Dr. Califf was confirmed for the job in a vote of 89 to 4; along with Mr. Manchin, Senators Edward J. Markey, Democrat of Massachusetts; Richard Blumenthal, Democrat of Connecticut; and Kelly Ayotte, Republican of New Hampshire, voted in opposition to him. But different Republicans, led by Senator Mitch McConnell of Kentucky, then the bulk chief, voted in favor.

That assist could also be one motive Mr. Biden picked Mr. Califf: His choice drew combined response.

“It is surprising that the White House has seemed really tone-deaf on conflicts of interest and very close ties to the industry,” mentioned Diana Zuckerman, the president of the National Center for Health Research, a nonprofit advocacy group.

But others mentioned they believed that Dr. Califf’s trade expertise shouldn’t bar him from the job, noting that he has disclosed his ties in publishing the outcomes of medical trials.

“The truth of the matter is industry develops drugs — you have to work with industry. The issue is disclosure in publication,” mentioned Ellen V. Sigal, the founder and chairwoman of the nonprofit Friends of Cancer Research, which accepts trade funding. “Rob has done many, many clinical trials with industry, but he has not been a pawn of industry. He’s completely committed to transparency, integrity and science.”

Dr. Aaron S. Kesselheim, who served on the F.D.A. advisory panel that thought-about the Alzheimer’s drug and resigned from the committee after it was authorised, mentioned Dr. Califf’s background operating medical trials could be beneficial for main the company.

“I don’t think it’s necessarily disqualifying,” mentioned Dr. Kesselheim, a professor of medication at Harvard Medical School and Brigham and Women’s Hospital. “I think the fact that he worked for such a long time in clinical trials demonstrates that he has expertise in understanding what goes into a good clinical trial. Hopefully, he can bring that into his role as an F.D.A. commissioner.”

But Dr. Kesselheim objected to Dr. Califf’s efforts, when he was the commissioner, to permit drug firms to promote off-label makes use of for his or her merchandise, noting that sufferers could be endangered by medicine which might be prescribed for makes use of that the F.D.A. has not authorised. “That to me is a red flag,” Dr. Kesselheim mentioned. “Hopefully, he’s moved past that as an idea, because it would be a terrible idea.”


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