​Ever upward for the School of Medicine

Last Tuesday, Duke School of Medicine cardiologist and lead clinical researcher Dr. Robert Califf, Trinity ‘73 and Medicine ‘78, was nominated to become the Food and Drug Administration’s commissioner. Califf is widely respected in his field for his research in cardiology and as the founding director of the Duke Clinical Research Institute. While his nomination was applauded by organizations like the American Heart Association and warmly received by his colleagues and admirers, questions have been raised about his vetting, ties to the pharmaceutical industry and relative lack of a public health background.

Following Califf’s nomination, commentators were quick to point out his paid consulting work for industry companies heavily regulated by the FDA. More than 60 percent of the funding for the DCRI comes from industry companies, whereas no previous FDA commissioner has ever had such strong ties. It is, of course, important to ensure that industries are not in some way capturing the officials who regulate them, but Califf has been markedly clear about disclosing his relationships with drug companies. He has also chosen to donate his consulting fees to not-for-profit organizations even as he has disclosed his potential conflicts of interest.

Califf’s resume is also a well-mixed blend of academic and industry work, diluting the image of him as some kind of industry puppet. He has been the FDA’s Deputy Commissioner since the beginning of this year, and though that tenure has been short, his track record in the position is open for all to see. We are also pleased that the nominee is not without any industry ties. As critics acknowledge, drug testing and clinical trial streamlining are increasingly important as medical advances are made. A thorough but impartial, or at least well-scrutinized, understanding of the drug industry is certainly a positive for any candidate.

Ultimately, Califf and his background reflect well on Duke institutionally: strengths in medical research but a striking lack of public health background. Turning back to the University, research opportunities related to public health exist but are limited. The only graduate public health program is a joint program with the University of North Carolina at Chapel Hill, and undergraduate programs are mostly lacking except in the form of Bass Connections clusters. In the interests of adding to one of the strongest medical schools and health systems in the country, we believe that space exists for further public health programs.

A. Eugene Washington, president of Duke University Health System since April, has a strong background in public health. In August, he indicated that his position is “chancellor for health affairs at Duke, not chancellor for health affairs in the medical school or Nursing School,” hinting at his interest in working closely with administrators like Kelly Brownell, dean of the Sanford School of Public Policy. While there are reasonable concerns to harbor for whether there is a way to teach public health at an undergraduate level, Duke has rarely shied away from looking into offerings for that reason. If anything, room for growth seems to exist in the undergraduate public policy major’s health policy track.

Returning to Califf’s nomination, should he continue to be honest and open about his connections and willing to seek advisors with more career public health experience than him, he will continue to do Duke proud in the FDA. His nomination brings yet another step forward for Duke based success on the national stage and further gives us opportunity to inspect Duke’s inter-school work with respect to the broad field of medicine.