engines installed on the same airplane at the DATES: Submit written or electronic Amendments of 1976 (the 1976
same time, if at all possible. comments by April 17, 2007. amendments) (Public Law 94–295), the
Alternative Methods of Compliance ADDRESSES: You may submit comments, Safe Medical Devices Act of 1990 (the
(i) The Manager, Engine Certification identified by Docket No. 2005P–0121, SMDA) (Public Law 101–629), and the
Office, FAA, has the authority to approve by any of the following methods: Food and Drug Administration
alternative methods of compliance for this Electronic Submissions Modernization Act of 1997 (FDAMA)
AD if requested using the procedures found Submit electronic comments in the (Public Law 105–115), established a
in 14 CFR 39.19. following ways: comprehensive system for the regulation
Related Information • Federal eRulemaking Portal: http:// of medical devices intended for human
www.regulations.gov. Follow the use. Section 513 of the act (21 U.S.C.
(j) GE Service Bulletin No. CF34–10E S/B
73–0013, dated December 15, 2006, pertains instructions for submitting comments. 360c) established three categories
to the subject of this AD. • Agency Web site: http:// (classes) of devices, depending on the
(k) Contact Tara Fitzgerald, Aerospace www.fda.gov/dockets/ecomments. regulatory controls needed to provide
Engineer, Engine Certification Office, FAA, Follow the instructions for submitting reasonable assurance of their safety and
Engine and Propeller Directorate, 12 New comments on the agency Web site. effectiveness. The three categories of
England Executive Park, Burlington, MA Written Submissions devices are class I (general controls),
01803; telephone (781) 238–7138, fax (781) class II (special controls), and class III
238–7199; e-mail: tara.fitzgerald@faa.gov for
Submit written submissions in the
following ways: (premarket approval).
more information about this AD. Under section 513 of the act, devices
• FAX: 301–827–6870.
Issued in Burlington, Massachusetts, on • Mail/Hand delivery/Courier [For that were in commercial distribution
January 10, 2007. before May 28, 1976 (the date of
paper, disk, or CD–ROM submissions]:
Francis A. Favara, Division of Dockets Management (HFA– enactment of the 1976 amendments),
Manager, Engine and Propeller Directorate, 305), Food and Drug Administration, generally referred to as preamendments
Aircraft Certification Service. 5630 Fishers Lane, rm. 1061, Rockville, devices, are classified after FDA has: (1)
[FR Doc. E7–498 Filed 1–16–07; 8:45 am] MD 20852. Received a recommendation from a
BILLING CODE 4910–13–P To ensure more timely processing of device classification panel (an FDA
comments, FDA is no longer accepting advisory committee); (2) published the
comments submitted to the agency by e- panel’s recommendation for comment,
DEPARTMENT OF HEALTH AND mail. FDA encourages you to continue along with a proposed regulation
HUMAN SERVICES to submit electronic comments by using classifying the device; and (3) published
the Federal eRulemaking Portal or the a final regulation classifying the device.
Food and Drug Administration agency Web site, as described in the FDA has classified most
Electronic Submissions portion of this preamendments devices under these
21 CFR Part 888 paragraph. procedures.
Devices that were not in commercial
[Docket No. 2005P–0121] Instructions: All submissions received
distribution prior to May 28, 1976,
must include the agency name and
Orthopedic Devices; Reclassification generally referred to as postamendments
Docket No. 2005P–0121 for this notice.
of Non-Invasive Bone Growth devices, are classified automatically by
All comments received may be posted
Stimulator statute (section 513(f) of the act into
without change to http://www.fda.gov/
class III without any FDA rulemaking
ohrms/dockets/default.htm, including
AGENCY: Food and Drug Administration, process. Those devices remain in class
any personal information provided. For
HHS. III and require premarket approval,
additional information on submitting
Notice of panel
ACTION: unless and until the device is
comments, see the ‘‘Comments’’ heading
recommendation. reclassified into class I or II or FDA
of the SUPPLEMENTARY INFORMATION issues an order finding the device to be
SUMMARY: The Food and Drug section of this document. substantially equivalent, under section
Administration (FDA) is issuing for Docket: For access to the docket to 513(i) of the act, to a predicate device
public comment the recommendation of read background documents or that does not require premarket
the Orthopaedic and Rehabilitation comments received, go to http:// approval. The agency determines
Devices Panel to deny a petition to www.fda.gov/ohrms/dockets/ whether new devices are substantially
reclassify the non-invasive bone growth default.htm and insert the docket equivalent to predicate devices by
stimulator from class III to class II. The number(s), found in brackets in the means of premarket notification
Panel made this recommendation after heading of this document, into the procedures in section 510(k) of the act
reviewing the reclassification petition ‘‘Search’’ box and follow the prompts (21 U.S.C. 360(k)) and part 807 of the
submitted by RS Medical Corp., as well and/or go to the Division of Dockets regulations (21 CFR part 807).
as consideration of presentations made Management, 5630 Fishers Lane, rm. Reclassification of classified
at the Panel meeting by the petitioner, 1061, Rockville, MD 20852. postamendments devices is governed by
FDA, and members of the public. FDA FOR FURTHER INFORMATION CONTACT: section 513(f)(3) of the act. This section
is also issuing for public comment its Michel Janda, Center for Devices and provides that FDA may initiate the
findings on the Panel’s Radiological Health (HFZ–410), Food reclassification of a device classified
recommendation. After considering any and Drug Administration, 9200 into class III under section 513(f)(1) of
public comments on the Panel’s Corporate Blvd., Rockville, MD 20850, the act, or the manufacturer or importer
mstockstill on PROD1PC61 with PROPOSALS
recommendation and FDA’s findings, 240–276–3600. of a device may petition the Secretary of
FDA will approve or deny the SUPPLEMENTARY INFORMATION: Health and Human Services (the
reclassification petition by order in the Secretary) for the issuance of an order
form of a letter to the petitioner. FDA’s I. Background (Regulatory Authorities) classifying the device in class I or class
decision on the reclassification petition The Federal Food, Drug, and Cosmetic II. FDA’s regulations in 21 CFR 860.134
will be announced in the Federal Act (the act) (21 U.S.C. 301 et. seq.), as set forth the procedures for the filing
Register. amended by the Medical Device and review of a petition for
VerDate Aug<31>2005 13:17 Jan 16, 2007 Jkt 211001 PO 00000 Frm 00006 Fmt 4702 Sfmt 4702 E:\FR\FM\17JAP1.SGM 17JAP1
1952 Federal Register / Vol. 72, No. 10 / Wednesday, January 17, 2007 / Proposed Rules
reclassification of such class III devices. III. Description of Device Proposed for receiving treatment, defective
In order to change the classification of Reclassification electrodes/coil delivering inappropriate
the device, it is necessary that the The Petitioner identified the device as output, incorrect electrode/coil size or
proposed new class have sufficient follows: alteration, inappropriate output, use of
regulatory controls to provide A non-invasive bone growth AC current source for treatment, and use
reasonable assurance of the safety and stimulator is a device that provides of control unit and battery charger while
effectiveness of the device for its stimulation through electrical and/or sleeping.
intended use. magnetic fields to facilitate the healing C. Skin Irritation and/or Allergic
Under section 513(f)(3)(B)(i) of the of nonunion fractures and lumbar spinal Reaction
act, the Secretary may, for good cause fusions. The stimulation may be
delivered through capacitive coupling A patient could experience skin
shown, refer a petition to a device irritation and/or allergic reaction
classification panel. The Panel shall (CC) with electrodes placed directly
over the treatment site or through associated with the use and operation of
make a recommendation to the the device via the use of non-
pulsed electromagnetic fields (PEMF)
Secretary respecting approval or denial biocompatible device materials and/or
with treatment coils placed into a brace
of the petition. Any such non-biocompatible electrode gel.
or over a cast at the treatment site. The
recommendation shall contain (1) A device is intended for use: (1) For the
summary of the reasons for the D. Inconsistent or Ineffective Treatment
treatment of established nonunion
recommendation, (2) a summary of the fractures acquired secondary to trauma A patient could receive inconsistent
data upon which the recommendation is (excluding vertebrae and flat bone), and or ineffective treatment via battery
based, and (3) an identification of the (2) as an adjunct to the treatment of deterioration, control circuit failure,
risks to health (if any) presented by the lumbar spinal fusion surgery for one or defective electrode/coils, device damage
device with respect to which the two levels. The device consists of an from dropping or bumping, device short
petition was filed. output waveform generator, either circuits, driver circuit failure,
battery-powered or AC-powered; a user electromagnetic interference (EMI) or
II. Regulatory History of the Device radio frequency interference (RFI),
interface with visual and/or audible
In accordance with section 513(f)(1) of alarms; and electrodes or coils to deliver failure to follow prescribed use,
the act, the non-invasive bone growth the stimulation. hardware failure, improper position of
stimulators were automatically electrodes/coil, inappropriate output,
IV. Recommendations of the Panel incorrect battery/battery charger,
classified into class III because they
On June 2, 2006, the Panel deliberated ineffective output, low battery voltage,
were not introduced or delivered for
on information in RS Medical’s petition; poor interface between electrodes/coil
introduction into interstate commerce
the presentations made by RS Medical, and patient, and switch failure.
for commercial distribution before May
28, 1976, and have not been found FDA, and members of the public; and E. Adverse Interaction with Electrical
their own experience with non-invasive Implants
substantially equivalent to a device
bone growth stimulators (Ref. 2). The
placed in commercial distribution after A patient with electrically-powered
Panel voted four to two to recommend
May 28, 1976, which was subsequently implants (such as cardiac pacemakers,
that non-invasive bone growth
classified or reclassified into class II or cardiac defibrillators, and neuro-
stimulators be retained in class III.
class I. Therefore, the device can not be stimulators) could experience an
placed in commercial distribution V. Risks to Health adverse interaction with an implanted
unless it is reclassified under section The Panel identified the following electrical device via EMI or RFI.
513(f)(3), or subject to an approved risks to health associated with the non-
premarket approval application (PMA) F. Internal/External Fixation Devices
invasive bone growth stimulator:
under section 515 of the act (21 U.S.C. A patient with internal or external
360e). A. Electric Shock fixation devices could receive
In a petition dated February 7, 2005, A patient or health care professional inconsistent or ineffective treatment due
that was received by FDA on February could be shocked from the use and to interaction of the device with the
9, 2005, RS Medical Corp. requested operation of the device via an AC line metallic fixation devices via
that FDA reclassify the non-invasive voltage exposure during charging, interference with treatment field
circuitry malfunction, connection/ through magnetic field interaction and/
bone growth stimulator from class III to
disconnection of electrodes or coils, or electrical inductance within metallic
class II. (Ref. 1) The petition was
control circuit failure, damaged channel device.
submitted under section 513(e) of the
jacks, defective electrodes/coil
act but FDA is reviewing the petition G. Biological Risks: Carcinogenicity,
delivering inappropriate output, faulty
under section 513(f)(3) of the act Genotoxicity, Mutagenicity, and
lead wires, inappropriate output, poor
because that section contains the connection between electrodes/coils Teratology
appropriate procedures for and lead wires, poor solder on circuit A patient may experience adverse
reclassification of postamendments board, reposition of electrodes/coils biologic affects resulting from prolonged
devices. FDA requested additional during treatment, and use of AC current exposure to the treatment signal via
information and the petitioner amended source during treatment. biologic interaction with the treatment
the petition on August 1, 2005. In signal at a cellular level.
B. Burn
mstockstill on PROD1PC61 with PROPOSALS
VerDate Aug<31>2005 13:17 Jan 16, 2007 Jkt 211001 PO 00000 Frm 00007 Fmt 4702 Sfmt 4702 E:\FR\FM\17JAP1.SGM 17JAP1
Federal Register / Vol. 72, No. 10 / Wednesday, January 17, 2007 / Proposed Rules 1953
to establish that special controls in mutagenicity and teratology). However, Reform Act of 1995 (Public Law 104–4).
association with general controls would the Panel believed that there was Executive Order 12866 directs agencies
provide a reasonable assurance of the insufficient evidence presented by the to assess all costs and benefits of
safety and effectiveness of the device. petitioner to control for the risk of available regulatory alternatives and,
inconsistent or ineffective treatment when regulation is necessary, to select
VII. Summary of Data Upon Which the because there is a lack of knowledge
Panel Recommendation is Based regulatory approaches that maximize
about how waveform characteristics net benefits (including potential
The petitioner provided the following (e.g., pulse duration, amplitude, power, economic, environmental, public health
information: frequency) affect the clinical response to and safety, and other advantages;
A. Reports on Non-Unions treatment. This concern was also distributive impacts; and equity). The
expressed by the Panel regarding agency believes that this reclassification
The petitioner submitted 35 articles (5 potential modifications made to the
describing capacitive coupling devices petition denial, if finalized, is not a
device. It is not known how a change to significant regulatory action as defined
and 30 describing the use of pulsed the device output due to device
electromagnetic field devices) reporting by the Executive order.
modifications may impact the clinical
outcomes for over 5,600 patients. response to treatment. The Panel The Regulatory Flexibility Act
According to the petitioner, these requested additional clinical data and/ requires agencies to analyze regulatory
studies indicate the device’s ability to or special controls to control for the risk options that would minimize any
promote osteogenesis in patients with of inconsistent or ineffective treatment significant impact of a rule on small
an established non-union, which may that may occur as the result of device entities. If FDA accepts the Panel
include previously failed surgical modifications (Ref. 2). recommendation and denies the petition
attempts to establish union. for reclassification, the regulatory status
VIII. FDA’s Findings of the device will remain the same as it
B. Reports on Adjunctive Lumbar Spinal
FDA believes that certain device is now. Because this action, if finalized,
Fusion
modifications are unlikely to adversely will maintain the status quo, the agency
The petitioner has submitted eight affect device safety and effectiveness certifies that the reclassification petition
articles (one utilizing capacitive and such changes could be adequately denial will not have a significant
coupling devices and seven utilizing validated using bench-top testing. economic impact on a substantial
pulsed electromagnetic field devices) However, FDA also believes that there number of small entities.
reporting outcomes for over 1,100 was not adequate evidence in the
patients. According to the petitioner, Section 202(a) of the Unfunded
petition to establish that the petitioner’s
these studies indicate the device’s proposed special controls could be used Mandates Reform Act of 1995 requires
ability to promote osteogenesis in to adequately mitigate the risk of that agencies prepare a written
patients as an adjunct to the treatment inconsistent or ineffective treatment. statement, which includes an
of lumbar spinal fusion for one or two Additional evidence is required to assessment of anticipated costs and
levels. establish special controls, including benefits, before proposing ‘‘any rule that
preclinical test methods, to mitigate the includes any Federal mandate that may
C. Reports on Preclinical Findings result in the expenditure by State, local,
risk of inconsistent or ineffective
The petitioner has cited 21 articles in treatment. and tribal governments, in the aggregate,
the petition amendment describing Because FDA has concerns about the or by the private sector, of $100,000,000
studies in animal models. The animal ability of the petitioner’s proposed or more (adjusted annually for inflation)
studies described in the petition special controls to control the risk of in any one year.’’ The current threshold
amendment were designed to evaluate inconsistent and ineffective treatment, after adjustment for inflation is $122
new signals, dose/response FDA is unable to conclude that general million, using the most current (2005)
relationships, and the potential controls and the petitioner’s proposed Implicit Price Deflator for the Gross
pathways of bone repair processes. In special controls would provide a Domestic Product. FDA does not expect
addition, 14 articles were presented that reasonable assurance of safety and this reclassification petition action to
describe studies in cell culture systems effectiveness for this device type. result in any 1-year expenditure that
designed to examine the mechanism(s) Therefore, based on the currently would meet or exceed this amount.
of action of various electrical stimuli in available information, FDA concurs
bone. These studies, conducted at the with the Panel’s recommendation to XI. Federalism
cellular level, were intended to retain the non-invasive bone growth
investigate the sequence of events that FDA has analyzed this action in
stimulator as a class III device. accordance with the principles set forth
occur as a result of electrical
stimulation, the interaction of the fields IX. Environmental Impact in Executive Order 13132. FDA has
at the level of the cell membrane with determined that the action, if finalized,
The agency has determined under 21
regard to ion channels and receptor CFR 25.34(b) that this action is of a type would not contain policies that would
interaction, and signal transduction; and that does not individually or have substantial direct effects on the
to identify cell types that do or do not cumulatively have a significant effect on States, on the relationship between the
respond to electrical stimulation. the human environment. Therefore, National Government and the States, or
The Panel recommended that the neither an environmental assessment, on the distribution of power and
proposed special controls (Ref 1.) were nor an environmental impact statement responsibilities among the various
mstockstill on PROD1PC61 with PROPOSALS
sufficient to control for the risk of is required. levels of government. Accordingly, the
electric shock, burn, skin irritation, and/ agency concludes that the action does
or allergic reaction; adverse interaction X. Analysis of Impacts not contain policies that have
with electrical implants; adverse FDA has examined the impacts of this federalism implications as defined in
interaction with internal/external notice under Executive Order 12866 and the Executive order and, consequently,
fixation devices; and biological risks the Regulatory Flexibility Act (5 U.S.C. a federalism summary impact statement
(carcinogenicity, genotoxicity, 601–612), and the Unfunded Mandates has not been prepared.
VerDate Aug<31>2005 13:17 Jan 16, 2007 Jkt 211001 PO 00000 Frm 00008 Fmt 4702 Sfmt 4702 E:\FR\FM\17JAP1.SGM 17JAP1
1954 Federal Register / Vol. 72, No. 10 / Wednesday, January 17, 2007 / Proposed Rules
VerDate Aug<31>2005 13:17 Jan 16, 2007 Jkt 211001 PO 00000 Frm 00009 Fmt 4702 Sfmt 4702 E:\FR\FM\17JAP1.SGM 17JAP1