August 10, 2009 The Pump Handle 0Comment

by revere, cross-posted from Effect Measure

Things have been quiet at CDC but apparently they have been changing. First, Dr. Richard Besser, who acquitted himself ably as Acting Director after January 20 until early June when Obama’s new appointment, Dr. Thomas Frieden took over, has decided to leave CDC for television. Yes, television. Many at CDC will be sorry to see him leave. He was “the people’s choice” for new Director, as one old CDC hand put it. I had heard that he had once had a TV show in California prior to his CDC days and he’s obviously telegenic, articulate and knowledgeable. He will be joining ABC News as its senior health and medical editor. ABC says it is expanding its coverage, but realistically is probably looking to the day when its well respected Chief Medical Editor, Dr. Tim Johnson, retires. Johnson has not announced any intention to retire, but he is 73 (he is also an extremely nice person; I have been interviewed by him a couple of times and he never fails to impress). CDC’s loss is ABC’s gain. Besser’s position as director of the Coordinating Office for Terrorism Preparedness and Emergency Response (which handles pandemic flu), will be taken over by another experienced CDC professional, (Dr.) Dan Sosin. People who have worked with him describe Sosin with words like dedicated, smart, thoughtful, conscientious and a nice guy. I heard the same things about Besser, so maybe it’s a good omen.

The other big news is one that we have been expecting. The New Director (Frieden) is starting to dismantle the bloated administrative structure created by the Old Director (Gerberding). We’ve been expecting this for two reasons. First, some kind of reorganization seems to be de rigueur when a new Director takes over. But Gerberding took it to extremes and it was wildly unpopular among CDC folks. One of Gerberding org chart boxes was something called a Coordinating Center. They will be no more. Frieden believes the structure was bad for CDC. Here’s some of a memo he sent to select CDC employees announcing the change:

I have consistently heard concerns about the structure of the organization, generally, and the Coordinating Centers, specifically. While the structural issues are of concern, I also have heard from many about their respect and appreciation of the expertise and dedication of the Coordinating Centers’ staff. CDC’s current organizational structure is not best suited to meet the agency’s mission. We must capitalize on all of our available assets—people, skills, and programs. Based on this information, I have made initial decisions. The first was to establish the Organizational Improvement team. The second relates to my intent to remove the Coordinating Centers from CDC’s structure. (Memo from Thomas R.Frieden, August 4, 2009).

Interestingly, Besser was a Coordinating Center Director and now Sosin is, so where that will leave him in the org chart I don’t know. Taking a look at the unofficial CDC blog, CDC Chatter, shows both relief about the end of the bad old Gerberding days, coupled with considerable cynicism. The Coordinating Centers will not be mourned, but there was a distinct opinion among many that the layers of bureaucracy spawned with them won’t die with them.

Whatever the outcome, there is no return to the CDC of old. The world has changed and CDC has to change with it. A lot will depend on Frieden’s management style. Gerberding’s was a textbook case in how not to do it and she was a political sycophant on top of it. She didn’t fight effectively (if she fought at all) for either public health or CDC in the Bush administration. That was her biggest sin in my book. But then I don’t work at CDC and didn’t have to deal with the managerial nonsense either. CDC lost a lot of scientific talent in those years and the damage will take a long time to repair. Can Frieden do it?

I don’t know him. From what I’ve heard he is a very different person than Gerberding and the agency was facing a rank and file revolt at the end of the Gerberding era. Besser seemed to be making headway healing the wounds. Frieden has been described an intense and “data driven” scientist. Once he is convinced that the science says something, he is a pit bull in getting it implemented. He is not considered a “people person.” That suggests he may be lacking in some political skills that would come in handy, but on the plus side it’s nice to have a reality based (and not a political) person running the show. He is well known in public health circles and has had a good relationship with Peggy Hamburg, the new FDA chief, which will be helpful. He also knows local public health.

But being a data driven pit bull may not be the best thing, either. Unless it’s an emergency, your scientific judgment has to be correct before you go all out. There is always uncertainty and complete commitment to something can sometimes lead to policy decisions that are less than optimal, such as dedicating too much resource to things you now for sure while not enough to things for which much uncertainty remains but for which a timely investment is important.

It is also not the best listening position. There’s a lot of listening that needs to be done at CDC these days. And the listening will have to be done in the midst of the thunder and tumult of a looming flu pandemic occurring just when state and local public health are taking a huge economic hit from cash strapped state governments.

A tough job. Frieden is going to have his hands full. I wish him luck. Because if he succeeds, so do we.

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