Balancing the books

It's been a tough few years for the US Food and Drug Administration, as it grapples with the problem of partial funding from the drug industry, which may compromise its impartiality; potential conflicts of interest on advisory committees; and the increasing difficulties in assessing risks and benefits of drugs.

Congress is expected to pass a law to cover the FDA soon after it returns from its summer break. Meanwhile the FDA commissioner, Andrew von Eschenbach, a surgeon and friend of the Bush family, says he sees the controversies as part of a more fundamental shift. He thinks medicine is rapidly changing from the observation of symptoms of late stage disease to a molecular understanding of the mechanisms of earlier stages of disease, with interventions becoming increasingly early and pre-emptive.

“The challenge for us is to not be a barrier to that new future but to be a bridge to it,” the commissioner told a small group of reporters last month. He acknowledges that the changes the agency must make may not …