Q&A with Dr. Robert Steinbrook, the new Director of Public Citizen’s Health Research Group
Public Citizen has announced that Dr. Robert Steinbrook is the new Director of its Health Research Group. In a question-and-answer format, Dr. Steinbrook discusses his background and the Health Research Group’s priorities.
Tell us a little about yourself, including your areas of expertise and specialization?
My medical training is in primary care internal medicine. Among other positions, my career has spanned work in academic medicine and as a medical writer for the Los Angeles Times, a deputy editor and national correspondent of the New England Journal of Medicine, and most recently as editor at large of JAMA Internal Medicine. I have written many peer-reviewed articles for medical journals, as well as editorials, viewpoints, perspectives, and health policy reports. I am particularly interested in the safety of drugs and medical devices and conflicts of interest, and more generally in health policy and medical ethics.
How will your work as an editor at leading medical journals and as a reporter for a major newspaper inform your work with the Health Research Group?
The focus of the Health Research Group is research-based consumer health advocacy. Effective advocacy requires not only research and investigative skills, but also the ability to communicate with government agencies, health professionals and the public. Throughout my career, I have emphasized clear, accurate, authoritative, and timely communications.
What drew you to Public Citizen and to the Health Research Group in particular?
First, I have known and admired the work of the Health Research Group for years. This is a unique organization with accomplishments that are too numerous to count. Second, public interest work on the wide range of issues within the Health Research Group’s scope is a continuation and extension of the work I have done throughout my career. Fundamentally, there is the opportunity to make a difference for the health of the public. Few positions in medicine offer that opportunity.
What is your general assessment of the healthcare system in the United States? What fundamental problems are most pressing to address?
When President Biden took office, we wrote an editorial at JAMA Internal Medicine. Among the points we made is that the United States spends 25% more per capita than the next highest-spending country, but it underperforms on many metrics, such as infant and maternal mortality rates. And despite all the money spent on health care, the United States is the only country among developed nations that does not provide healthcare to all its citizens. That is a shameful situation. We need a health care system that is accessible and equitable, and with an emphasis on the public good, not private profit. When people are sick, they want the same things regardless of their politics: to get well, to be treated with dignity and respect, and to not go bankrupt in the process.
Under your leadership, what are the top priorities for the Health Research Group?
Since the Health Research Group was established in November 1971, we have had a particular focus on the Food and Drug Administration, and the safety and effectiveness of drugs, devices, and other medical products. We will continue that focus, as well as our efforts to call out the FDA when it gets too close to the industries that it regulates. We will seek to expose conflicts of interest that can harm patients, wrong-doing in clinical trials, improve patient safety and medical board oversight of dangerous doctors, promote stronger health safeguards for workers, and, with our colleagues at Public Citizen, advocate for a national single-payer health care system. In short, although the priorities of the Health Research Group will not change, the specific issues will change with the times. Artificial intelligence in healthcare is an example of an emerging issue that we hope to address.
How would you assess the FDA’s drug safety and efficacy work right now? What are your main concerns?
The FDA is the leading drug regulatory agency in the world. That being said, it is essential that the agency strike the right balance between the clinically meaningful benefits of new drugs and their safety profile, and be fully independent of the industries that it regulates. Undue industry influence co-opts the FDA’s independence. Approving drugs with insufficient evidence of benefit and substantial safety concerns is very concerning.
The Health Research Group has been very critical of the FDA’ approval of new drugs for Alzheimer’s disease. What do those decisions signal about the agency’s direction?
Patients with Alzheimer’s disease and their families need and deserve better treatments. We understand that. FDA approval of drugs with minimal benefit and significant health risks is not a path forward, however. The FDA-industry collaboration on aducanumab was unprecedented and we (and many others) harshly denounced it. We’re worried that the aducanumab debacle signals a new approach to partnering with, rather than effectively regulating, Big Pharma. The path forward is an independent FDA that approves better and safer drugs, with compelling evidence of clinical benefit.