Nine of the last ten FDA commissioners now work for the companies they regulated. The tenth became a venture capitalist. Here is the ledger.

Nine of the last ten FDA commissioners have gone to work for the pharmaceutical industry after leaving the agency [1]. The tenth became a venture capitalist. This is not a series of coincidences, it is a documented transfer of regulatory power from a government agency to the industry it was created to police, playing out across decades with almost no meaningful resistance from Congress, the media, or the public.

The consequences are not abstract. When the people who approve your medications are simultaneously negotiating their next job at the companies whose drugs they’re reviewing, the approval process is structurally compromised. The FDA knows this. Industry knows this. The evidence is overwhelming. And almost nothing has changed.

The Official Story

The FDA’s public position is that it has “one of the strongest ethics programs in the federal government.” The agency requires incoming commissioners to divest pharmaceutical holdings, imposes a one-year “cooling off” period on certain post-government lobbying, and maintains an Office of Ethics that advises departing employees on conflict-of-interest rules. The FDA argues that its user fee system, under which pharmaceutical companies pay for the review of their own drug applications, is independently managed and that those fees fund agency operations without affecting approval decisions. The agency points to its scientific rigor, its accelerated approval pathways designed to speed life-saving drugs to patients, and its post-market surveillance systems as evidence that regulatory independence is maintained.

The record shows something different.

Follow the Money

In 1992, Congress passed the Prescription Drug User Fee Act, known as PDUFA [3]. The law, initially opposed by the FDA itself out of concern about industry influence, authorized the agency to collect fees from pharmaceutical companies in exchange for faster review of drug applications. The logic was pragmatic: Congress wasn’t funding the FDA sufficiently, and patients were dying while drugs languished in review queues. User fees would hire more reviewers.

What PDUFA created was a structural dependency. By the late 2010s, pharmaceutical industry fees were funding approximately 65 to 75 percent of the FDA’s Human Drugs Program budget [3], the core function of reviewing and approving medications. The original $100,000 application fee of 1992 had grown, by 2018, into a system generating over $1 billion annually [3]. As a New England Journal of Medicine analysis published in 2017 concluded [3]: the FDA had effectively become financially dependent on the industry it regulated.

The pharmaceutical industry spent $372 million on federal lobbying in 2022 [5] alone, more than any other industry in the United States, according to OpenSecrets. That figure represents the direct lobbying spend, not the indirect influence exercised through former FDA officials now working in industry roles. It also doesn’t capture what happens when those former officials return to influence the agency they left.

Industry funds 70 percent of the clinical trials [1] that decide whether your medication gets approved.

Industry funds approximately 70 percent of all clinical trials in the United States [1], by figures former FDA Commissioner Robert Califf himself cited. The agency evaluating the safety and efficacy of a drug often does so primarily on the basis of data generated, curated, and submitted by the company seeking approval. This is the architecture of the review process: industry-funded trials, evaluated by an agency funded by industry user fees, staffed partly by scientists who are interviewing for industry jobs. The structural conflicts are not aberrations, they are features of a system built on the assumption that independent government review can coexist with deep financial integration with the regulated industry. The evidence increasingly suggests that assumption was wrong from the beginning.

The BMJ published an investigation in May 2024, conducted by senior editor Peter Doshi [1], examining the financial histories of the last ten FDA commissioners. The findings were stark: nine of the ten went on to work for the pharmaceutical industry after their tenure. One, Margaret Hamburg, who served as commissioner from 2009 to 2015 [1], didn’t take an industry job, but her husband’s hedge fund held positions in FDA-regulated pharmaceutical companies throughout her tenure. The hedge fund, Renaissance Technologies, consistently held positions in drug companies while Hamburg ran the agency responsible for approving their products. An ethics waiver permitted this and let her retain those financial interests.

Robert Califf, who has served as FDA commissioner twice, under President Obama and again under President Biden, pocketed $2.7 million in salary and up to $5 million in stock from Verily Life Sciences [1], an Alphabet/Google subsidiary, during the period between his two stints at the agency. When the Senate considered his nomination the second time, in late 2021, senators raised this directly. Califf pointed to the Biden administration’s ethics pledge. The Senate confirmed him anyway.

The Network

Scott Gottlieb served as the 23rd FDA Commissioner from May 2017 to April 2019. Trade press regarded him as an effective commissioner, citing accelerated generic drug approvals and meaningful reforms. He left the FDA on April 5, 2019 [1]. Eighty-three days later, on June 28, Pfizer announced he was joining its board of directors [1].

This was legal. The one-year cooling-off period applies to direct lobbying of former colleagues on specific matters, it does not prevent a former commissioner from joining the board of one of the world’s largest pharmaceutical companies. As a board member, Gottlieb would not technically be “lobbying” the FDA on Pfizer’s behalf. He would simply be advising the company the agency he formerly ran regulates.

In November 2025, Gottlieb added another board seat: UnitedHealth Group [6], the country’s largest health insurer. He now sits on the boards of two of the most powerful entities in American healthcare, both of which are directly affected by FDA decisions.

Patrizia Cavazzoni ran the FDA’s Center for Drug Evaluation and Research, CDER, the division responsible for approving prescription drugs. She left the position in January 2025 [6]. On February 24, 2025, Pfizer announced she was joining the company as its Chief Medical Officer [6]. Cavazzoni had previously worked at Pfizer before joining the FDA in 2018 [1], meaning she completed a full circuit of the revolving door: industry to FDA to industry.

Peter Marks ran the FDA’s Center for Biologics Evaluation and Research, which oversees vaccines and gene therapies. The Trump administration pushed him out in 2025 [6]. By October 2025, he had joined Eli Lilly, one of the largest pharmaceutical companies in the world. As the head of biologics, Marks had been directly involved in regulatory decisions affecting vaccine manufacturers, including Lilly’s competitors, and, potentially, Lilly itself.

In July 2025, FDA Commissioner Marty Makary named George Tidmarsh, the founder and former CEO of three pharmaceutical companies, to head CDER, the division that approves prescription drugs. The revolving door spins in both directions.

The pattern at the staff level is equally clear. A 2016 investigation by Kaiser Health News and the Milwaukee Journal Sentinel found [2] that more than a quarter of FDA employees who approved cancer and hematology drugs between 2001 and 2010 subsequently went to work for the pharmaceutical industry. A STAT News report from April 2025 found that as many as 600 FDA drug reviewers had recused themselves from specific approval processes because they were simultaneously interviewing for jobs at the pharmaceutical companies whose applications they were reviewing. Six hundred. At the same time.

What Was Buried

In July 2024, the BMJ published a second investigation into the FDA revolving door, this one based on internal emails obtained through a Freedom of Information Act request. The emails revealed that the FDA’s own Office of Ethics had been advising departing employees that they could maintain influence over the agency from their new industry positions, not through formal lobbying, which the rules restrict, but through “behind the scenes” guidance to their industry employers.

The emails showed FDA officials telling departing staff that they could advise their new pharmaceutical employers on regulatory strategy, as long as they didn’t directly communicate with the FDA. The effect is the same: former FDA officials, steeped in knowledge of how the agency operates, its informal norms, its decision-making calculus, and its personnel, are using that knowledge to help pharmaceutical companies move through the approval process. The BMJ characterized this as a “critical loophole” in conflict-of-interest law. The FDA characterized it as standard guidance.

The Milwaukee Journal Sentinel reported in 2019 [2] that in the weeks before Gottlieb’s resignation, the FDA under his leadership had taken less aggressive action on a series of enforcement matters than it had in prior periods, raising questions about whether his impending departure to industry had affected the agency’s regulatory posture. These were questions, not established facts. But the pattern, documented by the Sentinel’s reporting, raised legitimate concerns about what happens to regulatory rigor as officials prepare to exit.

The accelerated approval pathway, created to speed breakthrough drugs to seriously ill patients, has expanded in scope and faced sustained criticism for approving drugs that later failed to show clinical benefit. A 2023 analysis found that a significant share of drugs approved through the accelerated pathway had failed to demonstrate the expected benefit in post-market confirmatory trials, and had remained on the market for years anyway. The financial beneficiaries of those approvals were the pharmaceutical companies whose drugs remained on formularies generating revenue while the agency awaited confirmatory data.

The Stakes Now

The revolving door has accelerated in the past year. The Trump administration’s mass layoffs at the FDA in early 2025, cutting approximately 3,500 employees [6], including experienced drug reviewers, safety scientists, and inspection staff, have simultaneously weakened the agency’s regulatory capacity and accelerated the exit of senior officials to industry positions. As STAT News reported in April 2025 [6], the mass departure of experienced staff has left the FDA in a condition of institutional fragility precisely when its independence is most needed.

FDA leadership named Richard Pazdur, a veteran cancer drug regulator, acting head of CDER in late 2025 after Cavazzoni’s departure to Pfizer. The FDA’s leadership in its most critical division has turned over three times in the span of a year. Each departure carries the same structural consequence: years of institutional knowledge about which drugs are under review, which manufacturers have compliance problems, and which applications are borderline, transferred to the private sector.

The BMJ’s 2024 investigation also found that most panelists on the FDA’s oncology advisory committees had ties to the pharmaceutical industry. These advisory committees provide the scientific recommendations that typically determine whether drugs are approved. Their members are not FDA employees, so the cooling-off rules don’t apply. The industry does not need a formal revolving door when it has already populated the advisory system with scientists whose research is funded by, or whose consulting fees are paid by, the same companies seeking approval.

The pharmaceutical industry spent more than $739 million on total federal lobbying in 2023 [5], a record, according to the Center for Responsive Politics. The revolving door is one mechanism that converts money into influence. The FDA’s official ethics rules are the other side of the equation, and the evidence suggests those rules contain enough gaps to make the system function largely as intended by those who profit from it.

The FDA does not fail because corrupt people staff it. It fails because the people who know the most are worth the most to the industry being regulated.

The same regulatory-capture pattern operates downstream of the FDA: private equity firms now own the emergency rooms where those drugs are administered.

The One Thing That Matters

The FDA does not fail because it is staffed by corrupt people. It fails because the system is designed so that the people who know the most about pharmaceutical regulation are the most valuable to the industry being regulated, and they know it. Every former FDA commissioner who joined pharma received a board seat or a consulting contract because of what they know and who they know, not because they are uniquely talented executives. The knowledge they carry was built on the public’s dime, through years of regulatory work funded by taxpayer dollars and industry user fees. What the revolving door does, with every revolution, is transfer that knowledge permanently to the other side. The patient sitting in the waiting room, wondering whether the drug they’ve been prescribed was approved because it works or because it was reviewed by someone whose next job depended on the reviewer’s goodwill, that patient has no way to know. The FDA has decided they don’t need to.

Sources: BMJ investigations by Peter Doshi (May 2024, July 2024); KFF/Milwaukee Journal Sentinel (2016, 2019); STAT News (April 2025); CNBC/NYT coverage of Califf confirmation hearings (2021-2022); BioSpace/Fierce Pharma/Pharmaphorum on Cavazzoni and Marks departures (2025); Center for Responsive Politics/OpenSecrets on pharma lobbying; NEJM analysis of PDUFA funding (December 2017); Stanford Law Policy Review, “FDA’s Revolving Door: Reckoning and Reform [4]” (2023); Warren Senate letter to FDA Commissioner Makary (March 2025).