The Food and Drug Administration

At the turn of the twentieth century, Americans had little way of knowing whether the food on their tables or the medicine in their cabinets was safe. Patent medicines laced with narcotics were sold as cures, and Upton Sinclair's 1906 novel The Jungle exposed the filth of the meatpacking industry so vividly that it turned the public's stomach. The outcry helped push the Pure Food and Drug Act through Congress that same year, creating the federal authority that grew into the Food and Drug Administration.

Disaster repeatedly drove the agency's expansion. In 1937 a medicine sweetened with a toxic solvent, the so-called elixir sulfanilamide, killed more than a hundred people, most of them children, and the horror produced the Food, Drug, and Cosmetic Act of 1938, which required that drugs be proven safe before they could be sold. Decades later an FDA reviewer's refusal to approve the sedative thalidomide spared the United States the epidemic of birth defects it caused elsewhere.

The FDA became the gatekeeper of American medicine, deciding which drugs, vaccines, and medical devices could reach the public and setting the rules for the safety of the food supply. That power placed it at the center of hard trade-offs between caution and speed — pressured to move faster during the AIDS crisis and the COVID-19 pandemic, and criticized whenever an approved product later caused harm.

Guarding a vast share of what Americans eat and take into their bodies, the Food and Drug Administration embodies the modern regulatory bargain: a government promise that the products of the marketplace have been tested and judged safe. Its history, written in the aftermath of scandals and tragedies, traces the nation's long effort to make its food and medicine trustworthy.