Washington DC

Hands on: Andrew von Eschenbach will try to head two huge US agencies.

Following the surprise resignation of its embattled commissioner, the US Food and Drug Administration (FDA) is now being led by Andrew von Eschenbach, director of the National Cancer Institute (NCI). He says that he will not give up his NCI job, despite the demands of both positions.

Lester Crawford was confirmed as FDA chief just two months ago, but he quit without explanation on 23 September. The agency has been buffeted by crises and has had a permanent commissioner for only 18 months of George W. Bush's administration.

Von Eschenbach will serve as interim commissioner until a permanent replacement can be found — or until President Bush nominates him for the job and the US Senate confirms him. In the meantime, he will remain at the helm of the NCI with its $4.8-billion budget, an unprecedented dual assignment that has drawn criticism from some.

“It makes no sense at all. It's two huge jobs. Most officials have struggled to keep up with just one of those jobs,” says a former senior FDA official who asked to remain anonymous. In addition, some are questioning whether von Eschenbach can ethically serve in both roles.

“As the head of the FDA, his job is to regulate the companies that are bringing products before the agency to cure cancer. Isn't that a conflict of interest?” asks Merrill Goozner, head of the integrity of science project at the Washington-based Center for Science in the Public Interest.

But other experts disputed the notion that the two jobs conflict. At the NCI, “they absolutely do have a stake in what happens” in FDA drug-approval decisions, says Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, Philadelphia. But that interest “is fuelled by public interest more than private gain”, he says.

Von Eschenbach, a urology surgeon and cancer survivor, was a key leader at the University of Texas M. D. Anderson Cancer Center in Houston before becoming NCI director in 2002 (see Nature Med. 8, 7 and 426; 2002). He has been closely associated with the US president's family, working with Bush and the first lady on the National Dialogue on Cancer — a public–private partnership that aims to develop a national cancer agenda. But at the NCI, he has displeased some cancer researchers by declaring an institute goal to eliminate death and suffering from cancer by 2015. Many in the field say that the goal is unrealistic and is setting up the public for disappointment.

Von Eschenbach could not be reached for comment by the time Nature went to press. In earlier statements he has said that he thinks promising drugs should be made available “as rapidly as possible”. That approach is winning plaudits from industry: his appointment was praised by Amit Sachdev, who is the top health-policy official at the Biotechnology Industry Organization, based in Washington DC. The industry group Pharmaceutical Research and Manufacturers of America also hailed von Eschenbach's new role.

The reasons for Crawford's sudden departure were still mired in speculation early this week. Some newspapers reported that he had a financial interest that was not disclosed to senators when they were considering whether to confirm him as FDA chief. The confirmation battle took months and became caught up in a fight over whether emergency contraception should be made available without prescription.

Later, Crawford delayed a promised decision on the contraceptive, prompting a top official to resign (see Nature 437, 179; 200510.1038/437179a). Crawford was also the FDA's highest-ranking official when the painkiller Vioxx (rofecoxib) was withdrawn a year ago, raising questions about the agency's vigilance on drug safety.