Public health and the federal advisory committee act at 40

This year marks the 40th anniversary of the implementation of the Federal Advisory Committee Act (FACA), the legislation that governs the design and operations of most outside advice to the U.S. government. The activities of scientific advisory committees are among the most visible aspects of the government's regulation and promotion of pharmaceuticals, vaccines, and related products. The substantial attention given to the deliberations and recommendations of groups at the FDA, the CDC, and elsewhere belies their formal roles limited to providing only non-binding guidance to federal health agencies. As part of the Affordable Care Act, outside experts will now have even greater influence on health care and public health in the United States, directly shaping government decision-making regarding the effectiveness and value of preventive and therapeutic interventions. This paper explores the history, legacy, and enduring impact of FACA on the government's regulation and promotion of public health. It highlights key moments in the evolution of what was initially an innovative and controversial plan to create formal mechanisms for incorporating outside experts in the day-to-day work of federal agencies responsible for public health. It also historicizes perennial concerns regarding alleged conflicts-of-interest among advisors and other threats to their independence. Forty years after the introduction of FACA, advisory committees are increasingly prominent and influential, playing critical roles in the translation of evidence into federal public health regulation and policy. An account of the past, present, and future of this system is therefore relevant to anyone active in public health research or practice.