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Why Most Health Commissioners End up in Bed With Big Pharma

Treatments for medical problems have been used since the beginning of human civilization.1 While many illnesses were thought to be the work of supernatural forces, various ancient civilizations created unique systems for treating individuals using, among other things, herbal remedies.2

Despite a lack of scientific knowledge and use of modern technology, many of these early remedies were useful and are still currently used.3 The beginning of pharmacy practice goes back as far as the Middle Ages.4 However, the industry we know had its roots in the 19th century.

Since then, it has become one of the most profitable and influential industries.5 In the past, many drugs were discovered by accident or through the identification of an active ingredient used in traditional remedies.6

The pharmaceutical industry of the 21st century chooses a different approach, attempting to understand disease and infection at the molecular and physiological level and then targeting the development of drugs based on this knowledge.7

The marriage of experimentation and the Industrial Revolution was likely first undertaken by Merck in Germany as they moved toward the manufacturing and selling of alkaloids. As the industry and their profits grew, George Merck, founder of Merck, declared:8

“We try never to forget that medicine is for the people. It is not for the profits. The profits follow, and if we have remembered that, they have never failed to appear. The better we remember it, the larger they have been.”

History of FDA commissioners and Big Pharma

Merck’s statement from 1950 continues to resonate within the industry as Big Pharmamanufacturers, markets and sells medicines to the people and for the people, raking in profits that far outweigh the benefits most experience. This is counter to the role given to the U.S. Food and Drug Administration to protect:9

“[The] public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices; and by ensuring the safety of our nation's food supply, cosmetics, and products that emit radiation.”

After leaving the top leadership position at the FDA, nine out of the last 10 commissioners in the past 33 years have gone on to work for pharmaceutical companies.

This stretch began when Arthur Hayes went on to join E.M. Pharmaceuticals in 1986 after resigning as commissioner in 1983.10 The last to join this group is the most recent FDA commissioner, Scott Gottlieb, who just announced he is joining Pfizer as a member of their board.11

Although none of these moves of past FDA Commissioners to pharmaceutical companies is illegal, the emerging pattern gives the perception of a revolving door, or an unstated agreement between the pharmaceutical industry and those who are charged with regulating the approval of their products.12

The single hold out who did not join any pharmaceutical company was David Kessler, who served as the FDA Commissioner from 1990 to 1997 under past President George W. Bush.13 Kessler went along to serve as the chair of the board of directors at the Center for Science in the Public Interest, a nonprofit nutritional watchdog organization.

He spoke to Quartz, saying he was worried the politicization of the FDA may be seen as a threat to independent, scientific analysis.14 He is not alone. Concerns were raised 34 years ago, in 1985 when the Chicago Tribune reported that Dr. Alexander Schmidt, commissioner under President Nixon, told state regulators:15

"We have more politicization of the agency than is either warranted by rational politics or good for the American people."

Scott Gottlieb joins ranks with Pfizer

Gottlieb announced his move from FDA commissioner, which he resigned April 5, 2019,16 to the Pfizer board of directors June 27, 2019, on his Twitter account, posting:17

“I’m honored to be joining the board of directors of #Pfizer and working together with more than 90,000 Pfizer colleagues to promote medical innovation, advance patient care, and secure access to better healthcare outcomes for families around the world. @pfizer”

This announcement came just four days after he announced18 he was joining the advisory board at the National Institute for Health Care Management Foundation. The NIHCM press release reported:19

“Gottlieb served under the Trump Administration as the 23rd Commissioner of Food and Drugs from 2017 to 2019, where he improved the efficiency of the regulatory process for novel drugs and medical devices and mobilized action on public health initiatives like teen nicotine use, opioid addiction and drug competition, and promoting affordable access to medicines.”

As Gottlieb splits his time between a nonprofit organization20 “dedicated to transforming health care through evidence and collaboration” and Pfizer pharmaceutical company whose mission is21 “to be the premier, innovative biopharmaceutical company,” it may be difficult to split his focus.