FDA Commissioner Marty Makary announced Thursday that the agency will limit pharmaceutical company employees from serving as members on its independent advisory committees, a move aimed at minimizing potential conflicts of interest and restoring public trust in the drug review process.
The new directive "limits individuals employed at companies regulated by the [FDA], such as pharmaceutical companies, from serving as official members on FDA advisory committees, where statutorily allowed," according to the agency's announcement. Instead, Makary plans to prioritize input from patients, caregivers, and other community representatives.
"There should be a user-friendly process for industry, but not a cozy relationship," Makary stated, expressing concern that industry representation on committees could undermine public confidence in the FDA's independence.
Practical Limitations of the New Policy
The implementation of this directive faces significant challenges due to existing legislation. The Food and Drug Administration Modernization Act of 1997 includes a provision that "has been interpreted to mean that newly created advisory committees must include an industry representative," according to Genevieve Kanter, an associate professor of public policy at the University of Southern California Price School of Public Policy.
This statutory requirement suggests the FDA may only be able to remove industry representatives from committees established before 1997, which include the Obstetrics and Gynecology Advisory Committee (established 1965), the Anti-Infective Agents Advisory Committee (1967), and the Vaccines and Related Biological Products Advisory Committee and Oncologic Drugs Advisory Committee (both active as of 1997).
Mixed Reactions from Policy Experts
Reaction to the policy change has been relatively muted among experts. "I don't think [the new directive] will move the needle much," Kanter told BioSpace, noting that industry representatives are already non-voting members on these committees.
"The central and perhaps more difficult conflict of interest issues relate to the industry ties of the scientific members of the committee, and that issue hasn't been directly addressed yet," she added.
Steven Grossman, policy and regulatory consultant and author of the FDA Matters blog, offered a balanced perspective: "Industry representatives on advisory panels do not vote, do not have a professional or monetary interest in the outcome and have little ability to sway the outcome. Yet, they do provide a useful perspective that other panelists often value."
Broader Context of FDA-Industry Relationships
The policy change comes amid heightened scrutiny of the FDA's relationship with the pharmaceutical industry. Both Makary and newly appointed Health and Human Services Commissioner Robert F. Kennedy Jr. have expressed concerns about the "revolving door" between the FDA and industry.
In a recent interview, Makary referenced the case of Curtis Wright, the FDA examiner who approved Purdue's OxyContin and later joined the company. "That's the kind of thing that breeds distrust and that's why people perceive that this agency, the FDA, has been captured by industry," Makary said.
Kennedy has taken an even more aggressive stance, recently describing the FDA as a "sock puppet" to the pharmaceutical industry during a tour of the agency's campus.
The Role of Advisory Committees in Drug Approval
FDA advisory committees consist of external experts who provide independent recommendations on products under review. Their votes are non-binding, though the FDA typically follows their advice. Several laws govern these committees to ensure rigorous recommendations and minimize conflicts of interest.
Under the new policy, pharmaceutical representatives will still be "welcome" at committee meetings, according to Makary, who acknowledged the importance of industry partnership in ensuring an efficient review process. Exceptions will be made "in rare circumstances," particularly when "expertise in an area is only available from an employee of an FDA-regulated company."
Patient and Consumer Representation
As industry representatives are phased out where legally permissible, Makary plans to increase input from patients, caregivers, and community representatives. FDA advisory committees typically already include a consumer representative who serves as a liaison between the committee and consumer organizations.
Kanter noted that patient advocates and caregivers bring valuable perspectives, "introducing information about the experience of living with the health condition or caring for someone with the condition, the needs, priorities, and sentiment of the patient community at large."
While supportive of Makary's effort to address industry influence, Kanter acknowledged that patient representatives "do not go through the same screening process for scientific expertise as the other members and may not know as much about the scientific issues."
Looking at Broader Reforms
As the FDA implements this policy change, experts suggest that more comprehensive reforms may be needed to address deeper concerns about conflicts of interest in the drug approval process.
"My advice to stakeholders: put your energies into proposals that make more of a difference than this one," Grossman advised, implying that the current directive represents only a modest step toward addressing the complex relationship between the FDA and the pharmaceutical industry.
Kanter concluded, "This move is an important sign that Commissioner Makary will take a second look at the issue of industry influence on FDA activities, and I am generally supportive of that."
