“I want to stress that, despite my feelings about the FDA, I don’t think individual FDA bureaucrats, or even necessarily the FDA director, consistently make stupid mistakes. I think that given their mandate – approve drugs that definitely work, reject ones that are unsafe/ineffective, expect people to freak out and demand your head if any unsafe/ineffective drug gets through, nobody will at all no matter how many lifesaving treatments you delay or stifle outright…
…we’re open to paying limitless costs, as long as it lets us avoid a very specific kind of scandal which the media will turn into 24-7 humiliation of whoever let it happen. If I were a politician operating under these constraints, I’m not sure I could do any better.”
You could apply the same to any bureaucracy. I know from personal experience that the incentive structure within bureaucracies can create perverse outcomes, even in less media-obsessed departments. Individual risk aversion (i.e. self preservation) tends to dominate all else.