Nature is one of the premier scientific journals in the world. But they are also getting out in front on some important issues in their news and Editorials. They are fast becoming THE premier scientific journal in the world. Its chief rival, Science hasn't changed with the times. Nature has embraced the new medium of the internet in very innovative ways and continues to experiment with it. Nature is adapting successfully. Its rivals are being left in the dust.
Nature is published in the UK. So it is strange that they, rather than the US-based Science, has weighed in on the disarray at CDC, not just in a news article but in a strong editorial:
Outside the United States, the CDC enjoys a hard-won reputation for its knowledge of infectious disease. Take, for example, its unparalleled 121 Cities programme for monitoring influenza, as part of which epidemiologists collect weekly figures on the number of influenza deaths from (as it happens) 122 US metropolitan areas. The programme, which can highlight a particularly pernicious flu season at its outset, is unmatched elsewhere in the world.But some of the people who respect and rely on the CDC are now expressing worries about its own state of health. Some of those concerns are being expressed at the very roots of the agency itself, by the dedicated public-health workers on whose reputation it was built.
[snip]
The complainants allege that good science at the agency is being hampered by bureaucracy and mismanagement. The problems have arisen in part as the result of a reorganization instigated by Gerberding in 2003, and some officials contend that they are being exacerbated by the Bush administration's efforts to exert political influence over the CDC. Some very senior people are leaving; others say they are staying only until they can collect a pension. (Nature Editorial)
An accompanying news story by Helen Pearson has more:
But privately, CDC employees say they are demoralized by the reorganization because it has introduced extra bureaucracy, lowered the status of science and placed too much emphasis on 'spin'. They say these changes, and the new corporate management style, are ill-suited to an agency that is supposed to investigate and protect public health. "The message from the current leadership is that the important scientific issues are decided elsewhere; we just have to look good to the media and not challenge conventional wisdom," says one senior public-health researcher at the CDC.
The sour situation is thought to be one reason behind a wave of high-level departures: at least eight directors of the former national centres of expertise have left since 2004. The repercussions are being felt both nationally and internationally, because the CDC plays a central role in coordinating public health across state and local health departments, as well as international responses to emerging infectious diseases. "Most people in public health are very concerned to see this level of a brain drain in the CDC," says Jeffrey Levi, head of Trust for America's Health, a non-profit organization based in Washington DC that works to promote disease prevention.
Observers lay some of the blame on the Bush administration, which they say encouraged the agency to focus on preparation for bio-terrorism at the expense of other needs. "All the emphasis was on terrorism, without willingness to recognize that the public-health infrastructure has been getting weaker for years," says Anthony Robbins, a professor of public health at Tufts University in Boston. In the 2006 financial year, the CDC received funding boosts for bioterror and pandemic-flu planning while many chronic-disease prevention programmes were cut.
The accusation that politics is usurping science has also reared its head. Critics say pressure from the administration stops the agency from investigating pressing public-health issues, such as whether abstinence-only programmes work in the fight against HIV or whether junk food is fuelling the obesity epidemic. "There is not a feeling that science drives the agenda," says a senior official who left the CDC more than five years ago. Others are critical of Gerberding herself for not resisting these political pressures and fighting for the agency's agenda.
The fear now is for what would happen if the country had to deal with a public-health crisis. Many in the field draw parallels between the CDC and the Federal Emergency Management Agency, the organization so heavily criticized over its inadequate response to Hurricane Katrina. "Our preparedness has been deteriorating in fairly dramatic and drastic ways," says Phyllis Freeman, who specializes in public-health policy at the University of Massachusetts, Boston. (Helen Pearson, Nature)
This isn't news to readers of Effect Measure since we have been posting on the deterioration of CDC for almost two years (latest post was this Monday discussing the very same Atlanta Journal Constitution news article that was the occasion for the Nature pieces. But it means something when the world's best scientific journal puts it front and center.
Nature doesn't stop with CDC. They also draw WHO into their net:
The CDC is not the only globally significant public-health organization whose performance is currently under scrutiny. Later this year, the World Health Organization (WHO) is due to elect a director-general to succeed Lee Jong-wook, who died this summer. It is critically important that the WHO chooses a leader with the political and administrative skills needed to make the organization an even more effective player in addressing global public-health issues. Unfortunately, given the intrigue that often surrounds such contests, close observers of the WHO have scant grounds for optimism that this election will yield such a leader. (From the Editorial)
So kudos to Nature (again) and a warning to CDC and WHO. The scientific world is watching. And it isn't pleased with what it sees.
- Log in to post comments
Funny that you make the observation - I stopped taking Science about four years ago for the same reason, but kept getting Nature. Instead, I use the cash toward subscribing to Nature Reviews Cancer and Nature Reviews Drug Discovery
One note: Nature, if I understand correctly, is a for-profit private journal like Cell and the Elsevier universe. Science is a non-profit society journal (the society being AAAS), like PNAS, Genetics, and others. In principle there should be some major differences between them on important publishing issues like open access, unfortunately in practice I agree there hasn't been much difference.
But it may not be surprising for the for-profit journals to be one step on the curve ahead of the non-profits (on the other hand J Cell Biol, a non-profit, has been WAY ahead of the curve on digital figures and setting up anti-fraud measures for their submissions). My intuition is that there is inherent value in supporting the scientific society journals as "ours" in the community rather than the product of a corporate mind.
But, when a journal gets it right, you've got to say, they've got it right. And as you point out, Nature is getting it right.
(sorry for being off-topic re:cdc and flu in particular).
Costs of personal subscriptions:
Nature $199 USD
Science $139 USD
The Science subscription supports AAAS, an important not-for-profit international science advocacy organization.
emptypockets, traumatized: You both make excellent points. But as ep says, when Nature gets it right it needs to be supported. Nature Publishing Groups is owned by Macmillan, so it is private, as you say. AAAS is (theoretically) non-profit, but they and other society publications have been in the forefront of opposing Open Access because subscriptions and reprints (bought by their advertisers) are major sources of income for both the profit and non-profit scientific publisheres. Moreoever, both Science and Nature have substantial value added news sections, of which both of today's posts make use, and they need a source of support which Open Access so far has not been able to provide.
Stepping back for a moment to look at the struggle for status and impact in the world of science, Science and Nature are both in the same arena and Nature is winning that battle (IMO) because it is adapting to the new world faster than Science is. that may be a reflection of its different institutional structural supports, but in reality both are fairly autonomous regarding editorial policy and publishing innovation. Don Kennedy and his staff can do all the same things Nature can and when Abelson was editor (the dark ages) took many editorial stands the membership found abhorrent.
AAAS's advocacy has Science as a prime mediator, so again the editorial content there is not unrelated. If Nature is a more effective advocate for progressive science issues (and they don't differ on things like Open Access), then IMO Nature gets the edge.
My two cents.
It seems that all some people can do is criticize. Let's see... The CDC sucks now because the leader is too political and too management centered. Then we see that it is "critically important that the WHO chooses a leader with the political and administrative skills needed to make the organization an even more effective player in addressing global public-health issues." Which is it folks???
Also, organizations have been criticised for not making plans for the possible pandemic. I have also read in the Effect Measure blog how planning for a pandemic will have positive effects for the whole healthcare infrastructure. Ok, I'll buy that. But then we turn around and criticise the CDC and the gub'ment because they are emphasizing bioterrorism planning. Let's see... PANDEMIC FLU - Possiblity of a large amount of the population infected with a highly contagious and highly deadly disease. Will probably result in a paniced populace overwhelming the healthcare system. BIOTERRRISM - Possiblity of a large amount of the population infected with a highly contagious and highly deadly disease. Will probably result in a paniced populace overwhelming the healthcare system. Nope, no overlap there!
David: LOL. See, you have to read the whole post, not just the first sentence or two. Yes, some people like to criticize CDC. Complainers. Like five of the six last CDC Directors. BT planning and pandmic flu planning, alas, are not the same thing. I've done both, BTW. You? Very little overlap in either principle or more importantly, practice.
Some people can't stand it when Bush is criticized (or Bush's lapdogs). Tough.
revere: Great debating tactic there, assign a love of Bush to me, one I have never stated.
Personally, I think Bush is the reverse side of the coin to Clinton. Both Bush and Clinton are megalommaniacs, willing to talk out of whatever side of their mouth serves their current need. For that matter, any strict party line Republican or Democrat (or insert any ideology here) are just two sides to the same coin. Note, the defining factor there is 'strict party line.' It shows inablility or and unwillingness to engage in critcal thinking, especially when considering the opposing viewpoint.
I was just pointing out that you, and Nature, AS MOST ALL PEOPLE DO, are doing the same thing.
Some people can't stand it when THEY are criticized. Tough.
revere: Another great debating tactic. "I've done both, Your?" No, I have not, so please elaborate on the lack of overlap between BT planning and pandemic flu planning as it would relate to what the CDC needs to do. Thanks.
Actually, David, I think revere also did an excellent job of highlighting that your comment about overlap between pandemic flu planning and bioterrorism planning revealed that you don't know much of what you're talking about.
Without that argument, all that's left in your comment is complaining about complaining.
Sorry for all the typos... I need to proof read better!
Davis: Your comment is laughable. All revere did is say that I am wrong. That is not "an excellent job of highlighting."
With your line of thinking, I just did "an excellent job" of refuting your post.
David: There are many differences. Pandemics happen everywhere at once, usually with highly contagious agents (that's how they become pandemics) without preventives. BT events (there have only been a few and very small) are local and involve non-contagious agents (anthrax is not contagious). The agents are very different because use as a bioweapon requires no blowback, not true for pandemic agents. Responding to BT is by law enforcement, not public health, so is organized (and planned for) very differently. The preps and prevention for pandemics involve strengthening public health. For BT it involves intelligence. There are so many agents it is ot feasible to have preventatives for most of them and most of them aren't practical anyway. Etc., etc.
I have blogged this many times in the past. See also a general post on Biodefense here.
But CDC would be involved in the healthcare response to a BT attach, not the prevention of the attack. What about weaponized smallpox? What about the development of a highly infectious flu or AIDS virus? Anthrax is just one of many agents that may be used. That does not rule out all possible contagous agents just because you pick one that isn't. Some of those who are bent on our destruction would have no concern with bringing down the entire world. You know, those religious fanatics that crave martyrdom and want to bring on an end of the world scenario.
What about the overlap between overwhelmed healthcare facilities? Again, we are discussing overlap WITHIN THE REALM OF HEALTHCARE RESPONSE, not just the prevention of a BT event compared to the prevention of pandemic flu.
I clicked on your Biodefense link... it gave me an error.
David: you suggested that BT and pandemic prep should have some overlap, with no evidence for why that should be the case. Someone who has experience in both says you're wrong. Even without further explanation (which revere has helpfully added above), it's far more reasonable to assume revere is correct than you are.
Davis & revere: Please forgive me for questioning!!! I bow down to your superior knowledge and complete subjective and unbiased view in reporting on all topics. Your statements only contain truth, not opinions. Please forgive all my questioning heretical blog entries heretofore, going forward I will only read and believe and follow........
David: what is it you wanted to say?
WHO doesn't need a strong person who can withstand some countries that like cover-ups and obviously are censoring media in order to play hide-and-seek?
CDC is allright introducing more bureaucracy and chasing away their own scientific personnel because there is some Bush-fan in top? You like another right-wing sound here?
Well, Clinton has been critisized here, but he is past tense.
Is it you want to say we shouldn't complain? Take more positive actions?
Or is it the problems in WHO and CDC are not the same? Or the problems are the same?
What is it you originally wanted to say?
I don't understand a bit of this discussion, it appears to be emotional and I don't capture the arguments.
I see you point at some parallels, but what's your suggestion? Some comment can sharpen your formulating the sentences (forgive me if my English isn't as it has to be), but you take the metacommunication. I like the content issue.
Short of nuclear war, something like the current, (by now, unmonitorable) (double-digit fatality rate in the young and healthy,) human-to-human H5N1 influenza virus going Pandemic
(or, any other similar virus; the untreatable new TB kills in weeks, but, the H5N1 in days, and is already in too many continents and mammal species)
is the worst thing that seems "a clear and present danger" we are facing, and we may have no more time to prepare against.
By failing to prepare the public on a household level, officials are preparing to fail the public.
Admitting there is a "Cat. 5" storm out there, and our "levees" *will* fail if it comes, and getting the public to work together on the best way to mitigate a disaster would be better than them getting blindsided by a catastrophe.
Unfortunately, the public and administration isn't paying much attention to scientists' warnings.
Guess the person in the street would almost buy the argument that the world might get so angry at the US that we'd get trade sanctions and get our imports cut off by human action, (or suffer a localized, short BT event we have meds for,) as a reason to prepare, than be able to see we might suffer Dr.Osterholm's "12- to 18-month global blizzard that will ultimately change the world as we know it today".
Being "modern" and having all our "advances" will do us no good; in many ways the world's population is in *worse* shape to weather a 1918 event. Look at the thousands of people flying around the globe right now; once a pandemic strain gets out, it will appear all over, and it will be too late to prepare, because of our just-in-time economy and short-sightedness. (And, wartime-footing spin.)
We are weak on Pandemic Preparedness, because TPTB have decided they know best and telling the public to prepare for a pandemic year is something they choose not to do.
I hope the articles in "Nature" and elsewhere are getting archived, so this history can be written up afterwards. "History doesn't repeat, but it sure rhymes a lot."
Revere: My experience with the CDC is that while some areas do excellent, strong science and have an international reputation for that, others are hacks using science as an inebriated sailor uses a lampost, promoting their political agenda in spite of or in the absence of scientific support. Some papers from such groups are real turkeys but they seem to make it into one particular high impact primary medical journal repeatedly. Masters students familiar with the area can have great fun with these in journal clubs.
JMG: That is also my experience, although it didn't used to be. The agency has some really terrific people but also a lot of second and third raters (or worse). And they couldn't manage their way out of an IV bag.
The problems aren't just at CDC. Politics now trumps science at all levels of public health in the U.S. Many of us working in public health stay because we have a passion for the work we do, but this passion is becoming harder and harder to sustain. It is very sad.
It occurs to me that the real reason our government(s) opt to err on the side of the economy is to protect their own pockets and those of their cronies. The top level decision makers do not want to warn the public to take the threat of an impending H5N1 catastrophic pandemic seriously, and to begin serious preparation and planning at individual and community levels nationwide, because to do so would cause negative impacts on the economy. However the only people who would be really seriously affected by such a temporary economic downturn from pandemic planning and preparation would be the extremely wealthy, the corporations that depend on a secure feeling, credit-card using overspending consumer base. And fellows like Halliburton don't really have to worry about being caught with their pants down if and when a pandemic should occur: they have the wherewithal to sequester themselves safely away for months with all the best medical care, flu prevention, and amenities money can buy. In the meantime they want to make all the money they can while they can, and the rest of us can just suck it up when the bug hits town.