Effect Measure

CDC happenings

Things have been quiet at CDC but apparently they have been changing. First, Dr. Richard Besser, who acquitted himself ably as Acting Director after January 20 until early June when Obama’s new appointment, Dr. Thomas Frieden took over, has decided to leave CDC for television. Yes, television. Many at CDC will be sorry to see him leave. He was “the people’s choice” for new Director, as one old CDC hand put it. I had heard that he had once had a TV show in California prior to his CDC days and he’s obviously telegenic, articulate and knowledgeable. He will be joining ABC News as its senior health and medical editor. ABC says it is expanding its coverage, but realistically is probably looking to the day when its well respected Chief Medical Editor, Dr. Tim Johnson, retires. Johnson has not announced any intention to retire, but he is 73 (he is also an extremely nice person; I have been interviewed by him a couple of times and he never fails to impress). CDC’s loss is ABC’s gain. Besser’s position as director of the Coordinating Office for Terrorism Preparedness and Emergency Response (which handles pandemic flu), will be taken over by another experienced CDC professional, (Dr.) Dan Sosin. People who have worked with him describe Sosin with words like dedicated, smart, thoughtful, conscientious and a nice guy. I heard the same things about Besser, so maybe it’s a good omen.

The other big news is one that we have been expecting. The New Director (Frieden) is starting to dismantle the bloated administrative structure created by the Old Director (Gerberding). We’ve been expecting this for two reasons. First, some kind of reorganization seems to be de rigueur when a new Director takes over. But Gerberding took it to extremes and it was wildly unpopular among CDC folks. One of Gerberding org chart boxes was something called a Coordinating Center. They will be no more. Frieden believes the structure was bad for CDC. Here’s some of a memo he sent to select CDC employees announcing the change:

I have consistently heard concerns about the structure of the organization, generally, and the Coordinating Centers, specifically. While the structural issues are of concern, I also have heard from many about their respect and appreciation of the expertise and dedication of the Coordinating Centers? staff. CDC?s current organizational structure is not best suited to meet the agency?s mission. We must capitalize on all of our available assets?people, skills, and programs. Based on this information, I have made initial decisions. The first was to establish the Organizational Improvement team. The second relates to my intent to remove the Coordinating Centers from CDC?s structure. (Memo from Thomas R.Frieden, August 4, 2009).

Interestingly, Besser was a Coordinating Center Director and now Sosin is, so where that will leave him in the org chart I don’t know. Taking a look at the unofficial CDC blog, CDC Chatter, shows both relief about the end of the bad old Gerberding days, coupled with considerable cynicism. The Coordinating Centers will not be mourned, but there was a distinct opinion among many that the layers of bureaucracy spawned with them won’t die with them.

Whatever the outcome, there is no return to the CDC of old. The world has changed and CDC has to change with it. A lot will depend on Frieden’s management style. Gerberding’s was a textbook case in how not to do it and she was a political sycophant on top of it. She didn’t fight effectively (if she fought at all) for either public health or CDC in the Bush administration. That was her biggest sin in my book. But then I don’t work at CDC and didn’t have to deal with the managerial nonsense either. CDC lost a lot of scientific talent in those years and the damage will take a long time to repair. Can Frieden do it?

I don’t know him. From what I’ve heard he is a very different person than Gerberding and the agency was facing a rank and file revolt at the end of the Gerberding era. Besser seemed to be making headway healing the wounds. Frieden has been described an intense and “data driven” scientist. Once he is convinced that the science says something, he is a pit bull in getting it implemented. He is not considered a “people person.” That suggests he may be lacking in some political skills that would come in handy, but on the plus side it’s nice to have a reality based (and not a political) person running the show. He is well known in public health circles and has had a good relationship with Peggy Hamburg, the new FDA chief, which will be helpful. He also knows local public health.

But being a data driven pit bull may not be the best thing, either. Unless it’s an emergency, your scientific judgment has to be correct before you go all out. There is always uncertainty and complete commitment to something can sometimes lead to policy decisions that are less than optimal, such as dedicating too much resource to things you now for sure while not enough to things for which much uncertainty remains but for which a timely investment is important.

It is also not the best listening position. There’s a lot of listening that needs to be done at CDC these days. And the listening will have to be done in the midst of the thunder and tumult of a looming flu pandemic occurring just when state and local public health are taking a huge economic hit from cash strapped state governments.

A tough job. Frieden is going to have his hands full. I wish him luck. Because if he succeeds, so do we.


  1. #1 Mary
    August 10, 2009

    Off topic, but…
    Could you or have you commented on L. Altman’s H1N1 articles in the NY Times? There’s a new article today that frequently quotes one expert, Dr. Wenzel, about observed lack of fever in H1N1, without also commenting that fever is seen in the majority (I believe) of confirmed US cases. This is Altman’s second article about fever and H1N1 that does not cite other experts or CDC data that are in conflict with Dr. Wenzel’s observations. I’m sure there are a variety of detection/classification/observation bias type issues as well as differences between infections and individuals that might explain this conflict. I wish the author were more careful with his reporting.
    Thanks for all your excellent writing on H1N1 and other public health topics.

  2. #2 revere
    August 10, 2009

    Mary: We did post on it the first time (http://scienceblogs.com/effectmeasure/2009/05/swine_flu_is_there_something_u.php). I believe CDC says anywhere from 10% to 40% of cases don’t have fever. That’s not just swine flu. That’s more or less “normal” for flu.

  3. #3 Matthew Cline
    August 10, 2009

    This is really off-topic, but do you know where I could find online medical texts on the effects of breast milk antibodies in humans? Googling brings up a mixture of advice to parents and scientific papers covering very narrow topics (though this article on how milk antibodies aren’t absorbed into the blood was useful). A PubMed search brought up 2691 results, which is way too much for me to wade through.

  4. #4 Phillip Huggan
    August 11, 2009

    As a genetic engineering library is built over decades, sensors and social distancing will have to keep pace.

    Designing genetic engineering machines to be as tamperproof as possible should be a good security precaution. If you can prevent outside hackers from accessing the alpha-numeric interface the only biosecurity risk is the machine operator.
    Cameras should help. In decades there may be mecha-insects and nearly invisible piezo-electric actuators used by spies to steal trade secrets, including from CDC. Maybe Boeing or whoever can make tamperproof panels for the machines, probably like ATMs and Slot Machines utilize today.
    Same for any portable devices bound for clinics and hospitals, with a car odometer panel as analogy.

    Doesn’t have to be perfect, just needs to buy time to figure out over the years how to quarantine airplanes and stuff. Wouldn’t worry until niversities are teaching how genes work (we don’t know now).

  5. #5 Rich
    August 11, 2009

    On Topic–the chief worry among CDCers is what will happen to all the deadwood that was piled up in GS-14/GS-15/SES positions in these coordinating centers. For every Besser or Sosin, there were numerous no name people who were either management sychophants or people that Divisions and Centers had been trying to get ris of for years. Another problem is the centralization of business functions that turned barely functional systems like travel and contracting into absolute headaches. Also unclear is whether budget authority will trickle back down to the Branch level.

    Frieden’s willingness to take action will annoy both the deadwood who burrowed-in during Gerberding’s reign and some of the old guard who stuck around, particularly if the action is top-down. The old CDC’s relatively decentralized organization gave Division Chiefs and even Branch Chiefs a lot of autonomy. Frieden comes from CDC’s infectious disease traditions (TB, in particular), so it will be interesting to see how he deals with the “newer” areas like chronic disease and injury. The kind of robotic medical infectious disease epi is one of the problems CDChas in becoming truly multi-disciplinary and making full use of non-MDs, who tend to be backbone of both research enterprises and program practice.

  6. #6 ipmat
    August 11, 2009

    Matthew Cline
    This is REALLY (never mind how many years) old info, and I don’t know how well or even if it applies to what you’re looking for, but I distinctly remember touring the lambing barn in college. They told us that the ‘half-life’ for absorbtion of maternal antibodies in lambs was 4 hours; 4 hours after birth, lambs could only absorb half the antibodies in their mothers milk. After 8 hours, it was 1/4 of the available antibodies. I think the interstitial spaces shrank so the bigger ones only crossed early, with smaller ones crossing later. But that was a while ago.

    It was so important to get that window that they saved colostrum from sheep who lost their lambs, and tube fed it to all lambs directly after delivery. They didn’t wait to see how quickly the lambs started nursing.

    I don’t remember anything about antibodies coating the gut, or providing immunity there. Could be new info.

  7. #7 paul
    August 25, 2009

    @ Rich: Dr. F may have a background as a CDCer in TB, but he certainly understands chronic disease issues, better than most at the top of NCCDPHP. Look at his track record in NYC… this guy gets public health.

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