JAMA Forum: Notes on the Presidential Transition

Joshua M. Sharfstein, MD

Joshua M. Sharfstein, MD

After a difficult and divisive campaign, the election of Donald Trump and Michael Pence has stunned many in the fields of medicine and public health who had hoped for a different outcome. Eight years ago, I was part of the transition after the election of President Barack Obama. Our excitement about what was now possible for the country was tempered with a recognition that others saw matters quite differently. This experience informs several thoughts about the current transition.

First, the incoming administration should reach out to understand the issues and concerns of those with whom it may disagree politically and to find areas of common ground.

In 2008, my team’s task was to write a transition report for the US Food and Drug Administration (FDA). We did not proceed in isolation. Over the course of several weeks, we met with dozens of organizations engaged with the agency, without respect to whom they might have supported in the election. Indeed, we learned through this process that although some of the more traditional Democratic Party constituencies were frustrated with the agency, so too were many conservative agency observers and industry representatives. We saw that the need for improved agency performance cut across the partisan divide. As a result, some of the agency’s first efforts in the Obama administration aimed at improving transparency and performance management.

Second, those of us who anticipate disagreeing with the new administration on a number of policies should nonetheless participate in opportunities for dialogue.

I found that the relationships that began during the transition period—even with those whose political views widely diverged from my own—helped in many ways during my 2 years at the agency. Calls to those contacts led to a joint press conference with dietary supplement companies to warn consumers about contaminated products on the market and to engagement with associations of device companies to find more effective pathways for approval of needed therapies. I also appreciated the openness and graciousness of former Bush Administration officials who were available for questions and advice.

It is even possible that constructive engagement can lead to new positions. During an HIV outbreak in Indiana, for example, the vice president–elect eventually recognized the need for needle exchange, his support helped change federal policy.

Third, disagreements with administration appointees should be framed around policy and action and not devolve into personal attacks.

As a political appointee, I was attacked on extremist websites and even found my name on lists of appointees sorted by religion. Over the course of my time at FDA, I received a great number of vicious emails, which foreshadowed, at least for me, the hatred that surfaced over social media during this election season. It will not be possible to recruit anyone reasonable to public service if we cannot find a more civil way to engage with one another.

Fourth, the new administration could take a very positive step by appointing respected physicians and other health professionals to the transition team to engage with federal scientists and to build bridges with the medical and public health communities.

One of the first questions I received during the transition was whether the new administration would respect the views of agency staff on key scientific questions. Providing this reassurance was essential to my ability to provide leadership to the agency. There is an acute need for such reassurance today at our nation’s science-based agencies. The current president-elect endorsed misleading information about vaccine safety in a Presidential debate and has called climate change a “hoax.” The vice president–elect has exaggerated the adverse effects of mifepristone, advocated public support for discreditedconversion therapy” to change sexual orientation, and written that “despite the hysteria from the political class and the media, smoking doesn’t kill.”

The stunned phase for many in medicine and public health will soon yield to determination and engagement. Setting the right tone early is critically important for an administration that aspires to represent the entire nation.


About the author: Joshua M. Sharfstein, MD, is Associate Dean for Public Health Practice and Training at the Johns Hopkins Bloomberg School of Public Health. He previously served as Secretary of the Maryland Department of Health and Mental Hygiene, as the Principal Deputy Commissioner of the US Food and Drug Administration, and as Commissioner of Health for Baltimore. He is a consultant for Audacious Inquiry, a company that has provided technology services and other support to Maryland’s Health Information Exchange. A pediatrician, he lives with his family in Baltimore.

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