Ex FDA Commissioner Robert Califf on FDA Authority, Politics, and the Health Crisis No One Wants to Name

Episode Description

In this episode, Darshan Kulkarni sits down with former FDA Commissioner Robert Califf for a wide-ranging conversation on FDA authority, politics, guidance, and public trust. From the loss of Chevron deference to the role of FDA as a referee, Dr. Califf explains how regulation really works and why wealth inequality has become the most serious health issue in the United States.

Episode Summary

What does it really take to run the FDA, and how political should the agency be? Former FDA Commissioner Robert Califf reflects on his path to the role, the skills a commissioner actually needs, and why FDA must act as an impartial referee rather than a political actor. The conversation explores guidance versus regulation, the loss of Chevron deference, industry expertise, the revolving door debate, and how social determinants of health shape outcomes far more than medicine alone. A candid, opinionated look at regulation from someone who has seen every side of it.

Key Topics Discussed

• How Dr. Califf became FDA Commissioner twice
• Why FDA should act as a referee, not a combatant
• Guidance documents and how they really function
• Politics, policy, and product level decision making
• Preparing for the loss of Chevron deference
• Wealth inequality as the biggest health problem in the U.S.
• Social determinants of health and FDA’s role
• Generic drugs, tobacco, and public health impact
• Digital health hype versus real-world impact
• The FDA–industry revolving door debate

Why This Episode Matters

As courts, politicians, and industry challenge agency authority, understanding how FDA decision making actually works matters more than ever. This episode explains what regulation can and cannot do, where political pressure becomes dangerous, and why ignoring inequality undermines health outcomes no matter how advanced the science becomes.

Guest

Robert Califf
Former Commissioner, U.S. Food and Drug Administration
Instructor in Medicine, Duke University

Dr. Califf has served twice as FDA Commissioner and brings decades of experience across clinical medicine, academia, industry, and government.

Host

Darshan Kulkarni
Founder, The Kulkarni Law Firm
Host, DarshanTalks

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