title: Medical device recalls and the FDA approval process.
abstract: BACKGROUND
  Unlike prescription drugs, medical devices are reviewed by the US Food and Drug Administration (FDA) using 2 alternative regulatory standards: (1) premarket approval (PMA), which requires clinical testing and inspections; or (2) the 510(k) process, which requires that the device be similar to a device already marketed (predicate device). The second standard is intended for devices that the FDA deems to involve low or moderate risk.
  
  
  METHODS
  We analyzed the FDA's high-risk List of Device Recalls from 2005 through 2009. Using FDA data, we determined whether the recalled devices were approved by the more rigorous (PMA) process, the 510(k) process, or were exempt from FDA review.
  
  
  RESULTS
  There were 113 recalls from 2005 through 2009 that the FDA determined could cause serious health problems or death. Only 21 of the 113 devices had been approved through the PMA process (19%). Eighty were cleared through the 510(k) process (71%), and an additional 8 were exempt from any FDA regulation (7%). Cardiovascular devices comprised the largest recall category, with 35 of the high-risk recalls (31%); two-thirds were cleared by the 510(k) process (66%; n = 23). Fifty-one percent of the high-risk recalls were in 5 other device categories: general hospital, anesthesiology, clinical chemistry, neurology, or ophthalmology.
  
  
  CONCLUSIONS
  Most medical devices recalled for life-threatening or very serious hazards were originally cleared for market using the less stringent 510(k) process or were considered so low risk that they were exempt from review (78%). These findings suggest that reform of the regulatory process is needed to ensure the safety of medical devices.
authors.affiliation: National Research Center for Women & Families, Washington, DC 20036, USA. dz@center4research.org
authors.forename: Diana M
authors.initials: DM
authors.lastname: Zuckerman
authors.forename: Paul
authors.initials: P
authors.lastname: Brown
authors.forename: Steven E
authors.initials: SE
authors.lastname: Nissen
mesh_terms: D018795:Device Approval / Q000592:standards*; D006801:Humans; D057052:Medical Device Recalls; D012307:Risk Factors; D014481:United States; D014486:United States Food and Drug Administration