Instead, the Trump administration’s policy has swung to his side, with the President himself retweeting his former FDA Commissioner’s advice, ratcheting up the notice those views receive. Dr. Gottlieb’s own Twitter following has risen from 57,000 last fall to well over 190,000 in recent weeks.
Perhaps the US’s most critical mistake, he says, was in not bringing together the work of academia, private business and government to address the need for tests. As he told CNBC, “There should have been, I think, a sense of urgency about taking an ‘all of the above’ approach and trying to get all of the diagnostic players into the game as early as possible. We ended up doing all those things, but we ended up doing them late. And now we’re still behind the curve.”
That directness and focus on efficiency are characteristic of Dr. Gottlieb. Appointed in 2017, he set a new standard as FDA Commissioner, earning praise for his agency while other offices in the Trump administration were seen to be falling into chaos. After his departure in 2019, he has remained a respected figure in both parties.
In addition to his medical expertise, Dr. Gottlieb has a knack for making complex matters understandable to the layperson and a clear-eyed view of the workings of business, government and media.
In a conversation with the Brunswick Review late last year, before the current crisis was on anyone’s radar, he shared his views on topics related to his time at the FDA, including the balance of government and business, and his approach to leadership.
How did being the son of a physician, particularly a psychiatrist, influence your career choice?
It’s hard to isolate what influence my proximity to doctors had on me. But I was drawn to medicine because of the nature of the profession itself. It meant the opportunity for service and rewarding work, while also offering lifelong learning and the chance to be a part of a profession. I also saw medicine as something that could allow me to continue expanding other interests, especially writing. There is a long history of physician authors. When I decided to pursue medical school, I was already editing my college newspaper. I knew I wanted to continue publishing, even if I didn’t do it full time. I eventually ended up working on the staff of a number of medical journals while I was a student and resident.
How does being a father of three daughters influence your leadership style and policy thinking?
It probably influenced me most directly in how I managed my team at FDA. Many of the people I worked with also had young children. I knew how important it was to allow people some flexibility to work and fulfill their commitments to their families. I understood how important it was to know what people’s boundaries were—when they needed to be offline or adjust their workday to fulfill family obligations. So, I tried to make sure we had a work culture that embraced these needs.
You became FDA Commissioner in 2017. What would have been your priorities in 1992?
The priorities evolved over time at FDA as the opportunity set has changed, along with people’s expectations for the agency. In the early 1990s, a lot of the scrutiny was over the efficiency of the review process. There was discussion of a “drug lag” between the US and Europe. The view was that drugs targeting important medical conditions were being approved in Europe months and sometimes years before they were approved in the US. So, there was a lot of focus on modernizing the review process to move drugs to market more efficiently.
This was also during a time period when FDA was being criticized for not moving to market quickly enough drugs targeting HIV. The outgrowth of that was the FDA Modernization Act of 1997, which created pathways like accelerated approval. In 2017, there were new priorities like opioid addiction, drug pricing, drug safety, and the imperative to help advance new technology platforms safely, like cell and gene therapy and regenerative medicine.