The nomination of Dr. Lester Crawford, Acting Commissioner of the FDA, for permanent appointment is scheduled for today. This also makes possible the activation of threatened “holds” on his nomination by 3 Senators. There is a great deal of concern over his willingness to act responsibly on women’s health and contraception, and over his refusal to do so so far.

Senators Patty Murray and Hillary Clinton, both Democrats, have announced they will block his nomination until the FDA agrees to process the pending application for over-the-counter sales authorization of “Plan B” emergency contraception. The application was initially approved 23-4 by the FDA’s safety committees, then rejected by an FDA administrator on political grounds; a revised application was submitted and has not been acted on. The FDA ignored its own deadline, in January of this year, for ruling on the revised application. Crawford has repeatedly been pressed to act on the application or announce a date for a final decision, and has flatly refused to respond. Murray and Clinton have stated that they will hold Crawford’s nomination until he agrees simply to process an application that has been in the works for years, and has been stalled completely for more than a year after approval by the appropriate safety panel - but that they are not demanding a specific decision one way or the other.

At the same time, Republican Senator Tom Coburn has announced that he will hold the application until the FDA develops regulations in keeping with a 2000 law requiring warnings on condoms that they do not provide absolute protection against sexually transmitted diseases. (Note that Coburn is not merely holding the application to force movement; he is holding it to force the particular action he favors.)

Actual controversy over Crawford, outside these issues, seems to be minimal. The FDA has been criticized under his tenure for bungling the flu-vaccine program, but otherwise the contraception issues are the only major controversies. Although Crawford is the first non-MD to be nominated to his post (he is a veterinarian with a PhD in pharmacology), his scholarly credentials are strong: he is a member of the National Academy of Sciences Institute of Medicine and a Fellow of the Royal Veterinary Society, both prestigious election-only scholarly organizations. His politics are what you would expect: he has been accused of too-close ties to the pharmaceutical industry, and he does frequently make speaking appearances at pharma conferences. Crawford gave the maximum $2,000 to George Bush in the 2004 campaign, and $500 in 2000, as well as $6,600 to GOP campaign funds since 1995 and a small contribution in 1991 to the “Food Products Association PAC”. These are hardly admirable but par for the course in the GOP pay-to-play political machine. He was recently accused of having an affair with a female subordinate, which he and she described as merely a “fatherly” mentor relationship; there was little evidence other than that they spent time together, and he was cleared upon investigation. Overall, his background is GOP/business leaning but otherwise unexceptional, and his technical background is acceptable for the position he is appointed to. The few controversies he personally has been involved in have not been substantial. He’s certainly a much stronger candidate for the FDA than Bush’s judges - some of them frankly hacks - were for the federal courts.

The pro-choice community is understandably concerned about Crawford, however. He has been acting Commissioner for over a year, during which time both the almost-unprecedented rejection of the safety panel recommendation on Plan B was implemented (and which Crawford could have overruled, but did not), and the blatant stalling on the revised application has taken place. And Crawford has pointedly refused to do anything about the situation. He does not seem to have a history as a wingnutter, but his actions in office have made him their water-carrier.

Planned Parenthood issued a critical report on Crawford today, noting his support from anti-choice Bush appointees and his failure to move on Plan B, as well as a critical press release arguing that “questions and doubt surrounding [Crawford’s] track record at the FDA disqualify him for such an important job.” Pseudo-Adrienne at Alas, a Blog, agrees, referring to Crawford as an “anti-choice lackey” and noting the horrendous track record of the Bush administration and the GOP on reproductive autonomy and women’s issues. These concerns are more than justified - and Crawford, who probably wouldn’t have qualified to be called an “anti-choice lackey” as much as two years ago, more than deserves that appellation for his actions since.

At the same time, I am hesitant to react quite as strongly. The real issue with Crawford is “only” (and I say that with no intent to minimize it) his behavior over Plan B. Outside that, he is probably as reasonable a figure as we are likely to get from an administration that is almost deranged in its assault on science and women’s health. (Note that Bush’s original choice for Surgeon General was Dr. David Hager - a fundamentalist loon who prescribes Bible verses for PMS and who wrote the secret “minority report” that triggered the FDA’s rejection of its own safety committee’s recommendation on Plan B! Crawford - merely a conservative but a real scientist and apparently not a religious nut - is a gift by comparison.) If he had moved the Plan B application in a responsible manner, there would be no objection to his appointment. If he moved it now, even, most objections would evaporate. (In the same press release in which Planned Parenthood Interim President Karen Pear stated that Crawford’s past actions “disqualify” him from appointment, she also stated that “Crawford should rule on emergency contraception . . . before the Senate votes on his nomination” - which seems an ambivalent form of opposition, at least.) The real fear in that case is that he would pull some other anti-choice rabbit out of the hat after confirmation. (If this is the way he behaves when two Senators are openly threatening him, how will he behave when he’s beyond their reach?)Yet these concerns - again except for the Plan B issue - are laregly speculative. If you read the PP statements carefully, you see they focus almost entirely on the Plan B problem and Crawford’s general association with the right wing - not on anything in particular he has done other than Plan B. I’m simply not convinced his record overall is as bad as some critics have claimed, even though his record on one particular issue is very bad indeed.

So, I too am very concerned about Crawford, not only because of his irresponsible behavior over Plan B but because of his penchant for sticking his finger in the eye of the pro-choice community by refusing even to respond to their concerns by agreeing to do his own job properly at any point in the foreseeable future. And I am concerned that the behavior he has exhibited will only get worse when he is off the leash. At the same time, I recognize that his overall track record is moderate, and he is a far better candidate than we might have gotten stuck with. I wonder if he is not secretly grandstanding for the right wing simply to get the job, after which he will no longer feel the need to respond to their concerns. That is, he may feel he has to put up a bluff front against choice until he is confirmed, to keep the winger base in line, at which point he can start acting like a scientist again. Hard to say who, exactly, he is jerking here. And therein lies the rub: we don’t know if he will get worse after he’s nominated, or better, and until we know we can’t afford to have him in office. Right now he looks like the wingers’ candidate more than anything else - which is good reason to fear him - and he is obviously deliberately making himself look that way by refusing to move on Plan B or even to hint, not say, that he will do so soon - which is an even better reason to fear him. But I don’t get a winger vibe off him - which may be the scariest thing of all, or may be the good news that he can’t allow himself to say out loud just yet.