As Scott Gottlieb addressed the World Health Care Congress in his first speech since stepping down from his role as Food and Drug Administration commissioner, an attendee leveled a question at him.
'If you could do it all over again, how would you have avoided the opioid epidemic?"
It was a question Gottlieb said he'd already thought long and hard about, particularly as he shaped the response to teen vaping that became a priority project for him in the latter part of his tenure.
He'd been at the FDA in 2002 and again starting in 2005 before later returning as commissioner. During that first stint, the agency didn't realize the scope of the U.S. opioid problem, but by his second tour, they did.
"The lesson there for me coming into this job was when you are facing a potential public health crisis, you have to intervene aggressively early enough to try to forestall the ensuing crisis," Gottlieb said. "That's why we intervened aggressively with respect to the vaping. You get criticized for that and you don't want to be wrong. It's easy to miscalibrate and be too heavy-handed up front."
But it's also easy for a public health crisis to get out of hand while trying to calibrate the appropriate response, he said.
"We were always one step behind with the opioid crisis. I didn't want to be one step behind with the crisis of youth nicotine addiction from e-cigarettes," Gottlieb said. "That was very much on my mind as I thought about what we did with respect to youth vaping."
Under Gottlieb's leadership, the FDA made high-profile efforts to highlight the problem of youth vaping and has announced plans to change the way it regulates e-cigarettes including banning all e-cigarette flavors.