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The Last Word: The Future of Protecting and Promoting Public Health

FDA Consumer magazine
The Centennial Edition / January-February 2006

By Andrew C. von Eschenbach, M.D.


From a modern perspective, it seems nearly unimaginable that for centuries--before there was a Food and Drug Administration or even a United States and until a decade or so ago--what we knew of diseases and biology was largely what we could see, touch, or detect with our other senses. Diseases were witnessed and chronicled, but rarely eliminated. Close to a century ago, science began to fully harness the power of the microscope. Bacteria, viruses, and tumors became visible. Diseases and conditions could be identified and causes assigned--even if the capacity to help patients remained largely elusive.

But the last decade or so has changed history. Biomedical science has experienced phenomenal growth, and cutting-edge technologies have fueled a molecular view of life. This exponential advance, including the decoding of the human and several animal genomes, is nothing less than a metamorphosis. The worlds of science and medicine being constructed today are no more like the past than a butterfly is like a caterpillar. We are learning that diseases are not events, but processes that begin long before they become something we can see, touch, or feel. Indeed, molecular discoveries are rapidly leading to an era of personalized medicine, when we will intervene ever earlier, delivering the right treatment to the right patient at the right time.

The FDA will be the bridge to the development required by that future, connecting the promise of discoveries to the delivery of each advance, guiding new interventions through the critical path of development, so that the fruits of progress will be available to patients and the public. The FDA of the 21st century will use the latest information technologies and techniques to facilitate life-saving and life-enhancing interventions, delivered quickly and affordably, with all the safety and security Americans expect.

A modern system of discovery, development, and delivery will require the FDA's regulatory mechanisms and its system of clinical trials to keep pace. The emerging field of genomics, for example, will allow doctors and scientists to predict, using genetic markers, who will respond to a new medicine, who might suffer a side effect, or who might experience no beneficial effect. This new world will require new ways of thinking and a new openness to collaborations. The FDA will need to work with partners, including the National Institutes of Health; the Centers for Medicare and Medicaid Services; the Centers for Disease Control and Prevention; the Agency for Healthcare Research and Quality; academia; and industry, to understand the implications of every potential advance.

The molecular era will lead to improved methods of developing and producing vaccines, and will make certain that immunization remains at the forefront of disease control. The sciences of medical device development, radiological health, and veterinary medicine will continue bringing impressive improvements. Our food will be safer and even more wholesome, setting global standards for protection from contamination, even as the FDA accelerates the public's knowledge of nutrition and continues to drive down the number of food-related hospitalizations in the United States. In short, we will be a healthier America.

One hundred years of success is worthy of celebration. The FDA stands tall because of each dedicated staff member. In the FDA's second century, we will build on a foundation of success to create a science-led regulatory agency dedicated to improving and enhancing health. Our second century will be based on new opportunities, but grounded in even greater responsibility.

This is a time to celebrate the past. It's also a time to be exuberant about our future. Whether it is freedom from the suffering and death due to disease or generations of healthier infants, the FDA must use its proud legacy to ensure the promise of an even more impressive future. And it must deliver on that promise to all Americans. At its core, the FDA is about people. None of its accomplishments would be possible without the work of the FDA's chemists, physicians, engineers, dentists, pharmacologists, nutritionists, veterinarians, nurses, attorneys, physiologists, technicians, administrators, and office professionals. We are all grateful--and much safer--because of the efforts you so generously offer every day.

Andrew C. von Eschenbach, M.D., is Acting Commissioner of Food and Drugs and Director of the National Cancer Institute. His four-decade career as a nationally recognized urologic oncologist, medical educator, and cancer advocate includes 25 years at the University of Texas M.D. Anderson Cancer Center in Houston.