FDA’s touches the lives of every American at least 6 to 10 times each day. The agency oversees 80% of the nation’s food supply, all of animal/human medical cosmetics and products, and almost all radiation-emitting devices. Put all that together, the agency is responsible for about 20% of all consumer dollars spent in the United States.
With the President set to deliver his State of the Union address to Congress in a few days, it seems a good time for FDA Matters to provide its view of the “State of the FDA.” At the beginning of 2011, the agency is doing well, but has a lot of catching-up to do and faces a number of threats.
Strengths: FDA’s most important strength is the dedication of the agency’s staff and the leadership of Commissioner Hamburg’s team. They have made great strides in advancing the public health mission of the FDA, aided by increasing appropriations and the momentum of a new presidency. The renewed emphasis on public health has become a core strength of the FDA.
The agency’s commitment to science is another strength. Not every decision can be answered with science (e.g. policy on social media), but a substantial number can. The FDA is successfully building its scientific capabilities, although it is a work in progress. Similarly, the agency’s new initiatives to establish an international presence represent a strong response to the challenges of globalization.
Weaknesses: While FDA has been doing better, it is still an organization with workplace issues (what workplace doesn’t have issues?). Within the agency, barriers still exist to sharing knowledge across offices and divisions. To the broader world, the whole agency seems insular. In particular, the FDA makes inadequate use of expertise that lies outside the agency, particularly in academia.
FDA’s information technology (IT) systems are grossly inadequate for an agency with such large, far-flung responsibilities. Some major, badly-needed databases aren’t going to be available anytime soon, preventing the agency from making the best, most well-supported decisions. It also dooms staff to perform super-tedious work that could be done in seconds with better tools.
Opportunities: Within FDA, there is the potential for a 21st century regulatory and public health agency that could be the world’s benchmark for decades. While such standing is a goal in itself, it is also true that the world-wide use of FDA standards opens up export markets and can contribute to our nation’s economic growth.
To realize this opportunity, FDA needs to do a better job in explaining regulatory science to Congress, the media and the public. The tools and standards FDA uses every day are still largely anchored in the last century. Public investment in improving regulatory science is what will bring the agency into the new century.
Another opportunity for the agency is to break the secrecy of how decisions are made. Observers often wonder about the agency’s rationale. Industry needs the benefit of understanding the agency’s actions. Dr. Hamburg and other senior FDA leaders have taken an important step by publishing more articles in mainstream journals. The handling of internal dissent in FDA’s ranks was accomplished deftly in last summer’s Avandia decision. In doing so, honestly and forthrightly, FDA increased it credibility and was better able to defend its ultimate decision.
A very different type of opportunity is presented by FDA’s ongoing consolidation of personnel at just two locations, White Oak and College Park. This provides the opportunity for a more cohesive workforce, as well as a more efficient one.
Threats: FDA’s largest threat relates to its funding and the possibility of being dragged back by budget cutting. Several years of increases have greatly helped the agency, but it is not enough to offset decades of budgetary neglect or carry the agency forward without more money. The gap can widen quickly because FDA’s responsibilities keep increasing: more complex science, globalization and two major new laws to implement, food safety and bio-similars.
Another looming threat comes from the ongoing negotiations for re-authorization of medical device and pharmaceutical user fees. FDA needs the funding, but not the likely hit on its public credibility. When Congress considers renewal legislation in 2012, the agency is likely to be caught in the crossfire between those who think FDA is too industry-friendly and those who think the agency impedes FDA-regulated industries in bringing new, sometimes life-saving products to market.
Compounding this threat, user fee re-authorization will probably be the only FDA legislation that must pass Congress over the next 2 years. Dozens of legislator are going to try to get their FDA-related concerns addressed in the legislation. No one knows how much damage the final legislation might do to FDA.