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Life expectancy in the U.S. is between three and five years lower than the average in other high-income countries — and the gap comes in part from misinformation, Food and Drug Administration Commissioner Dr. Robert Califf said. "It's looking worse, not better, over the last several years," Califf told CNBC in an interview Thursday at the agency's headquarters in Silver Spring, Maryland. It's not just the Covid pandemic contributing to the decline, he said, pointing out the gap with peer nations is widening. Califf said a new factor has joined the list of known causes of life expectancy disparities like race, ethnicity, income and education: living in a rural area, where he noted that people are exposed to different information sources. "Why aren't we using medical products as effectively and efficiently as our peer countries? A lot of it has to do with choices that people make because of the things that influenced their thinking," Califf said. The commissioner is just more than a year into his second turn at the top of the agency, one of only two top leaders of the FDA to return to the job for a separate second term. Since he left in January 2017, at the end of the Obama administration, the pandemic and rising political tensions have made combating misinformation even more complicated — and led Califf to make it one of his top priorities at the agency. "You think about the impact of a single person reaching a billion people on the internet all over the world, we just weren't prepared for that," Califf said. "We don't have societal rules that are adjudicating it quite right, and I think it's impacting our health in very detrimental ways." He said there's a need for better regulation, including "specific authorities at FDA, FTC and other areas" to root out misinformation.

Food and Drug Administration Commissioner Robert Califf testifies before a Senate Health, Education, Labor, and Pensions hearing to examine an update on the ongoing Federal response to COVID-19, at the U.S. Capitol in Washington, U.S., June 16, 2022. Kevin Lamarque | Reuters

A bigger bully pulpit

Califf spoke to CNBC a day before a federal judge suspended the FDA's approval of abortion pill mifepristone, a decision that could have broad implications both for abortion access and regulation of future drugs. The FDA commissioner spoke about multiple topics including efforts to cut drug prices, a priority for the Biden administration and lawmakers from both parties in Congress. Califf noted that while the FDA doesn't play a direct role in pricing medicines, it has tools to influence drug costs. "We have an indirect role, and we have a bully pulpit to make the public aware and put some pressure on," he said, noting that he has previously said drug prices are set by "what you can get minus the shame factor." Califf recently wielded some of that power after the agency approved the first over-the-counter version of Narcan, an opioid overdose reversal drug. He tweeted that the FDA encouraged the manufacturer, Emergent BioSolutions , to make the drug available "as soon as possible and at an affordable price." He plans to use that bully pulpit in a bigger way to rein in drugmakers on pricing — while trying to walk a fine line with checking a pharmaceutical industry that he noted produces lifesaving products from vaccines to statins. "There's a balance here that we have to reach," he said. "And in some areas we're not in the right balance right now."

Incentives for research

Califf is also encouraging the drug industry to consider investments in neglected areas of research. He spoke with CNBC the day the agency withdrew approval of the only available drug for preterm birth, Makena, after a confirmatory trial didn't verify its clinical benefit. "The data were quite clear," he said. "But we should be reminded that we're seeing an explosion of maternal mortality in this country and a lot of premature delivery leading to prolonged illness and neonatal intensive care unit stays for infants." "We need effective treatments," Califf said. "And the industry is not producing much in the way of effective treatment." He also pointed to tobacco cessation products and nonaddictive medicines for chronic pain as areas "where the industry is not really producing." Incentives put in place by the FDA and others in areas like cancer and rare diseases have revolutionized drug development for those conditions, and similar efforts could help in the development of other treatments, Califf said. "Now we've got to go back to these other areas and figure out what to do to stimulate activity," he said.

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