Breaking It Down to Build It Up: Understanding Trust in the US Food and Drug Administration
Friday, October 13, 2023
3:15 PM – 4:30 PM ET
Location: Iron (Fourth Floor)
Introduction: In this empirical bioethics study, we elicited perspectives from the public on its trust in the US Food and Drug Administration (FDA). Understanding the roots of FDA mistrust is a public health priority and vital to strengthening confidence in FDA decisions and improving health, particularly during public health emergencies.
Methods: We developed four axes of trust in regulatory institutions via a normative analysis of ethics literature: competence and effectiveness; commitment to acting in the best interests of the American public; abiding by rules and regulations; and expertise in health, science, and medicine. We then designed a novel survey, which we distributed in October 2022 to a nationally representative, cross-sectional sample of US consumers. Respondents rated their confidence on each axis using a 1-4 scale.
Results: Among 2,021 respondents, the mean trust score was 2.87 (standard deviation 0.79). On ordinal logistic regression, covariates associated with trust that the FDA acts in the public’s interests were: attention to media on health (β=0.349) and having children younger than 18 (β=0.385); female gender (β =-0.321) and conservative political views (β =-0.251) were associated with less trust. Findings were similar for these groups’ views on trust in abiding by rules and regulations. There was little significant variation in trust of FDA expertise.
Conclusions: This study demonstrated a new approach to understanding public perceptions of trust by breaking down the complex concept into four axes. Effective communication and stakeholder engagement to build trust should be responsive to the group and relevant component of trust.
Daniel Carpenter, PhD – Department of Government, Faculty of Arts and Sciences – Harvard University; Anushka Bhaskar – Harvard College – Harvard University; Aaron Kesselheim – Division of Pharmacoepidemiology and Pharmacoeconomics, Program On Regulation, Therapeutics, And Law (PORTAL), Department of Medicine – Brigham and Women's Hospital; William Feldman – Division of Pharmacoepidemiology and Pharmacoeconomics, Program On Regulation, Therapeutics, And Law (PORTAL), Department of Medicine – Brigham and Women's Hospital