Good clinical practice

Good clinical practice (GCP) is an international quality standard for conducting clinical trials that in some countries is provided by ICH, an international body that defines a set of standards, which governments can then transpose into regulations for clinical trials involving human subjects.

GCP follows the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) of GCP guidelines. GCP enforces tight guidelines on ethical aspects of a clinical study. High standards are required in terms of comprehensive documentation for the clinical protocol, record keeping, training, and facilities, including computers and software. Quality assurance and inspections ensure that these standards are achieved. GCP aims to ensure that the studies are scientifically authentic and that the clinical properties of the investigational product are properly documented.

GCP guidelines include protection of human rights for the subjects and volunteers in a clinical trial. It also provides assurance of the safety and efficacy of the newly developed compounds.

GCP guidelines include standards on how clinical trials should be conducted, define the roles and responsibilities of institutional review boards, clinical research investigators, clinical trial sponsors, and monitors. In the pharmaceutical industry monitors are often called clinical research associates.

A series of unsuccessful and ineffective clinical trials in the past were the main reason for the creation of ICH (The International Council for Harmonisation) and GCP guidelines in the US and Europe. Such was the case with the Elixir Sulphanilamide disaster in 1937 or the Thalidomide incident of the 1960s. These discussions ultimately led to the development of certain regulations and guidelines, which evolved into the code of practice by which all those involved in clinical research now work. This code is known as International Conference on Harmonisation of Good Clinical Practice

The first indicator in the regulation of drugs is the Food and Drugs Act established in the US in 1906. It is considered to be the result of very dangerous and even deadly drugs that could have been sold legally just like any other medical goods. For example, such drugs were ‘Grandma’s Secret’ and ‘Kopp’s Baby’s Friend’, which contained a huge amount of morphine. ‘Dr King’s Consumption Cure’ and ‘Dr Bull’s Cough Syrup‘ are examples of drugs which had large doses of morphine and chloroform as well.

Legal and Regulatory Status

• European Union: In the EU, Good Clinical Practice (Directive 2001/20/EC) is backed and regulated by formal legislation contained in the Clinical Trial Directive (Officially Directive 2001/20/EC). A similar guideline for clinical trials of medical devices is the international standard ISO 14155, which is valid in the European Union as a harmonized standard. These standards for clinical trials are sometimes referred to as ICH-GCP or ISO-GCP to differentiate between the two and the lowest grade of recommendation in clinical guidelines.
• United States: Although ICH GCP guidelines are recommended by the Food and Drug Administration (FDA), they are not statutory in the United States. The National Institutes of Health requires NIH-funded clinical investigators and clinical trial staff who are involved in the design, conduct, oversight, or management of clinical trials to be trained in Good Clinical Practice.

ICH GCP overview

• Glossary
• Principles of ICH GCP
• Guidelines for:
  • institutional review board (IRB) / independent ethics committee (IEC)
  • investigator
  • trial sponsor (industrial, academic)
  • clinical trial protocol and protocol amendments
  • investigator's brochure
  • essential documents

Criticism

GCP has been called 'a less morally authoritative document' than the Declaration of Helsinki, lacking moral principles and guidance in the following areas:

• Disclosure of conflict of interest
• Public disclosure of study design
• Benefit for populations in which research is conducted
• Reporting of accurate results and publication of negative findings
• Access to treatment after research has been conducted
• Restriction of use of placebo in control group where effective alternative treatment is available

In the book Bad Pharma, Ben Goldacre mentions these criticisms and notes that the GCP rules "aren't terrible... [they are] more focused on procedures, while Helsinki clearly articulates moral principles".

See also

• Data monitoring committees
• Directive 2001/20/EC (European Union)
• Drug development
• EudraVigilance
• European Forum for Good Clinical Practice (EFGCP)
• European Medicines Agency (EMEA)
• GxP
• Human experimentation in the United States
• Institutional review board
• Inverse benefit law
• Medical ethics
• Pharmacovigilance
• Pharmaceutical company

External links

• ICH Topic E 6 (R2) [1]
• Good Clinical Practice (from U.S. Food and Drug Administration)
• Some Relevant UK Statutory Instruments
  • The Medicines for Human Use (Clinical Trials) Regulations 2004
  • The Medicines for Human Use (Clinical Trials) Amendment Regulations 2006
  • The Medicines for Human Use (Clinical Trials) Amendment (No.2) Regulations 2006