Gottlieb's tenure began with Sen. Elizabeth Warren (D–Mass.) implying he was a shill for big pharma and asking him during his spring 2017 confirmation hearing if he thought the FDA "puts too high a priority on championing safety and unborn babies." Two years later, his track record resembles that of his Democratic predecessors. As a regulator, he has employed both incentives and punishments, particularly with branded drug companies seeking to shut out generic competitors, opioid makers, nutritional supplement companies, and nicotine product manufacturers. When and wherever public health conflicted with personal freedom, Gottlieb advocated for the former.
If you've read Reason's profile of him, you already know Gottlieb was never a free market radical, but a good-government reformer and bureaucratic streamliner who's long believed that government has a role to play in both medical innovation as well as policing a massive universe of everyday products.
In April 2017, Gottlieb was confirmed 57 to 42, making him the first FDA commissioner in at least 20 years to be confirmed on a party line vote. But after taking it on the chin from Senate Democrats, Gottlieb's most vocal critics since taking over at FDA have been libertarians and conservatives. When I watched him speak to a group of people at a December 2017 event hosted by the right-leaning Manhattan Institute, with which Gottlieb has been affiliated since the early 2000s, the toughest questions came from people who'd once considered him one of their own. This particular exchange is seared in my memory:
When the floor opens for questions, one is about his plan to require cigarette manufacturers to lower the nicotine in their products to a "minimally or non-addictive level."
"You want to take the nicotine out of cigarettes," the audience member says, incredulous. "Do you also want to take the alcohol out of booze?"
"The FDA does not regulate alcohol products," Gottlieb responds.
"Well, thank God for that," the questioner says, before plopping into his seat.
Gottlieb aggressively sought to restrict access to nicotine products, in particularly vaping devices. He also renewed the federal government's attempts to ban the herbal supplement kratom and pushed drugmakers to repackage the over-the-counter antidiarrheal drug loperamide, based on reports that opioid users took large doses of the drug in hopes of staving off the horrors of withdrawal. Again, the man never fashioned himself a libertarian.
Occasionally, however, he did things libertarians liked. In an era of ever more opaque government, Gottlieb was a chatterbox who personally explained many of the agency's decisions both on Twitter and in blog posts on the FDA website. He called for more access to medication-assisted therapy (MAT) for people addicted to opioids, and he was a frequent critic of drug patent holders who engaged in anticompetitive practices. That the Department of Health and Human Services continues to over-regulate MAT drugs and drug companies continue to sabotage their competitors speaks more to the limited powers of any one bureaucrat than it does to Gottlieb's commitment to changing those policies.
The Washington Post and Axios report that he's leaving due to the strain of commuting from Connecticut, where his wife and children reside. While his announcement apparently came as a surprise to some of his colleagues and officials in the Trump White House, I'm not sure it would shock those who have worked with him in the past.
"He knows that you basically have two years to accomplish anything," AEI's Joseph Antos told me back in 2017. The two were colleagues during one of Gottlieb's stints at the American Enterprise Institute. "Maybe in Scott's case it will be longer than that, but whatever the length of time is, it's very brief. You do all you can and then it's somebody else's turn."
Hopefully the next person up has Gottlieb's integrity, and not Trump's.