Making the case


Deadline day around here and things are a bit busy, but I wanted to comment on an FDA appropriations hearing I covered this morning.

The agency is getting a huge boost in the president’s 2010 budget proposal — $511 million, or 19 percent. Much of that money will pay for more than 1,200 new hires. That means a 30 percent staffing boost over two years, when you include the 1,500 new employees hired this year.

The numbers prompted some back-and-forth with legislators, as you might expect. A few Republicans thought they were too large; Democrats hinted they might be too small.

But the Goldilocks-esque search for a middle ground can seem very arbitrary. The FDA says, for example, that it needs money to hire 220 new food safety investigators, which will allow it to conduct 4,000 additional inspections every year. But why is 4,000 the right number? Why not 3,000, or 5,000, or 10,000?

Obviously there are political realities at work. The FDA can’t ask for too much extra money, but it has to ask for something extra, because Congress (and the public) is deeply unhappy with its performance over the last few years. Still, the figures often seem arbitrary, and that encourages Congress to poke holes in the budget. If there’s no solid reason for doing 4,000 extra inspections, why pay for them?

So it was encouraging to hear Joshua Sharfstein, the agency’s acting commissioner, talk about developing new metrics for the food and drug safety programs. He said, essentially, that it doesn’t make sense to measure the agency’s progress by the number of inspections it conducts.

A key management goal is to connect the investments that you are making, and the American public is making, to clear public health outcomes… we have to measure our success by how many people are dying or getting sick, not how many people we’re hiring or how many buildings we’re building.

If the FDA could quantify the impact of 220 new food inspectors on public health, it would probably have an easier time getting that request through Congress.

(Incidentally, the public health outcomes Sharfstein mentioned have actually gotten worse in recent years, according to data from the Centers for Disease Control.)


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