by Barbara A. Brenner
By the time you read this issue of the BCA Source, the 2008 U.S. presidential election will be over. The next president will have been chosen, and you might be thinking about what will and won’t change in the years ahead.
As a longtime political activist, and the head of an activist organization, I spend a lot of time thinking about what it takes to bring about change. As I have pondered the past eight years of Washington leadership and its impact on BCA’s issues, I’ve come to believe that it will take far more effort to undo the damage done than it took to create it in the first place. And this has clear implications for the work that lies ahead.
It makes sense that it takes longer to rebuild something than to destroy it. But the ways in which the Bush administration has undermined the Food and Drug Administration (FDA), environmental protections, and needs of women and people of color are unique, and will require exceptional commitment to undo.
It may seem that the problems at the FDA will be fixed by appointing a new commissioner dedicated to guaranteeing that drugs approved for the public’s use are both safe and effective, rather than favorable to the pharmaceutical industry’s bottom line. But the influence of the industry at the agency runs much deeper than the Office of the Commissioner. Over the last eight years, the industry has extended its grasp deep into the agency. Industry representatives now have free access to FDA decision makers, at meetings from which the public is excluded. Freeing the FDA from the power of drug companies and device manufacturers will require changes not only at all leadership levels, but also in the many rules that have been adopted that favor industry interests over the public good.
The same challenge exists at the Environmental Protection Agency. The work of Stephen L. Johnson, the agency’s head, to undermine environmental safeguards has been well documented in the news media. A change to a leader committed to protecting the environment would certainly be meaningful. But the rules that have been put in place and the decisions that have been made—things like delaying steps to protect workers from exposure to carcinogens and refusing to regulate perchlorate—can be undone only by committing energy and effort to understanding and reversing the many small steps that have so undercut environmental guardianship.
When it comes it health inequities, it’s hard to know where to start to address the issues that have been ignored for so long in the United States. Leadership changes will matter—at the National Institutes of Health, at the National Cancer Institute, and at the Department of Health and Human Services. (Some of these changes have already started to happen.) But the social and economic injustices that lead to health inequities must be redressed at the local level, where they exist. A national commitment will be needed, but the work will happen locally, as it’s happening now in places like Alameda County, California.
The road ahead is long, but it is not endless. And we have already started down the path. No matter who will be moving into the White House, women’s health activists must continue pressing for government agencies to put our health and our lives first.
Editor’s Note: The director of the National Institutes of Health, Elias Zerhouni, announced he would leave the agency at the end of October 2008. At press time a successor had not been appointed.
During his six-plus-year tenure, Zerhouni ultimately banned NIH scientists from consulting for drug and device companies, responding to intense congressional scrutiny about conflicts of interest involving NIH researchers who, while working for the agency, had contracts with private industry. Despite this ban, concerns about conflicts of interest persist at NIH, and must be addressed and resolved by the next director in a way that protects the public interest in unbiased research.
We applaud Zerhouni for his success in reinvigorating the NIH, his advocacy to reduce health care “disparities,” and his adoption of an open-access policy for NIH-funded research. At the same time, we are concerned that Zerhouni, like so many others in the government’s scientific community (and elsewhere) articulated promises that have been made for many years—but not kept—about more personalized medicine. We think the next NIH director would do well to tell the public where we are in public health as she or he argues for getting to where we need to go.