Monday, November 10, 2008

The New Administration: More Names to Consider

We didn't wait for the election to start the speculation about who might play an important role in an Obama Administration. But now that the voters have spoken, we've heard a few more names bandied about for key posts in the new Administration.

So, without further ado, here are some additions to our prior post:

HHS Secretary:

Rosa DeLauro (US Congress):
We thought Tom Daschle was sure to end up as HHS Secretary, but now we hear he may instead be leading the health care reform effort from within the White House. (You know, kind of like Hillary did in the Clinton Administration. Not exactly like that, we hope.) And we've heard that maybe Connecticut Congresswoman Rosa DeLauro (pictured) will get the job. DeLauro currently chairs the agriculture appropriations subcommittee in the House, which among other things oversees FDA's budget. She's no fan of DTC ads, sloppy overseas manufacturing, or anything that looks like overly cosy relationships between industry and regulatory. In other words, she would make a verrrrry interesting secretary for the pharmaceutical industry. The suspense on this position won't last long, so stay tuned...

FDA Commissioner:

Ezekiel Emanuel (NIH):
The National Insitutes of Health's chief bioethicist has a cv that is longer than a typical issue of IN VIVO, packed with publications, books, awards and honors. The one thing not on it: his brother, Rahm, was just named chief of staff to President-elect Obama. Those family connections ensure Emanuel will be an influential figure in the new Administration; whether FDA is the right fit is a different question. Still, his involvement in addressing conflict-of-interest issues--both within NIH and in other professional societies--is likely to set the tone for how clinical research and medical education evolve in the years ahead. (FYI, the third Emanuel brother is an agent in Hollywood. That's right: Mr. and Mrs. Emanuel have one son who is a hard driving political operative, one who is a hard driving Hollywood agent, and one who is...a bioethicist.)

Jerry Avorn (Harvard): One of the pioneers in the field of pharmacoepidemiology, Avorn's post at Harvard gives him an in with the Obama health team and the Massachusetts Senate delegation. FDA is prey to internal disagreements between its clinicians and its epidemiologists, and historically the leadership has come from the clinical world. But the emphasis on drug safety and post-marketing surveillance could make someone like Avorn an attractive candidate.

Joshua Sharfstein (Baltimore Commissioner of Health): Kennedy is the traditional power broker for FDA, but it is an open question whether his health will allow him to continue to play that role in 2009. So someone like Sharfstein, who once served on Rep. Henry Waxman's staff, could be a more likely candidate since House members have a strong interest in FDA as well. And he has Steve Nissen-like drug safety credentials, having helped led the charge to withdraw pediatric indications for OTC cough/cold medicines. A pediatrician by training, Sharfstein graduated from Harvard Medical School in 1996.

David Kessler (UCSF): Yes, that David Kessler. Plenty of folks are suggesting that he wants back into government and that he could end up back at FDA. We've been telling people for more than a year the next FDA commissioner will be from the Kessler mold, so we certainly can't resist passing on the notion that it will just be Kessler himself. He recently lost his post as Dean of the UCSF Medical School--under unpleasant circumstances--so we're betting a move back East would not be unwelcome.

CMS Administrator

Judy Feder (Ex-Georgetown): Feder is also certain to play a prominent role in the Obama health team after her unsuccessful bid for Congress in Virginia. Feder's campaign was closely aligned with the top of the ticket, and though she fell far short of unseating incumbent Frank Wolf in Virginia's 10 District, she is likely to be rewarded for helping increase Democratic support for Obama in what proved to be a pivotal state for the campaign. A veteran of the Clinton Administration (she was HHS principal deputy assistant secretary), she surrendered her position as Dean of Georgetown's Public Policy Institute before launching her unsuccessful bid.

Elizabeth Fowler (Senate Finance Committee): Fowler, one of the key Democratic staffers who worked on the Medicare Part D benefit, certainly has the resume for the job: in addition to her time on the Democratic committee staff, she worked as VP-public policy at Wellpoint, as an attorney at Hogan & Hartson, and as a health services researcher with HealthSystem Minnesota. Ironically, one drawback could be the key role she played as one of the few Democratic staffers who helped draft the Medicare Modernization Act. Changes to MMA are atop the agenda of many in the Democratic Congress, and having a CMS administrator so closely tied to the 2003 law could be a problem.

Cybele Bjorklund (House Ways & Means Committee): Bjorklund, on the other hand, would be the staffer who represents the Democratic opponents to MMA still bitter about being shut out of the end of the debate that created Medicare Part D. In the House, Bjorklund has worked on legislation to undo the "non-interference" clause in Part D - including proposals to have Medicare launch its own prescription drug plan.

Kevin Concannon (Iowa Department of Human Services): Concannon is only one of many state Medicaid program directors who could be considered for positions in the federal agency. However, he bubbles to the top of the pack because: (1) He has led two state Medicaid programs, first in Maine and now in Iowa; (2) In Maine, Concannon implemented a state-wide drug discount program that withstood a court challenge from the brand name pharmaceutical industry; (3) His boss, Gov. Tom Vilsack, helped deliver Iowa for Obama (after Vilsack ended his own presidential campaign, and then supported Clinton in the rest of the primaries), and may join the administration in the Department of Agriculture; and (4) Iowa is the home state of Finance Committee ranking Republican Chuck Grassley, which would presumably help Concannon get through the Senate.

1 comment:

Rick Tannenbaum, JD said...

I think you've got it backwards. Rosa DeLauro should head the FDA. She has a unique understanding of the failings of the agency and has the right temperment to make real change there.

Rick Tannenbaum