According to recent reports, the Office of Management and Budget seeks substantial cuts in federal health programs. Some cuts would affect health care delivery programs, but others -- specifically those for the Food and Drug Administration and the Centers for Disease Control -- would affect programs whose purpose is to prevent public health problems. The proposed cuts are elements of a broader budget- cutting program aimed at trimming huge future deficits, currently forecast to range as high as $200 billion.
Those who oppose the OMB proposals, as I do, are bound to be tagged as special-interest pleaders -- narrow-minded sorts who do not appreciate the overriding economic needs of the nation. In full recognition of those needs, however, I argue that some interests are, in fact, special -- and well worth protecting. FDA is one of them.
FDA's current budget is $349 million, virtually all of which is used to pay and directly support FDA's 7,000 employees. For this money -- just over $1.50 per citizen -- we get programs affecting the basic integrity of our most vital consumer products, products that account for almost 25 percent of all consumer spending. Among other things, FDA's programs assure the safety and sanitation of the food supply; the safety and effectiveness of medicinal drugs and medical devices (including everything from Band-Aids and crutches to eyeglasses, soft contact lenses, intra-uterine contraceptive devices, X-ray machines and heart pacemakers); the integrity of commercial blood bank operations and vaccines; the usefulness and accuracy of product labels; and the compliance of imported goods with U.S. standards.
It was FDA that mobilized rapidly in response to the Tylenol episode, collecting and analyzing in a matter of days over 1.5 million samples of Tylenol. This reassured the public of the drug supply's basic soundness and gave criminal investigators a correct focus for their efforts. It is FDA that evaluates and approves medical breakthroughs, such as the recent implantation of an artificial heart, striving to make such worthwile advances available promptly while protecting patients from uncontrolled experimentation. On a more mundane level, it is FDA's program and continuing vigilance that has virtually eliminated botulism as a public health problem.
The benefits of these activities are obviously great, but difficult to quantify because they go largely to the health and peace of mind of the consuming public. Some of the benefits, however, are more directly economic in nature. Consumers benefit economically by avoiding wasted expenditures on ineffective drugs and medical devices, fraudulently labeled foods and other products that fail to deliver full value for the money expended. Industry benefits because FDA's programs help build and maintain consumer confidence in products. This supports domestic markets and also fosters exports by helping make U.S. consumer goods a standard for the world.
The cuts proposed for FDA amount to only a few million dollars and thus would have no discernible impact on the government's fiscal problems. They would, however, have substantial impact on FDA's ability to do its job.
FDA's budget has grown little in recent years, which means that, with inflation, the agency's buying power has actually been decreasing. Staff levels have already declined in recent years from over 8,000 to about 7,000. Further cuts could stretch to the breaking a staff already spread too thin in many critical areas.
A further point, apparently overlooked by OMB, is that savings made today in FDA's budget will have to be made up tomorrow, and at much greater cost. FDA's programs, like those of CDC and other public health agencies, respond to genuine, persistent public needs. The increasing technical sophistication in medicine, food technology and other fields both increases the difficulty of FDA's task and ensures that the public demand for its programs will continue and increase. Cuts made today, however, will have a long-term effect on FDA's ability to do what is needed. FDA's resources are people--for the most part highly trained scientific, medical and pub- lic health specialists whose skills and experience are not readily replaceable.
In this regard, FDA is not like grant- dispensing agencies, whose budgets can expand and contract from year-to-year without seriously affecting their long- range capacity to perform. Investment in FDA is more akin to investment in the nation's roads, bridges and waterworks. The needed resource cannot be produced overnight: it must instead be maintained by a steady commitment of funds and effort.
The proposed cuts in FDA's budget are indicative of a broader problem facing much of the federal government. The waste and inefficiency inherent in government--as it is inherent in any organization of such immensity-- sometimes obscures the fundamental value of most of what the government does. In areas such as public health protection, in fact, the federal government's activities are substantially undervalued. By any reasonable measure, economic or otherwise, FDA and the other public health agencies deliver remarkable bang for the buck. They are a critical resource for our entire society. Damaging them to trim a few million dollars from a $200 billion deficit is shortsighted and wrong.