US Pharm. 2008;33(7):3.

For all the hoopla and noise being made by the two presidential hopefuls over the state of our health care, there is not much talk about life expectancy in the United States compared with that in other countries. Despite all the rhetoric about how great our health care system is, the Central Intelligence Agency's World Factbook states that the U.S. ranks 47th in life expectancy behind Japan, Canada, France, Sweden, Switzerland, Australia, Israel, and the UK (to name a few countries). Although the rankings make for an interesting news item, they don't explain the factors that contribute to our relatively poor standing.

While some critics will point to environmental hazards, substandard living conditions, lack of health insurance, or a host of other possible culprits we deal with on a daily basis in the U.S., the bottom line is that the low ranking is really about the quality of health care. Many will argue that even if we did have the best health care system in the world, there are millions of Americans who are not benefiting from it because they cannot afford it. Even more disturbing is that, among Americans who pay dearly for health care provided by insurance companies, many are not getting the tests, treatments, or drugs they need because of the restrictiveness of their health plans. And while we may have the best diagnosticians in the world, it all comes down to the availability of life-saving drugs. Other critics are quick to blame our poor showing on world life-expectancy charts on the FDA and its backlog of new drug approvals.

Some pharmacists are even suggesting that we don't need the FDA at all. My immediate response is: Of course we do. While the FDA has come under attack lately for some questionable drug approvals, overall I believe that the FDA does a creditable job of keeping this country's drug supply safe and effective. And when you think of the thousands of drugs it has approved over the years and the lives that have been saved, this is no small achievement. While most health care professionals are familiar with the FDA's watchdog function over the U.S. health supply, don't forget that the agency also monitors medical devices, biologics, blood, vaccines, veterinary medicine, cosmetics, products that emit radiation, and this nation's food supply, all of which factor into our life expectancy. Despite this seemingly impossible task, the FDA is woefully underfunded and understaffed; in fact, it recently announced that it has more than 1,300 positions to fill.

While the FDA may be a thorn in the side of many companies here and abroad, its mission of protecting the U.S. population from bad drugs, tainted food, and a number of other serious health matters is daunting. And despite all of its shortcomings, I am one American who is proud to say that I feel safer having the FDA on my side. The FDA has never wavered from its mission of protecting U.S. citizens since its humble beginnings in 1862 with one chemist in the Division of Agriculture. Since then it has grown to an organization of more than 9,000 employees and oversees items accounting for 25 cents of every dollar spent by consumers.

Under its current commissioner, Andrew C. von Eschenbach, MD, the FDA has recognized its shortcomings, and instead of burying its head in the sand like some other government agencies it has strengthened its focus on drug safety. Pharmacists who dispense the medications that the FDA approves should not be asking whether we need the FDA. Instead, they should be supporting the FDA with respect for the magnitude of its accomplishments over the years. They should embrace the agency's activities because, after all, pharmacists are a key component of the drug delivery system in this country and an extension of the FDA's drug safety program. I can only hope that the next president shares that same respect for the FDA and pharmacists by rewarding both of them monetarily for the important role they play in prolonging patients' lives.

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