Finally letting FDA be FDA

“Justice delayed is justice denied,” say people in legal circles.  In my circles the apt phrase is “health delayed is health denied.”

The Food and Drug Administration (FDA) has an enormous responsibility and opportunity to promote a healthier nation and reduce health-care costs.  However, having monitored and interacted with that agency for some four decades on food issues, my experience is that the FDA simply is not living up to its responsibility.

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A classic example is artificial trans fat, which enters the food supply as an integral component of partially hydrogenated vegetable oil.  Think Crisco.  The benighted oil was used by many restaurants for frying, and most shortenings, margarines, and baked goods were made with it.  For decades it was thought to be safe.  The first solid evidence that trans fat promoted heart disease came in 1990.  Over the next decade or so numerous clinical and epidemiology studies determined that it was the nastiest fat of all.  Researchers at the Harvard School of Public Health estimated that trans fat was causing upwards of 50,000 deaths per year.

In 2004 Denmark effectively banned partially hydrogenated oil.  Later that year, my organization, the Center for Science in the Public Interest, petitioned the FDA to do the same.  While the FDA required labeling in 2006 (a response to CSPI’s 1994 petition), it did not ban partially hydrogenated oil until 2015—and that ban won’t even become final until 2018.

The FDA’s inaction, through Republican and Democratic administrations, contributed to many tens of thousands of premature deaths.

But FDA can be even slower.  Consider salt.  Salt has long been known to boost blood pressure, which increases the risk of heart attacks and strokes.  Halving sodium consumption would save as many as 100,000 lives per year.

In 1978 CSPI petitioned the FDA to set limits on salt use and require better labeling.  The FDA’s reaction in the 1980s was to require the listing of sodium on some food labels and to suggest to the food industry that it reduce sodium levels.  We turned our attention to getting Nutrition Facts labels, which list sodium, on all packaged foods.

By 2005 it was clear that labeling wasn’t enough.  Americans were consuming about as much sodium as they were several decades earlier.  We once again petitioned the FDA to restrict sodium levels.  Then, in 2010, a committee of the Institute of Medicine (IOM) concluded that voluntary efforts had been an abject failure and recommended that FDA set gradually decreasing mandatory limits on sodium. 

However, because of vocal industry opposition to the IOM approach, FDA began developing voluntary targets for sodium reduction.  As of today, almost four decades since CSPI’s original petition to limit sodium, a decade after CSPI’s second petition, and half a decade after the IOM’s recommendation, the FDA still has not even proposed, let alone finalized, those targets. 

Those are only the headliners.  Other FDA measures that could help improve Americans’ health include requiring easy-to-understand front-of-package nutrition information; requiring warning notices on sugar drinks, a major cause of obesity; banning, or at least highlighting with a warning label (as in Europe), food dyes, which trigger symptoms of ADHD in many children; and barring the use of aspartame, because it caused cancer in laboratory rats and mice.

My diagnosis of the agency’s ills is institutional, not personal.  I’ve worked with FDA staff who are passionate about public health, but FDA commissioners have tended to be physicians more preoccupied with drugs and medical devices than foods.  With the Senate confirming another physician, albeit a cardiologist who should appreciate the potential benefit of reducing sodium and using healthier fats in food, that track record appears likely to continue.  And HHS secretaries have barely recognized the drug side of FDA, let alone the food side.  Moreover, congressional oversight has tended to magnify that preoccupation, with Democrats focusing on drug-safety lapses and Republicans pushing for looser regulation of drugs.      

To date, the institutional remedy proposed has been a single, independent, food-safety agency, combining units of the Department of Health and Human Services (HHS) and the U.S. Department of Agriculture.  However, even with great champions like Sen. Richard DurbinDick DurbinSyria activists cheer Kaine pick Democratic National Convention event calendar Opioid package clears key Senate hurdle MORE (D-Ill.) and Rep. Rosa DeLauro (D-Conn.), that notion has stalled.

Maybe, it’s my 40-plus years of advocacy showing, but I think I could be happy with a Federal Food Administration within HHS, and finally letting “FDA” stand for Federal Drug Administration and not Foot Dragging Artists.

Jacobson is founder and president of the Center for Science in the Public Interest. CSPI celebrates its 45th anniversary today, February 25.

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