I’m co-authoring a book on US health care and we deal with the Vioxx scandal. This is a great example of a major shortcoming in the standard economic argument against the FDA. Typically, libertarian economists will say that the FDA faces incentives such that if it approves a drug that kills people, the FDA will be blamed, whereas if the FDA refrains from approving a beneficial drug, the people who end up dead will be attributed to the disease. Hence, the FDA errs on the side of caution.
This argument is correct as far as it goes, but it ignores mountains of evidence that the FDA approves very dangerous drugs and then doesn’t respond when later evidence documents the risks. For the rest of my post, let me quote from a 2005 interview of Dr. David Graham, then a 20-year FDA employee. He had led a study showing that Vioxx was extremely dangerous (perhaps causing 60,000 fatalities), and claims that his superiors at the FDA tried to suppress the study. Here are some key portions of the interview:
DR. GRAHAM: Since November , when I appeared before the Senate Finance Committee and announced to the world that the FDA was incapable of protecting America from unsafe drugs or from another Vioxx®, very little has changed on the surface and substantively nothing has changed. The structural problems that exist within the FDA, where the people who approve the drugs are also the ones who oversee the post marketing regulation of the drug, remain unchanged. The people who approve a drug when they see that there is a safety problem with it are very reluctant to do anything about it because it will reflect badly on them. They continue to let the damage occur. America is just as at risk now, as it was in November, as it was two years ago, and as it was five years ago.
MANETTE: In that same PBS program, you were also quoted saying, “The organizational structure within the CDER is currently geared towards the review and approval of new drugs. When a serious safety issue arises at post marketing, the immediate reaction is almost always one of denial, rejection and heat. They approved the drugs, so there can’t possibly be anything wrong with it. This is an inherent conflict of interest.” Based on what you’re saying it appears that the FDA is responsible for protecting the interests of pharmaceutical companies and not the American people. Do you believe the FDA can protect the public from dangerous drugs?
DR. GRAHAM: As currently configured, the FDA is not able to adequately protect the American public. It’s more interested in protecting the interests of industry. It views industry as its client, and the client is someone whose interest you represent. Unfortunately, that is the way the FDA is currently structured. Within the Center for Drug Evaluation and Research about 80 percent of the resources are geared towards the approval of new drugs and 20 percent is for everything else. Drug safety is about five percent. The “gorilla in the living room” is new drugs and approval. Congress has not only created that structure, they have also worsened that structure through the PDUFA, the Prescription Drug User Fee Act, by which drug companies pay money to the FDA so they will review and approve its drug. So you have that conflict as well.