When Thomas Frieden took over as CDC Director less than a year ago, I didn’t know what to think. A smart, frenetic and intense former CDC epidemiologist who was most recently head of the New York City Health Department, he hadn’t made his reputation as a “people person.” He was reputed to being a quick study who sized up the science and once convinced, implemented science-based policy with a vengeance. His occasional appearances as the public face of CDC during the swine flu pandemic last fall were not auspicious. He appeared arrogant and blew off reporters’ questions if he didn’t know the answer (and like all people in that position, he got asked a lot of questions which no one knew the answers to). But his predecessor, Julie Gerberding, wasn’t a hard act to follow. Widely disliked by CDC veterans, she had tried to transform the agency from within into her personal vision of managerial valhalla and before long the agency began to lose its intellectual capital and institutional memory. We wrote about it quite a lot here. Lately, not so much, because CDC has been quieter and less roiled by controversy. Is this a good sign? We aren’t sure. But Frieden has gotten himself a nice profile in the New York Times which sounds good. Puff pieces in The Times aren’t unusual, unfortunately, so we’ll reserve judgment. But at least we weren’t dismayed by what we read, something that happened too frequently in the Gerberding era.
And some things seemed to hit just the right note as far as we were concerned:
Gone are the nonscientific managers whom Dr. Gerberding sprinkled throughout the agency?s top ranks. Gone is a layer of bureaucracy, agency officials said. Gone, too, are the captain?s chairs with cup holders from a conference room so fancy that agency managers dubbed it the Crown Room.
In their place, Dr. Frieden has restored not only much of the agency?s previous organizational structure and scientific managers, but also its drab furniture. And he has brought something new: a frenetic sense of urgency.
By the end of her tenure, Dr. Gerberding had become so removed from day-to-day management that some top agency officials went weeks without seeing or hearing from her, they said. Dr. Frieden, by contrast, sometimes wanders the agency?s hallways and drops in on scientists unannounced to ask about their work, both delighting and terrifying them.
Within two months, Dr. Frieden eliminated the ?coordinating centers,? a layer of management Dr. Gerberding had added between the agency?s scientists and top leadership. The Coordinating Center for Infectious Diseases, with 600 employees, became the Office of Infectious Diseases, with 12. No one was fired; the agency?s leadership was simply pared.
Dr. Frieden said that among his priorities for the agency, the most important are improving its disease tracking and supporting state and local government health offices.
?All of public health starts with more information,? he said. ?We have to analyze what we have better and disseminate it better.? (Gardiner Harris, New York Times)
These strike us as all the right moves. It’s an agency under a lot of budget stress and choices have to be made. Surveillance and support of state and local health should be at the top of the CDC agenda.
Gerberding knew how to ingratiate herself with the higher ups. Too bad she didn’t use it to better effect. It’s not clear Frieden has those skills so it remains to be seen if he can get done what it looks like he understands needs to be done.
We’re just going to have to see. I’m sure he would agree we should be demanding the evidence.