Being right isn't all it's cracked up to be. Sometimes I wish I were wrong. But CDC does it to me time and again. On April 14, 2005 I posted on the fiasco involving the distribution as a routine test reagent of a non-contemporary pandemic influenza strain (H2N2, responsible for the 1957 pandemic). This one hadn't been circulating for over 40 years so few people had immunity. But here it was, being sent to thousands of clinical laboratories in the US and abroad to see if they could identify influenza A in a blind sample: proficiency testing. There followed a mad scramble to retrieve the specimens or assure they were destoryed on site in the many labs to which they had been sent. How was this possible? Why didn't someone make sure pandemic strains weren't being sent, unlabeled willy nilly around the world in the mail?
Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention in Atlanta, said the agency has already recommended that change -- a step not previously taken because flu virus has never been considered a possible bioterrorism weapon. (AP)
My comment then:
This makes me want to scream. They didn't do it because it wasn't a BIOTERRORISM weapon? WAKE UP. There aren't any bioterrorism weapons around. There ARE a lot of naturally occurring agents that kill people every day.
WHAT THE HELL IS THE MATTER WITH YOU PEOPLE?! ARE YOU BRAIN DEAD? (Effect Measure)
On September 11 (two days ago) I wrote the following about what CDC called the "process" of preparedness:
The process is screwed up because the processors are screwed up, political lapdogs only too willing to distort public health and its priorities to satisfy the Bush administration imperatives of tightening up on individual liberties in the name of security and safety. As for being light years ahead of where we were six years ago, I partially agree, although I'd say it somewhat differently. We are light-years away from where we were six years ago.
Maybe even in a parallel universe. (Effect Measure)
The same day a communication arrived in my inbox from Dear Leader, CDC Director Dr. Julie Gerberding. Here's some of it, along with an interlineal translation and a gloss or two:
Today is the anniversary of the tragic events of September 11, 2001, and it is a sober reminder that our nation, like all nations, is not immune to terrorist attacks. Those events led to profound changes in America, as well as at CDC, and I doubt we fully understand their full impact, even today, 6 years later. Rightly or wrongly, I, like many others, have internalized the date as a major turning point that divides the "pre-9/11 era" from the "post-9/11 era."
Translation: I drank the Kool-Aid
CDC's overall response to the terrorist attacks saved many lives and was appreciated and respected by people everywhere. Our subsequent proactive decisions to learn from the things we should have done better created the foundation for the Coordinating Office for Terrorism Preparedness and Emergency Response, the Emergency Communications System, the Office of Enterprise Communications, the Director's Emergency Operations Center, and most importantly, our commitment to plan, train, exercise, and continuously learn to improve our preparedness and response for all hazards that could create public health emergencies. Building from our successful tradition of outbreak investigation and response, we have progressively scaled our capabilities and our experience to earn our reputation as a vital component of national and international emergency response efforts through our contributions to numerous large and small scale threats since 9/11/01.
Translation: We learned we need better PR.
Gloss: CDC saved many lives? News to me. I know about the four postal workers who got anthrax (two of whom died) because CDC released incorrect information on the number of spores it takes to infect someone. But of course that was then. CDC is continuously learning, training, exercising (as in being encouraged to take the stairs instead of the elevators).
In the post-9/11 era, CDC has also had to adjust to the painful reality that we are in fact a target. Our visibility as a leader in emergency response, our laboratory sciences that address pathogens and chemicals that could be used in terrorist attacks, the information systems that provide the backbone of our nation's detection and response capability, and the critical response assets that we possess on our campuses and in our stockpiles create vulnerabilities.
Translation: The bad guys are out to get us (mmm that Kool-Aid is good), but we are the firewall between them and the American people. Delusional or just PR.
And above all, we must protect our most precious resource: the "national treasury" of public health workers who contribute to the health and safety of people everywhere, every day. This is one of the most awesome responsibilities that a leader faces, and not one day passes when I don't think about it and struggle with the getting the balance right, for it is simply not possible to increase security without decreasing liberty in some way--and this is true for our nation as well as for CDC.
Translation: Maybe if I laud my workers they'll forget I am widely disliked and morale is at rock bottom.
This is one of the most awesome responsibilities that a leader faces, and not one day passes when I don't think about it and struggle with the getting the balance right, for it is simply not possible to increase security without decreasing liberty in some way--and this is true for our nation as well as for CDC.
Translation: Mmmm that Kool-Aid is good. Have some. It's for your own good.
CDC has transformed itself into a bioterrorism agency. Forget about the fact that overwhelmingly the things that kill people aren't bioterrorist agents. Forget about the fact that, as the H2N2 episode shows, the biodefense blinders make us less safe, not more safe. Forget about the fact that morale at CDC is a shambles, thanks to the acid tripping suicidal management style of the chief Kool-Aid drinker, Director Gerberding.
The CDC with the great brand name, proud history and high level of public confidence? Forget it.
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"The bad guys are out to get us"....who can tell any more who the 'bad guys' are with incompetent %$^*)s (bad word bad word) like these?
Katrina taught me well-it's every person for themselves.
I think I have been saying that for a while Grace in regards to any high path, high CFR fast moving pandemic. Anyone who thinks different is nuts.
Revere wont prepare so indeed, I hope there is enough Kool-Aid to go around.
Revere, was CDC that much better before? I have seen a lot of stuff indicating that it was mostly a bunch of names on doorways with little budget before, during, after, during, after and during Carter, Reagan, Bush1, Clinton, and Bush2. IMO the supposition that the folks and Ft. Detrick would really be calling the shots just behind the back of the CDC. E.g. Ebola Reston Va. Their staff was and is way too small just as FEMA'S was for Katrina to handle something like a pandemic other than to say they are on board.
So perhaps we should disband it and start over?
Talking of CDC, here is a great video lecture regarding the Bird Flu, by Kanta Subbarao, who did excellent work with the CDC and is now with NIAID.
The lecture is orgnised by The Immunology Interest Group (IIG), for the immunological community.
While the fairly long lecture (over 56 Minutes, including Q&A at the end) is addressed to a scientific audience, and goes in to a fair amount of the complicated technical details related to the virus, Kanta is also able to speak to the average person, who may have followed the development of the Bird Flu virus around the world.
That should not be a problem with the folks here though:)
http://videocast.nih.gov/launch.asp?14022
Randy: Yes, they were better. Much better. They had quality scientists and did quality work. They still have many quality scientists but many of them are waiting out their 20 years because it is so hard to get their work done. I don't know where you heard they were just a bunch names on doorways. It is far from the truth. As for disbanding it, after Gerberding gets through with it it won't be necessary.
You have dangerous pathogens.
Before sept 11, I'm guessing you had general procedures to ensure that they would not be shipped unsafely.
After sept 11, you throw away that procedure "because september 11 changed everything", and set out on a long process to re-evaluate everything from a bio-terrorism viewpoint, because of the chance that maybe you hadn't considerd bio-terrorism, or given it short-shrift, in constructing the old procedure (that procedure may not have been perfect: but at least it was there).
In the meantime you seem to have implemented ad-hoc procedures, and end up mistakenly shipping out dangerous pathogens.
And then you invoke the name of the devil (terrorists) and hide behind the flag when you belatedly realise that what you've done wasn't a good idea.
This is just a nice example of what is wrong about Bush's admin. The same things happen over and over in so many different areas. Throw away the process, toss the procedures, no thought, money wasted, moral degraded. If you have to ask why, the answer is always September 11 and terrorists.
In a time of universal deceit, telling the truth becomes a revolutionary act.
George Orwell
The anthrax screw-ups occurred on the watch of Gerberding's predecessor, Jeff Koplan. Koplan was very good in areas like strategic planning, but handled the anthrax business poorly. He also did things waste money on a new logo that no one liked (this was one of his first major actions).
Gerberding initially won people over because she was better at dealing with p.r. her reputation as a second rate academic clinical scientists who didn't understand prevention had not gotten much dissemination. She has sold out the agency at every turn to management consultants (who undersatnd even less about prevention) and to the Administration. Now her p.r. "skills" are viewed as the downfall of the place. In "normal" times, she would have been quitely turned out and replaced by someone marginally better. In this administration, she'd probably be replaced by some friend of Tom Couburn.
I suspect Gerberding would have left long ago, except the usual destinations are probably closed to her. No med school or school of public health of any credibility would want to hire her. The CDC disaspora has led to a great many people joining academic institutions and other govt agencies at levels that guarantee that only the most naive person would consider even interviewing her. She'll probably wind up being a flak for some pharmaceutical company.
Rich: Gerberding was central in the anthrax investigation even though she wasn't Director then. More to the point of the post, though, CDC shouldn't claim credit fo saving many lives from terrorists. On the contrary . . .
Seems like the 'struggle with getting the balance right' is already over for Dr. JG. For anyone else who is still interested in fighting that good fight, I would recommend reading some of the thoughts that Louise Richardson has on the topic of counteracting terrorism.
In reviewing much of our current reaction to 9/11, she quotes H.L. Menken who said "For every complex problem, there is a solution that is simple, neat, and wrong."
In Richardson's "What Terrorists Want: Understanding the Enemy, Containing the Threat, she gives quite a few knowledgeable suggestions about how we could increase security and counteract terrorist organizations without necessarily decreasing liberty.
In fact, instead of advocating less liberty, Richardson advocates quite the opposite, by including "Live By Your Principles" as one of her "Six Rules for Counteracting Terrorism". Beyond Benjamin Franklin's judgment of those who would give up liberty in search of temporary security, Richardson also argues that even at a pragmatic level, the approach with which Gerdebring is now collaborating is counterproductive.
Perhaps Dr. Gerdebring's memory needs to be refreshed.
for it is simply not possible to increase security without decreasing liberty in some way--and this is true for our nation as well as for CDC.
Um, what?
I don't see how steps taken to protect the CDC and its workers from background checks and security guards to lab safety measures can really be seen as a "decrease in liberty" similar to the "compromises" being asked outside their walls. It's always been a good idea to screen people for sensitive posts, and no one has a problem with that. It's always been a good idea to exercise appropriate precautions when dealing with dangerous infectious agents, and no one (Gerberding & co. excepted) seems to have a problem with that.
All I can conclude is that she changed subjects mid-paragraph without warning, and has moved from steps taken to protect public health workers and is now talking about steps taken to protect the public from people like Andrew Speaker (or what he represented). Which is a different subject, with a far more direct impact on the greater public, who never agreed to put on the moon suits and work with Ebola.
http://effectmeasure.blogspot.com/2006/04/report-card-time.html
http://effectmeasure.blogspot.com/2006/04/wherein-i-don-tinfoil-hat.html