מי כסף - ראשי
לדף הקודם
לדף הבא
ריפוי
מי כסף (אוליגו) קולואידים אילן רז - ריפוי מחלה זיהומית טלפון זמין 054-360-22-11 04-6230692 ריפוי קנדידה, ריפוי סרטן העור, סילוק סרטן השד, סרטן מלנומה, סרק
מכתב ל FDA לאחר שהוציאו תקנה סופית לגבי צריכת מי כסף בשנת 1999
מכתב זה נשלח לאירגון התרופות והמזון האמריקאי
בידי אמריקאי בשם פינינגן

במטרה לברר האם יש איזושהי סכנה או חוסר בטיחות בשימוש עם מי כסף.

המכתב מבהיר כי עד ל-14 לאוקטובר 1999 לא מופיע כל דיווח על תופעת לוואי כלשהי בשימוש עם מי כסף שיוצרו בתהליך האלקטרוליטי חשמלי והמכיל מים מזוקקים עם יוני כסף בלבד. כל דיווח על מקרה מוות או אינטראקציה בין תרופתית עם תרופות כימיות או תוספי מזון לסוגם.

Letter to the FDA

Is Colloidal Silver Safe?

The following is a letter that was sent to the FDA on 10-14-1999 and their response.

Brent Finnigan LMP
Tacoma, WA 98408

October 14th, 1999

Food and Drug Administration
U.S. Department Of Health and
Human Services
Public Health Service
5600 Fishers Lane
Rockville, MD 20857

Dear Sirs/Madam,

Persuant to the Freedom of Information Act and in regard to your August 17th, 1999 ruling regarding colloidal silver, could you please supply the following documentation on which you based your decision?

1. The number of deaths related to the consumption of colloidal silver.

2. The number of allergic reactions to the consumption of colloidal silver.

3. The number of harmful drug interactions from both OTC and prescription drugs when combined with colloidal silver.

4. The number of reported cases of Argyria from colloidal silver made with the AC or DC electrical process.

5. The number of cases of Argyria from colloidal silver that did not contain protein stabilizers.

Thank you for your time and consideration of this request.

Sincerely,
Brent Finnigan LMP

Here is the response to the above letter:



תשובת ה FDA


תשובת ארגון המזון והתרופות האמריקאי מצולמת - למעלה
הסבר למכתב
ב-17 לאוגוסט 1999 לאחר לחץ של בכירים בתעשיית התרופות דרך בכירים באירגון המזון והתרופות האמריקאי  
 FDA
הוציא אירגון הבריאות והמזון של אמריקה תקנה סופית שבה נאסר לייחס תכונות מרפא ל- מי כסף כתרופה לכל מחלה.
המסמך המקורי מצורף בהמשך הדף אך הוא ארוך ומיגע כ- 20 דפי פוליו.
לאחר הוצאת התקנה שלח אזרח אמריקני בשם ברנט פינינגן מטאקומה, ואשינגטון ובו ברנט שואל 5 שאלות כדי להבין על סמך אילו מיקרים נאסרו ייחוס התכונות והשימוש בחומר וזאת בעיקבות התקנה הסופית שהוכרזה על מי כסף  בידי אירגון הבריאות האמריקאי..
מספר מקרי המוות המיוחסים לשימוש ב- כסף קולואיד או עם מי כסף
מספר מיקרי האלרגיה ל- כסף קולואיד או ל- מי כסף
מספר מיקרי האינטראקציה ההדדית בין תרופות כימיות וגם בין תוספי מזון טבעיים בשילוב עם קולואיד כסף.
מספר מיקרי הארגיריה / כספספת משימוש עם מי כסף קולואיד שיוצרו בתהליך חשמלי אלקטרוליטי
מספר מיקרי הארגיריה מ- כסף קולואיד שאינו מכיל מייצבים חלבוניים

תשובת האירגון היתה שלאחר חיפוש מקיף במסמכי אירגון הבריאות האמריקאי לא נמצא מסמך אחד שיכול להיות תשובה חיובית לשאלותיו.
כלומר - התקנה הותקנה מבלי שיהיו מיקרים כלל של ארגיריה, מוות, אלרגיה ואו אינטראקציה בין תרופתית עם קולואיד כסף
קולואיד כסף זו שרשרת של עד 17י יוני כסף מחוברים במטען חשמלי קל
לרוב מי כסף מכילים קולואידים של עד 2 או שלושה יוני כסף ולכן נקראים מי כסף קולואידים.


תקנה סופית משנת 1999 של ה- FDA

תקנה סופית של ארגון המזון והבריאות האמריקאי לשימוש עם מי כסף
FDA
[Federal Register: August 17, 1999 (Volume 64, Number 158)]
[Rules and Regulations]               
[Page 44653-44658]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr17au99-6]                         
 
=======================================================================
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
 
Food and Drug Administration
 
21 CFR Part 310
 
[Docket No. 96N-0144]
 
 
Over-the-Counter Drug Products Containing Colloidal Silver 
Ingredients or Silver Salts
 
AGENCY: Food and Drug Administration, HHS.
 
ACTION: Final rule.
 
-----------------------------------------------------------------------
 
SUMMARY: The Food and Drug Administration (FDA) is issuing a final rule 
establishing that all over-the-counter (OTC) drug products containing 
colloidal silver ingredients or silver
 
[[Page 44654]]
 
salts for internal or external use are not generally recognized as safe 
and effective and are misbranded. FDA is issuing this final rule 
because many OTC drug products containing colloidal silver ingredients 
or silver salts are being marketed for numerous serious disease 
conditions and FDA is not aware of any substantial scientific evidence 
that supports the use of OTC colloidal silver ingredients or silver 
salts for these disease conditions.
 
DATES: This regulation is effective September 16, 1999.
 
FOR FURTHER INFORMATION CONTACT:  Bradford W. Williams, Center for Drug 
Evaluation and Research (HFD-310), Food and Drug Administration, 7520 
Standish Pl., Rockville, MD 20855, 301-594-0063.
 
SUPPLEMENTARY INFORMATION: 
 
I. Background
 
    In the Federal Register of October 15, 1996 (61 FR 53685), FDA 
published a proposed rule to declare that all OTC drug products 
containing colloidal silver ingredients or silver salts are not 
generally recognized as safe and effective, and are new drugs and 
misbranded within the meaning of section 201(p) of the Federal Food, 
Drug, and Cosmetic Act (the act) (21 U.S.C. 321(p)). Colloidal silver 
is a suspension of silver particles in a colloidal base. In recent 
years, colloidal silver preparations of unknown formulation have been 
appearing in retail outlets. These products are labeled for numerous 
disease conditions, many of which are serious diseases. The dosage form 
of these colloidal silver products is usually oral, but product 
labeling also contains directions for topical and, occasionally, 
intravenous use.
    FDA has not approved a new drug application (NDA) for any colloidal 
silver product. None of the silver salts evaluated as part of FDA's OTC 
drug review was found to be generally recognized as safe and effective 
for its intended use(s). FDA is not aware of any substantial scientific 
evidence that supports the use of OTC colloidal silver ingredients or 
silver salts for disease conditions. The agency invited any interested 
parties to collect and submit any existing data and information that 
support the safety and effectiveness of colloidal silver ingredients or 
silver salts for any of the uses not already evaluated under the OTC 
drug review. Interested persons were invited to submit written comments 
on the proposed regulation and on the agency's economic impact 
determination by January 13, 1997.
    In response to the proposal, the agency received 251 responses. 
Copies of these comments are on public display in the Dockets 
Management Branch (HFA-305), Food and Drug Administration, 5630 Fishers 
Lane, rm. 1061, Rockville, MD 20852. Additional information that has 
come to the agency's attention since publication of the proposal is 
also on public display in the Dockets Management Branch.
    Based on the information set forth in the proposed rule, and after 
consideration of the information submitted by the public comments (as 
summarized as follows), FDA is declaring that all OTC drug products 
containing colloidal silver ingredients or silver salts are not 
generally recognized as safe and effective, and are new drugs and 
misbranded within the meaning of section 201(p) of the act. Adequate 
safety and effectiveness data have not been provided to establish 
general recognition of the safety and effectiveness of colloidal silver 
or silver salt ingredients for any OTC drug uses. The data submitted 
did not include the required absorption, metabolism, tissue 
distribution, accumulation, excretion, and pharmacodynamics (effect of 
the drug at its action site) of silver in the body, both when taken 
internally and applied externally, and of the effect of the particle 
size of the silver on these systemic effects.
    FDA is amending subpart E of part 310 (21 CFR part 310) to add 
Sec. 310.548 for OTC drug products containing colloidal silver 
ingredients or silver salts. The agency has expanded proposed 
Sec. 310.548(a) to include some additional silver ingredients.
 
II. Public Comments and the Agency's Response
 
A. General Comments
 
    1. Many comments agreed with the proposed rule. One of these 
comments cautioned against the dangers of using untested drugs and 
recalled that Laetrile misled unsuspecting people in search of a quick 
cancer cure. Another comment provided personal experience as a victim 
of argyria who had been disfigured for 40 years as a result of using 
colloidal silver. This comment included an excerpt from a book that 
recorded 114 cases of argyria compiled in the 1930's. The comment 
contended that many marketers of colloidal silver deny the potential 
for harm and often misquote or distort the historical articles dealing 
with these products.
    A physician, who was formerly a pharmacist, recounted his own 
experience in reviewing cases of argyria. The victims had ingested 
silver products in the 1940's and 1950's. The physician was concerned 
that a product that does not have any rational use would lead to the 
redevelopment of argryia as a clinical problem. Another physician/
ophthalmologist commented that colloidal silver is dangerous quackery.
    The agency appreciates these comments in support of its proposal.
 
B. Comments on Safety and Effectiveness
 
    2. One comment expressed concern that many different silver 
products being marketed are inferior products and are not even true 
colloids. Another comment stated that the vast majority of silver 
products being sold are fraudulent products. The comment noted that it 
had tested a number of these products and found that several actually 
had no silver content, one did not contain the silver particle size as 
stated on the label, and only one product exceeded all stated purity 
and stability claims found on the label. The comment added that many of 
the products were only duplicates of older colloidal silver products. 
The comment considered these ``newer'' products as having the same 
dangers, intermittent effectiveness, and lack of stability as the older 
products. The comment contended that the vast majority of the colloidal 
silver products it tested are totally useless, some were dangerous to 
ingest, and some were possibly a threat to life. The comment stated 
that it is a major problem to keep off the market these so-called 
``colloidal silver'' products that contain significant amounts of 
silver ions and silver salts. The comment suggested a revision of the 
United States Pharmacopeia (USP) specifications for these products.
    Another comment stated that many of the colloidal silver products 
it analyzed are considered ``Bredig Sols'' (simple colloidal silver), 
referring to Bredig, Heidelberg, 1893. The comment added that a pure 
Bredig Sol is simply elemental silver in distilled water, while some 
Bredig Sols are mixed with saline to make them isotonic. The comment 
mentioned that the silver content in these products (a viable product 
could contain 0.005 percent silver) is many magnitudes less than the 
silver content of the products discussed by FDA in its safety and 
effectiveness evaluation (61 FR 53685 at 53686). The comment contended 
that the agency had not reviewed the Bredig Sols and disagreed with the 
agency's assumptions that there is an analogous comparison between 
colloidal silver proteins and other silver compounds to a simple Bredig 
Sol.
 
[[Page 44655]]
 
    These comments highlight the existing problems in trying to 
establish whether any silver salts or colloidal silver ingredients can 
be generally recognized as safe and effective. Because of the 
acknowledged differences in silver content and particle size of the 
silver in various products, it is difficult to draw conclusions from 
clinical studies conducted on different silver products. The agency has 
minimal manufacturing controls information on these products. The 
agency does not have information that assures the strength, quality, 
purity, and potency of various silver products used in clinical studies 
and other reports included in the comments.
    Concerning the comment suggesting a revision of USP specifications, 
the proposed rule stated that none of the formerly recognized colloidal 
silver preparations (e.g., colloidal silver iodide, strong (or mild) 
silver protein, ammoniacal silver nitrate solution) has been official 
in the USP or the National Formulary (N.F.) since 1975. It is 
industry's responsibility to have these silver ingredients reinstated 
in the USP or N.F. and to revise the specifications used in the former 
compendial monographs. Concerning ``Bredig Sols,'' the comment did not 
provide any specific safety and effectiveness data; thus, the agency is 
not able to establish that such products are generally recognized as 
safe and effective.
    3. Several comments submitted information purporting to support the 
safety of colloidal silver and other silver ingredients. The comments 
contended that silver is nontoxic and has minimal side effects. One 
comment stated that silver is poorly absorbed and not readily retained 
in the body when taken orally. Another comment stated that colloidal 
silver is harmless to the liver, kidneys, other internal organs, human 
enzymes, and the eyes; contains no free radicals; and has no reaction 
with other medications. Several comments mentioned that argyria, a blue 
skin discoloration resulting from prolonged administration of silver 
compounds and accumulation in the body, is the main side effect that 
occurs. One comment explained that argyria occurs because a small 
amount of the silver compound is absorbed and deposited in the skin, 
where it is reduced by light to metallic silver; the resulting skin 
discoloration persisting almost indefinitely, although there are no 
associated toxic effects. The comment contended that colloidal silver 
is the only known form of silver that is not deposited under the skin 
even with large doses. Another comment added that most of the reported 
cases of argyria resulted from the use of silver nitrate, various ionic 
silver salts, or highly concentrated mild silver protein. The comment 
concluded that the dilute, mild silver protein products marketed today 
are similar to pre-1938 colloidal silver solutions and do not cause 
argyria. The comment also discussed the levels of silver in the 
majority of silver products marketed today and indicated that the 
amount of silver ingested from these products and the diet are within 
the Environmental Protection Agency's maximum daily exposure reference 
dose of 350 micrograms per day for a 70 kilogram (kg) adult.
    Another comment presented the results of several animal (rat) 
studies involving acute or chronic administration of various amounts of 
colloidal silver (mild silver protein in colloidal suspension), 
approximately 1,500 parts per million (ppm), either by intravenous (IV) 
injection or in drinking water. The IV studies included an initial 
acute dose finding study followed by a chronic study (0.15 or 0.015 
milligram (mg) per 1 milliliter (mL)). Two groups of four rats received 
each dosage; two rats served as controls and received 1 mL of 
physiological saline solution. Each rat received a total of 12 
injections. The investigator reported that no abnormal clinical or 
behavioral signs were observed after 12 days of treatment. In another 
followup chronic IV rat study, three rats were injected with 1,500 ppm 
colloidal silver three times per week for 4 weeks (a total of 18 mg per 
300 gram (g) rat), and three rats served as controls. All treated and 
control rats were weighed at the time of injection. At the completion 
of the study, there were no differences in body weight and no clinical 
signs or gross pathologic changes between the treated and control 
groups. The drinking water study involved 15 rats fed 1.5 ppm mild 
silver protein solution in their drinking water for 40 days. The rats 
showed no clinical signs of gross pathological changes at the end of 
the treatment period. Three rats received regular drinking water and 
served as controls. The investigator stated that the data do not 
provide information about the metabolic fate of the silver, but support 
safety if extrapolated to humans because a 60-kg person would have to 
be given 3,600 mg to receive an amount equivalent to the rats' highest 
dose (18 mg/300 g rat).
    The agency does not consider this information adequate to establish 
general recognition of the safety of silver salts or colloidal silver 
ingredients for OTC drug use. The comments themselves indicate that 
ionic silver salts and highly concentrated mild silver protein clearly 
are not safe for OTC use. The animal data indicate that mild silver 
protein in colloidal suspension at low concentrations may be safe in 
rats when administered in specific concentrations for up to 40 days. 
Additional data are needed in humans on the absorption, metabolism, 
tissue distribution, accumulation, excretion, and pharmacodynamics of 
silver in the body, both when taken internally and applied externally, 
and of the effect of the particle size of the silver on these systemic 
effects. The agency concludes that a full pharmacologic profile that is 
relevant to human use is needed.
    4. Several comments submitted information purporting to support the 
effectiveness of colloidal silver and other silver ingredients. One 
comment provided a partial list of the more than 650 diseases that 
colloidal silver has been used against and included a number of 
testimonials. Another comment stated that silver will kill 650 disease 
organisms, but it does not cure 650 diseases. The comment added that a 
Bredig Sol of silver at 30 ppm is an effective germicide for both gram-
positive and gram-negative bacteria, fungi, yeasts, and viruses. 
Another comment noted the antimicrobial and bacteriostatic effects of 
diluted colloidal silver protein solutions. One comment provided a 
number of case reports involving the use of a colloidal silver (200 
ppm) suspension with protein and distilled water and a mild silver 
protein cream to treat various conditions (e.g., rash, pain, and sore 
gums).
    Another comment, from a physician, described a double-blind 
clinical study that he conducted using a commercial colloidal silver 
product (concentration not provided) in 22 men ages 50 to 82, with a 
mean age of 61.9 years. The physician obtained a brief medical history 
from each man and did a rectal examination. The men reported that 
nocturia (frequency of urination) ranged from one to five times a 
night. The physician assumed that the men had benign prostatic 
hypertrophy because of their age and the onset of symptoms in recent 
years. Of the 22 men, 15 took colloidal silver and 7 took placebo 
(colored water). The dose was 1 teaspoon (tsp) of the products morning 
and evening, and the duration of the study was from 19 to 23 days, with 
one exception of 10 days for a late entry. At the end of the study, 
four men (all on the colloidal silver) reported considerable 
improvement in the nocturia, with a reduction from 2 to 4 times to 1 
time each night, while six other men (five on the colloidal silver
noted some improvement in the nocturia. Two men with a history of
 
[[Page 44656]]
 
transurethral resection of the prostate, who were on the colloidal 
silver, did not report any improvement.
    Subsequently, all of the men continued on colloidal silver (1 tsp 
daily) for the next 8 weeks. The men were interviewed after about 4 
more weeks, and each completed an American Urological Association (AUA) 
Symptom Index representing symptoms at the time of the interview. The 
men also completed an AUA index representing symptoms before starting 
the colloidal silver. The AUA index is based on answers to seven 
questions, graded from 0 (not at all) to 5 (almost always), with the 
score being a sum of the answers to the questions. The one man who 
reported improvement on placebo reported marked improvement on the 
colloidal silver, with his nocturia decreasing from 2 to 3 times to 1, 
and occasionally 0, time each night. His AUA index was 9+ at the 
beginning and improved to a 3 at the last interview. One man moved, and 
a followup was not obtained. Of the remaining 21 men, 16 reported 
improvement of varying degrees. All reported decreased nocturia, with 
five men recording an improvement of 2 or less on the AUA index and 
nine men reporting an improvement of 3 to 10 on the AUA index. One man 
reported that he had been taking a prescription drug for benign 
prostatic hypertrophy before starting the colloidal silver. The last 
two men had improvements of 14 and 18 on the AUA index, with nocturia 
decreasing by 3 and 2 times, respectively. Five men reported no 
improvement during the study. Two of these men had a history of 
transurethral resection of the prostate, one had been taking a 
prescription drug for this condition for the past 6 months and his 
nocturia had already improved to 1 time each night, and the other two 
had been having symptoms for 6 and 15 years, respectively, and had an 
enlarged prostate when the study began. The physician noted that 
because the four men with a tender prostate improved, it was reasonable 
to suggest that the beneficial action of the colloidal silver was due 
to its antibacterial activity. He hypothesized that there may be some 
subclinical prostatitis in many men with benign prostatic hypertrophy, 
and this might explain why the colloidal silver resulted in a 
remarkable reduction in the men's symptoms. The physician concluded 
that the results of this study merit further investigation by the 
medical community.
    The physician also commented on some other observations from about 
50 men who had taken colloidal silver (most for symptoms of prostatism) 
under his direction before, during, and after the study (a period of 
about 6 months). Six noted clearing of acne or other infectious lesions 
of the skin, three reported improvement of mucus in the throat and 
associated cough of long duration, two indicated that irritation around 
the anus had cleared, one stated that he had no summer colds for 3 
months (which was unusual for him), eight reported improvement in nasal 
discharge and sinus trouble (especially when using colloidal silver in 
a nasal spray), two noted a reduction in upset stomach and abdominal 
pain, and two reported that their sexual enjoyment and performance had 
improved. The physician concluded that these observations suggested 
some areas that needed to be investigated further.
    The agency finds that the previous studies are not adequate and 
well-controlled clinical studies of the type described in Sec. 314.126 
(21 CFR 314.126) that need to be conducted. The studies have major 
methodic flaws. There needs to be a clear statement of the objectives 
of the investigation and a protocol containing a specific study design, 
the method of subject selection (with inclusion and exclusion 
criteria), the method of assigning subjects to treatment and control 
groups, well-defined methods for measuring the subjects' responses, and 
methods for analysis of the study results. Adequate measures need to be 
taken to minimize bias on the part of the subjects, observers, and 
analysts of the data, which is done by adequate blinding. The agency is 
unable to determine the adequacy of the blinding in the physician's 
study because the placebo was described as ``colored water.'' The 
agency is not able to ascertain the degree of similarity or difference 
that existed in the appearance of the colloidal silver product and the 
placebo to determine how well the study was blinded. The studies need 
replication by other investigators and need to follow Sec. 314.126. 
Likewise, the conditions described in the case reports provided by one 
comment need to be studied in adequate and well-controlled clinical 
trials. Finally, the information that silver will kill 650 disease 
organisms and that a Bredig Sol of silver at 30 ppm is an effective 
germicide for both gram-positive and gram-negative bacteria, fungi, 
yeasts, and viruses needs to be related to in vivo treatment for 
specific disease conditions. The agency concludes that the data and 
information submitted are not sufficient to establish general 
recognition of effectiveness for colloidal silver or other silver 
ingredients for any specific OTC condition.
 
C. The Grandfather Clauses of the Act
 
    5. One comment claimed that the silver products marketed today are 
the same as the more dilute mild silver protein products marketed pre-
1938 that did not cause argyria. The comment made the following 
recommendation: FDA should set guidelines of the acceptable levels of 
the solutions and the dosage based on current EPA safety standards and 
what was available pre-1938, so that a ``grandfathered'' standard is 
implemented. Another comment stated that not approving its colloidal 
silver product as a grandfathered colloidal silver would be to deprive 
the public of the use of an extremely safe and effective product 
already in use for 4 years.
    The ``grandfather exemption'' was discussed in detail in the 
proposed rule (61 FR 53685 to 53686). None of the comments provided any 
evidence to show that the composition and the labeling of colloidal 
silver or silver salt drug products have remained unchanged since 1938 
or 1962. Without such evidence, the products cannot qualify for either 
grandfather exemption, and there is no need to set any guidelines as 
requested by one comment.
 
D. Freedom of Choice
 
    6. A number of comments included individual testimonials or 
expressions of belief that colloidal silver benefited their health and 
that of their family members or friends. A few comments mentioned 
benefits experienced by pets. Many of the comments stated that the 
proposed rule would deny them the freedom of choice to select their own 
drugs.
    FDA's statutory mandate includes protection and promotion of the 
public health by ensuring that drugs are not only safe but also 
effective for their intended use. The Commissioner of Food and Drugs' 
decision on the status of Laetrile, published in the Federal Register 
of August 5, 1977 (42 FR 39788), expresses the agency's position on 
freedom of choice with respect to ensuring that drugs are not only 
safe, but also effective. That statement reads in part:
    In passing the 1962 Amendments to the act--the amendments that 
require that a drug be proved effective before it may be marketed--
Congress indicated its conclusions that the absolute freedom to 
choose an ineffective drug was properly surrendered in exchange for 
the freedom from the danger to each person's health and well-being 
from the sale and use of worthless drugs * * *. To the extent that 
any freedom
 
[[Page 44657]]
 
has been surrendered by the passage of the legislation which bans 
from the marketplace drugs that have not been proven to be 
effective, that surrender was a rational decision which has resulted 
in the achievement of a greater freedom from the dangers to health 
and welfare represented by such drugs.
    Agency regulations in 21 CFR 330.10(a)(4)(ii) state that the 
standards for effectiveness for an OTC drug that is generally 
recognized as effective include a requirement for controlled clinical 
 
investigations. Isolated case reports, random experience, and reports 
lacking the details that permit scientific evaluation are not 
considered adequate to establish effectiveness. Testimonials from 
consumers cannot be considered as adequate proof of effectiveness or 
safety. None of the comments presented any evidence of safety or 
effectiveness beyond personal experience.
    In the absence of data demonstrating that the ingredients present 
in OTC drug products containing colloidal silver ingredients or silver 
salts are generally recognized as safe and effective, these ingredients 
cannot be included in an OTC drug product. After the effective date of 
the final regulation, any such OTC drug product initially introduced or 
initially delivered for introduction into interstate commerce (unless 
it is the subject of an approved NDA, of which there currently are 
none) that is not in compliance with this regulation will be subject to 
regulatory action.
 
E. The Dietary Supplement Health and Education Act (DSHEA)
 
    7. Several comments, from consumers, stated that the specific 
product they used did not make any claims and might be considered a 
dietary supplement. None of the comments provided any labeling or 
specifics about the products they used.
    This final rule addresses products marketed as OTC drugs. A product 
that is not intended for OTC ``drug'' use in accord with section 
201(g)(1) of the act would not be subject to this final rule. A product 
containing silver could, under certain circumstances, be marketed as a 
dietary supplement if it meets the definition in section 201(ff) of the 
act and other applicable requirements. Among other things, such a 
product's label must state that the product is a dietary supplement and 
meet other labeling requirements of the act. (See, e.g., section 
403(q), (r), and (s) of the act (21 U.S.C. 343(q), (r), and (s)).) It 
must also meet the safety requirements of the act. (See, e.g., 21 
U.S.C. 342(a), (f), and (g).) FDA may take regulatory action against a 
product marketed as a dietary supplement when authorized to do so by 
the act.
    A dietary supplement containing colloidal silver or silver salts 
may not be labeled in whole or in part for topical use. Section 
201(ff)(2)(A)(i) of the act requires that a dietary supplement is a 
product that is ``intended for ingestion.'' The term ingestion has been 
addressed by the court in United States v. Ten Cartons, Ener-B Nasal 
Gel, 888 F. Supp. 393 (E.D.N.Y.), aff'd, 72 F.3d 285 (2d Cir. 1995). A 
topical product could not be a dietary supplement.
 
III. Analysis of Impacts
 
    FDA has examined the impacts of the final rule under Executive 
Order 12866 and the Regulatory Flexibility Act (5 U.S.C. 601-612). 
Executive Order 12866 directs agencies to assess all costs and benefits 
of available regulatory alternatives and, when regulation is necessary, 
to select regulatory approaches that maximize net benefits (including 
potential economic, environmental, public health and safety, and other 
advantages; distributive impacts; and equity). Under the Regulatory 
Flexibility Act, if a rule has a significant impact on a substantial 
number of small entities, an agency must analyze regulatory options 
that would minimize any significant impact of the rule on small 
entities.
    Title II of the Unfunded Mandates Reform Act (2 U.S.C. 1501 et 
seq.) requires that agencies prepare a written statement and economic 
analysis before proposing any rule that may result in an expenditure in 
any one year by State, local, and tribal governments, in the aggregate, 
or by the private sector, of $100 million (adjusted annually for 
inflation). As the agency stated in the proposed rule, this rulemaking 
is not expected to pose a significant impact on small business because 
only a limited number of products are affected (61 FR 53685 at 53687).
    The agency believes that this final rule is consistent with the 
principles set out in the Executive Order and in these two statutes. 
The purpose of this final rule is to establish that all OTC drug 
products containing colloidal silver ingredients or silver salts for 
internal or external use are not generally recognized as safe and 
effective and are misbranded. The agency's Drug Listing System 
identifies a multitude of silver-containing products. These products 
may contain silver, silver ion, silver chloride, silver cyanide, silver 
iodide, silver oxide, or silver phosphate.
    All of these manufacturers are considered small entities, using the 
U.S. Small Business Administration designation for this industry (750 
employees).
    Manufacturers will no longer be able to market OTC drug products 
containing any silver ingredients after the effective date of the final 
rule. While the manufacturers may incur a loss of revenue from some of 
these products, some silver products for internal use may be able to 
continue to be marketed as dietary supplements, provided they meet, 
among other regulatory requirements applicable to dietary supplements, 
the definition of dietary supplements in section 201(ff) of the act and 
meet the labeling requirements of section 403 of the act.
    Manufacturers have been aware of the possible effects on the status 
of these OTC silver drug products since October 1996 and have not 
submitted adequate safety and effectiveness data to the agency. Since 
publication of the 1996 proposal and with the 30-day implementation 
date after publication of the final rule, manufacturers should have 
ample time to deplete most of their remaining stock of OTC drug 
products containing the affected ingredients.
    The agency has considered a longer effective date for this final 
rule. However, manufacturers have not submitted the necessary data, and 
safety and effectiveness have not been established for the ingredients 
included in this final rule. Consumers will benefit from the removal 
from the marketplace of OTC drug products containing ingredients for 
which safety and effectiveness have not been established. If consumers 
purchase these products marketed as dietary supplements and if the 
product bears a statement claiming a benefit related to a classical 
nutrient deficiency disease and discloses the prevalence of such 
disease in the United States, describes the role of a nutrient or 
dietary ingredient intended to affect the structure or function of the 
body in humans, characterizes the documented mechanism by which a 
nutrient or dietary supplement acts to maintain such structure or 
function, or describes general well-being from consumption of a 
nutrient or dietary ingredient, then the labeling will have to inform 
them that ``This statement has not been evaluated by the Food and Drug 
Administration. This product is not intended to diagnose, treat, cure, 
or prevent any disease.'' (See 21 U.S.C. 343(r)(6).)
    While this final rule may cause manufacturers to discontinue 
marketing or reformulate or relabel some products, these manufacturers 
have known for some time that if adequate data were not submitted to 
support safety and effectiveness, cessation of marketing of the current 
OTC drug products would be required, in any event, when the final
 
[[Page 44658]]
 
rule was published and became effective.
    The analysis shows that this final rule is not economically 
significant under Executive Order 12866 and that the agency has 
considered the burden to small entities. Thus, this economic analysis, 
together with other relevant sections of this document, serves as the 
agency's final regulatory flexibility analysis, as required under the 
Regulatory Flexibility Act. Finally, this analysis shows that the 
Unfunded Mandates Reform Act does not apply to the final rule because 
it would not result in an expenditure in any one year by State, local, 
and tribal governments, in the aggregate, or by the private sector, of 
$100 million.
 
IV. Paperwork Reduction Act of 1995
 
    This final rule contains no collections of information. Therefore, 
clearance by the Office of Management and Budget under the Paperwork 
Reduction Act of 1995 is not required.
 
V. Environmental Impact
 
    The agency has determined under 21 CFR 25.24(c)(6) that this action 
is of a type that does not individually or cumulatively have a 
significant effect on the human environment. Therefore, neither an 
environmental assessment nor an environmental impact statement is 
required.
 
 
List of Subjects in 21 CFR Part 310
 
    Administrative practice and procedure, Drugs, Labeling, Medical 
devices, Reporting and recordkeeping requirements.
    Therefore, under the Federal Food, Drug, and Cosmetic Act and under 
authority delegated to the Commissioner of Food and Drugs, 21 CFR part 
310 is amended as follows:
 
PART 310--NEW DRUGS
 
    1. The authority citation for 21 CFR part 310 continues to read as 
follows:
 
    Authority: 21 U.S.C. 321, 331, 351, 352, 353, 355, 360b-360f
360j, 361(a), 371, 374, 375, 379e; 42 U.S.C. 216, 241, 242(a), 262, 
263b-263n.
 
    2. Section 310.548 is added to subpart E to read as follows:
 
 
Sec. 310.548  Drug products containing colloidal silver ingredients or 
silver salts offered over-the-counter (OTC) for the treatment and/or 
prevention of disease.
 
    (a) Colloidal silver ingredients and silver salts have been 
marketed in over-the-counter (OTC) drug products for the treatment and 
prevention of numerous disease conditions. There are serious and 
complicating aspects to many of the diseases these silver ingredients 
purport to treat or prevent. Further, there is a lack of adequate data 
to establish general recognition of the safety and effectiveness of 
colloidal silver ingredients or silver salts for OTC use in the 
treatment or prevention of any disease. These ingredients and salts 
include, but are not limited to, silver proteins, mild silver protein, 
strong silver protein, silver, silver ion, silver chloride, silver 
cyanide, silver iodide, silver oxide, and silver phosphate.
    (b) Any OTC drug product containing colloidal silver ingredients or 
silver salts that is labeled, represented, or promoted for the 
treatment and/or prevention of any disease is regarded as a new drug 
within the meaning of section 201(p) of the Federal Food, Drug, and 
Cosmetic Act (the act) for which an approved application or abbreviated 
application under section 505 of the act and part 314 of this chapter 
is required for marketing. In the absence of an approved new drug 
application or abbreviated new drug application, such product is also 
misbranded under section 502 of the act.
    (c) Clinical investigations designed to obtain evidence that any 
drug product containing colloidal silver or silver salts labeled, 
represented, or promoted for any OTC drug use is safe and effective for 
the purpose intended must comply with the requirements and procedures 
governing the use of investigational new drugs as set forth in part 312 
of this chapter.
    (d) After September 16, 1999, any such OTC drug product containing 
colloidal silver or silver salts initially introduced or initially 
delivered for introduction into interstate commerce that is not in 
compliance with this section is subject to regulatory action.
 
    Dated: July 14, 1999.
Margaret M. Dotzel,
Acting Associate Commissioner for Policy.
[FR Doc. 99-21253 Filed 8-16-99; 8:45 am]
BILLING CODE 4160-01-F

 

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