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In the recent flurry of posts here at the Cafe on the possibility of reduced role for the FDA and an expanded role for consumers and doctors in deciding what to put in our bodies, the most common complaint I receive is that we’re simply too busy to make these decisions for ourselves. After all, who wants to become an expert on drugs interactions and safety issues? Surely it’s better to rely on the experts at the FDA.
Imagine the same argument being made about cars.
Cars are very complicated. Few drivers have any idea how they really work. Few drivers want to master or are able to master the subtleties of engine performance, horsepower and mileage claims. Surely, it would be reckless and undesirable for drivers to make their own decisions on these complex issues.
Instead, let’s establish the FCA, the Federal Car Administration. The FCA would test new vehicle designs for safety and efficiency. That way, car shoppers could be assured that they would be getting safe cars and cars that did what they were supposed to do. A car advertised as a family mini-van would be tested to make sure that families could use these cars comfortably. An off-road vehicle would be tested off-road. A performance sedan would be taken on long trips to make sure it could handle winding roads without reduced driver comfort. The FCA would also make sure that there weren’t too many "me-too" cars, cars that simply added another choice to a pre-existing niche.
Such tests would be extremely thorough. After all, cars are dangerous and a major expenditure for most families. It would take a decade of test-driving to make sure that cars fulfilled the claims made by their makers. Of course, this process would make cars very expensive. You’d have to charge a lot for a car that survived such a rigorous process to make up for the foregone earnings from tying up all that capital for so long without any return. And some cars wouldn’t be approved. That would also tend to push up the price of cars that did get approved.
Choices would be few. Because of the high costs of the approval process, only cars that appealed to large numbers of consumers would receive attention from the manufacturers. On the plus side, the cars that did survive the process would be very safe and very good cars. They’d have to be. Manufacturers would want to reduce the odds of failure to avoid a ten year approval process that resulted in rejection.
Somehow, we survive without an FCA. We’re busy. Most of us don’t want to become experts on cars. We rely on a vast array of private information, voluntarily provided. We read Consumer Reports and Car and Driver. We ask our friends. We read columnists in our local paper. We listen to radio experts who give advice. It takes some time. There’s a lot of noise and the information we use is imperfect. But it works pretty well. Cars get better and better and cheaper and cheaper.
Could it work for pharmaceuticals? Buying a car that doesn’t work as well as you thought it would isn’t as serious a problem as taking a drug that turns out to be a mistake. So I assume that the incentives for providing quality private information would be even stronger than for cars. Who would provide that information? The AMA? Consumer Reports? The New England Journal of Medicine? Our doctors? All of the above? Who knows. All I know is that the current dominant role of the FDA means there’s little or no incentive for these private solutions to flourish. I also know that the FDA plays a major role in driving up the costs of pharmaceuticals and reducing innovation.
I’d prefer a world without the FDA. Not just because I think drugs would be cheaper but because I think we ought to find the time to make such decisions for ourselves. But even if you personally want to avoid that responsibility, why impose that cost on me? Leave the FDA in place to test all drugs. If you like the FDA, abide by their decisions. But why not let the rest of us make our own choices?