Attorney Scheineson, who represented Cetero during the FDA's investigation, acknowledged that the Houston lab's compensation system was "crappy" and that a handful of "dishonest" chemists at the Houston facility committed fraud.
In April 2009, Briscoe blew the whistle in a letter to the company written by his lawyer, reporting that "many of the chemists were manipulating and falsifying data." Soon thereafter, Briscoe told the company that he had documented the misconduct. According to Stone and documents reviewed by ProPublica, Briscoe had photographic evidence that mass spec operators had switched the quality control samples between different runs; before-and-after copies of documents with the dates and other material changed; and information about a shadow computer filing system, where data from failed runs could be stored out of sight of FDA inspectors.
On June 5, apparently frustrated with Cetero's response, Briscoe went a step further and called the FDA's Dallas office. He agreed to meet Stone the following Monday, but never showed. Stone called him, as did other FDA officials, but Briscoe had changed his mind and clammed up.
Still, Stone's brief phone conversation with Briscoe reminded the agent of all those suspiciously clean records he had seen at Cetero over the years. "Now that you have a bigger picture," Stone recalled, "you're like, 'Oh, some of this stuff is cooked.'"
Two days after Stone's aborted meeting with Briscoe, Cetero informed the FDA that an employee had made allegations of misconduct and that the company had hired an outside auditor to review five years' worth of data. That led to months of back-and-forth between the agency and Cetero that culminated when Stone and his inspectors arrived in Houston in May 2010.
Two teams of FDA investigators eventually confirmed Briscoe's main allegations and cited the company for falsifying records and other violations of Good Laboratory Practice. The net effect of the misconduct was far-reaching, agency officials wrote in a July 2011 letter:
"The pervasiveness and egregious nature of the violative practices by your firm has led FDA to have significant concerns that the bioequivalence and bioavailability data generated at the Cetero Houston facility from April 1, 2005, to June 15, 2010 … are unreliable."
Bioequivalence studies measure whether a generic drug acts the same in the body as the name-brand drug; bioavailability studies measure how much drug gets into a patient's system.
The FDA's next step was to try to determine which drugs were implicated — information the agency couldn't glean from its own records.
"We couldn't really tell — because most of the applications we get are in paper — which studies were actually linked to the key studies in an application without asking the application holders," the FDA's Woodcock said. "So we asked the application holders," meaning the drug manufacturers.
In the interim, the FDA continued to investigate processes and procedures at Cetero.
"We put their operations under a microscope," said Woodcock. A team of clinical pharmacologists, statisticians and IT experts conducted a risk analysis of the problems at Cetero, she said, and they "concluded that the risk of a misleading result was very low given how the studies were done, how the data were captured and so forth."
In April 2012, nearly three years after Briscoe first alerted the FDA to problems at Cetero, and nearly two years after Cetero handed over its documentation to inspectors, the FDA entered into a final agreement with the company. Drug makers would need to redo tests conducted at the company's Houston facility between April 1, 2005 and Feb. 28, 2008, if those studies had been part of a drug application submitted to the FDA. If stored blood samples were still usable, they could be reanalyzed. If not, the entire study would need to be repeated, the FDA said. The agency set a deadline of six months.