The Future of the American Medicine Cabinet

All the wrong people are excited about Obama's FDA picks.

Over the weekend, President Barack Obama nominated Margaret Hamburg to serve as the new commissioner of the Food and Drug Administration (FDA) and Joshua Sharfstein to serve as principal deputy commissioner of the agency.

The FDA regulates about a quarter of all the consumer products that Americans buy, which roughly equals $1 trillion. Many analysts predict that Hamburg and Sharfstein will divvy up their functions in the agency with Hamburg focusing chiefly on food issues and Sharfstein being charge of drugs and medical devices. What should we expect?

To some extent, their priorities can be discerned from statements greeting their nominations to the FDA. Many activists who have been fierce critics of the agency issued highly favorable assessments of the two nominees. For instance, Michael Jacobson, head of the Center for Science in the Public Interest (which calls itself the "food police") hailed their selection. Jacobson called Hamburg "forward thinking," which should "enable her to return the FDA to its role as a trusted, effective regulatory agency." Jacobson praised Sharfstein for eliminating trans fats from Baltimore's restaurants.

Jean Halloran, Director of Food Policy Initiatives at Consumers Union predicted that Hamburg will provide "the leadership it needs at a time when it faces huge challenges." Ellen Bloom, federal policy director for Consumers Union, added that Sharfstein is "just what the doctor ordered for FDA." The Consumer Federation of America (CFA) welcomed both Hamburg and Sharfstein, calling their resumes "extremely impressive." The CFA added, "We hope that these talented and caring individuals will bring a new era to the FDA."

On the other side of the equation, some industry representatives were a bit less enthusiastic. For example, the Pharmaceutical Research and Manufacturers of America issued a press release praising President Obama's "expeditious selection" of Hamburg, while passing over Sharfstein's appointment in decorous silence.

Both have impressive resumes. Hamburg is a former health commissioner in New York City who served as assistant secretary of Health and Human Services during the administration of President Bill Clinton. She now works at the think tank Nuclear Threat Initiative, a non-profit organization focused on reducing the public safety threat from chemical, biological, and nuclear weapons. Sharfstein is a former staffer for Rep. Henry Waxman (D-Calif.) and the current Baltimore health commissioner. Sharfstein made a name for himself by challenging the safety of cough medicines for children.

In his announcement, Obama focused on food safety issues. A lot of media attention has been devoted to stories about spinach contaminated with E. coli bacteria and peppers and peanuts tainted with salmonella. However, the most recent data from the U.S. Centers for Disease Control do not find a significant change, either up or down, in foodborne illnesses in recent years—although such illnesses are down appreciably from 10 years ago. Of course, that record could be improved, and Hamburg and Sharfstein have strong credentials in this area.

Both industry representatives and activists believe that the way the FDA regulates pharmaceuticals and medical devices needs to be reformed. But they strongly disagree on how. Industry would like to get new medicines to the bedsides of patients faster, while activists want to slow down that process in order make sure that medicines are safe.

In welcoming Hamburg and Sharfstein, Bill Vaughan, a Consumers Union health analyst, declared, "The American medicine cabinet has become a little shop of horrors. In recent years, the agency has been too slow to protect consumers and too willing to give industries a pass on safety." What Vaughan means is that he and other activists believe that the agency approves drugs too fast and takes too long to withdraw "dangerous" ones.

In response to the barrage of claims from activists and their supporters in Congress that hasty action by the FDA endangers the public, agency approval of new drugs has been on a downward trend since the 1990s. In 2007, the FDA approved only 19 new drugs, the lowest number since 1983. Last year saw an uptick to 24 new medicines. Part of the reason for this drug drought is that since the 1980s the FDA has doubled the number of clinical trials and tripled the number patients required for approving a new drug. This has boosted the cost of getting a new drug past cowed regulators from about $250 million (in constant dollars) in the late 1980s to over $1 billion today. But perhaps these more stringent requirements have improved drug safety? Not really.

A 2005 report by the Tufts University Center for the Study of Drug Development found that faster approval times do not correlate with increased drug safety withdrawals. In fact, the percentage of drugs withdrawn for safety reasons in 1980-1989 was 3.2 percent, rising slightly in 1990-1999 to 3.5 percent, and falling in 2000-2004 to 1.6 percent. In addition, approval time for drugs that are withdrawn is not appreciably shorter than the average approval time for all drugs. The good news is that the FDA snatches dangerous drugs from the market much sooner than it used to. The average time between FDA approval and subsequent safety withdrawal dropped from 3.7 years in the 1980s to 1.4 years in the 1990s and is now 0.7 years.

Sam Kazman, the general counsel and head of the Death by Regulation project at the Competitive Enterprise Institute, a free market think tank, opines, "Hamburg overall has pretty good credentials." He adds, "The question is does she see FDA overcaution as a big problem or does she see problems elsewhere?" With regard to Sharfstein, Kazman says, "I am much less optimistic given Sharfstein's past association with Henry Waxman."

Sharfstein's ties to Waxman are indeed worrisome. Waxman, head of the House Energy and Commerce Committee, which oversees legislation dealing with the FDA, has a vast backlog of projects he wants to impose on the agency. These include banning direct-to-consumer advertising for new drugs for two years, extending FDA regulatory authority over tobacco products and dietary supplements, creating a separate federal food safety agency, and forbidding pharmaceutical companies to supply physicians with medical journal articles describing off-label uses of drugs. Off-label refers to the use of a drug to treat a condition for which it has not been officially approved by the government. This practice is legal and common and has thus far been seen as appropriate by the FDA.

The ban on advertising and restrictions on off-label information will leave patients and physicians ignorant about the benefits and risks of medications. The FDA is supposed to regulate the safety of foods and medical drugs. Tobacco, of course, is neither, and everyone knows that while it pleasurable to use, it is not healthy to smoke or take snuff. With regard to dietary supplements, consumer education rather than increased regulation is the way to go. And finally, creating a federal food safety agency could have advantages, but food agency bureaucrats might become as risk-averse as FDA regulators currently are. In advancing Waxman's extensive FDA agenda, the signs point to Sharfstein becoming the congressman's hand puppet inside the agency.

"The big question is will Hamburg and Sharfstein treat any unexpected side effect of a new therapy as evidence that the FDA is falling down on its job?," asks Kazman. He adds, "The only way to guarantee zero unexpected side effects is to have zero new therapies."

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  • Lefiti||

    Shouldn't Ronald "Any Obscure Global Warming Skeptic Will Do" Bailey have some beat other than science. The man has a fucking BA in economics, for Christ's sake.

  • ||

    Shut up, Lonewacko!

  • ||

    In welcoming Hamburg and Sharfstein, Bill Vaughan, a Consumers Union health analyst, declared, "The American medicine cabinet has become a little shop of horrors. In recent years, the agency has been too slow to protect consumers and too willing to give industries a pass on safety."

    Get ready for more expensive medicines. You are welcome to come to Tijuana and buy as many as you want - and it is not like people down here are dying in droves for being unprotected by a bloated, inoperative bureaucracy. You can get cheap Viagra for $10.00 a BOTTLE, not $10.00 a pill.

  • ||

    [i]However, the most recent data from the U.S. Centers for Disease Control do not find a significant change, either up or down, in foodborne illnesses in recent years-although such illnesses are down appreciably from 10 years ago. Of course, that record could be improved, and Hamburg and Sharfstein have strong credentials in this area.[/i]

    The link contained in this statement in your article wants me to log in, Ronald. Can you point to the same data somewhere else?

  • ||

    Insert proper tags where required. And I will preview my statements almost all the time from now on.

  • ||

    Just guessing here -

    Bad for business.
    Bad for consumers.
    Good for regulators.

    All new processes/regulations will affect the margins, they won't be easily quantifiable.


    Oh yeah, it's a hand job for the activists. That is, not real satisfying but better that stroking your own pud.

  • Lefiti||

    Where is that propagandist pimp Jesse Walker to praise the high level of discourse on display here?

  • Bosco||

    Here's an interesting piece about diversity at Columbia:

    The "diverse" contribution that black and brown students purportedly offer is not important enough to a college education to justify elevating difference over performance.

    It certainly isn't even to them -- "diverse" students don't enjoy being called on it. "We are not here to provide diversity training for Kate or Timmy," black undergrads at Harvard have written in a guidebook for black students. In a poll of minority graduates of the University of Michigan's law school from 1970 to 1996 asking which of seven aspects of their education they had most valued at the school, the top two were "faculty ability as teachers" and "intellectual abilities as classmates." They rated "ethnic diversity of classmates" and "being called on in class" at the very bottom.

    In that light I shudder to imagine objectifying my black students by focusing attention on them when we discussed W.E.B. Du Bois. It's also instructive to imagine asking a middle-class black student precisely what "diversity" she brings to a campus -- as opposed to a Mormon, a lesbian, or someone who raises clams as a hobby.


    http://www.mindingthecampus.com/originals/2009/03/i_have_been_teaching_a.html

  • O\'Taktix®||

    Lefiti,

    You're back man! I missed you soooooo much this morning! Where were ya? :)

  • SIV||

    If I could abolish just one Federal agency it would be the FDA, unless the Justice Department is on the table.Then I'm kind of torn......

  • O\'Taktix®||

    SIV,

    Fuck that, FCC goes first, hands down...

  • ||

    Lefiti: Economics AND philosophy, thank you very much.

  • ||

    If the FDA tries to regulate vitamins, expect Obama's poll ratings to drop another five points.

  • Lefiti||

    But just B.A.s, right Ron?

  • Kevin Carson||

    You'd never guess it from the boilerplate the pharma apologists churn out, but most of the high cost of developing drugs comes not from the cost of developing the version actually marketed, but rather from gaming the patent system. The drug companies do all kinds of extra R&D to secure patent lockdown on the different possible variants of a drug, to prevent a competitor from marketing it.

    I'd like to see a REAL free market policy:
    1) eliminate drug patents;
    2) eliminate FDR testing requirements and let civil liability and insurance premiums drive safety; and
    3) eliminate all R&D subsidies.

  • Lefiti||

    I, of course, have a PhD in every scientific field, and received the commandments from God on high telling me how everyone should live their lives, which is why I'm qualifiied to come here every night to call you irrelevant assholes. God I hate my life!

  • Lefiti||

    Stop spoofing me, you free-market fundamentalist fucktard asshole dickhead Reptilian Jews from the center of the Earth! Or else I'll spoof you! Yeah, I know you're there, Episiarch! I'll own you so badly with my spoofing that you'll cry like a little girl and go running out of your squalid apartment weeping.

    Yeah, I'm that good.

  • Lefiti||

    Being angry gives me a hardon.

  • Lefiti||

    I didn't write that! AAARRRGHH!

  • Beelzebud||

    2) eliminate FDR testing requirements and let civil liability and insurance premiums drive safety;

    Are you for real? Correct me if I'm misreading you, but are you saying that after a few deaths the drug company and insurance companies will be forced to "do the right thing?"

    What planet do you people live on where you actually hate government enough to advocate just letting people die or be injured so the free market can regulate itself?

    This is why libertarians will NEVER be taken seriously by rational people. So much for 'reason'.

  • ||

    Correct me if I'm misreading you, but are you saying that after a few deaths the drug company and insurance companies will be forced to "do the right thing?"

    How many people are you willing to kill while they're waiting for the bureaucratic maze to be navigated? How many people are you willing to kill whose lives could be saved by taking a drug that has a rare but serious or fatal side effect, but you won't allow it to be approved because you think people are too stupid to make the decision for themselves?

  • Beelzebud||

    Unless someone is a PHD in medicine then they are too stupid to make a decision like that.

    Or do you think we should just get rid of universities now too?

    Individualism is fine, but you take it to the irrational unreasonable extreme.

  • ||

    Unless someone is a PHD in medicine then they are too stupid to make a decision like that.

    Ah, the fallacy of credentialism. I wondered when it would show its ugly head. That medical degree (hopefully) gives the doctor competence regarding knowledge of the uses and side effects of the drug in question. It gives them no, none, zero, zilch, nada competence to decide what side effects I should be willing to suffer. That is properly my decision, not the doctor's.

  • ||

    I heard Obama's going to tax aspirin, because it's white and it works.

  • Beelzebud||

    mike proves why this site is a waste of time.

    One set of people are fine to let the market decide what drugs are safe, which really means let companies do what they want until the pile of bodies gets too high to ignore; and another set that can't do much but make stupid racist jokes.

  • Old Soul||

    You all can insult each other all you want, but as someone with a chronic, incurable condition, I find parts of this extremely disturbing. Most of the medications that are effective are used "off-label." They weren't developed for my condition, but they are the only things that keep me functional. To prevent educating doctors on the other potential uses of a drug doens't make a lot of sense and is preventing the treatment of serious conditions for no good reason.

  • ||

    I was on a date the other day with this girl I've been seeing, and while she thought doctors should be able to prescribe marajuana (since her father had cancer a few years ago) she doesn't believe we should even be looking into genetics, or doing research or understanding beyond what we already do. "that's scary to even know, that's god's domain we shouldn't know that"

    wtf? Let people suffer and die then out of fear? I didn't say it like that but maybe I should have, it is disgusting how people are more than willing to put others through suffering out of their own fear or so that they can enforce their own morality.

  • ||

    "but are you saying that after a few deaths the drug company and insurance companies will be forced to "do the right thing?"

    people are already suffering and dying, we should not pat our selves on the back for getting in the way of those that want to help them, out of fear that they might harm some percentage of them instead.

    Which is better, a doctor informing a patient about the possible effects and the patient making an informed decision, or a lawyer or accountant making the decision for him, no matter what the patient or the doctor thinks? that's why I am no longer in an HMO.

  • Scarpe Nike||

    is good

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