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Institute of Medicine (US) Food Forum. Nanotechnology in Food Products: Workshop Summary. Washington (DC): National Academies Press (US); 2009.

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Nanotechnology in Food Products: Workshop Summary.

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3Safety and Efficacy of Nanomaterials in Food Products

This chapter summarizes the presentations and discussion that took place during the second session of the workshop. The first presenter, Martin Philbert of the University of Michigan, argued that scientists do not fully understand all of the safety issues associated with nanotechnology. He emphasized that in addition to thinking about the nanosized materials themselves, it is important to consider all of the “things that come along with the nanotechnology.” As examples, he pointed to the biocompatible surfactants often added to nanoparticles as a way to prevent clumping and the metals that are sometimes used during the synthesis of carbon nanotubes: both of these added substances raise potential toxicity issues. It is also important to consider how nanomaterials behave not just in the context of the food matrix (which Aguilera had previously addressed) but also in the context of the biological size scale (i.e., inside the human body). After commenting on some of what is already known about the toxicity of nanomaterials, Philbert briefly described some recent toxicity studies and then identified several key safety issues that remain unresolved.

The second presenter, Laura Tarantino of the U.S. Food and Drug Administration (FDA), provided an overview of the range of FDA authorities over food products and argued that nanotechnology can be viewed as a special case of what the FDA has been doing all along with food. Essentially, the burden of proof is on manufacturers to show that any changes they have made do not affect safety. The challenge is determining what types of testing and data are necessary for determining this. FDA has yet to issue formal guidance for nanotechnology in food, and Tarantino encouraged sponsors who are considering developing nanomaterials-based products to engage in early and frequent consultation with the agency. Not only would early consultation benefit manufacturers, by providing them with an indication of what types of testing and data would be required for approval, it would also provide the FDA with information that could be helpful as it develops the necessary guidance.

The third and final speaker of this session, Fred Degnan of King & Spaulding, broached some of the same issues that Tarantino did, but as Degnan put it, “from a practicing lawyer’s perspective.” He agreed with Tarantino that the FDA’s statutory authorities provide the agency with the necessary tools for evaluating and regulating the safety of nanomaterials with novel properties and that the FDA’s existing procedures and systems are adequate to evaluate and regulate nanotechnology in food. In fact, the Food Additive Amendment (FAA) of 1958, which was enacted in response to a post-WWII public health scenario created by the sudden availability of thousands of new synthetic chemicals, was designed to address the very same types of safety issues presented by the use in food of nanomaterials with novel properties. However, he argued that the basis of good regulation is in written guidance, not just “chatting” (to borrow Tarantino’s expression). Any type of written guidance, even if preliminary, would be of enormous benefit, not just for improving industry understanding but also for ensuring public confidence that FDA is engaged and focused on nanotechnology issues. This is particularly true of nanomaterials introduced into food products that have previously been exempt from premarket approval because they are Generally Recognized as Safe (GRAS).

Again, there was an open discussion period at the end of the session. Most of the questions pertained to issues around toxicology and whether there are any established criteria for how to proceed; how to encourage early industry consultations with the FDA; whether there is an approximate timeline for when the FDA will be providing written guidance pertaining to nanomaterials with novel properties in food products; and under what, if any, circumstances a food designed to deliver nutrients can and should be considered a drug for the purposes of regulation.


Presenter: Martin A. Philbert2

Philbert began by remarking: “We are in the realm right now of almost infinite possibilities and very few probabilities.” While it is easy to see in the laboratory or “boutique” commercial setting a variety of interesting, novel nano-structures with all sorts of desirable properties, turning nanotechnology into a “useful iteration that can be safely deployed into a human body is a very different proposition.” There are a wide range of safety issues that need to be considered. Importantly, in addition to thinking about the toxicity of the nanomaterial itself, he said, “We need to pay very close attention to those things that we add in order to deploy the nanotechnology appropriately. And in fact, the nanotechnology itself may be a bit of a misdirect in that really what we’re looking at is toxicity of things that come along with the nanotechnology.”

For example, consider that one of the fundamental properties of nanoparticles is the inverse relationship between particle size and the number of molecules expressed on the surface. As the diameter of a nanoparticle decreases the surface area increases; when particle diameter reaches the nanoscale level (< 100 nm) the ratio of surface molecules expressed increases exponentially. Below 100 nm, forces that are virtually negligible in the bulk scale begin to predominate (e.g., hydrogen bonding, van der Walls forces, and other interactions that tend to drive particles together). Philbert described the results of a study published in Science (Nel et al., 2006) showing more generally how dose metrics become more complex as size decreases (i.e., this is true not just of nanoparticles but all types of nanomaterials).3 For example, when carbon nanotubes are taken out of pristine deionized water and placed in solution, they tend to agglomerate very quickly because of the forces that predominate at these smaller sizes. Biocompatible surfactants can be added as a way to prevent agglomeration, but they present their own set of challenges.

The addition of biocompatible surfactants is an example of why close attention needs to be directed not just to the toxicity of the nanomaterial itself (e.g., the carbon nanotube) but also to “those things that we add in order to deploy the nanotechnology appropriately.” Another example, Philbert said, is the use of metals such as indium, vanadium, and sometimes technetium during the synthesis of carbon nanotubes and the consequent, unintended delivery of a very reactive metal during the delivery of the therapeutic to a biological setting.

Also in addition to considering the toxicity of all of the various added substances required to deploy a nanotechnology application appropriately, one must consider what happens to the nanomaterial in the biological context. Philbert pointed to some very interesting studies coming out of Dublin4 that show how durable carbonaceous materials, when introduced into a high protein environment such as the inside of a cell, can cause abnormal protein fibrillation. (Fibrillation is the formation of fibrils; amyloid protein fibrillation is a type of aggregation phenomena that has been linked to many human diseases.) This may be of some consequence in individuals who are either genetically predisposed to or already have the equivalent of familial amyloidosis (a protein-misfolding disease); the nanomaterial may act as a seed around which the amyloid proteins aggregate.

Nanomaterials Are Here: Factual and Fanciful

From C60 buckminsterfullerenes (spherical structures composed of carbon atoms) to dendrimers (structure with repeatedly branching molecules), nanomaterials are here, and they are being used in all sorts of “sublime” but also controversial ways. For example, novel metals and metal oxides are being encapsulated for the enhancement of color and the imparting of beautiful shimmering effects on the surfaces of cars, aircrafts, etc. As another example, nanosized titanium dioxides and zinc oxides are being incorporated into sunscreens, allowing people to stay in the sun 60 times longer than they can with sunscreens with chemical additives, preventing burns and decreasing the likelihood of developing basal cell carcinoma down the line. Philbert noted that the use of these sunscreens raises questions about potential adverse health effects associated with entry of the nanomaterials into the human body. For the home, you can now buy nano-based windows and wood floors. And finally, in health care, nanotechnology is being used to develop targeted delivery of therapeutics; Philbert pointed to the work of Donald Tomalia5 as one example of an application; targeting therapeutics to cancer cells.

One needs to be very careful, Philbert said, about the claims being made about nanotechnology, as these claims very quickly go “from the sublime to the ridiculous.” As just one example, there are “plans afoot” to add a nano-structured robot to the back of a spermatozoon, raising questions about the ethical implication of “subverting normal biological processes and achieving something that nature never intended to occur.”

Moreover, not all that claims to be nanotechnology is truly “nano.” There are now more than 800 self-identified nanotechnology products on the market. “Self-identified” is the key word. In fact, it is not really clear how many products on the market actually contain nanomaterials, Philbert said. They range from nanosilver-containing socks that people can wear for seven days without any appreciable odor to stain-resistant pants and ties. But then there are things like the iPod nano, a great example of a “nano” product that has nothing to do with “nano” except perhaps for the micro-circuitry (which Philbert said is irrelevant from a consumer perspective since consumers are never exposed to it).

Of those products that are coming on the market, many contain Nano-Ag0 (“Nano-Silver”) and other nanomaterials designed to come into contact with food. The life cycle of these composite materials is unknown, for example whether repeated dishwashing will “re-liberate” the nanomaterial despite the fact that there are physical forces that pull against that (i.e., once the material is embedded in a resin, it requires a great deal of energy to liberate the nanoparticle as a nanomaterial).

Evaluating the Safety of Nanomaterials

Philbert differentiated between risk and the perception of risk. He reminded the audience that risk is a product of hazard times exposure, which means that very few people are likely to be exposed to many of these products (especially because these materials are expensive). He showed an image of a person titrating an aerosolized nanomaterial and commented that while the worker is potentially exposed most consumers of the product containing this particular nanomaterial aren’t exposed to the actual nanomaterial. Rather, the risk for them is the greater force of impact resulting from a collision with a five-ton truck with nanoengineered high-tensile strength bumpers. “Where here is the greater risk?” Philbert asked. The potential health risks extend beyond exposure to the nanomaterial itself and include exposure to the final engineered products as well. He said, “I urge all of us to think more broadly about the implication of the inclusion into materials, not just the hazard associated with limited exposure to material.”

Current Knowledge of Nanoscale Material Toxicity

Knowledge about physical properties of other materials can be used to predict how nanoparticles will behave and whether they will be toxic in the human body. For example, some formulations of long and thin nanotubes would probably behave like asbestos, depending on the biological and physical context, since both materials have high aspect (length:width) ratios. Other properties with known toxicities include bio-persistence, the presence of reactive surfaces or points (i.e., areas capable of producing reactive oxygen species), certain compositions, and solubility. For example, manganese in welding fume produces an aerosol of particles, most of which are under 100 nm in diameter, and it is well known that many welders develop manganism as a result of this exposure. (Manganism is similar to Parkinson disease, with various part’s of the brain that control motor movement degenerating.) As another example, the cadmium, selenium, and arsenic in quantum dots are soluble at physiological pH; so while a quantum dot may have great functionality, it also serves as a delivery device for super-physiological concentrations of cadmium. While coating some of these potentially toxic materials with biocompatible substances (with dextran, titanium oxide, zinc oxide, or polyethylene glycol) can significantly reduce toxicity, it does not obviate all of the toxicity.

Size Is Not Everything

Philbert emphasized, “Size is not everything.” There is a tendency to think that all brand new nanomaterials are “bad,” but there are other factors besides size to consider before passing judgment. He described unpublished data showing that injecting even a ridiculously high dose of nanomaterial into the tail vein of a rat over the course of an hour, say 500 mg per kg, which he likened to injecting “cottage cheese,” has no pathological consequences (if the material can be injected without inducing any hydrodynamic changes). However, if the same nanomaterial carrier is used to deliver iron into a different biological context, namely the renal cortex and liver, the result is cortical renal necrosis and petechial hemorrhage (a subcutaneous hemorrhage occurring in minute spots) in the liver. So again, size is not the only factor to consider when evaluating safety.

Moreover, there is considerable variation in size among nanoparticles even in a single system. An carbon nanotube (CN) aerosolized, for example, contains particles ranging in size from smaller than 0.01 μm to greater than 1 μm in diameter. When the aerosol is agitated, the proportion of particles smaller than 100 nm increases drastically.

Toxicity Studies

Philbert described the results of a toxicity study that involved exposing mice to a variety of concentrations of aerosolized CNs, demonstrating that CNs can cause inflammatory disease and destruction in the lungs with widespread formation of granulomas.6 Based on data from studies like this, it is well known now that a variety of nanomaterials interact with the immune system to produce effects ranging from mild stimulation of the immune system to severe granulomatous change in, for instance, the lung.

It is important, however, to make sure that these experiments are done properly and that the properties of the nanomaterial do not, as Philbert said, “defeat the experimental design.” Philbert showed a light micrograph image of lung tissue from a rat exposed to 5 mg/kg of single-walled carbon nanotube (SWCNT). After only a few hours of exposure, the rats in this experiment started dying but not because of pulmonary toxicity; rather, they suffocated because their airways had been mechanically blocked by the SWCNT instillate. So in that case, the death and destruction had “nothing to do with nano.” In fact, if you disperse the SWCNT instillate appropriately, rather than suffocation, you see a progressive granulomatous disease.

When “assigning blame in the context of toxicology,” Philbert said, you also have to be very careful about which particle, or rather which particle shape, is the culprit. Even a single nanotube can have multiple morphologies.7 Is the damage being caused by the smaller nanotubes, the larger ones, or multimers of differently shaped nanotubes? Most commercial preparations are mixtures of morphologies, with the goal of increasing tensile strength for less cost, so very rarely are pure samples being prepared in bulk.

Despite the lack of clarity around what exactly is causing the damage, it appears that some organs, namely the liver, spleen, and lymph nodes, tend to accumulate nanomaterial much more quickly than other organs do. One could inadvertently concentrate a nanomaterial in these organs while targeting other tissues in the body. The liver, for instance, contains Kupffer cells (a specialized type of macrophage located in the liver and forms part of the reticuloendothelial system), which line the sinusoidal wall and are responsible for removing toxins from the blood entering the liver from the gut mesentery. The Kupffer cells normally pick up small viruses and infectious particles, which are in the nano range (i.e., less than 100 nm), and so they presumably pick up other nano-sized substances as well. Philbert mentioned a 2006 study published in the Proceedings of the National Academy of Science (PNAS) showing that no immediate adverse health effects were found after injecting individualized CNs directly into the bloodstream of rabbits.8 The nanotubes circulated in the blood for more than an hour before being removed by the liver. Philbert argued that having “unmodified CNs cleared by the liver” is not necessarily a good thing; while “it is good pharmacokinetically and maybe even toxicokinetically,” having these long-lived materials in the liver could be harmful.

Nanomaterials and the Biological Size Scale

Another important feature of nanomaterials with respect to safety is that they fall within the biological size scale. Indeed, this is why they have so many potential applications—nanomaterials can interact with biological components with very high affinity. For example, you can now purchase kits for CN-based methods for isolating nucleic acids: the method works because a nucleic acid phospholipid wraps around a carbon nanotube so readily.9 But that same affinity can be damaging. For example, work from Philbert’s lab suggests that an array of proteins, including apolipoprotein A, can readily stick to the surfaces of the coated nanoparticles (e.g., nanoparticles coated with wheat germ agglutinin) that are being developed as a novel mode of drug delivery. Apolipoprotein A is involved with the transport of lipids into the brain and also with some parts of the oxygenation cascade—its attraction to these coated nanoparticles, Philbert said, “may or may not lead to inflammatory damage.”

Philbert briefly addressed the issue of whether nanomaterials can penetrate the skin. He referred to work on quantum dots being done by Sally Tinkle of the National Institute of Environmental Health Sciences (NIEHS) and Paul Howard and others at the FDA. Tinkle has shown that quantum dots can penetrate flexed and stretched skin; Howard has shown the same with abraded skin. Also, nanoparticles can clearly penetrate cut skin, which Philbert said has implications for kids at the beach who are wearing nanoparticle-based sunscreen—if they have scuffed knees, for example, those nanoparticles are going to enter their bodies. Translocation (of just nanoparticles or both quantum dots and nanoparticles?) across the skin is always to the proximal lymph node, but it is unclear whether there is any lymphadenopathy as a result. There is no evidence yet of lymphadenoapathy, despite a long history of introducing fine and ultra-fine materials into the skin (e.g., tattooing).

Unpublished research in Philbert’s lab shows that, as the dose of introduced nanomaterial increases, a greater fraction of that dose resides in “interstitial state” tissue. That is, there are mechanisms that he and his colleagues do not quite yet understand that suggest that introduced nanomaterials are picked up by the liver and other major immune system organs but then diffuse through the tissue(s) such that their exact cellular location cannot be pinpointed.

One of these (other) major immune system organs is the gut, specifically the Peyer patches (and M cells, which is where the Peyer patches attach to the gut) and dendritic cells. The M and dendritic cells take part in the constant “sampling” of the microflora of the gut and are involved with mechanisms that promote a healthy flora.10 Philbert stated that since “not all guts are ‘normal,’ it would be foolish for us to assume that all interactions of nanomaterials in food are going to be utterly predictable.” Not only is there wide variation in gut microflora, but also there is wide variation in the “tone” of the epithelium of the gut, with the morphology of the gut lining changing with microfloral composition.

In conclusion, Philbert summarized the following:

  • Dosimetry for nanomaterials is not clear. Do we measure mass concentration, surface area, chemical identity, chemical dose, or some complex algorithm that incorporates all of these factors?
  • We are in “desperate need” of accurate quantitative methods for measuring nanomaterials in complex media such as food. There is an assumption that when we put a nanomaterial in food, it is going to remain a nanomaterial, but we have yet to confirm that this is true.
  • The long-term stability of nano-enabled products is unknown. We “sort of know intuitively” that our food naturally breaks down into nanomaterials before being absorbed (since the “machines of life” operate at the nanoscale), but we do not know what happens to these nanomaterials as they pass through various media, including after they are eliminated from the body. In fact, environmentally deposited nanomaterials may be reintroduced into the food chain at a later point; life cycle analysis is important.
  • Quantitative absorption, distribution, metabolism, and excretion (ADME) models are unavailable for most nanomaterials. Consider the C60 buckyball. If you were to add a hydroxyl group to it, there are 59! [59 factorial = 1 × 2 × 3 × … × 59] possible positions for the next hydroxyl group, 58! for the next, and so on. We will never have the resources or time to do an exhaustive toxicology on all of these new nanomaterials. Philbert said, “We need to put our collective thinking caps on and come up with a rational approach that is resource-appropriate for the identification of hazards and the establishment of risk and, ultimately, the management of risk.”
  • We need to know the impact of nanomaterials on non-pulmonary systems and determine whether or not the immune system effects that have been done in non-gastrointestinal (GI) systems translate to these other systems.
  • We need to better understand both the acute and chronic effects of nanomaterials on the immune system. We are gathering data on the former, but virtually nothing is known about the latter. We need to develop better animal models since, if asbestos is an indication, it takes about three decades after initial exposure before mesothelioma begins to manifest in humans. We also need to shift away from high-dose exposure studies and begin studying “more reasonable” exposures.


Presenter: Laura M. Tarantino12

Tarantino began her talk by remarking that many of the questions asked during the first session, coupled with some of the concepts that Philbert broached, served as an excellent lead-in to the issue of regulation and the challenge of risk identification. She remarked that the focus of her presentation would be the scope of FDA’s authority and oversight over foods, food ingredients, and nutrients and that she would be providing an overview of the regulatory framework currently in place.

Tarantino recommended the FDA Nanotechnology Task Force Report, which was issued in July 2007 as a source of information about the state of the science of biological interactions among nanomaterials (at that time—if the report were written today, its synopsis of the state of the science would be slightly different). The report also includes an analysis and recommendations for science issues and an analysis and recommendations for regulatory policy issues. Tarantino remarked that she would not be going into detail about the report but that she did want to highlight a couple of its “bottom line” messages regarding regulatory policy issues. These are issues that need to be considered soon because some of the nanomaterials mentioned and described during the previous presentations have already started appearing in food:

  • Can FDA identify products containing nanoscale materials?
  • What is the scope of FDA’s authorities to evaluate the safety and effectiveness of such products?

One of the conclusions of the FDA Nanotechnology Task Force Report was that the scope of FDA’s authorities depends on whether a product is subject to pre-market authorization. (The classic example of pre-market authorization is a new prescription drug, where there is a fairly rigid, robust pre-market approval process that encompasses both the product itself and the manufacturing methods. Only some types of food products are subject to a similar process.) For a product subject to premarket authorization, there is at least the presumption that FDA can demand the information (e.g., about particle size) and data (i.e., from the requisite tests) necessary to ensure that the product meets the safety standard before its approval. Tarantino remarked that this demand implies that “we know what to ask for” with respect to what kind of testing needs to be done. She said that she would be addressing only what types of products require pre-market authorization, not what kind of testing is required of those products.

The Spectrum of FDA Oversight Over Foods

FDA exercises a range of authorities over foods, with only certain types of food items requiring premarket authorization. Tarantino identified three categories of food items that she said were “somewhat arbitrary,” but the categorization makes it a little easier to understand the spectrum of FDA oversight:

  1. Dietary ingredients in dietary supplements
  2. Colors added to food
  3. Food additives and ingredients
    1. “Direct” food additives (substances that are added directly to foods [e.g., sweeteners, emulsifiers]).
    2. Food contact substances (e.g., substances added to the food packaging—Tarantino referred to some of the examples mentioned during previous presentations)
    3. Food ingredients whose use is generally recognized as safe (GRAS) (this category encompasses a wide spectrum of situations in terms of the kind of regulatory authorities the FDA has with respect to pre–market approval)

The first pre–market approval enacted for any food product didn’t occur until the Food Additives Amendment (FAA) of the Food Drug & Cosmetic Act was enacted in 1958, requiring all manufacturers to establish safety for any new food additives. The amendment includes a very broad definition of “food additive,” which as written covers everything from carrots and stew to aspartame. It established a new standard of safety; the reasonable certainty that no harm will result, and required pre–market approval for all food additives but also provided for a series of exemptions. One important exemption is GRAS. Two years later, there was another amendment to the Act, the Color Additive Amendment, which defined and required premarket approval for color additives. So while color additives are exempt from food additive regulatory policies, they have their own set of rules.

Food Contact Substances

Tarantino said that the regulatory situation with food contact substance is “probably most analogous to the new drug situation.” Food contact substances include all materials that could migrate from food packaging into food, and they require a mandatory notification process and approval before marketing. Approval is restricted to the notifier and the particular notified substance; and requires FDA authorization for marketing.

Food and Color Additives

As with food contact substances, food additives (which include emulsifiers, sweeteners, etc.) and color additives also require approval before marketing. The regulation ordinarily includes identity (e.g., chemical structure, if chemical structure is an identifying feature) and levels of use (if important) and may also include requirements regarding the manufacturing process and specifications for contaminants. In short, it covers all those circumstances necessary to ensure that any manufacturer that uses the additive in compliance with regulation is using it safely. The difference between this type of regulation and regulation for food contact substances is that the former is generic. Once a regulation for a particular additive is in the books, anyone can use that product as long as they are in compliance with the regulation.


At the other end of the FDA regulatory spectrum are food ingredients whose use is GRAS. GRAS food additives are exempt from the previously described pre-market approval process. This is a very practical and useful exemptionone based on the notion that if experts who are qualified to judge safety recognize and agree that an ingredient is safe, then there should be no need for an independent review and approval by FDA. An “expert” is somebody qualified by training or experience. He or she does not have to be a government official. What the GRAS exemption effectively means is that companies seeking to market a new food ingredient can make a determination that their use of the ingredient is GRAS, although they run the risk that the FDA will disagree. To minimize that risk, the FDA has implemented a voluntary notification process whereby manufacturers or those who wish to market a substance that they believe is GRAS can receive feedback from the FDA prior to marketing the product. While there is no pre-market approval requirement for GRAS additives, there is a burden to show that the ingredient in question meets the food additive safety standard; additionally, experts must agree that the ingredient meets that standard.

Dietary Ingredients in Dietary Supplements

Dietary ingredients in dietary supplements are exempt from the definition of food additive and do not require pre–market approval. Tarantino defined a dietary ingredient as “essentially the thing you take the dietary supplement for.” Other dietary supplement additives (e.g., color additives or added sweeteners) are still regulated under the color or food additive rubric. However, “new dietary ingredients” (i.e., those that one cannot show were marketed before October 15, 1994) are subject to required notification, whereby the FDA must be notified 75 days before the product is marketed. So this is not a formal pre–market approval process, but it does give the FDA a chance to hear about the product.

Nutrients, by the way, can fall under either the dietary ingredient or food ingredient rubric, depending on whether they are added to dietary supplements (in which case they would be classified as a dietary ingredient) or food (in which case they would be classified as a food ingredient).

Where Does Nanotechnology Fall Within This Spectrum?

This wide range of regulatory authorities over food serves as a “pretty adaptable system,” Tarantino said, and nano-sized product ingredients, or nanomaterials, are really just a “special case of something that we have been doing all along.” Consider, for example, a food additive regulation for a particular emulsifier. The regulation would include specification for all contaminants anticipated when the regulation was written (i.e., specification for the maximum amount of contaminant allowed). If the manufacturing process for that particular emulsifier changed in such a way that the regulation still applies and yet the process produces a new, unanticipated contaminant, that would create a new problem which would need to be dealt with accordingly—that is, by doing the requisite testing. The same would be true of the use of nanotechnology or nanomaterials. The burden of proof is on the manufacturer to show that what they have done differently does not affect the safety of the product, even though there may be nothing in that particular regulation about particle size. If some sort of change has been made that may impact safety, then the change requires testing. The challenge is in the nature of the testing. As Tarantino said, “The trick here is: What questions do you ask? And how do you do that testing?” Ideally, the manufacturer should be talking with the FDA at that point and having some sort of dialogue about what type of safety data to collect and how to conduct the necessary testing. Tarantino urged, “If you’ve made a change that requires some testing, you really ought to be talking to us.”

There are two main questions to consider when a change is made:

  1. Has changing the size affected the safety? Again, if it has, then the requisite testing must be conducted.
  2. Is it the same substance? If it is not, then the appropriate rules must be followed. If, for example, it has been changed in a way that now requires pre-market approval whereas it did not before, then pre-market approval must be sought.

The burden of proof is greater with GRAS ingredients. The use of a substance in the nano form may or may not be GRAS, even if the use of substance in the macro form is GRAS. It is difficult to argue that the nanoform of a GRAS macro substance is automatically itself GRAS because not only must the manufacturer show that the nanosized substance meets the safety standard, they must also show that the information they are relying on to make that statement is generally available and recognized and related specifically to the substance under consideration (i.e., even a nanosized substance). Gathering these data may be a very difficult thing to do in this fast-evolving emerging field of nanoscience and nanotechnology.

Recent FDA Actions

The FDA participated in a recent exercise jointly sponsored by the Project on Emerging Nanotechnologies at the Woodrow Wilson International Center for Scholars and the Grocery Manufacturers Association (GMA) that involved considering three case studies of potential applications of nanotechnology in food packaging. For each case, the participants considered what kinds of testing would be necessary, what kinds of things would be considered during the approval process, and generally what the approval process would encompass. The exercise resulted in a report, Assuring the Safety of Nanomaterials in Food Packaging: The Regulatory Process and Key Issues, which is published on the Wilson website.13 Tarantino said it was a very useful exercise—it was a training of sorts for FDA reviewers, and it gave developers of these types of products a chance to talk about some of the issues with both FDA and EPA regulators.

Additionally, there was an FDA-sponsored public meeting on September 8, 2008, designed to seek input on determining the data and test methods that are available and to hear public comments and concerns regarding nanomaterials in food. Tarantino reiterated that the FDA is very interested in receiving as much input as possible from people who are either thinking that they might need to conduct safety tests as they develop these types of products or already conducting such tests. Tarantino said that the comments from this meeting are currently being analyzed, and she urged workshop participants to use the meeting website as a source of information about what types of questions that FDA thinks that people ought to be considering as they move forward with developing food products with nanosized materials.

“We know that people want guidance,” Tarantino said. People want and need to know what to do and how to do it when developing their products. But this is not going to be an easy thing to provide, she said, partly because nanotechnology is not a single entity. It is a new technology that encompasses many different entities, and there is no checklist for determining safety. She emphasized again that the trick is in knowing what questions to ask. Tarantino said that identifying these questions is something that could be done as a collaborative exercise between the FDA and the developer of the product. She referred to an earlier comment about the fact that much of what is going on in the area of food nanotechnology is occurring “behind closed doors.” She made an appeal “to open that door at least a crack. Come on in as early as possible.” She said that, on a positive note, there is a lot of knowledge and information about the materials that are being used to develop these new products. But many practical questions still remain unanswered and those are where the discussions with FDA really need to take place, for example with respect to what these materials do in the gut and what effects they may have in the context of a complex food matrix.

While there is no complete written guidance available yet, Tarantino said that the FDA has updated its guidance for food contact substances to include some language about particle size. In December 2007, two statements were added to the Preparation for Premarket Submissions for Food Contact Substances: Chemistry Recommendations:14

  1. Section II.A.5. Physical/Chemical Specifications: “In cases where particle size is important to achieving the technical effect or may relate to toxicity, sponsors should describe particle size, size distribution, and morphology, as well as any size-dependent properties.”
  2. Section II.C. Technical Effect: “If technical effect is dependent on particle size, sponsors should present data that demonstrate the specific properties of the particles that make them useful for food-contact applications.”

In conclusion, Tarantino said that the more the FDA can be engaged in dialogue with sponsors, the more likely the agency will be able to write guidance that makes sense, is helpful, and is fully protective of public health. She again encouraged early consultation with the Agency for any food or food packaging product with nanomaterial, even if “it’s only a gleam in your eye.” If it is something that could potentially wind up in food, “the sooner [the FDA] knows and the more we can talk, the better.”


Presenter: Fred H. Degnan16

After some introductory remarks, including that he would be addressing much of the same territory that Tarantino covered but from a practicing lawyer perspective, Degnan identified two key regulatory issues with nanomaterials in food:

  1. Whether FDA’s statutory authorities provide sufficient tools to evaluate and regulate the safety of nanomaterials with novel properties when used in food, food packaging, and dietary supplements.
  2. Whether FDA’s existing procedures and systems are adequate to evaluate and regulate the safety of nanomaterials with novel properties when used in food, food packaging, and dietary supplements.

He emphasized the term “nanomaterials with novel properties,” reiterating Tarantino’s comments with respect to whether the substance in question is truly novel. The answer to the first question (above), he said, is a “resounding yes” with the possible exception of the safety system for dietary supplements which, as Tarantino alluded, is less comprehensive and less rigorous than the safety systems for other food items. Nonetheless, the system for supplements does provide a mechanism for evaluating the safety of those materials. The answer to the second question is, again, a “big yes” with respect to foods, food packaging, and color additives. But, again, with respect to dietary supplements, the current system is not as comprehensive, but nonetheless does exist.

Degnan argued, however, that “There is a ‘but’.… These systems really do need to be augmented by [written] guidance specifically addressed to nanomaterials.” While Degnan agreed with Tarantino that coming to the Agency and having discussions “would be wonderful,” he said that written guidance would provide the most value for both producers, and from a transparency perspective, the public. This is true even if that guidance evolves and changes over time as more information is gathered through dialogue with sponsors and experience with the technology.

Degnan commented on the complexity of the food supply, stating that the “good news” is that the Food, Drug, and Cosmetic Act (the “FDC Act”) reflects this complexity and contains a number of different “safety” standards. These standards vary according to the food itself, the use of a food substance(s), the conditions under which the food is made and held, and the ingredients or substances migrating into the food. Degnan remarked that the focus of his presentation would be on the last issue: ingredients and migrants; that is, the migration of substances from packaging into food.

He explained that, as Tarantino alluded, the critical difference in rigor that accompanies the different safety standards in the FDC Act depends in large part upon whether pre–market approval requirements or post-market enforcement authorities apply. The FDA has not always had a pre–market authority system in place. For the first 60 years of federal regulation, FDA’s only authority over food was based on post-market enforcement constructs, whereby the Agency had to go out and find food safety problems and then convince the courts that the problems rendered the food unlawful. In 1958, with enactment of the Food Additives Amendment (FAA), Congress enacted a pre–market approval system, whereby companies were required to have ingredients meeting the definition of “food additive” approved by the FDA before being able to lawfully market the ingredients. The FAA shifted the burden of proving safety from FDA to industry, creating a huge difference between the post-market and pre-market approval schemes. Of the more than 120 amendments to the FDC Act, the FAA is among “the best” in Degnan’s view. He characterized it as a “remarkably good piece of legislation,” one that is still vibrant and relevant today.

Remarkably, the safety issues presented by the use of nanomaterials with novel properties in food are almost identical to those that presented 50 years ago and which led to the passage of the FAA. These issues presented themselves then largely because of the technological and chemistry developments related to World War II. Synthetic food ingredients were being manufactured very suddenly, and the FDA was confronted with literally thousands of new ingredients whose safety had never been reviewed. The FAA was designed to address a public health scenario with the following:

  • Potentially thousands of novel substances to be added to food
  • Only a few such substances specifically tested/reviewed for safety
  • An existing regulatory system hampered by limited resources
  • Public/private sector concerns about under/over regulation

What makes the FAA so vibrant and effective? Degnan noted that the objectives of the FAA are actually twofold: (1) to assure safety and (2) to foster innovation in food technology. Degnan identified three tools that have made it possible to accomplish these dual objectives:

  1. Pre–market clearance with burden of proof on the sponsor.
  2. A rigorous but non-absolute safety standard (i.e., “reasonable certainty of no harm”). The FAA contains only one absolute binding standard: the Delaney Clause. (The Delaney Clause effectively states that no additive could be deemed safe or given FDA approval if found to cause cancer in humans or experimental animals.) Other than that, as Degnan stated, the statute requires a food additive to be “safe” but does not define in any meaningful way a standard for assessing an additive is “safe.”
  3. A broad, comprehensive definition of “food additive” coupled with reasonable expectations, including one flexible, forward-looking exception for substances Generally Recognized as Safe (GRAS).

The GRAS Exemption

A food additive is defined, in part, as “any substance that directly or indirectly may reasonably become a component of food.” This is a very broad definition and one that led Congress to apply certain exceptions. Pesticide chemical residues, for example, are not considered food additives and instead are regulated under another (nonfood) rubric. The most important exception, however, is for GRAS substances—that is, substances that are generally recognized as safe by qualified experts on the basis of knowledge derived from scientific procedures. Degnan characterized the GRAS concept as “the grease, … the element that allows the FAA to work, and it’s been that way since the inception of FDA’s regulation of food additives in 1958.” The GRAS provision allows the FDA to prioritize its limited resources and examine only those new and novel substances that demand its attention. And, it provides a flexible way to address food safety concerns in an efficient manner.

Degnan briefly described two recent important applications of the GRAS concept: (1) The GRAS provision was critical to the Agency’s ability to implement its transgenic plant policy. The provision allowed FDA to treat as GRAS most transferred genetic materials (primarily nucleic acids) thereby avoiding time-consuming food additive approval and unnecessary restraints on innovative technology. (2) More recent is FDA’s reliance on a voluntary notification process that offers a prompt and thorough review and encourages industry submissions. Under the process industry collects publicly available data with respect to the safety of a given use and assembles a panel of experts to review the information and opine on the safety of the subject compound for a use or set of uses. FDA, in turn, relies on the assembled data and the expert opinions to evaluate whether a question with respect to GRAS status is presented.

Degnan emphasized that determining that a substance is GRAS is “not a shortcut or loophole.” He said, “It is far from it. In my view, making a GRAS determination is harder than making a safety determination, because to be GRAS a substance has to have all of the fundamental proof that would accompany a food additive, and that proof must be publicly available. It’s a demanding standard.”

Nanomaterials with Novel Properties and GRAS

One of the key regulatory questions with respect to nanomaterials with novel properties is whether they can be considered GRAS. Or, because of the practical difficulty involved in establishing general recognition of a novel substance, is it an oxymoron or contradiction to say “GRAS nanomaterials with novel properties?” This is a key issue currently in consideration at the FDA and one that Tarantino and her colleagues must consider in the context of what was done with transgenic plants and, in 1997, with the notification policy. Degnan noted that the issue also relates to a question that Groth asked earlier: Can a line be drawn in the spectrum of differently sized materials such that those materials that fall on one side can be considered GRAS?

Degnan remarked that the situation is different with dietary supplements. As Tarantino had stated earlier, dietary ingredients in dietary supplements qualify as an exemption to the definition of a “food additive,” and thus are not subject to a pre–market approval process. The regulation process for dietary supplements is a post–market approval process, and the only way the FDA can take a dietary supplement off the market is to show that the supplement presents a “significant or unreasonable risk of illness or injury.” This is a difficult burden of proof for FDA to meet. However, there is a pre-market “notification” requirement for certain dietary ingredients. All dietary ingredients not used in dietary supplements before October 15, 1994, are considered “New Dietary Ingredients” (NDIs) and, as such, must be the subject of a pre-market notification filed with FDA 75 days before marketing. The notification must contain the basis for the manufacturer’s conclusion that a supplement containing an NDI is “reasonably expected to be safe.” Failure to provide that information gives the FDA reason to argue in enforcement action (i.e., post-market action) that an inadequate basis exists to determine whether the general adulteration standard is met. While not the most efficient system, it does provide FDA with a mechanism for evaluating a new ingredient, including a nanomaterial with novel properties.

Degnan noted a potential complication arises because some substances can be classified as either “food additives” or dietary ingredients, depending on how they are used. Vitamin D added to orange juice, for example, is considered a food additive and is regulated accordingly. On the other hand, vitamin D as an ingredient in a dietary supplement is considered a dietary ingredient and thereby falls under a different regulatory rubric. This variation in how nutrients are regulated, depending on how they are used in or added to foods, “could well in time prove to be another significant regulatory issue.”

So for dietary ingredients in dietary supplements, the issues are the following:

  • What criteria will FDA apply for determining whether nanomaterials with novel properties are “new dietary ingredients”? Degnan noted that presumably an effort would be made to use the same criteria used for evaluating the safety of a food additive.
  • What criteria will FDA apply in the “notification” process for evaluating safety of dietary ingredients nanomaterials with novel properties?

For other food substances (i.e., food and color additives and GRAS nanomaterials), the issues are the following:

  • What criteria will FDA apply for evaluating the safety of nanomaterials? Specifically, what are the criteria for (1) substances already holding approved additive status, including both food and color additives; (2) substances already under consideration by regulation or the notification process as GRAS; and (3) nanomaterials for use in new or unapproved substances?
  • Are there circumstances under which nanomaterials will not be considered to present a safety concern? Degnan identified this issue as “the more driving question.” If the answer is yes, then what factors need to be addressed to reach such a conclusion?
  • Similarly, what criteria will FDA consider applicable for establishing the GRAS status of nanomaterial substances with novel properties?

Concluding Remarks

In conclusion, Degnan reiterated four points:

  1. FDA’s statutory pre–market authorities provide a comprehensive regulatory framework for assuring the safety of nanomaterials with novel properties for use in food and food packaging. The framework for dietary supplements is not as comprehensive but still provides a mechanism for evaluation by the agency.
  2. FDA should author guidances with respect to the criteria to be followed in evaluating the safety of food, food packaging, and supplement uses of nanomaterials with novel properties. This is key Degnan said, not only from a public confidence perspective but also from the perspective of industry. Industry needs to have in hand written guidance on the agency’s criteria for showing the safety of nanomaterials of novel properties.
  3. FDA should provide leadership, on both the domestic and international fronts, not only in developing guidance but in refining guidance as knowledge evolves. Degnan remarked that FDA is providing this leadership, as evident for example by Tarantino’s encouragement to industry to engage in dialogue with the agency.
  4. Industry must conduct research and investigations to substantiate the propriety of the use in food of nanomaterials with novel properties. While FDA needs to take a leadership role, the ultimate responsibility is still always going to fall on industry.

As a “postscript” to the topic of FDA’s regulation of nanotechnology in the context of food and dietary ingredients, Degnan facetiously commented that the Food, Drug, and Cosmetic Act is “misbranded,” in light of the fact that the Act provides FDA authority to regulate far more than just food, drugs, and cosmetics. His point: “There is a whole universe of products that FDA regulates and each type of product (i.e., drugs, medical devices, cosmetics, etc.) is subject to advancement with nanomaterials with novel properties.” The potentially broad use of nanomaterials with novel properties in FDA regulated products is another reason why the FDA should provide leadership and why there needs to be discussion among the various agency centers involved with developments and ideas concerning nanomaterials and their safety. There are also potential concerns about exposure to nanomaterials from a worker, or Occupational Safety and Health Administration (OSHA) perspective. Finally, Degnan commented that the FDA could also provide leadership on the international front, where current regulatory approaches range from laissez-faire to moratoria on research involving nanomaterials. The basis for providing that leadership role, Degnan reiterated, is written guidance.


The second session ended with a 15-minute question and answer period. Most of the questions revolved around the issue of toxicology and testing of nanomaterials. Other topics of discussion included how to encourage early industry consultation with the FDA (and other regulatory agencies); when to expect written guidance on nanomaterials in food from the FDA; and the difference between foods with targeted delivery capacities and drugs.

Toxicology and Testing of Nanomaterials

Doyle opened the discussion by commenting on Philbert’s “very intriguing” comments about how scientists can apply what they already know about physical properties (from having studied other substances, such as asbestos fibers) to nanomaterials. He then asked if there has been any attempt by toxicologists or others to put together some sort of list of the types of things that need to be avoided when developing nanotechnology related materials. Philbert replied, “There have been various attempts.” The problem, however, is that there are very little comprehensive data available. For example, there are very few published pharmacokinetic studies of nanomaterials. The difficulty lies in not knowing where the nanomaterial ends; it depends on its physical or chemical characteristics. “I think there’s a lot of hand-waving going on. We need more data.”

Doyle then asked if this lack of data has any bearing on activity in the area of regulatory approval and whether there won’t be much regulatory activity until there are more data. Philbert replied, “We in some sense are jumping the gun because we simply don’t know what we’re regulating.” Importantly, however, we are “laying the landscape,” so that when the data do emerge, there is some context for interpreting it.

An unidentified workshop attendee remarked that the FDA is at a point where it can only examine each case individually. While doing so, the agency is building the very database in question—one that will allow the Agency to make some generalizations in the future. But it is too soon to be making those generalizations now.

This remark was followed by a question about Degnan’s emphasis on regulatory policies around “nanomaterials with novel properties” and whether the notion of novel properties included those that were unintended or unrecognized. Degnan responded by saying that intent in that context is irrelevant. The overriding intent, he said, is the ingredient or the nanomaterial itself, that is, the nanomaterial intended to be a component of food. He said that as long as that is the case, his remarks apply.

Workshop attendee Richard Bruner, WIL Research Laboratories, LLC, Ashland, OH, mentioned his background in preclinical animal testing of new drugs and commented on how he had attended this workshop hoping that the panelists would “lay out a platform of animal testing that we could all take back to our laboratories.” He said, “Obviously that’s a daunting task and is not about to happen.” He remarked that animal testing is very expensive and that testing even a single nanoparticle in a typical animal profile could exhaust a small company’s entire resources. He suggested that perhaps the “nanotechnology network” join forces and create an organization, much like the Chemistry Industry Institute of Toxicology (CIIT) was formed years ago, which would serve as an interface with the FDA and a filtering mechanism for all the small companies who have a need for testing requirements. The group would be a global network of toxicologists, engineers, and other scientists, and it would serve as a source of advice for the FDA and, in turn, a source of information for the scientific community about how the FDA views nanotechnology. It would also interface with regulatory agencies in other countries. “Is the pill too large to swallow?” Bruner asked.

Degnan responded, “No.” He pointed to work sponsored by the International Life Sciences Institute in the late 1980s and early 1990s on transgenic food safety and conducted by an organization called the International Food Biotechnology Council (IFBC). The IFBC assembled an international array of experts who worked together for a year and a half to produce a template document addressing every aspect of safety through regulatory approval and then circulated the template worldwide for comments. The end product provided a very helpful predicate for and actually prompted FDA to develop its own guidance on transgenic crops (in May 1992). So that approach is one that makes a great deal of sense.

Philbert mentioned that the Environmental Defense Fund and DuPont have worked together to develop a set of toxicology tests for use with a wide variety of nanomaterials. However, the set of tests is still “quite expensive” and does not obviate the cost issue, but it does provide a “happy intermediate” in the sense that the toxicity tests have been shown to be very useful for ruling out formulations that are not going to work and are therefore not worth developing further. Bruner remarked that these tests run the risk, however, of being rejected by the FDA. Philbert replied that the idea is to “cherry pick” among tests as a precursor to a Good Laboratory Practice (GLP) study. He said, “I think the days of developing a chemical and then looking at the toxicity are over” and that “involving the toxicologists and the biologists from the outset is the only way to do this.” Tarantino added that toxicologists and biologists from the FDA should be involved from the outset. She reiterated, “Come in before you do all the studies and talk to us, rather than at the end, and we’ll be less likely to reject them.”

Early Consultation with the FDA

Tarantino’s last comment prompted workshop attendee Bill Jordan of the U.S. Environmental Protection Agency (EPA) to remark that the EPA regulates pesticide products that may contain nanomaterials and, like the FDA, encourages folks who are making those products to engage in dialogue with the EPA in preparation for pre-market review. Based on some of the information presented at this workshop, he observed, “It would seem that there are a lot more folks who should have been doing that than actually have.” Jordan asked if this might also be the case with the FDA. He then asked what regulatory agencies, trade associations, or other organizations can do to encourage people who are developing these technologies to communicate more freely and earlier with the regulatory bodies that have responsibility over those products.

Tarantino replied that there have been a few applications and a number of what the FDA calls “pre-submission consultations,” meaning consultations conducted before formal submissions. She would not be surprised if there were some products out there for which manufacturers probably should have approached the FDA but did not. Although again (as Philbert elaborated during his presentation), things labeled “nano” may or may not actually involve nanotechnology or nanomaterials. Tarantino said that she didn’t know how the FDA could encourage earlier consultations. She noted the early and frequent consultations sought by industry when transgenic plants emerged as a regulatory issue, which was very helpful for the FDA. Degnan added that there were a number of factors that motivated the transgenic plant industry’s cooperation and consultation, a large one being consumer acceptance.

Timeline for FDA Guidance

An unidentified workshop attendee asked Tarantino if the FDA knows approximately when it will issue guidance on the topics that Degnan addressed during his presentation and when interim guidances will be available. Tarantino said that she could not provide a date but emphasized that the FDA recognizes the utility of such guidance, particularly with respect to food additives (which is where her office is most involved). With respect to interim guidances, those are done in a “cyclic manner.” She said to expect updates for some of the other guidances (i.e., in addition to the already completed updated guidance for food contact substances) “in the next year or so.”

When Does a Food Become a Drug?

Workshop attendee Van Hubbard, NIH, commented that nanotechnology has the ability to target specific tissues. But as scientists begin targeting tissues, where is the point at which this targeting becomes a pharmaceutical delivery? Degnan said that there was a legal response to the question and that the answer hinges on intent: “Foods can tout their effects on the structure and function of the body and do that lawfully. As soon as, however, a food even implies some therapeutic effect—some effect to treat, to mitigate, to cure, prevent or even diagnose disease— … it becomes a drug.” When it becomes a drug, a much more demanding and possibly clearer set of requirements with respect to the testing of both safety and effectiveness come into play. Whether targeted delivery makes something a food or drug depends on intent of the manufacturer, which can be implied and inferred by FDA.

Philbert commented on the emergence of Internet communities with their own sense of what foods can do: Manufacturers can now introduce components into their foods knowing that those components (and any implied therapeutic effects) will be discussed in the blogosphere, thereby circumventing the FDA process. He asked if there was any way that the FDA could regulate this type of activity. Tarantino said that part of the answer depends on whether these foods are being advertised as dietary supplements and whether the FDA can take action; and another part depends on what sort of claims are being made and whether those claims are supported (i.e., if not, then the FDA can take action). She referred to Hubbard’s original question and said that, in many cases, the line is blurred and will probably become even more blurred in the future as nanomaterials become very effective nutrient delivery vehicles. Degnan pointed out however, that nutrient delivery is in fact a perfectly appropriate food and dietary supplement use. A manufacturer can lawfully make claims about nutrients, and there is a rubric for dealing with those claims. Only if that nutrient delivery is used for a therapeutic purpose does one enter “drug territory.”



This section is a paraphrased summary of Martin Philbert’s presentation.


Martin A. Philbert, PhD, is Professor of Environmental Sciences and Associate Dean for Research at University of Michigan’s School of Public Health.


A Nel, T Xia, L Mädler, and N Li. 2006. Toxic potential of materials at the nanolevel. Science 311:622-627.


E.g., S Linse, C Cabaleiro-Lago, W-F Xue, I Lynch, S Lindman, E Thulin, SE Radford, and KA Dawson. 2007. Nucleation of protein fibrillation by nanoparticles. Proceedings of the National Academy of Sciences 104:8691-8696.


Tomalia is the Scientific Director of the National Dendrimer and Nanotechnology Center, Central Michigan University, Mt. Pleasant, MI.


The image and graph were Figure 1 in C-W Lam, JT James, R McCluskey, and RL Hunter. 2004. Pulmonary toxicity of single-wall carbon nanotubes in mice 7 and 90 days after intratracheal instillation. Toxicological Sciences 77:126–134.


MS Arnold, AA Green, JF Hulvat, SI Stupp, and MC Hersam. 2006. Sorting carbon nanotubes by electronic structure using density differentiation. Nature Nanotechnology 1:60–65.


P Cherukuri, CJ Gannon, TK Leeuw, HK Schmidt, RE Smalley, SA Curley, and RB Weisman. 2006. Mammalian pharmacokinetics of carbon nanotubes using intrinsic near-infrared fluorescence. Proceedings of the National Academy of Sciences 103:18882–18886.


Y Wu, JS Hudson, Q Lu, JM Moore, AS Mount, AM Rao, E Alexov, and PC Ke. 2006. Coating single-walled carbon nanotubes with phospholipids. Journal of Physical Chemistry B 110:2475–2478.


See J-P Kraehenbuhl and M Corbett. 2004. Keeping the gut microflora at bay. Science 303:1624–1625.


This section is a paraphrased summary of Tarantino’s presentation.


Laura M. Tarantino, PhD, is Director of the Office of Food Additive Safety in the Center for Food Safety and Applied Nutrition, FDA.


Available online at http://www​.cfsan.fda​.gov/~dms/opa3pmnc.html. Accessed January 19, 2009.


This section is a paraphrased summary of Degnan’s presentation.


Fred H. Degnan, JD, is a partner in King & Spalding’s Washington office, where he specializes in food and drug law.


This section paraphrases the open discussion that took place at the end of the second session.

Copyright © 2009, National Academy of Sciences.
Bookshelf ID: NBK32731
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