In an oral history conducted by FDA in September 2013, Andrew C. von Eschenbach recounted his eight-month stint in a dual role as both FDA acting commissioner and NCI director.
In the interview, von Eschenbach walks through his childhood in south Philly, his marriage to his childhood sweetheart, and his journey from Philadelphia to Texas for a year-long fellowship at MD Anderson, where he thought his four young children could temporarily “play cowboy.” Twenty-six years later, he was still at MD Anderson, and his children consider themselves Texans.
The bulk of the oral history, however, focused on von Eschenbach’s first-hand account of his attempt to lead two government entities at the same time: FDA and NCI.
Von Eschenbach became NCI director in 2002 (The Cancer Letter, Feb. 8, Jan. 25, 2002). When he was picked by then-President George W. Bush to be acting commissioner of FDA four years later, von Eschenbach said that he would continue as NCI director and that the FDA job was an “interim role.” Still, he said would give both jobs 100% (The Cancer Letter, Sept. 30, 2005).
Said von Eschenbach in the oral history:
After four years at NCI, in my fourth year then, of course, the phone rang on a Thursday night, and it was the White House, and the essence of the conversation, in short, was that the next morning, Commissioner Crawford was going to announce his resignation, and would I come over, take over at FDA, and that’s a whole interesting conversational story unto itself.
But, as you know, the bottom line of that was, the next morning, [the resignation of FDA Commissioner Lester Crawford] was announced and my appointment as acting director was announced. Over the weekend, I had intensive meetings, a phone conversation with Mark [McLellan, then director of Centers for Medicare and Medicaid Services], and by Monday morning Secretary Leavitt and I showed up at the FDA headquarters at Parklawn and I met all of you as your acting commissioner, and for six months I did both jobs.
So, I would start at NCI in the morning, very early, as a surgeon usually does, and then I’d come over to FDA mid-morning and stay till late afternoon and leave, and then go back to NCI and stay till whatever time it took at night, and did that for six months, because at the outset it was not, it was an intervention on my part. It was not intended to be a permanent transformation.
But when I got to FDA, as much as I had an appreciation and awareness of the institution, what I didn’t have was an understanding and appreciation of the stress and the incredible duress that the institution was under.
Once you’re inside the FDA, it’s impossible not to love it; it’s impossible not to love it. I could not walk away from that agency.
Andrew von Eschenbach
Von Eschenbach faced scrutiny from lawmakers and advocates about potential conflicts of interest and conflicts of commitment, which can be tracked in The Cancer Letter’s coverage at the time.
- Von Eschenbach a “misguided choice” for FDA, House members write to HHS Secretary Leavitt. Conflicts inadequately addressed, they said, Oct. 14, 2005
“This dual responsibility—which exists despite Dr. von Eschenbach’s pledge to give up his ‘day to day’ duties at NCI—opens the door to unacceptable conflicts of interest,” the three House members wrote in the letter dated Oct. 12. “FDA and NCI each have critical and independent roles in the drug safety system,” said the letter signed by Reps. Henry Waxman (D-Calif.), John Dingell (D-Mich.) and Sherrod Brown (D-Ohio) of the House Energy and Commerce Committee. “Having the same person at the helm of the NCI and the FDA violates the independent safeguards build into this system. There is no justification for merging these distinct roles.”
The letter represents the first open challenge to von Eschenbach’s efforts to address the conflicts of commitment and conflicts of interest. Others on Capitol Hill—on both sides of the aisle—have expressed similar reservations, but are waiting for the Administration to make its next move, insiders say.
Critics point out that von Eschenbach now heads the agency that regulates clinical trials sponsored by his institute. On Oct. 12, Reps. Henry Waxman (D-Calif.), John Dingell (D-Mich.), and Sherrod Brown (D-Ohio) wrote a letter to HHS Secretary Michael Leavitt saying that von Eschenbach’s attempts to address potential conflicts have been “inadequate.”
The Cancer Leadership Council sent a letter to President Bush, stating that “the absence of permanent qualified leadership at the two agencies is a cause for concern.” The council, comprised of patient advocacy groups and professional societies, urged Bush to “make appointment of a permanent FDA commissioner and permanent NCI director a priority” for the administration.
With increasing pressure from lawmakers, von Eschenbach had to choose between the two roles. Ultimately, von Eschenbach’s heart was with FDA, and he said he planned to step down as NCI director in March 2006. He officially resigned as NCI director on June 10, 2006 and was confirmed as FDA commissioner by the Senate in December of that year (The Cancer Letter, Dec. 8, June 2,March 24, 2006).
In the oral history, von Eschenbach said:
Once you’re inside the FDA, it’s impossible not to love it; it’s impossible not to love it. I could not walk away from that agency. I would never have been able to have looked myself in the mirror if I had left you all in that lurch, having come and seen what I saw, knowing how bad the situation, would be like walking past someone in the street who’d gotten hit by a car. I could never do that. I mean, I could never have left you, abandoned that agency. And so for the three years that I knew the rest of my time in the Administration, I made the commitment I’d stick it out to the very end, and I would do whatever I could. And we were going to get better.
The FDA has to change. It has to modernize. It was the gold standard of the 20th century. But what was obvious at that 2006 birthday was that the world around the FDA had radically changed and was radically changing, and will continue to radically change, but the FDA was not changing. And a lot of that had to do with the fact that it was so resource constrained; it had no energy to change; it had no freedom to change; it had no elasticity; it had no growth zone.
Von Eschenbach is now the president of Samaritan Health Initiatives Inc., a health care policy consultancy he founded.
Von Eschenbach’s oral history, along with 301 others conducted by FDA, have been hidden following the Trump administration’s order to purge government websites containing anything related to DEI or gender. The PDFs with transcriptions of the interviews are still online, but the central FDA landing page which formerly directed users to the agency’s collection of oral histories has been removed.
A partial list of scientists and officials who participated in FDA’s oral history project can be found in a previous issue (The Cancer Letter, Feb. 28, 2025).
Read von Eschenbach’s full oral history on the Cancer History Project.
This column features the latest posts to the Cancer History Project by our growing list of contributors.
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