It’s not every day that the president nominates your son to lead a major agency. It’s even more rare to witness two senators bickering over whose state gets to brag about him.
“The senators from North Carolina and South Carolina confronted each other; they both wanted to claim Rob,” said Sarah Califf, 88, of Columbia, S.C., who traveled to Washington with her husband to see their son, Dr. Robert Califf, testify in front of a Senate panel for the top spot at the Food and Drug Administration.
“I congratulate his parents on being able to outperform the requirements for South Carolina education,” Sen. Richard Burr, R-N.C., joked after Sen. Tim Scott, R-S.C., called him out for stressing the doctor’s North Carolina ties at the confirmation hearing in November. While Columbia is his hometown, Califf has spent the past three decades at Duke University in Durham, N.C.
Califf is recognized by the Institute for Scientific Information as one of the top 10 most cited medical authors, with more than 1,200 peer-reviewed publications.
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No one can blame them – Califf, 64, has an enviable resume. The prominent cardiologist is one of the nation’s leading experts in clinical trials and one of the 10 most cited medical authors in the country. But as his confirmation vote, expected before the end of the year, draws near in the Senate, the same traits that made Califf a prolific researcher are raising concerns that he may be too close to the pharmaceutical industry he would have to regulate.
One of four siblings, Califf was born in Anderson, S.C., and moved to Columbia in elementary school. His father worked as an architect and was part of the renovation of the University of South Carolina’s historic horseshoe, the institution’s original quadrangle.
Califf’s years growing up in Columbia were defined by basketball. As captain of A.C. Flora High School’s basketball team, where his nickname was “Grin,” he led the team to the 1969 AAAA South Carolina state championship. In the summers he volunteered at a local prison by playing hoops with inmates. Even after he left Columbia and went on to get his undergraduate and medical degrees at Duke, he stayed in touch with his old team.
“Every time that Rob would come home, he and his old basketball coach would meet at a doughnut shop, not too far from our house,” his mother said.
Califf married his high school sweetheart, Lydia Carpenter, also from Columbia, and the couple raised their three children in Durham. There he founded the Duke Clinical Research Institute, which runs research trials for pharmaceutical companies and today has more than 1,200 employees.
“I don’t know if Rob ever sleeps or where he gets his energy, because he’s always on,” said Lisa Berdan, who has worked with Califf since 1987, when she was a physician’s assistant. She began working with him to get the institute off the ground and now serves as its director of global outcome of commercial mega-trials.
“He forgets nothing, but not in a negative way – although perhaps I feel bad for his children. He has this laser focus and can bring large numbers of different people together to piece together information,” Berdan said.
But that background worries some opponents to Califf’s appointment, who say he can’t be expected to effectively protect public health by regulating the same drug companies that were his former clients.
He hasn’t changed in the 30 years that I’ve known him. No matter how renowned he got or how many papers he wrote, he’s still Rob.
Lisa Berdan of the Duke Clinical Research Institute
“Now we’re asking him, after working for the pharmaceutical industry and medical device industry for decades, to lead the agency that regulates it – it’s impossible for him to shed those relationships and step into that role,” said Dr. Michael Carome, who heads Public Citizen’s Health Research Group, a Washington-based advocacy group.
“There are people who have an in-depth understanding of clinical trials and industries the FDA regulates who have far less ties to them than Dr. Califf has accumulated,” Carome said.
Not only does Califf have deeper ties to the pharmaceutical industry than any FDA commissioner in recent memory, but he also lacks a public health background, opponents to his confirmation say.
His predecessor, Dr. Margaret Hamburg, who stepped down in February after leading the agency for six years, was a New York City health commissioner and worked in the U.S. Department of Health and Human Services. The current acting commissioner, Dr. Stephen Ostroff, was deputy director at the National Center for Infectious Diseases at the Centers for Disease Control and Prevention before coming to the FDA.
Some trials run by Califf and his colleagues at Duke also are being questioned. One such case involved Xarelto, a blood-thinning drug that was flagged by FDA reviewers as biased in the company’s favor.
“What gets me the most is that he wouldn’t meet the FDA’s own standards for being on an advisory committee and now he’s gonna head the agency,” said Dr. David Gortler, an associate professor of pharmacology at Georgetown University and a former FDA senior medical officer.
“You want to take money from drug companies that’s OK, but he’s never said no and the whole point of this job at the FDA is to say no,” Gortler said.
Califf’s ties to the industry came under fire during his Senate hearing. Sen. Elizabeth Warren, D-Mass., said “it’s no secret” that he received “significant financial support from the pharmaceutical industry, both for you personally and for your research.”
When drug companies give you money they don’t just hand you a check and say good luck. There’s a visit, they take you to dinner, pay for hotels. It’s hard not to have an attachment and be friends with these people, so you have to have the capacity to say no.
Dr. David Gortler, former FDA senior medical officer
According to open payments data, Califf personally received more than $29,000 in consulting fees, meals and travel expenses in the last year. His institute receives $320 million in annual funding, and more than 63 percent of its projects are funded by pharmaceutical and medical companies, according to its annual report.
Sen. Bernie Sanders, a Vermont independent who’s seeking the Democratic presidential nomination, also questioned Califf’s background for the job.
“We need a commissioner who is going to stand up to the pharmaceutical industry and protect American consumers. You are not that person,” Sanders told him.
Califf countered that in his career he has declined to do certain trials when the companies do not meet his criteria.
“If you look at my record, you will find I have never been a proponent of lowering standards; if anything I’ve argued for raising standards,” he said.
The appointment of someone who understands drug research reflects the political issues facing the agency, including a bipartisan effort to speed up the drug approval process that coincides with Califf’s expertise. He has held the No. 2 spot in the agency as deputy commissioner for medical products and tobacco since January.
Many in the medical research community point out that the pharmaceutical industry is a major funder of research, and collaborating with it does not necessarily mean there is a conflict.
“His reputation for being a person of integrity and the scientific rigor he has insisted upon as a researcher and a physician make him uniquely qualified, and the best person to lead the FDA,” said Dr. Ellen Sigal, chair of the Friends of Cancer Research nonprofit group.
Despite the objections raised, Califf is expected to be confirmed within the next month. His parents just hope he can get to work soon.
Traveling to Washington to see the confirmation hearing “was a big deal for us, a once-in-a-lifetime event,” said his father, John Califf, 92.
“Rob really thinks that he can make a difference and we hope that everything goes well. It’s just gotten all involved with politics,” Sarah Califf said.
Robert McKinnon Califf
Hometown: Born in Anderson, S.C., grew up in Columbia, S.C.
Education: A.C. Flora High School, Columbia, S.C. (1969). Duke University, Durham, N.C. (1973). Duke University School of Medicine (1978), internal medicine residency at the University of California, San Francisco, and fellowship in cardiology at Duke University.
Family: Married to Lydia Carpenter, retired nurse, and has three children and three grandchildren.