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RENEE MONTAGNE, host:

President Bush has nominated Andrew von Eschenbach to head the Food and Drug Administration. Von Eschenbach, who's still technically head of the National Cancer Institute, has been leading the FDA on an acting basis since last fall.

But as NPR's Julie Rovner reports, his formal promotion is anything but assured.

JULIE ROVNER reporting:

Von Eschenbach is a Bush family friend, and the former head of the M.D. Anderson Cancer Center in Houston. As a cancer expert, he's uniquely qualified to head the FDA, says Margaret Foti, who heads the American Association for Cancer research.

Ms. MARGARET FOTI (CEO, American Association for Cancer Research): The science is becoming so complex, and with molecular-targeted therapies, it's increasingly important that science be integrated into the process of drug approvals.

ROVNER: But within minutes of the White House announcement, von Eschenbach's nomination ran into a political buzz saw over something far removed from the approval of cancer drugs. After three years, the FDA still hasn't ruled on a request to allow the morning-after emergency contraceptive pill, called Plan B, to be sold without a doctor's prescription. And backers of that switch, including Washington Democratic Senator Patty Murray, say that until there is a decision, there won't be a new FDA commissioner.

Senator PATTY MURRAY (Democrat, Washington): This time around, we are being very firm. The FDA needs to follow its own rules and make a decision, yes or no, on Plan B. And their credibility is at stake. We will hold up this nomination until that decision is made.

ROVNER: If that sounds like the same threat Murray made a year ago, that's because it is. She and New York Democrat Hillary Rodham Clinton blocked Senate confirmation of then Deputy FDA Commissioner Lester Crawford for several months. They finally brokered a compromise with Health and Human Services Secretary Mike Leavitt last summer, to trade Crawford's confirmation for an up or down decision on Plan B--or so they thought.

Sen. MURRAY: We were told in a written letter by Secretary Leavitt that a decision was going to be made. And as soon as the nomination, we said fine, then we'll make a deal. It goes through. We were found out that they weren't going to make a decision.

ROVNER: Instead, Crawford announced another delay, that the agency would ask the public to comment on the question of whether to allow over-the-counter sales to women 17 or older, and prescription sales to younger teenagers. Kirsten Moore, of the Reproductive Health Technologies Project, says that violated more than just the spirit of the deal.

Ms. KIRSTEN MOORE (President and CEO, Reproductive Health Technologies Project): The FDA took a quote-unquote, "action" that we all regard as just pure political trickery by saying, oh, we can't rule on this application yet. We have to ask the public whether we should propose a regulatory rule-making process, which was a de facto indefinite delay.

ROVNER: The action led to the resignation of the FDA's top woman's health official, who said the decision was motivated by politics, not science. Some abortion opponents say Plan B, which the FDA classifies as a contraceptive, can work as a very early abortion by preventing the implantation of a fertilized egg. Crawford announced his resignation only a few weeks later under circumstances that still haven't been fully explained.

But Moore says that as acting commissioner, von Eschenbach has the power to make good on the original deal.

Ms. MOORE: So, Dr. von Eschenbach could at any moment say, you know, to restore the integrity and independence of this agency, I am going to dispense with the rule-making and actually go along with what Crawford said on August 26th, which is the FDA has found this product safe for over-the-counter use for women 17 and older.

ROVNER: But even if von Eschenbach's nomination is blocked indefinitely, it will be mostly status quo for the FDA under President Bush. In the five years he's been in office, the agency has had a Senate-confirmed commissioner for only 18 months.

Julie Rovner, NPR News, Washington.

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