WHEN the names of potential candidates for the new head of America’s regulatory agency for drugs, the Food and Drug Administration (FDA), were first circulated, you could almost hear the sound of jaws hitting desks throughout the pharmaceuticals industry. One contender was Jim O’Neill, head of Mithril Capital Management, an investment firm, who is such a libertarian that he doesn’t think the FDA should insist that medicines have to work. Another was Balaji Srinivasan, an entrepreneur from Silicon Valley, who thought roughly the same.

Removing such a core regulation might seem appealing to business. In fact, the idea of not approving drugs for efficacy is as unwelcome to the industry as it is to doctors and patients. It spends billions of dollars every year on research to deliver better treatments; this would be impossible to justify if drugs had merely to be safe. Patients, meanwhile, would face the awful prospect of having to identify which life-saving medications worked.

So, when the name of the FDA nominee was announced in March, there was widespread relief. Scott Gottlieb (pictured) a resident fellow at the American Enterprise Institute, a conservative think-tank, is qualified, experienced and knowledgeable. He is a doctor, has been a policy adviser and has also worked at the FDA before, as the deputy commissioner for medical and scientific affairs.

Some reckon that he has too many ties to the drug industry: he is on the boards of five health companies, for example, and does investing and consulting work. Yet his inside knowledge should also give him an edge when dealing with its tricks. His main priority, people in the industry reckon, will be to improve and enhance the FDA, not to dismember it.

Mr Gottlieb will certainly wish to find more ways of speeding drug approvals. The agency has done much on this front already. Yet inconsistency continues: some divisions of the FDA respond to routine inquiries from companies in a few weeks; others take three months. Mr Gottlieb has also criticised the agency for having a culture that values “excessive desire for certainty”. Attempts to change this will elicit criticism that patient safety is in jeopardy. Yet in some cases it is clear that the demand for ever-larger clinical trials of new drugs has done little for safety, raised costs and rewarded chiefly the very largest companies that can afford to run them.

One path will be to advance the trend for gathering evidence from trials that take place in the real world, not under tightly controlled conditions. GlaxoSmithKline, a British pharmaceutical group, recently completed the world’s first such test for a drug, Relvar, which treats asthma and chronic obstructive pulmonary disease. The four-year trial was conducted by monitoring thousands of patients’ electronic medical records.

Generic drugs is another area where Mr Gottlieb has signalled his views. In a commentary for the Wall Street Journal in August, he criticised the policymaking that had kept some generic medicines off the market, raising prices. He may want to tackle the rising cost and complexity of filing applications to market generic drugs—the problem that allowed Martin Shkreli, a controversial entrepreneur, to raise the price of Daraprim, an anti-parasitic drug, by 5,000% in 2015, causing fury.

The FDA also needs to run faster to keep abreast of innovation. Sudip Parikh, a policy adviser at the Drug Information Association, another think-tank, says the rate of change means that decades-old rules and regulations may not function well for new treatments. Some rules will be too restrictive, others too permissive. On the one hand, for example, more should be done to allow digital health-care products to escape the grasp of the FDA; on the other, the use of stem cells should face more scrutiny. Many clinics offer unregulated stem-cell treatments because of a loophole in the law. Three people were recently found to have been blinded by such treatments.

Mr Gottlieb still has to gain approval from the Senate, which will examine his industry ties and his zeal for deregulation. If confirmed, he may find that the biggest challenge is managerial. The FDA is a complicated agency of 17,000 staff and Mr Gottlieb may have little financial room for manoeuvre: under Donald Trump and a Republican Congress, the hope of more funds is slim. Mr Parikh says that if the FDA is to be more efficient and its regulations less burdensome, it still needs the right number of scientists and inspectors. Mr Gottlieb may have the technical ability to administer the correct medicine to the agency. But whether the government will foot the bill is another matter.