Jill Wechsler
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For the past few years, the FDA has struggled with a depleted work force, obsolete information technology, and a weak science
base, according to its advisory Science Board. A new administration and new FDA leadership provide an opportunity for change.
This is "a watershed time" for FDA, says Janet Woodcock, director of the Center for Drug Evaluation and Research (CDER).
The public is concerned about drug quality and imports, industry is struggling with a productivity crisis, and the global
financial meltdown may dry up investment for biomedical innovation, Woodcock observed at a meeting sponsored by the Generic
Pharmaceutical Association. Her goals are to restore public confidence in the drug regulatory process, capitalize on advances
in science and technology, improve postmarket oversight, and make FDA "the recognized leader in drug regulation."
Such a turnaround will not be easy. Rep. Rosa DeLauro (D-CT), who chairs the House Appropriations subcommittee overseeing
FDA's budget, asserted at a meeting sponsored by the Institute of Medicine in April that FDA needs "urgent and dramatic reform"
because it cannot perform basic functions, such as keeping track of clinical trials, conducting required inspections, and
following up on commitments for postmarket studies. DeLauro blames many of FDA's ills on manufacturers and has blocked funding
for the Reagan-Udall Foundation until its organizers ensure that it's "not just another tool for industry." She even fears
that FDA's Critical Path Initiative may send the message to agency scientists that it's more important to develop methods
to support product approval than to objectively evaluate safety and efficacy data.
Overhaul ahead? Fixing FDA may require major changes. Because the regulatory model for food is very different from that for drugs and biologics,
DeLauro and others propose to transfer FDA responsibility for food regulation to a new federal agency that would assume responsibility
for multiple programs now spread around dozens of government offices.
To avoid such a disruptive change, agency officials seek to demonstrate their ability to prevent and deal with food contamination
problems. They also propose a less radical reorganization that would split FDA into two "directorates," one for food and one
for medical products. There is support for such a move from food operators, who feel they play second fiddle to drugs at FDA,
and also from some medical product companies that fear being hit by more restrictive food import policies.
Taking the "food" out of FDA is not likely to happen any time soon, as the new Obama administration has much more crucial
tasks at hand in the economic and health arenas.
New leader
Improvements in FDA operations, resources, and infrastructure will be shaped considerably by the next FDA commissioner. Lots
of names have been circulating in the last month, a sign of the agency's high visibility and importance to the new administration
and to Congress. There's hope that FDA's new leader will be named by the Senate in a few months, instead of languishing at
the bottom of the White House appointments list.
One priority for the new commissioner is to push for continued growth in appropriated funds in the agency's 2010 budget. "FDA
is barely hanging on by its fingertips," attorney Peter Barton Hutt told the House Energy & Commerce Committee a year ago,
leading the chorus for increased resources for the beleaguered agency. The Alliance for a Stronger FDA has called for a 20%
increase in FDA appropriations to $2.25 billion for next year. That's less than $400 million in new money—a drop in the bucket
for most federal agencies.
FDA and industry also hope for less heated attacks from Capitol Hill, with Democrats in control of both the White House and
Congress. There may be less inclination to use FDA as a punching bag, says former FDA official Wayne Pines. But he fears that
the agency always will be controversial because of the nature of its operations and the scope of products it regulates.
The bottom line for pharmaceutical and medical product manufacturers is whether FDA can approve new therapies for market and
oversee product development, production, and marketing in a fair and efficient manner. All the attention on drug safety has
raised concerns about a more risk-averse atmosphere at the agency. Manufacturers say they're willing to see if things improve
in the coming months before getting too upset about CDER missing user fee deadlines.
"The agency was given a significant number of new authorities and tasks to accomplish and has been hiring and training a lot
of new employees," explains Alan Goldhammer of the Pharmaceutical Research and Manufacturers of America (PhRMA). "So it really
is this upcoming year that will be critical in looking at performance and benchmarking against PDUFA goals."
One light on the horizon is an increase in the number of innovative new therapies approved by FDA in 2008. The agency experienced
a new low in approving only 18 new molecular entities in 2007, and it looked like this past year would be just as bad or worse.
But in November, FDA passed the 2007 total and appeared on track to act on several more before year-end. While it's always
easier to show gains from a very low starting point, both industry and FDA are happy to consider this a sign of hope for the
new year.
