. 1, 106 S. Ct. 903, 89 L. Ed. 2d 1 (1986)(utilities)
    44.Pearson v. Shalala , 1998 WL 440621, Civ. A. No. 95-1865(GK)(D.D.C. Jan. 12, 1998).
    45.Peel v. Attorney Registration and Disciplinary Comm'n of Illinois, 496 U.S. 91, 111, 110 S. Ct. 2281, 110 L. Ed. 2d 83.(1990)(Marshall, J., concurring)
    46.Posadas de Puerto Rico Assoc. v. Tourism Co. of Puerto Rico(478 U.S. 328,341, 106 S. Ct. 2968, 92 L. Ed. 2d 266)(1986)
    47.Price Waterhouse v. Hopkins, 490 U. S. 228, 251-252(1989).
    48.R.A.V. v. City of St. Paul(1992), 505 U.S. 382,377, 386 .
    49.Retkwa v. Orentreich, 584 N.Y .S.2d 710 (N.Y.Sup.Ct.1992).
    50.Rubin v. Coors Brewing Co., 514 U.S. 476,490-491, 115 S. Ct. 1585, 131 L. Ed. 2d 532(1995) .
    51.Sterling Drug, Inc. v. Cornish, 370 F.2d 82 (8th Cir. 1967).
    52.States v. Concentrated Phosphate Export Ass'n, 393 U.S. 199, 203, 89 S.Ct. 361, 21 L.Ed.2d 344(1968) .  
    53.Securities & Exchange Commission v. Wall Street Publishing Institute, Inc 851 F.2d 365, 372 (D.C.Cir.1988).
    54.Shapero v. Kentucky Bar Ass'n , 486 U.S. 466, 476, 108 S. Ct. 1916, 100 L. Ed. 2d 475(1988) .
    55.Sita v. Danek Med. Inc., 43 F.Supp.2d 245 (E.D.N.Y.1999).
    56.Skilling v. United States, 130 S.Ct. 2896, 2929-30 (2010).
    57.Sorrell v. IMS Health,Inc.,131 S.Ct. 2653-2668(2011).
    58.Turner Broad., 512 U.S. at 642; Cent. Hudson Gas & Elec. Corp. v. Pub. Serv. Comm'n of N.Y., 447 U.S. 557, 563–64 (1980).
    59.Turner Broadcasting System, Inc. v. F.C.C., 512 U.S. 622, 641–642,114 S. Ct. 2445, 129 L. Ed. 2d 497(1994).
    60.Thompson v. Western States Medical Center, 535 U.S. 357,369,373,374(2002).
    61.United States v. Sullivan, 332 U.S. 689, 68 S.Ct. 231, 92 L.Ed. 297 (1948).
    62.United States v. W. T. Grant Co., 345 U.S. 629, 632, 73 S.Ct. 894, 97 L.Ed. 1303(1953).
    63.United States v. Wiesenfeld Warehouse Co., 376 U.S. 86, 92, 84 S.Ct. 559, 563, 11 L.Ed.2d 536 (1964) .
    64.United States v. An Article of Drug . . . Amodril Spancap.United States v. Articles of Drug, supra, 625 F.2d at 674(1975).
    65.United States of America v. An Article of Drug…Diso-Tate(E.D.La., Sept. 28, 1976).
    66.United States v. Evers,453 F. Supp. 1141 (1978).
    67.United States v. Evers(, 643 F.2d 1043 (5th Cir)1981).
    68.United States v. Rutherford, 442 U.S. 544, 557-58, 99 S. Ct. 2470, 61 L. Ed. 2d 68(1979).
    69.United States v. General Nutrition, Inc., 638 F. Supp. 556, 562(W.D.N.Y.1986) .
    70.U.S. Healthcare v. Blue Cross of Greater Philadelphia, 898 F.2d 914(3d Cir.1990).
    71.U.S. v. Edge Broadcasting Co., 509 U.S. 418, 430, 113 S. Ct. 2696, 125 L. Ed. 2d 345(1993).
    72.United States v. Caronia, 576 F.Supp.2d 385, 392 n.5 (E.D.N.Y.2008) .
    73.United States v. Abbott Labs., No. 12–cr–26 (SGW) (W.D.Va. May 7, 2012).
    74.United States v. Merck Sharp & Dohme Corp., No. 11–cr–10384 (PBS), ECF Doc. No. 30(D.Mass. May 18, 2012).
    75.Virginia Bd. of Pharmacy v. Virginia Citizens Consumer Council, Inc.,, 425 U.S. 748,756-57,759, 762,770-72, 96 S. Ct. 1817, 48 L. Ed. 2d 346,Pp. 373-376(1976)(1994).
    76.Weinberger v. Hynson, Westcott & Dunning, Inc., 412 U.S. 609, 629 ,612-14(1973).
    77.Whalen v. Roe, 429 U.S. 589, 97 S. Ct. 869, 51 L. Ed. 2d 64 (1977).
    78.Ward v. Rock Against Racism, 491 U.S. 781, 791,799, 109 S. Ct. 2746, 105 L. Ed. 2d 661(1989).
    79.Webster's Ninth New Collegiate Dictionary (1990).
    80.Wisconsin v. Mitchell , 508 U.S. 476, 489, 113 S. Ct. 2194, 2201-02, 124 L. Ed. 2d 436(1993).
    81.Washington Legal Found. v. Kessler, 880 F. Supp. 26 ("WLF I") (D.D.C. 1995).
    82.Washington Legal Foundation v. Friedman(D.D.C.1998),13 F. Supp. 2d 51,57-58,62-65 . ("WLF II")
    83.Washington Legal Foundation v. Friedman, 36 F.Supp.2d 16, 18 (WLF II)(D.D.C.1999).
    84.Washington Legal Found. v. Henney, 56 F. Supp. 2d 81,83,87("WLF III")(D.D.C.1999).
    85.Washington Legal Found. v. Henney , 202 F.3d 331,335("WLF IV"); 65 Fed. Reg. 14,286-287.45Id(D.C.Cir.2000).
    86.Whitaker v. Thompson, 239 F. Supp. 2d at 43,54(D.D.C. 2003).
    87.Whitaker v. Tommy G. Thompson, 353 F.3d 947(DC Cir.2004).
    88.Zauderer v. Office of Disciplinary Counsel, 471 U.S. 636, 646(1985).
    89.44 Liquormart, Inc. v. Rhode Island,,517 U.S. 484,497, 501,505, n. 7, 116 S. Ct. 1495, 134 L. Ed. 2d 711 (1996).
    【Chapter 5】
    1.Anderson v.Owens-Corning Fiberglas Corp., 53 Cal.3d 987, 810 P.2d 549, 281 Cal.Rptr. 528(1991).
    2.Beshada v. Johns- Manville Product Corp. , 447 A 2d 539(N.Y. 1982).
    3.Boston & Me. Corp. v. Hampton, 987 F.2d 855, 866 (1st Cir. 1993).
    4.Corley v. Rosewood Care Ctr., Inc., 142 F.3d 1041, 1050(7th Cir.1998) .
    5.Coyne v. City of Somerville , 972 F.2d 440, 442-43(1st Cir.1992).
    6.Correa-Martinez v. Arrillaga-Belendez, 903 F.2d 49, 51(1st Cir.1990).
    7.D. Dobbs, et al., Prosser and Keeton on Torts § 44, at 303-04(5th ed. 1984).
    8.Greenman v. Yuba Power Products, 59 Cal.2d 57, 27 Cal.Rptr. 697.the American Law Institute , Restatement of Torts,Second (1963).
    9.Green v. American Tobacco Co., 391 F.2d 97(1968).
    10.Gublo v. Novacare, Inc., 62 F. Supp. 2d 347, 355(D.Mass. 1999).
    11.Hill v. Wilmington Chem. Corp., 279 Minn. 336, 340-44, 156 N.W.2d 898, 902-04(1968).
    12.Hagood v. Sonoma County Water Agency, 929 F.2d 1416, 1421(9th Cir. 1991).
    13.Harrison v. Westinghouse Savannah River Co., 176 F.3d 776, 783-84,788(4th Cir.1999) .
    14.Hahn V Richter, 427 Pa Super 130, 628 A2d 860 (1993), app granted, 537 Pa 650, 644 A2d 736, 867-68 .(1994).
    15.Iacampo v. Hasbro, Inc., 929 F. Supp. 562, 567(D.R.I.1996).
    16.Medtronic, Inc. v. Lohr , 518 U.S. 470,485(1996).
    17.Mulder v Parke Davis & Co., 288 Minn 332, 181 NW2d 882, 885(1970).
    18.Magee v Wyeth Laboratories, Inc., 214 Cal App 2d 340, 29 Cal Rptr 322, 328(1963).
    19.New England Data Servs., Inc. v. Becher, 829 F.2d 286, 292(1st Cir.1987).
    20.Peterson v. Weinberger, 508 F.2d 45, 52 (5th Cir.)
    21.Peterson v. Mathews, 423 U.S. 830, 96 S. Ct. 50, 46 L. Ed. 2d 47 (1975).
    22.Pickens v. Kanawha River Towing, 916 F. Supp. 702, 705-06(S.D.Ohio 1996).
    23.Robak v Abbott Laboratories., 797 F Supp 475(D Md 1992).
    24.Riegel v. Medtronic, Inc.,552 U.S. 312(2008).
    25.Retail Clerks v. Schermerhorn, 375 U. S. 96, 103(1963).
    26.Sterling Drug, Inc., a Corporation, Appellant, v. Maxine F. Cornish, Appellee, 370 F.2d 82(8th Cir. 1967).
    27.Thomas v. Winchester, 6 N.Y. 397(1852).
    28.United States ex rel. Hopper v. Anton, 91 F.2d 1261, 1266-67(9th Cir. 1996).
    29.United States ex rel. Franklin v. Parke-Davis, 147 F. Supp. 2d at 46,51.
    30.United States ex rel. Lamers v. City of Green Bay, 168 F.3d 1013, 1020(7th Cir. 1999).
    31.United States v. Bank of Farmington, 166 F.3d 853, 858 (7th Cir. 1999) (citing S. REP. NO. 99-345, at 2 (1986), reprinted in 1986 U.S.C.C.A.N. 5266, 5267).
    32.United States v. Entin, 750 F. Supp. 512, 518(S.D. Fla. 1990).
    33.United States v. McNinch, 356 U.S. 595, 598 (1958).
    34.United States ex rel. Marcus v. Hess, 317 U.S. 537, 540,543-45, 63 S. Ct. 379, 87 L. Ed. 443(1943).
    35.United States v. Cohn , 270 U.S. 339, 345–46(1926).
    36.United States v. Rivera, 55 F.3d 703, 709 (1st Cir. 1995).
    37.United States v. Richard Dattner Architects , 972 F. Supp. 738, 746–47(S.D.N.Y. 1997).
    38.United States ex rel. Mazzola v. C.W. Roen Constr. Co., 183 F.3d 1088, 1092 (9th Cir. 1999).
    39.United States v. Anderson , 579 F.2d 455, 460(8th Cir. 1978) .
    40.US Ex Rel. Aranda v. Com. Psychiatric Centers, 945 F. Supp. 1485,1488-1889 (W.D. Okla. 1996).
    41.United States ex rel. Walsh v. Eastman Kodak Co., 98 F. Supp. 2d 141, 147-148(D.Mass.2000).
    42.United States ex rel. Thompson v. Columbia/HCA Healthcare Corp., 125 F.3d 899, 903(5th Cir. 1997).
    43.United States ex rel. Thompson v. Columbia/HCA Healthcare Corp. , 20 F. Supp. 2d 1017, 1048-49 n.33(S.D.Tex.1998).
    44.United States ex rel. Johnson v. Shell Oil Co., 183 F.R.D. 204, 206-07(E.D.Tex. 1998) .
    45.United States ex rel. Wilkins v. North Am. Constr. Corp., 101 F. Supp. 2d 500, 513(S.D.Tex.2000).
    46.United States v. Kensington Hosp., 760 F. Supp. 1120, 1125(E.D.Pa.1991).
    47.United State ex rel. Pogue v. American Healthcorp, Inc., 914 F. Supp. 1507, 1513(M.D.Tenn.1996).
    48.United States ex rel. Downy v. Corning, Inc., 118 F. Supp. 2d 1160, 1172-73(D.N.M.2000).
    49.United States v. Neifert-White Co., 390 U.S. 228, 232-33, 88 S. Ct. 959, 19 L. Ed. 2d 1061(1968).
    50.United States ex rel. Cantekin v. Univ. of Pittsburgh , 192 F.3d 402, 416(3rd Cir.1999).
    51.United States v. White , 765 F.2d 1469, 1479-80(11th Cir.1985).
    52.United States ex rel. Fallon v. Accudyne Corp ., 880 F. Supp. 636, 638 (W.D.Wis.1995).
    53.United States v. Incorporated Village of Island Park, 888 F. Supp. 419, 434-36(E.D.N.Y.1995).
    54.United States v. McClatchey, 217 F.3d 823, 835 (10th Cir.) 531 U.S. 1015, 121 S. Ct. 574, 148 L. Ed. 2d 492 (2000).
    55.United States ex rel. Kneepkins v. Gambro Healthcare, Inc. , 115 F. Supp. 2d 35, 43(D.Mass.2000)(O'Toole, J.)
    56.Wyeth v. Levine , 555 U.S. 555(2009).
    57.Wilkins ex rel. United States v. Ohio, 885 F. Supp. 1055, 1061 (S.D.Ohio 1995).
    58.Weinberger v Bristol-Myers Co. , 652 F Supp 187(D Md 1986).

    E、FDA Report and Guidance:
    【Chapter 1-2】
    1.FDA,Guidance for Industry-Providing Clinical Evidence of Effectiveness for Human Drugs and Biological Products, Pp 1-2(May1998).
    2.FDA, Non-Inferiority Clinical Trials to Establish Effectiveness Guidance for Industry(November2016).
    3.FDA,Brochure:The History of Drug Regulation in the United States, 1848: Imported Drugs, ch.1378, 32 Stat. 728 (1902).
    4.FDA, What We Do,History,Milestones in Food and Drug Law History,
    5.Carol Ballentine, Taste of Raspberries, Taste of Death,The 1937 Elixir Sulfanilamide Incident, FDA Consumer magazine(June 1981 Issue).
    6.FDA, Does the FDA control advertisements for all drugs?
    7.FDA, Investigational New Drug (IND) Application.
    8.FDA, Treatment Use of Investigational Drugs - Information Sheet.
    9.FDA, Reports of Information for Drug Effectiveness, 31 FEDERAL REGISTER 31,9426(31 Fed. Reg. 9426)(JULY 9, 1966).
    10.FDA, CPG Sec. 440.100,450.200,450.300,Marketed New Drugs Without Approved NDAs and ANDAs Guidance for FDA Staff and Industry, Appendix Brief History of FDA Marketing Approval Requirements and Categories of Drugs That Lack Required FDA Approval., P8-9.
    11.FDA, Regulatory Procedures Manual APRIL 2019 – Chapter 7: RECALL PROCEDURES, 7-5-2 FDA Requested Recall, P12(April 2019).
    【Chapter 3】
    1.FDA, Reports of Information for Drug Effectiveness, 31 FEDERAL REGISTER v 31,9426(31 Fed. Reg. 9426)(JULY 9, 1966).
    2.FDA, Guidance for Industry-Providing Clinical Evidence of Effectiveness for Human Drugs and Biological Products, Pp 1-2 (May 1998).
    3.FDA, Guidance for Industry Information Program on Clinical Trials for Serious or Life-Threatening Diseases and Conditions,Ⅲ. G., p6(2002).
    4.FDA, Guidance for Industry: Patient-Reported Outcome Measures: Use in Medical Product Development to Support Labeling Claims (December 2009).
    5.FDA, E3 Guideline for Industry Structure and Content of Clinical Study Reports(2013).
    6.FDA, Non-Inferiority Clinical Trials to Establish Effectiveness Guidance for Industry(November 2016).
    【Chapter 4】
    1.CTR, For Drug Evaluation & Research & CTR. For Biologics Evaluation & Research, FDA, Guidance For Industry:Format And Content Of Proposed Risk Evaluation And Mitigation Strategies (REMS), REMS Assessments, And Proposed REMS Modifications(2009).
    2.FDA, Requirements on Content and Format of Labeling for Human Prescription Drug and Biological Products. (“Physician Labeling Rule”(PLR)), 71(15)Federal Register 3921- 3997(January 24, 2006).
    3.FDA Adverse Event Reporting System (FAERS) (Formerly AERS)(last updated May.10, 2019).
    4.FDA, Draft Guidance, Good Reprint Practices for the Distribution of Medical Journal Articles and Medical or Scientific Reference Publications on Unapproved New Uses of Approved Drugs and Approved or Cleared Medical Devices, at 2–3 (quoting 21 U.S.C.§352(f))(2009)
    5.FDA, Final Guidance on Industry-Supported Scientific and Educational Activities, 62Fed.Reg. 64,074, 64,076-79 (Dec. 3,1997).
    6.FDA, Legal Status Of Approved Labeling For Prescription Drugs; Prescribing For Uses Unapproved By The Food And Drug Administration, 37(158) Fed.Reg. 16503,16504.( Aug.15, 1972)
    7.FDA, Labeling For Prescription Drugs Used In Man, Proposed Format for Prescription-Drug Advertisements, 40(67)Fed. Reg., 15392, 15392.(Apr. 7, 1975)
    8.FDA, Notice, Prescription Drug User Fee Rates for Fiscal Year 2014, 78 (149) Fed.Reg. 46,980, 46,984 table7.(Aug.2,2013)
    9.FDA, Guidance to Industry on Dissemination of Reprints of Certain Published, Original Data(1996).
    10.FDA, Advertising and Promotion; Guidances, 61 Fed. Reg. at 52,800. Ibid. at 52801.
    11.FDA, Guidance for Industry Funded Dissemination of Reference Texts(1996).
    12.FDA, Guidance for Industry Industry-Supported Scientific and Educational Activities.,62 Fed. Reg. at 64,094. Ibid.,at p1.
    13.FDA , Notice, 65(52) Fed. Reg. 14286(March 16, 2000).
    14.FDA, Guidance for Industry: Industry-Supported Scientific and Educational Activities(1997).
    15.FDA , Adancing Regulatory Science At FDA(2011).
    16.FDA, Legal Status Of Approved Labeling For Prescription Drugs; Prescribing For Uses Unapproved By The Food And Drug Administration, 37(158) Fed.Reg. 16503,16504(Aug.15, 1972).
    17.FDA, Final Amended Order Granting Summary Judgment and Permanent Injunction, 64 F.R. 44025(Aug.12,1992).
    18.FDA, Notice, Decision in Washington Legal Foundation v. Henney, 65 Federal Register 14286(March 16, 2000).
    19.FDA, Good Reprint Practices for the Distribution of Medical Journal Articles and Medical or Scientific Reference Publications on Unapproved New Uses of Approved Drugs and Approved or Cleared Medical Devices
    20.Food Drug Cos.L.(S.D.Fla. 1974) Rep. 38,009 at 38,035(2009 Jan.).
    21.GAO.,Off-Label Drugs : Reimbursement Policies Constrain Physicians in Their Choice of Cancer Therapies, GAO/PEMD-91-14 (Washington, D.C.: Sept. 27, 1991).
    22.GAO, Presription Drugs: FDA’s Oversight of the Promotion of Drugs for Off-Label Uses, P1(July 28, 2008), this report quoted from D.C. Radley, S.N. Finkelstein, and R.S. Stafford,“Off-Label Prescribing Among Office-Based Physicians,”Archives of Internal Medicine, vol. 166, no. 9 .(2006)
    23.Guidance to Industry on Dissemination of Reprints of Certain Published , Original Data and Guidance for Industry Funded Dissemination of Reference Texts, 61 Fed.Reg. 52,800(1996).
    24.Guidance for Industry: Industry-Supported Scientific and Educational Activities , 62 Fed.Reg. 64,093, 64,096-99(1997).
    25.Proposed New Drug, Antibiotic, and Biologic Drug Product Regulations, 48 Fed. Reg. 26720, 26733 (1983).
    26.See & Food Labeling; General Requirements for Health Claims for Food ., 58 Fed.Reg. 2478, 2525(1993).
    27.59 Fed. Reg. 59280, 59281.
    28.61 Fed.Reg. 52800 (Oct. 8, 1996).
    29.62 Fed. Reg. at 64079.(December 3, 1997).
    【Chapter 5】
    1.Department of Justice(DOJ), FACT SHEET SIGNIFICANT FALSE CLAIMS ACT SETTLEMENTS & JUDGMENTS FISCAL YEARS 2009-2016.
    2.The Department of Health and Human Services and The Department of Justice, Health Care Fraud and Abuse Control Program Annual Report 2018.
    3.Office of Inspector General, Compliance Program Guidance for Pharmaceutical Manufacturers(2003).
    4.S.Rep. No. 99-345, at 9 , U.S.Code Cong. & Admin.News 1986, pp. 5266, 5274(1986).
    F、European Union:
    1.Directive 2001/83/EC, Article 8(3)(j).
    2.European Commission, A Guideline on Summary of Product Characteristics (SmPC)(September 2009.).
    3.Regulation (EC) 726/2004, Article 6(1).
    G、TEXT BOOK:
    【Chapter 1-2】
    1.REMERS, EDWARD K , K EMERS AND URDANG’S HISTORY OF P HARMACY, at 216. ch. 70 (1848), 9 Stat. 237 (4th ed. 1976).
    2.MedWatch: The FDA Safety Information and Adverse Event Reporting Program.
    3.Heath, Wesley J., America’s First Drug Regulation Regime: The Rise and Fall of the Import Drug Act of 1848, 59 FOOD & DRUG L.J. 169, 175 (2004).
    【Chapter 5】
    1.Baumann, Linda A., ed., Health Care Fraud and Abuse: Practical Perspectives 116 (ABA Health Law Section, 2002).
    2.Wright, Charles Alan & Miller, Arthur R. (2nd ed.1990), Federal Practice and Procedure § 1298, at 625-26.
    H、Paper:
    【Chapter 1-2】
    1.Cowen David L., The Development of State Pharmaceutical Law, PH, ARMACY IN HISTORY, Vol. 37 No. 2, at 54(1995).
    2.Chhabra, Renu, Kremzner,Mary E, and Kiliany, Brenda J , FDA Policy on Unapproved Drug Products: Past, Present, and Future, 39 The Annals of Pharmacotherapy 1260, 1262(2005 July/August).
    3.Janssen,Wallace F. , Outline of the History of U.S. Drug Regulation and Labeling, 36 FOOD DRUG COSM . L.J. 420, 425(1981).
    4.Lebovitz, R., & Giffin, Y., R., Transforming Clinical Research in the United States:Challenges and Opportunities: Workshop Summary. Institute of Medicine of the National Academies, Forum on Drug Discovery, Development, and Translation Board on Health Sciences Policy. Washington, D.C.: The National Academies Press (2010).
    5.McGrath, Sue, Only A Matter Of Time: Lessons Unlearned at the Food and Drug Administration Keep Americans at Risk, 60 FOOD & DRUG L.J. 603, 604 (2005).
    6.Meadows, Michelle, Promoting Safe and Effective Drugs for 100 Years, part The First Federal Drug Law ,FDA Consumer magazine The Centennial Edition/January-February 2006(2006).
    7.Sertkaya et al., Examination of Clinical Trial Costs and Barriers for Drug Development, at ix, 4-1( July 2014).
    8.Tigerstrom , Barbara von, Revising the Regulation of Stem Cell-Based Therapies: Critical Assessment of Potential Models(2015).
    【Chapter 3】
    1.Begg Colin B.,Berlin Jesse A., Publication Bias: A Problem in nterpreting Medical Data, 151 J. ROYAL STAT. SOC’Y [SERIES A] 419, 421(1988).
    2.Berlin Jesse A.et al., An Assessment of Publication Bias Using a Sample f Published Clinical Trials, 84 J. AM. STAT. ASS’N 381, 391(1989).
    3.Carolyn J. Greene, Noninferiority and Equivalence Designs: Issues and Implications for Mental Health Research, 21(5) J Trauma Stress. 433, 434 .doi:10.1002/jts.20367(Oct 2008).
    4.Chhabra R.,Kremzner Mary E, Kiliany Brenda J, FDA olicy on Unapproved Drug Products: Past, Present, and Future, 39 The Annals of Pharmacotherapy 1260, 1262(2005 July/August).
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    30.Noa,Lars h & Noah, Barbara A., Liberating Commercial Speech: Product Labeling Controls and the First Amendment, 47 Fla.L.Rev. 63, 96(1995).
    31.Noah, Lars, Truth or Consequences?: Commercial Free Speech vs. Public Health Promotion (at the FDA), 21 HEALTH MATRIX 31 (2011).
    32.Netanel,Neil Weinstock, First Amendment Constraints on Copyright After Golan v. Holder, 60 UCLA L. REV. 1082, 1113 (2013).
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    34.Obertson, Hristopher R , When Truth Cannot Be Presumed: The Regulation of Drug Promotion Under An Expanding First Amendment, 94 Boston University Law Review 545, 554,557,note 64-67;supra note 195 at 558,560-561,563,565-566,568-570(2014).
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    38.RS, Stafford . Regulating off-label drug use -- Rethinking the role of the FDA. 358 N Engl J Med. 1427-1429(2008).
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    【Chapter 5】
    1.Androphy, Joel M. & Correro, Mark A., Whistleblower and Federal Qui Tam Litigation-Suing the Corporation for Fraud, 45 S.Tex. L. Rev. 23, 26,36,37,39,45-46. (Winter 2003).
    2.Alperowicz, M, A Case at a Crossroad: United States ex rel. Franklin v. Parke-Davis and the Intersection of Regulating Promotion of Off-Label Uses and Medicaid Fraud and Abuse, HLS Student Papers,Pp32-34,esp. note109.
    3.Bauer, Lane D. and Stith, Laura D., The Duty to Warn, in Donald E. Vinson and Alexander H. Slaughter, eds, Products Liability: Pharmaceutical Drug Cases 120, 149-52 (McGraw-Hill 1988).
    4.Bucy, Pamela H. , Growing Pains: Using the False Claims Act to Combat Health Care Fraud, 51 Ala. L. Rev. 57, 88(1999).
    5.Dixon, Marden G., 2 Drug Product Liability § 14.01 at 14-3 (Matthew Bender 1994).
    6.Krause, Joan H., “Promises to Keep”: Health Care Providers and the Civil False Claims Act, 23 Cardozo L. Rev. 1363, 1367-68 (March 2002).
    7.Krause, Joan H., Health Care Providers and the Public Fisc: Paradigms of Government Harm Under the Civil False Claims Act, 36 Ga. L. Rev. 121, 134.supra note 14, at 140 (Fall 2001).
    8.Munich, John & Lane, Elizabeth Lane, When Neglect Becomes Fraud: Quality of Care and False Claims, 43 ST. LOUIS U. L.J. 27, 30–31,36-37(1999).
    9.Owen, David G., Special Defenses in Modern Products Liability Law, 70 MO. L. REV. 1, 2-3 .supra note 85 , at p2-7,p12-14 (2005).
    10.Struve,Catherine T., The FDA and the Tort System: Postmarketing Surveillance, Compensation, and the Role of Litigation, 5 Yale J. Health Pol'y, L. & Ethics 587, p1(2005).
    11.Sheehan, James G. Sheehan , Health Care Fraud and Abuse: Practical Perspectives, 24(1) Journal of Legal Medicine 135-139,152(Jan., 2003).
    12.Stoffelmayrt, Kaspar J., Products Liability and "Off-Label" Uses of Prescription Drugs, 63 University of Chicago Law Review 275, 288,292 (1996).

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