CDC
revere | November 29, 2007It is not news that the Atlanta lawyer who had/didn't have Extremely Drug Resistant TB early in the year didn't infect anyone when he flew -- against advice or was it against orders? -- from Europe back to the US via Canada and through New York despite a no fly (or not?) order from CDC (or DHS?). Everything about this case was cocked up -- the diagnosis, the communication with the patient, the communication with the public, the communication between federal agencies, state agencies and local health agencies (see our posts here). The fact that no one who sat close to him or further from him or…
revere | November 24, 2007As you will see from the account below the fold, the flu summit was a contentious and complicated affair. Only time will tell if it was even a qualified success, but there are reasons to be hopeful. Tip of the hat to Ed Hammond, one of the NGO participants, who provided the public health community with his perspective at a time when no one else was talking. This involved late hours for him at the end of long days. We are grateful.
Here's his wrap-up:
Influenza Meeting Ends in Qualified Success
At the end of contentious meetings like the one on policies for sharing flu virus it is tempting to…
revere | November 17, 2007I wasn't at the Women's Health Fair and Symposium at Onandoga Community College in New York so I didn't hear all of what CDC Director Julie Gerberding said there. I just know what was reported in the Syracuse Post Standard. But I wasn't impressed:
"If I gave each of you $5,000 and said this is the money you can spend on health for yourself or for your children or family, how would you spend that money? she asked. "For a long time, many of us have been protected from thinking about the value of our health investments because our insurance took care of everything. Well, today more people don't…
revere | October 24, 2007CDC Director Julie Gerberding's draft testimony to be presented before a Senate committee was "eviscerated" by the Office of Management and Budget according to an AP story by Josef Hebert (hat tip MF). The missing pieces related to the potential health impacts of climate change:
Her testimony before the Senate Environment and Public Works Committee had much less information on health risks than a much longer draft version Gerberding submitted to the White House Office of Management and Budget for review in advance of her appearance.
"It was eviscerated," said a CDC official, familiar with…
revere | October 23, 2007If you have or have had small children you may be all too familiar with earaches. When our kids were small we felt as if we were single-handedly supporting the amoxicillin makers. A major cause of middle ear infection is the organism Streptococcus pneumoniae (S. pneumoniae), which sometimes it invades other tissues and causes bacterial meningitis (not the kind that you read about killing healthy teenagers, but bad enough) and sometimes other body sites. It is also a cause of pneumonia in adults and was a common cause of secondary bacterial pneumonia in the 1918 flu. That was then. Now there…
revere | September 26, 2007If you are in the elderly population (over 65 years of age) you are in the crosshairs of CDC's influenza vaccination program. The reasons seem clear -- at first, anyway. Risk of influenza-related death (as measured by a specific statistical technique to estimate excess mortality during influenza seasons) increases dramatically after 65 tears of age. If you are over 80, for example, your risks of being in the excess death category is more than ten times those in the age 65 - 69 age group. Three-quaters of the flu related deaths in a normal flu season are in the 65 plus group and more than half…
revere | September 13, 2007Being 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…
revere | July 4, 2007It now turns out that the XDR-TB case which caused such an uproar last month (see our posts here) wasn't XDR-TB at all but MDR-TB, a treatable form of the disease:
Andrew Speaker was diagnosed in May with extensively drug resistant TB, based on an analysis of a sample taken in March by the U.S. Centers for Disease Control and Prevention. The XDR-TB, as it is called, is considered dangerously difficult to treat.
But three later tests have all shown Speaker's TB to be a milder form of the disease, multidrug-resistant TB, a federal health official said on condition of anonymity before a news…
revere | June 12, 2007This was the kind of fallout from the TB case I was most concerned about:
States should have the power to restrict the movement of patients with contagious diseases even before they have the chance to disobey doctors' orders, federal health officials say.
The need for such authority to order someone quarantined emerged as lesson No. 1 from the case of the Atlanta lawyer who went to Europe despite having a dangerous form of tuberculosis.
[snip]
"First of all, up front, before the patient left the United States, we believe that we could strengthen our states' ability to restrict the movement of…
revere | June 5, 2007Many 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…
revere | June 3, 2007What do we know about transmission of tuberculosis on an airplane? Not much, apparently. There is very little literature on it and not a single case of active TB has ever been traced to an airplane contact. On the other hand, it isn't very easy to estimate the risks. The only way you can do it is in cases such as the current one where you know someone with TB got on an airplane and potentially exposed others. Then you would do intensive follow-up of fellow passengers and crew to see if you could find others who might have gotten infected. Now the problems really start.
First, there's the task…
revere | April 30, 2007Once upon a time, working at the Center for Disease Control (aka, CDC, now called the Centers for Disease Control and Prevention) was a dream job for a dedicated public health scientist or practitioner. No more. The independent CDC blog, CDC Chatter, is reporting results of a new survey of employee satisfaction in federal services. CDC is near the bottom of 222 agencies, with a score down from its 2005 score. CDC ranked 189th out of the 222 agencies and agency subcomponents.
CDC's ranking fell in the Partnership for Public Service's annual "Best Places to Work in the Federal Government"…
revere | April 15, 2007The last time we reported on the concern of five former CDC Directors that morale was going down the toilet at the agency was September 11, 2006. That was in a joint letter sent to Director Gerberding. Now it's 7 months later and the venue is more public, a symposium sponsored by the George Washington University School of Public Health. One of them was William Foege who was CDC Director under Carter and Bush (1977 to 1983):
Foege said that CDC must eliminate the "perception ... that politics trumps science and truth" and strengthen the "role of science that has always characterized CDC"…
revere | March 13, 2007Be prepared, and be careful not to do
Your good deeds when there's no one watching you
If you're looking for adventure of a new and different kind
And you come across a Girl Scout who is similarly inclined
Don't be nervous, don't be flustered, don't be scared,
Be prepared
(Tom Lehrer, Be Prepared)
The recent stories that CDC has not been able to determine the effectiveness of tax dollars meant to improve response to bioterrorism comes as no surprise. Not because CDC has misspent the money (which they probably have) or because they have been negligent in seeing if the money is well spent. The…
revere | March 11, 2007The CDC chief, Dr. Julie Gerberding was publicly spanked by a congressional panel this week. Not that she acknowledged it. As a good Bushie, she never admits fault. Like George W., she "understands" everybody's concern and she is concerned, too. About what? Morale at the very agency she runs, CDC. The only news here is that she admits there is a morale problem, because she has been denying any such problem for years even as morale was tanking as she bravely mismanaged the agency in the face of overwhelming evidence she was making a mess of things. Her acknowledgment was not an admission of…
revere | February 28, 2007When I started talking about this with friends and colleagues several months ago they thought I was quite crazy. But then they've thought that for a long time. It's mainly a source of amusement. I hope. Anyway. What I was talking about is using the online virtual world, Second Life, for public health purposes. Second Life (SL) is a "3D online digital world imagined, created and owned by its residents." Over 1.3 million have logged on in the last 60 days. You participate by constructing a 3D representation of yourself called an avatar. If you are an old geezer like me, there is a pretty steep…
revere | November 13, 2006One of the curious things about the response to Katrina was the relative invisibility of CDC Director Gerberding. She may be a catastrophically bad manager who likes to meddle in everything, but her great strength is as a superb communicator. Yet she appeared relatively little despite the many public health related questions in the aftermath of hurricane.
CDC has done its own internal critique of their response, a response they have trumpeted as one of the high points of the last few years, proof they say the Director's agency-wrecking re-organization that she has shoved done everyone's…
revere | October 15, 2006Our Flu Wiki partner, DemFromCT, has an important post up at DailyKos today. In June of 2005, Dem (The Next Hurrah), Melanie Mattson (Just a Bump in the Beltway) and The Reveres joined forces in an experiment in community public health planning we called The Flu Wiki. We were joined by our tech guru, the blogger, pogge (Peace, Order and Good Government, eh?), and after a time by anon_22. Anon_22 was "just another" wiki participant who chose her name arbitrarily, not thinking she would become a central figure. Based in the UK, she is a physician and soon became deeply engaged in the…
revere | September 21, 2006Nature 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,…
revere | September 18, 2006Another scandalous story about the CDC courtesy Alison Young's investigative reporting in the Atlanta Journal Constitution. It's about the unequal distribution of cash bonuses and the title says it all: "Science slighted in CDC awards."
As the CDC faces morale problems and the loss of key scientific leaders, the distribution of awards provides evidence, critics say, that the Atlanta-based agency is becoming more focused on management and bureaucracy and less on its public health mission.
The 72 CDC employees who received five or more awards of at least $2,500 from 2000 through July 21,…