Jill Wechsler
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Late last year, Congress approved a sweeping food safety legislation that provides the US Food and Drug Administration with
more authority to recall and monitor food products, boosts its inspection force, and strengthens its capacity to halt unsafe
imports. But that may be the last time for a while before the legislators bolster FDA's oversight capabilities or authorize
added resources. With Republicans taking over the House last month and increasing their clout in the Senate, the legislators
are contemplating severe federal budget cuts and more aggressive oversight of the administration's healthcare policies and
regulatory programs. The FDA is a ready target as agency critics move to examine an apparent slow-down in new drug approvals
and the agency's difficulties in keeping violative products off the market. It's not clear whether Congress even will provide
the $1.4 billion over five years, needed to hire about 2,000 additional FDA inspectors to expand food oversight.
House Democrats continue to support a similar drug safety bill that would give the FDA additional enforcement tools over drugs
and biologics, including mandatory recall authority, stiffer civil and criminal penalties, and authority to subpoena records
related to drug violations. As with food, there would be a big increase in foreign and domestic inspections and heightened
controls on imports and stronger plant registration requirements. But there's not likely to be any action on the measure before
2012, when Congress is scheduled to renew the prescription drug user fee program.
PROBING FDA
Instead, new Republican committee chairmen are preparing for extensive oversight hearings on administration health reform
legislation and regulatory stances. The Chairman of the House Committee on Oversight and Government Reform, Darrell Issa (R-CA),
considers FDA a "broken bureaucracy" and has included the agency on his priority investigation list. Issa was highly critical
of FDA officials and pharmaceutical executives at hearings before his committee last year on delays in drug recalls by Johnson
& Johnson's McNeil Consumer Products unit. Now as panel chairman, Issa plans to hold FDA officials accountable for such regulatory
lapses. In December, Issa sent FDA Commissioner Margaret Hamburg a letter questioning FDA's oversight of a contract manufacturer
for J&J, and of contract drug manufacturing practices in general. The new chairman also has his eye on the FDA's expanded
authority over food production and its growing involvement in tobacco marketing. And FDA's Office of Criminal Investigations
is expected to draw scrutiny following criticism of its operations last year by Congress's Government Accountability Office.
Similarly, House Energy and Commerce Committee Chairman Fred Upton (R-MI) is preparing to challenge specific health reform
policies, along with "job-killing regulations" that block technological innovation. FDA programs and policies are fodder for
the E&C Health subcommittee, which is headed by Reps. Joe Pitts (R-PA) and Mike Burgess (R-TX). In addition, the oversight
and investigations subcommittee, under Chair Cliff Stearns (R-FL), may continue to probe drug manufacturing problems, such
as FDA's handling of heparin contamination and its failure to adequately monitor foreign drug production.
CHANGES AT THE TOP
At hearings last year on J&J's manufacturing problems, the FDA was represented by Principal Deputy Commissioner Joshua Sharfstein,
who won plaudits for his command of the issues. Now someone else at FDA will have to fill the hot seat at Congressional hearings,
following Sharfstein's surprise departure from the agency last month.
Sharfstein was lured away by an offer to head Maryland's health department, a move that capitalizes on his public health roots
in Baltimore. In moving to the state agency, Sharfstein will manage a $7 billion budget and will be involved with implementing
the many health reform programs and policies that require state involvement, including an expansion in Medicaid and formation
of new health insurance exchanges.
At the FDA, Sharfstein helped engineer a get-tough compliance policy designed to curb perceptions that the agency is too cozy
with industry. The stronger enforcement stance has produced more warning letters that cite manufacturing and marketing violations
and more criminal investigations. Sharfstein also was involved in strengthening FDA's medical device approval process, which
is still ongoing, and he advocated establishing tight curbs on using more risky medicines, such as the diabetes drug Avandia.
Hamburg is using Sharfstein's departure as an opportunity to re-examine the agency's top management structure. Previous commissioners
have tried various organizational models of deputy commissioners, chiefs of staff, and special assistants, and Hamburg may
move away from the one-deputy arrangement. John Taylor, counselor to the commissioner, is filling Sharfstein's shoes while
Hamburg weighs her options, and he is likely to assume a more visible role at the agency.
Taylor has had a long career at the FDA in legal, enforcement, and regulatory affairs positions under several FDA commissioners
during both Democratic and Republican administrations. He rose to be associate commissioner for regulatory affairs from 2002
to 2005, and then served brief stints at Abbott Laboratories and the Biotechnology Industry Organization. Taylor returned
to the FDA in 2009 to be Hamburg's top legal advisor, and the commissioner might very well like to have a seasoned enforcement
official represent the FDA before contentious Congressional committees.
