Can the FDA’s New Commissioner Save the Agency From Itself?

The U.S Food and Drug Administration is experiencing a crisis of public trust. Very lowThis is largely because of its poor handling of pandemic. However, its failings were not. Monitoring, TestPlease see the following: CombatingCOVID-19 reflects decades of dysfunction at this agency. The incoming commissioner, Robert Califf, has an opportunity to pull the agency out of its fiery tailspin—but only if he is willing to confront an institutional culture of Negative incentives.

The FDA should be focused solely on public health in a world where it is better. Performance of the agency would be determined by how effective it is in reaching that goal. Employees would search for the most relevant data. Instead, the strongest incentives are to boost the bureaucracy’s reputation, budget, and scope of authority—which aren’t quite the same as public health gains.

Contrarian Incentives

He recently published a book. How to Fix FoodRichard A. Williams provides a disturbing glimpse into how these incentives can undermine the FDA’s mission. The basis of his account lies in personal experience. Williams worked nearly 30 years at FDA performing cost-benefit assessments on regulations.

These analyses are supposed to assist decision makers in choosing the most cost-effective course of action that maximizes the public health benefit. He quickly discovered that delivering real benefits to the public was not an agency leader’s top priority.

Williams was assigned to investigate a ban being considered on a component in hair dyes for men that could increase skin cancer risk. Williams did extensive research on the topic and concluded that it was unlikely that anyone would get cancer from the ingredient. Also, since there was no other ingredient available, prohibiting the use of the ingredient would not be economically feasible. Williams refused to accept the assessment and was directed by a supervisor at the Center for Food Safety and Applied Nutrition, Williams’ workplace, to revise the analysis. “They haven’t decided whether or not to ban this stuff yet. They need one that supports a ban and another that does not.”

Williams believed that changing the conclusion of an analysis in order to arrive at a predetermined result was equivalent to economic prostitution. When Williams refused to change his analysis, the deputy director of the center threatened to fire him.

Facing the possibility of being fired, it is difficult for employees with high moral standards to follow orders of their superiors. Williams eventually gave up. However, most employees have an implicit grasp of the rewards and punishes at work and what to do to help their lives and their careers.

Williams, for example, stated that he believed that bans on hair dye ingredients would not prevent anyone getting cancer. His supervisor disagreed and said that it was unnecessary to protect people with regulations. Our goal is to keep people from attacking us. They “have to make it appear that they are doing something” in order to accomplish this. The bright side is that “noone ever inspects to verify whether what we did did any good.”

This sums up both the incentive system and hazards of work culture.

This could have been dismissed as an isolated incident involving one manager, rule or administration. Williams’ report and others show that this kind of thinking is quite common because there are the same incentives throughout FDA’s entire chain of command. “Success,” for FDA bureaucrats, depends on their actions and how they affect the agency’s image with politicians who approve funding. The media covering its activities covers the agencies, as well as the industry it regulates. The influence of politics is evident in this emphasis on appearances and not results.

FDA, as with all federal agencies in the United States is political. It is part of the executive branches and reports to the president. The president nominates the commissioners, recommends funding levels and confirms the commissioners. Congress approves the budgets. If an agency issues rules or refuses to act on requests from politicians, they could find themselves in trouble at Congress hearings.

The theory is that this oversight gives elected officials the ability to hold nonelected agency bureaucrats responsible, making sure they follow their mandate, comply with laws and perform the public services they were set up to. Politicians care mainly about holding agencies accountable if it is in their political interest to do so. Legislators see very little value in holding agencies accountable, just as they do with FDA employees’ perverse incentives.

What to do?

A single FDA commissioner can only unilaterally implement reforms that are not restricted by law, executive orders from the president, or congressional intervention. However, a single FDA commissioner can make a difference in setting the tone for cultural change through the modification of the incentives and behavior that both govern bureaucratic as well as political behavior.

Regulators’ inability to see the consequences of regulation is the main problem. One way around this could be for the agencies themselves to justify the regulations that they issue. As Williams’ anecdote suggests, such rules already exist—on paper. Both Republican and Democratic governments have presented such guidelines since Richard Nixon. RequirementsThat agencies Justify regulationsIt is to a degree. However, there is no way around it. VerifyThese cost-benefit analysis are meaningless if they don’t address the assumptions used by agencies to make their calculations.

The Office of Information and Regulatory Affairs, which is part of the executive Office of Management and Budget, has been reviewing agency cost-benefit studies since the time of President Ronald Reagan. With approximately 45 employees OIRA is responsible for reviewing all major rules issued by agencies. It can also block any rule that does not comply with presidential agendas or economic executive orders.

OIRA can be circumvented by agencies using a variety of methods. OIRA can use one method to get around OIRA. It includes superfluous requirements into a rule. This allows OIRA to appear that it’s doing its job and eliminates unnecessary requirements, while keeping the original parts. But in Williams’ words, “the most common way to control OIRA is to lie to them”—or, more specifically, to fudge the numbers agencies use when producing cost-benefit analyses.

In the 1990s Williams was promoted to chief of CFSAN’s economics division. He was assigned the task of analyzing the benefits and costs of a proposal for new regulations on seafood processors in order to reduce food-borne diseases. From contamination, the most deadly of these illness was. Vibrio vulnificusThis is a flesh-eating bacteria, which can be transmitted through eating raw oysters. However, the rule didn’t address raw oysters. Williams concluded that the cost of the rule would prove to be too costly for small businesses, but not large seafood producers who already had adopted it.

But the rule was a priority for the FDA commissioner, who wanted to beat the Department of Agriculture at claiming regulatory jurisdiction over seafood—and the budget that goes with it. Williams was again told to alter his analysis. Williams was even given the numbers that he would use to calculate “benefits of” the rule. Williams claims that he was instructed to tell Williams “it will stop about half of the cases occurring.”

Williams received a second warning that Williams would not be able to falsify the numbers and that he wouldn’t return to work Monday.

Williams had to falsify an analytical result in order to support a decision by high-ranking officials. Williams received the Agency’s highest award for all this. Williams was informed that the award wasn’t given for any work he had done. It is only for his future plans.

Williams examined seafood-related illness cases fourteen years later after leaving FDA. His findings showed that there were no cases of Vibrio vulnificusThey had not doubled as predicted by the agency, and they hadn’t halved.

Consumers and small business paid the full cost of the error, but no one from the agency was responsible. Not the economists that were forced to create erroneous benefit and cost estimates.

This type of malfeasance is worsening without any negative consequences. Agency like FDA are unable to protect the public during dangerous epidemics because of politics and lack of preparation.

Can an FDA commissioner alter incentive plans within the agency or for its overseers?

A first step is to set higher standards for conduct. This includes rewarding staff who are committed to agency’s mission of public service and punishing people who favor politics. One other step is to increase the agency’s emphasis on results, and penalize falsifications of data. This could even be a way to support policy goals. Another is transparency. This would allow scientists at the FDA to talk freely with journalists and the general public. The FDA holds an “C” rating. Transparency in scienceUnion of Concerned Scientists) protecting whistleblowers and those who report unethical behaviour.

A commissioner’s most significant task is not to try to save its institution reputation but to draw attention to FDA’s failings and collaborate with lawmakers to fix them. Although publicizing the FDA’s failures and flaws could damage the chief’s reputation and reduce the agency’s authority or budget, it might be the best way to ensure that there is real oversight from outside.

Because of his outstanding achievements, reputationAs a scientist, his dedication to transparency, the environment, and human rights is important. He made mistakesOne can only pray that Robert Califf, his final stint as FDA commissioner will be a time when politics are forgotten and that he does what it takes to save FDA.