The other shoe has dropped at CDC. Yesterday Obama named a new CDC Director, New York City Health Commissioner Dr. Thomas R. Frieden, an infectious disease specialist (drug resistant TB) who worked at CDC prior to going to New York in 2002. Frieden has long been rumored to be at the top of Obama’s short list, so this wasn’t a surprise, but the impressive performance on the swine flu outbreak of Richard Besser as Acting Director suggested to some he might get the job. Besser may be relieved he didn’t:
At the C.D.C., [Frieden] will inherit a host of immediate and long-term problems, including a looming decision about whether and how to produce a swine flu vaccine. Health experts say the agency must resolve serious morale and organizational issues even as the administration struggles to overhaul the nation?s health care system. (Gardiner Harris and Anemona Hartocollis, New York Times)
Problems, indeed. Trying to right the morale and oganizational results of the previous Director, the one-person wrecking ball Dr. Julie Gerberding, will be a challenge. Gerberding was a sycophant unlikely to do anything bold. Frieden is unlikely not to do something bold. In New York he has aggressively taken on some major public health issues like smoking (a pack of cigarettes in NYC goes for about $9 — if you can find a place to smoke them after smoking was banned in workplaces — forced restaurants to disclose nutritional information and banned cooking with transfats in restaurants.
Dr. Frieden has a history of focusing on health threats that endanger large numbers of people, sometimes at the expense of more popular causes. This put him in marked opposition to the Bush administration, which spent more than $50 billion on bioterrorism initiatives and paid far less attention to problems like smoking.
Dr. Alfred Sommer, emeritus dean of the Johns Hopkins Bloomberg School of Public Health, who was on the team that recommended Dr. Frieden as New York?s health chief in 2002, recalled interviewing him shortly after the Sept. 11 attacks. Dr. Frieden had flown to New York from India, where he was living and working on tuberculosis control.
Before he left India, he was asked about his top priority, Dr. Sommer said. ?Oh, well, that?s easy, Al,? Dr. Sommer recalled him replying. ?Tobacco. Tobacco is killing more people, and that?s my top priority.?
?Tom, I don?t disagree that tobacco is a real scourge, but have you heard of 9/11?? Dr. Sommer said he countered.
?Of course I know about that, but bioterrorists are not going to kill more New Yorkers than tobacco is,? Dr. Frieden said. (New York Times)
Public health advocates are singing his praises, but no recommendation is higher than the opposition of the truly odious Center for Consumer Freedom:
The Center for Consumer Freedom, a group funded by restaurants and food companies, put out a statement decrying his selection, saying he was “an overzealous activist who doesn’t give any consideration to the importance of personal responsibility or privacy.” (David Caruso, AP)
I can’t argue with his overall public health priorities. But what he will do at CDC is another question. Or at least it should be. CDC is too small to be the “all things health agency.” Its expertise (before Gerberding side tracked it) was in investigating disease outbreaks and hazards from infectious agents and chemicals. Tobacco is a consumer product best left to the FDA. Obesity is a major problem but should be the overall responsibility of CDC’s parent Department, Health and Human Services. HIV-AIDS and TB should remain part of the CDC portfolio.
Like Besser, Frieden has been in the spotlight around swine flu. I’ve seen him nodding in agreement as Mayor Bloomberg tried to bring calm in the worst way: by constantly minimizing the seriousness of the illness. Yesterday I saw Frieden the same thing. Flu is always a potentially serious disease. This was a teachable moment for seasonal flu that was missed. Besser didn’t engage in this, to his credit.
Still, we remain optimistic, but the jury is still out. CDC took on (and carried) a lot of water during the Bush years. It remains to be seen if Frieden will activate the sump pumps or just try to turn a foundering boat in his own preferred direction.
It won’t be easy.