Can Sebelius Fix the FDA and Food Safety?

With yet another food recall in the news (this time it's pistachios), Kansas Gov. Kathleen Sebelius, now poised to take the helm of the U.S. Department of Health and Human Services (HHS), will undoubtedly face tough questions at her confirmation hearings about the failed safety record of products like peanut butter, pet food, spinach and tomatoes. The Food and Drug Administration, which is a part of HHS, has responsibility for oversight of the lion's share of the food supply and as such, touches every American three times each day like clockwork, at breakfast, lunch and dinner.

The spate of recalls due to contamination has caused a precipitous drop in consumer confidence in the FDA, and the food supply in general. President Obama recently signaled his intention to make food safety a signature issue of his administration, announcing the creation of a high-level Food Safety Working Group (including the head of HHS) to help him overhaul the system. Here are five questions Gov. Sebelius should consider as she prepares for the second day of her confirmation hearings on Thursday:

1. Former Secretary Tommy Thompson said that the safety of food imports used to "keep him awake at night," and he wondered aloud, ominously, "Why the terrorists have not attacked our food supply because it is so easy to do." The FDA regulates an increasingly huge volume of foods imported from ports all over the world. And we have experienced numerous problems with imports, such as melons and peppers tainted with salmonella and even pet food that was intentionally adulterated with melamine, albeit by unscrupulous manufacturers seeking to boost profits, not commit bioterrorism. How will she manage this threat and guarantee the safety of imported food?

2. The FDA has suffered a brain drain of many talented scientists, as well as suffering the loss of more than 600 inspectors during the Bush years. In addition, an FDA inspector might visit a peanut-processing facility one day, a pharmaceutical plant another day, a pacemaker factory the next. As a result, many inspectors don't get a chance to develop real expertise in the food area. What will she do to address this problem, and how will the department ensure the safety of products derived from genetically engineered animals, nanotechnology and other rapidly advancing technologies?

3. At least nine people have died and nearly 700 have been sickened from salmonella-contaminated peanut products from the Peanut Corporation of America. Investigators raced for months last year to track down the source of another salmonella outbreak that sickened more than 1,400. The infections were variously blamed on tainted tomatoes, jalapeños or serrano peppers, erasing consumer confidence in those otherwise-healthy foods and costing the industry hundreds of millions of dollars. Does Sebelius have a plan to shift the agency's focus from one that reacts to contamination after it's detected, to a posture that prevents it from happening in the first place?

4. Artificial trans fat and other common ingredients contribute to thousands of heart attacks and strokes each year. Food dyes make foods more appealing, yet they are linked to hyperactivity and behavioral problems in some young children. How will the FDA better police the ingredients and chemicals in Americans' foods?

5. Food and drugs have been combined in an uneasy regulatory marriage for more than 100 years. Some say it's time for a divorce. Food safety typically takes a back seat to drug approvals, both in terms of budget and the commissioner's time. Will the Obama administration support the creation of a new Food Safety Administration, separate from drugs but still under HHS, and headed by a food-safety expert?

Secretary-designate Sebelius has a lot on her plate, including—quite literally—what's on ours. How she addresses these questions will determine whether the food scares continue or whether confidence in the safety of our food is restored.