Many observers have known that politics has become an increasingly important part of CDC world. Now even the conventional media are noticing. From ABC News:.
The nation's first line of defense against these assaults, the Centers for Disease Control and Prevention, is once again in the spotlight and facing questions about its handling of this latest medical alert. But an even larger question is often debated when it comes to the CDC -- the extent to which it is an agency influenced by politics.For most government organizations, political influence is taken for granted. Yet the public is reluctant to think of the CDC that way. It enjoys a reputation for being independent and is among the government's most trusted institutions. In fact, in a Harvard School of Public Health survey in 2005, people gave the CDC higher marks than other health agencies with a 76 percent positive job rating.
Don Kettl of the Fels Institute of Government at the University of Pennsylvania explains that the public thinks of the CDC as "composed of and run by scientists and generally caring for the public health. There's no Republican or Democratic way to give somebody a flu vaccine."
But partisanship still may play a role. (ABC News)
No kidding. In 1995 there was a vibrant public health effort in the area of gun injuries. Then the newly elected Republican Congress applied the pressure of the gun lobby. Suddenly the half dozen or so states funded by CDC to do fire arm injury surveillance were defunded. Zeroed out. Shortly thereafter all CDC funded prevention and injury programs had to agree that there would be no activities, direct or indirect, related to gun control. Health department people we have spoken to reported that a profound chill settled over injury programs regarding gun injuries, like homicides from guns. Intense pressure was applied to the head of the CDC injury control program and he and some of his experts on the public health aspects of firearm injury were threatened with investigations over possible entanglement with gun control advocates. Now extreme care is taken in how data is reported or recommendations made in the area of gun injuries.
Unfortunately it's not an isolated example. It's not just guns. Last year we reported on CDC machinations to get pro-abstinence speakers inserted into a scientific panel on sexually transmitted diseases. Then there was the political vetting of overseas appointments that have resulted in inordinate delays in filling an urgent need. Or Director Gerberding rolling over on the budget. And about that budget, the budget Gerberding hasn't fought for because that's the way Bush wanted it. Here are Bush's budget requests (via Think Progress):
- 2002: Proposed a $174 million cut.
- 2003: Proposed a $1 billion cut, with no new funding for preventive health divisions working on TB.
- 2004: Proposed an increase of "less than 1 per cent.
- 2005: Proposed a $263 million cut, while simultaneously proposing a $270 million increase in abstinence education.
- 2006: Proposed a $500 million cut which would have slashed grants to state and local health departments like the Fulton County Health and Wellness Department involved in this week's TB-scare.
- 2007: Proposed a $179 million cut, in addition to unspecified plans for more CDC "savings."
- 2008: Proposed a $37 million cut, including "massive funding cuts in proven health protection programs."
It seems clear Dr. Gerberding is kept on a short leash by this administration. Like any good lap dog. When her pronouncements aren't cleared by the administration first, they don't sound the same:
CDC Director Julie Gerberding, in a 10-page report requested by the House Appropriations Committee, warned that bioterrorism, climate change, chronic diseases like diabetes and emerging plagues such as drug-resistant tuberculosis represent "urgent threats that have become more prominent in the dawn of the 21st century."
She said CDC's budget, now about $9.2 billion a year, should be increased to $10.2 billion in the 2008 budget year that starts Oct. 1.
President Bush, in his proposed federal budget for 2008, recommended reducing the CDC budget by about $500 million from the current level while earmarking hundreds of millions of dollars for pandemic preparedness and bioterrorism.
[snip]
Obey requested the report in March at a hearing where Gerberding testified on the president's budget request for CDC. Appropriations committees often ask heads of government agencies to submit "professional judgment" statements on their budgets.
But Obey took the somewhat unusual step of directing Gerberding to submit the report directly to the committee, rather than following the customary procedure of sending it to the White House first for clearance.
"It is the kind of unvarnished guidance the Congress needs to make its decisions," said Dr. Georges Benjamin, executive director of the American Public Health Association.
When Gerberding next testifies before an appropriations committee "she'll defend the president's budget, because that's her job, but this is her unfettered opinion," he said. (Jeff Nesmith, Atlanta Journal Constitution)
APHA's Dr. Benjamin in more charitable than I would be. If the president's budget is indefensible for protecting the nation's health, why is she defending it? True, if she tells the unvarnished truth in a public hearing, she'll be dead meat in this administration. But she'll go out in a blaze of glory and do some good for public health. It's not like she'll be living in a Kelvinator box on the street, either. She'd be an ex-CDC Director. I think she'd find another job.
Many public health professional's have a beef with Director Gerberding over two things. The first is her stubborn insistence on a reorganization at CDC carried out with supreme incompetence and arrogance. She has wrecked a proud agency. The second thing is her failure to fight for public health, being instead a pliant tool of an administration that could care less about public health.
Politics at CDC? I'm shocked. Shocked
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"Proposed a $1 billion cut, with no new funding for preventive health divisions working on TB."
revere, would some of those cuts be less capital expenditure because of the scheduled completion of their spiffy new lab buildings?
[I'm no shill for Bush, but CDC in terms of infrastructure is a lot better off now than it was seven years ago.]
Sock: I don't think that was the reason. Gerberding herself said she needed more in the direct communication with the Committee. The problem at CDC isn't in the bricks and mortar. It's in the human infrastructure.
Revere is mostly right. The brain trust with all of their little fiefdoms and idiosyncracies got tumbled when the Gerberdinator showed up. She has cut, and cut and cut. I dont disagree with some of it. But do you know how many condoms you could hand out to kids for 270 million?
It reminds me of the "Dont Drink and Drive" ahead of prom when everyone had to go down to the auditorium and watch "Blood on the Road." What did everyone do on prom night, they got drunk, they jumped bones. So the same logic applies, if you cut and cut and one day you look around and say "Wheres so and so" you find that their position was cut and they are gone. Typical government. Its like Clinton saying he reduced the size of government by 500,000. Yep, he did and they were all DoD people and soldiers. Not a lie, just an obfurscation of the true facts.
As for political vetting Revere, they have been doing that for years. Both Dems and Republicans wait until the last minute to fill those positions as they leave and hope that the next guy doesnt fire them. Its like Clinton firing not one but all 28 Republican Federal prosecutors. Gonzalez does the same and Congress puts it out like there was some big crime about it. Not so. And we got Janet "WACO" Reno.
Some of the funding definitely needs to go back to CDC but I think they are going to have to start to produce results Revere. Its unfortunate but the Republicans regard the public health to be a states issue. They are pretty much right, its not one of the entitlements that are in the constitution. They want to take it to a more decentralized program. Clinton started it somewhat when he had to balance the budget in '97. It became a case of too many chiefs with nothing left for the Indians or resources.
We COULD do away with the Dept of Energy and fund the CDC. To date I can only account for one program that produced one bit of energy and that was to make a microdam in East Tennessee that only runs in the wet season. Their budget is about 1/4th of the DoD. Anyone seen a kilowatt or a gallon of some sort of Go-Juice produced yet? Huge waste of money.
A lot of capital expenditures have been deferred. that was how they dealt with earlier cuts in the CDC budget. CDCers have always wanted to keep politics separated from their work and took pride in being away from DC. Unfortunately, their DC staff has tended to be nitwits and Congressional panels tend to bypass them. Beyond that, it's obvious that all aspects of public health are "political" to some degree and the technocratic approaches that CDCers try to advocate often are impractical because of limited funds at the state and local level or the lack of political will. The absence of real political savvy in the agency is one reason why the Administration has been able to "capture" the agency. That, and the large number of senior people who had no trouble leaving. Yes, agency directors have to perform for their different masters, but Gerberding has been far more of a sychophant than her predecessors. As for breaking up feifdoms, Gerberding's reorganization and the various new bureaucracies that were created were magnets for some of the least qualified people in the agency, including some of the most unconstructive infighters. It will take many years to undo the damage done by Gerberding.
Gerberding makes Zherhouni look like a hero for science and it may be because the NIH is simply too big and has too many people keeping an eye on it.
"and then, something went wrong, for Faye Wray and King Kong...
Wonder how that hearing with the straightforward title
will go this morning? (Is that still on?)
(Is Dr.Gerberding still head of the CDC?)
"oh, oh... oh, oh.... o-o-oh"...
"the NIH is simply too big and has too many people keeping an eye on it"
Talking of the NIH, what did people make of Fauci writing a character reference for Scooter Libby, asking the judge for leniency?
He is a Republican and a political animal, very shrewd. But he's a good scientist and I think fundamentally a straight shooter. But he lives in this administration which is very political and can't separate science from pollitics so he goes along with some things. At least that's my guess. I don't have any inside info.
A gunshot wound is not a disease. The political act was asking the CDC to treat it as such in the first place. I don't see how it's political to undo such a thing, for the same reason it's not criminal to punish a crime.
Jeff: Public health deals with lots of things besides diseases. It is about the prevention of premature disease, disability and death. CDC has long had an injury prevention center and fire arm injuries -- like automobile injuries -- are part of public health. I don't disagree that defining gun injuries (most of which have nothing to do with crime, by the way) as part of public health is a political decision. All of public health is political in the sense that it involves disposition of community resources, time and energy. It was also a political act to undo it, but it was a partisan political act, not politics in the larger sense.
That's a pretty expansive definition of health. Does any human activity fall outside this charter? Should the CDC make sure the sidewalks are level?
Jeff: Of course, there are many things that fall outide the current boundaries. Those boundaries change over time, somtimes shrinking and sometimes growing. Just like other human endeavors. It's the definition public health uses. Maybe you have a different one? You want to remove all injury prevention, perhaps? You want to remove virl records of births? (not disease). Substance abuse? Maternal and child health? Or is it just guns you want gone?
Revere: the issue is charter creep. The CDC was created to manage epidemics. It makes sense to have an organization of national or even global scope to deal with things like avian flu -- problems that can't be solved locally. But maternal health? Substance abuse? Car crashes? Those are the ultimate in local scope, and (IMO) are better solved locally.
As Jeff says, there is a move afoot to make states more responsible for their health care and social issues rather than the federal government. Its not a bad idea, it just upsets the apple cart. This is what happened at CDC and the Gerberdinator got out the knife and cut. Are guns part of public health issues? Are Fords that will go 180 and if you get into a crash does it mean that its a health issue or the fact you left the road airborne and ran into a tree? Its a good question Jeff and what is the mandate of the CDC? I
"CDC grew by acquisition. The venereal disease program came to Atlanta in 1957 and with it the first Public Health Advisors, non-science college graduates destined to play an important role in making CDCs disease-control programs work. The tuberculosis program moved in 1960, immunization practices and the Morbidity and Mortality Weekly Report in 1961. The Foreign Quarantine Service, one of the oldest and most prestigious units of PHS, came in 1967; many of its positions were switched to other uses as better ways of doing the work of quarantine, primarily through overseas surveillance, were developed. The long-established nutrition program also moved to CDC, as well as the National Institute for Occupational Safety and Health, and work of already established units increased. Immunization tackled measles and rubella control; epidemiology added family planning and surveillance of chronic diseases. When CDC joined the international malaria-eradication program and accepted responsibility for protecting the earth from moon germs and vice versa, CDCs mission stretched overseas and into space."
Funny that they also forget the issues related to syphillis research on black humans. 1957 they took THAT over as well and didnt end it immediately. Crime against humanity?
Here's why it's not a good idea at this point. Because too many people (e.g., you, Randy) don't want to pay for public health. You insist on cutting taxes and not allowing revenues to be raised. So as the states must cut back they rely more on the feds. If you want local public health, then pay for it. Tuskegee is (the usual) red herring. We all know what "states rights" mean in 1957.
Perspectives what they are Revere you have to agree that all things have a cycle. Surge, pull back, stagnation, surge. I was about 2 years old when they took over Tuskegee. We are now in a modality where there are those that say we HAVE to have socialized healthcare. There are those who vehemently disagree and I am one of them and not just because I dont want to pay for it. That would be second on my list. First would be that government once again gets yet another control over the population. I do not want them to have the power to tell me to do yet one more thing. I wont go into the costs because they are ambiguous. No one is sure what it will cost except hundreds of billions of dollars, which would quickly lead to what is covered and what is not, deductibles. People that dont have, feel that they should. It should only in my opinion be put in for those who cant work, walk, see, or require a medication that is beyond their reach. We can afford that for right now. Later on as the population ages, maybe not. Damned sure not if we get a pandemic. That alone would bankrupt the country completely.
I have written before what State run healthcare would be. A bottomless pit. A federal system would be nothing more, just bigger and then the haves would have to go and pony up more money to support even more have nots. Why? Because the cost of doing business in the US is already not competitive. Put it in? Then plan on a huge unemployment rate and inflation off the scale. Does anyone forget that Social Security is going to eat the entire budget in six years. Raise taxes for a new system?
Randy: Your use of the word "socialized health care" is not very informative. Do we have "socialized protection" with the military (who also have socialized health care; want to yank it?). We have socialized courts, which you want to extend (Jeff's mission creep) to cover disease as well as crime. Indeed we have an entire system of socializing losses and keeping the profits private. That's called pulbic policy in your world. I don't know what "socialized" means in your language but if you want to talk about universal coverage, fine, or universal health insurance, fine, or universal health care, fine. But the willy nilly use of the "socialized" label is just red baiting.
THE CDC has been asleep at the wheel for far too long. They were warned of disease and pestulance for long enough.
I believe we should march on the CDC. ASAP
Does any human activity fall outside this charter? Should the CDC make sure the sidewalks are level